Inspection on 09/04/08 for Culwood House

This inspection was carried out on 9th April 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

Culwood House 26/09/08

Culwood House 20/04/07

Culwood House 28/07/06

Culwood House 07/02/06

Culwood House 24/05/05

Culwood House 10/01/05

Culwood House 17/08/04

Culwood House 28/03/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Culwood House 130 Lye Green Road Chesham Bucks HP5 3NH Lead Inspector Jane Handscombe Unannounced Inspection 12:40 9 & 10th April 2008 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Culwood House DS0000022968.V361098.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. Culwood House DS0000022968.V361098.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Culwood House Address 130 Lye Green Road Chesham Bucks HP5 3NH 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) 01494 771012 01494 783051 webbecj4572@aol.com www.culwoodhouse.co.uk Mrs Anita Larkin Mr Larkin Mr Chris Webb Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (14) of places Culwood House DS0000022968.V361098.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The number of persons for whom residential accommodation with both board and care is provided at any one time shall not exceed 14 (fourteen) The Home is registered to accommodate older people 20th April 2007 Date of last inspection Brief Description of the Service: Culwood House is a privately run care home providing personal care and accommodation for 14 older people. The home is in an Edwardian building, located on the outskirts of Chesham about one mile from the town centre. There is dropping off space and parking at the front of the building. There is a mature garden with shady seating areas for residents. A part of the home is the private residence of the manager. The home is not purpose built and does not have a lift. All bedrooms are single and have en-suite facilities (WC and sink). The fees range from £460 to £625 pounds per week. Additional costs include hairdressing, chiropody, papers and personal effects. Information about the home can be obtained directly from the home. Culwood House DS0000022968.V361098.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 star. This means the people who use this service experience poor quality outcomes. This was an unannounced key inspection, which took place over 2 days and carried out by one inspector. The visit took place on the 9th and 10th April 2008. The purpose of the visit was to see how the home is meeting the National Minimum Standards. The home was currently providing care and support to 13 service users with one vacancy available. Nine of these users were sent questionnaires in order to ascertain their views upon the care they receive, and responses were received from five. Likewise surveys were forwarded to ten permanent staff and nine health care professionals to gain their feedback. Feedback was received from six members of staff and two health professionals at the time of writing this report. The CSCI Inspecting for Better Lives (IBL) involves us requiring the service to complete an Annual Quality Assurance Assessment (AQAA), which enables them to evaluate the quality of their service and forward to ourselves when asked. This initially helps us to prioritise the order of the inspection and identify areas that require more attention during the inspection process. The document was not completed within the required timescale due to a recent bereavement in the family, however we were supplied with information that we asked for whilst awaiting the completed AQAA. This document is referred to throughout the report. Results of this inspection report are derived from feedback gained from the service users, discussions with staff during the visit, viewing client’s records held within the service, viewing policies and procedures, staff personnel files, general observation throughout the day, along with information provided to us within the AQAA and any other information that CSCI has received about the service in order to gain an understanding of how the service meet the service users’ needs, and impact upon their lives. We looked at how well the home was meeting the key standards set by the government and have in this report made judgements about the standard of the service. Comments received from those using the service and from family members include: Culwood House DS0000022968.V361098.R01.S.doc Version 5.2 Page 6 ‘I go to bed when I feel like it’ ‘ have a bell in my room and have used it, they responded very quickly’ ‘It’s a lovely garden’ ‘there isn’t a great scale of activities’ ‘The ‘chain of command’ is not very clear and it sometimes difficult to know if I am talking to the right person about the right thing. This is obviously much more difficult for the residents.’ ‘the staff are friendly and caring’ We would like to thank all those who gave their time during the inspection process. What the service does well: What has improved since the last inspection? Following a requirement made at the inspection undertaken in April 2007, the registered manager has reviewed the said bathroom and plans are in place to convert it into a walk in shower room to ensure the needs of service users are met appropriately. An administrator has been recently appointed to the home to assist the registered manager in the administrative work, with a view to her undertaking relevant training and gaining skills and competencies to become deputy to the registered manager. Culwood House DS0000022968.V361098.R01.S.doc Version 5.2 Page 7 What they could do better: There are poor practices highlighted within this report, which place those using the service at risk. The service needs to ensure they work in the best interests of those using the service and improve on a number of areas to ensure their health, safety and welfare at all times; requirements and recommendations have been made to ensure that outcomes for those using the service are improved, these include: Service users are only to be admitted after a full and detailed assessment of needs has been undertaken by a person qualified to undertake such a task, to ensure that their full range of needs are known and can be met by appropriate staffing levels, before they are offered a place at the care home. All residents must have a care plan which is developed with them and which is reviewed regularly. Controlled Drugs, including Temazepam, must be stored in a Controlled Drugs cupboard complying with the Misuse of Drugs (Safe Custody) Regulations 1973. Medication with a short shelf life must be dated on opening to ensure the health, safety and welfare of those using the service Ensure to provide those using the service with fully working call bells in which they can get assistance when needed. Radiators must be guarded or have guaranteed low temperature surfaces to prevent service users from scalding. Carpets and flooring must be kept clean and offensive odours eliminated. Service users are to be provided with keys to their rooms and provided with lockable storage facilities for the safe storage of their medications unless their risk assessment suggests otherwise. The registered manager must ensure a robust recruitment procedure is followed and not employ persons to work at the care home until copies have been obtained of each of the documents listed under Schedule 2 of the care home regulations to ensure that only suitable persons are employed and users of the service are in safe hands at all times. Culwood House DS0000022968.V361098.R01.S.doc Version 5.2 Page 8 Staff must be provided with an induction providing them with the skills and knowledge to undertake their roles competently and safely and receive formal supervision at least 6 times a year. Hazardous substances must be stored securely at all times to ensure the health, safety and welfare of those using the service. The registered manager must ensure he has the appropriate training to ensure effective management of the home. The registered manager must ensure that both current and past service user records are kept securely in the care home. It is good practice recommendation that a controlled drugs register is obtained and used for recording Temazepam (or other CDs), to help audit and check levels of these medications. The service should cease the practice of sharing towels in communal washing/bathing facilities and provide paper towels to avoid the risk of cross contamination and protect the health and welfare of those using the service. It is strongly recommended that staff records are stored securely within the care home and advice is sought around the Data Protection Act regulations. 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. Culwood House DS0000022968.V361098.R01.S.doc Version 5.2 Page 9 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 Culwood House DS0000022968.V361098.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is poor Prospective service users needs are not thoroughly assessed by the service prior to be offered a place and therefore cannot be assured that their needs will be met appropriately at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The homes Annual Quality Assurance Assessment (AQAA) informs us that ‘all service users undertake a thorough needs assessment before entering the home ensuring we are able to deliver the correct care and allow for their lives to be as comfortable and happy as possible’. However evidence seen during this inspection did not support this, evidence seen suggest that prospective service users are not thoroughly assessed by the home’s staff prior to admission, their care needs are not fully documented prior Culwood House DS0000022968.V361098.R01.S.doc Version 5.2 Page 11 to arriving at the service and a placement is offered without the service and the service user knowing whether their needs can be met appropriately at the home. The files of three service users, admitted to the home since the last inspection were requested for viewing during this visit. There was no file available for one of the three service users who had been accommodated in the home 4 days prior to this visit, only an index card which noted details of the service users next of kins’ address and contact details, GP details, a medical condition relating to the service user and the drug used to control the condition. On the second day of the visit, these details had been placed in a file upon the homes appropriate documentation although no further information had been sought. The two further files viewed were very scant in information, the little information held within the files, fails to give an overall picture of the needs of the service users and how these needs are to be met appropriately. Risk assessment documentation was held in both the files although they had not been completed. The manager and the responsible individual continue to fail to recognise formal assessment and care planning as essential tools for effective delivery of care. The view that documenting information is undertaken to appease others outside of the home and is not a valued activity, does not act in the best interests of the people living there and does not provide for a good role model for staff working at the home. The manager acknowledged that the lack of a thorough assessment has been an ongoing requirement that has not yet been attended to and therefore remains in breach of the Care Home Regulations. An immediate requirement was made to ensure that an assessment of needs was undertaken and care plans are put in place for these service users within 48 hours. We received information within 48 hours to inform us that this had been dealt with. A further requirement is made to ensure that no one is admitted to the home without a completed care needs assessment to ensure that the home can assure both themselves and the prospective service user that they can meet service users needs prior to offering them a place. All residents living in the home were Caucasian and reflect the population of the area in which the home is situated. The home’s staff were aware of the Laws regarding equality and diversity. Culwood House DS0000022968.V361098.R01.S.doc Version 5.2 Page 12 The home does not provide for intermediate care and therefore standard 6 does not apply. Culwood House DS0000022968.V361098.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. Care plans for those people using the service do not set out clear indications as to the health, social and personal care needs of the people using the service. This is due to people being offered a place without a full assessment of needs and the providers’ complacency and continuing failure to recognise formal care planning as an essential tool for effective delivery of care. People using the service are at risk of not having their health, social and personal care needs met appropriately. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We chose to case track three users of the service from initial assessment to date. One user had recently been admitted for a respite stay and was Culwood House DS0000022968.V361098.R01.S.doc Version 5.2 Page 14 admitted to the home four days prior to this visit. The two remaining files viewed related to service users who had been admitted in December 2007. The first file viewed informed us that the service user had been admitted to the home 4 days prior to our visit; there was no evidence of any assessment of needs having been undertaken, or a plan of care detailing what care and support the service user required and how staff were to address these. Some information was held on an index card although this was generally contact names and numbers of the next of kin and the users’ GP, the service users age, home address, preferred name and date of admission and it was noted the service user was diabetic. Upon returning the second day, information had been transferred into a file although this had not been added to other than a description of the resident. Daily notes had been kept although there were no entries for the first 2 days of the service users stay at the home. We were informed that this particular service user was diabetic and was self medicating, however an entry in the daily notes on 8th April was worded in such a manner which suggested that medication was administered by staff; stating ‘medication given’. The second file viewed informed us that the service user had been admitted to the home in December 2007, some 15 weeks prior to this visit. The file consisted of a number of risk assessments with actions to take where necessary. The falls assessment indicated that the service user was at high risk and the documented actions to be taken stated ‘careful watch – prone to falls due to Parkinson’s – make sure eats and drinks plenty’. The document indicated that where residents are at medium risk they should have an action plan to try and prevent falls, and where at high risk help was to be sought from Doctor/District Nurse/Falls team. There was no evidence of any of these having been contacted with regard to the risk of falls. There was no evidence of the service users likes and dislikes, how he/she would like to spend their day, their interests and hobbies, any activities having been undertaken whilst at the care home. The third file viewed informed us that the service user had also been admitted to the home in December 2007. A contract was evident within the file although the resident or their representative had not signed it. There was no evidence of a thorough assessment of health, social and personal care needs or any guidelines as to what the service user needed help and support with. Daily notes informed us that the resident has been unsteady on his/her feet on numerous occasions although no moving and handling risk assessment or falls assessment had been undertaken. There was no evidence that a nutritional assessment had been undertaken or that of a tissue viability assessment; the paperwork was held in the file although they were all blank and not filled in. Likewise there was no medical history contained within the file. The monthly weight chart informs us that the service user had not been weighed on a monthly basis, but had been weighed in January and again in April. Over the course of three months, this particular service user had gained substantial Culwood House DS0000022968.V361098.R01.S.doc Version 5.2 Page 15 weight although there was no evidence of the service having contacted relevant healthcare professionals to seek advice on this gain in weight. Whilst this was pointed out to the registered manager, he informed us that new weighing scales had been purchased in January which the manager felt may have had an effect on the weight recorded; however, monthly weight records had not been maintained and there was no written evidence in the said users’ file to suggest this being the case. There was no information held within the file to inform of the service users likes/dislikes, how they would like to spend their day, their interests and hobbies. Overall the file did not contain detailed information to guide the staff as to what needs they were to address and how to address them. Evidence was held within the file documenting any visits from the GP and district nurse, although care needs to be taken to ensure that they cross reference with the daily notes. The District Nurse intervention sheet informed us that the district nurse had been to visit the service user on one occasion since his/her admission to the home, however the daily notes informed us that she had in fact visited on four occasions. There was evidence within the file to inform us that the service user had presented with challenging behaviour on occasions although there was no documentation to assess any risks to other users of the service or staff and how the staff were to deal with such behaviour. Information held within all three service users files evidenced that they were not detailed enough to inform staff of the health, personal and social care needs of the said users and how they were to address their needs. An immediate requirement was made during this visit requiring the registered manager to undertake a full assessment of needs and draw up a comprehensive plan of care for the above three service users within 48 hours. We received confirmation from the service informing us that this had been duly undertaken. During the visit we looked into the procedures around the safe storage, recording and administration of medication. Medication was stored in safes, which were accessed by a code known to those staff that administers medication. We viewed the administration records for those service users being case tracked. There was evidence that medication had been administered although gaps were present on the administration records, staff had not signed the records appropriately to acknowledge that the medication had been administered as prescribed. Since the home uses the nomad system, we were able to see that the prescribed medication had been given since they were not present in the nomad system, however staff must sign the administration records appropriately. Whilst touring the home, homely remedies were found to be stored in a cupboard in the kitchen area of the home. Whilst looking at the homely remedies it was found that two of the boxes were out of date, one being out of date by two years and the other by a Culwood House DS0000022968.V361098.R01.S.doc Version 5.2 Page 16 year. The registered manager removed those out of date and placed them in the locked medication safe for return to the pharmacy. It was acknowledged that one of the users was prescribed a schedule 2 controlled drug and whilst viewing the records it was ascertained that that there was no audit trial in place to inform us of when the medication had actually been opened and the administration had begun. The storage of this type of controlled drug does not meet with the current misuse of drugs regulations, which were amended last year and require that all care homes, both personal care and nursing care, must now store all Controlled Drugs, including Temazepam, in a proper Controlled Drugs Cupboard. A proper Controlled Drugs cupboard is one, which meets the standard set in the Misuse of Drugs (Safe Custody) Regulations 1973. Suppliers of CD cabinets can confirm that a cupboard meets the legal requirements. A requirement has been made within this report to purchase such a cupboard for the storage of controlled drugs within the home. Whilst temazepam does not need to be recorded in a controlled drugs register, it is good practice to do so. As discussed with the manager, it is recommended that a controlled drugs register be obtained to allow for an audit of all controlled drugs, since no systems were in place to audit this type of drug within the care home and confusion arose as to when the actual drug had been opened and administration began thereby having no audit system in place to ensure there is no mishandling of drugs. Whilst touring the kitchen area, it was noted that medication was being stored in the refrigerator, which is used for storing food items. The medication was stored in Tupperware boxes, one of which was prescribed eye drops. The eye drops have a shelf life of 28 days once opened, however there was no evidence of the date of opening and therefore the possibility that these were out of date. We highlighted this shortcoming to the manager who informed us that he would seek a further prescription to replace those in the refrigerator. Whilst in attendance at the home, the eye drops were not seen to be removed and placed with the returns for the pharmacy. It was noted that some service users were storing prescribed creams and medication in there rooms. Whilst service users who are able to administer their own medication hold their medication, these must be stored safely and securely so as not to place other service users who may wander at risk to their health safety and welfare. No lockable facilities were evident in any rooms viewed to enable service users to store any personal possessions or medication safely and no bedrooms viewed had locks on their bedroom doors. Likewise there was no evidence of any risk assessments around the self-administering of medication evident in the care plans. Culwood House DS0000022968.V361098.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. People using the service are provided with well-balanced, nutritional meals, which are cooked freshly on the premises. People using the service are encouraged to partake in activities provided both in the home and in the wider community. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People using the service are given some opportunities for stimulation through leisure and recreational activities in and outside the home. Up to date information about the activities on offer are posted in the home for service users, however it was noted that organised activities were only provided on a Wednesday each week; these include flower arranging, cookery classes, manicure and hand massage and book club. Whilst some users of the service were happy with the weekly provision of activities there were others who felt the provision of activities was minimal; a question in our surveys asked are Culwood House DS0000022968.V361098.R01.S.doc Version 5.2 Page 18 there activities arranged by the home that you can take part in? Of the five responses received, one said always, another said usually and three said sometimes. Whilst discussing the opportunities to partake in activities there was a mixed response with some happy with the amount offered and others who would prefer to see more. Comments included; “ there isn’t a great scale of activities…perhaps like to see more” whilst another said “sometimes have music, I’m happy to not have many things….when you’re a certain age it gets a bit tedious and you feel obliged to attend”. The service itself have recognised there could be improvements in the area of activities and are planning to address this area with more outings for those using the service, gaining input for different ideas on activities and events and to encourage local children’s clubs to take part in activities with the service users. Users of the service have the opportunity to take Communion once a month, which is undertaken by a local Reverend who comes into the home to provide this service. Those who wish to attend church on a regular basis are enabled to do so and the local church provides a car service for those who require. Visitors from the local Catholic Church visit the home regularly with some children from the church to provide them with entertainment in the evening, mainly that of singing. On the first day of inspection, it was noted that users of the service were enjoying the activity of flower arranging, some of which were placed around the home and some within the service users’ own bedrooms. In discussion with one service user, it was apparent that she was unaware of the flower arranging activity having taken place during this visit. Since this particular service user has very poor vision, it is recommended that the service ensures all those using the service are made aware of the activities being offered in other ways than just the notice board, to ensure all service users have equal access to them. Since the inspection we have been informed that the said service user did infact participate in the event and that his/her memory “can be bad at times” and “it is not a fair representation of what happened in reality”. It is therefore recommended that the registered manager log activities that the service users take part in, in their files/daily logs to provide such evidence. Visitors are welcomed into the home at any reasonable time and are made to feel welcome. Users of the service can choose to see their visitors in their own rooms or in the communal areas of the home, whichever is to their liking. The home does not handle the financial affairs of those using the service; it is an expectation that family members, solicitors or other representative will undertake this role. The home will signpost people to advocacy services or similar, where the need may arise. People are able to bring personal possessions with them, such as small pieces of furniture and memorabilia. Whilst touring the home bedrooms were seen to Culwood House DS0000022968.V361098.R01.S.doc Version 5.2 Page 19 be personalised and contain personal possessions, family photographs and framed pictures. The home provides well-balanced, nutritious meals all of which are cooked freshly on the premises. A choice of main course is not available although the staff and residents informed us that an alternative would be provided if a resident did not like what was on offer. We were also informed that people using the service are given choices with the teatime menu. Family members/visitors are able to take a meal with the service users if required. On the first day of inspection, service users enjoyed a lunch of roast chicken, cauliflower cheese, carrots, cabbage and gravy followed by fresh fruit and cream. On the second day of this visit, the inspector took a meal with those using the service, which consisted of meatballs, vegetables and potatoes, which was well presented and very tasty and whilst the portions appeared small, people informed us that the portions were ample for their needs. Special therapeutic diets can be catered for when advised by health care professionals. Staff were observed to provide assistance to those who required, in a discreet sensitive manner. Hot and cold drinks are available throughout the day and tea and coffee making facilities are available upstairs. Culwood House DS0000022968.V361098.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. People using the service and /or their representatives know how to make a complaint should the need arise. Staff are aware of the policies and procedures around the safeguarding of those using the service and are encouraged to use the whistle blowing policy where necessary. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints policy and procedure in place to enable people to make a complaint if the need should arise. The Annual Quality Assurance Assessment, provided to us by the service, informs us that ‘we have a complaints procedure which is also mentioned in our terms of agreement’, however whilst viewing three service users files evidence highlighted that only one of the users had a terms of agreement, which had not been signed by this particular resident or their representative. Likewise, of the five surveys received from those using the service, two informed us that they have not received a contract/terms of agreement, however responses from the surveys did inform us that they knew how to make a complaint and that they usually knew who to speak to if they were not happy. Culwood House DS0000022968.V361098.R01.S.doc Version 5.2 Page 21 The manager informs us that they have a copy of the Buckinghamshire local interagency policy and procedure for safeguarding adults and that staff are provided with safeguarding adults training, to enable them to recognise and respond to any incidences or allegations of abuse. We were informed that all staff were to be receiving an update to their safeguarding training on the 22nd April 2008. Speaking to staff during the inspection informs us that they are aware of their responsibilities and are encouraged to use the homes’ whistle blowing policy where the need may arise. The Annual Quality Assurance Assessment also informed us that the service ‘ensure all staff receive a CRB check’, however evidence found during this inspection does not support this (See section headed staffing). Since the last inspection undertaken in April 2007, the service have received no complaints made direct to them. The commission has received one complaint, which was directed to the proprietor to investigate under their complaints procedure, which we are informed was dealt with in a timely manner, although the service did not report back to us as requested. The service itself has not had any safeguarding referrals or investigations during the last 12 months, and we at the Commission have not been alerted to any such referral or investigation. Culwood House DS0000022968.V361098.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 25 and 26 Quality in this outcome area is adequate There are potential risks to residents such as unguarded radiators and dysfunctional call bells. Generally the home presents as clean, pleasant and hygienic, although care needs to be taken to ensure that carpets and flooring are kept clean and free from offensive odours. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Whilst touring the home it was noted that users bedrooms were comfortable and personalised with their own belongings. Culwood House DS0000022968.V361098.R01.S.doc Version 5.2 Page 23 There is a maintenance person who attends to any maintenance/repairs that need to be undertaken. We observed the documentation detailing any maintenance that had been either been undertaken or waiting to be undertaken, however there were areas of concern that had not been logged in the maintenance book. Generally the home provides an environment, which meets the service users needs, however there were a number of areas, which needed addressing to ensure the health, safety and welfare of those using the service for which immediate requirements were made. The call bell system in users rooms was not readily available for all, as many failed to be operable due to missing parts. Concerns were raised as to how the service users could call for help in the absence of call bells in place that were out of order, particularly in the evening when there is only one waking member of staff on duty. The registered manager agreed to put in place a monitoring system in which service users would be checked and monitored on an hourly basis throughout the night and confirmation was received within 48 hours informing us that this had been put in place and was being monitored and documented until the call bells were repaired. It was further noted that the pull cord to operate the light in one service users en suite bathroom was missing on our second day of this visit and therefore the user was unable to use the WC and washing facilities in safety. The registered manager informed us that the service user had both his family visiting and a gentleman repairing the WC, the previous day, and believes it happened on the second day of our visit, since neither of the visitors had reported the pull cord broken. The registered manager agreed to address this immediately as the inspector left the premises and sought to purchase a new pull chord to ensure the health, safety and welfare of this particular service user. Confirmation was received within 48 hours that this had been attended to and the light was in full working order. One service users’ bedroom failed to have a radiator guard on the radiator and one communal bathroom also failed to have a guard in place, although it was very hot to the touch. An immediate requirement was made to ensure that measures are put into place to ensure safety and welfare of the residents at all times. The pipe work in one communal bathroom was leaking and a plastic bowl was placed underneath to catch the drips. The registered manager informed the inspector that this had come to his attention that very morning and would be dealt with. The leak was not apparent on the first day of the visit. It was also noted that the said bathroom whilst providing liquid soap did not provide paper towels but that of communal towels for the purpose of drying ones hands. This is not good practice as places one at risk of cross infection and a requirement has been made to address this issue. Culwood House DS0000022968.V361098.R01.S.doc Version 5.2 Page 24 Generally, the home was cleaned to a good standard and in the main, free from any odours during this visit, however the prevalence of the odour of urine in one room was evident. This has been a continued problem and the service has sought the services of a contractor to deep clean the carpet to ensure that the room remains clean, fresh and odour free for the person who accommodates the room. Discussion took place around the use of vinyl flooring and it was agreed that the manager would seek the service users views on the use of vinyl flooring and if he/she should choose to have vinyl flooring full documentation would be held in the service users file with the rationale for its use and their signed agreement. The majority of people who returned our surveys informed us that the home is always fresh and clean, however we did receive two comments highlighting that there is a problem around the smell of urine, these included “ the home often smells unsavoury…” and another who tells us that “urine incontinence can sometimes be a problem for staff to keep on top of. There have been occasions when the smell in the lounge has been bad and not attended to, but if I draw their attention to it something happens”. A repeat requirement has been made within this report to ensure that carpets and flooring be kept clean and offensive odours eliminated. During a tour of the home on the first day of this visit, the inspector enquired into where hazardous substances were stored and was informed they were stored securely and appropriately. However, it was noted that some hazardous substances were being stored on a shelf in an area of the home in which the fresh vegetables were being stored and to which service users could access. This was pointed out to the manager who acknowledged the poor practice and informed us they would be stored appropriately. On the second day of this visit the substances still remained accessible and not stored away appropriately. The inspector accompanied the manager to the laundry where these types of products were stored. The laundry was accessible in that it was kept unlocked and hazardous substances were being stored in an unlocked cupboard. Users of the service have access to the outside garden and can easily access the laundry. The inspector received confirmation within 48 hours informing us that a lock had been purchased and fitted to the said cupboard to ensure that the risk be removed. Culwood House DS0000022968.V361098.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor The homes recruitment procedures do not ensure that only suitable persons are employed to work with people using the service and places them at risk of harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We asked to view 4 staff personnel files, chosen at random, to ensure that robust recruitment procedures were being followed and ensure that staff are provided with suitable training to ensure they have the skills and knowledge to undertake their roles competently. Whilst viewing four staff members’ files, it was evident that there were serious failings in the recruitment practices taking place within the home, thereby placing those using the service at a potential risk of harm. There was an absence of relevant CRB (Criminal Bureau) disclosures or POVA first checks having been undertaken for all four members of staff to ensure their suitability to work with older vulnerable people. There was a failure to gain 2 written references and a failure to enquire into their full employment history prior to offering employment in all four cases. An immediate Culwood House DS0000022968.V361098.R01.S.doc Version 5.2 Page 26 requirement was made with immediate effect to ensure that no person worked at the care home until all relevant checks and documentation listed under schedule 2 of the care homes regulations were in the homes possession. We are informed that all newly appointed staff undergo an induction training which is in line with that of skills for care, however as per the last inspection undertaken in April 2007, there was no evidence within any of the files viewed that the staff had in fact been provided with an induction. It was explained that staff work through a workbook during their induction, which covers the core areas to enable them to undertake their roles, however no such workbook was available to view during this inspection. The registered manager was reminded of the importance of recording and keeping documentation to evidence that all new staff have been provided with induction training to ensure they have the skills and knowledge to undertake their roles competently and safely and a repeat requirement has been made with a new timescale within this report. On the first day of the unannounced visit, the registered manager was in a meeting with a training company discussing and planning for updating the core training for staff. We are informed that dates have been planned for the delivery of training, to ensure that staff are kept up to date in their skills and knowledge. The manager informs us that he also undertakes the training that is delivered to his staff. Whilst the service have recognised that this is an area they need to address and are presently addressing the shortfall, a requirement has not been made on this occasion. The number of staff on duty during the two days of this visit was appropriate to meet the needs of those using the service. We are informed that at night there is one waking member of staff and the registered manager is on the premises to assist where the need arises. Whilst this level of staffing may be suitable for the present needs of those using the service, the manager must ensure that should the service users needs increase, the level of staffing must be recalculated Culwood House DS0000022968.V361098.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 and 38 Quality in this outcome area is poor. There are serious failings in the homes record keeping and practices taking place in the home, which place service users at risk and do not act in their best interests to protect their health, safety and welfare. This judgement has been made using available evidence including a visit to this service. EVIDENCE: While the manager has experience of this area of work the continued delays in achievement of expected levels of qualification remains disappointing. Poor procedures highlighted in previous sections of this report (see health and Culwood House DS0000022968.V361098.R01.S.doc Version 5.2 Page 28 personal care, staffing and environment) do not serve to protect the health, safety and welfare of those using the service and therefore does not act in the service users best interests. Essential documentation is not completed to an acceptable standard and therefore fails to give an overall picture of the service users assessed needs and how their needs are to be met. Likewise, it was noted that records containing personal details of both existing and past service users and those of staff were not being stored securely in the care home. The registered manager registered to undertake the National Vocational Qualification in Care and Management at level 4 in October 2003 although this was never undertaken. We are informed that the manager is still exploring NVQ options with a local NVQ qualification centre with a view to taking up the Registered Managers Award in the immediate future with the intention to also undertake the NVQ level 4 in care. In all those staff files viewed, there was no evidence of any formal supervision having been undertaken. A requirement has been made within this report to address this shortcoming. The registered manager was found to be failing to ensure the health safety and welfare of those using the service, in that persons had been employed to work at the care home without ensuring their fitness and undertaking essential checks to ensure their suitability to work with vulnerable adults. (See section headed staffing). Likewise, people’s health and personal care needs had not been appropriately assessed and documented prior to their moving into the home; their files failed to contain a comprehensive plan of care detailing how their needs were to be met and therefore potentially compromising their health and welfare. Whilst the home has a call bell system in place, this was inaccessible to a number of those using the service, important parts were missing making them dysfunctional. Likewise one user of the service could not wash or toilet in his/her en suite bathroom safely since the pull cord to switch on the light was missing. Immediate requirements were made to measure the risks and take appropriate actions to ensure the health safety and welfare of those using the service were not compromised. We received confirmation the day after this inspection informing us that appropriate measures had been put in place to address the dysfunctional call bell system, that the pull cord had been replaced to provide suitable lighting facilities in the en suite bathroom and that staff without the relevant CRB checks and documentation to ensure their fitness to work with vulnerable adults had been removed from their duties until the home has acquired all the required documentation as is required in the Care Homes Regulations 2001. Culwood House DS0000022968.V361098.R01.S.doc Version 5.2 Page 29 We were also informed that the service users who were storing medication in their own rooms had been provided with facilities to ensure that their medication is stored securely and safely. Culwood House DS0000022968.V361098.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 1 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 2 x x 2 x x 2 2 STAFFING Standard No Score 27 2 28 1 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 1 x 3 x 1 1 Culwood House DS0000022968.V361098.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14(1) Requirement Ensure that a system is in place to fully assess, identify and document the needs of all service users prior to admission to the Home by a suitably qualified and competent person. This is an unmet requirement of previous report and a new time scale has been set. Previous timescales of 30/04/07 remain unmet. 2 OP7 15 Ensure that care plans are completed and documented for and with all service users, which contain sufficient detailed information on their assessed care needs and guidance necessary for staff to support service users and meet their needs. This is an unmet requirement of previous reports and a new time scale has been set. Previous timescales of 31/05/07 Culwood House DS0000022968.V361098.R01.S.doc Version 5.2 Page 32 Timescale for action 06/06/08 06/06/08 remain unmet. 3 OP7 15 Ensure a system is in place to ensure that care plans and assessments for service users are kept under review and updated when necessary to reflect the current and changing needs of all people using the service. Controlled Drugs, including Temazepam, must be stored in a Controlled Drugs cupboard complying with the Misuse of Drugs (Safe Custody) Regulations 1973 Medication with a short shelf life must be dated on opening to ensure the health, safety and welfare of those using the service Ensure to provide those using the service with fully working call bells in which they can get assistance when needed. Radiators must be guarded or have guaranteed low temperature surfaces to prevent service users from scalding. Carpets and flooring must be kept clean and offensive odours eliminated. Previous timescale of 30/04/07 unmet Service users are to be provided with keys to their rooms and provided with lockable storage facilities for the safe storage of their medications unless their risk assessment suggests otherwise. The registered manager must ensure a robust recruitment procedure is followed and not employ persons to work at the care home until copies have been obtained of each of the DS0000022968.V361098.R01.S.doc 06/06/08 4 OP9 13(2) 10/07/08 5 OP9 13(2) 12/05/08 6 OP22 23(2) n 31/05/08 7 OP25 13(4) 31/05/08 8 OP26 16(2) k 31/05/08 9 OP24 23 and 12 31/05/08 10 OP29 19 Schedule 2 10/04/08 Culwood House Version 5.2 Page 33 11 OP30 18 12 OP38 13(4) 13 OP31 10(3) 14 OP37 17 documents listed under Schedule 2 of the care home regulations to ensure that only suitable persons are employed and users of the service are in safe hands at all times. Staff must be provided with an induction providing them with the skills and knowledge to undertake their roles competently and safely and receive formal supervision at least 6 times a year. Hazardous substances must be stored securely at all times to ensure the health, safety and welfare of those using the service. The registered manager must ensure he has the appropriate training to ensure effective management of the home. The registered manager must ensure that both current and past service user records are Kept securely in the care home 19/05/08 19/05/08 31/05/08 12/05/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP9 OP26 Good Practice Recommendations That a controlled drugs register is obtained and used for recording temazepam (or other CDs), to help audit and check levels of these medications. Cease the practice of sharing towels in communal washing/bathing facilities and provide paper towels to avoid the risk of cross contamination and protect the health and welfare of those using the service. It is strongly recommended that staff records are stored securely within the care home and advice is sought around DS0000022968.V361098.R01.S.doc Version 5.2 Page 34 3 OP37 Culwood House the Data Protection Act regulations. Culwood House DS0000022968.V361098.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Culwood House DS0000022968.V361098.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!