Inspection on 24/04/08 for Da-Mar Residential Care Home

This inspection was carried out on 24th April 2008.

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

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

Other inspections for this house

Da-Mar Residential Care Home 23/09/08

Da-Mar Residential Care Home 17/08/06

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Da-Mar Residential Care Home 83-87 Moore Street Northampton NN2 7HU Lead Inspector Katrina Derbyshire Unannounced Inspection 24th April 2008 14:50 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 Da-Mar Residential Care Home DS0000067519.V363009.R02.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. Da-Mar Residential Care Home DS0000067519.V363009.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Da-Mar Residential Care Home Address 83-87 Moore Street Northampton NN2 7HU 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) 01604 791705 01604 715850 da_mar@tiscali.co.uk Mr Anthony L Lampitt Mr Anthony L Lampitt Care Home 29 Category(ies) of Dementia (10), Old age, not falling within any registration, with number other category (29) of places Da-Mar Residential Care Home DS0000067519.V363009.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered persons 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 are within the following category: Older persons, not falling within any other category - Code OP. Dementia - Code DE. The maximum number of service users who can be accommodated is 29. 17th August 2006 2. Date of last inspection Brief Description of the Service: Da-Mar is a privately owned care home providing personal care for up to 29 people who are 65 years of age and over, 10 of whom may also have dementia. The care of people with dementia is a new element of registration for this home. Da-Mar is located in a residential area close to the town centre of Northampton and near to local shops. The building has been extended twice and offers communal accommodation, bedrooms and bathrooms over three floors. People with a physical disability are accommodated in the newer rear part of the home where a stair lift is available from ground floor to first floor. People have access to a secluded garden and car parking spaces can be found to the side of the home. The current range of fees is from £331.60 to £400.00 approx with the home accepting both private and funded placements. This information was taken from the service user guide given to the inspectors at this inspection. In addition extra charges are made for hairdressing and chiropody services and newspapers. Any charges incurred for private dentistry or ophthalmic services are the responsibility of the individual. Da-Mar Residential Care Home DS0000067519.V363009.R02.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. An Annual Service Review was undertaken about this home on 26th February 2008; we used written information that had been supplied by the home and feedback from eight people living there to help us when we did this. The Commission for Social Care Inspection was then passed information in April 2008 that had been sent to Northamptonshire Social Services and in addition further information had been sent from the Fire Service; on reviewing the information a decision was taken to carryout a Key inspection. Two Regulation Inspectors carried out this unannounced visit on 24th April 2008, the duration of the site visit was 10 inspection hours. The Acting manager had been in post since August 2005 and advised that she was in the process of submitting an application to become the Registered Manager. The owner of the home also arrived during the inspection. During the visit the communal areas of the home were seen alongside nine of the individual rooms. One of the inspectors spent time with many of the people who live at the home in their rooms and the communal area. Management and staffing records were examined. The care of three people was looked at in detail. Evidence used and judgements made within the main body of the report include information from this visit, feedback from people who live at the home and the management’s submission of documentation. Feedback from people who use the service was also received through returned comment cards. Observations of care practice and communication between the people living at the home and staff was also made at the inspection. The focus of this inspection was to look at the key standards, to look into the concerns that had been raised and to follow up on any previous requirements. What the service does well: Da-Mar Residential Care Home DS0000067519.V363009.R02.S.doc Version 5.2 Page 6 Medication at the home is managed in a safe manner. One person has responsibility for ordering any needed prescriptions and makes sure that there is enough stock kept at the home, so people receive their prescribed medication when they should. The storage of medication is also safe, and charts are signed by staff to show when medication has been given. People spoken to at this visit all confirmed that they had received their medication when they should, although one person said that at times they had to wait for 10 minutes. What has improved since the last inspection? What they could do better: There are many areas that must be changed to make things better for the people living at the home. Some examples are as follows: We made 3 immediate requirements at this visit. This is when something is a serious cause for concern and must be changed within days to safeguard people living at the home. The first was about the way staff had been recruited. There is a special check by the Criminal Records Bureau that must be carried out each time a person is employed in a home, in addition a minimum of two references must be secured before someone is allowed to work in the home in any capacity, this had not been carried out for some staff. The Acting managers knowledge of the requirements in recruiting staff was out of date and does not follow national guidance in this area. This increases the risk of someone being employed at the home, who may not be suitable to work there. Not all staff had received training in the areas that they must have, including moving and handling, food hygiene and dementia care. This places staff and people at risk of injury, inadequate hygiene relating to food service and people with dementia not receiving the care and support that they need. Da-Mar Residential Care Home DS0000067519.V363009.R02.S.doc Version 5.2 Page 7 Someone else who lives at the home days before this visit had physically attacked another person. This had not been reported under local protocols in Safeguarding adults. Any abuse must be reported so that Commission for Social Care Inspection, the police and local authority are aware of such incidents, and a strategy is agreed to safeguard people. The manager did not have a copy of the local protocols in safeguarding; also some staff had not received training in this area. People had not always received the medical attention that they needed, as staff had not always followed safe practice following an accident. One person for example had been sick following a fall, there was no accident form completed, Doctor called or evidence that staff had observed the person in the hours that followed their fall. This places people at serious risk. Other things that need to change include, staff making sure that they do not place a slice of cake on the same plate as baked potato and beans for people to eat. Staff also need to improve the amount of support they give to some people in the home to maintain their personal hygiene. Three of the people at the home had a brown substance under their fingernails and remnants on their face and clothes from a previous meal in the afternoon. The owner and Acting manager also need to look at how they respond to complaints, seek the views of the people living in the home and review the provision of care to people with dementia. 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. Da-Mar Residential Care Home DS0000067519.V363009.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Da-Mar Residential Care Home DS0000067519.V363009.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 & 6 Quality in this outcome area is poor. We have made this judgement using a range of evidence including a visit to this service. Pre admission information on the home is misleading so does not ensure people can make an informed choice as to whether to move into the home or not. The care provided to people with dementia is inconsistent so their needs are not being fully met and this is impacting on the other people living at the home. EVIDENCE: The care files examined included pre-admission assessment. Assessments included information from visiting the person at the hospital, or wherever he or she was living prior to admission and information from any referring social worker or health professional. There were sections covering the social, psychological and physical needs of the person although not all areas had been completed, one example was one person had no entry made in social needs of Da-Mar Residential Care Home DS0000067519.V363009.R02.S.doc Version 5.2 Page 10 the person. Linkage to care plans was also inconsistent; one person identified at being at risk of falls had no plan in place for this. Copies of the terms and conditions of residency were seen alongside contracts. These gave an outline of fees, responsibilities and notice periods. One-person relatives had received 28 days notice in writing for the person living at the home to leave. This did not follow the details as stipulated in the persons contract through Social Services. A person from Northants Social services confirmed that they had not been approached by the management in the home. In addition a person spoken to at this visit stated that they had been given verbal notice to leave and had only 2 weeks remaining and still had no where to go. The owner confirmed that this had taken place and confirmed that it had not been put in writing, the social worker that covers this home had not been informed and stated that the management had advised that they had left a telephone message for someone but the social worker did not know who this was. One inspector followed this up the following day, the name given to them at the inspection was not the person to whom notice would be given and this was passed to the safeguarding team. The statement of purpose was examined; no copy was on display at the time of this visit. The document provided information on the staffing, accommodation and services available at the home. The recent addition to the homes categories of registration had been referred to, stating that up to ten people could be accommodated with dementia. The document described the range of needs that it intended to meet as, ‘service users suffering from mild dementia’. It also detailed that people with challenging behaviours or aggression would not be catered for. However on the admission assessment of one person their assessment from the hospital stated ‘advanced dementia’. In addition it details that residents would be involved in planning and reviewing services through resident meetings and satisfaction surveys, people living at the home advised that these had not been taking place and no documentation in these areas supported this. It was observed that during the afternoon one person constantly walked around the sitting area in the home, reaching out to others and touching their personal items. Staff as they walked through this area asked the person to sit down, with the exception of the manager who took the person by the arm gently and walked with them along the corridor. Other people at the home became agitated and several started to shout out, one person sitting by the door who started to bang the arm of their chair had no attention from staff during a 1.5 hour period of observation. The home had recently admitted people with a diagnosis of dementia. No orientation tools were seen to be in place, or consistent practice amongst staff. Several people spoken with stated that they were unhappy, they said other people went into their rooms and touched their things and there wasn’t enough room to “find some peace and quiet”. There was limited space in the L shaped lounge area and one person Da-Mar Residential Care Home DS0000067519.V363009.R02.S.doc Version 5.2 Page 11 was pushing small items of furniture about. The care of people with dementia must be based on current guidance and a requirement is made in this area. Intermediate care is not provided at the home. Da-Mar Residential Care Home DS0000067519.V363009.R02.S.doc Version 5.2 Page 12 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 & 10 Quality in this outcome area is poor. We have made this judgement using a range of evidence including a visit to this service. Good medication management ensures people receive their medication. However inconsistencies in care planning, poor follow up following accidents and insufficient physical and emotional support place people at risk of not receiving the care that they need and increases the risk of deterioration in their health and well being. EVIDENCE: The care documentation seen in most instances for the person gave sufficient detail to show some of the individual needs of the person when they were first admitted to the home, although they were inconsistent in their standard. Changes to the persons well being however was not reflected in the care plans for those people selected for case tracking. Examples included one person not having documentation relating to the specific support needed following an injury sustained in the home and another around the specific diet that they Da-Mar Residential Care Home DS0000067519.V363009.R02.S.doc Version 5.2 Page 13 would need. Some of the descriptions detailed within the daily notes were not appropriate and were disrespectful, examples entered on 12/03/08 was ‘was covered in poo when we put them to bed’ and another on 14/04/08 ‘was a nightmare at bedtime, stripping in the lounge, fighting’. An immediate requirement was left relating to failure to follow up safely after an accident and/or injury for the people living at the home at this visit. An entry on the 29/03/08 on the daily notes for one person stated that the person had fallen on the fall and was then sick, it detailed that they were put to bed and slept well. No accident form was completed or Doctor called, or evidence of monitoring or follow up. Another entry for example on 14/04/08 described a carer discovering bruises on a persons right eye, ear and hip. They checked the accident book and discovered that the person had, had a fall the night before and banged their head on a table. Again no Doctor was called, monitoring or follow up, this places people at very serious risk through not seeking medical advice and attention or not monitoring the person. This entry also demonstrated that communication had failed as the carer was not aware of the accident. One of the inspectors observed that at least three of the people living at the home had a brown substance under their fingernails. Remnants of a previous meal were also seen on their clothes and around their mouths and the time that this was observed was 15.25. Other people seen and spoken with were seen to be of a higher level of personal cleanliness and hygiene. Several people living at the home would have had specific dietary needs relating to their medical needs, including diabetes. Through examination of care records and verbal confirmation of the Acting manager, it was evidenced that no one had a nutritional risk assessment in place. One person spoken to explain their own experience was, “ I have never had so many hypos since I came here in fact I have had more since I moved in here than I ever had living at home, my food can be late sometimes and its often not the right things”. Although a letter from the hospital in 2007 stated that the persons diabetes was being managed during their time at the home, and then another in 2008 offering advice as the person had been having unstable blood sugar. Medication storage in the home was noted to be satisfactory as was the ordering of medicines. The recording of medication stocks and balances were sufficient so an audit of the medication systems was possible. The medication administration records were seen to contain the signature of staff and showed that medication had been given as prescribed. One person at this inspection spoke of certain staff speaking to them in an abrupt manner, when they raised this with the manager they were not satisfied with their response. Other people commented that the main carers in the home were “lovely”, “they do what they can, but there is not enough of them so sometimes they rush me”. Da-Mar Residential Care Home DS0000067519.V363009.R02.S.doc Version 5.2 Page 14 Several people spoke of the length of time that they had to wait until their call bell was answered, one person stated that everyday especially in the evenings that they had to wait between 10 to 15 minutes, and another person stated that at times it could be 20 minutes. Of the 6 people spoken with regarding this at the visit, 4 stated that it was too long to wait to be answered. Da-Mar Residential Care Home DS0000067519.V363009.R02.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 – 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are able to continue personal relationships with opportunities to see relatives in private however resticted opportunities and participation in social activities and social contact does not meet peoples individual prefrences and needs. The delievery of food is not always sufficent to ensure people are served appropriatly and make use of available dining space. EVIDENCE: When the inspectors arrived a game of bingo was being held in the lounge at the home, prizes were seen to be given to the winners of the game. People spoken to stated that bingo was held every Tuesday and Thursday and that every three weeks there was entertainment. Three of the five people spoken with about activities felt that there was not enough to do in the home. One person said, “it’s a bit better in the summer as you can sit outside, but there needs to be something going on most days I get bored”. It was observed Da-Mar Residential Care Home DS0000067519.V363009.R02.S.doc Version 5.2 Page 16 during this visit that three people in the lounge area were restless over a period of 1.45 hours, one person constantly got up and walked around touching other people in the home and their things, another person was banging the arms of their chair and pushing small items of furniture around. No alternative activity was offered to these people even though their actions were demonstrating that they were not receiving many benefits from the game of bingo whilst that was taking place. On speaking to people who lived in the home, they confirmed that their relatives and friends visited them. None of the people spoken with were aware of any restrictions on visiting and all confirmed that they could meet with their friends and family within the privacy of their own rooms. Daily records also contained entries by staff to indicate when people had received visitors. Information was also available so staff would know whom to contact if a person had a change in circumstance. One relative spoken to who had been visiting said, “staff have been helpful when I have come to see my wife”. As detailed within the previous section no one had, had a nutritional risk assessment. Observation of the evening meal showed that people had a choice of baked potato with beans or cheese, sandwiches, fruitcake, yoghurt or ice cream. One person who had chosen baked potato with baked beans had their slice of fruitcake put on the same plate, another person was served baked potato, cheese and cake on the same plate. People were not offered a drink with their meal until 20 minutes after they had been given their food. An agency worker had told one person that there was no cake left and they were missed out from being offered a drink at all. The inspector sought out staff in the main kitchen to advise them of this. No cake could be found in the kitchen. However within 5 minutes a slice had been found and was given to the person alongside a drink. It was also observed that when the fruitcake was served to everyone earlier the agency carer used their hands to do so and was not wearing gloves. People spoken with said that the standard of food at the home changed. They said that if the cook was on duty then there was always a choice and the food was very nice, however when the cook was off there was no choice and it depended who was cooking as to the standard. It was observed that the dining area was only used by two people at tea time. People were asked why they had not used this facility, they stated that they didn’t know why, one person said, “ we never use it in the evening, just at lunchtime during the week”. People said that the dining room was not used at weekends when the manager was not about, so people remained in their chair in the lounge all day and ate from a small table in front of them. Da-Mar Residential Care Home DS0000067519.V363009.R02.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 – 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The training of management and staff is not sufficent to ensure they have a satisfactory level of understanding of the safeguarding protocols to protect the people living at the home. Systems in place for receiving, investigating and responding to complaints is inconsistent so people are not confident to raise concerns and are not assured that their concerns will be listened to and acted upon. EVIDENCE: The complaints procedure as detailed within the service user guide given to the inspectors stated that all complaints received would be recorded and investigated by the manager within 7 days. Information shared by the safeguarding team evidenced that this had not taken place following a written complaint made earlier in the year, although a response was made within 28 days as detailed within the regulations. The reply examined however did not respond directly to the issues that had been made by the relatives of one person, confirmation was given by Northants Social Services that the complainants were dissatisfied with the way in which their concerns had been dealt with. A book was also given to inspectors to look at; this was used to record complaints. It was not clear in all instances that a written response had been made to the complainant. Five people were spoken with about making a Da-Mar Residential Care Home DS0000067519.V363009.R02.S.doc Version 5.2 Page 18 complaint at the home, only one of the five people said that they would feel comfortable doing so. One person said, “I have said things before and it makes it worse, they turned funny on me”. Another person felt that they had been given notice to leave the home following a complaint that they made, they said, “I cant prove that’s why, they say its because they can’t manage me, but they told me I had to go straight after my do with the manager”. Records examined at this visit showed that not all staff had undertaken training in the safeguarding of vulnerable adults; the manager confirmed that this was correct. There was no copy of the local protocols in the home on safeguarding adults. Incidences of violence between people in the home had not been reported in accordance with these guidelines; on speaking to the manager she was not aware of the need to report these. The management and staff in place at the time of this visit did not demonstrate through discussion an understanding of the need to refer any allegation or suspected abuse. Da-Mar Residential Care Home DS0000067519.V363009.R02.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Individual accomadation is of a good standard meeting peoples needs and prefrences, however inconsitences in the level of cleanliness means some areas have an odour of urine and means some people do not have a pleasant enviornment in which to live. EVIDENCE: On arriving at the home it was observed that carpet cleaning was being undertaken in the dining area. However even though efforts were being made to clean areas, there was an odour of urine in several areas of the home. A short corridor separates the sitting area; this results in this area being L shaped. It was noted that there were not enough armchairs for the number of Da-Mar Residential Care Home DS0000067519.V363009.R02.S.doc Version 5.2 Page 20 people living in the home. Chairs were arranged very close together and several tables used to eat meals from further reduced the limited space available. There was a dining room available located near to the entrance of the building, however as detailed within the Daily Life section its usage was limited. Wheelchairs seen and tables in these areas were dirty around the legs and the level suggested that they had not been cleaned for some time. Five individual rooms were seen, all of these were clean and tidy and free of odours. All contained personal items to aid in creating a pleasant environment. All these rooms had been decorated to a good standard. People spoken to whose rooms they were all felt satisfied with their own rooms. Bathrooms and toilets were clean and tidy and the people had the choice of mechanical aids to assist them with bathing. Da-Mar Residential Care Home DS0000067519.V363009.R02.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The systems for reruiting and training staff is poor and the numbers and depolyment of thoes staff are not sufficent to safeguard the people and provide the care and support needed by the people living at the home. EVIDENCE: Two staff files inspected had an application form but the details on one form for the previous employment was not completed properly. The forms were completed on the 01/04/08. The files did not have a POVA first check, and CRB checks. There were also no references or any evidence of any relevant qualifications of the person. There was also no recent photograph of the people being employed and evidence of any health checks being carried out. This was discussed with the acting manager who stated that the two staff had not started employment but had started shadowing staff two days ago. The acting manager was not aware that she needed to have all the information stated in schedule 2 of the Care Homes Regulations. The inspector was informed that the two people employed were students and could only work 24 hours per week. However the acting manager stated that they had not yet Da-Mar Residential Care Home DS0000067519.V363009.R02.S.doc Version 5.2 Page 22 received proof of the courses being under taken by the staff. The home has to see this proof before they are employed. Another staff file inspected showed that the staff started on the 10/12/07. However the application form was not completed properly and the form was also not signed or dated by the person completing the form. The file did not have an induction programme but a checklist completed on the day the person started. There was also no photograph of the staff and had no references. Another staff file inspected showed that the person started on the 11th of July 2007 but the references were received on the 16th and 14th of July 07. The skills for care information had not been started. The induction list also had not been completed. The POVA first check had been received on the 10th of July and the CRB form was received on the 31st of July 07. There was no information recorded in the staff file to show that the staff had been supervised by the manager prior to receiving the CRB check clearance. Another staff file inspected showed that the person had started on the 10th December 07, however the two references were not received until on the 4th January 08. One training certificate was seen in one staff file and another staff file had two training certificates. However two staff files had no training certificates. This was discussed with the acting manager who stated that all the staff certificates should have been kept in the staff files. The home employed agency staff when they are short of staff. It was stated by the acting manager that the home did not have any information about the agency staff but this was kept at the head office. A copy of the staff training programme was given to the inspectors. The manager stated that five staff at the home had started their NVQ level 2 in care in January and February 08. It was also stated that she was planning a fire warden training on the 9th of May 08. It was also stated by the manager that she was planning the next safeguarding of vulnerable adults training. At present only four staff had received this training. The staff training programme showed that there were 13 staff and this included the acting manager, the weekend cook, the housekeeper and the handyman. The manager had identified that not all staff had received training on infection control, medication, food hygiene, risk assessment, death dying and bereavement, anxiety and depression, person centred care, nutrition awareness, the principles of care, fire safety, manual handling, dementia awareness and challenging behaviour training. The training programme for the weekend cook showed that she had only completed training on manual handling, fire safety and safeguarding of vulnerable adults training. No other training had been undertaken. Da-Mar Residential Care Home DS0000067519.V363009.R02.S.doc Version 5.2 Page 23 One staff had no training recorded in the records but in the recommended training requirements it stated that all training was required. Another staff only had one training recorded as being completed, which was mental health. Two other staff had 3 training recorded. This was fire safety, mental health and dementia for one staff and manual handling, first aid, and dementia for another staff. There were no training records seen for the cook. One staff had no training recorded because they had not done any training. The training programme showed that 8 staff had left from May 2007 to August 2008 and one left in February 2007. Evidence showed that some of the staff that had left had not completed training in infection control, safe guarding of vulnerable adults training, dementia awareness training, anxiety and depression, fire drills and evacuation, risk assessment, food hygiene, first aid, medication training, Manual handling, and fire safety training. Staff rotas were inspected and these were not clear to understand. There were names of a few staff on the rota that were not on the staff training programme. There were names of staff on the rota but these were not recorded on the training programme. The names of the agency staff were not recorded on the rota. The inspector randomly inspected the weekend the 26th and 27th staff rota. The staff working rota for Saturday the 26th of April 08 was: 07:00 to 14:00 07:00 to 21:00 07:00 to 13:00 14:00 to 21:00 14:00 to 21:00 09:00 to 21:00, this was a 12 hour shift. This member of staff did not have the POVA first check, CRB check and no references were seen in the file. There was no name of staff recorded to state which staff covered the 14:00 to 21:00 and 07:00 to 13:00 shift. There were two night staff names recorded but the hours started was not recorded. There was only one staff name recorded on this shift that was seen in the training staff programme. The rota for Sunday the 27th consisted of: 14:00 to 21:00 07:00 to 14:00 07:00 to 21:00 10:00 to 21:00 09:00 to 21:00. There were no hours recorded for the weekend cook. The staff covering this shift had worked 12 hours and the staff details showed that no POVA first check or CRB check had been taken up. There were also no references in the file. The nigh rota was being covered by an agency staff but no name was Da-Mar Residential Care Home DS0000067519.V363009.R02.S.doc Version 5.2 Page 24 recorded and by the homes staff. Evidence showed that the staffing hours at the home was not meeting the needs of the people being cared for. The inspector was unable to ascertain what training the staff had received. The inspector was also informed that the training records provided were of all the staff. Da-Mar Residential Care Home DS0000067519.V363009.R02.S.doc Version 5.2 Page 25 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, 36 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Health and safety systems are poor so are not sufficent to reduce the risks associated with this area for the people living at the home. Management systems are not sufficent to ensure an acceptable level of service ids provided for the people living at the home. EVIDENCE: The acting manager had been working in this role since 1st of august 2005. She stated that she had submitted her application to the Commission for Social Care Inspection to become the registered manager on the 10th of April 08. There had been a significant decline in standards at the home since its Da-Mar Residential Care Home DS0000067519.V363009.R02.S.doc Version 5.2 Page 26 previous inspection in August 2006, evidence of this is detailed in the previous sections of this report. The office systems need to be looked at to make improvements. The staff recruitment files need to be better systematic, as the information was disorganised and difficult to understand. At the inspection there were a few documents the home could not find and the acting manager was not sure where this information was kept. The requirement to include in the homes fire safety procedure on vertical and horizontal evacuation and night time procedure from the Fire Officer’s visit to the home on the 4th of March 2008 had not been met. This was discussed with the registered provider and the acting manager. It was stated that this was being worked on and it was at the planning stage. The inspector was informed that the managers from the two other sister home’s and from this home were having a meeting next Thursday with the registered provider to discuss and meet the requirement. The fire book was inspected and where it was stated that daily checks needs to be carried out for the building was not always happening. It also stated that the fire extinguishers were to be checked on a weekly basis but this was not happening. The emergency lighting was not tested on a monthly basis. The print out given by the acting manager for the last fire drill practice was stated to have been carried out on the 19th of July 2008. Having read the minutes of the fire drill where it stated that some of the staff did not react to the alarm and ‘there was no immediate response to the alarm from any staff/tradesman’ was very concerning and that the home had not undertaken further fire drills. As detailed within the staffing section, some staff working at the home had not received training in food hygiene or moving and handling. The staff files inspected had no recorded supervision records. This was discussed with the acting manager who stated that these were kept in a red folder. This file was inspected and evidence showed that there were only three supervision contracts for staff that were not case tracked these were recorded in May 2007. This was discussed with the acting manager who stated that she was not sure who’s responsibility it was to carry out supervisions of staff in the home. The manager stated that she thought this might be the responsibility of the registered provider. The acting manager stated that she had one to one with the registered provider. However she stated that the meeting was not recorded and she did not receive a copy of the supervision notes. It was stated that the information was recorded in the registered providers dictaphone. The home did not have a quality assurance that met the standard. No questionnaires had been sent out to people living at the home or their relatives Da-Mar Residential Care Home DS0000067519.V363009.R02.S.doc Version 5.2 Page 27 as set out in the statement of purpose or as required under regulations. The inspector was given a folder by the manager for quality auditing, all the documents within this folder had no entries on them. Towards the end of the inspection it was observed that two staff moved one of the people from their arm chair using an underarm lift, the senior person on duty also witnessed this. This places people at risk of injury. Da-Mar Residential Care Home DS0000067519.V363009.R02.S.doc Version 5.2 Page 28 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 2 1 2 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 3 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X X 1 X 1 Da-Mar Residential Care Home DS0000067519.V363009.R02.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4 Requirement The statement of purpose must be made available for people living at the home and must only contain information that is accurate so people are not mislead as to the services available at the home. Notice to leave must only be given to people in accordance with the terms of their agreement and when demonstrated through appropriate assessment that the home is not able to meet their needs. This is to ensure people are treated fairly, openly and have support. Assessments of peoples needs must be completed in full and linked to the care plans to make sure that their needs are met in full. Management must demonstrate the home’s capacity to meet the assessed needs (including specialist needs) of all individuals admitted to the home. In the case of people DS0000067519.V363009.R02.S.doc Timescale for action 31/05/08 2. OP2 10(1), 12(1)(b), 12(5)(a) & 14 31/05/08 3. OP3 14 31/05/08 4. OP4 12,16 & 23 30/06/08 Da-Mar Residential Care Home Version 5.2 Page 30 5. OP7 15 6. OP8 12 (1)(b) & 13(1)(b) Schedule 3 (j) 7. OP8 13(4)© 8. OP10 12(4)(a), 9. OP10 12(4)(a), (5)(b), 18(1)(a) 12(1)(b) 10. OP10 with dementia, the service provided must be based on current good practice and reflect relevant specialist and clinical guidance so that people receive sufficient stimulation, care and emotional support in their lives. A care plan containing sufficient information that is clear must be in place for each assessed need and kept up to date when changes occur, to ensure people receive the care and support that they require. Action and reporting of injuries and falls and incidences must be made in accordance with the homes policy, monitoring and follow up must be made by staff and medical attention sought when an injury has occurred. Incidences must be reported under the Northamptonshire safeguarding adults protocol. This is to maintain the safety and well being of the people living at the home. (Immediate Requirement made) A specific assessment regarding the nutritional needs of all people must be undertaken, to ensure the correct diet is provided and the risk of weight loss/gain is reduced and other risks associated with special dietary needs. People must always receive the support needed to maintain an acceptable level of personal hygiene to ensure they can live their lives in a dignified manner. Written records maintained about the people living in the home must be recorded in a way that is respectful and maintains the persons dignity. A review of the length of time people have to wait for their call DS0000067519.V363009.R02.S.doc 30/06/08 24/04/08 31/05/08 31/05/08 31/05/08 15/06/08 Page 31 Da-Mar Residential Care Home Version 5.2 11. OP10 12. OP12 13. OP15 14. OP16 15. OP18 bells to be answered must be undertaken. Action must then be taken and measures maintained so people do not wait excessive amounts of time for staff assistance. In waiting so long this places people at risk, as they may require emergency assistance. 12(4)(a) People must be addressed by & (5) staff in a respectful manner to ensure people are treated with dignity. 12(1)(a),1 People must be provided with 2(4)(b)16 stimulation and social and (2)(m) emotional support to enable &(n) them to receive sufficient support to maintain a satisfactory level of social and emotional wellbeing. 16(2)(i) Choices of food must be always available to the people living in the home even when the cook is off. Food must then be served using safe hygiene, in an appropriate setting and have sufficient quantities for everyone to have a choice, with a drink. This is to ensure peoples nutritional needs are met in accordance with their personal needs, choices and preferences. 22(3) All complaints received must be &(4) accepted in a professional manner and then responded to in accordance with the homes own policy. This is to ensure people and their relatives feel confident enough to raise a concern and feel listened to and their concerns are acted upon appropriately. 12(1), A copy of the safeguarding 13(6) protocols must be secured, the manager must be trained in understanding its content, staff must be trained in this area and all incidences of alleged abuse DS0000067519.V363009.R02.S.doc 31/05/08 31/07/08 31/05/08 31/05/08 31/05/08 Da-Mar Residential Care Home Version 5.2 Page 32 16. OP19 23(1)(a), (2)(a), 2(g) 17. OP26 16(2)(j) &(k) & 23(2)(d) 18 & 19 18. OP27 19. OP29 7, 9, 19 Schedule 2 20. OP30 18(1)(a) &(c)13(5) & (6) 21. OP31 9(1), (2)(b)(i) & 12(1) 24(1),(2) 22. OP33 must be reported in accordance with local policy to safeguard the people living at the home. There must be enough seating in the communal areas available for everyone who lives in the home, so that people can sit comfortably outside of their individual room if they wanted to. All areas of the home must be clean and free of odours so that people have a pleasant environment in which to live. There must be sufficient staff on duty to be able to meet the needs of the people living at the home at all times. A POVA First Check as a minimum must be secured alongside two references and all other matters listed in schedule 2, one reference from the most recent employer prior to commencement of employment of staff to verify their suitability to work with the people who use the service. This is to protect the people living at the home, from receiving care by someone who may not be suitable to work in a care home. (Immediate Requirement) Staff must have received as a minimum specific training relating to the individual needs of a person before being allowed to provide care to them, to ensure their safety and the protection and safety of people using the service. (Immediate Requirement) Management of the home must be effective and sufficient to ensure people receive the care and support required to meet their individual needs. There must be a system for DS0000067519.V363009.R02.S.doc 31/08/08 31/05/08 31/05/08 24/04/08 24/04/08 31/05/08 31/08/08 Page 33 Da-Mar Residential Care Home Version 5.2 23. OP36 24. OP38 25. OP38 quality monitoring that seeks the views of people living in the home, so that standards improve and people have an opportunity to influence the running of the home. 18(2) Staff must have a minimum of 31/08/08 six supervision sessions per year, this is to ensure their practice is monitored and any areas for development are identified and plans then made for further training if required. 13(4)(a),2 Action must be taken to meet 15/05/08 3(4) the requirements made by the fire safety officer and fire equipment must be checked regularly and fire drills undertaken to protect the people living and working in the home. 13(5) People must only be assisted to 15/05/08 move by staff using safe moving and handling techniques, the use of underarm lifts must stop. This is to reduce the risk of injury to people living at the home and staff. &(3) 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 Da-Mar Residential Care Home DS0000067519.V363009.R02.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Da-Mar Residential Care Home DS0000067519.V363009.R02.S.doc Version 5.2 Page 35 - 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!