Inspection on 16/07/08 for Drayton House

This inspection was carried out on 16th July 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

Drayton House 02/02/10

Drayton House 17/09/09

Drayton House 15/01/09

Drayton House 22/01/08

Drayton House 17/10/07

Drayton House 19/06/06

Drayton House 23/11/05

Drayton House 09/08/05

Drayton House 13/09/04

Drayton House 13/05/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 13/11/2008.

CARE HOMES FOR OLDER PEOPLE Drayton House 50 West Allington Bridport Dorset DT6 5BH Lead Inspector Ms Sue Hale Unannounced Inspection 16th July 2008 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Drayton House DS0000036054.V364710.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. Drayton House DS0000036054.V364710.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Drayton House Address 50 West Allington Bridport Dorset DT6 5BH 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) 01308 422835 01308 422835 Miss Andrea Helen Quirk Mrs Isabella Fitzgerald, Mr John Stanley Pitcher, Mrs Mary Josephine Pitcher Vacant Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places Drayton House DS0000036054.V364710.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. That four persons may be accommodated within the category DE (E). Date of last inspection 27.5.08 Brief Description of the Service: Drayton House is registered to provide personal care for a maximum of 19 older people including up to four with dementia. The accommodation is on the ground and first floors with a small passenger lift serving both floors. 7 of the 13 single bedrooms have en-suite hygiene facilities and there are 3 larger rooms that may be used to accommodate 2 residents who have made a positive choice to share with each other. None of the shared use rooms have en suite facilities; all bedrooms have a wash hand basin. Communal facilities include two lounges, a small dining room and 3 bathrooms including two for assisted use. Drayton House is within walking distance of Bridport town centre with its shops and services. There is space at the front of the house to park two cars; parking is not permitted in the road in front of Drayton House. Behind the house is a steep raised garden accessible only by steps and therefore rarely used by residents of the home. There is a small patio at the side of the house accessible via patio doors from the rear lounge. Laundering of clothing and household linen is carried out at the home and arrangements can be made for chiropodists, opticians and other health and social care professionals to visit individual residents. Fees are charged weekly and at present range between £417 and £450 per person. Drayton House DS0000036054.V364710.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 zero stars. This means that the people who use this service experience poor quality outcomes. The focus of the inspection was to inspect relevant key standards under the Commission for Social Care Inspection Inspecting for better lives 2 framework. This focuses on outcomes for residents and measures the quality of the service under four headings; these are excellent, good, adequate and poor. The judgement descriptors for the seven sections are given in the report. The inspection was under taken by two inspectors over the course of one day in July 2008.There were ten people living in the home. The home provides accommodation for men and women. The registered person has appointed a management company, P S Care Home Management, to provide management support for the home. The home was sent and returned an Annual Quality Assurance Assessment (AQAA) this was due to be returned by the 1st July 2008 but was not received until the 15th of July 2008 after an extension of the timescale was requested and agreed. Surveys were sent to residents, health professionals, care managers, GPs, staff and relatives of residents. The responses received were staff (6), relatives (4), and residents (3). The survey responses are incorporated into this report. The inspectors undertook a tour of the premises and looked at selected staff and resident’s files and other documents related to the running of the care home. An unannounced random inspection took place on the 27th of May 2008 to look specifically to concerns raised anonymously in relation to staff training and qualifications and challenging behaviour by a resident. The results of that inspection are incorporated into this report. It was positive to see that some of the outstanding issues had been addressed. Drayton House DS0000036054.V364710.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The courtyard area has been cleaned since the last inspection.Net curtains have been fitted to resident’s rooms that overlook the courtyard area. Residents have been involved in making their own sign for the door of their private room. Drayton House DS0000036054.V364710.R01.S.doc Version 5.2 Page 7 Some improvements have been made since the last key inspection in the amount of detail that care plans contain. The food budget has increased and the use of ‘value’ food reduced so that the standard of food offered to the residents has improved. There is enough staff trained in first aid to make sure someone qualified is available on every shift. A training programme is in place to make sure staff undertake mandatory training. Medication practice had improved and was stored and administered correctly. What they could do better: The service user guide/statement of purpose should be reviewed to make sure that it includes all the relevant information and makes clear the homes policy on equality and diversity. All residents should be given an up to date contract that meets the national minimum standards. Care plans should cover all the recommended topics and should give staff clear guidance and advice on how to meet resident’s needs. Care files should contain relevant information about individual’s medical conditions and disability, and any actions that may be necessary should someone become ill because of their medical condition. Staff should received training in these according to the needs of people living in the home. The home should decide if they are going to provide homely remedies in line with their policy, staff should then be given clear guidance and instructions in their use. Full information needs to be available in relation to risk assessments tools and staff need to have the skills and knowledge to know how to complete them correctly. All complaints must be recorded and fully investigated with outcomes and any actions recorded. Information about complaints should be consistent. Improvements must be made in relation to staff awareness and recording of issues relating to adult abuse and the protection of people who live at the home. Recruitment procedures including volunteers need to be more robust to safeguard people living at Drayton House. The exterior of the home needs to be better maintained. Drayton House DS0000036054.V364710.R01.S.doc Version 5.2 Page 8 Improvements still need to be made in relation to the number of staff qualified to NVQ level 2 or above. The range of training available should expand once everyone has completed mandatory training. The registered provider must take action to make sure that a registered manager’s application is received by us as soon as possible. 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. Drayton House DS0000036054.V364710.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 Drayton House DS0000036054.V364710.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): 1,2 and 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are provided with information about the home to make an informed decision about residency. Contracts of residency need minor amendment; all residents should be issued with current contracts. Pre admission assessment procedures are in place. EVIDENCE: The home has a joint statement of purpose and service user guide that is available for prospective residents and their relatives. It states that people are valued as individuals and treated equally but this statement does not include disability or sexuality and the homes brochure states that shared rooms are available for ‘married couples’ and does not make clear that people who are Drayton House DS0000036054.V364710.R01.S.doc Version 5.2 Page 11 not married may choose to share a room. The document does not make clear that the home is registered to provide personal care only and that the home does not provide nursing care. The home also produces a colour brochure which gives brief information about the home. The joint document does not include resident’s views of the home and it does not include or make reference to the latest inspection report or where this can be obtained. The home has a terms and conditions of residency and residents which is given to all residents. The contract does not make clear who is responsible for the fees i.e. the resident, local or health authority or whether the contract covers short, long or respite care. There was no evidence that all residents have been re issued with an up to date contract as recommended in the last report. The information about complaints in the terms and conditions should make it clear that people are able to contact the Commission for Social Care Inspection at any stage of a complaint. All relatives surveyed said that they had been given information about the home before their relative had moved in. At the time of the inspection no new people had taken up residence at the home. There is new documentation available to carry out an assessment of need that will demonstrate how the service will assess new and prospective residents. If these assessment documents are followed they should provide the basis for a comprehensive assessment. Drayton House DS0000036054.V364710.R01.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 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans are not fully reflective of individuals needs and do not include relevant information about health and medical issues. Assessment tools do not contain all the information required and staff do not always have the skills and knowledge to complete them correctly. Medication practice has improved and procedures safeguard residents. EVIDENCE: We looked at residents care files. Whilst there have been improvements since the last key inspection care files remain in need of significant improvement. In relation to the pressure sore risk assessment tool there was no advice or guidance for staff on what to do with the score or any information about any action necessary to reduce the risk such as the provision of pressure relieving Drayton House DS0000036054.V364710.R01.S.doc Version 5.2 Page 13 equipment. In relation to the dependency assessment this is based on a scoring system but there was no information or guidance of staff on what to do with the score. The care plans are generic with some additions at the end of some plans relating to the individual, the additions were handwritten and not dated or signed. The care plan does not make clear to staff what the residents are able to do themselves to enable staff to promote peoples independence. Some care plans do not give clear instructions so that staff are able to fully meet people’s needs. On one persons file care plans dated February 2008 covered six topics and had been reviewed monthly with some updates noted as necessary. There was a continence assessment on file but this was not dated. There was a record of professional visits including the chiropodist, hairdresser and district nurse. There was no record of a recent visit by a social worker and the reason and outcome of that visit. On a second care file looked at there was no specialised information about the persons medical condition or disability. The nutritional risk assessment did not include the score related to the medical condition, had this score been included the person would have showed as being at nutritional risk. The lack of inclusion of this score demonstrates a lack of staff knowledge about the medical condition. The care plans covered nine topics but did not include a care plan specific to the persons disability, a care plan for foot care which is necessary due to the persons medical condition and did not include information or guidance for staff on what to do should that be person become ill as a result of a change in their medical condition. The care plan in relation to nutrition said ‘supervise and give assistance when necessary if helping with feeding at residents own pace’. The resident concerned spoke to us and confirmed that the ‘food was good and the cook able to sort their special diet out’. It was observed during the inspection that the resident was able to feed themselves independently. There was no record that the person had been weighed although their medical condition means that their weight should be closely monitored. A member of staff spoken to confirmed that they had had no training in either the medical condition or disability. They also confirmed that they would not know what to do should the persons medical condition change. On a third care plan looked at the person was being seen by the district nurse two/three times weekly in relation to a health problem, but there was no care plan in relation to this and a lack of clear guidance to staff on what if anything needed to be done to meet the persons needs in relation to this specific issue. Although one resident had enduring mental health issues there was no evidence that specialist support had been sought or that staff had been given training in mental health. Drayton House DS0000036054.V364710.R01.S.doc Version 5.2 Page 14 In general daily records were well written with a reasonable amount of detail. However, on one care file looked at a serious incident had occurred but the daily record reported that ‘all is well’. People living in the home generally had access to health and medical professionals as necessary and this was recorded on their individual file. One relative surveyed said that it would be ‘nice if more than one bath a week was available’. Five staff surveyed said that they were always given enough information about the people they care for and one person said that they usually were. One member of staff said that the information they were given about residents was always clear and helpful. We looked at medication practice and this has improved since the last visit. Medication was stored and administered correctly. The home has a homely remedies policy but did not have any available. The senior carer responsible for medication was unaware of the role of homely remedies. Drayton House DS0000036054.V364710.R01.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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A range of activities is provided on some days of the week. Residents enjoy what is available. The routines of the home are flexible to suit the choices of the people living in the home. People who live in the home are satisfied with the food. Visitors are encouraged and made welcome in the home. EVIDENCE: During both visits to the home we observed that the routine of the home was as flexible as possible to suit resident’s choices in things such as the time they get up, go to bed and where they eat their meals. Drayton House DS0000036054.V364710.R01.S.doc Version 5.2 Page 16 The inspection of the 28th May 2008 noted that ‘staff interaction with residents was noted to be generally appropriate but it was observed that staff interacted more frequently and positively with more able residents. Staff were seen knocking on the door before entering resident’s private rooms. The home employs a part time activities organiser who was in the home on the day of the inspection. The residents spoke highly about the activities organiser and enjoyed events such as going out shopping, sing songs, hand massages, exercise, planning a trip to West Bay and the proposed summer fete’. However, one resident spoken to said that ‘there’s not much going on here during the day’. One resident had asked to go swimming and they were being supported to do this weekly by the manager designate. Prior to the visit on the 28th May 2008, we had received anonymous concerns in relation to the quality of food served at the home and that it was served cold. The inspection report in May 2008 noted that residents spoken to were satisfied with the food served at the home although one resident told us that the food ‘wasn’t as good’ when the regular cook was not working. One of the residents said that the ‘food was very good’ and that there was ‘always a second choice’. None of the residents spoken to said that the food was served cold. However, the quality of the food served varied with some items such as liver sausage, chicken roll, pate and some drinks being from a ‘value’ range. This means that the part of the complaint about cold food was not substantiated but the part about using poor quality food was substantiated. There was fresh fruit available in the communal areas. Residents were offered a drink and biscuit mid morning; it was observed that most of the biscuits were plain and broken. During the May 2008 visit we looked at the food budget for the home. The evidence of that inspection was that whilst sufficient food was provided this was not always of the best quality. However since that visit the food budget has increased and the use of ‘value’ food declined. A relative commented that the home provided a specialist diet and that the food was very good. The kitchen was clean and tidy. There were sufficient food stocks with a range of fresh, frozen, canned and dried products. The food in the freezers was all labelled and dated and dried goods that had been decanted from large containers were all dated. The statement of purpose/service user guide states that meals are home cooked by’ qualified’ catering staff but the person undertaking the majority of cooking at the home has no formal qualifications in the nutritional needs of older people. The cook was however, aware of individual resident’s likes and dislikes. All relatives surveyed said that the home helped residents keep in touch and that they are kept up to date by the manager or staff. Residents spoken to confirmed that they were able to receive visitors at any time and that they were made welcome by staff. The local vicar goes to the home regularly and people are able to continue with their religious worship if they want to. Drayton House DS0000036054.V364710.R01.S.doc Version 5.2 Page 17 Two relatives said that the home always met different needs with one person saying they usually did. A health care professional described residents as always nicely dressed, clean and appear happy. The home has a hairdresser who visits regularly. Local clergy also visit. Drayton House DS0000036054.V364710.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home has a complaints policy and procedure but information about this varies and is not always followed. Polices and procedures relating to adult abuse have been updated but are not always followed by staff. People living in the home are not protected from the risk of abuse. EVIDENCE: The home had received three complaints since the last inspection. One had been upheld and two were awaiting conclusions at the time the AQAA was completed. We had received an anonymous complaint in relation to several issues at the home and this was looked at during the visit of the 28th of May 2008. The report of that inspection noted that ‘a recent allegation of adult abuse had been received and was being investigated by Dorset Social Services. This had not been recorded by the home as an incident and had not been notified to us as required by the Care Home Regulations 2001.It was recorded during the inspection and dated retrospectively but did not record all the people involved Drayton House DS0000036054.V364710.R01.S.doc Version 5.2 Page 19 and affected by the allegation. The manager designate told us that they were unaware of the problem until Social Services had brought it to their attention. However, daily records showed that such an incident had been recorded but not taken seriously’. The adult protection policy has recently been reviewed and updated to reflect locally agreed safeguarding adults procedures. However in relation to a further incident that had occurred since May 2008, staff had not followed procedures and had not recorded on either resident’s daily record on the day of the occurrence but had reported it to the manager designate on the following day. One residents daily record stated that’ all is well’ despite the manager being told the following day that the person concerned had clearly appeared distressed’. An incident that occurred whilst the Dorset County Council monitoring officer was visiting was not recorded or notified to us. All relatives surveyed knew how to make a complaint and two said the home always responded to concerns with one saying they usually did. A resident told us that the staff were helpful, the manager was approachable and if they had any problems they would be confident they could approach the manager. All staff surveyed said that they knew what to do if they had concerns .One person said they were aware of their right to talk to us and outside agencies if they had any concerns that hadnt been addressed by the home. A staff members file contained details of concerns raised by a resident’s family. This had not been recorded in the complaints log and there was no record it had been investigated by the manager designate. Some minor maintenance work had been carried out by a volunteer; the manager designate had not undertaken any recruitment checks including a POVA First or CRB disclosure. Drayton House DS0000036054.V364710.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The interior of the home is of an acceptable standard and is clean, tidy and free from odours. The exterior of the home requires maintenance. Infection control policies and procedures are in place but further measures to reduce risk are needed. Improvements in signage to aid resident’s independence are needed. EVIDENCE: The home was clean and tidy, with no unpleasant odours on the day of the inspection. Drayton House DS0000036054.V364710.R01.S.doc Version 5.2 Page 21 Some residents chose to take their meals in the dining room, some in their private rooms and others in the communal lounge. There are not enough dining tables and chairs to accommodate all the residents in one sitting if the home was fully occupied. During the visit on the 28th May 2008, it was noted that some clocks in the home did not work; this could cause considerable problems for people with a cognitive impairment. Whilst the home has retained a certain degree of a domestic nature it still does not contain any visual clues as to where a person may be in the building. As the home has a registration which includes people who may have dementia this may mean that they are less confident to move around the building independently. Residents had made their own door plaques to put on their private room. Signage on bathrooms and toilets could be further improved to assist people who live there to retain their independence. One relative commented that the environment was not particularly suitable for people with a visual impairment and that the lift was small and difficult to operate. The interior of the home is decorated to an acceptable standard. However, the exterior of the home requires considerable work and investment. Some window frames need painting and many frames appear rotten with some putty missing around glass panes. The garden seats are worn and need revarnishing. The exterior housing of the fire escape is wooden and appeared rotten in some areas. The manager designate was asked to seek advice from the Fire and Rescue Service in relation to its safety. Minor maintenance was being done by a volunteer and the manager designate at weekends. Please see the outcome group relating to complaints and protection in relation to the volunteers recruitment. The courtyard area has been cleaned and is no longer a trip hazard. Resident’s rooms that overlook the courtyard had been fitted with coverings to protect people’s privacy. All staff surveyed felt that the home was safe and clean for the people who live there. On the visit of 28th May it was noted that ‘the laundry was noted to have improved since the last inspection with no flammable materials stored in there, it was cleaner and better organised. It was noted that some tiles are still missing and must be replaced’. Information supplied by the home in the AQAA states that the tiles have now been replaced. During the visit of the 28th May 2008 we noted that paper towels and hand wash was available in some but not all communal bathrooms and toilets Some bins were not foot operated to reduce the risk of cross infection. The training matrix showed that 7 staff has completed training in infection control but 6 staff has not. The home does not employ domestic staff; these jobs are undertaken by care staff. Drayton House DS0000036054.V364710.R01.S.doc Version 5.2 Page 22 The home was visited by Environmental Health in November 2007. The report was generally positive about the improvements made at the home. However, the report notes that it was agreed that the kitchen would be replaced within six months (May 2008); this work has not yet been undertaken. Drayton House DS0000036054.V364710.R01.S.doc Version 5.2 Page 23 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. This judgement has been made using available evidence including a visit to this service. There is sufficient staff to meet resident’s needs and residents like, and have confidence in the staff and manager designate. Recruitment procedures are poor and do not protect people living in the home form the risk of abuse. The number of qualified staff is improving but significant efforts are still needed to improve the numbers of staff qualified to NVQ level 2 and to increase the range of training available. EVIDENCE: A staff rota was in place. The manager designate told us that there was now enough staff trained in first aid for there to be someone with the qualification on every shift. The home does not employ housekeeping or domestic staff and this work is undertaken by care staff. A staff rota was seen that indicated that there were sufficient staff on duty for the number of people currently living in the home. The rota now identified each staff members designation. Drayton House DS0000036054.V364710.R01.S.doc Version 5.2 Page 24 We looked at the files of three staff. The application form on one file referred to a home of another name. The file contained a health questionnaire, a photo, proof of identity, a satisfactory POVA First check, and an undated offer of employment. Two references were on file, both were character references and one was undated. The person had been in employment elsewhere but there was no evidence that they had been asked to provide an employment reference. The application form showed a gap in employment but there was no evidence that this had been discussed at interview as there was no record of the interview. The file did not contain a job description or contract of employment. It recorded that the person had undertaken fire and health and safety training since starting work at the home. The second file contained an application form, proof of identity, a contract of employment, evidence of mandatory training and further training. It also contained details of actions taken when concerns were raised about the persons work performance. The third staff contained an application form, proof of identity, a satisfactory POVA first check and two references. One reference had been obtained after the person had started work at the home. Staff are given an individual copy of the General Social Care Council code of conduct which is good practice. Two relatives surveyed felt that the staff always had the skills and experience to care properly and one person said they usually did. The staff were described by one relative as always cheerful and welcoming. A health care professional described staff as caring and motivated. All staff surveyed said that they had received relevant training that helped them keep up to date. Three said that induction covered all aspects of the job with three saying that it covered most of the aspects. Three staff said they felt that they always and the right experience, support and knowledge to meet resident’s needs with staff usually feeling that they did. Information provided by the home showed that 36 of the staff were qualified to NVQ level 2 or above and that three staff are currently working towards this qualification. The manager designate told us that risk assessments were now in place for any staff with adverse CRB disclosures. Although the home is not fully occupied two staff surveyed said that was only sometimes enough staff, two said there usually was and three said there always was. A volunteer had been working at the home doing minor maintenance work; the manager designate had not undertaken any recruitment checks. Drayton House DS0000036054.V364710.R01.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): 33,35,36,38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Training, development and supervision of staff is inconsistent meaning that staff may not be able to fully and safely meet people’s needs. People who use the service may not be adequately protected through failure to operate robust recruitment procedures. Equipment used in the home has been serviced and maintained to ensure peoples safety. EVIDENCE: Drayton House DS0000036054.V364710.R01.S.doc Version 5.2 Page 26 There has not been a registered manager at the home for several months. A letter in relation to this was sent to the registered provider on the 1st August 2008. The manager designate told us that they are undertaking the registered managers’ award. They have confirmed to us that they will be making an application for registration. The use of a volunteer without undertaking appropriate checks is detailed under Complaints and Protection. Recruitment procedures and the poor recording and response of staff to serious issues within the home continue to be of serious concern. A health professional surveyed said that since the change in management the home appears to have improved. There have been two staff meetings since the last inspection. There was no evidence that residents meetings are held. The manager designate told us that they had regular contact with all residents and that their views were sought informally. Three staff said that the manager designate regularly had discussions with them, 2 said this happened often with two people saying this happened sometimes. Four staff said that communication in the home always worked well, with two saying it usually did. Staff comments included that there was good communication between staff, regular supervisions and team meetings, and that there is always support if you ever need it from the manager designate. We looked at selected staff files and a supervision record provided by the home which showed that some but not all staff had received formal supervision. The supervision format used in the home does not meet the national minimum standards. The manager designate had received two formal supervisions since January 2008. The manager designate told us that three staff had not had moving and handling training but that this was due to take place the following week. All staff will then have this qualification. We were also told that six staff had completed the first part of a first aid course with the second part due for completion the following week. The manager designate showed us a small number of surveys that were very positive about the new management of the home. All the surveys seen identified the people who had completed them. The statement of purpose/service user guide statement and quality assurance policy state that quality assurance questionnaires are anonymous and the home has told us that people had chosen to put their names on forms. The home does not hold any monies on behalf of residents. Drayton House DS0000036054.V364710.R01.S.doc Version 5.2 Page 27 The last entry in the maintenance book was April 2008 when the home employed a handyperson. Please refer to the outcome group on staffing in relation to maintenance being undertaken by a volunteer. The fire door in one private room did not close properly. The accident book was checked and all accidents had been recorded. The manager designate told us that all accidents were audited to identify trends so that measures could be put in place to reduce risks. The registration and insurance certificates were on display in the home. The home provided information in the AQAA that showed that the equipment at the home had been serviced and maintained. It was noted at this inspection that all substances hazardous to health were stored correctly and health and safety procedures followed. Drayton House DS0000036054.V364710.R01.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 2 X X X n/a HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 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 2 17 X 18 1 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X X 1 X 2 Drayton House DS0000036054.V364710.R01.S.doc Version 5.2 Page 29 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 OP7 Regulation 15(1)(2) Requirement The registered person must ensure that the residents care records include an action plan with sufficient detail to provide clear guidance to staff on the actions to be taken to meet all their identified needs. Previous timescale of 20/11/07 not met. 2 OP29 19(1)(b) (i)(4)(b) (i) 5(d) The registered person must ensure that people do not start work at the home until all the required documentation has been obtained. Previous timescale of 20/06/08 not met. 3 OP30 18(1)(a) (c) The registered person must ensure that the cook receives appropriate training. Previous timescale of 30/06/08 not met. 4 OP36 18(2) All staff must be appropriately supervised. DS0000036054.V364710.R01.S.doc Timescale for action 30/11/08 10/11/08 30/11/08 30/11/08 Drayton House Version 5.2 Page 30 5 OP37 37(1)(e) The registered person must ensure that all serious incidents are reported in line with this regulation. Previous timescale of 20/06/08 not met. 01/11/08 6 OP38 OP30 23(4)(d)( e) The registered person must ensure that all staff are trained in fire safety. Previous timescale of 15/07/08 not met. The registered person must ensure that there is a fire evacuation plan in place. Previous timescale 25/01/08 not met. The registered manager must ensure that all fire doors close properly. 01/11/08 7 OP38 OP30 18(1) 13(5) The registered person must ensure that all staff have received training in manual handling. Previous timescale of 15/07/08 not met. The registered person must ensure that all staff are trained in health and safety. 01/11/08 Drayton House DS0000036054.V364710.R01.S.doc Version 5.2 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations The statement of purpose/service user guide should include residents’ views of the home and a copy of the most recent inspection report or where it can be found. It is recommended that all residents be reissued with up to date contracts. Outstanding from last inspection. 2 OP2 3 OP2 The information about complaints in the terms and conditions of residency should make clear that people are able to contact the commission for social care at any stage of a complaint. The terms and conditions of residency should make clear who is liable for the fee and what sort of care [Long / short respite] is covered by the contract 4 OP7 Care plans should cover all the topics recommended in national minimum standards 3.3. All care plans, risk assessments and other documentation should be dated and signed. 5 OP19 It is recommended that the signage within the home is improved in order to assist people who live in the home access all areas as independently as possible. Outstanding from last January 2008 inspection. 6 OP28 A minimum of 50 of staff should be qualified to NVQ level 2 or above. Outstanding from May 2008 inspection. 7 OP29 A record of staff interviews should be kept. Copies of qualifications claimed on application forms should be retained on individual files. Outstanding from May 2008. Drayton House DS0000036054.V364710.R01.S.doc Version 5.2 Page 32 8 OP29 Gaps in employment history should be discussed with the applicant at interview and the reason recorded. References should be dated on receipt. At least one reference should be from a previous employer. The staff application form should be specific to Drayton house. 9 OP36 Staff Supervision should cover the topics detailed in national minimum standards 36.3. Supervision should take place at least six times a year. Outstanding from May 2008 inspection. Drayton House DS0000036054.V364710.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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