Inspection on 17/09/09 for Drayton House

This inspection was carried out on 17th September 2009.

CQC 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 15/01/09

Drayton House 16/07/08

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 16/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Drayton House 50 West Allington Bridport Dorset DT6 5BH Lead Inspector John Hurley Key Unannounced Inspection 18th September 2009 09:00 DS0000036054.V378013.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Drayton House DS0000036054.V378013.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Drayton House DS0000036054.V378013.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 Mrs Jeanette Rodway Care Home 19 Category(ies) of Dementia - over 65 years of age (4), Old age, registration, with number not falling within any other category (19) of places Drayton House DS0000036054.V378013.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) - maximum of 19 places Dementia aged 65 years or over on admission (Code DE(E)) maximum of 4 places The maximum number of service users who can be accommodated is 19. 15th January 2009 2. Date of last inspection 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. Seven of the thirteen 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. Drayton House DS0000036054.V378013.R01.S.doc Version 5.2 Page 5 At the time of this inspection fees ranged between £473 and £500 each week. Drayton House DS0000036054.V378013.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This was the second inspection of Drayton house for 2009. The inspection was undertaken over the course of two days in September 2009 by one inspector. The inspection was prompted following adult protection concerns and as such questionnaires were not sent to the people who live at the home or people important to them. We did however speak with people living and visiting the home during our visit and also listened to what other professional had told us. The focus of the inspection was to look at relevant key standards under the Commission for Social Care Inspection (now the Care Quality Commission) 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 judgment descriptors for the seven sections are given in the individual outcome groups and these are collated to give an overall rating for the quality of the service provided. The home had submitted an action plan in May 2009 setting out how it would met the requirements set at the inspection in that month. During this inspection we looked at how they had achieved their stated actions. We looked at two selected care files in detail, the staff files, undertook a tour of the building and looked at all the documentation relevant to the running of a care home. What the service does well: The home was found to be clean in all interior areas with the exception of the laundry area. Staff work hard to ensure that it stays that way. The home has good systems in place for the management of Substances Hazardous to Health. Drayton House DS0000036054.V378013.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: The management need to introduce systems to ensure the National Minimum Standards are established and maintained at all times. Failure to do this will put people at risk of unnecessary harm. The management need to improve its approach to care planning, on-going assessment and review of the needs of those who live at the home so that people do not have unmet needs. The systems that are in place for the safe administration of medication need to improve as they may put people at risk of harm or neglect. There needs to be activities based on peoples needs and aspirations in order to ensure people have enough opportunities for stimulation. The management needs to ensure that people are not put at risk through poor health and safety procedures, systems and risk assessments. The management need to carryout a quality assurance assessment of the services it provides. In order to ensure that people’s needs are met the management need to have enough trained staff on duty to meet the identified needs. Drayton House DS0000036054.V378013.R01.S.doc Version 5.2 Page 8 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Drayton House DS0000036054.V378013.R01.S.doc Version 5.3 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.V378013.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3,6 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are assessed prior to them moving into the home but aspects of the assessment need to be improved upon in order to ensure needs can be met EVIDENCE: We looked at the documents relating to the last person to take up residence at the home. The pre admission assessment generally followed the information that was available and restated the health and social care information provided by the service they were moving from. In general terms the registered manager carries out the initial assessment of need. The senior carer supports the manager by completing a number of the risk assessments associated with the care. Drayton House DS0000036054.V378013.R01.S.doc Version 5.3 Page 11 We spoke with the senior carer about these assessments and what some of the scoring meant, they informed us that they were not sure. Further discussion established that some of the clinical terms used in the assessments were not understood. The senior care also informed us that they had no specific risk assessment training and did not have a clinical background such as nursing. Some of the assessment tools, such as pressure ulcer assessments, were specifically designed for those with professional clinical experience. This means that some of the risks associated with the persons care needs have not been fully understood which may put people at risk. The registered manager informed us that they do not take people on an intermediate care basis. Drayton House DS0000036054.V378013.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care planning process and management of aspects of this process are insufficient to meet the needs of the people who live at the home. This may put people at risk of harm. The management of medication administration at the home may put people at risk of harm and neglect. People are not treated with respect and dignity. EVIDENCE: We looked at the care files in relation to those who lived at the home, two in depth and sampled the others. We also talked with staff and management about the needs of those who received care. Drayton House DS0000036054.V378013.R01.S.doc Version 5.3 Page 13 One file related to the most recent admission. It informed us that the person has mental health issues and can be suicidal. The person had a recorded social profile so as staff could understand the persons past and social interests. Although the assessment documentation acknowledged the person had suffered a stroke how this had impacted on the person life was not fully explored. There was no information in relation to the person’s long term rehabilitation either physically or emotionally. When speaking with staff they were unsure of what the persons needs was. One member of staff did identify that the person needed “plenty of 1:1 and reassurance” but given the staffing situation it is hard to understand how this need could be met (please see staffing section for further details relating to this comment.) Further these needs were not fully illustrated in the care plans. The risk assessments were found to be incomplete. This person required the use of bedrails but their use had not been risk assessed and only their fitting monitored. At the last inspection a requirement was made stating that “the home must seek further advice to ensure that bed rails are fitted securely and establish a system for monitoring the safety of the bedrail on a regular basis”. Whilst the monitoring had been achieved there was insufficient evidence to demonstrate that the management had taken advice as required. This should include evidence of risk assessment, consideration of alternatives and recorded consent to use. Risk assessments were carried out by giving numerical scores to a specific components of an issue, say mental health, and adding up the total to give an overall score. But these scores were not translated into any useable care plan which gave staff specific instructions on how to deal with the issue. The mental health care plan for this person stated that they had dementia. It was found to be a standard text / Proforma with the persons name filled into a blank space and did not identify specific care needs for this individual. When we talked with staff about what this persons needs were they were unsure. We asked if they had dementia, they did not know. When we informed them that this is what it said in the care plan they said “if it says there they must have”. At no point in the assessment documentation did it mention dementia as a diagnosis, but mental health problems associated with acquired disabilities and suicidal tendencies. There was no risk assessment in relation to suicidal tendencies or guidance to staff regarding triggers, cues or ways to support and safeguard this person. The manual handling plan for the person stated that it need two people to assist the person to stand as they were not fully weight bearing. A later document stated that one person can manage but there was no explanation as to how the persons needs had changed. When we asked staff how do you manage the persons care they informed us “as you would others, only weak on one side so just lift”. This approach put both staff and person at risk of injury and harm. Drayton House DS0000036054.V378013.R01.S.doc Version 5.3 Page 14 The care plan was found to be made up of proforma’s which could have been in relation to most people who live at the home rather than person centred and reflective of the individual; needs. The review of the care plan in 08/09 stated that it was “effective”. Another person’s file that had taken up residence this year was looked at. This person is dependent on staff and has dementia and dysphasia (problems understanding and being understood). The care plan did reflect that the person had dementia but was not person specific and was virtually the same as the aforementioned plan. The communication problems that are associated with dysphasia were not well documented and did not give clear instructions on how staff should communicate. Staff told us some times the person could fully understand you and could communicate, this was not evident in the plan of care. The person had experienced some behaviour problems associated with their dementia and a period of physical illness. The home had drawn up a behaviour management plan that was intended to protect the person and others from injury. This was to escort them to their room when their behaviour became problematic. This approach had not been agreed on a multi agency level and there was no evidence that the person’s capacity to make decisions had been assessed. Although we were informed that the persons relative had agreed to this approach there was no evidence to support this. The approach did not appear to be fully understood by staff who informed us of different actions to take. Some staff had been trained in managing challenging behaviour others had not. There was no mention of triggers to the behaviour, there was no monitoring of how staff had dealt with the issue and what had been learnt, staff were not debriefed. The lack of recording of the time when the person was removed from situations meant that it could not be evidenced if the person was being well cared for during these periods or if they were just left to their own devices. Although it was required that staff carryout 10 minute checks if this course of action was taken there was no evidence of monitoring available. (due to the nature of the persons illness they could not leave the room unaccompanied and so this could be seen as a restriction of their liberties) The persons own room had been risk assessed and we were reassured that any items that they person could self harm with had been removed. However when we looked in the persons room it was noted that at least one picture had glass in the frame. The lack of monitoring of the behaviour management plan and systems to protect the individual meant that the person was at risk of harm. Drayton House DS0000036054.V378013.R01.S.doc Version 5.3 Page 15 The plans of care that had been drawn up were again not person specific and were “Proforma” type. Although there were concerns over food and fluid intake there was no effective system for monitoring this situation. The other files sampled evidenced similar issues as noted above ie a prforma approach to care planning, invalid risk assessments and a lack of clear instruction to staff. There was sufficient evidence contained with the care records to demonstrate that when required health care professionals were involved in the lives of people who live at the home. We looked at the accident book and found that falls are being recorded. However the falls that had been recorded had yet to influence the persons care plans as there did not appear to be a system in place for managing reviews on monthly basis. We spoke with the registered manager regarding the lack of meaningful reviews who told us they had not been completed due to a lack of time. We looked at the medication administration within the home and found many areas of concern. Whilst looking around the home we found some prescribed medication discarded in the office bin. There was no explanation as to how it got there and the records did not shed any light on the matter or why medicines had been disposed of unsafely. The medication administration records were sampled and it was found that a staff member had signed to say that they had given a person medication. However closer examination of the records evidenced that the home had not received the medication from the chemists to dispense. This undermines the whole of the medication procedures and means that people have unmet needs as they have not been given medication that had been prescribed. Further more there was no recorded evidence of the efforts the home had made in getting the medication to administer once it had been established that there was none to give. Throughout our time at the home we noted that staff often refer to people who live there as “my darling” or “love”. This approach undermines the dignity of the people who live at the home. Further evidence of the lack of dignity afforded to people who live at the home was observed through the staff asking people in a loud voice if they wanted the toilet as it was dinner time soon. Drayton House DS0000036054.V378013.R01.S.doc Version 5.3 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a lack of stimulation and opportunities to develop social interactions in the home. People import to those who live in the home can visit at any reasonable time. Choices are only afforded to those who can make them. EVIDENCE: Whilst looking at the recording in peoples care files it was noted that it was regularly recorded in relation to activities that the person watched the television and had 1:1 talk with staff. With regards to watching the television this may be a form of activity on occasions but the amount of time this was recorded as an activity suggests that people have a lack of opportunity to be involved in other interests or needs. We spoke with staff with regards to the 1:1 discussions and established that this meant they had a chat with the person. Drayton House DS0000036054.V378013.R01.S.doc Version 5.3 Page 17 A visiting relative informed us of how the staff ensure that their relative is occasionally taken to the nearby shops or visits the bank with the local manager. They considered that staff do a very good job and work hard to meet the needs of their relative. This was the only person who had any form of staff directed activity. Throughout the inspection we spent periods of time sat with the people who lived at the home either looking at documents or speaking to them. During this time it was noted that there was little staff interaction with those who live at the home except for a cup of tea or assistance to the toilet and dinning room. We further observed that those people who were more articulate and engaging would be able to talk with staff as they passed or as they were served drinks. Those with enduring mental health issues had little to no stimulation from the staff group and appeared to become part of the furniture. As already discussed for one person their mental health problems had recently made their behaviour difficult to a manage and the home had considered this behaviour had put others at risk. The response by management and staff had been to remove them from communal situations and to sit them in their own room. Their restricted choices had not been fully documented nor had a multi agency approach been used to establish if this restriction of choice was the best course of action to take. The visitor’s book evidenced that relatives and people important to them come and visit people in the home at any reasonable time. Drayton House DS0000036054.V378013.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of knowledge with regards to risk assessments and safeguarding may put people at risk of harm. EVIDENCE: The people who we spoke with who could tell us what they felt told us they knew how to make a complaint and who to go to. A visiting relative also commented on the openness of the staff to look at issues raised and address them as soon as possible. There had been two safeguarding adult concerns one had been dealt with one that was still awaiting to be dealt with. The outcome of the concern that had been dealt with was that the issue raised could not be substantiated but a number of lessons needed to be learnt. The registered manager and provider worked with the local authority in resolving the issues raised. One action point was to complete a risk assessment in relation to the issue. We looked at the risk assessment that had been made and whilst aspects of this were appropriate others were not. It was also noted that actions that were required by the risk assessment had not been carried out. Drayton House DS0000036054.V378013.R01.S.doc Version 5.3 Page 19 The registered manager had previously alerted us to a staffing issue which may have put people at risk. This was our first opportunity to look at how effective the management of this issue had been. We had asked and received a risk assessment in relation to the continued employment of the staff member. The assessment that we received was not robust as it did not fully assess all aspects of the risk. This was explained to the registered manger at the time of the inspection. When we looked at the persons staff file it was evident that the risk assessment was invalid as it failed to acknowledge previous concerns in relation to the same staff member. We asked why this information had not been included in the risk assessment. We were told by the responsible individual that they were historical and before the registered manager had taken up their post. All available information needs to be considered when carrying out risk assessments and making judgements. (The full detail of this issue was discussed with the registered manger and provider at the time of the inspection) The registered manager acknowledged that more training is needed with regards to risk assessments. This lack of knowledge may put people at risk of harm and needs to be addressed. Drayton House DS0000036054.V378013.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19,29,21,24,25,26 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Risks identified at the previous inspection have not been addressed and so may put people at risk of harm. The home is kept clean. Substances that may be hazardous to health are well managed. The laundry area requires work to ensure good infection control practices are possible and so ensure the safety of those who live and work at the home. EVIDENCE: We carried out a self directed tour shortly after entering the building. We found that all of the communal areas of the home were clean and simply furnished. Drayton House DS0000036054.V378013.R01.S.doc Version 5.3 Page 21 The people we spoke with informed us that they felt the home was comfortable and warm. We looked in the persons own rooms and found that they were personalised to reflect individuals preferences. They were clean and all furniture appeared to be in good order with the exception of one persons own furniture. We noted that a table support was broken and needed to be replaced. Whilst it is good practice to allow people to bring in their own furniture if this furniture is in a poor state of repair or may poise a danger to the person or staff then action must be taken to ensure the risk of harm is minimised. The last inspection identified that risk assessments must be completed for unguarded radiators, heavy items such as wardrobes and unrestricted window opening on the first floor must be undertaken and action taken to minimise any risks identified. We received an action plan from the home on the 9/03/09 which stated that the “the window restrictor had been fitted to the window, radiator covers were on order and all wardrobes had been secured to the walls”. We found that the window restrictor had been fitted but at least 8 radiators remained uncovered and at least 4 wardrobes or heavy cabinets were not secured. There was no recorded risk assessment in relation to these items. We also found that although the home had said that the fitting of intumescent strips to the doors was work in progress back in march 09, this work has still to be completed. The communal bathrooms were inspected which were found to be in good clean order. Appropriate hand washing facilities consisting of liquid soap, paper towels and a foot-operated bin was in place. A previous requirement had been made relating to replacing the floor covering in the laundry area by the 6/03/09. The information provided by the home on the 9/03/09 by way of a response to the requirement informed us that the “laundry work (was) in progress”. We looked at the laundry area and found that the floor was not able to be robustly cleaned as it was plain concrete, the floor covering noted at the previous inspection had been removed but not replaced. It was noted that a significant number of tiles were missing and needed to be replaced in order to provide good infection control measures within this area. Within this area the home stores its cleaning products and other items that are covered by the Control of Substances Hazardous to Health (COSHH) regulations. We found that these items were stored well and in good order. The associated COSHH register appeared to be kept in good order. We noted that the home has invested in a new stair lift to assist people to access the first floor independently. Drayton House DS0000036054.V378013.R01.S.doc Version 5.3 Page 22 Drayton House DS0000036054.V378013.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is insufficient staff on duty at all times to provide for the social and emotional needs of those who live at the home. The recruitment process does reliably ensure the suitability of those who wish to work with vulnerable adults. Not all staff are trained to met the needs of those who live at the service. EVIDENCE: At the time of the inspection nne people were in residence. When we first entered the home it was noted that the registered manager was cooking as the cook was on holiday. They were supported by a senior carer and a care assistant. We spoke with the staff on duty who explained that they were responsible for getting people up, assisting them with their personal care and ensuring they had something to eat and drink. They went on to explain that when they had assisted some one to get up they would then take the dirty laundry away and clean the room as there were no ancillary staff. The rotas that we looked at evidenced that there was no ancillary staff to carry out cleaning or laundry duties. We found that on a regular basis 2 staff work from 8 am to 9pm on a Saturday. On Sunday to Saturday the home is Drayton House DS0000036054.V378013.R01.S.doc Version 5.3 Page 24 normally staffed by two people at any given time but this may include the manager. These numbers of staff mean that there is little time for any quality interactions between staff and those who live at the home. We looked at the documentation in relation to the appointment of staff. We found that the home takes up references and carries out Criminal Records Bureau (CRB) checks as well as Protection of Vulnerable Adults (POVA) checks. Some of the staff files provided photographic evidence of the persons identification others did not. In one case the gaps in the employment history that was noted had been explored with the applicant and the decisions relating to this had been recorded. In another staffs file the gaps in the employment history was not scrutinised. In one new staff members file it was clear that the applicant had been transparent with regards to an issue that may have been cause for concern at application stage. However when the person started work at the home this issue had not been risk assessed and so may put people at risk of harm should this happen again. Another new member of staff’s file reference informed the home that at the previous employment that would not allow the person to carry out certain practices because they did not feel that they were competent. This was not an issue that had been highlighted by the home and so may put people at risk if the training of the individual is not fully assessed. We were given the training matrix by the registered manager. This told us about what training the staff had received and what they needed to achieve in order to meet the statutory requirements. The training matrix indicated that staff on the day shift had received training in a number of key areas such as the administration of medication, first aid, infection control, food hygiene, fire safety, health and safety and adult protection. Day staff had also completed training with regards to dementia care and managing challenging behaviour. However the record also evidenced that the staff on duty overnight had not had training in the administration of medication, first aid, infection control, food hygiene, fire safety and moving and handling. Nor had they had training in dementia care and managing challenging behaviour. The responsible individual carries out a number of night shifts but they do not appear on the training matrix and so it is unclear what training they have undertaken. This means that people who live in the home are at risk overnight as the staff on duty do not have the training required to met their peoples needs. Drayton House DS0000036054.V378013.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,36,37,38 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management need to introduce systems to ensure the national Minimum Standards are established and maintained at all times. Failure to do this will put people at risk of unnecessary harm. Records required by regulation should be kept secure so as to ensure that they are available to guide and inform care practice. The health and safety of people who live and work at the home is not protected due to the lack of action with regards risk assessments and action to minimise risks. Drayton House DS0000036054.V378013.R01.S.doc Version 5.3 Page 26 EVIDENCE: There are a number of issues within this report that indicates the systems required for the smooth and efficient running of the home are not in place. This may be as a result of under investment into the property or a lack of staffing which has meant that the documents required by regulation have neither been kept up to date or have been robustly established. In one case records that were required by a Safeguarding Adult conference could not be produced as they had been “accidentally thrown away”. The net effective of these issues is that the home is not being managed effectively. Throughout the report it has been noted that the majority of requirements set out the previous inspection had yet to be met despite the homes correspondence reassuring us that action was being taken to address them. An example of this is evidenced when we looked at the regulation 26 report for August 2009 ( regulation 26 is a requirement placed on the registered person to formally visit the home and make a report of the visit). The report states that “ new radiator covers will be needed in the future and that the manager is to research this”. This appears to be contrary to the action plan that was submitted on the 9/03/09 that stated radiator covers were on order”. Whilst the risk assessments that were required following the last inspection by the 20/02/09 were not available, in relation to radiator covers, it is fair to assume that it had been the intention of the responsible individual to take action by covering them. The evidence that was available at the time of the inspection is that neither action had been carried out ie risk assessment or remedial action. We looked at the records relating to the management formally supervising the staff group and found that they were being kept up to date. However some supervision records that were required as part of a risk management strategy were not. The staff we spoke with stated that they felt supported by the manager and could take an issue to them for consultation. At the time of the inspection there was no documentation available with regards to a recent quality assurance assessment. As already discussed within the main report aspects of the Health and Safety of those who live at the home are not fully protected. The management need to introduce systems to ensure the national Minimum Standards are established and maintained at all times. Failure to do this will put people at risk of unnecessary harm. Drayton House DS0000036054.V378013.R01.S.doc Version 5.3 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 1 1 2 3 x x 2 1 2 STAFFING Standard No Score 27 1 28 2 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 2 x x 1 1 1 Drayton House DS0000036054.V378013.R01.S.doc Version 5.3 Page 28 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 OP8 Regulation 12 (1) b Requirement The home must seek further advice to ensure any bed rails are fitted securely. Original date for compliance was 20/02/09 The registered persons must ensure that risk assessments are completed in relation to: Unguarded radiators in communal and personal areas Heavy items such as wardrobes The unrestricted window opening within the first floor And undertake any action as necessary. Original date for compliance was 20/02/09 3. OP26 13 (3) The home must review current practice to ensure that people are not put at risk of cross infection. The flooring in the laundry is split and requires replacement. Drayton House DS0000036054.V378013.R01.S.doc Version 5.3 Page 29 Timescale for action 20/11/09 2. OP25 13 (4) a 20/11/09 10/11/09 Original date for compliance was 06/03/09 4. OP33 24 (1) a & b The registered persons must continue to regularly review the service provided and identify areas for development so that the service can continuously improve. Original date for compliance was 06/03/09 5. OP38 13 (4) c Fire doors must have smoke 11/11/09 seals and intumescences seals as required by Dorset Fire Service during their visit on 26/9/08. Original date for compliance was 06/03/09 01/12/09 6. OP7 15 7. OP9 13 8. OP37 13 9. OP30 18 The registered manager must ensure that all care plans and reviews accurately reflect the needs of the person and give enough detail to guide and inform staff as to how to met the agreed needs The registered manager must ensure that the receiving, administration, recording of and returning of medication is carried out in accordance with the National Pharmaceutical requirements so as not to put people at risk of harm. The registered manager must ensure that all accidents are recorded and evaluated to maintain the safety of those who live at the home. The registered manager must ensure that all staff have the necessary statutory training to ensure that peoples needs can DS0000036054.V378013.R01.S.doc 15/11/09 15/11/09 15/11/09 01/12/09 Drayton House Version 5.3 Page 30 10. OP29 19 11. OP38 13 be met in a safe manner. The registered manager must ensure that any prospective staff member has their fitness to work with vulnerable people established in order to protect those who live at the home. The registered manager must ensure that all risk assessments demonstrate how the safety of the people who use the service or work at the home is being maintained. 01/12/09 20/11/09 12. OP27 18 13. OP30 18 14. OP37 17 The registered manager must 10/11/09 ensure there is sufficient staff on duty to met the needs of those who live at the home. The management of the home 01/12/09 need to have risk assessment training so that it can improve its understanding of this issue and in turn better protect the people at Drayton house. The registered manager must 10/11/09 ensure that records required by regulation are kept at all times and that systems are in place to ensure they are not discarded. 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 OP9 Good Practice Recommendations All hand written entries on medication records should be checked and signed by a second staff member to reduce the risk of human error. The home should review the storage facilities for medication requiring refrigeration to ensure that this is Drayton House DS0000036054.V378013.R01.S.doc Version 5.3 Page 31 also stored securely. 2. 3. OP16 OP37 The complaints procedure should state that people are able to contact the commission for social care at any stage of a complaint. It is recommended that if the responsible individual continues to work at the home they should be included in on the training matrix. Drayton House DS0000036054.V378013.R01.S.doc Version 5.3 Page 32 Care Quality Commission Care Quality Commission South West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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