Inspection on 09/05/07 for Edwardian Care Home

This inspection was carried out on 9th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Edwardian Care Home 14/10/09

Edwardian Care Home 18/06/09

Edwardian Care Home 07/05/09

Edwardian Care Home 30/03/09

Edwardian Care Home 10/12/08

Edwardian Care Home 27/06/08

Edwardian Care Home 01/02/08

Edwardian Care Home 31/10/07

Edwardian Care Home 02/06/06

Edwardian Care Home 10/02/06

Edwardian Care Home 03/11/05

Edwardian Care Home 23/08/04

Edwardian Care Home 22/06/04

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

CARE HOMES FOR OLDER PEOPLE Edwardian Care Home 168/170 Biscot Road Luton LU3 1AX Lead Inspector Mr Pursotamraj Hirekar Unannounced Inspection 9th May 2007 12:00 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 Edwardian Care Home DS0000037799.V337653.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. Edwardian Care Home DS0000037799.V337653.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Edwardian Care Home Address 168/170 Biscot Road Luton LU3 1AX 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) 01582 705100 F/P 01582 705100 The Edwardian Care Home Ltd ** Post Vacant *** Care Home 30 Category(ies) of Dementia - over 65 years of age (12), Old age, registration, with number not falling within any other category (30) of places Edwardian Care Home DS0000037799.V337653.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1 named person above the age of 60 years Date of last inspection 2nd June 2006 Brief Description of the Service: The Edwardian was a purpose built residential home that provided single room accommodation for 30 older people including those who had dementia and/or physical disabilities that would be met within the registration for older persons. The home was located on a busy thoroughfare, which was a short car or bus ride away from Luton Town Centre. The home had been suitably adapted to meet service users’ assessed needs. At this inspection the accommodation for the service users was arranged on the ground and the first floor with a further third floor that accommodated administrative and staffing offices. Access to all floors was via staircases and a shaft lift. The bedrooms were arranged on the ground and first floor of the house. They were pleasantly decorated, each fitted with a hand washbasin, call system and TV point. Communal facilities were a lounge/diner on both floors and sufficient bathing and toilet facilities for convenient access. The home bordered straight onto the pavement area of the street with a small ornamental garden to one side that was not suitable for recreational purposes. A small patio area with summertime pagoda and garden furniture for the use of the service users was situated to the rear of the building, as was car parking for several vehicles. At present, the home does not have a registered manager. Edwardian Care Home DS0000037799.V337653.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the report of the unannounced key inspection carried out on 09/05/07 from 12.00pm to 1.45pm and from 6.05pm to 10.00pm by pursotamraj hirekar. The method of inspection included review of outstanding requirements and recommendations, notified incidents, study of a sample of care plans, risk assessments, discussion with the service users’, staff on duty, manager, coowner and observations. The manager coordinated the inspection. At present, the home does not have a registered manager. The information from the preinspection questionnaire and service users’ survey is considered for this report as well. What the service does well: What has improved since the last inspection? What they could do better: The home must ensure that staffs working at the home receive appropriate training to the work they are to perform. The home should regularly carryout routine maintenance and renewal of the decoration of the premises including hot water temperature of all points at suitable intervals. The home must ensure that so far as is reasonably practicable the health, safety and welfare of service users. The home must make arrangements by training staff to prevent service users being placed at risk of harm or abuse. Unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. The home must ensure that effective quality assurance and quality monitoring systems are in place and there is an annual development plan for the home based on a systematic cycle of planning – action and review reflecting aims and outcomes for service user. Edwardian Care Home DS0000037799.V337653.R01.S.doc Version 5.2 Page 6 The home must ensure that having regard to the statement of purpose and the needs of the service users, the manager has skills and experience necessary for managing the care home. The home must ensure that at all times competent staffs are working at the home. The home must ensure all allegations and incidents of abuse are followed up promptly and action taken is recorded. The home must ensure that service users are assessed, or at risk of developing pressure sores and appropriate intervention are recorded in the care plan. The home must ensure that staff does not work at the home without CRB clearances. The home must ensure that suitably trained staffs have assessed the needs of the service user. The home must complete the analysis of the service users’ survey, publish, and make available to the service users’ representatives and relevant stakeholders. Nutritional screening is undertaken on admission and subsequently on a periodic basis, a record of nutrition, including weight gain or loss, and appropriate action taken. The home must ensure all care plans are generated and drawn up in consultation with the service user or their representatives. The home should provide wholesome and nutritious diet, which is suited to individual nutritional assessment of service users’. The home should do a status report and send across to the commission detailing the implementation of recommendations made by Clare Hammond, Occupational therapist. The home should consult service user record the interests of the service users’ and they are given opportunities for simulation through leisure and recreational activities in and outside the home which suite their needs, preferences and capacities. 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. Edwardian Care Home DS0000037799.V337653.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Edwardian Care Home DS0000037799.V337653.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 6 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff were not suitably trained to carry out the needs and risk assessments of service users’ and the assessments did not help develop a comprehensive care plan for the service users’. EVIDENCE: On this inspection 3 service users’ preadmission records and their assessments were seen and found that the needs and risk assessments were not carried out by suitably trained staff and the assessments did not help develop a comprehensive care plan for the service users’. The manager and the staff spoken to have confirmed that none of the staffs were trained in mental health assessments and they continued carrying out mental health assessment for service users’. The details of the 3 service users’ are as follows: service user –1 mental health assessment scored heavy between the range of 11-24 no date of assessment, on 29/11/06 scored very heavy between the range of 25-48, and on 28/03/07 Edwardian Care Home DS0000037799.V337653.R01.S.doc Version 5.2 Page 9 scored 50 special assistance required. Physical health assessment carried out on 29/11/06 scored heavy between 23-44, on 28/03/07 scored medium between 12-22. Personal resident risk assessment scored 18 medium between 14-26 on 29/11/06, on 28/03/07 scored 8 low between 1-13. Service user – 2 was admitted to the home on the 02/11/06 the home had not carried out risk assessment that would have informed the preparation of a comprehensive care plan and provided appropriate care delivery package in the best interest of the service user. Service user – 3 the home had carried out an assessment of the service user in the fields of mental health, physical health, personal risk, behaviour, pressuresore, nutrition and falls risk. The mental health risk assessment carried out on the 29/11/06 scored 27 points and on 28/03/07 scored 50 points; behaviour assessment carried out on 29/11/06 scored 1 point and on 28/03/07 scored 42 points; pressure sore assessment carried out on 29/11/06 scored 16 points and on 28/03/07 scored 28 points. The 03/05/07 psychiatric nurse mental health assessment recorded stated that there was no evidence of mental illness for this service user. The commission had undertaken service users’ survey prior to this inspection, to get the feedback from the service users’ and their family members about the care and services they get from the home. A pre-inspection questionnaire was also used for the responsible individual/manager to provide information to the commission with regard to various aspects of care provision and delivery they undertake. 13 service users’ have responded to the service users’ survey undertaken by the commission, of which 10 service users have said that they had prior information about the home before they moved in, and 8 service users’ had signed the contract of services. However, 2 service users said they were not aware of the home prior to their admission. Some quotes in the words of the service users’: Service user –1 said ‘came to the Edwardian on discharge from L&D for respite care’. Service user – 2 said ‘awaiting contract from social services’. Service user – 3 said ‘ a family member was already a resident at the Edwardian, the home was chosen after several visits and also for its convenient location’. Edwardian Care Home DS0000037799.V337653.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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. All the service users’ have care plans. Care plans were inadequate, not regularly reviewed, did not take into account the changing needs of the service users’, and were not updated regularly. Therefore, the needs of the service users’ are not fully met. EVIDENCE: On this inspection 5 service users’ were case tracked and found that their care plans were inadequate, not regularly reviewed, did not take into account the changing needs of the service users’, and were not updated. This six monthly care plan review were general and not specific to the outcome of assessment of needs and risks of the service user. The six monthly care plan reviews had poor linkage with the assessment of needs that covered mental health, physical health, personal risk, behaviour, pressure-sore, nutrition and falls risk. Further, there was no evidence of incorporating changes / updating the care plan to reflect the changing needs and risks of the service user. The details are as follows: Service user – 1 was diagnosed with Alzheimer’s on the 06/12/06 and the latest monthly care plan review and evaluation was carried out on the Edwardian Care Home DS0000037799.V337653.R01.S.doc Version 5.2 Page 11 27/02/07 there after the home had not carried any care plan monthly reviews or evaluation. Record of bath dated 17/04/07 made observations of sores on the bottom of the service user. However, there was no information recorded in the daily record of 17/04/07 and the daily record for 18/04/07 was not made available on this inspection. The medication prescription mars sheet and the medicine in the cupboard was found to be in order. The commission had received on the 14/05/07 a copy of the monthly care plan review and six monthly care plan review, both were carried out on the 10/05/07 that is a day after this inspection. The six monthly care plan review covered 4 aspects. 1. Goals have been met – stated that ‘the service user been a lot better in herself she’s now made a friend with a service user they play games together and sit and chat in each other’s bedroom’. 2. Service user’s view – stated that ‘I some time worry about things I forget but am happy now I have a friend to talk to and not just the staff’ 3. Manager’s view – stated that ‘the service user has settled more since making friends with one particular service user, does not worry so much’. Service user – 2 there has been no care plan review undertaken since the admission in November 2006. The record of bath indicated that the home made attempts to support the service user for having bath on 12/03/07, 18/03/07 and 07/04/07 and recorded refused bath. However this information and the reasons for refusal was not recorded in the daily record. There was no evidence what so ever about any action the home had taken to help achieve personal hygiene goals of the service user who has not had bath for over 2 months. GP visit was undertaken on the 21/02/07. The medication prescription mars sheet and the medicine in the cupboard was found to be in order. The commission had received on the 14/05/07 a copy of the six monthly care plan review that was carried out on the 10/05/07 that is a day after the inspection. The review covered 4 aspects. 1. Goals have been met – stated that ‘the service user seems very content with in her self, also get along well with other service users. The service user is also given the opportunity to make her own choices and be as independent as possible within her environment’. 2. Service user’s views – it was stated that ‘the service user is quite happy and seems satisfied with her level of care and support’. 3. Manger’s view - it was stated that ‘the service user has settled in very well, pleasant private lady. There are no changes in care level at present. Keep me informed’. 4. Further action planned – it was stated that ‘next 6 monthly review would be in November. We will monitor any changes and family will be informed’. Service user – 3 the latest care plan review that was carried out by the home was on the 29/11/06, thereafter there was no monthly care plan reviews were carried out and the care plans were not updated to incorporate the changing needs of the service user. Despite the fact that the assessment scores over a period of 5 months have increased in the fields of mental health from 27 to 50, behaviour scores from 1 to 42 and pressure sore from 16 to 28. The mar sheet recorded that the service user refused medication since 09/04/07 onwards. The record of baths mentioned for dates 14/04/07 and 30/04/07 refused bath. Edwardian Care Home DS0000037799.V337653.R01.S.doc Version 5.2 Page 12 The daily activity record for 19/03/07, 25/03/07, and 02/04/07 recorded the service user stayed in her bedroom. The home did not provide any information what so ever, how they have planned to provide care to this service user in response to changing needs. Service user – 4 is privately funded. The monthly assessment for mental health, physical health, personal risk, behaviour, pressure-sore, nutrition and falls risk was carried out every month, from 05/08/06 to 30/01/07 recorded the same scores for each of the above fields. The monthly evaluation that was carried out until 22/01/07 recorded all needs being met and no evaluation carried out after 22/01/07. The latest monthly care plan review that was carried out was in February 2007 and thereafter there was no care plan review undertaken. The home had not carried out the 6 monthly care plan review. The medication prescription mars sheet and the medicine in the cupboard was found to be in order. The commission had received on the 14/05/07 a copy of the six monthly care plan review that was carried out on the 10/05/07 that is a day after the inspection. The review covered four aspects 1. Service user goals have been met - recorded that ‘the service user doing a lot more for himself that is washing and dressing and loves reading his newspaper’. 2. Service user’s views – recorded that ‘am alright thank you bye’ 3. Manager’s view – recorded that ‘to encourage the service user to continue to assist in care needs. The improvement needs to be encouraged’ and 4. Further action planned – recorded that ‘to inform manager of any changes with the service user before the next review due on 10/11/07’. Service user – 5 assessment of physical health carried out on the 13/11/06 scored 90 and on the 29/1/07 scored 107, pressure sore scored 51 on 13/11/06 and 60 on the 29/01/07 and falls risk scored 38 on 13/11/06 and 50 on the 29/01/07; meaning thereby the general health condition was deteriorating. The home had not carried out monthly evaluation review since the 29/01/07. The medication prescription mars sheet and the medicine in the cupboard was found to be in order. However, the commission had received on 14/05/07 a copy of the monthly care plan review sheet that was carried out on the 10/05/07 that is after a day of this inspection. Which, covered only three aspects; under general health it was recorded that ‘the service user been eating and drinking a lot better and put on weight, blood test done on 01/05/07 due to staff noting red/yellow in colour blotches and at the time of this care plan result’s not sent’. Under goal achievement update – it was recorded that ‘the service user will now say if she want the toilet or what she want to eat’. And under key worker recommendations, it was recorded that ‘to keep encouraging the service user to ask for what she want and need’. There was no reference made in the review to the deterioration of physical health, falls risk, and pressure – sore. Visit undertaken on 08/03/07 by team leader hospital social work team and safeguarding vulnerable adults manager. Found that the records of the residents seen were incomplete with many pages completely blank. Concern Edwardian Care Home DS0000037799.V337653.R01.S.doc Version 5.2 Page 13 was also raised in relation to care plans specifically relating to risk management. Care plans did not appear to be being used as ‘working documents’. Daily records contained insufficient information and did not record the events. The Luton borough social services had provided support to the home in carrying out monthly review of care plan in a revised format and a service user monthly care plan review was piloted in the first week of May 2007, to help staff understand, and follow similar method with other service users’ care plan reviews. The pilot monthly care plan review looked at the fields of incontinence, nutrition, moving & handling, skin viability, activities, aggression, and medication. These fields were detailed under care needs, action, and monthly evaluation. The manager and the staffs had mentioned on this inspection that the home had planned to carry out care plans reviews using the revised format. However, the care plan reviews carried out by the home on the 10/05/07 did not reflect the change and the home continued to undertake the care plan review in the old format and style which is inadequate to cover all aspects of needs, risks and care delivery. 13 service users’ have responded to the service users’ survey undertaken by the commission, of which 6 service users have said that they always receive the care and support they need and 7 service users said they receive usually. However, when asked do they receive medical support they need, 9 service users’ said they received medical support always and 4-service user said usually. Some quotes from the survey in the words of service users’: Service user – 1 said ‘I think that good care is always taken with my mother’. Service user – 2 said ‘ hopefully – I am told that a nursing home could not offer any additional care or support’. Service user – 3 said ‘staff are always kind & courteous’ Service user – 4 said ‘all staff are most helpful’. Service user – 5 said ‘sometimes I feel left on my own’. Service user – 6 said ‘if mum needs a doctor, the home call for one’. Service user – 7 said ‘staff call doctor if they have any concerns’. Service user – 8 said ‘ I have, in the past had to request that a doctor sees my husband’. Edwardian Care Home DS0000037799.V337653.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home had made appropriate arrangements to encourage service users’ to have good relations with their family members, friends, and relatives. EVIDENCE: The home had limited range of activities for the service users’. Such as dominoes, watching movie, go on a drive, one service user attends day care centre. The home had encouraged the service users’ to have good relations with their family members and relatives. Of the 13 service users’ who responded to the commission’s survey, of which 2 service users said they always participate in the activities and 6 service users’ said they usually participate in the activities the home conducts. It was reported in the previous inspection report that ‘the home had organised a visit of nutrition specialist in the month of May 2006 who provided literature with regard to nutritional assessment tool and explained how to use the same. 10 staffs members have had the opportunity to attend the same. The home now had prepared plans to use the nutritional risk assessment tool as part of their risk assessment and care planning processes. However, it was found on this inspection that the new nutritional assessment tool was not used for the risk assessment and care planning process. Of the 13 service users’ who Edwardian Care Home DS0000037799.V337653.R01.S.doc Version 5.2 Page 15 responded to the commission’s survey, of which 4 service users’ have said to the survey that they always like the meals at the home, 6 service users’ said they usually like the meals at the home and 3 service users’ said they sometime like the meals at the home. Some quotes from the survey in the words of service users’: Service user – 1 said ‘ no exercises or much encouragement goes on I feel my husband has become institutionalised without inspiration’ sometimes I have lunch with my husband meals are bland’ Service user – 2 said ‘ meals are always very nice’ Service user – 3 said ‘there are not a lot of activities mum can take part in’. Edwardian Care Home DS0000037799.V337653.R01.S.doc Version 5.2 Page 16 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 had a complaints policy and procedure. The home’s complaint’s procedures were appropriately applied when service users’ make complaints. EVIDENCE: The home had a complaint policy and procedures. The home’s complaints policy and procedures was available for service users and their representatives. Of the 13 service users who responded to the commission’s survey, of which 9 service users’ have said that they always speak to if they were not happy with any of the service at the home and 4 service users’ said sometime. Of the 13 service users’ 8 of which said they were aware how to make a complaint. The home has had adult protection investigations. Following an Adult Protection meeting regarding a service user, an urgent monitoring visit was made to the home on the 08/03/07 by team leader hospital social work team and safeguarding vulnerable adults manager. Specific concerns were raised regarding the following: • • • • • Lack of reporting/ recording regarding accidents/ incidents Discrepancies in accounts given for injuries to residents Failure to seek medical attention in a timely way Failure to seek advice or advise placing authority, when a resident’s condition has deteriorated Poor infection control DS0000037799.V337653.R01.S.doc Version 5.2 Page 17 Edwardian Care Home • Poor medicine management In the follow up meeting on the 23/03/07 at the Luton borough of social services, it was reported that improvements are being made regarding the above issues and more needs to be done. This inspection had found that the home had a long way to go to make improvements, for details please refer under various outcome groups of this report. However, administration of medication, was streamlined. Quotes from the service users’ survey in their own words: Service user – 1 said ‘ during the course of my complaint last year I was only able to speak to the deputy. No action was taken against the member of staff and I received comments such as condescending to other residents etc. I felt that if staff could speak to me like that what chance did residents have no care there’ Service user – 2 said ‘home seem reluctant to criticize the staff, especially the more senior they are’. Edwardian Care Home DS0000037799.V337653.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home was clean and tidy with out any offensive odours. The home need to carry out water temperature checks of all water points at least once a week and complete redecoration work to ensure comfort and safety of the service users’. EVIDENCE: The home was clean and tidy and there were no offensive odours. Water temperatures checks of the rooms were carried out on a random basis. For example room number 13 water temperatures was checked on 14/03/07 and then on 02/05/07 with a gap of 6 weeks. The home must check water temperature of all water points regularly, with not more than a gap of 1 week and record the same. Medicine fridge daily temperature was recorded regularly, and fire safety audit check sheet was presented on the inspection for the week starting 09/05/07. The home employed a new maintenance person and had undertaken the redecoration work of first floor lounge and 2 bedrooms that was in progress. Edwardian Care Home DS0000037799.V337653.R01.S.doc Version 5.2 Page 19 Of the total 13 service users’ those who have responded to the service users’ survey, of which 6 have said that the home is always fresh and clean and 7 service users’ have said usually. Quotes from the survey the words of service users’: Service user –1 said ‘toilet area was not always cleaned until I mentioned it to the cleaner’. Service user –2 said ‘ bedroom was badly decorated’. Edwardian Care Home DS0000037799.V337653.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home must have good mix of staffs with relevant skills. The home must provide staff with appropriate training to assess needs and risks of the service users’. The home must carry out all relevant statutory checks prior to the employment of the staff members. EVIDENCE: The home did not have adequately trained staff to meet the needs of the service users’. None of the staff carrying out mental health assessments had undertaken training in mental health. On a random sample 4 staff members document were seen and found that: Staff member – 1 had neither CRB nor the POVA check carried out. Staff member – 2 working as maintenance staff joined on the 08/05/07 had CRB and 2 references. Staff member – 3 had received induction training, had CRB and references. However, the contract was not signed yet. Staff member – 4 had CRB, completed application and references. Since the last inspection 9 staff members have left the home, of which 2 deputy managers, 2 senior carers, 1 team leader, 3 carers and 1 maintenance person included. This indicates a high percentage of staff turnovers at the home. In the pre-inspection questionnaire, it was recorded that the key management responsibilities were allocated in the home to 2 deputy Edwardian Care Home DS0000037799.V337653.R01.S.doc Version 5.2 Page 21 managers. However, it was found on this inspection that there the home had not even single staff member working in the capacity of deputy manager. Staff training needs assessment and staff training plan was not made available on this inspection. However, on the 14/05/07 the commission had received a training plan for the staffs, which said, ‘trainings due to be implemented: infection control link programme 24/05/07. Safe handling of medication, currently, working on by all senior members of staff, with Lloyds Chemist 3 levels. POVA being arranged with Lin Cross awaiting confirmation, all staff to re-train. Will be looking at challenging behaviour for all staff. Awaiting reply from Dr.Schuemen regarding Dementia training for all staff. All new staff will be trained in Mandatory training with in the next 2 months. Risk assessment training is to be looked into for all senior care staff over the next month’. 13 service users’ those who have responded to the commissions’ survey of which 13 have said that the staff listen and act to what the service users’ say. When asked are staff available when they need them, of the 13 service users’ 5 said that staffs’ are usually available, 5 said always and 3 said sometime available. Quotes from the survey in the words of service users’: Service user – 1 said ‘staff under pressure short staffed’. Service user – 2 said ‘if I have any questions they are dealt with’. Service user – 3 said ‘I have had to ask on more than one occasion to be notified if the doctor has to be called to my father’. Service user – 4 said ‘ need help with shaving and bathing’. Service user – 5 said ‘since a change in management at the home, staff under enormous strain to cook, kitchen, laundry duties as well as work on the floor’. Edwardian Care Home DS0000037799.V337653.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home had not complied with the outstanding requirements, had high staff turnover including POVA investigations, which indicated that the home was not managed well. EVIDENCE: At present, the home does not have a registered manager. The home appointed a new manager. No improvements were made with reference to the requirements and recommendations made in the previous inspection report. When the inspector asked the manager on this inspection, why the outstanding requirements and recommendations were not actioned. The manager said, she was busy and did not have time. The care documents filing system seen on this inspection found that various documents were not systematically organised and filed. 3 service users’ handle their own financial affairs, 5 service Edwardian Care Home DS0000037799.V337653.R01.S.doc Version 5.2 Page 23 users’ subject to power of attorney and 14 service users’ were subject to guardianship, the pre-inspection questionnaire reported. The home had carried out service users survey and summarised the feedback from the responses received and sent a copy of the same to the commission, which was received on 14/05/07. The summary analysis highlighted 2 key issues as outstanding and they are 1. Menu’s as choice not always liked – this is to be discussed at next service user meeting and the menus will be changed accordingly. 2. Staffs were not always easy to talk to – staff will be spoken to and if necessary training will be sort to assist in this. It was reported in the previous inspection report that Clare Hammond, Occupational therapist standard 22 environment assessment report recommended handrails and toilet support rails which needed adjustment. The deputy manager had agreed to do a status report and send across to the commission detailing the recommendations and their implementations. The commission had not received any response to this effect. The pre-inspection questionnaire indicated that the annual development plan for quality assurance was last implemented in 2005. Risk assessment and management policy was last implemented in 2004. The home had planned to complete the review of all the policies, procedure and codes of practice by August 2007. Following an Adult Protection meeting regarding a service user, an urgent monitoring visit was made to the home on the 08/03/07 by team leader hospital social work team and safeguarding vulnerable adults manager. Specific concerns were raised regarding the following: • • • • • • Lack of reporting/ recording regarding accidents/ incidents Discrepancies in accounts given for injuries to residents Failure to seek medical attention in a timely way Failure to seek advice or advise placing authority, when a resident’s condition has deteriorated Poor infection control Poor medicine management In the follow up meeting on the 23/03/07 at the Luton borough of social services, it was reported that improvements are being made regarding the above issues and more needs to be done. This inspection had found that the home had a long way to go to make improvements, for details please refer under various outcome groups of this report. However, administration of medication, was streamlined. Edwardian Care Home DS0000037799.V337653.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 1 X X 3 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 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 2 X X X X X X 3 STAFFING Standard No Score 27 1 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 1 Edwardian Care Home DS0000037799.V337653.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1)(2) schedule 3(1)(b) Requirement The home must ensure all care plans are generated and drawn up in consultation with the service user or their representatives (previous time scales 31/01/06, 30/04/06, 15/07/06 – partially met). ‘Statutory notices will be issued on this matter’ 2. OP8 14(1)(a) (2) Nutritional screening is 09/05/07 undertaken on admission and subsequently on a periodic basis, a record of nutrition, including weight gain or loss, and appropriate action taken (Previous time scale 31/03/06 & 15/07/06 not met). ‘Statutory notices will be issued on this matter’ 3. OP33 24 (1) (a) (b) (2) (3) The home must complete the 30/06/07 analysis of the service users’ survey, publish, and make available to the service users’ Version 5.2 Page 26 Timescale for action 09/05/07 Edwardian Care Home DS0000037799.V337653.R01.S.doc representatives and relevant stakeholders. 4. OP3 14(1) (a) The home must ensure that suitably trained staffs have assessed the needs of the service user. The home must ensure that staff does not work at the home without CRB clearances. The home must ensure that service users are assessed, or at risk of developing pressure sores and appropriate intervention are recorded in the care plan. The home must ensure all allegations and incidents of abuse are followed up promptly and action taken is recorded. The home must ensure that at all times competent staffs are working at the home. The home must ensure that having regard to the statement of purpose and the needs of the service users, the manager has qualifications, skills and experience necessary for managing the care home The home must ensure that effective quality assurance and quality monitoring systems are in place and there is an annual development plan for the home based on a systematic cycle of planning – action and review reflecting aims and outcomes for service user. Unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. DS0000037799.V337653.R01.S.doc 30/06/07 5. OP29 19 (4) 09/05/07 6. OP8 12 (1) schedule 3 (n) 30/06/07 7. OP18 12 (1) (a) 13(6) 17 (1) (a) 18 (1) (a) 9 (2) (b) 15/06/07 8. 9. OP27 OP31 30/06/07 30/06/07 10. OP33 24 (1) (a) 30/06/07 11. OP38 13 (4) (c ) 30/06/07 Edwardian Care Home Version 5.2 Page 27 12. OP38 13 (6) 13. OP38 12 (1) (a) 13 (4) (b) 18 (4) (c ) 14 OP19 15. OP30 18 (1) ( c ) The home must make arrangements by training staff to prevent service users being placed at risk of harm or abuse. The home must ensure that so far as is reasonably practicable the health, safety and welfare of service users The home should regularly carryout routine maintenance and renewal of the decoration of the premises including hot water temperature of all points at suitable intervals. The home must ensure that staffs working at the home receive appropriate training to the work they are to perform. 30/06/07 15/05/07 15/05/07 30/06/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP15 OP22 Good Practice Recommendations The home should provide wholesome and nutritious diet, which is suited to individual nutritional assessment of service users’. The home should do a status report and send across to the commission detailing the implementation of recommendations made by Clare Hammond, Occupational therapist. The home should consult service user record the interests of the service users’ and they are given opportunities for simulation through leisure and recreational activities in and outside the home which suite their needs, preferences and capacities. 3. OP12 Edwardian Care Home DS0000037799.V337653.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF 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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