Inspection on 09/06/08 for Forrester Court

This inspection was carried out on 9th June 2008.

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

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

Other inspections for this house

Forrester Court 14/09/09

Forrester Court 27/10/08

Forrester Court 21/06/07

Forrester Court 20/04/06

Forrester Court 11/01/06

Forrester Court 12/05/05

Forrester Court 11/11/04

Forrester Court 17/05/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Forrester Court Cirencester Street London W2 5SR Lead Inspector Ffion Simmons, Sheila Lycholit & Jane Shaw Key Unannounced Inspection 10:30 9 , 10 & 18th June 2008 th th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Forrester Court DS0000026014.V364511.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. Forrester Court DS0000026014.V364511.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Forrester Court Address Cirencester Street London W2 5SR 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) 020 7266 3174 020 7286 1068 manager.forrestercourt@careuk.com manager.burroughs@careuk.com Care UK Community Partnerships Ltd Mrs Hansa Menon Care Home 110 Category(ies) of Dementia (60), Old age, not falling within any registration, with number other category (50) of places Forrester Court DS0000026014.V364511.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 with Nursing Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia Code DE Old Age, not falling within any other category Code OP 2. The maximum number of service users who can be accommodated is: 110 Date of last inspection 21st June 2007 Brief Description of the Service: Forrester Court is located off the Harrow Road, with good access to local shops and services and close to Royal Oak tube station. It is registered to provide care including nursing for up to one hundred and ten residents of either gender and recently it has been registered for up to sixty beds for people with dementia and fifty for older people. The building opened approximately nine years ago and is purpose built. It is owned and run by Care UK and places are commissioned by Westminster Council and the PCT. The Royal Borough of Kensington and Chelsea commission some places in Kensington, the unit for people with early onset dementia. The weekly fees for the service ranges between £340 and £750. Forrester Court DS0000026014.V364511.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. The unannounced key inspection took place over three days between the 9th and 18th of June 2008 and lasted a total of 24 ½ hrs. Three inspectors were involved in this inspection. During the inspection, we spoke with residents, staff and relatives and their comments have been used as evidence. We observed care practices using the Short Observational Framework for Inspection (SOFI), a methodology we use to understand the quality of the experiences of people who use services who are unable to provide feedback due to their cognitive or communication impairments. We tracked the care of ten residents, and in doing so we checked their personal records. A number of other records and documentation were checked during the inspection, including the computerised care plans and risk assessment, staff files, health and safety documentation, the home’s computerised complaint records and incident records and quality assurance documentation. A full audit of medication was carried out by a specialist Pharmacist Inspector to assess the home’s management of medication following concerns identified during the earlier part of the key inspection. Questionnaires were sent to residents, relatives/carers and advocates, professionals and staff to comment on the service. We have used the information within these questionnaires to contribute to the content of the report. The Registered Manager took time to complete and return the Annual Quality Assurance Assessment (AQAA), which has been used as evidence to inform this report. What the service does well: A comprehensive on-line system for care planning and other recording, including staff training, complaints and accidents, is in place, which alerts senior staff to any omissions or overdue reports and allows Care UK’s clinical governance team to monitor records, as well as providing a range of management information about the service. Kensington Unit provides person centred care to people with early onset dementia, recognising their individual needs and giving care and support within Forrester Court DS0000026014.V364511.R01.S.doc Version 5.2 Page 6 a calm and pleasant setting. Feedback from regular visitors about this unit was very positive. An imaginative activities programme has been established, led by an activities officer and a designated support worker on each unit. The programme includes a range of sessions within the home, including cooking, crafts and regular film shows, as well as trips out, both locally and further afield. A wide choice of meals is available, with food freshly prepared on the premises. Individual likes and dislikes regarding food are met and the catering service is able to meet the cultural and ethnic needs of residents. What has improved since the last inspection? What they could do better: The home needs to immediately take steps to ensure that the safeguarding policies are followed when allegations of abuse are made or when there are incidents of abuse in the home. Staff must receive training in this area as there is a lack of understanding of when staff should report incidents and allegations of abuse. Urgent improvements are needed in this area to ensure that residents are adequately protected. Events which adversely affect the well-being and safety of residents must be reported without delay. Action must be taken to ensure that staff are aware of the importance of recording complaints and concerns and that they are effectively documented and investigated. This is so that residents’ concerns and complaints are listened to and acted upon. Action must be taken to improve relationships between a small number of staff, whose personal antipathy is preventing good teamwork on some units. A system of regular staff supervision must be established, with priority given to monitoring staff whose performance has given cause for concern and new staff without previous experience of working in social care. This is important so that staff feel supported and their work is monitored to ensure high standards of care. Where a member of staff is appointed who has a previous conviction, the decision to appoint must be supported by a full report. More robust auditing of the home’s management of medication and of the complaints and incidents records and staff supervision and training should take place. This is to ensure that incidents are reported promptly and complaints recorded and investigated Forrester Court DS0000026014.V364511.R01.S.doc Version 5.2 Page 7 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. Forrester Court DS0000026014.V364511.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Forrester Court DS0000026014.V364511.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 6 N/A People using the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Personalised assessments are undertaken prior to a resident moving in to make sure that residents’ needs are know prior to admission. EVIDENCE: It is the home’s policy to ensure that pre-admission assessments are carried out before residents are admitted to the home. This is in addition to the needs assessment, which is supplied by the funding authority. The Manager within the AQAA explained that, “if residents are being admitted to the dementia units, we insist on receiving psychiatric report by the ward or unit”. During the inspection we tracked the care of ten residents. In doing so we checked their personal records. We saw on the computerised system that there were good assessments in place for these residents. This provided the evidence the residents’ needs are well known prior to and during their admission to the home. The home does not provide intermediate care. Forrester Court DS0000026014.V364511.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 & 10. People using the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care plans are comprehensive and care planning is enhanced by the online system, which gives staff a range of assessment tools and highlights areas needing review. The recording of receipts, administration and disposal of medication are overall reasonably accurate. Several areas of concern were observed in relation to the management of medication, which either caused error or posed a risk of error and therefore some times the resident’s health and welfare could be placed at risk. EVIDENCE: Ten care plans were looked at, which were up to date and showed evidence of the resident and their relatives’ involvement. A relative spoken with confirmed that any changes to the care plan were discussed with him and that he was always invited to reviews. Care plans show that staff had sought information from the resident or relative regarding their relevant history so that their social care needs could be identified, as well as health and personal care needs. Detailed night care plans were available, which included the resident’s evening routine and preferred time of going to bed. The need for monitoring during the Forrester Court DS0000026014.V364511.R01.S.doc Version 5.2 Page 11 night, turning and recommendations for resettling the person if they awoke were included on the plans seen. The care planning format, which is completed on line, is comprehensive and includes a range of assessment tools, including risk assessments. Risk assessments, had been completed for nine of the ten residents. Only a moving and handling risk assessment had been carried out for one person who had been admitted 10 weeks previously, even though the assessment and preadmission information indicated that there were other areas of risk which should be considered. The risk assessments were generally up-to-date but we noticed that the risk of one of the residents developing a pressure sore had not been reviewed in six months. Eight fluid and nutritional intake chart were looked at in the home. These were up to date and showed that residents were receiving sufficient fluid daily. Arrangements for foot care for people with diabetes or other relevant conditions were unclear during the first part of the inspection. The care plan of one resident with diabetes noted that a referral to the Podiatrist should be made. No referral was made and staff noted that they cut her toenails for her. While staff have received training in cutting nails from the Podiatry service, clearer guidance regarding when to make a referral to the Podiatry service was needed. During the third day of the inspection, this guidance was clearer and we were informed that referral to the Podiatry service will be made for residents who have diabetes. During the first part of this key inspection, we had concerns about the management of medication on two units, one was a residential unit and the other a nursing unit. Some of these concerns included errors in the administration of warfarin. Medication Administration Records (MAR) indicated that a resident was administered 1mg more than prescribed on three occasions. The prescription on the MAR chart was unchanged despite 2 changes in International Normalised Ratio (INR) blood results. It was also very difficult to audit the warfarin tablets in use as these had not been entered separately onto the MAR sheet. We were also concerned to note that care staff on the residential unit, were secondary dispensing medication that had been received from the Pharmacy into a dossett box. In discussion with the Manager, she was not aware that this was happening and was asked to review this practice immediately due the potential risks to residents. We audited a sample of loose medication and found that they did not reconcile with signatures, the medication included adcal tablets and calcichew. All were signed as given, indicating that staff are signing for medication that they have not administered. This provided the evidence that residents were not receiving their medication as prescribed and that staff were not keeping accurate records. We also noted that there were two occasions where the count of Forrester Court DS0000026014.V364511.R01.S.doc Version 5.2 Page 12 tablets was short, but there was not explanation on the MAR sheets as to the reason for this. We were also concerned to note that there was a discrepancy noted between the date of entry in the Controlled Drugs register for Phentanyl patch and the date of administration on the MAR chart. This highlighted the need for accurate recording. We noted that there were also some confusion as to what constitutes the covert administration of medication, which needed addressing and clarified. During the inspection we also found examples within the home’s medication audit records that there had been errors in the administration of medication that had not been reported to the Commission as per the regulations. In view of the above concerns, a request was made by the Lead Inspector for a Pharmacist Inspector to visit the home on the third day of the inspection to undertake a full audit of the management of medication in the home. On the third day we inspected the other four units and followed up on the management of warfarin throughout the home .It was pleasing to note that the home had put new procedures into place which included double checking by a senior nurse or manager. All warfarin in the home was now being given correctly but we noticed on one unit an alternating daily dose was still not very clear. In a nursing unit we noticed that nurses were auditing the MAR and finding that several gaps were occurring. This means that medication was not being signed at the time of administration. Another resident had a lot of excess stock of inhalers and nebules and we questioned on how compliant he was and whether he needed to be reviewed. This inspection was near the beginning of a new cycle and all the random counts of medication were currently accurate. There was concern at the lack of a full supply of a medicine for a resident with a chronic condition on a residential unit. This resident was only receiving one dose per day instead of three. Another resident was prescribed a lot of medication for pain and there was no assessment made of the effectiveness in terms of pain charts. This resident was also self-medicating her own insulin and the risk assessments had not been updated recently. On this unit and several others lots of medicines had been discontinued but still remained listed on the MAR. On a nursing unit it was noted that the recent discharge medicines from hospital did not correlate with the medication listed on the MAR for one resident. This is subject to separate investigation by the home. Several residents were being fed enterally and there was evidence of regular review of their regimen by a dietician. There was evidence of liquid medicines being prescribed where possible. A detailed risk assessment had been drawn Forrester Court DS0000026014.V364511.R01.S.doc Version 5.2 Page 13 up since day 2 of the inspection for the resident who was unable to take her medicine unless it was mixed into her porridge. There was also evidence of the pharmacist being involved in the review of medication when swallowing difficulties were observed. Controlled drugs were secure in the home and balances were correct. Some attention is needed to make sure that the recording in the controlled drugs register in the nursing units is accurate. Spaces were left between lines and records of issue were not always completed at the time of issue and therefore did not correlate with the MAR. Waste medicines were inspected and we were very concerned at the unopened ampoules of diamorphine floating in a disposal kit. These were denatured at the time of the inspection. The practice of secondary dispensing had ceased in the home and staff now followed the homes procedures for when residents went out for the day. Attention must be given to the containers supplied as it was noted that another residents named dosette box was in use. Forrester Court DS0000026014.V364511.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. People using the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. A varied and imaginative programme of activities is available to residents, which meet their needs, abilities and interests. Visitors are welcomed into the home and residents are supported to maintain important personal and family relationships. The meals offered cater for the varying cultural and dietary needs of individuals. EVIDENCE: During the inspection, we welcomed the opportunity to discuss the range of activities available to residents living at the home with the Activities Senior Coordinator. Each unit has a programme of activities that is designed to meet the needs and abilities of the residents on each unit. The programme includes a range of sessions within the home, including cooking, crafts and regular film shows and sessions to maintain life skills such making beds other domestic tasks. Residents also have access to a computer, which is in the activities office. A home library service visits the home every third week in the month and the activities co-ordinator has access to local libraries to meet any individual requests. During the inspection we observed residents taking part in the activities on offer, including art and gentle exercises. A programme of social events and outings is also in place for the year. A range of outings have been arranged which includes an outing to the Tate Forrester Court DS0000026014.V364511.R01.S.doc Version 5.2 Page 15 Gallery, outings to the sea side, trips to Buckingham Palace and an outing to Covent Garden. For residents who do not wish to go on the arranged outings, social events are arranged within the home and include cinema shows, live music concerns and a multicultural day. The home takes steps through the assessment and care planning process to identify and respect the religious beliefs of residents living in the home. The majority of residents are of Christian faith and to meet the needs of these residents, a Church of England service takes place in the home on a weekly basis. Catholic Mass is arranged once or twice per month, and residents can be supported if they prefer to attend the Church, which is approximately three minute walk away. The Activities Co-ordinator explained to us that one of the residents were supported to visit a Buddhist temple. We noted that one of the residents whose care was tracked was of Muslim faith. A comprehensive care plan was in place for meeting their religious needs, including visiting the Mosque weekly. Regular visitors spoken with on Kensington confirmed that their presence was welcomed by staff and one visitor said that he was always offered a meal, if he arrived when residents were eating. Relatives commented “we feel the care home has a good relationship between themselves and the relatives of the person using the service”. Another relative however commented “there appears to be very little communication between the staff of the home and the relatives of service users – i.e. regarding deterioration of health and admittance to hospital etc” Lunchtime was observed on two units. The choice of meal was displayed on the boards in the dining room and on the printed menus. In one unit the menu on the board was out of date and did not correspond with the meals provided. Residents make their choice of meal the day before, though staff confirmed that there is normally sufficient food for people to make a different choice on the day. It is recommended that people who have difficulty in understanding the choices available are shown the two main options so that they can select a dish. Pureed food is also available, which is prepared in the kitchen. Bowls of fruit are placed on the tables. To encourage residents who are reluctant to choose fruit, it is recommended that staff or the kitchen prepare a plate of sliced fruit in addition to the bowls already provided. Mealtimes observed were generally well managed but interactions between some staff and residents need to be improved, for example one member of staff put clothes protectors around the necks of two residents without speaking to them. Staff must take care when positioning wheelchairs at the tables, as the footplates of one wheelchair narrowly missed the legs of another resident who was already seated. Staff ensured that food was kept hot for residents who needed support with eating. Forrester Court DS0000026014.V364511.R01.S.doc Version 5.2 Page 16 Records show that the kitchen provides a range of milk-based drinks, where there are concerns about residents’ nutritional intake. This is in addition to prescribed food supplements. Staff were observed to thicken some liquids in line with residents’ guidelines, though the thickener recommended for one resident by the Speech and Language Therapist because it was less likely to separate and cause choking, was not being used. The Unit Manager said that there had been difficulty in obtaining this brand of thickener. Comments we received about the food included “everyone agrees the FOOD is excellent” and “would like a hot meal in the evening instead of sandwiches”. Forrester Court DS0000026014.V364511.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. People using the service experience poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. Some individuals know how to make a complaint, but staff do not realise the importance of listening to and acting on residents’ concerns as complaints and/or concerns raised are not always recorded. There is a lack of understanding of when staff should report incidents and allegations of abuse and they require training in order to ensure that residents are protected from abuse. EVIDENCE: The home has a complaints policy, which is accessible to residents within the home’s brochure. Residents and relatives who commented on the service, said that they were aware of how to make a complaint or to raise concerns and some said that they did not have a need to raise concerns. One relative however commented “no one listens and they take no notice”. They continued, “at times, I have felt some of the staff are aggressive as I have questioned the way things are done or when they are done. They become offended and don’t respond to me in the way I would expect.” There is a comprehensive computerised system in place for recording complaints and to detail action taken to investigate including the outcome. Where complaints had been recorded on the computer system, they were well documented. Through checking incidents and records however, we found examples where concerns had been raised but these were not investigated under the home’s complaints procedures. We received the following comment “I report developments to the care worker on duty at the time but is not Forrester Court DS0000026014.V364511.R01.S.doc Version 5.2 Page 18 always acted on. Some care workers continue to sit on a chair after they’ve been told a particular service user is asking for help or is lost” Checking the home’s incident reports demonstrated that there have been a number of allegations and incidents of abuse, which had not been reported either to the local safeguarding team or to the Commission for Social Care Inspection (CSCI). We were seriously concerned to note that there was a lack of understanding of the safeguarding procedures and the need to report allegations or incidents of abuse involving two residents. We noted that other incidents that adversely affect the safety or well-being of residents were seen not to have been reported to the CSCI, including incidents of self-harm and drug errors. An immediate requirement notice was issued to ensure that the safeguarding policies and regulations are followed in the area of protection. Staff require additional training in the area of protection to ensure that they are aware of how to protect residents from harm. Forrester Court DS0000026014.V364511.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. People using the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents live in a clean and well-maintained home, which is homely, and comfortable, but there was an odour on one unit. The home is accessible and meets the specific needs of the people who live there. EVIDENCE: Forrester Court is a purpose built Nursing home, registered to provide a service to 110 residents. The home is situated off the Harrow Road with good access to local shops and services and close to Royal Oak tube station. There are six units within the home, three of these units are for residents requiring nursing care. There are two residential units within the home and a 10 bedded unit providing care and support to residents who have early onset dementia. All bedrooms are single with en-suite facilities. The home is safe and well-maintained and is accessible to people with a physical disability. There are various lounges and dining areas for residents to Forrester Court DS0000026014.V364511.R01.S.doc Version 5.2 Page 20 spend time in and there is a garden to the back of Kensington unit and Richmond unit. Some of the residents were observed to be enjoying their time in the garden during the inspection. The home employs domestic staff to clean the units. Staff commented that, “the home is clean and comfortable to work”. We noted however that there was a strong smell of urine on one of the units during the inspection. It was documented within the AQAA, which was completed by the Registered Manager that “we now have a five year plan to replace all of the beds within the home. We plan to renew the equipment and all other furniture as need be”. Some of the floor coverings have been changed since the last inspection including the floor coverings in one of the Nursing units. Carpets have been replaced by wooden flooring effect, which is thought to be easier to keep clean and hygienic. Comments received in relation to the environment included “it is not possible to permanently keep the home clean throughout but I have noticed dirt in the dining rooms e.g. on the walls or under the serving table etc.” Forrester Court DS0000026014.V364511.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, & 30. People using the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are generally satisfied with the care they receive but at times may need to wait a short time for staff support. There is a high use of temporary staff employed in the home, which could affect the quality and continuity of care of the residents. The service recognises the importance of staff training but staff have not been able to complete their on-line core training on time. EVIDENCE: Rotas indicate that there are sufficient staff on duty at all times, though comments from staff and visitors and notes of staff meetings refer to shortages of staff. One unit visited by an Inspector was seriously short of staff at lunchtime because staff were escorting a resident to hospital and a replacement had not been arranged. Staff normally work a 12 hour shift with an addition 15 minutes worked by RGNs and Unit Managers to allow for handovers. The AQAA, which was completed by the Registered Manager highlighted that 41 of the staff team were pool or bank staff. This figure is high and potentially may affect the quality and continuity of care to residents. Eleven staff files were looked at, which included the five most recently appointed staff. Files were in good order, showing that recruitment checks had been undertaken and each contained a copy of an employment contract. The file of one employee showed that their employment had been confirmed when their CRB check showed a previous conviction, which had not been disclosed on the application form. The Manager had interviewed the member of staff and Forrester Court DS0000026014.V364511.R01.S.doc Version 5.2 Page 22 after discussion with her line manager had decided to confirm the appointment. Notes of the interview with the member of staff and discussion with the line manager were not available, nor was there a copy of any letter to the employee regarding the failure to disclose the offence. The Manager undertook to ensure that all records were completed straightaway. Staff are offered a range of in-house training and distance learning. Training records are up to date and completion of training is regularly monitored by the Deputy Manager. Distance learning/ on-line packages are used for a range of training, including core training and palliative care. The Deputy Manager explained that she uses ‘classroom’ sessions to support on-line training. Monitoring of training indicates that staff are having difficulty in completing core and refresher training on time. Staff spoken with during the inspection confirmed that they were having difficulty with completing the on-line training as they are very busy during their shifts. The Deputy Manager has recently sent letters to over 50 of staff reminding them that their training is overdue. The AQAA outlined that 72 percent of the staff team have obtained the National Vocational Qualification at level 2 or above. The Manager confirmed that a further 21 are due to enrol on this course, some at level 3. Positive comments were received about the staff, which included “the staff show a caring and compassionate understanding of the individuals’ needs”, “they take time to get to know the individual and care for them accordingly.” “staff are caring and efficient”. We noted however, as highlighted earlier in the report that interactions between some staff and residents need to be improved. Forrester Court DS0000026014.V364511.R01.S.doc Version 5.2 Page 23 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, 32, 33, 35, 36 & 38. People using the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The Manager has the required experience and qualifications to run the home. The supervision of staff is inconsistent. There were serious shortfalls in following the home’s policies on complaints and protection. The auditing of quality and systems in the home need to be improved to ensure that staff are following procedures. EVIDENCE: The home’s Manager is experienced and has been in post for over four years. The Manager holds the SEN general nurse qualification and the Registered Mental Nurse qualification. She also holds the Registered Manager’s award and assessors award. There is a Deputy Manager in the home to support the manager. The Deputy Manager is also a Registered General Nurse and Registered Mental Nurse. Both Manager and Deputy were very open and Forrester Court DS0000026014.V364511.R01.S.doc Version 5.2 Page 24 receptive to comments made about the service and promptly responded to the feedback given during the inspection. Supervision notes seen on staff files, notes of team meetings and other records show that there have been a number of instances where staff relationships with each other are poor leading to unprofessional comments, gossip and accusations. The Manager and Deputy Manager have seen the staff involved both in supervision and by attending team meetings to try to resolve the problems, though recent incidents indicate that poor relationships persist. The home’s Quality Assurance systems include seeking the views of residents and relatives. The AQAA outlined that the home holds relatives and residents meetings on a four monthly basis. The home has a suggestions box at the entrance to encourage feedback on the service. Satisfaction surveys are distributed to relatives, friends and advocates twice per year. We checked the home’s quality assurance documentation in the home and saw that Regulation 26 visits take place on a monthly basis. In view of the concerns noted during this inspection, we require the reports from the Regulation 26 visits to be sent to the Commission until further notice. The home’s computerised system is comprehensive and allows Care UK’s clinical governance team to monitor records, as well as providing a range of management information about the service. We noted from checking the home’s quality assurance records that the clinical governance team undertake monthly audits on different aspects of care in the home, including bed rails, personal grooming and staff records. There was evidence that the home is auditing the home’s management of medication, however in view of the issues identified during the inspection, more robust auditing should take place. More robust auditing of the complaints and incidents records should also take place to ensure that incidents are reported promptly and complaints recorded and investigated. The home has a policy for the management of residents’ money. Where required, the home’s administrator is responsible for the safe handling of residents’ money. The systems for protecting residents’ finances were discussed with the administrator during the inspection and sample of residents’ money records was checked. Upon inspection, we noted that receipts are kept to show the purchases made and the balances of money kept on behalf of the resident were correct for those residents checked. A lockable drawer is provided in the rooms for residents to keep their valuables. Staff files show that supervision is not taking place regularly, with staff receiving far fewer than the required six sessions a year. In view of the number of support staff with no previous experience of care work who are employed, it is essential that regular supervision is established. It is also of concern that that where there have been performance issues identified, regular supervision has still not been implemented. The Manager undertook to monitor supervision more closely and to establish a schedule for all staff. Forrester Court DS0000026014.V364511.R01.S.doc Version 5.2 Page 25 Maintenance staff are employed in the home. We found the home to be wellmaintained throughout. The maintenance and health and safety records were checked during the inspection and no issues were highlighted in this area. The equipment used in the home such as assisted baths, hoists and lifts have been serviced regularly. Daily checks of the building are undertaken to check for any health and safety risks to residents Forrester Court DS0000026014.V364511.R01.S.doc Version 5.2 Page 26 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 X 3 2 X X Forrester Court DS0000026014.V364511.R01.S.doc Version 5.2 Page 27 No Are there any outstanding requirements from the last inspection? 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 13 (4) Timescale for action Risk assessments must cover all 01/08/08 areas of risk and must be updated regular. This is to make sure so that any risk to the safety and well-being of residents are identified and as far as possible eliminated. Medication must be recorded 01/07/08 accurately both on the MAR and in the CD register at the time of administration. Due attention must be given to the accurate recording of warfarin and other variable doses including alendronic acid. Discharge medication must be checked against the MAR Continuous supplies of 01/07/08 medication must be kept in the home. Medication must be thoroughly checked before the start of a new cycle. If not supplied or if labelled incorrectly then the pharmacist/GP must be alerted. Risk assessments for self 01/08/08 administration must be regularly updated to ensure that residents are safe when administering DS0000026014.V364511.R01.S.doc Version 5.2 Page 28 Requirement 2. OP9 13(2) 3. OP9 13(2) 4. OP9 13(2) Forrester Court 5. OP9 13(2) 6. OP9 13(2) 7. OP9 13(2) 8. OP16 22 9. OP18 37 10. OP18 13 (6) 11 OP18 13 (6) their own medication. There must be monitoring processes in place and evidence of review for residents with chronic pain. This is to ensure that residents’ pain in closely monitored and that the prescribed pain relief is reviewed and is effective. There must be a tightening up of recording of controlled drugs. Waste Controlled drugs must be disposed of by denaturing so that they are irretrievable. Audit processes must be tightened up to further identify recording errors, stock discrepancies and supplies Steps must be taken to ensure that staff are aware of the importance of and the procedures for recording complaints and concerns and that they are effectively documented and investigated. This is so that residents’ concerns and complaints are listened to and acted upon. All incidents which adversely affect the safety or well-being of residents in the home must be reported to the Commission for Social Care Inspection without delay. Immediate requirement. To ensure residents are safe, steps must be taken to ensure that all allegations of abuse and/or incidents when residents are abused by other resident(s), are without delay reported to the CSCI and reported to the relevant local safeguarding team as per the multi-agency policy for the protection of vulnerable adults. Immediate requirement. Steps must be taken to make DS0000026014.V364511.R01.S.doc 01/08/08 01/07/08 14/07/08 01/08/08 18/06/08 18/06/08 27/06/08 Page 29 Forrester Court Version 5.2 12. OP26 16 (2) (k) 13. OP27 18 (1) 14. OP29 18 15. OP30 18 16. OP32 12 17. OP33 24, 26 18. 19. OP33 OP36 26 18 sure that all staff are clear of their responsibilities for reporting allegations and incidents of abuse under the safeguarding adults policies. This is to ensure staff are familiar with the polices and that residents are protected. Steps must be taken to make sure that the home is free from offensive odours so that residents can benefit from a fresh environment. To ensure that the quality and continuity of care to residents is not affected, the high use of temporary pool/bank workers must be reviewed. Where a decision is made to appoint a member of staff who has a previous conviction, the reasons for this decision must be fully documented. Staff must complete core and refresher training within the specified timescales so that staff are clear on guidelines around safe working practices. To ensure good team working and good quality of care to residents, steps must be taken to improve relationships between some staff. More robust auditing of the complaints and incidents records must take place to ensure that incidents are reported promptly and complaints recorded and investigated. Reports on behalf of the registered provider must be forwarded to the Commission. Staff must be given supervision at least six times a year. Where it is identified that staff need extra monitoring and support, additional supervision should be provided. This is important so that staff feel supported and DS0000026014.V364511.R01.S.doc 01/08/08 01/10/08 01/07/08 01/09/08 01/09/08 14/07/08 01/07/08 01/09/08 Forrester Court Version 5.2 Page 30 their work is monitored to ensure high standards of care to residents. 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 OP15 Good Practice Recommendations Some residents could be supported to make a choice of meal by staff showing them the two main dishes. Residents could be encouraged to eat more fruit by staff or the kitchen providing a plate of sliced fruit in addition to the bowls of fruit, which are available on the units. Forrester Court DS0000026014.V364511.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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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