Inspection on 13/06/06 for Four Seasons

This inspection was carried out on 13th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 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

Four Seasons 26/07/07

Four Seasons 10/01/07

Four Seasons 02/02/06

Four Seasons 16/11/05

Four Seasons 06/01/05

Four Seasons 14/06/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Four Seasons 81 Halifax Road Littleborough Lancashire OL15 0HL Lead Inspector Diane Gaunt Key Unannounced Inspection 13th June 2006 08.45a 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 Four Seasons DS0000025472.V290503.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. Four Seasons DS0000025472.V290503.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Four Seasons Address 81 Halifax Road Littleborough Lancashire OL15 0HL 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) 01706 376809 Mrs Wendy Collinson Mrs Wendy Collinson Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places Four Seasons DS0000025472.V290503.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The home is registered for a maximum of 16 service users to include: up to 16 service users in the category of OP (Older People) The service should employ a suitably qualified and experienced Manager who is registered with the Commission for Social Care Inspection. Schedule of accommodation must not be varied without written consent. 2nd February 2006 Date of last inspection Brief Description of the Service: Four Seasons is a large detached house, which, over the years has been extended to offer personal care and accommodation to 16 service users over the age of 65 years. Nursing care is not provided. Accommodation is in 16 single rooms with 12 rooms having en-suite toilet facilities. The home is located on the main A58 Halifax - Rochdale Road, approximately half a mile from Littleborough centre where a variety of shops and other facilities are located. Transport links are good with a main bus route passing close to the home. A train station is located in Littleborough. The front door is accessed down three steps, ramped access is provided to the rear of the building. Parking is available on the main road across from the home and a small area is also located to the rear of the property. There are garden areas to the front and rear of the home. The home is owned and managed by Mrs Wendy Collinson. The home’s information booklet advised residents and their relatives that the most recent Commission for Social Care Inspection (CSCI) report was available in the entrance area although this was not so at the time of the inspection. At the time of this inspection weekly fees were £356, approximately £1542 per month. Additional charges were for dry cleaning, hair perming, private chiropody, and private telephone calls. Four Seasons DS0000025472.V290503.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report has been written using information held on CSCI records and information provided by people who live at Four Seasons, their relatives, professionals who visit the home, the staff at the home and the owner of the home, who is also the manager. A site visit to Four Seasons on 13 June 2006 took place over 10½ hours. The lead inspector was at the home for this time and a CSCI pharmacist inspector also spent 4½ hours at the home looking at arrangements for medication. The home had not been told beforehand when the inspectors would visit. The lead inspector looked around the building and looked at paperwork that has to be kept to show that the home is being run properly. To find out more about the home the inspector spoke with six residents, three visitors, three carers, the cook, the deputy manager and the owner/manager. Comment cards asking residents, relatives and professional visitors what they thought about the care at Four Seasons had been given out a few weeks before the inspection. Three residents, four relatives, 2 GP’s, 2 social workers and one District Nurse filled the cards in and returned them to the CSCI. What the service does well: What has improved since the last inspection? The manager had begun to visit people who were thinking about moving to Four Seasons. At this visit she gave information about the home and decided whether or not the staff at Four Seasons could give them the care they needed. Since the last inspection a plan of care had been written for all residents, although these were too brief in some instances. Care plans were discussed, Four Seasons DS0000025472.V290503.R01.S.doc Version 5.2 Page 6 reviewed and agreed with residents and their relatives and resident satisfaction questionnaires had been re-introduced. A procedure describing the handling of homely remedies had been introduced, allowing trained staff to administer some non-prescribed medicines for example, paracetamol for headache. As the home had no medicines fridge, a suitable, lockable container had been provided for the safe, occasional storage of medicines in the catering fridge. Following recommendation at the last inspection, photographs were included in the medication file to help staff identify residents they were giving tablets and medicines to. A part time activities co-ordinator had been appointed and more activities were provided for residents than previously. The monthly newsletter had started again and residents said how much they enjoyed this. Menus had been reviewed, more vegetables were provided and meals had a better nutritional balance. The cook was developing them further. Water temperatures were checked regularly and the plumber had visited to make sure the water and the heating worked properly throughout the building. Bathrooms were no longer used for storage and residents didn’t share toiletries. Fire doors were no longer wedged open. Staff wore suitable protective clothing i.e. gloves and aprons to control the spread of infection in the home and only went into the kitchen when necessary. Training and supervision of staff had improved. Accidents and incidents were recorded and the manager monitored accident reports to make sure appropriate action was taken. Management of the home had improved but there were still a number of areas where improvement was needed. What they could do better: Care plans must have more detail in them so staff know exactly what care each person needs, they should include advice given by the District Nurse. When ever there is a risk to a resident a detailed assessment and action plan must be written and regularly reviewed. Staff must make sure they weigh every resident regularly and closely monitor when they are gaining or losing weight, making referrals to GP and dietician whenever necessary. It would help the staff if the home had some sitting scales. Medication record keeping needs to improve so the handling of medicines can be clearly tracked from when they are received into the home, to being given to residents or returned to the pharmacy. Written procedures need to be expanded to more fully describe the way staff should handle residents’ medicines. The manager needs to look for a better place to store medicines at the home. Four Seasons DS0000025472.V290503.R01.S.doc Version 5.2 Page 7 Staff training must be increased so that at least half the carers have an NVQ level 2 in care; all the carers have completed necessary health and safety training and protection of vulnerable adults training; and new starters have induction and foundation training which meets national training standards. For the protection of residents, staff must not begin work until satisfactory references and Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks have been received. Also for the safety of residents, lifting equipment must be tested every 6 months; chemicals must be stored safely; and wheelchairs must not be used without footplates unless there is a specific reason which has been discussed and agreed with the resident. The manager must continue to improve her management of the home in order to meet legal requirements and provide a safe service for residents. 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. Four Seasons DS0000025472.V290503.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 Four Seasons DS0000025472.V290503.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Written information was given to prospective residents to help them make a decision as to whether they wanted to live at the home, but it was in need of amendment. Practice regarding assessment was improving as the manager was planning to visit people at home or in hospital prior to admission to make sure the home was able to provide the care needed. EVIDENCE: An Information Booklet was available which included terms and conditions and details about the home. It was given to people who were interested in living at Four Seasons, or their relatives, when they came to look around the home. A copy was also available in the entrance area and in each bedroom, although only one resident remembered having received this booklet. Some of the information in the booklet needed changing and further information adding, in particular the booklet did not explain the emergency admission procedure although records showed the home had recently admitted someone in an emergency. Four Seasons DS0000025472.V290503.R01.S.doc Version 5.2 Page 10 Residents returning comment cards to CSCI said they had enough information about the home before they moved in. Those interviewed said they had chosen the home because of word of mouth recommendation. Individual records were kept for each resident. Five files were inspected and these showed that of three people who moved in since the last inspection, one had an assessment by the manager two days before they moved in and two were assessed on admission. One of these people was admitted in an emergency. All these assessments were done at Four Seasons and not at the person’s home or in hospital. Only one had an assessment undertaken by a care manager. On the day of the inspection the manager arranged to visit a prospective resident at their home to assess them before agreeing to admission. Records showed that residents or their relatives had signed the assessments to show their agreement. Four Seasons DS0000025472.V290503.R01.S.doc Version 5.2 Page 11 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 at least once during a 12 month period. 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. Although residents considered their care needs were met, care plans were not sufficiently detailed to ensure residents would consistently receive the personal and health care they needed. Record keeping and written procedures describing how medicines were handled were not sufficient to ensure medicines were always handled safely. Residents were treated with respect and their right to privacy upheld in the main. EVIDENCE: Improvement was noted in that individual plans of care were written for every resident. Four were inspected. They were based on the assessment made by the manager and care manager where one was available. They were also seen to be written from a positive approach and advised staff to pay attention to resident’s privacy, independence and choice needs. However the three most recent plans were seen to record little detail – having just one page for day care and one for night care. Whilst this may be sufficient as a summary of the care provided it did not record enough detail of the care interventions required. A better format had been used previously, it listed each area of care to be addressed. This care plan was in use on the fourth file inspected. However, Four Seasons DS0000025472.V290503.R01.S.doc Version 5.2 Page 12 the new format was also in use and it was noted the day care plan conflicted with the night care plan with regard to getting up in the morning. All four plans had been regularly reviewed, but the reviews usually recorded ‘no changes’ rather than making any meaningful comment about the person’s progress. Since the last inspection all but two of the care plans had been reviewed with the resident and a relative and arrangements were being made in respect of the two outstanding. Risk assessments were not always completed when necessary and there was little evidence of regular review of these documents. Nutritional risk assessments were not in place and food/fluid intake charts only used when residents became very frail. Weight records showed that five residents had lost weight over recent months although two had regained weight and one had stabilised. In one instance weighing had increased to weekly but only for 3 weeks. Staff interviewed said they did monitor residents’ food intake if there was a concern. They gave examples of this practice in relation to two residents who had eaten little at lunchtime that day but when records were checked there was no reference to this monitoring on care plans, daily care notes and food choice records. In such instances the home must monitor weight and food/fluid intake and then contact the GP if improvement is not achieved. Weight records also showed that two residents had not been weighed for some time as they could not stand unaided and sitting scales were not provided. Whilst care plans described the person’s mobility and any aids they used, detailed moving and handling assessments were not routinely completed, although they had been in the past. Falls risk assessments were seen to have been completed but there was no record of regular review. The fall coordinator had been contacted in respect of one resident following the last inspection but the initiative had not been extended to other residents. The coordinator had visited the home to provide advice to staff and the manager was planning for a number of staff to attend a session at Rochdale Town Hall later in the month. There were no assessments about pressure sore risk on files. The District Nurse had been visiting one resident to treat pressure sores but apart from a reference to these visits on the daily care notes, the care plan did not record any information or advice about the treatment. The District Nurse returning the comment card did speak positively about the care given at the home however. Staff spoken with said continence assessments and reassessments were arranged as required but there was no evidence of this on care plans. Relatives returning comment cards considered they were sufficiently consulted and kept informed with regard to the residents’ care and well-being. GP visits were recorded and residents said the home called their GP when they needed them. This view was supported by information given by a GP who also considered that staff demonstrated an understanding of residents needs. Four Seasons DS0000025472.V290503.R01.S.doc Version 5.2 Page 13 Residents said chiropodist, opticians, and hearing aid specialists visited the home, as and when necessary. Regular dental consultations were not arranged and one resident was observed to have loose dentures. Residents and relatives interviewed considered needs were met. Three residents returning comment cards said they always received the care and medical support they needed. One person considered the home ‘had a very high standard of care’ and another thought they were ‘very well looked after’. Those interviewed considered they were well cared for. Those returning comment cards and all but one resident interviewed considered that staff always listened to and acted upon what they said. Those spoken with considered they were treated with respect. Written medication policy and procedures were in place. They were clearly written but needed expanding to include clear instructions to carers handling medication about how to: order, receive, store, record, administer, and dispose of medication safely. Observation showed that two members of staff managed the medication round but only one checked the written records. There was therefore a risk that they may not be aware of any special instructions for example, suck or chew before swallowing, or that they may give the prepared dose to the wrong person, particularly if residents had similar names. Where several residents were prescribed the same medication staff sometimes ‘shared’ one resident’s bottle of medicine with other residents. This is considered poor practice as it can lead to medicines running out or to medication error, as it is not possible to check the label instructions. One resident managed her own cream but this had not been assessed and selfadministration was not recorded in her care plan. The home had a written procedure supporting self-administration but staff said that they did not know that this included creams. The date that new supplies were given to the resident were not recorded. They should be in order to help monitor the correct use and to help make sure the medicines don’t run out. Eight staff had completed assessed and certificated medication training and a further nine were on the course at the time of the inspection. On completion the manager said that all carers handling medication would have completed the training. It was not possible to track the handling of medication within the home because complete records of medication received into the home were not maintained. Staff administering medication did not use the supplying pharmacists pre-printed medication administration records as they did not like them. Instead, the manager typed and printed her own records which sometimes differed from the pharmacist’s. This was time consuming and also Four Seasons DS0000025472.V290503.R01.S.doc Version 5.2 Page 14 meant that medicines and tablets were not given strictly as prescribed. For example the instruction ‘when required’ was not included on the home’s records, and some dosages and frequencies had been changed. It was of concern that scrap paper had been used to record the administration of one resident’s antibiotic. Handwritten entries should be made on a proper administration record and signed and countersigned to reduce the risk of transcription error. Medicines were securely locked away but the medicines trolley was stored in the kitchen. The kitchen is not considered a suitable place for the storage of medication. The manager should consider alternative locations. Consideration should also be given to improving the security afforded to controlled drugs. The handling of controlled drugs was appropriately recorded in a Controlled Drug register. Staff said that they put unwanted ‘refused’ tablets down the sink. All unwanted tablets should be return to the pharmacy for safe destruction. The pharmacy had supplied special bags and labels for this purpose. Single rooms are provided and residents enjoyed the privacy this gave them. They said they could come and go to their rooms whenever they wished. Those who chose to spend time in their rooms said they were not disturbed unnecessarily by staff, but were always brought a drink when they were served. Those interviewed said staff respected their privacy and dignity when providing personal care. Although safety locks were fitted to bedroom doors only one resident had a key. Lockable space was also provided but not all residents had keys. Only one risk assessment was seen on the four files inspected giving reasons why the resident should not have a key. Four Seasons DS0000025472.V290503.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Provision of social activities had improved but were in need of further development to meet residents social and religious needs. Contact with visitors was encouraged but residents were not encouraged or assisted to go out unless accompanied by relatives which limited their contact with the local community. Residents were able to exercise choice and control over their lives in other aspects. A balanced diet was provided and enjoyed by residents, it was under ongoing review to increase its nutritious value and ensure it met with residents liking. EVIDENCE: Since the last inspection improvement was noted in that an activities coordinator post had been created. Of the three residents returning comment cards, one said there were always activities they could take part in, and two said there usually were. The part time cook had been appointed as activities co-ordinator. She initially spent two days a week on activities but this had reduced to 6 hours on one day a week. There was evidence she had spoken to residents and researched to find interesting activities although she had not drawn on all information recorded on detailed resident activity profiles e.g. one resident had enjoyed gardening but there had been no gardening activities. However, activities which had been introduced had been successful and Four Seasons DS0000025472.V290503.R01.S.doc Version 5.2 Page 16 residents spoken with enjoyed them. She had also made contact with other activity providers and arranged for them to come to the home e.g. organist/singer. Staff interviewed said that they played dominoes or cards or manicured nails whilst having a chat with residents but this was not always recorded. Active Minds continued to provide a monthly session at the home which residents said they particularly enjoyed. Activities did not include physical exercise e.g. dancing, walking, exercising to music all of which have been proved to be good for residents’ health and well being. Inspection of the activities diary showed an average of 3 activities a week, residents would benefit from further development in this area. Since the last inspection the home’s newsletter had been reinstated. The June edition was seen to include information about organised activities and dates of activities at the home. One resident interviewed said they enjoyed receiving the newsletter and that it helped to know when activities would be on. Residents only went out with relatives. They were not accompanied out into the community with staff as the manager was concerned about the risk to residents. They should be consulted for their views on the matter. Care plans recorded residents’ religion. None of the residents went out to church but representatives of the local Church of England fellowship held an ecumenical Christian service at the home every 2 weeks. There were no arrangements to serve communion to residents and they had not been asked if they wished to have this service. A key worker system was in place and staff said that as key workers they would buy any shopping residents wanted, check to make sure they had sufficient clothing and review care plans. All relatives interviewed and returning comment cards considered they were well received when visiting the home. They could see their relative in either communal areas or the privacy of their rooms, they were made to feel welcome and were offered a hot drink. The choices residents made each day varied, dependent upon their mental frailty but residents who were able generally chose what time to get up, go to bed, what clothes to wear, where to spend their day and whether or not to participate in activities. As stated above, they were restricted with regard to going out. None of the residents chose to manage their own money and had passed the responsibility to relatives or solicitors. The home had no involvement with their money. All those spoken with were happy with the arrangements in place. Four Seasons DS0000025472.V290503.R01.S.doc Version 5.2 Page 17 Menus inspected showed improvement since the last inspection. Meals were more varied, balanced and nutritious. Residents had been asked for their ideas when the menus were written and these had been included. Vegetables and fruit had been increased on the menu although one resident commented that they did not often have fresh fruit. The cook on duty said that menus were still under review and that the home was looking to continue to increase nutritional value of meals. Food served during the inspection was well cooked and looked and smelt appetising. Three vegetables were served with the lunch. Although portions were small, residents said they were satisfied with the amount they were given as they did not like to be ‘over-faced’. Residents interviewed and those returning comment cards enjoyed the food, one described it as ‘excellent’ and another as ‘nice and varied’. They all said they had a choice which they appreciated – these daily choices were seen to be recorded in a book in the kitchen. One resident commented how grateful she was that she could continue to have the breakfast she used to have at home. The cook on duty said she would provide special diets e.g. diabetic or vegetarian but they were not required at the time of the inspection. One resident needed assistance with her meal and staff were seen to provide this help in a satisfactory way. The dining room was comfortable and provided sufficient space for residents to go to the table in wheelchairs. Tables were attractively set with condiments and napkins. Four Seasons DS0000025472.V290503.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and relatives knew who to go to with concerns and complaints and considered issues raised were addressed. Appropriate systems were in place to protect residents from abuse, but not all staff had training to ensure their full understanding of the procedures. EVIDENCE: The home had a complaints procedure. It was on the notice board in the entrance area and included in the home’s Information Booklet which was given to each prospective resident. A copy was also placed in each resident’s bedroom. A complaints log was kept but had no entries. The manager said that residents or relatives would go directly to her if they needed to raise an issue. With the exception of one relative, residents and relatives spoken to and returning comment cards all said they would know who to go to if they wished to make a complaint or were not happy with the service. They said the manager was available whenever she was in the home and left her office door open. CSCI had not received any complaints since the last inspection. Feedback from residents indicated they felt safe living at Four Seasons. A whistleblowing procedure was available as was an inter-agency procedure. Thirteen staff had attended Protection of Vulnerable Adult (POVA) training and arrangements were in place for a further 10 to attend updated training by the end of September 2006. The deputy manager was unclear as to reporting procedures, she should therefore be prioritised for this training. Staff spoken with understood the importance of reporting malpractice. Four Seasons DS0000025472.V290503.R01.S.doc Version 5.2 Page 19 Four Seasons DS0000025472.V290503.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The premises were clean and adequately maintained and provided a safe, comfortable, hygienic and homely setting for residents to live in. EVIDENCE: The home was seen to be light, bright, comfortable and well-maintained. A maintenance and renewal programme had not been written for 2006 although the manager had inspected the building and listed areas in need of attention. They had all been addressed. Four bedrooms and all communal areas were inspected and seen to be in good order. Residents and staff said the building was kept in good order. Sufficient aids and adaptations were provided to meet residents needs. Ramped access was provided to the rear of the building. It was noted during the inspection that some residents who had been sitting outside had some difficulty in climbing the step to get back in the front patio door. Access via Four Seasons DS0000025472.V290503.R01.S.doc Version 5.2 Page 21 the back door located near the laundry is more level. For residents safety, this door should be used for those experiencing difficulty. The home was odour free and residents interviewed and those returning comment cards said that it was always fresh and clean. Observation and discussion with staff and residents confirmed there were satisfactory infection control practices. Staff were seen to wear disposable gloves and aprons when assisting with personal care and cloth tabards when serving food. Since the last inspection bathrooms and shower rooms had been cleared of stored items and were seen to be tidy and orderly. There was no evidence of communal soap. The temperature in the bath opposite room 13 had been adjusted and ran at 40°C. The water in one bedroom was running at 16°C but was adjusted by the plumber the day after the inspection. Temperature monitoring was undertaken by the manager and, with the above exception, was satisfactory. As the inspection was carried out on a very warm day, the effectiveness of the heating could not be tested. Residents spoken with said they were usually warm enough. The manager said there had been a problem with the heating in the bathroom but this had been addressed. The laundry was seen to be in good order. equipment was provided. It was clean, tidy and sufficient Four Seasons DS0000025472.V290503.R01.S.doc Version 5.2 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 26, 27, 28 and 29 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Sufficient staff were provided to meet residents’ needs but they did not have enough training to ensure they could always meet residents needs. Recruitment and selection practices were unsatisfactory and did not provide sufficient safeguards for the protection of residents. EVIDENCE: Inspection of three weeks rotas showed that there were enough staff to care for the resident group of 14. Resident, staff and relatives interviewed and returning comment cards all thought that there were sufficient to meet residents needs. All the residents were female and this matched the gender of staff who were also female. Residents described staff as ‘excellent’, ‘very caring’, ‘very nice’, ‘pleasant’ and ‘alright’. One resident particularly liked them because she could ‘have a bit of fun’ with them. One resident commented that some staff ‘hurried her along’ in the morning. The manager said she would address the matter with staff. Four staff files were inspected, three were carer’s files and one was a domestic’s. In each instance staff had begun work prior to receipt of a satisfactory Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) check and two satisfactory written references. An immediate requirement was made that this practice ceased. In-house induction and a Four Seasons DS0000025472.V290503.R01.S.doc Version 5.2 Page 23 week’s shadowing took place immediately the carer began work but induction training which met SkillsforCare standards was not introduced until later. Of the 3 carer’s files inspected only one had begun this training and they had not completed within the recommended timescale. Less than 50 of care staff had NVQ level 2 training. Of sixteen care staff, four had completed NVQ level 2 training, and four were taking it at the time of the inspection. One carer had an NVQ level 3 and another was on the course at the time of the inspection. The deputy manager and one of the cooks had an NVQ level 2 in care. Staff files were seen to contain up to date records of completed training and these were supported by certificates. An up to date training matrix was made available after the inspection and showed that seven staff had attended diabetes awareness training, three had attended a dementia care course, and eleven had attended a falls awareness session. Further training had been arranged up until September 2006. The matrix also showed that health and safety training was not complete or up to date. Although extra training was planned this still left gaps in carers training. Further comment is made in the management and administration section below. Staff said they felt well supported by the manager. Four Seasons DS0000025472.V290503.R01.S.doc Version 5.2 Page 24 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Since the last inspection the manager had begun to discharge her responsibilities competently but some health and safety and protection issues areas were not adequately addressed leaving residents at risk. EVIDENCE: The manager was also the owner of the home and worked at the home five days of the week. She qualified as a nurse but had not maintained her training and registration number. She has managed Four Seasons for 18 years and holds the Registered Manager’s Award. She has not had any further management training since completion of the award. Improvement was seen in a number of areas since the last inspection: residents were assessed before or on admission; all residents had care plans the majority of which had been reviewed with residents and their relatives; the Four Seasons DS0000025472.V290503.R01.S.doc Version 5.2 Page 25 nutritional value of the menu had been improved; activities in the home had increased; training had been arranged for staff; appraisals and supervision had been re-introduced; water and heating problems had been rectified; bathrooms were no longer used for storage; resident questionnaires had been introduced; policies and procedures were being updated; accidents were recorded and monitored by the manager; pets were no longer allowed access to the kitchen; fire doors were no longer wedged open and staff wore suitable protective clothing when preparing food or providing personal care. Despite these changes there were still areas of concern about the management of home – in particular staff were being employed without the necessary checks which would protect residents from harm. There were also unsafe practices with regard to storage of chemicals (weedkiller and cleaning agents were kept in a cupboard which had been left unlocked) and risk assessments were not completed and reviewed as required with regard to resident care. Additionally, lifting equipment was not inspected and tested every 6 months and water was not tested for risk of Legionella. Staff were seen to use a wheelchair without footplates for one resident. The deputy said this was the resident’s choice due to stiff joints. A risk assessment had not been completed. There was no quality monitoring system in place at the home although a number of initiatives were in place: satisfaction questionnaires had just been re-introduced, as had staff supervision; care plans were being reviewed with residents and relatives. Staff, residents and relatives considered the manager to be open and approachable and said issues were addressed if raised with her. Staff meetings were held irregularly; due to the small size and homely nature of the home, residents meetings were not held. An annual development plan had not been written for 2006 although the manager had an appointment with Business Link later in the week of the inspection in order to address this matter. The manager had no involvement whatsoever with residents’ money – preferring family or solicitors to take on the role for those residents who did not wish to manage their own money. Provision of health and safety training had improved and it was noted that places had been booked on infection control training (4), moving and handling (12), and 1st Aid (6). Although none of the care staff had food hygiene training and only 3 had health and safety training, no courses had been booked in these areas. Further courses must be booked to ensure all staff receive up to date mandatory health and safety training on an ongoing basis. The majority of maintenance inspections were undertaken as required, exceptions are identified above. The fire precautions register was seen to be Four Seasons DS0000025472.V290503.R01.S.doc Version 5.2 Page 26 up to date and the majority of staff had attended a fire lecture. Fire practices were held as part of induction but not renewed each year. When the manager was not in charge of the home the deputy managed it. She has not had any management training for a number of years. It is recommended that she does. Four Seasons DS0000025472.V290503.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 X X 1 Four Seasons DS0000025472.V290503.R01.S.doc Version 5.2 Page 28 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 OP7 Regulation 15 Requirement Care plans must record sufficient detail of each area of need and reviews should record meaningful comment as to the residents’ progress, including information about District Nurse involvement. Risk assessments must be put in place, relevant to each person, and must be kept under review. The expectation is that this will be at least monthly. (previous timescale 10/03/06) A record of weight, including gain or loss, must be kept for each person, regularly monitored and appropriate action taken to address the issue. Timescale for action 13/08/06 2 OP8 13 13/07/06 3 OP8 17 13/07/06 4 OP9 13 5 OP9 13 The registered person must audit 10/07/06 the ordering of medication. (Extended from 10/03/06) and ensure that medicines are administered from the residents’ own supplies. The registered person must audit 25/06/06 the handling of medication in the DS0000025472.V290503.R01.S.doc Version 5.2 Page 29 Four Seasons 6 OP9 13 7 OP9 13 8 OP9 13 9 OP9 13 10 OP18 12 home to ensure there is a complete, clear and accurate list of currently prescribed medicines for each resident and the time and date of administration. Medication must normally be given as prescribed. Immediate requirement made 02/02/06 reissued. The registered person must ensure that there is written assessment of safe selfadministration. The registered person must ensure that records of all medication entering the home are kept. (Extended from 11/01/06) The registered person must audit the storage of medication to ensure they are safely stored in the best location. (Extended from 31/03/06) Staff must receive training relating to the protection of vulnerable adults. (Previous timescale 31/03/06 not met) More staff must undertake NVQ training to ensure at least 50 of carers are qualified. Staff must not be employed until two satisfactory references and POVA 1st and CRB checks have been received. (Immediate Requirement notice – 13/06/06) Staff must undertake SkillsforCare induction and foundation training within the timescales. The Registered Manager demonstrate that she manages the home competently. (Previous timescale 10/03/06 not met) 13/06/06 17/07/06 17/07/06 17/07/06 30/09/06 11 OP28 18 30/11/06 12 OP29 19 13/06/06 13 OP30 18 13/09/06 14 OP31 10 30/09/06 Four Seasons DS0000025472.V290503.R01.S.doc Version 5.2 Page 30 15 OP33 24 A quality assurance and quality monitoring system must be introduced. (Previous timescales of 28/02/05; 31/01/06 and 31/03/06 not met. 31/07/06 16 OP33 18 The home’s policies and 30/09/06 procedures manual must be reviewed and updated. Practice in the home must reflect its policies and procedures. Previous timescale 31/03/06) The cupboard storing substances hazardous to health must be kept locked whenever it is not in use. (Immediate Requirement notice – 13/06/06) All care staff must attend health and safety training in each of the required areas and have refresher training at necessary intervals. 13/06/06 17 OP38 13 18 OP38 18 31/08/06 19 20 OP38 OP38 13 13 All lifting equipment must be 13/07/06 tested by a competent person every six months. The risks of using a wheelchair 13/07/06 without footplates must be discussed with the resident and a risk assessment completed agreed and signed if the resident insists on not using the footplates. All staff must attend one fire 31/08/06 lecture and one fire practice each year. 21 OP38 23 Four Seasons DS0000025472.V290503.R01.S.doc Version 5.2 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 6 7 8 Refer to Standard OP1 OP7 OP8 OP8 OP9 OP9 OP10 OP12 Good Practice Recommendations The information booklet should be amended so it is accurate and includes the emergency admission procedure. Recording in documents relating to residents should be informative and meaningful. Entries should not demean or disrespect the resident. Sitting scales should be purchased to ensure all residents can be weighed regularly. Annual dental consultations should be arranged for all residents. Following the audit of medication handling, the written polices and procedures should be reviewed and expanded. A list of staff authorised to handle medication and their usual signatures should be maintained. Residents should be given keys for their rooms and lockable space on admission unless risk assessment advises otherwise. More time should be allocated to the activities co-ordinator to be spread throughout the week in order to increase the activities provided. These to include activities linked to residents profiles and physical exercise. The manager should ask residents if they wish to receive communion and make arrangements if required. Residents who wish to go out should be accompanied by staff is they so wish. The manager and deputy manager should attend management training. Quarterly staff meetings should be held. Tests should be undertaken to ensure there is no risk from Legionella. 9 10 11 12 13 OP12 OP13 OP31 OP33 OP38 Four Seasons DS0000025472.V290503.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG National Enquiry Line: 0845 015 0120 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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