Inspection on 11/04/05 for Germaina House

This inspection was carried out on 11th April 2005.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Germaina House 12/12/08

Germaina House 22/04/08

Germaina House 01/05/07

Germaina House 05/05/06

Germaina House 22/11/05

Germaina House 19/01/05

Germaina House 27/05/04

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

CARE HOMES FOR OLDER PEOPLE Germaina House 4-5 St Vincent Terrace Redcar TS10 1QL Lead Inspector Katherine Acheson Unannounced 11 April 2005 9:30 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 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. Germaina House Version 1.10 Page 3 SERVICE INFORMATION Name of service Germaina House Address 4-5 St Vincent Terrace Redcar TS10 1QL Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01642 475740 01642 473481 Mrs Anne Palmer Mrs Anne Palmer Care Home 18 Category(ies) of OP - Older People (18) registration, with number of places Germaina House Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 19th January 2005 Brief Description of the Service: Germaina House is a large, Victorian, converted, mid terraced facility, situated in a residential area of Redcar. The home is close to all local amenities. To the front of the house there is a small well-maintained lawned area. The rear patio area has been designed to provide a low maintenance planting area and a raised decking area with tables chairs and umbrellas. Accommodation is provided for eighteen residents in twelve single bedrooms and three double bedrooms. All bedrooms meet the spacial requirements of national minimum standards. Some bedrooms have ensuite facilities which comprise of a toilet and hand wash basin. There are two lounge areas and one dining area all of which are comfortably furnished. The kitchen and laundry whilst domestic in style, are not available for use by residents. The home provides a stair lift to enable residents with poor mobility to access their bedrooms. Germaina House Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection started at 9.30am and lasted for seven hours. Five residents, two care staff, the office administrator and the Manager were spoken to during the inspection. Numerous records including the home’s statement of purpose, care plans, policies/procedures maintenance and staff records were examined. A tour of the premises was carried out What the service does well: What has improved since the last inspection? What they could do better: A number of areas were highlighted during the inspection as requiring immediate action to ensure safety of service users. The areas identified were Germaina House Version 1.10 Page 6 The home is employing staff prior to the receipt of a satisfactory POVA FIRST/Criminal Record Bureau Check • Staff training in respect of moving and handling is out of date • Staff are not carrying out appropriate checks of controlled medication prior to administration to residents • Temperature regulators are required to be fitted to sinks, baths and showers in service user areas. • The home must employ a cook, there is not sufficient staffing on a teatime An immediate requirement notice was left in the home in respect of the issues; a further visit to the home will be carried out to ensure appropriate action has taken place. A frank discussion took place with the Manager following the inspection regarding the lack of systems in place, the high number of outstanding requirements from previous inspections and general poor management of the facility. The Commission for Social Care Inspection is to formally meet with the Manager of the home to discuss this; further visits to the home will be carried out. • Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Germaina House Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Germaina House Version 1.10 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3 People who use the service are given the information they need to make an informed choice of where to live. An assessment of needs is carried out on people moving into the home in order to ensure that the home can meet their needs. EVIDENCE: Since last inspection the home’s statement of purpose and service user guide has been updated to include all of the required information. It has been identified at previous inspections that the home must develop a statement of terms and conditions/contract for residents that includes all of the required elements. This contract has been developed, however not distributed to residents and relatives. The Manager said that prior to anyone moving into the home they would have had an assessment carried out by a Social Worker and that the home will receive a copy of the assessment. Two files sampled at random of people living at the home did contain a copy of the assessment carried out by the Social Worker. The home does not provide intermediate care. Germaina House Version 1.10 Page 9 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 standard(s) 7, 8, 9, 10 No progress has been made in respect of care planning and risk assessment to ensure that health care needs of people living at the home are met. The home’s medication policy is not robust and as such poor practice in respect of the administration of controlled medication is taking place. EVIDENCE: It has been highlighted at previous inspections that care plans require further development. Two residents files were examined during this inspection, both contained a basic assessment of needs, however, there were no care plans in place in respect of needs/problems/medical conditions. Although risk assessments were evident on file no progress had been made in respect of ensuring that they included individual specific preventative measures to prevent/reduce the highlighted risk from occurring, this also has been highlighted at previous inspections. Files examined did contain a record of visits carried out by chiropodists, GP’s, Opticians and dentists. Files examined contained a photograph of the resident, however no signature to confirm that they had been involved in drawing up the plan of care, files examined were Germaina House Version 1.10 Page 10 disorganised and difficult to follow. Residents interviewed said that staff always respected their privacy and dignity when attending to their needs. The home since last inspection has made no attempt to develop the policy in respect of medication. It was observed at the last inspection that staff were dispensing medication for all eighteen residents at the same time into prelabelled pots and then giving it out. The Home was informed that this practice must stop. The Manager and staff interviewed during this inspection said that medication is now dispensed and administered to each resident individually. Examination of records and a discussion with the Manager and staff during this inspection highlighted that practice in relation to the administration of controlled medication is not as it required to be. An immediate requirement was left in the home in respect of this, and a further visit to the home will be made to follow up on areas of concern. Germaina House Version 1.10 Page 11 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 standard(s) 12, 13, 14, 15 Contact with family and friends is encouraged, religious needs are catered for. Limited changes have been made to improve the recreational activities and outings carried out by the home to ensure that resident’s lives are enhanced. Residents receive a wholesome, balanced and varied diet. EVIDENCE: Following discussion with five residents it was evident that they were happy and well cared for. One resident said “this is the best place to be”, another said “you couldn’t find a better home”. Two of five residents spoken to during the inspection said that they were happy with the activities that the home provided. One resident said that she had an active social life and used dial a ride to go to church and a lunch club on a regular basis. Three residents said that they would like the home to provide more activities and outings. It had been highlighted at previous inspections that the home must consult with residents and provide a varied plan of activities. The Manager said that since last inspection she has spoken with residents about activities at a recent residents meeting. Records were available to confirm that this was the case, however no suggestions in respect of new activities or outings were suggested. The Manager said that she is looking into accessing suitable transport so that she can plan some outings for the residents. Germaina House Version 1.10 Page 12 Residents interviewed said that contact with family and friends is encouraged and that they can have visitors at any time. During the inspection one visitor was observed to be playing dominoes with a resident. The home operates a four-week menu plan, although an alternative choice is not documented on this residents spoken to said that they liked the food that is provided and that if they wanted an alternative they can. Mealtime was observed during the inspection, food served was well presented and mealtime was relaxed. Records examined confirmed that staff at the home keep a record of all food served and fridge and freezer temperatures. The home keeps a plentiful supply of food, fresh fruit and vegetables, however the home’s arrangements for storage of vegetables is not suitable. Currently potatoes and vegetables are stored in sacks and plastic containers on the garage floor. This was pointed out to the Manager at the time of the inspection who said that she would take immediate action to address the situation. Germaina House Version 1.10 Page 13 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 standard(s) 18 No progress has been made in respect of updating the home’s whistle blowing and adult protection policies/procedures. Staff have not received adult protection training to ensure an appropriate response to any suspicion or allegation of abuse. EVIDENCE: Residents spoken to during the inspection said that they felt safe living at the home. It was highlighted at the last inspection that the home’s adult protection and whistle blowing policy requires further development, and that staff must receive training in adult protection and action they must take if abuse is suspected. The Manager said that due to staff shortages she has been unable to action this. Germaina House Version 1.10 Page 14 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 standard(s) 19, 20, 21, 22, 23, 24, 25, 26 Some improvements to the décor of the home have been made, however outstanding matters highlighted in the requirements section of this report do not provide residents with a safe comfortable surroundings. EVIDENCE: Since last inspection improvements have been made to the home environment. Some corridor areas have benefited from painting and the purchase of as new carpet. Bathroom areas have continued to be upgraded, however, a number still require refurbishment and replacement flooring. It was highlighted at the last inspection that all baths, sinks and showers in resident areas must be temperature regulated and that those that are already temperature regulated with a thermostatic mixing valve must be serviced on a regular basis. No action has been taken by the Manager to address this and as such an immediate requirement was left at the home. Water temperatures taken on the day of the inspection were found to be close to 43 degrees Celsius. Germaina House Version 1.10 Page 15 The Manager said that one resident living at the home has a bed in which she can change her position and that another resident was being cared for on a pressure-relieving mattress. A walk round of the home during the inspection highlighted that the hoist and spare pressure relieving mattresses were stored amongst clutter in the garage area, suitable storage must be found. The Manager said that the hoist is stored in the garage area because none of the residents living at the home currently need to use the hoist on a day-to-day basis. Servicing of the hoist and slings has been allowed to lapse. A discussion took place with the Manager regarding if there was an emergency situation in the home and a resident had fallen to the floor. The Manager acknowledged that the hoist would be required in this situation and said that she would take action to find suitable storage and arrange for the hoist to be serviced. Residents said that they liked their bedrooms and that they had been able to personalize them by bringing personal possessions and items from home. Externally to the rear of the property there is a pleasant seating area for residents to sit, but due to the cold weather have not been able to do so as yet. The interior of the home was observed to be clean and tidy. Germaina House Version 1.10 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29., 30 The home’s recruitment procedures are not robust and as such do not provide protection for residents living at the home. The current staffing levels at the home are not sufficient to meet the needs of the residents. EVIDENCE: Staffing rotas examined for the week previous to the inspection and the week after showed that the majority of the time there were three care staff on duty 8am until 3pm and two care staff on duty 3pm until 9pm. Night duty is covered by one care staff member with the Manager who lives on the premises on call during the night. Due to the recent departure of the home’s cook the Manager is currently, alongside Managerial and on call duties cooking for service users at the home. The Manager was informed during the inspection that she must take immediate action to address this situation. Residents spoken to during the inspection said that on occasions they felt that there should be more staff on duty. Care staff spoken to during the inspection said that on a teatime there are two care staff on duty, however one of the staff members has to cook the tea for residents. A number of areas were identified at the last inspection as requiring further development in respect of recruitment of staff. Policies and procedures were required to be reviewed and updated. This has not been carried out. Examination of records identified that the Manager has employed staff to work at the home prior to the receipt of a satisfactory POVA FIRST/Criminal Record Bureau Check; an immediate requirement was left in the home in respect of Germaina House Version 1.10 Page 17 this. Staff files examined during the inspection did not contain a photograph of the staff member. The Office Administrator, at the time of the inspection updated the home’s reference request to include open questions and seek confirmation of dates of previous employment as identified at the last inspection. One staff file examined during the inspection was that of a new staff member, this staff member had received induction training. Moving and handling training for staff was identified as being required at the last inspection, this had not been carried out and as such an immediate requirement left in the home. Germaina House Version 1.10 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 34 The home does not carry out a formal effective quality assurance and monitoring system to ensure that the home is meeting aims and objectives and run in the best interests of the residents. Budgets, a business plan, or a statement of financial viability were not available to demonstrate efficient management of the business. EVIDENCE: The Manager said that residents and relatives meetings are held on a regular basis, records were available to confirm that this is the case. It was highlighted at the last inspection that the Manager must develop a formal quality assurance system; as yet this has not been carried out. The home’s certificate of registration and insurance were displayed in the main entrance of the home. Germaina House Version 1.10 Page 19 It was also highlighted at the last inspection that a statement of financial viability must be forwarded to the Commission for Social Care Inspection; as yet this has not been carried out. The Manager said that since last inspection she has carried out a fire drill and evacuation of residents. Records were available to confirm that this was the case, however, it was pointed out to the Manager at the time of the inspection that this record required more detail. Germaina House Version 1.10 Page 20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 2 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION 2 3 1 2 3 3 1 3 STAFFING Standard No Score 27 1 28 x 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 1 x x 2 2 x x x x Germaina House Version 1.10 Page 21 yes 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 OP2 Regulation 5 Requirement All residents must be provided with a statement of terms and conditions that includes all of the required elements (Previous timescale of 30th June 2004 not met) The Manager must plan and provide a structured program of activities and outings (Previous timescale of 30th June 2004 not met) The double glazed window seal in bedroom 3 requires replacing (Previous timescale of 20th July 2004 not met) Bathrooms in the home environment require refurbishment and replacement flooring (Previous timescale of 30th August 2004 not met) Records as listed in the care homes regulation 2001 must be available on staff files. All staff records must include a recent photograph (previous timescale of 30th June 2004 not met) Version 1.10 Timescale for action 30th June 2005 2. OP12 16 30th June 2005 3. OP19 23 30th July 2005 4. OP26 16, 23 30th August 2005 5. OP29 17 30th June 2005 Germaina House Page 22 6. OP34 25 7. OP7 13, 15 8. OP7 13, 15 Budgets, a business plan and a statement of finacial viabilty must be available for inspection. A statement of finacial viabilty must be forwarded to the Commission for Social Care Inspection. (Previous timescale of 30th July 2004 not met) A detailed assessment of needs must be completed for each service user. Following this assessment a plan of care must be developed for each individual problem/medical condition Care plans must clearly identify the problem goal and action/care that is required to manage the problem/medical condition Care plans must clearly state capabilities, limitations and assistance required by the resident Care plans must be evaluated on a monthly basis or more often if required. Evaluations must include any deterioration or improvements made Care plans must be drawn up with the resident and signed by the resident or representative Risk assessments require further development. The Manager must identify residents at risk, particularly in relation to falls and develop/update a risk assessment. Risk assessments must be reviewed and updated on a regular basis to confirm effectiveness Risk assessments require further development to include specific preventative measures to 30th July 2005 30th April 2005 30th April 2005 Germaina House Version 1.10 Page 23 reduce/prevent identified risk occurring 9. OP 9 13 The homes medication policy requires further development. This must be carried out by a suitably qualified person The home must obtain an up to date medicine reference book 10. OP18 13 The Registered Person must develop further the homes whistle blowing policy The homes adult protection policy requires further development to include action that staff should take if abuse is suspected All staff must receive appropriate adult protection training Thermostatic mixing valves must be serviced on a six monthly basis The homes policy/procedure in respect of staff recruitment must be reviewed and updated The Manager must develop a formal quality assurance system based on seeking the views of residents and their families. this must be carried out on an annual basis The Manager msut ensure that staff are trained and follow the correct procedure when dealing with controlled medication All baths, showers and sinks in service user areas must be temperature regulated The Manager must be in receipt of a satisfactory POVA FIRST/Criminal Record Bureau Check prior to the commencement of employment of any new staff member Version 1.10 28th February 2005 31st March 2005 31st March 2005 11. OP18 13 12. 13. 14. OP25 OP29 OP33 13 13, 17 24 28th February 2005 28th February 2005 30th April 2005 15. OP9 13 Immediate 16. 17. OP25 OP29 13 13 Immediate Immediate Germaina House Page 24 18. 19. 20. 21. 22. OP30 OP15 OP22 OP22 OP27 13 16 16, 23 13 13, 18 All staff must receive training in moving and handling Suitable storage must be found for potatoes and vegetables Suitable storage must be found for the hoist and pressure relieving mattresses The hoist must be serviced The Manager must ensure that suitably trained staff are employed in such numbers as to ensure safety of residents living at the home The Manager must address current staff shortages at the home in respect of employing a replacement cook and interim arrangements to be provided Staffing levels on a teatime must be reviewed The Manager must carry out a risk assessment and review of service users needs to determine if one night staff member is sufficient Immediate Immediate 15th May 2005 15th May 2005 Immediate 23. OP27 13, 18 Immediate 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. Refer to Standard OP31 OP28 OP38 Good Practice Recommendations The Manager should achieve by 2005 an NVQ level 4 in Management and care The Manager should continue with her action plan in which to achieve 50 of care staff trained to NVQ level 4 in Care by 2005 Records in respect of fire drills and evacuations should contain information in respect of zone activated/evacuated, comments on the practice, any problems encountered aswell as containing signatures of Version 1.10 Page 25 Germaina House staff in attendance Germaina House Version 1.10 Page 26 Commission for Social Care Inspection Unit B, Advance St Marks Court Teesdale Stockton-on-Tees 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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