Inspection on 13/08/08 for Glendon House

This inspection was carried out on 13th August 2008.

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

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

Other inspections for this house

Glendon House 05/09/07

Glendon House 01/05/07

Glendon House 04/04/06

Glendon House 10/01/06

Glendon House 17/06/05

Glendon House 01/02/05

Glendon House 30/06/04

Glendon House 17/02/04

Glendon House 09/09/03

Glendon House 26/03/03

Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

CARE HOMES FOR OLDER PEOPLE Glendon House 2 Carr Lane Overstrand Cromer Norfolk NR27 0PS Lead Inspector Kim Patience Unannounced Inspection 13th August 2008 09:35 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 Glendon House DS0000027384.V370304.R02.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. Glendon House DS0000027384.V370304.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Glendon House Address 2 Carr Lane Overstrand Cromer Norfolk NR27 0PS 01263 578173 01263 579164 info@glendonhouse.fsnet.co.uk info@glendonhouse.fsnet.co.uk Mr Rhoderick Smart Mrs Frances Smart Position vacant Care Home 36 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) Category(ies) of Dementia - over 65 years of age (36), Old age, registration, with number not falling within any other category (36) of places Glendon House DS0000027384.V370304.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Thirty-six (36) Older People may be accommodated. Thirty-six (36) people with dementia may be accommodated. The total number not to exceed thirty six (36) Date of last inspection 5th September 2007 Brief Description of the Service: Glendon House is a care home providing care and accommodation for 36 older people who are suffering from dementia. Mr Rhoderick Smart and Mrs Frances Smart own the home. The original house was built in 1917, and has been tastefully extended and adapted over the years. The home has 30 single bedrooms and 3 double rooms. Twenty-eight of the single rooms have en suite facilities and all of the double rooms have en suite facilities. A large part of the grounds has been made into a safe and secure garden area for service users. The home has the potential to provide comfortable accommodation in an attractive setting in a small coastal village, being very close to the sea. Details of the services offered within the home can be found in the Service User Guide. The fees within the home range from £375-£500. Details of services included within this fee and those excluded are identified in the Service User Guide. Glendon House DS0000027384.V370304.R02.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. This inspection considers information gathered about the service since the last key inspection in September 2007. In order to complete the inspection a site visit was conducted by three inspectors and we surveyed residents, relatives and staff. During the site visit we completed a tour of the premises and looked at records relating to people living and working in the home. In addition to observations of people living in the home, we spoke to residents, relatives and staff. Since the last key inspection we have conducted three general random visits and four random visits to assess medication practices. The reports relating to the random visits are available to the public on request. In February 2008 the Commission issued a notice of decision to cancel the registration of Mr and Mrs Smart to run this service. This was due to the poor quality outcomes delivered by this service over a considerable period of time. Mr and Mrs Smart have appealed against the decision and the appeal will be heard by the Care Standards Tribunal. The Care Standards Tribunal may decide to uphold the appeal, in which case the decision to cancel the registration of Mr and Mrs Smart will not take effect. Alternatively, the Tribunal may decide to dismiss the appeal, in which case the registration of Mr and Mrs Smart, in respect of this service, will be cancelled with immediate effect. What the service does well: What has improved since the last inspection? Since the last inspection some improvements have been made to the environment, such as new carpets in the sun lounge. A new manager has been appointed and has been in post since February 2008. The manager has made some changes to the staff group and staff that were not working in a way that promotes people’s health and welfare have ceased working at the home. The manager said she is working hard to make improvements to care plans and the way in which people’s holistic needs are being met. The provision of activities has increased and people are being taken on outings. In addition, the providers have appointed a consultant who has been completing monthly visits and providing advice about how improvements can be made. Glendon House DS0000027384.V370304.R02.S.doc Version 5.2 Page 6 Relatives said that activities have improved and that people were now enjoying being taken out of the home. We spoke with relatives and visitors to the home who said that the service is better and since the new manager has been in post the atmosphere has improved. What they could do better: 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. Glendon House DS0000027384.V370304.R02.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Glendon House DS0000027384.V370304.R02.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Quality in this outcome area is good. People can be assured they will not be admitted to the home without their needs being assessed and the home confirming they can be met. People are given sufficient information to make a decision that the home is suitable for them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection, the manager has admitted one privately funded person. The manager had followed the pre admission procedures and provided information about the service they offer. However, Norfolk Social Services are still not placing people in the home due to the serious concerns. Glendon House DS0000027384.V370304.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is poor. People living in the home cannot be assured that their health and care needs will be met. Medication arrangements still do not safeguard the health and welfare of people. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection we have conducted three random inspections, which included site visits and we have conducted four inspections of the medication arrangements. The findings of those inspections showed that the home continued to provide poor outcomes for people using the service. During this inspection we looked at care plans and associated health and risk assessments. We carried out some case tracking and made observations of how people’s needs were being met. We also completed an inspection of medication arrangements. Glendon House DS0000027384.V370304.R02.S.doc Version 5.2 Page 10 We looked at the records relating to eight residents, some in more detail than others. Since the last inspection the home has introduced another care plan system. We were told by a senior care assistant that the new care plan books had been introduced and implemented, but still needed to be improved. Previous records had been archived. However we saw that for some people new care plans had not been completed or only in part and old records that did not reflect their current needs were still in use. The records were difficult to follow and we had to search to find the information we needed, which was in several different places. We also found it difficult to establish if there was a system of review as this was not apparent. The new manager said she has been working hard to improve care records and make them more person centred. Life history information is being gathered from relatives so that they can begin providing care in a way that is consistent with people’s previous life experiences. But current records still lack person centred information. When we examined other care records we found that new records contained an identifying photograph of the resident and essential personal information such as their name, next of kin, GP and other health professionals involved. We also found that records contained health assessments such as nutritional screening, falls assessments, Waterlow assessments (pressure sores) and moving and handling assessments. However, where the health assessments had identified risks there was no care plan providing staff with clear guidance as to how the person’s needs should be met and how risk should be minimised. For instance we looked at the records for two residents and found that in both cases they were at high risk of developing pressure sores, as stated by Waterlow assessments. The assessments identified the need for pressure-relieving cushions. We made observations of both people and noted that when we arrived in the morning they were seated in chairs in the lounges. They remained in the same position throughout the day and we did not see them moved. Neither person was sitting on a pressure-relieving cushion. It was stated in the records relating to both of the residents that they already had pressure sores at the sacrum and heel. There was no action plan or care plan in place. In the records of another resident we saw that a ‘pressure sore assessment’ had been completed, but not in full. It stated the person must sit on a pressure-relieving cushion and this person was observed to be sitting in the same position throughout the day and again not on a pressure-relieving cushion. In addition, the assessment stated 4 hourly turns. We asked for the turn charts and they could not be found for the days after 20/07/08. For the same person a nutritional needs assessment stated monitor fluids, however, there was no clear guidance as to how much fluid should be offered and no fluid charts as a way of monitoring what the fluid intake is. Glendon House DS0000027384.V370304.R02.S.doc Version 5.2 Page 11 When we looked at nutritional needs, we found that nutritional needs assessments were not always completed in full and were not accurate in all cases. For instance, one assessment did not take into account the person was at risk of weight loss when there was evidence of this. It also did not take into account that the person did not have any teeth as their dentures had been lost and not replaced. We spoke to a relative of this person who said the dentures went missing in the home earlier this year and he was not aware anything had been done about it. We looked in the records relating to the person and found that a dentist had visited in April 2008 to assess for another set of dentures, however there was no record of any further action or follow up. We also confirmed this with the manager at the time of the inspection who said she would follow it up immediately. In addition, the relative said he arrived at 9:30 to find his wife in bed partly clothed, saying “she hasn’t got her stockings on”. He said she had not had any breakfast or drink and that he had given her some food he brought with him. This relative also made similar comments on a survey returned to the Commission as written on page 13. In some cases there were inconsistencies in the records. For instance, one nutritional needs assessment said the person was low risk and ‘observe weight and food’. However, another risk assessment for the same person said ‘offer food often’ ‘small amounts as many days not eating’. We looked at the daily care notes for this person and saw that on many occasions they were noted as being asleep through lunch and sometimes tea. In addition, this person was noted as a diabetic but there was no care plan guidance in relation to the condition, about checking the person is not in a diabetic coma when asleep, and how needs should be met. We looked at falls assessments and found that where risks had been identified there was no action plan or care plan setting out what steps should be taken to minimise risk. We also found conflicting information in moving and handling assessments and falls assessments. For instance, in a moving and handling assessment it said that the person could ‘weight bear’ and has ‘slightly limited mobility’. In a falls assessment it said they needed a ‘Zimmer frame’ and in other records it said they needed a ‘wheelchair’. Observations of this person indicated a wheelchair was needed and mobility was poor. When we looked at how people’s general care needs should be met we found that again assessments of physical and mental health had been completed but these were not followed by a care plan setting out how staff should assist people with their daily routines. We did see behaviour assessments for some people and they provided staff with some guidance on how to support people when experiencing behavioural disturbances. For instance, one behaviour assessment said ‘explain and repeat’ with detailed directions about supporting the person. However, another behaviour assessment referred to a risk assessment for the person’s behaviour that was not available in the file. Glendon House DS0000027384.V370304.R02.S.doc Version 5.2 Page 12 The Pharmacist Inspector identified an issue where the home was administering medicines to one person covertly (see medication section below). When we looked at the person’s records for evidence of an assessment of capacity under the Mental Capacity Act 2005 and a subsequent multidisciplinary ‘best interests’ decision, we could see no documentary evidence of a formal capacity assessment being conducted. We did see a written record made by the manager, which stated ‘ has severe dementia’ ‘unable to make decisions’ ‘does not have the capacity to make choices’. This was signed by a relative, Community Psychiatric nurse and the manager in agreement to give medicines covertly. However, this was not signed by the GP who the manager said completed the assessment. We surveyed people who live in the home, their relatives and people who work in the home. At the time of writing this report we received 3 completed relatives surveys, one resident survey and two staff surveys. When we asked the question ‘do you receive the support you need’ a resident said ‘usually’ and made a comment saying “but on occasions I am kept waiting for long periods as there is not enough staff on duty. This is for toileting, help with feeding and when I need a drink”. When we asked the question ‘do you receive the medical support you need’ a resident stated “I get my tablets every day and when I need antibiotics for a UTI, but I asked to see a doctor about getting my ears syringed a few months back but are still waiting”. When we asked relatives ‘ do you feel the care home meets the needs of your relative’ two indicated ‘sometimes’ and one indicated ‘usually’. When we asked ‘how do you think the care home can improve’ one relative said “I sometimes find my wife still in bed when I see her at 9:30 am, she has not had a drink or anything to eat. It would be a good idea to check if anything was alright with them”. When we asked ‘is there anything else you would like to tell us’ a relative stated “We feel information is not handed down to carers about clients as when we ask a carer (rarely see one) about our mother most of them don’t know what is happening”. When we asked staff ‘is there anything else you would like to tell us’ one member of staff stated “our residents should have better care. They very often stay messy and smelly and asleep left in chairs” “residents are not being toileted, but carers put that they are” “ residents stay in night pads all day long. Then again sore bottoms not being creamed” “bed linen not being changed. Very often messy” “if you ask me what is better in this place…new carpets have been done, new manager is lovely, agency staff have been called in. Otherwise nothing really” The inspection of the medication National Minimum Standard was conducted by the Commission’s pharmacist, Mark Andrews. We examined medication records, daily care notes and medicines available for administration to residents. The pharmacy inspection followed four previous visits at the home Glendon House DS0000027384.V370304.R02.S.doc Version 5.2 Page 13 when serious medicine management issues placing the health and welfare of residents at risk had been identified. Since the previous inspection the home has put in place a different type of medication charts to record the administration of medicines. Most medicine entries are now printed by the pharmacy supplying medicines to the home. We again noted, however, that some of the chart medicine entries were not complete because they did not have full dose directions indicated to assist with the safe selection of medicines by staff when giving them to people. The home has put in place information sheets for people who have medicines prescribed. These are alongside medication charts. They include people’s photographs for the purpose of identification when medicines are selected for their administration. One person at the home has medicines given covertly in their drink. An information sheet relating to this has been provided to assist staff but it was not clear from this information which prescribed medicine(s) is to be given covertly. The inspectors also looked at how the mental capacity of this person has been assessed (see below). When we arrived for inspection, we checked that records had been completed for all people so far given medicines on the morning of the inspection. The home has a handover form available to checklist people when they have been given their medicines. During the inspection, we observed a latter part of the morning medicine round. The manager undertook this task. Whilst we noted the order of medicine administration to be correct the manager was seen placing medicines in a person’s mouth by hand without due consideration for hygiene. We found there to be medicines prescribed for external application stored nonsecurely in people’s rooms. Whilst it was confirmed that the home has recently obtained lockable cabinets in rooms for this purpose, these were not in use. We also found there to be a lack of records confirming that these medicines had been applied as prescribed. Records indicated one person prescribed an antibiotic cream was having this applied only occasionally. The manager was unclear if the prescription for this medicine was still valid. For another person, there were no records of any of their prescribed external medicines that were available being applied. We noted the medicine refrigerator currently used to store medicines requiring refrigeration located in the ground floor office was not locked. In addition, when asked, the manager confirmed that the temperature of the refrigerator is not being monitored or recorded. Whilst there has been an overall improvement of records for the administration of oral medicines there were still incomplete or inaccurate records when some medicines scheduled for regular administration were not given to people. During the inspection, we conducted an audit of medication Glendon House DS0000027384.V370304.R02.S.doc Version 5.2 Page 14 records against medicines available for administration to establish if all could be accounted for and demonstrate they have been given to people in line with prescribed instructions. We again found there to be discrepancies. These were brought to the attention of and checked with the manager who was unable to explain them. The manager provided us a copy of the home’s own internal sample audit undertaken 04/08/08. This indicated that on that day eight medicine discrepancies were identified. Whilst the home now has a system in place to account for medicines there are still discrepancies arising. We found that for some recent entries in the controlled drug register the dose or strength of the controlled drugs entered were not indicated and that these entries were incomplete. We found when examining people’s care note records, that some recent prescriber interventions leading to new prescriptions or changes in doses of medicines were being recorded. For one person, however, the inspectors found that a scheduled review of medication did not go ahead as documented. The home failed to make proper provision to protect the health and welfare of this person. It is unclear if their medicines currently administered are in line with the prescriber’s intention. When we checked the medicines of a person recently admitted to the home, we found two strips of tablets that had expired in 2007 but were still available for use. The home has a specimen signature list available for all members of care staff currently authorised to handle and administer medicines. The manager provided us with certificated evidence of staff attendance at medication training events. However, she confirmed that so far she had only undertaken and recorded an assessment of the competence of one member of care staff who is currently authorised. Glendon House DS0000027384.V370304.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is poor. People cannot be assured that life in the home will match their previous experiences, expectations and preferences. People cannot be assured they will be supported to maintain sufficient food intake. This judgement has been made using available evidence including a visit to this service. EVIDENCE: As written in the health and personal care section, the new manager said she is trying to gather more life history information for each resident so they can provide activities in accordance with people’s interests and preferences. However, the quality of information relating to activities for each individual is variable and it was not clear how staff should provide meaningful activity. For instance, the records relating to one person stated ‘is to be offered the opportunity to take part in activities that are suitable’ there was no other guidance for staff as to what the person may be interested in or what should be provided. In another person’s records we saw ‘likes to sing along to music entertainment’ but again no guidance for staff as to how the individual needs of the person can be met considering previous life experiences and preferences. Glendon House DS0000027384.V370304.R02.S.doc Version 5.2 Page 16 The home has started to maintain an activities diary and staff said that they are intending to draw up a profile about people’s interests and hobbies once the information has been gathered. We looked at the diary and it showed that some group activity is provided. For instance, Music for Health each week and Pleasant Pastimes each fortnight. The home is trying to arrange outings and daily trips to the beach. However, the manager said that the home does not have sufficient wheelchairs to take people out and staff were doing fundraising in order to purchase some. (see standard 35) Resident’s records showed little evidence of activity and on the day of inspection, apart from the times when group activities were taking place, there was very little stimulation and occupation for residents. Many residents are unable to participate in group activities and very little meaningful one-to-one activity was seen. During the morning of the visit, a person came into the home to do nail painting and at lunchtime was helping with serving the meal. When we asked who the person was we were told they normally worked at Redlands (another home owned by the same provider) but had started to come to Glendon house weekly to do some nail painting and manicures. We noted this person was not on the staff rota and included in the staff numbers. On the resident survey, when we asked the question ‘are there activities you can take part in’ a resident responded ‘sometimes’ and wrote “we do more now than we used to, we go on outings, we have art and games afternoons and music entertainment” During the site visit we did see several visitors enter the home. We spoke with some who said they were welcome in the home at any time. Relatives spoken with noted there had been some improvement since the new manager started. One relative said ‘it was terrible before but it is better now’. Another relative said there is ‘an improvement in the atmosphere in the home since the new manager started’. During the site visit we observed people’s daily life in the home. We saw that the home offers a range of places for people to sit so they can experience a social environment that suits their needs and preferences. However, there are a significant number of people who are unable to mobilise independently and it was not clear in their records whether it would be their preference, for example, to sit alone in a quiet room. Although there was some activity taking place such as nail-painting and Pleasant-Pastimes there was very little else happening. People were sitting around with little interaction with staff as they were busy with other duties. One gentleman seen with his head on the table asleep when we arrived remained there for most of the day. We observed the breakfast period. When we arrived, some people were up and in the lounges and dining room and some were in the process of getting up. Glendon House DS0000027384.V370304.R02.S.doc Version 5.2 Page 17 One resident had their breakfast on the table in front of them untouched and had their head on the table asleep. Three other residents sat with breakfast in front of them, one with her arms folded and appeared as though she didn’t know what to do with it. There were no staff available to support and prompt people with their breakfast. By 11:10 the food had been cleared away and we noted some people had not eaten any breakfast or finished drinks. At 11:12 a member of staff serving drinks of tea was asked by a resident ‘what time do we get lunch’ and she replied 12 o’clock. The member of staff did not try to establish if the person was hungry and did not offer any snacks. We asked the cook if the home maintains records of people’s dietary intake and she stated that ‘she keeps records of who has been served a meal but not whether they have eaten any of it “that is recorded by care assistants in people’s records”. We looked at records and we could not find records in sufficient detail to establish if people have eaten anything or not. We observed the mealtime experience. The menu for the day was written on a board in the dining room, it was not easy to see as the sun was shining through the window and reflecting off the board. The menu was not presented in a way that people with sensory and cognitive impairments would necessarily find useful. There are fewer tables in the dining room now as some have been moved to other areas of the home such as the lounges. The manager said this was done to provide a greater choice of places to eat. People were being seated in the dining room at 12:30 at which time the tables were being set with placemats and cutlery. A choice of drinks was being offered. In addition to the dining room people were taking their meals in the two lounges, the sunroom, bedrooms and the entrance hall. There were eight people in the dining room with one member of staff to support. The meal was not served until 12:50, two meals were placed on the tables where residents were sitting but had since moved away. One of those meals remained throughout the whole lunch period and the person did not return, the meal was eventually cleared away. We went to see where the person was and found them in bed. A relative said this person had not had breakfast that day. We raised this with the manager and the person was brought back and given a pudding. We later looked at her records and staff had recorded ‘she didn’t eat her lunch at first but did later’ we had confirmed with the senior care assistant earlier that she only had a pudding. Several people needed support and prompting to eat their meals and there were insufficient staff available. It was noted that several people did not eat their meals. One person sitting in the entrance hall was seen smearing her food all over the table and throwing her plate and cutlery. We observed her for some time before the manager came along and cleared the food away, which by that time was also on the floor. The manager then left her with a full mug of tea, she was observed to put her hand in the cup and try to take the fluid from her hand. The tea was again all over the table and running onto a chair. We Glendon House DS0000027384.V370304.R02.S.doc Version 5.2 Page 18 observed two people sitting in the sunroom with meals in front of them but not attempting to eat them. There were no staff in the room to provide support. In the front lounge one carer was assisting a resident with her meal and completed this in a caring and sensitive manner. However, there was another resident in the room who sat with a meal in front of her and when we asked if she liked the food she replied ‘ no, ‘would you eat that’, ‘its too chunky and it would make me sick’ she did not eat her meal and was later heard calling out ‘where is my dinner’ indicating she may have been hungry. The one resident survey indicated that they ‘usually’ like the meals at the home and wrote “they seem plentiful although it seems to be convenience food” The manager said the home employs a cook who works 7-2pm and that other staff are currently covering the teatime period taking them away from care duties. Glendon House DS0000027384.V370304.R02.S.doc Version 5.2 Page 19 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 and 18 Quality in this outcome area is adequate. People living in the home and their representatives have information about how to make a complaint if they need to. However, their complaint may not always be acted upon. People can be assured that staff are trained in safeguarding and will raise any concerns. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has policies and procedures in place for making complaints and raising concerns. The manager said she has an open door policy and that people can talk to her at any time if they have concerns. The manager said that the home has not received any complaints since the last random inspection in February 2008. However, since the last key inspection in September 2007, the Commission has received a number of complaints from anonymous sources. Some of the concerns had been raised with the management of the home but the complainants did not feel that the concerns were listened to and acted upon. This suggests that people coming into contact with or working in the home did not feel confident that their complaints will be handled effectively. One member of staff reported on a recent survey that they had raised issues with the management team and did not feel that they were acted upon. Glendon House DS0000027384.V370304.R02.S.doc Version 5.2 Page 20 In addition, since the last key inspection, the Commission has received three serious complaints relating to issues of neglect of care and health needs, which were referred to the Norfolk Safeguarding Team and investigated by the Commission. Many elements of the complaints are substantiated and the evidence is being used in ongoing enforcement action against the home. There have been ongoing concerns about the homes ability to safeguard the health and welfare of people living in the home and further evidence of this is provided in this report. All staff are trained in safeguarding and know how to raise concerns with outside agencies if necessary. Glendon House DS0000027384.V370304.R02.S.doc Version 5.2 Page 21 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, 20, 22, 25, 26 Quality in this outcome area is adequate. People can be assured they will live in an environment that is reasonably well maintained and furnished. But the report indicates that the environment is unsafe for people and improvements are needed to reduce risk and improve hygiene. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Some improvements have been made to the environment since the last inspection. For instance, the quiet lounge has been finished and is back in use. The carpet has been replaced and the odour is not as strong as previously detected. Carpets in other areas have also been replaced. Glendon House DS0000027384.V370304.R02.S.doc Version 5.2 Page 22 We conducted a quick tour of the premises. When we entered the building strong unpleasant odours could be detected, also in some other areas of the home and in some bedrooms. In general, the home appeared to be clean and tidy. However, throughout the day there was food on the floor that was not cleared away promptly. We observed a care assistant collecting laundry from people’s rooms and the bag was left in the corridor along with a yellow bag containing clinical waste. A resident was seen looking in the bags when they were left unattended. We found a tablet on the floor in the lounge amongst other debris. One resident survey also said that “we had new carpets but sometimes residents foul on the carpets and if they are short staffed it can take a while before it is cleaned up” We looked in people’s rooms and found that again on the whole they were clean and tidy but during the morning, in some rooms, unpleasant odours could be detected and bedding was soiled. We found that en suites contained products such as razors and denture cleaning tablets that were not secured safely. We also found prescribed creams and ointments that were not secure. The home has installed lockable cabinets in people’s rooms but either these were not locked or not in use. We also saw incontinence pads in people’s rooms that were not stored away from view. Bedroom doors showed the name of the resident in small print and a number on the door. Rooms were not easily recognisable to the residents. There was some signage around the home to help people to orientate independently. However, the signage was text only and some of it was lost amongst other notices. We did not note any signage within rooms to assist people to find the en suites and exit. We did not see any assistive technology to promote independence whilst ensuring people are adequately supervised and safe. We noted that there were some chairs in the lounges and in one bedroom that did not have seat cushions on them. Some of the cushions were replaced later in the day. We discussed this with the manager who indicated that they had been removed due to soiling. We also discussed that not having a seat cushion (apart from the discomfort) is unsafe, lowers the chair making it difficult for people to get out of and could be seen as a form of restraint. People have free access to the outdoor courtyard, which contains some flowerbeds and some patio furniture. People were seen going out into the garden at times throughout the day. The manager said that the home employs two domestics at present each working 5 days and is in the process of appointing a third person. The laundry facilities were looked at briefly. The manager stated that staff now use proper laundry bags for heavily soiled items. Clean laundry was kept separate from dirty laundry and it all looked in order. We did note that there Glendon House DS0000027384.V370304.R02.S.doc Version 5.2 Page 23 was no hand soap or paper towels available for staff who may be handling soiled laundry and need to maintain good infection control standards. Glendon House DS0000027384.V370304.R02.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is poor. People cannot be assured the numbers of staff on duty are adequate to meet their needs. Staff are being provided with training but do not demonstrate competence. People are now protected by the homes recruitment practices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at the staff rotas to determine the number of staff on each shift and whether the home was meeting their own targets, as determined by people’s needs. The home’s target staffing levels were provided by the manager and stated as 5 in the morning, 4 in the afternoon and 3 at night. We looked at the staff rotas for week ending 07/08/08 and 14/08/08, which indicated that the home has maintained their target levels throughout this period of time. It indicates they have managed to achieve this by the manager covering some shifts (4 in one week) and by using agency staff. Agency staff appear on the rota 27 times in the two week period looked at and a total of 9 different agency workers were provided. The manager said that the home is in the process of appointing more staff from overseas. The person who arrived to do nail painting on the day of inspection and who said she comes in on a Wednesday did not appear on the rota. Glendon House DS0000027384.V370304.R02.S.doc Version 5.2 Page 25 The six surveys returned by a resident, relatives and staff all indicated that the home is in need of more staff. One relative wrote in response to the question ‘how do you think the care home can improve’ “ having more staff on duty at mealtimes. Sometimes they don’t seem able to cope. One Saturday they only had one junior male and one young female. They seemed stressed” and “if they have an emergency at mealtimes, which happened on one occasion patients are left waiting for food as they cannot cope”. Another relative wrote “ need more carers so they can have more attention paid to each individual” and “when we visit we hardly see anyone except when we are let in the home after standing at the door step sometimes 5 minutes”. A member of staff wrote “ more staff taken on – at first we are short. We need our own staff who know the residents. Agency staff don’t know our residents needs” We looked at staff training records and found that the home has made improvements to the provision of training. All staff are trained in dementia care and now each have a personal training plan. A training matrix and programme of training for the coming year was provided and showed that all the mandatory training was scheduled for 2008/09. Records show that 3 staff are trained to NVQ level 2 and 2 staff are in the process of completing the course. During the inspection we observed staff to assess their approach and understanding of people with dementia. We noted on many occasions there was very little interaction with residents and staff walked past people without acknowledging they were there. Staff were very task focussed and were under pressure to complete the work they needed to. Whilst we observed staff approaching residents in a kind and sympathetic way we did not see them engaged in any meaningful relationship, stimulation or occupation with residents. Further examples that indicate a lack of understanding and the need for further training are cited in this report. We looked at recruitment and found that the files examined relating to new staff were all in order. Glendon House DS0000027384.V370304.R02.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is poor. People can be assured they have a manager who is committed to making improvements. However, they cannot be assured that management systems and the running of the business, safeguard their health and welfare. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a new manager who started in February 2008. This manager has several years of previous experience of working in care homes and has been registered previously with the Commission. An application for registration at this home is being submitted. Although the manager has experience in caring for people in a residential care setting, she agrees she has limited experience of working with people with dementia. Since working at the home Glendon House DS0000027384.V370304.R02.S.doc Version 5.2 Page 27 she has completed dementia care training in addition to dementia care mapping and says she is trying to gain knowledge from publications and journals relating to dementia care. The manager has openly expressed her concern about how poor the outcomes were for people when she first took the post and had not fully realised the extent of it. She says she has worked hard to make improvements to the staffing arrangements and the range of knowledge and skills staff possess and this work is still in progress. The providers have appointed a consultant who has been completing Regulation 26 visits and giving advice and support to the managers of all the three homes owned by the providers. We did not look at quality assurance in full on this occasion. In April 2008, the home was given an opportunity to complete an Annual Quality Assurance Assessment (AQAA), which they did and returned to us within the required timescales. The AQAA tells us what the home thinks they do well, what they could do better and what plans they have for improving the service. We asked if the home manages any finances for people and were told by the manager that they did not. However, during the day we noted that the home is undertaking some fundraising and we saw a relative hand some money to the manager. When we spoke with the manager about the fundraising she informed us that the staff were raising money to purchase wheelchairs so they could take people out. We discussed fundraising for equipment that is considered essential to meet people’s physical, social and emotional needs. We asked the manager to consider if this activity is appropriate. The manager also informed us that she did not have any financial records relating to any money donated so far. We looked at records in general and found that records relating to individuals were not completed in full and kept up to date by regular review. We also found inaccuracies in the records made by staff in relation to how individual’s daily needs are being met. We asked about fire safety procedures and were told that a fire risk assessment has now been completed. Alarm checks are conducted weekly and the fire equipment is serviced under contract. Records indicate all staff are trained in fire safety. The home employs a maintenance man who completes all maintenance tasks and repairs. We looked at the way in which the home records accidents and incidents and found that since the last inspection the home has tried to redefine what Glendon House DS0000027384.V370304.R02.S.doc Version 5.2 Page 28 constitutes an accident and what constitutes a non-reportable incident. However, this has caused some confusion with care assistants and we saw accidents that had resulted in injury recorded as incidents and not reported as required. For instance, one resident had been found on the floor, he had lacerations and was bleeding. The paramedics were called but this was not recorded as an accident and reported as such. We saw similar records relating to falls that had also been recorded as incidents. We saw some risks to people’s health and welfare, such as products that may be hazardous if misused. The home had not completed risk assessments and therefore had no plan of action to minimise risk. The manager has now introduced a plan of regular supervision. Staff confirmed that they are receiving supervision and felt well supported by the manager. One member of staff in a survey, when asked the question ‘what could the service do better’ wrote “more supervision of staff”. Glendon House DS0000027384.V370304.R02.S.doc Version 5.2 Page 29 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 X 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 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 2 2 2 X 2 X 1 STAFFING Standard No Score 27 1 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 2 2 2 1 Glendon House DS0000027384.V370304.R02.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) 16(2)(m) Requirement Peoples care, health and social needs must be assessed and written into individualised care plans, taking into account their personal choices and preferences so that care staff have clear guidance as to how individual needs should be met. This is a repeat requirement and remains unmet. Enforcement action is underway. Individualised care plans must be reviewed monthly and updated as people’s needs change. So that there is an accurate record of peoples health and care needs. This is a repeat requirement and remains unmet. Enforcement action is underway People’s care and health needs must be met in accordance with their care plans. This is a repeat requirement and remains unmet. Enforcement action is DS0000027384.V370304.R02.S.doc Timescale for action 13/08/08 2. OP7 15(2)(b) 13/08/08 3. OP7 12(1) 13/08/08 Glendon House Version 5.2 Page 31 underway. 4. OP8 12(1)(b) People’s health needs must be identified and promptly referred to the appropriate health professional so that treatment can be provided where necessary. This is a repeat requirement and remains unmet. Enforcement action is underway. People’s health and welfare must be safeguarded by a robust risk management strategy. This must include action in response to assessed risks and provide staff with clear instructions as to how these should be minimised. This is a repeat requirement and remains unmet. Enforcement action is underway. Medicines must be safely managed to ensure that the health and welfare of residents is safeguarded. This is a repeat requirement and remains unmet. Enforcement action is underway. Decisions must not be made on behalf of people with dementia without conducting a full capacity assessment in accordance with the Mental Capacity Act 2005. Residents must be supported to maintain a varied nutritious diet, which is suited to the individuals assessed and recorded needs. People must be provided with a mealtime experience that meets their individual needs, preferences and choices. DS0000027384.V370304.R02.S.doc 13/08/08 5. OP8 13(4)(a)( b)(c) 13/08/08 6. OP9 13(2) 13/08/08 7. OP14 12.2 12.3 13/09/08 8. OP15 16(2)(i) 13/08/08 Glendon House Version 5.2 Page 32 This is a repeat requirement and remains unmet. Enforcement action is underway. 9. OP15 17(2)Sche Records of resident’s dietary dule 4 intake must be maintained to determine that a nutritious diet and any special dietary needs are being catered for. This is a repeat requirement and remains unmet. Enforcement action is underway. 12(2)&(3) Autonomy and choice must be promoted at all times so that people are enabled to make their own decisions about how they wish to live their lives. This is a repeat requirement and remains unmet. Enforcement action is underway. Privacy and dignity must be promoted at all times to ensure the psychological wellbeing of residents is enhanced. This is a repeat requirement and remains unmet. Enforcement action is underway. 13/08/08 10. OP14 13/08/08 11. OP10 12(4)(a) 13/08/08 12. OP16 12(5), 21 & 22 Staff working in the home must 13/08/08 be able to raise any concerns or complaints with the management team and have confidence that they will be dealt with and acted upon. This is a repeat requirement and remains unmet. Enforcement action is underway. The home must be free from offensive odours so that people’s dignity is promoted and they can DS0000027384.V370304.R02.S.doc 13. OP26 16(2)(k) 13/08/08 Glendon House Version 5.2 Page 33 live in a pleasant environment. This is a repeat requirement and remains unmet. Enforcement action is underway. 14. OP19 13(4) The environment must be safe and free from potential hazards so that people are safeguarded from harm. This is a repeat requirement and remains unmet. Enforcement action is underway. The premises must be suitable for achieving the aims and objectives of the service and equipment and adaptations must be provided so the individual needs of residents can be met. This is a repeat requirement and remains unmet. Enforcement action is underway. 13/08/08 15. OP19 23(2)(b)& (n) 13/08/08 16. OP27 17(2)Sche Accurate staff rosters must be dule 4(7) maintained so that it can be determined who is on duty on each shift. This is a repeat requirement and remains unmet. Enforcement action is underway. 18(1)(a) Trained and competent staff must be available in sufficient numbers on each shift so that residents needs can be met, taking into account their individual needs and preferences. This is a repeat requirement and remains unmet. Enforcement action is underway. Staff must be supervised and DS0000027384.V370304.R02.S.doc 13/08/08 17. OP27 13/08/08 18. OP36 18(2) 13/08/08 Page 34 Glendon House Version 5.2 supported so that good practice is promoted and outcomes for residents are improved. This is a repeat requirement and remains unmet. Enforcement action is underway. 19. OP38 13(4) Accidents must be identified and recorded appropriately so that the health and safety needs of individual residents are identified and met. This is a repeat requirement and remains unmet. Enforcement action is underway. 13/08/08 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 Menus should be displayed so that people reminded of the meal options on the day and memory and recall is promoted. Menus should be produced in various formats to meet the needs of individual residents so that meaningful choice is promoted. The mealtime experience could be enhanced by providing a setting that is conducive to dining and one that aids memory and recall. 2. OP15 3. OP15 Glendon House DS0000027384.V370304.R02.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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. Extracts may not be used or reproduced without the express permission of CSCI Glendon House DS0000027384.V370304.R02.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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