Inspection on 05/09/07 for Glendon House

This inspection was carried out on 5th September 2007.

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

Glendon House 13/08/08

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Glendon House 2 Carr Lane Overstrand Cromer Norfolk NR27 0PS Lead Inspector Ann Catterick Unannounced Inspection 5th September 2007 07:45 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.V350317.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. Glendon House DS0000027384.V350317.R01.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.V350317.R01.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 1st May 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 manager position is vacant at the time of writing the report. 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. 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 provides comfortable accommodation in an attractive setting in a small coastal village, being very close to the sea. Glendon House DS0000027384.V350317.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection that took place on the 5th September 2007 and lasted 10hrs. Ann Catterick was accompanied by Kim Patience, inspector, for the whole of the inspection and Mark Andrews, pharmacy inspector, for part of the inspection. There is a separate pharmacy inspection report and copies can be obtained by request to the Commission. The home has not had a registered manager for over 2 years and Lisa Rutter who is a registered manager for another home within the company is in the role of manager within the home. She plans to make application to become the registered manager for the home. This home was assessed as a poor home at the last key inspection on 01 May 2007. Since this time there has been a further random inspection and other information received on comment cards from staff and relatives as well as an annual quality assurance assessment form from the home. Although some positive comments were received from staff and some relatives the overall flavour of comments and evidence gathered show that this continues to be a poor home with the outcomes for the people who live in the home as generally unsatisfactory. Four significant concerns have been received and all were referred to the Adult Protection Strategy Unit. The investigations into these concerns are ongoing. At the time of the site visit the inspectors were able to speak with residents, staff and management, look at staff files, care plans, medication records and other document as well as have a tour of the building. The outcome of the inspection was that there continues to be significant concerns about the quality of care provided in the home and the outcomes for residents continue to be generally unacceptably poor. Thirty two requirements have been made at this inspection and many of these are repeated from the last inspection. Glendon House DS0000027384.V350317.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The proprietors need to ensure that the home have both the management systems and leadership necessary in order to provide a satisfactory level of care to the vulnerable residents. The manager needs to ensure that prior to admission of a new resident a full assessment takes place which confirms that the person’s needs can be met within the home. Care plans need to reflect the needs of residents and be reviewed on a regular basis. The health needs of residents need to be clearly identified and met. There needs to be enough staff on duty at all times to meet the physical, social and emotional needs of residents. Glendon House DS0000027384.V350317.R01.S.doc Version 5.2 Page 7 The staff rota needs to be an accurate record of who is on duty at any one time. Staff need to have the appropriate training to enable them to meet the needs of residents. The environment needs to be clean and free from offensive odours. The environment needs to meet the needs of residents. Old stained and soiled furniture and carpets need to be replaced. All staff need to be appropriately supervised. The home needs to keep accurate records, including Regulation 37 reports and incident and accident records. 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.V350317.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 Glendon House DS0000027384.V350317.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 and 6 People who use the service experience poor outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Residents who are considering moving into the home cannot always be sure that a comprehensive assessment of their needs will be made prior to admission. This can mean that the home is not the best placement to meet their needs. Glendon House DS0000027384.V350317.R01.S.doc Version 5.2 Page 10 EVIDENCE: Glendon House is registered for people with dementia. On the 30/08/07 a resident was admitted and in their care plan under the heading ‘Mental Health’ it states that they have no diagnosis of dementia. When speaking with the resident they expressed some concern about the special needs of the other residents and were able to express some concerns about being admitted to this particular home. No clear pre admission assessment had been made and there was nothing to say why this person with no diagnosis of dementia was admitted to the home. Evidence suggests this person was received in this establishment inappropriately. A requirement has been made in this area. Other pre admission assessments were seen and some sections within the assessment were incomplete. It was also noted that some information in initial assessments had not been transferred to the care plan. No evidence of family involvement was seen in those pre admission assessments inspected. A requirement has been made in this area. Glendon House DS0000027384.V350317.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use the service experience poor outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Residents cannot be assured that a care plan will be fully completed that will describe how their personal and health care needs will be met. When needs are identified in care plans the personal and health care provided does not always reflect the care plan. This means that personal and health needs of residents are often not met. The care and administration of medication is chaotic and does not promote safe practice. This means that residents’ health and safety is at risk of poor practice. The dignity of residents is not always promoted and this could affect their physical and emotional wellbeing. Glendon House DS0000027384.V350317.R01.S.doc Version 5.2 Page 12 EVIDENCE: Several care plans were seen and there has been no improvement since the last inspection. Not all care plans were fully completed, the reviewing system was often poor and information identified within care plans was not always transferred to practice. Health needs were not always being met. Significant concern was felt around all aspects of medication. The dignity of residents was not always promoted. For a resident who was admitted on 30/008/07 there were significant gaps in the care plan. No photograph was on in this care plan (and several other care plans had no photograph). A requirement has been made in this area. The weight chart was left blank, personal risk assessment left blank, moving and handling risk assessment left blank, social care left blank, social history left blank and the completion page of assessment left blank. A requirement has been made in this area. When speaking with this resident it did not appear that their needs could be best met in a home for people with dementia as they had no diagnosis of dementia and appeared to have a mental well being much healthier than other residents. For a resident who had been admitted to the home on 03/09/03, the needs had changed significantly since admission and the initial care plan. The care plan described the resident as someone who was ambulant and participating in daily life at the home. This resident is now being cared for in bed and their care needs had changed considerably. There were no clear guidelines on how to provided care and how often and when this resident should be turned or offered food and fluids. A review of the care plan stated that the care plan remains the same. This was completely inaccurate. Some changes were identified in the review form but no new care plan had been created. A requirement has been made in this area. On 11/08/07 when night staff went into a resident’s room to offer fluids the fluid chart had not been completed between 13.00hrs and 22.00hrs with no record of a drink being given. This would suggest that the resident had not received any fluid for nine hours. A requirement has been made in this area. There was also concern that the resident was too hot in bed and needed a wound redressing as their hair was stuck to it due to them being overheated. Glendon House DS0000027384.V350317.R01.S.doc Version 5.2 Page 13 This matter was investigated by a social worker in the Adult Protection Team. On the day of the site visit the resident was still being cared for in bed. Mostly fluids were given every two hours although there was one occasion when the chart had no record of fluids for six hours. The turning charts had been completed every two to four hours. This resident is receiving support from the district nurses and their skin is in good condition and intact. A resident who was admitted to hospital on 03/09/07 was noted, on admission, to be in an unkempt condition, looking emaciated. On a subsequent hospital admission the resident’s skin condition was found to be in a poor state with several pressure areas and multiple friction wounds. The home had informed the resident’s daughter that their skin had been intact before the hospital admission and this was clearly not the case. Evidence suggested that this resident’s health needs were not being met in the home. A requirement has been made in this area. A resident who was admitted on 13/04/06 had a limited care plan with many areas left blank. Mental health assessment - left blank; personal risk assessment - left blank; activities and hobbies - left blank; completion sheet left blank. The care plan did state that the resident wore glasses and used a stick. On the inspection visit, the resident spent all of her time between breakfast and afternoon tea sitting in the dining area. The resident was not wearing glasses and did not have a stick. A requirement was made in this area. Care plans need to be comprehensive, giving clear guidelines of how a resident needs to be cared for and staff need to follow the direction of the care plan. A requirement has been made in this area. On the day of inspection there was very little evidence to suggest that service users were being assisted to the toilet. Most residents wear continence aids and this appeared to be a way of managing residents toilet needs. This is seen as poor practice. A requirement has been made in this area. Very few residents were wearing glasses although care plans stated that they wore them. Very few residents use their walking frames. Seven frames were being stored in the corner of the small dining/lounge, on the day of the site visit. There is no explanation as to why residents do not have their frames and this was not indicated in any of the care plans seen. Residents were often moved from place to place with the assistance of staff. For example once a resident is standing a member of staff will hold their hands, wrists or elbows and help them to move forward. There were no clear moving and handling assessments and when they were in place they were usually not followed. This is seen as poor practice. A requirement has been made in this area. Glendon House DS0000027384.V350317.R01.S.doc Version 5.2 Page 14 When reading care plans it was noted that a significant number of residents suffered from urine infections. Residents’ fluid intake was not being monitored as would be expected if a resident were having reoccurring urine infections. Continence pads appeared to be worn by most residents and were not changed regularly. For example at lunchtime those residents in the large dining area were given a drink of squash. The four residents eating their lunch in the small dining area did not have a drink whilst they were eating their meal. At the end of the meal a member of staff who was assisting a resident with lunch realised the omission and brought drinks for three residents. The care coordinator then came into the area and said to one resident, “sorry I forgot your drink.” This resident was then given a drink. A requirement has been made in this area. At lunch time a resident sitting in the sun lounge needed assistance with their lunch. When approached by the Inspector they said, “all I want is something to eat.” The meal in front of the resident was cold and the inspector returned this to the kitchen asking for another meal and informing staff the resident needed assistance. After about fifteen minutes, no meal had been given to the resident and the Inspector asked a second time that they be given a lunch and assisted with it. Eventually the resident was given a meal and offered assistance. A requirement has been made in this area. The care plan of a resident who was admitted on 06/08/07 was inspected. The patient profile was incomplete. The care plan in parts was very limited, in others inaccurate and in others left blank. Within information regarding medical care it stated the resident had a catheter. It was noted that the edge of the resident’s mattress was badly stained with urine and this could indicate bypassing. This could have been caused by the bag not being emptied or a blockage but there was nothing written in the care plan to suggest there was a difficulty in this area. The care plan stated the resident wore glasses but these were not being used on the day of the site visit. The care plan and daily records were contradictory. Care plans stated no behavioural problems although running record identified that the resident had been aggressive to staff. These changes were not updated in the care plan. The care plan identified the resident needed a stick for mobility. The resident had the stick with him but was in a low chair with no seat cushion making mobility difficult, if not impossible. Overall the care plan for this resident was not a reflection of the residents needs and was not being appropriately reviewed as care needs changed. A requirement has been made in this area. Glendon House DS0000027384.V350317.R01.S.doc Version 5.2 Page 15 The inspection of the medication standard was undertaken simultaneously by the Commissions pharmacist inspector Mr M Andrews. This follows his inspection of 19/07/07. During this inspection he found that there were again widespread concerns that the homes management of medicines was placing the health and welfare of residents at serious risk. In particular, it was found that frequently the home is failing to promptly obtain medicines to enable them to be administered to residents and failing to respond adequately to residents’ illnesses by medical referrals, leading to delays in treatments being prescribed and supplied. In addition, the home is still unable to demonstrate by its record-keeping practices that all medicines can be accounted for and are given to residents as prescribed. The inspector found that the home was unable to account for a total of 53 temazepam tablets that are a controlled drug. The home is not safely handling medicines of a sedative nature and some prescribed for discretionary use only are being given to residents routinely when this cannot be justified. In addition, records indicate that some such residents are experiencing excessive sedation and falls. There was evidence that poor communication has led to errors in medicine administration and there was a lack of documentary evidence supporting changes to doses of medication. A full report on the pharmacy inspection has been sent separately to the provider and is available subject to request. Requirements have been made in this report. Residents were seen not to be having their dignity promoted. A resident who had needed assistance with their lunchtime meal, but did not receive it, spilt custard down their jumper. They had not been provided with any protective clothing or a napkin. When helped to move from the dining table to a lounge chair they were not cleaned up or offered another jumper. This did not promote dignity. When the afternoon staff came on duty they changed the resident’s jumper. A relative had observed a resident walking about the home with her blouse undone with no underclothes on. A member of staff was seen to pull the blouse together but did not attempt to do it up. This meant the resident continued to walk about the home exposing her upper body. A requirement has been made in this area. Comments made by staff Do what we can but still not enough Would not want my grandmother here. Don’t even have time to speak with residents. In my opinion the service we provide is very good. Glendon House DS0000027384.V350317.R01.S.doc Version 5.2 Page 16 Comments made by relatives. We are very pleased with the care our relative receives. I have had two lots of dentures lost. I take special surprises for my relative and they go missing. I often have to wash and shave my relative, as this has not been done. I am not always told when my relative is unwell. My relative has been admitted to hospital and was found to have several pressure areas and the family had not been informed of these. My relative often smelt terrible and would have dried urine on her underwear. My relative often has urine infections and does not always start antibiotics straight away. I feel residents at the home are not being well cared for. Three requirements were made in this outcome area at the last inspection. None of these requirements have been met and further requirements have been made. Glendon House DS0000027384.V350317.R01.S.doc Version 5.2 Page 17 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 and 15 People who use the service experience adequate outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Resident living in the home have limited opportunity to engage in meaningful pastimes or occupation and therefore spend much of their day with little to do. Visitors are always made welcome in the home. Meals are adequate but the setting and ambience at meals times could be significantly improved for residents to make this a more positive activity. EVIDENCE: Within care plans the information with regard preferences for social activity and leisure were limited. On the day of inspection most residents spent significant periods of the day without meaningful occupation or activity. The activity staff member was on duty and involved in some activity with a small group of residents including nail painting, cards games and knitting. The activity record book kept by the activity person was seen and showed that often only a few residents are involved in any activity. The activity person had recently been on leave and no activities had been recorded for this period. Care staff are very busy and have little time to spend any social or one to one time with residents. Glendon House DS0000027384.V350317.R01.S.doc Version 5.2 Page 18 Residents were observed in the sun lounge at 10.10hrs. Six residents were in the lounge, one resident was slumped in a chair, another asleep in a chair, three looking ahead blankly and another was walking around the room with one slipper on and one slipper off. There was nothing in the room to stimulate residents or occupy them. No magazines, books, games or anything to attract the eye or imagination was present. Four of the lounge chairs had no cushion and residents occupied two of these. A member of staff did come into the sun lounge and gave residents a drink. One resident was seen to be sitting at the table in the small dining area with their head on the table at 07.45 hrs. This resident remained sitting at the dining table until after lunch at 13.15 hrs. No member of staff was seen engaging with the resident other than to offer meals and drinks. A requirement has been made in this area. Another resident was seen to be sitting at the dining table in the large dining area at breakfast time and was still in this position in the afternoon when visited by a family member. This person was offered to do some knitting but little contact with staff was seen. Neither of these residents were seen to be assisted to the toilet throughout this time. The home has an attractive patio area that is little used by residents. The home has a large garden area that is also rarely used by residents. The home is very close to the sea and cafés are situated locally. Staff informed the inspector that “in times gone by” residents were taken out of the home and visited local cafes. This practice has now stopped, as there are never enough staff on duty to do this. Throughout the day of inspection, staff were task centred and there was very little evidence of staff spending any time with residents in a way that would meet social and emotional needs. A requirement has been made in this area. Visitors are always welcomed into the home and evidence of this was seen on the day of the visit to the home. None of the residents living in the home are able to manage their own financial affairs. Financial advocates or family members take on this role. The dining area is the focal part of the home. On the day of the site visit several residents were sitting in the dining area at 07.45hrs. The tables are not laid and residents are giving utensils at the time of being given breakfast. The same process takes place at lunchtime. Glendon House DS0000027384.V350317.R01.S.doc Version 5.2 Page 19 Residents had different types of drinking vessels and this was an indication that individual needs in this area were being met. This was seen as good practice. On the day of the site visit several residents needed assistance with their meals and staff were not always available to offer this. Not all residents had appropriate protective clothing or napkins to promote their dignity at meal times. There were not enough staff available to offer support to all of those residents who needed assistance at lunchtime. A requirement has been made in this area. The lunchtime meal on the day of inspection looked nutritious and appetising. Food was being served on different sized plates, another indicator that individual needs were being considered. Not all staff have completed MUST training and the home still uses semi skimmed milk. The cook was advised that full fat milk should be used and semi skimmed milk should only be used if a resident has a problem with obesity. Staff would benefit from malnutrition universal screening tool (MUST) training. A recommendation has been made in this area. Comments from relatives Staff are very welcoming to visitors. I have not witnessed any activities or stimulation in the last year. I am always welcomed when I go which is usually four or five times a week. Food is good plus help if you cannot feed yourself. The meals are usually good but the meals are sometimes difficult to eat with just one denture. When people came to play the old songs everyone really enjoyed it. Glendon House DS0000027384.V350317.R01.S.doc Version 5.2 Page 20 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 People who use the service experience adequate outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Residents and family and friends of resident will have the information needed to make complaints to the home if they choose to do so. The manger of the home needs, through regular supervision and training, to ensure staff have the knowledge and skills to protect residents form abuse. EVIDENCE: The home has a complaints procedure that is made available to residents and their families. The manager needs to ensure that all records regarding the investigation of concerns and complaints are available in the home for inspection. A requirement has been made in this area. Three concerns regarding adult protection have been referred to the Commission since the last inspection and these were dealt with by the Adult Protection Unit (APU). The manager does not always make the appropriate referrals to the APU. For example it would have been expected that at least one of the above concerns would have been reported to the APU. There have been other examples when the manager has made appropriate referrals to the APU. Glendon House DS0000027384.V350317.R01.S.doc Version 5.2 Page 21 Some staff have received training in this area and other staff are awaiting training. All staff would benefit from this training. A requirement has been made in this area. All of those staff spoken to said that they would report poor practice. Comment from staff I would always report poor practice. Comments from relatives If I have a complaint I see the coordinator. I usually go to the office if there is a problem. One requirement was made in this outcome area at the last inspection and this requirement has not been fully met. Glendon House DS0000027384.V350317.R01.S.doc Version 5.2 Page 22 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 and 26 People who use the service experience poor outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Residents are living in a home that has the potential to be a comfortable environment but at present the communal areas of the home are not very clean and are unkempt therefore offering at the best an adequate - and often a poor - environment for residents to spend their days. EVIDENCE: There is opportunity to make Glendon House a comfortable environment for residents to live. Unfortunately, over the past 12 months the environment has become more uncared for with shabby and stained furniture in the communal areas and a general air of neglect throughout. The manager is making some effort to keep the environment clean. The lack of cleanliness within the home could suggest that the home does not employ sufficient domestic staff. Glendon House DS0000027384.V350317.R01.S.doc Version 5.2 Page 23 A tour of the home was taken at the start of the site visit. Faeces was seen on the doorframe between the bedroom corridor and dining area. A requirement has been made in this area. The toilet in that corridor was soiled and no soap or towels available for residents. The bedrooms of residents who were up were locked giving no opportunity for residents to return to their bedrooms. One bathroom was also kept locked. A requirement has been made in this area. Bathroom doors had no signage. A recommendation has been made in this area. There was no evidence of the manager using assistive technology to promote independence and alert staff to residents’ whereabouts. A recommendation has been made in this area. There was evidence of products in residents’ rooms that could be hazardous if misused (razor) and no risk assessments were in place. In the sun lounge several chairs were badly stained and four chairs had no seat cushion. Later it was noted residents were sitting on chairs with no seat cushion. A requirement has been made in this area. In one bedroom there was a distinct smell of urine and the source was found to be the wardrobe. When mentioned to the manager and care coordinator they had identified that there was a difficulty in this area. This bedroom had an en suite but no signage was on the door to inform the occupant where the toilet facility was, hence mistaking the wardrobe for the toilet. A requirement has been made in this area. In two bedrooms general used laundry was in situ in laundry baskets, but was not only the laundry of the occupant of the room. A requirement has been made in this area. In many areas of the home an unpleasant odour was noticed. For example the sun lounge, small dining area and some bedrooms had an unpleasant odour. A requirement has been made in this area. In the downstairs corridor the lampshade was missing. A recommendation has been made in this area. During the afternoon the sun lounge became very warm and could become uncomfortable for those residents who were not mobile. A recommendation has been made in this area. Glendon House DS0000027384.V350317.R01.S.doc Version 5.2 Page 24 All radiators have now been covered. Bedrooms are generally of a good size and can provide comfortable accommodation for residents. The home has the benefit of attractive gardens, however, residents rarely use them. A recommendation has been made in this area. Two requirements were made in this outcome area at the last inspection. One has been met and one continues not to be met. Several other requirements have been made at this inspection. Comments made by relatives It gets quite smelly at times. A bedroom carpet was cleaned today. Gardens are kept nice. Glendon House DS0000027384.V350317.R01.S.doc Version 5.2 Page 25 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 and 30 People who use the service experience poor outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Residents living in the home cannot be sure that there will be enough competent experienced staff on duty to meet their needs. Residents cannot be sure that all staff will have the training needed to meet their needs. EVIDENCE: Following concerns over staffing identified at the inspections on 01 May and on 19 July, a Statutory Requirement Notice was issued to Mr and Mrs Smart, the proprietors of the home, on 06/08/07. This Notice related to both the number of staff on duty and the excessive hours worked by some staff. Although the manager has used agency staff to cover some of the shifts in the home, on the day of the site visit there were still not enough staff on duty to meet the needs of residents. On the day of the site visit 29 residents were being accommodated in the home. Glendon House DS0000027384.V350317.R01.S.doc Version 5.2 Page 26 The care coordinator was on duty between 07.00 and 16.00 and four care staff were on duty between 07.00 and 14.00 and two care staff between 08.00 and 15.00. The rota stated that all staff were on duty in the morning from 07.00 and, as previously brought to the notice of the manager, the rota is not a true record of staff on duty. A requirement has been made in this area. Those staff on duty were not able to meet the needs of residents. Staff were seen to interact with residents in a caring supportive way but appeared to spend much of their time focussed on tasks, such as laundry, serving meals, serving drinks, medication, preparing tea. Residents were seen to sit with no meaningful occupation or interest for long periods of time with the only contact with staff being to receive meals or drinks. At lunchtime there were not enough staff on duty to meet. Some residents were receiving assistance with their meals and others who also needed assistance were not. At 11.20 on the day of the site visit four staff were observed in the staff room leaving only two staff caring for the residents. Staff appear to be ‘caretaking’ residents with no evidence to suggest that person centred care was being provided. The rota showed that there were times when insufficient numbers of staff were on duty. On 25th August only four staff are seen to be on duty for the morning shift. On 8th September in the afternoon only four staff are on duty with one of these needing to prepare tea. All of those residents living at Glendon House have dementia and need a high ratio of competent staff to meet their needs. A requirement has been made in this area. Comment cards were issued to all staff and ten had being returned by the time at the time of writing this report. Generally comments from staff were positive. Some staff felt there were “usually” enough staff and others felt there were only “sometimes” enough staff. Some comments were less positive suggesting there was “often” not enough staff on duty. Nine comment cards were received from relatives that suggested staff were generally helpful but there were often perceived to be not enough staff on duty. Some staff spoken to on the day of inspection felt that staff numbers had improved. Some said that there were often not enough staff on duty. This information related mainly to night duty. For most of the time three staff are on duty of a night. There are domestic tasks to complete such as laundry, washing carpets, cleaning and peeling potatoes. These takes take the time of Glendon House DS0000027384.V350317.R01.S.doc Version 5.2 Page 27 one member of staff throughout the night. Many residents and now quite unwell and need to be turned and cared for on a regular basis during the night. Many of the residents need two staff to care for them. Night staff start work at 21.00 and there are sometimes 17 residents still up as this is their choice or there have not been enough staff on the evening shift to put more residents to bed. This leaves three staff to care for all residents with 17 still needing assistance to prepare for bed. A requirement has been made in this area. The afternoon shift used to work until 22.00 which meant there were more staff on duty between 21.00 and 22.00 to assist residents at this busy time. It is also expected that night staff will get residents up in the morning. Staff have been asked to get residents up from 05.50. Although staff spoken to said they would only get residents up who had their eyes opened and did not seem to mind getting up, this is clear evidence of task led and not person centred care and is poor practice. A requirement has been made in this area. Some staff spoken to said “we do not have time to talk to the residents” “they never go out” “I would not want my grandmother in here”. Staff are not completing care plans fully and reviews are limited. The overall level of qualification within the staff group – particularly relating to dementia care – is poor. They are also less than the recommended number of staff with NVQ Level 2 or above. A requirement has been made in this area. Recruitment records are generally poor. At the last inspection a 16 year old was working in the home in the kitchen and garden. A formal recruitment process had not taken place and a requirement was made in this area. At this inspection, it was seen that a staff file had still not been completed. An application form was seen with one reference. A POVAfirst had been sent back and the home was still waiting for a CRB. Two references should be sought and only one reference was on file. A requirement has been made in this area. No evidence of formal supervision was seen. The Inspector showed another member of staff his induction book. This was blank with only the name of the member of staff on the front. This member of staff had not seen the induction book before. A formal induction had not been completed. A requirement has been made in this area. Some training has taken place since the last inspection and some training had been cancelled. Little training is offered with regard caring for people with dementia and staff are not well trained in this area. A requirement has been made in this area. Glendon House DS0000027384.V350317.R01.S.doc Version 5.2 Page 28 Comments made by staff The staff at Glendon House are very caring and enjoy the job they do. Nights are very busy. Laundry is a 10hr job, which means only 2 staff to care for the residents. We do what we can but it’s still not enough. Despite problems we are improving the level of care we provide. Wouldn’t want my grandmother in here. Night staff have to get residents up. If residents have pain in the night medication cannot be administered, as we have not had the training. We now have a good quota of staff to meet the needs of service users. Comments made by relatives Extra training would be helpful specifically on dementia. It worries me that at weekends the staff are overworked. There could be more staff at weekends. The staff seem to be very patient, some times under difficult circumstances. I think the home could improve by having more staff at weekends and more activities. Residents are left for long periods alone and have no stimulation. There are some caring staff but often have to do double shifts and are very tired. It could get better with more staff; on August 21st there were two agency staff at the home so perhaps things are going to get better. Three requirements were made within this outcome area at the last inspection and none of these requirements have been met. Further requirements have been made at this inspection. Glendon House DS0000027384.V350317.R01.S.doc Version 5.2 Page 29 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, 36 and 38 People who use the service experience poor outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Residents living in the home are not being fully supported and protected by the management of the home. The health and safety of residents is not always promoted and clear record keeping and risk assessment does not take place. EVIDENCE: The home has not had a registered manager for over two years and this has had a significant impact on the quality of care being provided within the home. There have been manager and prospective managers but none have stayed long enough to make application to become the Registered Manager. Glendon House DS0000027384.V350317.R01.S.doc Version 5.2 Page 30 Since the end of June 2007 Lisa Rutter, who is the registered manager of another home in the organisation, has been appointed as manager at Glendon House. There has been no improvement to the quality of care at the home since this time and it is very disappointing to find at this inspection that hardly any of the requirements made at the last inspection have been met. The Annual Quality Assurance Assessment completed by the manager was limited in the information it included. The home has begun to develop a quality assurance system but as there were significant concerns about the care being provided on the day of the visit to the home this was not looked at in any detail. Residents’ money is not looked after by the home and relatives or financial advocates are invoiced for money spent. Relatives have made comment that the infrequency of billing can cause distress. For example one relative was billed for £400 for hairdressing and chiropody provided over an extremely long period. This is poor practice and invoices should be sent out on a more regular basis. A recommendation has been made in this area. Regular formal supervision does not take place. This is poor practice. A requirement has been made in this area. Not all records are kept up to date, are clear or available for inspection. A requirement has been made in this area. For example records of a recent complaint were requested but were not available in the home to see. Medication records are unclear and difficult to audit. Within a staff file it was not clear when a member of staff had commenced work. Staff do not assist residents with regard moving and handling in a safe way. On the day of the visit to the home seven frames were seen stored in the corner of the small dining area. Staff do not seem to encourage the use of frames and were seen to help residents to walk by holding their wrists or arms. A requirement has been made in this area. Not all moving and handling assessments had been completed in care plans. When completed they had not always been updated. The home has a significant numbers of falls. No evidence was seen in any care plan that the manager had sort guidance from the falls prevention team. Many residents did not have shoes on their feet. Others did not have walking aids although these were identified in the care plan. A requirement has been made in this area. Glendon House DS0000027384.V350317.R01.S.doc Version 5.2 Page 31 A resident whose mobility deteriorated within the home had not been reassessed for a mobility aid. There were concerns about infection control. In two bedrooms general residents laundry was seen to be in laundry baskets and staff had left them unattended. The laundry in the basket did not only belong to the occupant of the room but included other residents’ laundry. On the day of the site visit when visiting the kitchen butter and jam was on the top uncovered giving opportunity for contamination. A requirement has been made in this area. There have been concerns with regard the security of the premises. A resident left the building on 24/08/07, the police were involved and returned the resident. On another occasion, the same resident assaulted a visitor when they were trying to leave the building. A clear risk assessment needs to be completed with regard this resident. A brief risk assessment was on file but had not addressed the issue and needed to be redone and made more comprehensive. A requirement has been made in this area. Very few risk assessments were seen in care plans although daily records identified significant risks for some residents. A requirement has been made in this area. Incidents and accidents are not fully recorded. In a residents daily record it indicated that they had fallen nine times. In the same period the incident and accident book only recorded two falls for this resident. A requirement has been made in this area. The home is unclean and there is the potential of cross infection. Some of the chairs that residents sit on are not clean and on the day of inspection the inspectors experienced sitting on damp chairs that smelt of urine. Faeces was seen on a door frame and some bedrooms smelt strongly of urine. A requirement has been made in this area. The number of requirements made as a consequence of this inspection is clear evidence that this is a poorly managed home. Comments made by staff I often have regular meetings with the manager to discuss my working practice and ways in which I could improve. We now have a good training package. Cannot always approach senior staff and be assured of confidentiality. The manager never responds to any letters I write. Glendon House DS0000027384.V350317.R01.S.doc Version 5.2 Page 32 Comments from relatives Accounting system is very poor. They operate well. Get invoices for large amounts, as they do not send these regularly. Glendon House DS0000027384.V350317.R01.S.doc Version 5.2 Page 33 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 1 2 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 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 1 1 x x 2 x 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 x x 2 1 x 1 Glendon House DS0000027384.V350317.R01.S.doc Version 5.2 Page 34 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 OP3 Regulation 14.1(c) Requirement The registered person must ensure that consultation with the service user and/or their family takes place as part of the assessment process. The registered person must ensure that the home can meet the assessed needs of a prospective service user. This relates particularly to the admission of a resident who does not have a diagnosis of dementia. The registered person must ensure that a photograph of each resident is kept in included in the care plan The registered person must ensure that a completed care plan is written for all residents. The registered person must ensure that residents’ care plan are meaningfully reviewed on a regular basis. Timescale for action 01/11/07 2. OP4 14 01/11/07 3. OP7 17.1 (a) 01/11/07 4. 5. OP7 OP7 15.1 15.2(b) 01/11/07 01/11/07 Glendon House DS0000027384.V350317.R01.S.doc Version 5.2 Page 35 6. OP8 12.1(a) 7. OP8 12.1(a) 8. OP8 12.1(a) 9. OP8 12.1(a) 10. OP8 13.5 The registered person must ensure that the health needs of residents are met. This relates specifically to the monitoring and administration of fluid to residents. This could relate to the significant number of urine infection residents living in the home suffer from. The registered person must ensure the health and welfare of residents. This relates specifically to the poor condition of a resident when admitted to hospital. The registered person must ensure that identified health needs that are recorded in care plans are met. The registered person must ensure that the continence needs of residents are being met in the home. This relates particularly to the significant number of residents who wear continence aids all of the time and are not taken to the toilet on a regular basis. This could contribute to the large number of urine infections that residents in the home suffer from. The registered person must make suitable arrangements for the moving and handling of residents and ensure that residents have access to their walking aids and are assisted to move about the home as independently as possible. 01/11/07 01/11/07 01/11/07 01/11/07 01/11/07 11. OP8 12.(a) The registered person must 01/11/07 ensure that the good health of service user is promoted. The residents living in the home have a high level of urine infections and the manager should be addressing why this is so. DS0000027384.V350317.R01.S.doc Version 5.2 Page 36 Glendon House 12. OP9 13.2 13. 14. OP10 OP12 12.4(a) 16.2(n) 15. OP15 18.1(a) 16. OP15 18.1(a) 17. OP18 18.1(c)i. The registered person must ensure that there are suitable arrangements for the safe administration of medication. A separate pharmacy inspection has taken place with several requirements relating to medication. The registered person must ensure that the dignity of residents is promoted. The registered person must ensure that there are suitable activities and facilities for recreation for the residents. The registered person must ensure that there are sufficient numbers of staff on duty to offer support to residents who need assistance at meal times. The registered person must ensure that staff have the appropriate training and knowledge to ensure that all residents are receiving the quantity and quality food to meet their nutritional needs. The registered person must ensure that all staff receive the appropriate training to give them the knowledge of how to promote safe practice. This relates to several staff not having received safeguarding adults training. 01/10/07 01/11/07 01/11/07 01/11/07 01/11/07 01/12/07 18. OP26 23.2(d) The registered person must 01/11/07 ensure that all areas of the home are kept clean. This relates particularly to the door frame between the downstairs bedroom corridor and the dining area. The door frame was smeared DS0000027384.V350317.R01.S.doc Version 5.2 Page 37 Glendon House 19. OP21 23.2(e) 20. OP20 23.2 21. OP26 13.4(a) with faeces. The registered person must 01/11/07 ensure that residents have access to toilet facilities and their own private accommodation. On the day of inspection some bedrooms and toilets were found to be locked giving no access to residents. The registered person must 01/11/07 ensure that the seating in the communal areas is clean, usable and meets the needs of residents and visitors. This relates particularly to the stained and sometimes damp lounge chairs, some of which do not have seat cushions. That registered person must 01/11/07 ensure that general soiled laundry that is being collected by staff is not left in laundry baskets in residents’ rooms as this could promote infection. 22. OP26 23.2(d) 23 OP27 17.2 24 OP27 18.1(a) 25. OP28 18.1(c) The registered person must ensure that the home is kept clean and free from any offensive odours. The home has a general unpleasant musty stale smell and a strong smell of urine in specific areas. The registered person must ensure that the rota reflects the actual times worked by staff. The rota seen was not a true record of hours staff worked. The registered person must ensure that there are enough staff with experience and competence to meet the needs of residents. Many examples were evidenced on the day of inspection that this was not the case. The registered person must DS0000027384.V350317.R01.S.doc 01/11/07 01/11/07 01/11/07 01/11/07 Page 38 Glendon House Version 5.2 26. OP29 19 27. OP30 18.1(c) 28. 29. OP36 OP38 18.2 13.4(c) ensure that the home employs staff with the skill and qualification to meet the needs of the residents. The registered person must ensure that the recruitment policy and procedure protects residents and that all the appropriate documentation is received prior to the worker commencing employment. The registered person must ensure that all staff receive the appropriate training and induction to fulfil the care role in full. The registered person must ensure that staff receive regular supervision The registered person must ensure that when risks to residents are identified that appropriate risk assessments are formulated an actioned as a way of minimising the risk to the resident. The registered person must ensure that the incident and accident book is an accurate record of the incidents and accidents that take place in the home. 01/11/07 01/11/07 01/11/07 01/11/07 30. OP38 17.2 01/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP19 OP20 Good Practice Recommendations It would be good practice that all light fittings are furnished with a lampshade. It would be good practice to make sure that the DS0000027384.V350317.R01.S.doc Version 5.2 Page 39 Glendon House 3. 4. OP20 OP19 5. OP25 6. OP34 temperature in the sun lounge does not get too hot or too cold. It would be good practice to make better use of the garden for residents. The registered person must ensure the layout and design of the premises meets the needs of residents. This relates particularly to the lack of signage within the home for communal and private areas. The registered person must ensure that the home provides equipment that will promote the safety of residents. This relates particularly to the lack of assisted technology used by the home. It would be good practice to ensure that family are invoiced on a more regular basis so they do not receive unexpected large bills. Glendon House DS0000027384.V350317.R01.S.doc Version 5.2 Page 40 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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.V350317.R01.S.doc Version 5.2 Page 41 - 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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