Inspection on 08/11/07 for Abbey Care Home

This inspection was carried out on 8th November 2007.

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

Abbey Care Home 11/11/09

Abbey Care Home 18/05/09

Abbey Care Home 06/05/08

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

CARE HOMES FOR OLDER PEOPLE Great Clacton Hall 28 North Road Great Clacton Clacton On Sea Essex CO15 4DA Lead Inspector Marion Angold Key Unannounced Inspection 8th November 2007 11:00 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 Great Clacton Hall DS0000070394.V354575.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. Great Clacton Hall DS0000070394.V354575.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Great Clacton Hall Address 28 North Road Great Clacton Clacton On Sea Essex CO15 4DA 01255 420660 01255 420660 info@careone.co.uk 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) Care One Ltd Mrs Barbara Leggett Care Home 11 Category(ies) of Dementia (11), Mental disorder, excluding registration, with number learning disability or dementia (11), Old age, of places not falling within any other category (11), Physical disability (11) Great Clacton Hall DS0000070394.V354575.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service: Care Home - PC to service users of the following gender: Both Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - code OP Dementia - code DE Mental disorder, excluding learning disability - code MD Physical Disability - code PD Date of last inspection N/A Brief Description of the Service: Great Clacton Hall is a period property situated in the centre of Great Clacton, close to shops, the village church and public transport. The home was sold in August 2007 and registered under the new provider, Care One Ltd. The home is registered to care for eleven elderly people over the age of sixtyfive, who may or may not have dementia. There are two shared bedrooms on the ground floor (with bath or shower), one shared and five single bedrooms on the first floor. The bathroom is upstairs. As there is no passenger lift, service users upstairs must be fully mobile. Great Clacton Hall DS0000070394.V354575.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was the first to be carried out at Great Clacton Hall since the new owner was registered on 10 August 2007. It took into consideration all the information the Commission had received about the home since that date, including the Annual Quality Assurance Assessment (AQAA), completed for the Commission by the owner on 27 November 2007. The site visit, lasting 9.5 hours took place on 8 November 2007 and involved speaking with people living and working at the home, as well as the owner and a visitor. It also entailed a partial tour of premises, observation of care practice and the sampling of records. Although a number of staff surveys and relative/ representatives’ surveys were left for the owner to distribute, only one relative survey has been returned to the Commission. Two people living at the home completed surveys with the help of the inspector. What the service does well: What has improved since the last inspection? • People coming to live at the home had a full assessment of their needs and the home was in the process of re-assessing the needs of existing residents. Some care plans had been developed since the last inspection, giving clearer guidance to staff in the areas they covered. Excess stocks of medication had been cleared, ready to be returned to the pharmacy, thereby reducing waste and the possibility of mistakes in administration. A change in the shift arrangements meant that people had more choice about when to get up. DS0000070394.V354575.R01.S.doc Version 5.2 Page 6 • • Great Clacton Hall • • • A complaints record had been introduced to show how issues people raised were being addressed and monitored. A hoist had been installed so that some people would be able to have baths. One person said how lovely it had been to get into a bath. Staff meetings were taking place regularly to facilitate communication between management and staff. What they could do better: • People living at the home and prospective residents need information about the service they can expect from Great Clacton Hall and how to make a complaint (Service User Guide). They also need contracts, setting out the terms and conditions of their residence. Everyone living at the home should have a care plan covering all their needs so that staff know how to ensure individuals are experiencing the best possible quality of life. People must be enabled to make more choices, for example, in respect of what they have to eat. They must be stimulated and occupied in ways that enhance their wellbeing. The owner must ensure that people living at the home are not put at risk through inattention to safety regulations and procedures. Everyone must have access to suitable bathing or shower facilities. Arrangements for supporting people with their personal hygiene and laundry must protect everyone from infection. The manager / owner must follow all the required procedures for recruiting and selecting staff so that people living at the home are protected from anyone, who might not be suitable to work with them. People working at the home must also have contracts setting out the terms of their employment. Good quality training is needed to enable staff to develop and be aware of current good practice. • • • • • • • Great Clacton Hall DS0000070394.V354575.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Great Clacton Hall DS0000070394.V354575.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 Great Clacton Hall DS0000070394.V354575.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): 1, 2, 3 and 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People can expect to have their needs assessed before coming to the home but not to be given information in writing to help them make a decision about whether the home would be suitable for them. They can also not expect to have a valid contract, setting out the terms and conditions of their stay. EVIDENCE: The Statement of Purpose, prepared by the new owner, does not include information about bathing facilities. People living at the home said they had not been given information about what they could expect from the new owner (Service User Guide) or new contracts. This included a person who had come to stay at Great Clacton Hall since the change of ownership. Although the Annual Quality Assurance Assessment, Great Clacton Hall DS0000070394.V354575.R01.S.doc Version 5.2 Page 10 (AQAA) of 27 November 2007, stated that the home had a Service User Guide, this was not available for inspection. The admission of the new person had been based on a full assessment of their needs but they did not visit the home before moving in and could not recall receiving confirmation in writing that the home could meet their needs. Great Clacton Hall DS0000070394.V354575.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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People can expect their health and personal care needs to be met according to an individual plan but they cannot be sure that their emotional, social, spiritual and intellectual needs will be planned for or fully met. EVIDENCE: Five care plans were inspected, including one for a person new to the home. The three that had been developed under the new owner gave clear instructions to staff in respect of health and personal care but did not address each person’s needs holistically. For example, one person had detailed plans covering continence and unsteadiness but nothing to tell staff how to work with the various aspects of their dementia to enhance the quality of their life. Personal profiles, containing information about people’s backgrounds and interests, were not linked to individual care plans. Great Clacton Hall DS0000070394.V354575.R01.S.doc Version 5.2 Page 12 Care plans provided good examples of people being encouraged to maintain independence with personal care and choosing clothes. Individual risk assessments had been completed recently for all five people in this sample and daily records were sufficiently detailed to show that staff were monitoring people individually during their shift. Monthly evaluations of care plans had not been established. People expressed confidence that their healthcare needs were met at the home. One person’s particular health condition was covered in detail in their care plan and there was evidence of monitoring; another’s risk of falling had been assessed. A third care plan addressed the health risks associated with immobility, although the actual plan had not been put into action for the person concerned. The owner’s report to the Commission (September 2007) indicated that staff had received medication training, which discussion showed had been delivered in house. Excessive stocks of medication had been cleared from the shelves under the owner’s instruction, ready to be returned to the pharmacy. A box of standard painkillers, found to one side in the medication cupboard, but no longer used by the person, had yet to be returned to the pharmacy. Procedures for administering and recording lunchtime medication were satisfactory on the day of inspection. A sample of the signatures of people authorised to administer medication was kept with the records. The owner said that, in future, only people who attended the forthcoming medication training, would be given authorisation. The care plan inspected for a person new to the home showed that their medication had been recorded on admission. They were confident that they were getting the tablets prescribed. Another person living at the home expressed the view that medication was administered efficiently. They were routinely asked whether they needed their PRN (as needed) medication. People spoke very highly of the care they received and the way staff treated them. One person said, ‘you couldn’t get better staff’. Staff were observed treating people with kindness and respect. The telephone had been moved into the conservatory / dining room from the kitchen, so that people could make and receive calls. All rooms in use had an en-suite facility for privacy with personal hygiene. A member of staff entered a person’s room to empty their catheter bag. Although they knocked and told the person what they intended doing, it would have been good practice to consult them about proceeding in the inspector’s presence. In another situation, observed by the inspector, the person’s dignity was not respected when staff, involved in assisting them to mobilise, did not prepare them more for what they were about to do and hurried to prise from their hand the plastic brick they were holding. Great Clacton Hall DS0000070394.V354575.R01.S.doc Version 5.2 Page 13 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at Great Clacton Hall can expect a lifestyle, which mainly suits their needs and preferences but, with appropriate support, they could exercise more choice and control in some areas of their lives, and be stimulated and occupied in ways that enhanced their wellbeing. EVIDENCE: Two of the four people seated in the lounge had a selection of bricks and small toys to handle. These remained on their individual tables throughout the inspection and served well to provide them with individual stimulation and a focus for social interaction. Two other people sat unoccupied all day in their armchairs, with the television on in the morning and music playing in the afternoon. One said it was the same every day and they found it boring. This person was not able to see or adequately hear the television. Staff had been instructed to ensure that, whenever possible, one person remained in the lounge. They were observed talking with people intermittently. Great Clacton Hall DS0000070394.V354575.R01.S.doc Version 5.2 Page 14 The other people living at the home said they preferred to stay in their rooms and did not wish to take part in any ‘activities’ arranged by the home. One person was adamant that they did not wish to be encouraged to go into the lounge. One person said there were no activities apart from television, another said there were none they could take part in, although off duty staff sometimes took them into town. They also mentioned a mobile library facility and an impromptu singsong, which one of the staff had started up at breakfast that morning. Personal profiles were not linked to care plans. For example, one person with dementia had previously had a specific interest. However there was nothing in the care plan to show that thought had been given to how staff might use this knowledge in enabling meaningful activities. Discussion with another person living at the home showed that an improvement in their quality of life and wellbeing could be achieved by facilitating an activity they enjoyed. Although the owner said that a mini bus was available for outings, extra staff would be needed to support this plan. Staff indicated that a change in shift patterns meant that people living at the home were able to get up later. People who spoke with the inspector about this were satisfied with the arrangements. One said they usually woke on their own but they would be brought a drink at 7:00 am and did not mind if this woke them up. Another person had reported that they did not like being disturbed by staff checking on them at night and, after some delay, this was being addressed. One person living at the home commented on the phone being moved from the kitchen to the dining room, so that people living at the home as well as staff could use it. They indicated that visiting arrangements were as flexible as they had been under the previous owners. One visitor came every afternoon and stayed until after the evening meal. People living at the home said they usually enjoyed their meals. One said they had always liked the food ‘well enough to eat’. Another said they were given ‘good, plain food’ and had ‘choice to a degree’. People explained they could choose what they had for breakfast but lunch and tea were the same for everyone. They could anticipate fish on Fridays but otherwise did not know what would be served. One person said they would like to have a menu. People living and working at the home expressed concern about the owner changing the menu and imposing restrictions on what people could have, such as only one slice of toast for breakfast and no milk drinks at bedtime. Although the owner had talked with people living at the home about menus, they felt that their views were not fully taken into account. The owner acknowledged that he had changed the menu to bring in what he called ‘proper Great Clacton Hall DS0000070394.V354575.R01.S.doc Version 5.2 Page 15 meals’ as he did not consider, for example, ‘cheese and biscuits’ to be adequate. He had also moved the roast dinner to Sundays in respect of cultural tradition. One person said that they preferred the lighter teas they used to have and sometimes asked for bread and jam. The new owner had changed the times of the main meals to 9.00 am, 1:00 pm and 6:30 pm. Two people were happy with this, one said they preferred tea being earlier and got hungry during the afternoon. The inspector was informed that a dietician visiting 2 people in the home had approved the new menu for everyone. It was noted at this inspection, however, that all but one of the tea menus were high in fat and carbohydrate and did not include fruit, vegetables or salad, which meant people were sometimes having only 1 of the 5 recommended portions a day. There was no evidence provided to show that people were offered a choice of milk, such as semi-skimmed or full cream. The owner agreed to review menus in the light of feedback from this inspection. Great Clacton Hall DS0000070394.V354575.R01.S.doc Version 5.2 Page 16 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. This judgement has been made using available evidence including a visit to this service. People were confident about the good will of the people caring for them, and being able to say if they were not happy, but they were not fully confident that their views would be acted on. EVIDENCE: A couple of people said they had not been informed how to make a complaint. One said they would speak to staff if unhappy; another indicated that they felt able to challenge the owner about decisions and had done so. People indicated that staff listened and acted on what they said but two people felt the owner had sometimes discounted their views, as with the decision to exclude a dog that belonged to one of the people working at the home. The new owner was able to explain why this decision had been taken. The complaints log showed that 2 complaints had been received, one about the dog not being allowed in the home, the other about a person’s wish not to be disturbed at night by staff doing two-hourly checks. The action and outcome relating to the above complaints, made on 21/08/07 and 7/10/07 respectively had not been recorded. Staff were still monitoring the person every 2 hours during the night and telling them this had to be Great Clacton Hall DS0000070394.V354575.R01.S.doc Version 5.2 Page 17 done. The owner said he would draw up an agreement with the person to show that it was their choice not to be disturbed and complete the entries in the complaint log. The home’s policy and procedures for safeguarding adults did not take account new guidance issued locally, but the owner was aware that there had been changes and had obtained a copy of the Essex guidelines as a basis for in house training. Discussions with staff throughout the inspection showed that they were keen to promote the welfare of residents. People living at the home or visiting spoke highly of the way staff treated people, using such words to describe them as ‘caring’, ‘helpful’, ‘good’ and ‘kind’. CSCI considers that, despite the good intentions of staff, people at the home had been placed at risk by the home’s recruitment practice and recent events in respect of fire safety and moving and handling. These matters have been addressed under separate headings in this report. Great Clacton Hall DS0000070394.V354575.R01.S.doc Version 5.2 Page 18 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 and 26. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People benefit from a homely environment however they cannot be assured that they can access all parts of the home and that it is maintained in such a way to safeguard the people living there. EVIDENCE: Communal areas were well maintained. People expressed satisfaction with their rooms. One person said a second chair would be handy for visitors. One of the bedrooms inspected needed refurbishment. Tendring District Council, Environmental Services had issued a prohibition order in respect of the bath hoist, which the owner had installed, but not had Great Clacton Hall DS0000070394.V354575.R01.S.doc Version 5.2 Page 19 certified as safe and was, in fact, not securely bolted to the floor. People living at the home confirmed that they were unable to use the bath until the hoist had been fixed. One person said it had been ‘lovely to get in a bath’. Others expressed similar views. A representative from a company authorised to approve the safety of hoists, made adjustments to the installation of the bath hoist during the CSCI inspection and certified it as safe to use. The owner was advised to ensure that individual risk assessments for people using the hoist, and training for staff, had been completed before the hoist was put into use. Individual risk assessments would also be necessary in respect of other hoists, certified as safe during the inspection. The owner had also turned round a fire door, which shut off the stairwell without replacing the automatic closure. Although the Environmental Services officer had pointed out the seriousness on 31/10/07, it had still not been replaced by the date of this inspection, on 8/11/07. The fire door was also wedged open on this occasion. The owner explained the delay was due to having to replace the closure that had broken. Although previous records showed lapses in fire safety checks conducted by the home, a new log, provided by the company that tested the alarms on 20/10/07 had been started, with the first of a series of appropriate checks having taken place. Staff advised that the owner was planning the installation of a stairlift to address the fact that people with poor mobility could not use the stairs. It will be necessary to show that restricted space on the spiral staircase does not compromise the safety of people who go up and down on foot. In the meantime the home has had to move people around so that those with least mobility are accommodated on the ground floor. People living at the home said that it was always clean and fresh and this was the case in the areas inspected. The home did not have a sluice or a washing machine with sluice facility and, according to staff, the practice was to rinse soiled clothes in the butler sink in the laundry before placing them on a hot wash. This practice must be reviewed, as the butler sink discharged into the drains, rather than into a soil pipe, and the manual sluicing of soiled laundry presented a cross infection risk for staff and people in the home. Procedures for handling wet and soiled laundry presented a risk of infection. One laundry pile was observed by an outside door (next to the kitchen) waiting to be taken to the laundry in a separate building in the grounds. A member of staff, not wearing gloves and apron, was also seen carrying under their arm to the laundry unwashed clothes wrapped in a towel. The person concerned acknowledged that some of it was wet with urine but pointed out that it was in a towel. They did not use plastic bags to protect themselves of avoid the transfer of germs as they went through the home. Great Clacton Hall DS0000070394.V354575.R01.S.doc Version 5.2 Page 20 The armful of laundry, including slippers and towel, was put on a 40-degree economy wash, which was insufficient to control infection. The staff member then handled clean linen in the laundry room without washing their hands. Staff reported that they usually used a basket to take linen to the laundry and that the person going off the last shift had locked away the plastic aprons in error so they could not get to them. Supplies of gloves, however, were prominently available during the inspection. Although paper towels and liquid soap were supplied in the kitchen, there was no provision for washing hands in the laundry and anyone washing their hands after using the staff toilet, had a communal towel, which increases the risk of cross infection. Great Clacton Hall DS0000070394.V354575.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staffing levels met the basic needs of people using the service. The home’s recruitment practice did not fully protect people living at the home and lack of staff training impacted on the skills of people providing care and support. EVIDENCE: Staff said that the new owner had introduced a change in shifts, which now ran from 8:00 am – 15:00 pm; 15:00 pm – 21:00 pm; 21:00pm – 8:00 am. One member of staff said that this was an improvement for people living at the home because it meant that they did not have to get up so early. People living at the home confirmed this to be so. Shifts continued to be covered by two people, whose responsibilities included meal preparation, cleaning, laundry and management (the manager or deputy manager would count as the second person, when they were on duty), as well as the direct care of individuals. People who spoke with the inspector indicated that care staff were available when needed. One person said that carers checked on them periodically and would respond promptly to the ‘buzzer’, if they called for help. It became evident from discussion with the owner and staff that the owner was considering having only one person on duty at night. The home’s AQAA received on the 27 November showed that the change to one person had Great Clacton Hall DS0000070394.V354575.R01.S.doc Version 5.2 Page 22 already been made and that 1 person needed two people to assist them during the daytime only. Care plans showed that at least 2 people at the present time needed 2 people to assist them; a third person was observed to need 2 staff to help them mobilise. The home must be able to demonstrate that staffing levels meet individual needs at all times. Recruitment files were inspected for two people who had come to work at the home since it came under new ownership. These showed that not all the appropriate procedures and checks had been carried out. In one case the home had obtained only one written reference, instead of the required two. In the other, neither of the written references had been requested by the home in connection or related to the post, and one of them was not dated. One person had started working at the home over a month before their POVA First check that provides information about whether the person has been listed as unsuitable to work with vulnerable adults. The home’s AQAA stated that the home had a rolling programme of training but the inspector did not find evidence of this during the site visit. Discussions with staff and the owner showed they had not attended any external training since the last inspection on 12 April 2007, although the owner had given training on various aspects of their work, such as administering medication. Although it is recognised that the home changed hands as recently as August 2007, lack of formal training has been an ongoing issue (there had been none for at least a year leading up to the last inspection) and needs to be addressed as a matter of priority. This inspection highlighted a need for staff training in the areas of dementia care, infection control and moving and handling. For example, staff observed taking a person with dementia to the toilet, did not spend time engaging and preparing them for the exercise and, one member of staff, prised a plastic brick out of the person’s hand, showing lack of understanding of their experience. The owner said that staff new staff were working through the Skills for Care induction programme but had the course material with them to work on. The owner said all staff would be encouraged to undertake the programme. New staff were not available to talk about their experience of induction and other staff did not know about the Skills for Care programme, only that new staff shadowed them. Although the inspector left a number of surveys with the owner to distribute to staff, none have been returned. Great Clacton Hall DS0000070394.V354575.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People were not benefiting from a consistently well run home and could not always depend on the home’s practices and procedures promoting their safety and welfare. EVIDENCE: The owner had been very much involved in the day-to-day management of the home. A person living at the home reported that he visited at least once a week, sometimes twice. The owner advised that the registered manager would be expected to undertake the National Vocational Qualification in Care, Level 4 Great Clacton Hall DS0000070394.V354575.R01.S.doc Version 5.2 Page 24 and the Registered Manager’s Award, with a view to improving the running of the home. People living and working at the home acknowledged that the new owner had introduced some change for the better, examples of which have been given elsewhere in this report. However, discussions with the owner and staff also indicated that working relationships between employer and some employees were sometimes strained. Staff did not have contracts. The owner had provided the Commission with monthly reports of their monitoring visits to the home but not notified the Commission immediately, as required, when the manager’s absence from the home had exceeded a period of 28 days. The Annual Quality Assurance Assessment (AQAA) completed by the owner contained some information that was not consistent with the findings of this inspection. For example, the home did not have an industrial washing machine at the time of inspection, there were no individual activity plans for people living at the home or evidence of their regular participation in ‘activities that motivated them’ and reports from the Environmental Health Officer did not, as indicated, evidence good practice in respect of safeguarding people living and working in the home. One member of staff was responsible for service users’ money held in the safe, and another checked the records and balances for accuracy. Although the method of recording transactions was unconventional, an audit trail was maintained and receipts kept of personal expenditures. Records and cash balances were found to be in order, as sampled for two people. Relatives had endorsed the records of deposits they had made. In one case the member of staff had been acting as Department of Work and Pensions appointee for 5 years; this involved collecting the person’s weekly benefit and paying their residential fees, as well as recording personal expenditures. All these transactions were detailed. The owner understood that these arrangements needed to be reviewed with the introduction of the Mental Capacity Act. One person living at the home, whose transaction records were inspected, knew that their money was kept in the safe and paid for things they asked staff to get for them. Records and discussions showed that, in the manager’s absence, the new owner had held monthly staff meetings. The owner stated that regular supervision had also commenced and would take place every 2 months. One member of staff confirmed that they had had their first one to one meeting to discuss their work. This inspection highlighted a number of safety issues, which have been covered under the section on the environment and pertain to fire safety and infection control. The main concerns raised during a recent inspection by Great Clacton Hall DS0000070394.V354575.R01.S.doc Version 5.2 Page 25 Environmental Health Services (31 October) were lack of risk assessments relating to household chemicals used by the home, water safety (legionella) and other environmental hazards and also the use of a bath hoist, installed by the owner, that had not been certified as safe. The owner was addressing these matters at the time of inspection and all three hoists in the home were checked and, where necessary, made safe, on 8/11/07. Safety certificates inspected for gas and fire alarms had been issued recently; inspection of electrical systems and portable appliance testing were due. Great Clacton Hall DS0000070394.V354575.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 1 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 2 2 X X X X X X 1 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 1 Great Clacton Hall DS0000070394.V354575.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? N/A 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 OP18 Regulation 13 Requirement The home must have up to date safeguarding adults procedures, that are in line with locally and nationally agreed guidance so that staff know how to protect people and take the right action in the event of an incident or suspicion of abuse. People must have access to all areas of the home, designed for their use. Fire doors with automatic closing mechanisms (in this case a requirement of the Fire Authority) must not be deactivated or wedged open. Appropriate arrangements must be made to ensure that the handling of soiled linen does not present a risk of cross infection. Staff must have adequate training to ensure they have the up to date knowledge and skills they need to support and protect people living at the home. Before employing staff the home must obtain all the documents and records that are required to protect residents from people who should not be working with DS0000070394.V354575.R01.S.doc Timescale for action 15/12/07 2. 3. OP21 OP22 OP19 OP26 OP38 23 13 31/01/08 01/12/07 4. OP30OP38 OP19 13, 18 31/01/08 5. OP29 17 Sch 4 & 19 Sch 2 18 01/12/07 Great Clacton Hall Version 5.2 Page 28 6 OP31 38 (2) (4) them. Prospective employees must give a full employment history so that any gaps can be explored. Where the registered manager has been absent from the care home for a continuous period of 28 days or more, and the Commission has not been given notice of the absence, the registered person must without delay give notice in writing to the Commission of the absence, specifying the required details. 01/12/07 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. 3. 4. Refer to Standard OP2 OP12 OP7 OP15 OP29 Good Practice Recommendations People living at the home should have contracts of residence so that they know what they can expect from their home and what is expected of them. Activities should be tailored to each person’s needs and preferences. People should be more involved in deciding what they eat and have a menu they can refer to. Prospective employees should give a full employment history so that any gaps can be explored, as this helps to ensure they are suitable to work with vulnerable people. They should also have contracts, agreeing the terms of their employment. The registered manager should achieve the National Vocational Qualification in care and management, Level 4, to assist her in running the home. 5. OP31 Great Clacton Hall DS0000070394.V354575.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Great Clacton Hall DS0000070394.V354575.R01.S.doc Version 5.2 Page 30 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!