Inspection on 10/08/06 for Great Wheatley

This inspection was carried out on 10th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Great Wheatley 25/09/07

Great Wheatley 19/02/07

Great Wheatley 16/12/05

Great Wheatley 19/05/05

Great Wheatley 09/12/04

Great Wheatley 15/07/04

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

CARE HOMES FOR OLDER PEOPLE Great Wheatley 3a Great Wheatley Road Rayleigh Essex SS6 7AL Lead Inspector Carolyn Delaney Unannounced Inspection 10th August 2006 10:00 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 Wheatley DS0000048207.V306336.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 Wheatley DS0000048207.V306336.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Great Wheatley Address 3a Great Wheatley Road Rayleigh Essex SS6 7AL 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) 01268 777281 Mr Raju Ramasamy Mr Inayet Mohmed Patel Mrs Lai-Wah Collin Care Home 21 Category(ies) of Dementia - over 65 years of age (21), Old age, registration, with number not falling within any other category (21) of places Great Wheatley DS0000048207.V306336.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Personal or nursing care to be provided to no more than 21 people. Over the age of 65 years (OP). Personal or nursing care to be provided to no more than 21 people. Over the age of 65 years with dementia (DE). Number of service users to whom personal and nursing care is to be provided shall not exceed (21) twenty-one. The kitchen must be refurbished as highlighted in the home’s recent EHO visit on the 10th April 2003. This to be undertaken within six months from the date of registration. The steep slope on the patio and steps to the rear of the property present a satiety hazard. A gate with access is to be fitted across both the slope area and the steps. This to be undertaken within three months from the date of registration. The front gate and the signage for the home at the entrance to the driveway require replacement. This to be undertaken within one month from the date of registration. Storage facilities for equipment must be made available. This to be undertaken within three months from the date of registration. Pipework, which is presently temporarily lagged, must be priority risk assessed and boxed in. This to be undertaken within one month from the date of registration. Individual lockable facilities within a risk-assessed strategy should be made available for service users to use in their rooms. This to be undertaken within two months from the date of registration. A plan of renewal and routine maintenance for the home should be collated and forwarded to the National Care Standards Commission. This to be undertaken within two months from the date of registration. 16th December 2005 5. 6. 7. 8. 9. 10. Date of last inspection Brief Description of the Service: Great Wheatley is a care home, which provides services for older people in need of nursing care. Whilst most service users have long term care requirements, the home also offers short-term respite care provision when needed. The home is situated in a residential area of Rayleigh, close to all amenities and within a quarter of a mile from the A127 London/Southend. Service provision includes nine single rooms and six double bedrooms five of Great Wheatley DS0000048207.V306336.R01.S.doc Version 5.2 Page 5 which have ensuite facilities. Assisted bathrooms and WCs are provided on both floors. There are four communal areas for service users and a small terraced garden with seating. Car parking for up to four cars is provided at the front of the property. Both trained nurses and carers make up the staff team; qualifications and training provision are set out in the homes statement of purpose. The range of fees for accommodation and nursing care at the home is between £531.00 for a shared room and £577.00 for a single room. Other services such as hairdressing, chiropody and aromatherapy are available at an additional charge. Great Wheatley DS0000048207.V306336.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine unannounced Key inspection carried out on 10th August 2006. Lead inspector Carolyn Delaney and inspector Michelle Love carried out the inspection. As part of the inspection process a number of the Commissions ‘ Have your say about . . . ’ service users questionnaires were posted to the home prior to the inspection visit to be distributed to residents for their views and to be returned to the Commission. However at the time of writing this report none of these had been returned to the Commission. In addition a further six residents living at the home were spoken with during the inspection visit. The relatives of eleven residents at the home were contacted by post so as to offer them the opportunity to make comments about the services provided by the home. At the time of completing this report eight of these people had responded. Information regarding health and social care professionals who are involved with the care of residents living at the home was requested prior to the inspection. However this was not provided and the views of these people will be sought and incorporated into the next key inspection report. The comments and views of residents and those people who responded to questionnaires have been used in conjunction with the findings of the inspection visit so as to make a judgement about the level of services provided by the home and have been included throughout the report. Records including assessments, care plans, daily care notes, and medication records and risk assessment documents in respect of five people living at the home were examined. Five residents and one relative were spoken with during the inspection Four members of staff including the homes manager were spoken with and a number of records including duty rota’s and staff recruitment files were examined. A tour of the premises was carried out. Key standards as identified in the intended outcomes sections of this report are inspected at each key inspection. Key standards are identified for each section of the report. Where other standards have not been assessed these will have been assessed at previous inspections. Reports in respect of previous inspections may be accessed via the Commissions website www.csci.org.uk. Great Wheatley DS0000048207.V306336.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? What they could do better: The homes owners / manager should ensure that the home will be able to meet the needs of each person before they are admitted to the home. Staff working at the home could pay more attention to basic personal care needs such as ensuring that residents hair, nails teeth and dentures are clean. A Great Wheatley DS0000048207.V306336.R01.S.doc Version 5.2 Page 8 number of residents, particularly those who are less able and need to spend prolonged periods being nursed in bed did not look well cared for and nails and teeth were dirty. It was also noted that toothbrushes were dry and dirty and had not been used for some time. A number of resident’s relatives have commented that personal care of residents could be improved and that the facilities for bathing were not sufficient for the numbers and needs of residents. More care also needs to be taken when moving the more frail residents so as to minimise injuries such as skin tears. There have been a number of incidents where residents have sustained tears to their skin as a result of being moved by staff. A number of resident’s relatives commented that there were very little in the way of activities or stimulation for people living at the home. It was noted that there were no activities provided on the day of the inspection and that a number of residents were left in lounge areas without any stimulation or social interaction for most of the day and on occasions where staff were providing assistance such as at mealtimes they rarely engaged in any conversation with residents. Staff could offer more assistance to less able residents at mealtimes so as to ensure that these people receive meals, which are still hot. Residents who are more able may enjoy meals if they were offered beverages, condiments and sauces to compliment their meal. Some residents were left with their lunchtime meal which they clearly could manage to eat without assistance while staff served other residents their lunch. By the time staff came back to assist them their meal was cold and inspectors had to intervene to stop staff feeding residents cold food. Where relatives have made complaints they have not been happy with the outcomes and records did not indicate what outcomes were and whether complaints have been upheld or not. More could be done to make the home more comfortably and homely. A number of relatives made comments about the cleanliness and décor of the home. One relative said that the home was ‘shabby’ and another said the home could do with an update. Another relative complained about the lack of cleanliness in particular in resident’s ensuite bathrooms. On the day of the inspection carpets in communal areas and residents bedrooms were dirty and stained and a number of areas would benefit from redecoration. There were some unpleasant odours detected throughout the day in bedrooms, communal areas. The homes owners had reduced the numbers of staff working during the morning shift despite the fact that the homes manager was on holiday and that she had been spending less time at the home due her providing management support for one of the owners other homes. Great Wheatley DS0000048207.V306336.R01.S.doc Version 5.2 Page 9 Seven of the eight residents relatives who completed relatives comment cards said that in their opinion that there were not always sufficient numbers of staff on duty. One relative commented that staff ‘do their best under difficult circumstances’. Another relative commented that staff spent most of their time caring for residents who have dementia leaving very little time for the more mentally alert residents. It was clear from the observations on the day of the inspection that there were not enough staff on duty to provider proper care and attention to residents. All of the checks, which must be carried out before a person, is offered employment caring for vulnerable people have not been carried out. All staff working at the home have not received up to date training in respect of safe moving of people or protecting vulnerable and frail people from harm or abuse. Overall the home is poorly managed and run with only 4 of all standards inspected met in a satisfactory way and none of the key standards met. 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. Great Wheatley DS0000048207.V306336.R01.S.doc Version 5.2 Page 10 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 Wheatley DS0000048207.V306336.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The information contained within the homes statement of purpose does not accurately reflect the level of services provided by the home and the home fails to meet the level of service as set out in this document. Residents or their representatives receive a contract in respect of the accommodation and services provided by the home. Assessments of people needs are carried out prior to them being offered a place at the home however it is not clear that this is used so as to determine that the home will be the best place for the person to live. EVIDENCE: The home’s statement of purpose and service users guide was not readily available but was eventually provided by staff on the day of the inspection. There was no evidence that residents had been provided with a copy. The Great Wheatley DS0000048207.V306336.R01.S.doc Version 5.2 Page 12 statement of purpose describes services such as the provision of activities, staff recruitment and training which in reality the home fails to provide. The majority of people who have been admitted to the home recently had been issued with a contract of terms and conditions. There was evidence that people are not offered a place at the home prior to an assessment of their care needs having been undertaken usually by the homes manager. The pre- admission assessment documents for two people recently admitted to the home were assessed. One was very detailed and included very specific information about the person’s particular nursing and care needs. The second while lacking some specific detail did include sufficient information so as to allow staff to make a decision as to whether the home would be suitable and that staff would be able to provide appropriate care and treatment. However there was no evidence to suggest that any decision made to offer a place at the home is made having considered the needs of the individual, the people already living at the home and the resources including staff competencies and skills and it has been determined that the home will be able towards meet the persons needs. Great Wheatley does not provide intermediate or rehabilitative care. Great Wheatley DS0000048207.V306336.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Information about resident’s needs and wishes is not kept up to date and accurate and staff do not carry out care in accordance with care plan. Staff do not provide an acceptable level of care for the people living at the home and do not always act so as to promote residents health, welfare and dignity. Nursing staff do not act in a consistently safe manner in accordance with the homes policies and procedures, NMC Code of Conduct and current legislation when dealing with medicines. EVIDENCE: The homes statement of purpose states that relatives are involved in the care planning process however there was little evidence to support this in care plan, which were examined. Three of the eight residents relatives who completed comment cards indicated that they were not always informed of important Great Wheatley DS0000048207.V306336.R01.S.doc Version 5.2 Page 14 matter in respect of their loved ones and two said that they were not always consulted where residents could not make decisions for themselves. Care plans and other information recorded about the care and treatment for residents while generally fairly well written are not kept up to date in light of changes to a persons condition and where specific care is planned there was little evidence that care was given as per the plan. For example where it was recorded for residents who spent long periods being cared for in bed that they should have their position changed every two hours so as to minimise the risks of them developing pressure sores, there was little evidence that this care was carried out consistently. For one resident who required assistance and encouragement to eat and drink records in respect of oral intake should have been maintained. However these were not done so consistently and the resident was admitted to hospital suffering from the effects of dehydration. It was also recorded in the plan for one resident who has dementia and tends to wander around the home that staff should encourage the resident to engage in activities so as to keep him occupied and that staff should spend 1tp 1 time with the resident. There was no evidence to suggest that this support was provided for this resident. Residents who are particularly dependant upon staff to assist them with personal care are not supported in a satisfactory manner. A number of residents were examined and it was noted that nails, teeth, denture and mouth care was very poor. It was also noted that residents toothbrushes were dry’ dirty and unused. A number of resident’s relatives commented that personal care provision was not very good. Two relatives said that their loved ones only received a bath once every week and that bed baths were not satisfactory. One resident’s relative said that their mother could not have a bath as the hoist did not fit in the bathroom and another relative commented that there were no shower facilities. Assessments in respect of risks to resident’s health and welfare are not kept up to date and accurate and once risks have been identified staff do not act so as to minimise these risks. For example a number of residents have sustained skin tears due to staff handling. A resident sustained an injury when being moved by staff, which necessitated a visit to hospital. Following this incident a visit was made to the home and the registered providers were issued with an immediate requirement notice requiring them to ensure that staff assisted frail residents in an appropriate manner. It is noted with concern that following this visit the residents care plan and risk assessments had not been updated so as to minimise the risks of further injury. The home has a policy and procedure in place for the safe receipt, administration, storage and disposals of medicines. Staff were observed on the Great Wheatley DS0000048207.V306336.R01.S.doc Version 5.2 Page 15 day of the inspection to administer medicines at appropriate times. A number of Medication Administration Records (MAR) were examined: It was recorded on the MAR for one resident that they were to receive a particular medicine twice daily however records indicated that this was administered once a day. When the nurse in charge was questioned about this she said that it was an error and that the medicine should in fact be administered once daily. The nurse then proceeded to change the MAR without checking the prescription for the resident until advised to do so by the inspector. A number of omissions of nurse’s signatures in respect of medicines to be administered were noted in residents MAR. It was also noted on checking medicines that for one resident that twenty-eight tablets had been received and according to records twenty-four had been administered which should leave four. However there were at least ten tablets remaining and staff could not explain as to how this had occurred. Great Wheatley DS0000048207.V306336.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The home does not provide opportunities for activities, social interaction and stimulation in accordance with the statement of purpose or which meets the needs and expectations of the people living at the home. The majority of resident’s relatives feel welcomed to the home. Residents are not supported at mealtimes in a manner, which is suited to their individual needs. EVIDENCE: The homes statement of purpose states that there is a wide range of activities available for residents to participate in. However this is not evident. It was very disappointing to note that on the day of the inspection there were no activities and very little in the way of stimulation provided for the people living at the home. Staff spend little or no time engaging in social interaction and many staff were seen to carry out care and support without speaking with residents. A list of activities, which are available, was produced on the day of Great Wheatley DS0000048207.V306336.R01.S.doc Version 5.2 Page 17 the inspection. Four of the eight residents relatives who completed relatives comment cards indicated that there were not enough activities available for residents. One relative commented that her mother felt very isolated and spent most of the time in her bedroom. A relative commented that there were no activities or stimulation and that residents found it difficult to understand some staff due to their poor spoken English. One resident who has dementia was left for the most part to his own devices and spend the afternoon wandering around the home. Staff did not attempt to find any activities to occupy this resident nor did they engage in any social interaction with the resident. One relative actually having made several complaints about the poor quality of the television at the home bought a television and DVD’s for residents. Some residents were watching a DVD before lunch. When the programme had finished it reverted back to the main menu and the programmes theme tune played repeatedly for over twenty minutes before staff who were wandering in and out of the lounge area to notice and to change the DVD. Of the eight relatives who completed comment cards only one indicated that they were not always welcomed in the home at any time. During the day of the inspection and taking into consideration the comments made by relatives it is not clear that resident’s choices are considered and the routines of the home and staff practices are adapted so as to promote choice and independence. Two said that they were not always consulted where residents could not make decisions for themselves Inspectors observed the serving of lunchtime and evening meals. The lunchtime meal looked appetising and residents were offered beef stew with mashed potatoes and vegetables or a choice of eggs or cheese on toast or a salad. Staff were observed to serve the less capable residents their meal and leave them unattended. When inspectors commented upon this staff said that they were promoting independence, however it was clear that these residents required assistance. Staff took fifteen minutes to return and assist one resident with their meal by which time it was cold. When inspectors commented that the food would be cold staff reluctantly went to reheat the food. The more able residents were not served their meal in a setting, which was congenial, and promoted independence. Residents were served meals in the lounge area. Residents were not offered beverages with their meal and condiments or sauces etc were not offered. Staff were seen to take plated food, uncovered, on trays to residents in their rooms. The cook serves soft or blended meals in separate portions on a plate for those people who have difficulty in chewing or swallowing However it was disappointing to observe staff when assisting these people proceeded to mix the food altogether denying residents to enjoy their food in a normal way. Staff were also Great Wheatley DS0000048207.V306336.R01.S.doc Version 5.2 Page 18 observed to feed residents without speaking to them for the duration of the meal. The evening meal consisted of sandwiches or hash browns with beans. Portions were very small and while it is appreciated that some people may only wish to have small portions residents were not asked if they required extra. Great Wheatley DS0000048207.V306336.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 17 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Complaints and concerns are not always received and dealt with in a satisfactory manner. Measures including staff training and care practices are not in place so as to protect residents from unnecessary harm and or abuse. EVIDENCE: The home has a detailed policy and procedure in place in respect of how residents or their relatives etc may make a complaint and how this will be dealt with. There have been a number of complaints made by one residents relative and these issues have not been resolved at the time of writing this report. There were a small number of complaints recorded. Records regarding complaints were generally well maintained however outcomes were not recorded consistently so it was not clear how many complaints have been upheld. Three of the resident’s relatives who completed comment cards indicated that they had cause to complain abut the home. Two of the three indicated that they were not entirely satisfied about how the complaints were dealt with. The home has a policy and procedure for dealing with the protection of vulnerable people from abuse and harm. However there have been two incidents recently where residents have sustained injury through poor handling Great Wheatley DS0000048207.V306336.R01.S.doc Version 5.2 Page 20 by staff. One incident was brought to the attention of the Commission by staff at Southend Hospital. Staff at the home had failed to report this to the Commission. Following this a visit was made to the home on 9th June 2006 and it was found that a significant number of staff had not received up to date training in respect of the safe moving and handling of people or the protection of vulnerable people. An immediate requirement notice was issued at this time requiring the registered providers to take immediate action so as to ensure that staff were trained and acted so as to minimise the risks to residents of sustaining harm or injury. However at the time of this inspection staff had not undertaken training in respect of this. Great Wheatley DS0000048207.V306336.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, & 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The home is not maintained in a safe, clean and homely manner, which suits the needs of the people who live there. EVIDENCE: Three of the eight residents relatives who completed comment cards made comments about the décor and facilities provided by the home. One relative commented that the home had become ‘shabby’; another commented that the home could do with ‘an update’ and a relative complained about the lack of cleaning particularly in resident’s ensuite toilets. On the day of the inspection there was a dedicated member of staff on duty cleaning the home in the morning. However there were a number of areas throughout the home where unpleasant odours persisted throughout the day. Great Wheatley DS0000048207.V306336.R01.S.doc Version 5.2 Page 22 It was also noted that on the first floor items, which could be hazardous to health including cleaning materials, were left out within easy reach of residents who wander and may be at risk. Carpets were noted to be old, worn and dirty in both communal areas and some resident’s bedrooms. Two relatives commented that there were insufficient bathing facilities available as the hoist does not fit in the bathroom and there are no shower facilities. Another relative complained that one bathroom is out also out of use. These comments were not received until after the inspection visit and the registered provider had been contacted by post so as to confirm the arrangements available for washing and bathing at the home. Two relatives commented that their loved ones spent most of their days in their bedrooms as people who have dementia and who are disruptive and noisy make spending time in the communal areas unpleasant. Great Wheatley DS0000048207.V306336.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Staffing levels, skills and the practices for recruiting staff to work in the home are not satisfactory and do not best safeguard the welfare and interests of the people living there. EVIDENCE: Great Wheatley provides nursing care and accommodation for up to twentyone people many of whom are dependent upon staff for assistance with most activities of daily life including a number of people who have dementia. It was noted that the duty rota for the home was not maintained in an accurate manner and that it indicated that homes registered manager was working at the home on days when she was actually providing support to one of the other homes which is owned by the registered providers. The rota was also unclear in some instances as to what time some staff actually commenced and finished their duties The manager informed the inspectors that in her absence the numbers of staff working in the home had been reduced by one of the registered providers. This was confirmed on examination of the duty rotas. Great Wheatley DS0000048207.V306336.R01.S.doc Version 5.2 Page 24 Seven of the eight residents relatives who completed relatives comment cards said that in their opinion that there were not always sufficient numbers of staff on duty. One relative commented that staff ‘do their best under difficult circumstances’. Another relative commented that staff spent most of their time caring for residents who have dementia leaving very little time for the more mentally alert residents. During the inspection some staff were observed to spend very little time with residents and when they did they did not engage in any social interaction. A number of residents did not look well cared for in that their mouth, dentures and nails were not clean. Records did not evidence that staff assisted residents who are confined to bed to change their position in bed so as to minimise the risks of developing skin damage. A number of records were assessed in respect of staff who have been recruited to work at the home since the last full inspection. Records and information, which was available, indicated that recruitment practices at the home are very poor. There were no records to evidence that a Criminal Records Bureau disclosure or PoVA First check had been obtained for four of the five staff whose files were assessed. There was no evidence that leave to remain had been obtained for one member of staff in order to work at the home in accordance with their work permit and no proof of eligibility to live and / or work in the United Kingdom for another member of staff. References were not checked so as to determine that a candidate’s previous employer had provided them. The home uses a recruitment company to recruit staff from overseas. There was no evidence to suggest that the manager had carried out an interview of staff so as to determine that they would be suited to work in the home. There was evidence that some staff had received training such as wound management and use of syringe drivers for the administration of medicines for nursing staff. However it was not evident that all staff have had up to date mandatory training such as safe moving and handling pf people. This is of particular concern as poor moving and handling practices were highlighted in June when a random inspection was made to the home following concerns raised by social workers at Southend hospital. Records available and staff practices observed on the day of the inspection did not indicate that staff working at the home have been trained so as to best meet the needs of and protect the people living at the home from unnecessary harm. Great Wheatley DS0000048207.V306336.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The home is not managed in a manner, which meets the needs and protects the interests and safety of the people who live there. EVIDENCE: The homes manager cannot fulfil her responsibilities at the home due to the length of time she spend away from the home. This has had an adverse impact upon the way in which the home is managed. The home is not managed and run for the benefit o the people who live there and there are a number of areas where the level of service provided is poor. A number of resident’s relatives have commented that standards at the home have dropped considerably. Notably relatives commented that the cleanliness Great Wheatley DS0000048207.V306336.R01.S.doc Version 5.2 Page 26 and general state of premises had deteriorated and that there were little or no activities or stimulation provided for residents. Records maintained in respect of monies held by the home on behalf of residents are not maintained in a satisfactory manner. Receipts are available for hairdressing and chiropody however where staff use residents monies to purchase toiletries there are no receipts provided. It was also noted that records were not checked and countersigned so as to minimise the risk of error and mishandling. Staff said that regular audits of monies and records are carried out, however there was no evidence to support this. It was positive to note that staff receive regular supervision. However staff do not always act in a manner, which is expected of them by the management of the home. Records in respect of the maintenance and repair of gas, electric, fire and mechanical systems and equipment were very disorganised and it was not possible to determine that the checks as required by law and for the protection and safety of the people living at the home have been carried out satisfactorily. It has been recorded by maintenance staff that the closure systems for some of the resident’s bedroom doors have not been working satisfactorily for a period of months and in some cases do not close without staff intervention. There was no record of any action taken so as to deal with this issue. On the day of the inspection one resident complained that the closure system on their bedroom door had been ‘making a noise all night’. On examination it was found that the closures alarm was sounding. This was reported to staff who said that they were aware of this and that someone would deal with it during the day. However this problem had not been addressed at the time of inspectors leaving the home. It was further noted that the emergency lighting in the stairwell leading to the homes rear fire exit had not been working for some months. When questioned about this the homes manager said that the light was not needed and the light could be removed. However on examining this area it was seen to be dark with no natural light, making it unsafe particularly at night if residents had to vacate the home in the event of an outbreak of fire. A visit had been made to the home by the local fire authority in May 2006. Following this visit the home was required to undertake a fire safety risk assessment of the building. However at the time of this inspection this had not been carried out. A letter outlining the seriousness of the concerns raised at the inspection was sent to the homes registered providers requiring them to take immediate Great Wheatley DS0000048207.V306336.R01.S.doc Version 5.2 Page 27 action to address these issues, However at the time of writing this report the Commission has not received a response to this letter. Great Wheatley DS0000048207.V306336.R01.S.doc Version 5.2 Page 28 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 3 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X 1 X X X X 2 STAFFING Standard No Score 27 1 28 3 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 2 2 X 1 Great Wheatley DS0000048207.V306336.R01.S.doc Version 5.2 Page 29 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 OP1 Regulation 4&6 Requirement Timescale for action 30/09/06 2. OP3 14(1) (c) & (d) 3. OP7 15 (1) & (2) 4. OP7 12 &15 The registered persons must ensure that the homes statement of purpose is an accurate reflection of the services provided by the home, is kept up to date and is available to residents and others in accordance with Regulation The registered persons must 30/09/06 ensure that people are only offered a place at the home once a decision has been made taking into account the individuals specific needs, the needs of the current residents and the resources available at the home, that the home can best meet the needs of the individual. The registered persons must 30/10/06 ensure that all information relating to a persons health and care is recorded in a plan of care which is kept under review and is wherever it is practicable developed with the resident or their representative. The registered persons must 30/09/06 ensure that staff working at the home carry out care and offer DS0000048207.V306336.R01.S.doc Version 5.2 Great Wheatley Page 30 5. OP8 13(4) (c) 12(1) (a) support to residents according to each residents particular care and health needs. The registered persons must ensure that all assessments in respect of risks of injuries to people living at the home are sufficiently detailed and kept up to date so as to minimise these risks. This was identified as a requirement requiring immediate action on 9/6/06. However this timescale has not been met. 30/09/06 6. OP8 13(4) (c) 12(1) (a) 30/09/06 The registered persons must ensure that staff carry out care in a manner, which minimises the risks of injury or harm and promotes the health and welfare of people living at the home. The registered persons must ensure that nursing staff at the home administer medicines and keep accurate records in accordance with the homes policies and procedures and other relevant legislation. The registered persons must ensure that a programme of suitable activities is provided as per the statement of purpose, which meets the needs of the people living at the home. The registered persons must ensure that resident’s wishes are taken into consideration and so far as it is practicable that care and facilities provided so as to promote choice and independence. The registered persons must ensure that residents are supported according to their needs so as to ensure that they receive proper nutrition and DS0000048207.V306336.R01.S.doc 7. OP9 13(2) 30/09/06 8. OP12 16(m) & (n) 10/10/06 9. OP14 12(2) & (3) 10/10/06 10. OP15 16(2) (n) 30/09/06 Great Wheatley Version 5.2 Page 31 11. OP16 22(3) (4) 12. OP18 13(5) (6) 13. OP19 16 & 23 (2) (d) 14. OP21 23(2) (c) (i) 15. OP26 16(2) (k) 16. OP27 18(1) (a) 17. OP29 19 18. OP30 12(1) (a) hydration. The registered persons must ensure that complaints are dealt with in accordance with the homes policies and procedures and that outcomes and responses are recorded and available for inspection upon request. The registered persons must ensure that there are systems in place so as to ensure the safe moving and handling of residents and to minimise the risks of harm or injury to residents as a result of care practices. The registered persons must ensure that the home is well maintained and reasonably decorated in a manner, which provides a homely environment for the people who live there. The registered providers must ensure that the arrangements for providing personal care to residents are sufficient, accessible and maintained in good working order. The registered persons must ensure that the home is maintained clean and free from unpleasant odours. The registered persons must ensure that at all times suitably qualified and competent staff are employed in sufficient numbers so as to provide proper care and treatment for the people who live there. The registered persons must ensure that people are only employed at the home once all of the checks as required by regulation have been carried out and it is determined that the person is suited to work in the home. The registered persons must DS0000048207.V306336.R01.S.doc 30/09/06 30/09/06 31/10/06 30/09/06 30/09/06 30/09/06 30/09/06 30/10/06 Page 32 Great Wheatley Version 5.2 18(1) (c) ensure that all staff receive training appropriate to the work they are to carry out. This is a repeat requirement. The timescale of 26/06/06 has not been met. 19. OP31 4 & 18 20. OP32 4 & 24 21. OP33 26 22. OP35 17(2) & Sched. 4 23. OP38 23(4) The registered provider must ensure that the manager is employed at the home so as to ensure that the home is managed in a satisfactory way. The registered persons must ensure that the home is managed in accordance with the statement of purpose and the best interests of the people who live there. The registered provider must carry out unannounced visits to the home and provide reports in respect of these visits are sent to the Commission. The registered persons must ensure that all records in respect of monies held at the home on behalf of residents are accurate and kept under regular review so as to minimise the risks of mishandling. The registered persons must ensure that the home has robust systems in place for detecting and safely dealing with an outbreak of fire and that the home complies with the requirements and recommendations as made by the local fire authority. An Immediate Requirement notice was issued in respect of this on the day of the inspection visit. 30/09/06 30/09/06 30/09/06 30/09/06 10/08/06 Great Wheatley DS0000048207.V306336.R01.S.doc Version 5.2 Page 33 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP36 Good Practice Recommendations The registered manager should ensure that staff act in accordance with homes training and supervision provision. Great Wheatley DS0000048207.V306336.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Great Wheatley DS0000048207.V306336.R01.S.doc Version 5.2 Page 35 - 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. 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