Inspection on 17/04/08 for High Dene Residential Home

This inspection was carried out on 17th April 2008.

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

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

Other inspections for this house

High Dene Residential Home 29/07/09

High Dene Residential Home 17/12/07

High Dene Residential Home 19/04/07

High Dene Residential Home 16/10/06

High Dene Residential Home 04/05/06

High Dene Residential Home 23/02/05

Similar services:

Claremont House

Oak Ridge

Coopers Mill Ltd

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Paradise Lodge

Bilney Hall

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE High Dene Residential Home 105 Park Road Lowestoft Suffolk NR32 4HU Lead Inspector Mary Jeffries Unannounced Inspection 17th April 2008 3:30 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 High Dene Residential Home DS0000066149.V362695.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. High Dene Residential Home DS0000066149.V362695.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service High Dene Residential Home Address 105 Park Road Lowestoft Suffolk NR32 4HU 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) 01502 515907 01502 515909 highdene105@wanadoo.co.uk Subhir Sen Lochun Post Vacant Care Home 15 Category(ies) of Dementia - over 65 years of age (15), Learning registration, with number disability over 65 years of age (1), Old age, not of places falling within any other category (15) High Dene Residential Home DS0000066149.V362695.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One Service user in the category of LD (E) as detailed in the application received on 20/02/07 may be accommodated at the home. 17th December 2007 Date of last inspection Brief Description of the Service: High Dene is registered to provide personal care for up to fifteen older persons, all of who may have dementia, and one who also has a learning disability. The home is in an adapted Victorian house with an extension to the rear of the building situated in a residential area of Lowestoft and on a local bus route. It is near to shops and other community facilities and within walking distance of the sea. Accommodation consists of eleven single and two shared bedrooms, all with wash hand basins and approximately half of them with en suite toilets. Residents’ accommodation is on the ground and first floors, with shaft lift access. There is one bathroom on the first floor that is suitable for residents. On the ground floor there is a main lounge, a lounge/dining room and seating in the entrance hall. The second floor consists of office and staff rooms. There is a secure garden at the back of the property available for residents’ use. The Service User Guide states that the fees range from £430 to £470 per week. High Dene Residential Home DS0000066149.V362695.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. A random unannounced inspection was undertaken on 7th March 2008. This inspection was also unannounced, and was a key inspection. It focused on the core standards relating to older people. The report has been written using accumulated evidence gathered prior to and during the inspection. The inspection took place on one afternoon and early evening in April and took five and quarter hours. The manager facilitated the inspection, and other staff participated. There were 11 residents in occupancy at the time of the inspection, and four vacancies. Three residents were tracked. One of these was spoken with, the others were observed. The medication round was observed and a tour of the communal areas and some bedrooms was undertaken. A number of records were examined including residents’ care plans, medication records, training records and records relating to health and safety. The homes quality assurance exercise was inspected. An Annual Quality Assurance Assessment (AQAA) was provided by the home in December 2007. Relatives’ surveys were distributed prior to the last key inspection in December 2007. These were not received by CSCI until January 2008, when five surveys were received. These are noted in the text. What the service does well: Carers and the manager have a good knowledge of individual residents’ health needs, personal preferences and personalities. They are caring and relate to them well as individuals. Residents enjoy considerable freedoms within the home. Residents appear to be happy and contented, no signs of distress were apparent. High Dene Residential Home DS0000066149.V362695.R01.S.doc Version 5.2 Page 6 Care plans have been regularly reviewed, and the residents’ health needs are responded to and met. Visitors are made to feel welcome. What has improved since the last inspection? What they could do better: Whilst it is positive that the home achieved some positive outcomes for residents, and that most of the requirements made at the key inspection of December 2007 have been met, the provider has not yet provided the CSCI with a satisfactory Service User Guide, nor evidenced that this has been provided to relatives. The Statement of Purpose and Service User Guide are key documents that describe the service provided to residents under the contract. Both of these documents require some further modifications. Whilst the Service User Guide had been updated to include some important omissions; for example information on the charging structure and arrangements for payment, the High Dene Residential Home DS0000066149.V362695.R01.S.doc Version 5.2 Page 7 document still does not contain all of the information the residents and their relatives might require. Furthermore, neither the Service User Guide or the Statement of Purpose are entirely accurate; this could be misleading for prospective residents and their families when making a choice of home. For example, details of staff qualifications are not accurate in either document. The Service User Guide states incorrectly that religious services are taking place in the home, and does not a summary of key information from the Statement of Purpose, for example information about care plan reviewing arrangements. It has not been evidenced that the Service User Guide has been distributed to relatives. It is noted that progress has been made on requirements previously made by CSCI, and that some standards have been met with input from Social Care. However, a number of new requirements have been made, some of which relate to matters that have previously been the subject of requirements we have made. Other new requirements made at this inspection are in respect of shortfalls that have not been identified by the manager or provider. Updates on risk assessments for manual handling based must be completed so that staff know how best to care for residents mobility needs. There is a need for recording to be improved, to ensure staff are aware of what care residents have received, and therefore what other intervention or care is needed, and when. The home must demonstrate that the induction in place meets Skills for Care standards, to ensure that new staff fully understand what is required of them to care properly for the residents. Whilst the environment is generally of a good standard in terms of cleanliness, several dining room chairs have unsightly stains on the seats; a requirement to attend to this has previously been made by us and met by the home. Further work is required to ensure risks in the environment are minimised and that checks in place to do this are maintained. Uneven paving outside of the back of the home must be attended to so it is not a tripping hazard. Adequate checks must be in place to protect against the risk of bathwater scalding. Whilst management of the home is now generally adequate, there is little evidence of proactive initiatives by the home to identify shortfalls in the home or to maintain standards once achieved. The provider must demonstrate that they can maintain an adequate standard, and can continue to operate at an adequate standard when the home is fully occupied. High Dene Residential Home DS0000066149.V362695.R01.S.doc Version 5.2 Page 8 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. High Dene Residential Home DS0000066149.V362695.R01.S.doc Version 5.2 Page 9 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 High Dene Residential Home DS0000066149.V362695.R01.S.doc Version 5.2 Page 10 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): 1,3,6. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Prospective residents cannot be assured that they will receive accurate and full information to help them decide if the home will meet their needs. EVIDENCE: A copy of the Statement of Purpose (SOP) sent to us on 4th March was available in the home on the day of this inspection. The Statement of Purpose was generally acceptable, although it was not strictly accurate in at least three respects. The document states that a monthly prayer meeting is held in the home. Staff and the manager advised that this did not happen; the manager advised that it used to happen prior to 2006, when the home was owned by a different provider. The manager advised that they had been trying to achieve this, and would continue to do so, but that it was not yet in place. The Statement of Purpose also stated that there were outings and events on a regular basis available to residents. Staff advised that there had not been any outings for residents unless their friends or relatives took them. One outing for residents, only, was scheduled on the calendar for the late summer. The SOP states that 27 of staff have National Vocational Qualification (NVQ) level 2/3 High Dene Residential Home DS0000066149.V362695.R01.S.doc Version 5.2 Page 11 and that there are plans for more. This is less than the manager advised had NVQ on the day of the inspection, and less than stated in the Service User Guide which we received on the day after the inspection. A Service User Guide (SUG) provided to us following the last key inspection did not contain all of the information required by regulation, and at the random inspection a requirement was made that the home must provide residents or their representatives with a copy that includes all of the information required by regulation, including financial information, by the 14th April 2008. We had not received a copy of a revised SUG by this date, and a revised SUG was not available in the home on the day of the inspection. A copy was provided to us the day following the inspection, 18th April. The SUG dated April 2008, contains full information regarding fees and complaints. Fire precautions and associated emergency procedures, arrangements for contact between service users and their relatives, friends and representatives, and arrangements for reviewing care plans are not summarised or mentioned in the SUG. The SUG is also misleading in that it states that the manager is already registered with CSCI but awaiting registration with this home. The manager has previously been registered as a manager but is not currently registered with CSCI, and we have not yet received an application for registration of this manager to be Registered Manager of High Dene. The Service User Guide states that there are 18 staff, of which more than 50 are NVQ 2 qualified. At the inspection the manager was asked for the names of all care staff and their NVQ status. The manager advised that in addition to herself, who is NVQ qualified, there are 17 care staff currently working in the home and 6 have NVQ. This is 35 . The manager said that another 3 carers were currently undertaking NVQ 2, i.e., another 17.5 . This would bring the total to “more than 50 ”, but only once these have achieved their award. No evidence has been provided to us that the Service User Guide has been made available to service users or their representatives, therefore we cannot assure residents and prospective residents that they will receive the information they require. The manager and staff advised that no new residents had been admitted since the last key inspection. The majority of residents are funded by Social Care Services. Suffolk Social Care Services have temporarily suspended the homes accreditation, and are not making new placements during the suspension. At previous inspections the home has consistently been found to have assessments in place before admission. The home does not provide intermediate treatment. High Dene Residential Home DS0000066149.V362695.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10.Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can expect to have their health needs met and their personal care needs identified, but cannot be assured that good standards of recording will be maintained. This could lead to omissions in care routines being carried out as planned. EVIDENCE: Three relatives who provided surveys in January 2008 stated that they thought their relative receives the care and support that they expected or agreed. One thought that they usually did, another thought that they did not. All of the residents who were tracked at this inspection had a care plan that had been regularly and recently reviewed. The home is in the process of changing to a new, clearer, format for care plans; this had been completed for one of the resident’s tracked, only. As part of the new care plan, a manual handling assessment had been completed recently for all of the residents by the deputy manager. The deputy is trained to train other staff in moving and handling. Risk assessments based on these had not yet been completed; a folder was seen of this work in progress. High Dene Residential Home DS0000066149.V362695.R01.S.doc Version 5.2 Page 13 One resident tracked had had a number of falls recently, which were recorded, in the accident book and in their care plan. Appropriate action had been taken. Their G.P. had been asked to visit and had reviewed the resident’s medication, and they had also been referred to the falls team. The falls team subsequently referred the resident to the to the psycho-geriatrician, as all other relevant action had been taken by the home. Another resident tracked was using a walking frame and they did not yet have a moving and handling risk assessment. This resident had recently been more confused that they usually are; they had been referred to their G.P. who had diagnosed an infection diagnosed, and also organised a blood test, results were awaited. The third resident tracked had been spending most of their time on bed rest, and was receiving care for pressure areas. Whist the manager and staff advised that turns were carried out, these were not detailed on a moving and handling assessment. A district nurse was visiting the resident who was receiving treatment for pressure areas, which were all intact. The resident had handwritten charts for all aspects of their care which had been completed, including hourly checks. The resident was no longer on bed rest all of the time. The home had identified a special wheel chair with many functions, including tilting, which the resident was able to sit in. They had requested this be funded by the resident, and had arranged for an occupational therapist to set the chair up for them. Records showed improvement in the resident’s condition. The records of another resident also on hourly checks because they cannot reach their call bell, were not consistently recorded. For example, hourly checks were written in for the 14th April, but on 16th April, when checks were only recorded for 9am, 2pm and 7.15 pm, and 7.45pm. A member of staff spoken with advised that hourly checks were made. This resident spends all of their time in their room, with the door usually open, and they are visible to carers working on this ground floor corridor. They were contented, and actively engaged with their environment when observed during the afternoon and in the early evening. The manager and the care staff spoken with had a good knowledge of the residents’ needs, health, and preferences. The new care plan format has a section on life histories. A carer advised that these had been sent to relatives where possible, to complete. A carer spoken with had a good knowledge of the background of the residents tracked. Carers’ interactions with the residents was observed to be good, they engaged residents properly when they spoke with them and were polite and warm with them. The resident spoken with said that the carers were very good. A carer spoken with advised that they didn’t feel so rushed with only eleven residents in the home. High Dene Residential Home DS0000066149.V362695.R01.S.doc Version 5.2 Page 14 A resident seen being moved by two carers using a hoist was handled well and in no distress through this. Residents were generally clean and well dressed; one had their nails painted and reported that the carers had done this for them. During the afternoon, it was observed whilst sitting next to one resident in the lounge, that they required assistance to change. This was attended to when we brought it to the attention of the carers. The teatime medication round was observed. A monitored dosage system is in use. The carer administering the medication did so properly; they locked the cabinet when it was not attended, they popped tablets correctly into each pot before taking them to residents and recorded the event immediately afterwards. Records contained photographs of residents and specimen signatures of the seniors who can administer them. Two of the residents tracked had some “as required” medications. For one this was Lorazepam, for the other Diazepam. In both cases there were written instructions for the steps that should be taken to calm the resident before it is decided whether this medication was given. Records for 17 days for all residents were inspected. One gap, only, was identified. (This was for eye drops so it could not clearly be identified whether it had been given). The medicine trolley was chained to a wall when not in use, indicating that procedures to safeguard residents were in place. High Dene Residential Home DS0000066149.V362695.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can expect to have considerable freedom within the home, and for staff to engage with them throughout the day. They cannot be assured that opportunities to meet their social, cultural and religious interests and needs will be promoted. EVIDENCE: Throughout the inspection residents were seen to move freely around the home, mostly taking an interest in what was going on around them. At the end of the inspection, at 8.30, several residents were still up and dressed; a staff member advised that one resident who usually prefers to be in their own room sometimes comes into the lounge at around 10pm for a while to watch TV. The visitors’ book showed that visitors called at the home most days; one resident had recently had four visitors on the same day. Prior to teatime, a group of six residents were sitting in the lounge with a member of staff. Three of the residents nodded off for short periods, but roused and became engaged again with the conversation that the carer was stimulating. High Dene Residential Home DS0000066149.V362695.R01.S.doc Version 5.2 Page 16 The home has scheduled a programme of activities which included jigsaws, games, nail pampering, reading, and table skittles. Hairdressing was included as the main activity provided on one day a fortnight. A carer spoken with said that sometimes those who want to engage do not want to do the planned activity, and they will do something else. They advised that they engage residents as they can, and that one resident enjoys helping put out the washing. The manager advised that they were pleased activities were up and running, but that they thought there was still some way to go in developing these. As already noted, there is no regular worship in the home at present. One of the residents tracked takes a daily newspaper. A carer advised that they often sat in a in the corridor overlooking the garden to read this. This resident said that they felt down, from looking out at the lovely day and not being able to get out. With encouragement and the solicited assistance of a carer, the resident spoke with us whilst sitting out in the garden, and presented more positively afterwards. We pointed out that the back door was open. The resident said that they knew this, but that “they don’t encourage you to go out.” As we re entered the house, the resident pointed out the chair in the corridor that overlooks the back garden, and commented, “I often sit there.” It was a very warm and sunny afternoon, yet none of the residents were seen in the back garden which does have seating and is well laid out. A garden party was planned for 15th June, and a strawberry tea for one day in July. A carer advised that in the last few months two different choirs had visited the home, one being a school choir. These visitors had entered the visitor’s book. An outing to Somerton was scheduled for August. Food records were maintained for the main lunchtime meal, but few recent dates in the kitchen diary had the teatime food recorded. A record of appropriate checks on food temperatures, fridge temperatures was kept. A new cook had been appointed and lunchtime menus reviewed. The food looked acceptable and the six relatives questionnaires that the home had received indicated that they all thought the food was now good or very good. The questionnaire enquired into choice, variety, amount, presentation and time taken for meals. Residents’ dignity could be improved at teatime. Several residents had plastic aprons put on them but were not seen to be asked if they wanted this or an alternative on this occasion. There was no salt and pepper or tablecloths on the tables. Three people in the dining room at teatime received their meals some time before a resident who needed some assistance and encouragement to eat a soft option. Although the carer related to the resident well and was not hurried, it did not feel very homely that this resident should have to wait whilst two others sitting at the same table ate. High Dene Residential Home DS0000066149.V362695.R01.S.doc Version 5.2 Page 17 Lunchtime meals recorded in the diary were adequate. Records showed that an alternative was offered. Meals included minced beef or meat pie, pork steaks, sausage and onion pie. A roast was served at weekends. Puddings included angel delight and jelly. The quality of food served was discussed with the carers and the manager. One thought that soft options could be improved at teatime, and advised that they thought teatime meals were going to be reviewed next. The main choice at teatime was quiche and baked beans. The quiche was supermarket value brand. A carer was asked what the liquidised meal consisted; they advised potato, carrot and gravy. One said that sometimes a tin of stew would sometimes be liquidised to make a soft evening meal. This could not be confirmed, as records were not routinely kept for teatime meals. On one night earlier in the month a buffet tea and birthday cake had been served. A resident spoken with advised that they thought the food was “Alright, but not great in here”, they noted that they were not at the home for the food, and that they weren’t “very partial to food at the present time.” High Dene Residential Home DS0000066149.V362695.R01.S.doc Version 5.2 Page 18 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): 16,18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to have access to a proper complaints procedure, and that the staff caring for them to be able to protect them from abuse by being able to recognise and respond to it. EVIDENCE: The home has a complaints procedure that is displayed in the home in each resident’s individual room. The procedure is detailed in the most recent copy of the Service User Guide. The telephone number and contact address given to residents for the CSCI had not been valid since the end of February 2008. Residents should be directed to the CSCI contact team if they are not satisfied with the way that a complaint has been handled. The manager was had started to maintain a complaints log since they came to the home in August 2007. No complaints were logged. No complaints have been made directly to the CSCI. Four relatives’ surveys received by CSCI in January 2008 contained a response to a question on complaints. All stated that they knew how to make a complaint and that the home had always responded appropriately. One survey stated that the home had usually responded appropriately. A requirement was made at the last key inspection that there must be a clear and current procedure for Adult Safeguarding in the home. At the random inspection in March 2008, a copy of an appropriate document was available in the home and had been signed by all staff; the majority had signed the High Dene Residential Home DS0000066149.V362695.R01.S.doc Version 5.2 Page 19 document in February 2008. Carers spoken with were clear of the types of abuse that could occur and advised they would immediately report any concerns to the senior and record any matter that concerned them. The manager advised that all staff have recently viewed the No Secrets video. Certificates were seen to evidence that four carers had received training in safeguarding adults in August 2006, and confirmation was seen of more recent safeguarding training that had been arranged. Social Care services have advised us that they have not had further safeguarding concerns since the last key inspection. The manager advised that two new workers had been recruited since the last key inspection, a carer and a cook. Both had identification on file and a PoVA (Protection of Vulnerable Adults) First check had been received for both before they commenced employment. A Criminal Record Bureau (CRB) check had subsequently been received for the carer. The manager was asked what supervision arrangements had been in place for the carer since they started. They advised that the worker had a period of induction for one month, and would work with another carer for the first three months, and would receive formal supervision after 6 to 8 weeks in post. She advised that the worker supervising the new worker was not one particular worker, but that given the small size of the home the senior on duty would be responsible for supervising them. High Dene Residential Home DS0000066149.V362695.R01.S.doc Version 5.2 Page 20 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): 19,21,25,26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can expect the home to be clean, and for adequate measures to be in place to reduce the risk of the spread of infection. They cannot be assured that environmental checks will always take place as scheduled, or that all hazards in the environment will be identified. EVIDENCE: A tour of the home and the gardens was made. The home was generally found to be in good order and clean. The AQAA states that a contract is in place for regular cleaning and soft furniture, however, three of the dining room chairs had stained cushion pads, as did a similar chair in a resident’s room. Late in the afternoon one bin in a shared toilet was very full, to the extent that the lid did not properly close. Otherwise toilets were found to be clean and orderly with proper equipment in them. Commode pans in rooms were inspected and found to be clean. High Dene Residential Home DS0000066149.V362695.R01.S.doc Version 5.2 Page 21 At the random inspection one of the measures we had required to further reduce the risk of the spread of infection was the full partition of the laundry from the kitchen/lobby area, was found to be met. The partition between the two areas had been extended to reach the ceiling, thus reducing the risk of risk of airborne spores from the laundry entering the kitchen. The kitchen and laundry were found to be clean and in good order, apart from two small areas in a work surface in the kitchen where the top is damaged. This is on the far end of the kitchen, near the sinks, but could pose a risk to food hygiene if food is prepared in this area. At the random inspection, it was found that proper arrangement were not in place for the cleaning of commode pans; this was required at the last key inspection. A member of care staff was asked how they dealt with commodes if they had to empty one (this is a task normally performed by the cleaners.) The member of staff described a procedure whereby they would carry the commode with the lid on, to the nearest toilet to empty it, and then carry it with the lid on down to back stairs to the sluice sink where they would wash and disinfect the commode pan. This procedure was available in the home in written form and signed by all members of staff. With these arrangements in place the home has met the requirement made at the last key inspection and repeated at the random inspection, to provide adequate sluicing facilities and an adequate infection control policy. The cleaning rota was inspected; this now included the cleaning of the large sluice sink in the laundry area, which was found to be clean on this occasion. Suitable gloves and aprons were available in the home on the day of the inspection, and carers were seen to be using them appropriately. One double room had a privacy screen, which was set up in such a way as it would not provide privacy for both residents to wash unseen by the other. At the time of the inspection there was only one occupant in this room; this must be attended to before another occupant is put into this room. One vacant room on the middle floor does not have a lock, however this room is part of a fire escape route and cannot be locked. There is an alert system that goes off if the room is entered, so that privacy will be maintained. Hot water was tested at two outlets and found to be within appropriate limits. However, a member of staff seen drawing a bath advised that they did not test or record the temperature, as it was controlled by a regulatory valve. We tested the water and found it to be comfortable to the hand. The manager was asked whether there was any policy on taking or recording bath temperatures. She advised that there was not, but that the handy man took the temperatures each month. The record of water checks was inspected. There was a record of checks for 1/10/2007, 5/11/2007, 7/12/2007 and one more entry that recorded 12.2008. If this date was for February 2008, this meant that checks High Dene Residential Home DS0000066149.V362695.R01.S.doc Version 5.2 Page 22 for January and March 2008 were missing, and there had not yet been a check in April. The exterior of the home was in good order with the exception of paving close to the house in the back garden, which is cracked and uneven, and therefore a tripping hazard. This needs to be risk assessed, and appropriate action taken. High Dene Residential Home DS0000066149.V362695.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to be looked after by a caring group of staff, many of whom have, or are undertaking, training to develop their professional knowledge and understanding of the residents’ needs. EVIDENCE: At the last key inspection, and at the random inspection, the home was found to be fully staffed. The home’s diary contains a record of when actual staff deployment varies from the regular fortnightly rota. There is no other clear single document showing shifts worked. The diary entries indicated that the home has maintained it full staffing level since the last key inspection, and has occasionally used agency staff to achieve this. Staff spoken with confirmed that staffing levels had been maintained at three on duty including a senior during the morning and afternoon/evening shifts and two on duty at night. The care records of residents inspected and the accident/incident book support the view that the level of staffing has been adequate for the number and dependency of residents in the home. A cleaner and a cook had been on duty on the morning of the inspection. The recruitment records for the two most recently recruited staff showed that references had been received before they were employed, and that a proper process had been undertaken. One of the workers requires some documentation regarding their right to work in the U.K, and there was nothing High Dene Residential Home DS0000066149.V362695.R01.S.doc Version 5.2 Page 24 on file to indicate this had been obtained. The manager has been advised to look into this. The new workers induction record was seen. This was a checklist that detailed all of the main areas, but did not specify what was included within them, how the learning had been delivered or what outcomes that had been achieved. The most recently recruited carer had received manual handling training. The home had previously used a booklet that was consistent with Skills for Care standards; the home was not able to evidence that this induction met this standard. Manual handling training was discussed with staff and records were inspected. The deputy manager had attended a training course to enable them to train other carers in manual handling, and the certificate for this was seen. Records showed that staff did receive updates in manual handling, and that this training was mainly up to date. In one case it was a couple of weeks overdue, but evidence was seen that an update session had been planned. A member of staff advised that they were due to attend a one day training course on dementia the following day; records showed that two sessions were due to take place on 18th March and 21st March, and that all staff including cleaners and the handy man were booked to attend. Further training was planned for food hygiene and first aid. The manager advised that six of the 17 care staff, excluding herself have NVQ 2 or above. Random checks were made on the staff files of two of these, and they had evidence of the award. The manager advised that a further three were undertaking it. The visitors’ book showed that attendance of the NVQ assessor in the home. Staff were seen to relate well to the carers throughout the inspection, and residents seen to be relaxed and comfortable with them. A resident spoken with confirmed that they thought the carers had a good manner and were very nice. High Dene Residential Home DS0000066149.V362695.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,37 & 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can be assured that the current manager has the confidence of the staff group and is working to improve the service for them, however, they cannot be assured that the home has adequate quality controls in place to maintain standards and respond to short falls in a timely way. EVIDENCE: The home has not had a Registered Manager since it was purchased by the current owner in December 2005. The current manager who was appointed in August 2007 has recently commenced the process of applying to be registered, but they are not yet ready to submit their application form. They hold an NVQ 3 and 4, and have previously been a manager in a home which cared for people with dementia. The manager advised that they intend to undertake further training in dementia care. High Dene Residential Home DS0000066149.V362695.R01.S.doc Version 5.2 Page 26 There was no manager in place between February 2007 and August 2007, although there were arrangements to cover the role from within the existing staff team. Regulation 26 reports of the provider’s visits were not routinely provided to the manager once they were in post. At the random inspection, back dated Regulation 26 provider visit reports up until February 2008 were found to have been made available in the home. At this inspection the manager advised that the owner had last visited to undertake a Regulation 26 visit on 27th March. This was supported by an entry in the visitors’ book. However, at this point in time, the report for that visit, which was three weeks before the inspection, was not available in the home. The manager advised they had yet to receive it. Given that a manager would be expected to respond to any action points arising for a Regulation 26 report, the tardiness of this means that it is not the effective management tool it should be. This is particularly relevant, as the home was rated poor at the last inspection. The most recent AQAA requested by the CSCI was requested, in a letter to the manager in October 2007, with a return date by 22 November 2007. It was not received, until 4th December 2007, after a reminder had been sent. The AQAA stated that the infection control policy had been reviewed on 1st December 2007, but staff spoken with at the key inspection on 17th December 2007 stated that they had not had a revised policy brought to their attention, and the senior who facilitated the inspection did not know of a revised policy. We were advised that the provider had taken the policy away to amend it, and a repeat requirement was made in respect of this. (This has now been met.) A staff meeting had been held shortly before the inspection and the notes of the meeting were displayed in the home. This demonstrated that staff were informed of changes and matters that they needed to attend to. In the case of the emergency plan, we were advised that the provider was working on this. There is no indication that staff are involved in policy reviews and development. This would enhance the understanding and commitment of staff working with the policies, and also ensure that policies reflect lessons learnt from actual practice. Social Care Services have been working with the home to support it to achieve improvements since December 2007. They advised us prior to this inspection that that they have been disappointed with the lack of progress that had been by the home when they attended in February 2008. Progress has been achieved in the home since the last key inspection; however, the lack of continuity of management in the home during the last twelve months and the quality of management support from the owner is still having some residual impact. For example a basic induction checklist was being used for new care staff, whilst under the previous manager a booklet for induction that met Skills for Care standards had been used. Similarly, a requirement made at the key inspection of April 2007 that stained dining room High Dene Residential Home DS0000066149.V362695.R01.S.doc Version 5.2 Page 27 chairs must be cleaned, and was found to be met in July 2007, was identified as one again at this inspection. On this occasion, it was seen that a questionnaire seeking the views of residents’ relatives on a wide range of issues had been distributed in February. Six had been returned at the time of the inspection; these were consistently positive, with only one of the six, and on one question only, indicating that a matter was less than satisfactory. Quality control of all care and domestic workers documentation is required to ensure that good record keeping is maintained. It is noted under the environment section of this report that monthly checks of water temperatures had not been regularly carried out. This had not been identified by the home’s manager until we requested to inspect the records. Although hot water temperatures were found to be satisfactory in this occasion, without the back up of carers taking water checks when a bath is drawn, residents were potentially at risk. It is also noted in the Health and Personal Care section, that some records of regular checks on residents had not been fully maintained. Under the Daily life and Social activities section, it is stated that records of teatime meals taken had not been recorded consistently. This was to be satisfactory at the last key inspection in December 2007, but a requirement that a record of all meals must be maintained had been made previously, at the random inspection of October 2007. We wrote to the provider on 23rd January 2008 requesting that we were provided with evidence of the home’s financial viability. A document entitled trade assessment was provided on the 18th March 2008; it was not dated, and only provided one set of figures for a full one-year period. We wrote again to the provider on the 7th April 2008, to request clarification of the information provided. The provider wrote to us on 14th April 2008, advising us that the document provided was a management account referred to the current financial year (2007-2008), and represented actual and forecast expenditure. The figures provided however, show projected profit based on occupancy of 14 throughout the year, and this level of occupancy has not been achieved. The provider also advised us that they have requested a full set of accounts, and that these will be provided to us promptly once they have received them. As an interim measure we requested last years accounts, the information returned to us was not a set of accounts. We have not therefore been able, yet to establish whether residents are protected by the accounting and financial procedures and business planning of the home. The revised Service User Guide states; “For those residents on whose behalf money for such services are held by the Home, the manager will pay for these services on the day the services were provided and obtain a receipt and an up to date record kept for all transactions made on behalf of the residents. For those residents for whom there is no money available in the Home, the provider pays from his account to the service provider and an invoice made to High Dene Residential Home DS0000066149.V362695.R01.S.doc Version 5.2 Page 28 them on a monthly basis.” Records and invoices were checked for the three residents tracked, and also for another three residents. Individual envelopes are held in a locked box in a locked cabinet. Sums held and records kept tallied; the three residents tracked all had negative sums, i.e. they owed monies for hairdressing etc. There had been no deaths or hospital admissions, deaths or outbreaks of infection in the home since the last inspection, according to the manager and documentation inspected. This was in line with the fact that we had not received any Regulation 37 notices from the home, which are required reporting in those circumstances. Scaffolding that was seen on the second floor landing was seen to have been removed at the random inspection, and the area appeared to be intact and well decorated. The provider subsequently advised us in writing that the two Acropoles had served the purpose of holding a swollen plinth to which sealants were applied, and that the swelling was due to water leakage. They have advised that there is no remedial work outstanding in the hall, and that the building has recently been risk assessed and is structurally safe; we have not been provided with evidence of this. A requirement was made at the key inspection that the fire risk assessment must be reviewed and updates on fire training must be provided so that staff are aware of action they must take to protect residents in the event of a fire. At the random inspection it was found that the fire risk assessment has been reviewed. Fire training seen to have been arranged then, had since taken place. Staff spoken with were aware of the actions they should take in the event of a fire, but there was no plan in the home to detail steps that should be taken in any other type of emergency. The manager advised that the owner was currently working on this. High Dene Residential Home DS0000066149.V362695.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 1 X 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 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 3 X X X 2 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 3 2 3 X 2 2 High Dene Residential Home DS0000066149.V362695.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP1 OP1 Regulation 4(1)(b) 5 Requirement The Statement of Purpose must accurately reflect services and facilities available to residents. Residents or their representatives must be provided with a copy of the Service User’s Guide that includes all of the information required by regulation. This is so that they have direct access to information they require. This is a repeat of a similar requirement from the inspections of 17/12/07, 19/04/07 and 16/10/06.It had a time scale of 30/06/07 when it was first repeated, which has not been met. Enforcement action is being considered. The updating of manual handling risk assessments must be completed, to ensure that care staff have current information on which to base the residents’ care and minimise risks to them. Records of all meals taken must be maintained, so that the quality of their nutrition can be assessed and so that records are DS0000066149.V362695.R01.S.doc Timescale for action 31/05/08 17/04/08 3. OP7 15(2) (c) 17(1)(a) 20/05/08 4. OP15 17(2) Schedule 4 (13) 20/05/08 High Dene Residential Home Version 5.2 Page 31 5. OP19 OP38 23(2)(o) 6. OP19 23(2) 7. 8. 9. OP25 OP30 13(4)(a) 18(1)(c) 17(1)(a) OP37 available in the event of sickness. Uneven paving at the rear of the house must be risk assessed and appropriate action taken to ensure this area is not a tripping hazard. The dining chairs must be cleaned to remove stains on seats, so that residents’ accommodation is of an acceptable standard and their dignity is upheld. Adequate checks must be in place to safeguard residents against the risk of scalding. An induction programme that meets skills for care standards must be in place. Records of checks on residents must be maintained in accordance with the care plan. 14/06/08 31/05/08 21/04/08 31/05/08 20/05/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP12 Good Practice Recommendations The home should develop the home’s social activities and daily living regimes to positively support and encourage residents’ emotional well-being. High Dene Residential Home DS0000066149.V362695.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI High Dene Residential Home DS0000066149.V362695.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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