Inspection on 17/12/07 for High Dene Residential Home

This inspection was carried out on 17th December 2007.

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

The inspector 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 17/04/08

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 December 2007 12:15 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.V356855.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.V356855.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.V356855.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. 19th April 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. No Service User Guide was available to ascertain the fees for the home. High Dene Residential Home DS0000066149.V356855.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection was unannounced and focused on the core standards relating to older people. The report has been written using accumulated evidence gathered prior to and during the inspection. Since the previous key inspection which took place in April 2007, there have been three unannounced random inspections, including a pharmacy inspection in June 2007, an inspection by an inspector and the pharmacy inspector In July 2007, and a random inspection in October 2007. This inspection took seven and a half hours and was facilitated by the assistant manager and when they left the shift, a senior carer. Several members of care and domestic staff contributed. Three residents were tracked; other residents were observed throughout the course of the day. Two visitors were spoken with. An Annual Quality Assurance Assessment (AQAA) was provided by the home prior to the inspection. What the service does well: What has improved since the last inspection? At the last key inspection the home had improved considerably, some, but not all requirements from that inspection have been met. Where care plans were in place they had been reviewed, and there were current risk assessments on file. The administration of medicines has improved. High Dene Residential Home DS0000066149.V356855.R01.S.doc Version 5.2 Page 6 Staff recruitment processes were satisfactory. . The lock on the door at the top of the fire escape- which is linked to the fire system- had been repaired. No doors were found to be propped open without proper devices linking them to the alarm system. Carpets and chairs have been cleaned. Suitable arrangements and equipment for the movement of soiled laundry around the house were in place. The fridge was maintained at a proper temperature. In addition to outstanding requirement, seven new requirements were made at the random inspection in July 2007, and eleven new requirements were made at the random inspection in October 2007. The home has acted upon a number of these requirements, but not all. Following previous concerns about staffing levels, and hygiene in the home, improvements were found. What they could do better: Enforcement action is being considered by the CSCI in respect of matters relating to resident’s health and safety, the lack of evidence of regular visits from the provider to the home, as is required under Regulation 26, and outstanding requirements relating to residents’ health and safety. It was not possible to view a current copy of the Service User Guide, and therefore was not possible to state if was one was available, so it cannot be confirmed that residents and their relatives have all of the information they are entitled to about the services provided. One recently admitted resident did not have a care plan, although there is better daily recording in place for all residents. The environment deteriorated in cleanliness since the key inspection; it has now improved again although there are some outstanding requirements around infection control. Adequate sluicing facilities are required to wash commode pans, and the staff must have access to an adequate infection control policy. Some structural work is required to minimise the risk of airborne spores from the laundry entering the kitchen. There is unsightly scaffolding on the second floor landing that has been there since October, and it has not been established whether the roof is structurally safe. There has been no registered manager since December 2005. The home lacked an appointed manager between February and August 2007, although arrangements were in place for existing staff to cover these duties. A new manager was appointed in August 2007. Several of the requirements relate to the management arrangements for the home. There is no evidence of the High Dene Residential Home DS0000066149.V356855.R01.S.doc Version 5.2 Page 7 current manager receiving regular regulation 26 reports from the provider. Lack of appropriate reporting to the CSCI through regulation 37 has been identified as an issue since the random inspection in July and remains an issue. No updates in fire training have been for over 18 months. 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.V356855.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection High Dene Residential Home DS0000066149.V356855.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,6. 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 be assessed before being admitted to the home. They cannot be assured that they or their family will get all of the information they require to make an informed decision about deciding to live in the home. EVIDENCE: A requirement was made that residents must be provided with a Service User Guide at the inspections of 16th October 2006 and 10th April 2007. No Service User Guide was available in the home. The manager subsequently advised that they understood that a copy had been sent to the relatives of all of the residents, but no evidence of this was available. Enforcement action is being considered by CSCI. All three residents tracked had pre admission assessments on file. The home does not provide intermediate care. High Dene Residential Home DS0000066149.V356855.R01.S.doc Version 5.2 Page 10 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 staff to know them as individuals, and to have their medical needs met. EVIDENCE: Prior to the last random inspection undertaken by CSCI, Social Care Services had held a series of strategy meeting to which CSCI had been invited, to discuss an increasing number of concerns that they had become aware of. These concerns were mainly concerned with personal hygiene and standards and quantities of food, and included an adult safeguarding matter. An outcome of this was that all residents placed in the home by Social Care Services would be reviewed, and privately funded residents would be offered a review. Social Care Services wrote to the owner to advise that they had temporarily suspended the home’s accreditation on 31st August 2007, pending improvements in care and the satisfactory resolution of requirements made at previous inspections. Residents have subsequently had their needs and High Dene Residential Home DS0000066149.V356855.R01.S.doc Version 5.2 Page 11 placement reviewed by Social Care Services, and the temporary suspension remains in place. A privately funded resident had been admitted to the home in early November; they did not have a care plan in place. The carer facilitating the inspection advised that this was partly because the manager was in the process of changing the care plan format. At the random inspection in October 2007 it was noted that these contained some good documentation, but were somewhat muddled in their presentation. Three other residents were tracked they had care plans in place which had been reviewed regularly. Staff spoken with had a good knowledge of individuals’ likes and dislikes, and there were risk assessments in place on residents’ files. Daily recording of meals and drinks served to residents are now maintained. The care of one resident who had developed pressure areas and had been admitted to hospital was investigated under safeguarding procedures. They were found to have received appropriate care and to have been correctly referred to medical services in a timely way. The care plans for the three residents who were tracked showed good contact with appropriate medical services. One resident was taken to the dentist on the day of the inspection. A number of residents were sick during October; hygiene in the home did not best support this outbreak being dealt with as quickly as it might have been, for example one member of staff working in the home less that 48 hours after having been ill. At this inspection residents were clean and well groomed, but one resident’ wheel chair, which they sat in all day, was dirty. The need to clean the resident’s wheel chair was pointed out to a carer who advised they had just picked two biscuits out of it. A visiting friend commented on how well the person they were visiting looked, and noted that their nails had been painted. The resident in a wheel chair and one other were seen to have the slings for hoists in place on the chairs at all times. The resident in the wheel chair said that they were happy in the chair. It was not possible to establish whether the slings which are of made of heavy canvass material with seams, caused discomfort. Both residents had risk assessments signed by relatives to indicate that this was acceptable to them. This was discussed with a carer who advised that it was otherwise difficult for the residents each time they wanted to go to the toilet. They advised that one of the residents will not lean forward and so the sling is put in place when the resident is got out of bed and sat in their chair. The carer advised that the other resident slips forward when the sling is being put on. At the random inspection in October 2007, two residents who were not independently ambulant were seen in their rooms without access to their call High Dene Residential Home DS0000066149.V356855.R01.S.doc Version 5.2 Page 12 bells. In one case the bell was out of reach, in the other no cord was attached to the wall socket. On this occasion, one of these residents did have their call bell within reach; it was pinned onto their cardigan, which did not enhance their dignity. The other resident did not have their bell in reach; staff advised that this resident would not be able to use it, and that hourly room checks were in place. Records of this were seen in the resident’s room. An unannounced pharmacy inspection had been undertaken on 6th June 2007, to monitor the home’s medicine management practices following previous inspections, (most recently the key inspection in April 2007) when issues of serious concern were identified. The random inspection undertaken in July 2007 also included inspection by a pharmacy inspector. Overall, the pharmacy inspector found continuing improvement when compared to previous inspections. The senior member of staff on duty confirmed that all members of staff, including those working at night who do not handle and administer medicines, had received training related to the management and knowledge of medicines on 15/06/07. Further improvement was found at this inspection. Two new requirements made at the random inspection in July 2007 were found to be met. Where changes had been made to Medicine Administration Records (MAR sheets) it had been properly authorised by prescribers, these were properly recorded and supported by a record of the prescriber’s advice. Records for the previous five weeks were inspected and no gaps or errors were found. There were no controlled drugs in the home, and there were no boxes of paracetamol for general use in the drugs trolley. The teatime medication round was observed. This was carried out properly and on the whole sensitively, but one resident was given eye drops whilst they were still sitting at the tea table in company; this practice does not support the privacy and dignity. High Dene Residential Home DS0000066149.V356855.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. 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 enjoy a good quality of interaction with staff but cannot be assured they will be offered a range of activities to provide stimulation, or that staff are fully aware of all of their daily living needs. EVIDENCE: Concerns considered by Social Care Services since that last key inspection, focused on staffing levels and hygiene in the home, there were also concerns that some residents’ meals were inappropriate or insufficient. On this occasion the home was found to be maintaining full records of all food and drink taken by residents. A relative spoken with advised that they had seen considerable improvement over the last few weeks, but that they were concerned that when residents were given a drink in the sitting room the drink was often placed in front of them, and then taken away when cold having hardly been touched by the resident. During the inspection residents were observed in the lounge at afternoon tea. Two residents were seen to be leaving the drinks that were placed on their tray/trolleys. We encouraged one of these residents by placing the drink in their hands at paced intervals; they proceeded to drink most of their tea with this encouragement. Although the resident could physically manage their cup they were not inclined to take the drink without this help. High Dene Residential Home DS0000066149.V356855.R01.S.doc Version 5.2 Page 14 This was discussed with care staff, and the sensory stimulation that can assist residents remember tasks was not something they were aware of. Staff interaction with residents was seen to be good during the day, and this created a homely atmosphere. There was very little evidence of any activities occurring routinely in the home, although staff said that they do sometimes play music or sing with the residents. The handyman who attends twice a week enjoyed some friendly banter with residents which they clearly enjoyed. The care staff and domestic staff took a short break in the dining room, during which time residents could access their attention if they needed to. One joined them for a cup of tea. During the afternoon one carer was doing manicures for people in the main living room. All of the other residents in the lounge at this time appeared settled. A visitor spoken with advised that they or another relative visit frequently and at different times of the week, and are always made to feel welcome. At mealtime residents some residents sat at table, others had meals in their rooms. On one table, all four wore plastic aprons, at another just one of the four residents did. Carers advised that they asked residents if they wanted to, and wouldn’t ever make them. Whilst they may have a choice, this practice does not enhance the residents’ dignity. The main meal served was basic but tasty and was served with fresh salad. High Dene Residential Home DS0000066149.V356855.R01.S.doc Version 5.2 Page 15 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 adequate. This judgement has been made using available evidence including a visit to this service. Residents can expect that they and their relatives will have access to a good complaints policy but cannot be assured that they will receive a timely response if they make a complaint. EVIDENCE: The home has a complaints procedure which is displayed in the home. A relative spoken with said that they would not like to complain, but had no specific reasons for this. In June a relative contacted the CSCI with a copy of a complaint that they sent to the home. This was not responded to within 28 days, as specified in the home’s complaints policy. In May 2007 an anonymous complaint was received regarding the staffing levels, which related to both care and domestic staff. The provider was asked to look into this; their written response was not fully reassuring and did not clearly advise that the planned level of three carers on duty was being achieved. We wrote a further letter to ask the provider for clarification on this but did not receive a reply. At the random inspections undertaken on the 16/17th July 2007 the home was found to be short staffed on some shifts including on the days of the inspection, and the requirement was repeated. At the random inspection in October 2007, a resident who had previously been named in a Safeguarding referral, was seen in the room of two other residents. This upset one of them, who was unable to walk independently and who, at High Dene Residential Home DS0000066149.V356855.R01.S.doc Version 5.2 Page 16 that time, did not have their call bell within reach. This resident asked the inspector to, “get (them) out of here.” Staff were unaware that this had occurred until the inspector drew their attention to it by ringing the call bell. A member of staff then attended promptly and encouraged the visiting resident to leave. It was established that the visiting resident had a note on their file, dated 20th September 2007, stating, “ Can all staff make sure of……..…’s whereabouts at all times. Make sure wander mat is on at all times. Record any incidents by separate statement.” There was evidence of a number of incidents, which staff had recorded and which had been read by the deputy. The overall record was muddled so that it was not possible to track the specific behaviour of the resident wandering into other’s rooms and behaving inappropriately, to the care plan. There was no evidence then that the risk assessment had been reviewed in the light of further incidents. At this inspection, there was no record of the “visiting” resident having been found in other residents’ rooms since then. The brief risk assessment had not been amended, but staffing levels had improved. The policy on Safeguarding maintained in he home was seen, it was dated February 2004, and contained out of date instructions, including that protection issues had to be reported to CSCI in the first instance. This was discussed with a senior carer who thought that this was correct, but advised they would contact a manager in the first instance if they had any concern. It was established that a safeguarding matter relating to missing monies, which had occurred in the spring, had been referred to the police, rather than to the Adult Safeguarding team in the first instance, although it had been referred to them subsequently. No new complaints or safeguarding referrals had arisen since the random inspection in October 2007. High Dene Residential Home DS0000066149.V356855.R01.S.doc Version 5.2 Page 17 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): 19,22,24,26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can currently expect the home to be clean, and can expect to feel that they are unrestricted in the home. They cannot be assured that any problems in the environment will be attended to quickly. EVIDENCE: Since the last key inspection there have been some serious concerns about infection control policies and practices in the home. The random inspection undertaken on 24th October 2007, was as a result of information received from Waveney District Council Environmental Health (regarding the homes environment, health and safety, 18 October 2007), the Health Protection Unit (regarding the outbreak of a diarrhoea and vomiting bug, 17 October 2007) and Suffolk Adult Social Care (regarding concerns over a shortfall in staffing at the home due to staff sickness, 17 October 2007). At the inspection, accumulated rubbish was seen outside of the home. The manager provided a letter from Waveney District Council Environmental Health Technical Officer High Dene Residential Home DS0000066149.V356855.R01.S.doc Version 5.2 Page 18 who had visited on the 10 October 2007, having received an allegation of accumulation of rubbish, bird fouling, and the sighting of rats around the storage bin area. On the 24th October 2007 there was no cleaner on duty and no sign of any cleaning being undertaken by staff during the inspection (10.30am – 5.00pm.) The manager advised that the cleaner was off sick, and there was no other cleaner available. There was no evidence that the recommendations made by Environmental Health had been fully acted on. Waste outside the home had not been removed, and there were excessive pigeon droppings on the building including windowsills. The manager advised that she had permission from the home’s owner Mr Lochun, to arrange for a skip, and was intending to order one but had not yet done so. The Environmental Health Officer who visited on 18th October 2007 was concerned about the design and layout of the laundry, lobby, kitchen area. This area was inspected, on 24th October 2007 and no changes had been made to the building or staff practices since the Environmental Health Officer had visited. The back door to the laundry was locked to prevent residents wandering in, and the door into a lobby, which is effectively used as part of the kitchen, was the main entrance used into and out of the laundry. This door is within a partition wall that does not reach the ceiling. We inspected the rest of the home on the 24th October. Pipe work in the bathroom on the middle floor had flaking paint and was rusty, a commode frame in Room 3 upstairs, was rusty, the upstairs bathroom next to Room 9 had no paper towels or toilet paper in it. Room 9 upstairs was not occupied, however the toilet in the bathroom was soiled and had not been flushed, the en-suite bathroom for Room 2 in the annex was inaccessible, and had been used to store equipment. A member of care staff was asked how they emptied commodes. They confirmed the notice in the laundry that stated that the sluice attachment had been removed, and advised staff to fill buckets in a downstairs bathroom, and that this bathroom was still in general use. The sink in the laundry had no hot water. The carer advised that the cleaner is normally responsible for commode cleaning, but when no cleaner was on duty they emptied care staff. They advised that they did so in the toilet, and then washed them under the hot tap in the upstairs bathroom, next to room 6. They advised that commodes were sometimes cleaned with Milton, but were unclear what the cleaner used. The manager advised that the policy and procedures for infection control had been taken away by the home’s owner Mr Lochun to update. An old policy only was available, that was not adequate. This was supplemented by notices posted in the house reflecting recent advice. Information subsequently received by CSCI from the Health Protection Unit showed that they had advised the home on 19th October 2007 to have a “deep clean”. No evidence was provided at the CSCI inspection on 24th October 2007 that this had been completed. Following another visit by the Health Protection High Dene Residential Home DS0000066149.V356855.R01.S.doc Version 5.2 Page 19 Unit on 26th October 2007 the home was again advised to have a “deep clean”, and the information provided shows this advice was repeated over the telephone on 30th October 2007 and 2nd November 2007. On 5th November 2007 the deputy manager informed the Health Protection Unit that they would ensure deep cleaning was carried out, that the home had been cleaned with Milton on 1 and 2 November and they would arrange for carpets to be steam cleaned. The Health Protection Unit recorded on 6 November 2007 that a cleaning company were due to visit the home and carpets were to be steam cleaned in the morning. A Statutory Requirement Notice was issued by us on 23rd November 2007, which required the provider to put effective arrangements and systems in place to ensure that: 1. All internal and external areas of the home must be maintained to prevent residents suffering harm from disease and/or infection, and to ensure their health and welfare is protected as far as possible at all times. Any waste material must be removed in a timely and prompt manner. The infection control policy must be available to all staff within the home and include measures/systems to control the spread of infection. Dirty laundry must not be carried through the lobby next to the kitchen. The laundry must be operated separately from the lobby area, which is used as part of the kitchen, to prevent cross infection and protect resident’s health and welfare. 2. 3. At this inspection, December 17th 2007, the home was found to be very clean and was odour free. A deep clean had taken place inside the home. All bathrooms and bedrooms were inspected and found to have appropriate soap and paper towels, and toilet paper. There was still some flaking paint on the pipe work in the bathroom on the middle floor and there was a small amount of rust on the floor fixings on toilet frame in this bathroom, although commode frames seen had been thoroughly cleaned. The kitchen was found to be clean, and the fridge was maintained at a proper temperature. Staff advised that they had new arrangements for carrying dirty laundry through the home to the laundry, and now used the back entrance to the laundry, avoiding the kitchen area. There was a notice displayed on other door into the laundry stating this. It was noted at the last random inspection that new suitable bags had been provided for carrying soiled laundry. Staff had keys to the back entrance of the laundry, and those spoken with confirmed that they were using this way in and out of the laundry rather than using the front entrance door which shares a lobby with the kitchen. There was High Dene Residential Home DS0000066149.V356855.R01.S.doc Version 5.2 Page 20 still no water supply to this large sink, and no other sluicing facilities for washing commodes. Care staff spoken with advised that as far as they were aware, the cleaners still used the same method that was described to us previously. The AQAA states that the infection control policy had been reviewed on 1st December 2007, but staff spoken with 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. Further enforcement action is being considered by the CSCI in respect of this. The handy man advised that they had been asked to make the partition wall from the laundry to the lobby reach the ceiling to reduce the risk of air borne spores from the laundry entering the kitchen. At this time however, it did not, and the kitchen door which opens into the same lobby was held open by a door guard. Recommendations made by the environmental health officer regarding the exterior of the home had been met. The exception to this was that a metal grill was to be put inside of a large waste container, to prevent vermin entering it. The handyman was spoken with. They had instructions to do this job, but were waiting for the bin to be emptied to carry it out. During a tour of the home, it was noted that two bathrooms were still used to store equipment, however it was established that these ensuite bathrooms were not used by the residents as they required double assistance and the ensuite bathrooms rooms were too small for this. It was also noted that one bedroom on the middle floor still had no lock, however the room was not occupied. At the last random inspection it was noted that on the middle floor landing there was a scaffolding rig, close to the wall, supporting the ceiling. It was not restricting access but neither was it protected from passing residents who do wander freely in the home. The environmental health officer had asked the home to provide a report from a builder of engineer to confirm the safety of the roof, as the manager had not been able to advise him what function the scaffolding was serving. On this occasion the scaffolding was still in place, and no report was available. The handyman advised that as far as he knew there was no report, but that they had put it up to support the coving, only, which had started to fall down. They were asked what work had been done to establish the source of the problem; they were unaware. It is not known if the ceiling is safe; at the very least the continued presence of scaffolding is not homely. Enforcement action is being considered by the CSCI in respect of this. Residents were seen to be unrestricted in their movements around the home on the day of the inspection. High Dene Residential Home DS0000066149.V356855.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can expect that the home will achieve adequate staffing levels and that staff will receive appropriate training to meet the needs of those who require a higher level of assistance with personal care. EVIDENCE: Staffing levels at the home have been a matter of concern to the CSCI since the last key inspection in April 2007. A requirement was made then that there must always be sufficient staff on duty to ensure that the needs of residents as assessed in their care plans can be adequately and safely met. CSCI received a letter from the owner on 4th September 2007 stating that two new staff had been recruited and another was due to start once satisfactory pre employment checks had been completed. The letter stated “we will make sure that all day shifts have 3 staff on duty.” The home’s planned staffing levels are for three carers to be in duty during the daytime, and for two carers to work a waking night shift. One carer on each shift is a senior carer. The AQAA states that seven residents require two members of care staff to help with their care, both by day and by night. Staffing levels on this occasion were found to be adequate, with three carers on the day shift. Inspection of the homes diary and signing in book, which evidence changes to the basic rota showed that this had been maintained for the previous fortnight. These records also showed that some agency staff were High Dene Residential Home DS0000066149.V356855.R01.S.doc Version 5.2 Page 22 being used when needed to maintain the level. Additionally the manager was working three days a week in their management role; there were two cooks employed and two cleaners, as well as the handyman who was working in the home at the time of the inspection. During October the home had an outbreak of sickness, and this affected a number of staff available for duty. In conjunction with there being no arrangements for agency cover, this led to difficulties and Social Care Services were called upon to provide staff cover for two shifts, and at the inspection in October 2007, the home was operating with less than the planned number of carers on shift, and one of those on duty had been supplied by Social Care Services. The manager advised then, that arrangements to enable the home to use agency staff had not been completed. Arrangements for the manager to access agency staff are now in place, at this inspection there was evidence that agency staff had been used recently. The staff files of two recently recruited members of staff were inspected at the October inspection and were found to be in order, containing PoVA first checks and references obtained prior to employment commencing. Satisfactory Criminal Records Bureau checks had subsequently been obtained for these two carers. One further member of staff had been recruited since October, a domestic. Their file was inspected on this occasion and was found to be in proper order, containing all necessary documentation. Manual handling training was discussed with staff and records were inspected. New staff received this in induction, and a recent update had been provided for existing staff. Some staff had missed this update, a member of staff had been trained to provide Manual handling training and they had scheduled a session for any staff who had missed the recent up date training. Dementia training was discussed with staff. A number of staff had been enrolled on a distance learning training course from Otley College. One member of staff spoken with advised that after completing their first assignment they had not continued with the course. The other established member of staff on duty had not taken on the course, but advised they had undertaken a one-day course. The third member of staff was recently recruited. Staff did demonstrate a good manner with residents in one to one communication throughout the day, but as noted under the section of this report on daily life and activities, lack a good understanding of the ways in which those with dementia may need assistance. High Dene Residential Home DS0000066149.V356855.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,37,38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents cannot be assured that effective management systems are in place for the effective and safe running of the service, or that improvements will be maintained. EVIDENCE: The home has not had a Registered manager since it was purchased by the current owner in December 2005. Two managers have been appointed and submitted applications, which they subsequently withdrew. The previous manager had formally left their post at the end of February 2007, and had worked on Fridays, only, for a number of weeks following this. The homes deputy manager had covered the post until August 2007, and an assistant manager was appointed from the existing staff. A new manager was appointed High Dene Residential Home DS0000066149.V356855.R01.S.doc Version 5.2 Page 24 to work three days a week from 2nd August 2007. the beginning of August 2007. No application has yet been received for this person to be registered. A requirement was made at the inspection in October 2007 that Regulation 26 visits were undertaken and the manager provided with reports of these visits, as the manager had no knowledge of them. Prior to the last key inspection, regulation 26 reports had been received by the CSCI for the proceeding 6 months, following a written request from the CSCI. (The manager at that time had advised that they had not received them, but this could not be established.) Staff on duty on December17th 2007 did not know where regulation 26 visit reports were kept. The manager was asked immediately following the inspection. They advised that they had not received one of these since they became manager in August 2007, and that the provider had informed them that they were sent to CSCI. The CSCI have, since February 2007 received two regulation 26 reports, one in August and one in September. The visitors’ book evidenced that the manager had visited once a month in October, November and December, however these entries were not supported by Regulation 26 reports. Enforcement action is being considered by CSCI. The importance of these reports are that they advise the manager of the needs identified by the provider and form part of the quality assurance process. We have previously discussed, with owner, the importance of sharing these. A requirement was made, and then repeated at the last two random inspections that personal monies must not be handled unless there is a policy and proper arrangements in place under which this will take place, so that residents are protected from financial abuse or loss. On this occasion there was a policy to state that small sums could be held in he home on behalf of residents under locked conditions. These monies and records were seen. The residents’ personal monies were kept within a metal box; the lock on the actual box was broken but it was kept within a locked cabinet. Monies inside the metal box were in individual paper envelopes, but these were not sealed. A pound fell out of one envelope as the assistant manager returned it to the box after we had inspected the contents. The contents of three envelopes were checked and found to tally with a record maintained by the manager. The envelopes also had the amount they contained written on them. In one case this was incorrect, it showed the sum that should have been present before the last logged transaction. A Statutory Requirement Notice issued on 23rd November 2007 advised that the provider was in breach of Regulation 37(1)(2) which requires that we are notified of death, illness and other events without delay, and that any oral reports are confirmed in writing. This followed the last random inspection of 24th October 2007 when it was established that regulation 37 reports had not been received by the CSCI in respect of two of the Safeguarding referrals considered by Social Care Services at the strategy meetings they held. Additionally, the CSCI had not been notified immediately of the outbreak of High Dene Residential Home DS0000066149.V356855.R01.S.doc Version 5.2 Page 25 infection in the home. At this occasion it was found that a resident had died unexpectedly in November 2007, but the CSCI had not been notified. This was just prior to the statutory requirement notice was served. During the random inspection undertaken in October 2007 it was noted that there were heavy duty plug in air fresheners, throughout the home; it was recommended that the home consult with the fire officer regarding the safety of these. These were found to have been taken out of use on this occasion. Fire extinguishers had been recently serviced. The handy man advised that he was now was now testing smoke alarms on a weekly basis, and had a record of this which was seen. They advised that they were seeking equipment to test the alarm system more regularly without the need to always sounding the alarm. The home’s fire logbook showed that fire training had occurred in May 2006. There was no record of update training since then. The carers and assistant manager on duty could not locate the home’s fire risk assessment. The fire officer visited the home on 27th November 2007. They have subsequently advised CSCI that the manager is aware of a number of matters identified within the home’s fire risk assessment undertaken in June 2006 as requiring action that have not been attended to. The fire officer has advised that the fire risk assessment should be reviewed and that in addition to these, the home should consider the develop of an emergency plan, maintenance of the fire alarm system and emergency lighting in accordance with current British Standard. Staff must be trained and kept up to date with any updated policies and emergency plan developed as a result of the fire risk assessment review, and records maintained for each member of staff detailing the training provided. High Dene Residential Home DS0000066149.V356855.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X 3 X 3 X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 2 X 2 X 2 2 High Dene Residential Home DS0000066149.V356855.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 5 Requirement Timescale for action 17/12/07 2. 3. OP18 OP26 13(6) 13(3) 16(2)(j) Residents must be provided with a copy of the Service User’s Guide. This will provide them with information about what they have a right to expect from the home. This is a repeat requirement from the inspections of 16/10/06 and 10th April 2007. Enforcement action is being considered. There must be a clear and 15/01/08 current procedure for Adult safeguarding in the home. Adequate sluicing facilities must 31/03/08 be provided for washing commodes to reduce the risk of cross infection in the home. This is a repeat requirement of the inspection of 24th October 2007, and was referred to in the Statutory Requirement Notice of 23/11/2007, which required adequate measures to control infection to be put in place. High Dene Residential Home DS0000066149.V356855.R01.S.doc Version 5.2 Page 28 4. OP26 16(2)(j) 5. OP33 26 6. OP37 37(1)(2) 7. OP38 13(4) 13(6) 8. OP38 23(4) The infection control policy must be available to all staff within the home and include measures / systems to control the spread of infection. As per Statutory Requirement Notice of 23/11/2007. Timescale given 7/12/07 Regulation 26 visits must be undertaken and a copy of the report held at the home. This is a repeat requirement from the random inspection of 24th October 2007. Enforcement action is being considered. CSCI must be notified, on an ongoing basis, of any significant event, without delay, as detailed under regulation 37, so that residents’ welfare can be monitored. This is a repeat requirement of the 16th/17th July 2007. As per Statutory Requirement Notice of 23/11/2007. Timescale given 7/12/07 The home must evidence that the first floor ceiling and the scaffolding in place are safe, and inform the CSCI of the timescale of works to be completed in this area. This is a repeat requirement from the random inspection of 24th October 2007. Enforcement action is being considered. 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. This is, in part, a repeat requirement from the inspection of 19th April 2007. Enforcement action is being considered. DS0000066149.V356855.R01.S.doc 07/12/07 17/12/07 07/12/07 17/12/07 17/12/07 High Dene Residential Home Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP12 OP30 Good Practice Recommendations A programme of activities should be maintained. Further training in dementia care should be provided. High Dene Residential Home DS0000066149.V356855.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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