Inspection on 04/05/06 for High Dene Residential Home

This inspection was carried out on 4th May 2006.

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 17/12/07

High Dene Residential Home 19/04/07

High Dene Residential Home 16/10/06

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 Key Unannounced Inspection 4th May 2006 10:30 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 DS0000066149.V293494.R01.S.doc Version 5.1 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. DS0000066149.V293494.R01.S.doc Version 5.1 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 515907 Mr Subhir Sen Lochun Post Vacant Care Home 15 Category(ies) of Dementia - over 65 years of age (15), Old age, registration, with number not falling within any other category (15) of places DS0000066149.V293494.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd February 2005 Brief Description of the Service: Highdene is registered to provide personal care to up to fifteen older persons, all of whom may have dementia. 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. DS0000066149.V293494.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection, which focused on the core standards relating to older people. The report has been written using accumulated evidence gathered prior to and during the inspection. Two inspectors undertook this inspection, breaking for lunch to liaise on progress. The inspection took approximately six and a half hours. The first half of the inspection was facilitated by a senior carer, the manager who came on duty at 3pm, but was initially undertaking fire training. The manager was spoken with at the end of the inspection. Other care staff and the cook also participated. Part of the staff handover at change of shift was observed, and the administration of lunchtime medication was observed. One resident was spoken with, others were observed or spoken with more briefly, and five relatives were spoken with. There was one vacancy at the time of the inspection. What the service does well: What has improved since the last inspection? Care plans contained Waterlow pressure area risk assessments. Risk assessments were in place for residents with bedsides, and these had been signed by resident’s representatives. The hammer to access the key to the front door, which is in a box with a glass panel had been replaced and secured with a chain to prevent loss. DS0000066149.V293494.R01.S.doc Version 5.1 Page 6 Inappropriate notices that compromised privacy and dignity have been removed. The functioning remnants of an old lock have been completely removed from the outside of a bedroom door. Training in Protection of Vulnerable adults has been arranged for the acting manager. Manual handling training and food handling training had been arranged. Fire training delivered by a specialist consultant had been arranged. Bars of soap had been removed from communal bathrooms. What they could do better: The Statement of Purpose must be available on request in the home. A policy on emergency admissions should be formulated, and included in the Statement of Purpose. Whilst a number of specific requirements around privacy and dignity made at the last inspection had been met, not all had, and there was further evidence that this is not a concept that is fully taken on board by the home. Incontinence pads must be discretely stored. Meetings regarding residents must not be conducted where they can be overheard. Care plans should be signed by the resident or their representative and must contain a photograph. They must be reviewed thoroughly and any changes recorded. Daily records, including any food and fluid charts in place must be completed on an ongoing basis, must be adequate, and reflect events and observations related to residents’ identified care needs. A risk assessment and appropriate recording must be composed and monitored for a resident with unexplained bruising. Care staff must ensure the personal hygiene of each resident is maintained, including keeping their hair clean and tidy. Appointments with health professionals must be arranged in accordance with care plans. Staff administering medication must be trained by a competent person, and their competency assessed following training and at regular ongoing intervals. Medication must be given at appropriate times, and must be signed for immediately after it is given to each resident. The programme of activities must be reviewed. Residents must not be left in bed for most of the day due to a shortage of appropriate staff on duty. DS0000066149.V293494.R01.S.doc Version 5.1 Page 7 Residents’ food must improve. Residents must be offered at least one cooked meal a day. Fresh food must be available at all times as part of residents’ diet. It must be ensured that all residents are offered a snack and hot drink at suppertime. Choice of meal should be actively promoted, and picture menus provided to facilitate choice to this group of residents. The home must have a food safety management system based on the principals of HACCP. The complaints policy must be updated, and a log of complaints received must be maintained in the home. The complaints procedure should be more prominently displayed. Enhanced Criminal Records Bureau checks must be applied for any all existing staff who only have standard level Criminal Record Bureau checks but require enhanced. The acting manager, and staff must receive training in the protection of vulnerable adults. Any allegation death illness or other event as required by regulation 37 must be reported to the CSCI. Damaged work surfaces in the kitchen must be replaced, and a schedule for redecoration and renovation should be produced and implemented. The home must have sufficient wheelchairs for residents’ needs. They must be serviced regularly and they must not be used for transporting residents without footplates. High cleaning must be maintained. Towels must be removed from communal bathrooms to reduce the risk of cross infection. The kitchen flooring must meet the fittings without a gap. The manager’s job description must clearly show their distinct responsibilities for meeting the aims and objectives of the home. Staffing levels must be adequate at all times. Arrangements should be in place to ensure that a sufficient staff have an NVQ 2 in care. All care staff must have regular manual handling training updates. Staff must receive regular formal supervision in line with the standard. Health and safety practices must be improved. Fire Doors without automatic closures must not be propped open. A fire door into and out of the kitchen which has been compromised by a keyhole must be made good. Action must be taken to minimise the risk posed by a small raised bar at the back door entrance to the home. The hot water temperatures in the kitchen must be risk assessed to minimise the possibility of harm to residents if they are to continue to have access to the kitchen. The manager must ensure that any activities occurring in the home are appropriately risk assessed and proper precautionary action taken. A record of all visitors to the home must be maintained. DS0000066149.V293494.R01.S.doc Version 5.1 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. DS0000066149.V293494.R01.S.doc Version 5.1 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 DS0000066149.V293494.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,6 Residents can expect to be assessed prior to admission to the home. EVIDENCE: The home’s Statement of Purpose was requested but could not be located. Care plans for the two most recently admitted residents were inspected. Both had assessments, undertaken prior to admission, on file. The manager confirmed that the home does not provide intermediate care. DS0000066149.V293494.R01.S.doc Version 5.1 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 None of these standards were found to be met, residents cannot be assured their health and personal care needs will be fully reviewed or consistently met. Residents cannot be assured that their right to privacy and dignity will be upheld. EVIDENCE: Care plans contained Waterlow pressure area risk assessments. Risk assessments established to be in place for three residents who had bedsides, signed by resident’s representatives. A care plan for a resident admitted in March 2006 did not have a photograph in it, and had not been signed by the resident or their representative. Care plans had a single line entry by the manager on a monthly basis indicating that they had been reviewed, but there was no evidence that all aspects of the care plan had been reviewed fully. One resident had seen a General Practitioner within the previous month and had chiropody appointments on file. The care plan stated chiropody appointments every 6 DS0000066149.V293494.R01.S.doc Version 5.1 Page 12 weeks, but there had been a gap between 11/10/05 and 9/2/06 of three months, and no appointment was recorded after 9/2/06, which was over 8 weeks prior to the inspection. The records of monthly reviews amounted to a single line entry, and did not refer to a planned change in accordance with the change in frequency of chiropody. On the day of the inspection a G.P. had attended to see a resident who had developed a black eye with no apparent explanation. The resident had previously developed one on the other sided. Both of these were recorded in the accident book, however the senior member of staff spoken advised that the possible causes had not been considered. The residents and their relative were spoken with, both spoke well of the manner and attitude of staff. As detailed under the complaints section of this report, prior to the inspection a relative had raised concerns that their relative’s underclothes had been found to be stained after coming back from the laundry. The home’s laundry was inspected. Bio-tex was used to remove staining; the inspector was advised that staining was rare, and there was no staining of clothes seen in the laundry. One relative spoken on the day said that they had noticed that their relative’s tops had stains on them, and that they thought the clothes were not washed often enough. Staff advised that laundry was done on a daily basis. During the day, one inspector sat with the residents in the lounge, and was aware that one resident who required the assistance of two staff to move them smelt of faeces. This was brought to the attention of staff who attended to the resident. Two carers used a hoist and the resident clearly felt safe, and staff made this an enjoyable experience for the resident. They were then, however, put into a wheelchair without footplates and moved. This resident’s daily notes were checked later in the afternoon to establish whether they had been incontinent, the only entry was “ hasn’t eaten well.” One resident’s visitors took the resident and washed and cut their hair for them on the day of the inspection. Another resident spoke of the lack of a hairdresser for several weeks. They were asked who had washed their hair since then, and they advised it had not been washed for about two months. This resident’s relative was present when they were spoken with did not contradict this. Another resident’s daily records were checked, there was no record of them having had their hair washed in the previous two weeks. The lunchtime medication was observed at 1pm, which was after lunch. The senior on duty in the morning advised that this was an hour late, as the morning medication had been an hour late and they needed to give sufficient time between doses of medication. Medication was appropriately stored, and the senior carer giving the medication locked the cabinet after them whenever they left it to give out medicine, even if they only went a short distance from it. They ensured each DS0000066149.V293494.R01.S.doc Version 5.1 Page 13 resident having medicine had a drink to take it with. The carer however, signed for the medication after having given it all out. The carer advised that the only training that they had received was a short talk from the manager who had undertaken Boots medication training, and advised that they did not consider this adequate. Staff training files indicated that only the manager had received training in the administration of medicines. One resident, a very slightly built person, had hardly eat any of their lunch. This resident who had medication for pain relief after lunch said that they did not feel like eating because they were in pain. This was not recorded or discussed at handover. Residents’ privacy and dignity was not well respected. A requirement made at the last inspection to remove a notice on a resident’s door reminding staff to use gloves and apron had been met, and the notice removed, as had a bowel chart previously seen on the wall in a communal toilets. However, there were two large boxes of incontinence pads just inside the door of a resident’s room where the resident was in bed until past 3 pm. The contents were clearly visible. During the handover meeting, staff made some efforts to ask residents not to stand in the corridor, where they were meeting. They initially spoke quietly, but after observing some of the handover, the Inspector walked and stood around the corner of the corridor, staff voices raised to normal levels and the content of the discussion was clearly audible. A member of care staff sat in the living room with residents writing up care records. As the office is on the third floor, the Inspector asked if there was anywhere they could look at notes privately downs stairs. A carer offered an empty room, which as there was one vacancy the inspector assumed would be a vacant room; the room they were shown to was clearly a resident’s room that the resident was not in at that time. The offer was declined. The staff handover meeting was held in the corridor. One resident who was playing cards in the dining room was asked to move by a carer wishing to lay the table, and they stated that they were being pushed, not given a chance. This did not appear to be the case, but it was the resident’s perception. Carers spoke to displayed caring non-judgemental attitudes, and residents’ comments reflected this. DS0000066149.V293494.R01.S.doc Version 5.1 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Whilst residents can expect to be able to have visitors and to see them in their own rooms, other aspects of daily living were not as good as they are entitled to expect. EVIDENCE: No organised activities were taking place on the day of the inspection. There was no activity planned for the day and relatives spoken with said that ‘very little happens socially’. There was no record of activities offered or planned for residents and only minimal social interaction when carers were undertaking physical or personal needs. One relative spoken with said “why do they sit them in a circle and not take them out – I come in at all times, they never seem to have activities they are just dumped, that’s my impression, they don’t even get them out in the garden.” It was a very pleasant day on the day of the inspection, but no residents were seen to be taken out into the garden. One resident spoken with asked about any activities or social life they were able to enjoy, responded, “social life, that’s the past.” DS0000066149.V293494.R01.S.doc Version 5.1 Page 15 A number of visitors were in the home on the day of the inspection, and those spoken with confirmed they were free to visit and could see residents in their rooms. Residents were free to move around the home. An old lock fitted to the outside of one bedroom, that had only been partially removed was found to have been removed. On the day of the inspection one resident was in bed until shortly after 3.15pm. The senior carer was asked the reason for this and advised that this resident needed two people to move them, and could be aggressive. One of the carers on duty was pregnant, and the other had made it known that they would not move this resident, so there were not two able and willing staff to get the resident up during the early shift. The resident’s care plan was inspected and it confirmed that two carers were required for moving, and daily notes had at least one entry to state that the resident had been “hitting out”. Other entries included, “…. lovely”, “…no problem.” This resident’s room was rather airless, and the curtains were drawn closed. There was a drink with a straw in it, but this was out of reach. A carer was asked if the resident could manage to drink without help, and they advised that they try. There was a food and fluid chart in the room, that had no recent entries. The carer spoken with advised, “ I did give them a drink at 11 and at lunch time but I haven’t written them up yet. When the carer left the room they allowed the door to bang closed. This resident was discussed at the handover meeting when it was relayed to the late shift that he was still in bed, followed by the quote, “you know why.” See standard 28. One of the home’s cooks had left and had not yet been replaced at the time of the inspection. The remaining cook advised that they worked for 4 days one week, three days the other week. When the cook was not on duty, or was on leave, other carers have been doing the cooking. They advised that they were put on the rota to do this, but when they left work each day after lunch the carers on duty usually had to prepare the tea. The cook advised that they had one resident who was diabetic, but that they had not been formally told this. Tuna bake followed by fresh fruit salad was served on the day of the inspection. The diary was inspected for the Easter period, which had been the time when a specific complaint had referred to. The cook advised that they had been on leave, but had been distressed to find that no cover had been put on for this period. The diary record for foods provided over the Easter period was examined. Over the four-day holiday period there were two consecutive days without a substantial cooked meal. Fish and chips and mixed vegetables were served on Easter Friday, mixed sandwiches were provided for the main meal on Easter Saturday, followed by waffles, Spaghetti and sausages for tea. Finger food, including quiche and savoury eggs had been provided as the main DS0000066149.V293494.R01.S.doc Version 5.1 Page 16 meal on Easter Sunday, with tuna sandwiches and scones for tea. Chicken was provided on Easter Monday. Three of five relatives spoken to said that meals were not as good as they used to be. They said that there was no choice of meal as there used to be, and no biscuits or fruit. Relatives also referred to residents having only sandwiches and soup for a main meal one Sunday. The cook advised that the home has a basic menu, so they can track what food was served by knowing what part of the menu they are on, but that choices are written down if someone has something different. The cook advised of a lack of organisation with delivery of the menus, as care staff preparing the tea sometimes used ingredients required for a scheduled main meal, rather than stick to the plan. A relative advised that if they did not like what was offered for tea, that staff would always bring something else. One resident who chooses to spend most of their time in their room, and their relative were spoken with. They stated that it was a long time to go from teatime, at 4.30 pm, to the morning breakfast, without anything to eat. The resident said that they were not offered a milky drink and biscuit at suppertime. Staff spoken with said that this was offered to residents regularly. This resident had a food and fluid chart which had the last entry at 5pm on four days at the end of April/ beginning of May. The cook spoken to advised that the owner did the main shop for the home, and only a budget of £20.00 for bread and milk was available in the home. They said that they had been advised that the shop would be done on Mondays, but did not know if this was to be weekly or fortnightly, but was in either case properly concerned that this would not provide the required fresh food, which they felt should be purchased twice a week. On the day of the inspection the fridge was full of food including fresh food; the cook advised a shop had been done three days prior to the inspection. A carer spoken to separately said that there had been no fresh meat, usually frozen vegetables, and that the joint of beef served for Sunday dinner recently was tiny. The carer advised that the owner had advised that 2 joints had been purchased and one had gone missing. The cook advised that they did not have the opportunity to check stock in, on that day they had also cooked sausages to supplement the small joint; this was recorded in the diary. DS0000066149.V293494.R01.S.doc Version 5.1 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Residents cannot be sure that complaints put to the owner will be fully resolved. Residents cannot be assured that staff and management within the home have the skills and knowledge they need to protect them from abuse. Residents cannot be assured that all care staff have a Criminal Records Bureau Check at the correct level, or therefore that the risk to them of abuse has been minimised. EVIDENCE: A notice board in an inset in the hall that that care staff use for administrative purposes had been cleared of residents’ information, and the complaints notice had been moved to the wall of the hall. Unfortunately, it was behind the front door which was open for most of the day of the inspection was still not clearly visible. The complaint notice refers to speaking to the owner if the manager is not available. The policy was inspected, and it referred to the previous owner, who was routinely available in the home. Concerns were raised about food in the home by a relative two weeks prior to the inspection, and it was agreed that the inspection would look in some depth at the issues raised. The relative was concerned about the lack of choice of meal being offered, staff being unsure food would be available to make a meal on one occasion and staff having received eggs without a date stamp. They were also concerned about the quality of washing powder purchased for use in DS0000066149.V293494.R01.S.doc Version 5.1 Page 18 the home. Very similar concerns had been expressed to the CSCI emergency duty team on Easter Friday which they had discussed with the owner. A record of this should have been available in the complaints log. There was no log of complaints available in the home. These matters were looked into on this occasion and requirements were made in respect of meals and maintenance of residents’ personal hygiene. The cook remained unsure of when food supplies would be delivered, therefore matters which were reported to Social Care Services had not been fully resolved. At the previous inspection it had been found that not all CRB’s for staff were at enhanced level, and a requirement was made that Enhanced Criminal Records Bureau checks must be applied for any all existing staff who only have standard level CRBs but require enhanced. The administrator advised that this was their area of work and they had been told to do this, but had not taken any action as they believed that the existing checks were all at enhanced level. Evidence was seen that training in the protection of vulnerable adults had been arranged for the acting manager within the timescale for this requirement made at the last inspection. It had yet to be undertaken. Within the policies and procedures file there were descriptions of instances of abuse, but no procedure. Some carers spoken with were not aware of what was included in this file on the subject. When asked about the home’s whistle blowing policy and procedure for reporting abuse none of the carers gave a consistent response as to who they should refer to and in what circumstance. Some staff expressed a lack of confidence that such a matter would be dealt with appropriately by management, There was a lack of confidence expressed to the inspector about the manager’s ability to act appropriately if informed of these matters and some doubt about whom they would inform of an allegation of abuse, and some doubt about whom they would inform of an allegation of abuse. DS0000066149.V293494.R01.S.doc Version 5.1 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,22,26 Hygiene and cleanliness standards within the home need to improve. Residents cannot expect wheelchairs to be properly fitted or be assured they have been serviced. EVIDENCE: The front of the house was well maintained, with gardens in good order. No changes had been made to the décor since the last inspection. The owner’s regulation 26 report received by the CSCI in January stated that refurbishment would take place in summer 2006. No documented plans were available to demonstrate how this was to happen even though this should be imminently happening. One relative said, “The whole place could be brighter for residents, it needs painting and decorating.” Two worktops in the kitchen had holes in the surface. The blind was stained. The dining room was more cheerful in the spring sunlight than it had previously appeared, but table settings remained spartan. DS0000066149.V293494.R01.S.doc Version 5.1 Page 20 See standard 38, regarding fire doors. A requirement was made at the last two inspections that wheelchairs must be regularly serviced, and a record maintained to evidence this. Following the first time this requirement was made, the then owner advised that enquiries had been made, and the outcome was that the home’s handyman was going to service the wheelchairs. The manager could not provide any evidence this had been done, but produced an empty schedule proforma for the purpose from the handyman’s folder. Only one of the wheelchairs seen in the home had footplates. Residents were seen to be transported in chairs without footplates. A store of wheelchairs was kept inside the porch/ doorway; none of these had footplates on, these were stored separately. A relative advised the inspector that they had needed a wheelchair to take their relative out in the latter part of the morning, but that there were none available. No action had yet been taken in respect of making good the gap at the edge of the flooring where it met the units and curls up. There were no bars of soap found in communal bathrooms on this occasion, however there were still towels on rails that were dirty. Staff advised that the home only has one cleaner who works on 5 days a week, having until recently had two cleaners providing seven days cover. They advised that the cleaner was off sick, and that they were also expected to cover these duties, but were unable to do so when short staffed. They advised that on this day they had only been able to do the beds. There were no odours in the home, but cupboard tops on the kitchen were found to have thick dust. DS0000066149.V293494.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Whilst staff are experienced by residents to be genuinely caring, the lack of full recording, lack of activities, lack of attention to hair, and other requirements detailed in this report indicate that residents’ needs are not being met by the numbers and skill mix of staff. EVIDENCE: The home’s rota showed planned staffing, actual staffing was shown by notes in the diary. The planned level of staffing was for three members of staff on both the early shift, i.e. 7.15 am to 3.15 pm, and also the late shift, i.e. 3pm to 10pm, including the acting manager, working as a senior carer. One resident commented, “When you ring the bell they come pretty quick.” On the day, a call bell was heard at lunchtime, and it was responded to promptly. A relative who regularly visits the home said, “I’m satisfied that all of the workers here are good.” The diary showed that for the coming weekend there were only 2 staff on the late shift for both Saturday and Sunday. Staff rotered to work the late shift were regularly leaving early, as referred to in the home’s diary/log, and an Inspector was advised this had been approved by the owner. The diary showed that on the day of the inspection, the manager was working to cover care duties and would leave at 8pm. From 8pm until 10 pm, there would therefore be only 2 members of staff on duty, neither of which were a senior. DS0000066149.V293494.R01.S.doc Version 5.1 Page 22 A carer advised that sometimes there are only two carers on the late shift, and it can be a problem then if the cook hasn’t been able to prepare the tea. Staff said that they would work shifts as either carers, seniors or cleaners depending on the ‘cover’ needed and not according to their designation of role or according to skill and experience. The most senior person on duty on the morning of the inspection advised that they did not have an NVQ. It was noted at the last inspection that whilst only two staff had NVQs, however seven had commenced NVQ 2. On this occasion, staff advised that NVQ training had ceased, but that staff were not sure why or what was happening about this. The manager was unable to clarify why the NVQ training was not progressing as planned. The manager advised that three members of staff were off work due to illness, that another is due to go on extended leave at the end of May. The manager advised she was not allowed to advertise other than in the job centre, and this caused her some anxiety. Recruitment files were inspected for the two most recently recruited members of staff. Both had enhanced Criminal Record Bureau checks and two references, received prior to their employment. Both had proof of identity on file. A requirement was made at the last inspection that all care staff must have regular manual handling training updates; evidence was seen that training had been planned for the 10th June 2006. Food handling training had been arranged for staff on 18th May 2006. Staff advised that training in dementia awareness had started for some staff. DS0000066149.V293494.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,36,38 The home is not being well managed. Residents cannot be sure that systematic management activities such as supervision of staff, full care plan review, audits of medication practice, maintenance of health and safety within the home are being carried out. EVIDENCE: The home has not had a registered manager since the beginning of December 2005 when the current owner took over the business. The acting manager was previously the deputy for three years, before becoming the Care Manager. The acting manager holds an NVQ3. The home’s business plan identified the need to support them to undertake the Registered Manager Award. An application for Registration had been received by the CSCI, on 5th December 2005, however it had not been possible to complete this process as incomplete information had been provided. DS0000066149.V293494.R01.S.doc Version 5.1 Page 24 The job description for the Manager and the Deputy Manager were inspected. The Manager’s job description did not refer to any specific responsibilities carried by the role for overall management of the home, including those required by the CSCI for a Registered Manager. The manager advised that they are only responsible for a budget of £20.00, which is for bread and milk. Staff morale was found to be generally low. Staff advised that a cook and a cleaner had left recently, and that and a hairdresser who used to attend to residents within the home had also stopped coming. A member of staff advised that the maintenance person now attended on two days a week, rather than daily. One relative spoken with advised they were disappointed about the expectations that the new owner had given them of positive changes in the home. The home’s Certificate of Registration was displayed. A large number of repeat requirements were made at this inspection. The home’s previous Inspection report was available in the home. It was acknowledged that there was no requirement for this is be displayed. CSCI had not received a response or an action plan to this report, although a reply was received to the immediate requirements issued. That reply advised that fire doors had been found to be properly closed, and that the matter would be reinforced with staff through supervision. From supervision files, discussion with the staff and the manager it was clear that regular supervision for staff had not taken place, the last dates noted for planned supervision were in March 2006, and these had not taken place. Some staff indicated that they did not want to be supervised, as they felt it would be a waste of time. One member of staff said that they received different information from he manager and from the owner. Two members of staff said they were not confident in the manager. Staff advised that any resident’s money looked after by the home can only be accessed by the manager and the administrator. Due to the relatively brief availability of the manager on the day, and the large number of issues to feed back to them, this standard was not fully inspected, and will be inspected fully next time. The home had a policy for the safekeeping of substances hazardous to health, and a locked cupboard had been provided for these. The hammer to access the key to the front door, which is in a box with a glass panel had been replaced and secured with a chain to prevent loss. The manager advised that fire training had been arranged with a private specialist contractor for next week as well as today, when they were seen to be present in the home. However, a wedge was in place holding open a fire door into the kitchen, and also bedroom 8. DS0000066149.V293494.R01.S.doc Version 5.1 Page 25 Notices had been put up to remind visitors to sign in and out in the visitor’s book, but not all visitors in the home on the day of the inspection had signed in. Staff advised that residents were kept away from the kitchen, as one had been entering a lock had been put on the door. The door, which was a fire door, had been fitted with a lock and key, which had compromised the integrity of the door. Despite this, during the inspection the inspector was able to walk into the kitchen which was unstaffed at the time. Residents were still, therefore exposed to the risk of the hot water in the kitchen which is not regulated. There was a small raised bar at the back door entrance that was a tripping hazard, and it was not marked. On the day of the inspection, a fire extinguisher training exercise for staff occurred, part of which took place in the back garden. A low sharp edged tray of water was set out, as was a stovetop – which although it had no heat source had two hot hot plates. This equipment was left unattended. The exercise that followed involved very high flames. There was no notice on the back door to warn individuals entering this space, and the back door was not secured. They did not have a food safety management system based on the principals of HACCP, had not heard of this and had not received any training. DS0000066149.V293494.R01.S.doc Version 5.1 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 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 1 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 2 2 X X 2 X X X 2 STAFFING Standard No Score 27 2 28 1 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 2 X X 2 X 1 DS0000066149.V293494.R01.S.doc Version 5.1 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 2 Standard OP1 OP7 Regulation 4(2) 15(2)(c) Requirement The Statement of Purpose must be available on request in the home. Care plans must be reviewed thoroughly and any changes recorded. This is a repeat requirement. Care staff must ensure that the residents’ personal hygiene is maintained. Resident’s must be assisted to kept their hair clean and tidy. A risk assessment must be composed and appropriate documentation for monitoring instigated for a resident with unexplained bruising. Daily records, including any food and fluid charts in place must be completed on an ongoing basis, must be adequate, and reflect events and observations related to residents identified care needs. Appointments with health professionals must be arranged in accordance with care plans. Medication must be signed for immediately after it is given to DS0000066149.V293494.R01.S.doc Timescale for action 31/05/06 30/06/06 3 4 5 OP8 OP8 OP8 12(1)(a) 12(1) 14(2) 23/05/06 23/05/06 23/05/06 6 OP7 17(1)(a) Sch 3 (m) 31/05/06 7 8 OP8 OP9 13(1)(b) 13(2) 23/05/06 04/05/06 Version 5.1 Page 28 9 OP9 13(2) 10 11 OP9 OP10 13(2) 12(4)(a) 12 OP10 12(4) 13 OP12 16(2)(n) 14 15 16 17 18 OP15 OP15 OP15 OP16 OP16 16(2)(i) 16(2)(i) 16(2)(i) 22(1) 17(2) sch4 19(1)(b) Sch2 19 OP18 20 OP18 13(6) each resident. Staff administering medication must be trained by a competent person, and their competency assessed following training and at regular ongoing intervals. Medication must be given at appropriate times. Incontinence pads must be discretely stored. This is a repeat requirement from the previous inspection. Staff meetings in which residents are discussed must not be conducted where they can be overheard. The programme of activities must be reviewed. This repeat requirement from the previous inspection was within timescale. Fresh food must be available at all times as part of residents diet. Residents must be offered at least one cooked meal a day. It must be ensured that all residents are offered a snack and hot drink at suppertime. The complaints policy must be updated. The acting manager must ensure that a log of complaints is maintained. This is a repeat requirement. Enhanced Criminal Records Bureau checks must be applied for any all existing staff who only have standard level CRBs but require enhanced. This is a repeat requirement from the previous inspection. The acting manager must receive training in the protection of vulnerable adults. This repeat requirement is within timescale. DS0000066149.V293494.R01.S.doc 30/06/06 04/05/06 04/05/06 04/05/06 30/06/06 30/06/06 23/05/06 23/05/06 31/05/06 04/05/06 04/05/06 30/06/06 Version 5.1 Page 29 21 OP18 13(6) 22 23 OP19 OP22 13(4) 13(5) 24 25 26 27 OP22 OP22 OP26 OP26 23(2)(n) 23(2)(n) 16(2)(j) 13(4) 28 OP26 13(4) 29 30 OP27 OP28 18(1) 18(1) (a)(c) 18(1) 13(5) 31 OP30 32 OP31 12(1) 33 OP36 19(1) Staff have must receive training in the protection of vulnerable adults. This repeat requirement is within timescale. Damaged work surfaces in the kitchen must be replaced. Wheelchairs must be regularly serviced, a record maintained to evidence this. This is a repeat requirement from the last two inspections. Residents must not be transported in wheelchairs without footplates in use. The home must have sufficient wheelchairs to meet resident’s needs. High cleaning must be maintained. Towels must be removed from communal bathrooms to reduce the risk of cross infection. This is a repeat requirement from the previous inspection. The kitchen flooring must meet the fittings without a gap. This repeat requirement from the previous inspection was within timescale. Staffing levels must be adequate at all times. This is a repeat requirement. The home must ensure it is staffed with appropriately skilled workers to meet residents’ needs at all times. All care staff must have regular manual handling training updates. This repeat requirement was within timescale. The manager’s job description must clearly show their distinct responsibilities for meeting the aims and objectives of the home. Staff must receive regular formal DS0000066149.V293494.R01.S.doc 30/06/06 15/06/06 04/05/06 04/05/06 30/06/06 31/05/06 04/05/06 31/05/06 04/05/06 30/06/06 30/06/06 15/07/06 04/05/06 Page 30 Version 5.1 34 OP38 23(4) 35 36 OP38 OP38 17(2) 23(4) 37 OP38 13(4) 38 OP38 13(4)(a) 39 OP38 13(4)(a) 40 OP38 13(4)(c) supervision in line with the standard. This is a repeat requirement from the last two inspections. Fire Doors without automatic closures must not be propped open. This is a repeat requirement from the previous three inspections. A record of all visitors to the home must be maintained. This is a repeat requirement. A fire door into and out of the kitchen which has been compromised by a keyhole must be made good. A risk assessment and appropriate remedial action must be taken to minimise the risk posed by the very hot water in the kitchen, if residents are to continue to have access to the kitchen. This is a repeat requirement. Action must be taken to minimise the risk posed by a small raised bar at he back door entrance to the home. The manager must ensure that any activities occurring in the home are appropriately risk assessed and proper precautionary action taken. The home must have a food safety management system based on the principals of HACCP. 04/05/06 04/05/06 04/05/06 04/05/06 04/05/06 04/05/06 30/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000066149.V293494.R01.S.doc Version 5.1 Page 31 1. 2. 3. 4. 5. Standard OP3 OP7 OP14 OP16 OP19 A policy on emergency admissions should be formulated, and included in the Statement of Purpose. Care plans should be signed by the resident or their representative. Choice of meal should be actively promoted, and picture menus provided to facilitate choice to this group of residents. The complaints procedure should be more prominently displayed. A programme for renewal of the decoration of the premises should be produced and implemented. DS0000066149.V293494.R01.S.doc Version 5.1 Page 32 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000066149.V293494.R01.S.doc Version 5.1 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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