Inspection on 29/04/08 for Immacolata House

This inspection was carried out on 29th April 2008.

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

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

Other inspections for this house

Immacolata House 04/12/07

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Immacolata House Portway Hurds Hill Langport Somerset TA10 0NQ Lead Inspector Kathy McCluskey Unannounced Inspection 29th April 2008 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 Immacolata House DS0000070446.V360618.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. Immacolata House DS0000070446.V360618.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Immacolata House Address Portway Hurds Hill Langport Somerset TA10 0NQ 01458 254200 01458 254201 danielle@notarohomes.co.uk www.notarohomes.co.uk N Notaro Homes Limited 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) ****Post Vacant**** Care Home 49 Category(ies) of Dementia (38), Old age, not falling within any registration, with number other category (49) of places Immacolata House DS0000070446.V360618.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) 2. Dementia (Code DE) - maximum of 38 The maximum number of service users who can be accommodated is 49. 4th December 2007 Date of last inspection Brief Description of the Service: Immaculata House is registered with the Commission for Social Care Inspection to provide nursing care for up to 38 people over the age of 65 years in the category of dementia and 11 service users who require general nursing care. The home was registered with the Commission in August 2007. The registered manager has recently left her post and the registered person has put management arrangements in place whilst they recruit to this post. The home is owned by N.Notaro Homes Ltd. The registered person/responsible individual is Mr Nunzio Notaro. Immacolata House is purpose built and has been designed with the environmental recommendations for service users with dementia. The home is decorated and furnished to a very high standard. Accommodation is over two floors with stairs and a large passenger lift giving access to the first floor. The 49 single bedrooms have been divided into 4 selfcontained units to enable smaller group living. The home is set within its’ own grounds of 5 acres in a peaceful setting not far from the small town of Langport. The home’s current fee range is £650 - £751 per week. This does not include any ‘free nursing care’ element, so this would be included in the fees. Immacolata House DS0000070446.V360618.R01.S.doc Version 5.2 Page 5 The home does have a number of beds which are block contracted by Social Services. Additional charges are met by service users for personal toiletries, hairdressing, chiropody, newspapers/magazines. The home provide transport for service users to attend healthcare appointments. Immacolata House DS0000070446.V360618.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience Adequate quality outcomes. The focus of this inspection visit was to inspect relevant key standards under the Commission’s ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service for each outcome group under four general headings. These are; - excellent, good, adequate and poor. The home’s last key inspection was conducted on 4th December 2007. This was the home’s first inspection since being registered by the Commission in August 2007. Following this inspection, the registered person was required to submit an improvement plan to the Commission which identified action to be taken to improve the quality of the service. This was received by the Commission within agreed timescales. The Commission conducted an additional ‘random’ inspection on 17th January 2008 to monitor compliance. At this inspection we primarily focused on care planning procedures and staffing. This unannounced key inspection was conducted over one day (7 hours) by CSCI Regulation Inspector Kathy McCluskey. The recently appointed acting manager was available throughout this inspection and the registered manager from another of the company’s homes who has been managing Immacolata House since the last inspection, was available during the afternoon of the inspection. We were given unrestricted access to all parts of the home and records requested for this inspection were made available to us. We were able to speak with a number of staff, one relative and some people using the service. We observed staff interactions with people using the service and were able to see lunch being served in each of the four units. A selection of records were examined relating to staff, people using the service, and health and safety. As part of this inspection the Commission sent a selection of comment cards to people living at the home, relatives, staff, care managers and healthcare professionals. We received one comment card from a person using the service, two from staff, six from relatives and one from a healthcare professional. Comments have been included in this report. Immacolata House DS0000070446.V360618.R01.S.doc Version 5.2 Page 7 We would like to thank all involved, for their time and cooperation with the inspection process. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. What the service does well: Immacolata House is purpose built home and has been designed with the environmental recommendations for older people with dementia. Décor, fixtures and fittings are of a very high standard. The home is set within its’ own five acre grounds and is located just outside of the small town of Langport. A wheelchair accessible mini-bus is available for people using the service. All bedrooms are for single occupancy and exceed the National Minimum Standards for size. Bedrooms are very comfortably furnished and are fitted with telephone, television and internet points. All are provided with flat screen televisions which have freeview access. The home is registered for up to 49 people and the home has been designed to allow smaller group living. The home is made up of 4 self-contained units. Information about the home is made available to people living at the home and to people thinking about using the service. The home ensures that anybody wanting to move to the home is appropriately assessed and the home will liaise with healthcare professionals during this process. The home ensures that visitors are made to feel welcome. Meals and refreshments are made available. People living at the home are treated with respect. Under the heading, ‘What do you feel the home does well?’, relatives made the following comments in completed comment cards for the Commission; ‘Dementia care – excellent standards of care as experienced in my relatives degree of comfort, general well-being and lack of distress’ ‘Very good with birthdays and celebrations’ ‘Good holistic care’ ‘Very friendly and welcoming’ ‘Beautiful home in lovely surroundings’ ‘The front of house staff member is excellent’ ‘They listen and care very much about the people in their care and their families and they offer a good service of care’ ‘Meal provision is good’ Immacolata House DS0000070446.V360618.R01.S.doc Version 5.2 Page 8 One comment card was received from a healthcare professional. They felt that the home ‘have provided individualised care for the residents’ What has improved since the last inspection? People can now be more confident that staff have the skills to meet their needs. We were able to see evidence that newly appointed staff had completed a satisfactory induction programme. Training for staff in dementia care and the management of challenging behaviour has taken place since the last inspection. Care staff spoken with during this inspection did not express any concerns in their ability to meet the needs of people living at the home. The home have taken appropriate steps to ensure that a suitably qualified registered mental health nurse (RMN), is on duty at all times. The home’s care planning procedures have improved. Care plans examined at this inspection were reflective of the individuals’ assessed needs. Information for staff on how needs should be met contained sufficient information and the preferences of the individuals’ had been recorded. This will enable staff to deliver a more person centred approach to care. Care plans for the management of wounds still need improvements to ensure that wounds are managed in a consistent manner. At the time of this inspection we were informed that one person was being treated for a pressure sore. The home have taken steps to ensure that registered nurses appropriately sign records to confirm that a persons medication has been administered as prescribed. Further improvements in the home’s procedures for the management of peoples’ medication are needed. Systems are now in place to ensure that people are offered a programme of activities. Social history’s are in the process of being completed for people living at the home. This will give staff a better understanding of the individuals’ life history and hobbies/interests. Records are now being maintained for each person, which identifies the outcome of each activity. Appropriate steps have been taken to ensure that meals are served at an appropriate temperature. Hot trolleys are now in use. Following the last inspection, the dining arrangements in the two units on the first floor have been reviewed. Each unit now utilise their own dining areas during meal times. Appropriate menus are now displayed for people. Individuals’ dietary preferences had been included in the care plans examined. Immacolata House DS0000070446.V360618.R01.S.doc Version 5.2 Page 9 The home have ensured that appropriate procedures are followed to reduce the risk of harm or abuse to people using the service. Since the last inspection staff have received training in Adult protection/abuse. Staff recruitment procedures have improved in that no staff commence employment until all appropriate checks and references have been received. Further improvements are needed. What they could do better: This inspection highlighted five outstanding requirements raised at the previous inspection and two additional requirements were made as a result of this inspection. Care plans for the management of wounds did not contain sufficient information about the treatment prescribed or of the frequency of treatment. This needs to be addressed to ensure that wounds are managed in a consistent manner. Improvements are still required for the home’s procedures for the management and administration of people’s medication. The home need to ensure that staff recruitment files contain an up to date photograph of the employee and that applicants provide an employment history. At the last inspection there was no evidence that staff were receiving formal supervision sessions at least six times a year. At this inspection there was evidence that this had taken place for some staff, but not all. There was no system in place to demonstrate that supervision sessions had been planned for staff. The home needs to demonstrate that all staff have received up to date training in fire safety and moving and handling as this could not be established from the information made available at this inspection. The home must ensure that they inform the Commission of all required incidents as listed in Regulation 37 of the Care Homes Regulations 2001. At this inspection we found that an incident involving medication had not been reported or investigated. The management team stated that they had not been Immacolata House DS0000070446.V360618.R01.S.doc Version 5.2 Page 10 made aware of the incident. Systems need to be introduced to ensure that regular audits are made on all accidents/incidents. We recommended that the home reviews its’ current arrangements for offering menu choices to people living at the home. People are currently asked about their choices the day before. This may not be appropriate for people with dementia or memory loss. Comment cards completed for the Commission identified the following areas that could be improved; ‘Perhaps more staff’ ‘They could have coffee mornings’ ‘They could put more resources into social/recreational activities and trips’ ‘They must always make absolutely sure that they recruit staff who have an affinity with people who have dementia’ 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. Immacolata House DS0000070446.V360618.R01.S.doc Version 5.2 Page 11 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 Immacolata House DS0000070446.V360618.R01.S.doc Version 5.2 Page 12 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 4. Standard 6 is not applicable as the home is not registered to provide intermediate care. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Information about the home is made available to people thinking about moving there. The home ensures that people are appropriately assessed before they are offered a placement. People can now be more confident about the home’s ability to meet their assessed needs. Staff have now received training in dementia care and an appropriately trained registered nurse is available on each shift. EVIDENCE: Immacolata House DS0000070446.V360618.R01.S.doc Version 5.2 Page 13 The home has produced a Statement of Purpose and Service User Guide. Both give detailed information about the home and services offered. These documents are in the process of being updated to include changes to the management structure. We were able to speak with one relative during this inspection and they confirmed that they had received sufficient information about the home to enable them to make an informed decision. One person using the service completed a comment card for the Commission. In response to the question; ‘Did you receive enough information about the home before you moved in so you could decide whether it was the right place for you?’, they responded ‘Yes’. It was also confirmed that they had received a contract. All persons using the service who are privately funded, receive a contract from the home which identifies the terms and conditions of occupancy. Information received from the home states that action is being taken to ensure that all people funded by social services also receive this information. Care plans examined demonstrated that people had been appropriately assessed by the home before they were offered a placement. Assessments from appropriate healthcare professionals had also been obtained where available. At the last inspection concerns were raised regarding the home’s ability to meet the assessed needs of all people living there. This related to the lack of staff training, appropriately trained registered nurses and specialised equipment. At this inspection we were able to see evidence that the home had taken appropriate action to address this. It was confirmed that a registered mental health nurse (RMN) was now available on each shift. There was evidence that staff had received some training in dementia care and in the management of challenging behaviour. Details on staff skills/training can be found under Standard 27. Staff spoken with during this inspection were positive about the training which had taken place and all confirmed that they now felt they had the skills needed to enable them to meet the needs of the people living at the home. Registered nurses spoken with confirmed that they were able to meet the needs of all people currently using the service. The newly appointed acting manager confirmed that placements would not be offered unless she was sure that staff had the skills to meet any specialist needs that a person may have. The home is purpose built and has been designed to meet the needs of people with dementia. At the last inspection it was noted that specialised cutlery and Immacolata House DS0000070446.V360618.R01.S.doc Version 5.2 Page 14 seating was not available for one person with an assessed need. At this inspection we were able to see that the person had been provided with specialised cutlery and they were very positive about this. A specialised wheelchair had not yet been made available but the person stated that they thought ‘this was being sorted’. The home should ensure that this is followed up. Immacolata House DS0000070446.V360618.R01.S.doc Version 5.2 Page 15 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. Care planning procedures have improved and care plans now provide sufficient information on individuals’ assessed needs. Care plans contain reference to the preferences of individuals’. Care plans relating to the management of wounds need improvements to ensure a more consistent approach. People have access to a range of healthcare professionals and the home ensures that healthcare needs are met. Improvements are required for the management and administration of peoples’ medication. People are treated with respect. EVIDENCE: Immacolata House DS0000070446.V360618.R01.S.doc Version 5.2 Page 16 We examined four care plans at this inspection and were able to see evidence that the requirements raised at the last inspection had been addressed. Care plans viewed were up to date and contained more detailed information about the persons assessed needs. Information for staff on how needs should be met contained information about the individuals’ preferences thus allowing for a more person centred approach to care. There was evidence that care plans were reflective of individuals assessed needs. Care plans had been raised to meet needs relating to nutrition/weight loss, psychological needs & social interaction. Up to date risk assessments were seen in one care plan for a person with complex mental health needs and appropriate care plans had been developed to ensure a consistent approach to care. Care staff spoken with all confirmed that they were encouraged to refer to people’s care plans. Two staff members completed comment cards for the Commission and some concerns were raised regarding the lack of information given about new admissions to the home. It was confirmed that detailed ‘handovers’ take place during the morning and evening but ‘handovers’ for changes of staff at lunch time were ‘not sufficient’. This was discussed with the acting manager who agreed to look into this. Care plans contained evidence that people had access to appropriate healthcare professionals. Records are maintained for all visits. There was evidence that people’s weights are monitored on a monthly basis. As previously mentioned, there was evidence that care plans had been developed to address concerns raised. The acting manager informed us that arrangements had recently been made for a local GP to visit the home on a weekly basis. We sent comment cards to a number of healthcare professionals and care managers to seek their views about the home and care provided. We received one completed comment card from a healthcare professional. Comments were positive. In response to the question, ‘Are individuals’ health care needs met by the home?, the response was ‘Always’, ‘I have reviewed 3 clients, on each occasion all family members have been satisfied with the care provided’. It was also confirmed that the home seeks advice where required, ‘Clients at the home have always had satisfactory reviews and care needs met’ As required at the last inspection, improvements are needed relating to the management of wounds. At this inspection we were informed that one person was receiving treatment for pressure sores. The care plan raised did not contain information regarding the treatment prescribed or of the frequency of treatment. There was good information maintained for the size and status of the wound but dates recorded were not consistent – i.e.: frequency of Immacolata House DS0000070446.V360618.R01.S.doc Version 5.2 Page 17 dressings/treatment ranged from daily to every other day. Clear information must be available to ensure that wounds are managed in a consistent manner. Specialised pressure relieving aids were seen to be in place for those people with an assessed need. Six relatives completed comment cards for the Commission and in response to the question, ‘Do you feel that the home meets the needs of your relative?’, 2 responded ‘Always’ & 4 ‘Usually’. They also made the following comments; ‘Excellent basic care’, ‘Staff changes and use of agency staff for several months has impacted on how well needs are met’. Comments about staffing issues were discussed with the acting manager who confirmed that this was now improving following a recruitment drive. Some agency staff are still being used to cover shortfalls though it is envisaged that this will reduce. Relatives also made the following comments under ‘What the home does well’, ‘Dementia care – excellent standards of care as experienced in my relatives degree of comfort, general well being and lack of distress’, ‘Good holistic care’, ‘The overall care and understanding of people with dementia’, ‘They listen and care very much about the people who are in their care home and their families – they offer a good service of care’. We met with one relative during this inspection and they were very positive about the care their relative received. One person living at the home indicated that ‘things have improved’, ‘Now a five star service’. During this inspection we spent time on each unit, observing staff interactions with people at the home. Two staff were available on each unit. The atmosphere was relaxed and unhurried. Staff were observed sitting and interacting with people. This is positive. Staff communicated with people in a kind and professional manner and were heard using the individuals preferred form of address. People appeared to respond positively to staff interaction and all looked relaxed and comfortable. We examined the home’s procedures for the management and administration of peoples’ medication. At the last key inspection, three requirements and one good practise recommendation were raised regarding the home’s procedures and we were able to see evidence that one of the requirements had been addressed relating to the signing of all medication administered. When we examined medication administration records we found that the amount administered for variable doses was not always being recorded. Hand written entries had not always been confirmed by two staff signatures. Some entries had not been signed. Protocols for the use of ‘as required’ medication were not available. Action must be taken to address these outstanding requirements. Immacolata House DS0000070446.V360618.R01.S.doc Version 5.2 Page 18 We found an incident report which related to ‘missing medication’. There was no evidence that this had been appropriately reported and this incident had not been investigated (refer to Standard 38). Providing that assessed needs can be fully met, Immacolata House provides people with a ‘home for life’. Care plans examined at this inspection contained information about peoples’ preferences following death. Immacolata House DS0000070446.V360618.R01.S.doc Version 5.2 Page 19 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 Good. This judgement has been made using available evidence including a visit to this service. The provision of activities at the home has improved and appropriate records are maintained. People are offered a wholesome and varied menu and can enjoy their meals in comfortable surroundings. The arrangements for offering choices could be improved. There was evidence that people are consulted about their dietary preferences. EVIDENCE: The home employs an activities co-ordinator who works 9-5 Monday & Thursday and 9-3 Tuesday, Wednesday and Friday. At the last inspection activity hours were 9-5 Monday to Friday. This person is responsible for providing activities/social stimulation to all people in each of the four units. At the last inspection an activities programme was not in place and no information about the preferences/social history’s of people were available. At Immacolata House DS0000070446.V360618.R01.S.doc Version 5.2 Page 20 this inspection we were able to see evidence that action had been taken to address this. A programme of activities was seen to be displayed and life history’s for people were nearing completion. Individual records were being maintained for each person which identified the activity offered and whether the person took part in or enjoyed the activity. There was evidence that people had recently enjoyed a trip out in the home’s mini bus. On the day of this inspection, no activities were observed taking place as the activity person was not available. As previously mentioned in this report, staff were observed spending ‘quality time’ with people and were not ‘task orientated’. Staff spoken with confirmed that were able to spend time with people. The registered mental health nurse (RMN) on duty confirmed that this is something that is encouraged. Relatives expressed some concerns regarding the provision of activities. In completed comment cards (March 2008), relatives stated that, ‘we expected more activities which are individual & meaningful and more outings but this has not been the case’, ‘It is obvious that residents are given choices where possible but there is insufficient resource devoted to meaningful activities’, ‘They could have someone to encourage people with their interests’, they need to ‘Put more resources into social/recreational activities and trips’ These comments were shared with the acting manager who confirmed that they were currently in the process of reviewing the provision of activities. Records demonstrated that a range of activities were offered and taken up so this will be followed up at the next inspection. We met with one relative during this inspection who confirmed that they were able to visit their relative at any time and were always made to feel welcome. In completed comment cards, relatives were positive about the staff member in the reception office who was described as ‘excellent’. Relatives indicated that they liked the fact that there was always somebody there to greet them. During this inspection we were able to observe lunch being served in each of the four units. Meals were served from two hot trolleys which are shared between the four units. Whilst there were no concerns noted on the day of the inspection regarding the time people were waiting for meals, the home should review the arrangements for how food is stored for serving. This relates to one of the puddings which was in a large serving bowl. When this arrived at the first unit it was attractively presented and had been finished with a topping of cream and strawberries. This arrived at the second unit partly used and lacking in strawberries. In these circumstances, the home need to ensure that separate servings are made available for each unit. Menus were available in each unit and these had been produced using photographs. Whilst the main dish was reflective of the menu, the vegetables Immacolata House DS0000070446.V360618.R01.S.doc Version 5.2 Page 21 and potatoes were not. Staff stated that they had not been made aware of the changes. This should be kept under review. Staff confirmed that people are asked about there choice of meal the day before and that a list of names and choices was given to the cook. One person could not remember what they had ordered. This routine of asking people about their choices the day before should be reviewed as this is not always appropriate for people with dementia/memory loss. We suggested that perhaps staff could show people plated meals of the choices available at the time of the meal. Staff felt that this would be more appropriate. People spoken with said that ‘There is always plenty to eat’ and that they ‘liked the food’. We met with one person who was having lunch with their relative. They confirmed that ‘the food is lovely’ and that they often joined their relative for lunch. Copies of a four week menu were made available to us and this identified choices for every meal. People can choose from a full English breakfast, cereal, porridge or toast at breakfast. Six relatives completed comment cards for the Commission. A comment was made regarding the limited choice of meals and that there were ‘lots of pies and chocolate puddings. This was not apparent in the menus made available to us. Options appeared wholesome and varied. As previously mentioned, the home should monitor the meals offered to ensure that they are being delivered in line with the menus. Comments were shared with the home. As recommended at the last inspection, the dining arrangements on the first floor have been reviewed. We were able to see that people were now utilising the dining rooms on each unit. Meal times were noted to be relaxed and unhurried and staff were offering assistance in an appropriate manner. Tables were attractively laid and condiments and napkins were available. Staff were observed offering a choice of three different fresh fruit juices. There was evidence in the care plans examined that people are consulted about their dietary preferences. Immacolata House DS0000070446.V360618.R01.S.doc Version 5.2 Page 22 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints procedure in place and people feel confident that their concerns will be appropriately responded to. The home’s procedures to reduce the risk of harm or abuse to people living there have improved. EVIDENCE: The home has a satisfactory complaints procedure in place. This is also available in the Statement of Purpose and Service User Guide. Five of the six relatives who completed comment cards for the Commission confirmed that they knew how to make a complaint. Three stated that the home ‘Always’ responded appropriately to concerns raised and two responded ‘Usually’. They also made the following comments; ‘It has not been necessary to raise concerns but if a concern was raised I am sure it would be dealt with effectively’, ‘Not all staff have appropriate skills so will have to wait for a trained person to come on duty’. The relative spoken with during the inspection stated that they would not hesitate in raising concerns if they had any. Immacolata House DS0000070446.V360618.R01.S.doc Version 5.2 Page 23 The Commission have not received any complaints about the home since the last inspection. One comment card was received from a healthcare professional and no concerns about the service were raised. The home’s complaints records indicated that they had investigated one complaint since the last inspection which related to two items of missing clothing. Records demonstrated that this had been responded to writing agreed timescales. The home has a range of policies and procedures in place for staff to protect service users from the risk of harm or abuse. As required at the last inspection, we were able to see evidence that staff had now received training in adult protection issues/prevention of abuse. Staff recruitment files demonstrated that staff do not commence employment until receipt of a satisfactory criminal record check (CRB), protection of vulnerable adults check (POVA) and two satisfactory references. Immacolata House DS0000070446.V360618.R01.S.doc Version 5.2 Page 24 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, 20, 21, 22, 23, 24, 25 & 26 Quality in this outcome area is Excellent. This judgement has been made using available evidence including a visit to this service. People live in an environment, which has been well designed for people with dementia. It has been furnished, equipped and decorated to a very high standard. All bedrooms are for single occupancy and all are fitted with en-suite toilet facilities. All but three have the provision of a shower. People are encouraged to personalise their rooms. People living at the home have access to the environmental aids and adaptations they need to promote mobility and orientation. The home takes appropriate steps to reduce the risk of the spread of infection. EVIDENCE: Immacolata House DS0000070446.V360618.R01.S.doc Version 5.2 Page 25 Immacolata House is purpose built and has been designed with the environmental recommendations for service users with dementia. The home is decorated and furnished to a very high standard. The home is divided into four units over two floors to allow for smaller group living. Each unit has its’ own lounge, dining and kitchenette facilities. On the ground floor there are two units for people who require nursing care by means of their dementia; ‘Rosetta’ has 10 bedrooms and ‘Sofia’ has 15 bedrooms. On the first floor there are a further 13 beds in the ‘Carolena’ unit for people with ‘higher’ dementia nursing needs. 11 beds are allocated for those who require general nursing care in the ‘Serena’ unit. All bedrooms are for single occupancy and are fitted with en-suite toilet facilities. All but three bedrooms are fitted with a shower. The registration visit noted that all bedrooms and communal space exceeded the National Minimum Standards for size. Bedrooms are fitted with an appropriate lock and lockable space is in place. All bedrooms have a profiling bed. All bedrooms have internet access, telephone and television points and rooms are provided with a flat screen television with ‘freeview’ provided. All areas of the home are decorated and furnished to a very high standard and orientation aids have been put in place to assist people with dementia. Handrails are appropriately sited throughout the home and ramps are in place at the main entrance. A large lift gives access to the first floor. Nurse call systems are available throughout the home. Assisted toilet and bathing facilities are available on each floor. The home was clean and warm on the day of this inspection. The home is fitted with under-floor heating and additional radiators in corridors are fitted with thermostatic controls and are covered to reduce the risk of injury to the people living there. The home has appropriate sluicing facilities and hand washing facilities. Staff have access to a good supply of protective clothing. One comment received from a relative was, ‘A beautiful home in lovely surroundings’. Immacolata House DS0000070446.V360618.R01.S.doc Version 5.2 Page 26 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, 29 & 30 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. The number of staff on duty are sufficient to meet the assessed needs of people currently living at the home. The home have taken steps to ensure that staff have the skills needed to meet the needs of people currently at the home. An appropriately trained registered nurse is now available on every shift. There have been some improvements in the home’s procedures for staff recruitment which reduce the risk of harm or abuse to people living there. The home’s procedures could be further improved. EVIDENCE: At the time of this inspection we were informed that 34 people were currently living at the home. This included one person who was in hospital. 8 people were living on the Rosetta Unit 13 on the Sofia Unit Immacolata House DS0000070446.V360618.R01.S.doc Version 5.2 Page 27 5 on the Serena Unit (general nursing unit) 8 on the Carolena Unit. We were informed that current staffing levels were as follows; AM = 2 registered nurses (1 RGN & 1 RMN) 8 care staff PM = 2 registered nurses as above 11 care staff Nights = 1 or 2 registered nurses & 5 care staff. Staffing levels also take into account three people living at the home who require one to one staffing. Two people require this level of support in the morning, 3 in the afternoon and 1 at night. During this inspection we noted a staff presence throughout the day on each of the four units. Staff spoken with did not express any concerns about staffing levels and said that there were ‘always 2 staff on each unit’. The acting manager works in addition to the care hours and the home employs administrative staff, catering, laundry and domestic staff. A full time maintenance person is also employed. It is positive that a registered mental health nurse is now available on each shift and as required at the last inspection, staff have been provided with training in caring for people with dementia and managing challenging behaviour. The home continues to use agency staff to cover shortfalls though this is reducing as permanent staff are employed. We examined three staff recruitment files at this inspection. Each file contained references and appropriate criminal record (CRB) and protection of vulnerable adult checks (POVA). Files did not contain a photograph of the employee as required at the last inspection. An employment history had not been provided on an application form for one staff member. We were able to see that, as required at the last inspection, newly appointed staff had completed an appropriate induction programme which was in line with the Skills for Care Common Induction Standards. We were able to meet with a number of staff who had recently been appointed and they confirmed that they had received a satisfactory induction. All stated that they had been given the information and training needed to enable them to meet the needs of people living at the home. Immacolata House DS0000070446.V360618.R01.S.doc Version 5.2 Page 28 In completed comment cards, relatives indicated that staff had appropriate skills to look after people at the home, ‘Standard of dementia care is excellent generally’, ‘There will always be staff undergoing training’. No concerns were raised in the comment card completed by a healthcare professional. This is a positive improvement. Staff confirmed that they were being given the opportunity for NVQ training. The number of staff who hold a minimum of an NVQ level 2 in care was not established at this inspection. Immacolata House DS0000070446.V360618.R01.S.doc Version 5.2 Page 29 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): 34, 35, 36, 37 & 38 Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. The home does not have a registered manager. Appropriate management support has been in place in the interim and an acting manager is now in post. The home has quality assurance procedures in place though these have not yet been fully implemented as the home has only been registered since August 2007. The home needs to ensure systems are implemented to ensure that all staff receive formal supervision at least six times a year. Some aspects of the home’s procedures relating to health & safety require improvement. Immacolata House DS0000070446.V360618.R01.S.doc Version 5.2 Page 30 EVIDENCE: In the absence of a registered manager and because the acting manager has only been in post for one week, standard 31 & 32 could not be fully assessed. The registered provider has ensured that the home has been effectively managed in the absence of a registered manager. The registered provider has based himself at the home and an experienced registered manager from another of the company’s homes has been in place to oversee the day to day management of the home. An acting manager commenced employment a week prior to this inspection. This person was previously employed as a registered manager in another area. It is envisaged that an application for registered manager will be submitted to the Commission in the coming months. The company have recently recruited an experienced person who takes responsibility for overseeing the home and other home’s within the company. It is evident that the registered provider has taken pro-active steps to address the concerns/requirements raised at the last inspection. Staff told us at this inspection that ‘things were improving’. As the home has only been registered since August 2007, the home’s quality assurance procedures were not fully assessed (Standard 33). The registered person had been conducting monthly visits to the home in accordance with Regulation 26 of the Care Homes Regulations 2001. A recent very detailed report was submitted to the Commission by the recently appointed person who will take responsibility for overseeing the home. The home follows satisfactory procedures for the management of peoples’ money. Peoples’ money is held in individual accounts which are overseen by the company and invoices provided. A ‘float’ of money is held at the home to ensure that people have easy access to funds as required. At the last inspection there was no evidence that staff were receiving formal supervision sessions at least six times a year. At this inspection there was evidence that this had taken place for some staff, but not all. There was no system in place to demonstrate that supervision sessions had been planned for staff. The acting manager confirmed that this was something that she planned to address. Immacolata House DS0000070446.V360618.R01.S.doc Version 5.2 Page 31 Two staff members completed comment cards for the Commission and both responded, ‘Never’ to the question, ‘Does your manager meet with you to give you support and discuss how you are working?’ This was also the response from staff spoken with during the inspection. Action must be taken to address this requirement within the given timescale. The home displays an up to date employers liability certificate. All records pertaining to people using the service are appropriately stored. We looked at the home’s procedures relating to health and safety and the findings were as follows: FIRE SAFETY – There was evidence that the home carry out weekly in-house checks on the fire alarm systems. This was last recorded as 28/04/08. Monthly checks are carried out on the emergency lighting systems and visual checks are made on fire fighting equipment. This was last carried out on 02/04/08. Annual servicing by an external contractor will not be due until later this year. Fire safety training for a number of staff was recorded as having taken place on 14/01/08 & 03/03/08. Staff spoken with during this inspection confirmed that they had received training in fire safety. We were unable to see evidence that domestic employed in February had received training in fire safety. There was no evidence in the recruitment file, induction programme or training matrix. This was brought to the attention of the management team at the time. EQUIPMENT SERVICING – Six monthly servicing of hoists was seen to be up to date. There was evidence that all hoists had been serviced in accordance with LOLER regulations by an external contractor on 19/03/08. ELECTRICAL SAFETY – The home has an up to date electrical hardwiring certificate. Annual testing on portable appliances are not yet due. ACCIDENTS – Appropriate records are maintained. The number of accidents were unremarkable and no traits were noted. It has been recommended that the home introduces systems to analyse accidents on a monthly basis as this will help to identify any traits. This was also identified in the Regulation 26 report submitted to the Commission. We noted that an incident report had been completed by a registered nurse relating to some tablets going missing. There was no evidence that this had been followed up or investigated. The Commission had not been informed. On Immacolata House DS0000070446.V360618.R01.S.doc Version 5.2 Page 32 discussion with the management team, it appeared that they were unaware of the incident. MANDATORY TRAINING - Staff spoken with during this inspection were able to confirm that they had received up to date training in moving and handling and fire safety. There was also evidence of this in two of the three staff recruitment files examined. In one file, there was no evidence that the staff member had received this training and there was no evidence of this on the training matrix made available to us. The staff training matrix did not provide evidence that all staff had received training in moving and handling or fire safety. We were informed that the staff training matrix ‘may not have been updated’. It has been required that the home provide the Commission with evidence that all staff have received mandatory training. The staff training matrix needs to clearly identify dates of training that has taken place and systems should also be in place to highlight when updates are due. HOT WATER/SURFACES - All hot water outlets are fitted with thermostatic controls and the home conducts monthly checks to ensure temperatures do not exceed the Heath & Safety Executive (HSE) safe upper limits of 44c for bath outlets and 42c for shower outlets. To ensure the safety of service users, all first floor windows are restricted, any freestanding wardrobes are secured to the wall and any wall-mounted radiators are guarded. Immacolata House DS0000070446.V360618.R01.S.doc Version 5.2 Page 33 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 3 3 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 4 4 3 4 4 3 3 STAFFING Standard No Score 27 3 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x x 3 3 1 3 1 Immacolata House DS0000070446.V360618.R01.S.doc Version 5.2 Page 34 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 OP8 Regulation 12(1) & 13(4) (c) Requirement The registered person must ensure that appropriate care plans are in place to effectively manage and monitor any wounds or pressure sores. Previous timescale of 20/12/07 not met. 2. OP9 13(2) To ensure the health & well being of service users, the registered person must ensure that staff record the amount administered to service users where a variable dose of medication has been prescribed. Previous timescale of 20/12/07 not met. 3. OP9 13(2) To ensure service users receive their medication as prescribed and to ensure the health & wellbeing of service users, the registered person must ensure that clear guidelines/protocols are in place for ‘as required’ medication. Previous timescale of Immacolata House DS0000070446.V360618.R01.S.doc Version 5.2 Page 35 Timescale for action 10/05/08 10/05/08 10/05/08 4. OP29 19 & Schedule 2 20/12/07 not met The registered person must 10/05/08 ensure that staff do not commence employment at the home until all required information has been obtained. - The registered person must ensure that a recent photograph of the employee is maintained in the recruitment file. - More detail must be obtained for employment history to enable any gaps in employment to be identified and discussed. Previous timescale of 20/12/07 not fully met. 5. OP36 18(2) The registered person must make suitable arrangements to ensure that staff are appropriately supervised. Staff should receive supervision at least six times a year. Previous timescale of 31/12/07 not met. 30/06/08 6. OP38 13(4), 13(5) & 23(4)(d) The registered person must 20/05/08 supply the Commission, on the given date, with evidence that all staff have received up to date training in moving and handling and fire safety. The registered person must ensure that the Commission is informed without delay, of all incidents listed in this regulation. Robust systems must be in place to ensure that concerns are reported and fully and appropriately investigated. (This relates to the incident of missing medication). 10/05/08 7. OP38 37 Immacolata House DS0000070446.V360618.R01.S.doc Version 5.2 Page 36 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations To reduce the risk of any errors, it is strongly recommended that the registered persons ensures that two competent staff sign to confirm hand written entries on the service user medication administration records (MAR) The current arrangements for offering meal choices for service users with dementia should be reviewed. Systems should be introduced so that accidents are analysed on a monthly basis as this will assist in identifying any traits. 2. 3. OP15 OP38 Immacolata House DS0000070446.V360618.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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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