Inspection on 04/12/07 for Immacolata House

This inspection was carried out on 4th December 2007.

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

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

Other inspections for this house

Immacolata House 29/04/08

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 4th December 2007 10:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Immacolata House DS0000070446.V355728.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.V355728.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 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) N Notaro Homes Limited ****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.V355728.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. NA – new service 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. Immaculata 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 added to the fees. Immacolata House DS0000070446.V355728.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.V355728.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. 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 under four general headings. These are; - excellent, good, adequate and poor. This was the home’s first inspection since being registered by the Commission in August 2007. This unannounced key inspection was conducted over one day by regulation inspectors Kathy McCluskey and Gail Richardson. The registered manager left her post a week prior to this inspection and the registered person has based himself at the home and an experienced registered manager from another of the company’s homes has been put in place to oversee the day to day management of the home. Both were available throughout this inspection. The inspectors were given unrestricted access to the home and records required, were made available to the inspectors. During the inspection, the inspectors were able to meet with service users, staff, relatives and healthcare professionals. As part of this key inspection, the Commission sent comment cards to service users, staff, relatives and healthcare professionals. A low number of completed comment cards were returned. As appropriate, comments have been included in the report. One healthcare professional felt unable to comment on the service indicating that ‘it is too early to comment’ The inspectors would like to thank service users, staff, visitors and the management team 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. Immacolata House DS0000070446.V355728.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? What they could do better: The registered manager left her post a week prior to this inspection. The home is currently advertising this post. The registered provider has put management systems in place to ensure that the home is effectively managed in the interim. Immacolata House DS0000070446.V355728.R01.S.doc Version 5.2 Page 8 The registered provider has based himself at the home and an experienced registered manager from another of the company’s homes has been put in place to oversee the day to day management of the home and it is anticipated that action will be taken to address the concerns raised at this inspection. Some issues/concerns raised at this inspection had been identified by the registered provider and acting manager prior to the inspection and both are in the process of addressing these concerns which is felt to be positive. The home needs to ensure that it does not offer a placement to a service user unless it can demonstrate that it can fully meet the assessed needs of the individual. At this inspection concerns were raised regarding the skills and experience of, and lack of appropriate training for registered nurses and care staff employed. Specialised equipment was not in place for two service users with an assessed need. The standard of service user care plans was found to be poor. Care plans had not been fully completed and did not identify a service users assessed needs. The home’s procedures for the management of wounds/pressure sores were also poor. Care plans do not promote a person centred approach to care. There was no evidence of service user/representative involvement and the preferences of service users had not been identified. The inspectors discussed all of their findings with the registered person and acting manager at the time of the inspection. It was positive that both the registered person and acting manager had also raised concerns about the home’s care planning systems and how they had been managed/implemented, and were in the process of reviewing all care plans to ensure that all documentation is complete and that all care needs are identified. The inspectors found that the home was not following the correct procedures for the management and administration of service users medication. The home needs to ensure that all service users benefit from meaningful social interactions from appropriately trained/skilled staff. The lunch time meal looked wholesome and plentiful. The inspectors were able to observe the lunch time period for service users from the dementia unit and general unit on the first floor. Concerns were raised regarding the temperature of the food served. This was described as ‘barely warm’. Staff files and training files made available to the inspectors did not provide evidence that all staff had received training in the prevention of abuse. The home are currently providing nursing care to a service user who’s care plan indicates that they may at times require ‘physical intervention’ to keep them and other safe. It was confirmed that no staff at the home have received Immacolata House DS0000070446.V355728.R01.S.doc Version 5.2 Page 9 any training in physical restraint/intervention and the care plan did not give clear instructions on the type of restraint to be used. The home’s procedures for staff recruitment do not fully protect service users from the risk of harm or abuse. (Refer to standard 29). This relates to references and employment history. Enhanced criminal record checks (CRB) and protection of vulnerable adult checks (POVA) were in place in all staff recruitment files seen. The inspectors were unable to see evidence that staff have undertaken a period of induction on commencement of employment and there was no evidence that staff were appropriately supervised. 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.V355728.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Immacolata House DS0000070446.V355728.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 4. Standard 6 is not applicable as the home is not registered to provide intermediate care. Quality in this outcome area is Poor This judgement has been made using available evidence including a visit to this service. Information about the home is made available to service users, prospective service users and their representatives to enable them to make an informed decision about moving to the home. The home ensures that prospective service users are assessed before a placement is offered though service users have been offered placements where the home is not able to fully meet their assessed needs. Staff do not currently have the skills to meet the needs of service users with dementia or mental health needs. EVIDENCE: Immacolata House DS0000070446.V355728.R01.S.doc Version 5.2 Page 12 The home has produced a Statement of Purpose and Service User Guide. Both give detailed information about the home and services offered. Relatives spoken with during the inspection confirmed that they had been provided with the above information and that they had been given the opportunity to visit the home prior to making a decision on behalf of their relative. One relative returned a comment card to the Commission and indicated that they had been provided with sufficient information about the home to enable an informed decision. Four care plans were examined at this inspection and all contained evidence that the service users had been assessed by the home prior to a placement being offered. At the time of this inspection, it was not clear that the home was able to meet the assessed needs of service users living at the home. Specialist equipment was not available for two service users with an assessed need. This related to specialised cutlery, specialised wheelchair and specialised recliner chair. The inspectors were unable to see evidence that care staff had received any training in caring for people with dementia. Gaps were also noted with regard to mandatory training. One service user’s care plan indicated that they required on occasions, physical intervention but no staff had been trained in this technique. Staff have not received training in the management of challenging behaviour. Healthcare professionals expressed concerns that there was not always a registered mental health nurse (RMN) on duty and that cover was provided by a registered general nurse. This was discussed with the registered person and the acting manager who confirmed that action had been taken to address this. Staff records did not contain any evidence that they had received an induction on commencement of employment. The registered person and acting manager informed the inspectors that prior to the home opening, all staff employed at this time had a two week induction period prior to service users moving in. Records relating to this could not be located. One recently appointed staff member spoken with informed the inspectors that they had not received an induction. Immacolata House DS0000070446.V355728.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is Poor This judgement has been made using available evidence including a visit to this service. Service user care plans are poor and do not provide sufficient information on the needs of service users. The home is not currently taking appropriate steps to ensure that the healthcare needs of service users are fully met. The home’s procedures for the management and administration of service user medication requires improvements. EVIDENCE: Four care plans were examined at this inspection. Information recorded was insufficient to enable staff to meet the assessed needs of service users. PreImmacolata House DS0000070446.V355728.R01.S.doc Version 5.2 Page 14 admission assessments and assessments from other professionals had identified assessed needs but care plans had not been raised to address these needs. Basic care needs, such as personal care had not been identified. Psychological care plans had not been raised for those with an assessed need. A nutritional care plan had not been raised for two service users with an assessed need. One service user had been assessed as requiring a ‘high protein’ diet to aid in the healing of pressure sores. No care plan had been raised and there was no evidence that the service user was receiving a high protein diet. Comments raised by healthcare professionals in completed comment cards included: ‘Not all care needs have been properly monitored and sometimes basic care is not always being carried out’ ‘Diet is not always monitored’ No documentation had been completed for one service user who had very complex mental health needs. A care plan had been obtained from the service user’s previous hospital placement, but this could not be implemented by staff at the home given the lack of training in physical intervention and numbers of staff available. The inspectors were informed that this service user required one-one support/supervision for 8 hours a day. There was no indication of this in the care plan and it was not clear how this individual was supported or what outcome was expected. The inspectors were informed that the service user became more anxious during the evening but that the one to one support was only available during the day. The inspectors were concerned about the home’s ability to meet the assessed needs of this service user and these concerns were raised with the registered person and acting manager at the time. Both acknowledged that they were planning to re-assess service users as it had become apparent that some service users had been offered admission when it was clear that the home could not meet the individual’s assessed needs. In one service user care plan, the pre-admission information identified that the service user ‘should not be isolated in their room’. The inspectors noted that this service user remained alone in their room throughout the inspection. A staff member did check on the service user during this time. There was no care plan in place in relation to the service user’s diabetes. The service user had been assessed as requiring diet and fluids to be monitored, but no care plan was in place. The service user was observed during lunch time as being assisted with a pureed diet, but there was no care plan to support this. No weights had been recorded. An assessment identified that the service user required supervision during the night but again, no care plan had been raised. Immacolata House DS0000070446.V355728.R01.S.doc Version 5.2 Page 15 One service user had been assessed as ‘anorexic’. A nutritional assessment had not been completed. No care plan had been put in place. No weights were recorded. The inspectors noted that the service user had been prescribed fentanyl patches for pain. There was no care plan in place to reflect the management of the service users pain. Medication records indicated that these were not always being administered as prescribed. Relatives spoken with expressed concerns that the service user was being nursed in bed as an appropriate chair was not available. It appeared that the previous registered manager had agreed to take action to address this but no action had been taken. This was discussed with the registered person and acting manager who agreed to look into this as a matter of priority. The inspectors looked at two care plans for service users with pressure sores. These were found to be poor and did not contain sufficient information about the wound or how this should be managed. It could not be ascertained how the outcome of any treatment was monitored. In one care plan, an assessment completed by a healthcare professional prior to admission stated that wound dressings should be changed twice daily. Records seen did not reflect that this was happening and since admission, only five entries had been made in the seven weeks that the service user had been at the home. Comment cards indicated that district nurses provide input with regard to some nursing interventions such as wound care and catheterisation as qualified nurses ‘did not have these skills’ Pressure relieving mattresses were seen to be in place for the two service users with pressure sores that the inspectors case tracked. The registered person needs to ensure that all staff are aware of the correct use of pressure relieving mattresses as in one room, a ‘kylie’ type sheet had been placed on top of the air-flow mattress. This practise reduces the effectiveness of the mattress and can increase the risk of pressure sores. It was brought to the attention of the inspectors that an air-flow mattress was found to be on a very high setting for a service user with very low body mass. The member of staff did take action to address this but there is no information available in care plans to indicate the type of mattress in place or the setting levels for air-flow mattresses. Staff files including those for registered nurses, did not evidence that staff had received any training in the management of wounds or pressure area care. Care plans do not promote a person centred approach to care and in the care plans examined, there was no evidence of service user/relative input. The inspectors discussed all of their findings with the registered person and acting manager at the time of the inspection. It was positive that both the registered person and acting manager had also raised concerns about the Immacolata House DS0000070446.V355728.R01.S.doc Version 5.2 Page 16 home’s care planning systems and how they had been managed/implemented, and were in the process of reviewing all care plans to ensure that all documentation is complete and that all care needs are identified. The inspectors examined the home’s procedures for the management and administration of service users medication. The inspectors were informed that only the registered nurses on duty administer medicines. This was seen to be the case at the time of the inspection. Medicines were found to be securely stored. Medication administration records (MAR) were examined and the findings were as follows: - hand-written entries on MAR charts had not been confirmed by two staff signatures. This is required to reduce the risk of any errors. - The amount administered where variable doses are prescribed, is not being recorded. - Prescribed creams were not signed on the MAR chart as having been administered. - For two service users prescribed fentanyl patches for pain, there was no evidence that they were being administered as prescribed. Staff had not recorded why they were not administered. - No protocols were in place for the use of ‘as required’ medication. - One service user had been prescribed medication for the management of their mental health needs. MAR charts indicated that the medication was not being administered as prescribed. - Service user photographs were available on some of the MAR charts seen. This provision should be made available on all MAR charts. The inspectors were able to observe some staff interactions with service users. Staff were heard communicating with service users in a kind manner. Service users appeared clean and well-attired though three male service users were observed walking around with no footwear. The inspectors did not observe any physical interactions such as personal care but all bedrooms and bathrooms are fitted with appropriate locks and all bedrooms are for single occupancy. Immacolata House DS0000070446.V355728.R01.S.doc Version 5.2 Page 17 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, 14 & 15 Quality in this outcome area is Poor This judgement has been made using available evidence including a visit to this service. The arrangements regarding the provision of activities for service users requires improvement. The home needs to ensure that service users receiving general nursing care, feel comfortable in utilising the lounge and dining areas. Meals appear wholesome but the home need to ensure that they are served at a satisfactory temperature. EVIDENCE: The inspectors were informed that the home employs one activities coordinator 9-5 Monday to Friday. This person is responsible for providing activities/social stimulation to all service users in each of the four units. The inspectors were able to meet with the activities co-ordinator on one of the units. It did not appear that the activities co-ordinator had a programme of Immacolata House DS0000070446.V355728.R01.S.doc Version 5.2 Page 18 activities to follow and it was not clear how the time was allocated between each of the four units. No social history’s were not available in service user care plans though the activities co-ordinator stated that she was trying to complete some. The activities co-ordinator stated that she had not had any training in providing activities for older people with dementia but that some training in reminiscence was planned. The staff member stated that she ‘had just been left to get on with it’. The inspectors observed three lounges being utilised during the inspection. In one downstairs lounge old time music was being played and the activities coordinator was setting up a card game for two service users, although one wandered off when the member of staff left the room. In another lounge, a male carer was present and pop music was playing from ‘radio 1’. It was not clear whether this music was appropriate for the service user group. Very little appeared to be going on in one of the upstairs lounges. One staff member was present and was providing one to one support to a service user from one of the dementia units in the lounge designated for the general nursing unit. No service users from the general nursing unit were observed utilising this lounge. It has been recommended that the registered person reviews the current arrangements of service users from the dementia unit utilising the lounge and dining areas designated for the general nursing wing as two service users expressed concerns about this to the inspectors. The inspectors were able to observe the lunch time period for service users from the dementia unit and general unit on the first floor. As previously mentioned, both units were utilising the dining area designated for the general nursing unit. The meals arrived already plated and covered. The plastic covers were barely warm and the plates were cold. The inspectors asked two service users about the meal and both stated that the food was ‘barely warm’. This was also confirmed by a visitor who was assisting their relative with lunch. Staff did not have access to a microwave. This was discussed with the registered provider and acting manager at the time of the inspection. The registered provider agreed to look into this and confirmed that hot serving trolleys were available at the home. A requirement has been raised that this is addressed within a given timescale. Meals looked plentiful and appetising. Some service users had roast pork and some had cauliflower cheese. The inspectors were informed that service users were asked for their lunch choices during the morning. This arrangement should be kept under review to ensure that it remains appropriate for service users with dementia. Immacolata House DS0000070446.V355728.R01.S.doc Version 5.2 Page 19 It has also been recommended that the menu for the day is clearly displayed for service users. Dietary preferences should be discussed with service users and their preferences should be recorded in their plan of care. Immacolata House DS0000070446.V355728.R01.S.doc Version 5.2 Page 20 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 poor. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints procedure in place. The home has policies and procedures in place for staff regarding abuse but not all staff have received training. The home’s procedures for staff recruitment do not fully protect service users from the risk of harm or abuse. EVIDENCE: The home has a satisfactory complaints procedure in place. This is also available in the Statement of Purpose and Service User Guide. The home has a range of policies and procedures in place for staff to protect service users from the risk of harm or abuse. Staff files and training files made available to the inspectors did not provide evidence that all staff had received training in the prevention of abuse. The home are currently providing nursing care to a service user who’s care plan indicates that they may at times require ‘physical intervention’ to keep them and other safe. It was confirmed that no staff at the home have received Immacolata House DS0000070446.V355728.R01.S.doc Version 5.2 Page 21 any training in physical restraint/intervention and the care plan did not give clear instructions on the type of restraint to be used. The home’s procedures for staff recruitment do not fully protect service users from the risk of harm or abuse. (Refer to standard 29). This relates to references and employment history. Enhanced criminal record checks (CRB) and protection of vulnerable adult checks (POVA) were in place in all staff recruitment files seen. Immacolata House DS0000070446.V355728.R01.S.doc Version 5.2 Page 22 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. Service users live in an environment, which has been well designed and 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. Service users are encouraged to personalise their rooms. Service users 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.V355728.R01.S.doc Version 5.2 Page 23 The home was registered with the Commission in August 2007. As part of the registration process, a regulation inspector from the Commission’s registration department conducted a thorough site visit where all areas of the home were seen. At this inspection, the inspectors sampled a number of bedrooms and viewed communal areas on each unit. The home is divided into four units over two floors, with each unit having its own lounge and dining and kitchenette facilities. On the ground floor there are two units for service users 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 ‘Carolina’ unit for service users with ‘higher’ dementia nursing needs. 11 beds are allocated for service users 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 recent site 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 for service users. 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 service users. The home has appropriate sluicing facilities and hand washing facilities. Staff have access to a good supply of protective clothing. Immacolata House DS0000070446.V355728.R01.S.doc Version 5.2 Page 24 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 Poor. This judgement has been made using available evidence including a visit to this service. The nursing needs of service users with dementia are not always met by appropriately qualified/trained staff. The home’s procedures for staff recruitment are not robust and therefore do not fully protect service users from the risk of harm or abuse. There was no evidence that staff had undertaken a period of induction on commencement of employment. EVIDENCE: At the time of this inspection, the inspectors were informed that 33 service users were currently living at the home; 9 in the ‘Rosetta’ unit 13 in the ‘Sofia’ unit 5 in ‘Carolena’ 6 in ‘Serena’, which provides general nursing care. The inspectors were informed that on the day of this inspection, the home was staffed as follows; 1 registered nurse (mental health) Immacolata House DS0000070446.V355728.R01.S.doc Version 5.2 Page 25 1 registered nurse (general) 6 care staff 2 additional staff were on duty and were providing 1:1 support to 3 service users. Nights are covered by 1 or 2 registered nurses and 5 care staff. The home is currently using a high number of agency care staff to cover shortfalls though the home is currently in the process of recruiting more staff. It was noted that a registered mental health nurse was not always on duty. This is concerning given that the home is registered for 38 service users who require nursing care by means of their dementia. As previously mentioned in this report, no care staff have received training in dementia care. Concerns were also raised by visiting healthcare professionals and in completed comment cards; ‘It appears that there are gaps in the training for carers especially with the nature and complexity of some of the clients’ The acting manager informed the inspectors that she was in the process of addressing this. Given the needs of service users, a requirement has been raised to ensure that this is addressed within a given timescale. During the inspection, it was not clear how care staff were deployed. There was registered mental health nurse on duty who was overseeing three units, two on the ground floor and one on the first floor. A registered general nurse was in place to oversee the care of service users in the general nursing unit. At least one carer was observed on each of the units. It appeared that care staff ‘moved’ around the home to provide cover/assistance to units as required. It appeared that the care staff lacked leadership and guidance. This was confirmed by care staff spoken with during the inspection. One healthcare professional commented that there should be ‘more staff’. It is anticipated that this will improve now that the registered person has put management systems in place. NVQ training will be followed up at the next inspection. The inspectors examined the home’s procedures for staff recruitment. Five staff recruitment files were examined. In three files, no references had been obtained from the employees lat employer. One file only contained one reference. In one file, neither reference had been requested from the referees identified on the application form. On two occasions the home had accepted references addressed ‘to whom it may concern’. There was no evidence that the home had requested these references or checked their authenticity. Photocopies of photo identification were available in some of the files but these were of a poor quality. Immacolata House DS0000070446.V355728.R01.S.doc Version 5.2 Page 26 Employment history was insufficient and it could not be established whether there were any gaps in employment. The home must ensure that employment history provides full dates of employment and not just the year employed. In all five files, there was no evidence that staff had been given an induction on commencement of employment. The registered person and the acting manager stated that all staff employed at the time the home was registered were given a two week induction period prior to service users moving in to the home. Records relating to this could not be located. One member of staff spoken with at the time of the inspection stated that they had not received an induction since commencing employment. Immacolata House DS0000070446.V355728.R01.S.doc Version 5.2 Page 27 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): 32, 35, 36 & 38 Quality in this outcome area is Adequate This judgement has been made using available evidence including a visit to this service. The registered provider has put systems in place to improve the management of the home. The home does not have a registered manager. 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. Staff are not appropriately supervised. Not all staff have received appropriate mandatory training to ensure the health and safety of service users. Immacolata House DS0000070446.V355728.R01.S.doc Version 5.2 Page 28 EVIDENCE: Standard 31 could not be assessed as the registered manager left her post a week prior to this inspection. The home is currently advertising this post. The registered provider has put management systems in place to ensure that the home is effectively managed in the interim. The registered provider has based himself at the home and an experienced registered manager from another of the company’s homes has been put in place to oversee the day to day management of the home and it is anticipated that action will be taken to address the concerns raised at this inspection. This was also the view expressed by healthcare professionals in completed comment cards; ‘I am hopeful that the change of management will improve the overall situation’ ‘It would appear that the acting manager and registered provider are responding to concerns raised’ Some issues/concerns raised at this inspection had been identified by the registered provider and acting manager prior to the inspection and both are in the process of addressing these concerns which is felt to be positive. Staff indicated that they did not feel well supported and lacked leadership. This will be followed up at the next inspection. The home’s quality assurance procedures were not fully assessed as the home has only been registered since August 2007. The inspectors were able to see evidence that the registered person had been conducting monthly visits to the home in accordance with Regulation 26 of the Care Homes Regulations 2001. Reports were made available to the inspectors. The inspectors examined the home’s procedures for the management of service users money. Appropriate records were seen to be in place but it was noted that money had been pooled in one tin. The registered person informed the inspectors that service user’s money was held in individual accounts which were overseen by the company and invoices provided. A ‘float’ of money is held at the home to ensure that service users have easy access to funds as required. It appeared that the sum of money found in the tin for one service user, had recently been paid in by a relative. The inspectors were informed that relatives usually pay by cheque, which went into the service users’ individual accounts. It has been recommended that any cash held on behalf of a service users, is clearly marked and not pooled with other money held at the home. Five staff recruitment files were examined at this inspection and only one contained evidence that the staff member had received supervision since commencing employment. Immacolata House DS0000070446.V355728.R01.S.doc Version 5.2 Page 29 A requirement has been raised that all staff receive appropriate supervision. This should be at least six times a year. As part of the registration process by the Commission, the home were required to produce evidence that health and safety requirements were in place. The Commission received evidence that electrical, gas and fire systems had been approved. All hoists, assisted bathing facilities and call bells were newly installed. The inspectors were able to see evidence that the home were conducting inhouse checks on the fire detection systems and hot water outlets. All hot water outlets are fitted with thermostatic controls to ensure that temperatures do not exceed the Heath & Safety Executive (HSE) safe upper limits of 44c for bath outlets and 42c for shower outlets. The inspectors noted that the temperature for one bath hot water outlet exceeded the HSE safe upper limit. To ensure the safety of service users, all first floor windows are restricted, free standing wardrobes are secured to the wall and any wall mounted radiators are guarded. Staff recruitment files and training files examined did not confirm that staff had received training in safe moving and handling. Two of the five files examined did not contain evidence that staff had received fire training. Requirements have been raised. Immacolata House DS0000070446.V355728.R01.S.doc Version 5.2 Page 30 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 x 2 1 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 x 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 1 3 4 4 3 4 4 3 3 STAFFING Standard No Score 27 1 28 x 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x 2 3 x 2 1 x 2 Immacolata House DS0000070446.V355728.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? N/A 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 OP4 Regulation 12, 14(1)(a) & (d) & 18(1)(a) Requirement The registered person must ensure that no service user is offered a placement at the home unless it can demonstrate that the home and staff can fully meet all of the individual’s assessed needs. The registered person must ensure that service user care plans are in place where an assessed need has been identified. Care plans must contain sufficient information about the individual’s assessed needs and instructions for staff must be detailed to ensure continuity of care. Service users and/or their representatives must be given the opportunity to be involved in the care planning process and care plans should promote a person centred approach to care. The registered person must ensure that appropriate care plans are in place to effectively manage and monitor any wounds or pressure sores. DS0000070446.V355728.R01.S.doc Timescale for action 20/12/07 2. OP7 15(1) 10/01/08 3. OP8 12(1) & 13(4) (c) 20/12/07 Immacolata House Version 5.2 Page 32 4. OP8 12(1) & 13(4) (c) 5. OP9 13(2) 6. OP9 13(2) 7. OP9 13(2) 8. OP12 16(2)(m) &(n) 9. OP15 16(2)(i) 10. OP18 13(6) The registered person must ensure that nutritional assessments are appropriately completed and that care plans are raised where there is an assessed need. Service user weights should be monitored at least monthly. The registered person must ensure that service users receive their medication as prescribed. Where medication is not administered, staff must make an appropriate entry on the MAR chart. This also applies to any prescribed creams. To ensure the health & wellbeing 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. 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. The registered person must ensure that service users are consulted about their social interests and that a programme of appropriate activities is developed and implemented. Records should be maintained for each service user which identify the type of activity and the outcome for the service user. The registered person must ensure that meals offered to service users are served at an appropriate temperature. The registered person must make arrangements for all staff DS0000070446.V355728.R01.S.doc 20/12/07 20/12/07 20/12/07 20/12/07 20/01/08 20/12/07 10/02/08 Page 33 Immacolata House Version 5.2 11. OP18 13(6), (7) & (8) 12. OP27 18(1) 13. OP27 18(1) 14. OP29 19 & Schedule 2 15. OP30 18(1)(a) & (c) 16. OP36 18(2) to receive appropriate training in the prevention of abuse. The registered person must ensure that where a service user requires physical restraint, that this is only undertaken by staff who have been appropriately trained. The registered person must ensure that, at all times, appropriately trained registered nurses are on duty to meet the nursing needs of service users with dementia. The registered person must make suitable arrangements for care staff to receive training in dementia care. The registered person must ensure that staff do not commence employment at the home until all required information has been obtained. - All references must be requested by the home and the registered person must be satisfied as to the authenticity of references. One reference should be from the employees most recent employer. - 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. The registered person must ensure that all staff employed by the home receive an appropriate induction period on commencement of employment. This should be in line with the Skills for Care Common Induction standards. The registered person must make suitable arrangements to DS0000070446.V355728.R01.S.doc 30/12/07 20/12/07 15/02/08 20/12/07 20/12/07 31/12/07 Page 34 Immacolata House Version 5.2 17. OP38 18. OP38 ensure that staff are appropriately supervised. Staff should receive supervision at least six times a year. 13(4) & To ensure the health & safety of 14/01/08 13(5) service users, the registered person must make arrangements for all staff to receive appropriate and up to date training in moving and handling. 13(4) & The registered person must 31/12/07 (23)(4)(d) make arrangements for all staff to receive suitable and up to date training in fire safety. 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 registered person should review the current arrangements regarding the upstairs communal areas being shared by service users from the general nursing and dementia nursing wings. The registered person should ensure that daily menus are displayed for service users in an appropriate format. The current arrangements for offering choices for service users with dementia should be kept under review to ensure that it remains appropriate. The registered person should ensure that any money held on behalf of a service user is stored separately from other monies held at the home. 2. OP14 3. OP15 4. OP35 Immacolata House DS0000070446.V355728.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Taunton Local Office Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Immacolata House DS0000070446.V355728.R01.S.doc Version 5.2 Page 36 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!