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Inspection on 05/05/05 for Inglemere House Residential Home

Also see our care home review for Inglemere House Residential Home for more information

This inspection was carried out on 5th May 2005.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home is comfortable and clean. Service users are well cared for the majority of the time. Relatives and friends are welcome to visit at any reasonable time.

What has improved since the last inspection?

The hot water outlets used by service users have been risk assessed. The Statement of Purpose now meets the necessary requirements.

What the care home could do better:

Staff must treat service users with sensitivity and respect at all times. Records must be kept of regular formal supervision provided to staff.The range of activities must be improved particularly for those suffering with dementia. All the service users must be satisfied with their meals. Staff must move and lift service users correctly and with care at all times. Staff must adhere to the health and safety procedures at all times. The proprietor must respond to the recommendations made by the Occupational Therapist to ensure the home is safe and service users have the necessary aids and appliances.

CARE HOMES FOR OLDER PEOPLE INGLEMERE HOUSE Waterloo Road Crowthorne Berks RG45 7NW Lead Inspector Robert Dawes Unannounced 5th May 2005 Time: 11:20 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 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. INGLEMERE HOUSE H51-H01-S11127-Inglemere House-V217724030505-Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Inglemere House Address Waterloo Road, Crowthorne, Berks, RG45 7NW Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01344 772120 Mrs Y Y Jackson Mrs Y Y Jackson Care Home 14 Category(ies) of Old Age, not falling within any other category registration, with number of places INGLEMERE HOUSE H51-H01-S11127-Inglemere House-V217724030505-Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: No Date of last inspection 21 December 2004 Brief Description of the Service: Inglemere House provides a service for older people in need of care by reason of old age only. It is registered for fourteen residents of either gender. The home does not provide nursing care.The home operates within a Victorian house with later extensions to each side. The house is located in a residential area which is ten minutes walk of the shopping and other facilities in Crowthorne High Street.This is a privately operated home owned and managed by Mrs Y. Jackson, who lives on site most of the time. Mrs Jackson has operated the home since January 2000, having purchased it as a ‘going concern’ from the previous owner.The accommodation is on three floors. All the bedrooms are single with hand basins. There are two bedrooms with en suites (one is a bath/toilet, the other a toilet). The home has a passenger lift serving all floors. INGLEMERE HOUSE H51-H01-S11127-Inglemere House-V217724030505-Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection in response to a complaint and as part of the routine schedule of inspections. The inspection took place between 11.20am and 5.15pm on Thursday 5th May 2005. The proprietor, three members of staff, six relatives and three service users were interviewed. The Inspector also saw records and toured the premises. Outside of the inspection a care manager and a relative spoke with the Inspector. Seventeen standards were assessed of which seven were met, nine almost met and one not met. Fourteen requirements and three recommendations were made. What the service does well: What has improved since the last inspection? What they could do better: Staff must treat service users with sensitivity and respect at all times. Records must be kept of regular formal supervision provided to staff. INGLEMERE HOUSE H51-H01-S11127-Inglemere House-V217724030505-Stage 4.doc Version 1.30 Page 6 The range of activities must be improved particularly for those suffering with dementia. All the service users must be satisfied with their meals. Staff must move and lift service users correctly and with care at all times. Staff must adhere to the health and safety procedures at all times. The proprietor must respond to the recommendations made by the Occupational Therapist to ensure the home is safe and service users have the necessary aids and appliances. 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. INGLEMERE HOUSE H51-H01-S11127-Inglemere House-V217724030505-Stage 4.doc Version 1.30 Page 7 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 Standards Statutory Requirements Identified During the Inspection INGLEMERE HOUSE H51-H01-S11127-Inglemere House-V217724030505-Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 and 3. Standard 6 does not apply to this home. A Statement of Purpose is available to service users. New service users are admitted only on the basis of a full assessment. EVIDENCE: St 1. The Statement of Purpose has been amended and now complies with the requirements of the standard. St 3. A full assessment is undertaken on prospective service users. INGLEMERE HOUSE H51-H01-S11127-Inglemere House-V217724030505-Stage 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, and 10 Each service user has an individual care plan but should include more detailed recording of care and health needs. Service users are treated with respect the majority of the time but there are occasions when this does not happen. EVIDENCE: St 7. Service user files seen by the Inspector contained care plans and risk assessments but did not identify ways and means of responding to the needs of the service users who suffer from dementia or have visual and hearing impairments. Health records containing appointments with health professionals are included in the daily notes. The Inspector recommended these should be kept separately. St 10. The feedback the Inspector received about this standard was very varied. A care manager who spoke with the Inspector said he had had no complaints from the service users he has placed at the home. The six relatives who spoke to the Inspector during the inspection said they were very pleased with the care their relatives were receiving and found staff to be kind and friendly, personal care was good and they had no complaints. A relative who spoke to the Inspector before the inspection complained about the INGLEMERE HOUSE H51-H01-S11127-Inglemere House-V217724030505-Stage 4.doc Version 1.30 Page 10 disrespectful treatment her mother was receiving from a particular member of staff. Allegedly the member of staff made her mother get out of bed on her own when she wanted help. The inspector was informed it is home’s policy that service users should be encouraged to be as independent as possible but if a service user becomes upset then that person is not being treated with dignity or respect. One of the service users said staff treat them well and are kind and respectful but two service users said staff are, on occasions, irritable and have raised their voices at them. One member of staff said the proprietor is irritable with the service users on occasions. Another member of staff said the proprietor has been heard to raise her voice at the service users. The impression the Inspector gained was that the majority of the staff are caring and respectful to the service users the majority of the time but on occasions can be irritable and raise their voices to service users. Staff may not appreciate the impact this has on service users and even if this happens on isolated occasions this is not acceptable. The Inspector was talking to a service user in his room when a member of staff entered without knocking. The Inspector observed this practice on another occasion. This is unacceptable practice and shows a lack of respect for the service user. One service user has to sleep in his clothes at night in order that his incontinence pad remains in place. The Inspector was informed that if the service user sleeps in nightclothes he would remove his incontinence pad and wet himself and the bed. If they try to wake him in order for him to go to the toilet he becomes very aggressive and uncooperative. Relatives have been consulted and agree with this practice. The Inspector recommended the needs of this service user is reviewed with key professionals to determine if this is the best practice to employ, i.e. incontinence nurse. INGLEMERE HOUSE H51-H01-S11127-Inglemere House-V217724030505-Stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 and 15. Service users are invited to participate in a range of activities but these need to be developed with particular consideration being given to people with dementia. Service users are able to have visitors at any reasonable time. Every effort must be made to ensure all the service users enjoy their meals. EVIDENCE: St 12. Two service users go to a local community day centre once a week; birthdays are celebrated and service users are invited to participate in activities such as painting, games, light exercise, sing songs and reminiscence sessions. Other than at Christmas no entertainment or activities is brought into the home to provide stimulation on an individual or group basis. There are also insufficient activities specifically for dementia sufferers. Minister and priest visit service users who wish to take communion. St 13. All six relatives said they visit frequently and unannounced. They are always made welcome and can discuss the service user’s care with the proprietor St 15. A complaint was made to the Inspector, by a relative on behalf of her mother, about the poor standard of meals she was being offered. The cook INGLEMERE HOUSE H51-H01-S11127-Inglemere House-V217724030505-Stage 4.doc Version 1.30 Page 12 considered the quality and quantity of food offered to the service users was not satisfactory and little choice is offered if a service user doesn’t like the menu. Two of the three service users interviewed said they were happy with the meals. One service user was not happy with the quality of the meals offered. The service users receive regular cups of tea and drinks. Dietary needs are catered for and food is liquidised if required. The Inspector saw a varied menu. INGLEMERE HOUSE H51-H01-S11127-Inglemere House-V217724030505-Stage 4.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) This section was not assessed during this inspection. EVIDENCE: INGLEMERE HOUSE H51-H01-S11127-Inglemere House-V217724030505-Stage 4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 22, 24 and 26. Service users live in comfortable and clean environment. The home is generally well decorated but several issues need attention. The recommendations made by the Occupational Therapist in November 2004 must be actioned to improve the safety of the service users. EVIDENCE: St 19. The property is comfortable, homely and generally well maintained. However there are areas of the home which requires renovating, i.e. doors painted where door handles have been changed; the toilet roll holder in the first floor bathroom is broken and needs replacing; the hot water tap in the first floor bathroom is not working and needs to be repaired; the lino in the bathrooms is torn and needs replacing; and the first floor fire door still does not shut properly. There is a large garden and patio area which is accessible to the service users but requires adaptations and renovating to make it safe. . INGLEMERE HOUSE H51-H01-S11127-Inglemere House-V217724030505-Stage 4.doc Version 1.30 Page 15 St 22. An assessment of the premises and facilities by an occupational therapist took place in November 2004. A number of recommendations were made including; all flooring in bathrooms and toilets should be non slip and firmly in place; step and hand rails should be provided in shower to assist transfer; taps used by service users should be fitted with lever handles; and lighting in communal facilities and corridors should be sufficiently bright. Only two of the recommendations have been actioned. The registered person must produce a planned programme of implementation and start responding to the remaining recommendations immediately. There is not a permanent ramp leading up to the front door but metal suitcase ramps are kept in the garage and used to allow wheelchair access in and out of the front door when needed. St 24. The bedrooms seen were well decorated, comfortable and contained items belonging to the service user to personalise their room. St 26. The home was clean and hygienic. INGLEMERE HOUSE H51-H01-S11127-Inglemere House-V217724030505-Stage 4.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30 More permanent care staff need to be recruited and a stable staff team developed. Three of the six staff have a NVQ 2 or 3 in care and other staff are currently studying for the NVQ2 in care. The proprietor has complied with the recruitment procedures except for one member of staff who she employed without any checks being made. EVIDENCE: St 27. Retention of staff has been a major problem for the proprietor resulting in a high turnover of staff in the last two years. Some improvement has taken place since the last inspection but the home is still approximately seventy hours less than the number of hours required for two carers to be on duty during the day and one carer to be on duty at night. The vacant hours have been covered mainly by staff and the proprietor. This has resulted in one member of staff regularly working a night shift and then being on duty six hours later; the proprietor working a day shift immediately after a night shift; and other staff working many hours in a week. The Inspector considers this practice is undesirable as staff cannot be alert and responsive to the needs of the service users. When the proprietor is on duty at night there is no back up if there is an emergency or a service user requires two members of staff. The proprietor should look to increase the hours of the deputy manager who is only contracted to work six hours a week during the day and eleven hours at night. St 29 Staff records seen showed the proprietor has operated a thorough recruitment procedure except for one member of staff who has been working as a carer for at least two months with no CRB check, POVA check or INGLEMERE HOUSE H51-H01-S11127-Inglemere House-V217724030505-Stage 4.doc Version 1.30 Page 17 references being obtained. The duty rotas for the last two weeks showed she has worked seven shifts. She used to work at the home 3-4 yrs ago. The Inspector informed the proprietor that this carer must not work in the home until all the required recruitment checks have been made. Sts 28 and 30. Staff have undertaken training in first aid and manual handling but for food hygiene and health and safety new staff have been given books to read. Three of the six staff have a NVQ 2 or 3 in care and staff are currently studying for NVQs in care. Staff informed the inspector that they have had induction and foundation training although no record of foundation training was seen in their staff files. INGLEMERE HOUSE H51-H01-S11127-Inglemere House-V217724030505-Stage 4.doc Version 1.30 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 36 and 38. Supervision must be recorded. Overall the proprietor ensures so far as is reasonably practicable the health, safety and welfare of service users but needs to ensure the issues identified below are addressed. EVIDENCE: St 36. Staff meetings take place and the proprietor is usually on duty to supervise the work of her staff. No record of this supervision is made to show the areas recommended in the standard are covered and that formal supervision takes place at least six times a year. St 38. Records seen showed the proprietor ensures the required health and safety checks take place with the exception of an annual fire extinguisher test. Hot water outlets that are accessible to service users have been risked assessed by the proprietor INGLEMERE HOUSE H51-H01-S11127-Inglemere House-V217724030505-Stage 4.doc Version 1.30 Page 19 A complaint was made that toilets and bathrooms do not have soap and towels for service users to use. The Inspector was told that service users can wash their hands in their rooms and bars of soap are unhygienic. The Inspector recommended that liquid soap and hand towels are available in toilets areas for service users to use. A complaint was made that meals are not covered when taken to service users in their rooms. Although there are covers that can be used the Inspector saw uncovered meals being taken to service users. The Inspector saw staff walk through the kitchen area with laundry. This must not happen in future. One service user said he is moved roughly at times. INGLEMERE HOUSE H51-H01-S11127-Inglemere House-V217724030505-Stage 4.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 x 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 2 COMPLAINTS AND PROTECTION 3 x x 2 x 3 x 3 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x 2 x 2 INGLEMERE HOUSE H51-H01-S11127-Inglemere House-V217724030505-Stage 4.doc Version 1.30 Page 21 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard 10 2 Regulation 12 16 Requirement Staff must treat service users with dignity and respect at all times. Service users must be given opportunities for stimulation through leisure and recreational activities in and outside the home which suit their needs, preferences and capacities; particular consideration must be given to people with dementia. Service users must be provided with varied, appealing, wholesome and nutritious food in adequate quantities. The proprietor must repair the fire door on the first floor landing to ensure it shuts properly. (This requirement was originally made at the 21/12/2004 inspection). Repairs and decoration identified above must be actioned. The Occupational Therapist made recommendations in November 2004 that must be actioned by the proprietor. (This requirement was originally made at the 21/12/2004 inspection). The proprietor must ensure that at all times suitably qualified, competent and experienced H51-H01-S11127-Inglemere House-V217724030505-Stage 4.doc Timescale for action Immediate 30/6/2005 3. 15 16 31/5/2005 4. 19 23 31/5/2005 5. 6. 19 22 23 23 30/6/2005 31/8/2005 7. 27 18 31/5/2005 INGLEMERE HOUSE Version 1.30 Page 22 8. 29 19 persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. (This requirement was originally made at the 21/12/2004 inspection). Staff must not be employed to work in the home before recruitment checks have been made. The proprietor must show care staff receive formal supervision at least six times a year. An annual inspection of the fire extinguishers must take place. The proprietor must ensure staff cover meals when taking them to service users rooms. Liquid soap and hand towels must be provided in all toilet and bathrooms/toilets. The proprietor must ensure staff lift and move service users correctly. Immediate 9. 10. 11. 12. 13. 14. N/A 36 38 38 38 38 18 23 13 13 13 31/5/2005 30/6/2005 Immediate Immediate Immediate RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard N/A 7 7 10 Good Practice Recommendations N/A Service users files should identify ways and means of responding to the needs of the service users who suffer from dementia or have visual and hearing impairments. Service users files should have specific health records instead of appointments with health professionals being kept in the daily notes. The proprietor should seek the advice of appropriate professionals to determine if the practice employed on the service user, referred to in this standard, is in his best interests. H51-H01-S11127-Inglemere House-V217724030505-Stage 4.doc Version 1.30 Page 23 INGLEMERE HOUSE Commission for Social Care Inspection 1015 Arlington Business Park Theale Berks RG7 4SA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI INGLEMERE HOUSE H51-H01-S11127-Inglemere House-V217724030505-Stage 4.doc Version 1.30 Page 24 - 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!