Inspection on 18/10/06 for Irene House

This inspection was carried out on 18th October 2006.

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

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

Other inspections for this house

Irene House 16/10/07

Irene House 06/03/07

Irene House 05/01/06

Irene House 03/08/05

Irene House 23/02/05

Irene House 13/09/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Irene House 1 Parkfield Road Worthing West Sussex BN13 1EN Lead Inspector Miss Helen Tomlinson Key Unannounced Inspection 18th October 2006 10:30a 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 Irene House DS0000024160.V313313.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. Irene House DS0000024160.V313313.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Irene House Address 1 Parkfield Road Worthing West Sussex BN13 1EN 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) 01903 529060 01903 529058 www.guildcare.org Guild Care Mrs Sandra Elizabeth Daniels Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Irene House DS0000024160.V313313.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th January 2006 Brief Description of the Service: Irene House is a care home registered to accommodate forty residents over the age of sixty-five years, some of who may have nursing needs. The home is situated in a residential area of Worthing. It is a detached, two-storey building with a central courtyard area and private parking facilities at the front entrance. Residents are accommodated in single rooms with a wash hand basin. Two bedrooms have en-suite toilet facilities. There is a passenger lift for access from the ground floor to the first floor. There are three lounge areas and two dining rooms. Irene House is owned by Guild Care, an organisation which has three other care homes in the area. Irene House DS0000024160.V313313.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection. The inspector arrived at the home at 10.30am and left at 5.20pm. The registered manager was present throughout the inspection. She informed the inspector that she had resigned her position and was leaving the home on the 9th November. Interim management arrangements had been put into place, by the organisation, until a suitable candidate could be appointed. At the time of this inspection thirty five residents were accommodated. Prior to the visit to the home information was gathered from previous inspections and information received regarding the service. During the inspection a full tour of the premises took place; the inspector spoke to the residents, staff and manager. Care practices were observed, care plans examined and other documents seen as necessary throughout the inspection. Following the last inspection four requirements were made. At this inspection two of these had been met with two being outstanding. Three new requirements were made. What the service does well: Residents spoken with said they were pleased with the general environment of the home, the communal areas were “bright” and their bedrooms and bathrooms were kept clean and tidy. The home was well maintained. Residents spoke highly of the staff saying they were polite and kind, showing them respect when they were assisting them in any way. They said they understood how to protect their dignity and they made sure their privacy was preserved when offering personal assistance. Residents and relatives said they could approach any member of staff with any concerns or complaints and these would be resolved. All information is obtained and checks carried out, on new staff, prior to them starting work. Staff receive training for the work they are to perform. There is a commitment to NVQ training although the home has not yet reached fifty per cent of staff having completed this training. Quality assurance measures were in place, to ensure the home is run in the best interests of the residents. Residents have the opportunity to contribute to the day to day running of the home, should they wish. Irene House DS0000024160.V313313.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: 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. Irene House DS0000024160.V313313.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Irene House DS0000024160.V313313.R01.S.doc Version 5.2 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 the following standard(s): 3 Residents had an assessment of their needs completed before being admitted to the home. A full picture of the resident’s needs and abilities was not obtained. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service EVIDENCE: The registered manager confirmed that no resident was admitted to the home without an assessment of their needs having been carried out. A checklist for the fee band the resident falls into is used as for the pre-admission assessment. This covered the activities of daily living and some other health assessments, such as pressure sore risk assessments, were used. No additional information regarding the resident’s physical, social or emotional needs or preferences, was documented. Those seen were not signed, dated and nor was there documentation of where they were carried out and with whom. Irene House DS0000024160.V313313.R01.S.doc Version 5.2 Page 9 A more full picture of the resident’s needs should be gained prior to being accommodated at the home, to ensure they can be met by the facilities and services offered. Irene House DS0000024160.V313313.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 The health and personal care needs of the residents were not always met. There was a lack of accurate documentation and an inadequate number of appropriately trained staff. Medication was safely administered and recorded. One aspect of storage requires to be made safe. Resident’s privacy and dignity was protected and respected by the staff in the home. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service EVIDENCE: The nurse on duty discussed how further guidance and training had been provided to the nursing staff, since the last inspection, in order to assist them to improve the plans of care within the home. Whilst some improvements were seen on specific care plans, these improvements were not present for all residents and shortfalls in the documentation remained. Not all residents had a written plan of their needs and how these were to be met. Of the four resident’s files which were examined, three had a documented plan of care, Irene House DS0000024160.V313313.R01.S.doc Version 5.2 Page 11 although this did not always include all aspects of their care nor were all up to date. Health assessments, such as the risk of developing a pressure sore and a nutritional assessment, were present. These were not fully completed in all files and a plan of how to meet any needs identified in the assessments were not always present. One resident had no daily notes documented and so there was no record of the care or support they had been given during their stay in the home. Charts for the intake of food and drinks were present for many residents. Those seen had not been completed which could indicate a lack of fluid and nutrition for the residents. Staff were seen to leave drinks out of the reach of residents and not return to assist them. It was discussed that the dependency levels of the residents accommodated were high, with most requiring assistance from two staff. One qualified nurse was on duty at each shift, with an overlap of several hours per week when two nurses were on duty. Staff and residents spoken with felt this was inadequate to fully meet the needs of the residents accommodated. Staff had documented where a resident’s personal hygiene needs and preferences were not met due to shortage of staff. The health and personal hygiene needs of the residents must be met, at all times. The qualified nurses administered the medication in the home. The administration records were kept. Where changes had been made to the resident’s medication it was not made clear who had ordered these changes. The majority of the medication was safely stored, however the fridge containing medication, which was in the dining room of the home, was not locked. Residents spoken with said their privacy and dignity was protected by the staff in the home. They said they knocked on the bedroom doors prior to entering and used signs to indicate personal care was being delivered. Staff were seen to speak to residents politely, with informal banter taking place. Irene House DS0000024160.V313313.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 A programme of activities was not offered in the home. Some did take place on an ad hoc basis. Visitors were welcomed into the home. Some of the residents said their choices and preferences were understood and respected, whilst for those unable to discuss this with staff they were not adequately explored or documented. The meal served was of poor quality. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service EVIDENCE: There was no set activities programme in the home. Weekly trips out of the home and a weekly visit by an aromatherapist took place. There was no person employed to provide activities within the home. One care assistant took the lead on providing activities, with the help of others, if staff numbers allowed. This resulted in no group or one to one activities being available for much of the time. Some residents spoken with said they would like “more to go on” whilst others were satisfied with their personal leisure pursuits of reading or watching television. Visitors spoken with said they were welcomed into the home and could visit at any reasonable time, staying for as long as they wished. They were seen to Irene House DS0000024160.V313313.R01.S.doc Version 5.2 Page 13 visit their relatives either in the communal areas or their own bedrooms, whichever they chose. Residents who were able said the staff did ask them their preferences on some of the aspects of care and support offered. Some of the resident’s preferences were documented on their plans of care, though this was not thorough. For those residents who were unable to verbally discuss how they would like to be supported and assisted, more information would be needed to ensure their choices were understood and respected. There was one large dining area in the home, with a smaller dining table set up in another area. Many residents required assistance to eat and drink and at meal times they were given this assistance in the lounge or their own bedrooms. The inspector ate lunch with the residents. A choice of two main meals was offered. Several residents were complaining that the potatoes served were too hard and one said “the vegetables are like water” with another commenting “I don’t know what this is.” One of the main meals served was bland and tasteless, with very hard overcooked parts, was colourless and unappealing. Several residents returned this lunch, though none complained about it. Residents who returned meals were not offered an alternative. A choice of sweet was served. The poor quality of the meal served was discussed with the manager during the inspection. Irene House DS0000024160.V313313.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Residents and relatives could bring their concerns or complaints to the manager and these were resolved and recorded. Procedures were in place to protect vulnerable adults. Not all staff had received relevant training. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service EVIDENCE: The home had received six complaints since the last inspection. The investigation and outcomes were documented. All had been resolved to the complainants’ satisfaction. Residents and visitors spoken with said they would approach the manager or other staff in the home, should they have any issues. If they had had cause to raise any concerns they said these had been dealt with quickly. No allegations of abuse had been received at the home. The person in charge of the home was aware of the procedure to follow should an allegation of abuse be made. Fifty per cent of the staff had received training in the protection of vulnerable adults. All staff must receive this training. Irene House DS0000024160.V313313.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,22 and 26 The home was clean, warm and free from offensive odours. The communal areas were bright and welcoming. Equipment necessary for the safe moving and handling of residents was available. The size and layout of some bedrooms make them unsuitable for residents who need this equipment. Measures to control the spread of infection were in place. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The home was clean, tidy, warm and free from offensive odours. The communal areas were bright and the residents said there had been some improvements to the environment, which they liked. They said their bedrooms were kept clean and tidy. At the last inspection there was some discussion about the courtyard at the centre of the home and the development of this. No changes had been made to this area. At the last inspection a requirement was made regarding the number of bathrooms available for the residents. At this Irene House DS0000024160.V313313.R01.S.doc Version 5.2 Page 16 inspection one bathroom on the ground floor had been altered into a level access shower and toilet. One bathroom on the first floor was under refurbishment. The majority of fire doors in the home were closed. Some bedroom doors were wedged open and they should be fitted with a device which meets the guidance of the fire authority. At the last inspection a discussion took place regarding the size and layout of some bedrooms, making them unsuitable for use by residents who needed equipment in place. At this inspection risk assessments, for every bedroom, had been completed and action had been taken to minimise the risks identified. Equipment needed for the safe moving and handling of residents was available to staff. One area of wheelchair storage was unsafe as it was protruding into the corridor and blocking a toilet door. An increased number of specialist chairs had been purchased. These were shared between dependant residents to enable them to have some time out of bed. Staff used appropriate protective clothing and appropriate hand hygiene equipment was available. Some staff had received training in infection control. Irene House DS0000024160.V313313.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28,29 and 30 The number of nursing staff on duty was not sufficient to meet all the resident’s health care needs, complete the documentation and provide direction to other staff. Staff received training for the work they were to perform. The recruitment procedures in the home protected the residents. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. EVIDENCE: A qualified nurse was on duty at each shift. At the last inspection a requirement was made to review the nursing staff hours due to the high dependency of the residents accommodated. The duty rota showed that on one day there was an overlap of two registered nurses on duty. The staff spoken with said this was inadequate to ensure all nursing and personal care tasks were undertaken, that staff were adequately supervised and all paperwork up to date. At weekends this was of greater concern since the one nurse on duty was also in charge of the home, having no administration staff present. The tool used to determine the staff numbers did not include the dependency needs of the residents. As discussed in the health and personal care and daily life sections there was evidence that not all resident’s needs were being met due to a shortage of staff. The requirement to ensure Irene House DS0000024160.V313313.R01.S.doc Version 5.2 Page 18 adequate numbers of appropriately qualified staff are on duty, to meet the needs of the residents, remains unmet. Thirty six per cent of the care staff had completed NVQ level two or above. The statutory training was kept up to date by the Guild Care central training programme. A comprehensive induction programme was in place. Other training needs were identified in line with specific resident’s needs. As discussed not all staff had completed the protection of vulnerable adults training. Two files for newly appointed staff members were examined. All the necessary checks and information to be obtained, prior to a member of staff starting work, was present. Irene House DS0000024160.V313313.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 The registered manager had resigned her position and would leave the home in early November. Interim management arrangements had been put into place, by the Guild Care organisation, until a suitable candidate was appointed. Residents can contribute to the running of the home. Quality assurance measures were in place. Management of the resident’s personal monies safeguarded their interests. The health and safety of the residents was protected. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The manager had resigned her position and would leave employment in the first week of November. Arrangements had been put into place to ensure management cover for the home until a suitable replacement was appointed. Irene House DS0000024160.V313313.R01.S.doc Version 5.2 Page 20 The Guild Care organisation had a number of measures in place to review the quality of care and service provided at the home. These included audits and spot checks, surveying the residents and relatives, trustees unannounced visits to the home and various committees with resident representatives. Residents spoken with said they felt staff and management were approachable and they felt involved in the home, if they wished. The manager was currently undertaking a survey of the food served in the home. The organisation has an accounting system set up on the computer. Records were kept of the individual residents money and receipts were produced. The resident’s personal money was pooled together and some was held in a bank account, in the name of the organisation, until the individual requested it. Following the last inspection further discussion had taken place and the Commission had agreed that safeguards were in place within this system, which, as far as possible, protected the resident’s money. No issues of health and safety were raised at this inspection. Staff had received training in health and safety. Accident records were kept. Irene House DS0000024160.V313313.R01.S.doc Version 5.2 Page 21 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 X X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X 3 3 X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Irene House DS0000024160.V313313.R01.S.doc Version 5.2 Page 22 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 OP7 Regulation 15 Requirement All residents must have a plan of care drawn up in consultation with them, where possible, and kept under review. These must include all aspects of health care as assessed by the nursing staff e.g. pressure sore prevention. This requirement remains unmet since the inspection of 3/8/05 and 5/01/06. The timescale given of 31/8/05 has expired The health care needs of the residents, including the provision of adequate diet and fluids, must be met by appropriately qualified staff. The registered person shall consult residents about a programme of activities and provide this suitable for their needs and abilities. The registered person shall provide suitable, wholesome, nutritious food, which is properly prepared. The number and skill mix of staff DS0000024160.V313313.R01.S.doc Timescale for action 05/11/06 2. OP8 12 05/11/06 3. OP12 16(2)(n) 30/11/06 4. OP15 16(2)(i) 05/11/06 5. OP27 18(1)(a) 05/11/06 Page 23 Irene House Version 5.2 on duty must be appropriate to meet the needs of the residents accommodated. This requirement remains unmet since the inspection of 5/01/06. The timescale given of 31/8/05 has expired RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Irene House DS0000024160.V313313.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Irene House DS0000024160.V313313.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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