CARE HOMES FOR OLDER PEOPLE
Irene House 1 Parkfield Road Worthing West Sussex BN13 1EN Lead Inspector
Helen Tomlinson Unannounced Wednesday, 3 August 2005, 07.30am, V242728
rd 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. Irene House H60-H11 S24160 Irene House V242728 030805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Irene House Address 1 Parkfield Road, Worthing, West Sussex, BN13 1EN 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) 01903 529060 Guild Care Mrs P Hall CRH 40 Category(ies) of OP-40 registration, with number of places Irene House H60-H11 S24160 Irene House V242728 030805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: NONE Date of last inspection 23rd February 2005 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 whom may have nursing needs. The home is situated in a residential area of Worthing. It is a detached, two-storey building with a central garden 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. A room on the first floor is used as a hairdressing salon. Irene House is owned by Guild Care, an organisation which has three other care homes in the area. Irene House H60-H11 S24160 Irene House V242728 030805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection. The inspector arrived at 7.30am and left the premises at 5pm. Over the course of the inspection the inspector spoke with sixteen residents, seven staff members and four visitors. Their views were sought on various aspects of life at the home. Some residents were spoken with in the privacy of their own bedrooms. Staff were observed giving support and assistance. Three residents files were examined in detail and other records were seen as was necessary. A tour of the premises took place. Staff files were examined. What the service does well: What has improved since the last inspection?
Some communal areas had been redecorated and this was ongoing at the time of the inspection. Residents said this brightened up the home.
Irene House H60-H11 S24160 Irene House V242728 030805 Stage 4.doc Version 1.40 Page 6 The porch outside the front door had been repaired. There was an increase in the time allocated to care staff for joining in activities with the residents. This had resulted in more residents getting out of the home to visit local areas and more one to one attention for dependant residents. What they could do better:
At the time of this inspection some aspects of health and safety gave the inspector grave cause for concern. Storage of many articles was inappropriate and caused a serious hazard to the residents. This had implications for fire safety, as some fire doors could not be closed. Other fire doors were left open or wedged open. This inappropriate storage included soiled articles left in communal bathrooms and toilets. This had implications for the infection control in the home. The registered manager was asked to take immediate action to rectify these issues and this was done within 3 hours. Staff must be made aware of the health and safety of residents, visitors and staff and prevent risks from occurring. Not all staff had received fire safety training. This must be done for all staff. Not all residents had a plan of care. The documentation used was in the process of change and staff were becoming used to the new forms. Lack of a formalised and up to date care plan could lead to inconsistent care and all residents must have one recorded. The records for resident’s ongoing condition were inadequate to meet with the qualified nurses guidance on documentation. This should be reviewed and ensure a clear picture of the residents condition is documented. All visits by other professionals should be clearly recorded to ensure their instructions are carried out. Residents should have up to date plans of care, which reflect their current needs. Not all care plans had been regularly reviewed and this should be done. Residents who cannot communicate their needs must be kept comfortable when sitting in specialist chairs. Their legs should be supported and not left to “dangle.” In order to make sure resident’s wound care is consistent the documentation used must be clear and up to date. When a particular risk for a resident is identified this should be assessed, documented and action taken to minimise that risk. Any charts devised to ensure these risks are minimised, on a daily basis, should be properly completed. The storage and administration and recording of medication should meet with the guidance of the Royal Pharmaceutical Society and the Nursing and Midwifery Council. Clear records of medication to be administered, in line with the prescriber instructions, must be kept. No medication should be stored unlabelled and all medication must be safely stored in the home. The additional railings on the balconies of two first floor bedrooms must be put into place, in line with guidance from the environmental health department.
Irene House H60-H11 S24160 Irene House V242728 030805 Stage 4.doc Version 1.40 Page 7 Staff recruitment and employment checks were not complete and did not demonstrate that all staff were fit to work with vulnerable adults. 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 H60-H11 S24160 Irene House V242728 030805 Stage 4.doc Version 1.40 Page 8 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 Irene House H60-H11 S24160 Irene House V242728 030805 Stage 4.doc Version 1.40 Page 9 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) 3 Residents were not admitted to the home unless an assessment of their needs had been carried out EVIDENCE: Three resident’s files were examined. All had an assessment of their needs documented. These had been completed prior to the resident coming into the home, but they were not signed or dated. Where appropriate nursing assessments were present on file Irene House H60-H11 S24160 Irene House V242728 030805 Stage 4.doc Version 1.40 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 standard(s) 7,8,9 and 10 Not all residents had a plan of care. The resident’s health care needs were fully met. Some aspects of health care were not adequately documented. Some practices around the storage and recording of medication did not meet with current guidance. Residents had their privacy and dignity protected by staff and practices in the home. EVIDENCE: Of the three files examined two had thorough and comprehensive care plans documented. These had been drawn up from various assessments which indicated the resident’s needs. For the remaining resident no plan of care was documented though a moving and handling assessment was present. Staff discussed that the documentation used for care planning was in the process of being changed and new documentation was being introduced. This new documentation was thorough and would present a good picture of the residents personal, health, social and emotional needs if completed fully. All residents must have a plan of care to ensure consistency in how their needs are met. Residents should be involved in the drawing up of their care plans and agree the actions to be taken.
Irene House H60-H11 S24160 Irene House V242728 030805 Stage 4.doc Version 1.40 Page 11 Assessments to identify the resident’s individual health care needs included, moving and handling, wound assessments and the risk of development of pressure sores. These formed the basis for the plans of care which were documented. Not all risks or needs identified by assessment had a corresponding plan of care. Falls risk assessments were not completed, even though the risk of falls was documented. A nutritional risk assessment was not completed. The wound charts for one resident were confusing and contained conflicting information. It was not possible to understand what dressings should be used. Daily charts for food and fluid intake and output and daily care provided are used for the more dependant residents. These were not always completed with nil recorded from 8am to 3pm on 2/8/05 for one resident. For one resident a visit from the G.P. was not recorded therefore there was no assurance that any required actions were being carried out. It was discussed with the qualified nurses and the manager that the documentation must be completed and up to date to reflect the care given in practice. Residents with bed rails in place did not have protectors present. It was discussed these must always be used with bed rails for any resident. The care plans which were in place had not been regularly reviewed with no review documented for one resident between December 2004 and April 2005. These should be reviewed monthly and reflect the current picture at all times. The qualified nurses completed a daily progress sheet to indicate the resident’s present condition. For the resident without a care plan documented it was written that the care was given as agreed in the plan. It was discussed that this did not meet with the nurses code of practice regarding documentation and the way daily progress or change was recorded should be reviewed. The monitored dosage system of medication storage and administration was used in the home. There were two medicine trolleys in the home. One was kept on the ground floor and the second on the first floor. These were secured to the wall. A storage cabinet was available downstairs and a storage cupboard. The medications in current use were correctly and securely stored. There was an unlabelled bottle, containing many different kinds of tablet, in the trolley. The nurse stated these were tablets which had been dropped or refused and had to be discarded. No medication should be kept in unlabelled bottles and these should be correctly labelled and safely stored before being disposed of. The instructions for insulin administration for one resident had been altered and were very unclear. There were two conflicting instructions and incorrect dosage could have been given. All altered or hand written instructions must be clear, witnessed and signed by two members of staff. The prescriber directions must be cross referenced. At the time of this inspection there had been a change in the rules for disposal of waste medication. Advice was given and the organisation must appoint a licensed operator as soon as possible. Each resident had a signed agreement by the G.P. for homely remedies to be given. The residents stated that the staff treated them with dignity and respected their privacy. Staff were trained on induction how to protect resident’s privacy and they were seen to do this when providing care and support. Staff knocked
Irene House H60-H11 S24160 Irene House V242728 030805 Stage 4.doc Version 1.40 Page 12 on bedroom and bathroom doors and closed doors behind them. They were seen to be polite to the residents and visitors to the home. Irene House H60-H11 S24160 Irene House V242728 030805 Stage 4.doc Version 1.40 Page 13 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 and 15 The activities in the home suited the needs and wishes of the residents living there. The food was nutritious and appealingly served with a variety and choice, which suited the residents. It was served in a pleasant environment. EVIDENCE: Since the last inspection staff had been allocated a certain number of hours to carry out activities with the residents. Staffs discussed how they enjoyed this aspect of care and were taking out residents on a one to one basis, with one member of staff taking a few residents at a time in the minibus. Residents discussed how they enjoyed these outings. Activities took place in the home, which included entertainers coming in, board games and individual manicures. A singer was present on the afternoon of the inspection and many residents joined in a sing-a-long. Residents said if they did not wish to join in they could choose to stay in their rooms. Televisions, radios, books, magazines and newspapers were provided for residents on an individual basis. One member of staff discussed with the inspector how this aspect of resident’s care was being given a higher profile within the home. Residents said the food they received was tasty and there was plenty of it. They were particularly pleased with the choices of food available. At breakfast time there was a choice of cereals, porridge, toast, bacon sandwiches or full cooked breakfast. Residents were seen enjoying the full range offered. There
Irene House H60-H11 S24160 Irene House V242728 030805 Stage 4.doc Version 1.40 Page 14 was a choice of two hot dishes or a salad at lunchtime, with two sweets. Home made cakes were given and hot and cold drinks were offered throughout the day. Assistance was given discreetly were needed and the dining room provided a comfortable environment for eating. Some residents chose to eat in their own bedrooms and this was respected. Irene House H60-H11 S24160 Irene House V242728 030805 Stage 4.doc Version 1.40 Page 15 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) No standards in this section were assessed. EVIDENCE: Irene House H60-H11 S24160 Irene House V242728 030805 Stage 4.doc Version 1.40 Page 16 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) 19,21 and 26 Residents lived in an environment, which required some refurbishment. Some areas of the home presented a hazard to residents. The number of bathrooms available for resident’s use was insufficient for the number of residents accommodated. Some practices in the home were a possible risk to the control of infection. EVIDENCE: On arrival at the home at 7.30am the inspector found many items stored inappropriately which presented a hazard to the residents. One bathroom on the ground floor had seven commodes, a carpet cleaner, a hoist, part of a bed, two Zimmer frames, a bath seat that was not attached to the bath and a plastic light fitting stored in it. These items were not stored neatly and blocked the doorway so that it could not be shut. One bathroom on the first floor was used for storage also. The remaining bathroom on the first floor had wet towels in the bath. One toilet had a soiled foam mattress propped on the wall next to the toilet. The door to the hairdresser’s room, on the first floor, was wide open with the window wide open and no restrictor present. The decorators paint tins were in this room without lids. The sink had a large ball of hair in the plughole.
Irene House H60-H11 S24160 Irene House V242728 030805 Stage 4.doc Version 1.40 Page 17 The majority of the bedroom fire doors were wedged open, the sluice door was wedged open and the fire doors to the linen cupboards were open and not shut or locked as the signs on them stated. The cleaners store containing hazardous substances was unlocked. The automatic fire door on the laundry was propped open by a linen basket. A requirement to make all areas of the home safe for the residents was issued immediately. Within 3 hours many of the items incorrectly stored had been removed. One bathroom on each floor had been designated for temporary storage and locked to the residents. The manager was made aware that this could not be a long-term solution and the bathrooms must be available for the resident’s use. The fire doors had been closed with additional signage and, where appropriate, further lock being added. It was discussed that all staff must have training in health and safety and be made aware of their responsibility, on a day to day basis, for the health and safety of the residents at all times. Some of these issues also were a risk of spread of infection and all staff should be aware of this risk to residents in the home. The decorator was present in the home and the communal areas of the home were being decorated. The facilities manager of the organisation which owns Irene House, discussed that a substantial budget has been allocated for the refurbishment of the home and they are aware of the need for further work to be done. This includes the redecoration and new furniture for some bedrooms, new carpets in the communal areas and new kitchen and dining room equipment and furniture. Irene House H60-H11 S24160 Irene House V242728 030805 Stage 4.doc Version 1.40 Page 18 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 and 29 The number and skill mix of staff was sufficient to meet the needs of the residents. The recruitment procedures were not adequate to ensure protection for the vulnerable adults in the home. EVIDENCE: The duty rota for week commencing 1st August 2005 was examined. This showed that a registered nurse was on duty at all times. In the mornings there were seven care assistants, reducing to five in the afternoons and three at nights. This was sufficient to meet the needs of the residents accommodated at the time. Two staff files were examined. These did not contain all information required to ensure the person is fit to work with vulnerable adults. For one the employment history was not fully completed and so it was clear if there were gaps in employment. There was no evidence a satisfactory check had been carried out on the Protection of Vulnerable adults register, prior to employment, for either staff member. For one staff member there was no form of identification or photograph on file. The manager was made aware of the need to obtain all information for every new member of staff. Irene House H60-H11 S24160 Irene House V242728 030805 Stage 4.doc Version 1.40 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 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) 38 The health, safety and welfare of the residents was not promoted or protected by some practices in the home. EVIDENCE: As discussed under standard 19 the storage of articles in the home presented a risk to the safety of the residents. The fire safety in the home was not adequate with fire doors being propped open. One member of staff, who may have been in charge of the home, had not received fire safety training. All staff must receive fire safety training and be involved in fire drills. All staff must be made aware of the protection of residents from risks to their health and safety. This should include the risk of spread of infection. Previously it had been discussed that the balcony outside two bedroom on the first floor could present a risk to the residents in that room. Following consultation with the environmental health department it had been agreed that the balcony wall was too low and additional railings should be added. This had not been done at this inspection. The facilities manager said it was on the plan
Irene House H60-H11 S24160 Irene House V242728 030805 Stage 4.doc Version 1.40 Page 20 to be carried out in the next few weeks. It was required this was done as soon as possible. Irene House H60-H11 S24160 Irene House V242728 030805 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3
COMPLAINTS AND PROTECTION 2 x 2 x x x x 2 STAFFING Standard No Score 27 3 28 x 29 2 30 x 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 x x 2 Irene House H60-H11 S24160 Irene House V242728 030805 Stage 4.doc Version 1.40 Page 22 NO 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. Standard 7 Regulation 15 Requirement All residents must have a plan of care drawn up in consultation with them, where possible, and kept under review. All bed rails must have protectors fitted All storage and administration of medication must be in line with current guidance and safe for residents. All fire precautions to ensure the safety of the residents must be carried out, in line with guidance from the fire authority. All staff must receive fire safety training. Suitable storage must be available. The bathrooms cannot continue to be used for storage purposes Suitable arrangements must be made to prevent the spread of infection. This should include staff training. All necessary checks to ensure a person is fit to work in the care home must be carried out All parts of the care home to which residents have access must be, as far as practicable, free from hazards to their safety. The additional balcony railings Timescale for action 31/8/05 2. 3. 8 9 13(4)(c ) 13(2) 31/8/05 30/9/05 4. 19 24(4) 30/9/05 some were immediate 30/9/05 5. 19 23(l) 6. 26 13(3) 30/9/05 7. 8. 29 38 19 and Schedule 2 13(4)(a) 31/8/05 31/8/05 9. 38 13(4)(c ) 30/9/05
Page 23 Irene House H60-H11 S24160 Irene House V242728 030805 Stage 4.doc Version 1.40 must be put into place outside the two identified bedrooms. 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. 5. 6. 7. Refer to Standard 7 8 10 8 8 8 8 Good Practice Recommendations All risks identified should have a plan of management documented Wound charts should be kept up to date and clearly documented If daily charts are to be used for the care of residents these should be completed fully All visits by other professionals should be recorded The daily progress sheets should reflect the care actually given Residents should be made comfortable when sitting in any kind of chair. All identified risks should be assessed and a management plan implemented Irene House H60-H11 S24160 Irene House V242728 030805 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection 2nd Floor, Ridgeworth House Liverpool Gardens Worthing, West Sussex BN11 1RY 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 H60-H11 S24160 Irene House V242728 030805 Stage 4.doc Version 1.40 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. 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!
