Inspection on 11/12/05 for Isard House

This inspection was carried out on 11th December 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.

Other inspections for this house

Isard House 25/03/09

Isard House 20/04/08

Isard House 25/04/07

Isard House 19/04/06

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Isard House Glebe House Drive Hayes Bromley Kent BR1 7BW Lead Inspector Wendy Owen Unannounced Inspection 11th December 2005 11:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Isard House DS0000063943.V269533.R01.S.doc Version 5.0 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. Isard House DS0000063943.V269533.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Isard House Address Glebe House Drive Hayes Bromley Kent BR1 7BW 020 8462 6577 020 8462 0952 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) Shaw healthcare Ltd *** Post Vacant *** Care Home 66 Category(ies) of Dementia - over 65 years of age (33), Old age, registration, with number not falling within any other category (33) of places Isard House DS0000063943.V269533.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st November 2005 Brief Description of the Service: Isard House is a large two-storey building built around two secure quadrangles. The home is set at the end of a cul-de-sac with open fields bordering onto the rear and side of the home’s grounds. It is situated within walking distance of public transport links and local shops. This home provides care and accommodation for 66 older persons. The home is registered to care for 33 service users with dementia and 33 for service users in the older frail category. Service users’ accommodation is mainly on the ground floor. However four, residents have accommodation on the first floor, which is accessed by stairs, making these bedrooms unsuitable for people with significant mobility difficulties. There are grab and hand rails in corridor areas, stairs, toilets and bathroom. Specialised bathing and toilet equipment and lifting aids are available for residents use. There are various lounges and sitting areas available and all public areas of the home are accessible to every resident. Central heating is provided to all areas of the home and residents can control the temperature of their own rooms. The management of the home has, since April 2005, been provided by Shaw Healthcare, who successfully tendered for the six the Local Authority homes in the area. Care is provided by a management; administrative; ancillary team and a team of support worker providing 24 hour care. The home is in need of redecoration and refurbishment. Isard House DS0000063943.V269533.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over the course of a lunch time with two inspectors undertaking the inspection. The inspection included viewing of the home; discussions with relatives and staff; viewing of medication records and observation of routines and practices. Since the inspection dated 11/08/05 there have been two further visits. One visit was undertaken during the night, whilst the second visit investigated a complaint. The report will comment on the findings of these two visits. There has also been a visit made by the Pharmacy Inspector where the requirements and recommendations will be monitored at the next Pharmacy inspection. Requirements and recommendations raised in previous inspections will be monitored fully at the next inspection. What the service does well: What has improved since the last inspection? Two units and the reception area have been redecorated and the reception area has had new carpet fitted. The standard of cleanliness has also improved since domestic staff have concentrated on domestic chores only. Towels and flannels have now been replaced. The home has a Deputy Manager in place supporting the Acting Manager. Checks are now being made on the temperature of the water in the home and an updated Public Liability Insurance certificate is now in place. Isard House DS0000063943.V269533.R01.S.doc Version 5.0 Page 6 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. Isard House DS0000063943.V269533.R01.S.doc Version 5.0 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 Isard House DS0000063943.V269533.R01.S.doc Version 5.0 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): EVIDENCE: The core standards have been assessed previously and were therefore not inspected on this occasion. Requirements raised at that time will be monitored at the next inspection. Isard House DS0000063943.V269533.R01.S.doc Version 5.0 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 the following standard(s): 9 & 10 Medication practices place service users health, safety and well-being potentially at risk. EVIDENCE: The inspector met with three groups of relatives. All relayed positive comments about the home, staff and care provided. The relatives were frequent visitors, either weekly or twice a week. One relative was particularly pleased with the way their mother was cared for in respect of her physical decline, which rendered her bed-bound. The inspectors observed staff undertaking personal care tasks respecting residents’ privacy and dignity and dealing sensitively with their needs. The medication charts were inspected. The standard of record keeping was poor. The allergies were not recorded on charts on any of the charts inspected and many charts had gaps in the recordings. The morning medication had been administered late, although the time of administration was not actually noted as suggested by the inspecting pharmacist. In addition it is essential that a sufficient time period has lapsed between some medications. Isard House DS0000063943.V269533.R01.S.doc Version 5.0 Page 10 On resident’s medication chart was altered and information changed. The chart had no record in respect of administration of one medication, which had been commenced 2 December 2005. In addition it was evident that many morning medications had been omitted over a period of days therefore leaving residents at risk of not receiving the medication required to maintain their health. In Langley Unit there was a duplication of a medication chart, one hand written and one hand transcribed. There appeared, from the lack of signatures on some days, to be confusion over which medication chart was being used. It also gave rise to potential problems of duplication of medication. Hand transcriptions of medications had no staff signatures in place nor were the amounts received into the home recorded. Discussions with staff members identified that that the morning medication had been administered by two staff members, one of whom dispensed and signed that the medication had been given whilst the other administered the medication to the resident. This practice must be stopped immediately and medication practices must be reviewed. The home has also received a visit from the CSCI Pharmacy Inspector in June 2005. The requirements raised during this visit will be monitored during the next Pharmacy inspection. (Requirement 17 and Recommendation 1) Care plans were not viewed on this occasion nor were the records in relation to the health and well-being of residents. Requirements raised at previous inspection are to be monitored at the next inspection. Isard House DS0000063943.V269533.R01.S.doc Version 5.0 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 the following standard(s): 13, 14 & 15 Meal time routines do not adequately provide all residents with the diet or the assistance required to ensure their nutritional are met. EVIDENCE: The inspectors arrived a little before lunch was served. Tables were laid with tablecloths (not ironed) and condiments and the lunch in Hayes Unit was nicely presented and juice served with the meals. Staff on this unit were seen to assist residents with their lunch in an unhurried caring manner. One resident required assistance which the staff member addressed showing great patience. In Keston Unit residents had already started their meal, with some residents having food stains on their clothes. It was much later that staff provided protective covering. Residents were given very little help or assistance with eating, despite some obvious problems. One resident was served her meal later in the lounge area on her own. The member of staff placed the dinner plate and drink on a small coffee table, with only a fork provided to eat the meal. The resident was extremely confused and not able to understand what was required, having just been awoken abruptly from a nap. It was very difficult for her to eat the meal or drink her juice, which was immediately spilt on the floor. The inspector waited a while and then attracted a member of staff attention who said they were getting a knife, although her activity at that point was clearing the other plates. This is unacceptable practice and residents Isard House DS0000063943.V269533.R01.S.doc Version 5.0 Page 12 must be given help and assistance to eat their meals. This had been raised as a requirement at the inspection of 11/08/05. Staff also informed the inspector that the residents, who were not in attendance for their meals, would have their meals re-heated. However, they would be thrown away after half an hour. The inspector was concerned about what would be offered if this occurred and whether residents may miss out on the hot meal of the day. Later discussions with the home identified that the home have not implemented the requirement raised at the last inspection which required the home to record changes made to the menus. (See requirement 5 & 6) There were a number of visitors in the home at the time of the inspection and all seemed relaxed and comfortable in the environment. One relative was observed obtaining food for their relative to assist with feeding. The interaction between the relative and staff was once again relaxed, open and friendly. Relatives also said that the home contacted them regarding any issues or concerns the home has with their family member’s well-being and if they are involved in accidents. This had been raised as a requirement in the report of 3/11/05. It was also good to see staff coming into the home to take a few residents to a Carole service for the afternoon to begin the Christmas celebration. Isard House DS0000063943.V269533.R01.S.doc Version 5.0 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 the following standard(s): EVIDENCE: The core standards were inspected previously and therefore not inspected on this occasion. Requirements raised during previous inspection are to be monitored at the next inspection. Isard House DS0000063943.V269533.R01.S.doc Version 5.0 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 the following standard(s): 19 & 26 There has been some progress in the redecoration required. There must be further progress to provide the residents with a comfortable, well maintained and satisfactorily decorated place to live. EVIDENCE: There has been some progress in the decoration required at the inspection in August 2005. The reception area has been redecorated and re-carpeted and Langley unit redecorated. Hayes lounge has also been decorated although this was to a basic standard. The home had been decorated with Christmas decorations. Other areas of the home highlighted during previous visits, including the hall carpets and the flood damage in Hayes unit remained unattended to. The Provider must provide the Commission with the action plan and timescales for this redecoration as required by previous inspection. (See requirement 8, 9 & 10) The inspection dated August also highlighted the need to improve the standard of cleanliness throughout the home. There is some evidence that this has Isard House DS0000063943.V269533.R01.S.doc Version 5.0 Page 15 been improved along with the reduction in the strong odour reported during the visit on 1/11/05. However, the poor standard of décor, in some areas, detracts from this. Isard House DS0000063943.V269533.R01.S.doc Version 5.0 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 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 & 29 The staffing levels and consistent use of agency staff does not provide residents with the continuity of care to ensure their needs are being fully met. EVIDENCE: Discussions and observations identified that the morning shift included four permanent staff and seven agency staff. Two of the four permanent staff were Team Leaders. On the Langley Unit there were twenty-two service users and four members of staff. Staff spoken to said that they felt it difficult to provide the care required with this number of staff, especially with the increasing dependency of residents. On this particular unit one resident was palliative care; two had fractures and therefore poor mobility, whilst another refuses to walk. All need two members of staff to assist. Staff appeared quite demotivated, although there was no evidence that this affected the care provided. It was also noted hat there was no laundry assistant and therefore care staff also undertook this task. Three agency staff, all from the same agency, were providing the care on Keston unit. Discussion with staff showed that some had been in the home frequently, whilst for others this was not so. Discussions with other agency members showed that not all had been inducted in the home, not all had received fire training and, for those working on the dementia unit, some had not received dementia training. Others had received First Aid and food hygiene training through their agency. The inspectors did not have the opportunity to Isard House DS0000063943.V269533.R01.S.doc Version 5.0 Page 17 monitor the requirement made on 1/11/05 regarding written confirmation of the suitability of agency staff used. (See requirement 12 & 18) Isard House DS0000063943.V269533.R01.S.doc Version 5.0 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 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 & 38 The lack of a Registered Manager and inexperienced senior staff does not provide the leadership and guidance to support manage staff and provide for the health, safety and well-being of residents. EVIDENCE: Since the last inspection last inspection the home has appointed a Deputy Manager to support the Acting Manager. The Deputy Manager’s previous experience was that of a Team Leader in another home and therefore experience of management is limited. The organisation has not yet been successful in appointing a Manager and the home continues to be managed by another home’s Manager. The organisation is aware of the need to prioritise this to ensure secure management is in place. (See requirement 13) Previous comments have detailed the need for agency staff to be inducted into the home, including fire procedures and to ensure they have the core health and safety training required. Requirements have been made in relation to this. Isard House DS0000063943.V269533.R01.S.doc Version 5.0 Page 19 Previous inspections have highlighted the lack of monthly visits by the Registered Providers. There is still little evidence that these take place. No reports have been sent to the Commission. Considering the current issues in the home the monitoring process is integral to the required improvement. (See requirement 14) Discussions with agency staff identified that, not all had received inducting into the home’s health and safety or emergency procedures. (See requirement 18) Isard House DS0000063943.V269533.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X X X X 2 Isard House DS0000063943.V269533.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? Yes. Not all requirements were monitored during this visit. 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 OP3 Regulation 14 Requirement The Registered Person must ensure assessments are completed on all residents admitted into the home. These assessments must be current. The home must confirm in writing that they are able to meet the needs of the individual. Not inspected on this visit. The Registered Person must develop care plans which are reflective of the residents holistic needs. The care plans must be subject to regular reviews. This was not inspected on this occasion. The Registered Person must develop risk assessments where risks have been identifed. The risk assessment must record the risk and the action the home is taking ot minimise the risk. This was not inspected on this occasion. The Registered Person must ensure the home records all accidents within the home. DS0000063943.V269533.R01.S.doc Timescale for action 01/11/05 2 OP7 15 01/11/05 3 OP8 12 01/10/05 4 OP15 12 01/12/05 Isard House Version 5.0 Page 22 This was also raised as a requirement in the report dated 3/11/05. 5 OP15 12 The Registered Person must ensure that the meal time routines are suitable for residents who require assistance. Residents must be given appropriate assistance at meal times. Care plans must detail the assistance or support required at this time. This was also raised as a requirement in this inspection. Previous timescale expired 01/11/05 The Registered Person must ensure that any changes to the menus or indiviudal residents choices are recorded and maintained by the home. This has not been met. Previous timescale expired 01/11/05 The Registered Person must maintain a record of all complaints made, including the action the home has taken to resolve the complaint. The Registered Provider must ensure all complaints or concerns raised are responded to appropriately. This requirement was not inspected during this inspection. The Registered Person must provide the Commission with an action plan for the redecoration of the home. A separate letter detailing the areas requiring attention has been sent to the Registered Provider. An action plan must be provided detailing the timescale within six months, for completion of the work identified. Previous request for an DS0000063943.V269533.R01.S.doc 01/02/06 6 OP15 17 01/02/06 7 OP16 22 01/09/05 8 OP19 23 01/02/06 Isard House Version 5.0 Page 23 9 OP19 16 10 OP20 16 11 OP27 18 12 OP28OP27 18 13 OP18 31 14 OP33 24 & 26 action plan not received. Timescale expired 1/10/05. Some progress has been made in the redecoration of parts of the home. The Registered Person must replace worn carpets in the home. A separate letter has been sent detailing specific areas. This requirement has not been met. Previous timescale 01/10/05 The Registered Person must replace worn and torn furniture. This requirement has not been met. Previous timescale 01/10/05 The Registered Person must ensure that the staffing mix within the home meets the needs of the residents. Specifically, domestic staff must be employed to undertake domestic chores and rosters developed to indicate numbers, names and hours worked by staff. Rosters were not viewed ont his occasion The Registered Person must recruit permanent support staff to meet the needs of the residents. There remians issues with the staffing level and high use of agency staff. Previous timescale 01/11/05 The Registered Provide must employ a Registered Manager without delay. This requirement has not been met. Previous timescale 01/11/05 The Registered Provider must ensure that the monthly visits required of the Provider are completed and a report of these visits supplied to the DS0000063943.V269533.R01.S.doc 01/02/06 01/02/06 01/10/05 01/11/05 01/11/05 01/10/05 Isard House Version 5.0 Page 24 15 OP37 17 16 OP38OP18 12 & 13 17 OP9 13 Commission. Monitoring including audits of the organisations policies and procedures must be undertaken. This requirement has not been met. Previous timescale 01/10/05. The Registered Person must ensure that the home records any events which affect the wellbeing of the resident. These records must be clear, specific, accurate and up to date and record any actions the home has taken. This was not inspected on this occasion. The Registered Person must investigate any incidents/accidents which result in injury to service users. This was not inspected on this occasion. The Registered Person must ensure medication practices are improved. Specifically, administration practices must be improved and record of medications for individuals must be improved. 01/12/05 01/12/05 01/01/06 18 OP38 18 The Registered Person must 01/02/06 ensure that agency staff are fully inducted into the home to ensure the health, safety and well-being of service users. 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 Isard House DS0000063943.V269533.R01.S.doc Version 5.0 Page 25 1 OP9 Where medications are hand transcribed there should be two signatures to confirm the accuracy of the recording. Isard House DS0000063943.V269533.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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 Isard House DS0000063943.V269533.R01.S.doc Version 5.0 Page 27 - 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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