Inspection on 19/04/06 for Isard House

This inspection was carried out on 19th April 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Isard House 25/03/09

Isard House 20/04/08

Isard House 25/04/07

Isard House 11/12/05

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 Key Unannounced Inspection 19th April 2006 10:00 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.V288184.R01.S.doc Version 5.1 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.V288184.R01.S.doc Version 5.1 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.V288184.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18/01/06 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. Isard House is situated within walking distance of public transport links and local shops. Since April 2005 Shaw Healthcare have been responsible for the management and provision of care having been successful in the Bromley Council tendering process. All referrals are made through the Local Authority Social Services Department. The home does have two beds available for private purchasers. 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. In the last year Shaw Healthcare have reduced the number of double beds to one and the remainder are all private rooms. Keston Unit has eleven beds for dementia residents; Hayes has twelve beds for dementia service users and Langley has twenty-two beds for the physically frail service users. Service users’ accommodation is mainly on the ground floor. However four service users 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 service user. Central heating is provided to all areas of the home and service users can control the temperature of their own rooms. Fees range from £373.00 for those residents placed by the Local Authority placements to £480.00 for those purchasing care privately. Items such as toiletries, hairdressing, private chiropody are paid from individual’s personal monies and not included in the fees. Isard House DS0000063943.V288184.R01.S.doc Version 5.1 Page 5 The home provides prospective service users or their relatives with information on the service through a Statement of Purpose which can be supplemented on request with a copy of the latest inspection report. Information, advice an guidance is also available through visits to the home and discussions with the manager and staff team. Isard House DS0000063943.V288184.R01.S.doc Version 5.1 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This inspection visit took place over one and half days with two inspectors and a pharmacy inspector on day one and two inspectors on day two. The inspection included fifteen written feedback cards from service users; verbal feedback from two relatives, three service users six written feedback from relatives. The inspectors had discussions with the manager, three members of staff and the deputy manager The visit also included observation of care practices, a tour of the home and viewing of records. The units were inspected independently and there may, therefore, be differences in the outcome of the inspection on each unit. Where requirements have been made within the same standard with the same timescale the inspectors have placed these together. However, where these may not have been met within the timescale the individual requirements will be recorded as not being met. What the service does well: There was evidence of a good rapport between staff and service users and staff and relatives. Service users said they were well cared for and enjoyed good interaction with staff, although this was less evident on dementia units. Staff have a caring approach which respects the privacy and dignity of service users. The newly appointed manager is seeking to improve lines of communication and involvement of service users, relatives and staff which was evidenced the commencement of regular meetings. The home has an open and transparent approach to dealing with issues raised about the quality of care with service users feeling they are able to voice their concerns. There is also an open and welcoming approach to relatives and other visitors with good communication beginning between the home and relatives. Service users in general said food is of a good standard and is “plentiful and good” Isard House DS0000063943.V288184.R01.S.doc Version 5.1 Page 7 What has improved since the last inspection? What they could do better: There are a number of requirements raised in previous inspections which remain outstanding. The organisation has comprehensive information available for prospective residents. However, this information is not always provided nor do they contain up to date information, as evidenced in the current Statement of Purpose. The records relating to the care of the individual must be improved to ensure a more holistic approach to the care provided. This includes the assessments, care planning and risk assessment information. These are outstanding from previous inspection reports. Staff should be provided with the opportunity and guidance to ensure they have an understanding of the residents’ needs, including physical and mental health needs. Medication procedures also require improvement to ensure the service users’ health is not placed at risk. Of greatest concern to relatives and the inspectors was the high use of agency staff used. This must be reduced to ensure service users’ receive consistent care by staff who understand their needs. Urgent action also must be taken to Isard House DS0000063943.V288184.R01.S.doc Version 5.1 Page 8 ensure training is improved in the home. Specifically, induction training must be provided in a timely manner and the home’s induction must ensure staff are provided with core training, especially in emergency procedures and moving and handling practices. More specific training must also be provided in relation to resident’s healthcare needs and dementia as well as more role specific training, such as health and safety training for the home’s representative. Without such training the needs of the service users cannot be met. The manager must also ensure the recruitment procedures are improved with this inspection showing some gaps in the appropriate checks required. This will ensure that vulnerable service users are protected. Whilst some progress has been made in the redecoration of the home there is still much work to do to and an action plan must be provided without delay to ensure service users are provided with a comfortable and homely environment in which to live. The home was also, in places, requiring a deep clean and removal of clutter from areas accessed by service users and steps required to ensure malodours are removed. Some bathrooms were being used as storage areas and therefore not able to be used by service users. This restricts the number of bathrooms within the home. The home has procedures in place for ensuring the safekeeping of service users’ monies. These have not been fully implemented with a lack of appropriate individual receipts for those audited. This is also true of the procedures regarding the auditing of the procedures. Audits were not being completed regularly nor was there any action noted to ensure compliance, where non compliance had been recorded. This does not provide an accurate reflection of the quality of care provided or identify where care could be improved. The feedback in relation to the food was, as stated earlier, positive. However, there are some areas which could be improved. This included how some foods are presented and staff providing the appropriate assistance and support to those unable to eat independently. 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.V288184.R01.S.doc Version 5.1 Page 9 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.V288184.R01.S.doc Version 5.1 Page 10 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): 1,2,3 & 6 “Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service.” All information is available for prospective service users, although this is not supplied routinely to the resident or their relative. Assessment information and admission records were incomplete and not fully reflective of needs, hence it would be difficult to comprehensively plan individual’s care from this. EVIDENCE: Shaw Healthcare have comprehensive pre-admission procedures in place for prospective service users. All service users admitted into the home are referred though the local authority (with the exception of two private beds) and therefore the home should obtain the Care Manager assessment followed by the home’s assessment. The home has developed a Statement of Purpose and Service Users’ Guide providing information on the home including some of its policies and procedures. These documents, when viewed did not reflect the current situation within the home eg current manager, number of double and single room. (See recommendation 1) The file of the last resident admitted to the home in January 2006 was viewed. It showed an assessment completed by the home but the inspector was unable Isard House DS0000063943.V288184.R01.S.doc Version 5.1 Page 11 to determine the date of the assessment or who completed it. It was also evident that not all the records had been completed during this time. For example, weights had not been recorded nor any nutritional assessments. The Care Manager assessment had been supplied but there was there no evidence of the home confirming that the home is able to meet the individual’s needs. The record keeping in relation to the admission was incomplete, including the record of property brought into the home. (See requirement 1 & 2) Discussions with two service users showed that, whilst they had not visited the home prior to admission, family members had undertaken visits on their behalf. This was confirmed by a relative, although this discussion also showed that the home had not provided any information prior to admission such as the Statement of Purpose, details of the terms and conditions of residency or other matters such as how monies are managed and the policies and procedures in general. These were believed to be an important part of the process. During the course of the day one visitor arrived to view the home on behalf of their relative. The three files viewed contained the service agreement between the Provider and the resident. These are in the process of being signed by the parties involved with one relative confirming this to be the case. Many residents were unaware of any contracts in place. Such information should be provided prior to admission. The Manager is also in communication with the placing authority to ensure these agreements are also held by the home. (See requirement 1) Progress on this will be monitored at the next inspection. The home does not admit residents for intermediate care. Isard House DS0000063943.V288184.R01.S.doc Version 5.1 Page 12 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 & 10 “Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service.” Records related to care plans and staff interventions were not sufficiently comprehensive in content to fully reflect the residents’ current needs and assistance required. Medication procedures and practices introduce a margin for error and the lack of knowledge and understanding of some residents’ healthcare needs potentially place residents’ health and well-being at risk. The staff present a caring and sensitive approach to residents providing a warm and friendly environment where they feel they feel valued. EVIDENCE: The staff spoken to had a basic understanding of the care needs of the service users. The four files viewed contained assessments of needs and three of the four contained care plans. These were in various stages of development and did not always reflect the current needs of the service users. For example, one service user is in constant pain, the care plan did not detail their physical health needs nor the action/treatment required to support them. This was also the case in relation to healthcare needs such as the ability to eat and dental care. When issues had been identified the practice did not reflect the content in the care plan. One example of this was a service user, which was said to need to be involved and associate with other service users, however at lunchtime Isard House DS0000063943.V288184.R01.S.doc Version 5.1 Page 13 she was sat on her own. This same service user had documented that she had a high waterlow score, however she was sat in a wheelchair on the two days of the inspection, even during her lunch. There was a cushion in this chair, however sitting in the same position and sitting in a wheelchair is not conducive to promoting skin integrity. It was positive to note that those viewed contained risk assessments in respect of nutrition; pressure care; challenging behaviour and falls. Interventions were limited and supporting risk assessments in need of review and updating. For example: high risk of pressure sores or nutrition but no corresponding record of actions taken to minimise the risks. There was little information regarding mental or psychological needs. One service user who had dental issues had problems with eating. Staff spoken to where unaware of the plan of action to resolve this issue and the records viewed did not provide evidence of access to dental appointment etc. The same service user also suffered with painful arthritis but the pharmacy inspector assisting with the visit identified that they had been without painkillers for approximately two weeks. Feedback from relatives felt in general the health needs of relatives are being met. However, this feedback also showed that this was, at times, more due to relatives’ actions rather than staff being proactive. (See requirements 3 & 4) There was evidence of service users receiving appropriate healthcare from the GP and where necessary from the District Nursing team and this was supported by service user and relative feedback. Inspectors also noted the use of pressure care equipment such as mattresses and nursing beds. The inspectors also noted the use of bedrails for some service users. There was no evidence of risk assessments in respect of their use and any risks to the service user. (See requirement 4) The home maintains a record of accidents in the home with appropriate actions taken to ensure the health and safety of the service user. Service users spoken to said that staff are very kind and caring. One service user said that they were “very satisfied with the care” whilst another said they were “very settled and comfortable”. There was also warm and friendly communication between service users and staff on the physically frail unit. However, less interaction was noted on the dementia units. Service users would benefit from staff being more proactive in addressing their identified needs and ensuring they are aware of those needs identified in the care plan. (See recommendation 2) The inspectors observed staff undertake care respectful of the service users’ dignity and privacy. Service users spoken to on the physically frail unit also told the inspector that staff make them feel valued and provide a friendly environment. Written feedback from relatives and service users also showed that staff were caring, compassionate, warm and friendly and respected their privacy and dignity. One relative said “ they treat…. as one of their family” and how much their relative enjoyed “the joking banter”. Isard House DS0000063943.V288184.R01.S.doc Version 5.1 Page 14 The home had drawn up local procedures for medicines as required at the previous inspection. However, there were no local procedures for homely remedies, leave medicines and drug errors. The home had a procedure for accepting telephone instructions, which is not good practice. The procedure for self-administration stated that the resident must collect their own prescriptions. This should be reviewed. There was no detail in the procedure for self-administration regarding initial risk assessment and documentation of compliance. Records relating to medicines were generally good but some areas needed attention. Administration records were computer generated by the pharmacy, but included many medicines that had been discontinued which was confusing. This was noted at the previous inspection. The pharmacy should be informed which medicines have been discontinued in order to remove them from the administration records. Some gaps were noted where a code for nonadministration had not been recorded. The administration of creams and ointments was not often recorded. This was noted at the previous inspection. The allergies box was also not completed on the administration records. Records of disposal of medicines were made on sheets provided by the pharmacy. However, in one drug trolley there were several envelopes of refused medicines which were not marked and therefore records could not be made of these. Storage facilities for medicines were good. The temperature of the medicine refrigerator was not monitored and a new thermometer was required which allowed monitoring of minimum and maximum temperatures. This was a requirement of the previous two inspections. Some out of date creams were found in service users rooms that were no longer prescribed. One medicine had been out of stock for one week. One inhaler had no directions on the label. One resident had refused essential medicines for several days. There was no formal system to verify medicines on admission to the home. This was a requirement of the previous two inspections. Medicines were checked for three residents but quantities did not agree with administration records for one service user. (See requirement 5) Isard House DS0000063943.V288184.R01.S.doc Version 5.1 Page 15 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 & 15 “Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service.” It was evident that service users make choices in their day, although this was less evident on the dementia units where interactions were task orientated with little spontaneous interaction. Whilst in general the provision of meals was satisfactory and served in congenial surroundings, appropriate assistance is not provided where required and the way in which some foods are presented is poor. This may leave some service users without appropriate nutritional being met. Visitors are made welcome into the home. EVIDENCE: Two service users spoken to on Langley unit told the inspector that they were able to choose how to spend their days, choosing when to get up and go to bed, with one resident saying how much they enjoy their early morning tea before they get ready for the day. They also spoke of their decisions as to whether to join in planned activities. One service user had their routine of spending time in their room, whilst another spoke of enjoyment of the bingo and quizzes and was looking forward to the inter-house quiz. On the morning of the inspection bingo was taking place on Langley Unit, whilst in the afternoon the activity co-ordinator went to dementia units but had little response for games activity. On Keston unit, three residents were sat in the Isard House DS0000063943.V288184.R01.S.doc Version 5.1 Page 16 dining room- all looked very sleepy. On the first day of the inspection there was no music or stimulation, on the second day the radio was playing. No staff were present on either day. The remainder of the service users were in the lounge or their own bedrooms. Again many of the service users in the lounge were sleepy and there were little signs of well being during the morning. In the lounge the TV was playing. The activities coordinator was organising a group activity although there was little interest shown from the residents in Keston. The inspector spoke to the activities coordinator about the hobbies the pastimes of on individual service user with whom time had been spent with .She was unaware of her specific likes which was gardening. The key worker was also unaware of this fact. The TV was playing throughout the afternoon in Keston. Staff did not spontaneously engage with interactions were task led i.e. offering a cup of tea. Feedback from some service users and relatives showed that there could be a greater range of activities and more entertainment, whilst another service user “enjoyed them immensely.” (See recommendation 3) Service users spoken to told the inspector that the food was of a fair standard with two choices at lunch-time and a choice in the evening. Written feedback received showed that whilst most enjoyed the food, many said that there could be more variety although the quality and quantity is sufficient with a good supply of fluids provided. The inspectors noted that fluids were available in individual rooms and refreshments provided during various parts of the day. One service user spoken to had a jug of water on their bedside table, although they preferred other drinks. This was not detailed in the care plan. In another service users room where the service user was bedridden they had drinks in close proximity to them. The records viewed in respect of individual service users did not provide a good deal of information on their dietary needs or likes and dislikes and the food provided to one service user was liquidised altogether and presented in a small dish. This did not look very appetising and the service user stated that they would prefer the meal to be provided as separate foods. The dining room on Langley unit was laid with table-cloths and table mats with condiments on some tables. The reason for the lack of condiments on other tables according to staff was due to the inappropriate use. The inspector did not observe staff serving meals offer condiments to those without access and also noted that the gravy had already been served without enquiring as to whether the service user wanted gravy and how much. The staff did offer mint sauce to a service user to accompany the lamb dinner. The three service users in the dining room had tea served. Approximately half an hour later two had not started to drink it whilst the third service user had a few sips. They were all quite sleepy. The inspector contacted staff who arrived and assisted the service users with the drinks, which would have been cold by Isard House DS0000063943.V288184.R01.S.doc Version 5.1 Page 17 this point. Biscuits were handed to residents by staff, service users are not invited to choose from the tin. (See requirement 6 & recommendation 4) In one of the other units, lunch was nicely presented and staff offered mint sauce with the lamb and juice was served with the meal. Staff assisted some service users and some had their meals in their own bedrooms. There was more evidence of interaction with service users and staff during the meal It was noted that no adaptations were in use, such as plate guards, adapted cutlery, although the inspector was unclear if any service user needed these aids. The inspector received very positive feedback regarding how the home welcomes visitors and the warm and friendly environment provided. Visiting is not restricted and whilst there is no visitor’s room there are quiet areas and service users’ bedrooms for private conversations. The manager said that they would also make office space available, if required, for specific meetings etc. The inspector noted the local election polling cards in the reception area awaiting distribution to residents in time for the forthcoming local election. Isard House DS0000063943.V288184.R01.S.doc Version 5.1 Page 18 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 & 18 “Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service.” There has been some improvement in the way complaints and adult protection issues are responded to and the home has developed an open and transparent approach where frank communication is encouraged. EVIDENCE: Shaw Healthcare have comprehensive procedures in place for dealing with complaints and allegations of abuse. Previous reports have highlighted the lack of records and delays in investigating complaints raised within the home. Since the last inspection last inspection there have been no complaints or allegations made to the Commission nor any complaints made to the local placing authority regarding the quality of care provided. This is reflected in the monthly reports made by the Area Manager. The home’s records show that there one complaint recently raised is in the process of being investigated. It was positive to note that the Manager had responded to the complainant stating how the complaint would be dealt with. When the inspector asked two service users what they would do if they had any concerns or wished to raise issues they responded that they would talk to staff or the Assistant Manager. Written feedback showed that the majority of service users knew who to speak to if they had any concerns about the care provided, whilst others had little information and would be glad to be given advice on this. There has been one relatives meeting held since the new manager came into post. Discussions were held at this time regarding the importance of raising concerns to ensure the service user receive a good Isard House DS0000063943.V288184.R01.S.doc Version 5.1 Page 19 quality of care. In general the written feedback from relatives showed that they were aware of how to make a complaint. The feedback also showed that the manager is keen to ensure open communication between service user, relatives and staff in the home to make sure issues or concerns are dealt with. The induction training provides staff with guidance on how to deal with and manage adult protection issues. Over the last year Shaw Healthcare have been open and transparent where issues have arisen and followed their procedures, enduring all necessary agencies have been informed and decisions made on the appropriate course of action. Isard House DS0000063943.V288184.R01.S.doc Version 5.1 Page 20 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): 19,20,21,23,24,25,26 “Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service.” Generally the environment was of an unsatisfactory standard with some areas identified as both hazardous and malodorous. The home is in need of redecoration and refurbishment in many areas. EVIDENCE: There has been some progress in the redecoration of the home and the flood damage noted on previous inspection on Hayes unit has now been rectified. However, there are still a number of areas requiring redecoration or refurbishment. The recent monthly reports have identified that there are a number of areas requiring attention. The Commission has still not received an action plan in respect of this issue. A tour of the home showed that bedrooms are individualised and personalised and generally containing the furniture required to meet the individual’s needs. The standard of some of the furnishings, in particular, curtains, were poor with curtains hanging off the rails and quite grubby. Carpets remain worn throughout the corridors and some furniture needs replacing. Isard House DS0000063943.V288184.R01.S.doc Version 5.1 Page 21 Langley unit large lounge/dining room still lacks a homely feel, despite redecoration and the kitchen area on Keston unit was open and accessible to residents, there was a kettle in this area as well as other equipment. A service user was seen to access the area, which was unmanned and unlocked. The kitchen area itself was poor with broken and cracked tiles, rust on the fridge door and perished grouting. In bedroom 41 there was an area of exposed plaster behind the bed and on the floor. The room was generally congested. (See requirements 6-10) There was little in the way of reality or directional signage, which is beneficial in units, mainly those with Dementia sufferers. (See recommendation 5) There were two bathrooms being used as storage for wheelchairs, chairs and general items, such as carpet shampoo equipment. Discussions later showed that these bathrooms were not being used. These were neither locked nor did they have any signs stating they were out of use. The Manager must also review the number of bathrooms available with the number of service users to ensure suitable provision. WCs were also untidy with items such as lids off bins and therefore service users had access to continence sacks therefore providing a potentially hazardous environment. (See requirement 11) Relatives and service users feedback all showed that they felt the home was generally fresh and clean. The inspectors agree with this, although there are some areas in need of a deep clean and the reception area was at the time of the visit malodoorous. The inspectors are aware of the vacant hours in domestic posts and recruitment may help address the issue. (See requirement 9) Isard House DS0000063943.V288184.R01.S.doc Version 5.1 Page 22 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 & 30 “Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service.” The current level of staff vacancies have lead to a high use of agency staff which does not provide a consistency of care for service users or promote team working. Whilst the organisation arranges comprehensive training, there is often a delay in ensuring staff are sufficiently inducted prior to the commencement of their employment. There is also a need to ensure they are trained relevant to the specific needs of the service users and to their roles and responsibilities. EVIDENCE: Much of the feedback from relatives related to the lack of staff on the units and, for some service users, this was also a concern, in particular regarding the length of time they have to wait to be given assistance by staff. The manager told the inspector that this is in hand and recruitment had been taking place. The manager is also aware of the high use of agency staff and the need to reduce this to ensure continuity of care for service users. He has communicated this need to all staff at a senior level in the home. The feedback also shows that there are times when there is an absence of staff for quite long periods of time. There is a need to review the staffing on the units to ensure there is a staff presence and service users are being monitored and supervised. (See requirement 12) Discussions with staff showed that, whilst induction training policies and procedures comprehensive and include in-house induction and three-day Isard House DS0000063943.V288184.R01.S.doc Version 5.1 Page 23 organisation induction, this may not take place prior to staff being placed on the staff roster and therefore required to work unsupervised. The home does not, at present, implement the organisations home induction procedures and therefore does not provide the staff with the information or guidance in core areas, such as accident reporting; fire procedures and moving and handling, to ensure the health and safety of service users and themselves. This is also true of the induction of new agency staff used by the home and both these areas have been raised as a concern on previous inspections. (See requirement 13) The home has had the key post of administrator vacant for some time and this has had an impact in a number of areas. The manager and assistant manager have had to undertake some of these tasks and there are other tasks, such as updating of records that have not taken place. The inspectors are aware that the post has now been filled but it will be some time before this has a positive impact on the administration within the home. The lack of up to date training records meant that the inspector was not able to gain an objective overview of the training which has taken place. However, discussion with staff highlighted the need for more regular in depth dementia training for staff working on the dementia units and more basic training in relation to ensuring the healthcare needs of residents are being met. (See requirement 14) Up to date figures could not be provided regarding the number of staff with NVQ 2 or above. However, the management team agreed that this was less than 50 . (See requirement 15) One member of staff had been given the responsibility of health and safety representative but had received no more training for this than general training provided for all staff. The manager should give consideration to the provision of more in-depth training in relation to the job role. Recruitment procedures are comprehensive but do not fully meet with the Care Homes Regulations 2001 (Schedule 2 amended July 2004). Gaps included lack of information on exploration of gaps within the application form and no verification of the reason why the applicant left their previous employment in the care sector. (See requirement 16) Previous inspections have highlighted the lack of formal supervisions within the home. It is positive to note that the manager, since he has been in post, has commenced supervisions for staff and put in place a system to ensure all staff are supervised by their line manager. There is still some way to go before all staff are in receipt of regular supervision but progress has been made in this area and will be fully monitored at the next inspection. Isard House DS0000063943.V288184.R01.S.doc Version 5.1 Page 24 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 & 38 “Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service.” The newly appointed manager demonstrated clear management objectives and an understanding of some of the longstanding issues within the home which he is beginning to address. He is open to facilitate clear lines of management responsibility and promote open and inclusive communication. Records confirmed that health and safety issues were being addressed by ongoing maintenance, staff training and regular monitoring whilst improvements are required in the auditing and record keeping procedures in some areas. EVIDENCE: The home has had a new manager since February 2006, after a considerable amount of time without a permanent manager. He has experience of being a registered manager, mainly in learning disability homes and has a variety of experience. He demonstrated a good knowledge of management practices and Isard House DS0000063943.V288184.R01.S.doc Version 5.1 Page 25 an understanding of the key areas for improvement. He is currently undertaking the Registered Manager’s Award but must ensure that he fulfils the NVQ 4 in Care qualification required. The Commission is awaiting his application for registration. The feedback provides some positive comments regarding the improved communication between relatives and the manager and the manager and staff. Since coming into post a relatives’ meeting has been held and there are individual reports of positive communications with relatives looking forward to a good relationship with the manager. There is also evidence of staff and team meetings being held. The inspector took the opportunity to observe a Seniors’ meeting on one of the days. Previous reports have commented on the lack of monthly reports required to be undertaken by the Registered Providers. This has since improved and provides the Commission with a regular report of the quality of care. The organisation also has a system in places for auditing of the procedures. These have not been as regular as the procedures require and not always a true reflection of the standards in some areas. The inspector is pleased to note that the organisation has agreed that manager audit each others homes in the future. This may bring with it a more objective overview. The system also requires amending to ensure that where the home has not complied with the procedures there is an action plan in place to ensure future compliance. (See recommendation) Two service users monies were audited with two personal monies crosschecked and found to be accurate. There was, however, a lack of individualised receipts. The lack of administrator has had an impact on the efficiency and organisation throughout the home including that of ensuring the administration of service users monies. The service users’ plans contain little information regarding management of service users’ monies and one relative spoken to had not received any information on how monies would be managed. This is reflected in previous comments about pre-admission information. (See recommendation) There is evidence of the required servicing of various equipment and machinery and also the inspectors viewed evidence that the urgent requirements raised in the August 2004 fixed wiring service has now been completed and the fixed wiring now safe. The inspectors viewed records relating to fire drills but not fire training. An agency member of staff stated that they had not received any induction into the home or their emergency procedures. New staff recently joined and not yet undertaken induction had not been provided with moving and handling training. This included a member of staff without any previous care experience. There is also evidence that such training has lapsed for a number of staff. ((See requirement 13) Isard House DS0000063943.V288184.R01.S.doc Version 5.1 Page 26 The home was unable to furnish the inspectors with the number of staff with current First Aid certificates. This meant that the inspectors could not confirm through rosters and training records that there is always designated first aid person on duty. (See requirement 17) Isard House DS0000063943.V288184.R01.S.doc Version 5.1 Page 27 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 2 3 2 x 3 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 2 13 2 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 1 2 2 x 2 2 1 2 STAFFING Standard No Score 27 1 28 1 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 2 2 x x 3 Isard House DS0000063943.V288184.R01.S.doc Version 5.1 Page 28 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 OP1 Regulation 4&5 Requirement Timescale for action 01/06/06 2 OP3 14 3 OP7 15 The Registered Person must ensure prospective service users, or their relatives receive information on the home, prior to admission. This information must be up to date. The Registered Person must 01/06/06 ensure that full assessments are completed on all service users prior to admission. The assessments must be signed and dated by the individual completing the assessment and written confirmation must be sent to the relative or the service user confirming that the home is able to meet the individual’s needs. This is an outstanding requirement. The previous timescale of 1/11/05 has not been met. The Registered Person must 01/08/06 ensure care plans reflect the whole and current needs of the service users and that staff are aware of these needs to ensure they provide the appropriate care. This is an outstanding requirement. The previous DS0000063943.V288184.R01.S.doc Version 5.1 Isard House Page 29 4 OP8 13 5 OP9 13 timescale of 1/11/05 has not been met. The Registered person must ensure that where risks have been identified, the assessment details the intervention or actions to be taken to minimise the risks. This is an outstanding requirement. The Previous timescale of 1/10/05 has not been met. The Registered Person must ensure safe receipt, handling, administration and disposal of medication. Specifically: Local policies and procedures must written for homely remedies, leave medicines and drug errors. Policies and procedures for selfadministration and telephone instructions are reviewed. On admission to the home a list of currently prescribed medicine including dose and frequency must be obtained from the GP. This was a requirement of the previous two inspections. The administration records must detail only currently prescribed medicines. This was a requirement of the previous inspection Administration records must detail any allergies, or “non known”. This was a requirement of the previous inspection. Administration records must be kept for all medicines including creams and ointments. This was a requirement of the previous inspection. Disposal records must be kept for all medicines. Administration records and quantities of medicines in stock DS0000063943.V288184.R01.S.doc 01/08/06 01/08/06 Isard House Version 5.1 Page 30 have no discrepancies. Action must be taken regarding refused medicines and medicines out of stock is clearly documented. Prescription only creams and ointments must be kept in the medicine trolley. The minimum, maximum and current temperature of the refrigerator must be recorded daily. This was a requirement of the previous two inspections. Creams and ointments no longer prescribed must be disposed of. All medicines must be fully labelled. 6 OP15 16 The Registered Person must ensure that service users are provided with the support and assistance specific to their needs to ensure their nutritional needs are being met. This is an outstanding requirement. The previous timescales of 1/11/05 & 1/02/06 have not been met. The Registered Provider must provide, without delay, an action plan detailing the plans for the redecoration of the home. This is an outstanding requirement. The previous timescales of 1/11/05 & 1/02/06 have not been met. The Registered Provider must provide an action plan detailing their plans for the replacement of the furniture in the home and the replacement of carpets in the corridors. This is an outstanding requirement. The previous timescale of 1/11/05 & 1/02/06 have not been met. The Registered Person must DS0000063943.V288184.R01.S.doc 01/08/06 7 OP19 23 01/07/06 8 OP19 16 01/07/06 9 OP26 16 01/07/06 Page 31 Isard House Version 5.1 10 OP19 23 11 OP21 23 12 OP27 18 13 OP38 18 14 OP4OP 18 ensure that the home is free from malodours. This is an outstanding requirement with previous timescale of 1/12/05 not met. The Registered Person must ensure that the wall in room 41is repaired and the decoration made good. The Registered Person must ensure that there is an appropriate number of bathrooms and WCS for the number of service users in the home and that they are kept free from hazards. The Registered Person must review the number of support staff on each units and ensure that there is the appropriate staff number and skill mix within the home to ensure the needs of the service users are met and to ensure appropriate supervision and monitoring of service users. The number of agency staff used must be reduced through recruitment to the vacant posts. This is an outstanding requirement. The previous timescale of 1/11/05 has not been met. The Registered Person must ensure all staff are provided with structured induction into the home. This is an outstanding requirement. The previous timescale of 1/02/06 has not been met. The Registered Person must ensure staff receive training in identifying and meeting the health and dementia needs of the service users. Please send the Commission an action plan detailing the training to be provided and the timescales. DS0000063943.V288184.R01.S.doc 01/07/06 01/07/06 01/07/06 01/06/06 01/07/06 Isard House Version 5.1 Page 32 15 OP28 18 16 OP29 17 The Registered Person must 01/07/06 provide the Commission with an action plan as to how they intend to have 50 of staff qualified to NVQ 2 level. The Registered Person must 01/07/06 ensure that recruitment procedures meet with the Regulations. Specifically, any gaps in work history must be explored and written verification received as to why the individual left any period of employment in care. The Registered Person must ensure that, a member of staff acting as the designated first aid person, is always on duty in the home. 01/07/06 17 OP38 13 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 OP1 OP7 OP12 OP15 Good Practice Recommendations The Registered Person should ensure that the Statement of Purpose and Service Users’ Guide are up to date and accurate. The Registered Person should ensure staff are provided with adequate time to update themselves in the residents’ needs to ensure their needs are being appropriately met. The Registered Person should ensure that staff provide appropriate activities, stimulation and interaction with service users on the dementia units. The Registered Person should ensure that all meals, including those that are liquidised, are presented in an appetising and appealing manner. The Registered Person should ensure that there is appropriate guidance and orientation for service users on the dementia units. DS0000063943.V288184.R01.S.doc Version 5.1 Page 33 5 OP22 Isard House 6 7 OP35 OP33 The Registered Person should ensure that individual receipts are maintained in relation to any monies spent on behalf of the service users. The Registered Person should ensure that where audits are undertaken and non-compliance indicated, action plans for improvement are produced to ensure these shortfalls are addressed. Isard House DS0000063943.V288184.R01.S.doc Version 5.1 Page 34 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.V288184.R01.S.doc Version 5.1 Page 35 - 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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