Inspection on 25/04/07 for Isard House

This inspection was carried out on 25th April 2007.

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 19/04/06

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 10:00 25th April 2007 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.V334767.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Isard House DS0000063943.V334767.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Isard House Address Glebe House Drive Hayes Bromley Kent BR1 7BW 020 8462 6577 020 8462 0952 isard.manager@shaw.co.uk 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 vacant post 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.V334767.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th September 2006 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 46 older persons who or may not have dementia. In the last year Shaw Healthcare have reduced the number of double beds to one and the remainder are all single rooms. Service users’ accommodation is mainly on the ground floor. 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 £458.17 to £624.00. The fees for Local Authority placement and those purchasing care privately are different as are the fees for those with dementia. Items such as toiletries, hairdressing, private chiropody are paid from individual’s personal monies and not included in the fees. 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 and guidance is also available through visits to the home and discussions with the manager and staff team. Isard House DS0000063943.V334767.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place over one and a half days by two inspectors. The visit included a tour of the building, discussions with four relatives, two residents, three staff and the Manager. Records were also viewed along with observations of the daily routines lasting approximately two hours. What the service does well: The inspectors found the home to offer a relaxed and friendly environment for residents. The staff demonstrated a caring approach to people living in the home and were responsive to the issues raised by the inspectors. Medication practices have improved to ensure the healthcare needs of residents are being addressed. The change in the management of the home has provided a more able, approachable and open approach for residents, relatives and staff. The Manager also provides guidance and leadership to staff to ensure the care needs of residents are being met although there are still improvements required in some areas. The organisation provides staff with a comprehensive training programme for all staff. Agency staff are checked before used and provided with induction into the home. The residents are protected through robust adult protection and health and safety procedures and the quality of care provided is monitored and reviewed regularly. The organisation has developed comprehensive recruitment policies and procedures. Isard House DS0000063943.V334767.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: There are still a number of areas of concern. A number of these have been repeated over the last two years. The pre-admission assessment processes and care planning do not ensure that there is information on the needs of the individuals admitted to the home. Whilst risk assessments have been developed these are not regularly reviewed in light of the assessment of risk identified and there are still some improvements required in the medication practices. The home must also ensure that the nutritional needs of the residents are being addressed through checking weights regularly where issues have been highlighted and ensuring there are adequate staffing levels at core times including assistance of residents at mealtimes. The Commission has serious concerns in relation to ensuring the personal care needs of residents are being addressed through ensuring flexible routines, adequate staffing and appropriate numbers of bathrooms in place. The organisation has some robust procedures for managing complaints and safeguarding people using the service. However, the procedures in respect managing complaints are not always implemented. Isard House DS0000063943.V334767.R01.S.doc Version 5.2 Page 7 There have been improvements in the decoration of the home. However, there are areas of the home and the furnishings that remain in a poor condition and strong odours remain throughout the building. The organisation must also ensure that the service provision is reviewed regularly with a report on the outcome provided to the Commission and made available to residents, relatives and other stakeholders. . 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. The summary of this inspection report can be made available in other formats on request. Isard House DS0000063943.V334767.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Isard House DS0000063943.V334767.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 & 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The pre-admission processes do not ensure that staff have the information to provide good care to prospective individuals who wish to use the service. EVIDENCE: The Statement of Purpose has been developed. This contains basic information and is in written format. It would be beneficial to have this written in larger print for those with poor eyesight. The Manager stated that the document is available in other formats such as tape etc. The document should give more information about how they are able to care for the range of needs. (See recommendation) The inspectors discussed the admission process with the Manager. Although staff and Manager stated that individual residents are assessed prior to admission there was little evidence that this was so. The files of the last two Isard House DS0000063943.V334767.R01.S.doc Version 5.2 Page 10 people admitted were viewed. In one case there was no assessment completed by the home and in the other it was only partly completed. Nor was there evidence, that the home obtains the core assessment from the Care Management team or any multi disciplinary information. The inspector noted that the Manager does write to confirm they are able to meet the needs of the individual. (See requirement) All contained the Service Agreement signed between Shaw and the individual and, in most cases, there was a Local Authority Placement agreement. Isard House DS0000063943.V334767.R01.S.doc Version 5.2 Page 11 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. 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. There have been improvements in the information required by staff to ensure the needs of individuals are being met, although gaps still mean that individual needs may not be addressed. The lack of reviewing of the identified risks means the healthcare needs of individuals may not be met. EVIDENCE: The inspector selected six care plans for checking, two relating to those residents with pressure sores, one for whom swallowing and diet intake were problems, one for a resident being cared for in bed and another for a resident with mobility problems and dementia. The care plan documentation is under review and updating was evident in all the care plans, although this needs to be fully completed. Information contained on file details assessment of daily Isard House DS0000063943.V334767.R01.S.doc Version 5.2 Page 12 living (ADL) and a care plan. Both give information about the needs of the individual. Those viewed were of a mixed standard with ADL often incomplete and focussing in general on the physical needs and little mention of the mental health or cognitive impairment of the individual. This is integral to the care of those with dementia. Care plans viewed detailed most of the identified needs of the individual with evidence, in some, that they had recently been reviewed. Discussions with a relative showed that the care plan reflected the individual’s needs. However, often the records had not been signed or dated by the individual completing the documentation and there was little evidence of the resident or their relative involvement in the developing of the care plan or being reviewed by Social Services. A relative confirmed that they were able to view the care plan, if requested, and also stated that they had not participated in any review of their family members care. There was some evidence that the home had begun the reviewing of residents’ needs and discussion with the Manager showed that they were aware of the need to involve people in the own care plans. With the exception of the last person admitted during the week of the inspection there was evidence of individual risks being identified including falls, moving and handling, nutrition and pressure care. Some of these had been reviewed recently, whilst others were over a year old, even where there was a high risk. Staff had recorded for one resident that they had diabetes even though there was little evidence of this and staff were unaware of it. One resident had dietary problems and this should have been kept under review and updated appropriately. Documented on the weight chart was evidence that the resident has lost significant weight, yet this had not been actioned nor the scales checked to see if this was an accurate record. A further two months lapsed before the weight was re-checked. The dietician had seen this resident, in respect of weight loss and provided information for staff, although it was difficult to establish if this had been put into practice. In another record the care plan identified the need to ensure the resident was weighed monthly yet the last weight recorded was February 2007. There was little evidence of any resident being weighed on admission. (See requirements) The staff have implemented food and fluid charts in respect of those residents with nutritional problems. The charts were not always completed, especially where food supplements had been prescribed. There was also little evidence of any one auditing the total intake with one resident showing less than one litre being taken on occasions. (See recommendation) There was evidence of pressure relieving equipment being used for those who require them. Some residents also have profiling beds which enable staff to Isard House DS0000063943.V334767.R01.S.doc Version 5.2 Page 13 support residents much easier. There was also evidence of the District Nurse visiting the home to provide support to those with pressure sores. There was evidence of various health care professionals visiting the home and staff detailing any action taken. The medication charts for one unit were inspected. The majority of them were completed with the residents’ name, photograph and the drug allergies. Medications received in to the home had been recorded and signed. Medications were signed for and no gaps were evident, except where creams and ointments were prescribed. Creams, ointments and food supplements were not always signed for. Those medications that were prescribed on a PRN basis had directions for administration, although not in all cases maximum dose and duration. Hand transcriptions were without two staff signatures to confirm the accuracy of the information recorded. There was list of staff signatures and initials in the front of the medication folder. Staff confirmed that only those trained to do so were allowed to administer medication. The fridge temperatures were recorded usually daily, although a few gaps were evident. There was evidence that the medication procedures had been audited by the home and by the contracted pharmacy. Staff also received training from the pharmacy. (See requirement) Discussions with staff and relatives confirmed that the staff treat residents with respect and dignity and privacy is respected. Staff knock on doors before entering and use call staff by their preferred names. Isard House DS0000063943.V334767.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents are not provided with the stimulation and interaction to ensure their emotional well-being is addressed in a consistent and effective way. The daily routines do not always ensure that residents’ personal care needs are being met in a flexible manner. Food provided is nutritious and healthy with choices available at each mealtime. EVIDENCE: The inspectors made observation in the lounge area of the Hayes and Langley unit. On Hayes unit during this period there was, for the majority of the time, one care staff member supervising residents. The care staff member was an agency staff and this was her second shift. There was old time music playing in this area. There was no clock or calendar and, in general orientation aids, were limited in the majority of areas. (See recommendation) A second care staff came to assist this staff with giving out the mid morning tea and biscuits at 11 o’clock. Apart from this drink, there was no other fluids Isard House DS0000063943.V334767.R01.S.doc Version 5.2 Page 15 available in this area. The weather is now becoming warm and elderly people can become dehydrated quickly, fluids should be freely available and evident in all areas. Within the lounge area there were eight residents who had their eyes closed. Whilst the agency staff was very pleasant, there a little spontaneous interaction with residents. During the time the inspector was in this area there was no requests made by residents in respect of assistance hence for that period one staff was sufficient. During this time there was no evidence of any resident being assisted with toileting despite the evidence from records that this was needed. Some residents could have been better presented, particularly the female residents whose hair looked unkempt. Lunch was observed in this unit. The tables were laid with cloths serviettes and napkins and cutlery. Individual large print menus were on the tables, however Items such as salt pepper and sauces were not available nor were plate guards, adapted cutlery and non-slip mats in use although these may have enabled some residents to eat more independently. Initially two staff were assisting residents to eat, joined later by a third staff. It was evident that more staff were needed, as some residents were assisted some while after their meal had been put in front of them. All staff patiently assisted residents and engaged with them throughout the meal. (See recommendation & requirement) There were two choices of hot food fish and pork. The pork was tender and on checking the food waste there was little, this was the same for the waste left on the plates. Three choices of desserts were offered and residents enjoyed these. The inspector met with one relative of a resident who was selected for case tracking. This relative was very happy with the service that her mother received felt staff were pleasant hard working and kept in touch with the family on developments. She said she felt welcomed when she visited. Langley unit was visited with the inspector spending about two hours on the unit observing residents, staff and routines. The inspector noted that no resident was toileted during this time, despite residents being immobile and in wheelchairs. Three residents spent time between breakfast and lunch at same dining table where breakfast was taken. One resident spent all this time in a wheelchair. The lunchtime meal was observed with choices offered of main meal and dessert. The tables were pleasantly laid and, on most tables, condiments were evident. Most residents were independent in this area, although one resident Isard House DS0000063943.V334767.R01.S.doc Version 5.2 Page 16 was assisted to eat his meal. There was limited interaction/communication between the staff member and resident during this time. The home has an Activities Co-ordinator who works five days a week although was on annual leave for the first day of the inspection. During the inspectors’ observations there was no active interaction between residents and staff and nothing to stimulate, except for the TVs in the lounges. There was evidence of various games and quizzes taking place when the coordinator was on duty and discussions with two relatives showed that, due to the efforts of the fundraising committee, there was far more entertainment brought into the home. However, stimulation remains limited for a number of residents, especially those who have dementia. (See recommendation) All relatives spoken to said that they are made welcome and visit at various times of the day. Drinks are offered and visits can take place in the lounge areas, bedrooms or one of the seated areas along the corridors. The inspector also gathered feedback regarding the bathing routines. There are major areas of concern, where due to the lack of baths in use (only three in the home for 46 residents) baths do not appear to be taking place. Relatives also started that staff informed them that for some residents it was too difficult to bath due to two staff being required, or issues with the use of hoists. The relatives also spoke to the inspector of lack of toileting even though the staff say there is a two hour toileting routine. Previous comments provide information confirming this. There are also concerns about the lack of oral hygiene. Records viewed showed that there has been little attention to these areas. (See requirement) Isard House DS0000063943.V334767.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is potential for the organisation to ensure that complaints or concerns are listened and responded to in an effective and efficient manner. The residents are protected from harm through robust safeguarding adults procedures. EVIDENCE: Shaw Healthcare have a complaints procedures in place. This is on display in the home. However, the one on display did not include the timescales for responding to complaints. This was addressed by the second day with the Manager providing the full procedure and placing it on display. A summary of the procedure is included in the Service Users Guide and Statement of Purpose. The procedure could be made available in a larger print. The Manager stated that the procedure could also be made available on request, in other formats such as audio or video. Complaints are recorded in complaints file which when viewed showed six recorded over the last twelve months. Three of these were about items gone missing. These had not been recorded full with no investigatory route, outcome or action taken. There was no indication as to whether complainant satisfied with any response and action. Discussions with Social Services Isard House DS0000063943.V334767.R01.S.doc Version 5.2 Page 18 complaint department stating they had received one complaint over the last twelve months still needing to be resolved. Two relatives spoken to said that would have no problem in raising concerns and have done so. They were not always satisfied with outcome or time taken to respond and, in one case no response had been received (this was over two years ago). However, all said that they felt that the new Manager is approachable and tries to resolve complaints and that she is often seen around the home playing a “hands on” role. They felt that there were improvements made by this manager to address their concerns. (See requirement) Shaw healthcare also have comprehensive procedures in place for investigating allegations of abuse. These are implemented when need arises with the home informing the agencies as appropriate. The Manager is aware of the role of the Lead Agency in co-ordinating investigations with recent allegations being managed according to the Local Inter-Agency Guidelines. Currently there is one investigation into a recent incident. Staff are provided with training during induction and attend training provided by the London Borough of Bromley when arranged. However, staff knowledge of what to do in the event of any concern of allegation was mixed. This should be further pursued by the Manager to ensure all staff, including agency staff to ensure they are fully aware of their responsibilities in protecting residents and that they are aware of what may constitute abusive situations. Isard House DS0000063943.V334767.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20,21,22,23,24,25,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There has been progress in the redecoration of parts of the home. However more improvements are required to ensure the residents are provided with a warm, comfortable and well-maintained environment. The lack of bathrooms in operation severely restricts the ability of the home to ensure the personal care needs of residents are addressed. EVIDENCE: The previous reports have highlighted issues with the standard of the environment. The key inspection in April 2006 judged this outcome group as poor. There have been some improvements made in some areas. The reception area and some corridors and communal areas have been redecorated and re-carpeted. However, there remains some areas of the home where the Isard House DS0000063943.V334767.R01.S.doc Version 5.2 Page 20 standard is still unacceptable. New furniture is also needed to replace some of the worn and, in the Inspectors’ view, dirty furniture. It is positive to note that all but two of the bedrooms are now single and where the rooms are shared this is because there is a desire to do so. Bedrooms were overall of a good size, contained adequate furniture and were generally personalised with photographs, mementoes and personal belongings. Residents benefit from a variety of equipment such as hoists in bathrooms and for mobility of residents. Some residents also benefit from profiling beds and other pressure relieving equipment. The home also has a variety of aids including grab rails and hand-rails. Equipment viewed has been serviced regularly. However the previous comments show that there is a lack of reality orientation aids around the home which would support some residents. The building surrounds a courtyard area which is safe and secure. The area is well presented with plants and shrubs and seating areas and can be accessed though any of the units. There are currently only three bathrooms in working order for forty-six residents. This is far less than the minimum detailed in the National Minimum Standards. There are no baths in working order on Langley unit, which is the biggest unit. The relatives spoken to have concerns over the lack of bathing of their family members with some recounting various reasons for this. Please see comments made in the outcome group for routines and daily living. The Inspectors were informed that two bathrooms are to be made into shower rooms. However, there is no evidence that this is desired by the residents. The Commission has written to the Providers relaying their serious concerns about the lack of bathing facilities and the bathing taking place. The standards of some of the bathrooms and WCS were also poor with broken toilet seats and some of the toilet bowls were dirty. (See requirements) The laundry area is of a basic standard with the equipment required to undertake the laundering of residents bedding and clothing. Hand-washing facilities were located throughout the home in bathrooms, WCS and laundry. Clinical waste bins (foot operated) were also in evidence although there is a need to ensure these have the clinical waste sacks inserted ready for use. Previous reports have also detailed the malodour in the home. Unfortunately this still remains despite the efforts of the Manager to eradicate odours. (See requirement) The Inspectors found the home to be of an adequate standard of cleanliness, although there is evidence that a thorough cleaning is required, by moving furniture and cleaning under beds. Isard House DS0000063943.V334767.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is evidence that the home is progressing in the recruitment of permanent staff employed in the home to ensure there is consistency of staffing to meet the needs of the residents. Staff are trained in providing care for residents and ensuring their health, safety and well-being, although the training is not always evident in practice. EVIDENCE: There have been issues over the last few years with the high number of agency staff used by the home. Shaw Healthcare have found it difficult to recruit due to the location of the home. Discussions with relatives and staff confirm that this is still the case. Relatives spoke of agency staff being on duty and had concerns, especially where the agency staff member has not been in the home before. It is evident from the rosters that the home tries to provide continuity by requesting the same agency staff and there is evidence that the Manager has been active in recruiting staff to work at Isard House. They are currently awaiting confirmation that the required checks have been completed and this often takes some time. If all those that have been offered posts do commence employment at the home then this will reduce the number of agency staff being used. Relatives spoken to were positive about the care Isard House DS0000063943.V334767.R01.S.doc Version 5.2 Page 22 provided by the permanent staff with the use of agency staff being the main concern raised. The use of agency staff will be monitored more closely at the next inspection in light of the recent recruitment campaign. Where agency staff are used the manager asks for confirmation that the agency has undertaken the required checks and staff have been provided with induction training set up for agency staff. There is evidence that this is being completed, although there is a need to ensure all checks have been completed and confirmed by the agency. eg proof of identity. The Inspector viewed the personal file of the last two staff recruited. Most of the information is maintained on the file and it can, at times, take some while for this evidence to be collated with only part information held on files. The Manager should ensure that there is a copy of the information required by the Commission held on file. The organisation had the required documents and completed the required checks for both staff members with the exception of the last employer’s reference. The Manager should also ensure when checking the application form that any gaps etc are explored with the applicant and documented. The Manager must also ensure that they obtain copies of any certificates held by the staff member. (See requirement) It is evident from observation on the day that there is a high dependency of residents on Langley unit and that staff are very task orientated. The inspector was informed that five residents require assistance of two staff for personal care and that there are a “few” with dementia and many are confused. A team leader and three staff provide care on this unit and, whilst for physically frail residents, this may be adequate it is not so for the increased needs of the current residents. This is evident from the lack of bathing, toileting and time spent with interacting with residents. The inspectors also noted on the dementia units that there were not enough staff to assist residents at mealtime with some residents having to wait whilst their meals went cool before assistance given. The Commission require the organisation to assess fully the residents on each unit and provide a staffing level that is able to fully meet the needs of the people living in the home. (See requirement) Shaw Healthcare has a good induction training programme for new staff with a four-day induction away from the home that meets Skills Sector Common Induction standards. A new staff member had commenced that week and the Manager ensured that she was supernummary, being provided with information on the home environment, observing practice and getting to know the residents etc. The organisation also has developed its own training programme for the year, covering core training and some specific training. They have also joined the London Borough of Bromley training consortium where staff are able to access a number of different training programmes. Isard House DS0000063943.V334767.R01.S.doc Version 5.2 Page 23 There has also been progress in the number of staff with NVQ 2 and whilst the home does not meet the 50 required the Manager confirmed that further staff are to be registered this year. Isard House DS0000063943.V334767.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There have been improvements in the way the home is being managed to ensure the safety and wellbeing of residents. There is potential for the people using the service to receive good, quality and consistent care. EVIDENCE: Since the last inspection last inspection there has been a change in Manager with the previous manager leaving in November 2006. The current Manager has not yet applied for registration with the Commission and must do so as a matter of urgency. The manager has a City and Guilds in Care Management Isard House DS0000063943.V334767.R01.S.doc Version 5.2 Page 25 equivalent to NVQ 4 and the Registered Managers Award. She has a number of years experience in care and management. The home also has an experienced Deputy Manager is in post. The current team have given the home a greatly needed consistent management team with staff and relatives providing positive feedback on improvements the way the home is being managed and residents care needs addressed. All those spoken to stated that the manager is approachable, is present on the floor and helps with the residents care if needed. The Manager demonstrated that she is aware of the issues at Isard House and that these may take time to address and overall quality of care improve. Shaw Healthcare have a quality assurance system in place. The last quarterly review took place in March 07 and was undertaken by a manager from another home. The records did not clearly evidence who this was or on what date the audit took place. The quarterly reviews include service user and relative feedback where there was mixed feedback from both groups, albeit small samples. Regulation 26 visits are being undertaken with the last one contained on file being 02/07 and there were reports going back to Sept 06. However, the Commission is still not receiving copies of the reports despite a request sent in a letter to Shawl Healthcare in February 2007. A review of the service is required to ensure the home is continuously looking to improve the service for those people living there. (See requirement) There have been issues over the last year with the lack of administrators and therefore the administration not being as consistent and up to date as it should have been. This should now be resolved with a new administrator in place. The inspector selected four residents’ finances to check. Each resident had a sheet which records the transactions made, including withdrawals and deposits. Two staff sign to confirm the actual transaction, although there were no residents signatures in place. The administrator and Manger both confirmed that there were residents in the home who could understand and sign financial transactions and they stated that this would be implemented. All money checked was correct and where available, receipts confirmed expenditure, although there were very few of these. The home has a tick list for the hairdresser and the chiropodist which indicates who was seen There is no individual receipt or indeed any other receipt provided simply a total amount stated on the bottom of the list. The home needs to develop a system for finances, were all expenditure has receipts to support the transactions, which are itemised where possible. Money deposited by residents is held in a non-profit making account. There was discussion around interest payment for those residents with larger amounts of money. (See recommendation) Accounts are audited on a regular basis, although it was unclear if a written report was submitted following the audit. Money is securely stored in the safe Isard House DS0000063943.V334767.R01.S.doc Version 5.2 Page 26 A sample of service contracts were viewed. There was evidence that the fixed wiring remedial work had been completed but there was no confirmation that the system was now satisfactory. The Commission has required evidence from the Provider that this has been resolved with a satisfactory outcome. All other equipment had been serviced regularly including fire alarm system and equipment. There is evidence that staff are trained in core training including moving and handling, First Aid and health and safety. There have been issues with moving and handling practices recently and this is being addressed by the Manager. The registration certificate is not reflective of the current situation with numbers reduced due to the reduction in double rooms. The organisation are aware of the need to make an application for variation to their certificate as part of the legal requirements. Isard House DS0000063943.V334767.R01.S.doc Version 5.2 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 N/a 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 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 3 1 3 3 3 2 2 STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 X X 2 Isard House DS0000063943.V334767.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 Requirement The Registered Person must ensure that full assessments are completed on all service users prior to admission. To ensure staff have the information they require to meet their needs. The assessments must be signed and dated by the individual completing the assessment. This is an outstanding requirement. The previous timescale of 1/11/05 and 1/12/06 has not been met. The Registered Person must 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. These must be reviewed regularly with residents and relatives involved in the process. This is an outstanding requirement. The timescale of 1/12/06 has expired. The Registered Person must DS0000063943.V334767.R01.S.doc Timescale for action 01/08/07 2 OP7 15 01/08/07 3 OP8 13 01/07/07 Version 5.2 Page 29 Isard House ensure risk assessments are reviewed in line with the risk identified. 4 OP9 13 The Registered Person must ensure that where medication records are handwritten, the records are confirmed by two staff members, to ensure accuracy of recording. Administration records must be kept for all medicines, including creams and ointments. 01/06/07 5 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. This requirement was not monitored at this inspection. Previous timescale extended. 01/08/07 6 OP8 12 7 OP12 12 8 OP16 22 The Registered Person must 01/06/07 ensure that the home weighs residents on admission and regularly as identified on the care plan or risk assessment. This will ensure staff are able to address any concerns regarding the nutritional needs of the residents. The Registered Person must 01/06/07 ensure that routines in the home are flexible to ensure the bathing and personal care needs of residents are being met. The Registered Person must 01/08/07 ensure that the record of complaints details the full investigation route, outcome of DS0000063943.V334767.R01.S.doc Version 5.2 Page 30 Isard House 9 OP19 16 the investigation, action taken and whether the complaint is satisfied. This will ensure there is an open approach to listening to and resolving issues raised. The Registered Provider must 01/07/07 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 a repeated requirement. The previous timescales have not been met. The Registered Person must 01/09/07 ensure redecoration takes place in Langley unit corridors, Keston dining room and lounge area to ensure residents are provided with a comfortable environment to live in. The Registered Person must 31/05/07 ensure that there are an appropriate number of bathrooms and WCS for the number of service users in the home. This remains outstanding with timescale of 1/07/06 & 01/09/07 not met. Please provide the Commission with your action plan on how this requirement is to be met with the timescale for action. The Registered Person must 01/07/07 ensure that the home is free from malodours to provide residents with a fresh environment. This is repeated requirement with previous timescales not met. The Registered Person must ensure recruitment checks include a reference from the DS0000063943.V334767.R01.S.doc 10 OP24 23 11 OP25 23 12 OP26 16 13 OP29 17 01/06/07 Isard House Version 5.2 Page 31 applicants last employer; that gaps in information provided are explored and a record made to ensure residents are safeguarded from potential harm. 14 OP27 18 The Registered Person must assess the dependency of residents in the home to ensure the staffing levels meet the needs of the residents. The Registered Person must ensure a review of the service takes place to ensure improvements in care are continuous. 31/05/07 15 OP33 25 01/12/07 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. Refer to Standard OP1 Good Practice Recommendations The Registered Person should ensure that the Statement of Purpose and Service Users’ Guide are up to date and accurate. The food/fluid charts completed by the home should be completed in full to ensure staff are able to determine the nutritional intake of residents. 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 adapted crockery and cutlery are provided to assist residents at meal times. The Registered Person should ensure that there is appropriate guidance and orientation for service users on the dementia units. 2 3. OP8 OP12 4. OP15 5. OP22 Isard House DS0000063943.V334767.R01.S.doc Version 5.2 Page 32 6 OP35 The system for recording residents monies should be reviewed Isard House DS0000063943.V334767.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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.V334767.R01.S.doc Version 5.2 Page 34 - 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. 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