Inspection on 12/01/06 for Ismeer

This inspection was carried out on 12th January 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

Ismeer 17/06/08

Ismeer 03/01/08

Ismeer 17/07/07

Ismeer 23/05/06

Ismeer 10/08/05

Ismeer 09/03/05

Ismeer 24/06/04

Ismeer 01/10/03

Ismeer 19/09/02

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

CARE HOMES FOR OLDER PEOPLE Ismeer Trewollack Lane Gorran Haven St Austell Cornwall PL26 6NT Lead Inspector Alan Pitts Unannounced Inspection 12th January 2006 09:00 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 Ismeer DS0000009040.V273484.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ismeer DS0000009040.V273484.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Ismeer Address Trewollack Lane Gorran Haven St Austell Cornwall PL26 6NT 01726 843480 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) Mrs Margaret Yvonne Wrigley Ann Elizabeth Carthew Care Home 27 Category(ies) of Dementia - over 65 years of age (7), Old age, registration, with number not falling within any other category (27) of places Ismeer DS0000009040.V273484.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th August 2005 Brief Description of the Service: Ismeer is a comfortable, tastefully decorated, extended detached property situated within walking distance of the village of Gorran Haven. The home is registered to provide care for 27 older people in need of personal care.Service users accommodation is currently located on three floors. Each floor is serviced by a stair lift. Although twin rooms are available all rooms are presently used for single occupancy. All bedrooms have washbasins and many have separate en-suite facilities.The property has spacious, well-tended landscaped gardens that over look the bay of St Austell and adequate parking facilities Ismeer DS0000009040.V273484.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 12th January 2006 over a five hour period. The inspector met with the senior staff on duty, Ann Carthew and Lisa Thomas, the registered provider, a visiting District Nurse, and with 4 service users. During the course of the day the inspector observed the service users being attended to by staff in a courteous and professional manner. Service users informed the inspector that their expectations of being in a care home were being fully met, and they expressed satisfaction with all aspects of the home. Various records, policies and procedures were inspected and found to be satisfactory. The inspector toured the building. What the service does well: What has improved since the last inspection? What they could do better: Ismeer DS0000009040.V273484.R01.S.doc Version 5.0 Page 6 Whilst the comments of the District Nurse and service users confirm to the inspector that a high quality of care is being provided, this is currently being provided in an unsafe working environment. The registered provider and registered manager must clarify the managerial responsibilities within the home and rectify the predominantly ‘managerial’ requirements and recommendations resulting from this inspection. 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. Ismeer DS0000009040.V273484.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ismeer DS0000009040.V273484.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 5 Prospective service users are, where possible, offered the opportunity to visit the home for a trial period before making a decision about admission on a permanent basis. Each service user receives a Statement of Terms and Conditions and/or contract of care. EVIDENCE: The registered manager should amend the Statement of Terms and Conditions provided to service users to ensure that this includes the identification of the room being offered as accommodation. The registered manager advised the inspector that opportunities for trial visits are available to prospective service users, including day care, short stays, and the standard one-month trial period following admission. Ismeer DS0000009040.V273484.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 Care plans are in use for each service user, which the registered manager is currently reviewing. Both service users and a visiting District Nurse were complimentary about the care provided. EVIDENCE: Care plans are in operation, though the registered manager advised the inspector that these are currently being reviewed with a view to a different format. The registered manager should ensure that, where possible, service users/representatives are involved in care plan reviews, and the entries provide clear instruction as to what the care needs and interventions necessary are (e.g. more specific than “needs assistance with dressing”). The inspector met with a visiting District Nurse who was complimentary about the care provided by the home’s staff and this was supported by the comments of the service users. Ismeer DS0000009040.V273484.R01.S.doc Version 5.0 Page 10 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): 14 Service users felt that they were able to exercise choice and determine their own lifestyle, within the parameters of their care needs and capabilities. EVIDENCE: There is some recorded evidence of social/recreational activities, but this is not recorded as frequently as it could be. The registered manager advised the inspector that there are weekly outings and regular activities on Mondays and Fridays. There is a tendency for entries in the care documentation such as “usual day”. The registered manager should encourage better recording of the service user’s daily life in the individual service user’s file. Service users confirmed that they find that they have enough to do and that they have the ability to largely determine their own lifestyle. Ismeer DS0000009040.V273484.R01.S.doc Version 5.0 Page 11 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): 17, 18 Service users are protected from abuse, and their legal rights are protected. EVIDENCE: All the service users are entered on the electoral roll and mail is delivered without interference, though assistance is available if required. Service users spoken with confirmed the above. The registered manager has reviewed and amended the Protection Of Vulnerable Adults procedure since the last inspection, and undertook to add a few more details and information. Ismeer DS0000009040.V273484.R01.S.doc Version 5.0 Page 12 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): 20, 21, 22, 23, 24, 25, 26 Ismeer provides comfortable, clean, personalised accommodation for the service users. Service users spoken with expressed contentment with their accommodation. However attention is needed to the ongoing maintenance and safety of the home in areas such as, for example, regular electrical checks. Service users have sufficient toilet and bathing facilities. EVIDENCE: Service users have access to spacious dining and lounge facilities, which are comfortably and pleasantly furnished. Access to the garden/patio area is available in more clement weather. There are 2 double rooms and 23 single rooms, 12 of the latter offering en-suite accommodation. There is one staff lavatory. There are 7 communal lavatories, 3 of which are located in bathrooms. There are 4 bathrooms, one of which offers assisted bathing. The home works closely with supporting agencies and health care professionals to ensure that specialist equipment is made available to service users as necessary. Service user rooms are pleasantly decorated and furbished, and service users expressed satisfaction with their accommodation. Service user Ismeer DS0000009040.V273484.R01.S.doc Version 5.0 Page 13 rooms are personalised to varying degrees according to the service user’s individual circumstances. A health and safety report, dated 26th January 2005 identified a number of concerns that required a response from the registered provider: • Some COSHH information is available, but the registered manager should ensure that this is complete and includes all the relevant products used in the home, and that the information is kept at the point of use. • According to the records available, the last electrical appliances check took place in 2003. The registered manager must arrange for annual testing of the electrical appliances by a qualified electrician. • The registered manager and registered provider were unsure when the fixed electrical system was last tested. The registered manager must arrange for the testing of the hard-wiring system by a suitably qualified electrician. This is a 5-yearly requirement. • Whilst there are service user focused risk-assessments (e.g. risk of falls), there are no environmental risk-assessments. The registered manager must provide a written risk-assessment (to include any remedial action and time scales) with reference to hot water, hot surfaces, windows, and legionella). The registered manager should audit the staff hand washing facilities available in bathrooms and lavatories to ensure that there is a facility for staff to wash their hands in all communal bathrooms and toilets (e.g. alcohol solution). In the interests of infection control the registered provider should consider replacing the existing laundry machines with industrial-type machines (a washing machine with a sluice facility), which would then allow for the use of dissolving red laundry sacks for fouled linen and negate the need for staff to hand sluice laundry. The office downstairs is small, cluttered, overly warm, and has no ventilation without the door being open. The registered provider assured the inspector that adaptations were being considered. The adaptation or relocation of this office would benefit the management of the home, and the storage of records. The registered provider should consider the adaptation or relocation of the downstairs office as important and of benefit to the home. Ismeer DS0000009040.V273484.R01.S.doc Version 5.0 Page 14 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): 28, 29, 30 It is not possible to confidently state that service users are in safe hands without the evidence of comprehensive staff employment and training records to support this. The registered provider and registered manager need to focus attention on the training requirements of the staff, and implement a robust employment procedure. EVIDENCE: There is no doubt in the inspector’s mind that the staff are well motivated and committed to the welfare of the service users. Service users spoken with were, without exception, complimentary about the care received and the kindness and consideration of the staff and registered manager. Please see comments made under the Management and Administration section of this report and comments in respect of Standard 25. There are 19 care staff, not including the registered manager, of which 6 have achieved NVQ Level 2 or above (approximately 30 ). The registered manager advised the inspector that a further 5 staff are undertaking this training. There is an induction programme for new staff, which is specific to the home. As discussed, the registered manager undertook to ensure that the completion of this shows a date and initials to demonstrate training being undertaken over a period of time. The registered manager should implement a National Training Ismeer DS0000009040.V273484.R01.S.doc Version 5.0 Page 15 Organisation compliant training programme for new staff (www.topssengland.net Skills for Care). The registered manager should obtain General Social Care Council handbooks for all staff (www.gscc.org.uk). Two sample personnel files were inspected and it was noted that the home is not adhering to a robust employment procedure: 2 references were not evident, Criminal Records Bureau checks were not carried out, Protection Of Vulnerable Adults First checks were not carried out, the home’s job application form does not ask for sufficient detail of the applicant’s employment history. The registered manager must implement a robust employment procedure, with immediate effect. Ismeer DS0000009040.V273484.R01.S.doc Version 5.0 Page 16 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): 32, 34, 35, 37, 38 The home has a registered manager who has been appointed within the last 12 months. The registered manager has made improvements in areas such as the review and amendment of the home’s policies and procedures, but the registered manager needs to impose her leadership on the home to establish an effective management hierarchy. EVIDENCE: Changes in the management structure have taken place following the retirement of the previous registered manager. Ann Carthew has been appointed the registered manager. Ann has worked at Ismeer since 1999. She has obtained the NVQ Level 4 in care, the Registered Manager’s Award, and the A1 and A2 assessors award. Ismeer DS0000009040.V273484.R01.S.doc Version 5.0 Page 17 Lisa Thomas, who has joined the staff more recently, assists the registered manager. Lisa is qualified to NVQ level 3 in care and NVQ level 4 in management. She also holds the A1 and A2 assessors awards. Accounting and financial procedures were not inspected on this occasion, though the registered provider and registered manager advised the inspector that the staff do not ‘handle’ any service user monies. Appropriate insurance cover is in place. The registered manager and the deputy manager have reviewed the home’s policies and procedures, and this will now be undertaken annually. There is an accident book for service users, but the inspector was advised that the staff book was on order. However, the need for appropriate accident books was identified in the health and safety inspection report of 26th January 2005. The registered manager advised the inspector that there have been no staff accidents in the past 12 months. The registered manager must arrange for the provision of an accident book for staff and encourage its use. The home’s health and safety statement is dated 2004 and should be reviewed. The home’s health and safety poster on display in the kitchen should be completed fully. The registered manager advised the inspector that the health and safety policy was current, and that staff were informed of this via its inclusion in the staff wage packets. The registered manager should ensure that staff signatures are obtained when they have been made aware of new or reviewed policies. There is insufficient staff training in health and safety: manual handling, COSHH (Control of Substances hazardous to health), RIDDOR (Reporting of Injuries, Diseases, and Dangerous Occurrences Regulations), 1st Aid, and fire safety. Training in respect of the latter was identified as an immediate requirement at the time of the inspection, and the registered manager undertook to commence making arrangements for this the same day. The registered manager must make arrangements for staff training in respect of manual handling, 1st Aid, COSHH, RIDDOR, and fire safety. The home does not have information relating to RIDDOR available to staff, and the relevant forms for reporting incidents are not available. The registered manager must obtain RIDDOR explanatory booklets and the relevant reporting forms. Ismeer DS0000009040.V273484.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 2 X X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 2 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 3 18 3 X 3 3 3 3 3 1 2 STAFFING Standard No Score 27 X 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 2 X X 3 X 3 1 Ismeer DS0000009040.V273484.R01.S.doc Version 5.0 Page 19 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 OP2525 Regulation 13(4) Requirement The registered manager must arrange for annual testing of the electrical appliances by a qualified electrician. The registered manager must arrange for the testing of the hard-wiring system by a suitably qualified electrician. This is a 5yearly requirement. The registered manager must provide a written riskassessment (to include any remedial action and time scales) with reference to hot water, hot surfaces, windows, and legionella). The registered manager must implement a robust employment procedure, with immediate effect. The registered manager must make arrangements for staff training in respect of manual handling, 1st Aid, COSHH, and RIDDOR. The registered manager must make arrangements for staff DS0000009040.V273484.R01.S.doc Timescale for action 01/04/06 4. OP29 18, 19 12/01/06 5. OP38 13(4)(6) 01/04/06 6. OP38 13(4)(6) 12/01/06 Ismeer Version 5.0 Page 20 7. OP38 13(4)(6) 8. OP38 13(4)(6) training in fire safety. The registered manager must obtain RIDDOR explanatory booklets and the relevant reporting forms. The registered manager must arrange for the provision of an accident book for staff and encourage its use. 01/04/06 01/04/06 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 OP2 Good Practice Recommendations The registered manager should amend the Statement of Terms and Conditions provided to service users to ensure that this includes the identification of the room being offered as accommodation. The registered manager should ensure that, where possible, service users/representatives are involved in care plan reviews, and the entries provide clear instruction as to what the care needs and interventions necessary are (e.g. more specific than “needs assistance with dressing”). The registered manager should encourage better recording of the service user’s daily life in the individual service user’s file. The registered manager should ensure that COSHH information is complete and includes all the relevant products used in the home, and that the information is kept at the point of use. The registered provider should consider the adaptation or relocation of the downstairs office as important and of benefit to the home. The registered manager should audit the staff hand washing facilities available in bathrooms and lavatories to ensure that there is a facility for staff to wash their hands in all communal bathrooms and toilets (e.g. alcohol solution). In the interests of infection control the registered provider should consider replacing the existing laundry machines DS0000009040.V273484.R01.S.doc Version 5.0 Page 21 2. OP7 3. 4. OP14 OP25 5. 6. OP25 OP26 Ismeer 7. 8. 9. OP30 OP30 OP38 with industrial-type machines (a washing machine with a sluice facility), which would then allow for the use of dissolving red laundry sacks for fouled linen and negate the need for staff to hand sluice laundry. The registered manager should implement a National Training Organisation compliant training programme for new staff (www.topss-england.net Skills for Care). The registered manager should obtain General Social Care Council handbooks for all staff (www.gscc.org.uk). The home’s health and safety statement is dated 2004 and should be reviewed. The home’s health and safety poster on display in the kitchen should be completed fully. The registered manager should ensure that staff signatures are obtained when they have been made aware of new or reviewed policies. Ismeer DS0000009040.V273484.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD 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 Ismeer DS0000009040.V273484.R01.S.doc Version 5.0 Page 23 - 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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