Inspection on 17/07/07 for Ismeer

This inspection was carried out on 17th July 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

Ismeer 17/06/08

Ismeer 03/01/08

Ismeer 23/05/06

Ismeer 12/01/06

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 17th July 2007 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 Ismeer DS0000009040.V340398.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. Ismeer DS0000009040.V340398.R01.S.doc Version 5.2 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.V340398.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. To include one named service user in the category DE(E) Total number of service users not to exceed 27 Date of last inspection 23rd May 2006 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. Residents’ 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. Fees for care at Ismeer range from £300 - £365 per week. Ismeer DS0000009040.V340398.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection took place on the 17th July 2007 over a period of approximately 7 hours. The inspectors met with Lisa Thomas (deputy manager), staff, and residents. During the course of the day the inspector observed the residents being attended to by staff in a courteous and professional manner. Residents 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. The inspection included a tour of the building, discussion with Lisa Thomas and staff, and inspection of a wide variety of records including the home’s Statement of Purpose and a self-assessment form completed by the registered manager. What the service does well: What has improved since the last inspection? What they could do better: There is insufficient importance placed on accurate informative record keeping, and improvement is needed with care planning. The home needs to do more to ensure the safety of residents in respect of medicine administration. More could be done to show that residents are able to exercise choice in their daily lives. The management of the home should be more effective to ensure the safety and protection of the residents. Ismeer DS0000009040.V340398.R01.S.doc Version 5.2 Page 6 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. Ismeer DS0000009040.V340398.R01.S.doc Version 5.2 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.V340398.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 6 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are provided with the information they need. Evidence suggests that prospective residents have a needs assessment carried out before they are admitted to the home. The home does not provide intermediate care. EVIDENCE: There is a combined Statement of Purpose and Service User Guide, which is dated and includes a summary of feedback from quality assurance questionnaires. The registered manager states in the home’s Annual Quality Assurance Assessment that the service could improve by “giving a Service User Guide to all prospective residents before they enter the home”. Examination of the care documentation for the most recent admission to the home and discussions with the deputy manager and residents confirms that prospective residents are assessed prior to admission to ensure that the Ismeer DS0000009040.V340398.R01.S.doc Version 5.2 Page 9 service can meet their care needs. The home’s Service User Guide states “the individual’s plan of care provides the basis on which Ismeer care services is delivered”, but the most recent admission did not have a care plan. Ismeer does not provide intermediate care. Ismeer DS0000009040.V340398.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 - Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The majority of residents have a care plan. The plan in most cases includes basic information, but insufficient personalised information to plan the individuals care. The health care needs of residents are met, but the home’s handling of medicines does not protect residents. Residents were complimentary about the care and the manner in which it was delivered. EVIDENCE: Care plans are written by care staff and there is evidence of residents’ contribution or involvement, but this was contradicted by the comments of residents who said that they did not know if they had a care plan. Care documentation and care plans are incomplete and therefore do not provide sufficient information in order to properly direct and inform care. The information provided in care plans does not provide sufficient detail in order to ascertain the individual’s care needs. The personal profile for one resident was Ismeer DS0000009040.V340398.R01.S.doc Version 5.2 Page 11 completely blank. One resident did not have a care plan at all. When asked how the home has improved in the last 12 months the registered manager stated in the Annual Quality Assurance Assessment “we have care plans which contain more information about the service user’s needs”. The home’s Service User Guide states “the individual’s plan of care provides the basis on which Ismeer care services is delivered”. The care documentation and discussions with staff and residents confirm that external health professionals are used and available. Each resident is registered with a GP, and has access to specialist services. Residents may be at risk from the home’s medicine storage and administration practices. At the time of the inspection the medicine trolley was found to be unlocked and the contents were therefore accessible by staff and residents. Stock counts were inaccurate in the control drug book (Temazepam). There are a significant number of gaps in the Medicine Administration Records, where staff have not signed to indicate medicine has been administered. The home uses the monitored dosage system (blister packs) and also has a number of traditionally packed medicines. There is a medicines policy and procedure. The home’s Service User Guide states that the home will “establish and carry out careful procedures for the administration of residents medicines”. The residents spoken with were content with the care provided and the manner in which it was delivered. Residents confirmed that staff knock before entering their rooms, and staff were observed to do this. The home’s Service User Guide includes a section on privacy, dignity, and respect. Ismeer DS0000009040.V340398.R01.S.doc Version 5.2 Page 12 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): 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. Residents were complimentary about the lifestyle at Ismeer, and confirmed that they are able to maintain contact with family and friends. More could be done to demonstrate the opportunity for residents to exercise choice and control in their lives. A healthy balance diet is provided in sufficient amounts. EVIDENCE: The home’s Service User Guide makes mention of regular social and recreational activities, including weekly trips out. The registered manager states in the Annual Quality Assurance Assessment “we provide social activities on a daily basis”. The entries in the care documentation do not show activities happening, nor do they show that residents are aware of the activities being available. Lisa Thomas confirmed that there are regular activities, but said that some residents refuse to participate. The residents choice to participate or otherwise is not reflected in the entries. There were no activities on the day of the inspection as two staff were off-sick, reducing the number of staff available to residents (please see comments below and under staffing). The inspectors made use of a recognised observational tool in order to assess the wellbeing of residents and the quality of the interactions with staff and Ismeer DS0000009040.V340398.R01.S.doc Version 5.2 Page 13 others. The inspector recorded observations over a period of approximately 1.5 hours, and residents were seen to be in a positive (happy, contented, comfortable, relaxed) or passive (neither happy nor unhappy, awake, alert, but showing no signs of pleasure or sorrow) state of wellbeing in 61 of these. Residents were asleep for 37 of the time during this period. There were only 7 staff/resident interactions observed, though these were all positive interactions. Residents were largely left to their own devices. The home’s documentation and discussions with staff and residents confirm that visiting is open and unrestricted. Residents or their representatives handle their own financial affairs for as long as they wish or are able. The home’s Service User Guide includes contact details for useful agencies, such as advocacy services. Residents’ rooms are personalised to varying degrees with their own possessions. There is a two-week menu in operation. The menu shows a choice of two hot meals at lunch, but the tea menu is predominantly a cold fare (sandwiches). A record of food provided is kept, but inconsistently, and Lisa Thomas confirmed that residents are not actually asked on a daily basis for their choice of meal from the menu. The menu is displayed in the dining room, but this is in a small font and could be better suited to the care needs of the residents. Residents were satisfied with the quality and quantity of food provided. Ismeer DS0000009040.V340398.R01.S.doc Version 5.2 Page 14 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 good. This judgement has been made using available evidence including a visit to this service. Residents were confident that they could safely voice any concerns. Residents are protected from abuse. EVIDENCE: Residents were not necessarily aware of the complaints procedure, but they said they would feel able to voice any concerns, and had confidence in the staff. There is a complaints procedure, which is included in the home’s Service User Guide, and provides relevant contact details for the local Adult Social Care office and Commission for Social Care Inspection office. The majority of the care staff have undertaken adult protection training. There is an adult protection policy and procedure in use. Ismeer DS0000009040.V340398.R01.S.doc Version 5.2 Page 15 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, 26 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Ismeer provides safe, comfortable, clean, personalised accommodation for the residents. Residents spoken with expressed contentment with their accommodation. There are sufficient toilet and bathing facilities. EVIDENCE: Residents 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, two of which offer assisted bathing. The home works with supporting agencies and health care professionals to ensure that specialist equipment is made available to residents as necessary. Residents’ rooms are personalised to varying degrees, pleasantly decorated and furbished, and residents expressed satisfaction with their accommodation. Ismeer DS0000009040.V340398.R01.S.doc Version 5.2 Page 16 A new bathroom hoist and stair lift have been fitted since the last inspection. The home was seen to be clean generally, though more attention to air vents is needed. Relevant documentation showed that the home is regularly maintained and there are regular equipment checks. Ismeer DS0000009040.V340398.R01.S.doc Version 5.2 Page 17 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 poor. This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of staff does not always meet residents’ care needs. Residents are not protected by the home’s recruitment procedure. The staff are trained and able to do their jobs. EVIDENCE: On the day of the inspection two staff reported in sick reducing the numbers on duty to 3 staff for 24 residents. There would normally have been 5 staff on duty. The deputy manager, Lisa Thomas, said that she had tried to get extra staff in from the team employed at the home, but was not allowed to use agency staff. Earlier comment reports on the observation that residents were largely left to their own devices. The staff on duty was observed to be very busy, but nevertheless professional and caring in their approach to the residents. Usual staff numbers • 08.30-16.30 • 16.30-21.00 • 21.00-08.30 are: 5 care staff 3 care staff 2 care staff There is 21 care staff, of which 14 have achieved NVQ Level 2 or above (approximately 67 ). The home is using photocopied documentation from a National Training Organisation compliant induction programme for new staff. Ismeer DS0000009040.V340398.R01.S.doc Version 5.2 Page 18 The deputy manager, Lisa Thomas, confirmed that all staff have been provided with a General Social Care Council handbook, and that there is regular access to ongoing training such as 1st Aid and manual handling. A sample of staff personnel files were inspected, and these showed that the home is still not consistently applying a rigorous employment procedure, despite the registered manager’s statement in the Annual Quality Assurance Assessment “we recruit staff by following the set policy and procedures”. The employment application form in use does not seek sufficient information from applicants. Sufficient and appropriate references are not sought. This matter has been repeatedly raised at previous inspections, and will be specifically followed-up by the Commission for Social Care Inspection. Ismeer DS0000009040.V340398.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 - Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is insufficient evidence to support the assertion that residents live in a home that is well managed and run for their benefit. Residents’ financial interests are safeguarded. The home’s approach to the health, safety, and welfare of residents is inconsistent. EVIDENCE: Anne Carthew has worked at Ismeer since 1999, being the registered manager for approximately 18 months. She has obtained the NVQ Level 4 in care, the Registered Manager’s Award, and the A1 and A2 assessors award. Lisa Thomas, the deputy manager, 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. Ismeer DS0000009040.V340398.R01.S.doc Version 5.2 Page 20 The registered manager mentions having residents’ meetings in the home’s Annual Quality Assurance Assessment, but nothing is planned as yet. The registered manager says “we hold regular appraisals and supervision” in the Annual Quality Assurance Assessment, but there were no records produced to support this, and the deputy manager stated that staff do not receive supervision. The requirements and recommendations identified in this report are indicative of ineffective management, and the Commission for Social Care Inspection will be asking the registered provider for an improvement plan following this inspection. There is evidence of ongoing quality assurance, and discussion took place with the deputy manager as to how the publication of a summary of the findings could be improved. There are appropriate and proper financial records for the small amounts of residents’ money handled by the home, and receipts support these. The registered manager and deputy manager are fire wardens. The fire training record shows that whilst there is ongoing training some staff have not received any fire training. There is relevant health and safety information at the home, and regular maintenance of fittings and equipment. Ismeer DS0000009040.V340398.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 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 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 1 X 2 Ismeer DS0000009040.V340398.R01.S.doc Version 5.2 Page 22 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 OP7 Regulation 15 Requirement The registered manager must ensure that an individual care plan is in place for each resident, and that the care plan provides sufficient information to effectively direct care. The registered manager must ensure the safety of residents by the safe storage and administration of medicines. The registered manager must ensure that a record of food provided is kept in sufficient detail to determine whether the diet is satisfactory. The registered manager must ensure that there are sufficient staff numbers to meet the needs of the residents. The registered manager must apply a rigorous and robust employment procedure in order to protect residents. The registered manager must ensure that staff working at the home are appropriately supervised. The registered manager must ensure that all staff received DS0000009040.V340398.R01.S.doc Timescale for action 01/09/07 2. OP9 13(2) 01/08/07 3. OP15 17(Sched ule 4) 01/08/07 4. OP27 18(1) 01/08/07 5. OP29 19 01/09/07 6. OP36 18(2) 01/10/07 7. OP38 23(4) 01/08/07 Ismeer Version 5.2 Page 23 regular and frequent fire training. 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 manager should ensure that prospective residents receive a Service User Guide. The registered manager should do more to ensure resident involvement in the care plan process. The registered manager should ensure that daily entries reflect the choices made by residents, and provide a snapshot of their lifestyle. The registered manager should ensure that residents are offered a choice at meals on a daily basis. The registered manager should ensure that the menu is displayed in a format suitable to the care needs and capabilities of the residents. 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. 5. OP26 Ismeer DS0000009040.V340398.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Devon & Cornwall Area Unit D1 Linhay Business Park Ashburton Devon TQ13 7UP 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 Ismeer DS0000009040.V340398.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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