Inspection on 17/06/08 for Ismeer

This inspection was carried out on 17th June 2008.

CSCI found this care home to be providing an Adequate service.

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 03/01/08

Ismeer 17/07/07

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Ismeer Trewollack Lane Gorran Haven St Austell Cornwall PL26 6NT Lead Inspector Mike Dennis Unannounced Inspection 17th June 2008 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.V364497.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.V364497.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 Vacant 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.V364497.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 3rd January 2008 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.V364497.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This key unannounced inspection took place on the 17th. June 2008 over a period of approximately 6 hours. The two inspectors met with the manager, staff, and residents. The inspection included a tour of the building, inspection of a wide variety of records, and discussion with residents and relatives. People who use the service told us that they were happy living at Ismeer. They said that the staff are “lovely” and the meals “good”. Three people told us they have a choice at meal times, one said you get what you are given. With reference to complaints, the majority of people spoken with told us they would tell relatives or go to senior staff. Others commented that they have never needed to complain. The subject of activities was discussed with some people saying there was enough and others preferring to see more. The trips out were popular. Some people told us they prefer their own company. Residents told us that they were happy with the staff and the care provided by them. They felt there was enough staff on duty but noted that at times they were very busy. They told us that staff respond quickly to the call bells. A relative told us that he had been involved in the admission process and was aware of the care being provided to his mother. He said the staff work well as a team. He was particularly pleased to be allowed to stay in the home until quite late one evening to help support his mother. He felt the environment was a bit shabby in places. Staff described the activities offered to residents. They appeared generally satisfied with their working environment. They commented that they had noticed an improvement in the paperwork since the new manager had been in post. The new manager has made some significant progress in a short period of time to the overall standard of this home. The rating has moved from poor to adequate. If the progress is maintained a good rating is achievable. Ismeer DS0000009040.V364497.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Whilst improvement is noted, generally, in medication practices, the storage of medication must be secure at all times. Unwanted medication must be promptly returned to the pharmacist. Ismeer DS0000009040.V364497.R01.S.doc Version 5.2 Page 7 Old and worn carpets that represent a hazard to residents, staff and visitors are in need of replacement. The manager must now concentrate on complying with all the National Minimum Standards to build upon the progress that has already been made. 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.V364497.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 Ismeer DS0000009040.V364497.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, 3, 6 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with the information they need. Prospective residents’ care needs are assessed prior to admission. The home does not provide intermediate care. . EVIDENCE: The manager visits prospective residents and completes a needs assessment. A standard format for assessment and care planning is now used. When completed in sufficient detail, this record covers the assessment issues specified in the standard and the diverse needs of prospective residents. The residents’ records case tracked contained completed and comprehensive needs assessments. The home’s staff carry out an assessment for both private Ismeer DS0000009040.V364497.R01.S.doc Version 5.2 Page 10 purchasers and those commissioned by the local authority. The home’s assessments, in the past, have not always stated who was present at the assessment. The paperwork pertaining to the latest two admissions recorded these details. The records for a resident case tracked included the assessment and commissioning documents from the local authority. The assessments part of the care planning records were completed in good detail. This home does not provide Intermediate Care. Ismeer DS0000009040.V364497.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. Residents have a plan of care. Residents have access to other healthcare professionals. Medicines are being administered in adherence to pharmaceutical guidelines. Improvement is required in the return of unwanted medication. Creams should also be securely stored. Residents are treated with respect and their privacy is upheld, though comments under the ‘complaints’ section should be noted. EVIDENCE: There has been a marked improvement in the quality of the care plans, which now provide clear instruction to care staff as to the interventions needed to meet the care needs and capabilities of the residents. All of the care plans case tracked complied with the National Minimum Standards. There was evidence to indicate that these plans are reviewed at regular intervals. They are signed Ismeer DS0000009040.V364497.R01.S.doc Version 5.2 Page 12 and dated and the majority include who was present or consulted at the time of inception. 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. The home has struggled to maintain a satisfactory standard in it’s management of medication as detailed in past reports. Some improvement is noted and the day to administration and recording of medication is now satisfactory. It is however important to ensure that any unused or unwanted medication is returned to the pharmacist. Any medicines without a prescription label attached should also be returned. In general medication was appropriately stored within locked facilities. Some creams however were not and it is important that ALL medication to include creams are securely kept. Residents were observed to be treated with respect when staff interacted with them. Staff were seen to knock before entering residents’ rooms, and the residents spoken with confirmed that staff are respectful of their privacy. Ismeer DS0000009040.V364497.R01.S.doc Version 5.2 Page 13 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 good. 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. Residents and records 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 manager states in the Annual Quality Assurance Assessment “we provide social activities on a daily basis”. The entries in the care documentation have improved to show activities happening, and residents’ choices made in respect of how they spend their day. The home’s documentation and discussions with staff and residents confirm that visiting is open and unrestricted. One resident had visitors during the course of the inspection. Ismeer DS0000009040.V364497.R01.S.doc Version 5.2 Page 14 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. One resident confirmed that they planned to bring in a few more “bits” from home. The menu shows a choice of two hot meals at lunch. A record of food provided is kept, and residents confirmed that they are asked on a daily basis for their choice of meal from the menu. The menu is displayed in the dining room. Residents were satisfied with the quality and of food provided. Ismeer DS0000009040.V364497.R01.S.doc Version 5.2 Page 15 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. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints procedure that would ensure that complaints are listened to and acted upon. There are arrangements to protect service users from abuse. EVIDENCE: The home has put in place a new, clear and simple complaints policy and procedure that includes the address and telephone number of the CSCI and the timescales for complaint investigation. The address of the Department of Adult Social Care should be included in this document. A copy of the complaints procedure is kept in each of the residents’ bedrooms. The home maintains a complaints log that includes the action taken to resolve the complaint. The manager and all but the newest of staff have attended Adult Protection training run by Cornwall County Council. Further training is booked for all staff to ultimately receive this training. An adult protection policy and procedure has been developed and expanded to include clear procedures for informing agencies with an alert. The policy now Ismeer DS0000009040.V364497.R01.S.doc Version 5.2 Page 16 describes the steps to be taken when an allegation of abuse is made and how to set up an Adult Protection Strategy Meeting. Ismeer DS0000009040.V364497.R01.S.doc Version 5.2 Page 17 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 adequate. This judgement has been made using available evidence including a visit to this service. Ismeer provides comfortable, personalised accommodation for the residents. Residents spoken with expressed contentment with their accommodation. There are sufficient toilet and bathing facilities. Ongoing maintenance of the environment has improved, but some areas still require attention. 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 Ismeer DS0000009040.V364497.R01.S.doc Version 5.2 Page 18 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. Improvements are noted to the environment. A new washing machine has been recently fitted, some carpets replaced and the boiler room door is now secure. The home was seen to be clean, and generally tidy. There are still a number of carpets that are worn, in some cases frayed to such an extent and in such a position as to present a potential tripping hazard to residents, staff and visitors. The condition of bedding has improved since the last inspection. Relevant documentation showed that the home is regularly maintained and there are regular equipment checks. The laundry area was very hot and would most definitely benefit from the installation of a fan. The toilet area opposite the laundry is used for storage. We were told that this area is redundant to resident needs. If it’s use is to be continued for storage the facility should be kept locked when not in use. The maintenance plan should give priority to the safety of residents. Ismeer DS0000009040.V364497.R01.S.doc Version 5.2 Page 19 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. The manager should concentrate on managing the home and not be drawn into the caring role as this detracts from the management of the home. In excess of 70 of staff are qualified to NVQ Level 2 or above. Residents are now protected by the home’s recruitment policy. A National Training Organisation compliant induction programme is in use. EVIDENCE: Lisa Thomas has been appointed to the post of manager. There were five care staff on duty from 8am until 4.30pm. From 4.30pm until 9pm there are 3 care staff on duty. Through the night there are 2 waking staff plus an on call system. There are two cooks, who have now obtained catering qualifications. Two domestic staff are employed. There is a maintenance man employed on Thursday mornings only. Effective management has been the predominant issue for this home and it is important that the manager gives full priority to the management role. Ismeer DS0000009040.V364497.R01.S.doc Version 5.2 Page 20 All but five staff have achieved NVQ Level 2 or above. A sample of staff personnel files were inspected, and these showed that the home is now consistently applying a rigorous employment procedure. CRB checks are obtained, two references, application forms, all before someone is allowed to commence work. This represents a marked improvement on previous practice. There is a record of training undertaken by staff to include infection control, food hygiene, moving and handling, first aid, and No Secrets. The manager is aware of the need for regular and frequent fire training for all staff. A National Training Organisation compliant induction programme is in use. Residents told us that the staff are caring, fulfil their needs and respect their dignity and privacy. Ismeer DS0000009040.V364497.R01.S.doc Version 5.2 Page 21 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, 38 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The new manager has made improvements to the benefit of residents. Residents’ financial interests are safeguarded. The home’s approach to the health, safety, and welfare of residents is still somewhat inconsistent. EVIDENCE: Lisa Thomas has worked at Ismeer since 2005, and has recently been appointed to manager of the home. Her application to be registered with the CSCI is currently being determined. She has obtained the NVQ Level 4 in care, Ismeer DS0000009040.V364497.R01.S.doc Version 5.2 Page 22 the Registered Manager’s Award, and the A1 and A2 assessors award. She is currently studying for a diploma in Mental Health and Social Care. Ms. Thomas has demonstrated her potential ability by making a number of improvements throughout the home enabling the rating to be increased from poor to adequate. There are also examples of good care being delivered. There is evidence of ongoing quality assurance, and the Annual Quality Assurance documents have been returned to us as have a number of surveys. The manager said “we hold regular appraisals and supervision” and records were produced to support this. Financial records were not inspected at this time, though they were satisfactory at the previous inspection. There is relevant health and safety information at the home, and practices have improved to comply with these policies. There is further room for improvement, which the manager is aware of. This report notes some general improvement and it is to be hoped that the manager will continue to enhance the overall quality of care and meet all the National Minimum Standards. Ismeer DS0000009040.V364497.R01.S.doc Version 5.2 Page 23 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 2 Ismeer DS0000009040.V364497.R01.S.doc Version 5.2 Page 24 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. 2 3 Standard OP9 OP9 OP19 Regulation 13(2) 17(1) 13(2) 17(1) 13(4) Requirement The registered manager must ensure that ALL medication is stored securely at all times The registered manager must return all unused or unwanted medication to the pharmacist The registered manager must ensure that old and worn carpets do not place residents at risk. This applies to a stair carpet in particular which is in need of replacement. Timescale for action 30/07/08 30/07/08 01/09/08 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 OP16 Good Practice Recommendations Include the name and address of the Department of Adult Social Care within the complaints policy. Ismeer DS0000009040.V364497.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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.V364497.R01.S.doc Version 5.2 Page 26 - 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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