Inspection on 03/01/08 for Ismeer

This inspection was carried out on 3rd January 2008.

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 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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Ismeer Trewollack Lane Gorran Haven St Austell Cornwall PL26 6NT Lead Inspector Alan Pitts Unannounced Inspection 3rd January 2008 08:45 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.V356829.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.V356829.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.V356829.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 17th July 2007 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.V356829.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 3rd January 2008 over a period of approximately 6 hours. The two inspectors met with the registered manager, the deputy manager, staff, and residents. The inspection included a tour of the building, inspection of a wide variety of records, and discussion with residents. What the service does well: What has improved since the last inspection? What they could do better: Medicine administration has been a consistent issue at recent inspections and it is of concern that the registered provider and registered manager cannot rectify this matter. Residents should feel confident that they can express any concerns. The environment needs a planned approach to maintenance and safety. More needs to be done to protect residents when employing staff. Some of the identified requirements have carried over from one or more previous inspections. There is insufficient evidence to show that the home is well managed. Ismeer DS0000009040.V356829.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.V356829.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.V356829.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 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 registered manager amended the combined Statement of Purpose and Service User Guide in June 2007, and the comments of the registered manager and the records show that this is provided to residents. Prospective residents are assessed prior to admission to the home, as shown by the care documentation provided. The home does not provide intermediate care. Ismeer DS0000009040.V356829.R01.S.doc Version 5.2 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. 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. Residents have a plan of care. Residents have access to other healthcare professionals. Medicines are not being administered in adherence to pharmaceutical guidelines and residents could be at risk. 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. As discussed, there is still room for improvement, specifically in ensuring the care plans accurately reflect any issues identified on assessment (e.g. resident is diabetic or wears glasses). Ismeer DS0000009040.V356829.R01.S.doc Version 5.2 Page 10 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. Medicine administration is poor and residents may be at risk from the home’s practices. The records show: medicines given when they shouldn’t be; medicines omitted when they should be given; printed instructions altered by hand without initial, date or evidence of authority; administration instructions hand written on scraps of paper; gaps where staff have not signed to indicate a medicine has been administered; confusing hand written Medicine Administration Records. This is of serious concern to the inspectors and should be to the registered provider and registered manager. Medicine administration has been a consistent issue at recent inspections and it is of concern that the registered provider and registered manager cannot rectify this matter. An additional random inspection will be arranged to monitor medicine administration. 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.V356829.R01.S.doc Version 5.2 Page 11 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 registered 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. 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 Ismeer DS0000009040.V356829.R01.S.doc Version 5.2 Page 12 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, though there were some comments made about smaller portions being provided recently. The registered manager undertook to arrange for residents to be asked individually about portion sizes. Ismeer DS0000009040.V356829.R01.S.doc Version 5.2 Page 13 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. Residents were not confident that they could safely voice any concerns, or that they would be acted upon. Residents are protected from abuse. EVIDENCE: Residents were not necessarily aware of the complaints procedure, and one said they would not feel able to voice any concerns to the registered manager. Another said they were not sure if they would be listened to, though another resident said they would feel able to voice any concerns. It is important that residents know there is a set procedure and that they will be listened to. 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. There has been one complaint received and investigated by the Commission for Social Care Inspection since the last key inspection. This complaint was upheld, the issues reflecting many included in this report. The majority of the care staff have undertaken adult protection training. There is an adult protection policy and procedure in use. Ismeer DS0000009040.V356829.R01.S.doc Version 5.2 Page 14 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. More needs to be done to ensure the ongoing maintenance of the environment. 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. Ismeer DS0000009040.V356829.R01.S.doc Version 5.2 Page 15 Residents’ rooms are personalised to varying degrees, pleasantly decorated and furbished, and residents expressed satisfaction with their accommodation. A new washing machine has been fitted since the last inspection. A new door alarm has been fitted to two external doors since the last inspection. The home was seen to be clean generally, though there were faeces on the carpet and a used continence pad in the waste bin in one room. More attention is needed to cleaning high areas. The boiler room accessible off a bathroom was open and should be kept locked. A number of carpets 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. Bedding was seen to need replacement (e.g. torn pillowcases). Cleaning materials were evident around the home, accessible to residents. Relevant documentation showed that the home is regularly maintained and there are regular equipment checks. Ismeer DS0000009040.V356829.R01.S.doc Version 5.2 Page 16 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 registered manager is included in the care staff numbers, and this detracts from the management of the home. In excess of 50 of staff are qualified to NVQ Level 2 or above. Residents are not protected by the home’s recruitment policy. A National Training Organisation compliant induction programme is in use, but not consistently. EVIDENCE: Lisa Thomas, the deputy manager, said that the home was currently recruiting for one care staff vacancy, and that the staff are also hoping the current domestic hours will be increased too. There was five care staff on duty (including the registered manager). There are two cooks, though neither currently have the Intermediate Food Hygiene Certificate. Two domestic staff are employed. There is a maintenance man employed on Thursday mornings only. Reference should be made to the comments in the ‘Environment’ section of this report. Effective management is the predominant issue for this home and the duty rota does not distinguish between ‘managerial time’ and ‘floor time’ for the registered manager. All but three staff have achieved NVQ Level 2 or above. Ismeer DS0000009040.V356829.R01.S.doc Version 5.2 Page 17 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”. None of the files displayed a photograph of the individual. One application form was 70 blank. One did not include details of previous employer and the interview record sheet was blank. One provided only one reference. This has been a consistent issue at recent inspections. There is a record of training undertaken by staff. This identifies infection control and food hygiene as areas for attention. Fire training was provided in October 2007, and the registered 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, but not consistently. The files inspected showed that two staff did not receive induction training. Ismeer DS0000009040.V356829.R01.S.doc Version 5.2 Page 18 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 poor. This judgement has been made using available evidence including a visit to this service. As at the previous inspection, 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 2 years. She has obtained the NVQ Level 4 in care, the Registered Manager’s Award, and the A1 and A2 assessors award. The registered manager has assured the inspector during previous inspections that issues raised would be rectified; yet they continue to reoccur. The Ismeer DS0000009040.V356829.R01.S.doc Version 5.2 Page 19 registered manager left the inspection and the building at the feedback stage, saying that she was handing in her notice. An immediate requirement was made that the registered provider informed the Commission for Social Care Inspection of the managerial arrangements that would exist in the absence of the registered manager. There is evidence of ongoing quality assurance, and discussion took place as to how the presentation of the summary of the findings in the Service User Guide might be improved. The registered manager said “we hold regular appraisals and supervision” in the Annual Quality Assurance Assessment, but the records produced to support this are inconsistent and infrequent. 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, though practices do not always adhere to the relevant procedure or guidance (e.g. medicines, COSHH, employment procedures). Please see comments in the ‘Health’, ‘Environment’ and ‘Staffing’ sections of this report. The requirements and recommendations identified in this report are again indicative of ineffective management, and the Commission for Social Care Inspection will be asking the registered provider for an improvement plan following this inspection. The Commission for Social Care Inspection will be asking to meet with the registered provider to discuss the future of this home. Ismeer DS0000009040.V356829.R01.S.doc Version 5.2 Page 20 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 1 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 2 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 4 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 1 X 2 Ismeer DS0000009040.V356829.R01.S.doc Version 5.2 Page 21 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 OP9 Regulation 13(2) Requirement The registered provider and registered manager must ensure the safety of residents with the safe administration of medicines. The registered provider and registered manager must ensure that residents are aware of how to voice concerns and are confident that they may do so without recrimination. The registered provider and registered manager must provide the Commission for Social Care Inspection with a written audit of the premises and fittings to identify work that needs to be carried out and items for repair or replacement. The audit must include timescales for the proposed work. The registered provider must ensure that the registered manager has sufficient allocated managerial time, and that this is shown on the duty rota. The registered manager must apply a rigorous and robust employment procedure in order to protect residents (properly DS0000009040.V356829.R01.S.doc Timescale for action 31/01/08 2. OP16 22 31/01/08 3. OP19 13, 23 01/03/08 4. OP27 18 01/02/08 5. OP29 19 01/02/08 Ismeer Version 5.2 Page 22 6. 7. OP36 OP9 18(2) 17 completed and scrutinised application form, two relevant references including previous employer, and Criminal Records Bureau check). The registered manager must ensure that staff are appropriately supervised. The registered manager must ensure that records required by regulation and for the protection of residents are kept. 01/04/08 01/02/08 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. 2. Refer to Standard OP19 OP19 Good Practice Recommendations The registered manager should make safe the bottom and sides of the external steps at the rear of the building. The registered manager should review COSHH arrangements to ensure the safe storage of chemicals in the home at all times. Ismeer DS0000009040.V356829.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton 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.V356829.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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