Inspection on 13/04/06 for John Collin House

This inspection was carried out on 13th April 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

John Collin House 17/04/07

John Collin House 14/11/06

John Collin House 27/09/05

John Collin House 19/04/05

John Collin House 25/10/04

John Collin House 07/02/04

Similar services:

Ashlong House

Norbury Crescent (30)

Henry Nihill House

Birchwood

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

The Infirmary

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

CARE HOMES FOR OLDER PEOPLE John Collin House Sutton Lane Hounslow Middlesex TW3 3BB Lead Inspector Ms Jane Collisson Unannounced Inspection 13th April 2006 9:45 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 John Collin House DS0000022891.V286676.R02.S.doc Version 5.1 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. John Collin House DS0000022891.V286676.R02.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service John Collin House Address Sutton Lane Hounslow Middlesex TW3 3BB 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) 0208 572 2684 0208 572 2685 Servite Houses To be appointed Care Home 26 Category(ies) of Learning disability (0), Learning disability over registration, with number 65 years of age (0), Old age, not falling within of places any other category (0) John Collin House DS0000022891.V286676.R02.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th September 2005 Brief Description of the Service: John Collin House is a detached purpose-built home situated in a residential area of Hounslow. It is leased to Servite Houses by the London Borough of Hounslow. Situated between Hounslow Town Centre and Hounslow West, there are bus routes close by. The home is registered for twenty six users who can be older people, or people with learning disabilities either over or under 65 years of age. There are four separate units, two accommodating six service users and two accommodating seven. One was previously designated as being for six people with learning disabilities. Each unit has a lounge/dining room with kitchenette area. A larger multi-purpose lounge, on the ground floor, is used for social activities and functions. There are twenty two single bedrooms and two double bedrooms. The double rooms and one single room are en-suite. The offices, kitchen, laundry room and staff sleeping in room are located on the ground floor. There is a large garden around the home, with seating and a greenhouse. The staff team consists of the Registered Manager, an Assistant Manager, three Senior Carers, a team of day and night Support Workers, domestic and laundry workers. The provision of meals is contracted to a catering company, who employ the kitchen staff. John Collin House DS0000022891.V286676.R02.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection commenced on the 13th April 2006 from 9.45am to 5.00pm. The Manager Designate, who had been in post for eight weeks, was present. There were twenty three service users in the home and three vacancies. Only one person with learning disabilities is accommodated currently. Additional visits were made on the 18th April and 27th April 2006 to examine further records, including fire precautions and finances, with the Manager Designate and Deputy Manager. The inspection process took a total of thirteen hours. Two Immediate Requirements were made. One was in respect of the improvements required to care plans and risk assessments to show how service users’ health needs are being met. The second was in respect of the lack of fire drills that have been carried out. Eight staff and approximately half of the service users were spoken to during the course of the inspection. One meal lunchtime meal was sampled. Although no activities were taking place, service users confirmed that they enjoy the bingo sessions and coffee mornings that take place. At the previous inspection, fourteen requirements were made of which eleven have not been fully met and have been repeated. A further fifteen requirements were made at this inspection. What the service does well: What has improved since the last inspection? Some improvements have been made to the environment with the fitting of new carpets throughout the corridors and foyer. John Collin House DS0000022891.V286676.R02.S.doc Version 5.1 Page 6 What they could do better: The home has continued to admit service users outside of its categories of registration. The staff carrying out assessments for new service users must ensure that their needs can be met by the home and that they are within the home’s categories of registration. Staff need to be shown to have the expertise and training to work with service users who have a variety of health and social needs. It must be demonstrated, where health needs change, that referrals are made to obtain professional diagnoses and appropriate treatment. The risk assessments and care plans were all in need of improvement. Insufficient information and guidance was recorded for service users’ support needs. An Immediate Requirement was made to ensure that these were to be improved, with service users who have the highest support needs prioritised. Referrals to health professionals are required to be made where it has been noted that there is any deterioration, particularly in mental health. Although the medication systems have improved, and monitoring is taking place, errors were still noted with stock control. The systems in place for senior staff to monitor medication administration must be made more robust to ensure that errors can be identified and rectified promptly. A number of training issues had arisen which need to be addressed by the new manager. These include the lack of evidence regarding the induction of new staff, all of the staff receiving the core training required to fulfil their roles and the specialist training to meet the needs of service users. It must be demonstrated that senior members of staff who provide in-house instruction receive appropriate training themselves to be able to do so. The Registered Providers must also demonstrate that all of the health and safety procedures required are in place and that there is robust monitoring to ensure that staff fully understand their responsibilities with regard to these. It has been an ongoing requirement that a record is maintained of the food provided to the service users, to determine if their diets are satisfactory. This is still outstanding. Consultation with the service users about the quality of, and the way in which food is prepared, discussions with staff about the popularity of the menu, and better promotion of the food and its availability could significantly improve the mealtimes for the service users. Although some improvement has been made, with the addition of new carpets, an Action Plan is required to ensure that the home is redecorated where required, and furniture and fittings maintained in good condition for the remainder of the home’s life. The security of the building needs to be improved to enhance the safety of service users and staff. The home only has sufficient staff to cover the rota with the use of relief staff and must recruit sufficient permanent staff to ensure cover for the rota hours, leave and training. The record of National Vocational Qualifications training is poor and an Action Plan is required to be produced to demonstrate how the John Collin House DS0000022891.V286676.R02.S.doc Version 5.1 Page 7 home intends to meet the target of having 50 of the carers trained to NVQ Level 2 or above. The record keeping in the home has required improvement for some time and work is still required by the management of the home and Registered Providers to ensure that health and safety, recruitment, care plans and risk assessments are all in place, up-to-date and, where required, seen to be reviewed. In particular, the care plan, risk assessments and fire precautions were the subject of Immediate Requirements because of deficiencies. The emergency lighting had not been serviced or checked for more than two years. Although some consultation had taken place with service users and families, there is no system of reviewing the quality of care which demonstrates how the quality will be improved. Whilst some supervision had taken place with the managers and staff, this was not carried out consistently. This has now recommenced and it needs to be shown that this is carried out regularly, particularly to support new staff. 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. John Collin House DS0000022891.V286676.R02.S.doc Version 5.1 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 John Collin House DS0000022891.V286676.R02.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 More robust systems of admission and assessment are required to ensure that only service users whose needs fall within the home’s registration categories, and can be met by the staffing, services and facilities, are admitted. It is still required to be demonstrated that staff have the training and expertise to meet the requirements of the service users admitted. EVIDENCE: The Manager Designate said that the Statement of Purpose and Service Users Guide have been updated to reflect the changes in management of the home. However, the information is not provided in other formats, such as large print, and it is recommended that these are made available to assist the service users needing this facility. Service users and their representatives have been required for some time to be provided with copies of the terms and conditions which explain the facilities, services and fees payable. In the sample of files examined, these were now in place, although one had not yet been signed. A copy of the Local Authority agreement was also included in the files. John Collin House DS0000022891.V286676.R02.S.doc Version 5.1 Page 10 In the three care files examined, each had a needs-led assessment carried out by the social workers referring the service user. Assessments by the home’s management, to ascertain that the prospective service user’s needs could be met, were not in evidence for two of the service users. The third service user’s file showed that the assessment was carried out on the day that the person was admitted, although this did not appear to be an emergency admission. The information available in one service user’s file showed that the needs identified in the referral were not within the home’s registration categories. The care plan prepared for the service user had not taken into account any of the specialist support that is required. Another service user had been admitted in the last few months who also had a history of mental health problems and had to be readmitted to hospital. The service user has not returned to the home. The management staff of the home have now identified a further three service users who do not fall within the home’s registration categories of old age or learning disabilities. The Manager Designate said that variations to the registration will be made to the Commission for Social Care Inspection as they feel that the needs of the service users can be met, with external professional support. In future, the home must use more robust systems of assessment and admission to ensure that the service users admitted are within its registration categories and have needs as defined in its Statement of Purpose. In order for staff to be able to support service users with learning disabilities, or other specialist needs, it was required that the home demonstrate that staff are suitably trained. No progress had been made on this requirement until recently. The Manager Designate has arranged for training to support staff to work with people with learning disabilities to be held shortly. Training for dementia and for specialist health needs, such as diabetes, has not yet been arranged. This requirement remains outstanding. Several service users have been admitted to the home at very short notice, usually from hospital, and there has been limited time for prospective service users to visit to help them make a decision about the home being suitable. Staff said that, in some cases, families had visited on the service user’s behalf. Every effort should be made to ensure that service users have the opportunity to make prior visits to help them to come to an informed decision about their future home. There is no Intermediate Care unit in this home, so this National Minimum Standard was not examined. John Collin House DS0000022891.V286676.R02.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Insufficient progress has been made in improving the care plans and not all of the care plans and risk assessments required for each individual service users are in place. In particular, risk assessments for manual handling and health needs must be improved. It needs to be demonstrated that appropriate referrals are being made where health needs are changing and that the home is only accommodating service users whose health, social and emotional needs it can be shown to meet. EVIDENCE: An examination of five of the care planning files of service users showed that not all of the care plans that should have been prepared were in place. It was a requirement at the last inspection that the plans must be updated on a regular basis, in consultation with the service users and their representatives. In one of the files, a number of the care plans had not been completed, and this included those on the health needs of the service user. The information was very limited in two of the files and did not reflect the information which had been clearly identified in the needs-led assessment. This also applied to the risk assessments, which had not been completed for areas of risk identified, such as the risk of falls, support when bathing, pressure sores or mental health issues. The details of those service users with diabetes were not John Collin House DS0000022891.V286676.R02.S.doc Version 5.1 Page 12 shown in sufficient detail to ascertain the individual treatment, risks involved or the involvement of health professionals. New information, noted at service users’ review meetings, had not been added to the care plans, although it was indicated that some reviews of the care plans had taken place since the meetings. The Registered Providers have introduced a new care planning system, which the Manager Designate said they would be putting into operation. This did not include a detailed manual handling risk assessment which would provide sufficient information to minimise the risks to service users who require this support. An Immediate Requirement was issued for the care plans and risk assessments to be completed, with priority given to those service users who have more complex health needs and those who require manual handling. These need to be undertaken by staff who have the appropriate training, or with professional assistance. It was noted during the inspection that some of the service users may be in need of assessment and diagnosis, with regard to the onset of dementia, to ensure that their health and welfare needs are being met. In the care plans examined for these service users, it was noted that confusion and disorientation have been identified but no professional assessments have taken place to ascertain to identify the cause and provide appropriate treatment. District nurses visit the home on twice weekly to carry out any medical treatment that the service users require, such as dressings. Two service users have recently had pressure sores and it was confirmed that both have been successfully treated. Although staff said that appropriate equipment has been supplied, the care plan and risk assessment for one of the service users did not show this or how the pressure sore was being treated. Pressure sore risk assessments were seen to have been completed in a number of files as part of the care plan. However, these were not completed accurately and did not appear to have been carried out by trained staff and, where service users were assessed as being at a high risk, no risk reduction plans were in place. These assessments must be carried out with appropriate professional assistance. Where any health risks are identified in care plans, it must be shown how these will be managed. At the last inspection, two requirements were made regarding medication administration. There is now a system for senior staff to monitor medication but, on this inspection, two errors of stock control were found, at least one of which should have been found by the monitoring system. The Manager Designate needs to ensure that senior staff are more diligent in their checking of the medication. The system of only senior staff giving medication had resulted, in the past, of medication being given late and a number of care staff have now been trained to administer medication. However, in one unit it was observed that the medication was given more than an hour after the John Collin House DS0000022891.V286676.R02.S.doc Version 5.1 Page 13 prescribed time. The times of actual administration are not noted and it is recommended that this is done so that senior staff monitoring can ensure medication is dispensed as close to the prescribed time as possible. As the induction records examined were not completed, and there has been very limited National Vocational Qualifications training, it was not shown that staff have received instruction with regard to treating service users with respect and maintaining their dignity. Several staff confirmed that they had not previously worked in a care environment and training and guidance in these areas needs to be demonstrated, particularly during their induction period. However, during the inspection, service users were seen to be treated respectfully by the staff. There are limited private areas for meeting with visitors, other than bedrooms. Although the large lounge could be used, this adjoins the kitchen and staff room so is not fully private. The new care plans that are to be introduced have the section for recording the wishes of service users with regard to any arrangements they would like in the event of serious illness or death. John Collin House DS0000022891.V286676.R02.S.doc Version 5.1 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 The service users would benefit from a fuller programme of activities, including the opportunity for trips outside of the home. The recording of meals, to show that service users are having a nutritious, wholesome and varied diet, is an outstanding requirement which must be met. Further consultation on the menu, and the way in which food is prepared, could improve the service users enjoyment of the meals. EVIDENCE: Although no activities were observed during this inspection, service users confirmed that bingo and coffee mornings do take place. There is no regular programme of activities and no organiser is employed. In all of the units the televisions were on, one showing a music video. In one unit, a staff member said that the service users had been supported to do a jigsaw that morning. A small number of service users prefer to sit in the foyer of the home where staff and visitors pass by. A small number of service users are able to go out unaccompanied. One service user, who is unable to go out alone, expressed concern about the lack of opportunity to go out of the home. The staff said that they hoped to book a short holiday for four or five service users this summer, an activity which had been enjoyed in previous years. One of the staff is able to drive a hired minibus, so outings were being planned for the summer. John Collin House DS0000022891.V286676.R02.S.doc Version 5.1 Page 15 Although no service users’ visitors were met during this inspection, service users confirmed that their family and friends were welcome to visit. The care plans in place demonstrated that service users are asked their views on the lifestyle they wish to pursue, including whether or not they wished to be checked on during the night. The meal being served on the first day of the inspection was liver, creamed potatoes, runner beans and swede. The alternative to the liver was macaroni cheese. The dessert was trifle. The cook said that diabetic service users preferred to have ice cream as their dessert but could be provided with alternatives if requested. Fresh fruit was seen to be available on each unit. Comments from service users, on the menu included “good” “OK” and “there are good days and bad days”. Two service users particularly commented on the quality and type of liver, which was not to their taste or cooked in the way they prefer. Although there is an alternative to sandwiches for the supper, one service user said that the quality of the alternatives, such as sausage rolls, was poor and others said that they usually had sandwiches, although were “fed up” with these. Some consultation had taken place and the cook does speak to the service users about the food. However, this needs to be ongoing to ensure that new menus, particularly, are agreeable to the service users and the ways in which food is prepared in the way in which the service users prefer. The photographic menus, which had been available in each unit and provided service users with clear information about the meals available, had been withdrawn due to being wrongly produced when the new menu was introduced. It is planned that these will be reintroduced when amended. It was confirmed that, in accordance with a service user’s wishes, culturally appropriate food is served. However, it has been a requirement at the last two inspections that the meals taken by service users are recorded to meet Regulation 17 (2) Schedule 4 (13) of the Care Home Regulations 2001. This states that records are to be kept “of the food provided for service user in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory, in relation to nutrition or otherwise, and of any special diets prepared for individual service users”. To meet the National Minimum Standards, a snack meal should be offered in the evenings to ensure that there is no more than a twelve hour gap between meals. Staff confirmed that bread, cheese and spreads are available if ordered in advance from the kitchen, which is closed in the evening. The provision of an evening snack is not specifically advertised on the menu. Service users should be made more aware of the snacks and alternatives, such as diabetic desserts, which could be made for them rather than staff relying on their requests. John Collin House DS0000022891.V286676.R02.S.doc Version 5.1 Page 16 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): 16, 18 Training in adult protection had not progressed, but the Manager Designate addressed this during the inspection. While some service users are happy to make complaints, some need support to be able to raise their concerns and the staff need to encourage the confidence to do so. EVIDENCE: A total of four complaints were seen to have been recorded since the last inspection which were dealt with appropriately. Two of these concerned food. A number of service users complained about one of the meals served and another complained that a meal had not been kept. It appeared that there may have been another complaints log being used that could not be located. If so, there needs to be a system to ensure that a full record of complaints is kept and is available for inspection. While some of the service users felt they would be happy to make a complaint, others expressed the view that there would not be any point. Although service users’ meetings are held, it is recommended that other ways of consulting service users, perhaps on a oneto-one basis, are held to encourage service users to voice their concerns. It was a requirement that the management of the home must ensure that all staff are aware of the steps to be taken in the event of an adult protection issue arising and how service users should be protected. This followed an issue at the previous inspection. No progress had been made with adult protection training but the Manager Designate made arrangements, during this inspection, with the London Borough of Hounslow’s safeguard adults officers to provide this in the near future for some of the staff. This should be extended to all staff as soon as possible. John Collin House DS0000022891.V286676.R02.S.doc Version 5.1 Page 17 A further issue arose shortly before this inspection which was reported to the Social Services department and the Commission for Social Care Inspection. Although this was reported to the Safeguarding Adults officer by the Social Services, the management of the home need to ensure that they also contact them directly when any issue is discovered. The case was being investigated by the Social Services care manager and was still ongoing. John Collin House DS0000022891.V286676.R02.S.doc Version 5.1 Page 18 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): 19, 20, 21, 23, 26 Now that the lease has been extended on the home, the Registered Providers must ensure that it is maintained in good condition. Some work has commenced, with the provision of new carpet in the halls and foyer. EVIDENCE: Although there has been some uncertainly about the future of the home, there are plans that it will remain open for another two years. During the course of the inspection, new carpets were fitted to the corridors and foyer of the home, which are a great improvement. However, there are areas of the home, including the bathrooms, which require redecoration and an Action Plan is required to ensure that the home is maintained in good condition. There is a large garden to the rear, which had just been mowed, and which provides a pleasant area for the service users. The Manager Designate said that the greenhouse had been cleared and the home has a volunteer who would be helping with some planting. Whilst keeping the home accessible to service users and visitors, more attention needs to be paid to the security of the home as, on all three visits to John Collin House DS0000022891.V286676.R02.S.doc Version 5.1 Page 19 the home, access was gained by the Inspector, once without staff being aware of this for some time. The Manager Designate said the problem arises because of people leaving the home without informing staff that the door needs to be secured after them. Although confidential information is in locked cabinets, the offices are generally left unlocked for access by the staff and would be vulnerable if unauthorised visitors gained access, as would the service users and staff. Each of the four units has its own small lounge and dining area, and there is a large lounge on the ground floor which is used for communal activities, such as bingo and coffee mornings. The foyer of the home is also used as a communal area. Although none of the areas can be used in complete privacy, there is the opportunity for service users to choose from a variety of places to spend time or to meet other service users. There is a lift to the first floor, and assisted facilities in all of the four bathrooms. All areas of the home are easily accessed. The bathrooms would benefit from being decorated and generally brightened and this needs to be included in the action plan. The home has two shared rooms, which are en suite, and one single room with en suite. The remaining twenty one are single rooms, with wash hand basins. Both double rooms had single occupancy at the time of this inspection and there was one single room vacancy. One person was pleased to be given the opportunity of moving from a double room to a single. The rooms seen were pleasantly furnished and the service users spoken to, regarding the furniture and fittings available, said that they had the items they required. The carpets had been recently shampooed in the home and no malodour was detected. This had been the subject of a requirement at the previous inspection. The hall carpets were replaced towards the end of the inspection which should assist with this. The home was found to be generally clean and hygienic. New washing machines had just been installed and the company representatives were in the home giving instructions on their use. As the laundry has no natural ventilation, a new extractor system has been required, by the company, to be installed. John Collin House DS0000022891.V286676.R02.S.doc Version 5.1 Page 20 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): 27, 28, 29, 30 Although there has been a number of management changes in the home, there has been some consistency with the use of regular permanent and relief staff. However, the home relies on relief staff to complete the rota each week and a permanent staff team needs to be recruited. Not all of the basic training courses have been undertaken by the staff and there has been a lack of opportunity for staff to gain National Vocational Qualifications. All of these need to be addressed. EVIDENCE: Few agency staff have been used except when there was a recent bout of sickness among staff and service users. However, the home relies on relief staff to cover the rota even when there is little leave or training being taken by permanent staff. It was noted that eleven shifts were being covered in one recent week. The Registered Providers have introduced a rule that staff may not work for more than 60 hours a week. This still allows for staff to work more than eight shifts a week, which may have health and safety implications, particularly if worked as double shifts over consecutive days, as was seen on the rotas examined. The home needs to have a full compliment of staff to cover the rota and sufficient to cover for leave and training. The current staffing level allows for five staff in the four units throughout the day and two waking night staff. The rota also provides for the Assistant Manager and the Senior Care staff to cover most early and late shifts. The senior on duty for the late shift also sleeps in at night. There is a team of John Collin House DS0000022891.V286676.R02.S.doc Version 5.1 Page 21 staff for the domestic and laundry duties and the catering is contracted to an external company. Very few of the staff have undertaken National Vocational Qualifications training and only two from the current staff team are qualified, one with NVQ Level 2 and one with Level 3. The Manager Designate said that the Registered Providers are in process of finding a college to verify the training as there are three NVQ assessors among the senior staff. The Manager Designate is undertaking her NVQ Level 4 independently. The Registered Providers were required, at the last inspection, to produce an Action Plan to demonstrate how the home will meet the target of having 50 of the staff trained. Because of the lack of progress, a further Action Plan is required to show how the target will be met. A sample of staff recruitment files showed that most of the requirements of the National Minimum Standards and Care Home Regulations 2001 have been met. However, not all of the files had photographs of the staff and some of the references seen were not completed with the dates of employment. It must be ensured that the staff files contain all of the information required by Schedules 2 and 4 of the Care Home Regulations 2001 and comply with the National Minimum Standards to help to safeguard the service users. A spreadsheet had been compiled showing all of the staff training which has been undertaken. The records showed that not all of the staff have manual handling, health and safety, food hygiene, COSHH or fire safety training and this must be rectified. The Manager Designate said that she was in the process of booking courses through Servite Houses and the London Borough of Hounslow, who offer access to training courses. In the files of two staff, in post for some months, the induction records were blank. It is a requirement that records of staff induction are available for inspection and it needs to be demonstrated that they have the information and training to carry out the work. This must be rectified. John Collin House DS0000022891.V286676.R02.S.doc Version 5.1 Page 22 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): 31, 32, 33, 35, 36, 37, 38 There have been recent and ongoing changes in the management of the home, which have not supported the consistency of record keeping and general management of the home. EVIDENCE: Since the last inspection, the Registered Manager has left the home and a new Manager Designate had been in post for eight weeks at the start of this inspection. The post is being advertised, on a two year fixed contract, and the Manager Designate was in the process of applying to the Commission for Social Care Inspection to become the registered manager in the interim. There is an Assistant Manager but the remaining permanent senior staff member was about the leave Servite Houses. The second senior has only been in post for a short time, although has many years of experience. There are two care staff, one who is employed by an agency, who cover the senior care posts when required. John Collin House DS0000022891.V286676.R02.S.doc Version 5.1 Page 23 Some consistency has been provided to the service users by the use of regular relief staff, rather than agency staff. However, the changes have not assisted with the general running of the home and record keeping, which needs updating and monitoring on a regular basis, both by senior staff and by the staff carrying out Regulation 26 visits on behalf of the Registered Providers. On the most recent report seen, some deficiencies were noted but not included in the plan of action to be undertaken by the Manager. An external company carried out a customer satisfaction survey and a copy was submitted to the Commission for Social Care Inspection. However, this was not produced in a user-friendly format and it was noted that service users’ families, in the minutes of a recent relatives’ meeting, did not feel that it reflected the views they had expressed. The home still needs to produce a review of the quality of care, in accordance with Regulation 24 of the Care Home Regulations 2001. This requires a system of reviewing at appropriate intervals, and improving, the quality of care provided in the care home. The system of keeping the service users’ financial accounts was examined. A straightforward system is maintained, with the record of transactions, receipts and cash balance being held individually for each service user in pre-printed envelopes. The majority of service users have small amounts of money provided by relatives for day-to-day expenses such as the hairdresser, newspapers, chiropody and bingo. Five of the service users have money held by Servite Houses. The Manager Designate said the accounts are interest bearing. The management staff makes requests for cash and larger sums have to be requested through senior managers. Only a limited amount of money can be held by the home on behalf of each service user and the Manager Designate or Deputy Manager check the accounts weekly and sign to say they have done so. A receipt book is used should relatives bring money to the home when managers are not on duty and receipts are kept for all transactions. The Manager Designate confirmed that no bank or building society books, or bank cards, are held on behalf of service users. The Manager Designate said that regular supervision sessions, which are carried out by managers and senior staff, are now underway. In the staff records examined, there was inconsistency, and not all of the staff had received one-to-one supervision on a regular basis. This was particularly noticeable in the new staff files, where staff should be seen to be supported through the induction period. It is intended that supervision sessions will now be held on a regular basis to meet the National Minimum Standards. A sample of the new format for supervisions was seen. Regular meetings of the senior team and the care staff, including night workers, are being held. Among the records sampled were those of the service users, staff, maintenance and complaints. The fire records were incomplete. Not all of the procedures required under the Servite Houses policy were being carried out John Collin House DS0000022891.V286676.R02.S.doc Version 5.1 Page 24 and the management staff need to ensure that there are systems in place to monitor the record keeping. An examination of the fire records showed that fire drills had not been held on a regular basis and limited fire safety instruction has taken place. Requirements, including an Immediate Requirement, have been made at the previous inspections in September 2005 and April 2005 to ensure that that staff attend sufficient fire drills to comply London Fire and Emergency Planning Authority guidance. An Immediate Requirement was issued for all of the staff to participate in fire drills by the 13th May 2006. Regular fire drills must be held to demonstrate that all of the staff are trained to deal with an emergency. Up until now, only in-house training on fire safety has been provided to staff but it is planned that the staff will be attending external courses. The staff member responsible for maintaining the fire records and providing guidance has not had fire safety training and it must be demonstrated that staff who provide specialised training have the knowledge and expertise to do so. The other fire records examined showed that no checks of the emergency lighting system had been carried out since 2003, when it was noted by the company carrying out the service that the system needed replacing. The lighting had not been checked on a monthly basis by the home’s staff. Arrangements were made with the Servite head office for the emergency lighting to be checked and this was due to take place the day after the final visit of this inspection. The Registered Providers must demonstrate that all of the health and safety procedures required are in place and that staff fully understand their responsibilities with regard to these. The fire risk assessment does not take into account all of the potential risks, such as service users smoking in their rooms, which one service user currently does. The risk assessment for this service user had not been reviewed. The risk assessments must be updated and reviewed on a regular basis. John Collin House DS0000022891.V286676.R02.S.doc Version 5.1 Page 25 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 3 2 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 3 X 3 X X 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 2 2 1 John Collin House DS0000022891.V286676.R02.S.doc Version 5.1 Page 26 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. Standard 1 OP3 Regulation 15 (1) Requirement Timescale for action 31/05/06 2 OP3 3 OP4 4 OP7 5 OP7 The care and support needs of new service users must be assessed in sufficient detail to identify that these can be met by the home. 14 (1) (a) Variations to the category of (c) registration must be made for service users who fall outside of these, detailing how the needs of the individual service users can be met. 18 (1) (a) It must be demonstrated that staff working with people with learning disabilities and other disabilities and illnesses have appropriate training to meet their needs. (Previous timescale of 31/12/05 not met) 15 (1) & (2) Care plans must be updated, and then reviewed on a regular basis, in consultation with the service users and their representatives. (Previous timescales of 31/12/04 and 30/11/05 not fully met). 12(1)a,b That the care plans for each 13 (4)c service user which relate to health, and to health and safety, are reviewed. That where the DS0000022891.V286676.R02.S.doc 31/05/06 30/06/06 30/06/06 30/06/06 John Collin House Version 5.1 Page 27 service users require support from medical professionals, appropriate advice is sought to complete the care plans. Risk assessments must be completed where risks are identified and the ways in which the risks can be reduced must be detailed. That care plans and risk assessments are reviewed on a priority basis, with those service users with health needs requiring support from medical professionals, and those requiring assistance with manual handling, being reviewed first. Professional advice must be sought where staff are not trained to carry out the assessments. IMMEDIATE REQUIREMENT ISSUED. 4 (1) (a) Appropriate referrals must be 12 (1) (b) made to health professionals where the needs of service users have changed and may fall outside of the home category of registration. (Previous timescale of 31/10/05 not fully met) 12 (1) (a) & The health needs of the service (b) users must be recorded and reviewed as necessary, with appropriate guidance in place to ensure their needs can be met. (Previous timescale of 30/11/05 not met) 13 (2) The systems in place for senior staff to monitor medication administration must be made more robust to ensure that errors can identified and rectified promptly. 18(1)c(i) Staff must receive induction and 17(2) Sch.4 training in the basic courses such 6g as manual handling, first aid, food hygiene, fire prevention and health and safety, and the records made available for DS0000022891.V286676.R02.S.doc 6 OP8 31/05/06 7 OP8 31/05/06 8 OP9 31/05/06 9 OP10OP30 31/07/06 John Collin House Version 5.1 Page 28 10 OP15 17 (2) Schedule 4 (13) 11 OP18 13 (6) 12 OP19 23 (2) (c) (d) 13 OP19 13 (4) (c) 23 (1),(2) 18 (1)(a) 14 OP27 15 OP28 18 (1) (a) 16 OP28 18 (1) (a) 17 OP29 17 (2) 19 (1) (b) 18 OP32 23 (2) (c) 26 (4) (b) inspection. Records of the food provided to the service users, to determine if their diet is satisfactory, must be maintained. (Previous timescales of 31/05/05 and 30/11/05 not met). All staff must receive instruction, by training or other means, in the procedures for safeguarding adults. (Previous timescale of 31/12/05 not met) An Action Plan is required to ensure that the home is redecorated where required, and furniture and fittings maintained in good condition. The security of the building must be improved to minimise the risk to service users, staff and property. The home must recruit sufficient permanent staff to ensure cover for the rota hours, leave and training. The Registered Manager must ensure that all of the staff have the required training to enable them to support the service users appropriately. (Previous timescales of 31/07/05 and 31/01/06 not met) An Action Plan is required to be produced to demonstrate how the home intends to meet the target of having 50 of the carers trained to NVQ Level 2. (Previous timescale of 30/11/05 not met) All of the information and documentation, under Schedules 2 and 4, which are required to be held for staff employed in the home must be obtained. (Previous timescales of 31/05/05 and 30/11/05 not fully met) It must be demonstrated that the health and safety DS0000022891.V286676.R02.S.doc 31/05/06 30/06/06 30/06/06 30/06/06 31/08/06 31/07/06 30/06/06 30/06/06 31/05/06 Page 29 John Collin House Version 5.1 19 OP33 20 21 OP36 OP37 22 OP38 23 OP38 24 OP38 25 OP38 26 OP38 requirements of the home are being monitored, through record keeping and documentation, by the management of the home and the Registered Providers. 24 (1) (2) & A system of reviewing the quality (3) of care in the home is required to be undertaken, at appropriate intervals, which demonstrates how the quality will be improved. (Previous timescales of 30/6/05 and 31/01/06 not fully met) 18 (2) Regular supervision of all of the staff team must take place. 17 (1) a,(2) Records must be kept in (3) accordance with Schedules 3 and 4 of the Care Home Regulations 2001 and monitoring systems in place to ensure that these are maintained and up-to-date. 18 (1)(c)(i) It must be demonstrated that 13 (4) staff who provide specialised training to the staff team must have the knowledge and appropriate training to be able to do so. 23(2)c,(4)c The emergency lighting system (iv) must be in good working order, maintained and checked on a regular basis. 13 (4) The Registered Providers must demonstrate that all of the health and safety procedures required are in place and that staff fully understand their responsibilities with regard to these. 23 (4) (c) The fire risk assessment must be (v) updated, and reviewed on a regular basis, and include the risks posed by service users, staff and visitors smoking in the home. 23 (4) (e) All staff must participate in fire drills by 31/5/06 and thereafter on a regular basis. Evidence of this must be provided. (Previous timescale of 31/05/05 not fully DS0000022891.V286676.R02.S.doc 31/07/06 31/07/06 31/05/06 30/06/06 31/05/06 30/06/06 30/06/06 31/05/06 John Collin House Version 5.1 Page 30 met) IMMEDIATE REQUIREMENT ISSUED. 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 OP1 OP9 Good Practice Recommendations That the information regarding the facilities and services in the home should be provided in formats which suit the communication needs of all of the service users. That staff administering medication make a note of the time of this so that senior staff monitoring can ensure medication is dispensed as close to the prescribed time as possible. In order to provide suitable activities to meet all of the service users’ needs, training in providing activities for older people and those with learning disabilities should be available to all of the staff. That other ways of consulting service users, perhaps on a one-to-one basis, are held to encourage service users to voice their concerns. 3 OP12 4 OP16 John Collin House DS0000022891.V286676.R02.S.doc Version 5.1 Page 31 Commission for Social Care Inspection West London Area Office 58 Uxbridge Road Ealing London W5 2ST 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 John Collin House DS0000022891.V286676.R02.S.doc Version 5.1 Page 32 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!