Inspection on 14/11/06 for John Collin House

This inspection was carried out on 14th November 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 13/04/06

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 Key Unannounced Inspection 10:00 14th November 2006 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.V313262.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. John Collin House DS0000022891.V313262.R01.S.doc Version 5.2 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 Care Home 26 Category(ies) of Learning disability (0), Learning disability over registration, with number 65 years of age (0), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (4), Old age, not falling within any other category (0) John Collin House DS0000022891.V313262.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. As agreed on the 9/05/2006, four named service users (1 Male, 3 Female) with a Mental Disorder can be accommodated within the home. 13th April 2006 Date of last inspection Brief Description of the Service: John Collin House is a detached purpose-built home situated in a residential area of Hounslow. The London Borough of Hounslow leases it to Servite Houses, who manage the home. It is situated between Hounslow Town Centre and Hounslow West, where there are shopping facilities and underground stations. There are bus routes passing 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 unit was previously designated as being for six people with learning disabilities but is no longer used for this purpose. Each unit has its own 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. There are two members of staff on waking night duty and a senior member of staff sleeps in each night. The provision of meals is contracted to a catering company, who employ the kitchen staff. The current fees for the home are £541 per week. John Collin House DS0000022891.V313262.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 14th November 2006 from 11.15am to 5.30pm. The Acting Manager was not present but the Deputy Manager was on duty. There were six care staff on duty in the morning and four in the afternoon. Further visits were carried out on 20th November to meet with the Acting Manager to discuss the outstanding requirements and, on the 28th November, to look at staff records. The inspection process took a total of twelve hours. The Acting Manager has been in post since March 2006 and had applied to the Commission for Social Care Inspection to become the Registered Manager. However, she has been appointed to a management position in another Servite home and no arrangements had been made for her departure or replacement. The home had twenty three service users. The three vacancies are in the two double rooms and one single room. The majority of the service users were met throughout the three days of the inspection. While the majority were spending their time in the four unit lounges, a small number choose to remain in their bedrooms. A small group choose to sit in the busy foyer of the home, which they said they enjoy. The home has four variations, for mental disorder, in addition to its usual categories of registration. There is one service user with learning disabilities in the home, who is over 65, who has an additional staff provision. Two tours of the home took place, one with the Deputy Manager. Three service users were spoken with privately, and three service users’ visitors were met. Two of the local district nurses, and a student, were met during one of their twice-weekly visits. Staff were busy making preparations for a service user’s 100th birthday party at the first visit and, at the second visit, service users said how much they had enjoyed the party. One visitor was particularly appreciative of the staff team’s efforts at making it a memorable occasion. Since the last inspection, some redecoration of the home has taken place, carried out by staff members. There are still several areas where improvements are needed, including the kitchenettes, bathrooms, toilets and corridors. The lighting in several areas is quite poor. The heating system was requiring some attention and this had been arranged. There were five care staff vacancies at the time of the inspection, although three staff were in the process of being employed. One senior staff member is employed by an agency and one was on secondment from another home. Relief and agency staff have been filling the vacant posts. There are some communication issues in the home which need to be addressed. The concerns John Collin House DS0000022891.V313262.R01.S.doc Version 5.2 Page 6 raised in this report regarding the health needs of a group of service users, were an example of poor communication, monitoring and a lack of training. Work was completed, after the last inspection, on the fire alarm system and the provision of emergency lighting. For an assessment of all of the key standards, this inspection report should be read in conjunction with the unannounced inspection of the 13th April 2006. At that inspection twenty six requirements were made. Six are repeated as not met or fully met. A further twelve requirements have been made at this inspection. What the service does well: What has improved since the last inspection? What they could do better: The Registered Providers need to clarify how the needs of the service users with special requirements are being met to enable prospective service users to make a decision about moving into the home. Whilst care planning documentation has been improved, the staff did not demonstrate that care plans are being followed accurately, that they are reviewed for compliance, or that the relevant health professionals have consulted where necessary. Staff undertaking any specialist health procedures must be provided with the relevant training and be shown to be competent to undertake the procedures. The information maintained in the medication files, and on the medication administration sheets, must be monitored regularly for accuracy. Any new procedures that are introduced into the home must have the guidance in place to support good practice and be in the best interests of the service users. John Collin House DS0000022891.V313262.R01.S.doc Version 5.2 Page 7 It has been a long outstanding requirement for the home to demonstrate that service users are receiving a nutritious and appropriate diet, particularly where they have health needs. A record of the food taken by service users would evidence that they have a diet that suits their needs and wishes. Staff showed a lack of awareness of taking action, and reporting, when a number of issues have arisen, particularly throughout this inspection. These included adult protection issues and a variety of health and safety procedures. Further guidance, training and monitoring is required to ensure that staff are fully aware of their responsibilities to support the safety of both service users and other staff. This includes the senior staff, who must undertake better dayto-day supervision of the units. Knowledge of the National Minimum Standards and the Care Home Regulations 2001, particularly the Schedules, could enable to staff to know better, and to understand why, records are required to be kept. Recording, particularly with regard to health needs, is poor and needs to be improved. Some of the staff team have undertaken work to improve the environment and some new furniture has been provided, but further work is required to bring the home up to a good standard throughout. An Action Plan is required to show when the necessary improvements to the décor, kitchenettes, bathrooms and lighting will be undertaken. While the Acting Manager has tried to ensure that the training needs of the staff are being met, there are still some staff without up-to-date basic training. Specialist training to support health needs was not undertaken until shortfalls were noted during the inspection. The home has not met the target of having 50 of the carers trained to NVQ Level 2 or above and a concerted effort is required to support staff to complete this qualification. There is evidence of poor communication among some of the staff team and a breakdown in relationships. The Registered Providers must work to improve these within the staff team to ensure that they are working together to support the service users, and to develop and improve the home. The organisation is putting into place some user involvement schemes but these had yet to commence. Although new quality assurance systems are planned, no review of the quality of care has been produced. This is an outstanding requirement and efforts should be made to look at ways in which the home can make improvements. 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.V313262.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 John Collin House DS0000022891.V313262.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 6 – Not assessed as there is no Intermediate Care unit. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although some progress has been made in providing specialist training to staff, it needs to be demonstrated that the home is meeting the varied needs of the service users accommodated in the home. The categories of registration no longer fully reflect the range of needs being met in the home and these need clarification. EVIDENCE: The home has four service users whose needs are outside of its current categories of registration. A further two service users are awaiting assessments for possible dementia and there are other service users in the home who may be experiencing the early stages of the illness. One service user’s file was seen to contain information regarding dementia, from a health care professional, but this has not been included in the service user’s original assessment and also needed to be followed up. The home is currently not equipped to provide specialised services for people with dementia, or other John Collin House DS0000022891.V313262.R01.S.doc Version 5.2 Page 10 mental illnesses, and needs to consider it categories of registration if the service users are to remain in the home. One of the units had, previously, been designated for six people with learning disabilities but only one service user remains for whom some additional staffing is provided. As the home is registered for both younger and older people with learning disabilities, the Statement of Purpose will need to reflect the changes to the service user group. As required at the last inspection, some of the staff team have now received learning disability and mental health training to be able to support the relevant service users. Further courses were being arranged for both subjects and approximately half of the staff team will have had training once these are held. Prospective service users need to be aware of the range of needs being met, to assist them to make an informed decision about moving into the home. One service user expressed the view that, because the home now caters for such as range of illnesses and disabilities, there is less opportunity to socialise with other service users. It is recommended that the Registered Providers consider the provision of a separate unit, or units, for people with dementia, if they wish the service users with this condition to remain in the home. A more appropriate environment, and staff with the relevant training, could then be provided. John Collin House DS0000022891.V313262.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 at least once during a 12 month period. 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. The new care planning system has provided clearer information about the service users’ needs. However, the information recorded, to evidence that the service users’ health needs are being fully met, must be monitored to ensure they are complete, accurate and current. The lack of monitoring around diabetic support was of particular concern. The appropriate training must be in place when staff undertake health care, and support from health professionals needs to be sought to monitor progress or concerns. Although the medication procedures show improvement, more attention needs to be paid to keeping records accurately. EVIDENCE: The care plans at the last inspection required updating. Since then, a new care planning system has been introduced. Care plans are now produced on the computer, which improves clarity. Paper copies are maintained in the service users’ files, which are stored in the individual units. It is planned that a review of this system, for effectiveness, will be undertaken in March 2007. John Collin House DS0000022891.V313262.R01.S.doc Version 5.2 Page 12 There is space on the care plan for monthly reviews to be documented and these were seen to have been recorded. However, when examining one of the service user’s files, who has diabetes, it was shown that there had been inconsistent recording of the blood sugar levels. Limited recording, or none, had been made of the action taken when the levels were too high or too low. Three further files of service users who have diabetes were checked but it was found that the care plans had not been followed. These all required twice weekly tests of blood sugar levels to be taken and these had not been carried out regularly. The care plans did not appear to be personalised to take into account each service user’s individual needs. None of the senior staff designated to carry out this procedure had received training. The Acting Manager arranged for training after the first visit, from nursing professionals, but this did not take place. Training was taking place on the third visit to the home. The Deputy Manager has produced new forms for recording, which include the dates of the tests, so that any gaps can be easily identified. After this concern was raised, the service users had readings taken. However, no action had again been recorded for a high reading and there was no evidence that this had been retaken that day. Robust monitoring must be in place to ensure that these procedures, which are only undertaken by senior staff, are carried out correctly. The Acting Manager said that the district nurses would be overseeing the recording, but probably only fortnightly. It was also noted that not all of the service users have regular monitoring of their diabetes, by health professionals, and referrals should be made to ensure this is available. The Acting Manager said that there had been no medication errors and, should they occur, they have to be reported to the Area Manager, with the name of the staff responsible, so that appropriate action can be taken. Service users’ medical and health visits are recorded on one sheet in the new care plans. One service user appeared not to have had any chiropody since April and, on another record, no chiropody at all had been recorded. The staff spoken to agreed that, on some occasions, records are not completed fully. However, one service user confirmed that a six month period had elapsed without a chiropodist attending and this had resulted in some service users paying privately. Senior and management staff, who each have responsibility for one unit, with a maximum of seven service users, must ensure that there is consistent and up-to-date recording carried out. The medication administration was examined in two of the units. A system is now maintained in each unit to keep a daily check on non-blistered medication. One service user was seen to have one tablet too many, and another service user one tablet too few, of the same medication. This had been noted although it was not clear what action had been taken when the error had occurred. John Collin House DS0000022891.V313262.R01.S.doc Version 5.2 Page 13 In Glade unit, the medication is currently stored in the filing cabinet with the care plans and close to where service users sit. The medication cupboard had been removed to accommodate service users having their meals in the unit. Although there is limited space within the unit, alternative arrangements need to be made to provide safe and secure medication storage for that unit. The Acting Manager said that it is planned to have individual medication cabinets in each bedroom and this is to be piloted in the Blossom unit, where cabinets were in the process of being installed. A policy and procedure was not available for this new administration. The timing, recording, key holding and monitoring of the system will need to be carefully considered as there are limited staff who undertake medication administration and it will need to be ensured that service users have their medication at the correct time. It was noted that the service users had not signed to give consent to having their medication administered and this should be added to the care plans. Any controlled and PRN medication is stored in a cupboard only accessible by senior staff. The stock of the controlled medication was checked and was found to be in order. However, the dosage for one service user had changed and some of the tablets were no longer in use, although still included in the total. The Acting Manager was advised that they should dispose of medication that is no longer prescribed. One of the Medication Administration Record sheets indicated that a service user should have two medications that were not available in the medication cupboards. The senior staff member on duty said that they were no longer being given and should have been deleted. Staff responsible for the medication procedures must ensure that the medication administration sheets reflect what is prescribed and, if discontinued, it must be clearly recorded on the documentation. The information in each medication folder, showing the staff who are trained to give medication, was out of date. This should clearly identify who is able to give medication, following appropriate training, with their name and initials for monitoring purposes. John Collin House DS0000022891.V313262.R01.S.doc Version 5.2 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. While the service users enjoy the activities that are provided, some would appreciate these on a more regular basis. There is no activities organiser and the care staff provide those which do take place, and any outings that are arranged. Limitations are inevitable as the units only have one staff member on duty in the afternoons and evenings. Concerns about the catering have been resolved and the service users were generally complimentary about the food provided. However, the continued lack of evidence regarding the meals taken, particularly where service users have special diets or health needs, must to be addressed to show that nutritional and health concerns are being met. EVIDENCE: There is no activities organiser in the home but staff team provide some communal activities, such as the coffee morning and bingo. The records showed that occasional quizzes, singalongs or exercise sessions are also held. A small number of service users go out independently, or enjoy occasional shopping trips with staff. One service user said that the exercises sessions that used to be arranged regularly are missed. A small group of service users John Collin House DS0000022891.V313262.R01.S.doc Version 5.2 Page 15 like to sit in the foyer of the home enjoy chatting with the staff, visitors and other service users who pass by. A short holiday had been planned for a small number of service users but, for various reasons, had not taken place. The Acting Manager said that they were hopeful that it could be arranged for next year. A number of outings had taken place in the summer, including a theatre trip for four of the service users. Outings were being planned to the Christmas lights in central London and a pantomime. The home has no transport and minibuses will be hired for this purpose. The big event, during the inspection, had been the birthday party for a service user who was 100 years old. Service users said that they were encouraged to “dress up” for the party and sounded pleased to do so. The service users seen after the event were very appreciative of the efforts of the staff. The Mayor had attended and the local paper had featured the event. Three visitors were seen during the inspection, who were positive about the care and support that the relatives and friends were receiving. The home has a relaxed atmosphere and the more able service users confirmed that they are able to choose how they spend their time. This may be by staying in their own rooms, or in one of the lounges. The less able service users usually remain in one of the unit lounges, and some choose to do so because of the opportunity for company. Although few are able to go out unaccompanied, those that can do so make use of the local facilities and public transport. A staff member reported that a 42” screen television is to be purchased so that the service users can watch films, and other programmes, in comfort. The money had been raised through the home’s fund-raising and charitable donations. Problems highlighted in the complaints log, regarding various aspects of the catering, have been resolved. The service users were generally complimentary about the meals, although one said that they were not cooked to their personal taste. The menu, with photographs of the dishes, is displayed in each unit. There has been a long outstanding requirement for the home to record the food provided to service users, to determine whether their diet is satisfactory, particularly where special diets are provided. No records had been kept in relation to any of the service users and, in particular, those with diabetes whose care plans detail that snacks should be offered on a regular basis. The Deputy Manager put in place a system to record meals, following the first visit, but it was noted, on subsequent visits, that staff were not maintaining these records. The home is required to demonstrate that service users have a satisfactory diet, in relation to nutrition and otherwise, and must provide evidence of this. John Collin House DS0000022891.V313262.R01.S.doc Version 5.2 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The complaints made in the home have been dealt with in a satisfactory manner. The reporting of potential adult protection issues needs to be improved and staff training, on the safeguarding of adults, should be extended to all staff. EVIDENCE: The recorded complaints, of which there had been nine since May 2006, have been dealt with promptly by the Acting Manager. A number of these had concerned the food and staff had advocated for a number of service users in making the complaints. Action has been taken to remedy the situation. Two issues of adult protection had been raised in the home, both of which were investigated by the London Borough of Hounslow’s safeguarding adults officer. The second one had not been reported promptly to the local authority or the Commission for Social Care Inspection. Neither of the issues were taken further. Staff need to be more aware of the processes to be taken in the event of any allegation. Eight of the staff still required training on adult protection, which has now been arranged. John Collin House DS0000022891.V313262.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 at least once during a 12 month period. 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. The home is reasonably comfortable, and staff have made an effort to make a number of areas more homely. Improvements are still outstanding for the kitchenette areas and the bathrooms, and the lighting also needs attention. EVIDENCE: An Action Plan had been required at the previous inspection to show how the home would be maintained to a reasonable standard. No work has been carried out by the Registered Providers but the staff had undertaken some painting in unit lounges and other areas to improve the environment. The paintings, many undertaken by a former service user of the home, are hung throughout the building and help to provide interest. The Acting Manager said that there had been no provision in the home’s budget to complete the refurbishment and redecorating work but this would be available in the new financial year. This should provide for the replacement of John Collin House DS0000022891.V313262.R01.S.doc Version 5.2 Page 18 the kitchenette cupboards in the four units, some of which are in poor condition. The bathrooms, toilets and corridors also require upgrading and the Acting Manager said that these would be included in the new budget. She also said that, although they had tried, it had not been possible to improve the lighting in a number of areas because of the current fittings and this needs attention. Several service users said that they enjoyed the garden in the summer and it is a pleasant area to use. The greenhouse had been cleared earlier in the year and brought back into use. Staff said that vegetables had been grown in the summer, with service user involvement. Some bedroom furniture has been replaced and further furniture had arrived recently for a number of bedrooms. One service user expressed pleasure with the new furniture provided. The bedrooms seen on this inspection were comfortably furnished and service users confirmed they had the items they needed. As required at the last inspection, the security of the building has improved. Although the front door can be opened from the inside without assistance, staff need to be called to let visitors in. On each of the three visits to the home, the front door was found to be secure. There remains an odour of urine in some areas of the home. The Acting Manager said that shampooing of the carpets has not eradicated the problem, so non-slip flooring is to be provided in two bedrooms and carpet in three of the bedrooms. She agreed that new service users would be offered carpet should they be provided with a room which has only floor covering. It was reported that there has been some difficulty in finding new service users to share the double rooms. John Collin House DS0000022891.V313262.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 at least once during a 12 month period. 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. Three of the five care staff vacancies had been filled but staff had not yet commenced because documentation was still required. Further recruitment is required to complete the care staff team. Urgent attention needs to be given to providing a permanent management team to support the service users, improve communication and to support the development of the staff, particularly in relation to undertaking National Vocational Qualification training. The training in relevant areas, such as mental health, dementia and common illnesses, must be continued to ensure that the service users can be supported with any special needs. The outstanding training for the staff in the basic courses, such as manual handling, need to be completed as soon as possible to minimise any risk to the service users. EVIDENCE: There have been a number of staff vacancies in the home for some months. Three staff had been recruited but were awaiting their Criminal Records Bureau disclosures before commencing. Two care worker vacancies remain, one for day and one for night. The position of part-time handyperson is also to be advertised. The training schedule provided included all but the latest training courses staff had attended. Those for foot care and working with people with learning John Collin House DS0000022891.V313262.R01.S.doc Version 5.2 Page 20 disabilities had not been added and it was noted that there were some gaps in basic training which still needed to be undertaken. The Acting Manager said that she was in the process of arranging the outstanding training and has managed to access training from the London Borough of Hounslow, as well as using the Servite Houses courses. Evidence of the courses was provided. The home has not met the target of having 50 of the staff trained to National Vocational Qualifications Level 2 or above. Of the fifteen care staff in the home, two of the night staff have NVQ Level 3 and two other staff have NVQ Level 2. Four staff have been accepted to commence the qualification at Level 2 and are due to start shortly. Another place had recently been made available. However, the college had not accepted a number of staff and others require ongoing support to undertake the qualification. As the home has an establishment of twenty care staff, an Action Plan is required to show how the 50 target will be met within a reasonable timescale. A third visit was made to the home to look at the staff records as these has been the subject of a requirement at the previous inspection. The Acting Manager has provided a file of information for inspection should the management staff not be present. However, this was incomplete and an examination of the full records was required. While these were found to be in better order than previously, the information regarding one Criminal Records Bureau disclosure was not available. The Deputy Manager was asked to check with the Servite Houses personnel department that they had obtained this. No information was available for a seconded member of staff. Information, for all of the staff working in the home, must be available for inspection to evidence that the documentation is in place and has been obtained before staff commence work. No new staff have been employed since the last inspection on a permanent basis so the induction processes could not be fully examined. John Collin House DS0000022891.V313262.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 36, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Because of the imminent changes to the management of the home, the Registered Providers need to ensure that the current difficulties are resolved as promptly as possible. There needs to be a strong and consistent management team in the home during the changes, and in the future, to develop and improve the home. Although there have been some improvements, in supervision, training and the environment, these need to be maintained. Better monitoring of the systems is essential, particularly in regard to the health needs of the service users. There is a lack of staff awareness about the responsibilities of reporting, to safeguard the service users and other staff, and this must be addressed. John Collin House DS0000022891.V313262.R01.S.doc Version 5.2 Page 22 EVIDENCE: The home was going through another change of management at the time of this inspection. The Acting Manager, who had joined the home in March 2006, was to leave shortly for a post in another Servite home. She has gained her National Vocational Qualification at Level 4 and the Registered Managers Award. One of the Senior Care Workers is on secondment from another home and the second senior is employed by an agency, although has worked in the home for some time. The Area Manager said that management arrangements would be made to cover the interim period when the Acting Manager leaves and a new manager is appointed. The staff team need to be aware, through training and guidance, of their responsibilities to report where there are any shortfalls in the support of service users. The review of care plans must take into account whether or not the plan has been followed and should, wherever possible, involve the staff members who work with the service user, the service user and their families. This lack of consultation and proper review was highlighted in the examination of the care plans of the service users with diabetes. Management staff had not monitored the procedures sufficiently well, or checked that staff were following the care plans. Another incident, involving missing items belonging to a service user, was brought to the attention of a senior member of staff during the inspection but had not been communicated to other members of the management team. There are issues in the home, which were being investigated at the time of the inspection, regarding staff relations, and these need to be resolved at the earliest possible time. The Registered Providers must work to improve the relationships within the staff team to ensure that they are working together to support the service users. With the imminent departure of the Acting Manager, it is of the utmost importance that this is addressed. The Acting Manager explained that a new quality assurance system was being introduced into the home. As part of this, a group in each home, which has representatives from the service users and their families, are to examine the policies and procedures. Each home had been allocated a number of policies and procedures to go through. The group was to meet shortly to commence work on this. There has been no review of the quality of care this year and this is an outstanding requirement. A supervision schedule is now in place and this provided evidence of the staff supervision in the last year. Because of some deficiencies in the amount of supervision that took place with previous senior staff, not all staff will meet the National Minimum Standard of participating in a minimum of six sessions a John Collin House DS0000022891.V313262.R01.S.doc Version 5.2 Page 23 year. However, the situation in the second part of the year was seen to be much better and staff are now receiving regular supervision. The Deputy Manager had attended a fire “training for trainers” course during the inspection to enable fire awareness training to be given to the staff team. He had produced a programme for the staff, which included instruction four times a year for day staff and six times a year for night staff. The trainers from the company were due to come to the home within the next two weeks to look at the building and advise on appropriate staff training. There were a number of issues during the visits that demonstrated a lack of staff awareness of health and safety procedures, and a failure to report to senior staff when repairs or maintenance were required. During a tour of the home, the fire door to the stairs in Meadow unit stairs needed adjustment to close properly. This had not been repaired by the second visit, although a company had been sent in to do so. The Acting Manager said that she had arranged for a further visit to be made. During the second visit, the COSHH cupboard in Glade unit was found unlocked and unattended. The materials are kept in the kitchenette cupboard, close to where the service users sit and where they have meals. The staff did not seem aware of the dangers of this. On the last visit to the home, whilst walking around the home with the Deputy Manager, the COSHH cupboard in another unit was unlocked and the member of staff said that this was because it was broken. Although this was not so, the member of staff had not reported that it was considered to be broken, nor removed the potentially hazardous materials. The provision of doors which lock automatically, and do not need a key to secure them, should be considered for cupboards where COSHH materials are stored, particularly in the kitchenettes. Every effort is needed to minimise the risk to service users. When the fire risk assessment was read, it was found that mention was made of the combustible materials under the stairs. The Acting Manager said that, because of the lack of storage, some of the cleaning materials and the hoist were kept under the stairs. It was not known if any of these were combustible. For safety, no materials should be stored under the stairwells and, if this had been identified as a concern in the fire risk assessment, then action should have been taken to remove the items. This was brought to the attention of the senior staff who said that the items would be removed. Since the last inspection, the fire alarm board has been replaced. It had been noted then that the home had no working emergency lighting and this has now been provided. A spreadsheet is now in place to show when staff have attended fire drills. John Collin House DS0000022891.V313262.R01.S.doc Version 5.2 Page 24 A number of accidents were seen in the files which should have been reported under Regulation 37 of the Care Home Regulations 2001. The management staff were asked to ensure that the staff team know when to report to the Commission for Social Care Inspection. John Collin House DS0000022891.V313262.R01.S.doc Version 5.2 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 2 X 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES5 Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 X X 3 X 2 John Collin House DS0000022891.V313262.R01.S.doc Version 5.2 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. 1 Standard OP1 OP4 Regulation 4 (1)(a) 12 (1)(b) Requirement Timescale for action 31/01/07 2 OP7 3 OP8 4 OP8 5 OP9 To enable prospective service users to make a choice about the home, the categories of registration, and the way in which special needs are met, require clarification. The Statement of Purpose must reflect this. 12(1)(a) Where service users have care 15(2)(b) plans for health needs, these must be individual, produced in conjunction with the relevant health professionals. These must be reviewed for accuracy and compliance. 12(1)(a) Staff undertaking any specialist 18(1)(c)(i) health procedures with service users must have the relevant training and be shown to be competent to undertake the procedures. 12 (1)(a) & Service users’ health and medical (b) needs must be referred to the appropriate health professionals for assessment and treatment. 13(2)17(1) The information maintained in (a) Sch.3, the medication files, and on the 3(i) medication administration sheets, must be checked on a regular DS0000022891.V313262.R01.S.doc 31/12/06 31/01/07 31/01/07 31/12/06 John Collin House Version 5.2 Page 27 6 OP9 7 8 OP9 OP15 9 OP18 10 OP19 11 OP28 12 OP29 13 OP32 14 OP32 basis for accuracy and be kept up-to-date. 13(2), 17 Policies and procedures, including (1)(a) guidance on record keeping, for the administration of medication from individual medication cupboards, must be in place before the new system commences. 13 (2) Appropriate and safe storage of medication must be available. 17 (2) Records of the food provided to Sch.4 (13) the service users, to determine if their diet is satisfactory, must be maintained. (Previous timescales of 31/05/05, 30/11/05, 31/05/06 not met). 13(6),18 All staff must be aware of the (1)(c)(i) procedures for reporting adult protection issues, though training or other means, and to take the appropriate action as any issues arise. 23(2)(c)(d) An Action Plan is required to show when the necessary improvements to the décor, kitchenettes, bathrooms and lighting will be undertaken. 18(1)(c)(i) 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 or above. (Previous timescale of 30/11/05 and 30/06/06 not met) 17(2) All of the information, under 19(1)(b) Schedules 2 and 4, which are required to be held for staff employed in the home, must be available for inspection. 12(5)(a) The Registered Providers must work to improve the relationships within the staff team to ensure that they are working together to support the service users, and to develop and improve the home. 23 (2) (c) It must be demonstrated that the 26 (4) (b) health and safety requirements of DS0000022891.V313262.R01.S.doc 31/01/07 31/12/06 31/12/06 31/12/06 28/02/07 31/01/07 31/12/06 31/01/07 31/12/06 Page 28 John Collin House Version 5.2 15 OP33 16 OP37 17 OP38 18 OP38 the home are being monitored, through supervision and record keeping, by the management team of the home and by the Registered Providers. (Previous timescale of 31/05/06 not met) 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 31/07/06 not met) 17 (1)(a), 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. (Previous timescale of 31/05/06 not fully met). 13 (4) The Registered Providers must 37 demonstrate that all of the health and safety procedures required are in place and that staff fully understand their responsibilities in regard to health and safety and for reporting any deficiencies. (Previous timescale of 30/06/06 not fully met). 13 (4) The COSHH materials must be stored safely at all times. 31/03/07 31/12/06 31/12/06 15/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations That the Registered Providers consider the provision of a unit or units to meet the special needs of the service users DS0000022891.V313262.R01.S.doc Version 5.2 Page 29 John Collin House 2 OP38 with dementia. The provision of locks which close automatically, on the cupboards which house COSHH materials, should be considered when the kitchenettes are replaced. John Collin House DS0000022891.V313262.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection West London Area Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE 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.V313262.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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