Inspection on 17/04/07 for John Collin House

This inspection was carried out on 17th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

John Collin House 14/11/06

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 Unannounced Inspection 17th April 2007 09:45 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.V334768.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.V334768.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 ****Post Vacant**** 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.V334768.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. As agreed on the 9/05/2006, four named people (1 Male, 3 Female) with a Mental Disorder can be accommodated within the home. 14th November 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, 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 people 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 a Registered Manager, an Assistant Manager, three Senior Support Workers, 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 £551 per week. John Collin House DS0000022891.V334768.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 17th April 2007 from 9.45am to 4.45pm. The Manager Designate, who has been in post since December 2006, was present. In addition to the senior support staff member, five support staff were on duty. An additional visit took place on the 23rd April to examine further records and to meet more people living in the home. The Servite Houses Quality Manager, who is newly in post, was met on this occasion and the Inspector has discussions with him and the Manager Designate regarding their future plans for the home. One visitor was met during the inspection, which took a total of twelve hours. The home has twenty three people living permanently in the home, one of whom was in hospital. One person was staying in the home for a week’s respite. The Inspector met and spoke with most of the people living in the home during the two days of the inspection. Some were in their bedrooms, others were sitting in the lounges or the foyer. On the first visit, communion and a coffee morning were arranged and a small group of people took advantage of the mild weather to have afternoon tea in the garden. The busy foyer remains a popular place for people to sit and talk to visitors and staff. The Inspector toured the home and examined samples of records, which included care planning files, medication administration, maintenance and complaints. In each of the four units’ dining areas, lunch was observed. The Inspector sampled some of the food on offer. Several people said they had enjoyed their lunch. Since the last inspection, there have been a number of staff changes. The Manager Designate had recently been appointed as the permanent manager, having been employed previously through an agency. There has been no Deputy Manager in post but an appointment was made between the visits to the home. Agency and relief staff are being used to fill the five support worker and two senior support worker vacancies. The recruitment process had commenced and the Manager Designate was short listing from a large number of applicants. At the second visit, a St. George’s Day lunch was being held in the large lounge. The Inspector was also in the home when the evening meal of soup and sandwiches was being served. Between the two visits, a large flat screen television had been obtained and the people watching in the communal lounge, during the early evening, were very pleased with it. There have been no major changes to the environment, but redecoration is planned for a number of areas and estimates for work to improve the lighting have been sought. John Collin House DS0000022891.V334768.R01.S.doc Version 5.2 Page 6 At the last inspection in November 2006, there were eighteen requirements. Fifteen of these were met or partly met. Three have been repeated at this inspection and an additional thirteen have been made. The changes in management, lack of permanent care staff, and changes to the administrative procedures, have not assisted the process of keeping records updated or helped to develop the quality of care. However, the new management staff showed an awareness of the shortfalls and had started to address these. The Registered Providers were providing additional support from senior management to assist this process. What the service does well: What has improved since the last inspection? What they could do better: Better information on the way in which special needs are met by the facilities, staffing and activities in the home, needs to be included in the Statement of Purpose. The Statement of Purpose and Service Users Guide are required to be kept up-to-date and include all of the information to enable prospective users of the service to make an informed decision about choosing the home. The inclusion in the Service Users Guide of the terms and conditions, in respect of accommodation to be provided for service users and the fees, will aid this process. A more thorough system of assessment, of the people wishing to move in to the home, is needed so that all their needs can be seen to be fully assessed, any specialist support is taken into account, and the home can be shown to have the capacity to support these. John Collin House DS0000022891.V334768.R01.S.doc Version 5.2 Page 7 People using the service must have the opportunity to have the fullest input into their care plans. Regular reviewing of the plans is needed to ensure they are accurate and complete, and everyone has their needs and wishes taken into account. Care plans must have full information about health needs and how they are met. Where required, these must be produced in conjunction with the relevant health professionals. Regular reviewing for accuracy and compliance will support the wellbeing of the people using the service. The completion of risk assessments, with guidance on risk reduction, will assist in the promotion of safety. Although medication administration is better, staff awareness of the procedures for checking medication stock needs to be improved so that records are accurate. Insufficient recording of food intake, where people using the service may have special dietary and nutritional needs, has been taking place. The evidence is required that people are encouraged to maintain a good balance of foods, suitable to meet any special needs they may have. There are still a number of environmental issues which still need to be addressed and the Registered Providers are required to provide an Action Plan to show when the improvements to the décor, kitchenettes, bathrooms and lighting will be undertaken. The target of having 50 of the staff team with National Vocational Qualifications Level 2, or above, has not been met. The Registered Providers must provide an Action Plan to show how the home intends to do meet the target to demonstrate staff development and training. Systems to review the quality of care, such as surveys of the people using the service, their families, and professionals visiting the service, have not been integrated into the home’s development plan. Some staff did not demonstrate a good awareness of health and safety procedures, particularly in relation to the storage of potentially hazardous materials. The Registered Providers need to strengthen this knowledge, by training or other means, to ensure that staff fully understand their responsibilities in regard to health and safety, and for reporting any deficiencies to equipment or fittings. The updated information on the Care Home Regulations 2001 was not available in the home. To support the new management staff to fulfil their responsibilities, the Registered Providers need to ensure that current documentation is available, and staff are provided with the information they require. John Collin House DS0000022891.V334768.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. John Collin House DS0000022891.V334768.R01.S.doc Version 5.2 Page 9 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.V334768.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 (6 does not apply) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The documentation to support people to make a decision about moving to the home is not current or sufficiently informative. The information regarding the terms and conditions that people wishing to use the service are required to have has not been provided. The assessment procedures do not always take account of individual needs and preferences or demonstrate how these will be accommodated. There is a lack of clarity about how specialist needs are being met. EVIDENCE: Copies of the Service Users Guide and the Statement of Purpose were not available and had not been provided to the people most recently admitted. The Manager Designate said that the information had not been updated but this would now be done now that permanent management appointments have been made. John Collin House DS0000022891.V334768.R01.S.doc Version 5.2 Page 11 The Manager Designate said that the contracts/terms and conditions had not yet been made available to all of the people coming into the service. These should be available, with the Service Users Guide, to ensure people have the information they require about the facilities and services. It was requirement at the last inspection that the home clarifies, in its Statement of Purpose, how it will meet the needs of the people using the service. The home has people who have developed dementia and a number who have mental health difficulties. People have been admitted to the home whose primary need does not fall within its categories of registration. The Statement of Purpose is required to have the information to demonstrate how people with dementia, mental health concerns, learning disabilities or any other specialist needs, have their support needs met. The Statement must evidence how the staffing levels, environment, facilities, training and activities are suitable to provide for these needs. From the information gathered, and discussions with the people using the service, the actions of a small number of people are affecting the quality of life of others in the home. One person had asked to move to another unit and this had been accommodated. The Manager Designate said that she is taking action to try and bring these situations to a satisfactory conclusion, through discussions with professionals and families. The provision of a unit or units to specifically meet the needs of people with dementia is again recommended to ensure that the people using the service have choices and have their individual needs met. Issues had been noted on the referral documentation which needed to have clarification before the admissions were agreed. The Manager Designate must ensure that all of the needs of the person have been seen to be considered and that agreements are reached regarding health care, or other requirements, so that any difficulties are minimised. As there have been no changes to the staffing levels, types of activities, or environment, the needs of people with diagnosed dementia, for instance, would need to be carefully considered. Not all of the care plans and risk assessments demonstrate that specific needs can be accommodated or how the support is achieved. The home does not have an Intermediate Care unit, so this key standard could not be assessed. John Collin House DS0000022891.V334768.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care planning and risk assessment procedures have not been completed or reviewed to demonstrate that all of the health or social needs of the people using the service have been fully considered. Better monitoring of the information is required to ensure accuracy. Risk assessments are not satisfactory, or fully completed, to demonstrate how the risks can be minimised and safety promoted. Staff awareness of medication monitoring still needs to be improved. EVIDENCE: Since the last inspection, a new care planning system has been introduced. Not all of the care plans, or the risk assessments, have been prepared for all of the people in the home or thoroughly reviewed. Some of the new care plans were incomplete, particularly where the details of interests and life histories were to be recorded. John Collin House DS0000022891.V334768.R01.S.doc Version 5.2 Page 13 The Inspector examined five care plans in detail. The people for whom they were completed had signed some of them but one person had declined to sign any. Inaccurate information was seen on a number of care plans. The Manager Designate took action to correct these between visits, but monitoring is needed to ensure that information is correctly recorded initially. In order for care plans to be completed, and be more useful in supporting the people living in the home, the change to the new documentation should be concluded as soon as possible and priority should be given to achieving this. The risk assessment documentation was not sufficiently detailed for all of the risks to shown to have been taken into consideration. Only one person living in the home self-medicates but no risk assessment had been completed. This should have been carried out as part of the assessment processes so that the person’s welfare needs were taken into account before admission. Insufficient risk assessments were seen for a person, with diagnosed dementia, in respect of the person’s safety out of the home. The assessments need to be discussed, wherever possible, with the people using the service and the risk reduction plan seen to be agreed. At the inspection in November 2006, it was of concern to the Inspector that the care needs of people with diabetes were not being monitored sufficiently. The care plans did not reflect the individual health needs of the person. Although the care plans specified that blood sugar levels would be taken regularly, this was not being done. Shortly after this, senior staff were trained to take readings. However, the care plans have not been updated and this needs to be carried out in consultation with medical professionals. The Manager Designate raised her own concerns about the way in which the diabetes care is provided. She said that she intended to discuss this with the medical professionals who visit the home to try and improve the quality of the support. It was noted from the records that regular chiropody has not been available from the NHS. One of the senior staff explained the difficulties getting this service and showed evidence of requests sent for the service to be provided. If this support is not forthcoming, then alternative arrangements will need to be made to ensure that health needs are being met. Where people are required to pay for a service, this must be explained in the Service Users Guide. Plans to have medication stored individually in each person’s bedroom have not been put into practice and the system of having the medication stored in the four units continues. A medication cupboard has now been provided in the unit where medication was previously stored in a filing cabinet. This was in the process of being fitted during the inspection. John Collin House DS0000022891.V334768.R01.S.doc Version 5.2 Page 14 Medication is administered from a 28-day monitored dosage system. Although daily stock checks are in place for non-dosetted medication, an error had been found, on the day of the inspection, and reported to the senior staff. However, the wrong amount had been carried forward for three days and the total had not been checked against the number shown to be dispensed on the Medication Administration Record sheet. The systems for monitoring medication need to reviewed to ensure that they are sufficiently robust and that accurate stock checks are being made. The home’s policies and procedures for medication administration were found to be incomplete, with several pages missing. The people using the service were positive about the support they received from the staff and generally had no issues in respect of the way in which they are treated. However, there are a small number of people who, because of their personal circumstances, have concerns about living in the home. The Manager Designate was aware of these and was working to resolve the issues. There are two double rooms in the home but, as both have single occupancy at present, there are no issues in regards to privacy. John Collin House DS0000022891.V334768.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service are given the opportunity to join in a regular activities programme. Those people who are able to do so exercise choice about their daily lives. Friends and family are free to visit as they wish. The menu provided is popular with the residents but some have small concerns which could be addressed by regular consultation with the management and catering staff. EVIDENCE: The people spoken to during this inspection were generally satisfied with the quality of life in the home and the choices they are able to make about their support. There has been a more regular programme of activities and records were seen to support this. Those people not able to make informed choices tend to remain in the small lounges, generally where the televisions are on. Others choose to sit in the foyer, where is it busier, and there is generally music playing. A small number of people said that they preferred not to join in with any activities and confirmed that their wishes are respected. John Collin House DS0000022891.V334768.R01.S.doc Version 5.2 Page 16 The provision of a large screen television in the main lounge was seen as a welcome addition, particularly for those people who like to watch sport or films. Only one visitor was met during this inspection. People spoke of their friends and relatives visiting, occasionally on a daily basis. It has been an outstanding requirement for a number of inspections that the home meets the Care Home Regulations 2001 to have records to determine if the diet provided to people is satisfactory. This was particularly to demonstrate that people with special dietary requirements, such as those with diabetes, are shown to have a diet to suit their needs and promote good health. It was also noted that there are people with low weight. Their care plans need to reflect how this is being managed. In some cases, the care plans on health needs and nutrition were insufficient to show when additional support, such as food supplements, are required. Records are maintained of the food ordered from the kitchen, from the choices on the menu. Although charts had been introduced since the last inspection to record the amount of food taken, these had not always been completed. It was discussed with the Manager Designate that this system would not, without extensive cross referencing, demonstrate that individual dietary needs were being met or highlight any deficiency which may affect a person’s health. Where people choose not to comply with a planned diet, for instance, then this also needs to be recorded. Care plans need to be sufficiently detailed to demonstrate that health and dietary needs, and the wishes and choices of the person, are discussed and recorded appropriately. The monitoring of a person’s diet is required where the provision of an inadequate intake or inappropriate food may affect their health and wellbeing. The recording can be of particular importance when the home does not have a full complement of permanent staff, making monitoring more difficult. Although the people spoken to were generally positive about the meals, there was a concern from two people about too much salt in the main choice of the day, which was cottage pie with roast potatoes and mixed carrots and swede. One person chose the alternative of vegetable cobbler and a small number had requested sausages. The dessert was advertised as a “fresh fruit platter” but only in one unit was the fruit being prepared. In the other units, staff were offering a piece of fruit from the bowl and one person had supplied their own dessert. As fresh fruit should be available as part of the regular diet, an alternative dessert should be offered for variety. Two people were concerned about the kind of bread provided, which was not liked, and the type of sandwiches. John Collin House DS0000022891.V334768.R01.S.doc Version 5.2 Page 17 An external catering firm provides the meals and the contract had recently been awarded to a new company. A new cook was in post and the menu was due to be changed. Meetings were being held with the people using the service to decide on the menu they would like. A cooked breakfast is available twice weekly at present, prepared in the kitchenettes, and bread and sandwich fillings are available in each unit. There was some confusion between staff about how often fresh fruit was available. This varied between daily and twice weekly, which had been the system noted previously. The Manager Designate was asked to ensure that people living in the home, and the staff, are aware of what is available and when it can be supplied. This should be included in the Service Users Guide to minimise any confusion. John Collin House DS0000022891.V334768.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Although many people were aware that they could voice their concerns, not everyone has the full documentation to support them to use the formal procedures. Copies of the complaints policy, in formats to suit their needs, would support people using the service to know the procedure. Support for those less able to use the procedures, such as the provision of an advocacy service, should be explored. The safeguarding of people using the service has been addressed through the investigation of the concerns raised. EVIDENCE: One complaint had been made since the last inspection concerning the cleanliness of an area in the building. This had been satisfactorily resolved. The more able people using the service said that they felt they could voice their concerns, but there are a small number who, because of dementia or frailty, would be unlikely to make these known. The Manager Designate has recommenced residents’ meetings to ascertain peoples’ wishes and enable them to voice their opinions. Although the complaints procedure is available, the reissuing of the updated Statement of Purpose and Service Users Guide will ensure that everyone has a copy. Large print and other formats should be made readily accessible. Where people without families or friends need support, the use of advocacy services should be actively pursued. There have been two issues since the last inspection reported through the Safeguarding Adults department of the London Borough of Hounslow. Both John Collin House DS0000022891.V334768.R01.S.doc Version 5.2 Page 19 have been investigated by the Registered Providers and appropriate action taken. One was not reported initially to the Commission for Social Care Inspection but was treated subsequently as a disciplinary matter within the home’s procedures. John Collin House DS0000022891.V334768.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 23, 25, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. While most areas are reasonably comfortable, and some improvements have been made, the programme to bring all of the areas up to an acceptable standard, including the lighting, bathrooms and kitchenettes, has not been carried out. Some staff did not demonstrate that their awareness of their health and safety responsibilities would help safeguard the people living in the home. EVIDENCE: For a number of inspections, action has been required to bring areas of the home up to a good standard. This includes all of the kitchenettes in the four units, where doors and drawers are in a poor state of repair. The Inspector was informed that this work is to be undertaken. The lighting in many areas is too low and an estimate has been obtained for its replacement. John Collin House DS0000022891.V334768.R01.S.doc Version 5.2 Page 21 The bathrooms are in need of refurbishment and it is difficult to judge their cleanliness because of the worn fittings. The new Quality Manager was present at the second visit, with the Manager Designate, and said that they are to address the problems. In order to confirm this, the Registered Providers must have a programme of refurbishment and redecoration for the home, which includes firm timescales for action. One of the fire doors, to the first floor, has previously been in need of attention as it does not close properly. It was found not to close automatically on this inspection. The Manager Designate ensured that work was carried out to correct the fault and confirmed that it was in working order. It was not known if this had been reported by staff, who must be shown to take responsibility for the health and safety in the home. The bedrooms seen on this inspection had been personalised to suit the needs of the individual persons. Although the rooms are small, they are reasonably comfortable and the people able to comment said that they suited their needs. While most people are mobile, some use wheelchairs throughout the day. Although the home is not fully adapted for wheelchair use, there is a lift between the floors and most areas can be accessed. One person commented that wheelchair access in and out of the home, without having to call for staff assistance, would be a welcome addition to the facilities. John Collin House DS0000022891.V334768.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The lack of permanent management and care staff has not supported the home’s development or helped to provide continuity. The recent management changes should address this concern. Staff recruitment records were satisfactory, with information to safeguard the people in the home being available. Basic training is satisfactory but a training and development programme, to enhance the skills needed to support the diverse needs of the people using the service is lacking. EVIDENCE: Action is now being taken to recruit a full team of management and care staff on permanent contracts. The home has not had a permanent management team for a long period This, together with a high level of agency and relief care staff being used, has not supported the development and training of the staff team or provided consistency for the people using the service. It is also reflected in the way in which there is always ongoing work to try and ensure documentation is up-to-date and accurate. The Manager Designate had recently been confirmed in post as the permanent manager, after working for four months through an agency. A Deputy Manager was appointed during the inspection. The Manager Designate was also in the process of recruiting for the two seniors and five support worker vacancies, following a successful recruitment drive. John Collin House DS0000022891.V334768.R01.S.doc Version 5.2 Page 23 The Manager Designate has introduced a different method of handover between staff shifts, with time for this to be included within the rota hours. The Inspector attended one of the afternoon handovers. Although the handovers provide for a better level of communication, most staff were present at the session and there are limited staff around the home. The Manager Designate has introduced a more formalised system for staff taking their breaks to ensure that people are not left unattended and this should be extended to the handover periods. The files of five staff were checked. The Manager Designate acknowledged that there was work to be carried out on the recruitment files to ensure that they were in better order and these were examined on the second visit to the home. Most of the information to support the safeguarding of people using the service was in place but the Manager Designate had to find information about a visa, which she undertook between visits. The Manager Designate provided information on National Vocational Qualifications, which showed that the Manager and the Deputy Manager both have Level 4, one staff member has Level 3 and two have Level 2. One staff member is completing Level 3, four have commenced Level 2 and it is planned that five will commence Level 2 next September. Although four our of ten of the permanent staff have the NVQ, the home will not meet the target of having 50 of the care staff team trained to NVQ Level 2 or above for some time. Two domestic staff are undertaking a NVQ Level 2. Staff spoken to were positive about the training and one said that there was “lots of training” available. The recruitment records examined showed that staff had undertaken the basic training courses but the full information on training was not available, for all of the staff team, as the Manager Designate was in the process of collating this information. When this is complete, the Manager Designate should have in place an individual development plan for each member of staff to show the areas where training is required to enhance skills and how it is intended to achieve this. This needs to take into account the diverse needs of the people currently living in the home. John Collin House DS0000022891.V334768.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The recruitment of a permanent management team should ensure that the improvements which are required, particularly in relation to the accuracy of record keeping, will be achieved. Staff awareness of health and safety issues, and their responsibilities, is in need of reinforcement through monitoring and increased supervision. EVIDENCE: The new Manager Designate had just been appointed to the permanent staff, having worked in the home, for an agency, since December 2006. She was in the process of applying to the Commission for Social Care Inspection for registration. She has a Diploma in Nursing and the National Vocational Qualification Level 4. She intends to undertake the Registered Managers Award in due course. The information to keep the management of the home John Collin House DS0000022891.V334768.R01.S.doc Version 5.2 Page 25 updated with the changes to the Care Home Regulations 2001 was not in place. The Registered Providers need to ensure that management staff are supported to understand fully all of their responsibilities in relation to changes in legislation. At the last inspection, there had been a breakdown in relationships between a number of staff members. The Registered Providers gave information to show how they were attempting to improve the situation. There have been a number of staff changes since that inspection and Manager Designate said that she felt that the ethos and morale in the home were gradually improving. The Registered Providers have made available additional senior management support to improve standards in the home. No surveys have been given to people using the service, their relatives, or professionals, to gain their views of the home, its services, management or staff. A quality audit had been carried out in 2006 but there was no report available arising from this. The Manager Designate said that there is a working party in Servite Houses looking at user involvement but this was still due to report. She has introduced resident meetings as a way of hearing the views of the people living in the home. As mentioned elsewhere in this report, the record keeping in the home is in need of updating and monitoring for accuracy as a matter of priority. Without complete and accurate records, it cannot be evidenced that the home is meeting the Care Home Regulations 2001 and the National Minimum Standards. The changing documentation for care plans has taken some time to come into place. Staff need to be given sufficient time to prepare the information, in consultation with people using the service and their representatives, for it to be meaningful. The time to carry out monitoring of the care plans, risk assessment, medication administration and other records needs to be available to senior staff to ensure that the health and welfare of the people living in the home is being met. It had been a requirement at the inspection in November 2006 that COSHH materials must be stored safely at all times. At this inspection, all four of the unit kitchenettes, which are fully accessible to the residents, had COSHH materials in their unlocked cupboards. Two cupboards were without locks and the keys were missing for the others. The materials were removed and locks placed on the cupboards by the second visit. Some of the staff showed little awareness of this hazard, which is of particular concern given the number of people who have dementia or mental health difficulties. It has now been agreed that the kitchenette cupboard doors will be replaced. When this is done, it is recommended that, to aid safety, locks are fitted which lock automatically when the door is shut. This is preferable to those which have to be both opened and closed with a key. John Collin House DS0000022891.V334768.R01.S.doc Version 5.2 Page 26 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 2 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 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 3 2 X X X 3 X 2 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 John Collin House DS0000022891.V334768.R01.S.doc Version 5.2 Page 27 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 Regulation 4 (1)(a) 12(1)(b) Requirement Timescale for action 30/06/07 2 OP1 6 (a) & (b) 3 OP2 5 (1) (b) 4 OP3 12 (1)(b) 14 (1) The Registered Providers must ensure that, to enable people wishing to use the service to make a choice about the home, the categories of registration, and the way in which special needs are met, are clarified. The Statement of Purpose must reflect this. (Previous timescale of 31/01/07 not met) The Registered Providers must 30/06/07 ensure that the Statement of Purpose and Service Users Guide are kept up-to-date and include all of the information required to support prospective users of the service to make an informed decision about moving to the home. 30/06/07 The Manager Designate must provide each person using the service with a copy of the terms and condition in respect of accommodation to be provided for service users, including the amount and method of payment of fees. The Manager Designate must 30/06/07 ensure that people moving into DS0000022891.V334768.R01.S.doc Version 5.2 John Collin House Page 28 5 OP4 12 (1)(a) 6 OP7 15 (1) (2) 7 OP8 12 (1) (a) 15 (2) (b) 8 OP8 13 (4) 9 OP9 13 (2),18 (1)(c)(i) 10 OP15 17 (2) Sch.4 (13) the home have their needs fully assessed and that any specialist support they require is taken into account. The Registered Providers and the Manager Designate must ensure that the home can be shown to have the capacity to meet the needs of people that it admits in relation to their health and welfare. The Manager Designate must ensure that each person using the service has fully completed and accurate care plans, compiled in consultation with the person or their representatives, wherever possible, which are reviewed on a regular basis. The Manager Designate must ensure that care plans for health needs are current and produced in conjunction with the relevant health professionals. These must be reviewed for accuracy and compliance. (Previous timescale of 31/12/06 not met). The Manager Designate must ensure that appropriate risk assessments are completed, where any potential hazard is identified, with guidance for the reduction of harm to the person concerned and to the staff. The Manager Designate must ensure that staff are fully aware of their responsibilities for managing medication administration, are competent to do so, and understand the systems for identifying errors. The Manager Designate must ensure that records of the food provided for people using the service are documented in sufficient detail to enable any DS0000022891.V334768.R01.S.doc 30/06/07 30/06/07 30/06/07 30/06/07 31/05/07 30/06/07 John Collin House Version 5.2 Page 29 11 OP19 12 OP25 13 OP30 14 OP31 15 OP33 16 OP38 person inspecting the record to determine whether the diet is satisfactory, in relation to nutrition and otherwise, and of any special diets prepared for individual service users. 23(2)(c)(d) The Registered Providers are required to provide an Action Plan to show when the necessary improvements to the décor, kitchenettes and bathrooms will be undertaken. 23(2)(p) The Registered Providers are required to provide an Action Plan to show when the necessary improvements to the lighting will be undertaken. 18(1)(c)(i) The Registered Providers must provide an Action Plan to demonstrate how the home intends to meet the target of having 50 of the carers trained to NVQ Level 2 or above. 10 (1) The Registered Providers must ensure that management staff are supported to understand fully all of their responsibilities in relation to changes in legislation to enable them to manage the care home. 24 (1)(2) A system of reviewing the quality of care in the home is required to be undertaken, at appropriate intervals, which demonstrates how the quality will be improved. (Previous timescale of 31/03/07 not met) 13 (4)37 The Registered Providers must 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. 30/06/07 30/06/07 31/07/07 30/06/07 31/08/07 30/06/07 John Collin House DS0000022891.V334768.R01.S.doc Version 5.2 Page 30 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 OP38 Good Practice Recommendations That the Registered Providers consider the provision of a unit or units to meet the special needs of the people 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.V334768.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection West London Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI John Collin House DS0000022891.V334768.R01.S.doc Version 5.2 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. 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