Inspection on 19/04/05 for John Collin House

This inspection was carried out on 19th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

John Collin House 17/04/07

John Collin House 14/11/06

John Collin House 13/04/06

John Collin House 27/09/05

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 Jane Collisson Unannounced 19th April 2005 at 8.45am 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 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 Version 1.10 Page 3 SERVICE INFORMATION Name of service John Collin House Address Sutton Lane, Hounslow, Middlesex, TW3 3BB Telephone number Fax number Email 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 Ms Ivorine Facey Care Home 26 Category(ies) of LD(E) Learning disability - over 65, LD Learning registration, with number disability, OP Old age of places John Collin House Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 25/10/04 Brief Description of the Service: John Collin House is a detached purpose-built home situated in a residential area of Hounslow. It is leased to Servite Houses by the London Borough of Hounslow. Situated between Hounslow Town Centre and Hounslow West, there are bus routes close by. The home is registered for twenty six users who can be older people, or people with learning disabilities either over or under 65 years of age. There are four separate units, one of which has been designated for six people with learning disabilities. Each unit has a lounge/dining room with kitchenette area. A large 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 sleeping in room are located on the ground floor. There is a large garden around the home, with seating and a greenhouse. The staff team consists of the Registered Manager, an Assistant Manager, three Senior Carers, a team of day and night Support Workers, domestic and laundry workers. The provision of meals is contracted to a catering company, who employ the kitchen staff. John Collin House Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Unannounced Inspection was carried out on the 19th and 20th April 2005, between the hours of 8.45am and 5.45pm, for total of 11.75 hours. As the Registered Manager was not present on the first day, a second visit was made to discuss the progress of the requirements from the previous inspection, examine records and discuss the services being provided. The previous inspection took place in October 2004 when thirteen requirements were made. The Registered Manager confirmed that ten of these remain outstanding and an Immediate Requirement was issued for one of these regarding the fire drills. An additional seventeen requirements were made. There were twenty three service users resident in the home and the majority were seen and spoken to during the course of the inspection. Three relatives and one professional visitor were met. Service users and visitors raised concerns about the many changes of staff because of the level of agency staff used in the home. Only two permanent members of the day staff, in addition to the Registered Manager, were on duty during the two days of the inspection, leading to a lack of continuity for the service users. The home has a unit for six service users with learning disabilities, who can be either under or over the age of 65. Only two service users in this category were accommodated and the remainder of service users in the unit were older people. At previous inspections, it was required that there is training to support the staff to understand better the needs of people with learning disabilities, but this training has not taken place. There are also service users in the home who may have dementia but have not been professionally diagnosed. The home does not have a category of registration for people with dementia and, in order to accommodate people who have, will need to apply to make changes to this to the Commission for Social Care Inspection. Because these service users have specialist needs, the Registered Providers would need to ensure that there are sufficient staff to meet these, including the provision of suitable activities. Service users were found to be appreciative when activities take place, particularly the weekly bingo and coffee mornings. A group of service users enjoy using the foyer of the home as a meeting place and were seen to do so throughout the inspection. However, the lack of activities to stimulate and interest all of the service users, particularly those with specialist needs, is of concern. An examination of the care plans indicated that service users, and their representatives, have not been fully involved in the planning of their own John Collin House Version 1.10 Page 6 support. It could not be shown that the information on the health needs and risk assessments of the service users had been updated and all of the guidance put in place to support the service users where needs have changed. Meals were generally reported by the service users to be satisfactory although the presentation of the food seen during this inspection could be improved. A meal of chicken chasseur, carrots, beans and potatoes, followed by ginger sponge and custard was served on the first day of the inspection. Kidney turbigo was the alternative, but this was not chosen by any of the service users. Lamb curry, which was seen to be popular, or sausages, were the choices on the second day. It was found that fruit, soft drinks and snacks are not freely offered through the day and staff rely on service users asking for them. Not all of the service users were found to be able or willing to do so, and these items need to be actively offered on a regular basis by the staff. Service users were found to need reassurance that they can make requests that are acted upon. The service users and families were not confident that making complaints would bring positive action. Practical tasks had apparently not been carried out speedily in spite of frequent requests. Service users spoken to felt unable to make complaints about staff as they did not feel that action would be taken or it may be held against them. This is an area where the Registered Providers and the Registered Manager need to encourage a more open atmosphere in the home and ensure that all of the service users and their families benefit from this. Because it has been planned for some years that the home would be relocated, there are areas that have not been well maintained. It is now planned that the home will remain open for the next two years. Several areas of the home were found to need improvement including the kitchenettes, where there are several broken cupboards and drawers, and main kitchen. These must be brought up to a good standard to provide a safer and more comfortable environment for service users and staff. What the service does well: What has improved since the last inspection? What they could do better: Attention to the recruitment and retention of staff is essential to provide the continuity to the service users which is lacking at present. There are few John Collin House Version 1.10 Page 7 permanent staff members, particularly on day shifts, which was an expressed concern of the service users and their relatives. The recruitment of a permanent staff team, particularly the senior team, would improve the opportunity for staff to work individually with service users and ensure that their needs are being met by active involvement and better recording of their needs. Permanent staff can also be trained and developed to improve the quality of care to the service users. The completion of the management team of five staff, which currently has three vacancies including the post of Assistant Manager, is essential to maintain a good quality service. These vacancies impact on the supervision and support of the staff and the Registered Providers need to address this urgently. The expansion of the activities programme, perhaps with a activities organiser or by having staff trained in this field, would enhance the wellbeing and quality of life for the service users. The service users need to be assured that the activities will take place and are not subject to cancellation because of the staff changes. Concerns and complaints need to be dealt with in such a way that the service users and their relatives feel confident that appropriate action is being taken and that there are no repercussions should a formal complaint be made. The requirements and recommendations made at this inspection cover the range of concerns which have been addressed at this and previous inspections. The Immediate Requirement issued was to ensure that all of the staff have participated in a fire drill before the end of May 2005 as not all of the staff had been involved as required. Requirements have been made on staffing and management levels, training, activities, food and drink, the improvement of the environment and the documentation on care planning and health needs. Improvements are needed in the information that is given to service users and their representatives to enable them to make a decision about coming to live in the home. The home has also been required to look at its categories of registration to ensure that it can meet service users’ specialist needs. A recommendation has been made to support the service users to be more involved in choosing their meals and to know what is available. The Registered Providers are required to carry out the actions details in the requirements within the timescales given. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. John Collin House Version 1.10 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 Standards Statutory Requirements Identified During the Inspection John Collin House Version 1.10 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 standard(s) 1, 2 , 3, 6 The information available to service users does not provide sufficient information to support them to understand fully the running of the home and the facilities and service available. It is not demonstrated that the needs of service users with learning disabilities and those who have other specialist needs are being fully met. EVIDENCE: Service users spoken to during the inspection were not all aware of the information regarding the facilities and activities in the home. This included information about the complaints procedure. One service user commented that he/she had not been aware of the social activities in the home until some weeks after admission. The service users have been issued with a copy of the Statement of Purpose and Service Users Guide but these do not contain all of the information required by the Care Homes Regulations 2001. At the last inspection in October 2004, the Service Users Guide was required to be completed. Different versions of the documentation were seen and need to be dated to ensure that the most recent copy is available that includes up-to-date information. John Collin House Version 1.10 Page 10 The current Guide has been provided in larger print for service users with visual impairments but has not been provided in formats for service users with learning disabilities. In order to ensure that service users have the information they require to make a choice about where to live, and about the facilities available, the Service Users Guide needs to contain sufficient information and the documentation required by the Care Homes Regulations 2001. Further information on the needs of the service users that can be met by the home, and how they will be accommodated, needs to be added, particularly in relation to the service users with learning disabilities and other specialist needs. Where there are service users accommodated who are not within the home’s category of registration, the Registered Providers must ensure that their needs can be met if they continue to live in the home. Applications to change the registration of the home or variations to the home’s conditions must be made to the Commission for Social Care Inspection. The requirement to have each service user provided with a statement of terms and conditions has not been fulfilled by the Registered Providers. The service users, and their representatives, need to be issued with the information to ensure that they are fully aware of their rights and responsibilities. Needs-led assessments from Social Services care managers were seen in the service users’ files examined. However, no written confirmation information was seen to have been sent to service users to confirm that their needs could be met. In order for service users and their representatives to be assured that the home is suitable, this is required to be carried out. The home does not provide Intermediate Care facilities. John Collin House Version 1.10 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 standard(s) 7, 8, 9 The care planning in the home has seen limited improvement and the system being used is lengthy and not user-friendly. Not all of the information required to maintain the wellbeing of the service users was seen and there has been insufficient progress on monitoring the care plans to ensure that changing needs are being met. It has not been demonstrated that that service users and their representatives have been involved in planning their support. EVIDENCE: The system being used for care planning is lengthy, not particularly informative and would not allow the service users and their representatives to participate in the planning of their care. It has been required at previous inspections that care plans must be in place, updated and reviewed as required to ensure that the needs of the service users are known and appropriate support provided. The monthly visit reports, carried out on behalf of the Registered Providers, have also observed this deficiency. Five service users’ plans were examined and all were found to be in need of review to show that the service users’ current needs are being fully addressed. Service users or their representatives were not seen to have signed all of the care plans to evidence their approval. The lack of permanent and senior staff must be a factor in the lack of monitoring and updating of the care plans that takes place. The involvement of service users and their representatives, using a care planning system which John Collin House Version 1.10 Page 12 is user-friendly, would enable service users to be involved in their own support plans, demonstrating that their wishes and preferences are taken into account. The service users’ health needs are noted in the care plans but not all have been updated as changes have taken place, or recorded in sufficient detail to show that their needs are being met. It is particularly important, in view of the number of agency staff working in the home, that easily accessible information is in place to enable them to support the service users who may not be able to explain their needs. Several service users were met who would be unable to do so because of frailty and the possible onset of dementia. Their needs must be reassessed. One service user is awaiting a nursing home placement. Although one service user was noted to have epilepsy, no guidelines were in place to show how the staff would deal with a seizure and no assessments were in place to minimise the risk if this were to happen. The staff spoken to were unsure of the action which would be taken as the service user has not had any seizures since being in the home. The Registered Manager put guidance in place during the inspection after this was discussed with her. It was a previous requirement that risk assessments must be completed for service users who self-medicate. No service users were currently selfmedicating but in the care plans examined it was not clear if this had been considered as an option upon assessment. It needs to be demonstrated that service users have been consulted regarding how their medication will be administered and consent obtained if the home is responsible for this. One error was found in the medication stock in one unit. Following discussion with the staff, it was found that insufficient monitoring takes place to check for errors, such as non-signing or the inaccurate stock of medication. Senior staff must ensure that regular monitoring of medication administration is carried out and evidence provided that this is done. The practice of the home is that there are limited staff who are allowed to administer medication and it is usually the senior staff member on duty who does so. The lack of senior staff impacts on this arrangement. On the first day of the inspection the service users in one unit did not receive their morning medication until 10am, one hour after it was due. Another unit’s service users were still to receive theirs. One support worker had been administering medication in one unit but no information was available to show that his/her competency had been assessed and the person’s initials were not included on the sheet of staff responsible for administering medication. Sufficient staff must be on each shift, who are trained and demonstrated to be competent, to ensure that service users receive their medication as close to the prescribed time as possible to ensure their health needs are not adversely affected. John Collin House Version 1.10 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 15 Although there is a programme of activities advertised, these do not always take place and the service users have limited opportunities to go out of the home. Cultural and special dietary needs were found not to be fully met by the catering arrangements. EVIDENCE: Service users were appreciative of the social activities which do take place on the home, such as the weekly bingo sessions. However, other activities advertised, such as the coffee morning and a discussion, did not happen during this inspection and service users expressed disappointment about this. The activities programme is limited and Sunday’s activity was noted to be “relaxation”. The provision for a range of activities, which are seen to be of the service users’ choice, needs to be in evidence. The lack of a permanent staff team impacts on the opportunity for staff to get to know the service users and their preferences. A small group of service users are able to enjoy other service users’ company by sitting in the foyer of the home. In each lounge, the television was on without any indication that the programme was the choice of any of the service users. None of the service users indicated that the programmes were of their choosing and no-one appeared to be actively watching them. There are other options that service users might enjoy, including the use of music videos of their choice. Visitors to the home commented that this was not an option seen to be used, and another John Collin House Version 1.10 Page 14 commented on the unsuitability of some of the programmes which are chosen. The opportunity should be taken, through better consultation with service users and their families, to ensure that choices are available. Speaking to service users individually, or in small groups, may lead to a better understanding of their preferences, as would the completion of information on their hobbies and interests upon admission. A holiday was arranged last year which four service users attended. One service user expressed the hope this could be repeated this year although the lack of permanent staff may prevent this. The home has an open visiting policy for family and friends to see service users as they wish. Three family members were met during the course of the inspection. There is limited private space available, although the majority of the service users have single bedrooms in which to see visitors privately if they wish to do so. The catering in the home is by a private company who supply all of the food used and provide the kitchen staff. The majority of service users spoken to during the inspection were satisfied with the food provided. Although a menu is displayed on the kitchenette notice boards, it is in small print and few service users were aware of the meals they would be having for the day. It is recommended that menus are displayed more prominently, in a suitable format, that would encourage service users to make choices and know what is available for the day. A cooked breakfast is available twice a week, on set days, and has to be preordered so that the kitchen staff can provide the necessary food items to the unit. This does not encourage any spontaneous choice. Service users spoken to were not aware of the possibility of having a snack during the evening, and staff who were asked about its availability said that that tea and biscuits could be offered. Only bread and cheese were seen in the unit kitchenette refrigerators should a snack be requested. The menu should reflect the National Minimum Standard 15.3 that no more than a twelve hour gap should occur between meals. No fresh fruit was seen any of the units during the two days of the inspection which took place on Monday and Tuesday. The agreement with the catering company is that fruit is provided once a week, on a Monday, in the units and as an alterative to the dessert. This was discussed with the Registered Manager who said that service users are able to ask for fruit as they wish. Some of the service users spoken to were aware that fruit was available as an alternative to the desserts. The access to fresh fruit, as and when the service users wish to eat it, is essential to support a balanced and varied diet. As only two vegetables are offered at lunch, in addition to potatoes, the opportunity to eat the amounts of fruit and vegetables recognised as being necessary to maintain a healthy diet are not always available. It was also noted during the John Collin House Version 1.10 Page 15 inspection that none of the service users had soft drinks or water readily to hand throughout the day, other than at mealtimes. The Registered Manager said that they are available if requested. Senior staff need to monitor this situation on a regular basis to ensure that service users’ needs are known to all of the staff and that drinks are offered, rather than relying on service users who may be unable or unwilling to ask for them. Incorrect information was seen in one service user’s care plan regarding dietary requirements and the service user’s preferences were only partly met by the kitchen. The information on special diets required by individual service users, such as those who are diabetic, was not clearly shown in the kitchen. The kitchen staff agreed to put this in place. A record of meals chosen by service users is passed to the kitchen but there is no recording of meals actually taken. Regulation 17 (2), Schedule 4 (13) of the Care Homes Regulations 2001, requires that records are kept of the food provided to the service users, to determine if the diet is satisfactory, and to record if any special diets are prepared. John Collin House Version 1.10 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 standard(s) 16, 18 Because service users and visitors were not confident that complaints would be dealt with appropriately, the management and staff need to encourage service users to voice their concerns and to demonstrate that action will be taken without repercussions. The documentation in place for explaining the procedures is not user-friendly or sufficiently clear. EVIDENCE: Service users and visitors said that they had not wished to report their concerns as formal complaints to the management of the home. Their concern was that these would not be acted upon or that complaints about staff could be held against the service users. Although there is a complaints form in place, which goes to the Servite Houses Director of Care Services, the information given in the Statement of Purpose and Service Users Guide does not clearly demonstrate how the full range of concerns, from grumbles to serious issues, are dealt with. The large print version of the Service Users Guide does not have the procedure for complaining to the Commission for Social Care Inspection and other documentation still refers to the National Care Standards Commission, which may be confusing for service users and their families. The procedure needs to be improved to encourage service users and their families to be able to voice their concerns without fear of reprisals and be confident that complaints will be acted upon. A total of three complaints were seen to have been made in the last year which were substantiated. The Registered Manager confirmed that there have been no adult abuse issues in the last year. Agency staff confirmed that they do not take part in Servite Houses training, even if working regularly in the home, so may not have the training and information on adult protection required. The management of the John Collin House Version 1.10 Page 17 home need to make ensure that all staff are aware of the steps to be taken in the event of an adult protection issue arising and how service users should be protected. John Collin House Version 1.10 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 23, 24, 26 There are areas of the home which, because of the possibility of closure, have not been maintained to a good standard. In order to provide a pleasant and safe environment for the service users, the Registered Providers must have a programme of renewal and redecoration that addresses this for the lifetime of the home. EVIDENCE: The areas of the home which require attention includes the unit kitchenettes where there are broken drawers and cupboards which can no longer be repaired and are all in need of replacement. These areas would not be able to be used safely by any service users who might wish to use the facilities to make a cup of tea, for instance. Staff find these areas difficult to maintain in a reasonable condition. The door of the refrigerators in three of the areas have rust patches. The Registered Manager said that she now has the budget to replace these. John Collin House Version 1.10 Page 19 The home has a large garden which was being maintained on the day of the inspection. There are seating areas for the service users to use and the staff and service users confirmed that the garden is used during good weather. A greenhouse is available for the service users’ use. One service user expressed an interest in using this facility and said that staff have indicated they would be willing to give support. The communal lounge on the ground floor, which is used for social activities, has recently been recarpeted. Although this area could be used for meetings, the main kitchen and staff room are located off the room, and are in regular use, so complete privacy is not assured. There are four bathrooms, one in each unit, and twelve toilets, for the use of the service users. Assisted baths are available. The service users have the use of the lift to the first floor. The service users’ bedrooms seen on this inspection were comfortably furnished. They are all around 12 square metres and are generally able to accommodate the furniture the service users require. Service users are able to bring items of their own and, where they have done so, this is recorded in their files. A previous requirement to have locked areas for the service users’ private items or medication storage has not been actioned, except for the provision in one service user’s room. This requirement remains outstanding. There are areas of the home which were found to have an odour of urine. This was also noted on a recent monthly visit carried out on behalf of the Registered Provider. This is unpleasant for the service users, staff and visitors to the home and needs to be addressed by additional cleaning, or replacement of the floor coverings where the problem cannot be eradicated by cleaning. John Collin House Version 1.10 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29, 30 There has been little progress in filling the large number of vacancies for care workers and senior staff. The Registered Manager is aware of the implications for the service users, and for the training and development of staff, where the majority of the team are not permanent. Although some recruitment has taken place, there is little improvement because of the high level of vacancies. EVIDENCE: It has been an ongoing concern that there has been a lack of a permanent staff in the home and has been a requirement that the Servite Houses recruits sufficient and suitable staff, to provide cover and continuity for the service users. Visitors and service users both commented on the many changes of staff, one commenting that they appeared to “change every month” and another remarked that the home seemed to have problems in retaining staff. Apart from the Registered Manager, only two permanent staff were on the early and late duty rota during the inspection. The remainder of the care staff, domestic staff and laundry staff were either agency or bank workers. The lack of permanent staff means that staff training is limited and that the supervision and development of staff is not maintained. Bank staff undertake an induction programme, which includes first aid, manual handling, food hygiene and fire precautions and it was seen that three bank staff and a permanent staff member had recently undergone this training. Not all of the inductions records were completed. Regular agency staff do not participate in the Servite Houses training courses. The Registered Manager must ensure that all of the staff have the required training to enable them to support the service users appropriately. John Collin House Version 1.10 Page 21 For the protection of service users, it was a requirement previously that the staff records documentation was completed and available. This requirement has not been completed satisfactorily as the Criminal Records Bureau disclosures were not available for inspection and full employment histories have not been recorded. All staff working in the home are required to have this necessary documentation before the commencement of work. This requirement is repeated. An Action Plan for NVQ training, to show how the target of having at least 50 of the staff trained, was required after the last inspection in October 2004. Because of the lack of permanent staff, there remains a limited number of staff with the qualification. It has not been evidenced that the home has provided staff with the training to work with the service users who have specialist needs, such as those with learning disabilities. Although additional staff have been provided on the unit designated for six service users with learning disabilities, there is little evidence of that extra services are provided. Staff training to meet the specialist needs of the service users with learning disabilities was a requirement at the October 2004 inspection but the Registered Manager confirmed that this training has not yet taken place. This requirement remains outstanding. John Collin House Version 1.10 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) The lack of a full senior team and use of agency and bank staff does not promote the strong management and leadership of the home that is required to provide a consistent and high quality service to the service users. The monitoring systems in the home are not robust enough to ensure that all of the required tests and checks, to maintain the health and safety of the service users, are carried out as required. EVIDENCE: Since the last inspection the Manager has been registered by the Commission for Social Care Inspection. She has a Certificate in Management Studies and has commenced the NVQ Level 4 in care. She has had experience of working with older people for a number of years. The lack of permanent staff, particularly among the senior staff team, has not assisted in developing a positive management ethos. The individual supervision and day-to-day management of staff cannot be satisfactorily John Collin House Version 1.10 Page 23 undertaken without a consistent staff team and the Registered Providers must address this. The lack of positive comments about the home is an indication that there is room for improvement to increase the wellbeing of the service users. Although service users’ meeting are held, the last one was in January 2005, and service users spoken to did not indicate that they were consulted fully regarding their daily lives. Not all of the service users appeared able to make decisions and their representatives need to be fully involved in this process. A review of the quality of care is required under the Care Homes Regulations 2001 and to evidence that service users, their representatives, staff and professionals have been given the opportunity to improve the quality of life in the home. Service users and their representatives need to be kept informed of the future plans for the home. The lack of senior management staff has not assisted the requirement, made at the inspection in October 2004, that staff have regular supervision to develop their practice, give guidance and to provide a good quality care to the service users. The Registered Manager said that the requirement has not been met in accordance with the National Minimum Standards. From the fire records examined, the previous requirement for all of the staff to undertaken regular staff drills had not been carried out. An Immediate Requirement was issued to ensure that all of the staff in the home undertake a fire drill by the end of May 2005. It was also a previous requirement that the emergency lighting is checked regularly. The Registered Manager said that the current system does not allow for the system to be tested independently. She said that it is planned to replace the system with one that can be tested regularly. In the meantime, the lighting continues to be tested when the fire alarm servicing is carried out. Although health and safety checks, including those on the service users’ rooms, were seen to be carried out by staff on a regular basis, the action taken when faults are found was not necessarily recorded. It has been of concern to a visitor to the home that maintenance issues are not addressed when reported, sometimes on a number of occasions. Monitoring of the checks needs to take place to ensure that work identified is actioned. The home is required to be kept in good repair and equipment must be maintained in good working order to ensure risks to service users and staff are minimised. John Collin House Version 1.10 Page 24 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 1 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 x 15 2 COMPLAINTS AND PROTECTION 2 3 3 x 3 2 x 2 STAFFING Standard No Score 27 1 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 1 x 2 3 2 2 x x 2 x 1 John Collin House Version 1.10 Page 25 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 5 (2) Requirement The Service Users Guide must be completed in accordance with the Care Homes Regulations 2001 and include the terms and conditions. (Previous timescale of 31st December 2004 not met) The Statement of Purpose must be completed in accordance with the Care Home Regulations 2001. Appropriate Contracts/Terms and Conditions must be issued to each user, agreed and signed by them or their represenatives.(Previous timescale of 31st December 2004 not met) The home must only admit service users whose needs it can meet, in acccordance with its Statement of Purpose. (Previous timescale of 30th November 2004 not met) The Registered Manager must confirm to prospective users that thie needs can be met by the home before admission. Care plans must be in place for all service users, updated and reviewed as required. (Previous timescale of 31st December Version 1.10 Timescale for action 30/6/05 2. 1 4 (2) 30/6/05 3. 2 5 (1) (b) 30/6/05 4. 3 14 (1) 15/5/05 5. 3 14 (1) (d) 15/5/05 6. 7 15 (1) & (2) 30/6/05 John Collin House Page 26 2004 not met) 7. 8 12 (1) (a) & (b) The health needs of the service users must be recorded and reviewed as necessary, with appropriate guidance in place to ensure their needs can be met. Senior staff must ensure that regular monitoring of medication administration is carried out and evidence provided that this is done. Sufficient staff must be on each shift, who are trained and demonstrated to be competent, to ensure that service users receive their medication as close to the prescribed time as possible to ensure their health needs are not adversely affected. The Registered Manager must ensure that service users are consulted regarding the activities available in the home and the community. Special diets required by service users must available in accordance with their needs and preferences. The provision of sufficient and varied food, in adequate quantities must be provided and be available at times reasonably required by the service users. Records of the food provided to the service users, to determine if the diet is satisfactory, and to record if any special diets are prepared, are required to be kept. The complaints procedure must be improved and action taken to to encourage service users and their families to be able to voice their concerns without fear of reprisals and be confident that complaints will be acted upon. The management of the home Version 1.10 31/5/05 8. 9 13 (2) 15/5/05 9. 9 12 (1) (a) 13 (2) 31/5/05 10. 12 16 (2) (m) & (n) 31/5/05 11. 15 12 (1) (a) 16 (2) (i) 16 (2) (i) 15/5/05 12. 15 15/5/05 13. 15 17 (2) Schedule 4 (13) 31/5/05 14. 16 22 31/5/05 15. 18 13 (6) John Collin House Page 27 16. 19 23 (2) (b) (c) (d) 12 (4) (a) 23 (2) (m) 17. 24 18. 19. 26 27 16 (2) (k) 18 (1) (a) 20. 28 18 (1) (a) 21. 28 18 (1) (a) 22. 29 23. 33 17 (2) Schedule 4 (6) 19 (1) (b) Schedule 2 (7) 24 (1) (2) & (3) must ensure that all staff are aware of the steps to be taken in the event of an adult protection issue arising and how service users should be protected. A maintenace and replacement programme must be made available to show how the home will be kept in good condition. Lockable spaces must be provided in service users bedrooms to ensure service users are afforded privacy. (Previous timescale of 31st December 2004 not met) Where the odour of urine cannot be removed by cleaning, the floor coverings must be replaced. Sufficient, suitable staff must be recruited to provide cover for the rota, training and leave. (Previous timescale of 31st December 2004 not met) The Registered Manager must ensure that all of the staff have the required training to enable them to support the service users appropriately. (Previous timescale of 31st January 2005 not met) An Action Plan is required to be produced to demonstrate how the home intends to meet the target of having 50 of the carers trained to NVQ Level 2. The documenation required to be obtained for staff employed must be obtained, and be available in the home for inspection. (Previous timescale of 31st December 2004 not met) A review of the quality of care is required to be undertaken, submitted to service users and the CSCI, and involve consultation with service users and their representatives. Version 1.10 30/6/05 30/6/05 30/6/05 31/7/05 31/7/05 31/5/05 31/5/05 30/6/05 John Collin House Page 28 24. 25. 36 38 18 (2) 23 (4) (e) 26. 38 13 (4) 23 (2) (b) & (c) 23 (2) (b) & (c) 27. 38 The staff must receive regular supervision. (Previous timescale of 31st December 2004 not met) Evidence of the staff attending sufficient fire drills in accordance with the London Fire and Emergency Planning Authority guidance must be recorded. (Previous timescale of 31st December 2004 not met) IMMEDIATE REQUIREMENT ISSUED Health and safety checks which identify that repairs or replacements are required must be seen to be actioned. Suitable systems and monitoring must be in place to ensure that the premises are kept in a good state of repair and the equipment provided maintained in good working order. 31/5/05 31/5/05 31/5/05 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 15 Good Practice Recommendations It is recommended that menus are displayed more prominently, in a suitable format, that would encourage service users to make choices and know what is available for the day. John Collin House Version 1.10 Page 29 Commission for Social Care Inspection Ground Floor 58 Uxbridge Road Ealing London W5 2ST National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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