Inspection on 27/09/05 for John Collin House

This inspection was carried out on 27th September 2005.

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

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

Other inspections for this house

John Collin House 17/04/07

John Collin House 14/11/06

John Collin House 13/04/06

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 27th September 2005 15.20 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.V252646.R01.S.doc Version 5.0 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.V252646.R01.S.doc Version 5.0 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 Ms Ivorine Facey Care Home 26 Category(ies) of Learning disability (0), Learning disability over registration, with number 65 years of age (0), Old age, not falling within of places any other category (0) John Collin House DS0000022891.V252646.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service Users to include older people, older people with a learning disability and younger service users with a learning disability, up to 26 users 19th April 2005 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. Servite Houses leases the building from the London Borough of Hounslow. Situated between Hounslow Town Centre and Hounslow West, there are bus routes to both 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 DS0000022891.V252646.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection commenced on 27th September 2005 from 3.20pm to 8pm. The Registered Manager was present for part of the inspection only so additional visits were made on the 6h, 7th and 17th October to meet with her to discuss the previous requirements and look at additional records. The inspection took a total of ten hours. There were twenty service users living in the home initially and two more were admitted during the course of inspection. The majority of the service users, ten of the staff and four family members were met. The service users’ records were examined, along with records for the staff, fire precautions, medication, accidents, meals and maintenance. Four vacancies remain in the home. The unit designated for six people with learning disabilities is full, but only two service users have learning disabilities. The remainder are frail older people. There were twenty seven requirements at the inspection in April 2005 and twenty two of these have been met. Five are restated and a further nine have been made. What the service does well: What has improved since the last inspection? There has been a successful recruitment drive and a number of new care and housekeeping staff have been employed who are currently waiting for their employment checks to be completed. The records indicated that more planned activities are taking place, including trips to the coast and local amenities. The administration of medication was previously only undertaken by senior staff and it was found that, on occasions, this could not be given at the specified time. Other care staff have now being trained to give medication, which should improve the situation. However, further monitoring of the system is still required to ensure that medication is administered in accordance with the prescribed instructions. Service users now have more information about the meals being provided and photographic menus are used to support them to choose their meals. John Collin House DS0000022891.V252646.R01.S.doc Version 5.0 Page 6 What they could do better: Because the home’s category of registration is not for service users with dementia, it must be ensured that appropriate referrals are made to health professionals where the needs of service users change. Although improvements have been made to the care planning systems, the care plans were not all seen to be regularly reviewed. The health care needs of one service user were not seen to have been included in the care plan and there was no guidance for staff to support the service user’s condition. Health needs must be recorded and reviewed as necessary, with appropriate guidance in place to ensure their needs can be met. There are areas of the home where physical improvements still need to be made. This includes the kitchenette areas and new floor coverings in a number of areas. A programme of redecoration is needed to improve the general appearance in some of the communal lounges and kitchens. Although the deep cleaning of carpets had commenced during the inspection, the odour of urine in some areas of the home remains. Where it cannot be removed by cleaning, the floor coverings must be replaced. A number of concerns were found in the administration of medication. This included the late administration of the lunchtime medication, which had been a concern at the last inspection. One error of non-administered medication was found during a sample check of stock. Better monitoring and more robust systems need to be in place to ensure medication stocks are regularly checked, particularly those not in the monitored dosage system. Staff competency needs to be tested were errors are found and systems introduced to minimise them. Although the information on menus and on service users’ special needs is improving, the recording of meals taken by the individual service users must be undertaken to show that they are receiving a nutritious and wholesome diet. There are areas of training which require improvement. Not all of the staff have adult protection training and the home’s management needs to 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. Training or refresher courses for the basic training needs, such as first aid, health and safety, or food hygiene, need to be undertaken by all of the staff and several staff needed manual handling training, which must be a priority. Training to work with people with learning disabilities, older people, and to provide activities, are areas where specialist training is required. The home has not reached the target of having 50 of the care staff trained in NVQ. Not all of the documentation required to be obtained for staff employed was available for inspection. This has been a previous requirement and the Registered Manager must ensure that it is available to be inspected. John Collin House DS0000022891.V252646.R01.S.doc Version 5.0 Page 7 The organisation has not carried out a review of the quality of care, although a new quality system will be introduced in the New Year. It needs to be shown that service users and their representatives are regularly consulted about the activities, services and facilities in the home. Evidence of the staff attending sufficient fire drills, and training, in accordance with the London Fire and Emergency Planning Authority guidance, must be recorded. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. John Collin House DS0000022891.V252646.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection John Collin House DS0000022891.V252646.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Information is available for prospective service users and their representatives to assist them to make a choice about the home, although not presented in formats to meet the needs of all of the service users. It needs to be demonstrated that staff have the training to meet the requirements of service users with special needs. EVIDENCE: Prior to the last inspection, the Statement of Purpose and Service Users Guide were not completed in accordance with the Care Homes Regulations 2001 and did not include the terms and conditions. These were amended and copies of these, dated April 2005, were received by the Commission for Social Care Inspection. Although information has been provided in large print, it is not provided in formats suitable for people with learning disabilities or those with visual impairments. In order to meet the needs of all the service users in the home, it is recommended that the Service Users Guide is produced in other formats. Service users and their representatives had not previously had all of the information on the fees payable. The files examined on this inspection showed John Collin House DS0000022891.V252646.R01.S.doc Version 5.0 Page 10 that details from the Local Authority on the fees payable by Social Services and by the service users are now included in the service users’ files. However, Licence Agreements supplied to the service users had not been completed by the inclusion of the fees. This was brought to the attention of the Registered Manager who said that she will ensure the details are included in the Licence Agreements. These need to be completed prior to service users being asked to sign them. At the last inspection, it was required that the home must only admit people for whom it is registered and whose needs it can be shown to meet. A service user, with a diagnosis of dementia, is no longer in the home and the Registered Manager said that she would no longer admit service users with this diagnosis in the future. However, one service user seen on this inspection may have dementia and the Registered Manager was advised to make the appropriate professional referrals. In the six-bedded unit designated for people with learning disabilities, there are currently two people with learning disabilities with the remainder of rooms accommodating older people. Although additional staff are rostered for this unit, no staff have had learning disabilities training to support them with the work and there are no specialised activities. It needs to be demonstrated that the home is able to meet the needs of this service user group. Although service users are able to visit the home before admission, two service users who were due to be admitted on the first day of the inspection had not visited to help them make their decision. One was an emergency placement but, as the other service user had been in hospital for some months, the opportunity could have been taken to visit the home and this should always be encouraged. Both service users, who had family members visiting, were seen during the later visits to the home and appeared to have settled in well. John Collin House DS0000022891.V252646.R01.S.doc Version 5.0 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Progress has been made in improving the care plans although not all have been reviewed to reflect changes in support or had information on all of the service users’ needs. Insufficient monitoring of the medication procedures has resulted in service users not having their medication at the correct time or errors being identified speedily. Increased monitoring by senior staff is required to rectify this. EVIDENCE: The care planning sampled has generally improved. This followed a requirement at the last two inspections for all care plans to be in place, updated and regularly reviewed. Regular reviews, held in consultation with the service users and their representatives, would evidence that needs are being met, and their views are taken into account. However, some care plans had not been reviewed for some time. It was recommended to the Registered Manager that the senior staff, who are responsible for the updating, should provide information on a monthly basis, to her, to ensure that this is carried out. The presentation of the care plans makes them easier to follow but a new Servite Homes system, which can be used on the computer, is to be introduced by December 2005. From the documentation seen, it appears to be John Collin House DS0000022891.V252646.R01.S.doc Version 5.0 Page 12 comprehensive but also need to be easy to follow, both for staff, service users and their representatives, and be able to be monitored. Current care plans have no social history or background information, which could enable service users’ social needs to be better met but provision for this is made in the new care plans. At the last inspection, it was required that better recording of the health needs of the service users, together with appropriate guidance where necessary, was in place. At this inspection, visits from health professionals were seen to be recorded and district nurses have a book for recording treatments. However, the presence of pressure sores, for which a service user was being treated, were not noted on the care plan of a service user, nor any details of equipment being used to alleviate the problem. The Registered Manager agreed to ensure that appropriate information on the care plan was completed, in conjunction with the district nurses. An audit of care plans is required to take place to ensure that all health needs are recorded appropriately. The risk assessment in place for one service user, who has had falls, was recorded as being low. The risk assessments need to be reviewed regularly and monitored to ensure that an accurate assessment has been made. Those staff carrying out risk assessments need to have the appropriate training to do so. There were concerns noted at the last inspection regarding the late administration of some medication, due to the fact that only the senior staff were able to perform this task. Since then, some care staff have been trained to administer medication and evidence of competency testing was provided. The pharmacist who supplies the monitored dosage system is providing training. However, on the last day of this inspection, in two of the units, the lunchtime medication was not administered at the times shown on the Medication Administration Sheet sheets. The Registered Manager was made aware of this situation, which appeared not to be unusual, and said that she would ensure that this is corrected. It is advised that staff record the time that medication is administered so that this can be monitored. Although the Assistant Manager said that medication is checked at two handovers a day, and a monitoring sheet has been put in place, an error was found on one unit. This showed that one tablet too many in stock. It could not be shown when the tablet was not administered as there had been no stock check. The Registered Manager must ensure that all medication stock is checked on a regular basis and she was advised to get staff to monitor the amount of non-dosetted medication daily. To avoid errors in PRN (“as and when”) medication it is now kept separately, and only the senior staff on duty have access. A list of the staff able to administer medication are kept on each unit. The master list held centrally did not accord with those lists held on the units and senior staff must take responsibility for ensuring that records are John Collin House DS0000022891.V252646.R01.S.doc Version 5.0 Page 13 current, so that it can be seen that only staff deemed competent administer medication do so. The service users spoken to confirmed that they are supported by staff in a respectful manner. They are able to use the areas of the home that they prefer, such as the foyer but can remain in their bedrooms if they wish to do so. Service users now have the option of using a lockable space in their bedrooms for the storage of personal items. John Collin House DS0000022891.V252646.R01.S.doc Version 5.0 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): A new system has been introduced to record the social activities offered to the service users which has provided evidence that opportunities have been available. However, this needs to be maintained and further opportunities provided for all of the service users to enjoy appropriate leisure pursuits. EVIDENCE: A lack of regular activities in the home has been noted at previous inspections. A new activities record book is being maintained which demonstrated that both regular indoor activities and outings have been offered. Two trips to Brighton, one to Windsor and one to Kew Gardens have taken place this summer. There are weekly bingo sessions which staff said that most of the service users attend and service users said that they enjoy. A group of service users gathered in the communal lounge for “singalong” during the first day of the inspection and a small group met during the evening to enjoy the televised football. Other service users like to meet in the foyer, where there is a small seating area, to chat to each other and to people visiting the home. Two service users said that they had enjoyed, in the past, gentle exercise sessions but these no longer take place. Whilst the improvements are to be welcomed, there needs to be an effort to maintain and develop the activities and it is recommended that activities training for the staff is provided to work with older people and those with learning disabilities. John Collin House DS0000022891.V252646.R01.S.doc Version 5.0 Page 15 Three of the service users met said that they preferred not to join in any communal activities and that this is respected by the staff. An autumn bazaar was due to be held at the weekend following the end of the inspection to raise money for outings and activities. One service user is involved in a fund-raising scheme and another was knitting for the bazaar. There are notice boards in each lounge to inform service users of any events taking place. To keep service users up-to-date with activities and other events, the suggestion of a newsletter to service users, in a suitable format, was raised with the Registered Manager who said that she would consider this. The families of three service users were seen during the inspection visiting at different times of the day. The Service Users Guide states that the home has an “open visiting” policy. Improvements are being made to provide information to service users about the meals available and about recording their special needs, following requirements at the last inspection. The catering company has provided attractive menus for each table, with photographs of the main dish, for lunch and evening meals. The options for snacks are not included, although bread and sandwich fillings are available in the unit fridges. The Registered Manager said that she would speak to the catering company about including these on the menu when they are next updated. Laminated copies of the four week menus have just been supplied to the service users, to keep in their rooms, so that they and their families are able to see the choices available. There are two options for lunch, one of which is vegetarian or fish. On the day of the inspection, the evening options were macaroni cheese, mushroom soup or sandwiches. Ice cream was available, but the cake shown on the menu was not. Chicken in red wine, with lasagne as an alternative, were on the menu on the second day of the inspection. Service users made positive comments about the meals. In the kitchen it was found that information on each of the service users is now being kept, with details of their dietary needs, including those with diabetes, low fat and other special diets. The Registered Manager said that the cook is in the process of providing separate menus for those with special needs, such as a diabetic diet. The requirement to have meals recorded, to evidence that service users are having a balanced and nutritious diet has not fully commenced. While service users’ comments about meals are being recorded to give feedback to the catering company, the meals taken by individual service users, particularly those who may have health problems, are not recorded in sufficient detail and this needs to be done. The Registered Manager said that the new care planning system has documentation to record this and this should be implemented as soon as possible. John Collin House DS0000022891.V252646.R01.S.doc Version 5.0 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Improvements have been made to the complaints process but it needs to be demonstrated that service users have every opportunity to voice any concerns they may have. Because of incidents which have arisen in the home, it needs to be shown, by training and other methods, that staff are supported to deal with potentially difficult situations. EVIDENCE: At the last inspection, the Registered Manager was asked to ensure that the complaints procedure is improved and action taken 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. No complaints have been recorded since the last inspection and the complaints procedure is now accessible in the foyer and each of the service users has the information. One service user did express concerns about a number of issues and it needs to be shown that these have been taken up and the outcomes noted. There have been no adult protection issues until recently when an issue between two service users resulted in a report to the adult protection officers in the London Borough of Hounslow. The Registered Manager was waiting to hear from them if further action was required. In the meantime, the relevant professionals have been involved and meetings are taking place to resolve the situation. Only five staff have had adult protection training and this needs to be extended to include all of the team. John Collin House DS0000022891.V252646.R01.S.doc Version 5.0 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): There are areas of the home which have been neglected and require upgrading. These include the floor coverings and kitchenettes. Although some work is now imminent, this is overdue, and a regular programme of repair and refurbishment is needed to maintain a pleasant and comfortable environment for the service users. EVIDENCE: Because it is planned that the home will eventually close, there has been a lack of maintenance to ensure the home is kept in good order. In particular, the kitchenettes in each unit have required refurbishment for some time. The Registered Manager said that the worst of these, which has broken drawers, is to be replaced shortly and she is obtaining estimates for the remaining three units. The unit refrigerators, which were all in poor condition, have been replaced. Service users now have the opportunity to store private items, money or medication by the provision of lockable spaces in their rooms. This has been a requirement for two inspections but has now been fulfilled. Only three service John Collin House DS0000022891.V252646.R01.S.doc Version 5.0 Page 18 users have chosen to have keys at present but they are now available for those who wish to have them in the future and for new service users. In some areas of the home, the odour of urine persists. It has been a requirement that, where the odour cannot be eradicated by cleaning, the floor coverings must be replaced. At the third visit of this inspection, the situation had improved by deep cleaning taking place. However, the Registered Manager acknowledged that some areas and rooms require new carpets and will be including this in her next budget for approval. John Collin House DS0000022891.V252646.R01.S.doc Version 5.0 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Problems with the recruitment of a permanent staff team, for a long period, have led to poor continuity for service users and a lack of development of the staff team. The recent successful recruitment should help to improve the situation if retention, training and the development of staff is maintained. EVIDENCE: Although there has been progress with the recruitment of a permanent staff team, seven agency staff were noted to be working on the current rota and several were on duty during this inspection. This situation has meant that there have been many changes of staff, providing a lack of continuity for the service users which was commented on by some of them. A successful open day for recruitment has led to eleven new care and domestic staff being recruited. The Registered Manager said that Servite Houses were going through the employment processes to obtain references and CRB disclosures. The senior staff team consists of the Registered Manager, an acting Assistant Manager and four senior staff. Six care staff, including a staff member not attached to a particular unit, are on duty in the mornings and five in the afternoon. There are two staff on each shift in the unit for service users with learning disabilities and one on each of the other three units. Two staff are on waking night duty and a senior staff member sleeps in. An examination of the training records did not provide evidence that all of the staff have the required core and specialised training to meet the needs of the service users. At the first visit, the Assistant Manager said that he was going John Collin House DS0000022891.V252646.R01.S.doc Version 5.0 Page 20 through the staff files to get an up-to-date record of the current situation. This has been an outstanding requirement since the beginning of 2005 and it must be shown that all staff have a training and development record, to demonstrate the training undertaken and training requirements. At the third visit, a more up-to-date list was produced but still did not evidence all of the training which has taken place. The Registered Manager was asked to ensure that this was completed and maintained. The record did show that not all the staff have current moving and handling training and this must be rectified within the timescale given. The Registered Manager said that sufficient training courses are being provided for this to take place within the timescale. There were presently three carers with NVQ Level 2 and one in the process of undertaking this. Because of the lack of permanent staff, there has been little progress in moving towards 50 of the staff team having NVQs. With the recruitment of permanent staff, 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. It has been a requirement for the last two inspections that the documentation required for staff employed must be obtained, and be available in the home for inspection. Whilst some of the information is now available, gaps remain in the information, including health declarations. The Registered Manager was advised to ensure that the Human Resources Department of Servite Houses is fully aware of the information required and ensure that it is provided to the homes for inspection. John Collin House DS0000022891.V252646.R01.S.doc Version 5.0 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Long periods without permanent care and management staff have not assisted with the development of the staff team. Service users and their representatives are not being consulted formally about the services in the home and it is not demonstrated that the quality of care is monitored and developed. EVIDENCE: Because of the long periods without a permanent care staff and senior management staff, there have been difficulties for the Registered Manager in building and developing the staff team. Whilst there has been progress recently in rectifying this situation, the Registered Providers need to demonstrate that efforts are made to retain the staff and improve the quality of care in the home for the benefit of the service users. The opportunity for the service users and their representatives to be consulted formally about the quality of the services and support provided by the home has not yet been completed. Service user meetings do take place but there John Collin House DS0000022891.V252646.R01.S.doc Version 5.0 Page 22 has been no written consultation. It has been a requirement that a review of the quality of care is required to be undertaken, submitted to service users and the Commission for Social Care Inspection, and involve consultation with service users and their representatives. This has not yet been carried out. The Registered Manager said that the new systems being brought in by Servite Houses early next year will measure continuous improvement , which provide for better monitoring to be carried out. Insufficient staff supervision had taken place, prior to this inspection, to support staff and to meet the Care Home Regulations 2001 and National Minimum Standards. The Registered Manager said that the staff now receive regular supervision and a sample of staff files evidenced this. As a number of senior staff are involved in providing supervision, it is recommended that a schedule of dates is kept for her to be able to monitor that these have been carried out. At the inspection in April 2005, an Immediate Requirement was issued to evidence that all of the staff had participated in fire drills. A list of staff who had attended was provided within the timescale required. However, the records available at this inspection did not evidence that all of the staff had attended the number recommended by the London Fire and Emergency Planning Authority, which is four a year for night staff and two for day staff. The Registered Manager was asked to ensure that attendance at sufficient drills is maintained and that there is a recording system in place to be able to evidence this. The fire training available to the staff is in-house and there is no external training. It must be ensured that this training is sufficient to ensure the staff fully understand the fire safety procedures. In an unlocked cupboard in Sunnyside unit, bottle of potentially hazardous substances, such as urine deodoriser, were found. These were removed and the Assistant Manager was asked to ensure their safe storage. It was discussed with the Registered Manager that the items were not marked with warnings, although the information provided by the company supplying the products suggested they were potentially hazardous. She agreed to contact the company concerned to clarify the information. For the safety of the service users, the staff must be made aware of the necessity of storing materials safely. The system in place for dealing with service users’ finances was examined. Six of the service users have their finances managed by Social Services with the money being paid to the home from Servite Houses head office. Others have small sums of money brought to the home by relatives. Each service user has an individual envelope, kept securely, and this is pre-printed so that details of receipts, withdrawals, signatures and balances are held as well as receipts kept. Weekly checks are made by the home’s staff and Servite Houses carried out its last audit in March 2005. John Collin House DS0000022891.V252646.R01.S.doc Version 5.0 Page 23 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 ENVIRONMENT CHOICE OF HOME Standard No Score 1 2 3 4 5 6 Standard No 19 20 21 22 23 24 25 26 Score 3 3 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X 3 X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X 3 X 2 John Collin House DS0000022891.V252646.R01.S.doc Version 5.0 Page 24 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 OP3 Regulation 4 (1(a) 12(1 (b) Requirement Appropriate referrals must be made to health professionals where the needs of service users have changed and may fall outside of the home category of registration. It must be demonstrated that staff who work with people with learning disabilities and other specialist disabilities must have appropriate training. Care plans must be updated and reviewed on a regular basis, in consultation with the service users and their representatives. (Previous timescale of 31st December 2004 partially met only) 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. It must be ensured that medication is administered to service users as close as possible to the time on the Medication Administration Sheet or as prescribed by the General DS0000022891.V252646.R01.S.doc Timescale for action 31/10/05 2 OP4 18(1)(a) 31/12/05 3 OP7 15(1)& (2) 30/11/05 4 OP8 12(1)(a) &(b) 30/11/05 5 OP9 13(2) 31/10/05 John Collin House Version 5.0 Page 25 6 OP9 13(2) 7 OP15 17(2)Sch 4(13) 8 OP18 13 (6) 9 10 OP26 OP28 16 (2) (k) 18 (1) (a) 11 OP28 18(1)(a) 12 OP29 17(2) 19(1)(b) 13 OP33 24(1)(2) &(3) 14 OP38 23 (4) (e) Practitioner. Senior staff must ensure that regular monitoring of medication administration and stock checks are carried out and evidence provided that this is done. Records of the food provided to the service users, to determine if their diet is satisfactory, must be maintained. (Previous timescale of 31/05/05 not fully met). The management of the home must ensure that all staff are aware of the steps to be taken in the event of an adult protection issue arising and how service users should be protected. Where the odour of urine cannot be removed by cleaning, the floor coverings must be replaced. 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 31/07/05 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 documentation required to be obtained for staff employed must be obtained, and be available in the home for inspection. (Previous timescale of 31/05/05 not fully 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. (Previous timescale of 30/6/05 not met) Evidence of the staff attending sufficient fire drills, and training, in accordance with the London DS0000022891.V252646.R01.S.doc 31/10/05 30/11/05 31/12/05 30/11/05 31/01/05 30/11/05 30/11/05 31/01/06 30/11/05 John Collin House Version 5.0 Page 26 Fire and Emergency Planning Authority guidance must be recorded. (Previous timescale of 31/05/05 not fully met) 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 OP12 Good Practice Recommendations That the information regarding the facilities and services in the home should be provided in formats which suit the communication needs of the all of the service users. In order to provide suitable activities to meet all of the service users’ needs, training in providing activities for older people and those with learning disabilities should be available to all of the staff. That a monitoring system is introduced to ensure that staff supervision and support is carried out on a regular basis. 3 OP36 John Collin House DS0000022891.V252646.R01.S.doc Version 5.0 Page 27 Commission for Social Care Inspection West London Area Office 58 Uxbridge Road Ealing London W5 2ST National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI John Collin House DS0000022891.V252646.R01.S.doc Version 5.0 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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