Inspection on 27/07/07 for Ladesfield

This inspection was carried out on 27th July 2007.

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

Other inspections for this house

Ladesfield 18/02/09

Ladesfield 25/03/08

Ladesfield 18/07/06

Ladesfield 06/01/06

Ladesfield 14/07/05

Ladesfield 18/01/05

Ladesfield 06/10/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Ladesfield Vulcan Close Borstal Hill Whitstable Kent CT5 4LZ Lead Inspector Anne Butts Key Unannounced Inspection 09:30 27th & 30th July 2007 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 Ladesfield DS0000037645.V343161.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ladesfield DS0000037645.V343161.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ladesfield Address Vulcan Close Borstal Hill Whitstable Kent CT5 4LZ 01227 261090 01227 266201 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) Kent County Council Mrs Patricia Ann Hales Care Home 35 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (35) of places Ladesfield DS0000037645.V343161.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The total number of service users accommodated at one time should not exceed 35. To include up to ten (10) persons in the category Dementia Elderly (DE)(E) accommodated on the top floor. 18th July 2006 Date of last inspection Brief Description of the Service: The premises which were purpose built in the 1970s, are a three storey detached property set in its own grounds in a quiet area in the outskirts of Whitstable Town. This is a non-smoking environment. The ground and the first floor are registered for 25 older people, 5 of which are respite beds. All bedrooms are single accommodation, none are en-suite but all bedrooms have a wash hand basin. All of the bedrooms also have a call point, which is designed to help service users summon help should it be needed. The second floor of the building has recently been registered for accommodating people with dementia, and this is registered for 10 people. All rooms are single accommodation with a washbasin. This unit is secure and kept locked at all times. People can only access the garden area in the company of a member of staff. There is a secluded garden to the rear of the property, although this is not currently secure. Kent County Council are the Registered Providers and the day-to-day operation of the Home is supervised by the Registered Manager, the Deputy Manager and by a number of Team Leaders. The current fees for the service at the time of the visit start at approximately £351.00 Information on the Home services and the CSCI reports for prospective service users are detailed in the Statement of Purpose and Service User Guide. Ladesfield DS0000037645.V343161.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced Key Inspection that was carried out by one inspector over the course of two days. Key inspections are aimed at making sure that the individual services are meeting the standards and that the outcomes are promoting the best interests of the people living in the home. As part of the process for a Key inspection, services are requested to complete and return an Annual Quality Assurance Assessment (AQAA). This is a legal requirement, and provides information about how the service is performing; the AQAA was completed and returned prior to the site visit. Other information about the service was obtained by sending out surveys to people who are using the service, relatives and health care professionals. At the actual site visit time was spent touring the building, talking to people living in the home, talking to staff and reviewing a selection of assessments, service user plans, medication records, menus, staff files and other relevant documents. At all times the staff were helpful and co-operative. Judgements have been made with regards to each outcome area in this report, based on records viewed, observations and written and verbal responses given by those people. These judgements have been made using the Key Lines of Regulatory Assessment (KLORA), which are guidelines that enable The Commission for Social Care Inspection (CSCI) to be able to make an informed decision about each outcome area. Further information can be found on the CSCI website with regards to the IBL process including information on KLORA’s and AQAA’s. The inspection process evidenced significant failings that did not serve to keep service users safe and free from harm. The Registered Providers (Kent County Council) have since taken stringent measures to address this. What the service does well: Staff interaction with service users is supportive, especially in the Somerset suite (Dementia unit), where people are treated with kindness, patience and respect. There is a varied menu with a selection of fresh fruit, vegetables and meat available. There is a range of organised activities, although people do not have much opportunity to take part in individual pastimes. Visitors are made welcome to the home. Ladesfield DS0000037645.V343161.R01.S.doc Version 5.2 Page 6 Staff have been trained in meeting the needs of people with a diagnosis of dementia. What has improved since the last inspection? What they could do better: Pre-admission assessments are poor and uninformative, where there are joint assessments in place from Care Management these are not used to support the home’s own processes and the information within these is often ignored. Care planning is poor with little information on how to support people and limited evidence to show that people’s individual preferences, wishes and views are taken into account. The diversity of individuals are not reflected in care plans. They are not supported by meaningful risk assessments that identify people’s needs. People are not supported with their healthcare needs with no evidence of nutritional screening, weight records, support with pressure sores or visits by healthcare professionals. Medication practice is incompetently managed and places service users at risk from harm due to inaccurate administration of medication. Activities are limited with people not always having the opportunity to take part in meaningful social pastimes that always suits their needs. Accidents and incidents are recorded, but there are no outcomes on how to reduce any future occurrences or any details of appropriate action taken at the time. The management of the home consistently failed to recognise the seriousness of some of the incidents and were therefore leaving service users at serious risk from harm. Whilst some improvement work has been carried out, the gardens are not safe and secure and this means that people cannot go outside unless a member of staff accompanies them. This is particularly relevant in the Somerset Suite where people are effectively locked in for the duration of their stay. Staff training has addressed some areas but there are many outstanding training needs particularly with relevance to mandatory areas such as movement and handling and adult protection. There also appears to be a Ladesfield DS0000037645.V343161.R01.S.doc Version 5.2 Page 7 substantial shortfall in training in the specialist care of people with diabetes and a lack of awareness and knowledge of infection control procedures. Staff are not supervised appropriately. Staffing levels means that staff are not always able to meet the needs of the people living in the home. People’s money and belongings are not safeguarded by the procedures in the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ladesfield DS0000037645.V343161.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ladesfield DS0000037645.V343161.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 4. Standard 6 does not apply. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Prospective service users cannot be confident their needs will be accurately assessed or met by the home. EVIDENCE: A selection of service user files was sampled to review how the home assesses people. Records showed that there is a pre-assessment process in place, and for many of the service users there is a joint assessment obtained from Care Management. However, the information contained within the home’s assessment process was sparse and uninformative. There is a dependency assessment that covers the areas as described in Standard Two of the National Minimum Standards for Older people – but this is only used as a ‘scoring’ system and where a higher need is identified then there is no further assessment that shows as to actually support anyone with their needs. Further concerns with the home’s own assessment process is that it does not Ladesfield DS0000037645.V343161.R01.S.doc Version 5.2 Page 10 reflect anything identified within the Care Management assessment and in places is also contradictory of the information that is then placed in the care plan and not a true reflection of their actual needs. Areas around the pre-assessment process were of a higher concern in the Somerset Suite, which is the secure unit for people with a diagnosis of dementia. This is a respite unit only and this means that there is a high turnover of people coming in and out. Any assessments completed by the home were brief and again lacking in full details, again they did not reflect any needs provided in the joint assessment provided by Care Management, and also on at least one occasion this assessment was seen to be more than a year old. The Home does not appear to request any updated information on people when they were returning to the home and therefore cannot demonstrate that they can fully meet people’s needs at point of admission into the home. On reviewing records it was not always possible to distinguish when someone had stayed in the home in May and then returned for another visit in July – as records ‘ran into each other’ and an updated assessment to reflect any changing needs were not in place. Discussions with staff also showed that they did not feel that they were aware of people’s needs and comments included “I am not always sure of how to support people because the information is not always there”. One part of the assessment process does include a ‘Map of Life’, which contains information about people’s history – staff did state that they found this useful. The assessment process does not provide sufficient clarity around individuals needs regarding their (often) complex care needs. This means that service users and their representatives cannot be sure that the home will meet the needs of individuals, and service users may be at risk from harm because of this failure. The home does not provide intermediate care. Ladesfield DS0000037645.V343161.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users do not benefit from care plans that meet their needs and cannot be confident that their health care needs, including any changing needs, will be met. These shortfalls are putting service users at risk Service users are not adequately protected by the Home’s administration and recording of medication. EVIDENCE: Care plans in both units were poor, a selection was reviewed and all of those were considered to have major shortfalls. Specifically, care plans were very brief – both in terms of identifying care needs and the type of support required on how to assist an individual. For example: the care plan stated that that all a service user’s religious needs are met – but did not state how, or even what the persons religious needs were. Another care plan stated that “two carers Ladesfield DS0000037645.V343161.R01.S.doc Version 5.2 Page 12 have to do personal care” – again no explanation as how to support with these needs. Information contained within the care plans was also contradictory in places. For example: a care plan stated that a service user managed their own mobility with the aid of a stick, but was prone to falls, elsewhere it stated that the service user used a three wheeled frame, but walks too fast – neither of these entries provided further information on how to support the individual with their mobility. Service users’ wishes regarding how they are supported with personal care are not recorded, and there was very little evidence to show that they had taken an active role in devising their plans. One care plan did reflect a service user’s choice, wishes and preferences – however this was not the norm. Where Care Management has provided care plans, as with the joint assessments there was no evidence to show that they had been used to inform or support the home’s plans. Information provided in these, some of which would be a valuable asset in supporting people was not reflected. A Care Management care plan for one service user in the Somerset suite stated that the gentleman frequently wandered, but the home’s care plan stated that he may wander. Records showed that this gentleman had been admitted on the 9th and there had been a high incidence of wandering – the home’s care plan had been written on the 13th and was not reflective of this. Where care plans have been reviewed, in some cases this appeared to be a paper exercise only and changes were not reflected. For example: a care plan stated that a service user was to have six small meals a day rather than three main meals and this had been reviewed twice since the care plan was written. On asking how the service user was supported with this the inspector was informed that the service user had never had six small meals and therefore any reviews had not taken into account any changes. The Manager had reflected in the returned AQAA that care planning is an area that they could do better. However, the current minimalist approach to care planning does not meet with either accepted good practice guidelines, or National Minimum Standards. Staff and service users appear to just ‘get by’, and do not benefit from a clear, consistent and professional approach towards care planning in relation to meeting service users’ needs and ensuring goals and expectations are met. The Manager stated that staff had been supported in care planning processes but staff stated that they had been given limited information and were not clear on how to write a care plan. All risk assessments inspected were inadequate. None described the risk or support in any way that could be considered effective, and where there were risk assessments in place they had been completed on the wrong forms and very little information from any of these was actually fed into the plans. Ladesfield DS0000037645.V343161.R01.S.doc Version 5.2 Page 13 Incomplete records also did not support how the home meets individual healthcare needs. There was no evidence of nutritional screening, minimal weight records, no monitoring of food and fluid intake and incorrect information contained in care plans. Visits from the G.P., District Nurse and other visiting health professionals were not recorded properly and there were no records of incidents of pressure sores. A care plan from the Care Manager also indicated that regular medication reviews should be taking place, but this was not reflected into the home’s plan and there was no evidence to show that a review had taken place. Comments from the District Nurse returned on a survey also supported their high concerns about the healthcare management and support of people living in the home. Concerns centred around the management of people with diabetes and staff understanding of this condition, lack of understanding of infections, lack of training and lack of awareness of mobility needs. A review of medication also evidenced poor practice with inaccurate administration and poor record keeping including the monitoring of medication being brought into the home. On evidence seen during the inspection process it was identified that one service user had been administered a prescribed medication at the wrong dosage for a minimum of twelve days. Where the instructions had identified that the service user should receive two tablets per day he was only being administered one. In the case of another service user, where the records indicated that there should be seven tablets remaining, there were only six. There were no records to show what had happened to the missing tablet. One service user had sixteen sachets of Movicol remaining, whilst records indicated that there should only be fifteen. Primarily in the Somerset Unit, where people stay on a short-term respite basis, where medication is being delivered into the home there are no records on the MAR sheets and therefore it is not possible to fully audit if the administration of medication is accurate. Also where people have gone out for the day, they were routinely missing their lunchtime medication and there appeared to be no systems in place to manage medication on day trips. One service user had also been routinely given two painkillers, four times a day for at least three weeks. These had been prescribed on an ‘as and when basis’ and there was no evidence to show that there were appropriate guidelines in place for the use of PRN medication. An immediate requirement was left at the time of the visit with regards to medication. Further requirements are being made in this report. A specialist pharmacist inspection has also been arranged. Ladesfield DS0000037645.V343161.R01.S.doc Version 5.2 Page 14 The principles of the home’s philosophy of care, with regards to privacy and dignity are not evident in the care planning or assessment process with any minimal evidence to show that people’s views and wishes being taken into account. Observations did show that overall staff respected service users and treated people with kindness and patience. In the Somerset suite one member of staff was observed to patiently respond to a service user who repeatedly asked the same question. She answered each time as if it had been the first time the question had been asked. In the larger residential unit staff were seen to be overall patient with people. Comments from service users included “The girls are very polite and always nice to me” and “If I need anything I only have to ask they girls are very good”. Ladesfield DS0000037645.V343161.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a range of organised activities available, although not all people benefit from being able to exercise their individual choices and preferences with regards to activities. Service users benefit from being encouraged to maintain contact with families and friends. People also enjoy a good balanced and wholesome diet with special diets being well catered for. EVIDENCE: Time was spent with service users asking about their experiences of living in the home. Overall the response was positive from people with comments including “I like living here” and “I am quite happy here”. There was some evidence of activities including trips to local beaches and a local pub. There was also a planned trip to see the local carnival on the following weekend. People were observed enjoying a Karaoke session and particularly evident in the dementia unit was how staff spent their time with service users – playing cards, reminiscing and reading papers and magazines to people. Ladesfield DS0000037645.V343161.R01.S.doc Version 5.2 Page 16 However people did appear to spend the majority of time watching television, with little choice of programmes – on one day it was observed that the TV remained on for the children’s programmes. Feedback from service users did also include comments such as “There isn’t a lot to do” and “I spend most of my time sitting here”. A returned survey from a relative also voiced concerns that her mother did not have the opportunity to go out and sit in the garden or go for a walk – so while there are some organised activities that benefit some of the people not everyone has the opportunity to exercise their own choices. Aspirations of service users are not recorded. Some history is recorded on file, but detail is missing. On some files there is no information regarding previous hobbies or current aspirations. The home is not responding to the diverse needs of people and there was little evidence to show that their religious, cultural and social interests are being taken into account in their daily lives. Family and friends are welcomed at any time and people are able to have visitors when they want. Relatives all spoke highly of the staff and stated that they were always made welcome. The Deputy Manager has arranged small seating areas around the home so that people can sit in privacy. Overall comments about the meals were highly complimentary and mainly positive and there is a varied menu in place with fresh fruit, vegetables and meat available. The cook demonstrated a very good awareness of the needs of the client group and of individuals with special diets. The kitchen was clean, well maintained and suitable for the needs of the home. Ladesfield DS0000037645.V343161.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users are potentially at serious risk from abuse due to lack of staff training in Adult Protection and understanding by the management of Adult Protection Protocols. Service users cannot be confident they will be protected from harm. EVIDENCE: The complaints records within the home were not viewed on the day of the visit. There is a countywide procedure in place and people who were spoken to did state that they felt confident in talking to staff if they had any concerns. A relative had also exercised their full right to make a complaint and this is currently being investigated and addressed. Information provided from the AQAA stated that there had been eight complaints within the last twelve months, two of which had been upheld. There are high concerns that people are not being protected from abuse and that the systems in the home do not protect service users. There is a high record of incidents and accidents and none of these actually addressed how to reduce the occurrence of this happening again. One lady was admitted to hospital following two accidents on the previous day. There were no records to show that appropriate action had been taken at the time of the accidents, and Ladesfield DS0000037645.V343161.R01.S.doc Version 5.2 Page 18 the Manager had failed to notify either Care Management or The Commission of this and other serious incidents that had happened in the home. There was an incident with another service user and a member of staff – this had not been investigated properly or any appropriate action taken and remained unresolved at the time of the visit. It was not evident that the seriousness of some of these incidents had been recognised. Accidents and incidents should be monitored for patterns so that appropriate action can be taken to prevent or reduce the likelihood of future reoccurrence. Healthcare authorities and Care Management had also voiced concerns and there was no evidence to show that the home had responded appropriately to these concerns. There was limited training around Adult Protection procedures. The Registered Provider is Kent County Council and as such all staff are fully subject to all checks such as Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA). Ladesfield DS0000037645.V343161.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users benefit from living in an environment that has undergone some refurbishment with further works planned. However the gardens are not safe and many people are not supported in going outside. EVIDENCE: Since the last inspection there has been some extensive renovation work carried out – primarily the top floor has been refurbished and now accommodates people with a diagnosis of dementia. The improvement works have been carried out with sensitivity and has made this unit comfortable and pleasant. Overall the environment is sparse, although this is mainly due to this being a respite unit only. There are further plans in place to refurbish the remainder of the building and this can only be of benefit to people living there. Ladesfield DS0000037645.V343161.R01.S.doc Version 5.2 Page 20 There are concerns about the suitability of the top floor for accommodating people with dementia. This is a secure unit and people are not able to gain access to the gardens without the support of staff. The Statement of Purpose says that ‘the unit will offer a high level of support and use of the garden area’ – this is not happening. Staff spoken with at the time of the visit all stated that people could not get into the garden as they needed one-to-one support and the staffing structure does not allow for this. The garden area is not secure and safe meaning that people can leave the grounds if they are unsupervised. Care plans and assessments did not support how people could go outside, and although this is a respite unit where people are staying on a temporary basis, they are in effect locked in for the duration of their stay. At the time of the visit there was only one service user who had access to outside and this was so he could have a cigarette. Further concerns about the environment in the Somerset Suite is that there is no drinking water available except for in one of the bedrooms and a toilet, and water is brought up in jugs from the downstairs kitchen. There were also limited places to plug in the food trolley when it was brought up for lunch, and this could result in food not being maintained at the correct temperature prior to serving. Overall the standards of hygiene are well maintained with systems in place to control the spread of infection. All rooms were clean and tidy Ladesfield DS0000037645.V343161.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The service users benefit from being cared for by staff that have a good basic understanding of their needs. However, their care may be compromised as staff have not received adequate training and at times the ratio of staff is not sufficient to meet the needs of the people living in the home. EVIDENCE: As previously stated the home is set out into two separate units, and as such the staffing structure reflects this. In the larger unit, which is set out over the ground and first floor, there are three staff on duty for the 7 – 2 and 2 – 9 shifts, although an additional member of staff is also on duty at key times within these shifts. There are also two waking night staff. In the smaller Somerset Unit, the staffing levels are dependent upon the amount of people staying at any current time varying from one to three members of staff. There is also one waking member of staff allocated. There is a sleep-in Team Leader who is available during the night hours if required. Although on the surface this appeared to be sufficient - comments from staff did not support this. Staff reported that they had been requested on more than one occasion to transfer from the Somerset Unit to cover shifts in the downstairs unit, so leaving the top unit short-staffed. They also stated that they were quite often short staffed at the weekend in various areas of the home. Staff stated that they did Ladesfield DS0000037645.V343161.R01.S.doc Version 5.2 Page 22 not have time to spend with people living in the home. Both the Manager and Deputy Manager stated that there was always enough staff on duty. They admitted that there were times when they struggled to cover shifts but that they always managed to do this. There are designated kitchen and cleaning staff. Rotas were difficult to decipher and it was not possible to fully evidence as to what members of staff were working where within the home, or what their role was. Rotas need to be explicit and state exactly in what capacity the member of staff is on duty at during any one shift. The home should consider having a separate ‘signing in’ / duty sheet for the Somerset Suite so that they can evidence that there are sufficient staff on duty at all times. The main concerns in the Somerset Suite was that even when the allocated numbers of staff were on duty were at the stated level there were times when staff had difficulty managing the needs of the people staying. The indicative staffing levels did not take into account if people had more complex needs and needed more support and all staff spoken with stated that they would not cover a night shift on the Somerset Unit on their own. Comments from relatives also reflected that there were not enough staff available to take people out into the garden and one comment was “It is a great shame that when a person reaches old age, that all there is left to do is to sit in a chair and look out the window. I know people go out occasionally but not very often”. There is a proportion of staff with an NVQ in Care, but there was no evidence to show that the minimum ratio had been achieved. All staff are undertaking the common induction training in line with Skills for Care as an update for current skills. Overall recruitment practices were fairly robust with set interview questionnaires, fully recorded outcomes and interviews set up with people living in the home. On two files, however, there was only one reference and there was no CRB checks seen in files. The Manager stated that these were held with Kent County Council, as they were the employers. The home does need to make sure that they hold some record that staff are in receipt of a satisfactory CRB check. Records viewed in individual files and a matrix provided by the management again did not support that sufficient training had taken place for care staff. There was some evidence that Team Leaders had undertaken medication training and that staff working in the Somerset Suite had undertaken dementia training. Some mandatory training such as Movement and Handling, Adult Protection, Health and Safety and Basic Food Hygiene had not been undertaken and the majority of staff did not appear to be up to date in these areas. Contradictory verbal information was given to the inspector during the Ladesfield DS0000037645.V343161.R01.S.doc Version 5.2 Page 23 visit with staff stating that they did not have the opportunity to attend training, but the management team stating that members of staff were reluctant to attend training. Either way a requirement is being made that staff are trained in the areas that will enable them to support people in fully meeting their needs. District Nurses also voiced concerns as to the level of training available within the home. Comments in a returned survey stated that there was “an incident regarding a diabetic patient. Staff were unable to recognise a diabetic coma – they thought the patient was asleep” and “there seems to be a lack of awareness in monitoring patient conditions”. They also identified that there had been incidents where people had been inappropriately ‘labelled’ as having an infection and therefore staff felt that they should not be looking after these people – they observed that this could be due to lack of understanding and knowledge. Service users and visitors were complimentary of the daily support given by the staff and the management team. Comments included “Everyone is really good here” and “everyone is really helpful” and “They have a friendly and caring manner towards all residents”. Ladesfield DS0000037645.V343161.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The management of the home is lacking in leadership, guidance and direction to staff to ensure service users receive consistent quality care. This results in practices that do not promote and safeguard the health, safety and welfare of the people using the service. EVIDENCE: The manager has a number of years of experience working in social care settings and of the management of care homes for older people. She has achieved her NVQ 4/RMA. A Deputy Manager who also has a number of years experience in care supports her. There are clear lines of accountability in the home. There was, however, obvious conflict between management and the Ladesfield DS0000037645.V343161.R01.S.doc Version 5.2 Page 25 staff group with contradictory statements made by both parties with regards to staffing levels and training. Both management and staff acknowledged that there had been some staff conflict previously but this had now been resolved. In order to make sure that the Management team and staff are able to work together as a cohesive unit the Registered Provider must be pro-active in monitoring and supporting the home. A senior manager visits the service on a monthly basis to audit records and talk with selected staff and residents. There are systems in place to enable service users to feedback about the service such as resident meetings and as advised at the last key inspection the service should survey service users and other stakeholders to gain a more formal review as to how they feel the service meets their needs. The safety of service users’ money and belongings whilst staying in the home cannot be guaranteed as there does not appear to be a robust support system for helping people safeguard their money whilst it is in their possession. For example: An inventory for a respite service user stated there was x amount in notes and x amount in cash and a visa card, the daily notes stated that the service user wanted to retain possession of these but there was no evidence to show that the home had discussed the safeguarding of the possessions and showed the service user the lockable safe and the information on the inventory sheet was sparse. This was of a particular concern as the inspector had been informed that there had been occasions where money had gone missing. When the question was asked what safeguards were in place the reply was “If they want to keep their money on them then it is their right” but it is the home’s responsibility to safeguard and protect the interests of the service users. There were no records viewed that evidenced this was occurring. Regular staff supervision had not been taking place. The manager and deputy manager both stated that there were a lot of informal supervision and that there were regular staff meetings. They were both aware of the need to improve the structure for formal one-to-one sessions. Given the concerns about the conflict in the home supervision for staff must be given a high priority. A full review of safety maintenance within the home was not undertaken, however the returned AQAA gave dates for when the maintenance of electrical equipment, electrical circuits and gas appliances had been carried out. As identified previously there are concerns around the movement and handling training of staff Ladesfield DS0000037645.V343161.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 1 1 X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 1 X X X X X X 2 STAFFING Standard No Score 27 2 28 1 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 1 1 X 2 Ladesfield DS0000037645.V343161.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Home’s Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 (1) (2) Requirement Timescale for action 28/09/07 2 OP7 3 OP7 4 OP8 The Registered Provider must make sure that (1) Service users undergo a through pre-assessment process that shows how the home will meet their needs. (2) Where people are currently living in the home and the assessments are inadequate these people must be reviewed and their needs fully re-assessed as a matter if urgency. 15 The Registered Provider must make sure that all service user plans adequately address the needs and risks of individual service users providing clear guidance for staff. This remains outstanding with previous timescales of 01/10/06 and 01/04/07. 14 (2) Where care plans are reviewed they must accurately reflect any changes and this must be clearly defined within the plan. 14(1)(a) 2 The Registered person must 17(1)(a) make sure that the people living Sch 4(13) in the home undergo a nutritional assessment and weight records are maintained to monitor peoples health and well being. DS0000037645.V343161.R01.S.doc 28/09/07 28/09/07 28/09/07 Ladesfield Version 5.2 Page 28 5 OP8 OP30 18 (1) (a) 6 OP8 17(1)(a) Schedule 3 (3)(n) 7 OP9 13 (2) 8 OP9 13 (2) 9 OP18 12 (1)(b) 17 10 OP18 13 (6) 11 OP19 12 (1) (a) 23 (2) (o) The Registered Provider must make sure that the healthcare needs of people using the service are safeguarded through appropriate training for staff including knowledge of diabetes and other care needs indicative of the people using the service. A training plan must be implemented. The Registered Provider must make sure that a clear record is maintained of any incidence of pressure sores or breakdown of skin integrity and where support or treatment given. Where service users are going out for the day the Registered Provider must make sure that there are systems in place or advice sought from the GP for how people are supported with their medication during this time The Registered Provider must make sure that where people are regularly given PRN medication then are guidelines in place and if necessary then further advice is sought from the GP to make sure that the healthcare needs of the individual are safeguarded. The Registered Provider must make sure that where there are records of accidents and incidents then appropriate follow up action has been taken, fully recorded and addresses how to safeguard the future health, safety and welfare of the service users. The Registered Provider must make sure that service users are protected and safeguarded by staff that has been trained in Adult protection procedures. The Registered Provider must make sure that people have access to external grounds that DS0000037645.V343161.R01.S.doc 28/09/07 31/08/07 31/08/07 31/08/07 31/08/07 28/09/07 28/09/07 Ladesfield Version 5.2 Page 29 12 OP27 18 (1) (a) 13 OP27 17 (2) Sch 4 (7) 18 (1) (c) (i) 14 OP30 15 OP35 13 (6) 16 OP37 37 are suitable for and safe for use by the service users. The Registered Provider must make sure that there are sufficient staff on duty at all times to meet the needs of the service users. This is particularly important in the Somerset Suite and the home should consider individual arrangements that reflects who is on duty in this area at all times. Rotas must be maintained accurately in that they show what staff were on duty at any one time and in what capacity. The Registered Provider must make sure that staff have received training appropriate to the work they are to perform. A training plan must be implemented. Service users must be supported in safeguarding their money and possessions in accordance with their individual needs. The Commission must be notified of any death, illness or other events that adversely affects the well-being or safety of service users. 31/08/07 31/08/07 28/09/07 31/08/07 31/08/07 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 OP7 OP8 Good Practice Recommendations It is strongly recommended that the daily notes are reflective of the care plans and the care delivered. It is strongly recommended that when service users are visited by specialist healthcare professionals that records of visits are maintained. DS0000037645.V343161.R01.S.doc Version 5.2 Page 30 Ladesfield 3 4 5 OP29 OP29 OP36 It is strongly recommended that all staff files contain two references. It is strongly recommended that the home has a record of current CRB checks on all staff files. It is strongly recommended that a staff supervision programme is implemented and maintained. Ladesfield DS0000037645.V343161.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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