CARE HOMES FOR OLDER PEOPLE
Lea House 40 Terminus Avenue Bexhill on Sea East Sussex TN39 3LZ
Lead Inspector Andy Denness Unannounced 19 April 2005 10:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lea House Version 1.10 Page 3 SERVICE INFORMATION
Name of service Lea House Address 40 Terminus Avenue Bexhill on Sea East Sussex TN39 3LZ 01424 309580 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Sadna Seesarun Mr Baldeo Seesarun Mrs Sadna Seesarun Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (OP) 15 of places Lea House Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The maximum number of residents to be accommodated is fifteen (15) Date of last inspection 12 October 2004 Brief Description of the Service: Lea House is a large detached property situated in a quiet residential area of Bexhill on Sea. The home is situated a short walk from local shops and the local railway station with Bexhill town centre approximately half a mile away. Accommodation is provided on two floors and and a shaft lift is fitted to assist those service users who may have mobility problems. There are large well tended gardens to the front and rear of the property. The home is registered to accommodate fifteeen older people and the registered owners are Mr and Mrs Seesarun. Lea House Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over an afternoon in April lasting 4.25 hours and was undertaken by two Inspectors. To help gather evidence on how the home is performing the Inspectors met with staff and the home’s manager, examined a range of records and written information and undertook a short tour of the premises. In depth discussions took place with six service users. What the service does well: What has improved since the last inspection? What they could do better:
The Inspection highlighted serious concerns. The plans which detail service users needs and the help required from staff were especially concerning; some service users did not have such a plan; some contained insufficient information whilst in others the guidance was being ignored. This means that particularly in instances where service users had difficulty communicating, their needs were not being met. Concerns were also noted over medication matters, in some cases medication had not been dispensed to service users and record keeping was poor. A service user had been admitted from outside of the category of the home; as the home is not set up to care for service users with such complex needs, her needs are not always being met. The manager failed to inform the Commission for Social Care Inspection of serious occurrences in the home, as she is required to do. She has also not arranged formal supervision for staff or staff meetings, which was required of her following the last inspection of the home. The manager has no time to carry out her management duties as she is on shift as a carer every day. The manager has been asked to carry out a review of staffing levels at the weekend. Because of the serious concerns identified during the Inspection the proprietors have been called to an urgent meeting with the Commission for Social Care Inspection to discuss these matters.
Lea House Version 1.10 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Lea House Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Lea House Version 1.10 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 3, 4 & 5. More able service users admitted to the home are provided with sufficient information and opportunities to help them judge if the home is appropriate for them; this is not the case with those less able service users. The assessment process has failed in at least one instance where a service user has been admitted whose needs the home cannot meet. EVIDENCE: Written guidance was examined which provides service users with information about the home and how their needs would be met and some service users said that they had an opportunity to look around prior to moving in. In one instance a service user whose assessed needs stated that they had dementia, has been admitted. This is clearly in breach of the home’s registration, as they should only admit people whose assessed needs are that of old age only. Lea House Version 1.10 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 & 9 The poor quality of, and in some instances the complete lack of, written guidance for staff on how to meet service users needs means that sometimes they are not receiving the help and support necessary to meet their health and personal care needs. Poor procedures and practices in medication matters mean that it was not obvious if in all cases prescribed medication was being taken. EVIDENCE: An Inspection of records indicated that there were no plans of care in place for the last two service users who had been admitted to the home. Those plans that were in place were very brief and did not fully describe service users’ needs. The guidance included in the plans was not always followed; in one instance a service who said that they did not like meat and whose care plan said they might be a vegetarian had been given chicken for her dinner, which she had left. Staff spoken to did not know that she did not like meat. One service user whose care plan said was partially sighted did not have their glasses and staff did not know where they were. Their care plan said that they liked a daily shave, but they had not had one for several days and they could not remember when they had last had a bath. Because of poor record keeping it was not possible to verify when personal care needs had been met. Records
Lea House Version 1.10 Page 10 examined showed that one service user, who had recently been very unwell, had been wandering off site unaccompanied; on one occasion he had fallen and had to be returned by the Police; the plans of care contained no guidance on how staff should ensure his safety. Lea House Version 1.10 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 15 Generally a varied and wholesome menu, with choices, is provided for service users although one service user’s dietary needs were not being met EVIDENCE: The menus examined indicated that a varied and wholesome menu is provided and most service users spoken to were complimentary of the meals provided for them. It was observed in one instance that a service user who said she did not like meat and whose assessment said was possibly a vegetarian had been given chicken for dinner, which she left. Staff said that she had difficulty eating and was very slow and because of this was given her meals in her room. Lea House Version 1.10 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 Practices and procedures regarding complaints were satisfactory. EVIDENCE: The home’s written complaints procedure was seen and service users spoken to were confident that should they have a complaint that their concerns would be listened to and acted on. Lea House Version 1.10 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20,21, 22, 23, 24, 25 & 26. Service users live in a safe, comfortable and non-institutional environment EVIDENCE: An inspection of the premises took place; accommodation is on two floors and a shaft lift is fitted to assist those service users who may have mobility problems. The home has a pleasant dining room and lounge. Bedrooms are decorated and furnished in a comfortable homely style and service users said that they were able to bring their own furniture with them if they so wished; all bedrooms have ensuite facilities. Sufficient bathrooms and WCs are available to meet service users needs. The home was clean and hygienic throughout. Lea House Version 1.10 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 & 30. Staffing levels are not sufficient to ensure that service users needs are always appropriately met and staff training arrangements are not satisfactory. Robust recruitment procedures and practices help ensure the safety of service users. EVIDENCE: The home’s rota indicated that minimal staffing numbers are available to meet service users needs. During the week care staff undertake all cleaning duties and at weekends cleaning and catering. Service users confirmed that levels at weekends are low, the manager has been asked to review these staffing arrangements. The manager herself confirmed that she is having problems recruiting new staff and is working an extremely high number of hours as a carer. The manager said that none of her staff currently hold or are undertaking required vocational training. (NVQ 2) Lea House Version 1.10 Page 15 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 35, 37. The fact that the manager has no time shown on the rota to carry out her managerial responsibilities is having a serious detrimental effect on the home and the standard of care provided for service users. EVIDENCE: Rotas examined confirmed that the manager has no time currently rostered to spend on her management responsibilities. Staff meetings do not take place and formal one to one meetings between the manager and individual staff do not happen. The manager is responsible for compiling care plans; they were of a poor quality and in some instances non-existent. Accidents were not recorded appropriately and other record keeping was poor. Also the manager had failed to inform the Commission for Social Care Inspection of significant occurrences that had happened in the home, as she is required to do. Records and balances regarding money held by the manager on behalf of one service user were examined and found to be in order. A selection of health and safety records was examined, these were in order.
Lea House Version 1.10 Page 16 Lea House Version 1.10 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 1 x 1 1 3 x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 1
COMPLAINTS AND PROTECTION 3 3 3 3 3 2 3 3 STAFFING Standard No Score 27 1 28 x 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 1 1 x x 3 x 2 3 Lea House Version 1.10 Page 18 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 4 Requirement That in line with the homes statement of purpose service users are not admitted out of category That care plans are compiled for all service users; that all care plans contain sufficient detail covering all neccesary areas and that staff ensure they follow all guidance included in the plans and record when they have done so. That staff ensure all prescribed medication is dispensed to service users; that accurate medication records are maintained and that written guidance is drawn up for staff regarding under what circumstances individual PRN (when required) medication can be given to service users. That formal supervision is is provided for all care staff at least 6 times per year.(THIS REQUIREMENT WAS MADE FOLLOWING THE PREVIOUS INSPECTION OF THE HOME) That the accident record is accurately maintained at all times. (THIS REQUIREMENT
Version 1.10 Timescale for action 19/4/05 2. 7 15(1) 19/5/05 3. 9 13(2) 19/4/05 4. 10 18(2) 19/5/05 5. 13 17(1)(a) 19/4/05 Lea House Page 19 WAS MADE FOLLOWING THE PREVIOUS INSPECTION OF THE HOME) 6. 7. 8. 9. 27 31 31 18(1)(a) 37(1)(e) 18(1)(a) That weekend staffing levels are reviewed. That the manager ensures that she informs CSCI of significant occurences in the home. That the manager ensures she has sufficient hours off shift to spend on her managerial responsibilities. That risk assessments are undertaken regarding dangers of service users going out unescorted. 19/4/05 19/4/05 19/5/05 10. 38 12(1)(a) 26/4/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 28 32 Good Practice Recommendations That a minimum of 50 of staff are trained to NVQ level 2 by the end of 2005. That regular formal staff meetings are arranged. Lea House Version 1.10 Page 20 Commission for Social Care Inspection Ivy House, 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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