Inspection on 29/08/08 for Linwood

This inspection was carried out on 29th August 2008.

CSCI found this care home to be providing an Poor service.

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Linwood 06/07/09

Linwood 10/02/09

Linwood 31/08/07

Linwood 04/05/06

Linwood 19/04/05

Linwood 01/12/04

Linwood 19/07/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

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 23/11/2008.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Linwood 9 Mercer Close Thames Ditton Surrey KT7 0BS     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Joseph Croft     Date: 0 1 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 36 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 36 Information about the care home Name of care home: Address: Linwood 9 Mercer Close Thames Ditton Surrey KT7 0BS 0208 335 6800 0208 339 3485 lorraine.hillsavery@anchor.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): Type of registration: Number of places registered: Anchor Trust Lorraine Hills-Avery care home 66 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: Of the service users to be accommodated in the home up to TWENTY SEVEN may fall within the category Dementia DE(E) and up to NINE may fall within the category Physical disability PD(E). Temporary respite care may be provided for one named service user under the age of 65 years. 0 0 0 Over 65 27 30 9 Date of last inspection Brief description of the care home Linwood is a purpose built care home that has been operating since April 2004. Service provision is for personal care for up to sixty-six older people, some of whom may have moderate dementia or mental health needs and/or physical and sensory disabilities. The home is owned and managed by Anchor Homes who are the registered providers. Care Homes for Older People Page 4 of 36 Linwood is located in a residential area within walking distance of Thames Ditton village where there are a small number of shops and other community amenities. A GP practice is nearby. There are car-parking facilities to the front of the building and further parking spaces and an enclosed garden to the rear. The accommodation is divided into six named living units over three floors. Upper floors are accessible by one passenger lift and stairs. The home is wheelchair accessible throughout, however wheelchair users are restricted to two per unit other than on the ground floor, for health and safety reasons. There are eighteen single bedrooms on the ground floor, all with fully functioning ensuite shower rooms. There are forty-eight single bedrooms over the first and second floors. These are all fitted with en-suite shower rooms for which a single charge applies for showers to be made functional. Communal facilities are arranged on each floor comprising of small kitchens, dining rooms, lounges, toilets and assisted bathing facilities. Care Homes for Older People Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is zero star. This means the people who use this service experience poor quality outcomes. The Commission for Social Care Inspection (CSCI) (us,we) undertook an unannounced site visit on the 29th August and the 1st September 2008 using the Inspecting for Better Lives (IBL) process. Regulation Inspectors Mr Joe Croft and Mrs Mavis Clahar undertook the site visit on the 29th August, and Mr Joe Croft undertook the second site visit on the 1st September. The registered manager was present throughout. People living at the home prefer to be known as residents, therefore this term of reference is used throughout his report. Care Homes for Older People Page 6 of 36 The inspection process included a tour of the premises, direct observation of practice and sampling of residents care plans and risk assessments. Other documents sampled included the menu, records of medication, training records, staff recruitment files and health an safety records. The inspectors had discussions with the manager, staff, residents and visitors throughout the site visits. Residents told us that that they were happy living at the home, some were complimentary about the care they receive from staff, some stated that the staff look after them well. Some residents stated the food was good, and they were offered choices, others were not very complimentary about the food. During observations staff were interacting in an appropriate manner, however, two issues in regard to staff behaviour were discussed with the manager, The Annual Quality Assurance Assessment (AQAA) completed by the manager of the care home has been used as a source of evidence in this report. At the time of writing this report we have received six surveys from a residents, four from members of staff and three from health care professionals. One survey from a health care professional stated that staff would benefit from attending free training on continence. This was discussed with the manager who told us that this would be arranged for staff. The weekly fees for the home range from £520 to £770. The inspector would like to thank the manager, staff and residents for their cooperation during this site visit. Feedback was provided on both days of the site visits. The date of the last key inspection was the 24th September 2007. What the care home does well: What has improved since the last inspection? What they could do better: Staff must ensure the identified resident has their call pendant placed around their neck to enable them to summon help when required. The dirty blouse/jumper worn by an identified resident had to be changed. Monitoring residents clothing for cleanliness is necessary to ensure their dignity and respect are maintained. The linen on resididents beds should be checked daily to ensure acceptable standards of cleanliness and hygiene are evident. A review of the identified residents needs must be undertaken with the funding authority to ensure the home is able to continue to meet their needs. The registered manager must monitor and ensure that residents are appropriately dressed and their dignity is promoted at all times. The missing manhole cover in the identified bathroom must be replaced and a thorough cleaning of the bathroom to be undertaken. This was an immediate requirement. The manager must ensure that residents who have mobility difficulties are wearing their call pendants. The registered person must ensure the staff working at the care home keep the doors leading to the balconies locked and alarmed. The registered person must ensure that all staff are provided with up to date training in regard to safeguarding adults. Malodours must be eliminated in the identified bedrooms. Staff break times must be reviewed to ensure that there are sufficient numbers of staff available at the home throughout the whole day. The long hours identified staff are working must be reviewed. Training in regard to first aid and food hygiene must be updated as required for staff working at the home. Care Homes for Older People Page 8 of 36 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line – 0870 240 7535. Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are provided with the information they need to enable them to make a choice about living at the home. Assessment documentation is in place to ensure the individual needs of residents can be met. Evidence: The Anchor Trust have produced a Statement of Purpose and Service User Guide for the care home. These documents provide information about the care home, the services provided, facilities, staffing at the home and training for staff. There is a DVD provided with the Service User Guide that includes large text and commentary. One resident, who had the Service User Guide in their bedroom, told us that they had not been able to access this document due to their visual impairment. This was discussed Care Homes for Older People Page 11 of 36 with the manager who told us that the Serviuce User Guide is not available in Brail, however, a member of staff or a member of the persons family would be asked to read through the Service User Guide for them. A good practice recommendation has been made that the home should ensure all residents are able to access the contents of the Service User Guide. The manager told us that the Statement of Purpose is sent out to people who make enquiries about the home. The Statement of Purpose is displayed in the reception area of the home along with the complaint leaflets and the last Key Inspection report. The Annual Quality Assurance Assessment (AQAA) informs that the home has a Referral and Admissions Policies and Procedure that was last reviewed in April 2008. The manager told us that prospective residents are encouraged to visit the home when an assessment of their needs would be undertaken to ascertain if the home could meet their needs, and that assessments from the Community Care Team and Health Care Assessments are also obtained prior to admission. This was confirmed during discussions with some residents who could remember visiting the home prior to deciding to move in. Staff who undertake the pre - admission assessments include the manager, two deputies and team leaders. The AQAA informs that the these assessors are experienced and competent in their role to enable quality pre-admission assessments to be undertaken. Pre - admission assessments were viewed in the three care plans sampled. These included information in regard to their next of kin, religion, mental health, medication, activities of daily living, mobility, eating and drinking. It also included the residents views of their placement. The AQAA informs, under what we could do better, that they are to try to extend the pre-admission visits to twenty four hour stays. The home does not offer intermediate care. Care Homes for Older People Page 12 of 36 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have care plans and risk assessments in place to ensure their health care needs are met. Residents are protected by the homes storage of medication and administration procedures. The dignity of residents is not being promoted or appropriately monitored. Evidence: Three care plans were sampled during the site visit. Care plans were appropriately maintained and included information in regard to meeting the personal, physical and health care needs. Care plans had been signed by residents and had been reviewed on a monthly basis. Daily notes were maintained. Risk assessments were in place and had been reviewed on a six monthly basis. Dietary assessments are undertaken monthly including the monitoring of weights. Mobility and continence risk assessments are in place. The care plans viewed include a Care Homes for Older People Page 13 of 36 medication plan that is also included in the medicine records. A copy is maintained in their personal care plan and in the medicine trolley. Social activities had been included in the care plans, two of which had been signed by the resident to inform that they did not want to partake in activities. Sleeping patterns are included to ensure night staff have an understanding of their night time needs, and hourly checks are documented in the care plan with the agreement of residents. Care plans have monthly reviews and care plan evaluation sheets are completed that provide information in regard to the progress being made to the identified needs. Care plans included nutrition and weight charts that are monitored by the home on a monthly basis. Fluid intake was also monitored on a daily basis, this was in line with a requirement that was made in the previous inspection report. Falls risk assessments were in place, and mobility risk assessments were monitored on a weekly basis. One resident told us that they do not take part in activities, this was their choice and was recorded in their care plan. They also told us that there is nothing to do living at the home, and they were observed asleep on top of their bed during the site visit. The same resident was in an unkempt state. Their en-suite bathroom had a manhole cover missing and the bathroom required cleaning. The bed linen was soiled. Discussions took place with the manager regarding how the home was meeting this residents needs. The last evidence of a review with the residents care manager was March 2007. The manager stated that she thought another review had been undertaken since then but could not find evidence to support this. The manager contacted the funding authority during the site visit to arrange a date for this review, however, a requirement has been made that the manager must ensure a review of the identified resident must be undertaken with the funding authority to ensure the home is able to continue to meet their needs. An immediate requirement was made under the Environment section of this report in regard to the missing manhole cover and the cleanliness of the bathroom. An immediate requirement was made under this section in regard to the soiled bed linen. Records of all health care professional appointments are maintained that include the GP, district nurse, diabetic nurse, the community psychiatric nurse, and chiropodist and physiotherapy appointments. Medication records sampled were good and no gaps were identified in the Medicine Administration Record sheets (MARs). Boots provide the training in regard to the safe administration of medication. The home has a Controlled Drug (CD) register, which the manager stated was signed by two people each time a CD is administered. Explanations were provided on the reverse of the MAR sheets describing the reasons why action had been taken, for example, if medication was refused or if they had to Care Homes for Older People Page 14 of 36 administer PRN medication.The manager told us that records of receipt and returns of medication are maintained, however, these were not viewed during the site visit. During discussions staff told us that they respect residents privacy and dignity through knocking on bedroom doors, attending to personal care needs in the privacy of bedrooms and calling residents by their preferred names. During the tour of the premises two residents were observed to be an unkempt state wearing dirty clothing and undone buttons and zip. Staff had to be asked to attend to these residents. These issues were discussed with the manager in particular who told us that staff are responsible to ensure residents are appropriately dressed and clean. A requirement was made that the registered manager must monitor and ensure that residents are appropriately dressed and their dignity is promoted at all times. One resident was observed in their bedroom eating lunch, however, they were choking and spluttering and had no access to call for help as their personal alarm pendant had not been put on by staff. The inspectors had to summon staff to assist them. The top they were wearing was also dirty. This residents care plan informed that a member of staff must feed them using a small spoon, and they must be wearing their call pendant. An immediate requirement was made in regard to this. The AQAA informs that the home uses an holistic assessment tool, available as part of the service user plan, which enables effective identification of individual needs. Robust medication policies and procedures are in place and staff training is delivered by Boots. Under the plans for improvement during the next twelve months the manager has identified the need to monitor and train staff in the area of privacy and dignity. Care Homes for Older People Page 15 of 36 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are provided with opportunities to improve their lifestyle, and are encouraged to maintain contact with their family. Meals are varied and choices are offered ensuring that residents have a balanced diet. Evidence: The home employs two activity co-ordinators, one who had recently commenced their role at the home. The activity co-ordinators provide activities twice a day, six days per week, with the exception of Thursdays when there are four activity sessions. Different views in regard to the activities were received from residents. Some told us that there were enough activities, some stated there were insufficient and others stated that they choose not to join in with activities. On the day of the site visit activities were taking place with the residents. The home had undertaken a survey in March 2008 to obtain views of residents in regard to the activities provided by the home. This was in line with the requirement that was made at the previous key inspection. A summary of the findings had been produced. This informed that most residents living at the home Care Homes for Older People Page 16 of 36 prefer to do group activities and some like to entertain themselves. Activities provided include light exercises, singing, dancing, bingo, dominoes, reminiscence and quizzes. Individual activities are also provided throughout the week. Outings have been organised that have included trips to local amenities and pub lunches, however, the activity organiser told us that residents are enthusiastic about these trips, but the last outing had to be cancelled due to the lack of interest from residents. A list of the daily activities provided are clearly displayed throughout the home on large posters. Some residents told us that they can go to the local shops in the community. One resident was seen returning from a visit to the library. This person told us that they like reading and go the library on a weekly basis. It was noted in the care plans sampled that residents had a record of their activities and life style plan. The manager, staff and residents told us that visitors are always welcome at the home, and there are no restrictions to visitors. Residents are able to meet their visitors in the privacy of their bedrooms, and can go out with them if they wish to. Discussions took place with some visitors on the day of the site visit. The manager told us that external entertainers visit the home that include music groups, singers, pantomimes and Christmas carol choirs. The local Church of England vicar visits the home on a monthly basis and provides a religious service for residents to attend. One resident told us that they are Roman Catholic, and observe the abstinence of not eating meat on Fridays. They told us they would like to see the Priest visit on a more regular basis. This was discussed with the manager who told us that this would be followed up. It was observed that all residents living at the home are of a White British Origin. The manager and staff told us that they encourage the residents to be as independent as possible. Residents make choices about their daily lives, the food they eat, activities and what they wish to do throughout the day. The home employs two chefs who provide food for the residents living at the home. The head chef was on annual leave at the time of the site visit, however, discussions took place with the deputy chef. The kitchen area was observed to be tidy, and the storage of food was satisfactory. The fridge/freezer temperatures are monitored twice a day, and food stored in fridges are covered and labelled. The home uses a four week menu that includes meat, fish, pasta, fresh vegetables and fruit. There is a choice provided on the menu. Residents can have a cooked breakfast every morning if they choose to. The deputy chef told us that residents can have a different meal from the Care Homes for Older People Page 17 of 36 menu if they wish to, which was confirmed during discussions with residents, and special dietary requirements are catered for. Feedback is sought from residents about the food being provided. The deputy chef told us that the head chef attends the monthly residents meetings that are held on the first Friday of every month, Evidence of the minutes of these meetings were viewed during the site visit. Care staff also provide feedback to the kitchen each day, and each unit has a comments book that the chef views. Residents and visitors told us that the food is generally good, however, one told us that the week prior to the site visit the meat was very tough and like pigswill. This was discussed with the manager who told us they were aware of this, and discussions took place with the kitchen staff. The deputy chef confirmed this. They told us that it was due to the quality of the meet the home had been provided with on that particular day. Training is provided for the chefs by the Anchor Trust that includes the BTEC level 2 Intermediate Diploma in Food Preparation and food handling and hygiene. On the day of the site visit bowls of fresh fruit were observed in the units, and residents had been provided with drinks throughout the day. Drink dispensers were also observed in the units. Meal times were observed to be relaxed and unhurried occasions with staff available in the dining rooms. The AQAA informs that activities are service user specific, community participation is actively encouraged, fresh water and fruit juices are available in each unit and individual nutritional screening feeds into the menu planning by the chef. Plans for improvement include developing protocols of practice for specific areas promoting individual daily life and social activities. The home is a member of the National Activities Providers Association (NAPA). Care Homes for Older People Page 18 of 36 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have access to a satisfactory complaints system that enables them to raise concerns. Staff require training in the Protection of Vulnerable Adults to ensure residents are fully protected from abuse. Evidence: The Commission for Social Care Inspection has not received any complaints in regard to the care home during the last twelve months. The home uses the Anchor Trust Complaints Policy and Procedure that includes the timescale for responding to complainants and the up to date contact details of the Commission for Social Care Inspection. Copies of the complaints procedure are included in the Service User Guide and complaint leaflets were observed to be available in the home for both residents and visitors. The AQAA informed that the home had dealt with ten complaints since the previous inspection, however, on viewing the complaints book there were only eight recorded complaints. The manager told us that there must have been a miscalculation when completing the AQAA. During discussions residents told us that they knew how to make a complaint. One resident stated that they may have read the complaints policy but could not Care Homes for Older People Page 19 of 36 remember as they have a bad memory. One family member told us that complaints are not acted on. This was discussed with the manager who told us that all staff have been told that they must forward all complaints to her so they can be addressed. The manager was aware that there had been concerns raised as to whether complaints had been addressed. A letter that was sent to all relatives and staff, dated 23rd April 2008, was viewed. This was informing relatives and staff that all complaints are taken seriously, and must be referred to the manager to be dealt with. The home follows the Anchor Trust Safeguarding Adults Policy and Procedure that was last reviewed in May 2008. A copy of the recent 2008 Surrey Safeguarding procedures are available for staff to read. The training matrix provided during the site visit provided evidence that there were short falls in regard to training on the Protection of Vulnerable Adults (POVA). Of the thirty six care staff there was no evidence that sixteen had received this training, and eleven staff had last attended this training in 2005. This was discussed with the manager who told us that abuse is covered during the training on Rights and Responsibilities. Information provided in the Statement of Purpose informs that staff are provided with training on POVA and Rights and Responsibilities. For the majority of staff, the training matrix showed that they had not received recent training or any training in regards to Rights and Responsibilities. The manager did provide a programme for the most recent training on this subject, of which forty minutes was allowed for discussions on abuse, but evidence of who attended this training was not available. A certificate was viewed that the manager had attended the Surrey POVA training in June 2005, this is now due for renewal. The manager told us that POVA training had been arranged for the 17th September 2008, however, not all staff could attend this one day training event. A requirement has been made that the registered person must ensure that all staff are provided with up to date training in regard to Safeguarding Adults. During discussions, staff were able to demonstrate that they were aware of the different types of abuse. Scenarios in respect of abusive situations were discussed with four members of staff and the manager. They were able to demonstrate an understanding of Safeguarding Adult issues and the importance of reporting to senior staff and the manager. The manager was aware and has reported Safeguarding issues under the Surrey Safeguarding Procedures. The AQAA informs that two Safeguarding issues had been dealt with since the previous inspection. The manager told us that there is one Safeguarding issue that she had made a referral for the week before this site visit and is currently ongoing. The Commission For Social Care Inspection had received an allegation about the home Care Homes for Older People Page 20 of 36 in August 2008 that was refereed under the Surrey Safeguarding Procedures, however, the manager told us that she had not received any contact from the Surrey Multi-Agency Team in regard to this. The home has policies and procedures in place to protect residents from financial abuse. Residents and/or their relatives are responsible for their finances. The home holds small amounts of monies for residents that is kept secure in a locked safe that only four people working at the home can access. Residents are provided with monthly statements of their accounts. Records for three residents were viewed during the site visit. These itemised monies credited and debited, and were signed by the resident and member of staff. The AQAA informs that complaints and feedback is actively welcomed. POVA training for all staff has taken place, however, this was not the findings during the site visit. Care Homes for Older People Page 21 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The location and lay out of the home are suitable the homes stated purpose. Identified issues that effect health and safety must be addressed to ensure that people using the service live in a safe and well-maintained environment. Evidence: A tour of the premises was undertaken. This took much longer than usual due to the findings and discussions taking place with staff, residents and visitors present on the day of the site visit. The accommodation consists of 64 single bedrooms and one double bedroom. The ground floor accommodates eighteen residents. The ground floor bedrooms had full en-suite facilities. The first and second floors consist of two living units, each accommodating twelve residents in single bedrooms with en-suite toilets and sinks. Each floor is accessed by a passenger lift and stairs. The manager told us that they are waiting for quotes for the installation of stair lifts. The passenger lift was last serviced in June 2008. Communal facilities on each floor include a small kitchen, dining room, lounges, toilets and assisted baths/showers. It was noted that the bathrooms had curtains to provide extra privacy if the bathroom doors were opened for any reason. Communal toilets and bathrooms had liquid soap and paper towels. The communal areas and corridors were observed to be clean and brightly decorated. Care Homes for Older People Page 22 of 36 One domestic staff told us that they and other domestic staff had attended training in regard to Infection Control. Bedrooms viewed during the tour were also brightly decorated and included residents own possessions such as family photographs and some furnishings. Residents told us that they like their bedrooms, and they have enough privacy if they close the doors. Some residents had land line telephones in their bedrooms, and there is a public telephone in the home. A married couple living at the home have been provided with a double bed and a lounge area. During the tour, some residents and visitors told us that the home has been much cleaner during the last month, a huge improvement had been made. Previous to this there were issues in regard to the carpets being dirty and malodours. Four bedrooms visited had a smell of urine. These were discussed with the manager and requirements in regard to this has been made. One en-suite bathroom had a manhole cover missing that left an old and dirty shower outlet pipe exposed. The bathroom also required to be cleaned. The manager told us that the resident must have removed this. An immediate requirement was made in regard to this. The same bedroom had a strong smell of urine, and the bed clothes were soiled. An immediate requirement was also made in regard to this. An Ergolet hoist in the main corridor of Fairbanks was very dirty. An immediate requirement in regard to this was made. The manager told us that a book was kept in the reception of the home that domestic staff had to complete in regard to the cleaning duties that had been undertaken that day. A requirement was made at the last key inspection that a system must be put in place for monitoring the standards of cleanliness in the bedrooms. This had been completed and was recorded in a Regulation 26 report of March 2008 stating that systems are now in place to ensure the cleanliness of rooms. The manager told us that the handy man maintains these records, however, he was on annual leave on the first day of the site visit, and these records were not viewed. The manager stated that she is reviewing this and that a new system is being put into place that she is to monitor. Bedrooms had call bells and all care staff carry a bleep that alerts them to a call. This was tested during the site visit and the response was prompt. It was observed that in some bedrooms the call bell cords were lying on the floor behind the bedside cabinets. The communal lounges had call alarms on the walls, but residents with mobility difficulties could not access these to summon help. Two residents were observed calling for help, one for twelve minutes. The inspector had to call on a member of staff to each resident. The manager told us that residents with mobility difficulties should be wearing call pendants, however, these were not observed during the site visit. A requirement has been made in regard to this. Care Homes for Older People Page 23 of 36 There are two balconies on the first and second floor. The manager told us that a surveyor is investigating the possibility of enclosing these with some type of netting. The manager told us that the height of the balcony rails are compliant with the building regulations, and staff have been instructed that residents must be supervised at all times when using the balconies. The manager also told us that the doors leading onto the balconies are kept locked and are fitted with alarms. On the day of the site visit one door leading to the balcony on the second floor was unlocked and not alarmed. There is a risk assessment in place in regards to the use of the balconies that was last reviewed on the 7th July 2008, but was not being adhered to. A requirement in regard to this has been made. The home follows the Anchor Trust policy and procedure in regard to Infection Control. Evidence was viewed that twenty-nine staff had attended training in regard to Infection Control on the 14th August 2008. Care Homes for Older People Page 24 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for staffing are satisfactory. Staff are provided with NVQ training required to ensure the needs of residents are met. People who use the service are protected by the homes recruitment policy and procedures. The staff hours and cover for staff breaks require attention to ensure there are sufficient numbers of staff on duty at all times of the day. Evidence: The home employs a multi-cultural staff team that includes male and female staff. The manager had undertaken a review of the staffing levels for the home. This was a requirement made at the last key inspection. Staffing levels for the ground floor are now three per shift. The manager told us that the staffing levels for the home are now one staff to six residents and that she feels this meets the assessed needs of the residents. The waking night staff have been increased from four to five per night. The manager told us that staff at the home includes the manager, two deputies, three day time team leaders and three night time team leaders, a team of care assistants, five domestics, two chefs and a handy man. The duty rota for July 2008 was viewed. This provided evidence of the numbers of staff working in each of the units during the Care Homes for Older People Page 25 of 36 day and night. It was noted that most staff are working thirteen hour shifts with a one hour break in the afternoon. These breaks take place between 2 and 4pm. This means that there is a two hour period where there is only one member of staff on duty in each of the units. This was discussed with the manager who told us that she was aware of the long days being worked, and the need to provide cover during the afternoon breaks. During the site visit residents and visitors told us there are times when there is not enough staff on duty and the call alarms can take a long time to be answered. Other residents told us that they felt there were enough staff on duty, and they would do as you ask of them. This was further discussed with the manager and a requirement has been made that the cover for staff breaks must be reviewed to ensure there are enough staff on duty at all times of the day to ensure the assessed needs of residents can be met. Of the six sureveys received from residents, two informed that staff are only sometimes available, the other four infromed that staff are usually available. Some residents and visitors told us that some of the staff could be too loud, and one member of staff is a mixture of kindness and a bully. One member of staff was observed being loud on the day of the site visit. The manager told us that this had been reported to her by one of the deputy managers on duty at the time of the site visit, and that she would address this with the member of staff concerned. The manager told us that due to the recent staff turnover the number of staff holding the NVQ level 2 and above had fallen from 60 to 50 , however, two new members of staff are to commence duties who hold this qualification, therefore this would take the percentage to over 50 . A tracking form from the Anchor Trust dated 4th August 2008 confirmed this. The home follows the Anchor Trust recruitment policies and procedures that was last reviewed in April 2008. The recruitment files for the three recent staff appointments were viewed. These contained the information required including an application form, two written references, Criminal Record Bureau and POVA first checks. One application form only provided the years of employment, not the months. The manager told us that she would address this with the member of staff. New members of staff attend the BTEC induction training that is provided by the Anchor Trust. Other training undertaken by staff included Dementia, Rights and Responsibilities, care plans and Control Of Substances Hazardous to Health (COSHH). Care Homes for Older People Page 26 of 36 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for management and administration do not ensure the home is run in the in the best interests of residents, and their health and safety is not fully promoted or safeguarded. Evidence: The manager registered with the Commission for Social Care Inspection in 2006. Qualifications held by the manager include the NVQ level 4 in care and the Registered Managers Award (RMA), BTEC certificate in management, is an NVQ assessor and verifier. Other training undertaken includes the diploma in Dementia Care Matters and the Care of Medicines. Staff told us that the manager is supportive and has an open Care Homes for Older People Page 27 of 36 door policy for staff, residents and visitors. The manager must address the identified issues raised in this inspection report in regard to the personal appearance of residents that would promote their dignity, the malodours and cleanliness of the home that affect the health, welfare and safety of residents, staff hours and break times, training in regard to Safeguarding Adults, and the needs of identified residents. This would ensure that the home was being appropriately managed. The quality assurance system for the home was viewed. The manager told us that the home is now using a self assessment tool that had been provided by the Anchor Trust. This tool is used to assess how well the home is doing against the National Minimum Standards for Older People, and was introduced to the home in May 2008. Team leaders have the responsibility for co-ordinating this. A survey of residents was undertaken in January 2008, however, a summary of the findings had not been produced. The manager told us that she would undertake a survey for relatives and other stakeholders this week, and would forward a copy of the summary of findings to the Commission for Social Care Inspection. Regulation 26 visits are being undertaken on a monthly basis, and copies of these reports were available at the home for inspection. The home has an annual development plan for 2007 to 2008. The manager told us that residents and/or their relatives are responsible for their finances. The home holds a small amount of money for residents, up to a maximum of £100. Each resident receives a monthly statement from the home. Residents sign a Residents Agreement to confirm that they have read and agree with the Anchor Trusts policy and procedure in regard to residents personal money. Three residents records of money were sampled. Records of all transactions and receipts are maintained. The money is kept secure in a locked safe, and only four members of the senior team can access this. The training matrix provided by the manager evidenced that mandatory training had taken place. There were gaps in regard to first aid and food hygiene and handling. The manager told us that training in regard to food hygiene and handling is to be delivered by the chef when he returns from annual leave. Some staff had not received this training since 2004. A requirement has been made that staff must receive training in regard to first aid, food hygiene and handling and Safeguarding Adults training must be updated as required. Of the four surveys received from staff, under what the service could do better, one informed that staff could receive regular training, keep Care Homes for Older People Page 28 of 36 them updated with elder residents, giving them more knowledge. Two surveys informed that training is provided. Generic risk assessments for the home were in place and were last reviewed on the 17th July 2008. The following service certificates and records in regard to health and safety were viewed during the site visit. Records of fire drills, testing of emergency lighting and fire alarms were viewed during the site visit. Fire extinguishers had been serviced in August 2008. The home had fire risk assessments in place that were last reviewed on the 26th November 2007. The home also has a fire evacuation plan. The manager told us that the fire officer, who visited the home on the 7th November 2007, viewed these documents and did not raise any issues in regard to them. The report of this visit was viewed. The AQAA informs that the health and safety equipment used at the home had been serviced as per the manufacturers guidelines. The emergency call bells were last serviced in May 2007. The manager told us that she would organise a date for this to be undertaken. Care Homes for Older People Page 29 of 36 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 10 12 The registered person shall, for the purpose of providing care to service users, and making proper provision for their health and welfare, so far as practicable ascertain and take into account their wishes and feelings. Staff must ensure the identified resident has their call pendant placed around their neck to ensure they are able to summons help. The dirty blouse/jumper must be changed. 29/08/2008 2 10 13 The registered person shall 30/08/2008 make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. Soiled bed linen on the double bed in room 34 must be replaced immediately. 3 26 13 The registered person shall 30/08/2008 make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. The Ergolet hoist in the corridor of Fairbanks near the fire extinguisher is very dirty and must be cleaned immediately 4 26 13 The registered person shall 30/08/2008 make suitable arrangements to prevent infection, toxic conditions and the spread of Page 31 of 36 Care Homes for Older People infection at the care home. The manhole cover missing in en-suite bathroom 34 must be replaced, and thorough cleaning of the bathroom must take place. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The registered person shall 01/10/2008 where appropriate, unless it is impracticable to carry out such consultation, after consultation with the service user or representative of his, revise the service users plan. A review of the identified resident must be undertaken with the funding authority to ensure the home are able to continue to meet their needs. 2 10 12 The registered person shall 29/09/2008 make suitable arrangements to ensure that the care home is conducted in a manner which respects the privacy and dignity of service users. The registered manager must monitor and ensure that residents are appropriately dressed and their dignity is promoted at all times. Care Homes for Older People Page 32 of 36 3 18 13 The registered person shall make arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm. The registered person must ensure that all staff are provided with up to date training in regard to Safeguarding Adults. 01/11/2008 4 19 13 The registered person shall ensure that unnecessary risks to the health or safety of service users are identified nad so far as possible eliminated. The registred person must ensure that staff working at the home keep the doors leading to the balconies locked and alrmed. 29/10/2008 5 22 23 The registered person shall 29/10/2008 having regard to the number and needs of the service users ensure that suitable adaptations are made, and such support, equipment and facilities, including passenger lifts, as may be required are provided, for service users who are old, infirm or physically disabled. The manager must ensure that residents who have mobility difficulties are wearing their call pendants when accessing communal areas of the home. Care Homes for Older People Page 33 of 36 6 25 16 The registered person shall having regard to the size of the home and the number and needs of service users keep the home free from offensive odours and make suitable arrangements for the disposal of general and clinical waste. Malodours must be eliminated in the identified bedrooms. 29/10/2008 7 27 18 The registered person shall, 29/10/2008 having regard to the size of the care home, the statement of purpose and the number of and needs of service users, ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. Staff breaks must be reviewed to ensure there are enough staff on duty at all times of the day to ensure the assessed needs of residents can be met. The long hours identified staff work must be reviewed. 8 38 18 The registered person shall, having regard to the size of the care home, the statement of purpose and the number of and needs of service users, ensure that the persons employed by the registered person to 30/11/2008 Care Homes for Older People Page 34 of 36 work at the care home receive training appropriate to the work they are to perform. Staff must receive training in regard to first aid, and food hygiene and handling training must be updated as required. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 14 1 The home should ensure all residents are able to access the contents of the Service User Guide. Care Homes for Older People Page 35 of 36 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). 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