Inspection on 03/09/07 for Maitland House

This inspection was carried out on 3rd September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Maitland House 26/08/08

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Maitland House 33 Church Road Clacton On Sea Essex CO15 6AX Lead Inspector Pauline Dean Key Unannounced Inspection 3rd September 2007 09:05 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 Maitland House DS0000068186.V350083.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. Maitland House DS0000068186.V350083.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Maitland House Address 33 Church Road Clacton On Sea Essex CO15 6AX 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) 01255 421415 maitlandhouse@blackswan.co.uk www.blackswan.co.uk Black Swan International Limited Mrs Celia Conroy Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (23) of places Maitland House DS0000068186.V350083.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Four named persons, over the age of 65 years, who require care by reason of dementia. Date of last inspection Brief Description of the Service: Maitland House is an established care home situated in a residential area close to the town centre of Clacton on Sea. It is within walking distance of local shops, post office, library, churches, leisure facilities and the railway station. Fees were said to be £374.50 - £437.57 per week. Additional charges are newspapers, toiletries, chiropodist, dry cleaning and magazines at cost. Maitland House offers accommodation for twenty-three service users, on the ground and first floor, with fourteen single bedrooms and one double room having en-suite facilities. There is passenger lift access to all floors. The home has gardens to the front and rear. The front garden offers off road parking, with flowerbeds and borders. The rear garden has paved patio, shrubs and flowerbeds. Communal areas are found at the front and rear of the property. The rear lounge has patio doors to the garden. A second lounge and dining room are found at the front of the building. There are bathroom facilities on each floor, including a Parker bath and a shower room on the first floor. A call bell system is in place, with handrails, aids and hoists in the home. Maitland House DS0000068186.V350083.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection of Maitland House took place on 3rd September 2007 over an 8¾-hour period. This was the first inspection under the new registered providers of Black Swan International Limited. The inspection involved checking information received by Commission for Social Care Inspection (CSCI) since the last inspection in September 2006, looking at records and documents at Maitland House, and talking to the registered manager, Mrs Celia Conroy, care staff and the people living at the home. In addition the Annual Quality Assurance Assessment (AQAA) completed in June 2007 was considered as part of the inspection process and a partial tour of the premises was completed at the visit to the care home. Surveys were left with the home for distribution to all of the people living at Maitland House, some relatives and health professionals. Nineteen surveys have been completed and returned by the people living at the home. Overall the comments within this survey work was positive and is reflected on in detail in this report. During the inspection five people who live at Maitland House were spoken with. All were pleased with the service and happy about way they are supported and assisted by the staff. They considered the manager and staff to be kind and courteous. What the service does well: Maitland House has developed an assessment and admission process, leading to a detailed care plan, with health care needs considered. The environment is homely and comfortable with ongoing improvements and maintenance implemented. Food and catering in the home continues to be regarded highly in the home with the home’s cooks taking pride in their work. All five people spoken to at the inspection complimented the home on the meals served, highlighting roast dinners as a favourite. Within the survey work completed by the Commission for Social Care Inspection (CSCI), four people living at the home had commented on the quality of food served at the home, praising the home’s cook, one stating it was like a ‘1st class hotel.’ As noted at the last inspection, it was noticeable that the people who live in the home have established friendships amongst themselves and during the Maitland House DS0000068186.V350083.R01.S.doc Version 5.2 Page 6 inspection we were told of ways in which they support and help each other day by day. What has improved since the last inspection? What they could do better: Improvements are required in record keeping and the arrangements around the provision of social and leisure activities in the home. The registered provider needs to review and revise the current contract and the statement of terms and conditions issued to new residents to ensure that they are appropriate and applicable to people who live at Maitland House. The registered provider needs to review current staffing levels to ensure that the assessed needs of the people living at Maitland House are met at all times. Staff recruitment practices require immediate attention. The new providers have stated that they have developed a training and development programme, which had not been progressed by the registered manager. A training and development programme needs to be developed to ensure that all staff, including new staff received basic care skills as they enter the employment of the care home. Maitland House DS0000068186.V350083.R01.S.doc Version 5.2 Page 7 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. Maitland House DS0000068186.V350083.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 Maitland House DS0000068186.V350083.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): 1, 2, 3 and 6. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. A comprehensive admissions process ensures that people who come to live at Maitland House are assured that their needs are met. They cannot however be assured that they will receive accurate information about the service or facilities on offer when deciding to move to the service. Intermediate care is not offered at Maitland House. EVIDENCE: Black Swan International Limited had developed a new Service User Guide, which includes the Statement of Purpose, as they took over the ownership of Maitland House. A copy was seen at Maitland House and was dated September 2006. Within this guide, detail as required by the National Minimum Standards – Standard 1 was seen with details of fees included. Maitland House DS0000068186.V350083.R01.S.doc Version 5.2 Page 10 Of the two new admissions sampled one was seen to have completed a statement of terms and conditions documents as produced by Black Swan International Limited. This format was confusing and inaccurate with regard to Maitland House. For it spoke of residents being under 65 years of age and spoke of no lift access in a learning disability home. This is clearly confusing to new residents at Maitland House. The registered manager was advised of the need to review this document with the providers to ensure that is both accurate and appropriate to Maitland House. The second sampled care plan file had no evidence of a statement of terms and conditions or a contract. The registered manager said that this person was a private placement who had entered the home in May 2007. It was acknowledged by registered manager that a contract should be in place. On the day of the inspection there were twenty-one people living at the Maitland House. The registered manager, Mrs Celia Conroy, said that the primary care needs of these people related to their old age. The admission process was discussed and considered with the registered manager and sampled paperwork was seen to support a comprehensive assessment and admission process. An initial assessment was conducted before admission to the home, with supporting evidence of assessments completed by health professionals and social workers. The registered manager said that family and relatives are encouraged and had been part of the admission processes for the two sampled admissions. Record keeping supported this. No intermediate care is offered at Maitland House. Maitland House DS0000068186.V350083.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. People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care planning documents were comprehensive detailing health, personal and social care needs with regular monthly reviews in place to ensure that the people who use the service receive the care they wish and require. People who use this care service were assured that their health care needs were met through the management of medication and they were supported to access health professionals as needed. People who live at the home were treated with sensitivity and respect. Maitland House DS0000068186.V350083.R01.S.doc Version 5.2 Page 12 EVIDENCE: The admission procedures in the home provided sufficient introductory information. From this information the home could determine whether they could meet the identified needs and commence an individualised plan of care. The care plans of three people living at the home were sampled and inspected and they were used to case track care in the home. An assessment of needs identified, health, personal and social cares needs. Within two care plans sampled, care plans had been created which covered topics such as Medical Care, Personal Needs, Mobility, Moving, Handling & Transferring, Behavioural & Emotional, Activities, Financial Management & Restrictions of Choice & Specific Risks. Within each care plan detail was seen and goals/objectives and agreed action was noted. Monthly reviews were evident in the three care plans sampled and a change had been noted and action taken in one of the sampled care plans. Alongside the care plans, risk assessments were seen in place. Risk assessments for Self-Medication, Prevention of Falls, Diabetes, Smoking, Going out of the Home unaccompanied, Challenging Behaviour, Manual Handling and Nutrition & Health were considered. The registered manager said that the new registered providers had developed these. In addition to these identified risks, the home had developed a risk assessment around the use of bedside rails and this had been brought into operation as needed and was seen to be appropriate and reviewed. The registered manager said that the practice of writing daily records had ceased following an instruction from the new registered providers. Weekly record keeping had commenced and this was found to either very brief i.e. ‘…had a good week’ or where the notes were more detailed it had been found impossible to follow through what action had been taken either in the notes made weekly or in medical notes. We therefore do have concerns, for the care plan could fail to reflect the current care required. People living at Maitland House use the services of five GP practices in the area. Many have been able to remain with their previous GP as they moved into Maitland House. At the time of the inspection, the registered manager said that one person was having regular visits from the District Nursing Service. One person spoken to at the inspection said that they had recently had the services of an Optician and they were awaiting their new glasses. Another person said that when they needed to see the doctor, the home would contact them and they would visit them at the home. Maitland House DS0000068186.V350083.R01.S.doc Version 5.2 Page 13 The registered manager said that the home has a variety of aids and equipment to assist with caring for the people living at the care home. They said that they currently had five pressure mattresses in use and the home has one stand-up hoist, three mobile hoists - two electric and one manual available for use. The registered manager told us that the home is changing pharmacist at the end of the month. A Monitored Dosage System will be used. Medication records, storage and administration was sampled and inspected for three people living at the home. Photographs were seen in the medication folder of each person on medication and records were found to be in good order. A list of drug givers with their signatures and initials is used. It was recognised by the registered manager that some updating is required to this list. During the inspection, staff were seen to treat all of the people living at Maitland House with respect and dignity. Within care planning notes there were the details of the preferred names, which some people wished to be called. It was also evident that the people living at Maitland House were also able to express their individuality in their accommodation, for there was evidence of personal possessions, small pieces of furniture and photographs in their rooms. During the inspection we were able to observe staff going about their duties and as they approached and spoke with the people living at Maitland House, it was pleasing to see that they were both respectful and sensitive to their needs and there was lots of friendly banter and joking going on between staff and residents. One person living at the home did raise an issue concerning some staff not necessarily waiting to gain admittance once they had knocked their bedroom door. This was raised with the registered manager, who agreed to discuss the matter with the resident and the staff member concerned. Maitland House DS0000068186.V350083.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The daily routine and activites in the home were flexible and optional, with people who live at Maitland House being encouraged to make choices with regard to their social, cultural, religious and leisure activities. Family contact and visiting arrangements were open and relaxed, with family links encouraged and promoted. Links with the local community are encouraged and promoted as wished by the individuals living at Maitland House. Maitland House provides a varied and nutritious menu for individuals to select from. Maitland House DS0000068186.V350083.R01.S.doc Version 5.2 Page 15 EVIDENCE: Throughout the day of the inspection, the people who live at Maitland House were seen to come and go as they pleased. Some people choose to sit in the lounge areas, whilst others sat in their rooms listening to the radio, watching television or reading. One person living at the home said that they enjoyed watching their television and listening to the radio. They had the magazine ‘Radio Times’ and they said that they used this magazine to select programmes to watch and listen to in the evening. Another person said that they enjoyed reading a magazine, which they have weekly and doing word searches and quizzes, whilst a third person said that they enjoyed a sing song together. They also enjoyed the company of the caged bird in the lounge. A weekly programme of activities was on display in the hall of the home and on the day of the inspection, Bingo was listed as planned. This did not take place however. When the registered manager was asked why, we were told that the home did not have sufficient staff on duty to run the event. The registered manager said that normal staffing levels in the afternoon are three care staff, a reduction from the morning staffing levels of four care staff and with this reduction it was difficult to arrange and provide activities in the home. As the practice of writing daily reports had ceased it was not possible to evidence what activities had taken place and who was taking part in them. A group of four residents told us that they have entertainment approximately every three weeks, but that activities such as bingo, quizzes and armchair exercises only happen when there are enough staff to put these activities on. Within the home’s completed Annual Quality Assurance Assessment, it was said that the home did need to increase and improve their range of activities offered and following receipt of a draft copy of this report, the registered provider has stated that ‘activities have increased significantly’ and they had listed some planned activities for November/December 2007 . One response from a person living at the home said that they enjoyed a singer who visited the home and a couple who sang and danced for them. In addition they said they enjoyed the ‘armchair exercise lady who is friendly and kind’. When asked in the survey – ‘Are there activities arranged by the home that you can take part in?’ – four said that there was always activities arranged, seven said there were usually activities arranged and five said there were sometimes activities arranged by the home. Maitland House has a policy on visiting arrangements in the home. There was said to be no restriction on visiting, the choice being up to the resident. Maitland House DS0000068186.V350083.R01.S.doc Version 5.2 Page 16 The registered manager said that family and friends are involved in assisting the people who live at Maitland House to manage their financial affairs. Should this not be possible then the home would assist the individual to find an independent financial advisor and/or an advocate. On the tour of the premises it was evident that there was a range of personal belongings in the home. Several people living in the home had items of furniture including chairs, storage units, bookcases and small tables. In addition there was evidence of pictures, photographs and ornaments on display in the bedrooms. The home accommodated this by hanging the pictures and putting up shelves, as needed. A three-week rotation menu is used to plan meals at Maitland House. At least two sometimes three choices were offered at both the lunch and teatime meal, with a choice of a cooked or cereal and toast for breakfast. The cook on duty said that the menu had recently been revised to take into account the likes and dislikes of the people living at Maitland House. They said that they are responsible for finding out what people would like to eat and they would go around the home asking the residents. Record sheets were seen of the meals selected and food supplies were plentiful to ensure that choice was on offer. Fridge and freezer space was available inside the home and in the outside food storage area. Roast dinners were said to be popular and one resident said the cook made ‘wonderful gravy’. Another person said that the ‘food was good’ and they were able to tell us about a meal they had enjoyed and what they had chosen for tea. Maitland House DS0000068186.V350083.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. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who live at Maitland House were well treated and listened to, with complaints and adult protection procedures in place. EVIDENCE: A copy of the home’s complaints policy and procedure of June 2006 was seen and inspected at the inspection. This referred to ‘The Homes Inspection Officer or his absence a colleague, will record details of the complaints and after due consideration and investigation will give a decision.’ The registered manager was informed that it is not the role of the Commission to investigate complaints, but to review the management of complaints and their investigations through regulation and inspection of the care service’s complaint procedure. The Service Users’ Guide reference to complaints was also said to need revision. Subsequently on receipt of this inspection report in draft, the registered provider advised us that this policy had been revised and from the information and detail received of the revised current policy this would seem to meet requirements. Maitland House DS0000068186.V350083.R01.S.doc Version 5.2 Page 18 Management of complaints was discussed with the registered manager and they acknowledged the need to listen and record all complaints. A recent complaint regarding staffing levels, which had been raised in writing with the home had been acknowledged and responded to by the home’s management. A complaint regarding the lack of social activities, which had been raised verbally with the registered manager, had been acknowledged by the registered manager, but no remedial action taken by them. The registered provider said that they were not aware of this complaint. At the inspection visit an Adult Protection Policy dated June 2006 was seen. This was found to have some shortfalls with regard to reflecting current practice for making a referral to Social Care Direct and the Safeguarding Adults Unit. Following receipt of the draft report of this inspection, the registered provider advised us that this document had been revised in July 2007. A copy of this policy was sent to the Commission and it was found to meet requirements. The management of adult protection issues has been managed well by the home. Two recent adult protection referrals were discussed with the registered manager. In both cases the registered manager had responded immediately raising the home’s concerns and taking appropriate action to safeguard service users. With regard to an allegation of financial abuse, safeguarding action had been taken and reassurance and support given to the service users. The Police, Social Services and the Commission had been notified and involved in the management of this concern. With regard to the second safeguarding adults concern, appropriate action had been taken by the home and a referral to the Protection of Vulnerable Adults (POVA) register is being considered. Maitland House DS0000068186.V350083.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, 22 and 26. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Overall, Maitland House provides a safe environment that is accessible to the people who live at the home. It is homely and meets individual’s needs. EVIDENCE: A tour of the home was conducted at the inspection. There was evidence of ongoing decoration, maintenance and repair, with maintenance records completed as a task is done. Two bedrooms had had new carpets. The rear garden had been paved over to provide a good seating area, but the registered manager said that the home needs to introduce some shade and shelter provision next summer. Whilst there was no evidence of a record of a programme of planned work, the registered manager said that it is Maitland House DS0000068186.V350083.R01.S.doc Version 5.2 Page 20 acknowledged that hall and stair carpets will need replacing in the near future, for on doorway thresholds there was evidence of wear and tear. The registered manager said that the registered providers are looking to improve the bathroom facilities within the home, moving shower and bathing facilities in the main communal bathrooms. An Occupational Therapist assessment was completed in February and June 2007. Some recommendations had been made with regard to bathing facilities in the home and these were being given consideration. In addition some recommendations around the installation of handrails was being actioned. Maitland House has an in-house laundry room. Two washers and two dryers were in place with care staff responsible for laundry both day and night. There were areas for hanging clothes to dry and air and individual baskets are used to ensure individual laundry items are returned to the people living at Maitland House. Maitland House DS0000068186.V350083.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. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There was insufficient staff to ensure the people who live at Maitland House have their individual needs addressed. People who live at the home are not protected by the home’s recruitment practices and training. EVIDENCE: The registered manager said that staffing hours are reviewed and revised according to the assessed needs of the service users. Copies of the staff rotas for the weeks commencing 20th August, 27th August and 3rd September 2007 were inspected and staffing levels were seen to be three carers on duty 08:00 hours to 09:00 hours, four carers on duty from 09:00 to 13:00 hours, reducing to three carers 13:00 hours to 19:00 hours. After 19:00 hours the staffing levels reduce again to two carers, with two awake carers with a senior on call at night. The registered manager was seen to be part of these calculations for the majority of the week, with only thirteen hours designated each week for management duties. They did not feel that Maitland House DS0000068186.V350083.R01.S.doc Version 5.2 Page 22 this was sufficient. On receipt of the draft report, the registered provider stated that the registered manager had eighteen of her contracted forty hours set aside as supernumerary for administration work. Within the staff meeting minutes of 29/05/07, it was noted that a relative had commented on the time it took for staff to answer the door bell, especially at weekends and they had commented that they thought there were low staffing levels in the home. In the minutes it said that this was being reviewed. Within the survey work completed by the Commission one person completing the survey had commented ‘some problems at weekend’ when asked are staff available when you need them and they had commented that they felt the cleanliness of the home was ‘neglected at weekends.’ When asked in the Commission ‘s surveys whether they receive the care and support they needed, eleven had said that they always receive the care and support needed and six had said that they usually received the care and support needed. Two care staff who work the evening shift said that they are ‘sometimes stretched’ particularly in the evening when staffing levels reduce to two care staff. One carer said that it is noticeable that the current people in the care home have higher dependency needs and they ‘sometimes feels stretched when trying to put residents to bed, hoisting etc. and then another resident calls’. Whilst staff did not seem noticeably stretched during the inspection, the provider does need to ensure that staffing levels meet the dependency needs of the home’s current service users. The registered manager said that eight care staff have completed National Vocational Qualification training (NVQ) level 2 in care, two of whom are starting their NVQ level 3 in care and three staff are currently on NVQ level 2 in care. The home was therefore said to have met the minimum ratio of 50 trained members of staff with NVQ level 2 or equivalent. Two care staff spoken to at the inspection confirmed that there were training opportunities and one had completed their NVQ level 2 in care, whilst the other was planning to do it. Staff recruitment practices and paperwork were sampled and inspected for three care staff. Within this paperwork there were omissions and shortfalls. For one new employee who had started work on 24/08/07 there was no evidence of an application form or written references. The registered manager said that the home is not holding these documents, but they are currently with the registered provider. One verbal telephone reference had been completed and recorded by the registered manager and they were awaiting confirmation of completion of the written references. Furthermore, there was no confirmation of completion of an Enhanced Criminal Record Bureau (CRB) in the home. The registered manager said that she had been informed by the Maitland House DS0000068186.V350083.R01.S.doc Version 5.2 Page 23 registered providers that a Protection of Vulnerable Adults (POVA) 1st Check had been completed. No supporting written evidence was seen at the inspection, although the registered provider has advised the Commission that a staffing matrix detailing each member of staff and all checks and paperwork received is held at the home. This was not seen or offered for inspection at the site visit. One shortfall was noted in the paperwork of a second staff recruitment file, there was only one written reference on the file. Shortfalls were noted in the third staff recruitment file inspected. The applicant had given insufficient detail as to the dates of their employment i.e. they had given the year only and not the month they had commenced and ceased employment and therefore it was difficult to explore their employment history. This carer had a Protection of Vulnerable Adults (POVA) 1st check clearance, but was still waiting for their Criminal Record Bureau (CRB) clearance after three months. There was no evidence of this staff member being supervised during this period. They were rotated as being part of the staff team. The registered manager did recognise the need to chase up this outstanding check. Overall the management and practices relating to staff recruitment were poor. Of the three staff files sampled, two carers had commenced employment since the last inspection. Both had started or had completed Induction training. The home was using a Skills for Care Induction training package and carers were working on a booklet entitled - ‘How to be a Great Care Assistant.’ Staff files sampled showed evidence of basic training courses attended. In 2007 care staff had attended First Aid, Basic Food Hygiene, Moving and Handling, Fire Safety, Health & Safety, Medication, Infection Control and Dementia Awareness training. In addition in-house training and as provided by the local Primary Care Trust on Protection of Vulnerable Adults (POVA) had been completed by the majority of staff. Whilst information was available to indicate what training had been received together with attendance certificates etc, the care home did not evidence that a robust approach is used to identify what training needs have been prioritised and a plan in place to address training shortfalls. One file sampled indicated that the carer had been employed for approximately three months and had not received any training in Moving and Handling, Basic Food Hygiene, Fire Safety, Health & Safety, Infection Control training, which are essential. Overall, the evidence seen at the inspection did not confirm as stated in the Annual Quality Assurance Assessment that ‘improvements have been made in our staff recruitment, induction and training’. Maitland House DS0000068186.V350083.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, 37 and 38. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use this service benefit from a developed quality assurance and quality monitoring system and appropriate practices in place to safeguard individual’s personal monies. Safe working practices are promoted through ongoing training. Overall, servicing and checks at the care home promotes a safe working environment. Maitland House DS0000068186.V350083.R01.S.doc Version 5.2 Page 25 EVIDENCE: The registered manager informed us at the inspection that they were leaving the care home and subsequently the registered providers have notified the Commission. Since the new providers had taken on the home, the registered manager said that they had not received supervision and they stated that they did not feel they had been supported in their role. The registered provider said that the registered manager had received at least two visits a week by a director or the Operations Manager and this had included one to one sessions. However, no records were seen of these meetings. Survey work had been completed by the home using the ‘Living in the Home’ format. Surveys had been completed Service Users and the results of the survey work had been shared with Service Users at a recent meeting in August 2008. In addition the outcome of the survey work had been published and placed on the home’s notice board. Minutes of the August meeting were seen, as was the minutes of a meeting in February 2007, when reference had been made to increasing social activities. As detailed earlier in this report, it would appear that no action had been taken. Records and monies held by the home were sampled and checked for three people living at the care home. They were all found to be in good order. Records required for the protection of service users and for the efficient and effective running of the care home were inspected and reviewed during this inspection. Schedule 2 records, Information and Documentation in Respect of Persons Carrying on, Managing or Working at a Care Home, were found to have omissions and shortfalls – see National Minimum Standard - Standard 29 for detail. The management of hazardous materials, i.e. cleaning materials required immediate attention. Cupboard doors had been taken of both kitchen cupboards and kitchen units in the tea bar area of the dining room. Whilst both the kitchen and the tea bar units looked tired and worn, particularly where the cupboard doors had been removed, more concerning was the storage of cleaning materials and a waste paper bin in the same unlocked floor level cupboard as squash for diluting and drinking by the residents of the home. Action was taken immediately to remove the cleaning materials and the bin, but consideration is needed to management of these products under the Control of Substances Hazardous to Health Regulations (COSHH) 1988. Regulation 26 visit/reports were inspected at the inspection. Reports were seen for visits in June and July 2007. These reports however were brief and did not identify issues considered or matters to be considered following the visit. Maitland House DS0000068186.V350083.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 3 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 2 2 Maitland House DS0000068186.V350083.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 Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP2 Regulation 5(esp. (b)(c) Requirement People who use the service must be assured that they are provided with appropriate a written contract or a statement of terms and conditions. People who use the service must be assured that there are sufficient staff to meet their assessed needs, with particular regard to the provision of social and leisure activities in the home and getting people to bed in the evening. People who use the service must be assured that they are safeguarded by staff recruitment practices. This is with particular regard to obtaining full employment history on application, satisfactory references and completion of a CRB disclosure. People who use the service must be assured that they are safeguarded by the introduction of a staff training and development programme to ensure all staff, including newly appointed staff receive basic training. DS0000068186.V350083.R01.S.doc Timescale for action 26/11/07 2. OP27 18(1)(a) 26/11/07 3. OP29 OP37 17(2) 19 (1) (a)-(c) 19(2)-(7) Schedule 2 26/11/07 4. OP30 12(1)(a) (b) 18(1)(a) (c) 26/11/07 Maitland House Version 5.2 Page 28 5. OP38 13(3)(4) (6) 16(2)(g) 26(1)–(5) 6. OP38 People who use the service must 26/11/07 be assured that they are safeguarded by the management and storage of cleaning materials as required by COSHH. People who use the service must 26/11/07 be assured that the registered providers fully comply with their responsibilities in accordance with Care Homes Regulations 2001 – Regulation 26 visits and report. This is with regard to providing detailed reports on the conduct of the home and to share with the registered manager. 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 OP9 Good Practice Recommendations Record keeping should ensure that there is sufficient detail to ensure that care plan needs of the people using this service are appropriate. The list of signatures and initials of care staff who administer medication needs to be reviewed and updated to detail current staff who administer medication. Maitland House DS0000068186.V350083.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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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