Inspection on 13/10/09 for Maris Stella Wing

This inspection was carried out on 13th October 2009.

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

Maris Stella Wing 22/03/10

Maris Stella Wing 19/08/08

Maris Stella Wing 19/09/06

Maris Stella Wing 13/01/06

Maris Stella Wing 12/08/05

Maris Stella Wing 16/02/05

Maris Stella Wing 09/08/04

Maris Stella Wing 02/02/04

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 16/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Maris Stella Wing Nazareth House 111 London Road Southend On Sea Essex SS1 1PP Lead Inspector Ann Davey Key Unannounced Inspection 13th October 2009 9.00am DS0000015458.V377967.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Maris Stella Wing DS0000015458.V377967.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Maris Stella Wing DS0000015458.V377967.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Maris Stella Wing Address Nazareth House 111 London Road Southend On Sea Essex SS1 1PP 01702 345627 01702 430352 gm.southenduk@nazarethcare.com www.sistersofnazareth.com The Congregation of the Sisters of Nazareth 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) Mrs Christine McCarthy Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32) of places Maris Stella Wing DS0000015458.V377967.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th August 2008 Brief Description of the Service: Maris Stella is registered to provide personal care and accommodation for 32 older people. It is one of two separately registered care facilities sited at Nazareth House. The home is near the Southend town centre, the railway station, bus routes and all local amenities. The grounds include wellmaintained gardens and ample car parking facilities. The premises are older in style and retain many of the characteristics including a large main hall, which is used for activities and entertainment. Accommodation is sited on three floors and there are two shaft lifts. Most bedrooms are single, some have ensuite facilities. There are three lounges, which retain a family home-style environment. Additional seating areas are available around the home. Kitchenettes are available on each floor where residents and visitors can make drinks and snacks. There is a Statement of Purpose and Service User’s Guide available. A copy of the last inspection report is available upon request from the home. The weekly charges range from £383.18 - £580.00. The exact fee depends on the type of accommodation available/requested, assessed care needs and the source of funding i.e. private or local authority. There are additional charges for items of a personal nature. Maris Stella Wing DS0000015458.V377967.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this care home is 0*, poor provision The last key inspection took place on 19th August 2008. This inspection took place over approximately nine hours. The visit started around 9am and finished approximately 6pm. The registered manager and the general manager helped us throughout the inspection. The registered manager is responsible for the day to day management of Maris Stella and the general manager has an overall management responsibility for Maris Stella and St Joseph’s which is a care home with nursing provision. Maris Stella and St Joseph’s are on the same site and share some facilities. For the purposes of this report, there will be reference to the ‘general manager’ and the ‘manager’. Their respective role and responsibilities are different. Since the last inspection, there have been significant changes in the general management structure of the home. The registered manager had not changed. The home’s Annual Quality Assurance Assessment (AQAA) which is required by law had been completed. It was dated 24th September 2009. The document provided the home with the opportunity of recording what it does well, what it could do better, what had improved in the previous twelve months and its plans for the future. We noted that the content of the AQAA was basic in detail and the information did not always agree with our findings. Reference to this has been made within the report. We sent questionnaires to the home asking that they be distributed to stakeholders and returned to us so that we could have an understanding of how residents, staff and health/social care professionals felt about the care provision. We received five completed questionnaires from residents, one from a healthcare professional and six from staff. We have made reference to some of the comments received within the report. During the day we spoke with residents and staff. We would have spoken with relatives and any visiting health/social care professionals if the opportunity had arisen. We looked around the home, viewed aspects of various records and observed care practices. We discussed all our findings with the registered and/or the general manager. We asked that they took notes so that immediate development work could be started where necessary. During the inspection we noted that some issues required urgent attention. These were brought to the attention of the general and registered manager and they addressed them where appropriate and possible. We have made reference to this within the report. Maris Stella Wing DS0000015458.V377967.R01.S.doc Version 5.2 Page 6 As a result of this inspection, we will be requesting an Improvement Plan (Care Homes Regulation 2001 - Regulation 24) asking the home to detail how the shortfalls are going to be addressed, who is going to take responsibility for them and we will agree with the home a reasonable and appropriate timescale. This is to ensure that the health, safety and wellbeing of all residents living in the home is safeguarded and the quality of care is improved. What the service does well: Two of the main strengths of Maris Stella were the provision of food and the activities programme. Residents were provided with a wide range of food and a varied menu. Residents we spoke with were very complimentary about this aspect of care. The other strength of the home was the social and recreational activity programme. Residents also spoke very positively about this aspect of care and their experiences. All staff on duty including the administration and support members of staff were very helpful to us. All those we asked to speak with or needed information from made themselves available. The home provided good hospitality to us. The home was very quiet which may suit residents who prefer to be in an environment such as this. The grounds to the front of the home were very pleasant. Residents were able to access these well kept and maintained garden areas. Car parking facilities were good and there was easy access to Southend town centre. What has improved since the last inspection? What they could do better: The home’s AQAA was dated 24th September 2009. Our inspection was undertaken 13th October 2009, less than three weeks from the date of the document. The content of the AQAA was brief and provided us with little information about the care provided to residents. It consisted mainly of statements which in many cases could not be qualified or elaborated by the home during the inspection. The majority of the home’s self assessment under the ‘what we do well’ statements could not be evidenced or supported by the home. The training, development and supervision of staffing was inconsistent. Staffing levels particularly at night were not safe. We asked the general manager to increase them immediately as there was a clear element of risk to residents. Maris Stella Wing DS0000015458.V377967.R01.S.doc Version 5.2 Page 7 Information and detail within residents’ care plans and risk assessments were inconsistent and not current. Residents who require support and assistance because of their dependency needs may not feel confident that the service is able to meet their social activity and nutritional requirements in full or that records are in place to support that their needs have been met. We noted that fluid charts were not completed properly and there might be a lack of stimulation should they require care in bed. If a resident wished to access the garden area and was dependant on a member of staff accompanying them, it may not happen very often because of staffing levels during the day. Management systems within the home demonstrated weaknesses and there was confusion about the respective role and responsibility of the general manager and the registered manager. Although the owners of the home (or their representatives) had visited on a monthly basis, there was little to evidence what positive impact this had made to improve the quality of care. The overall outcome of the inspection was that Maris Stella lacked sound management, direction and focus. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Maris Stella Wing DS0000015458.V377967.R01.S.doc Version 5.3 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 Maris Stella Wing DS0000015458.V377967.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 (standard 6 was not assessed as intermediate care is not provided by the home) People using the 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 using the service cannot be confident that their needs will be assessed or identified to ensure that their admission would be appropriate. EVIDENCE: The home had a Statement of Purpose and a Service User’s Guide in place. Both documents were recorded as being reviewed and updated in May 2009. We noted that the contact details for the Commission were out of date. At the last inspection we made a requirement on the home to ensure that suitable pre admission assessments were undertaken to ensure that the respective resident’s care needs had been identified and could be met by the Maris Stella Wing DS0000015458.V377967.R01.S.doc Version 5.3 Page 10 home. The timescale for this requirement to be addressed was 15th October 2008. At this inspection the following incidents came to our attention. The general manager had arranged for a prospective resident to come to the home that morning direct from hospital with a view to admitting them for a post operative convalescence period. The registered manager said that they knew nothing about it until that point in time. The general manager was to carry out the assessment. We expressed our concern about the proposed action and spoke to the general manager. The general manager went ahead with the assessment. We were told later by the registered manager that they had been given the completed assessment documentation and had been asked for their opinion. The registered manager told us that ‘clearly the decision has been made and the prospective resident was downstairs with a suitcase ready to be admitted, what can I do’. During the morning it also came to our attention that a further assessment on another prospective resident had been undertaken by a member of staff working in St Joseph’s. The registered manager told us that they had just been handed the documentation with the expectation that the resident would be admitted. Our understanding of the day’s events was that the assessment process used was not in either of these residents’ best interest to determine the appropriate care required. We looked at the pre admission assessment documentation of three residents who had been admitted to the home within the past 3 months. The quality of the information recorded varied from adequate to poor. For example, one document recorded detail about a resident’s preference regarding food. A another set of records initially recorded that the resident required a named medication which had specific care implications, but no reference to the required care was made on the care plan. Maris Stella Wing DS0000015458.V377967.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9, and 10 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents cannot expect to receive the level of care to meet their assessed needs. They also cannot expect their confidential information to be kept secure. EVIDENCE: Following last year’s inspection, we required the home to ensure all aspects of every resident’s personal care and healthcare needs were assessed and documented in the care plan. Risk assessments were also to be put in place to support the consistent delivery of person centred support to each resident. Information must be current. This was to be addressed by 15th October 2008. At this inspection we looked at and assessed various elements of care records selected at random belonging to four residents. We also looked at various Maris Stella Wing DS0000015458.V377967.R01.S.doc Version 5.3 Page 12 aspects of associated risk assessment documentation and health care recorded visits. We spoke to residents and staff about aspects of the care within the home. We also observed care practice within the home. The quality of the recording system ranged from adequate to poor. In the four care plans we looked at, there were at least two very different recording formats being used. The registered manager told us that it had been confusing for staff. One format was entirely handwritten and the other was pre printed format with just the name of the resident written in. We were confused about the two systems as they were very different and not easy to follow and understand. No care plan had been endorsed by the respective resident or their family. We noted that two residents had visual impairment care requirements and it had been clearly recorded that there should be no obstacles in the building. We found a significant number of physical obstacles in the home. These are noted within the environment section of the report. One resident required particular care because of a named prescribed medicine they were taking. The associated care needs and risk factors were not noted on the care plan. One resident’s care needs had changed significantly because of medical intervention, but the care plan had not been updated. Another care plan record only contained the elements of ‘sleeping’, ‘eating/drinking’, ‘incontinence of urine’ and ‘personal cleansing and dressing’. We noted that planned and forward dated reviews of care plans had not taken place. On the back of care plans in place, there was a section headed ‘evaluation review’. Information in these sections was a mixture of updated information, changed care needs and daily records. Records such as those with ‘bath, hair, nail’ headings were poorly completed. We looked at a ‘fluid chart’ belonging to a resident who was being cared for in bed. According to those records the resident had received nothing to eat or drink from 7pm to around 9am the following morning. This amounted to a total of up to 14 hours. The registered manager told us that ‘I’m sure they have sips of water’, but agreed that there were no records in place to support their statement. We looked at another set of ‘fluid charts’ for a different resident. The charts were poorly completed. For example, the only entry for 12th October 2009 was ‘10am tea’ and on 10th October 2009 the entries were ‘8.10am - wheetabix, toast, tea’ and ‘noon - main meal, pudding, juice’. Within the AQAA under the heading ‘what we do well’, the home had recorded ‘pre admission assessments, risk assessments, listening to service users, developing staff’. Under ‘our evidence to show that we do it well’ the following was recorded by the home, ‘documentation, care plans, risk assessments, satisfaction surveys’. These comments were not evidenced or supported in our findings during the inspection. We found that the residents’ daily care record logs had been left open and unattended in one of the residents’ lounges. Anybody using the lounge would have had free access to personal, sensitive and confidential information. Maris Stella Wing DS0000015458.V377967.R01.S.doc Version 5.3 Page 13 Outside the office and stuck to a wall, was typed a list of resident’s names together with an overview of their respective personal care needs. This was in an area which was in constant use by staff, residents and visitors to the home. In the ground floor lounge we found a collection of ‘fluid’ records belonging to a named resident. These practices do not support that the home had ensured that private, confidential and personal information held on residents had been kept secure. Following the inspection, we were informed that this information was for emergency purposes and had since been stored in a more private location. The registered manager told us that the home had a good working relationship with all social and healthcare professionals. We were informed that the health care needs were being met. We saw on resident’s records that GP’s had visited the home to see individual residents when required. However, the recording of these visits and subsequent care and attention had been poorly documented. For example, one resident had seen a GP because of a significant health issue but the care plan had not been updated to reflect the changed care need. We asked the registered manager who had responsibility for monitoring and evaluating the quality of recording on the care plan documentation system. The registered manager told us that they undertook this responsibility, but never had enough time to do a thorough assessment. They also told us that the general manager had a responsibility for monitoring the system. The outcome for residents is that they can not be assured that the information within their respective care plan reflects their current care/health needs or that staff will necessarily know about their needs because of the patchy and incomplete information available or that personal and confidential information about them is kept secure. Another significant issue noted was that the registered manager told us that the home is totally reliant on agency staff to maintain staffing levels. With various agency staff within the home on different shifts, the poor management of information on residents could result in inadequate or inappropriate care being provided. The registered manager told us that the home had a good working relationship with all health and social care professionals. We received a completed survey from a GP who commented that the home ‘provide(s) good care and support’…’I am satisfied with the care they provide’. We looked at various aspects of the medicines storage, administration and recording system. We sampled a number of the MAR (medicine administration records) and found no gaps. The medicine storage trolley was orderly and clean. There was a list of the names of staff who undertake responsibility of administering medicines. We noted that some staff had not had any refresher training in the safe administration of medicines since 2006. The registered manager agreed that this should be reviewed. The home looks after and administers medicines that must be stored and administered in a certain way because of their potency. The storage of the medicines was satisfactory but we Maris Stella Wing DS0000015458.V377967.R01.S.doc Version 5.3 Page 14 noted an anomaly regarding the number of tablets in the pack against the administration record. Initially the registered manager was unable to explain the situation but later said they had spoken to a senior member of staff who was able to account for the anomaly. Because of the potency of this medicine, a requirement has been made at the end of this report to ensure that the training for all members of staff that have a responsibility for dealing with medicines is reviewed and that we receive a written explanation of the identified anomaly. Maris Stella Wing DS0000015458.V377967.R01.S.doc Version 5.3 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The majority of residents benefit from a varied, balanced diet and are able to participate in a range of social activity. EVIDENCE: The social activity programme and the provision of food were the main strengths of the home. The home employs two designated social activity coordinators. The social and community activity programme was wide and varied. It ranged from entertainers coming into the home, organised art classes, trips out into the community, bring and buy mornings and coffee mornings. Activities are daily and some days there are two or three different events planned to take place. The home had a designated well equipped hall which was used for many of the events. The home shared a chapel with St Joseph’s and there were morning services to which all residents were invited. Maris Stella Wing DS0000015458.V377967.R01.S.doc Version 5.3 Page 16 The registered manager told us that the majority of residents have regular visits from their respective family and friends. We were advised that there were no residents who did not have somebody to act on their behalf should the need arise. There was a good range of planned and organised activities and events to take place in the activity hall. In some of the smaller lounges in the home a television was on, often with nobody in there. Some residents were in their bedrooms with their television on, others were reading or being attended to by staff. One resident was being cared for in bed. On their care plan it was noted that they liked music and the manager told us that they liked to listen to the daily service which could be relayed from the chapel. We went into the bedroom late morning, early and late afternoon and at no time was there any stimulation or evidence of staff spending time with this resident other than to provide task orientated care. We spoke to the registered manager about this who told us that ‘staff were probably too busy’. We observed staff on duty and noted that they indeed were very busy undertaking task orientated duties. Throughout the whole day we only saw one member of staff sitting beside a resident in their bedroom speaking with them. This was an agency member of staff. During the afternoon, we saw a small group of residents in the ground floor lounge with no member of staff present. We went up to a lounge on the 1st floor and noted that two residents were there with four members of staff. The menu for the day was displayed in the corridors and on the dining room tables. We could see that there was choice and variety. All the residents we spoke with were very positive about the quantity and quality of food. We saw both lunch and a cooked tea being served and eaten by residents. The food was hot and looked most appetising. Tables had a clean cloth and linen serviettes. Each table had a tray of condiments so that residents could help themselves. We sensed from the ‘chatter’ between residents that meal times were a very sociable and enjoyable occasion for them. We noted that staff in the dining area were attentive to residents and those requiring assistance were being helped in a sensitive manner. We saw a detailed daily record of what individual residents had ordered at meal times. The record demonstrated that residents are provided with a good choice and variety of food. For example at tea time we saw a cooked tea, boiled eggs, toast, cake, fresh fruit, yoghurts, omelettes, bread and butter and a variety of drinks on offer. We noted that lunch consisted of soup, main meal and dessert. We were informed that the home had recently implemented ‘protected’ mealtimes. This meant that residents could enjoy their meals without unnecessary interruption. The home should be complimented on the good provision of food served in the main dining areas. However, our concern remained with the poorly recorded and documented fluid charts that we found in a resident’s bedroom and in the ground floor lounge. Details about this have been recorded within the previous Maris Stella Wing DS0000015458.V377967.R01.S.doc Version 5.3 Page 17 section of the report. The home was unable to demonstrate through clear recording processes that all residents had been provided with an adequate level of food and drink. We received some positive comments about the provision of food within the completed staff surveys. For example.…‘the home does well in food offered during meal times’...’food very delicious and nicely cooked’…’the food is quite good’. There were no comments to quote from within the residents’ surveys, but when ‘asked do you like the meals?’ all had ticked either ‘always, usually or sometimes’. There were no comments to quote from residents surveys about activities, but when asked ‘does the home arrange activities that you can take part in if you want to?’, five residents had ticked ‘always’ and one had ticked ‘sometimes’. This was a very positive response about the provision of activities for these residents in particular. Maris Stella Wing DS0000015458.V377967.R01.S.doc Version 5.3 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents cannot be guaranteed that they will be protected or their complaints will be managed appropriately. EVIDENCE: The home’s complaints procedure was displayed in the home and also detailed in the Statement of Purpose and Service User’s Guide. The registered manager told us that the home did not have a formal record book or folder where details of a complaint would be recorded and the process of investigating it together with the outcome would also be recorded. Since the last inspection, we were made aware from a relative (of a resident) who raised the concern with us that their written complaint to the home had not been acknowledged or investigated. We had raised this with the home and following our intervention, the concerns were investigated by the general manager and a concluding letter written to the complainant. The complaint was about care standards, staffing matters and missing laundry. In the concluding letter to the complainant dated 3rd September 2009, the general manager acknowledged that there had been some issues which they felt had been resolved and offered compensation for the missing clothing. In the home’s letter to the complainant, Maris Stella Wing DS0000015458.V377967.R01.S.doc Version 5.3 Page 19 it was stated that there would be a member of staff allocated to each floor at night. There are three floors in the home. During our inspection we noted from the rota that there were two staff routinely on duty at night. We were told that there were not three, because the registered manager had been unable to find a third member of staff. In that letter, the issue of missing or lost clothes was acknowledged. During our inspection, we noted that there remains an issue about lost, mislaid and delayed items of laundry. This matter is further detailed within the environment section of the report. We asked two members of senior staff about their understanding of the term ‘safeguarding vulnerable adults from harm’ and what they would do should an incident come to their attention. Neither were able to demonstrate competence, knowledge and understanding expected of staff in a senior position. One member of the senior staff told us that they had not attended any safeguarding training. The manager told us that they were not aware of this shortfall but explained it may have happened because the member of staff had been unable to attend the session planned. There had been no follow up about this. We spoke with the registered manager about their understanding of safeguarding. There were gaps in their knowledge and understanding too. The general manager explained to us that the registered manager was due to attend a course on the matter later in October. We were also aware of a safeguarding matter relating to dignity and respect during the summer of 2009. The home was asked to investigate this matter and as a result, the member of staff was dismissed. We spoke to residents and asked them if they felt confident in raising any issue of concern with the home. All felt that they would be happy about that or ask their respective family member to do that for them. We asked the residents who they would speak with. Some weren’t sure but others said ‘staff’. Within the home’s AQAA under ‘what we do well’ it was recorded ‘follow home policy procedure’ and under ‘our evidence to show that we do it well’ it was noted ‘records maintained’. This statement was not supported by our findings during the inspection. Maris Stella Wing DS0000015458.V377967.R01.S.doc Version 5.3 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19,24 and 26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a comfortable home but may be at risk because of physical obstructions. EVIDENCE: In the morning, we looked around the various aspects of this large home with the registered manager. During the afternoon, we had a further look around the home on our own. Residents’ accommodation was on three floors. Some bedrooms doors had the occupants name on it, others did not. The registered manager was unable to provide an explanation for this. Maris Stella Wing DS0000015458.V377967.R01.S.doc Version 5.3 Page 21 The bedrooms we saw were functional and contained items of personal belongings. Some bedrooms were quite homely. We saw that some bedrooms had private phone lines installed. We noted that a relative number of the bedroom floors were not carpeted. They had washable floor surfaces. We asked the registered manager about this and were told that it was easier for the home to keep clean. We acknowledged that on some occasions it may be appropriate for identified bedrooms to have washable floor surfaces to assist with infection control measures or based on need or personal choice. The outcome for residents should be that they enjoy a comfortable room and there is an expectation that there would be a carpet unless there are documented reasons why this would not be advisable. The general manager told us that the home was due to have a new carpet cleaner. Therefore, with that in place, there should be a rolling programme of carpet cleaning. There were no unpleasant odours anywhere in the home. We noted that domestic staff were undertaking duties during the morning. Communal areas were clean, practical and functional. Apart from televisions being on in the lounge areas, there was no other stimulation observed, for example, a radio or other forms of music or entertainment. We saw some newspapers on a chair outside the registered manager’s office in the morning, these were still there at lunch time, but had been removed by mid afternoon. We asked a member of staff about this and they said ‘not sure, ask Chris (the registered manager)’. Within the last inspection report, we recorded ‘some areas of the home are in need of maintenance. For example, areas of paintwork have seen better days and the tiling in one bathroom in particular was in poor condition….we spoke to the manager about the apparent high use of hospital style beds within the home. The home is not registered to provide nursing care and should therefore be careful to retain a setting more suitable to assessed care needs’. At this inspection, the situation remained unchanged. Within at least two resident’s care plans we noted that there were visual impaired care related needs noted. The information within the care records was clear that there should be no obstructions or obstacles as there was a risk of falls. As we went around the home with the manager (we did not tour the entire home) we noted that two cleaning trolleys had been left in different areas of the home. Both were in main corridors. We saw two unattended plugged in hoovers and their training leads left in corridors and the sluice door was wide open with a key left in the lock. In one bedroom which the registered manager said was unoccupied, we noted a jug of water with a glass. The registered manager was not able to explain the reason for our findings or how long these had been there. In communal bathrooms we noted towels and flannels on radiators. The registered manager said they were not sure who they belonged to. In one on the main bathrooms, we noted two wheelchairs, a ‘standing’ hoist (which the registered manager Maris Stella Wing DS0000015458.V377967.R01.S.doc Version 5.3 Page 22 said was not used), two sets of weighing scales, six piles of folded towels, a broken cupboard with a further three piles of towels, two uncovered waste bins and items of personal bathing such as comb, talc and body lotion. The outcome for residents was that their bathing had taken place in a room that was cluttered and unkempt. We were aware that in July 2009, the hoist used for lifting and moving residents had broken. At this inspection we were advised that since that time, the home had been sharing a hoist with St Joseph’s. The registered manager told us that there had been occasions when residents had been late for meals and their morning and evening routines had been disrupted because the hoist was in use at St Joseph’s. The Nazareth House site had a central laundry facility which dealt with the large items of laundry and Maris Stella had a smaller laundry to deal with the day to day laundry. At this inspection the general manager told us that the laundry facility on Maris Stella had been closed for ‘economic reasons’. We discussed the implications of this and the complaints that had arisen. The registered manager told us that residents’ clothing continues to get lost or mislaid and other laundry had been late coming back to Maris Stella. With the registered manager we went to see the main laundry facility. The member of staff was taking washing out of the washing machine and putting it into one of the tumble dryers. The member of staff told us that they had not attended any infection control training and they did not have any plastic aprons for protection. They told us that they didn’t know about safe working practices in the laundry area. There was no provision for drying hands by the wash hand basin. We noted three dirty sponge/scourer pads in the sink. There was no explanation. The industrial electric roller iron was plugged on and felt hot. It was unattended. We noted that the operating instructions for this machine were 90 obscured by a box stacking system for residents’ laundry. The general manager told us later that this person in the laundry was not actually working there. We explained that although the person may have not been rostered to work there, they were clearly performing laundry duties because we had observed them. When we spoke with residents they were all positive about the environment and expressed satisfaction with their respective bedrooms and dining room provision. Two residents we spoke with together commented on ‘not like it used to be’. When we asked further about this we were told ‘well, the atmosphere is different, used to be happy, now staff do what they have to do, no time you see, still we’re ok aren’t we x’. Maris Stella Wing DS0000015458.V377967.R01.S.doc Version 5.3 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are looked after by caring staff but may be at risk because of low staffing numbers, lack of a structured staff induction programme and inadequate staff training reviews. EVIDENCE: A staff rota was on display in the office. The home was registered to provide care for thirty two residents. Twenty eight residents were accommodated at the time of this inspection, with another resident being admitted on the day of the inspection and a further resident due to be admitted the following week. There would be a total of 30 residents and the capacity to accommodate a further two. The registered manager confirmed that the rota recorded there were a maximum of five care staff on duty in the morning and four care staff on duty in the afternoon and evening. In addition and when on duty, the registered manager was also present. At night there were two members of staff rostered to be on duty. In addition, the home employs supportive members of staff such as domestic and kitchen staff. The registered manager told us that the Maris Stella Wing DS0000015458.V377967.R01.S.doc Version 5.3 Page 24 home is totally reliant on agency staff to maintain care staff levels during the day. The manager described the dependency levels of current residents as ‘relatively high’. Within the AQAA it was recorded that ‘twenty two residents require two or more staff to help with their respective care’. Seven residents were reported as being ‘doubly incontinent’. With only two staff on duty at night, we could not see how all residents’ care needs could be met in full and be kept safe. The registered manager told us that staff recruitment had been an issue since the last inspection. We were told that there were two care staff applications pending. We were very concerned that twenty nine residents were to be accommodated in bedrooms on three floors that night with only two staff rostered to be on duty. The general manager said that they thought there were three on duty but the registered manager said that they had been unable to get a third member of staff. According to the rotas, the situation had remained for some time. We requested that immediate action be taken to ensure that three members of staff would be on duty at night for the wellbeing and safety of residents. The general manager telephoned and arranged for an agency member of staff to be on duty. We were surprised that the general manager was not aware of the situation, as previously they had told us that they had overall responsibility for Maris Stella and received a daily report. The report contained statistical information and would have recorded that there had been two staff on duty. The staffing situation at night in particular must be monitored daily. The registered manager informed us that there had only been two members of staff recruited since the last inspection. We asked to see their recruitment files and assessed various elements of the records. The general manager acknowledged that the files were not orderly and explained that they will be properly indexed soon. On one file we noted there was inadequate information about the member of staff’s education and employment history. The general manger said that this was because they had been educated overseas and had no employment history. We explained that whilst this may be the case, the employer had a responsibility to ensure that they have carried out all aspects of recruitment required by the law and where there are anomalies; they should be clearly recorded and justified. The general and registered manager confirmed that there were no records to support that these members of staff had undertaken any robust induction training. Both members of staff started work in April 2009. We asked to see staff training records. The registered manager said that they had been recently given a printout of completed training. When we looked at the printout, the information was a year out of date. We asked the general manager about this as we were told that they deal with training. The general manager showed us an electronic spreadsheet document which they said was Maris Stella Wing DS0000015458.V377967.R01.S.doc Version 5.3 Page 25 still is the process of being updated. There were staff names, dates and training courses noted on the document. We asked about the process by which training needs are identified and how it is established that refresher training is required. There was no clear evidence that a system currently exists. On the notice board in the Maris Stella office there was the following notice headed ‘Study Sessions and Courses 09/09/09’ and recorded: …...staff will be paid for attending mandatory study sessions. This includes health and safety, food safety, manual handing, fire training, safeguarding adults training and other mandatory training’. The notice went on to say ‘any training which you elect to do yourself will not be paid for by Nazareth House. You are not entitled to paid time off to attend courses which are not mandatory or not considered essential to your role. You may seek to negotiate with the unit manager if you wish to pursue a course of you choosing’. There was a separate notice with a list of courses, the dates, venues and payment details. At the bottom of the notice was ‘tel xxxx (number given) to book – self payment’. There were nine courses in total listed and included, care planning, health and safety (level 2), dementia and challenging behaviour, infection control, fire awareness, emergency first aid, activities, food safety, health and safety’. The registered manager told us that the general manager had asked that these notices be displayed and we asked them about the situation. The general manager said that there had been economic cutbacks and in the past staff had been booked for training courses, but had not attended. We asked how the registered manager would be able to identify what training needs would be ‘essential’ to individuals when the staff training programme was not robust. The registered manager had previously told us that some staff training was ‘out of date’ and/or required refresher courses. We had also established that a senior member of staff had not attended a safeguarding adults from harm training course. The general manager told us that staff would be able to go on training if it was deemed pertinent to their job. The home was unable to demonstrate any robust process by which identified training needs could be assessed. We felt that the current process did not motivate or inspire staff to undertake any of the training courses available. Some of the training courses on the document, we would assess as being essential, such as infection control, care planning, health and safety, and fire awareness. The general manger expressed a view that we had misunderstood the notice. We said we had read what was posted on the notice board and found the whole matter very ambiguous. We asked the registered manager what was considered as ‘mandatory’ by the home. This was not clarified. We asked the registered manager about staff supervision. They told us that staff had yearly appraisal sessions but agreed that regular supervision sessions were not robust. When we asked to see the programme of supervision we were told that there wasn’t one and sessions took place on an ‘ad hoc basis’. They Maris Stella Wing DS0000015458.V377967.R01.S.doc Version 5.3 Page 26 explained that the staff supervision programme was of a cascading style and they were ‘trying to keep on top of it’. The registered manager asked if we wished to see what records there were, but we declined on this occasion. The registered manager informed us that they had not received any line management supervision. We were shown records of various staff meetings that had taken place. There had been a senior staff meeting on 28th August, The last ‘domestic’ meeting took place on 5th June 2009 and the last staff meeting took place on 29th May 2009. Within the various records, the common themes raised were staffing levels and laundry issues. The outcomes were unclear as to the action to be taken. The homes AQAA under ‘what we do well’ and ‘our evidence to show that we do it well’ recorded ‘staff training, good recruitment procedures, training records, application and appointments documents’. These statements did not support our findings during the inspection. Residents within their surveys told us the following about their view of staffing at the home ‘they could do with more staff to help them’…’more staff’…’shortage of staff is the problem’…’could do with more staff’. Within staff surveys the following comments were noted ‘not enough staff’…’organising more training for the staff to keep their knowledge up to date’…’reduce staff shortages’…’more staff to work’…’be better staffed’…’hire more staff’. When staff were asked within the surveys ‘are there enough staff to meet the individual needs of all the people who use the service?, the response ranged from ‘usually to never’. The information within the surveys did not specify whether this related to day or night staff. We spoke with staff about the staffing situation and was informed ‘there’s just not enough staff here, they’ve known that for a long time, but nothing is done’…’there’s not enough time’…’I’ve nor been asked about training for a while now’…’yes, w get on here, but so much to do and there’s an atmosphere now’. One member of staff told us (with the registered manager present) ‘low staff’…not good’…no quality time’…’don’t get good care, all too quick’. Residents told us ‘not enough of them (staff)’…’rushed off their feet’…always have to wait, nice people though’…’no staff ever around’. Other resident we spoke with were positive about individual staff, but all those we spoke with commented on staffing levels. One resident said ‘oh, night time is the worse, don’t see anybody’. Two residents also commented on the use of agency staff and said ‘the trouble is we don’t always know them’…’suppose they (the home) have to do something because they haven’t got enough of their own’. Maris Stella Wing DS0000015458.V377967.R01.S.doc Version 5.3 Page 27 Maris Stella Wing DS0000015458.V377967.R01.S.doc Version 5.3 Page 28 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,37 and 38 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are at some risk because the day to day management within the home is not robust. EVIDENCE: The general manager, who had been in post since March 2009, advised us that as part of their responsibilities, they oversaw the management of Maris Stella. They told us that this involved receiving a daily report on Maris Stella, providing support and supervision to the registered manager. The registered manager’s view was that they had received no formal line management Maris Stella Wing DS0000015458.V377967.R01.S.doc Version 5.3 Page 29 supervision. We did see the daily report sheets which were in essence statistical information. They would not have provided the general manager with a rounded overview of care and management issues. We felt that the current professional interaction and communication systems between the general manager and the registered manager were not conducive to ensuring that the management of Maris Stella was in the best interest of residents. For example, care plans were not current, staffing levels at night were low, the staff induction process was not robust, there were issues with pre admission processes, the staff training programme was not robustly structured, a formal complaints log did not exist, staff supervision was ‘ad hoc’ and there remained issues regarding the laundry. The respective roles and responsibilities of the general and registered manager’s were not clear. The outcome of this has been referred to within this report. We saw that Regulation 26 reports (monthly visits undertaken either by the owner of the home or their representative) had been completed. The general manager explained that these visits and reports had been undertaken by ‘a mixture of people’. The owner may wish this to happened, however the system provided no continuity of overview or assessment. It was not clear how the process of evaluating the information from these visits had impacted on the management of the home to improve the quality of care for residents. The outcome following our inspection was that residents were living in a home which was not being managed in their best interests. The registered manager told us that there used to be a joint manager’s meeting with St Joseph’s but this had been discontinued. They had found this meeting very helpful and thought that it had been detrimental to stop it. The registered manager told us that they had received a staff appraisal back in the summer but there was no formal line management supervision process in place. The registered manager told us that they had obtained the registered Manager’s Award certificate and completed their NVQ level 4 training prior to the last inspection. The registered manager was unclear about her future training needs and requirements. The general manager reported that the registered manager was booked to attend a safeguarding vulnerable adults from harm course later in October 2009. We were informed that the senior carer who undertook many of the management duties on Maris Stella had been on a period of sick leave. The feedback from the registered manager was that the absence of this person’s skills and knowledge had been detrimental to the day to day management of Maris Stella. The registered manager acknowledged that systems in the home were not effective and felt that they ‘didn’t know where to start’. At this inspection, we did not look and assess the system which looks after and safe keeps residents personal monies if requested. The system was viewed at the last inspection and the outcome was ‘the system for financial transactions had a good audit trail’. The registered manager informed us that a satisfactory Maris Stella Wing DS0000015458.V377967.R01.S.doc Version 5.3 Page 30 audit of the system had taken place the week before by themselves and the general manager. We asked to see some general maintenance contracts and service agreements. They were selected at random. Essex Fire and Rescue visited the home on 14th September and requested some improvement. We were informed that the matters requiring attention had been addressed. There was a gas safety certificate dated 23rd September 2009 and the passenger lift was serviced on 7th September 2009. We saw records to support that the fire alarm system, the emergency lighting system and checks on the temperature of the hot water coming from taps in bedrooms were undertaken on a regular basis. There were no systems in place to support that fire drills had been undertaken, there were no designated fire marshalls and there was no system to check that residents’ call bells were functional. The registered manager also told us that there was no system in place to ensure that staff ‘pagers’ worked properly. Residents are cared for on three floors and we were informed that ‘pagers’ were vital to staff to be able to respond to call bells. With only two staff on duty at night covering three floors, we reinforced how vital it was that staff were confident that their ‘pagers’ were working properly. Residents needed to be confident that their call bells were checked regularly to ensure that they were in good working order and staff would respond appropriately when alerted. We asked the registered manager about how the home seeks the views of residents and other stakeholders. They told us that questionnaires had recently been completed and a quality assurance report would be available by the end of the year. We noted that the last residents meeting had taken place on 16th September. We could see that residents had raised the issue of staffing levels and the matter of missing laundry had been recorded. Within the AQAA it was recorded ‘we know that we give a service that provides value for money because of resident’s feedback, relative feedback, satisfaction survey’. The information we had within our surveys and from discussions with residents and staff was that not everybody was entirely satisfied. We will be interested to see the home’s next quality assurance report. Within the staffing section of this report we had discussed our findings regarding the staff supervision system within the home. The outcome was that there was no supportive evidence that this was being managed effectively. Within the management and administration section of the home’s AQAA, we noted the following. Under ‘what we do well’ it was recorded ‘manager has NVQ 4 Manager’s Award and reads care magazines to be aware of changes and implement best practice for residents’. There was no evidence to support that the manager’s qualification or the fact that they read care magazinces had resulted in the management of the home being undertaken ‘well’, as recorded within the AQAA. Under ‘how we have improved in the past 12 months’ it was Maris Stella Wing DS0000015458.V377967.R01.S.doc Version 5.3 Page 31 recorded ‘registered manager is now controlling the role in the unit’. We felt that the first statement demonstrated a lack of understanding and awareness of a registered manager’s role and responsibility. With regard to the second statement, there is a clear regulatory expectation that a registered manager is responsible for the day to day management of a home. We were unclear about what this statement meant in terms of what the home ‘did well’. Our findings of the inspection were unable to support what the home had recorded within the AQAA. Maris Stella Wing DS0000015458.V377967.R01.S.doc Version 5.3 Page 32 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 X 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 1 11 N/A DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 2 2 X X X 3 X 3 STAFFING Standard No Score 27 1 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 2 X 3 2 1 1 Maris Stella Wing DS0000015458.V377967.R01.S.doc Version 5.3 Page 33 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 Requirement Residents must not be admitted to the home unless a full and detailed assessment has been undertaken by a suitable person to ensure that the home can meet all the presenting care needs. This is required to prevent a resident being admitted when the care requirements have not been properly assessed and then for the manager to realise that the placement is not appropriate. The timescale reflects the discussion we had with the registered and general manager on the day of the inspection. This requirement was made at the previous inspection and remains outstanding. 2 OP7 15 Every resident in the home must have a current care plan and associated risk assessments in place. These records must be reviewed and updated either when changes in the care are DS0000015458.V377967.R01.S.doc Timescale for action 13/10/09 30/11/09 Maris Stella Wing Version 5.3 Page 34 required or at a period of no less that one month. This process will make sure that the information is up to date. This is to ensure that all staff are aware of the current care needs of residents, how they are to be met, who by and the regularity. This requirement was made at the previous inspection and remains outstanding. 3 OP9 13 Arrangements must be made to ensure that the administration of medicines record is kept in good order and the detail within it equates with the number of tablets held by the home. This is with regard to a medicine identified at the inspection that required specific safe handing. The record of administration was not clear and the manager did not know of the anomaly. The manager must be clear about how the error occurred and arrange staff training as appropriate. The matter was to be investigated and addressed immediately following the inspection by the manager and this is reflected within the timescale. 4 OP10 12 Documentation that contains residents’ private, confidential and personal information must be kept secure. This relates specifically to the personal and confidential information we found in two of the lounges and on a wall Maris Stella Wing DS0000015458.V377967.R01.S.doc Version 5.3 Page 35 13/10/09 13/10/09 outside the office. The timescale reflects the discussion we had with the manager at the time of the inspection. 5 OP12 16 The home must ensure that all residents receive a suitable and appropriate social, recreational provision according to their needs and wishes. This is with reference to a named resident whose wishes were clearly documented, but the provision was not being delivered on the day of the inspection. The timescale reflects the discussion we had with the manager at the time of the inspection. 6 OP15 17 Records must be kept to demonstrate that all residents are provided with adequate and suitable dietary provision. This in includes all fluids especially when the resident has been assessed by the home as not being able to eat food. Without these records the home will not be able to demonstrate that all residents have received adequate nutrition in sufficient quantities for their health and wellbeing. This is with reference to the two fluid charts we saw. One resident, according to the record seen, had not received any food or fluids for a period of 14 hours. Maris Stella Wing DS0000015458.V377967.R01.S.doc Version 5.3 Page 36 13/10/09 13/10/09 The timescale reflects the discussion we had with the manager at the time of the inspection. 7 OP16 22 The home must review its complaints policy and procedure to ensure that all complaints are managed within the set time as detailed within the documents. There must be a clear log to show full details of any complaint or concern, how it was investigated and the outcome. This is to ensure that complaints and/or concerns are handed and managed appropriately. Failure to do this may result in a further complaint about the mishandling of the original issue. The Commission is aware of such an issue. This is referenced within the report. Reference is also made to the concerns raised with the home by Southend Borough Council. Timescales were set by them to address the concerns made, but there was no evidence to support that all have addressed as agreed. 8 OP18 13 Arrangements must be made for all staff to attend a training session on all aspects of safeguarding adults from harm. This includes how to recognise the signs of any abuse and the correct reporting procedures. During the inspection Maris Stella did not have any current guidance on the matter. We had to assist the general manager to locate the guidance on the Maris Stella Wing DS0000015458.V377967.R01.S.doc Version 5.3 Page 37 30/11/09 30/11/09 internet. Following the inspection we were advised that the general manager ‘already had the information printed but at the time was unable to locate it because they had moved things around to facilitate the inspection’. We asked at the inspection that a copy of the located guidance be placed on Maris Stella immediately and all staff be made aware of it. This is to make sure that residents are kept safe. This timescale reflects a period of time by which arrangements must be made for a suitable training course to take place. The manager must make more suitable and immediate arrangements for staff currently working in the home who have had no training. 9 OP27 18 There must be an adequate number of staff who are suitably qualified, competent and experienced to fully meet the assessed needs of all residents on duty at all times. A full review of the day and night care staffing arrangements must take place with some urgency and adequate numbers of staff must be on duty. This is reflected within the timescale. At the inspection, despite assurances to the contrary with Southend Borough Council, there were only two night care staff on duty, not three. The home provides care for 32 residents who are accommodated on three floors. We asked the general Maris Stella Wing DS0000015458.V377967.R01.S.doc Version 5.3 Page 38 14/10/09 manager to address with immediate effect. Residents identified care needs may not be met and may be at risk unless adequate numbers of staff are on duty at all times. 10 OP29 30 Arrangements must be made for a full review of staff training needs and requirements to be undertaken and recorded. This information should be known to the registered manager. During the inspection process it was clear that training was required in a number of areas. These have been detailed within the report. All staff providing care for residents must have received suitable and adequate training so that residents can be cared for in a safe and knowledgeable way. A process by which the competence of all staff is assessed should be put in place. The timescale reflects the period of time by which a full review must have taken place and the training needs of all staff have been identified and arrangements put in place for the training to be provided. 11 OP30 18 All staff must undertake a period 14/10/09 of induction training which meets with current requirements. There must be records in place to evidence that the training has been given. This is to ensure that new staff to the home understand the home’s philosophy, the polices Maris Stella Wing DS0000015458.V377967.R01.S.doc Version 5.3 Page 39 15/12/09 and practices and good working practices. No further staff whether agency or permanent staff should start working in the home until the registered manager is satisfied that this requirement is met. This is reflected within the timescale. 12 OP31 9 Arrangements must be made by 31/12/09 the owner of the home to ensure that the designated responsible person for the day to day management of a registered care home is suitably qualified, trained, competent and experienced to meet the home’s Statement of Purpose. This is to ensure that residents live in a home where there is clear leadership and direction. 13 OP32 9 Arrangements must be made by the owner of the home to enable the leadership and management approach to be of benefit to residents and staff. There must also be clear lines of communication and responsibility within the home. The professional working relationship between the general manager and the registered requires clarification and consolidation. This to ensure that residents live in and for staff to work in a home where there is clear leadership and direction. 14 OP33 26 The owners of the home must review the process by which their Regulation 26 visits are undertaken and recorded. DS0000015458.V377967.R01.S.doc 31/12/09 30/11/09 Maris Stella Wing Version 5.3 Page 40 The owners of the home have known that there have been matters of concern throughout the summer of 2009, but there has been no evidence of a positive impact by way of addressing the matters through the Regulation 26 visits and reports. A full reflection of the way in which regulation 26 requirements are currently undertaken will enable the owner to undertake a full and robust quality assurance process. We require a copy of all future Regulation 26 reports to be sent to us with immediate effect. 15 OP37 17 All records held on residents must be maintained with current and up to date information. Records must also be kept in a secure place. This is to ensure that staff have current information on residents and residents can be sure that the home treats their confidential information with respect and dignity. 16 OP38 12 Systems must be reviewed, assessed and be put in place to ensure that the health, safety and welfare of residents and staff are safeguarded. This is to ensure that everything that is practically possible through robust safe working practices and procedures are in place to keep residents and staff safe. Maris Stella Wing DS0000015458.V377967.R01.S.doc Version 5.3 Page 41 30/11/09 31/12/09 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 Refer to Standard OP1 Good Practice Recommendations The information within the Statement of Purpose and the Service User’s Guide must be up to date. This includes the contact details of the Care Quality Commission. The manager should ensure that the health care needs of all residents are known to staff, details of them should be made clear in respective care plans. For example, where a resident is taking medication that has known possible side effects, it should be made clear in the resident’s respective records to minimise any risk. Arrangements should be made to ensure that all areas of the home are kept in good condition and free from any obstructions. Adequate and suitable laundry facilities should always be available. This is with reference to broken and missing tiles in bathrooms. This was highlighted in the previous inspection report. Residents should expect to live in a home that is kept in reasonable repair. This is with reference to the obstructions we noted in corridors such as trailing hoover electrical leads and domestic trolleys which had been left. It was clearly noted in some identified care plans that there were residents with visual impairment and there should be no obstructions. This is with reference to the laundry facility being closed on Maris Stella due to economic reasons. Arrangements should be made to ensure residents clothing is not further mislaid or lost. Laundry required by staff such as towels and bedding should be available when required with no delays. 2 OP8 3 OP19 Maris Stella Wing DS0000015458.V377967.R01.S.doc Version 5.3 Page 42 4 OP28 The home should review the training programme so there is a clear understanding of staff members who have or who are undertaking NVQ training. At the inspection, the registered manager was unclear and only had an outdated staff training record for reference. The staff supervision programme should be structured in such a way that staff are mentored by a competent and qualified person on a regular basis. This is vital to the professional development of all staff. 5 OP36 Maris Stella Wing DS0000015458.V377967.R01.S.doc Version 5.3 Page 43 Care Quality Commission East Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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 © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. 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