Inspection on 30/05/08 for Maxey House

This inspection was carried out on 30th May 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Maxey House 03/11/09

Maxey House 11/11/08

Maxey House 09/10/07

Maxey House 06/03/07

Maxey House 14/02/06

Maxey House 19/09/05

Maxey House 21/03/05

Maxey House 14/09/04

Maxey House 19/02/04

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Maxey House Lincoln Road Deeping Gate, Peterborough PE6 9BA Lead Inspector Elaine Boismier Unannounced Inspection 30th May 2008 10:10 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 Maxey House DS0000015189.V365122.R02.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. Maxey House DS0000015189.V365122.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Maxey House Address Lincoln Road Deeping Gate, Peterborough PE6 9BA 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) 01778 342244 01778 345850 Mrs Laura Louise Levin Mrs Jacqueline Watson Care Home 31 Category(ies) of Dementia (1), Old age, not falling within any registration, with number other category (31) of places Maxey House DS0000015189.V365122.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th October 2007 Brief Description of the Service: Maxey House is a large Georgian country residence standing in three acres of grounds. The home is within half a mile of the town of Market Deeping and approximately five miles from Peterborough city centre. The home consists of a main house with a modern single storey extension. Residential accommodation is provided in twenty-seven single and three double bedrooms. Twelve bedrooms have en-suite facilities. A lounge, dining room with quiet area, and conservatory form the communal areas of the home. Residents have access to the gardens. Current fees range from £405 to £415 per week. Additional costs include those for hairdressing and private chiropody. Further information about fees can be obtained from the home Copies of CSCI reports are made available on request or from our website at www.csci.gsi.org Maxey House DS0000015189.V365122.R02.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 service is 0 star. This means the people who use this service experience poor quality outcomes. This report makes reference to information that we have received from the home and other agencies between the last inspection of October 2007 and up to this inspection of May 2008. This report includes information that we have received in surveys from residents and their representatives and from staff. There is also reference to the Annual Quality Assurance Assessment (AQAA) that was completed by the Registered Owner and Registered Manager, referred to in this inspection report as the management team. We, the Commission for Social Care Inspection, carried out this key unannounced inspection, by two Inspectors, between 10:10 and 15:30 and it took 5 hours and twenty minutes to complete. We looked at documentation and looked around the premises, spoke with staff, including members of the management team, residents and visitors to the home. We observed also staff working and residents’ activities. For the purpose of this inspection report people who live at Maxey House are referred to as “people”, “person” or “resident/s”. November 2007 and April 2008 We attended two meetings held under the safeguarding procedures. (Safeguarding was previously referred to as protection of vulnerable adults or POVA.) The reason for the meeting in November 2007 was following allegations made by a member of staff, about the standard of care practices carried out by another member of care staff. As a result of the meting held in November 2007 it was decided that an investigation was to be carried out by the home. The meeting in April 2008 was to discuss the outcome of the home’s investigation. It was concluded, by all parties represented that there had been borderline abuse carried out due to neglect and poor standards of care. Action had been taken and the member of staff was no longer working at the Maxey House. Maxey House DS0000015189.V365122.R02.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Maxey House DS0000015189.V365122.R02.S.doc Version 5.2 Page 7 Pre-admission assessments must be recorded to demonstrate that the home is suitable to meet the needs of prospective residents. We expect the home to manage this, rather than we make a requirement on this occasion. Care plans must be developed to provide clear guidance for staff in how to meet the assessed needs of the people. People must be consulted about their care plan to ensure care is provided with consent of the resident. Care plans must be reviewed each month, or sooner. We expect the home to manage this, rather than we make a requirement on this occasion. Risk assessments must be carried out for any activity people take part in, to ensure that any risks identified are managed and people are safe whilst their choice is respected. A requirement has been made about this. People should have their health care needs acted on in a proactive way. We expect the home to manage this, rather than we make a requirement on this occasion. People must have access to health care professionals to ensure that they are receiving the optimum health care. A requirement has been made about this. Medication must be stored safely to ensure that people receive medication that has not deteriorated, due to high temperatures and any person, that the medication is not prescribed for, does not take medication. A requirement has been made about this. The method of providing drinks on the dining tables should be considered to reduce the risk of harm to people’s health. We expect the home to manage this, rather than we make a requirement on this occasion. A record of complaints/concerns and allegations must be kept. We expect the home to manage this, rather than we make a requirement on this occasion. A policy for the safeguarding of people must be developed and this is to include reference to the local safeguarding reporting procedures. A requirement has been made about this. Action must be taken to ensure that no window poses any risk to residents’ health and safety. We expect the home to manage this, rather than we make a requirement on this occasion. The staff roster should have the full names of staff, including the Manager, recorded on the duty roster. We expect the home to manage this, rather than we make a requirement on this occasion. The home should have 50 of care staff with NVQ level 2 in care. We expect the home to manage this as part of good practice. Maxey House DS0000015189.V365122.R02.S.doc Version 5.2 Page 8 No person must work at the home without all the required information about him or her, as this poses a risk to the safety of residents from (potentially) unsuitable staff. A requirement has been made about this. The contents of the staff induction training must be improved upon to ensure people get the right and proper care from staff new to the home. We expect the home to manage this, rather than we make a requirement on this occasion. The Manager’s knowledge of practices and procedures, national minimum standards for older people and Care Homes Regulations (2001) could be improved upon. We expect the home to manage this, rather than we make a requirement on this occasion. A quality assurance system must be developed to ensure that people receive up to date care and that they benefit from an improved management of the home. A requirement has been made about this. Protective aprons for people to wear in the kitchen should be placed elsewhere other than in a box on the floor. We expect the home to manage this, rather than we make a requirement on this occasion. 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. Maxey House DS0000015189.V365122.R02.S.doc Version 5.2 Page 9 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 Maxey House DS0000015189.V365122.R02.S.doc Version 5.2 Page 10 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& 3 Quality in this outcome area is adequate. People have adequate information about the home to help them in their decision where to live, although this could be improved upon. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All of the residents’ surveys said that the person had enough information about the home before they moved in. A copy of the Service User’s Guide was seen and this was satisfactory. The AQAA informed us that there have been 6 new admissions to the home and 2 placement breakdowns. We examined 4 people’s care records and spoke with the Manager. A copy of the assessment carried out by a care a manager for a person placed by a local authority was available. For the remaining three record files there was no pre-admission assessment information. The Manager told us that she assesses people but these assessments are not recorded. As a Maxey House DS0000015189.V365122.R02.S.doc Version 5.2 Page 11 result of this we were unable to assess the home’s admission procedure in full. We expect the home to record their pre-admission assessments rather than we make a requirement on this occasion. According to the AQAA there has been very few vacancies within the last 12 months although the AQAA did not provide any information how the home directly met the standards in this section (e.g. availability of information and pre-admission procedures). Under these headings the AQAA informed us that there has been a new boiler provided. Such information is more relevant to standards 19-26 for older people, where this has also been included. Copies of the inspection reports were in the Manager’s office although staff told us that they had not seen these reports. Maxey House DS0000015189.V365122.R02.S.doc Version 5.2 Page 12 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 & 10 Quality in this outcome area is poor. People are at risk to their health and safety due to poor standards of care planning, monitoring of people’s health and some medication practices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Examination of three people’s care records indicated that people have their needs assessed and members of their families, about the person, provide information to the home. The assessments of people’s needs were reviewed and there had been changes noted with regards to medication. However, there were no plans of care to show how these assessed needs were to be met. For example, for a person described as having “challenging behaviour” there was no plan of care to describe how this affected the person and how such behaviours were to be managed. Another example was a person who had been diagnosed with the medical condition of diabetes (mellitus). There was no care plan for how this Maxey House DS0000015189.V365122.R02.S.doc Version 5.2 Page 13 person should be monitored and how the person should have their insulin given. Without the existence of an actual care plan it was difficult to assess if residents are consulted about their care. We discussed our findings with the management team and we expect this to be managed by the home rather than we make a requirement on this occasion. A requirement was made for risk assessments to be carried out with particular regard to falls. We examined people’s care records and spoke with the Manager and evidence suggests that, although these assessments were brief, this requirement has been met. We found, however, no clear records for risk assessments for nutrition, risk of pressure sore development or moving and handling. Staff told us that no current person required the use of a hoist and the AQAA informed us that there had been no person who had acquired a pressure sore whilst living at the home. One of the people was responsible for giving their own medication. There was no full assessment and no risk assessment for this. We have made a requirement that all risks are identified and recorded (see also standard 25 of this report). All of the residents’ surveys said that the person received the right care to meet both their personal and health care needs. All of the surveys from relatives said that the home met the care needs of the resident they were linked with although one of these surveys said that they would like, “…the staff go round the residents where they are sitting e.g. lounge or conservatory more often to check they are ok. Sometimes they don’t come in for over an hour.” We noted that during the staff handover period there was no member of staff on the “floor” although at other times staff were in attendance in the conservatory area as well as other areas of the home. Another of these relatives’ surveys said, ”We the family are most pleased with all aspects of care and service that our mother receives” and both visitors and people told us the same. Examination of people’s care records indicated that the records for professional contacts could be improved upon. It was unclear when such people had been contacted although there was evidence, from letters contained in the files, that GPs, District Nurses, Community Psychiatric services and opticians had seen people. Examination of a person’s care records indicated that the person had their blood sugars monitored before staff gave the person their insulin. Examination of a person’s care notes and discussion with this person, indicated that the person’s mental health needs might have changed, since September 2006 when the person was then discharged from the community psychiatric services as the person was considered happy and well. Examination of the person’s care records and discussion with the Manager indicated that there had been no contact made with the community psychiatric services for a review of Maxey House DS0000015189.V365122.R02.S.doc Version 5.2 Page 14 this person’s mental health needs. It was also unclear how the home meets residents’ health care needs in proactive and planned way e.g. routine checks for opticians and chiropody visits. We have made a requirement about this. Medication is administered by senior care staff only. Observation of the medication being given at lunchtime was carried out and this indicated people are given medication in a dignified and hygienic manner. The member of staff signed medication administration records after the residents had taken their medication. Medication is kept in a cupboard in the Manager’s office. With the door open the air temperature was recorded as 27.5 degrees centigrade. The Manager informed us that when no one is in the office the door is always locked. There was no method of recording the air temperature of this room where medication is stored. Such practice poses a risk for medication to deteriorate and poses a risk to people’s health and welfare. Discussion with a resident, staff and the Manager and observation of staff working indicated that the storage of medication is not always safe. We observed that generally medication was safeguarded during the medication round by staff, although there were three blister packs with medication left unattended in a receptacle. Insulin was kept on the top of a person’s wardrobe and another person, who was giving their own medication, kept their inhalers on top of a table, in their room. This person said, and we saw this was the case, that they left their room to have their meals in the dining room. They informed us that they left their medication in their room that had no lockable storage space and the door to their room had no lock. We have made a requirement about the safe storage of medication. The Manager told us that home has had a review of their medication by a local pharmacist and this was satisfactory. The report of this visit was not examined on this occasion. Staff were seen interacting with residents in a kind, caring and respectful manner. People and visitors had high praise of the staff and told us that the staff were “very kind” and “very good”. The AQAA provided information for these standards although the information was very brief, and did not tell us how personal care was provided and how dignity of residents was valued. The information provided was not always relevant to these standards e.g. under “What we could do better” the response was “keep residents active with social events they want.” Although we acknowledge that activities are important in maintaining the health and welfare of people, such a response would be more appropriate under standard 12 for older people. Maxey House DS0000015189.V365122.R02.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 &15 Quality in this outcome area is good. People benefit from an improved quality of social life. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two of the 4 surveys from residents said that the home provided suitable activities that the person could take part in; the remaining two surveys said that the home sometimes provided such activities. According to the AQAA there has been an improvement in the range of activities provided. On offer are activities that include exercise games supervised by an outside organiser, “Sporting Chance”, bingo, entertainment and coffee mornings. Examination of people’s care records, the record of monthly activities and the minutes of the last two residents’ meetings indicated that there has been an improvement in the range of activities provided and staff confirmed such activities had taken place. On the day we were at the home a number of people were playing a game of bingo that had prizes for the winners, including chocolate. A trip out to a local butterfly farm was pending and this was as a result of people’s requests. Staff told us that a coach is hired by the home and staff escort people out on such trips. Maxey House DS0000015189.V365122.R02.S.doc Version 5.2 Page 16 All of the surveys from relatives considered that the person they were linked with was able to live their life as they chose to. People we spoke with told us that they were able to get up and go to bed when they liked and staff described how they offered choice to people in such activities of daily living. We saw people receiving their guests in private and in the lounge areas of the home and a record of visitors was in the main foyer and we saw a visitor to the home use this. All of the surveys from residents said that the food provided was generally good and the people we spoke with said that the food was very good. On behalf of a resident a relative commented on in their survey, “My (sic) be the menu could be a little MORE up market….just a little more INTERESTING.” Dining tables were well presented, with table linen and condiments were provided on each table. We saw orange juice poured in plastic tumblers, without any covering at least 1.5 hours before lunch was served. Such methods of leaving and serving drinks pose a risk to the health of residents and we expect the home to consider ways to improve this, to reduce such risks. Records of food provided are kept in a diary in the kitchen, and these contained details of a range of food. People were having fish and chips and fruit flan and “cream” for their lunch. Maxey House DS0000015189.V365122.R02.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 & 18 Quality in this outcome area is poor. People are listened to but the systems in place for managing concerns complaints and allegations of abuse must be improved upon to protect vulnerable people from the risk of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All of the surveys from residents, relatives and staff told us that people knew about the home’s complaints procedure and what to do if they had concerns about the home or were made aware of any such concerns. All of the surveys from residents said that the person knew who to speak to if they were unhappy about something and they felt staff listened and acted on what the residents said to them. Visitors and people we spoke with said that they knew who to speak to if they were unhappy about something. During the safeguarding meeting of April 2008 there was a concern that the recording of complaints and concerns could be improved upon and this area of improvement was identified within the AQAA by “Recording events as and when they happen.” The AQAA told us that the home has received 3 complaints and two of these were responded to within 28 days and neither was proven. The remaining Maxey House DS0000015189.V365122.R02.S.doc Version 5.2 Page 18 complaint was pending an outcome by the time the AQAA was completed in March 2008. The AQAA was not correct as it declared there was no safeguarding investigation although we are aware that this was not the case; one safeguarding investigation was ongoing at the time the AQAA was filled in, in March 2008. According to The Manager there has been no complaint made against the home and therefore there was no record of complaints. We discussed the findings of the AQAA (that stated there had been 3 complaints made) with the management team and it appeared that there was some misunderstanding by the home regarding this issue. The management team asked our advice about recording complaints and concerns to improve how the home deals with such issues and to have a greater understanding of the difference between a concern and a complaint. As a result of this current level of understanding we have assessed this standard as not met at all although we expect this to improve following our advice. We have not made a requirement, on this occasion, about maintaining a record of complaints, as required under Schedule 4 of the Care Homes Regulations (CHRs) 2001 as the home has identified this to be an area for improvement and therefore we expect the home to manage this issue. People we spoke with said that they felt safe living at Maxey House. In November 2007 and April 2008 we attended two meetings held under the safeguarding procedures. These meetings were held as a result of concerns made about the standard of care provided by a member of staff. Following the meeting of November 2007 a decision was made for the investigation to be carried out by the home. The second meeting, held in April 2008 was to hear the outcome of this investigation. We were satisfied with the investigation process and the outcome of this indicated that there had been some elements of allegations substantiated and these were considered due to poor practice/neglect. During the meeting of April 2008 we reminded representatives of Maxey House of the correct safeguarding reporting procedures and individual people’s responsibilities; this included health care professionals’ responsibilities, such as nurses, to follow these procedures to safeguard vulnerable people. During this inspection of May 2008 the management team acknowledged that they were unaware of such safeguarding teams or safeguarding procedures until the meetings held in November 2007 and April 2008. In our report of the inspection carried out in October 2007 there was a factual inaccuracy that was not challenged by the home. This factual inaccuracy told the reader that the home had a policy on protection of vulnerable people and that this policy was in line with the local reporting procedures. We apologise for such an error in our reporting. Maxey House DS0000015189.V365122.R02.S.doc Version 5.2 Page 19 According to the AQAA the home does not have a policy in safeguarding adults and prevention of abuse and we confirmed this was the case. Up until the safeguarding meetings of November 2007 and April 2008 the management team informed us that they had no knowledge of safeguarding procedures and we were informed during our visit that there was no knowledge of the Department of Health’s guidance or other guidance available to care homes. Staff we spoke with told us what they would do if they witnessed an incident of abuse although there was no information for them, or any other person, including visitors to the home, in who to contact (e.g. the local authority or police) should such an event be witnessed. We have made a requirement that a policy is developed in line with local reporting procedures to be developed and this information to be made available to everyone. Staff we spoke with and examination of their training files indicated that staff have attended training in safeguarding vulnerable people. Maxey House DS0000015189.V365122.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,25 & 26 Quality in this outcome area is adequate. People live in a clean and pleasant home although there are some risks to people’s health and safety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: According to the AQAA the home has had a new patio area provided within the last 12 months and we saw this was the case. The patio area is located to the side of the house, near the main entrance. Garden furniture was provided. We saw some of the people sitting outside in the sunshine as the well-kept grounds were having their lawns mowed. The home was well decorated and presented with pictures and ornaments throughout the home. Access to the garden is via a side entrance and a ramp. Maxey House DS0000015189.V365122.R02.S.doc Version 5.2 Page 21 Not all of the windows could be opened and therefore the flow of fresh air was restricted. One of the windows, looking out into a “gulley” had no window restrictor and was opened with ease. We expect the home to manage the issues identified with the windows. The AQAA informed us that a new central heating and water boiler has been provided and we saw this during our visit to the laundry room. According to the Manager staff take the temperature of the bath water, with the use of a thermometer, each time a resident has a bath and staff confirmed this was the case. There were no records for the temperatures of the hot water and there were no thermometers available in either of the two bathrooms that we visited. Three samples of hot water were tested in an upstairs bathroom and this test showed that the hot water exceed the safe temperature of 43 degrees centigrade with ranges between 56.8 and 58.4 degrees centigrade. Staff told us that people “self-test” the water before they get into the bath. Nevertheless there remains a risk of harm to people due to the existing systems in place for bathing people with age related conditions (e.g. compromised circulation and nervous systems). Whilst choice of what people like, with regards to the temperatures of their bath water is considered, there should be risk assessments carried out for such activities. A requirement about this has been made under standard 7 of this inspection report. All of the surveys from residents said the home was clean and fresh and we found this to be the case with the exception of a slight smell of urine on arrival to the home. The laundry room was visited and this was not in direct location with the kitchen area. Sluice facilities were provided and the Manager stated that incontinence pads are used and these are placed in appropriate bags and deposited in clinical waste bins for collection. Maxey House DS0000015189.V365122.R02.S.doc Version 5.2 Page 22 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 & 30 Quality in this outcome area is adequate. People receive care from kind and caring staff who are adequately trained although people are at risk due to poor recruitment practices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We observed staff working and they were providing care and attention in an unhurried and individual manner. Staff we spoke with told us that they enjoyed working at the home and people we spoke with, including visitors, were very satisfied with the response from staff as no person told us that they had to wait for attention. All of the surveys from staff said that there was a sufficient number of staff to meet the needs of the residents and all of the staff who had completed these surveys felt supported by the home. The staff roster was examined and the names of staff working were recorded with their first name only. This is a legal document and therefore should have the full names of staff, including the Manager, recorded on the duty roster. According to the AQAA 6 of 17 care staff have NVQ level 2 qualification in care i.e. 35 . Staff we spoke with said that there were arrangements in place for them to attend this training if they wanted to do so. Maxey House DS0000015189.V365122.R02.S.doc Version 5.2 Page 23 Three staff files were examined to assess the home’s recruitment practice. Photographs and application forms with dates of their employment history were available. The information not available in the staff files was: • There was no start date in any of the files and the staff and the Manager were unable to tell us the exact date of when any of the members of staff started working at the home. For the first member of care staff there was no POVA 1st check carried out and there was only one reference obtained. This member of staff told us that they had provided personal care, without supervision of any member of staff, before their CRB check had been issued. For the second member of care staff, who told us that they had been working at the home for approximately 3 years, there was no CRB applied for on behalf of Maxey House and no POVA 1st. One reference was obtained for this person and there was no reference obtained from this member of staff’s previous employer. This member of staff told us that they had assisted a resident with their bath, the day before this inspection, without supervision by any other staff member. For the third member of staff, who was employed to work in the kitchen, there was no CRB that had been applied for on behalf of Maxey House. Although there was no information when this person started working at the home the application form was signed and dated on the 14th March 2005. • • • A requirement has been made about these findings. All of the three staff surveys we received said that the person had received an induction training programme that helped prepare them for the job they were to do and had attended ongoing training. Examination of the staff inductiontraining programme was carried out and evidence suggests that this needs to be improved upon to include safeguarding training and reference to the Skills for Care induction training standards. We expect the home to manage this rather than we make a requirement on this occasion. A requirement was made for staff training to be improved upon and we consider this requirement has been met. Speaking with staff and examination of their training files indicates staff have attended training to include infection control and care of a person with dementia. Maxey House DS0000015189.V365122.R02.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 & 38 Quality in this outcome area is poor. People are at risk to their health and safety due to poor management systems in place. This judgement has been made using available evidence including a visit to this service. EVIDENCE: According to the Manager she has worked at Maxey House for 17 years and intends to commence her registered manager’s award training in July 2008. One of the relative’s surveys said, “This Manager is very good for someone who is very busy, she has time for all.” During the safeguarding meeting we attended in April 2008 the Manager told us that generally she works mornings with the other shifts covered by senior Maxey House DS0000015189.V365122.R02.S.doc Version 5.2 Page 25 care staff. On the day of our inspection the Manager was on a day off but attended the inspection at the request of a member of staff. Regulation 37 notifications are sent to us to tell us of any event, such as a death of a person. The Manager said that she does not keep copies of these notifications for records and she informed us that she knows what events have taken place as she remembers these things. During our discussions with her we considered that, as the Registered Manager for Maxey House, her knowledge of practices and procedures, national minimum standards and CHRs could be improved upon. This includes knowledge of temperatures of storage of medication and temperatures of hot water. The standard of management of Maxey House is reflected also in other findings of this inspection, with particular regard to safe recruitment practices (Standard 29) and we have therefore judged, from our evidence, that there are poor outcomes for people currently living at the home. Minutes of the last two residents’ meetings were seen and these included views of people and what they would like to take place, including activities. According to the AQAA the home does not have an annual development plan for quality assurance. A policy for carrying out surveys was available and dated 2003 but there have been no surveys carried out to ask people their views about living at the home. Although the registered owner visits the home on a regular basis there are no reports of such visits. The AQAA informed us that there is no written policy for first aid or food safety and nutrition and there was no indication if such policies were to be developed as part of the quality assurance of the home. The AQAA was brief in detail and we were unable to tell what specific action was being taken to improve the service in all areas. For example the AQAA told us that staff training had improved although there were no details what type of training had been attended. The AQAA did not tell us what quality assurance systems are in place, other than there had been an increase in the number of residents meetings. We acknowledged, with the management team, that the AQAA is the first one that the home has completed and it is our expectation that subsequent AQAAs will be completed to provide more detail and directly related to the standards. A requirement has been made for the home to develop quality assurance systems to ensure that care practices are safe and in date and that people live in a home that is safely managed. According to the Manager the home keeps money for 6 of the current 27 residents and two of these people’s monies were counted and the amounts of Maxey House DS0000015189.V365122.R02.S.doc Version 5.2 Page 26 these reconciled with the balances. We were told that receipts, for any person’s expenditure, are not always obtained on behalf of the residents. A requirement was made with regards to staff receiving supervision. Staff told us that they receive 1:1 supervision every 3 months and records of these sessions were seen. As a result of this evidence this requirement is considered as met. Discussion with the Manager, however, indicated that the frequency of these supervision sessions do not meet the standard of 6 sessions each year. The Manager considered increasing the number of staff supervision sessions. According to the AQAA 2 of catering staff and 10 of care staff have attended training in safe food handling. According to the staff and the Manager arrangements are in place for staff to increase this percentage of staff who have been trained in safe food handling. Staff told us, and examination of their training files confirmed that they have attended training in fire safety, moving and handling and infection control. The Manager informed us that arrangements are in place for fire drills to be carried out. We requested reports of the last fire safety officer and environmental health officer although these reports were not made available to us. Records for temperatures of food fridges and freezers, fire alarms, emergency lighting and portable appliance checks were seen and these were satisfactory. A report of a service check for the passenger lift was dated September 2004. Aprons for staff to wear when entering the kitchen were in a box on the floor and as such there is a higher risk of these becoming contaminated than if they were placed higher up, away from the floor. The door to the cupboard, that keeps substances that are hazardous to health, was unlocked with the keys left in the cupboard door. Immediate action was taken by the Manager to ensure that this cupboard door was locked to safeguard any resident from accessing such substances. Staff were able to tell us what first aid action they would take in the event of someone choking or suddenly collapsing and the responses they gave were satisfactory. The Manager told us that first aid training of staff is to be updated and arrangements have been made for this. Maxey House DS0000015189.V365122.R02.S.doc Version 5.2 Page 27 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 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 x 18 1 3 x x x x x 1 3 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 1 x 3 2 x 2 Maxey House DS0000015189.V365122.R02.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO 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. 2. Standard OP7 OP8 Regulation 13(4) 13(1)(b) Requirement People’s risks must be identified and action taken to reduce any risk identified. People must have access to any health care professional to ensure that their health needs are being met. People’s health and welfare must be protected by the safe storage of medication. People must be protected from any risk of abuse by the implementation of safeguarding policies and procedures. People must be protected from the risk of abuse from unsuitable staff by ensuring all required information about staff is obtained before they work at the home. A quality assurance system must be developed to ensure that people are safe and the home is managed in their best interests. Timescale for action 31/07/08 31/07/08 3. 4. OP9 OP18 13(2) 13(6) 20/06/08 30/06/08 5. OP29 19 20/06/08 6. OP33 24 31/07/08 Maxey House DS0000015189.V365122.R02.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Maxey House DS0000015189.V365122.R02.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Eastern Region Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge CB21 5XE 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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