Inspection on 20/09/07 for Mornington Hall

This inspection was carried out on 20th September 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Mornington Hall 13/06/08

Mornington Hall 18/12/06

Mornington Hall 09/05/06

Mornington Hall 21/07/05

Mornington Hall 07/04/05

Mornington Hall 01/11/04

Mornington Hall 01/04/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Mornington Hall 76 Whitta Road Manor Park London E12 5DA Lead Inspector Sarah Greaves Unannounced Inspection 10:30 20 ,22 and 24 September th nd th 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 DS0000007363.V348380.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000007363.V348380.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mornington Hall Address 76 Whitta Road Manor Park London E12 5DA 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) 020 8478 7170 020 8478 6793 thompsmi@bupa.com www.bupa.com BUPA Care Homes (CFHCare) Limited Michalae Katherine Ann Thompson Care Home 120 Category(ies) of Dementia (60), Old age, not falling within any registration, with number other category (60) of places DS0000007363.V348380.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 30 at Cornwell House 30 Elderly Mentally Ill at Haywood House 30 Elderly Mentally Ill Nursing at Hamfrith House 30 Nursing at Roding House Minimum Staffing Notice Date of last inspection 18th December 2006 Brief Description of the Service: Mornington Hall is a registered care home for older people, owned by BUPA Care Homes Ltd. The home is divided into four separate units; residential care, residential care for people with dementia, nursing care and nursing care for people with dementia. The home is located in Manor Park, within short walking distance of an over ground station and bus routes. There are car-parking facilities for visitors within the grounds of the home. DS0000007363.V348380.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors conducted an unannounced inspection on the 20th September 2007. The inspectors toured the premises, spoke to residents, relatives and staff, checked staff recruitment practices and looked at health and safety practices. Random samples of care plans were read on this visit and the inspectors joined residents for lunch. The inspectors interviewed the activities staff and looked at activities equipment. The lead inspector returned to the care home on the 22nd and 24th. The inspector undertook a Short Observational Framework Inspection (SOFI) in order to assess the care received by people with dementia. Further evidence was gathered through checking the service’s administration of medication and speaking to the catering manager. The Commission for Social Care Inspection issued the care home with an Annual Quality Assurance Assessment (AQQA) several weeks before the inspection. The registered manager completed this document and information was used for this report. The lead inspector met the registered manager on the final day of the inspection in order to gather information that was not available in her absence and to provide a verbal feedback of the inspection findings. What the service does well: Some good interactions between residents and staff were observed during this inspection; the inspectors watched residents being supported into the transport to their pub lunch and there was a cheerful atmosphere. The service demonstrated some positive practices, such as the serving of fruit smoothies for people that needed to boost their nutritional intake and the use of every day items as ‘tactile’ objects for residents with dementia. The inspectors found the management of residents’ personal finances to be well organised. DS0000007363.V348380.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? Seven requirements and two recommendations were issued in the previous inspection report; five requirements and the two recommendations have been met. The service demonstrated that staff were aware of the medication that they administered and residents were observed to receive the support that they needed at mealtimes. Formal one-to-one supervision was regularly provided, although the quality of this supervision was changeable. Staff training for the protection of vulnerable adults has been provided by Newham Safeguarding Adults Team. One of the requirements was for staff to receive training to address the issues of concern identified in the report, which has been provided (or was due to occur for care planning). One of the requirements regarding the quality of the care planning has been deleted, due to the care home introducing a new care planning system. Recommendations for the safe storage of food thickening granules and for the training of staff to use sensory equipment were met. What they could do better: 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. DS0000007363.V348380.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000007363.V348380.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The needs of residents are assessed prior to moving in; however, the service needs to ensure that staff are trained to understand and meet individual needs. Residents can visit the service and/or receive a visit from senior staff. EVIDENCE: The inspectors looked at ten randomly pre-admission documents and the corresponding care plans. Pre-admission assessments were produced for the ten case-tracked residents, which were noted to contain information from relevant professionals (such as social workers and doctors). The manager of DS0000007363.V348380.R01.S.doc Version 5.2 Page 9 one of the residential units informed the inspectors that one of the residents had a learning disability; however, there was no information within the preadmission assessments to indicate this. The inspectors asked for further information about the learning disability but the unit manager described entirely physical symptoms associated with a physical disability. The inspectors were concerned regarding this apparent lack of knowledge regarding learning disabilities, since there was at least one other resident on the unit with a confirmed learning disability. This finding was discussed with the registered manager, who stated that information suggesting that the resident might have a learning disability had been very recently received. It was noted that a preadmission assessment undertaken by the care home described the hospital matron of a small hospital in Redbridge as being the individual’s care manager; this information demonstrated a lack of understanding regarding the roles of external health and social care professionals. The inspectors found that the care home was admitting residents with more complex needs, hence the need for staff to possess better knowledge regarding a wider range of health and social care needs. Via discussions with relatives of residents and with the registered manager, the inspectors found that a limited number of residents visited the care home prior to moving in for a trial period. The registered manager stated that all prospective residents are invited to visit but this invitation is declined due to circumstances beyond the control of the service (such as the physical and/or mental frailty of the individual or transport problems). The service invited relatives and friends to tour the premises and a senior member of staff made an assessment visit to the prospective resident. The registered manager confirmed her commitment to encouraging visits to the care home by prospective residents. Key Standard 6 was not assessed, as the service does not offer intermediate care. DS0000007363.V348380.R01.S.doc Version 5.2 Page 10 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 and 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service needs to demonstrate improvements in the planning and delivery of care to meet the personal and health care of the residents. Although the service demonstrated satisfactory systems for the management of medication, staff must undertake a more rigorous approach to ensuring consistently safe practice. The dignity of residents must always be maintained and the service needs to evidence knowledge of meeting the individual wishes of residents who are dying within the care planning documents. EVIDENCE: The inspectors read ten care plans, including five care plans for residents living on the two units for people with dementia. The deputy manager showed the inspectors documentation for a new care planning system that the service was in the process of switching to. At the time of the inspection, training for the DS0000007363.V348380.R01.S.doc Version 5.2 Page 11 new care planning system was being delivered to the registered manager although plans had been established for all of the existing care plans to be switched to the new system in October 2007. Requirements were issued in the previous inspection report for the service to improve upon the quality of its care plans. It was noted at the last inspection that the care plans contained inappropriate terminology and inaccurate clinical judgements. One of the care plans was noted to state ‘X is incontinent so he wets himself’ and another care plan stated ‘X manipulates staff’. Residents (and/or their representatives) are invited to read the care plans and to sign their agreement with the contents, hence the need for information to be written in an objective and sensitive manner. The inspectors found a care plan for a resident, which stated that this individual had a grade one pressure sore; however, the most recent written entry by the unit manager stated that this grade 1 pressure sore was ‘granulating well’. This entry was discussed with the staff nurse on duty, who acknowledged that it was not clinically possible for a grade 1 pressure sore to form granulation tissue. Another care plan stated that an individual required weekly weighing but only monthly weights were recorded. It was noted that a care worker had entered information into a care plan, which they signed with their first name only. The ‘falls risk assessment’ within one care plan did not acknowledge that the resident was prescribed diuretic medication, which would have increased the score. The Commission for Social Care Inspection has been notified of several concerns relating to the care of residents since the last inspection; these concerns were referred to the Newham Safeguarding Adults Team for full investigations. The concerns identified a need for the care home to have more robust systems in place for staff to seek managerial advice if a resident becomes unwell or has an accident. The inspector was shown a staffing rota with clear details of who should be contacted if the manager or deputy manager are not in the premises. A resident was taken ill on the second day of the inspection and an ambulance was called. The inspectors found that this incident was dealt with calmly and promptly; for example, a portable screen was brought into the communal lounge so that staff could administer resuscitation and other care in a discrete manner in the presence of residents with dementia. The communication with ambulance staff appeared to be polite and professional and no unnecessary delays were observed in preparing written information for the hospital. The resident was accompanied to hospital by an escort. The care plans addressed health care needs and reported upon medical and health care interventions (such as doctor’s visits, psycho-geriatric assessments, podiatry and dental care). Advice for managing the nursing needs of residents was provided by registered nurses from the Primary Care Trust (PCT) that visited twice weekly. The inspector was informed that staff had received training in pressure sore care from the PCT. DS0000007363.V348380.R01.S.doc Version 5.2 Page 12 The inspectors noted that a medication-dispensing container had been left on a table next to a resident in a communal lounge on a unit for people with dementia; this observation was made at 12.30 pm. Following discussion with staff, it was discovered that the medication had been administered in the morning. Upon examination of the contents of the container, the inspectors found that there were two separately prescribed medications within the one container that should not be mixed together. The inspectors checked the storage and recording of medications on a nursing unit. It was noted that a mistake had been made by two registered nurses for the recording of the quantity of a controlled drug. It was also observed that the temperature of the medication refrigerator was not within the acceptable range on several days; however, there was no evidence to demonstrate that the staff had re-checked the temperatures on these occasions. It was noted at an Adult Protection strategy meeting that the care home did not have a homely remedies policy; this policy was now in place. A requirement was issued in the previous inspection report for staff to demonstrate an understanding of the medication that they are administering; this requirement was satisfactorily met. A recommendation was issued for the service to ensure that food thickening granules (prescribed items) were safely stored rather than being openly displayed in bedrooms; this was achieved. Observations of the interactions between residents and staff were generally positive. The inspectors conducted a Short Observational Framework Inspection on one of the units for people with dementia. During this observation, five residents were closely observed for two hours in order to assess and evaluate their welfare. The inspectors observed definite improvements in the manner in which staff were able to communicate with people with impaired communication skills due to dementia. However, this progress was being hampered through the lack of information within care plans about residents social history, likes and dislikes and former interests. The inspectors informed care staff that a resident (who was sitting in her bedroom) was asking for assistance in order to return to the lounge. The inspectors were told that the resident needed personal care and a change of clothes after breakfast; however, the care worker proceeded to strip the individual with the bedroom door open and the inspectors standing in the corridor. The inspectors viewed the care home’s ‘End Of Life’ policy. The registered manager stated that the care home would be subscribing to the Gold Framework. The information contained within the current care plans was very limited, although the new care plans were stated to provide a template to ensure that comprehensive information is gathered. The registered manager stated that agreements were being undertaken in order to determine the preferred place of care for residents who are dying; the inspectors did not request to see any of these written agreements. DS0000007363.V348380.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents were offered opportunities to participate in social activities within the home and local community, and maintain links with people outside of the care home. However, the care home needs to develop these services in order to provide better outcomes for all residents. The food choice was good, but staff need to be aware of the food that they are serving to properly support and advise people with dementia and/or impaired vision. EVIDENCE: The inspectors noted that a group of residents went out for a pub lunch on the first day of the inspection; this was a pre-planned trip and was attended by a relative. The inspectors met with the care home’s activities organiser, who had been in this full-time position for a few weeks at the time of this inspection. The activities team employed two part-time staff that worked a total of fiftyone hours per week. The inspectors looked at the activity plans for a couple of months, which included visiting entertainers, visits to an external bingo club, DS0000007363.V348380.R01.S.doc Version 5.2 Page 14 arts and crafts, and pub lunches. The activities organiser stated that he was proposing to set up new activities such as gardening and cake decorating, and to provide apparatus on the units to enable residents to engage in occupational tasks such as dusting, if they wished to. The inspector was shown new ‘tactile’ equipment on the units for residents with dementia, such as scarves and shawls. The inspectors noted that one of the units displayed a notice stating that open visiting was allowed; via discussion with the registered manager this notice was identified as being inaccurate as visitors were not encouraged at mealtimes so that residents could focus on their meals. The inspectors spoke to several visitors during the course of the inspection and were informed that the visiting hours were flexible and that they were made to feel welcome. The service had made some links with local community organisations (such as the bingo club) and visits were received from religious ministers. The inspectors were aware from previous inspections that the care home received visits at particular times of the year from community groups (for example, schools and church choirs at Christmas); however, it is hoped that the new activities organiser will pursue regular links with a broad range of local resources, including individuals and/or organisations that meet the cultural needs of residents from minority ethnic communities. During the Short Observational Framework Inspection (SOFI), the inspectors noted that a member of staff spent some time attempting to interest a resident in playing with a ball, which the resident constantly declined. The inspectors noted that the resident had formerly worked as a skilled crafts person but they were not offered any opportunities to use sensory equipment that matched their occupational knowledge. The activities co-ordinator stated that he was attempting to get information from relatives so that the care plans could assess how best to stimulate people and meet their social needs. It was acknowledged that not all relatives/friends could provide past history information. However, during the SOFI observation the inspector noted that some staff demonstrated good skills communicating with people through music, walking together, looking at old photographs and holding hands. A recommendation was issued in the previous inspection report for nursing and care staff to receive training to use sensory equipment; this recommendation was deemed to have been met. The vast majority of residents were not in a position to manage their own finances due to cognitive and/or physical frailty. The inspectors looked at a randomly chosen sample of the individual files and noted that residents appeared to spend their personal allowance in accordance to their own wishes and needs (for example, hairdressing, chocolates, outings, toiletries and clothes). The registered manager stated that she was updating the Service User Guide; this document previously contained guidance regarding how to contact advocacy services. The inspector was informed by a relative of the support given by the home to enable the resident to actively participate in a DS0000007363.V348380.R01.S.doc Version 5.2 Page 15 family wedding, in accordance to the resident’s own wishes to be closely involved. The inspectors met the catering manager and looked at the main kitchen. The catering manager stated that an in-depth inspection of the kitchen by Newham Environmental Health department was due to occur soon. The inspectors found the kitchen to be clean and food was hygienically stored. The menu plans evidenced that a good choice of foods were available, for example, cooked breakfasts, porridge and five different cereals were available in the morning. The inspectors were informed that additional cereals could be provided, in accordance to residents’ requests. The menu plan identified that a couple of savoury choices were available each lunchtime, plus ‘off menu’ choices such as salads and omelettes. The inspectors were shown fruit ‘smoothies’ (blended fruit and ice-cream), which were produced for residents that were not able to avail of the fresh fruit sent to the units three times per week. The inspectors joined residents at one meal and another mealtime was observed. It was noted that there was insufficient space for all residents to sit at the dining tables. The inspectors spoke to a staff nurse on one of the units, who was able to provide acceptable reasons regarding why some people remained at their armchairs for their meals. The registered manager confirmed that this information would be confirmed within the new care plans. The inspectors observed that staff were unaware of what pudding they were serving to residents, who were told that it was rice pudding, sago or tapioca. The staff were also offering residents a spoonful of marmalade on the pudding as opposed to the more customary (red) berry fruit jam. The inspectors enquired why residents were being offered marmalade and were informed that it had been sent up on the trolley with the lunchtime food, although some staff appeared to know that the marmalade was inappropriate. This observation took place on a residential unit for people with dementia; one of the residents expressed her surprise at the presentation of the pudding. The inspector noted that biscuits had been sent to one of the units in a plastic bag and had arrived in a crumbled state. A requirement was issued in the previous inspection report for the service to demonstrate that all residents who are unable to independently feed themselves are provided with appropriate support. Via two separate observations at mealtimes, the inspectors found that staff met the needs of residents in an organised and composed pace. DS0000007363.V348380.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care home demonstrated that complaints were appropriately investigated and actions were taken to improve the service. Staff have been provided with recent training to protect vulnerable residents; however, on-going staff guidance is needed. EVIDENCE: The inspectors found that the care home produced a satisfactorily written complaints procedure. The service’s investigations for all the complaints received since the last inspection were looked at by the inspectors, including some complaints that were subject to Adult Protection strategy meetings. The inspectors were satisfied with the service’s management of complaints and noted that actions had been taken to remedy areas of weak practice that had been identified via a complaint. A requirement was issued in the previous inspection report for the service to ensure that all staff received Adult Protection training; this training was being provided by an officer from Newham Safeguarding Adults Team. The service produced an appropriate Adult Protection policy and procedure. DS0000007363.V348380.R01.S.doc Version 5.2 Page 17 Incidents since the last inspection have demonstrated that staff have failed to recognise the wider range of issues within the remit of protecting vulnerable adults, such as promptly and effectively responding to a resident that was injured following a fall. Concerns have been raised by relatives and a visiting health care professional. The inspectors were concerned as to whether staff fully understood their roles and responsibilities. A unit manager informed the inspectors that a resident on their unit was inappropriately placed but was being kept on the unit in response to pressure from the family. The inspectors advised that this information should be immediately reported to the registered manager, given the potential risks to the health, safety and welfare of an individual stated to need more intensive care than they currently receive. The inspectors discussed this issue with the registered manager, who stated that Social Services have been asked to re-assess. DS0000007363.V348380.R01.S.doc Version 5.2 Page 18 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, 20, 24 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service needs to promote the safety of residents through providing a secure and hygienic home. Bedrooms were well maintained. EVIDENCE: The inspectors arrived at 10.30 am on the first day of the inspection. Following a brief discussion with the deputy manager, the inspectors toured the premises. The inspectors were concerned that staff did not challenge their presence in staff only areas (such as the laundry room), although staff members admitted that they did not recognise either of the inspectors. DS0000007363.V348380.R01.S.doc Version 5.2 Page 19 One of the washing machines was broken and was stated to have been broken for a couple of months; the registered manager stated that it was due to be replaced. The first residents unit visited by the inspectors was Hamfrith (nursing unit for people with dementia). The inspectors found that there was faeces in one of the showers. A member of staff reported that the shower room had not been used that morning. The unit was in an untidy condition although staff were appropriately focused on providing personal care for residents as opposed to making beds. It was noted that a section of a carpet in a communal lounge had become unsightly due to staining; it was confirmed that this carpet would be replaced. The inspectors were also concerned about an ornamental fireplace feature that had become detached from the wall. This was regarded as an unnecessary obstacle in a communal room used by people with dementia who may also have unsteady mobility and/or impaired vision; the registered manager agreed to the removal of this item. The inspectors pulled an alarm cord in an unoccupied bedroom and found that there was no response after over five minutes. It was noted that a couple of staff wore bleeps that alerted them to a call bell; the inspectors were very concerned that these bleeps were not being worn by all nursing and care staff on duty. The inspectors spoke to the unit staff and were informed that staff promptly responded to constant bleeping as that could indicate an emergency but they did not prioritise a single call for assistance. The inspectors were concerned as to how people with dementia would understand this dual calling system and whether their relatives and friends were aware of the different ways to summon help when they were visiting. This information was discussed with the registered manager and the deputy manager who stated that they were unaware of this practice, which was not part of company policy. The inspectors found that residents’ bedrooms were pleasantly and comfortably decorated. Many of the bedrooms had been personalised and demonstrated people’s interests and their role within their family. The inspectors observed that the insect executor in one of the kitchens needed to be cleaned. There was a noticeable unpleasant odour in the sluice rooms, which permeated through to the communal corridors. DS0000007363.V348380.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels and staff recruitment was satisfactory; however, the holistic needs of residents needs to be addressed through improved staff training. EVIDENCE: The staffing levels were observed on early and late shifts, on a weekday and at the weekend. The number of staff and the skill mix were found to be satisfactory. The inspectors were concerned as to whether one member of domestic staff was sufficient for a morning shift on the nursing unit for people with dementia, although the inspectors found that the residential and nursing units were satisfactorily clean and tidy on the second day of the inspection (which commenced at 12.30pm). At the time of this inspection, 33 of care staff had a minimum of a National Vocational Qualification in Care at Level 2 (or equivalent). This figure was below the National Minimum Standard of at least 50 of care staff possessing this qualification. The inspector acknowledged that there was a significant DS0000007363.V348380.R01.S.doc Version 5.2 Page 21 recruitment of new staff in January 2007 and staff are supported to access this training. The inspectors checked a random sample of seven staff files on the first day of the inspection and a number of omissions were discovered. The registered manager was able to clarify these issues on the final day of the inspection. Although no requirements or recommendations have been issued, the registered manager is advised that there should be a more detailed level of scrutiny when checking staff references. The inspectors were provided with details of staff training, which demonstrated that staff accessed mandatory training. As previously stated in this report, the main forthcoming training for staff was the implementation of the new care planning system. The serious concerns investigated through the Adult Protection Strategy meetings identified issues of ineffective leadership at unit level (in addition to poor care practices), which the registered manager stated was being managed by the service provider. Although some positive observations were made during the SOFI observation, the inspectors were surprised by the gaps of knowledge demonstrated by a senior staff nurse on the nursing dementia unit. The inspectors would expect a registered nurse to present some current knowledge of issues in dementia care and be able to speak about BUPA’s own dementia practices. DS0000007363.V348380.R01.S.doc Version 5.2 Page 22 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 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although the views of the residents were sought, the service needs to achieve substantial improvements in order to consistently and safely meet the needs of individuals. The quality of staff supervision was variable, but personal finance records for residents were appropriately maintained. EVIDENCE: DS0000007363.V348380.R01.S.doc Version 5.2 Page 23 The registered manager has been in post since January 2007. She is a registered nurse and has previous experience of managing a care home. The inspectors acknowledge that the registered manager took over a service with specific weaknesses, as identified in the last inspection report. The service demonstrated that it is striving towards improvements; however, very concerning evidence of poor practices were detected at this inspection (such as staff leaving medications unattended in communal lounges and implementing their own systems for answering call bells). The inspectors felt that the registered manager has achieved some clear achievements (such as the improvements communicating with people with dementia and the better working relationship with ambulance staff). The inspectors observed that meetings were advertised for residents and their relatives, and surveys were sent to the relatives. The inspectors thought that the service was in a position to positively respond to some views from residents and their representatives (for example, issues regarding the food service or activities); however, issues regarding the improvement of the quality of care would require a sustained programme of staff training, supervision and leadership. As previously stated within this report, the inspectors looked at five randomly selected financial records, inclusive of receipts for all expenditures. The care home’s administrator explained how they managed the financial records, which were audited by BUPA regional financial staff. No issues of concern were found. The inspectors found that staff received regular formal one-to-one supervision at a suitable frequency to meet the stipulations of the National Minimum Standards. The inspector noted that the quality of the supervisions varied. Other findings within this report have indicated that some senior staff that deliver supervision have distinct gaps in their own knowledge. The inspectors were concerned to find a letter from a social worker within a resident’s file that alleged an inaccurate and unprofessional remark by a unit manager. The unit manager informed the inspectors that they had never made this remark but had not notified the registered manager/deputy manager of this letter. The inspectors thought that senior staff should know that such issues must be raised in forums such as supervision. The inspectors looked at the health and safety records, which were found to be satisfactorily maintained. The inspectors noted that the lids for the external clinical waste containers were left unlocked in an area that could be accessed by residents. The registered manager stated that the containers would be moved to a fenced area. The inspectors looked at the accident records. Following concerns that these records were not detailed enough and were not checked by a manager, the inspectors noted that these records were now more comprehensively written and were signed by the deputy manager. The inspectors were concerned to find that the doors to two staff changing rooms were left unlocked, including the changing room on the nursing unit for people DS0000007363.V348380.R01.S.doc Version 5.2 Page 24 with dementia. This issue has been raised at a previous inspection, including discussions about the potential danger of confused people accessing prescribed medication owned by staff. DS0000007363.V348380.R01.S.doc Version 5.2 Page 25 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 X X 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 X X X 3 X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X X 2 DS0000007363.V348380.R01.S.doc Version 5.2 Page 26 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 18 (1) (c) Requirement The Registered Manager must ensure that staff receive training to understand the needs of people with a learning disability. The Registered Manager must ensure that care plans do not contain inappropriate terminology. This is a repeated requirement. The Registered Manager must ensure that staff do not leave out prescribed medications, so that residents are protected from the dangers of taking medications prescribed for other people. The Registered Manager must ensure that staff receive training to correctly present food to residents, so that meal times provide a nutritionally balanced and enjoyable experience. The Registered Manager must ensure that staff are trained to address unknown person within the premises, in order to maintain the safety of the residents. DS0000007363.V348380.R01.S.doc Timescale for action 31/03/08 2. OP7 5 31/01/08 3. OP9 13 (2) 31/12/07 4. OP15 18 (1) (c) 31/01/08 5. OP19 18 (1) (c) 31/12/07 Version 5.2 Page 27 6. OP19 18 (1) (c) 7. OP38 13 (4) (c) 8. OP26 16 (2) (k) 9. OP28 18 (1) (c) 10. OP36 18 (2) The Registered Manager must ensure that staff are trained to respond to call bells in accordance to BUPA policy, so that residents can be assured that their safety and care needs will be addressed. The Registered Manager must ensure that the staff hanging rooms are kept locked, so that confused residents do not access any items that could be harmful to their health and welfare. The Registered Manager must ensure that there is appropriate ventilation equipment in the sluice rooms, so that a hygienic odour is maintained within the premises. The Registered Manager must ensure that at least 50 of care staff undertake National Vocational Qualification Level 2 in Care. The Registered Manager must ensure that supervision identifies issues that staff need additional support and training for. 31/12/07 31/12/07 31/01/08 31/10/08 31/01/08 DS0000007363.V348380.R01.S.doc Version 5.2 Page 28 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 OP9 Good Practice Recommendations Staff should demonstrate that they have taken action if the medication refrigerator temperatures are not within normal ranges, in order to preserve the safety of residents’ medications. Activities staff and care staff should actively seek social histories of the residents, in order to provide individualised care. Activities staff should assist residents to enjoy a wider choice of community resources. 2. 3. OP12 OP13 DS0000007363.V348380.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Text phone: 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. Extracts may not be used or reproduced without the express permission of CSCI DS0000007363.V348380.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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