Inspection on 19/05/08 for Mount Pleasant, St Agnes

This inspection was carried out on 19th May 2008.

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

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

Mount Pleasant, St Agnes 16/12/09

Mount Pleasant, St Agnes 16/10/09

Mount Pleasant, St Agnes 02/10/09

Mount Pleasant, St Agnes 01/04/09

Mount Pleasant, St Agnes 27/01/09

Mount Pleasant, St Agnes 14/10/08

Mount Pleasant, St Agnes 21/01/08

Mount Pleasant, St Agnes 03/08/07

Mount Pleasant, St Agnes 03/05/06

Mount Pleasant, St Agnes 16/02/06

Mount Pleasant, St Agnes 23/06/05

Mount Pleasant, St Agnes 11/02/05

Mount Pleasant, St Agnes 07/09/04

Mount Pleasant, St Agnes 29/06/04

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Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Mount Pleasant, St Agnes Rosemundy St Agnes Cornwall TR5 0UD Lead Inspector Ian Wright (with Melanie Hutton) Unannounced Inspection 19th May 2008 09:30 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 Mount Pleasant, St Agnes DS0000008913.V364783.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. Mount Pleasant, St Agnes DS0000008913.V364783.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mount Pleasant, St Agnes Address Rosemundy St Agnes Cornwall TR5 0UD 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) 01872 553165 01872 553776 Mr Godfrey William Sear Mrs Susan Ann Sear Manager post vacant Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Mount Pleasant, St Agnes DS0000008913.V364783.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To accommodate one named service user under the age of 65 years (62 years) 21st January 2008 Date of last inspection Brief Description of the Service: Mount Pleasant is located near the centre of St. Agnes. The registered providers are Mr G Sear and Mrs S Sear. Mount Pleasant provides accommodation and personal care for up to 22 older persons. The accommodation is on one level; there is full access around the home for people who use the service. Corridors are wide to suit people who use the service who use a wheelchair. There are 20 rooms of which 18 are for single occupation and two shared rooms. The majority of bedrooms have an en-suite toilet and washbasin facilities. Communal areas and rooms are decorated and furnished to a satisfactory standard. The kitchen area is clean and organised. The house is set in well laid out gardens, with pleasant views of the town and countryside. There is satisfactory parking for visitors. The home is close to local amenities with access to transport links into the main city of Truro. The range of fees at the time of the inspection were £308-£410. A copy of this and previous inspection reports is available from either CSCI, for example at our website at www.csci.org.uk or from the registered provider. Mount Pleasant, St Agnes DS0000008913.V364783.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. Two inspectors completed this unannounced key inspection in eight and a half hours in one day. This inspection was completed after the serving of a notice issued in accordance with paragraph 6.7 of Code B of the Police and Criminal Evidence Act 1984 (Code of Practice for the Searching of Premises and the Seizure of Property Found on Persons or Premises) for the period of the inspection between 09:40 and 17:37. The reason this was served was because the commission believed an offence, for example, under the Care Standards Act 2000(Care Homes Regulations 2001) may have been committed. The inspector explained the purpose and contents of the notice to the designated person in charge at the time of inspection. The person in charge of the home was advised to take a copy of the notice. The methodology used for this inspection was: • To case track people who use the service. This included, where possible, meeting and discussing with the people who use the service their experiences, and inspecting their records. • Discussing with two staff their experiences working in the home. • Discussion with other people who use the service and their representatives. • Observing care practices. • Discussing care practices with management. • Inspecting records and the care environment. Other evidence gathered since the previous inspection such as notifications received from the home (e.g. regarding any incidents which occurred) were used to help form the judgements made in the report. What the service does well: Generally people living in the home spoke positively regarding the support they received. People were also positive about the food provided and the choice of food that is available. Routines were viewed as relaxed. Staff were viewed by people who use the service as kind and caring. Mount Pleasant, St Agnes DS0000008913.V364783.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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 Mount Pleasant, St Agnes DS0000008913.V364783.R01.S.doc Version 5.2 Page 7 be made available in other formats on request. Mount Pleasant, St Agnes DS0000008913.V364783.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Mount Pleasant, St Agnes DS0000008913.V364783.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information provided to people who use the service (e.g. regarding services offered) is satisfactory. However pre assessment procedures need improvement so people who use the service, and their representatives can be assured the needs of people who use the service are assessed appropriately. EVIDENCE: Several files of people who use the service were inspected. Most had a copy of a contract of care on file. However, this was absent for one person. The registered provider said they were awaiting the completed copy to be returned from the representatives of the person using the service. The inspector spoke to several people who use the service. People who were admitted to the service, since the last inspection, said they could not recall anyone completing an assessment before they moved in. The inspector said information gathered regarding assessments that were seen could be improved. For example: Mount Pleasant, St Agnes DS0000008913.V364783.R01.S.doc Version 5.2 Page 10 • • Assessments need to be signed as it needs to be identifiable who undertook the assessment. Information gathered should be more comprehensive. National Minimum Standard 3.3. clearly details what information should be obtained at the time of the assessment. It may be helpful for the registered provider to develop an assessment form containing this information. The registered provider obtains a copy of assessments completed by either social services and/or the National Health Service where necessary, and these were inspected on several people’s files. However, third party assessments should not be considered a substitute for the registered provider to complete a pre admission assessment. The commission has been involved in a multi agency review of a person who lived in the home. The review concluded a need for systemic improvements by a number of agencies. With regard to the registered provider, there is a need for improvement of reassessment procedures if someone’s needs change significantly; for example if someone is readmitted after spending time in hospital. In this case there was a lack of clear reassessment of the person’s needs and how the person’s changed needs would be met. This should include, where appropriate, a complete reassessment of the person’s needs, the registered provider arranging a multi disciplinary meeting to ascertain how a person’s needs will be met, and the sharing of responsibilities to ascertain who and how a person’s needs would be met. At the same time as this person was resident, there was also another person living at the home who needed significant levels of care. Concerns have been expressed about the care given by the person’s family and by external professionals. It must have been very difficult to meet the needs of both people, and the needs of others, to a satisfactory level. This is particularly the case as staffing levels were not raised. It is essential when assessments are completed, that the needs of other people who live in the home are considered. Part of proving competence regarding this standard, particularly in these cases, would be evidence that the registered provider either increases staffing levels to cope with changing needs, requests more assistance from external agencies, and /or understands the limitations of what service can be provided. Unfortunately, despite staff appearing to do what they could, and trying to ensure the ‘home’ of the individuals concerned was maintained, there does appear to be a lack of insight regarding these matters in these cases. Mount Pleasant, St Agnes DS0000008913.V364783.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Health and personal care standards are generally satisfactory. People who use the service and their representatives said they were happy with the care provided. However, improvement is required to care planning. Having an appropriate plan of care will help ensure people who use the service receive appropriate care according to their wishes and needs. EVIDENCE: There is a copy of a care plan on most people’s files. Care plans are accessible to staff. Care plans appear to be reviewed. Although most people who use the service, who the inspector spoke to, did not seem aware they had a care plan, they all said care is delivered to a good standard, and staff did their best to meet their needs. However at least two people did not have a care plan in place. For these people, even though they were recently admitted, at least an interim care plan should have been in place, after admission, so staff could be aware of what care is required. Mount Pleasant, St Agnes DS0000008913.V364783.R01.S.doc Version 5.2 Page 12 The inspectors also said, where possible and applicable, care plans need improvement. For example care plans should: • Not be only task orientated and should pay more attention to people’s wishes and choices. • Involve people who use the service (and their representatives as appropriate) more in the development and review of individual care plans. • Include specific guidance regarding physical care and medical conditions (e.g. continence, catheter care, epilepsy, cellulitis) A summary of each care plan is also included on the ‘Cardex System’ in the home. The registered provider was advised to discontinue the summary system as there is a risk the summary may not get appropriately updated. This could result in contradictory and misleading information being provided regarding people’s care. A ‘night book’ is also maintained. This should be discontinued and observations recorded in care records. People who use the service said they were satisfied with the healthcare support they received. This includes visits from GP’s, district nurses, chiropodists, dentists and opticians. Medical interventions appear to be appropriately recorded in care files. However, we have received two concerns about the care of people in the home. Both people’s needs became significantly higher. Although staff appear to have done their best to meet the people’s needs, there appears to have been shortfalls in the care which was provided. The investigations regarding these matters is yet to be concluded. The registered provider has a medication policy. Medication is administered via the monitored dosage system. The medication system was inspected and appeared to be managed to a generally satisfactory standard. Storage appears to be appropriate, and administration records are completed to a satisfactory standard. The registered provider said all staff who administer medication have received training from the pharmacist. However, despite looking for the certificates, the registered provider could not find these. These need to be available for inspection, and if the registered provider cannot find the originals duplicates need to be obtained and included in individual staff files. Some improvement regarding the operation of the medication system is required: • • The medication trolley is kept in the dining room and is not fastened to the wall. This subsequently needs to occur to prevent theft. People who self administer need to have a lockable facility to store their medication. Mount Pleasant, St Agnes DS0000008913.V364783.R01.S.doc Version 5.2 Page 13 • • Two signatures are required if the dosages of medication are changed (on a GP’s instruction), or additional medication is added to the pre printed medication sheet after a doctor’s consultation. There should be a photograph of the individual person using the service within each section of the medication file. People who use the service generally said they felt staff worked with them in a manner, which respected their privacy and dignity. People who use the service were positive about their care. People who use the service said personal care was provided to a good standard. Staff were observed working with people, in a positive manner and appeared caring and kind. However one person raised concerns that they could not watch TV after 11pm. They said staff had come into his bedroom, and turned off the television. The registered provider said that the person would put the TV on loud, and this would disturb other people living in the home. The person concerned said the TV was only on quietly. The person also said that they did not like being checked each hour at night as this would wake them up and they could not get back to sleep. It appears unreasonable that the person’s views about the service provided are not being considered. However, it is important that individual people using the service respect other people living in the home. The inspector recommended to the registered provider: 1. Senior staff held a meeting with the person. It could be agreed the person could buy headphones to prevent any disturbance if this is occurring. 2. A risk assessment is agreed with the person concerned regarding whether regular checks are required. The registered provider has a satisfactory policy regarding anti discrimination. There are currently no people who use the service from ethnic minorities, although it is understood the registered provider would be happy to accommodate people who use the service from other cultures. The local population is predominantly Cornish, and from ‘White-UK’ background. The manager and some of the other staff are due to attend a training course regarding equality and diversity shortly. Issues regarding sexuality and gender seem to be suitably addressed. Mount Pleasant, St Agnes DS0000008913.V364783.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is generally good. This judgement has been made using available evidence including a visit to this service. Routines, food and opportunities generally meet the needs of people living in the home. EVIDENCE: The inspector was able to speak to many of the people who use the service. All said they could get up and go to bed when they wanted to, and that routines were not rushed. The inspector also observed practices as relaxed. Some activities are available, for example, keep fit sessions, a clothes show (an external company coming in to sell clothes to the residents), an entertainer, and a fortnightly church service. One person however did say they would like more to do. No organised activities were observed on the day of the inspection. People who use the service said they were able to receive visitors when they wished, either in one of the lounges or in their bedrooms. People who use the service said they felt they could exercise choice over their lives for example how to spend their time, what they could wear etc. A concern was expressed by one person, as outlined in the previous section of the report. We also have said that there should be more evidence in care plans regarding how people’s individual wishes and choices, regarding their care, are Mount Pleasant, St Agnes DS0000008913.V364783.R01.S.doc Version 5.2 Page 15 accommodated. There should be information in care plans regarding activities people wish to pursue, and how these needs will be met. The inspector shared a meal with some people who use the service. Food served was of good quality and there was a choice available of main course and sweet for people. This is excellent as there is often only a limited choice in many care homes. People who use the service all said they were happy with the food provided. They said there was always enough food and meals were well cooked. A choice of evening tea is also provided, and hot and cold drinks appear to be available throughout the day. However one person said there did not appear to be hot drinks available on a Sunday. The registered provider said they thought hot drinks were available. The inspectors asked the registered provider to look into the matter. Another person said breakfast is only served within a limited time period. If this is the case breakfast times should be flexible either earlier or later according to individual wishes. Mount Pleasant, St Agnes DS0000008913.V364783.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, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A suitable complaints procedure is in place. Adult protection processes and procedures need improvement. Improvement in this area should give people who use the service more confidence about adult protection processes at the home. EVIDENCE: There is a suitable complaints procedure. The registered provider said they have not received any complaints regarding this service. The commission has received one concern regarding this service in December 2008. We have also received a complaint regarding care standards which is being dealt with under Cornwall County Council’s Adult Protection Procedures. 1. The concern related to the care of one person, who’s health deteriorated and had to go to hospital. The person subsequently returned to the home, but had significantly higher needs than when they were originally assessed. Although staff seem to have done their best, the commission and other bodies did have concerns regarding how the injury occurred in the first place, whether it could have been avoided, and that this was not reported to CSCI. Secondly, we were concerned about the lack of assessment completed by the registered provider regarding whether they could meet the person’s continuing needs. Thirdly whether the care plan contained satisfactory information regarding the persons needs. Fourthly whether staff had sufficient training to meet the person’s needs. Although there were failings of other agencies involved in the person’s Mount Pleasant, St Agnes DS0000008913.V364783.R01.S.doc Version 5.2 Page 17 care, it is clear improvements in these areas would have possibly assisted in the person receiving a better outcome from the service. 2. A complaint has been received regarding the care of another person using the service. This was regarding whether the needs of someone with deteriorating health needs were appropriately met by the registered provider. This matter is being investigated under Cornwall County Council’s Adult Protection procedures. 3. Concerns were also raised by the contacts in both cases above regarding the home not being consistently warm, the lack of hot water, staffing levels and competence. These matters were investigated as part of this inspection and are addressed elsewhere in the report. The registered provider has an adult protection policy. The policy does need some development to make it more robust. The policy also needs to be clearer regarding what people living and working in the home should do if there is an allegation: 1. Firstly, any accusations must be reported to Cornwall County Council’s Department of Adult Social Care. The registered provider has a duty to ensure such matters are always reported- even if the victim of alleged abuse wishes confidentiality to be maintained. The current policy states this may not happen if the person concerned does not wish it to be reported. The person subsequently needs to be informed of the registered provider’s duty if an allegation is made. If the person does wish the matter not to be raised, the social services department should be informed of the person’s wishes. This will ensure if there is a need for an investigation this can be carried out sensitively. 2. The Department of Adult Social Care are the coordinating agency for any investigation. The manager, registered provider or other persons should not investigate any allegations, beyond basic information gathering, unless delegated by social services to do so. 3. The policy should state how people using the service, and their representatives, will be informed of what to do if they have any allegations of abuse or poor practice. 4. The policy should state what pre employment checks and training staff will receive. It should detail how staff will be informed (e.g. on induction) of correct protocols they should follow if there is an allegation. 5. Contact addresses and phone numbers should be in the policy and readily available to staff, people who use the service and their representatives. When the registered providers have become aware of matters which need to be reported regarding adult safeguarding (protection) issues, they have reported these appropriately. The matter therefore appears to be about ensuring the wording of the policy is correct and staff are subsequently guided appropriately by it. Mount Pleasant, St Agnes DS0000008913.V364783.R01.S.doc Version 5.2 Page 18 The two staff the inspector spoke to seem generally aware what to do if there was an allegation. For example people said they would either report any allegation to management, CSCI or social services. Personnel files showed 7 of the 12 staff had received training regarding adult safeguarding (whistleblowing) from the county council. The registered provider needs to ensure all staff receive this training, as training opportunities arise. The registered provider said there had been no allegations of abuse, and they had not had to refer any ex members of staff for inclusion on to the Protection of Vulnerable Adults Register. The inspector was concerned regarding recruitment checks completed on new staff, for example in relation to Criminal Record Bureau checks and people receiving two written references before they commence employment. This is detailed in the ‘Staffing’ section of this report. People living in the home were positive about the staff group and said they were not aware of any poor or abusive practice. Mount Pleasant, St Agnes DS0000008913.V364783.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Mount Pleasant provides a generally satisfactory environment for the people living there, although further action is required regarding ensuring there is an appropriate hot water supply and satisfactory heating. EVIDENCE: The building was inspected. There is suitable shared space for example a large lounge and a dining room. Communal lounges are generally pleasant and homely. Toilet and bathroom facilities are suitable in size and facilities provided. Bedrooms are generally decorated and furnished according to individual tastes. People who use the service said they were able to bring their own furnishings and belongings with them when they moved in. This helps to make the bedrooms individual and homely. Some of the double glazed windows have become clouded with patches of condensation. This matter has been raised on the last two key inspections in Mount Pleasant, St Agnes DS0000008913.V364783.R01.S.doc Version 5.2 Page 20 August 2007 and January 2008. The registered providers improvement plan sent to CSCI on 9th May 2008 states the provider will attend to this matter gradually due to cost issues, as and when funding is available. After further discussion at this inspection, the registered provider agreed to have the work completed by 30/9/08, where the problem was most apparent e.g. room 20. Concerns have been raised to the commission regarding there not being enough hot water in the home, and also regarding whether the home is kept warm enough. These matters were raised at the previous key inspection in January 2008. Since the last key inspection two formal concerns have been made to the commission regarding this matter. Both of these latter sources are unrelated. The commission has also been notified previously regarding lack of hot water in December 2006, which resulted in an immediate requirement being issued. Subsequently to the immediate requirement the registered provider confirmed that the problem had been resolved. The registered provider addressed this issue in the Improvement Plan following the last key inspection on 21st January 2008. In the plan they stated that the system had been checked professionally by a plumber who found no fault. The provider subsequently concluded the problem occurred due to the taps being left running, and suggested certain tap heads could be replaced (where appropriate) to prevent taps being left running. The registered provider clarified this at the inspection by stating ‘push’ type taps would only be fitted where a problem occurred, and the type of tap would be usable to people who had limited strength. Whatever measures are adopted, a sufficient supply of hot water must be always available in the home 24 hours a day. This needs to be readily available, without assistance, to all people living in the home. The supply of hot water was checked several times during the inspection by the inspectors. At each test performed there was a sufficient supply of hot water. On one occasion the temperature measured 48 degrees centigrade. To prevent scalding the national minimum standard states that pre set valves should be fitted to ensure water is provided close to 43 degrees centigrade (NMS 25.8). This needs to be risk assessed, and suitable measures taken to minimise any potential harm to people using the service. One person using the service did comment that there was sometimes still a problem of lack of hot water, and this could occur in the late afternoon. The registered providers therefore need to monitor the situation, ensure the water tank is sufficient in size and make appropriate changes if there are any further problems. We are concerned that this matter has been brought to the attention of CSCI on several occasions. However, at this inspection it appeared the hot water supply is satisfactory. We do require the registered provider to write to us again confirming there is a satisfactory supply of hot water. If further concerns are expressed to us, and we find sufficient evidence that the hot water supply Mount Pleasant, St Agnes DS0000008913.V364783.R01.S.doc Version 5.2 Page 21 is inadequate (i.e. not available to all people living in the home, 24 hours a day) we will consider taking enforcement action. The commission has also received concerns, from two separate sources regarding suitable heating in the home. We also expressed concerns in the previous inspection report dated 21st January 2008. In the registered provider’s Improvement Plan dated 9th May 2008 the registered provider stated that staff adjust temperature of residents rooms according to the resident’s preference, and check with residents that their rooms are a suitable temperature. During the discussion with the registered provider at this inspection, Mrs Sear said that one of the people who expressed a concern would turn off the night storage heater at the wall, despite staff telling the person that it was counter productive to do so. The provision of heating in the communal areas e.g. main lounge was also discussed. At the last key inspection, concerns were expressed in the report that it was a bit drafty in the lounge. Part of the reason for this may be that the home only has storage heaters, which can have limited efficiency, and there is limited scope to control heat output. The registered provider said the problem could be minimised if the internal door was kept shut. However, this such action needs to be balanced with people’s needs and wishes to move about the building easily and freely, and for staff to be able to hear residents if they call out or have an accident. The fitting of an additional storage heater in the main lounge was also discussed. The registered provider needs to outline what action they will take regarding this matter. This needs to be outlined in the registered provider’s Improvement Plan. Concerns were expressed at the previous inspection that people are not allowed to open their windows, and this had been reported to inspectors on previous occasions. The registered provider confirmed to the inspector that people using the service could open the windows in their bedrooms at any time according to their wishes. The building was generally clean and hygienic on the day of the inspection. A cleaner is no longer employed, but the registered provider said she had employed an additional carer for the morning shift. There did appear to be a need for some additional ‘deep’ cleaning tasks to be performed e.g. cleaning skirting boards. The inspector also noted that the extractor fans needed cleaning e.g. in the toilets and bathrooms. The parrot’s cage was also dirty. The registered provider said a cleaning book is maintained to ensure the correct delegation of these tasks. The registered provider needs to ensure appropriate infection control procedures are followed e.g. staff do not clean the toilets, then assist with feeding people etc. Laundry facilities are generally suitable. However, there should be impervious non-slip floor covering in the laundry area. No concerns were expressed regarding the laundry service made by people living in the home. Mount Pleasant, St Agnes DS0000008913.V364783.R01.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 poor. This judgement has been made using available evidence including a visit to this service. Staffing levels appear satisfactory to meet current people’s needs. However these need to be adjusted as appropriate if people’s needs change, or if people with a higher level of need are accommodated. Improvements are required to staff recruitment checks e.g. obtaining references and Protection of Vulnerable Adult checks / Criminal Records Bureau checks (CRB/POVA) for new staff. Some improvement is required to staff training. These measures will ensure people who use the service are better protected from staff deemed unsuitable to work with vulnerable people, and they are supported from staff who are appropriately trained to meet their needs. EVIDENCE: On the days of the inspection there were four care staff rostered on duty from 0700 to 1400, and two care staff on duty from 1400 to 2100. There is one waking night person on duty each night. The registered providers live in the neighbouring bungalow. A cook is employed, and a person is employed from 16:30 to 20:30 to provide teas for people using the service. On the day of the inspection the cook was sick, so one of the care staff had to work in the kitchen. The staff roster and record of hours staff have worked (which is kept in a diary) appear to show there is satisfactory staffing provided according to the current needs of people accommodated. However, as expressed earlier in the report, the commission does have concerns about staffing levels, if people Mount Pleasant, St Agnes DS0000008913.V364783.R01.S.doc Version 5.2 Page 23 with higher needs are accommodated, or if people’s needs do change. If this is the case staffing needs to be reviewed and adjusted accordingly. Personnel records were inspected for twelve staff. These records are now stored in the office, and the senior carer has a key to access these. These need improvement. The following was found at the inspection: 1. Only a minority of files had evidence confirming identity (e.g. copy of a passport). However the registered provider must have seen this information in order to process the POVA /CRB check, and a copy should have been obtained and kept on file. It is essential this information is obtained, as required by the Care Homes Regulations 2001, so the registered provider can confirm the person working in the care home is who they claim to be. 2. Some staff had an application form in their files. However, some of these were incomplete, and did not include a full (or in some cases any) employment history. Of particular concern is that two staff, who commenced employment in October 2007 and January 2008, did not have an application form on file. It is essential this information is obtained, as required by the Care Homes Regulations 2001, so the registered provider can confirm the person’s employment history. This information can also be used to ascertain if there are any gaps in the person’s employment history, and if so why these have occurred. It is also important to ascertain whether the referees given are from the previous employer, and/ or when the person has previously worked in a caring capacity. If such referees are not given, the registered provider should ascertain why. 3. Evidence of the registered provider obtaining two references for new staff needs improvement: 3.1. One person who completed employment in January 2008 only had a ‘verbal reference’ (of which a note was made dated 17/1/08). This reference appears to be from a previous employer, although as there is no application form, or employment history this cannot be confirmed. Another reference does not appear to have been requested, and there is nothing on file. 3.2 A second person was employed in October 2007. A verbal reference was recorded (dated 4th October 2007) from what appeared to be a previous employer. Again there is no application form for this employee and no employment history so we could not confirm this. Again no further references were on file and, from discussion with the registered provider, they do not appear to have been obtained. 3.3. There is evidence that references for at least a further four staff have not been obtained. However these staff have been employed for a significant period of time. The commission would have Mount Pleasant, St Agnes DS0000008913.V364783.R01.S.doc Version 5.2 Page 24 notified the registered provider regarding this deficit in previous inspection reports. It is essential this information is obtained, as required by the Care Homes Regulations 2001, for the reasons stated in (2), and also so the registered provider can ascertain the person is suitable to work in a care setting with vulnerable people. 4. Some of the staff records do not have a statement by the person as to his /her mental and physical health. This helps the registered provider to assess whether the person is fit to work in a care home setting and is required by the Care Homes Regulations 2001. 5. The registered provider appears to have obtained a Protection of Vulnerable Adults ‘First’ check for staff who have been employed since records were last assessed. A subsequent Criminal Records Bureau / Protection of Vulnerable Adults check (CRB/ POVA) has been obtained for eleven of the twelve staff. A CRB /POVA check was not obtained for one member of staff who was employed in March 2008. A POVA First check was obtained for this person on 25/3/08 and this stated no match existed for the person on the Protection of Vulnerable Adults List (This is a list of people who are deemed unsuitable to work with vulnerable people). However there is no record whether a full CRB /POVA check was subsequently applied for. From the record of staff hours (listed in the home’s diary) and the night records, it is clear the person worked alone in the home at least on the following shifts; 29th March 2008, 2, 3, 6, 7, 11, 12, 16, 17, 20, 21 of April 2008. This shift runs from 21:00 and 07:00. Mrs Sear confirmed that the person would have been on duty alone ‘for at least four hours’ of each shift, although the person is rostered to work on their own throughout the shift. The registered provider said she believed if someone had a POVA First check they could work unsupervised. However, the guidance issued by the Criminal Records Bureau, as well as CSCI is clear that this is not the case. This has also been previously explained to the registered providers by the lead inspector. It is essential a full enhanced Criminal Records Bureau / Protection of Vulnerable Adults check is obtained, as required by the Care Homes Regulations 2001, and other government guidance. This will ensure the registered provider can confirm the person working in the care home does not have a criminal record and is fit to work with vulnerable people. The Commission for Social Care inspection is very concerned there is unsatisfactory evidence regarding recruitment records, and pre-employment checks as required by the Care Homes Regulations 2001. We have now renotified the registered provider on four previous occasions regarding compliance with the appropriate regulations. The registered provider has Mount Pleasant, St Agnes DS0000008913.V364783.R01.S.doc Version 5.2 Page 25 stated in previous Improvement Plans dated 23rd November 2007 and 9th May 2008 that they would comply with the regulations regarding this matter. Failure to obtain these checks could put people living in the home at serious risk if staff are employed who are deemed not fit to work in a caring capacity. The inspector spoke to two staff regarding induction arrangements. Both staff said they had received an induction which involved working with, and being shadowed by senior staff, and the completion of an induction checklist. Both of these people’s staff files contained an induction checklist. However this is basic, and following the Improvement Plan dated 23/11/2007 the registered provider said a more comprehensive version of the checklist would be introduced. This was not used for these staff, and there was no evidence of staff induction for a third member of staff who commenced employment in March 2008. The requirement from the last inspection is therefore repeated so the commission can be assured there is comprehensive induction arrangements for all staff, and this is appropriately documented. Staff training records were inspected for all staff. Six of the twelve staff files inspected had evidence that staff had at least a National Vocational Qualification in Care at level 2. Following the last inspection reports dated 3rd August 2008 and 21st January 2008, there has been improvement in training received by staff. By law all staff must have: • Regular fire training in accordance with the requirements of the fire authority. • There must always be at least one first aider on duty (at appointed person level). • All staff must have manual handling training and regular updates of this (e.g. annually.) • All staff must have basic training in infection control. • If staff handle food they must receive training regarding food hygiene. • All new staff must have an induction and there should be a record of this. However training received by staff has not been universally completed. For example: 1. One person only has a food hygiene certificate dated 1994, a first aid certificate dated 2003, and last received medication training in 1997. Manual handling for this person was last completed in 2006. The person has not received infection control training. The commission understands this person works in the kitchen and also as a carer. 2. There are still some gaps in staff receiving fire training, infection control and medication training. 3. One person was employed in March 2008. This person is no longer employed, but did complete at least a series of night shifts. There is no evidence this person received any induction or further training to do the job (although the person’s application form states they had Mount Pleasant, St Agnes DS0000008913.V364783.R01.S.doc Version 5.2 Page 26 worked previously in care homes, and was undertaking nurse training). However the person did not have a first aid certificate and worked on their own on night shifts. This could have put people using the service at serious risk for example if the person had an injury and needed first aid attention. The commission is very disappointed at this situation, particularly considering the concerns expressed in previous reports, and the reassurances received from the registered provider in the improvement plans sent to us dated 23rd November 2007 and 9th May 2008. Although the commission is not going to take enforcement action, at this stage, regarding the registered provider’s failure to provide suitable training, we do require the registered provider to do the following: 1. Develop a training policy. This must outline what training differing grades of staff will receive, and when, during the duration of their employment. 2. Develop a training profile for individual members of staff which includes training received, and further training required. This needs to be regularly reviewed. 3. Ensure all staff receive the training they require according to regulation, and the policy. 4. Ensure staff are not placed on duty, untrained and in situations where they and people using the service are put at risk. Mount Pleasant, St Agnes DS0000008913.V364783.R01.S.doc Version 5.2 Page 27 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, 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The commission has concerns regarding the registered provider’s competence to manage the service according to the regulations and National Minimum Standards. Action is required to improve assessment, care planning, adult safeguarding arrangements, staff recruitment, staff training, and health and safety standards. This will ensure people using the service are supported by a wellmanaged service. EVIDENCE: The registered providers have owned and managed the home for a number of years. Mrs Sear said she has attended a City and Guilds Advanced Management Course, and an accountancy-training course. Mr Sear is from an electrical engineering background. Although the registered providers have made some improvements to the service over the last year, this report still outlines several significant concerns about the management of the home. We Mount Pleasant, St Agnes DS0000008913.V364783.R01.S.doc Version 5.2 Page 28 are also concerned whether when improvement does occur, the registered providers will sustain it. For example previous reports for at least the last two years detail failures to adhere to the regulations regarding care planning, availability of hot water, staff recruitment checks, staff training, health and safety checks. We note that there has been some improvement regarding some of these issues, but we then note issues of concern are raised again. The commission needs to subsequently be assured that the registered providers can make the required improvements and then, for example by introducing appropriate systems, that improvement is sustained. The registered providers have a quality assurance policy. The registered provider said they have tried to introduce a ‘residents committee’ but they have not had much success with this. A survey of people who use the service and their representatives was completed in June 2007. The results stated people were positive about the service. Comments received by the inspectors generally concur with the results. However there does not appear to be effective systems in place to ensure the regulatory issues raised in this and previous reports are proactively addressed. This is of concern and disappointment as it appears that only sustained regulatory action ensures that minimum standards are maintained for some aspects of the service. Subsequently the registered providers need to: 1. Revise its quality assurance policy to state how standards will be maintained and developed for example regarding care planning, medication, policies and procedures, environmental standards, recruitment procedures, staff training, and health and safety standards. 2. Subsequently develop a system to ensure these matters are regularly checked and there is a more proactive approach to ensuring standards are met and maintained. Some small amounts of cash are looked after on behalf of people who use the service, and records are kept regarding these. However, it was not possible for the inspector to audit expenditure, as receipts were not available. Subsequently the registered provider needs to ensure receipts are obtained, or if this is not possible in some cases, at least a petty cash voucher completed and signed by the registered provider. Other monies of people using the service are either maintained via individual solicitors or people’s relatives via Power of Attorney arrangements. Otherwise people who use the service or their representatives are responsible for their finances, and fees are paid via bank transfer. Suitable insurance for the building and people using it appears to be in place. The registered persons have a health and safety policy. The home has a fire risk assessment. However emergency call points for the fire system have not been tested since 6th May 2008, the effectiveness of fire doors since 15th April 2008 (both tests should be performed weekly), and emergency lighting since Mount Pleasant, St Agnes DS0000008913.V364783.R01.S.doc Version 5.2 Page 29 31st March 2008. An immediate requirement was issued at the end of the inspection regarding this matter. According to records the fire system was last serviced in February 2008 which is satisfactory. Health and safety risk assessments have been completed. A risk assessment regarding legionella has also been completed. These matters have both been completed by external health and safety consultants. However, it is not clear from documentary evidence that the recommended systems to improve any health and safety risks have been subsequently implemented. The registered provider however has assured the commission that they are dealing with the issues raised in the consultants’ reports. We will check this again, on the next inspection. All hoists appear to have been tested on 23rd November 2007, and were deemed as satisfactory. Portable electrical appliances were tested in August 2008 and these were deemed as safe. The registered provider employed an external electrical contractor to test the electrical ‘hardwire’ system in December 2007, and a certificate was obtained dated 4th February 2008. The system was deemed as ‘unsatisfactory’. The registered provider has got another electrical contractor to carry out remedial work, and the inspector was presented with an invoice confirming the work had been completed. The registered provider said they would subsequently receive a certificate, of which a copy needs to be forwarded to the commission within the timescale given. Some concerns have been raised in the ‘staffing’ section of the report regarding some aspects of health and safety training provided. Mount Pleasant, St Agnes DS0000008913.V364783.R01.S.doc Version 5.2 Page 30 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 3 1 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 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 2 17 X 18 1 2 X X X X X 1 3 STAFFING Standard No Score 27 2 28 3 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 2 X X 1 Mount Pleasant, St Agnes DS0000008913.V364783.R01.S.doc Version 5.2 Page 31 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 OP8 OP27 Regulation 7,12, 13, 14, 18 Requirement Timescale for action 01/08/08 2. OP7 OP8 3. OP9 A suitable assessment regarding the needs of people using the service must be completed before they are admitted to the service. There should be appropriate reassessment of people’s needs if, for example, the person’s needs significantly change. Suitable staffing levels need to be provided to meet these needs. This will help ensure people using the service have their needs met to a satisfactory standard. 12, 13, 15 Each person who uses the service must have a care plan. Each care plan must contain appropriate information and be reviewed on a regular basis. Suitable care plans will help ensure people who use the service receive appropriate care and support from the registered provider. 13 The management and storage of controlled drugs needs to be improved, with reference Royal Pharmaceutical Society Guidelines and Care Homes Regulations 2001. Issues DS0000008913.V364783.R01.S.doc 01/08/08 01/09/08 Mount Pleasant, St Agnes Version 5.2 Page 32 4. OP18 10, 12, 13, 19 outlined in the report need to be addressed. People who use the service can then be more assured their drugs are appropriately stored and managed in a secure manner. The registered provider must have a suitable adult safeguarding policy. Matters outlined in the report must be addressed. Having an appropriate policy will help to give people who use the service, and other stakeholders, more assurance that agreed multi disciplinary procedures will be followed when necessary. 01/09/08 5. OP19 23 6. OP19 OP25 16, 23 7. OP24 OP25 16, 23 Where the glass in some of the 01/09/08 windows is clouded, the registered provider must replace the glass. This will ensure people who use the service can see out of the window. (Timescale of 01/06/08 amended to 01/09/08) The registered provider must 01/08/08 ensure there is a satisfactory supply of hot water throughout the home throughout the 24hour period. The registered providers must monitor the supply is satisfactory to meet the regulations. The registered providers must write to CSCI confirming availability of hot water throughout the care home, 24 hours a day. We must receive written confirmation within the timescale set. This measure will help to ensure people who use the service can have satisfactory hot water according to their needs and wishes. The registered provider must 01/09/08 ensure the home is heated appropriately according to the needs and wishes of people who DS0000008913.V364783.R01.S.doc Version 5.2 Page 33 Mount Pleasant, St Agnes 8. OP29 OP18 OP31 19 9. OP29 18(c)(i)(ii) use the service. Plans to improve levels of heat in communal areas must be outlined in the Improvement Plan, with appropriate timescales. This measure will ensure people who use the service can have satisfactory heating according to their needs and wishes. (Previous timescale of 01/04/08 not met. Second Notification) You are required to carry out appropriate checks prior to staff commencing work at the home. There must be evidence that POVA First checks are in place for all staff working at the home, and evidence that CRB checks are in process for all staff working at the home, and evidence of this must be available for inspection in the home. All staff that are employed on the basis of a POVA First check, prior to receipt of a CRB check, must be monitored by a clear system that ensures these persons are constantly supervised. Evidence of the operation of such supervision must be available for inspection in the home. The home must obtain two references for all staff prior to the commencement of their employment and documentary evidence of these references must be available for inspection in the home. (Previous requirement and timescale of 21/01/08 not met. Fifth Notification) The registered person shall ensure there are appropriate induction arrangements in place for all new staff, there is a DS0000008913.V364783.R01.S.doc 01/08/08 21/05/08 Mount Pleasant, St Agnes Version 5.2 Page 34 10. OP29 18, 19 comprehensive induction checklist, and induction is appropriately documented. This will help to ensure people who use the service are supported by suitably trained and skilled staff. (Previous deadline of 21/01/08 not met. Seventh Notification.) The registered person must: 1. Develop a training policy. This must outline what training differing grades of staff will receive, and when, during the duration of their employment. 2. Develop a training profile for individual members of staff which includes training received, and further training required. 3. Ensure all staff receive the training they require according to regulation, and the policy. 4. Ensure staff are not placed on duty, untrained and in situations where they and people using the service are put at risk. This will help to ensure people who use the service are supported by suitably trained and skilled staff. 01/09/08 11. OP31 OP33 7, 9, 12, 13, 24 12. OP35 13(6), 20 Further develop the quality 01/09/08 assurance system to monitor standards in the home for example regarding care planning, medication, staff recruitment, staff training, health and safety etc. Measures taken should be included in the quality assurance policy. This will help improve service quality and help minimise risks to staff and people who use the service. Receipts must be provided for 01/07/08 DS0000008913.V364783.R01.S.doc Version 5.2 Page 35 Mount Pleasant, St Agnes 13. OP25 OP38 12, 13, 16, 23 14. OP38 13(4), 23(4) 15. OP38 13, 23 expenditure carried out on behalf of people using the service. This will help to ensure there is suitable evidence that any expenditure on behalf of people who use the service is legitimate, and any risk of financial abuse of people’s monies is minimised. Minimise the risk of scalding if 01/09/08 hot water is above 43 degrees centigrade (e.g. via risk assessment- the fitting of thermostatic valves should be considered). This will help minimise health and safety risks to staff and people who use the service. The registered providers must 19/05/08 ensure all fire equipment is tested in line with requirements of the fire authority. This will help minimise health and safety risks to staff and people who use the service. Immediate Requirement The registered provider must 01/07/08 ensure there are suitable systems in place to prevent legionella. This will help minimise health and safety risks to staff and people who use the service. (Previous deadline of 21/01/08 not met. Fourth Notification.) A copy of a satisfactory electrical hardwire certificate must be forwarded to the commission. This will give the commission assurance that the electrical circuit in the home is safe, and there is less health and safety risk to staff and people who use the service. 01/09/08 16 . OP38 13, 23 Mount Pleasant, St Agnes DS0000008913.V364783.R01.S.doc Version 5.2 Page 36 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2. Refer to Standard OP10 OP26 Good Practice Recommendations The registered provider should address the issues of concern raised by one person, as outlined in the report Impervious non slip floor covering should be fitted in the laundry area. Mount Pleasant, St Agnes DS0000008913.V364783.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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. Extracts may not be used or reproduced without the express permission of CSCI Mount Pleasant, St Agnes DS0000008913.V364783.R01.S.doc Version 5.2 Page 38 - 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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