Inspection on 26/07/06 for Norfolk House

This inspection was carried out on 26th July 2006.

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

Norfolk House 29/11/06

Norfolk House 02/06/06

Norfolk House 31/10/05

Norfolk House 25/04/05

Norfolk House 23/11/04

Norfolk House 07/06/04

Norfolk House 15/01/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Norfolk House 39 Portmore Park Road Weybridge Surrey KT13 8HQ Lead Inspector Lesley Garrett, Pauline Long, Suzanne Magnier. Key Unannounced Inspection 26th July 2006 07:15 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 Norfolk House DS0000017628.V306003.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. Norfolk House DS0000017628.V306003.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Norfolk House Address 39 Portmore Park Road Weybridge Surrey KT13 8HQ 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) 01932 820300 Ashbourne Homes Limited Mrs Elizabeth Werrett Care Home 76 Category(ies) of Old age, not falling within any other category registration, with number (76), Physical disability over 65 years of age (3) of places Norfolk House DS0000017628.V306003.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 52 beds providing nursing care for elderly people from the age of 60 years. 24 residential beds including up to three service users in the category PD(E). 1 person aged 56 years or above may be admitted for short term convalescent residency at any time. 2nd June 2006 Date of last inspection Brief Description of the Service: Norfolk House is a purpose built home situated in central Weybridge, providing nursing and personal care to seventy-six older people. Accommodation is provided over three floors, with six spacious lounges and, three dining rooms. The majority of the bedrooms are single with a few double rooms. All bedrooms have en-suite facilities. Passenger lifts and stairs serve the first and second floors. The home is served by good transport system, the railway station is close by, and the home is easily reached from junction 11 of the M25. The home has its own transport in the form of a mini bus in which service users can enjoy visits to many of the local attractions such as Hever Castle, Polsden Lacey and Gamshaw mill. To the rear of the property is a large garden with patio area, whilst the front of the property is laid out for car parking. Fees at this home are in the range of £635.00 to £950.00 per week. Norfolk House DS0000017628.V306003.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over eleven hours and was the second key inspection to be undertaken in the Commission for Social Care Inspection year April 2006 to 2007. The inspection was in response to concerns raised under the Surrey County Council Safeguarding Adults procedures. Lesley Garrett, Pauline Long and Suzanne Magnier Regulation Inspectors carried out this inspection and the registered manager represented the service and was joined by the operations manager and the head of unit for the feed back at the end of the inspection. Southern Cross Healthcare has recently purchased the home from Ashbourne Homes. A tour of the premises took place and the inspectors saw all of the service users and spoke to some of them in more detail. The exceptional weather conditions due to the heat were noted as being well managed by the home and service users were offered and had drinks and additional ventilation (fans) was available. Records were also sampled as part of the inspection process including care plans, health and safety records, menus, accident records, policies, procedures and staff files. This was a far-reaching inspection and a number of areas of concern were identified. The inspectors would like to thank the service users, staff and manager for their time, assistance and hospitality during this inspection. What the service does well: What has improved since the last inspection? What they could do better: Norfolk House DS0000017628.V306003.R01.S.doc Version 5.2 Page 6 There was evidence to indicate that the home may be admitting service users with mental health needs including dementia. It is required that the home must review the current categories of registration and consider making an application for a variation to include dementia. The service users individual plans of care were not all complete and contained no biographical information. The home could not demonstrate that medication was administered to all service users as prescribed for them by their doctor. This could put at risk the health and well being of the people using the service. A requirement made that at the previous inspection in June 2006 that medication arrangements be audited and reviewed had not been evidenced as met. Service users were treated with respect however their privacy and dignity were not respected in several areas for example during meal times and addressing service users. Further development is required in obtaining service users wishes regarding increasing infirmity, terminal illness and death. Insufficient staff resources in the home do not allow time for activities to take place and there has been no activity co-ordinator for some time which compromises service users regarding choice and control in their lives. One service user told the inspector that the staff were very kind yet they missed having people to talk to and the staff were focussed on the tasks they had to do. Relatives also commented that staff were so busy they too had little time to sit and talk. Several service users informed the inspectors that they missed people to talk to with one service user telling the inspector they were depressed as there was ‘nothing to do’. The home must review the current skills and practice of staff supporting service users at meal times. The crockery and equipment available to service users must be individually assessed and ensure that meal times are unhurried and a pleasurable activity. The service users are not protected by the homes complaints and safeguarding adults procedures. There were a variety of areas in the home which required maintaining. The home must also consider the purchase of specialist equipment for example profiling beds to ensure the safety, comfort and welfare of service users and others in the home. The staffing levels of the home were evidenced as inadequate to meet the current needs of service users. The service users were not protected by the homes recruitment policy and procedures. More work needs to be done to make sure staff are trained and competent to do their jobs. Norfolk House DS0000017628.V306003.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Norfolk House DS0000017628.V306003.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 Norfolk House DS0000017628.V306003.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3, 6. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The homes admission and assessment procedures require improvement to ensure that service users needs are appropriately identified and met. EVIDENCE: The inspectors sampled several service users care needs assessments and found that care needs were assessed prior to admittance to the home, however some of these documents were not completed as the home is in the process of transferring their documentation to a new system. Whilst sampling the homes handover records and other records the inspectors noted that the records stated as many as twelve service users had mental health needs including dementia. The home is not currently registered to provide care to this category of service users. This would indicate that the current assessment and admission procedures are not adequate. The current categories of registration must be reviewed alongside the homes admission and assessment practices to ensure that service users needs are identified and that the home can accommodate individuals and meet their needs. The service Norfolk House DS0000017628.V306003.R01.S.doc Version 5.2 Page 10 must consider making an application for a variation of conditions of registration in respect of mental health and dementia. Any request for a variation must include written proposals regarding how the home intends to provide care for service users. with such needs. Where this is not the service users primary diagnosis, the combined and special needs of service users must be catered for and met in the home. Such arrangements for meeting service users needs must be detailed in the home Statement of Purpose and Service User Guide. The CSCI have been advised that the organisation does have two separate assessment tools for older persons and for persons with mental health needs. It was not evident that such tools for persons with mental ill health were being implemented in this service at the time of the site visit. Norfolk House DS0000017628.V306003.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The service users individual plans of care are comprehensive and some demonstrate that their health and personal care needs are met, however not all were fully completed with biographical information. The home could not demonstrate that medication was administered to all service users as prescribed for them by their doctor. This could put at risk the health and well being of the people using the service. Service users were treated with respect however their privacy and dignity were not respected in several areas for example during meal times and addressing service users. Further development is required in obtaining service users wishes regarding increasing infirmity, terminal illness and death. EVIDENCE: As discussed earlier in this report the home is transferring documentation from one system to another and this has yet to be fully completed. The inspectors found that although the paper work was comprehensive there were large areas that had gaps, with no signatures and dates. One care plan sampled by the Norfolk House DS0000017628.V306003.R01.S.doc Version 5.2 Page 12 inspector did not contain agreed working practice regarding percutaneous endoscopic gastric feeding (PEG) and additional recording of obtaining specimens for example swabs. The care plans lacked any biographical history for the service users and the manager stated that the home has no activities co-ordinator to help with this process. It is required that the home ensures that the service users care plans are kept under review, reflect the lifestyle and preferences of the person and are revised at any time due to the changes in the service users circumstances. The inspectors noted that the staff team were so busy that there was insufficient time in the day to sit with the service users and talk. During the course of the inspection the inspector found a medication tablet on the floor of a residents bedroom. The inspector brought this to the attention of the staff nurse administering the medication The staff nurse placed the tablet in a bottle which, it was noted was full of an assortment of tablets. The staff nurse confirmed that the bottle of assorted tablets/medication had quite a large capacity and was full. It was reported by staff that this medication was obtained ‘where people hadn’t taken it’ or ‘it was found’. When questioned about the procedure the staff nurse appeared unsure how to record that the tablet had not been administered but had signed the MAR sheet to indicate the tablet had been taken by the service user. Additionally the inspector was advised by the staff nurse that the GP would be informed regarding the non-administration of the medication and the bottle of tablets would be disposed of appropriately. At 13.00 the inspector spoke to the staff nurse who advised that the incident had been reported to the manager and the service user had not had the morning medication. This issue raised serious concern regarding the level of staff competency and the medication administration procedures of the home. In addition to the welfare of service users who have not received their medication. A requirement made at the previous inspection in June 2006 that medication arrangements be audited and reviewed had not been evidenced as met. The registered person must ensure that the current procedures in respect of the medication administration are reviewed immediately. On arrival at the home it was noted by the inspectors that a young child was in the building. The child was following a carer in and out of the service users rooms while the staff member was undertaking administration of medications. The observation was discussed with the staff member who stated that service users liked to see the child and were quite happy for her to be in their bedrooms. It was noted that several service users were in the state of undress and one service user was naked. This practice did not promote the service Norfolk House DS0000017628.V306003.R01.S.doc Version 5.2 Page 13 users privacy and dignity and it is required that this matter is investigated by the home. It was observed that a packet of incontinence aids had been left on a dining room table and in a variety of service users bedrooms notices regarding issues of care and key worker details were attached to the bedroom walls. It is required that the home must ensure that consideration of the rights of service users privacy and dignity are upheld and alternative arrangements must be made for the sharing of sensitive information in the home. A hole in one of the service users bedroom door was noted but this is discussed in the environment section of the report. The inspector observed sensitivity and respect to a service user, their relatives and members of the clergy that were visiting the home at the time of a person dying. Later during the day the inspectors discussed, with the managers, the arrangements in the home with regard to the physical, emotional and spiritual needs of the dying and the home advised that several outside specialist agencies had been encouraged to talk with staff yet further development in cultural aspects of death and dying would be of benefit to the home. The care plans sampled by the inspectors lacked sufficient information regarding the service users wishes concerning terminal care and arrangements after death and it is required that the home ensures that the service users family and friends are involved (if that is what the service users wants) in planning for and dealing with increasing infirmity, terminal illness and death. Norfolk House DS0000017628.V306003.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Insufficient staff resources in the home do not allow time for activities to take place and there has been no activity co-ordinator for some time which compromises service users regarding choice and control in their lives. Visitors are welcomed to the home to maintain contact with their family members. The food at the home was of a reasonable standard however the current skills and practice of staff supporting service users at meal times and the crockery and equipment available was in need of improvement. EVIDENCE: The home has been without an activities co-ordinator for a long time. One staff member told the inspector that staff used to provide some activities but they were not able now to do this, as they are so busy with their own duties. There was no activity programme displayed and the inspectors saw no activities taking place on the day of inspection. It is required that the home consults residents about their social interests, and makes arrangements to enable them to engage in local, social and community Norfolk House DS0000017628.V306003.R01.S.doc Version 5.2 Page 15 activities. In one-service users bedroom the television was broadcasting an Italian programme to suit the cultural and linguistic needs of the service user. During the course of the inspection the inspectors sampled the serving of the breakfasts and midday meal. The dining areas within the home were spacious, well decorated and offered a pleasant surrounding during meal times. The inspector noted that several service users were offered a choice of meal from observing plated meals and were able to exercise their meal preference. Staff served the midday meal from the servery with kitchen staff available however serious concerns have been raised regarding the following observed practice. The inspectors observed the lack of awareness regarding the serving of the breakfasts to service users and noted that the breakfasts were placed on bedside tables out of reach of the service users and some service users were in bed and had the tray placed at chest height on top of their body. There was a lack of appropriate furniture for example over bed side tables which would assist the service user to eat their meal in bed more comfortably and safely. The inspector noted that on the ground floor several trays were placed on a trolley containing hot items of food. Concern was raised regarding the length of time the hot food was left on the trolley and then served to the service user. One service user told the inspector that the toast was cold and another told the inspector that they would prefer to have a larger cup of milk in the morning. The cooked breakfasts observed by the inspector looked appetising yet one staff member was cutting up the breakfast for a service user whilst standing over them as opposed to sitting with the individual and providing support more appropriately. In one of the shared bedrooms a service user was observed to be eating their breakfast whilst sitting next to an uncovered soiled commode. The inspectors observed, at the midday meal, that some service users were seated at the dining room tables either in dining chairs or wheelchairs. The service users seating in wheelchairs were at a distance from the table, which caused difficulty for them to sit up appropriately in order to reach their meal. The home uses disposable bibs and several service users bibs were soiled by a trail of food, which looked undignified and unsightly. The registered nurse stated that this promoted the residents dignity, as they would not have food on their clothes. The inspectors stated that the home could use napkins instead or indeed change the soiled clothes after seeking the views of the service users as to their preference. Several service users were using cups in order to have their soup and the homes staff advised that the service users were unable to use a bowl and Norfolk House DS0000017628.V306003.R01.S.doc Version 5.2 Page 16 spoon, the inspectors noted that the same service users were using spoons and bowls for their desert, which was ice cream. During the previous inspection it was reported that the service users had stated there were not enough vegetables. This was brought to the attention of the chef who advised the home had ordered serving dishes so that service users could help themselves from the dishes at mealtimes. During the inspection the inspectors did not observe any dishes on the dining tables. There was little or no interaction between the care staff and service users during the midday meal. It was noted that when the maintenance person visited the downstairs dining room the service users responded in a warm and interested manner due to the staff members approach. Due to the concerns raised it is required that the home must review the current skills and practice of staff supporting service users at meal times, the crockery and equipment available to service users, which must be individually assessed, and to ensure that meal times are unhurried and a pleasurable activity for service users. Norfolk House DS0000017628.V306003.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The service users are not protected by the homes complaints and safeguarding adults procedures. EVIDENCE: The homes complaint policy and procedures were written by Ashbourne Homes and were written as corporate documents. As previously stated in the report the home has recently been purchased by Southern Cross Healthcare and it is required that the complaint, policy and procedures are amended to include the local procedures of the home. The inspectors sampled the homes safeguarding adults policies and procedures and noted that the document was unclear as to the process of reporting allegations of abuse. Discussions were held with the operations manager and registered manager and it is required that the policy is amended to reflect the guidance of the local authority Safeguarding Adults procedures. A matter is presently being dealt with under the local authority Safeguarding Adults procedures and is yet to be resolved. Norfolk House DS0000017628.V306003.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22, Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. A number of matters in relation to the environment were adequately maintained and the range of specialist equipment to meet the service users needs was not in place. EVIDENCE: There were a variety of areas in the home which required maintaining. The home must also consider the purchase of specialist equipment to ensure the safety, comfort and welfare of service users and others in the home. The inspectors were able to gain easy access to the building on the day of inspection and were later advised that the staff member was aware that they had not secured the door to the home adequately. The indoor communal areas of the home were observed to be well decorated, sufficiently bright and pleasant. The homes gardens were well maintained yet several areas of the external roof guttering was in a poor condition due to vegetation growth which needs to be removed to allow appropriate drainage. Norfolk House DS0000017628.V306003.R01.S.doc Version 5.2 Page 19 The inspectors observed that several ceiling panels in the home were not adequately fixed and were advised by staff that there had been a flood in the home and the panels had not been put back properly. A hole in the bedroom door, where the lock had been removed had not been repaired. Requirements have been made that all areas of the home are maintained in a good state of repair. During the tour of the premises the inspectors noted that the floor covering of the stairwell was dislodged and required re adhesion. In the majority of service users bedrooms electrical flexes, from fans and specialised equipment were trailing across floors which was viewed as a potential trip hazard. The bathrooms and toilets throughout the home were clean and sufficient in numbers for the service users current needs. The inspector noted that one communal toilet on the first floor did not contain a toilet seat, and one service users en-suite toilet was cracked and required repair to ensure the comfort and dignity of the service user. An en-suite bathroom on the ground floor that had been prepared for a new admission had not been cleaned and toiletries and information regarding the previous occupant had not been removed. The home uses portable hoists to support service users with moving and handling. Several hoists inspected indicated that they had been recently serviced and maintained. The inspectors observed two staff members supporting a service user with a transfer belt. The procedure was undertaken with skill and sensitivity to ensure the comfort and security of the service user. The inspectors observed several service users being transferred from their wheelchairs to arm chairs in the lounge area. Attention was drawn, by the inspectors to one service users legs dangling due to the height of the chair as staff had not provided a footstool for the service user to place their legs on which could potentially cause health complications and discomfort to the service user. A requirement has been made that the home must ensure that the service users are provided with adequate equipment suitable to their needs and comfort. The home provides single and shared bedrooms. The majority of the bedrooms were well decorated and contained personal items belonging to the service user. The inspector sampled the homes maintenance and decoration plan, which indicated that several areas of work had been undertaken. The inspectors noted that several bedrooms were in a state of redecoration for example had no wall-paper or required decoration. A requirement has been made that the decoration is undertaken to provide the service user a pleasant bedroom surrounding to which they are entitled. During the course of the inspection it was noted that a number of call bells, in service users rooms were not in their reach and records of maintenance at the Norfolk House DS0000017628.V306003.R01.S.doc Version 5.2 Page 20 home indicated that a number of call bells had not been working for several months. It has been immediately required that all call bells throughout the home are repaired and in reach of service users in order that they can summon assistance. It was noted that the home has several adjustable high/low profiling beds, which assist in the comfort and safe moving and handling of service users however the home also has a significant number of divan beds. It is required that the home review the number of adjustable beds for service users receiving nursing care to ensure that service users have the specialist equipment they need to maximise their independence, comfort and promote safe moving and handling techniques. The exceptional weather conditions due to the heat were noted as being well managed by the home and service users were offered and had drinks and additional ventilation (fans) available. Several service users bedroom doors had been wedged open and this concern is more fully documented in the final section of the report. The inspectors observed inappropriate disposal of protective clothing and soiled bedclothes within the sluice area. For example soiled bed linen was left on the floor of the sluice room and not disposed of appropriately. It was also observed that staff continued to wear plastic aprons and gloves in the corridors following supporting service users with personal care. It is required that the home makes suitable arrangements to prevent infection and the spread of infection in the care home. The sluice area was noted as cluttered and hazardous with insufficient equipment readily available for the appropriate disposal of soiled laundry and linen. Red bags were available for soiled laundry yet it was observed that soiled laundry was placed in a white linen bag on the floor of the sluice room. Norfolk House DS0000017628.V306003.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29,30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The staffing levels of the home were evidenced as inadequate to meet the current needs of service users. The service users were not protected by the homes recruitment policy and procedures. More work needs to be done to make sure staff are trained and competent to do their jobs. EVIDENCE: The inspectors raised concern regarding the staffing levels within the home particularly with specific regard to the first floor. It was noted that several service users, had not received personal care or support from the day staff until 11.00 and staff had not had a rest break from 08.00 until 11.30. Two inspectors toured the first floor at 11.00 and observed that at least five service users had not been supported with their personal care and were still in bed. One relative told an inspector that their ‘relative was often in bed at 10.00 when they visited”. This had been discussed with the manager who stated she would have a discussion with the night staff to get the service users up early and this did happen. However, he found that his relative had been got up, washed and dressed and then put back to bed again. The dependency levels and care needs of service users were observed to be very high at the time of the site visit and feedback from staff and relatives Norfolk House DS0000017628.V306003.R01.S.doc Version 5.2 Page 22 interviewed at the time of the visit indicated that they viewed the staffing numbers as inadequate. Staff on duty were observed wearing protective clothing with notices attached for example stating ‘do not disturb…doing medication round’. Another incident was observed whereby a member of staff supporting a service user with moving and handling required assistance from a second member of (qualified) staff who declined to offer support and assist stating that she was doing the drinks for service users. The qualified member of staff proceeded to advice the staff member to request support from two other staff who were extremely busy at the time providing personal care to other service users. The registered person must review the adequacy of the staffing arrangements with a view to increasing the numbers of staff on duty. The review must incorporate the arrangements across the 24-hour period and written proposals must be submitted to the CSCI regarding this matter. Urgent attention must be given to increasing the numbers of staff on duty during the undertaking of such a review to ensure the safety and welfare and to meet the care needs of service users during the interim period. The care staff recruitment files were sampled by the inspectors and found to be well documented. One inspector sampled the house keeping staff file and noted that no professional reference from their last employer had been obtained, there were unexplained gaps in the recorded employment history and the persons work permit did not refer to the place of employment. It is required that all recruitment records are obtained prior to the employment of a person in order to ensure the safety and wellbeing of service users. The staff training records sampled indicated that staff had received mandatory training. The inspectors were concerned that the induction records evidenced that the Fire training and safeguarding adults training had been held 8th May 2005 and the basic food hygiene and manual handling courses had been held on the 12th May 2005. It is recommended that the home review the current arrangements regarding staff induction, with particular regard to the mandatory training and refer to the Common Induction Standards which will come into force in September 2006. The staff team were observed to be extremely hard working, polite and dedicated in their work. Staff knocking on service users bedroom doors before entering their room observed the service users dignity and privacy. As previously documented in the report several service users told the inspectors that there was little to do in the home and that there were difficulties in service users understanding the staff and vice versa due to English not being the first language of many staff. One staff member was overheard on several occasions to refer to service users as ‘good girl’. Although this statement was well meaning it did not reflect and lacked awareness of the service users right to dignity, respect and appropriate interaction. Norfolk House DS0000017628.V306003.R01.S.doc Version 5.2 Page 23 It is required that difficulties of appropriate language, communication and interaction with the service users by staff must be addressed in order that appropriate regard is given to the cultural and linguistic background of the service users. Norfolk House DS0000017628.V306003.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. 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 management of the home needs to be more robust in order to ensure the safety and wellbeing of service users. EVIDENCE: The current management arrangements of the home include the registered manager, the deputy manager and several registered nurses. During the course of the inspection it was noted and observed that the deputy manager worked proactively with the care staff on duty. During the previous inspection in June 2006 it was reported that the home does not act as an appointee for any service user. Pocket money is kept for the service users who request the service and all transactions are documented and receipts obtained which are available for inspection. Norfolk House DS0000017628.V306003.R01.S.doc Version 5.2 Page 25 Due to the extreme weather conditions the home and relatives of the service users had purchased several electric fans and air conditioners, which were located in service users bedrooms and in the corridors. Some electrical flexes in service users rooms were noted to be trailing across the floors. Crockery from the previous day, which included celebration cake and curdled milk in a glass, had not been disposed of. It is required that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. Items of left over food and drink and soiled crockery must be removed from service users bedrooms. During the tour of the premises the inspectors noted that the fire extinguishers had not been serviced since May 2005, a piece of paper had been placed over a bed side table lamp and a lava lamp in one service users bedroom was extremely hot which raised concern regarding a significant fire hazard. Several service users bedroom doors had been wedged open in order to increase the amount of air flow and ventilation to the room yet this practice had not been risk assessed or discussed with the homes fire safety officer. It is required that all parts of the home to which the service user has access are so far as reasonably practicable free from hazards to their safety. Adequate precautions must be taken against the risk of fire regarding the maintenance of all fire equipment and potential fire hazards must receive urgent attention. Throughout the home hand washing facilities and disinfectant spray hand rub was observed and available for use. It was also observed that staff continued to wear plastic aprons and gloves in the corridors following supporting service users with personal care. It is required that suitable arrangements are made to prevent infection and the spread of infection in the care home. The sluice area was noted as cluttered and hazardous with insufficient equipment readily available for the appropriate disposal of soiled laundry and linen. The inspectors observed inappropriate disposal of protective clothing and soiled bedclothes within the sluice area when soiled laundry was placed in a white linen bag on the floor of the sluice room. Red bags were available for soiled laundry, yet were not used on this occasion. It has been required that suitable arrangements are made for the disposal of general and clinical waste to prevent infection and the spread of infection in the home. The inspectors sampled the water temperature records, accident and incident records, which were audited quarterly as a measure of good practice and the records of servicing of portable hoists, which were up to date. One inspector toured the homes kitchen and found that the area was clean, safe and well staffed. Health and safety records had been well maintained. The chef discussed the new ordering system that the home had implemented which included less frozen food and much more fresh meat, fruit and vegetables as the budget had been increased. The Inspector noted that food in the main kitchen refrigerator was not labelled/dated /stored in compliance with food Norfolk House DS0000017628.V306003.R01.S.doc Version 5.2 Page 26 hygiene standards, herbs and spices were out of use by date and raised significant risk to service users. It is required that the home ensure that all food is stored in compliance with food hygiene standards to ensure as far as reasonably practicable the home is free from hazards to residents safety and unnecessary risks to the health and safety of residents are identified and so far as possible eliminated. Norfolk House DS0000017628.V306003.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 2 3 2 1 3 2 3 2 STAFFING Standard No Score 27 1 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 x x 1 Norfolk House DS0000017628.V306003.R01.S.doc Version 5.2 Page 28 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 OP1 Regulation CSA Part 2 15.(3) Requirement The registered person must review the current category of registration, to ensure they are not operating outside the condition of registration and that the home can meet service users needs. The registered person must ensure that the needs of the service users have been assessed by a suitably trained or qualified person in order to ensure that the home can meet the needs of the service user. The registered person must ensure that the service users care plans are kept under review, reflect the lifestyle and preferences of the person and are revised at any time due to the changes in the service users circumstances. The registered person must make arrangements for the recording, handling, safekeeping, safe administration and safe disposal of medicines received into the home. Urgent attention must be paid to this DS0000017628.V306003.R01.S.doc Timescale for action 26/07/06 2 OP3 14.(1)(a) 26/08/06 2 OP8 14.(2)(ab) 26/10/06 3 OP9 13 (3)(a) 26/07/06 Norfolk House Version 5.2 Page 29 4 OP9 18 (3) 5 OP9 13 (4)(c) 6 OP10 12 (4)(a) 7 OP11 12.(1)(a) (2)(3)(4 a-b) 8 OP12 16 (2)(n) 9 OP15 12 (1)(ab) 12.(4) 14.(1a) matter in order to ensure the safety and welfare of service users. The registered person must ensure that at all times the medication is administered by competent and suitably qualified at the care home. The registered person must ensure that unnecessary risks to the health and safety of residents regarding the administration of medication is identified and an audit of the homes medication procedures are undertaken to ensure the safety and welfare of service users. The registered person must ensure that a pharmacist is requested to conduct this audit. Not met 02/06/06 The registered person must ensure that the home is conducted in a manner that respects the privacy and dignity of service users. The registered person must ensure that the service users family and friends are involved (if that is what the service users wants) in planning for and dealing with increasing infirmity, terminal illness and death. The registered persons must ensure that the home consults service users about their social interests, and makes arrangements to enable them to engage in local, social and community activities. The registered person must review the current skills and practice of staff supporting service users at meal times, the crockery and equipment available to service users, which is individually assessed, and ensure meal times are unhurried DS0000017628.V306003.R01.S.doc 26/07/06 26/07/06 26/07/06 26/10/06 26/10/06 26/07/06 Norfolk House Version 5.2 Page 30 10 OP16 22.(2)(5) 11 OP18 13.(6) 12 OP19 23.(2)(b) (o) 13 OP19 23 (b) 14 OP21 23.(2 c) 15 OP22 16 (2)(c) and a pleasurable activity for service users. The registered person must develop a complaints policy, which reflects the homes procedure in order to promote service users, or others, views concerns and complaints regarding the service provided at the home. The registered persons must ensure that the homes policy and procedure regarding safeguarding vulnerable adults is in line with the Surrey multi agency safeguarding Adults policies and procedures in order to prevent service users being placed at risk of any harm or abuse. The registered person must ensure that the home is of sound construction and kept in a state of good repair both internally and externally. Vegetation must be removed from the roof guttering. Ceiling panels must be fixed securely and service users bedrooms decorated or redecoration completed. The registered person must ensure that the premises are of sound construction and kept in a good state of repair. All potential trip hazards must receive attention and trailing cables must be made safe. The registered person must ensure that equipment provided in the home is maintained in good repair and working order. The communal toilet on the first floor must be fitted with a toilet seat and a cracked toilet in one service users en-suite toilet must be repaired. The registered person must ensure that the service users are DS0000017628.V306003.R01.S.doc 26/08/06 26/08/06 26/08/06 26/07/06 26/08/06 26/07/06 Page 31 Norfolk House Version 5.2 16 OP22 13 (4)(c) 17 OP24 16.(2 (c) 18 OP26 13 (3) 19 OP26 16 (2)(k) 20 OP27 18 (1)(a) 21 OP29 7,9,19, Sch 2 provided with adequate equipment suitable to their needs and comfort for example foot stools/rests or specialist assessed armchairs are available to service users. The registered person must ensure that at all times call bells are working and are in reach for service users in order that they may summon assistance as required. The registered person must review the number of adjustable beds for service users receiving nursing care in order to ensure that service users have the specialist equipment they need to maximise their independence and comfort and promote safe moving and handling techniques. The registered person must make suitable arrangements to prevent infection and the spread of infection in the care home. The registered person must make suitable arrangements for the disposal of general and clinical waste in the care home to prevent infection and the spread of infection. The registered person must review the staffing arrangements (across the twenty four hour period) to ensure that at all times persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. The staffing levels must be increased to ensure the safety and welfare of service users and to meet their needs pending the outcome of a more detailed review. The registered person must ensure that all recruitment records are obtained prior to the DS0000017628.V306003.R01.S.doc 26/07/06 26/08/06 26/07/06 26/07/06 26/07/06 26/08/06 Norfolk House Version 5.2 Page 32 22 OP30 12.(4)(b) 23 OP31 24(a) 24 OP38 13 (4)(c) 25 OP38 13.(4)(a) 23 (4)(a)(c) (iv) 26 OP38 13.(3) 27 OP38 16 (2)(k) employment of a person in order to ensure the safety and wellbeing of service users. The registered person must ensure that difficulties of appropriate language, communication and interaction with the service users by staff must be addressed in order that appropriate regard is given to the cultural and linguistic background of the service users. The registered person shall produce an improvement plan setting out the methods by which, and the timetable to which, the registered person intends to improve the services provided in the care home. The registered person must ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. Items of left over food and drink and soiled crockery must be removed from service users bedrooms. The registered person must ensure that all parts of the home to which the service user has access are so far as reasonably practicable free from hazards to their safety and take adequate precautions against the risk of fire for the maintenance of all fire equipment. Potential fire hazards must receive urgent attention. The registered person must ensure that staff do not continue to wear plastic aprons and gloves in the corridors following supporting service users with personal care. Arrangements must be made to prevent infection and the spread of infection in the care home The registered person must DS0000017628.V306003.R01.S.doc 26/09/06 26/08/06 26/07/06 26/07/06 26/07/06 26/07/06 Page 33 Norfolk House Version 5.2 28 OP38 13(4)(a) (c) make suitable arrangements to prevent infection and the spread of infection and make suitable arrangements for the disposal of general and clinical waste. The registered person must ensure that all food is stored in compliance with food hygiene standards to ensure as far as reasonably practicable the home is free from hazards to residents safety and unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. 26/07/06 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 OP30 Good Practice Recommendations It is recommended that the home review the current arrangements regarding staff induction, with particular regard to the mandatory training and refer to the Common Induction Standards which will come into force in September 2006. Norfolk House DS0000017628.V306003.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 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 Norfolk House DS0000017628.V306003.R01.S.doc Version 5.2 Page 35 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!