Inspection on 22/03/08 for Northfield

This inspection was carried out on 22nd March 2008.

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

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

Other inspections for this house

Northfield 30/07/07

Northfield 06/06/06

Northfield 22/02/06

Northfield 12/09/05

Northfield 15/09/04

Northfield 23/04/04

Northfield 29/01/04

Northfield 10/07/03

Northfield 21/01/03

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

CARE HOMES FOR OLDER PEOPLE Northfield 85 George Street Ryde Isle Of Wight PO33 2JE Lead Inspector Mark Sims Unannounced Inspection 22nd February 2008 10:30 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 Northfield DS0000012517.V357878.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. Northfield DS0000012517.V357878.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Northfield Address 85 George Street Ryde Isle Of Wight PO33 2JE 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) 01983 562064 01983 562064 northfieldresidential@hotmail.co.uk Mr Anthony George Kingsley Carlyle Obeyesekere Mrs Pauline Edith Obeyesekere Miss Melanie Jane Paterson Care Home 24 Category(ies) of Dementia - over 65 years of age (5), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (4), Old age, not falling within any other category (21), Physical disability (1), Physical disability over 65 years of age (3) Northfield DS0000012517.V357878.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. MD(E) applies to the current service users only and will cease upon those service users no longer being accommodated at the home. Accommodate one named service user in MD category who is 64 years of age. 30th July 2007 Date of last inspection Brief Description of the Service: Northfield is a care home for up to 24 older people. The home is a large 3 storey detached property with a ground floor extension. It is located close to the centre of Ryde and within walking distance of the sea front, ferry, rail links and shops. There is off road parking at the front of the home. Access for those with a physical disability or mobility problem is possible as the home has a passenger lift and stair lift from the street to the front door. The passenger lift, however, does not serve those residents accommodated in the ground floor extension and there are steps from the ground floor extension to the lift. At the rear of the home there is a large conservatory, which leads onto the garden. The current scale of charges is £369.25 - £452.41 per week. There are additional charges for chiropody, hairdressing, toiletries, newspapers and transport. Northfield DS0000012517.V357878.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* stars. This means the people who use this service experience poor quality outcomes. This inspection was, a ‘Key Inspection’, which is part of the regulatory programme that measures services against core National Minimum Standards. The fieldwork visit, the actual visit to the site of the agency, was conducted over six and a half hours, where in addition to any paperwork that required reviewing we (the Commission for Social Care Inspection) met residents, staff and management. The inspection process involves pre fieldwork activity, gathering information from a variety of sources, surveys, the Commission’s database and the Annual Quality Assurance Assessment (AQAA) information provided by the service provider/manager. Two service users and six staff surveys were returned to the Commission, prior to the report being written, four service users were spoken with during the fieldwork visit. As a result of this inspection, serious issues of concern were identified around the safety and care of the people living at the service and the environment that they live in and therefore statutory notices will be issued. What the service does well: Training, on the ‘Mental Capacity Act’, has lead to each resident’s capacity to make decision for themselves, based on differing situations having been completed. The outcome of these assessments have been documented and have been used to inform care staff of when a person will require support making a decision and when the person will be able to determine for themselves their action or response. The assessments have also lead to referral to professional agencies and an increased use of representatives or advocates for people. People are supported in going out with one couple observed going to the pub with a carer and people’s running records documenting when they have been out. Northfield DS0000012517.V357878.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The service user plans and risk assessments are not being appropriately maintained, with reviews not taking place following changes in people’s circumstances or behaviours. An example would be the increased number of falls being experienced by a resident whilst away from the home, which are documented in their running record but have not prompted staff to review or update their risk assessment, which still indicates the person is a low risk of injury or harm when out unaccompanied. The staff are failing to both ensure the resident’s are receiving their medications appropriately and to maintain accurate medication records with gaps noted in the medication administration records (MAR) of clients. The environment is generally shabby with the tour of the premise identifying areas of the home that required redecorating or freshening up, areas were repairs were required, holes in walls, cracked window panes, etc and furniture that required replacing or repair, draws coming off cupboards, vent covers needing fixing or replacing. The home was also found to be dirty, with carpets covered in matter, dust noted in high locations and tops of wardrobes/shelves and bath sets dirty underneath. We also identified that bed linen was being put back on people’s beds or beds remade with soiled and stained bedding and that people were also being expected to sleep on thread bare and ripped bedding or wash and dry with worn towels and flannels. The service’s recruitment and selection procedures are still not being robustly implemented and followed, with staff commencing employment before the service has received all of the outcomes of their employment checks. Northfield DS0000012517.V357878.R01.S.doc Version 5.2 Page 7 The manager has devised a new Quality Auditing programme, which unfortunately has yet to be fully implemented or completed, there are no service users meetings and the responses to surveys or questionnaires is generally poor with only three respondents to the last in house survey, this was conducted in June 2007. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Northfield DS0000012517.V357878.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 Northfield DS0000012517.V357878.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): 3, Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users now receive a pre-admission assessment, which considers their immediate care needs, however, as identified by the service manager the assessment tool could be improved. The home does not provide an intermediate care service. EVIDENCE: The service user plans of four people were reviewed during the fieldwork visit, two contained professional assessments, provided by the placing care manager. Another resident had both a professional assessment and an in house assessment completed prior to the date of their admission to the home and the fourth person had undergone an in house assessment carried out by the manager prior to being offered accommodation at the home. Northfield DS0000012517.V357878.R01.S.doc Version 5.2 Page 10 The in house assessment provided an account of the persons’ current needs and abilities and clearly identified why the client was seeking a placement within a residential care setting. The professional assessments were clear and detailed documents, which set out the reasons why the person required accommodation within a social care setting and brief details of their health and social care history. The manager stated that when visiting prospective clients’ she take with her a copy of the ‘Service User Guide’, which she leaves with them, this however could not be verified during the fieldwork visit, as the home does not keep records of the guides provided. One of the two service user surveys returned did say that they had been provided with sufficient information about the home prior to making the decision to move in, the other person however, indicated that they had received no information in advance of moving into the home. The AQAA indicates that improvements have been made to the ways the home manages its referrals and assessments, however, it also acknowledges that further improvements could be made: ‘we need a more comprehensive initial assessment to ascertain the clients abilities and this highlight if the home is able to meet the clients needs. staff recording in care plans needs to depict more details particularly when highlighting clients behaviour’. Northfield DS0000012517.V357878.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 poor. This judgement has been made using available evidence including a visit to this service. The ‘service user plans’ are not being appropriately reviewed, updated and amended and therefore not reflective of the care or support people are currently requiring. However people are being appropriately supported to access health and social care services and they feel they are treated with respect and dignity. The management of people’s medications is not robust and improvements in record keeping and the efforts made by staff to ensure people receive their medicines, as prescribed could be made. EVIDENCE: The manager indicates through the AQAA that: ‘care plans should be recording that all identified needs are being met, in general this is being met, however more attention needs to be given to clients with complex needs. Northfield DS0000012517.V357878.R01.S.doc Version 5.2 Page 12 There is not currently sufficiently detailed documents such as food offered/refused, discussions with clients and observations of behaviour changes’. During the fieldwork visit the service user plans of four people were reviewed and found to contain some examples of good work. The statements of people’s capacity to make decisions for themselves, as prescribed under the ‘Mental Capacity Act’, were very clear and detailed. The daily routines or personal choices sheets created by the management are very informative and set out specifically how the clients’ like to structure their day and their normal habits or routines, rising and retiring times, dining arrangements, social activities, rest or preferences for solitude, etc are all addressed. However, some aspects of the home’s care planning system are being less well managed, with clients’ risk assessments not being appropriately reviewed or updated. Examples of the home’s poor management of this process include: a client who left a cigarette in an ashtray with tissues. They had not had had their risk assessment updated since 28/01/08, when the incident occurred on the 04/02/08. A client whose running records document that they have had a series of falls both in the home and whilst outside not having had their safety whilst away from the home re-assessed and was stated as a low risk. Perhaps the most serious issue was the occasional aggression shown by one client towards another, which was documented in the running record but had not lead staff to producing risk assessment guidelines. This was further compounded by their failure to respond when they found that one of the people involved had a history of violence, although the care manager was informed. The continued failure of the service to appropriately respond to changes in people’s care needs and therefore place them at risk of injury or harm is serious and a Statutory Requirement Notice will therefore be issued. People’s health care needs are being well managed within the home, with the care plans containing records of people’s contacts with both health care professionals, general practitioners and psychiatrists; and allied services, such as dentists, opticians and chiropodists. On arriving at the home it was noticed that the manager was completing an application to register people with a local dentist surgery, which was offering Northfield DS0000012517.V357878.R01.S.doc Version 5.2 Page 13 domicilliary visits, which would suit some of the clients and that a member of the community nursing service was undertaking a visit. In discussion with service users it was clear that they felt the home provided good support to them when accessing health care services and when attempting to maintain their own wellbeing, one person describing how the staff assist them to exercise each day, which is important as they are recovering from a stroke. Information taken from the residents’ surveys also support the fact that people are generally well supported when accessing appropriate health care services, one person ticking ‘always’ in response to the question: ‘do you receive the medical support you need?’, whilst the second person ticked ‘usually’. The home’s training matrix also provides evidence of the skills and/or knowledge sets completed by staff, which include health related topics such as dementia awareness and mental health awareness. The matrix also records that eight staff have completed medication training, the manager stating that only these staff undertake medication adminstration. A review of the home’s medication adminstration records (MAR) charts revealed that staff are not maintaining these documents accurately with a number of gaps observed in clients’ records. It was also noted that on occasions the staff have documented that medications are being omitted as the client is asleep, despite their being opportunities to administer the medication at a later time, wnen appropriate, this is not occurring. The home’s controlled medication storage facility does not at present comply with the guidance, as stipluated or set out within the ‘safe custody regulations’ and the need for this to be addressed was discussed with the manager during the fieldwork visit. The manager stated, during the fieldwork visit, that following the last inspection she introduced a system for monitoring the home’s stock medications, with one of the senior care staff delegated the responsibility for undertaking the weekly audits. This action was undertaken in response to the findings of the last inspection when in was noticed that people were not given their medications, as the home had insufficient stocks available. Whilst reviewing clients medications and their storage, it was noted that the residents / service had ample stocks of people’s medicines available, with staff having that day gone out and obtained a prescription in response to changes in the persons’ medication regime, as directed by their general practitioner. Northfield DS0000012517.V357878.R01.S.doc Version 5.2 Page 14 Statements taken from the service user surveys’ show that they feel they are treated with respect and dignity and that staff both listen to them and act appropriately upon their requests. The AQAA indicates that: ‘all staff have received the General Social Care Council (GSCC) code of practice and discussions have been held in staff meetings regarding privacy and dignity’, alhtough specific staff training around this area has not been provided according to information, as evidenced by the staff training matrix. The accomodation at Northfield is single occupancy and locks are fitted to each door, with those people wishing to hold the key to their door being assessed prior to being provided with the key; one of the four people’s care plans seen identifyed that they had request to hold their own key and that following an assessment they were provided with the key, a master key is retained by the manager. The locks insitu are generally of a ‘yale’ design, which is not the most appropriate lock design for older people with dexterity problems and this could explain why very few service users opt or can lock their doors, which is an issue the manager should consider addressing via a development plan for the home, as discussed during the fieldwork visit. Toileting and bathing facilities are also fitted with locks, which are functional but which should also be reveiwed to ensure they remain suitable for use by clients residing at the home. Efforts are made to involve people within the development and updating off their care plans, as evidenced by people signing to agree the plan produced, however, unless the documents are appropriately updated and maintained in the first instance, as discussed above, people’s involvement in the review process is undermined. Northfield DS0000012517.V357878.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The range of activities and social experiences available within the home are meeting the needs of the service users and contributing to maintenance of family contacts and access to community based activities. The service users feel the meals provided are satisfactory and that they meet their general dietary needs. The abilities or capacity of people to make independent decisions is being assessed and guidelines produced for the staff on when to support people in the decision-making process. EVIDENCE: The AQAA states that: ‘recreational and social activities are provided every weekday. Visitors are welcome at any time and the clients have the privacy of their room if they wish to receive visitors in private. If a client has requested not to see someone this wish is upheld. The AQAA states that ‘restrictions are only implemented if there is a risk to the client or visitors’ wellbeing and an appropriate risk assessment is documented’. Northfield DS0000012517.V357878.R01.S.doc Version 5.2 Page 16 The service user plans reviewed during the fieldwork visit provide evidence to support the statement that activities are offered and/or provided on a daily basis, with each file containing a tick sheet, which is used to record a person’s involvement in a particular activity, although this does not indicate if they enjoyed the activity provided. The running records, on the service user plans, are used to document when people undertake independent activities away from the home i.e. if they go out shopping or on visits, etc and the home does undertake risk assessments, aimed at ensuring any potential risks involved with the activity are assessed, although as stated previously these are not being well maintained. During the fieldwork visit we observed one couple being escorted out to a local pub for a drink, which, on their return, they confirmed they had enjoyed, another client was observed talking to the manager about her need to go out to the bank and her husbands wish to go into town, which the manager was happy to arrange. The service user spoken with during the fieldwork visit, were happy with the activities provided within the home and the opportunity to socialise, two gentleman spoken with discussed how they like to watch football together, as one of the clients has a digital television system in his room. The response to the surveys were less positive with one person indicating that the home ‘usually’ provided sufficient activities, whilst the second person had ticked ‘sometimes’ in response to the same question. During a conversation with the manager it was established that one of the staff had been delegated the role of activities co-ordinator and that the staff member had already spoken with the service users and produced a plan of activities based on their preferences, although this was still in the draft stage. The manager produced for us a file that the staff member is using to store her draft plans and which contained weekly schedules of events/activities that she plans to display around the home; and inventory of the activities equipment the home has available and draft records on which to record people’s participation in the activities provided. People were also seen visiting the home during the fieldwork visit, with several parties coming to the office to speak with the manager, whilst we were present, these were none confidential issues. The home makes service users relatives or representatives aware of its visiting arrangements via the ‘statement of purpose’, which is available upon request; and via the ‘service users guide’, which the manager stated she provides to all prospective clients’. Northfield DS0000012517.V357878.R01.S.doc Version 5.2 Page 17 The home also has a signing in book, which is well used by visitors and provided evidence of the number and variety of people to visit the home, which are a mix of professional and social contacts. The service user plans also contain references to people being taken out by family members and provides a record of contacts for people in emergencies. People are also provided with opportunities to maintain community based links or contacts, with a representative of the catholic church seen visiting the home during the fieldwork visit, the manager stating that this person undertakes weekly visits to the home, conducting short religious services for people. As mentioned earlier the community nursing service were also observed undertaking visits to the home and a member of the local social services was also seen during the fieldwork visit, the latter professional accompanying service users to visit some potential new accommodation. As mentioned earlier, assessments are being undetaken of people’s capacity to make independent decisions, the assessments include statements about when the person can, when they cannot, or might not be able to make decisions without support. These decisions, or assessments, involve appropriate liaison with professional agencys, with psychiatric services involved with clients’ experiencing cognitive impairments, as evidenced via the medical/general practitioner records and correspondents. The home’s risk assessment process is also used to gauge people’s abilities to retain the keys to their rooms, to manage their own medications and to go out independently, although problems with these processes have been highlighted through the report. The manager states via the AQAA that: ‘we allow clients choice to suit the clients expectations, preferences and capabilities. Some clients are in control of their own finances, some have power of attorney or court of protection. Clients are encouraged to bring in personal possessions so they may personalise their rooms and help them to feel more settled, if any client wishes to access their records they may do so. Information taken from the service user surveys indicate that people feel the staff both listen to them and act upon what they say, comments mirrored by the views of people spoken with during the fiekdwork visit, with one client discussing how the staff help hin manage his cigarettes, as he cannot roll his own and another person describing how staff come and help him exercise when he wishes. Northfield DS0000012517.V357878.R01.S.doc Version 5.2 Page 18 The AQAA also states: ‘a varied appealing, wholsome and nutritious diet is provided taking into account clients specific dietary needs. Snacks are available at any time on request. The dining room/lounge is a large pleasant room although some clients prefer to eat in their rooms or the sun lounge. Staff support clients who need assistance and mealtimes are relaxed and informal’. During the fieldwork visit lunchtime was observed and noted to be a social occasion with most of the residents dining together. The home does not have a separate lounge and dining room, however, the lounge-diner appeared to accommodate those present comfortably. Whilst talking to the cook it was established that the home had recently been awarded a four star rating by the Environmental Health Office (EHO). Records of meals provided are retained and a four weekly rotational menu is in operation. It was noted during the visit that lunchtime meals were taken to the people who opted to remain in their bedrooms, for dinner, at 11:30, which seemed was early. However, the cook said that this had been agreed with the clients’ and that it was designed to ensure that the deliver of meals and the assisiting of people in the lounge, etc, could be managed effectively. In discussion with a client, who resided in a room in the annex, it was established that he was in agreement with his lunchtime meal being brought to him around 11:30 and that as breakfast was so early he was often ready to eat his dinner then. The manager should consider reviewing the home’s mealtimes to ensure that they are occurring at times that meet the needs and wishes of the service users and that they are appropriately spaced, thus avoiding people feeling hungry between meals. Information taken from the two service user surveys reflect that one of the parties ‘sometimes’ likes the food served, whilst the second person ‘usually’ enjoys the food prepared. As neither party appears overly supportive or enthusistic about the meals provided and considering the managers statement, that menus are produced by the provider, manager and cook, with no direct input from the service users, it is suggested that this be reviewed and consideration given to how people can become more involved in planning and influencing the home’s menus. Northfield DS0000012517.V357878.R01.S.doc Version 5.2 Page 19 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. Service users and their relatives are aware of how to make complaints, however staff training records indicate that safeguarding refreshers are required and the home’s risk assessment process improved to ensure people are protected from abusive situations. EVIDENCE: The responses to the service user surveys indicate that both parties are aware of the home’s complaints process and whom to make complaints to. The staff surveys also show that they are aware of their role in supporting people in raising concerns about the service, the complaint’s log maintained by the service providing evidence to support both statements, with staff having logged clients’ concerns, the last entry made in June 2007, when a client complaint that insufficient fresh fruit was available, this was resolved. The dataset, which forms part of the AQAA documentation, indicates that over the last twelve months the home has received eight complaints and that all have been investigated and resolved within 28 days, six of the complaints were upheld. Northfield DS0000012517.V357878.R01.S.doc Version 5.2 Page 20 The dataset also makes clear that the home has a complaints process in place and that this was last updated in May 2007. The manager stated that a copy of this procedure is made available to clients and their representatives via the ‘service users guide’, ‘statement of purpose’ and a copy of the procedure, which is kept at the front of the visitors log. This however, is not an effective way of advertising or raising awareness of the home’s complaints process, as the visitors log is always open and therefore people do not get to see opening pages where the complaints procedure is maintained. Prior to undertaking the fieldwork visit a complaint was received by us about Northfield. This has been forwarded onto the manager for investigation under the home’s own complaints process and a response will be made to the complainant by the manager, this was discussed at the fieldwork visit. The dataset again establishes that policies for the protection of the service users are in place: ‘Safeguarding adults and the prevention of abuse’ and ‘Disclosure of abuse and bad practice’, both last reviewed in May 2007. Training around safeguarding adults is not being effectively delivered, with five staff, according to the training matrix, requiring updated safeguarding training, which is a third of the staff team. The home’s risk assessments, as mentioned earlier, also needs to be reviewed and updated; and where a person is placed at risk of harm from another i.e. aggression, this should be documented, a plan produced to monitor and manage the situation and liaison with professional parties under safeguarding clearly documented. Northfield DS0000012517.V357878.R01.S.doc Version 5.2 Page 21 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, 26, Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The environment is poorly maintained, decorated and does not provide a clean or hygienic environment for service users. EVIDENCE: A tour of the premise raised a number of issues or concerns that were pointed out to the manager who accompanied us throughout. These included: a large hole in a clients’ bedroom wall, which the manager said had been created to access a leaking pipe and was left uncovered to speed drying of the area, although this had occurred some weeks previously. Northfield DS0000012517.V357878.R01.S.doc Version 5.2 Page 22 The wall in one clients’ bedroom was badly marked and dirty due to the behavioural traits of the occupant, but which the home could routinely freshen up as the area is only painted. Cupboard drawers in people’s bedrooms were noted to have been damaged, missing and broken fronts, handles on some units do not match. There was a missing tile in a first floor bathroom, the macerator was broken and a grate over an extractor or vent was loose in a second floor toilet. A trunk that covered electrical cabling in a lower ground floor room was coming adrift from the wall. The top floor bathroom requires the flooring to be sealed around the toilet. There is a cracked pane of glass in one bedroom and a radiator cover requires re-fixing to the wall in a top floor bedroom, the screws and fixings had been left on top of the radiator by staff, which could have resulted in injury. The locks in use on bedroom doors are of a ‘Yale’ type and not therefore suitable for people with dexterity problems and in some case people with confusional problems. During discussion the cook stated that the home had achieved a four star rating from the EHO and that a five star rating would have been if the ceiling had not required repainting and the seals around the fridges clean. A review of the maintenance logs was both difficult and confusing, the manager, proprietor and maintenance person all producing different working documents. At the time of the fieldwork visit the manager could not locate the maintenance persons’ log, whilst neither the manager’s room checks nor the provider’s log identify any of the issues picked up during the fieldwork visit. The AQAA does state that improvements have been made in the following areas: ‘the stairwell has been redecorated, as have some of the rooms’, the latter statement supported by our observations of a room being redecorated during the tour of the premise. However, as the maintenance person only works 16 hours per week and he is currently occupied in room redecoration, smaller items like those listed are not being addressed. The tour of the premises also raised concerns over the cleanliness or cleaning of the home, with large amounts of debris noted along corridors carpets and bedroom floors. Northfield DS0000012517.V357878.R01.S.doc Version 5.2 Page 23 The manager stated that the cleaners/domestics were both at a training events and that one of them had visited the home to clean the toliets before going of to the training event. However, dust and debris were also noted along shelfing units and the tops of wardrobes, etc. The seat of the bath hoist in the top floor bathroom was in need of a clean, as the underneath side was heavily impregnated with grime. The tour of the premise also enabled us to identify that staff are remaking people’s beds without changing the bedding, when clearly they are marked with bodily waste. The bedding was also noted to be in a generally poor condition, with ripped sheets noted on a client’s bed and ripped and worn linen found in the laundry room, although the manager stated this had been set aside for disposal. The clients however, are satisified with the cleanliness of the home, one respondent to the staff surveys ticking ‘always’ and the second ‘usually’, in response to the question: ‘is the home fresh and clean’. Domestic staff are, according to the manager, and a statement contained within the AQAA, employed to work six days a week, one person for three hours a day, and the second four hours a day. There is no domestic cover on a Sunday, the manager stating that the staff will undertake basic cleaning, however, on the evidence of the fieldwork visit, when the domestic staff were not available, the staff are occupied with other duties and unable to manage the cleaning effectively. The manager, should also have considered the implications of arranging for both domestic staff to be away from the home at the same time and taken appropriate steps to arrange cover or make alternative arrangements. As a result of concerns around the continually poor condition of the premises a Statutory Requirement Notice will be issued. Northfield DS0000012517.V357878.R01.S.doc Version 5.2 Page 24 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. Sufficient care staff are employed to meet the needs of the service users, however improvements could be made to the way that the manager monitors staff training and development needs and would ensure training updates are effectively planned and meet. The home’s recruitment and selection process continues to offer service users inadequate protection from abuse and harm. EVIDENCE: The AQAA states: ‘the residential forum is used on a regular basis to check staffing levels are appropriate to the clients needs’. The residential forum being a matrix style calculator that provides an indication of the hours of care required based on a persons dependency. The staffing roster indicate that staff work the following hours: 08:00 hrs to 19:00 hrs 3 care staff are on duty. 19:00 hrs to 21:00 hrs 2 care staff are on duty. Northfield DS0000012517.V357878.R01.S.doc Version 5.2 Page 25 21:00 to 08:00 2 care staff are on duty, one waking and one sleep-in. In addition to the care staff the home also employs: the manager who is supernumerary, domestic staff, catering staff and the maintenance person. During the fieldwork visit a staff member was observed taking two clients out for a drink, which supports the fact that sufficient staff are on duty to meet people’s needs, the presence of the manager on a supernumerary basis freeing up the third carer to escort people when going out. The people completing the service users’ surveys produced a mixed response, one person indicating that staff are available when needed, whilst the second person opted not to answer this question. The staff surveys suggest that the staff feel the home provides sufficient carer cover with one of the six people ticking ‘always’ in response to the question: ‘are there enough staff to meet the individual needs of all the people who use the service’, whilst the other five people ticked ‘usually’ in response to this question, two people clarifying their responses by adding that staff sickness and holidays can be a problem but that the manager or on call person is always available. However, we would remain concerned over the appropriateness of the weekend domestic cover and suggest, based on the evidence of the fieldwork visit, that this be reviewed. The manager should also review, with the providers, the maintenance hours made available again given the findings and evidence of the fieldwork visit. The manager uses a variety of training and development mediums/sources to enable the staff to maintain their skills and knowledge, including distance learning, in house training and attendance at courses at external venues. The manager has produced a training matrix to support her in her efforts to ensure staff remain up to date and aware of current good practice, however, the evidence indicates that this process is presently not fulfilling its purpose, with five staff requiring updated safeguarding training, and 14 staff needing to update their infection control. However, other entries indicate that 8 staff have completed medication training, 12 staff have completed Makaton training, 12 staff Mental Capacity Act training, 10 staff training on mental health and four staff have attended the ‘Isle of Wight College’ for dementia awareness training. The manager also has available an induction programme produced by ‘Portsmouth City Council’, which covers the ‘Skills for Care’ induction standards, that all new care staff are required to complete, although no completed inductions were seen during the visit. Northfield DS0000012517.V357878.R01.S.doc Version 5.2 Page 26 The staff surveys also indicate that they feel they are provided with ample opportunity to attend skills and knowledge development courses, one person commenting: ‘training is always on hand’. Information taken from the dataset indicates that currently the home employs fifteen care staff. Seven of the fifteen care staff have completed a National Vocational Qualification (NVQ) at level 2 or above and this gives the home a percentage of 47 of its care staff possessing an NVQ at level 2 or above. The manager also stated that a further person is completing their NVQ level 2. Neither the residents spoken with during the fieldwork visit or the people completing the surveys raised any concerns over the skills or abilities of the care staff to meet their needs, with people generally happy with their attitudes and commitment. At the last inspection the home’s recruitment and selection process was found to be being poorly managed with the Commission requiring that: ‘residents must be protected by thorough staff recruitment systems. This must include obtaining two satisfactory written references before new staff start working in the home’. At this visit it was established with the manager that two new staff had been employed since the last visit one person in the role of a carer and the second as a general assistant as she is still in full time education. The review of the records identified that the carer had commenced her induction within the home two days before she received satisfactory ‘Protection Of Vulnerable Adults’ (POVA) clearance, all other checks, with the exception of the ‘Criminal Records Bureau’ (CRB) check had been returned. However, the regulations are clear that staff should not commencement employment within the home without the appropriate clearance, in exceptional circumstance an employee may work under supervision if they receive POVA clearance, whilst awaiting the outcome of their CRB check. The second person, the general assistant had not `commenced employment before her POVA clearance had been returned, although her CRB had not been received by the employer. She also only had a single reference, from a character referee and a clearance to work from the Local Education Authority, which the manager stated had been sent when applying for a reference from the person’s school. Northfield DS0000012517.V357878.R01.S.doc Version 5.2 Page 27 However, this is not a reference and the manager is responsible for ensuring that such matters are appropriately followed up, which in this instance has not occurred. The staff surveys indicate that they feel they have undergone appropriate recruitment checks, however, the findings of this and the last inspection challenge those opinions. The continued inability of the manager and/or service provider to operate a robust and thorough recruitment and selection process is placing residents’ at risk of injury or harm and a Statutory Requirement Notice will therefore be issued. Northfield DS0000012517.V357878.R01.S.doc Version 5.2 Page 28 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. 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 manager has both the experience and educational skills to manage the home effectively, however, the findings of the inspection raise concerns about her ability to discharge these responsibilities fully, including concerns over the operation of the homes’ quality auditing and health and safety processes. The financial interests of the service users are now being safeguarded. EVIDENCE: The AQAA states: ‘the manager has the necessary qualifications (including Registered Managers Award (RMA), NVQ 4 and Certificate in community Northfield DS0000012517.V357878.R01.S.doc Version 5.2 Page 29 mental health) and experience to run the home and is aware of the areas where improvements are needed and is taking action to address these issues. Our records support the statement regarding the managers’ qualifications and experience, with information relating to her skill and qualifications gathered for previous visits. However, her ability to manage those areas of the service that require improving show that she has failed to make improvements to the home’s recruitment and selection process; the risk assessment process is still not ensuring people’s wellbeing and safety and the changes to the home’s quality assurance programme is not completed. Information taken from the staff surveys are supportive of the manager and describe her as: ‘always available and very supportive’, three of the surveys also indicate that they meet ‘regularly’ with the manager, two state this occurs ‘often’, whilst the sixth person says meetings ‘sometimes’ occur. Observations support the claim or statements that the manager makes herself available to people, as both staff, relatives and professional visitors were all seen to visit the office to speak with the manager during our visit. The manager has reviewed the home’s quality assurance process, introducing a tool which benchmarks or measures the home’s performance againts the National Minimum Standards (NMS). This tool was introduced in December 2007, according to the manager, although the process of review and/or audit has yet to be completed. Room checks, which the manager refers to as ‘Standard 24 checks’, are undertaken on a weekly bases with a tick box system used to document that articles/items referred to within ‘Standard 24’ of the NMS are present in each room and in good working order. However, as the tour of the premise identified a number of issues that directly effect the service users’ accommodation, the value and/or benefit of the checks does not have postive benefits for people using the service. There are no service user meetings, which the manager attributes to a history of poor attendance, although when a trial meeting was last arranged is unclear, as no records are available. As indicated within the ‘daily life and social activities’ section of the report, people currently are not being offered the opportunity to comment upon even the smallest aspects of the service, such as the menus, with neither respondent to the surveys satisified with the meals provided. These are the types of issue that could be addressed via a residents’ meeting. Northfield DS0000012517.V357878.R01.S.doc Version 5.2 Page 30 The home does have a questionnaire, which the manager states she shares with the residents twice a year, the response to the last questionnaire was poor, with only three people completing and returning their questionnaires. The manager is also failing to monitor the staff when maintaining accurate records, with both the clients’ risk assessments not being appropriately updated or reviewed and gaps appearing in the medication adminstration records. The failure of the service to develop and introduce an effective quality auditing system is of concern and therefore a ‘Statutory Requirement Notice’ will be issued. The home no longer become involved in holding or securing money for residents’, with the AQAA stating that clients either manage their own finances, are subject to court of protection or have a power of attorney setup. The manager is presently still supporting two longstanding clients with their finances and is their appointee, which enables her to collect their pensions, records are maintained of all financial transactions undertaken. Health and safety is a problem, with the tour of the premise raising concerns over cleanliness and hygiene, which has implications under infection control; a concern that is further heightened when you consider that 14 of the 15 staff require updated infection control training. The home’s approach to individual risk assessments is poor with staff failing to appropriately identify and/or updates people’s risk assessments placing people at risk of harm or injury. The dataset states that policies and procedures are made available to staff around health and safety issues, including a health and safety statement, first aid, fire safety and moving and handling. Information taken from the dataset also indicates that all major applicances and domestic services, gas, electric, etc, are being routinely serviced and maintained. Northfield DS0000012517.V357878.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 1 X X X X X X 1 STAFFING Standard No Score 27 3 28 2 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 X X 1 Northfield DS0000012517.V357878.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation Requirement Timescale for action 11/04/08 Regulation It must be ensured that the staff 13(2) maintain accurate medication administration records. Regulation The Controlled drugs cabinet 13(2 must be updated to comply with the ‘safe custody and storage’ regulations. Regulation It must be ensured that staff 18 have access to appropriate safeguarding training and that this is regularly updated. Regulation It must be ensured that the 16 & 23 home is effectively cleaned at all times and that staff are aware of the need to remove from clients beds both soiled and worn bedding Regulation It must be ensured that where 18 staff require training updates these are provided 2. OP9 11/05/08 3. OP18 11/05/08 3. OP26 11/04/08 4. OP30 11/04/08 Northfield DS0000012517.V357878.R01.S.doc Version 5.2 Page 33 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Northfield DS0000012517.V357878.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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