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Inspection on 04/11/05 for Noss Mayo Residential Home

Also see our care home review for Noss Mayo Residential Home for more information

This inspection was carried out on 4th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home provides accommodation for people to take short-term and longterm care. The residents state that they are happy with the care being provided by the home.

What has improved since the last inspection?

The proprietor has carried out repairs to the windows of the care home which were in need of major repairs.

What the care home could do better:

There were 18 requirements identified at this inspection. The home needs to address the following areas to ensure the Care Home Regulations are met. The recruitment policy of the home must be followed. All new staff must be provided with a formal induction. Training must be provided which enables staff to obtain the skills and experience necessary to provide care for the residents who fall within the registration category of the care home. Staff must be provided with supervision and appraisals. Staff administering medication must be provided with appropriate training. The medication policy of care home must be followed. The infection control policy of the home must be followed. A review of all care records must be carried out to ensure that sufficient information is on every residents individual file to allow safe care to be provided. The choices and the wishes of the residents must be recorded.Staffing levels should be reviewed to ensure that the needs of the residents are always met. The proprietor should employ a cleaner and not use allocated staff care hours for cleaning and cooking. The proprietor should instigate an ongoing maintenance programme which addresses the poor environment of the care home. A quality control assurance system should be introduced to the care home.

CARE HOMES FOR OLDER PEOPLE Noss Mayo Residential Home 2 High Street Burgh Le Marsh Skegness Lincs PE24 5DY Lead Inspector Mr Ken Hague Unannounced Inspection 4th November 2005 09:00 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 Noss Mayo Residential Home DS0000044376.V265069.R01.S.doc Version 5.0 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. Noss Mayo Residential Home DS0000044376.V265069.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Noss Mayo Residential Home Address 2 High Street Burgh Le Marsh Skegness Lincs PE24 5DY 01754 810729 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) Mr Parbat Chana Kadchha Mrs Shanta Kadchha Care Home 14 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (13) of places Noss Mayo Residential Home DS0000044376.V265069.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registration for 1 DE(E) placement is on a named basis only. Date of last inspection 27/06/05 Brief Description of the Service: Noss Mayo is a detached listed property, which was formally a vicarage. It is set in its own grounds, with a large garden to the rear and a car park at the front of the premises. The home is set back from the main road near the centre of the village of Burgh-le-Marsh approximately six miles from the seaside resort of Skegness. The home is registered to provide care for thirteen service users over the age of 65 who require personal care and one place for the category of MD (Mental Disorder). Service users are accommodated in six single and four double rooms on the ground and first floor, the latter being reached by the use of a stair lift. The Home is owned by Mr Parbat C Kadchha and Mrs Shanta Kadchha.. Noss Mayo Residential Home DS0000044376.V265069.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Three visits were made to the home to complete this inspection. A total of 9.5 hours was spent in the care home. The home was visited on the 4th of November and the 6th of November the final visit being made on the 10th of November 2005.The main method of inspection used is called case tracking which involved selecting three residents and tracking the care they receive through the checking of their records, discussion with them, the care staff and observation of care practices. A tour of the premises was conducted and care records were inspected. Two members of staff and 5 service users were interviewed. What the service does well: What has improved since the last inspection? What they could do better: There were 18 requirements identified at this inspection. The home needs to address the following areas to ensure the Care Home Regulations are met. The recruitment policy of the home must be followed. All new staff must be provided with a formal induction. Training must be provided which enables staff to obtain the skills and experience necessary to provide care for the residents who fall within the registration category of the care home. Staff must be provided with supervision and appraisals. Staff administering medication must be provided with appropriate training. The medication policy of care home must be followed. The infection control policy of the home must be followed. A review of all care records must be carried out to ensure that sufficient information is on every residents individual file to allow safe care to be provided. The choices and the wishes of the residents must be recorded. Noss Mayo Residential Home DS0000044376.V265069.R01.S.doc Version 5.0 Page 6 Staffing levels should be reviewed to ensure that the needs of the residents are always met. The proprietor should employ a cleaner and not use allocated staff care hours for cleaning and cooking. The proprietor should instigate an ongoing maintenance programme which addresses the poor environment of the care home. A quality control assurance system should be introduced to the care home. 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. Noss Mayo Residential Home DS0000044376.V265069.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Noss Mayo Residential Home DS0000044376.V265069.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3 & 4 Residents are not aware of the terms and conditions for their stay at the care home. The home is not carrying out assessment for new residents before admitting them to the care home. The needs of all residents are not identified within their care record. The failure to carry out an assessment and write a care plan could have placed residents at risk. EVIDENCE: The individual residents files inspected contained no terms and conditions for the residents stay at the care home. The file of a resident admitted to the care home since the last inspection contained no paperwork completed by staff at Noss Mayo care home other than daily notes. There was no assessment made prior to admission, no ongoing care plan or risk assessment. The information on this resident’s individual file had been completed by outside agencies. The needs of the resident had not been identified. By not assessing the resident, the home could not match available resources to the identified needs of the resident. Noss Mayo Residential Home DS0000044376.V265069.R01.S.doc Version 5.0 Page 9 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 The care needs of residents are not set out consistently on individual care plans. Staff are not been provided with the essential information to provide safe care. The health care needs of all service users were not being met at the time of this inspection .The medication policy of the home is not been followed. Residents wishes regarding the action to be taken at the time of their death are not always recorded on their files. The residents rights to privacy and dignity is not always respected. EVIDENCE: The residents care records have not been completed in a consistent manner. One resident had no care plan or risk assessment. A number of residents had care plans which were written 17 months ago but had not been reviewed. A second residents care plan contained no evidence of being appropriately reviewed. There were two reviews recorded on this residents file. The reviews were carried out in May 2005 and July 2005, the original care plan being written in September 2003. The statements at each review were limited to one sentence. Which ended with no changes to care plan. This is despite the fact that reading the care records the residents condition had changed considerably since September 2003. Noss Mayo Residential Home DS0000044376.V265069.R01.S.doc Version 5.0 Page 10 A resident complained to staff of being in pain during the inspection. The staff were unable to give pain relief as the appropriate medication was not recorded on the individual’s medical records. The staff stated that they thought paracetamol was the appropriate drug but that the MAR record sheet appeared to have been removed from the file. No pain relief was given. A resident had to attend a hospital appointment during the inspection. The acting manager stated that the home was unable to provide a member of staff to go to hospital with a resident. The Inspector observed that a medical dressing was on the unit in the kitchen. The staff were heard to comment “I think this must be for “????” it was established and that this bandaged was a dressing identified to be used for a resident and had been supplied by the district nurse. This information had not been recorded within the care records. The medication policy of the home is not being followed. On two of the inspection visits the medication cupboard was left open. On the second occasion this was open for a period exceeding 20 minutes when residents coming into the kitchen could obtain someone elses medication. The Inspector heard a resident complaining about the manner in which personal care was being provided in his bedroom. The staff member did her best to help the resident but in the Inspectors judgment his privacy and dignity was not been respected. On a Second occasion the Inspector heard a resident of shouting help for over five minutes. The staff were working in the kitchen area and were unable to hear his cries. The Inspector had to reassure the resident before asking staff to respond to his request for help. Another resident’s bedroom contained no Call bell system. The acting manager stated that this had broken and was in the process of being repaired. Only one of the files inspected contained details of residents wishes regarding the action to be taken in the event of their death. Noss Mayo Residential Home DS0000044376.V265069.R01.S.doc Version 5.0 Page 11 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 The home encourages relatives to visit residents. Their dietary needs are being met but there is no evidence of choice been offered. The residents have very little choice and control although their lives. The religious needs of residents are not been addressed by the home. EVIDENCE: The home could not produce evidence of choice of menu being offered to residents. Breakfast is restricted to cereals and toast. The Inspector observed a resident having to ask for a cup of tea and later asking “where is my Toast?” On the day of this visit the staff were having difficulties assisting residents to get up and serving breakfast at the same time. In his discussions with residents the Inspector could not find evidence of a hot breakfast being offered. One resident stated “I have not been offered a hot breakfast”. In discussions with the residents it was established that they were not aware of what was for lunch on the day of this inspection. There was no evidence produced of the religious needs of residents being met. The Inspector was not informed of any minister of any denomination visiting the home. The religious persuasion of all residents was not recorded on the care plans. Noss Mayo Residential Home DS0000044376.V265069.R01.S.doc Version 5.0 Page 12 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 The home has a complaints policy which is known to staff and service users. Service users are able to raise any complaints or concerns using this procedure or through service user meetings. EVIDENCE: The Home’s complaints procedure meets the National Minimum Standards. Residents confirmed that they were confident and felt able to raise any concerns with staff. The home has within its procedure manual a vulnerable abuse procedure and a copy of the Lincolnshire County Council Vulnerable Abuse Policy. Noss Mayo Residential Home DS0000044376.V265069.R01.S.doc Version 5.0 Page 13 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): The home has no ongoing maintenance program. The comfort of residents is directly affected by the lack of maintenance. Residents rooms are not fitted with all of the furniture and fittings set out in a National Minimum Standards. Not all areas of the home are comfortable. EVIDENCE: The acting manager stated that the home has no ongoing maintenance program. There are still outstanding requirements from the last inspection in respect of environment. The proprietor has carried out major repairs to the windows but this work has not been completed to the National Minimum Standards and some additional work is required. The fabric of the home is worn, and many rooms need redecorating. The acting manager stated that the central heating boiler needs replacing as some radiators are not working. The hot water temperature in some parts of the building does not meet the National Minimum Standards. The external building required maintenance; guttering was blocked and damaged. A tour of the home was made, all areas were seen to be clean and smelt fresh. One resident’s lounge was found to be unheated. A resident complained that “this room is very cold”. Staff stated that they had difficulty moving on handling one resident and required a hoist Noss Mayo Residential Home DS0000044376.V265069.R01.S.doc Version 5.0 Page 14 to do this task safely. The management had been made aware of this problem but on the day of the inspection this had not been addressed. Noss Mayo Residential Home DS0000044376.V265069.R01.S.doc Version 5.0 Page 15 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,,28,29 & 30 Staff are not being provided with training to ensure they can meet the needs of residents. The recruitment policy of the home is not being followed which could result in residents being placed at risk. Staff have difficulty meeting the needs of residents due to lack of training. EVIDENCE: The recruitment policy of the home has not been followed. The individual files for all staff were studied and only one was found to meet the National Minimum Standards. There were failures to obtain appropriate criminal records bureau checks for some staff. There were two members of staff on the day of this inspection who were working unsupervised but only had protection of vulnerable adult 1st form and no criminal record bureau check. The Care Home Regulations state that these two members of staff must only be employed in the home after an action plan demonstrating how they had to be a supervised is in place. This action plan should continue until a criminal bureau check has been obtained by the care home. The home has failed to obtain references for a member of staff. There was one file which contained no proof of identity for the staff member. The two members of staff on duty on the first day of this inspection had been provided with no induction. The Care Home Regulations requires that all staff have an enhanced criminal bureau check or Protection of Vulnerable Adults 1st check before being employed. If a member of staff has a conviction recorded on their criminal record bureaus check, the proprietor is expected to take the following action. They must discuss with the applicant the conviction and make a decision after completing a risk assessment whether it is appropriate to employ the Noss Mayo Residential Home DS0000044376.V265069.R01.S.doc Version 5.0 Page 16 applicant. This process must be recorded within the staff member’s individual file. In the case of two employees of this care home this process had not been followed. For each a manager was unable to demonstrate to the Inspector that there was a training plan in place for the development of staff. Staff stated that they were having difficulty meeting residents needs due to the size of the building and staffing hours provided. They stated that at least 10 hours per week allocated to care hours are being used for cleaning and cooking. The home does not employ a cleaner. The Inspectors observations during his two days in the care home supported these statements. One resident was heard to be distressed while personal care was being provided. A member of staff was attempting to provide care in a sensitive manner. However as the resident was becoming more distressed she was unable to carry out the task as the resident was unable to assist her due to his poor mobility. Staff later stated it requires two members of staff to move this resident. The bedroom door was left open enabling everyone to hear the personal conversation. On the second days visit the same resident was heard shouting for staff in a very distressed voice. Staff were unable to hear him as they were in the kitchen area. He could not physically use his Call bell. The inspector had to sit with the resident for five minutes before he was able to calm him down and request staff to go to his room. Noss Mayo Residential Home DS0000044376.V265069.R01.S.doc Version 5.0 Page 17 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 The proprietor has failed to discharge his legal duties in ensuring that the Care Home Regulations are met. This failure could have placed service users at risk. EVIDENCE: The home has 9 requirements from the last inspection in June 2005 which have not been addressed. One of these requirements was the in January 2003 has been recorded in all inspection reports from that date. Two requirements were identified in April and July 2004 and remained outstanding. The acting manager stated that there is no emergency budget in the care home. The provider had agreed to make available an emergency budget after this was raised at a previous inspection. Supervisions and appraisals have not been carried out in accordance with the National Minimum Standards. The recruitment policy of the home has not been followed. See standard 29. There is no ongoing maintenance program for the care home. Noss Mayo Residential Home DS0000044376.V265069.R01.S.doc Version 5.0 Page 18 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 2 1 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 x 9 x 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 1 2 x 2 x 2 2 3 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 1 x x x x x Noss Mayo Residential Home DS0000044376.V265069.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2 3 Standard OP2 OP3 OP4 Regulation 5-1 14-1 4 Requirement Service users must be given a copy of the terms and conditions for their stay at the care home All service users must receive an assessment before being admitted to the care home. The proprietor must ensure that resources of the home must meet the identified needs of the service users. The proprietor must write a written care plan for every service user stating how the needs of each individual can be met by the resources of the home the proprietor must ensure that the right of privacy and dignity is respected for each service users the registered person must consult service users about their social interests and make arrangements them to end take part in appropriate activities. the registered person must ensure the service users are helped to exercise choice and control over their lives. DS0000044376.V265069.R01.S.doc Timescale for action 15/01/06 15/01/06 15/01/06 4 OP7 15-1 15/02/06 5 OP10 12-1 30/12/05 6 OP12 16-1 (m) 30/12/05 7 OP14 16 30/12/05 Noss Mayo Residential Home Version 5.0 Page 20 8 9 OP15 OP19 10 OP22 11 OP24 12 13 Op25 OP28OP27 14 15 OP29 OP30 16 17 OP33 OP36 the registered person must ensure service users can see the choice of menu 23 (2) 9b) All windows and frames in the home must be maintained, repaired or replaced where necessary. Outstanding from previous inspections 22/01/03 12/05/04 and 8/02/05 13-a the registered person must ensure that where there is difficulty moving on handling the service user an assessment is carried out an appropriate equipment provided. 16-2 (b) Service users must be provided with lockable storage space in their bedrooms. Identified previously at the inspection on 12/5/04 23 the registered person must ensure that all part of a home are safe and uncomfortable. 18-1 (c) The registered person must ensure that persons employed by the registered person to work at the care home receive training appropriate to the work they are to perform - including time for the purpose of obtaining further qualifications appropriate to such work from inspection report 27/07/04 19-1 recruitment policy of the home must be followed 18-1 The registered person must ensure that unnecessary risk to the health and safety of service users are identified and insofar as possible eliminated. Outstanding from the inspection report 26/07/04 24 The home must have in place a quality assurance monitoring system 18-2 Supervision arrangements must be put in place for all staff identified at previous inspection DS0000044376.V265069.R01.S.doc 16-1-(i) 15/01/06 14/01/06 30/12/05 16/01/06 01/01/06 14/02/06 30/12/05 30/12/05 14/02/06 01/02/06 Noss Mayo Residential Home Version 5.0 Page 21 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 Noss Mayo Residential Home DS0000044376.V265069.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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 Noss Mayo Residential Home DS0000044376.V265069.R01.S.doc Version 5.0 Page 23 - 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. 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