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Inspection on 05/04/07 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 5th April 2007.

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

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

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

Residents live in a comfortable, clean environment with a choice of communal areas and personalised bedrooms. Staff try to meet the needs of all residents. .

What has improved since the last inspection?

There has been no improvement since the last inspection. Deterioration in standards has occurred with three requirements from the last inspection having shown no improvements. A further eight issues have been identified following this inspection. A new carpet has been fitted in the main hall way since the last inspection and this enables residents to move around this part of the home safely.

What the care home could do better:

The home could improve in many areas and is required to carry out a great deal of work to meet the National Minimum Standards. Care records must be completed particularly assessments, care plans and risk assessment. It is important to make a record of medication taken by residents on admission. This is not being done consistently at the moment. The failure to record information and consult with residents does not produce evidence that personal choice and wishes are considered. Social activities can be improved. No member of senior management and many of the care staff have no understanding or formal training in the recognition or management of abuse. The environment is tired and worn. The proprietor has carried out work within the care home but no ongoing maintenance plan is evidenced. There is a failure to recruit staff, appropriately train staff and supervise staff. The reduction in staffing places residents at risk of not having their care needs met. The home has failed to demonstrate at the last two inspections that appropriate staff are on duty to meet the needs of residents. The home has lost a significant number of staff in the last six months. The acting manager and care staff need to work together. There are problems with teamwork and the proprietor should review his management practice to ensure that it works for the benefit of residents and his business plan.

CARE HOMES FOR OLDER PEOPLE Noss Mayo Residential Home 2 High Street Burgh Le Marsh Skegness Lincs PE24 5DY Lead Inspector Mr Ken Hague Key Unannounced Inspection 5th April 2007 08:00 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.V335172.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. Noss Mayo Residential Home DS0000044376.V335172.R01.S.doc Version 5.2 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 vacant post 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.V335172.R01.S.doc Version 5.2 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 30th August 2006 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.V335172.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over six hours. A tour of the premises was undertaken. The acting manager and proprietor were provided with feedback at the end of the inspection. The main method of inspection used was called ‘case tracking’ which involved selecting three residents and tracking the care they receive through the checking of their records, discussion with them and the staff, and where more appropriate observation of interaction between staff and residents and related care practices. A sample of care records was inspected. Two members of staff were interviewed. Three Relatives and a Lincolnshire County Council social worker were spoken to during the site visit. A Pre-inspection questionnaire was supplied by the care home to the Commission for Social Care Inspection, prior to the site visit being made. The registered manager makes available to all potential new residents a copy of the statement of purpose of the care home when they visit the home for the first time. A copy is displayed in the care home reception area. A copy of the last Commission for Social Care Inspection report is included in the statement of purpose. The home charges residents £325 to £380 per week. An immediate requirement form was left at the time of the visit as it was found the Care Home was not meeting essential key Regulations. What the service does well: What has improved since the last inspection? There has been no improvement since the last inspection. Deterioration in standards has occurred with three requirements from the last inspection having shown no improvements. A further eight issues have been identified following this inspection. A new carpet has been fitted in the main hall way since the last inspection and this enables residents to move around this part of the home safely. Noss Mayo Residential Home DS0000044376.V335172.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Noss Mayo Residential Home DS0000044376.V335172.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Noss Mayo Residential Home DS0000044376.V335172.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 & 6 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Initial assessments are not carried out for new residents. Staff therefore cannot meet all of the care needs of these residents and this puts them at risk EVIDENCE: Three individual files were sampled for the last residents admitted to the care home. No file contained an initial assessments carried out prior to admission or on the day of admission. Risk assessments had not been carried out for the three new residents. We were told by the acting manager and there were no records, that residents do not get written confirmation that their care needs can be met when they live at the home. Confirmation is not sent, as residents are not assessed. This means that residents cannot be confident that their care needs will be met. The acting manager stated that at this time the home does not offer a dedicated intermediate care service. Noss Mayo Residential Home DS0000044376.V335172.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 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. Care Plans are not being written for new residents. This will result in the home being unable to demonstrate that health care needs and personal care are being met. The care home does ensure that all residents are treated with respect and their dignity and privacy is upheld. The failure to record medication on care plans puts service users at risk. EVIDENCE: The inspector looked at the files of three residents admitted since the last inspection. There was no initial assessment completed for any resident. No resident’s file contains a detailed care plan which set out their care needs social needs and health care needs. The acting manager stated that care plans and assessments had not been written by the home for any of the three residents. The acting manager stated that risk assessment have not been carried out for any of the three residents. Noss Mayo Residential Home DS0000044376.V335172.R01.S.doc Version 5.2 Page 10 One resident had suffered a fall two days before the site visit. No risk assessment has been carried out as a result of this incident; no management of risk has been written to avoid a future occurrence. There was no record of the likes; dislikes and choices/wishes of any of the new residents recorded within their individual care records. The details of the medication required by the new residents were not recorded on Noss Mayo care records when the residents were admitted. Medical Administration Records (MAR) had been completed but there was no evidence to show how this information had been acquired. The acting manager confirmed that one resident had been admitted to the home without being seen by any member of Noss Mayo staff. One new resident’s care records and information supplied by the hospital stated that the resident had a diagnosed dementia condition. The care home is not registered to admit residents with dementia. The proprietors have breached the registration categories of their care home by admitting this resident. Noss Mayo Residential Home DS0000044376.V335172.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 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. Service users are enabled and supported to keep in contact with their family and friends. Catering arrangements for the home do not reflect service users choices, preferences and personal dietary needs. EVIDENCE: Interviews with residents, their relatives, and a visiting social worker provided evidence that Service users are encouraged to keep contact with their family and friends. Relatives of the new residents stated that they were made very welcome when they came to the home of the first time. On the day of the site visit staff were observed to greet them with courtesy and to find a private area for them to talk to their relative. The choice and wishes of all residents is not being met by the care home. Staff stated in formal interviews that they had little knowledge of the new residents. One staff member said that she had no knowledge whatsoever of the choices and wishes of any of the new residents. The staff member added Noss Mayo Residential Home DS0000044376.V335172.R01.S.doc Version 5.2 Page 12 that as there were no care plans in place for these residents, personal judgment of the individual carer decided what help they required and how this was given. The care home does have a menu, which offers choice to residents. One staff member said, “We don’t keep to the menu”. At the time of the visit residents we spoke with were not aware what the lunchtime meal was going to be. The acting manager stated that the likes and dislikes of long-term residents are recorded within the care plans. She accepted this was not the case in respect of the last three residents admitted to the care home. The care home could not therefore, demonstrate that the dietary needs of these new residents are being met. The acting manager stated that the range of activities offered to residents is to be increased. She added that she has started fund raising with a view to be able to provide a wider range of activities including community excursions. The Pre inspection information states that activities take the form of board games, bingo, Coffee mornings and occasional activities held within the care home, for example, an Easter bonnet competition. Noss Mayo Residential Home DS0000044376.V335172.R01.S.doc Version 5.2 Page 13 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): Standards 16 & 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Overall the records policies and staff training is insufficient to protect residents. Staff have not been trained in the recognition and management of potential abuse situations which places residents at risk. Residents are able to raise concerns or complaints with staff and are satisfied with the response. EVIDENCE: The home and the Commission for Social Care Inspection have not received any complaints since the last inspection. Residents spoken to during the site visit stated they felt comfortable in being able to raise concerns with the care home management or any member of staff. The registered manager stated that all staff have not received training in the recognition and the management of abuse. The proprietor, the acting manager and at least two members of staff have received no training whatsoever in recognition of abuse. There is therefore no core knowledge within the management and in senior staff to protect residents from abuse. Noss Mayo Residential Home DS0000044376.V335172.R01.S.doc Version 5.2 Page 14 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): Standards 19 & 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is no evidence of planned ongoing maintenance, which does not ensure that residents can be confident that they will live in clean, safe and comfortable surroundings. EVIDENCE: There are many areas of the care home which are aged and worn. There are bedrooms with ceilings, which are cracked, and wallpaper, which is in need of being replaced. The proprietor has replaced the hall carpet since the last inspection. No other ongoing maintenance has been carried out. Noss Mayo Residential Home DS0000044376.V335172.R01.S.doc Version 5.2 Page 15 The proprietor has ceased to employ a cleaner and all cleaning duties are now carried out as part of care hours by care staff. The home was clean but was not as tidy as at the last inspection. The proprietor states that the lack of cleaning staff is a temporary measure due to the low levels of occupancy in the care home. Noss Mayo Residential Home DS0000044376.V335172.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff are not employed in sufficient numbers with appropriate skills to ensure residents’ needs are met. The recruitment process and lack of training places residents at risk. EVIDENCE: A new member of staff was employed in December 2006. An application form was on their file but this had been completed after the carer-started work. A member of staff stated that no interview was carried out. There were no interview notes on the file. There were references but these were not originals and one was dated from 3 months before the carer started work. The start date for the carer was before a protection of vulnerable adults check (POVA) and a criminal record bureau check (CRB) were obtained. Lack of these checks means that residents are placed at risk of potentially being cared for by someone who may not be suitable to work with vulnerable people. The staffing rota for the week following the site visit demonstrated that some staff would be working 12 - 14 hour shifts. One member of staff planned to work 72 hours in one working week, 30 of these hours would be as the only waking member of staff during three night shifts. The care team consists of the acting manager, the two owners and 1 other care staff who works full time. There are other two care staff who work part time. The home also employs a cook for 16 hours per week, which does not cover all meal times. Noss Mayo Residential Home DS0000044376.V335172.R01.S.doc Version 5.2 Page 17 A member of staff told us that no training has taken place since the last inspection. There were no training records or plan in place. Noss Mayo Residential Home DS0000044376.V335172.R01.S.doc Version 5.2 Page 18 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): Standards 31,32, 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 service is not managed in the best interest of the residents. Lack of up to date training, unsafe recruitment practices and lack of assessments and care plans place residents at risk. The home’s policies and procedures are followed and ensure that residents’ finances are safeguarded. The up-to-date infection control policy is not being followed. This places residents at risk of contracting infectious diseases. EVIDENCE: Noss Mayo Residential Home DS0000044376.V335172.R01.S.doc Version 5.2 Page 19 There is an acting manager in place who commenced her employment in October 2006. An application has not been submitted for registration, as the acting manager states that she is unable to work well with one of the proprietors. The proprietors live on the premises Monday to Friday and some weekends. Two staff stated that they do not find one of the homes proprietors approachable. They added that in their opinion there is a lack of leadership within the care home. There is a lack of training, inadequate staff levels and unsafe recruitment procedures. There is a lack of pre-admission assessments ,care plans and risks assessments. There is a lack of understanding of new residents needs. The proprietors admitted a resident who needs were outside the homes registration categories as the resident was not seen until they arrived at the home to be admitted. The acting manager stated that the care home does not manage the financial affairs of any residents. Personal allowance is recorded and issued to residents on the signature of two members of staff. The home has a policy and procedure to ensure that residents’ finances are protected. The acting manager stated that no specialised courses have been offered to staff since the autumn of 2006. She stated that staff supervision sessions have not been provided to staff. Staff confirmed this statement to be correct. The infection control policies of the home are not being followed. The acting manager stated that staff have not been given any fire training since the autumn of 2006. No fire drill has been carried out at the home since October 2006. We were told by a member of staff that they had been instructed by one of the proprietors to place clinical waste in to general rubbish bags rather than the appropriate clinical waste bags. The infection control policy of the care home is therefore not been being followed, which constitutes a health and safety risk. . Noss Mayo Residential Home DS0000044376.V335172.R01.S.doc Version 5.2 Page 20 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 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 1 2 X X X X X x 3 STAFFING Standard No Score 27 1 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 1 3 x 3 2 X 1 Noss Mayo Residential Home DS0000044376.V335172.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14-1 Requirement Resident must be assessed before they are admitted to the care home. An assessment is needed to ensure the homes resources can meet individual residents needs. It also ensures the resident fits within the home’s registration category. Care plans must be written for three new residents. Care plans are essential to inform staff of the individual needs of each resident and to guide staff how these needs are to be met. Medication details must be recorded when new resident are admitted to the home. Medication records must be maintained to ensure residents good health 4 OP18 13-6 Staff must be trained in the identification and management of abuse. DS0000044376.V335172.R01.S.doc Timescale for action 18/04/07 2 OP7 15-1 18/04/07 3 OP9 13 (1) 2 18/04/07 14/06/07 Noss Mayo Residential Home Version 5.2 Page 22 5 OP19 23 (1) b Staff must have the knowledge to protect residents and other staff members from any potential abusive. A Planned maintenance programme is required 14/07/07 6 OP27 18-1 7 OP29 19 (10 The home’s environment is aged and worn. This affects the quality of life for all residents. The lack of sufficient numbers of 14/06/07 staff on duty means resident’s needs cannot be fully met. This was a requirement at the last key inspection held on 11/04/06 The timescales for action was 28/05/06 The lack of sufficient numbers of 18/04/07 staff on duty means resident’s needs cannot be fully met. This was a requirement at the last key inspection held on 11/04/06 The timescales for action was 20/05/06 Sufficient staff training must be provided. Staff members need training to obtaining the skills and knowledge to meet the needs of residents. The proprietors of the care home must listen and act on staff member’s concerns. A positive and approachable management style is important so that staff can raise concerns and feel able to use the whistle blowing policy. . The home must hold fire drills and provided fire training. Staff need to know what action to take in the event of a fire. staff must follow the infection DS0000044376.V335172.R01.S.doc 8 OP30 18 (1) c 01/07/07 9 OP32 12 (5) 14/06/07 10 OP38 12 (1) 14/06/07 11 OP26 13 (1) 3 14/06/07 Page 23 Noss Mayo Residential Home Version 5.2 control policy of the care home. This was a requirement at the last key inspection held on 11/04/06 The timescales for action was 20/05/06 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 OP36 Good Practice Recommendations Staff would benefit from planned supervision. Noss Mayo Residential Home DS0000044376.V335172.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Noss Mayo Residential Home DS0000044376.V335172.R01.S.doc Version 5.2 Page 25 - 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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