Inspection on 12/05/08 for Oliver House

This inspection was carried out on 12th May 2008.

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

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

Other inspections for this house

Oliver House 05/11/08

Oliver House 21/05/07

Oliver House 14/06/06

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Oliver House Oliver Road Ilkeston Derby DE7 4JY Lead Inspector Janet Morrow Unannounced Inspection 12th May 2008 05:30 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 Oliver House DS0000067423.V364423.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. Oliver House DS0000067423.V364423.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oliver House Address Oliver Road Ilkeston Derby DE7 4JY 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) 0115 9440484 0115 9440417 Sajid Mahmood Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places Oliver House DS0000067423.V364423.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Oliver House is registered to provide personal and nursing care for service users of both sexes whose primary needs fall within the following categories: Old age not falling within any other category: OP up to 26 service users PD up to two, both on a named basis To admit a named service user to Oliver House in the category learning disability (PD) under variation V35355. 21st May 2007 2. Date of last inspection Brief Description of the Service: Oliver House is situated in a quiet, accessible area within the village of Kirk Hallam, close to the town of Ilkeston. The home is registered for the care of 26 elderly residents and admits residents with nursing needs. There are separate sitting and dining areas within the home. There is a garden to the rear of the building, which has been designed to be easily accessible to residents. There is passenger lift and staircase access to the first floor facilities. The home provides 24 single bedrooms (8 with en-suite facilities) and 1 double bedroom (without en-suite facility). There are sufficient additional toilet and hygiene facilities provided throughout the home. Residents are encouraged to personalise their rooms if they wish. All rooms are equipped with a link to the call system. Support services are in place with a choice of General Practitioners, and chiropody, dental, optician and other services arranged as appropriate. A visiting hairdressing service is provided. The home has open visiting arrangements. Written information provided by the home in June 2008 stated that the scale of fees was from £472.87 - £520.87 per week. Inspection reports are on display in the home’s entrance and details of previous inspection reports can also be found on the Commission for Social Care Inspection’s website: www.csci.org.uk Oliver House DS0000067423.V364423.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This inspection visit was unannounced and took place over one day for a total of 7.75 hours, with follow-up telephone calls for specific information. Care records and staff records were examined. A partial tour of the building was undertaken. Seven of eighteen people currently accommodated were spoken with. One relative, nine members of staff and the owner were spoken with. The manager was on sick leave at the time of the inspection visit. The Commission for Social Care Inspection received seven surveys from people living in the home, six from relatives and one from a health professional prior to the inspection visit. Written information in the form of an annual quality assurance assessment was provided by the home. Two short inspection visits took place in December 2007 and February 2008 to check compliance with requirements issued at the previous key inspection in May 2007. These visits are referred to in the report. Two complaints about similar issues were received in April 2008 and the enquiries made about these issues formed part of the inspection process. What the service does well: What has improved since the last inspection? Oliver House DS0000067423.V364423.R01.S.doc Version 5.2 Page 6 There appeared to be little improvement in the service over the last year. The visit made in December 2007 found additional concerns regarding care records, although these had been addressed by the visit in February 2008 and the standard of recording had been maintained at this visit. Additional plants and water features had been purchased for the patio area but the paving remained uneven in places that could pose a trip hazard for people with mobility problems. New lighting had been installed in the lounge and new curtains in the small lounge. New pressure mats and slide sheets had also been purchased. Although some areas had shown improvement at the inspection visit in February 2008, such as activities and recruitment practices, these had not been maintained. What they could do better: Staffing was raised as a major issue on this visit with two complaints being received about inadequate numbers, particularly in the afternoons, high use of agency staff and staff working long hours. Although the owner used the Residential Care Forum staffing tool to work out number of care hours required and was supplying above these hours, staff reported difficulty in providing adequate care in the afternoons and two of the five surveys from relatives and three of the eight received from people living at the home also raised concerns about staffing. Some staff were also working long hours. The number of hours worked and how staff are deployed must therefore be reviewed in order to ensure people’s care needs are met throughout the day. Staff training needs to include care issues and all staff must have training in safeguarding adults and night staff should receive twice yearly fire safety training. The responsible individual must inform the Commission for Social Care Inspection of the Registered Manager’s absence and what the alternative managerial arrangements are. Complaints must be fully documented so it can be seen that the actions taken in response to them are clear and satisfactory. The policy on safeguarding must be updated so that the home is acting on current guidance and procedures. Infection control procedures must include appropriate containers for soiled waste Oliver House DS0000067423.V364423.R01.S.doc Version 5.2 Page 7 Quality assurance systems must be properly devised and results of surveys acted on, with records to show what has been done. This will demonstrate that the home is improving and taking into account the views of people living in the home and their relatives. Activities have been an ongoing concern and both relatives and people living at the home stated there was not enough to do. Activities and entertainment therefore need to be reviewed to ensure that people at the home are not bored and inactive. Recruitment procedures need further improvement to ensure that all information required by the Care Homes Regulations 2001 is in place prior to someone commencing work at the home. There must be a prompt response to repairs to ensure equipment is safe and annual maintenance checks must always be available for inspection. The personal money of people living in the home must be located in a specified bank account in their own name to ensure all personal money is clearly identified and accounted for. 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. Oliver House DS0000067423.V364423.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 Oliver House DS0000067423.V364423.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 and 4. Standard 6 is not applicable as the home does not provide intermediate care. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There was sufficient admission information available to establish that the home was able to meet peoples’ needs. EVIDENCE: Two peoples’ care records were examined and showed that assessment information was received from external professionals and the home also conducted their own assessment and background information prior to admission. This established that the home was able to meet individual needs. Those people living at the home and relatives spoken with confirmed that their care needs were met. Oliver House DS0000067423.V364423.R01.S.doc Version 5.2 Page 10 There were risk assessments in place that covered nutrition, falls, pressure sores and a general assessment of potential hazards in bedrooms. Oliver House DS0000067423.V364423.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 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvements had been maintained in care and medication records and this helped to ensure health and personal care needs were identified and met. EVIDENCE: Two peoples’ care files were examined and both had a care plan in place that contained detailed information on how to address needs. There were plans available on how to address needs where a risk had been identified. For example, where a risk of falls was identified on one file there was a care plan in place and where a risk of pressure sores and treatment was required, there were appropriate care plans and information and advice from external professionals. This showed that there had been an improvement since the inspection visit in December 2007 where care plans had not been available for Oliver House DS0000067423.V364423.R01.S.doc Version 5.2 Page 12 key areas and resulted in an immediate requirement notice being issued on that visit. Access to health professionals such as opticians and dentists was recorded in the files examined and there was monthly recording of weight and blood pressure on one file. People living at the home commented favourably on the care received; for example, one person stated that they were ‘looked after very well’ and another said they ‘couldn’t fault anything’. Four of the eight surveys received from people living in the home responded that they ‘always’ received the medical support needed and four responded that they ‘usually’ did. Five of the six relatives’ surveys responded that the home ‘always’ gave the support expected and one responded that it ‘usually’ did. General observation during the inspection showed that staff and people living at the home enjoyed warm relationships and privacy and dignity was upheld. People and relatives spoken with also confirmed this and one said attention was given ‘when needed’. A general check on six medication administration record (MAR) charts showed that most charts were signed properly, with the exception of one gap on three charts on one specific date. Two people were signing handwritten MAR charts and quantities of medicines received were recorded. Two charts were then examined in more detail and both were completed accurately. Storage of medicines was satisfactory and refrigerator temperatures were within safe limits. The controlled drugs record was examined and showed that the medicines in stock corresponded with the written record and that two people were signing the controlled drugs register. This showed that improvement had been maintained since the inspection visit in December 2007 that had highlighted a number of errors in medication recording. Oliver House DS0000067423.V364423.R01.S.doc Version 5.2 Page 13 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 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Activities were not well managed and this had an adverse effect on the quality of life of people living in the home. EVIDENCE: The inspection visits of December 2007 and February 2008 examined the level of activities for people living in the home, as this had been the source of dissatisfaction on the last key inspection in May 2007. Some improvement had been noted at the visit in February 2008, with monthly entertainment being arranged and staff recording activities that had taken place. However, the last activity recorded was in February 2008 and most people spoken with during the inspection with said there ‘wasn’t much to do’ and one relative spoken with said there was ‘very little’. This view was confirmed from several other sources, including surveys from relatives and people living in the home and the home’s internal quality assurance survey, where at least five of the responses received had rated the activities as ‘poor’. Oliver House DS0000067423.V364423.R01.S.doc Version 5.2 Page 14 One relatives’ survey received commented that ‘boredom is a problem; sitting all day must be demoralising and depressing’, and another said ‘there should be daily or weekly activities to stimulate the residents as all they do is sit in their chairs with nothing to do’. Four of the eight surveys received from people living in the home responded that there were ‘sometimes’ activities arranged that they could take part in and two responded that there ‘never’ were. However, although the written information provided by the home stated that ‘we have organised more in house activities/games’, this was not borne out by the evidence and comments received during the inspection visit. The owner stated that they were trying to recruit an additional person for four hours per week to co-ordinate activities for the home and provided evidence that a job advertisement had been devised. The notice board in the home advertised a social event for May 2008. Visitors confirmed that they were able to call at any time and those relatives spoken with stated that they were always made to feel welcome. The serving of the breakfast meal was observed and all people spoken with stated that they enjoyed the food. A variety of options were available and individual preferences were taken account of. For example, some people were having cereal, some toast and two opted to have a hot cooked meal. One relative commented that the food was ‘lovely’ and two people living at the home stated that the food was ‘good’. Four surveys received from people living in the home responded that they ‘always’ liked the meals, three responded that they ‘usually’ did and one responded that they ‘sometimes’ did. Food stocks were examined and showed that a good range of foods was available, including fresh fruit and vegetables. Menus were examined and showed that a choice was available and that food was nutritious. The kitchen was clean and tidy and the Local Authority Environmental Health Department had rated the food hygiene standards as ‘very good’. The dining area was bright and cheerful but it was noted that the practice of people eating in their armchairs at an adjustable table continued. One visitor commented that they were ‘disappointed’ that their relative did not sit at a table and that mealtimes were not social occasions. There was no information available in the absence of the manager to determine if anyone had an advocate, although previous inspections have noted that the manager was aware of how to obtain one for someone if necessary. The written information supplied by the home stated that one of the Oliver House DS0000067423.V364423.R01.S.doc Version 5.2 Page 15 areas where the home could improve was to supply advocacy information to everyone, rather than when asked. Oliver House DS0000067423.V364423.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Lack of information regarding complaints and overdue safeguarding training for staff did not fully safeguard people living at the home. EVIDENCE: The home had a clear complaints procedure that stated complaints would be investigated within seven days. However, the written information supplied by the home did not specify whether any complaints had been received since the last inspection visit in May 2007 and the complaints record seen contained no entries for the past twelve months. It was therefore not possible to assess how well the home dealt with complaints. Two complaints had been received at the office of the Commission for Social Care Inspection regarding staffing and maintenance in April 2008. Enquiries were made about these during the visit and are referred to in the relevant sections of the report. Oliver House DS0000067423.V364423.R01.S.doc Version 5.2 Page 17 Those people spoken with were aware of the complaints procedure and who to contact if they had any concerns. Six of the seven surveys received from people living at the home stated that they knew how to make a complaint and five of the six relatives’ surveys also responded that they knew how to make a complaint. Safeguarding issues were discussed as part of a national theme being undertaken by the Commission for Social Care Inspection during May 2008. Six staff spoken with about safeguarding knew there were policies available but only two had actually looked at them. They were all aware of their responsibility to report any allegations of abuse. Safeguarding training had not been undertaken by any of the staff in the last twelve months, including a newer member of staff, but the notice board showed an advertisement for the training in May 2008. The policy on safeguarding adults needed updating as it referred to organisations whose name had changed. It contained information about the referral process to other authorities and had references to the Department of Health Guidance ‘No Secrets’. However, there was no information seen on how to refer people to the Protection of Vulnerable Adults (POVA) list, although the previous report noted that this information was available. The written information provided by the home stated that there had been no allegations of abuse in the last twelve months. There was no other reference to safeguarding issues in the written information, apart from a comment stating staff and people living at the home were made aware of the procedure for reporting any suspicions of neglect. Oliver House DS0000067423.V364423.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home was generally well maintained, but a quicker response to repairs would further enhance the accommodation. EVIDENCE: The home was clean, tidy and odour free at the time of the inspection visit. The written information supplied by the home stated that the garden area had been landscaped since the last key inspection in May 2007. However, the visit in December 2007 identified trip hazards, particularly where the gravel border area joined the paving. This had not been addressed. Oliver House DS0000067423.V364423.R01.S.doc Version 5.2 Page 19 The inspection visit of December 2007 also identified a number of repairs that needed urgent attention; a hazard was identified in two bathrooms where the bath panel was not fully attached to the bath and sharp edges were exposed. An immediate requirement notice was therefore issued to ensure that these were made safe. Other issues raised regarding the environment were poor lighting in the lounge, a patio door that was wedged shut, an area of carpet that was taped in the lounge and rubbish being stacked outside the home being an eyesore. These areas had been addressed when the inspection visit of February 2008 took place, with the exception of the patio door. Staff spoken with highlighted other repairs required on this visit such as a broken bed leg and damaged panel in the laundry door that had not yet been addressed. Repairs were recorded in a book and showed that most were addressed, although some had been outstanding for two weeks. The owner supplied a list of repairs and improvements undertaken during 2007/8 shortly after the inspection visit. This included three bedrooms that had been decorated, new curtains in specified areas had been supplied, a new carpet had been fitted in the small lounge and new specialist mattresses had been supplied. The laundry was neat and tidy. There were two washing machines, both with a sluice wash facility. Staff training on infection control was booked for June 2008. Staff spoken with reported that there was adequate protective equipment such as gloves and aprons and they were aware of how to prevent the spread of infection. However, they also expressed concerns that information about infectious conditions, such as MRSA, was not always routinely passed on to all staff and that red bags were not always available for soiled items. Oliver House DS0000067423.V364423.R01.S.doc Version 5.2 Page 20 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 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff recruitment, training and unsafe practice regarding hours worked did not ensure that people living at the home were in safe hands. EVIDENCE: Enquiries were made as part of this inspection visit regarding two complaints received during April 2008 about lack of staff at night and high use of agency staff. The owner stated that this had been an issue for a few weeks whilst staff were on leave but was now improving and that he had employed regular bank staff to cover any shortages. The staff rota for 28th April 2008 – 25th May 2008 was examined. This showed that there were three care staff on the morning shift, two in the afternoons and two at night, plus a qualified nurse on each shift for eighteen people currently accommodated. The owner stated that he was using the Residential Care Forum staffing tool to determine the care staff hours required and the Oliver House DS0000067423.V364423.R01.S.doc Version 5.2 Page 21 hours provided were within these guidelines. However, staff spoken with stated that they struggled to provide the care required, particularly in the afternoons, and surveys from relatives also commented on this. One stated that they felt there were ‘not enough staff on duty at times’, another commented that the home could improve by ‘having more carers working on the shifts so that there can be someone on hand at all times’ and another commented that ‘more staff at times’ would be an improvement. Two surveys from people living at the home responded that there were ‘sometimes’ staff available when needed and one commented that there were occasions when there was ‘no cleaner’. Other issues noted from the rota were the number of shifts being worked by the same person; for example, one nurse had worked eight consecutive shifts, including five double shifts, and had therefore worked in excess of eighty hours over an eight day period. The nurse on night duty on the day of the inspection visit had also worked an afternoon and night shift in succession totalling eighteen consecutive hours. This resulted in a notice being issued under Part 11 of the Care Standards Act 2000 (sections 31 and 32) to remove documentation relating to this issue. There was also no cleaner on duty during the inspection visit, although efforts were made to locate someone to cover the shift. The written information supplied by the home stated that recruitment checks were in place. However, when three staff files were examined for recruitment information, there was still information missing from some files. Although the inspection visit in December 2007 noted some improvements and Criminal Record Bureau (CRB) checks and Protection of Vulnerable Adults (POVA) First checks were in place, one file had no identity information available, two had no evidence of qualifications and another had no evidence of license to practise from their governing body. This resulted in a notice being issued under Part 11 of the Care Standards Act 2000 (sections 31 and 32) to remove documentation relating to the non-compliance. These shortfalls also resulted in an immediate requirement notice being issued to commence the process of obtaining this information. The written information supplied by the home stated that twelve of seventeen care staff had undertaken National Vocational Qualification at level 2 or above. This meant that the home had met the target of having a minimum of 50 of care staff with an NVQ2 qualification. However, although training in mandatory health and safety areas was undertaken, there was little evidence that other training in relation to care (apart from NVQs) occurred. The written information supplied by the home stated that additional training had been arranged but did not specify in what areas. Staff spoken with did not indicate that any care training was undertaken and no records were seen that showed care issues were covered. This was Oliver House DS0000067423.V364423.R01.S.doc Version 5.2 Page 22 recommended at the previous key inspection in May 2007 and had therefore not yet been addressed. Oliver House DS0000067423.V364423.R01.S.doc Version 5.2 Page 23 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 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Lack of attention to quality assurance processes, staffing concerns, peoples’ personal financial management and continued issues regarding health and safety repairs does not ensure the service is safe and run in the best interests of people living at the home. EVIDENCE: There was a registered manager in place who had the necessary skills and qualifications. However, at the time of the inspection visit, she had been on sick leave for an extended period and no alternative managerial arrangements had been made. The qualified nurses were undertaking the running of each Oliver House DS0000067423.V364423.R01.S.doc Version 5.2 Page 24 shift and one of the regular nurses was assuming responsibility for managerial tasks related to care provision but was working excessive hours; eight consecutive shifts and five of these had been double shifts during the week leading up to and during the inspection visit. Other managerial issues that have raised concerns are staff recruitment practices; this was an issue at the previous key inspection in May 2007 and although some improvements were noted at the short inspection visit in December 2007, further issues were raised in this visit as detailed in the staffing section and an immediate requirement notice was issued. Several comments received indicated general concerns about the running of the home. For example, one relatives’ survey commented that ‘I feel there is not enough staff in the afternoon now to deal with everyone’s needs (toilet etc)’ and a survey from someone living in the home commented that help was available ‘mostly in the morning’. Staff spoken with were dissatisfied with the staffing arrangements in place and stated that they were unable to bath and take people to the toilet when required. Another relatives’ survey stated that they were ‘concerned about staff turnover’ and a survey from someone living in the home stated that it was ‘not like it used to be’. The additional inspection visit in December 2007 looked at quality assurance processes. These were discussed with the owner. He stated that he used financial plans to determine what improvements were made and also used surveys to gauge satisfaction with the service. Surveys undertaken in September 2007 showed that there was general satisfaction with the service and the friendliness of the home was rated as ‘good’ and ‘excellent’. A more recent survey undertaken in May 2008 gave generally positive feedback about the care but activities were consistently rated as ‘poor’ and some also identified a the environment as ‘poor’. These have been an ongoing issue over the last two years and surveys received at the Commission for Social Care Inspection in May 2008 also identified activities as an issue. Although the owner was aware of the comments received, there was little evidence to suggest what was taking place in response to the survey findings, other than an advertisement for a person to undertake four hours of activity co-ordination per week. The written information (annual quality assurance assessment) supplied by the home in April 2008 did not provide detailed information on how the service intended to improve and the inspection visit was unable to confirm that the areas that the written information stated had improved, such as staff training and activities, had actually done so. The owner stated that the home did not deal with individuals’ finances, with the exception of one person who had no one to administer them for him. Money coming to the home for the person was paid into a bank account for the business and not into an account named for the individual concerned. This Oliver House DS0000067423.V364423.R01.S.doc Version 5.2 Page 25 raises concerns as legal requirements stipulate that any personal money must be kept separate from the business account. There were computerised records available for the personal amounts being paid by the Local Authority into the business account. A relative had also raised a concern in April 2008 about the delay in being reimbursed for the free nursing care element of the care fees. This was discussed with the owner who said that this had now been satisfactorily resolved. The written information provided by the home stated that maintenance checks were undertaken but did not state the date when these were completed. A random sample of maintenance records showed that water safety had been checked in May 2007, the lift in March 2008, emergency lighting in March 2008 and gas safety in March 2008. This meant that those checks completed in 2007 were overdue. Staff spoken with raised issues about electrical sockets in the laundry and downstairs corridor giving them a shock and were unclear whether this had been addressed. The owner stated that there was a valid up to date five-year wiring certificate in place and provided evidence shortly after the inspection visit that this had been updated in May 2008 and was certified satisfactory. Mandatory health and safety training was undertaken and a training matrix showed that food hygiene training had been completed in February 2008, moving and handling in January 2008, infection control in January 2008 and fire safety training in December 2007. However, no night staff had completed the fire training in December 2007. Oliver House DS0000067423.V364423.R01.S.doc Version 5.2 Page 26 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 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 1 X X 2 Oliver House DS0000067423.V364423.R01.S.doc Version 5.2 Page 27 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 OP12 Regulation 16 (2) (m) & (n) Requirement There must be a programme of suitable activities arranged in consultation with people living in the home. This will ensure that peoples’ quality of life is enhanced and boredom prevented. The complaints record must clearly document the complaints received and the action taken in response to it to ensure that issues are fully resolved. The home’s policy on safeguarding adults must be updated and there must be information available on how to refer to the Protection of Vulnerable Adults (POVA) list. This is to ensure procedures are properly followed and people living at the home are fully safeguarded. All staff must receive training in safeguarding adults to ensure people living in the home are safe. DS0000067423.V364423.R01.S.doc Timescale for action 01/07/08 2. OP16 22 (4) 01/08/08 3. OP18 13 (6) 01/07/08 4. OP18 13 (6) 01/09/08 Oliver House Version 5.2 Page 28 5. OP19 23 (2) (b) The trip hazards in the patio area 01/07/08 must be rectified to ensure the outside area is safe to use. The repairs identified in the record must be undertaken promptly to ensure the home is safe and well maintained. 01/07/08 6. OP19 23 (2) (b) 7. OP26 13 (3) Appropriate bags must always be 01/07/08 available for soiled items to prevent the spread of infection. A review of staffing hours must be undertaken to ensure there are sufficient staff on duty at key times to ensure peoples’ needs are met and that employment legislation is complied with. Staff recruitment information must include all the items listed in Schedule 2 of the Care Homes Regulations 2001, including verification of PIN numbers, evidence of qualifications and identity information. This is to ensure people living in the home are fully safeguarded. Immediate requirement notice issued. 01/07/08 8. OP27 18 (1) (a) & (b) 9. OP29 19 (1) (b) (i) & Schedule 2 14/05/08 10. OP31 38 (1) & (2) The Commission for Social Care 01/06/08 Inspection must be notified if the registered manager is away for more than twenty-eight days and of the alternative managerial arrangements made in their absence. This is to ensure adequate managerial arrangements are in place. The responsible individual must 01/07/08 establish a system to review and improve the service. This is to ensure the quality of the service and that identified improvements DS0000067423.V364423.R01.S.doc Version 5.2 Page 29 11. OP33 24 (1) Oliver House are made. 12. OP35 20 (1) The personal money of people living at the home must be located in their own bank account to ensure there is a clear audit trail of how personal money is administered. Certificates to show water safety and gas safety checks have been undertaken must be available for inspection. This is to ensure the building is safe. 01/06/08 13. OP38 23 (2) (c) 01/06/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP30 OP38 Good Practice Recommendations There should be sufficient training on care issues made available to all care staff. Night staff should complete fire safety training twice yearly. Oliver House DS0000067423.V364423.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Oliver House DS0000067423.V364423.R01.S.doc Version 5.2 Page 31 - 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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