Inspection on 11/11/05 for Park House Care Home

This inspection was carried out on 11th November 2005.

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

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

Other inspections for this house

Park House Care Home 29/11/07

Park House Care Home 02/05/07

Park House Care Home 17/01/07

Park House Care Home 29/09/06

Park House Care Home 31/08/05

Park House Care Home 25/01/05

Park House Care Home 19/05/04

Park House Care Home 24/02/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Emmanuel Christian Care Home 1 Palm Grove Prenton Birkenhead Wirral CH43 4UU Lead Inspector Jeanette Fielding Unannounced Inspection 11th November 2005 09:30 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 Emmanuel Christian Care Home DS0000032923.V266186.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. Emmanuel Christian Care Home DS0000032923.V266186.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Emmanuel Christian Care Home Address 1 Palm Grove Prenton Birkenhead Wirral CH43 4UU 0151 652 1021 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) Gladman Care Homes (Emmanual Christian Care Home) Ltd Bryn Williams Care Home 111 Category(ies) of Dementia - over 65 years of age (41), Old age, registration, with number not falling within any other category (70) of places Emmanuel Christian Care Home DS0000032923.V266186.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 70 (OP - Nursing Care), 8 (OP - Personal Care) in the overall number of 70 41 (DE/E) Four named service users under the age of 65 years for OP Nursing Care 30th August 2005 Date of last inspection Brief Description of the Service: Emmanuel Christian Care Home – Park House, is located in a quiet residential area of Birkenhead. The home is owned by Gladman Care Homes Ltd which is a wholly owned subsidiary of Four Seasons Health Care Limited. The home is registered to provide general nursing care to forty elderly persons on the second floor, general nursing care to thirty elderly persons on the ground floor and dementia care to forty one persons on the first floor. Personal care may be given to eight service users accommodated for general nursing care. The home provides single en-suite accommodation to all service users and has several lounges on each floor. There are an adequate number of toilets and bathrooms. Access to the upper floors is via the two passenger lifts and several stairways. The home is accessible by public transport and there are a variety of local shops nearby. The home employs qualified nurses and care staff to provide care to the service users. There are separate domestic, laundry, catering and maintenance staff. Emmanuel Christian Care Home DS0000032923.V266186.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was undertaken in response to a complaint made. The focus of the inspection was the care given to service users, the records relating to service users, the staff numbers provided at the home and all issues relating to the medication procedure and practice. The requirements made following the last inspection were assessed to evaluate whether the home had complied with those legal requirements to provide service users with the necessary services and facilities. The inspection was undertaken by a team of three Regulatory Inspectors, together with two specialist Pharmacy Inspectors and 60 Inspector Hours were spent in the home. A high number of concerns were identified during this inspection, consequently a meeting was held with the Registered Manager, Responsible Individual and Regional Manager to address these concerns. At the meeting, assurances were given that all issues identified in the inspection would be addressed within short timescales. These timescales will be set by CSCI following further discussion. The records within the home relating to the care needs and care provision of service users were poor, with a lack of assessments and effective care planning. The maintenance of the premises has deteriorated since the last inspection with some previously made requirements not being met. What the service does well: What has improved since the last inspection? There was no evidence of any improvements since the last inspection. Emmanuel Christian Care Home DS0000032923.V266186.R01.S.doc Version 5.0 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. Emmanuel Christian Care Home DS0000032923.V266186.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 Emmanuel Christian Care Home DS0000032923.V266186.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): 1, 3 Insufficient information is available in the form of a Service User Guide and Statement of Purpose to enable prospective service users to make a choice regarding admission to the home or their long-term care provider. Lack of information in the pre-admission assessment results in poor care planning thereby denying staff the necessary information necessary for care provision. EVIDENCE: The home became a subsidiary of Four Seasons Healthcare Ltd in September 2005. The documentation in the home is now being changed from Gladman Care Homes Ltd to Four Seasons Healthcare Ltd. A new brochure has been prepared for the home but contains some inaccuracies and does not reflect service provided. The Statement of Purpose and the Service User Guide has not yet been changed to reflect changes within the home. The inspectors were advised that a review of these documents was Emmanuel Christian Care Home DS0000032923.V266186.R01.S.doc Version 5.0 Page 9 being undertaken but was not yet available to current or prospective service users. Service users who have recently been admitted to the home were assessed with the use of the documentation used by Four Seasons. These assessments were found to be informative and clearly identified service users needs. Sufficient information was recorded to enable a plan of care to be prepared and also identified some of the service users choices and preferences. The files for many of the service users did not contain the pre-admission assessment form and the manager explained that these had been filed away as they no longer reflected the current needs of the service users. It was therefore not possible to establish the service users initial care needs and to evaluate the progress or deterioration of the service users condition. Those pre-admission assessments that were in place were extremely poor. The format for the assessment did not identify service users health and social care needs and did not provide sufficient information to enable an appropriate plan of care to be prepared. This resulted in a lack of information for both nursing and care staff and there was some evidence that the care needs of the service users were not met and the preferences of the service users were not respected. The format for those pre-admission assessments did not prompt the assessor to ask appropriate questions and no information was recorded as to whom the information was gathered from. The assessments should include information from the service user, their family and all health care professionals involved in their care, including hospital, community and social work staff. Emmanuel Christian Care Home DS0000032923.V266186.R01.S.doc Version 5.0 Page 10 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 The care plans produced by the home are poor and do not provide staff with sufficient information to meet service users individual needs and has the potential for placing service users at risk. The systems for ordering, storing, administering, recording and disposal of medications are extremely poor and places service users at risk. EVIDENCE: The care plans prepared for each service user do not contain sufficient information to enable the staff to provide the appropriate level of care. This is due to the lack of a detailed assessment identifying specific care needs and also to the failure of staff adequately recording relevant information. The majority of service users within the home are accommodated for long term general nursing care, however, the records held in the home do not give details of the reason for their accommodation, their nursing needs or the planned nursing and care requirements. The care files for many service users who are accommodated on the ground floor of the home indicate that they are accommodated for reasons other than the category that this area of the home is registered for, indicating that the home is in breach of its’ registration. It is Emmanuel Christian Care Home DS0000032923.V266186.R01.S.doc Version 5.0 Page 11 therefore imperative that the specific nursing needs are clearly identified within the assessment and the plan of care. Nutritional assessments have been prepared for all service user but do not give information regarding special diets required by service users. Many of these have not been sufficiently reviewed and amended to reflect the changing needs of service users. No information is recorded for those service users who are accommodated for dementia care regarding their individual food preferences or dining requirements and this is particularly important, as many are unable to express their preferences due to their mental health condition. Some information is recorded regarding the moving and handling and the mobility of service users. Where hoists, wheelchairs and other moving equipment is necessary to assist service users, little information is recorded regarding the risks involved, the type of sling to be used and the number of staff necessary to assist the service user. There is a lack of information regarding the use of walking aids and no evidence that the appropriate aid is in use. Risk assessments are also to be prepared giving full details of the appropriate use of bed rails i.e. the reason for their use and the type of rails to be used, together with any additional protection A high number of accidents are recorded in the files of some service users but there is a lack of risk assessments and risk management strategies to protect the service users. A full audit of accidents should be prepared to clearly identify the falls and the details surrounding those falls to enable a clear protection plan to be put in place. Insufficient information is recorded regarding the treatment and care of pressure sores and leg ulcers. Full mapping of sores must be undertaken to ensure that improvements and deteriorations can be identified in the early stages to further plan the treatment to be given. Full assessments are required on all service users and a comprehensive plan of care prepared. These care plans should give details of each service users health and social care needs and provide staff with sufficient information to enable them to meet the individual needs and preferences of service users. The care files for service users accommodated for dementia care should include details of their dementia, how it is displayed, triggers for those who have behaviour management problems and action plans for dealing with these. Full mental health assessments should also be undertaken on those service users who have a history or diagnosis of dementia, confusion, Alzheimer’s disease or other mental health problems. Evidence that the care plans have been discussed with service users or their representative, together with their agreement with the plan, is to be held on the service users files. Emmanuel Christian Care Home DS0000032923.V266186.R01.S.doc Version 5.0 Page 12 All care plans and risk assessments are to be reviewed on a monthly basis and amended where necessary. The inspectors found that records relating to visits made by doctors and other health care professionals were not sufficiently detailed to enable the staff to identify changes to service users medication, health care needs or treatments. Staff confirmed that the daily reports on the care given to service users are written by the care staff and these reports signed by the qualified nurses. It is evident from the daily reports inspected, that the care staff do not have the skills, experience or knowledge to complete the reports adequately. This has resulted in an absence of the necessary information regarding the care given at the home. This has been discussed with the manager of the home and CSCI have been informed, subsequent to the inspection, that this practice is no longer in effect and that all daily reports are completed by qualified nurses. The medications were inspected by two Pharmacy Inspectors from CSCI. Serious concerns were identified by the Pharmacy Inspectors relating to the ordering, storage, administration, recording and disposal of medications. A copy of the medications policy and procedure were not readily accessible to staff at the time of the inspection. An extremely high number of medications were held in the home that were awaiting disposal due to the failure to address recent changes in legislation relating to the disposal of medications. The inspectors observed a high number of creams and lotions in bathroom cupboards. The majority of these items were issued to service users on prescription and were not held securely as required. Some items were found not to be labelled and it was not known to whom they belonged. The storage of creams and lotions in communal bathrooms is dangerous, particularly to those service users who have dementia and do not understand the risks relating to the use of medications prescribed for other people. Two immediate requirements were made regarding the amount of medications held in the home and the appropriate and timely disposal of unwanted medications. Other immediate requirements were also made regarding the poor staff practice, record keeping and the facilities provided. A separate report has been prepared by the Pharmacy Inspectors which will be published independently. The requirements made by the Pharmacy Inspectors are included in this report. Further visits will be made to the home to ensure compliance with the legal requirements. The medication room on the first floor was found to be excessively hot. At a meeting subsequent to the inspection, it was agreed that the work to reduce the temperature of the room would take place during January 2006 on the proviso that all medications would be stored in alternative medications rooms with a protocol regarding storage and administration. Emmanuel Christian Care Home DS0000032923.V266186.R01.S.doc Version 5.0 Page 13 All service users are accommodated in single bedrooms, each having en-suite facilities. Personal care is afforded to service users in the privacy of their bedroom or in the bathroom as appropriate. Insufficient information is recorded regarding the service users preferred form of address. This is to be detailed in the documentation completed following the re-assessment of service users and the information accessible to all care and nursing staff. Emmanuel Christian Care Home DS0000032923.V266186.R01.S.doc Version 5.0 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Service users are denied the opportunity to exercise choice and control over their lives due to the lack of activity or social stimulation. The cutlery and crockery within this home is in poor condition with little evidence of improvement. The home does not, therefore, provide a homely and safe environment. EVIDENCE: During the inspection, it was evident that the routines within the home are not designed to take service users preferences into consideration. Assurances were given to inspectors by staff regarding the choices that were offered to service users but it was evident that few options were available for service users to choose from. Some care files give details of individual preferences regarding the time that service users have requested to get up or go to bed but it was evident during the inspection that some service users were already dressed in their nightwear at 6:15 pm. No evidence of activities or social stimulation was found. The activities coordinator position continues to be advertised but the home has not been able to recruit a suitable person. The last activities co-ordinator left the home in August 2005. At the last inspection, it was evident that some staff tried to Emmanuel Christian Care Home DS0000032923.V266186.R01.S.doc Version 5.0 Page 15 provide stimulation, however at this inspection, staff spoken to confirmed that none are provided and stated that they did not have time to attend to service users social needs. Televisions are provided in all lounges although the seating layout deprives the majority of service users from seeing the screens. No alternative activities were identified i.e. music or conversations with staff. A number of jigsaws were seen in the corridor of one area but none within the lounges or seating areas. Books are provided on the ground floor but many of the service users are not given the opportunity to make a selection when they wish due to their lack of mobility or capacity. Visitors are welcomed to the home at any time and service users are free to meet with their visitors in the privacy of their bedroom or in any of the communal areas. A number of visitors were spoken to during the inspection and all confirmed that they were able to visit at a time that suited them. Two service users confirmed that they could request drinks and that staff would make these for both the service users and the visitors on request. One service user spoken to said that she would like to be able to go out as she loved the fresh air but was unable to because there was no one to go with her. She said she would like to sit outside for a short time but had been informed that she was at risk of falling and so would have to wait until her family arrived to take her out. Individual interests and social activity preferences were not recorded on care files. At the previous inspection, the inspector was advised that activities were recorded in a separate file held by the activities co-ordinator, but in view of the lack of an activities co-ordinator, it is advisable for all activities and social stimulation to be recorded in the daily reports to enable staff to identify the level of activities provided and balance this against the service users wishes, needs and risk assessment. Two care plans specifically identified the need for the service users to be given activities and social stimulation, however, no evidence of this being provided was recorded. No information was displayed of social events taking place outside the home which would give service users and their families opportunities to make arrangements to attend where possible. Most service users are encouraged to take their meals in the dining room although they may be served in the service users bedroom or in the lounge as appropriate or on request. The meals are prepared in the main kitchen of the home and are delivered to each unit in heated trolleys. Meals are served on to plates by the care staff. A choice of meals is offered and service users request their meals on the day prior to it being served. A list of individual preferences is prepared and meals are cooked and served according to the list. Emmanuel Christian Care Home DS0000032923.V266186.R01.S.doc Version 5.0 Page 16 The first floor of the home is divided into two separate areas as it is designated for the care of elderly people who have dementia. On this floor, the meals are served to one group of service users first, and then the heated trolley is moved to the other area for the serving of meals. This results in one area taking their meal later, sometimes up to 1.30pm. A cooked breakfast can be prepared on request, although few service users take this. Breakfast usually consists of cereal or porridge, tinned fruit, toast or bread with tea. Some service users were seen to be taking their breakfast during the late morning, up to 11.00am which would appear to be extremely late in view of the fact that lunch, the main meal of the day, is served at 12.30pm. Details should be recorded on care plans of the time that service users choose to rise in the mornings to give an indication of the time that breakfast is to be served. Staff spoken to confirmed that some service users rise early but did not take their breakfast until two hours later. Special diets are delivered to the dining rooms separately from the main meals. Soft diets were seen to be delivered cold, and are heated by the staff in the dining room. Concerns were expressed regarding this practice and the inspectors have been advised at a meeting subsequent to the inspection, that this practice has ceased and that all meals are delivered hot to the dining rooms. Some service users choose or require to take their meals in their bedroom. No trays or plate covers were provided for the transportation of meals. Appropriate measures must be taken to ensure that meals are transported safely and hygienically. The main meal of the day is served at lunchtime with a lighter meal provided in the evening. Snacks are provided mid morning and mid afternoon with supper served by the night staff. Some concerns were expressed regarding those service users who were dressed for bed by 6.30pm and who would be in bed by the time the night staff came on duty. It is not known whether these service users would take supper, or if they would be offered additional sustenance prior to breakfast being served. A record of meals served to service users, and the times that they take their meals should be recorded in the daily reports. The menu follows a four-week rotation and provides evidence that a balanced diet is offered. Some service users require to be fed and concern was reported to the manager regarding the practice in effect. The soft diet provided for service users is attractively presented, with the meat, potatoes and vegetables being placed separately on the plate. One member of staff chose to stir all the contents of the plate into a brown semi liquid consistency thereby denying the service user the opportunity to taste the various flavours provided in the meal. One Emmanuel Christian Care Home DS0000032923.V266186.R01.S.doc Version 5.0 Page 17 member of staff was seen to be sitting on a dining table, adjacent to a service user who was seated in an armchair, whilst feeding the service user. Training is to be given to staff regarding feeding technique and appropriate practice. It was found that the home does not provide sufficient cutlery and crockery for all service users, particularly spoons and bowls. One member of staff stated that desserts had to be served on a rotational basis to enable the bowls to be washed between service users. A high proportion of dinner plates were found to be chipped around the edges. The inspectors were advised that new crockery had been ordered and their delivery is awaited. This is clearly not acceptable and it is imperative that sufficient and suitable crockery and cutlery is provided immediately. The cutlery container in one dining room was found to be dirty and the contents appeared unwashed. Two of the inspectors undertook an inspection of the main kitchen during the afternoon when the main catering tasks of the day had been completed. It was undertaken at this time to avoid the risk of contamination by non-catering staff within the kitchen during meal preparation. It was evident that the catering staff had failed to follow cleaning schedules adequately with some surfaces being greasy. Some pans used at breakfast had not been washed. Cooked meats in the refrigerator had not been dated or labelled or appropriately covered, and the chef was not aware of when the meats had been placed there. These meats were disposed of. Cold water dispensers were seen at various points throughout the home to provide service users with fresh chilled water at all times. Plastic disposable cups are provided at the dispensers with appropriate disposal arrangements. Emmanuel Christian Care Home DS0000032923.V266186.R01.S.doc Version 5.0 Page 18 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 Arrangements for ensuring that complaints are dealt with adequately are not in place and has the potential for placing service users at risk. EVIDENCE: The complaints procedure is displayed in the home and will be detailed accurately in the statement of purpose. Four complaints have been received by CSCI from persons who did not feel that the home had dealt with their complaints adequately. These were subsequently investigated by CSCI. Three relatives commented that they had expressed concerns to the home regarding various issues but did not feel that the Manager or Responsible Individual had dealt with them adequately. None of the relatives spoken to had made formal complaints to CSCI. It is evident that the home has failed to respond to complaints to the satisfaction of the complainants, whether these are formal complaints or concerns. The staff records were not inspected, however, at the last inspection, it was evidenced that all necessary checks had been made on staff to ensure the protection of service users. No new staff have been employed since the last inspection. It is evident that the home took appropriate action when a recent allegation of abuse was suspected. Emmanuel Christian Care Home DS0000032923.V266186.R01.S.doc Version 5.0 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 26 The standard of maintenance within this home is deteriorating thereby denying the service users with the pleasant and safe environment that they had previously enjoyed. Personal support is not offered in such a way as to promote and protect service users dignity. EVIDENCE: The home is a purpose built care home which is registered to accommodate a total of 111 elderly persons. All service users are accommodated in single bedrooms, each having en-suite facilities. Some en-suites have been provided with a shower. Bedrooms were seen to be decorated and furnished to a good standard and it was evident that some service user’s families had assisted in personalising the room to reflect the personality of the service user. Some rooms were stark and bare and contain little in the way of personal items or memorabilia. The manager stated that where rooms were stark, discussion Emmanuel Christian Care Home DS0000032923.V266186.R01.S.doc Version 5.0 Page 20 had taken place with family members to encourage them to provide items to assist with personalising room, but some families chose not to address this. A selection of lounge areas are provided and are furnished to an adequate standard. The lounges are large and it was observed that the layout of these rooms did not always encourage social interaction. One lounge in the dementia care unit was poorly laid out with chairs placed around the walls of the room. The television in this room is located in one corner and the majority of the service users using the lounge were unable to see or hear it. No coffee tables were provided for service users to place cups or other items, and a number of service users were using over-bed type tables. Two armchairs were seen not to have cushions on them which made them unusable. The gardens of the home are small, with much of the surrounding area being used for car parking. The grassed area at the rear of the home is on a steep slope making it unsuitable for service users. No secure garden area is provided for those service users who have dementia. These service users are accommodated on the first floor of the home and do not have access to the outside without staff supervision. At the time of the inspection, the weather was not conducive to outdoor activities. The bathrooms and shower rooms were found to be in a poor condition. The concerns relating to the bathrooms and shower rooms include, offensive odours from the drains on the second floor, paintwork flaking and the ease of access to dangerous items i.e. razors and creams prescribed for other service users. Some razors were found in unlocked cupboards and two were found on the window ledge and washbasin in one bathroom. The flooring was observed to be lifting in the ground floor shower rooms as water had penetrated under the non-slip flooring. These rooms did not present as a pleasant environment for service users. The majority of toilet roll holders were found to be broken or missing. Toilet rolls had been placed on radiators or on the floor presenting as a risk to service users and denying them access to basic facilities. These are to be replaced or repaired as appropriate. One relative had expressed concern to CSCI that the clothes belonging to a service user were not folded in drawers and wardrobes. A number of wardrobes and drawers were checked, in the presence of a member of staff and the majority were found to contain clothes that had not been dealt with appropriately. Clothes were found to be disorderly and creased. Clothes had been placed at the bottom of wardrobes without having been folded. The inspectors were advised that the placing of clothes in drawers and wardrobes was the responsibility of the night staff, however, it is evident that many service users are in bed when the night staff are on duty and so access to the bedrooms at night is not available. Some service users appeared dishevelled due to them wearing creased clothing. Emmanuel Christian Care Home DS0000032923.V266186.R01.S.doc Version 5.0 Page 21 Some of the bedroom door handles were found to be faulty or missing. The inspectors were informed that some bedrooms on the dementia care unit were kept locked on the request of relatives to prevent service users who wander from entering. The lack of suitable locks negates this practice. Staff coats were found to be hanging in the sluice. This presents as a cross infection risk and must cease. Staff handbags were found in cupboards in service users dining rooms. Adequate staff facilities are provided within the home, including lockable facilities for personal items. The practice of leaving personal items in service users areas is not acceptable. The inspectors observed a dirty hairbrush on a trolley used for transporting linen. A member of staff was asked about the use of this brush as there was no service users name on it. The member of staff confirmed that this hairbrush was used by more than one service user when they were washed and dressed in the mornings. The use of communal hairbrushes is not acceptable and this practice must cease. A selection of toiletries, all of the same brand, was seen in bathrooms. None of these items had service users names on them. The Responsible Individual denied that communal toiletries were used and that these were provided to service users on an individual basis where necessary. Many of the towels provided for use by service users were found to be frayed and in a very poor condition. This was highlighted at the previous inspection and a requirement made for damaged towels to be replaced, however, it is evident that the home has failed to meet this requirement. Emmanuel Christian Care Home DS0000032923.V266186.R01.S.doc Version 5.0 Page 22 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, 30 Staff morale is extremely low resulting in poor attendance which results in an inconsistent and unsatisfactory service. EVIDENCE: The number of staff on duty at the time of the inspection did not meet the requirement set at the time of registration. Staff spoken to at the time of the inspection stated that they were short of staff and were struggling to meet service users needs. They were rushing tasks and not giving the service users the time necessary when attending to them. Baths were rushed and were for the purpose of ensuring service users were clean rather than letting them enjoy the time spent in the bath. A meeting was held with the Manager, Responsible Individual and Regional Manager subsequent to the inspection and the staffing levels within the home reviewed. Regular visits to monitor the staffing provision will be made by CSCI. The home employs qualified nurses and care assistants to provide for the service users. Many of the care assistants are experienced in providing care for elderly people and 50 of care staff hold NVQ at level 2. The care practices observed by inspectors gave cause for concern, particularly at meal times as detailed under standard 15 of this report. It is evident that Emmanuel Christian Care Home DS0000032923.V266186.R01.S.doc Version 5.0 Page 23 staff are not sufficiently supervised in respect of the day-to-day tasks that they undertake. Discussion with the Manager identified that training had been given to staff on a regular basis, however, from observation, staff failed to follow good practice guidelines and the home’s policies and procedures relating to care practices. Two relatives commented to inspectors regarding the attitude of the staff. They did not feel that the staff had the best interests of the service users at heart, and one relative said that one member of staff ‘pouted and tutted’ when a request for care was made by relatives. Five relatives said that most of the staff were caring and willing to do anything to assist the service users but were severely overworked. Staff spoken to said that they had raised concerns with the management regarding the staffing levels within the home but did not feel that those concerns were taken seriously or were given any consideration. This has resulted in low morale. One of the other major causes of low staff morale is the recent change in ownership of the home. Staff stated that they had not been given information prior to the change and as a result of this, some staff had left as they felt insecure and lacked confidence in the home. Staff sickness, particularly short-term sickness i.e. one or two days, results in the home using the services of agency staff. This has proved to be an additional cost both financially on the home and the lack of consistent care for service users. Some of the care staff employed in the dementia care unit of the home have recently undertaken training on dementia care mapping. One member of staff said that she had enjoyed the training and gained a lot of knowledge and understanding from it, but was unable to implement that knowledge due to time constraints. Other recent training includes Accountability, Responsibility and Record Keeping through the Royal College of Nursing. Continence Advisors provide training and Diabetes training is currently being undertaken by some staff at Chester College. The home also employs laundry and domestic staff. At the last inspection the laundry staff expressed concern regarding the amount of laundry that was required to be undertaken during the weekend, when fewer staff were on duty. The laundry department attends to the laundry for Park House, which accommodates 111 service users, and also Grove House which accommodates 63 service users. At this inspection the laundry staff said that they did not feel that their concerns had been addressed. Emmanuel Christian Care Home DS0000032923.V266186.R01.S.doc Version 5.0 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 38 Since the last inspection the quality of service provision has deteriorated resulting in a lower quality of living and a poorly maintained environment for the service users. EVIDENCE: The Registered Manager of the home is a qualified nurse who has considerable experience is the provision of care for older people and those who have mental health condition. He is an experienced manager who also holds teaching, assessing and mentorship qualifications. He undertook considerable management training during a previous employment with the Health Authority and was able to further his knowledge and understanding by completing an Advanced Certificate in Dementia Care Mapping. At this inspection, it was not possible to establish that he home is run in the best interests of the service users. No activities are provided and the lack of Emmanuel Christian Care Home DS0000032923.V266186.R01.S.doc Version 5.0 Page 25 staff have resulted in service users individual preferences not being met. No evidence was seen of any self-monitoring systems to give both service users and their representatives the opportunity to express their views objectively through questionnaires or group discussions. These issues were discussed with the manager at a meeting subsequent to the inspection who agreed that a greater level of monitoring and supervision was necessary. Policies and procedures for the home are currently being reviewed following the recent change of ownership and these are to be made accessible to all staff. Staff spoken to stated that they did not receive formal supervision and some stated that they did not feel supported. The lack of risk assessments and risk management strategies places both staff and service users at risk. Domestic and laundry staff stated that they were given full information on the products they use under the Control of Substances Hazardous to Health Regulations 1988. A number of cleaning products were seen in cupboards in kitchens and bathrooms and these must be removed and stored securely. Security of the building is good with keypad access and egress to all parts of the home as necessary. Emmanuel Christian Care Home DS0000032923.V266186.R01.S.doc Version 5.0 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 1 X 1 X X X 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 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 3 2 2 2 X X X X 2 STAFFING Standard No Score 27 2 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X X X 2 Emmanuel Christian Care Home DS0000032923.V266186.R01.S.doc Version 5.0 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 OP1 Regulation 4(1) Requirement The registered person must produce and make available to service users an up to date statement of purpose setting out the aims, objectives, philosophy of care, services and facilities, and terms and conditions of the home. The registered person must ensure new service users are admitted only on the basis of a full assessment undertaken by people trained to do so, and to which the prospective service user, his/her representatives (if any) and relevant professionals have been party. The registered person must ensure a service user plan of care generated from a comprehensive assessment (see Standard 3) is drawn up with each service user and provides the basis for the care to be delivered. This remains outstanding from inspection of 30/8/05. The registered person must promote and maintain service DS0000032923.V266186.R01.S.doc Timescale for action 31/12/05 2 OP3 14(1) 03/12/05 3 OP7 15(1) 28/02/06 4 OP8 13(1) 28/02/06 Emmanuel Christian Care Home Version 5.0 Page 28 5 OP9 13(2) 6 7 OP9 OP9 13(2) 13(2) 8 OP9 13(2) 9 OP9 13(2) 10 OP9 13(2) 11 OP9 13(2) 12 OP12 16(2) 13 OP14 12(2)&(3) 14 OP15 16(2)(g) users’ health and ensures access to health care services to meet assessed needs. Evidence of this must be maintained with immediate effect. All medication must be administered in accordance with the prescribers direction. Requirement issued on 11/11/05 All records regarding medication must be complete and accurate. Requirement issued on 11/11/05 A full audit train must be available of all prescribed and non-prescribed medication. Requirement issued on 11/11/05 All discontinued and out of date medication to be disposed of in accordance with current legislation. Requirement issued on 11/11/05 Medication must be stored at appropriate temperatures according to manufacturers information. Requirement issued on 11/11/05 Adequate supplies of medication to be available for all residents at all times. Requirement issued on 11/11/05 All registered nurses to administer medication in accordance with NMC Guidelines. Requirement issued on 11/11/05 The routines of daily living and activities made available are flexible and varied to suit service users’ expectations, preferences and capacities. The registered person conducts the home so as to maximise service users’ capacity to exercise personal autonomy and choice. Evidence of this must be held. The registered person must ensure that suitable and sufficient cutlery and crockery is DS0000032923.V266186.R01.S.doc 11/11/05 11/11/05 13/11/05 18/11/05 11/11/05 11/11/05 11/11/05 14/12/05 28/02/06 14/12/05 Emmanuel Christian Care Home Version 5.0 Page 29 15 OP15 16(2)(j) 16 OP15 12(4)(a) 17 OP15 16(2)(j) 23(2)(d) 22 18 OP16 19 OP21 23(2)(j) 20 OP19 13(4)(a) 21 22 OP19 OP19 12(4) 12(4) 23 OP19 16(2)(c) 24 OP19 12(4)(a) provided. The registered person must ensure that suitable arrangements for maintaining satisfactory standards when transporting food are provided. This remains outstanding from inspection of 30/8/05 The registered person must ensure that meals are given to service users in a manner which respects the dignity of service users. The registered person must ensure that the kitchen is maintained in a clean condition immediately and at all times. The registered person ensures that there is a simple, clear and accessible complaints procedure which includes the stages and time-scales for the process, and that complaints are dealt with promptly and effectively. The registered person must ensure that all bathrooms and shower rooms are safe and suited to the needs of the service users. This remains outstanding from inspection of 30/8/05. The registered person must ensure items of risk in bathrooms and shower rooms are to be securely stored. Requirement issued 11/11/05 The registered person must ensure service users clothes are stored appropriately. The registered person must ensure that handles on bedroom doors are replaced or repaired as necessary. The registered person must ensure that worn and frayed towels are replaced. This remains outstanding from inspection of 30/8/05 The registered person must DS0000032923.V266186.R01.S.doc 14/12/05 14/12/05 11/11/05 05/12/05 31/03/06 11/11/05 05/12/05 14/12/05 14/12/05 03/12/05 Page 30 Emmanuel Christian Care Home Version 5.0 25 OP26 16(2)(j) 26 OP27 18(1)(a) 27 OP30 18(2) 28 OP33 24(1) 29 OP38 13(4) ensure that communal hairbrushes are not used. The registered person must ensure that staff personal items are not held in service user areas to prevent the risk of cross infection. The registered person must ensure staffing numbers and skill mix of qualified/unqualified staff are appropriate to the assessed need of the service users, the size, the layout and purpose of the home, at all times. This is as agreed at the meeting of 17/11/05 The registered person must ensure that all staff are appropriately supervised in line with Four Seasons policy. Effective quality assurance and quality monitoring systems, based on seeking the views of service users, are in place to measure success in meeting the aims, objectives and the statement of purpose of the home. The registered manager ensures so far as is reasonably practicable the health, safety and welfare of service users and staff. 14/12/05 18/11/05 14/12/05 31/12/05 05/12/05 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 Emmanuel Christian Care Home DS0000032923.V266186.R01.S.doc Version 5.0 Page 31 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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 Emmanuel Christian Care Home DS0000032923.V266186.R01.S.doc Version 5.0 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!