Inspection on 15/11/07 for Peter Shore Court

This inspection was carried out on 15th November 2007.

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

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

Other inspections for this house

Peter Shore Court 19/05/08

Peter Shore Court 26/04/06

Peter Shore Court 10/10/05

Peter Shore Court 25/04/05

Peter Shore Court 30/10/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Peter Shore Court Beaumont Square Stepney London E1 4NA Lead Inspector Nurcan Culleton Unannounced Inspection 10:30 15th and 16 November 2007 th 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 Peter Shore Court DS0000052366.V353851.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. Peter Shore Court DS0000052366.V353851.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Peter Shore Court Address Beaumont Square Stepney London E1 4NA 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) 0207 790 2660 0207 790 7331 Excelcare Holdings vacant post Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41) of places Peter Shore Court DS0000052366.V353851.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th April 2006 Brief Description of the Service: Peter Shore Court is a purpose built residential home, managed by Excelcare Ltd, providing personal care and support for 41 older people. All service users have en suite rooms, there are 4 separate day/resource rooms located on the ground and first floors with an additional big lounge area on the ground floor for large functions. There is an additional quiet/smoking area. The premises consist of four separate units, located on the two floors. The home has lift facilities and aids and is suitable for people with disabilities. It is located within Stepney Green and is a short distance to Mile End, the Royal London Hospital and the City. The home is within walking distance of local shops, amenities and transport links. The fees are currently a minimum of £504 per week, varying according to assessed levels of needs. Fees are subject to review. Peter Shore Court DS0000052366.V353851.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over two days on 15th and 16th November 2007 and was unannounced. The Manager of the service assisted the inspector throughout. The inspector spoke with three staff members, service users throughout the home and one relative. The inspector toured the premises and examined several randomly selected residents’ files, staff files and records related the residents’ service, including medication sheets and financial records. The inspector also examined health and safety records and certificates and toured the premises. The inspection takes into account the homes’ Annual Quality Assurance Assessment (AQAA). What the service does well: What has improved since the last inspection? Medication practises have improved since the last inspection; advocacy services have been strongly promoted and the take up of advocacy referrals has subsequently increased; themed cultural entertainment afternoons have been introduced to provide more stimulating social activities; the Service Users’ Guide and Pre-Admission Assessment has been updated providing improved information to residents and obtaining improved information about residents’ needs, for example, their social, cultural and religious needs. Peter Shore Court DS0000052366.V353851.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Peter Shore Court DS0000052366.V353851.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Peter Shore Court DS0000052366.V353851.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1-6 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Peter Shore Court provides sufficient information to potential and existing residents of the home about the service. Peter Shore considers residents’ individual and diverse needs when providing their service. EVIDENCE: Peter Shore Court has in place a Statement of Purpose and Service Users’ Guide providing good information about its service provision for prospective residents and people living in the home. The Service Users’ Guide has been updated. Pre-admission assessments are conducted by the home, as seen in residents’ files, confirming information provided by the Local Authority with the resident and their family members. Peter Shore Court DS0000052366.V353851.R01.S.doc Version 5.2 Page 9 The Manager informed that improvements have been made to this form which now includes peoples’ social, cultural, religious needs and a personal hygiene section, asking whether people have specific toiletry, washing or bathing needs for personal or cultural reasons or whether their mobility affects their praying. Peter Shore has in place a person centred approach to working with its residents. An example of this can be seen in one persons’ care plan which identifies providing reassurance, spending time to talk to and helping to keep this resident calm when she shows signs of anxiety and depression, in addition to other practical responses. The home also has in place Pre-Admission Care Diaries to provide more rounded information about the individual, listing people’s personal likes, background experiences, history, and preferences for food. Residents’ religious and cultural needs are considered on an individual basis and while service planning. One resident attends a Jewish day centre three times a the week. Priests of the Church of England and a Sister of the Catholic faith attend the home weekly and residents are supported to attend places of worship in the local area or other area of their own choice. Residents’ meetings take place regularly and relatives meetings take place every three to four months. Positive comments can be seen recorded in minutes of meetings. The home has contracts with individual residents and their placing local authority. Trial visits are encouraged. Of the recent admissions, one persons’ daughter visited on their parents’ behalf and another resident visited themselves prior to their admission. However whist it is evident from discussion with staff and the Manager that residents’ needs are met for the most part, the inspection found that the service must improve in its records practises to provide sufficient evidence to demonstrate that individual residents’ needs are being fully addressed and met. Peter Shore Court DS0000052366.V353851.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7-11 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Each resident has a care plan, though the format of care plans could further improve in the way residents’ needs are identified and recorded. Staff uphold residents’ rights to be treated with privacy, dignity and respect. The home must provide improved evidence that the health care needs of individuals are fully promoted and met. EVIDENCE: All files examined contain care plans as used by Excelcare. These cover a range of areas under general headings, each area of which is reviewed separately on a monthly basis. The standard of information contained in care plans sampled is variable. The good care plans identify well the residents’ needs, associated goals, such as to ensure a resident’s independence is promoted, and actions required to meet defined needs are clearly stated. Peter Shore Court DS0000052366.V353851.R01.S.doc Version 5.2 Page 11 Other care plans, whilst they generally identify residents’ needs, information contained in them is not always clear or well organised, for instance, a resident with a speech problem had this issue identified under the heading of ‘Dressing’ rather than in a more appropriate category related to communication. Whilst residents maintain contact with family and friends, some files lacked clarity about the importance of this need in the care plans. In one persons’ care plan, encouragement for friends and family to visit was noted under the Mental State section of their care plan rather than in the Social Care Contacts section of the care plan. Importantly too in this file, there had not been any mention of family or friends in the persons’ assessments or contact information either. It is recommended that care plans in the home are better organised to make information about residents’ needs more easily accessible. The inspector noted that the care plans used by Excelcare do not provide headings to cover areas around sexuality/sexual issues; finance; religion and culture. Whilst this information may be available elsewhere in other documents, such as the Pre-Admission Assessment, this information may also become less accessible or missed altogether in the structure of the current care plans. Information, such as whether or not a person is able to manage their own finances and associated actions, may be key areas of need and therefore are also required to be identified in the person’s care plan. Care plan confirmation forms are blank in some files. These forms are intended to show that the resident confirms their understanding of and agreement to their care plan. Residents or their representatives must sign their care plans or care plan confirmation forms to evidence their understanding of and agreement to residents’ care plans. The Manager and staff inform that residents’ health care needs are attended to. Appointment cards, letters and logs in residents’ files; the homes’ visitors book and diary also show residents having contact with health professionals. Residents spoken to on the day of the inspection were themselves unable to confirm how their health care needs were being met. Several of the residents were suffering with pain at the time of the inspection and informed the inspector of their individual health complaints, requesting assistance with these. The Manager was aware of the individual health complaints reported back by the inspector. Whilst the Manager was able to provide accounts of residents being in contact with health professionals about their complaints, records relating to the health care needs of the residents do not specify clearly whether residents’ health care needs are being fully addressed. Peter Shore Court DS0000052366.V353851.R01.S.doc Version 5.2 Page 12 For instance, in one residents’ file, it is recorded in the professionals’ visit sheet that a sleep log was requested by of the home by the psychiatrist following a psychiatric review in February 2006. There is no evidence of this log being compiled in the file or outcome of a subsequent review or further reference in any subsequent recording. A further example is when two health care professionals visited to review the needs of a woman with dementia. The professionals’ contact record section of her file inaccurately stated only that she had seen a social worker. The outcome of this visit/assessment had not been recorded, for example, that an assessment took place and a report with recommendations for action was pending. The outcome of significant conversations with family relatives related to information about residents’ health needs are not being recorded in residents’ files. For instance, the Manager informed the inspector about a conversation she had with a relative of a resident who provided a key piece of information about the resident’s decision, made in the past, not to see a health specialist about his particular need. This information resulted in the home not making any subsequent referral to such a health specialist, however this key information was not recorded. It is a requirement that there is improved recording of residents’ contact with healthcare professionals, in particular, of recording the outcomes of any healthcare appointments, visits, reviews and assessments, in order to evidence that residents’ health care needs are being fully met. Another resident identified to have depression, low mood, memory loss and deemed to be at risk of self neglect, lacked any relevant and sufficient detail in her monthly reviews to adequately monitor these identified areas of need. It is recommended that residents’ monthly reviews are more detailed and linked to identified needs in care plans in order to provide improved and adequate monitoring of residents’ needs. It is also recommended to take appropriate action in response to any changes in their needs and this action is recorded. A pharmacist from a visiting pharmacist inspecting the homes’ medication procedures at the same time as this inspection, informed that the medication practises are overall good order in the home, including the areas where requirements were given at the last inspection. The Pharmacist inspector provides training to the staff at the home every six months to staff at the home and conducts medication audits every three months. Peter Shore Court DS0000052366.V353851.R01.S.doc Version 5.2 Page 13 The Manager informed that she is pleased at how people have improved in the way they administer medication to residents. However the medication administration consent forms are not signed by some residents. Residents or their representatives must provide a signed statement to evidence their consent to receive assistance with medication administration. Staff have a person-centred approach to care planning and focus on residents as individuals. It is evident in records and in interviews with staff and residents that the ethos of the home is treat residents with dignity and respect. Statements seen in care plans include, “.…ensure door to room is closed and curtains drawn to promote privacy and dignity when washing … use own favourite toiletries to promote self-esteem …maintain high standard of grooming… to uphold dignity, privacy and modesty”. Residents’ completed wishes after death forms are available in three of the four files examined. However in one file, this form is blank. Two audits in March and June 2006 identified this omission, however to date, this form has not been completed. This is also addressed in the management section. It is recommended the death and dying wishes are obtained and available for every resident in the home. Peter Shore Court DS0000052366.V353851.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12-15 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Peter Shore Court provides a range of activities, however the homes’ records could improve to identify whether individual residents engage with and benefit from the social activities provided. EVIDENCE: Residents are encouraged to make choices to maintain their sense of self and independence. One care plan records, “encourage..always to choose her clothes for the day, only offering assistance as needed”. Residents engage in a number of daily social activities in the home. On Mondays there are visiting ministers, a church service and religious music. On Tuesdays, there is gentle exercise to music, board games, arts and crafts. There is music hour on Wednesdays; reminiscence, current affairs and discussions and bingo. Peter Shore Court DS0000052366.V353851.R01.S.doc Version 5.2 Page 15 On Saturdays people choose external activities of their own choice. Residents have made visits to places of interest such as the Docklands Museam and the Generation Experience. More recently the Manager has introduced themed cultural afternoons with cultural meals with entertainment in the afternoons. Residents enjoyed a Cockney afternoon at the end of October with a pie and mash meal and a visit from a pearly king and queen impersonating cockney characters and reminiscing. On the day of inspection residents were taking part in a singing session with outsider entertainers. Residents also have the option of attending day centres of their own choosing, such as the Jewish day centre attended by one woman three times a week. The activities programme on display in the reception area requires updating however as it does not reflect all the outings and entertainment the residents have taken part in. Social activities are however inadequately recorded in residents’ files, with one to six entries per month in some files. Additionally staff divide the recording of these activities between the social activities record sheets and the daily monitoring sheets, making it difficult to monitor the overall social activities undertaken by individual residents. The quality of these recordings are also inadequate, providing little information about the residents’ involvement in activities and whether or not they find them stimulating. These shortfalls presents with some difficultly in monitoring the engagement of individual residents in these activities and hence, to some extent, the quality of life which they experience in the home. More detailed and improved recording of social activities is recommended. Residents maintain existing links with family and friends, as seen on the day of inspection where family members were visiting their relatives in the home. The visitors’ book also contained entries from family members. The Manager informed that residents have been encouraged to take up advocates and that as a result of advocacy being made more available to people eight more referrals for advocates have been made. Residents have the opportunity to formally express their views and make suggestions about the service in the residents’ meetings that take place every two to three months. It is recommended that the outcome to suggestions or issues raised at residents and relatives meetings is recorded. The financial affairs of most of the residents are managed either by family members or the Local Authority. However in one woman’s case where the daughter is currently managing the residents’ money, there is no reference to clarify the financial situation including who has financial responsibility either in Peter Shore Court DS0000052366.V353851.R01.S.doc Version 5.2 Page 16 the home’s Pre-Admission Assessment or in the residents’ care plan, though this information is recorded in the Residents’ Information Sheet. The Manager informed that in this case, the Local Authority had applied to take financial responsibility for the resident due to concerns expressed about the daughter’s personal circumstances. However the file lacks records to show this. The home must ensure that for all residents it is clearly defined with whom financial responsibility lies and that such responsibility is formally recorded in residents’ care plans. The menu is selected in consultation with residents and shows that meals are balanced and varied. Residents spoken to on the day of inspection all informed that they had enjoyed their meal. Care plans recorded “ encourage ..to make choices in relation to her dietary preferences”. Staff are aware of individual meal preferences and were observed to support residents with their meals. Peter Shore Court DS0000052366.V353851.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents know how to complain at Peter Shore Court, though complaints are successfully dealt with promptly and informally minimising the number of formal complaints. EVIDENCE: A complaints policy and procedure is in place which both residents and relatives are informed about. There are few complaints generated in the home, indicating that the service is generally running smoothly, minimising the need for formal complaints. A daughter of a resident visiting the home informed the inspector that she was very pleased with the service for her mother at Peter Shore Court and that she found that issues they raise are promptly resolved to their satisfaction when raised which has not necessitated a need to make any complaints. Peter Shore Court DS0000052366.V353851.R01.S.doc Version 5.2 Page 18 There were three recorded complaints in 2007 with the outcomes detailed in the complaints folder. To further improve the complaints procedure it is recommended that the start and end date of any investigation and date of response to the complainant is also recorded. When seeking to discuss residents’ level of satisfaction with the home, unfortunately many of the residents who spoke to the inspector expressed various health complaints which they were experiencing and were giving them pain and discomfort. This has been addressed in the section above. However they did advise that they were aware of how to complain if they had a need to do so. A summary of the complaints procedure was also seen contained in the residents’ Service Users’ Guide. Peter Shore Court has in place a Safeguarding Adults policy and procedure and staff are provided with safeguarding adults training. A sample of residents money was checked and were correct against the balance of monies shown in residents’ financial records, demonstrating that proper procedures are followed in handling residents’ finances. Peter Shore Court DS0000052366.V353851.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19-26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Peter Shore Court provides a suitable environment for its residents which is pleasant, comfortable and well maintained. The space available for use as a garden at the back of the home could be further developed still to improve the quality of life experienced by service users in the home. EVIDENCE: Peter Shore Court is a comfortable two-storey purpose built building designed to meet the needs of the service provision. Residents are accommodated into four units across the ground and first floors. The inspector toured the premises and observed the home to be generally in good order and homely in its décor. It was clean, tidy and free from odours. Peter Shore Court DS0000052366.V353851.R01.S.doc Version 5.2 Page 20 Bedrooms are ensuite with showers, toilets and basins and furnished with personal possessions and rooms were generally clean, tidy and suitable for service users’ needs. There are aids and adaptations, including wheelchairs, hoists and lifts suitable for disabled persons and pressure relieving mattresses, for people assessed by occupational therapists as requiring them. There are two lounges used also as dining rooms on each floor, a hairdressing room and there are suitable bathrooms with an Apollo bath on the premises. The large ground floor lounge is frequently used to provide entertainment for all the residents in the home. On the day of inspection several residents and one relative expressed that they were satisfied with the environment and thought the home was very pleasant, reflecting views stated in the homes’ latest survey results. The garden at the back is yet to be further developed for those residents who may wish to enjoy a garden, particularly for people who may have restricted choices in their activities. Some planting has begun, however it remains a recommendation to improve further, as also identified by a relative in the homes’ satisfaction survey. Peter Shore Court DS0000052366.V353851.R01.S.doc Version 5.2 Page 21 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): 27-30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home must review its staffing levels to ensure that staff numbers are adequate to meet current residents’ needs. Sound recruitment procedures are in place and staff receive induction and regular training on an ongoing basis. This ensures that residents are supported by suitable staff who are trained to understand their roles and responsibilities. EVIDENCE: There are currently 33 residents in the home, all described by the Manager as having medium level dependency needs. Staff numbers are presently 27 carers, including 22 full-time staff, five relief staff and seven seniors. The home is divided into four units on two floors. They are staffed with one carer to a maximum of eight residents on each unit. There is in addition one floating carer and one senior. Overnight there are three wake-in staff, including two carers and one senior. The Manager informed that staff numbers can and have increased in the past depending on the needs of the residents. An example given is when another staff member was employed to assist a wheelchair using resident who had additional needs. Peter Shore Court DS0000052366.V353851.R01.S.doc Version 5.2 Page 22 However three staff members informed the inspector that frequently staff shortages occur when staff go off sick at short notice. At such times, staff informed that they are stretched to ensure that residents’ needs are met and that residents may need to wait longer before they are attended to. Additionally, some staff expressed that there are tensions existing in the relationship between a number of staff which, on occasions makes cooperation with each other difficult during staff shortages. The Manager informed that in her view there are no staff shortages as the floating carer and senior employed already act as additional staff who are there to assist in such situations. However it is a requirement that the Manager reviews staffing levels, to ensure that staffing levels and current staffing arrangements are sufficient to meet the needs of residents. A training matrix is in place, however it has not been updated to accurately reflect the training undertaken by staff. This was also identified in the Regulation 26 report in September 2007. It is recommended that comprehensive and updated information is available for individual staff members and for the staff team as a whole. Staff spoken to confirmed they receive regular training on a range of areas relevant to their work. The majority of staff have NVQ Level 2 and three seniors are currently undertaking NVQ Level 3. On the day of inspection, the Manager was taking part in training called ‘Sonas’, a programme providing activities around engaging with people who have dementia which is designed to enhance their senses and improve their sense of wellbeing. In May 2007 15 staff members attended a 12 week course in dementia, including the Cook and Activities Co-ordinator. It is planned that eventually all staff will be trained in dementia care. Staff receive induction when recruited by the home, as confirmed in staff interviews and records seen in staff files. The home follows the Skills for Care induction handbook, to establish that staff have key competencies necessary to undertake their duties and responsibilities. Staff demonstrated their knowledge about the needs of individual residents and how to support them. Due to the discomfort felt by some residents on the day inspection as a result of their health complaints, only a couple of residents expressed their views about staffing, informing that they like the staff in the home. Four staff files examined contained all documents required, including I.D, application forms, two references, health declarations, and separate files containing CRBs, indicating that robust recruitment procedures are followed and that suitable staff are selected. Peter Shore Court DS0000052366.V353851.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): 31-38 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Supervision of staff is inadequate and the Manager must ensure the service is well co-ordinated and delivered by skilled and competent staff. The Manager must demonstrate that they can apply their previous skills and experience to effectively manage and lead the service at Peter Shore Court. Entrenched staffing issues must be examined and resolved to ensure the delivery of a good service. Audits and quality monitoring of the service must improve in order to raise standards. Good health and safety practises are observed. EVIDENCE: Peter Shore Court DS0000052366.V353851.R01.S.doc Version 5.2 Page 24 The home has been through another unsettled period with four changes in management since the last inspection. There is some evidence to indicate that this has affected some parts of the service, such as the supervision of staff. However there have been no major incidents or serious complaints since the last inspection. Nevertheless it is clear that the service needs permanent, effective management and strong leadership for its future stability in order to provide a quality service that benefits people who use the service. The present manager has been employed in the home since June 2007 and intends to going through the registration process to become the Registered Manager. The Manager has several years of experience of working in social care, including three years as Registered Manager at another home also run by Excelcare. Prior to this, from 1996 onwards, she has experience as a senior/supervisor and carer and housekeeper in similar settings. Currently she has an NVQ Level 2 in care and is undertaking her Registered Managers’ Award (RMA). The Manager informed that she has found the RMA course very helpful, for example, finding more strategies to deal with issues as they arise and working more purposefully in managing the service. However the Manager must now demonstrate and apply her management skills and leadership of the service at Peter Shore Court to ensure that shortfalls in service are addressed and minimum standards are achieved and maintained. During the inspection and in the Annual Quality Assurance Assessment (AQAA), The Manager informed about some improvements to the service, as highlighted throughout this report, around medication, advocacy, cultural activities and updating some forms, such as the Service Users’ Guide and PreAdmission Assessment. She informed about her proposals for other improvements to the home for the future. Staff spoken to informed that the Manager is open and approachable to them and will listen to and encourage them. It is also apparent by verbal accounts given to the inspector that there exists a history of entrenched and unresolved staffing issues leading to low morale and poorer working relationships between some staff members and between some staff members and the management of the service. This must be effectively addressed by the current Manager of the service, with support as may be required, if it is not to have an adverse impact on the delivery of the service. Audits of files takes place by the Manager on a random basis and additionally every six months, the overall service provision is audited by a senior manager in Excelcare. These audits were seen in files examined. However whilst shortfalls in service provision are identified, such shortfalls are not always addressed and are repeated in subsequent audits. An example is how it was identified in an audit in March 2006 that there were no wishes after death form completed by one resident. This was identified in a further audit in June 2006 and was still unavailable by this inspection. It is recommended that more Peter Shore Court DS0000052366.V353851.R01.S.doc Version 5.2 Page 25 robust audits of files are in place and for actions identified in audits to be addressed. The home has undertaken surveys with residents and relatives. Nine out of nine residents who took part in the surveys between February and March 2007 found staff welcoming; helpful, answered their questions; treated them with respect; were available to listen to them; found the home warm and welcoming; were given choice and were satisfied with their meals. Relatives also gave similarly positive comments. Regulation 26 monthly monitoring visits have continued to take place and monthly reports were available when requested. The home has in place an employers’ liability insurance certificate but no public liability insurance certificate. It is recommended that the organisation ensures the employers’ liability insurance provides sufficient cover for public liability costs which may be incurred. The Manager has had several meetings with the seniors and there are regular team meetings. However the lack of staff supervision is a significant area of concern following this inspection and an area where improvement must be made to ensure the service effectively meet its objectives. It is apparent from discussions with the Manager and staff and from the lack of supervision records that staff have not been received supervision. Senior staff have informed about the need to develop more confidence to supervise carers. Excelcare have addressed this by planning to give training to seniors in supervision. However only two seniors have received formal supervision since the Manager came into post in June. Given the following factors: successive changes in management experienced by residents and staff alike; existing tensions within the staff group between some staff members and the need to work more cohesively as a team and ensuring the needs of residents are met, it is even more imperative to apply National Standards to ensure that all staff members receive regular supervision. Whilst some records are available in residents files, staff files, policies and procedures and those required for the health and safety and business functions of the home, there are also gaps in information in residents’ files, as identified throughout this report. The quality of recording in residents care plans, their monitoring and review records and other records identified in this report, must improve in order to effectively monitor the needs of residents and whether the service provision is adequate for their needs in response. Peter Shore Court DS0000052366.V353851.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 3 3 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 3 3 1 3 3 Peter Shore Court DS0000052366.V353851.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement Improve recording of residents’ contact with healthcare professionals, in particular, the outcomes of any healthcare appointments, visits, reviews and assessments to ensure that residents’ health care needs are fully addressed. Ensure it is recorded in residents’ care plans whether residents or their representative have financial responsibility for managing residents’ finances. Ensure all residents or their representatives sign their care plans or care plan confirmation form to confirm their understanding and agreement to their care plan. Ensure all residents or their representatives must provide a signed statement to evidence their consent to receive assistance with medication administration. Review staffing levels to ensure that staff numbers and staffing arrangements are sufficient to meet the needs of the current DS0000052366.V353851.R01.S.doc Timescale for action 31/01/08 2 OP7 15 31/01/08 3 OP7 15 31/01/08 4 OP9 13(2) 31/01/08 5 OP27 18 1(a) 31/01/08 Peter Shore Court Version 5.2 Page 28 6 OP36 18(2) residents. Ensure all staff receive regular supervision. 31/01/08 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 Refer to Standard OP7 Good Practice Recommendations Update care plans to record information about residents’ needs in a clearer, more accessible way under relevant care plan headings. Update care plans pro-forma to include residents’ finance matters; sexual issues; culture and religion. Ensure that residents’ monthly reviews are more detailed and linked to identified needs. Ensure all residents’ views are obtained regarding their death and dying wishes. Update the activities programme on display in the reception area to reflect all the outings and entertainment the residents have taken part in. Provide more detailed and improved recording of social and activities. Record outcomes to suggestions or issues raised at residents and relatives meetings. Ensure the start and end date of complaints investigations and date of response to the complainant are recorded. The garden in the space available at the back of the home is further developed and more suitable garden furniture is purchased. Ensure that staff training records are updated and easily accessible. Ensure unresolved staffing issues are addressed in order to ensure there is no adverse impact on the delivery of service. Ensure more robust audits of files are in place and for actions identified in audits to be addressed. Ensure the employers’ liability insurance provides sufficient cover for public liability costs which may be incurred by the home or organisation. 2 3 4 5 6 7 8 9 10 11 12 13 OP7 OP7 OP11 OP12 OP12 OP14 OP16 OP20 OP30 OP32 OP33 OP34 Peter Shore Court DS0000052366.V353851.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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