Inspection on 19/05/08 for Peter Shore Court

This inspection was carried out on 19th May 2008.

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

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

Other inspections for this house

Peter Shore Court 15/11/07

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Peter Shore Court Beaumont Square Stepney London E1 4NA Lead Inspector Nurcan Culleton Unannounced Inspection 19th May 2008 09:40 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.V364174.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.V364174.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) 020 7790 2660 020 7790 7331 Excelcare Homecare Division Ltd Manager post vacant Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41) of places Peter Shore Court DS0000052366.V364174.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th November 2007 Brief Description of the Service: Peter Shore Court is a purpose built residential home providing personal care and support for 41 older people. The premises consist of four separate units, located on the two floors. They contain day rooms for dining and social functions and an additional big lounge area on the ground floor for large functions. All bedrooms are en suite rooms. There is also a quiet/smoking area. 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 £440 per week and are subject to review. Peter Shore Court DS0000052366.V364174.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This report outlines the key findings of an unannounced inspection conducted by two inspectors to the home on 19th May 2008. We spoke with the manager, staff, individuals living in the home and visiting relatives. The views of people who had completed surveys were also taken into account, including six surveys from residents, three surveys from relatives, seven from staff and three from health professionals. We also examined a range of documents and records kept by the home, including the files of people living in the home, staff personnel files, minutes of meetings and the homes’ latest AQAA. We toured the premises and observed interactions between staff and people who were resting in the lounges and during lunch time to assess the extent to which people were being supported and how their needs were being met on the day of inspection. What the service does well: What has improved since the last inspection? Medication practises are improving in the home. There is better monitoring and more emphasis on staff training and staff training needs and there has been some more progress in staff supervision. The recording of consultation with health professionals has improved. An activity programme called SONAS has Peter Shore Court DS0000052366.V364174.R01.S.doc Version 5.2 Page 6 started for people with dementia. The spaces at the back and front of the building have been developed as gardens, containing more flowers and seating for people to sit outside. A new experienced manager has been appointed who is currently undergoing registration to become the registered manager of the home. The new manager has been reviewing practises and is introducing changes to the way the service is being delivered with a view to making long-term improvements in the service. The effect of these changes will become more apparent at the next inspection. What they could do better: Whilst the above improvements since the last inspection in November, three requirements were not met at the time of this inspection and are restated in this report. Additionally seven new requirements and nine recommendations have been given at this inspection. This demonstrates that there has been insufficient progress in meeting minimum standards and to ensure improved outcomes for people living in the home. Care plans are not all signed by individuals or their representatives; it remains unclear as to who holds responsibility for managing peoples’ finances; care plan reviews lack detail about the progress of individuals and all staff have not yet received supervision, affecting their ability to conduct their work more effectively. The home has had three new managers since the last inspection and five managers over the last year. This has added to the instability and upheaval experienced by staff and people living in the home. Staff have strongly expressed dissatisfaction with the management and care practises of the home. Issues raised in the complaints have been examined in this inspection and reported as to whether or not evidence was found to substantiate or unsubstantiated these complaints. People in the home have provided mixed views about their experience of living in the home, some negative. One individual spoken to said she did not like the home, adding, “ there are never enough staff and you never see the same staff.” One comment in a survey states “ I would like lunch time cover as this is a difficult period for me.” A number of people responded “sometimes” to the questions stated above in ‘What the service does well.’ Comments from a relative about how they can improve include, “more staff and assigning staff to each person so they know by name two or three carers for emotional bonding/care.” Another relative stated, “maybe more on the social and recreation side of things. More attention to organising social events.” People need more opportunity to engage in local, social and community activities of their choice. Peter Shore Court DS0000052366.V364174.R01.S.doc Version 5.2 Page 7 Staff are insufficient in numbers or inadequately deployed to appropriately and safely meet the identified needs of people who use the service. Management audits need to be more robust to identify and effectively tackle shortfalls in service for the benefit of people living in the home. The management and organisation of the service must continue to raise overall standards and provide sufficient resources to deliver a more person-centred service to people living in the home. Compliance with requirements given at this inspection must be achieved within the timescales stated to avoid enforcement action. 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.V364174.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Peter Shore Court DS0000052366.V364174.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4, 5, 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 for potential and existing residents of the home about the service. People’s needs and suitability for placement are identified prior to their admission. Individuals would benefit from a more person-centred approach to the service. EVIDENCE: A Statement of Purpose and Service Users Guide is available in the home. They are satisfactory, except that the Statement of Purpose has the old contact details for CSCI and needs to be updated and the Service Users Guide does not contain any details for the CSCI should people wish to complain. Peter Shore Court DS0000052366.V364174.R01.S.doc Version 5.2 Page 10 Contracts were not assessed at this inspection. Pre-admission assessments are completed prior to people moving in. The new manager has completed two since she took up her post in March this year, including an individual assessed as needing support with transfers using a hoist. The manager also informed that she has considered other assessments for prospective resident, considering them to be unsuitable due to their high levels of need and therefore did not undertake pre-admission assessments for them. Preadmission assessments were available in files examined. Staffing levels are based on the total overall dependency level scores in the home. Evidence was obtained during verbal feedback from people living in the home, staff interviews and records that people have the opportunity to visit the home and stay overnight if they wish prior to moving in. It has been observed at this inspection that individuals would benefit from living in a home that has a more person-centred approach to the service, as highlighted under Health and Personal Care and Staffing. People’s diversity needs are considered as part of their assessments and care plans, however it was noted that more consideration could be given as to how well these are identified, recorded and accommodated in individual files. Peter Shore Court DS0000052366.V364174.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7-10 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The personal care needs and dignity of people in the home are compromised by the inadequate deployment or insufficient numbers of staff. Care plans need more development and to evidence consultation with individuals. Care plan reviews need to be more detailed to adequately monitor individuals’ progress. The monitoring of individuals’ health needs must be linked to the outcome of risk assessments related to their health. Medication practises are improving in the home. EVIDENCE: Requirements given to improve care plans at the last inspection were reviewed at this inspection. Files examined contain care plans as used by Excelcare which cover a range of areas under general headings. The quality and content Peter Shore Court DS0000052366.V364174.R01.S.doc Version 5.2 Page 12 of information contained in care plans was variable and not always clear on the overall action required to meet specific needs. The manager informed that she has made efforts since taking up her post to improve care plans, however they still require improvement. Three care plans were randomly selected. Only one individual had signed their care plan to indicate their agreement with it. Another care plan had no signature and the file of the other individual showed that a previous manager had sent a range of documents in 2006 to their family to sign or action, including the care plan confirmation sheet, (the form used to provide the signature of agreement), however there was no evidence of follow up action since that time. Monthly evaluations of care plans record statements such as ‘no changes; to continue as per care plan; needs remain the same; follow care plan…’ without variation or evidence of any real review in the twelve care plan areas identified by Excelcare in each of the individual files selected. The lack of detail and information recorded by staff gives the impression that monthly reviews are seen by staff as a paper exercise rather than a means of recording any real monitoring of individuals, their progress or changes in their areas of need. It is noted requirements to improve care plans have been given over several past inspections to Peter Shore Court. A requirement given at the last inspection for care plans to include a record of who has responsibility to manage individuals’ finances has not been met. It was not known in care plans seen or records available as to who has responsibility for managing the financial affairs of the individuals whose files were examined. Forms related to managing people’s money were either not in the files or left blank. There was no indication of people’s health care needs not being met at this inspection. It was evident in files seen that referrals had been made to appropriate health care professionals, including consultant psychiatrists for the Mental Health Care of Older People Team. Assessments were available in files seen related to peoples’ physical and mental health needs. Files still lacked signed confirmation statements from individuals giving their agreement for assistance with medication administration, as identified at the last inspection. An anonymously given comment received in a survey by a staff member alleged that people who are wheelchair bound have been woken up at 5am to have personal care and left in the lounge all day. It was not possible to investigate any specific incidents of this kind without specific details of individuals this could relate to. Peter Shore Court DS0000052366.V364174.R01.S.doc Version 5.2 Page 13 However the manager stated that she had made an anonymous spot check of the night shift at 4am and found that all individuals were asleep in all the units, other than those requesting assistance to use the toilet. Risk assessments were seen in files examined. The moving and handling risk assessment form requires a level of clinical knowledge and understanding to be completed, for example, scores must be given for spasm, low haemoglobin and so on. Neither the staff nor the manager have or are required to have this knowledge. The inspector was informed that these forms are generically used across nursing homes which are run by Excelcare. There is no apparent way of having a total moving and handling score rating. These forms are not considered to be well suited in a residential setting. The nutritional risk assessment form for one individual showed that they needed to have their weight monitored on a monthly basis, however records showed that their weight was last monitored on 28/02/08. This had not been picked up in any audit. A requirement is given to ensure that directions for monitoring individual health needs identified in assessment tools are adhered to. The Waterlow chart identifies an individual as being at very high risk of developing pressure sores due to being wheelchair bound and her medical condition. Whilst the care plan states that a separate plan should be compiled if a pressure sore develops there is poor description of action required to prevent a pressure sore from developing. A complaint made anonymously to the CSCI prior to this inspection alleged that staff have been unsafely lifting people who are twice the weight of carers. The manager informed that this related to an individual who had been assessed as being appropriate for residential care and needing hoisting. The manager had provided staff with training on the use of a hoist including to those staff who would need to use the hoist for this individual. The manager informed that despite this training, staff still lacked confidence in using the hoist and needed more support about using the equipment which was then given. There was therefore no evidence available at this inspection to substantiate this complaint. The complaint also alleged that there had been an increase of falls and accidents which were not all recorded. The manager informed that two people had been referred to the falls clinic for further assessment, and that staff needed more guidance to improve the recording of incidents, accidents, complaints and events. These are currently being entered in communication sheets but not in the appropriate forms designed for proper reporting and monitoring purposes. It was not possible to further examine any account of falls or relevant records about the individual referred to in the complaint without knowing the identify of the individual. Peter Shore Court DS0000052366.V364174.R01.S.doc Version 5.2 Page 14 It is recommended that record any incidents or accidents using the forms designed for this purpose as according to the homes reporting policies and procedures, in order to improve recording for data collection, case monitoring and audit purposes. Medication records checked against the home’s Medication Administration Record (MAR chart) showed that generally good records of administration were being kept. However one cream which had been discontinued should have been removed from the MAR chart. Staff must ensure that MAR charts accurately reflect medicines currently prescribed to individuals. Staff confirmed they receive medication training. The manager informed she had changed the pharmacist due to her dissatisfaction with the records and organisation of the previous pharmacy supplier. The manager has also written to all the GPS to request specific instructions on medicines previously prescribed as needing administration ‘as required.’ The manager has now taken on the responsibility of ordering all medication and is keen to ensure improved medication practises. Controlled Drugs are stored in a Controlled Drugs cabinet and the temperatures of the room and fridge where medication is stored are taken daily by staff. End of Life wishes were seen recorded in the individual’s ‘Assessment and Carers’ Guide.’ Death dying wishes had been recorded in one individual’s file, stating they wished her family to make the arrangements, however this was not signed by the individual or their family. Variable responses were received about the standard of service in surveys received from individuals living in the home and from their relatives. Responses were given as “always” “usually” and “sometimes” to a range of questions asked about the support given in the home. An individual we spoke to in the home said that her privacy is respected, for example, if she is called to receive a phone call in the office she is always left alone in the office until the call is ended. On the day of inspection we were concerned to observe the following: 1 One individual whose glass was empty was not offered or given a refill. This individual was observed to struggle to break the pie up into suitably sized pieces before putting it into his mouth. At one point he put in an extremely large chunk, and was observed to cough this up. This individual was sat at the far end of the dining room, with the most distance between him and the care worker. He was sat with his back to the care worker. The individual was not supported or observed at all whilst eating his dessert. We subsequently sampled his personal file which contained an assessment by Peter Shore Court DS0000052366.V364174.R01.S.doc Version 5.2 Page 15 the home dated November 2007 in which it was recorded that “this person overloads mouth….has to be supervised”. We spoke with a regular care worker on unit 3 who advised of their understanding that food should be cut into small pieces prior to it being served and that the individual should be observed whilst eating. 2. Another individual rose from the dining table and said “ I need the toilet” several times, they were told to wait, as the care worker was assisting another resident to transfer from the dining area to the lounge area. During this transfer this individual was observed to leave the communal area by themselves. 3. Soon after one of the domestics returned the individual to the dining area saying that she had found the individual in the corridor removing their underclothes as if preparing to use the toilet. The individual was left standing in the middle of the dining area whilst the care assistant continued to assist the other resident with their transfer. The individual then lifted up their dress and started to remove their undergarments. The care worker ran across the room to stop the individual. The care worker then accompanied the individual to the toilet and settled them on to the lavatory. 4. We relocated to the corridor several minutes later and could hear the same individual calling for assistance, it was several minutes before the care worker responded. Information available to us through the inspection combined with observations made on the day evidenced that the needs of people living in the home are compromised by inadequate staffing arrangements. On the day of inspection the service could not demonstrate good practice. Neither could the service demonstrate, through records and systems available that the service was of exceptional quality on the day of inspection and was not representative of the quality of service provision overall. As a result of our concerns on the day we could reasonably assume that there are generally increased risks to the safety and wellbeing of the people at Peter Shore Court. Peter Shore Court DS0000052366.V364174.R01.S.doc Version 5.2 Page 16 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 adequate This judgement has been made using available evidence including a visit to this service. Whilst social activities are provided in the home, more opportunities are needed for individuals to access social and leisure activities of their choice and within the community. The home needs to provide better evidence of the extent to which individuals’ engage in activities in order to gage the quality of life they experience in the home. EVIDENCE: The home has introduced SONAS therapy which is a group activity for people with dementia using the five senses. The manager stated that this began two weeks ago. An activities rota is displayed in the foyer with activities such as exercise to music, board games and arts and crafts. Once a month a different Peter Shore Court DS0000052366.V364174.R01.S.doc Version 5.2 Page 17 entertainer/musician visits the home for a sing a long in the lounge, and refreshments are also provided. One individual commented in the pre-inspection survey “four days a week we have bingo, cards or games, we also have live entertainment and birthday parties.” One individual attends a Jewish day centre. The rota for that day identified that religious music or visiting ministers would be available in the lounge however there was no evidence of this occurring and a visiting dentist was using the lounge area during the appointed time. The rota identifies that residents will be supported to engage in outside activity each Saturday morning. However none of the staff or residents spoken to could recall this happening. In response to a question about what could improve in the home, one relative commented “maybe more on the social and recreation side of things. More attention to organising social events.” One resident commented that she hadn’t left the home since she had been admitted, and was desperate to visit the local park or do anything that involved leaving the home. The Service User Guide states that for those people who wish to go out the home can arrange trips to the seaside, to enjoy pub lunch to the local shops and also the zoo. However the manager acknowledged this has not happened since she came into post and did not know whether trips out had occurred before she came. The activities coordinator works four days a week. We were told that the activities coordinator has now signed everyone up for Dial-A-Ride. Individuals in the home would benefit from more opportunities to engage in suitable and adequate activities of their choice, including in the local and wider community. The organisation must provide sufficient resources to make these opportunities available to people, including to ensure that adequate staffing arrangements in place. At the last inspection, the recording of social activities was identified as being inadequate in individual files and a recommendation was given for this to improve. There has been no change and no improvement in the quality of recording at this inspection. The previous report states that records provided, “little information about the residents’ involvement in activities and whether or not they find them stimulating. These shortfalls present with some difficultly in monitoring the engagement of individual residents in 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. Peter Shore Court DS0000052366.V364174.R01.S.doc Version 5.2 Page 18 It is clear that there needs to be a shift in the culture and practises of the home which actively promotes the engagement of individuals in activities of their choice. Records of activities to assist in evidencing this should reflect the extent to which people are consulted, supported and engaged in their activities for the purpose of individual care planning, service development and to ensure that positive outcomes are experienced by individuals in the home. Staff training and support including supervision, performance management and improved management audits are needed to ensure improved records. People maintain family contact as evident when we spoke with family members visiting the home. Other individuals also confirmed that their relatives visit and family contact is recorded in individual files and the visitors’ book. A range of views have been expressed about the meals. Comments from residents received in surveys include “I think the meals are excellent” and a tick of “sometimes” to the question “Do you like the meals at the home.” Comments from the residents meeting also said that the food “had gone down” and was “cold” by the time it was transported from the kitchen to the units. People eating their lunch at the time of the inspection indicated that they enjoyed their meal. The Service Users Guide states that the home has the facility to provide individual dietary requirements to meet any specific medical, religious or cultural needs. People are consulted about their meals and a variety of meals are served as shown in the menus displayed on the units. A four week menu is displayed, and this includes a choice of two main courses and vegetables. The menu appeared varied and nutritious and was reflective of the cultural backgrounds of people who use the service. One West Indian person who predominately likes British food also likes salt fish and rice and peas which is catered for when they request it. The manager informed that she has spoken with the cook to provide more variation in the meals in colour and texture, for example, to vary deserts from tapioca and rice pudding. A vegetarian menu has also been introduced, however we noted that ham sandwiches and roast turkey were included in it. People on the day of inspection commented that they liked their meals. A notice was observed displayed on one unit about an individual with her name underlined on the notice listing her preferred choice of meals. The individual no longer lived at the unit, however the inappropriateness of this publicly displayed notice about a matter that is private to the individual was stressed. Peter Shore Court DS0000052366.V364174.R01.S.doc Version 5.2 Page 19 The manager stated that she was aware of the need to take down clutter and several notices around the home. Individuals’ are encouraged to exercise their legal rights. One individual confirmed that she had recently completed a voting form however she had chosen to abstain from voting. However the extent to which individuals can exercise control over their own lives is severely limited by the lack of choice in their day time occupation and insufficient staff to support them with their daily needs. Individual’s finances are managed by their placing authorities, their families or by the service which acts as appointees. A random sample of petty cash balances held by the home were checked and tallied with accounts recorded. Peter Shore Court DS0000052366.V364174.R01.S.doc Version 5.2 Page 20 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 adequate This judgement has been made using available evidence including a visit to this service. Individuals cannot be certain that their complaints will be appropriately listened to and dealt with by all staff. The service is unable to effectively gage the level of satisfaction in the home or to monitor and take necessary action to improve and develop the service. EVIDENCE: We observed that three complaints had been recorded in the complaints book since the last inspection and that they had been appropriately investigated. However we also observed that staff do not record all complaints received in the complaints book: Examination of one individual file showed an incorrect use of the home’s Behavioural Assessment Sheet. This is a form used to identify antecedents to the behaviour of an individual and the consequences of their behaviour. However a member of staff had used the form to record a complaint of an allegation of theft made by one resident against another living in the home. Peter Shore Court DS0000052366.V364174.R01.S.doc Version 5.2 Page 21 This had not been recorded in the complaints book nor evidence of any appropriate investigation. One individual complained that her clothes go missing and that she has made numerous complaints about the service but that nothing has happened. Her file showed no record of any complaints and no complaints recorded in the complaints book. It is evident that the home is unable to demonstrate any accurate reflection of the actual complaints received in the home, making it difficult to gage the level of satisfaction in the service or to monitor and take necessary action to improve and develop the service. The service must ensure that staff appropriately record complaints using the home’s complaints procedure. Another individual we spoke to informed she had made several complaints, however these had not been recorded in the complaints book nor in records of her individual file. A staff member made an anonymous complaint to the Commission regarding issues of staff numbers, individual needs of people in the home and the management of the organisation. This was investigated by the senior management of the service and communicated to the CSCI. Where relevant to minimum standards and regulations the issues raised in the complaint were examined for any evidence during this key inspection and incorporated into the report and overall outcome of this inspection. The manager was asked about the safeguarding incidents recorded in the homes’ recent AQAA before she took up her position in March, but she expressed no knowledge about them and was not able to refer to any records of these. Staff spoken to were able to identify that ‘safeguarding adults’ and POVA related to protecting residents from abuse, and each was able to identify several types of abuse. Each was able to identify their responsibilities if they suspected abuse. However when only the Tower Hamlets policy and procedure was seen on the office shelf, staff spoken to were not aware of whether the home has a separate policy on safeguarding in the home. This must be addressed by the home to ensure that all staff are aware of internal procedures for dealing with abuse. Peter Shore Court DS0000052366.V364174.R01.S.doc Version 5.2 Page 22 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 people living in the home which is pleasant, comfortable and better maintained. Individuals who have improved gardens to enjoy sitting outdoors if they wish. Maintenance of the environment has improved. EVIDENCE: Peter Shore Court is a two-storey purpose built building designed to meet the needs of individuals in the home. We toured the premises and the home was generally in good order, however the following were observed: Peter Shore Court DS0000052366.V364174.R01.S.doc Version 5.2 Page 23 • • • • • Missing carpet tread on the stairs which present a potential trip/slip hazard. A rusty shower seat that needs replacing in room 22 A broken leg on a nest of tables in the lounge of unit 2 A strong smell of urine in room 16 Use of the bathroom in units 2 and 3 for the storage of equipment. Soiled soft furnishings and clothing items had also been discarded in this area. The bath was badly stained with limescale and the tap was dripping. In unit 3 a soiled incontinence pad had been discarded in the toilet. • These repair/maintenance and domestic issues must be addressed. The home was bright and well ventilated. There were pictures and photographs on the walls throughout the home. Individuals had been given opportunities to personalise their room, and some had bought in some of their own furniture, pictures and momentos. There are aids and adaptations throughout the home, including wheelchairs, hoists and lifts suitable for disabled persons and pressure relieving mattresses, where individuals have been assessed by occupational therapists. 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 used to provide entertainment for all the individuals in the home. The garden at the back now has large containers filled with flowers and seating for people to enjoy an outdoor space if they wish and another garden around the side of the building has also been further improved. The manager informed that maintenance has been improving as she has become firm with the maintenance contractor to ensure that outstanding jobs get done. Peter Shore Court DS0000052366.V364174.R01.S.doc Version 5.2 Page 24 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 poor This judgement has been made using available evidence including a visit to this service. Staffing arrangements are inadequate to appropriately and safely meet the identified needs of people who use the service. Staff interaction and engagement with individuals needs to be more person-centred. Good recruitment procedures are in place to ensure that individuals are safeguarded by suitably employed staff. There is more emphasis on staff training. EVIDENCE: The manager informed that there are currently 33 care staff in total to 38 individuals living in the home. A requirement given at the last inspection for the service to review its staffing levels in the home to ensure that people’s needs are met. The anonymous staff complaint received prior to this inspection referred to insufficient and unsafe staffing levels. At this inspection we were showed that staffing levels had been formally reviewed using a guidance tool from the National Care Forum used to calculate staffing hours against the assessed dependency levels of people living in the home. Peter Shore Court DS0000052366.V364174.R01.S.doc Version 5.2 Page 25 On the day of inspection, in the afternoon (from 2pm onwards) four care workers and one senior care assistant were on shift. The manager left at 3 pm, one resident had returned from their day centre and one individual had a GP appointment in the afternoon. They were accompanied by one care worker, leaving three care staff and the senior to cover the four units and 37 residents. During the period when we were interviewing staff or the senior was assisting us, one unit was left unstaffed, as there were only three care workers available to cover the four units. Staff spoken to on the day of the inspection advised that this level of cover was not unusual. Minutes from a recent residents meeting included comments from people who use the service that they did not see the night staff and were worried about who would help them if they had a fall at night. Staff have complained anonymously to the CSCI about their concern regarding insufficient staffing leading to unsafe care practises. We spoke with four staff on the day of inspection. Shortage of staff was identified as a real difficulty by all. Two identified this as a long-term problem since Excelcare took over the home. One individual spoken to who also completed a survey informed that staff are always available and was very complimentary about staff saying they were always friendly and willing to help. Another ticked that staff were “never” around when they needed them and “usually” by another individual. One individual spoken to said she did not like the home, adding, “ there are never enough staff and you never see the same staff.” Staff interaction with individuals was observed to be task-based focusing on care needs rather than demonstrating individual person-centred engagement. Based on our stated observations and the overall evidence available to us, we strongly concluded that, on the day of inspection, there was insufficient staffing to appropriately and safely meet the identified needs of people who use the service. Supervision notes with one senior on duty for April 2008 noted that the manager had mentioned her concerns that individuals who require two care staff were actually being attended to by a single staff member. Staff training is an area of improvement in the home as the manager informed that apon starting her post she had discovered that staff had received little supervision or training. Peter Shore Court DS0000052366.V364174.R01.S.doc Version 5.2 Page 26 Randomly selected staff files examined showed that all sought documents required were available to evidence that the home follows good recruitment procedures, including ID for prospective employees, references, health checks and CRB checks. All of the CRB’s were obtained by Excelcare, however some were more that four years out of date. The administrative worker told us that new CRB’s were in the process of being obtained. The office wall has displayed a range of training for staff to attend and the list of names of staff to attend them. The majority of staff have NVQ Level 2 and are working towards gaining NVQ Level 3. Staff receive induction following the Skills for Care induction programme. The manager is in the process of improving how staff training and development files are organised. A list of core training courses seen displayed on the wall included the names of all staff enlisted to attend training. The manager has sought to make improvements in how staff organise themselves, for example, informing their senior when going on a break to ensure their position is covered. Staffing and management issues have been identified over previous inspections. At the last inspection a recommendation was given to ensure that unresolved staffing issues are addressed in order to ensure there is no adverse impact on the delivery of service. Evidence available prior to and during the inspection showed that staffing issues remain and do impact on the quality of service provision. There remains high levels of sickness and absence among staff, leading to increased use of agency staff which still impact on the consistency of service experienced by people living in the home. The lack of continuity in staffing was also reported to us by an individual and their family during the inspection. Staff surveys received prior to the inspection specify a high level of dissatisfaction with the service delivery and management of the service where staff report being unsupported and not listened to. The service has been affected by the lack of management consistency due to the many changes in management in the home. Relations have continued to be strained between management and some staff members in the home. The new manager has identified that consistency in service is important for people using the service and has changed the rota to ensure that staff are assigned to the same floor and units over several months rather than to work across units. The benefit of this change may take some time to become apparent. Peter Shore Court DS0000052366.V364174.R01.S.doc Version 5.2 Page 27 Staffing issues remain an ongoing challenge and urgent issue for action to be taken by the leadership and senior management of the organisation and must be positively addressed. CSCI will consider the effects of poor relations in terms of its impact on service delivery, effect on any individual living in the home, the quality of service under minimum standards and compliance with regulations. Peter Shore Court DS0000052366.V364174.R01.S.doc Version 5.2 Page 28 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. Whilst there has been some improvement in staff supervision, staff supervision and support has been inadequate overall affecting the ability of staff to carry out their duties more effectively. The management and organisation of the service have been unable to raise standards thus far affecting the overall quality of service provision experienced by individuals in the home. Health and safety practises are generally well observed. EVIDENCE: Peter Shore Court DS0000052366.V364174.R01.S.doc Version 5.2 Page 29 The present manager has worked in the care sector for nine years and is an experienced manager. She took up her position in March this year and has applied to become the Registered Manager. This inspection acknowledges that the new manager has made several changes in the home intended to improve the service and to address some of the issues included in this report. This is a challenge against resentment and resistance to changes from staff, seen also in the pre-inspection surveys. Staff in the home have complained twice to the CSCI about new management practises in the home and their dissatisfaction with Excelcare. Issues relevant to this inspection have been examined and incorporated into this report. Other matters concerning communication and individual staff support needs are predominately matters to be resolved internally between staff and the management at Excelcare. It remains clear however that difficulties with management and staffing remain and there is a clear need for positive intervention. It is hoped that changes being introduced will improve the service in the short and long term, though these cannot be anticipated ahead of time and the effect of these changes will be assessed at the next inspection. At the last inspection it was identified that more effective management is needed by any staff with supervisory responsibilities, including all senior staff, staff to ensure that the care staff they support, supervise and monitor fully meet their roles and responsibilities. Inadequate records completed by carers in individual residents’ files; inadequate auditing of carers’ work, delegated to seniors and the ongoing lack of supervision of care staff by seniors demonstrates that supervision, staff support and performance management also continues to be inadequate and affecting the quality of service. In this type of environment it is difficult to be confident that individuals’ assessed needs are being met and that standards of service are being consistently maintained. Whilst it is acknowledged that a programme of supervision and training is now underway, the requirement to ensure that all staff receive regular supervision made at the last inspection is restated at this inspection. Failure to ensure that all staff are regularly and appropriately supervised is likely to result in enforcement action being taken. As referred to in Health and personal Care, it was unclear as to who held the responsibility for managing the finances of individuals whose files we examined. Health and safety records examined were satisfactory and documents and certificates of safety required to be kept by the home, as recorded in the Peter Shore Court DS0000052366.V364174.R01.S.doc Version 5.2 Page 30 homes’ AQAA were in-date, showing that good health and safety practises are being observed. Management action must focus on the shortfalls identified throughout this report to raise standards and to improve the quality of life experienced by people living in the home. In addition to the staffing issues already raised, a key area for improvement in the home is in the quality monitoring and auditing of all the records and documents as completed by carers. Management auditing of work has been ineffective in identifying poor recording practices including the inappropriate use of recording tools that has consequently resulted in a lack of effective action to meet identified needs. The organisation must focus on delivering its service from a more personcentred approach overall. The quality of engagement and interaction of staff with individuals is a key factor and the social and leisure opportunities made available to people must be considered. Staff must be sufficiently skilled, trained and supported to respond to individual needs and individuals in the home need to be confident that the service is sufficiently resourced, organised and managed to serve their best interests. Peter Shore Court DS0000052366.V364174.R01.S.doc Version 5.2 Page 31 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 x 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 1 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 2 18 2 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 1 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 1 3 1 2 1 3 Peter Shore Court DS0000052366.V364174.R01.S.doc Version 5.2 Page 32 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 OP7 Regulation 15 Requirement 1. 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. The timescale of 31/01/08 has not been met. Ensure that individual health monitoring charts are recorded in line with the level of monitoring identified in their risk assessments. Ensure there are improved pressure sore prevention plans detailed in files. Staff must ensure that MAR charts accurately reflect medicines currently prescribed to individuals. Ensure that staff are sufficient in numbers to enable individuals to engage in local, social and community activities of their choice. Ensure that all complaints appropriately recorded and DS0000052366.V364174.R01.S.doc Timescale for action 11/10/08 2. 2. OP8 OP9 12(1) 13(2) 11/10/08 11/10/08 3. OP12 16(m) 11/10/08 4. OP16 22 11/10/08 Peter Shore Court Version 5.2 Page 33 5. 6. OP19 OP27 23 18(1)(a) 7. OP36 18(2) investigated using the home’s complaints procedure. Ensure all the maintenance and repair issues highlighted in this report are addressed. Ensure that staffing levels are adequate in numbers and in their deployment to meet the assessed needs of all individuals in the home. Ensure all staff receive regular supervision. The timescale of 31/01/08 has not been met. Ensure a more robust management monitoring and auditing system of records and files. This is to ensure that shortfalls in the quality of records in care plans, care plan reviews, risk assessments, individual and social activity records, complaints and incidents records and medication records and practices are identified and effectively addressed. Ensure the home identifies who has responsibility for managing individuals’ finances. The timescale of 31/01/08 has not been met. 11/10/08 11/10/08 11/10/08 8. OP33 24(1) 11/10/08 9. OP35 15 11/10/08 Peter Shore Court DS0000052366.V364174.R01.S.doc Version 5.2 Page 34 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 OP1 Good Practice Recommendations The new contact details for CSCI in Statement of Purpose needs to be updated. The Service Users Guide needs also to contain the contact details for the CSCI should people wish to complain. The home should strive to develop a more person-centred approach in all aspects of its service and throughout all engagement between staff and individuals in the home. 1. Provide more recorded detail in monthly monitoring evaluations linking and reviewing the progress of individuals with their identified care plan needs. 2. Implement an improved moving and handling risk assessment form that is more suitable for use in a residential home environment. Ensure all residents or their representatives provide a signed statement to evidence their consent to receive assistance with medication administration. Improve the quality of recording individual social activities to ensure that records contain more detail about individual engagement with activities. Staff to record any incidents or accidents as according to the homes reporting policies and procedures, using the forms designed for this purpose, in order to improve recording for data collection, case monitoring and audit purposes. Ensure that individuals or their representatives, if more appropriate, sign to confirm their death/dying wishes in documents recording their views. Record outcomes to suggestions or issues raised at residents and relatives meetings. Ensure that staff training records are updated and easily accessible. Ensure appropriate action is taken to effectively address unresolved staffing issues to ensure there is no adverse DS0000052366.V364174.R01.S.doc Version 5.2 Page 35 2 3. OP4 OP7 3. 4. 5. OP9 OP12 OP17 6. 7. 8. 9. OP11 OP14 OP30 OP32 Peter Shore Court impact on the delivery of service. Peter Shore Court DS0000052366.V364174.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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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