Inspection on 25/04/05 for Peter Shore Court

This inspection was carried out on 25th April 2005.

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

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

Other inspections for this house

Peter Shore Court 19/05/08

Peter Shore Court 15/11/07

Peter Shore Court 26/04/06

Peter Shore Court 10/10/05

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 Peter Shore Court Beaumont Square London E1 4NA Lead Inspector Nurcan Culleton Unannounced Inspection 27th April 2005 at 11.30am 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 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 G57 G06 S52366 Peter Shore Court V222942 270405 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Peter Shore Court Address Beaumont Square, Stepney, London, E1 4NA Telephone number Fax number Email 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 sam.dunn@excelcareholdings.com Excelcare Holdings Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41) of places Peter Shore Court G57 G06 S52366 Peter Shore Court V222942 270405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 30th October 2005 Brief Description of the Service: Peter Shore Court is a purpose built residential home for older people. It is registered to provide personal care, support and accommodation for a total of 41 service users. The home is situated in Stepney Green, within walking distance of local shops, amenities and transport links. The premises consist of four separate units, located on two floors. The home has lift facilities and aids and is suitable for people with disabilities. Excelcare Ltd is the registered private sector provider which manages the home. Peter Shore Court G57 G06 S52366 Peter Shore Court V222942 270405 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 27th April 2005. The Acting Manager and Regional Operations Manager were present during the inspection. The inspector examined documentation relevant requirements made at the at the last inspection. The inspector also toured the premises and interviewed staff and service users. The inspector examined key aspects of the service where requirements were given at the last inspection. The inspector found that many of these issues raised at the last inspecction still require improvement in the home. These requirements have been restated in this report and require urgent attention. Staff spoken to inform that staffing numbers are insufficient to meet the demands of service users needs and of working conditions being pressurised and stressful as a result. Staff morale appeared generally to be low. The inspector observed wholesome, nutritious food being served to service users on the day of inspection, however staff and service users gave varying reports about the food. Requirements are restated concerning the Statement of Needs, Service User Guide, care plans and social activities. A new requirement is given concerning medication and poor recording practises. Reassessments are needed for service users whose needs have increased who require higher levels of staffing and resources in the home. Issues raised in the report have a direct impact on the quality of care received by service users living in the home. The home is required to comply with all the restated requirements. Most of the issues raised in the report were discussed in a meeting with managers of the home in October 2004. Progress must now be made on all outstanding matters if enforcement action is to be avoided. What the service does well: The service users informed the inspector that they were treated well by the staff in the home. The home was clean and free of odours. Family contact and visitors are encouraged. Social activities have begun in the home. The home ensures access to health care services. Peter Shore Court G57 G06 S52366 Peter Shore Court V222942 270405 Stage 4.doc Version 1.20 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Peter Shore Court G57 G06 S52366 Peter Shore Court V222942 270405 Stage 4.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection Peter Shore Court G57 G06 S52366 Peter Shore Court V222942 270405 Stage 4.doc Version 1.20 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 4, 5 Reassessments are needed when service users’ needs change or increase in order to ensure that their needs can continue to be met by the home. Service users and their relatives are given a copy of the home’s Statement of Purpose and Service User Guide providing information about the home, though these documents need to be updated. EVIDENCE: Care staff and the managers informed that one service user, whose needs had increased whilst in hospital, had been discharged inappropriately, putting pressure on the staff team to meet the service user’s increased needs. This, according to the managers, occurred following pressure exerted from the hospital on a senior care assistant in the home. Requirements were given at the last inspection concerning the Statement of Purpose and Service User Guides. The inspector examined these documents and found they contained most of the information required. However some updates are required including the change of inspector for complaints and staff numbers. These documents must be kept under review. This ensures that accurate information about the home, terms and conditions and their rights, Peter Shore Court G57 G06 S52366 Peter Shore Court V222942 270405 Stage 4.doc Version 1.20 Page 9 are available at all times to prospective and existing service users or interested parties. Documents seen confirmed that relatives were able to visit to assess the quality of care and suitability of the home for the service users. Minutes of relatives meetings seen indicated that relatives were satisfied with the delivery of care in the home. Service users interviewed confirmed that relatives were able to visit regularly. Peter Shore Court G57 G06 S52366 Peter Shore Court V222942 270405 Stage 4.doc Version 1.20 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10, 11 Care plans are in place for all service users, however they still require further development and must include all identified needs. Medication recording practises are generally observed, however recording procedures must be robust in order to evidence the safe administration of medicines in all cases. Service users are treated with dignity and respect by staff. EVIDENCE: A requirement was given at the last inspection to improve care plans. The care plans seen by the inspector did not contain such specialised medical and nursing language as identified at the previous inspection and were therefore clearer and simplified. The Regional Development Officer cited the managerial changes and her other commitments within the organisation which had led to a delay in revising the care plans. She informed that she was responsible for developing the care plans together with the new Head of Care (for the London region) who came into post only last week. Risk assessments seen by the inspector for some service users clearly recorded needs, for example fire risk behaviour and aggressive behaviour, with actions required as a result. These were not contained in the care plans. Care plans Peter Shore Court G57 G06 S52366 Peter Shore Court V222942 270405 Stage 4.doc Version 1.20 Page 11 must be updated to incorporate any additional needs identified in risk assessments and must be kept under review. The medication MAR sheets seen showed gaps in signatures by staff where signatures are required to evidence the administration of medicines. Service users commented that on the whole, they were treated with dignity and respect by staff. A policy on death and dying for service users still needs to be developed. Peter Shore Court G57 G06 S52366 Peter Shore Court V222942 270405 Stage 4.doc Version 1.20 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15 Progress has been made concerning social activities within the home. However these activities are limited and may exclude service users who do not show interest or are unable to engage with the activities. Wholesome, nutritious food was observed to be given to service users, however conflicting views given concerning service users’ satisfaction with food. EVIDENCE: Requirements were given at the last inspection concerning social activities inside and outside of the home and as regards food. An activities co-ordinator is in post and was observed by the inspector during the inspection to undertake reminiscence activities with service users. Activities such as board games, painting, dominos, bingo are undertaken. The managers informed that a day out was being planned with Pat Shaw House care home and that service users receive some entertainers within the home. The inspector did not observe much engagement in local and community events by service users, apart from visits to church. This is an area requiring further development to include a broader range of entertainments within the home and more engagement of service users in local and community events. Service users spoken to gave varying comments about their like or dislike of the food and of the quantity received. The inspector viewed written information Peter Shore Court G57 G06 S52366 Peter Shore Court V222942 270405 Stage 4.doc Version 1.20 Page 13 provided by staff on duty stating service users’ like or dislike of food following meals received, which on the whole showed satisfaction with the meals. However the staff team advised the inspector that on occasions, food was not given in sufficient quantities for service users and that particular requests by service users could not always be met due to the need to stick within a budget, as seen by the chef. One service user informed that she bought cheese and biscuits with her personal allowance as the food was not always sufficient. However inaccuracies were found in some accounts given by service users who suffered from dementia. The Regional Operations Manager informed that service users were consulted about their food choices and that the budget did not affect individual requests for food. The inspector saw no evidence of fruit around the units, though fruit was incorporated into the menu. The menu provided a choice of meals. The managers of the home must demonstrate that service users’ views regarding food and drink are taken into account and be able to clearly evidence any individual food and drink requests with the provision of those items. Peter Shore Court G57 G06 S52366 Peter Shore Court V222942 270405 Stage 4.doc Version 1.20 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 Service users and staff are not protected by a sufficiently robust complaints procedure. EVIDENCE: The inspector viewed the complaints book. One complaint had been logged in November 2004 since the last inspection with the complainants name, however no further information was detailed. The two complaints procedures in the home, one ‘official’ and one for the service users, must be amalgamated to include details of the CSCI. Service users expressed a lack of knowledge to the inspector as to how to complain. Staff were aware of how to complain, however staff collectively expressed dissatisfaction and apathy with the process of complaining, stating that in their view, issues raised were not dealt with by the management team. The managers were unable to evidence that complaints are encouraged or taken on board when made. The acting manager must ensure that service users and staff are encouraged to complain and that these complaints are recorded. All complaints must be investigated, in particular, whether the complaint was substantiated, fully, partly or not with the outcome noted. The acting manager must evidence that there is an effective system for hearing and responding to any issues and concerns raised by staff and service users before they develop into formal complaints. Peter Shore Court G57 G06 S52366 Peter Shore Court V222942 270405 Stage 4.doc Version 1.20 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 25, 26 Whilst the environment is generally clean, pleasant and kept to a good standard, bathroom facilities appear to be inadequate for some service users at the time of the inspection. EVIDENCE: The home was generally clean, well lit, free of odours, with evidence of some personalised items in bedrooms. Staff expressed concern that service users needs could not always be met, for example, a service users with increased needs following discharge from hospital having to share one hoist in the bathroom. The managers informed that this service user had been discharged inappropriately from hospital following pressure exerted on a senior care assistant in the home. The managers reported that service users needs were currently being reassessed between the home and Social Services. The acting manager must ensure that the home’s facilities are adequate to meet service users’ needs at all times. Peter Shore Court G57 G06 S52366 Peter Shore Court V222942 270405 Stage 4.doc Version 1.20 Page 16 A previous requirement to purchase garden furniture was met as new furniture had been purchased for the garden. Carpets in some areas of the home had been cleaned, however some rooms still required further cleaning. Some service users needs have increased. Peter Shore Court G57 G06 S52366 Peter Shore Court V222942 270405 Stage 4.doc Version 1.20 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 The home is unable to evidence that service users needs are met by a sufficient number of staff. Staff receive supervision and training. EVIDENCE: Staff reported being stretched and understaffed, citing the lack of sufficient care staff on each of the four units, describing how staff numbers were very poor recently on one particular day. Staff also described how some of the service users whose needs had increased following hospital discharge had further stretched care staff and facilities in the home. The managers reported that social workers had been contacted to reassess the needs of the service users whose needs had increased. In contrast to the staff members, the managers advised that staff are brought in from the organisations other units when staffing is insufficient in the home. The issue about staffing is subject to further discussion in a meeting scheduled to take place shortly between the Regional Operations Manager and the Provider Relationship Manager at the CSCI. The managers informed that there had been operational difficulties in the use of internal ‘acting up’ seniors concerning the commitment of staff to this role when acting up is required. Service users informed the inspector that they thought the staff were on the whole caring however very busy and not always available. The managers must ensure that there are sufficient numbers of staff to meet the dependency levels of service users at all times. The staff rota must also be improved for management purposes and inspection. Peter Shore Court G57 G06 S52366 Peter Shore Court V222942 270405 Stage 4.doc Version 1.20 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 36, 37 There is a lack of positive leadership, guidance and direction to staff. Management practises do not promote and safeguard the health, safety and welfare of the people using the service. EVIDENCE: The inspector saw evidence of discussion in a team meeting with staff of the CSCI inspection report following the last inspection. Staff expressed a lack of confidence in the management team, particularly that their issues of concern would be not be responded to and acted apon. Staff members advised the inspector that they did not always highlight issues with the management team due to this perception. There is a need to work on team building and to improve the relationship between staff and the management team and possibly staff working conditions in order to improve staff morale. Through discussion with staff, it was evident that there were unresolved issues within the staff team concerning working practises and the relationship between staff and the management team. If not Peter Shore Court G57 G06 S52366 Peter Shore Court V222942 270405 Stage 4.doc Version 1.20 Page 19 tackled, these issues could become entrenched and may lead to resentment among staff, a deterioration of the status quo and potentially high levels of absence. This lack of cohesion and poor communication could have a detrimental effect on the delivery of care and may put service users at risk. The staff did however inform that they received training and supervision. Peter Shore Court G57 G06 S52366 Peter Shore Court V222942 270405 Stage 4.doc Version 1.20 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 2 x 1 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 1 10 3 11 1 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 1 COMPLAINTS AND PROTECTION 3 3 1 1 3 2 3 3 STAFFING Standard No Score 27 1 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 1 x x x 1 x x x 1 1 x Peter Shore Court G57 G06 S52366 Peter Shore Court V222942 270405 Stage 4.doc Version 1.20 Page 21 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4, 5 Requirement The Registered Person must ensure that the Statement of Purpose and Service User Guide is updated and accurate. The Registered Person must ensure that the assessment of service users needs is kept under review. The Registered Person must ensure that care plans are revised. They must include needs and actions identified in risk assessments. (Timescale of 15th March 2005 not met) The Registered Person must ensure there are no gaps in the medication MAR sheets at any time. The Registered Person must ensure that the home has a policy for meeting the needs of people who are dying. (Timescale of 31 Jan 2005 not met). The Registered Person must ensure that the opportunity for service users to engage in local and community events and a broader range of entertainments is further developed. The managers of the home must Timescale for action 10th Aug 2005 10th Aug 2005 10th Aug 2005 2. OP4 14(1), (2) 3. OP7 12(1),15 4. OP9 13(2) 10th Aug 2005 10th Aug 2005 5. OP11 12(1) 6. OP13 16(2)m 10th Aug 2005 7. OP15 12, 10th Aug Page 22 Peter Shore Court G57 G06 S52366 Peter Shore Court V222942 270405 Stage 4.doc Version 1.20 16(2)(i) 8. OP21 23(j) 9. OP26 23(2) 10. OP27 18(1)(a), 12 11. OP32 12,18, demonstrate further consultation with service users regarding food and drink and be able to clearly evidence the provision of any individual food and drink requests. The Registered Person must ensure that there are adequate bathroom facilities to meet service users needs. The Registered Person must ensure that carpets are maintained in a hygenic condition. (Timescale of 31st Dec 2005 not met). The Registered Person must ensure that there are sufficient numbers of staff to meet the needs of service users at all times. The Registered Person must take appropriate measures to improve communication and working practises between care staff and the management team. 2005 10th Aug 2005 10th Aug 2005 10th Aug 2005 10th Aug 2005 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 Good Practice Recommendations Peter Shore Court G57 G06 S52366 Peter Shore Court V222942 270405 Stage 4.doc Version 1.20 Page 23 Commission for Social Care Inspection 4th Floor, Gredley House 1-11 Broadway, Stratford London E15 4BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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