Inspection on 03/09/08 for Petteril House

This inspection was carried out on 3rd September 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

Petteril House 18/02/09

Petteril House 21/11/07

Petteril House 23/05/06

Petteril House 12/10/05

Petteril House 20/05/05

Petteril House 01/11/04

Petteril House 23/06/04

Petteril House 18/02/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 27/11/2008.

CARE HOMES FOR OLDER PEOPLE Petteril House Lightfoot Drive Harraby Carlisle Cumbria CA1 3BN Lead Inspector Marian Whittam Unannounced Inspection 3rd September 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Petteril House DS0000036543.V370763.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. Petteril House DS0000036543.V370763.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Petteril House Address Lightfoot Drive Harraby Carlisle Cumbria CA1 3BN 01228 606393 01228 606402 petteril.house@cumbriacc.gov.uk www.cumbriacare.org.uk Cumbria Care 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) Mrs Helen Harrison Care Home 38 Category(ies) of Dementia - over 65 years of age (17), Old age, registration, with number not falling within any other category (37) of places Petteril House DS0000036543.V370763.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The service must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. The home is registered for a maximum of 38 service users to include: up to 38 service users in the category of OP (older people not falling within any other category) up to 17 service users in the categroy of DE(E) (Dementia over 65 years of age) Two service users may share a bedroom of at least 16 sqm usable floor space only if they have made a positive choice to do so, when one of the shared spaces becomes vacant the remaining service user has the opportunity to choose not to share, by moving to a different room if necessary. 21st November 2007 3. Date of last inspection Brief Description of the Service: Petteril House is a residential care home registered with the Commission for Social Care Inspection to provide care and accommodation for up to thirtyeight people over 65. The home is owned by Cumbria County Council and run and managed by Cumbria Care. The home is located on the outskirts of Carlisle and is close to local shops and public transport routes. The property is a two storey building and is equipped with a passenger lift to assist residents to access accommodation on the first floor. Accommodation is provided in four living units, each with its own sitting and dining area and small kitchen. One living unit specialises in providing care to people with dementia. There are toilets and bathing facilities close to all accommodation provided for residents. The home is set in its own grounds and has car parking available at the front of the property. Fees charged to residents include care, accommodation, meals and laundry. Fees are charged weekly and currently range from £326.00 - £434.00 per week, depending on the level of care a resident requires. Residents pay separately for their own toiletries, newspapers and hairdressing. Information about the services provided and fees charged is included in the home’s statement of purpose and service users’ guide. Petteril House DS0000036543.V370763.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 stars. This means the people who use this service experience poor quality outcomes. This site visit that forms part of a key inspection carried out at Petteril House by two inspectors. We (The Commission For Social Care Inspection, CSCI) were in the home for a total of eight hours. We assessed the handling of medicines through inspection of relevant documents, storage and meeting with the manager Helen Harrison, other staff and residents. Information about the service was gathered in different ways: • An Annual Quality Assurance Assessment document completed by the manager, identifying what the service does well and what could be improved. • The service history. • Observations made by us in the home during the visit. • Completed questionnaire survey forms from people living in the home, staff working there and from health professionals coming into contact with the service. • Interviews with residents, visitors and staff on the day of the visit. We looked at care planning documentation, pre admission information and made a tour of the building to inspect the environmental standards. Staff recruitment and training files were also examined. What the service does well: The home provides a homely atmosphere and most people living there are able to bring in their own things from home such as pictures, ornaments and suitable items of furniture to make their rooms more homely and personal. We saw during the day that care staff appeared to have a good rapport with residents and their approaches to residents were friendly and informal. Staff are aware of people’s personal preferences and work hard to meet people’s needs. One person, who had lived there a long time, told us, “ This is the best home in the world”. There are robust recruitment procedures for staff and the thoroughness of pre employment checks helps to safeguard the welfare of people living in the home. Petteril House DS0000036543.V370763.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: We recommended for good practice that the manager review the service’s admission process to see if they can find ways to personalise admissions for people and promote their involvement in developing their own care plans. The service needs to look at ways to make the admission less process led and more resident led according to individual’s needs and circumstances. All people using the service must have a care plan in place, developed with them, that reflects their healthcare and personal needs. This will ensure that their needs are monitored and they receive care, treatment and advice promptly to meet changing needs. The manager should consider using protocols or care plans to inform staff on the use of ‘as required ‘drugs. This would help staff make sure that they are given only when residents need them and allow easier monitoring and identifying potential problems. It is recommended that individual’s mental health be consistently monitored and thorough nutritional and pressure area screening. We recommended that the manager does a regular formal audit of the care plans and medication practices and records to ensure they are accurate, complete and up to date. A complete record must be kept of all quantities of medicines received into the home for people so there is a complete audit trail and all medicines received can be accounted for. The administration of controlled medicines should also be recorded on medication administration records used by the service to minimise the risk of duplication or omission. Given the layout of the sluice and laundry areas we strongly recommend that the manager should carry out a risk assessment on the use of the sluicing Petteril House DS0000036543.V370763.R01.S.doc Version 5.2 Page 7 facilities adjoining to the laundry and when cleaning commode pots in proximity to the laundry area and find ways to minimise any cross infection risk for people living there. We found the doors to the sluice areas on both floors in the home unlocked and both rooms contained cleaning and disinfecting substances that could be harmful to people if ingested or inhaled. Any substances harmful to health must be kept safe and secure whilst being stored in accordance with the appropriate legislation. Items of equipment should not be stored where they limit people’s access to the home’s communal telephone and there should be seating for people using the telephone. We found a person who was in a bedroom that did not meet their physical needs. People must not be admitted into bedrooms that do meet their assessed needs and environmental standards and that are not suited to meeting their individual physical needs and lifestyle choices. People should also be accommodated in rooms that are of a sufficient size to allow them to bring in some of their own possessions or equipment to provide a more personal place for them and follow their lifestyle choices. The manager must always follow current guidance on safeguarding people and refer potential safeguarding issues to the appropriate agencies to investigate promptly in order to ensure people are protected and their concerns fully investigated. The manager should also make sure the complaints log is easily available for staff to use and for inspection by CSCI. Training records indicate that not all staff have had training on the Protection of Vulnerable Adults (POVA). We recommended that this be done so staff are all aware of their responsibilities and what actions to take to safeguard people. Where decisions are made about capacity to consent they should be fully recorded. Records need to be kept up to date and when stored should be done so securely. Training records should be kept up to date and clearly show what training is needed. Fire training needs to be brought up to date for a small number of staff. The manager must look at staffing provision and deployment on the elderly frail units in terms of delivering outcomes for people rather than rigid staff requirements and deploy staff in such numbers as appropriate to meet residents’ assessed individual needs safely. The manager should consider the ways they feedback any actions they take as a result of views expressed from any surveys and meetings so people can see what effect their views have had on the service. The manager has not acted to address requirements from the last inspection and we recommend that the manager needs to communicate a clear sense of direction to staff and managing change and workload. Petteril House DS0000036543.V370763.R01.S.doc Version 5.2 Page 8 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. Petteril House DS0000036543.V370763.R01.S.doc Version 5.2 Page 9 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 Petteril House DS0000036543.V370763.R01.S.doc Version 5.2 Page 10 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): NMS 1, 2, and 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is an assessment process in place for people coming to live in the home but assessments do not sufficiently describe individual’s needs and preferences. Adequate information about the service is available in the home. EVIDENCE: Information about this home and the services it provides is available in the Statement of Purpose/service user guide that is on display in the foyer of the home. The statement of purpose also includes comments from people living in the home. This is in a standard written format and has recently been updated by the organisation. A copy of the latest inspection report is also available for people to read. We asked people living there if they had a copy of the service information and those we spoke with did not have this. However resident’s survey responses indicated that they felt they had enough Petteril House DS0000036543.V370763.R01.S.doc Version 5.2 Page 11 information about the home before they moved in. One person said, “My family chose this home and I think they did well”. General information is also on display regarding equality and diversity in the service and age related issues. An individual care needs assessment is carried out under care management arrangements by someone qualified to do this for each prospective resident. This is done by a social worker before people are placed in the home and the manager obtains a copy of the assessment and relies on this in deciding if the service can meet that person’s individual needs. The service has taken several people on short term placements at short notice and this could lead to badly planned admissions with needs not being fully understood before admission if information is not thorough. We discussed with the manager the sole use of the social services admission assessments and how the service ensures they are able to meet the needs of people being admitted under care management plans to avoid inappropriate admissions. The manager told us that if they found the information provided was insufficient to use for assessment they would get back to social services for clarification. The manager confirmed she does not does not routinely go out to meet and assess prospective residents individual needs before they come to the home. We recommended for good practice that the manager review the service’s admission process to see if they can find ways to personalise admissions for people and promote their involvement in developing their own care plans. The service needs to look at ways to make the admission less process led and more resident led according to individual’s needs and circumstances. Residents are provided with terms and conditions of residency so they are aware of their rights and responsibilities. Resident surveys support this. The home does not provide intermediate care. Petteril House DS0000036543.V370763.R01.S.doc Version 5.2 Page 12 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): NMS 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The health and personal care needs of some residents are not being assessed and met within their individual care plans and inconsistent medication and care records and practices can affect people’s health care. EVIDENCE: During the visit we looked at people’s care plans and a sample of six care plans in detail and spoke with and observed these people. We found that supervisory staff were in the process of transferring people’s care plans over to a new more individualised format for care planning. Supervisors were working extra shifts to try to achieve this. We looked at both old and new formats and found that when fully implemented they should help staff to work with people in a more person centred way. However we found that reviews of care plans were not being done regularly following transfer and updated to reflect changing needs and current objectives for health and personal care. Generally we found Petteril House DS0000036543.V370763.R01.S.doc Version 5.2 Page 13 that plans were not detailed and there were no dates or signatures on the assessment documents on care plans. On some it was difficult to find their date of admission. We examined four plans that had only basic nutritional information, no detailed evidence of psychological/emotional monitoring and no evidence of skin assessments. It is recommended that individual’s mental health be consistently monitored and thorough nutritional and pressure area screening done to consistently monitor healthcare for all residents. We found that one person did not have a complete care plan developed with them and in place to provide the basis for the care to be delivered for them. The information available about this person’s care did not contain a pressure area or moving and handling and falls risk assessments or a psychological/ emotional needs assessment despite evident risk factors. We found that skin care problems for one person were not assessed with them, recorded or being monitored despite there being evident risk factors. There were brief dietary details including weight but no planning of care with information setting out in detail the needs and objectives of this person and actions that were needed to meet their needs. We found that this person’s needs were not being fully met and there was no evidence that their care was person centred. There was no personal information or profile or support preferences in place to guide person centred care or promote individual choices in care. We found that one person was not having their health care needs attended to promptly in regard to pain relief and potential side effects another. All people using the service must have a care plan that reflects their healthcare and personal needs. One person had no record on how a decision on their care had been made in their best interests. We recommended that the manager does regular formal audit of the care plans to ensure they are complete and up to date. For good practice carers need to adopt in practice an individualised approach to a person’s care that includes the person’s own perspectives, where possible, on how they want to be supported, cared for and their independence and rights promoted as they feel able or in their best interests. This was discussed with the manager and supervisor who appreciates the need for more person centred thinking in practice not just on paper. We looked at the medication handling and records and found that not all medicines received into the home have the quantity checked and recorded on the Medicine Administration Record (MAR) or elsewhere. Therefore for a significant number of medicines there was not always a complete audit trail to follow and assess handling. Medicines received, from whatever source, must have the quantity recorded so all a person’s medicines can be accounted for and verified as correct on entry to the home and any errors can be dealt with quickly. We recommend that the manager do a regular formal audit of the medication systems to monitor for quality and compliance with procedure. Several people have medicines prescribed to be take ‘as required’ especially for pain and it would be good practice if the service had protocols in place for their use with all people or within their care plans to guide and inform staff on safe Petteril House DS0000036543.V370763.R01.S.doc Version 5.2 Page 14 use and potential side effects for people, such as constipation. Some people had such protocols but not all. It would also help staff make sure that such medicines are given only when residents need them and allow easier monitoring for medical review of pain control. We found that the recording of administration had improved partially with some staff signing charts when they give medicines. We also checked the procedure for recording any controlled drugs that may be prescribed and found the Index needed to be kept up to date and it was not always recorded when items had been returned. Controlled medication for one person was not recorded as given on the medication record but only in the drug register. This could result in medicines being duplicated or missed altogether. Petteril House DS0000036543.V370763.R01.S.doc Version 5.2 Page 15 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): NMS 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are being supported to make choices about meals and recreational activities and are able to maintain contact with family and friends. EVIDENCE: The home encourages relatives and friends to visit and residents say there are no restrictions on when people can visit them. We spoke to a visitor who said they were pleased with their mother’s care and that the staff always made them welcome. Care plans generally have information about people’s preferred social and religious activities and some useful personal profiles and preferences. This is useful information that could be used effectively in promoting a person’s own perspective on recreation particularly for those who have difficulty communicating their thoughts and feelings at present. There is a programme of activities on display and a designated member of staff to promote this on different days of the week. Staff support people on the to units to take part in group activities as they wish, such as dominoes, cards and Petteril House DS0000036543.V370763.R01.S.doc Version 5.2 Page 16 bingo. One person told us that they set the tables for breakfast on their unit in the mornings and they liked to “do for themselves”. Some people choose to go out into the community or with their families. We talked with people living there and they told us they had a choice about what they did during the day with their survey responses indicated there were activities for them to take part in. We saw that staff do support people living there to take part in activities in groups and individually and to make choices in their daily lives. The hairdresser was visiting the home on the day of the visit. Several people were sitting in the hairdressing room chatting and others having their hair done, it was a pleasant and sociable occasion. The service has an amenities fund that is used for social events for people living there and the accounts for this are displayed so people can see what the money is spent on for the people living there. Provision is made for people to follow their individual religious preferences. We spoke to the cook and visited the kitchen, which was clean and tidy with the fridges and freezers well stocked, as was the dry goods store. We looked at the menus in use and the meals seemed varied and wholesome. The cook confirmed that new menus were being developed. We talked to people living in the home about the food they were offered and they told us that there was a choice of meals and one said that the food was “delicious” and “top class”. Survey responses also indicate that people were satisfied with the meals they received. There are some diabetics to prepare food for at present and the special diets needed are provided. We observed lunchtimes and preparation for meals with residents on the units. We saw that staff helped people with their meals as well as they could given the number of staff available on some units to do this. Petteril House DS0000036543.V370763.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): NMS 16, 17 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is an accessible complaints procedure and there are adult protection procedures in place to help protect resident’s welfare. Lack of understanding of safeguarding procedures and prompt referral may affect outcomes for people living there. EVIDENCE: The service has a complaints procedure that is displayed in the home and within the service guide. There has been one complaint made to the service since the last inspection according to information provided about the service. We were not able to assess the logging and investigation of the complaint during the visit as the complaints log could not be found for examination and so there was no record available. Since the last inspection there has been one referral made by CSCI to social services under safeguarding procedures. This was investigated by the appropriate agencies. The service has safeguarding procedures and multi agency guidance on safeguarding vulnerable adults, although an up to date copy of the guidance referred to in the services procedures was not available. We found that the manager did not follow at the time of an allegation the multi agency procedures referred to in the services own procedure. A matter raised that day was not referred to the Social Services department until CSCI Petteril House DS0000036543.V370763.R01.S.doc Version 5.2 Page 18 requested this. The managers actions did not demonstrate an adequate understanding of safeguarding procedures and if concerns are not referred promptly this can leave vulnerable people at risk of abuse. We discussed the matter with the manager and advised on the importance of prompt referral for follow up by the appropriate agencies. Training records indicated that not all staff had received training on the Protection of Vulnerable Adults (POVA). This was confirmed by staff we spoke to and one person had received no training since their induction some time ago. We recommended that this be done so all staff are aware of their responsibilities to safeguard people from abuse in its many forms. Staff we spoke to were however able to describe how a referral should be made. The homes supervisors have had training on adult protection and preventing abuse. Survey responses and comments from people in the home indicate that they are aware of how to make a complaint, although people did not have their own copies of the procedure. Visitors to the home we spoke with were also aware of the process. Surveys from local GPs indicate the home has always responded to any concerns they have raised. One person had in their daily notes that they were not having further intervention but no record of how this decision had been made in their best interests or who had been involved. The home did not deal with any resident’s personal finances only small amounts of spending money for safekeeping. Practices and procedures are in place to protect resident’s financial interests. Petteril House DS0000036543.V370763.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): NMS 19, 20, 21, 22, 23, 24, 25 and 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The premises are kept to a satisfactory standard of cleanliness but the use of bedrooms that do not suit people’s needs means that they may not receive the care and support they need to meet their physical needs and personal lifestyle choices. EVIDENCE: There is an annual programme of maintenance and improvement agreed with the accommodation manager for the home. Five bedrooms have been redecorated to an attractive standard and to improve bathing facilities a new ‘rise and fall’ bath has been installed. There are toilet and bathing facilities accessible to people living there, four bedrooms have en suite facilities and the others all have wash basins for people to use. The home has a range of Petteril House DS0000036543.V370763.R01.S.doc Version 5.2 Page 20 adaptations and equipment to assist individuals to maintain their independence and to meet their assessed needs. There are sufficient communal areas on the units for people living there and these are comfortable and warm. One of the kitchenettes on the units has been replaced and two more are planned to improve these facilities for residents. There is outdoor space accessible from the EMI suite that people may use. The home is generally comfortable and homely and people living there are able to personalise their rooms as space permits. We found that equipment was being stored in the area where the communal phone is situated and this meant that people could not get easy access to the communal telephone. There was also no seat available for anyone making a call and the whole area was unattractive and dark. We recommended to the manager that items of equipment should not be stored where they limited people’s access to the telephone. During the inspection we found that one person who used a wheel chair as a means of independent mobility was in a bedroom that was not large enough for its use and did not allow for the use of their other equipment and personal items that met their needs and lifestyle choices. This person’s accommodation did not suit their physical needs or personal choices about daily life and so was not suitable to meet their needs. Their recliner chair was in the lounge area down the corridor, but the person did not wish to spend their day in the lounge. Pre admission information regarding this person’s individual needs was basic but should have indicated this was not a suitable room and an alternative offered that was large enough to suit their needs. The home was generally clean and tidy and has its own small laundry area on site with suitable washing machines and driers. There are manual sluice facilities on the EMI unit and on the first and second floor. The ground floor sluice area where commode pots are cleaned and disinfected adjoins the main laundry area where we saw linen and clothing stored following washing. It is not good infection control practice to have manual sluicing facilities attached to the room where clean laundry is kept and is contrary to The Department of Health’s published professional guidance. We discussed this with the manager and recommended that she carried out an assessment of the potential risks and then find ways to minimise any risks to people living there from cross infection. This should be part of their overall infection control procedures for the home given the layout of the laundry and sluice. Petteril House DS0000036543.V370763.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): NMS 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are effective staff recruitment processes in place and support for staff training but the present staffing deployment on day duty is not consistently based around delivering person centred and flexible outcomes for people that can affect their quality of life. EVIDENCE: We looked at staff rotas for the previous 2 weeks, spoke with people living there, observed staff deployment during the visit and discussed staff levels generally with the manager. On day duty there are two staff on the EMI unit and one support worker on each of the other three elderly frail units. On duty during the visit were 5 support workers providing support and care to the people in the home. The rotas showed that sometimes there was an additional sixth staff member, a ‘floater’ who assisted where needed in the home, but this was not the case during the visit and for the previous week. We found that more often there is only 1 member of staff working and supporting residents on the Lakeland unit. This unit is split over two floors with lounge and dining areas and 2 of the bedrooms being on the ground floor. Care plans and asking staff indicated some of these people have dementia and physical care needs. On one first floor unit with one staff member on duty we saw that there were 3 people with limited physical capabilities that needed assistance with Petteril House DS0000036543.V370763.R01.S.doc Version 5.2 Page 22 their meals. With only 1 member of staff providing care and support people may have to wait for their meals, limited their choice of where they ate or have rushed or cold meals. This does not promote enjoyment of the meal and people’s independence and dignity. We looked at care plans and talked with staff and found that this is regarded as a “heavy unit” with people needing help and equipment to aid their mobility. There is only 1 member of staff working here and two people are needed for some moving and handling procedures. If staff need help with assisting and moving people they have to call on someone from another unit or the ‘floater’ if one is on duty that day. Staff told us and we saw that they often have to rely on staff leaving other units to come to help with care activities assessed as needing two people to carry out, leaving that other unit unattended There are 3 members of staff on night duty recognising the need for additional supervision and support to meet individual needs at night, especially on the EMI unit. Survey responses from people living there indicated that there are staff available when they need them and one felt staff “always look after me”. One person did comment that, “sometimes when staff are off there is not enough staff on duty”. Staff surveys and comments also indicated that there may be times when there are not sufficient staff to meet the needs of all the people living there when they are “ Short staffed often due to sickness” also that “there is low morale due to working in limited spaces, often using stand aids without help from other carers”. This with what we observed caused us concern. We observed that staff were however attending to people’s needs and supporting them in a conscientious manner as their time and resources allowed. We discussed all such matters with the manager who has not looked at staffing provision and deployment on the elderly frail units in terms of delivering outcomes for people rather than rigid staff requirements required at the last inspection. Staff deployment at present does not promote flexibility, individualised and person centred care and levels are not always appropriate to supervise people and meet residents’ assessed individual needs safely. The manager must still review staffing provision and deployment in terms of delivering outcomes for people rather than rigid staff requirements. Staff training is on going and recorded in individual’s personal development files showing staff receive a minimum of 3 paid days training. NVQ training is well established and supported and over 50 of staff have achieved this qualification. New care staff also have a five day induction period before they start work. A training profile is kept on computer but there were no start and end dates so it was difficult to assess when the training was done and if it needed updating and it was not up to date. Training records should be kept up to date and clearly show what training is needed. We looked at the staff files and recruitment process for new members of staff. These contained all the necessary checks including Criminal Records Bureau (CRB) checks and references. This helps protect the welfare of people living in the home. Petteril House DS0000036543.V370763.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): NMS 31, 32, 33, 35, 37 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Procedures are in place to safeguard resident’s financial interests and gain people’s views of the service but a lack of overall management planning and monitoring could affect outcomes for people living there. EVIDENCE: The home has a manager, Helen Harrison, registered with CSCI, has relevant experience working with older people is and has achieved the Registered Manager’s Award. The registered manager is being well supported by the supervisors who undertake a wide range of supervisory duties. They have been very busy implementing new care planning systems in addition to their usual duties and also have to provide cover on units when staff levels are low. Petteril House DS0000036543.V370763.R01.S.doc Version 5.2 Page 24 The new care plan implementation has been a significant piece of work for supervisors who now have to put person centred care into practice. There was no evidence of effective planning by the manager on how this major change was going to be managed within the resources available. The manager needs to communicate a clear sense of direction on managing change and putting person centred care into practice and provide leadership that relates to the aims and purpose of the home. Requirements from the last inspection have not been addressed fully by management. We spoke with staff and received surveys back and some comments indicated that the manager was “pleasant” and “ a lovely person” but also that some staff did not feel they were supported to develop. One person felt they got “good support from the supervisors but does not see much of the manager”. The service has staff and residents meetings and these are recorded. The home gives out an annual “customer satisfaction survey” with residents, relatives and advocates to get feedback on the service. The manager completes a report, which is part of a quality monitoring system that relates to the organisations business plan and enables the manager to measure the home’s progress against Cumbria Care’s key targets. The manager should consider the ways they can feedback any actions they take as a result of views expressed from any surveys and meetings so people can see what effect their views have had on the service. Policies and procedures are reviewed corporately and updated in the home when needed. An internal health and safety audit is also completed on an annual basis by the organisation. The home is responsible for small amounts of residents’ monies used to pay for personal items. Records are kept with all receipts held on file and expenditure signed out by two members of staff as a safeguard for the residents. Whilst walking around the home we found the doors to the sluice areas on the units on both floors unlocked and both rooms contained cleaning and disinfecting substances that could be harmful to people if ingested or inhaled. We spoke to the manager about this and that any substances harmful to health must be kept safe and secure whilst being stored in accordance with the appropriate legislation. Records show that servicing and maintenance of equipment is being done, that electrical testing of portable appliances lifts and hoists, and alarms are being serviced, and that periodic electrical testing has been done. Records indicate that some fire training needed to be done to keep staff up to date and this should be addressed. Overall the standard of record keeping needs to be improved so all records are up to date and easily available when needed. The storage of any personal information or old records also needs to be improved as we found people’s old records and information in files in an unlocked cupboard on one of the units. Petteril House DS0000036543.V370763.R01.S.doc Version 5.2 Page 25 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 2 18 2 3 3 3 2 1 2 3 2 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 X 3 X 2 2 Petteril House DS0000036543.V370763.R01.S.doc Version 5.2 Page 26 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(1) Requirement Timescale for action 01/10/08 2. OP9 13 (2) 3. OP18 12 (1) 4. OP23 23 (1) (2) All people using the service must have a care plan that reflects their changing healthcare and personal needs. This will ensure that their needs are monitored and they receive care, treatment and advice promptly to meet changing needs. This was to have been met by 31/12/07 A complete record must be kept 01/10/08 of all medicines received into the home for people so there is a complete audit trail and all medicines received can be accounted for. This was to have been met by 31/12/07 The manager must follow current 01/10/08 guidance on safeguarding people and refer promptly potential safeguarding issues to the appropriate agencies to investigate so that people are protected and their concerns fully investigated. People must not be admitted into 01/10/08 bedrooms that do not meet their assessed needs and relevant DS0000036543.V370763.R01.S.doc Version 5.2 Petteril House Page 27 5. OP27 18 (1) 6. OP38 13 (4) environmental standards that are not suited to meeting an individual’s physical needs and lifestyle choices. The manager must look at 01/10/08 staffing provision and deployment on the elderly frail units in terms of delivering outcomes for people rather than rigid staff requirements and deploy staff in such numbers as appropriate to meet residents’ assessed individual needs safely. This was to have been met by 31/12/07 The manager must ensure that 01/10/08 areas used to store hazardous substances are always kept secure in accordance with appropriate regulations to reduce potential risks to people living in the home. 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 OP3 Good Practice Recommendations The manager should review the service’s admission processes to see if they can find ways to personalise admissions for people, promote their involvement in developing their care plan and make admission less process led and more resident led according to individual needs. We recommended that the manager does regular formal audits of the care plans to ensure they are complete and up to date to accurately reflect people’s needs and preferences. It is recommended that individual’s mental health be consistently monitored and thorough nutritional and pressure area screening done consistently assess and to DS0000036543.V370763.R01.S.doc Version 5.2 Page 28 2. OP7 3. OP8 Petteril House 4. 5. 6. OP9 OP9 OP9 7. 8. OP16 OP17 9. OP18 10. 11. OP22 OP24 12. OP26 13. 14. OP30 OP32 15. OP33 monitor health care for all residents and recorded within their individual care plans. The administration of controlled drugs should be recorded on the medication administration records to minimise the risk of error, duplication or omission. For best practice and to ensure quality monitoring of medication practices the manager should do a regular medication audit and quickly follow up any errors found. The manager should consider using protocols or care plans to inform staff on the use of ‘as required ‘drugs. This would help staff make sure that they are given only when residents need them and allow easier monitoring when maximum doses are reached. The manager should make sure that the complaints log and records are easily available for staff to use and for inspection by CSCI. Decisions regarding treatment withdrawal and a person’s ability to consent should always be fully recorded including who was involved in the decision in some ones best interests to protect their rights under Mental capacity legislation, The manager should make sure all care staff have up to date training on protecting vulnerable adults, so all care staff in the home are aware of their responsibilities and the action to take. Items of equipment should not be stored where they limit people’s access to the home’s communal telephone and seating should be provided for people using it. People should be accommodated in rooms that are of a sufficient size to allow them to bring in some of their own possessions to provide a more personal place for them and follow their lifestyle choices. Given the layout of the sluice and laundry areas we strongly recommend that the manager should carry out a thorough risk assessment on the use of the sluicing facilities adjoining to the laundry and when cleaning commode pots in proximity to the laundry area and find ways to minimise any cross infection risk for people living there. Training records should be kept up to date and clearly show what training is needed, what has been done and when. The manager needs to communicate a clear sense of direction on managing change and workloads and provide leadership that relates to the aims and purpose of the home. The manager should consider the ways they feedback any DS0000036543.V370763.R01.S.doc Version 5.2 Page 29 Petteril House 16. OP37 17. OP38 actions they take as a result of views expressed through surveys and meetings so people can see what effect their views have had on the way the service is run. The standard of record keeping and storage of old records within the service needs to be improved so all records are kept securely in line with legislation and that they are up to date and easily available when needed and show clearly what has been done. The manager should make sure all staff fire training is kept up to date to promote resident’s safety. Petteril House DS0000036543.V370763.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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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