Inspection on 06/11/07 for Portcullis House

This inspection was carried out on 6th November 2007.

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

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

Other inspections for this house

Portcullis House 19/07/06

Portcullis House 02/11/05

Portcullis House 26/07/05

Portcullis House 18/01/05

Portcullis House 07/07/04

Portcullis House 26/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Portcullis House The Embankment Langport Somerset TA10 9RZ Lead Inspector Ms Sue Hale Unannounced Inspection 6th November 2007 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 Portcullis House DS0000016076.V353312.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. Portcullis House DS0000016076.V353312.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Portcullis House Address The Embankment Langport Somerset TA10 9RZ 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) 01458 250800 01458 253772 Somerset Care Limited Mrs Christine Carol Dowdell Care Home 40 Category(ies) of Dementia - over 65 years of age (40), Old age, registration, with number not falling within any other category (40) of places Portcullis House DS0000016076.V353312.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Registered for 40 persons in categories OP and DE (E) One named service user aged under 65 years to be admitted to the home 19th July 2006 Date of last inspection Brief Description of the Service: Portcullis House is a purpose built residential home, located within a residential area of Langport. There is a range of communal areas at the home. A passenger lift, assisted bathrooms and a call system are provided. The home is set in pleasant gardens that are accessible to service users. The home is registered with the Commission for Social Care Inspection to provide care for up to 40 residents over the age of 65 years. Within the home there is a Specialist Residential Care (SRC) unit called Rose Garden that provides additional care and support to residents who have a dementia. Day care is also offered at the home, including services for those who have specialist mental health needs. The Registered Manager is Mrs Christine Dowdell, and the Registered Provider home is Somerset Care Limited. Portcullis House DS0000016076.V353312.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of this inspection visit was to inspect relevant key standards under the CSCI ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are; - excellent, good, adequate and poor. These judgement descriptors for the seven chapter outcome groups are given in the report. The quality rating for this service is 0 stars. This means the people who use this service experience poor quality outcomes. The inspection was undertaken over the course of one day in November 2007 by two inspectors. The inspectors undertook a tour of the home, looked at selected staff and resident’s files and other documentation related to the running of the home. The home completed an Annual Quality Assurance Assessment, AQAA, prior to the inspection. A number of service user, staff and relative surveys were sent to the home, of which 6 staff ones were returned, 3 from G.Ps, 6 from professionals, and 8 from residents. The responses are incorporated into this report. There were 38 people living in the home on the day of the inspection. The current fee levels range from £373 to £455 per week, per resident. What the service does well: The home provides clear, detailed information about Portcullis House to give to prospective residents and their families and representatives so they can make an informed decision about residency. Some people living at the home are seen as individual adults with the right to make choices themselves as far as possible about their lives. The majority of the residents spoken to on the day of the inspection and who returned surveys were very satisfied with the care they receive and the way in which it is delivered by staff. Considerable efforts had been made to develop communication with a resident whose first language was not English. Bi lingual signs were evident on toilet doors in Rose Garden. Residents are only admitted to the home following a meeting with the manager or her deputy and the completion of the pre admission assessment to ensure that the home can meet their social, health and care needs. Prospective Portcullis House DS0000016076.V353312.R01.S.doc Version 5.2 Page 6 residents are given the opportunity to visit the home and spend time there before they make a decision about moving in. Each resident is provided with a clear statement of terms and conditions that sets out the terms and conditions of residency. Communication between the home and social, medical and healthcare professionals is good and advice and support is sought appropriately. A G.P. commented that ‘ have always found the staff to be helpful when I visit and they demonstrate a caring attitude to my patients’. The atmosphere and routines in Rose Garden are person centred to suit the abilities, choices and prefences of people who live there. The allocation of designated staff works well and allows staff to build up appropriate knowledge and skills to proved a good standard of care. The residents are encouraged to personalise their rooms and the home was clean and tidy on the day of the inspection. The home is well maintained with a regular programme of maintenance. Aids and adaptations are provided to make sure that resident’s needs are met. The home has a complaints policy and most people who live in and visit the home are aware of how to raise any concerns. Procedures are in place to safeguard the people who live in the home from the risk of possible abuse. The residents are generally satisfied with the meals served the home. The home has supported staff to obtain external qualifications and 70 have achieved NVQ level 2 or above qualifications. A professional surveyed said that staff ‘has a can do attitude’ Visitors to the home feel welcome and know they can visit the home at any time. The home has clear health and safety policies and regular checks take place to ensure that the home is a safe environment. Policies and procedures in relation to infection control are provided by the organisation and protective clothing is provided for staff to reduce the risk of cross infection. What has improved since the last inspection? COSSH risk assessments had been reviewed and updated where necessary. Portcullis House DS0000016076.V353312.R01.S.doc Version 5.2 Page 7 What they could do better: The statement of purpose should give readers the details of the fire and emergency procedures within the home to make sure that residents and visitors to the home are familiar with these, and safe should an emergency occur. It should also make clear that the main part of the home provides personal care only for older people. All pre admission information should be fully completed to make sure that the home is aware of and can meet individuals health, social and care needs. Prospective residents should be fully involved with the assessment and planning related to moving into the home. Care planning is poor with little detail available on some files, they were not always reflective of residents current needs, not all recommended topics are covered and there is little personal information such as individuals life histories, likes and dislikes. Risk assessments were not always up to date and reflective of individual current needs. There is no involvement by residents or their relatives/representatives in the care planning and review process and they are not asked their opinion on how care is delivered. All documentation should be dated and signed. The routines of the home appear to be much less flexible for those residents who are very dependant on staff for support and help with daily living tasks. Some residents have little control over their lives and are being ‘put’ to bed very early to suit staff rather than by their own choosing. Some residents told the inspectors that they had little choice over their lives and could not choose when to get up or got to bed. Care must be taken to make sure that residents nails are clean and of a suitable length to reduce the risk of self-injury. Consideration should be given to having a designated activities organiser and to providing opportunities for people to go out on trips, including the chance to be able to go shopping. This would be line with the information given by the home in its terms and conditions of residency and service user guide. Some residents think that the staffing levels are too low to allow time for any activities to be arranged. Two people commented that there isn’t ‘something to do everyday’. If this is not possible the terms and conditions of residency and the service user guide should be amended to reflect this. The advocacy policy should give the details of the Commission for Social Care Inspection and external advocacy agencies and make clear that this is good practice and that ‘self advocacy’ is not always possible for all people. Soiled clothing must not be left to soak in the laundry as this is poor practice and increases the risk of infection. Hand washing facilities must be provided in the laundry to reduce the risk of cross infection. Portcullis House DS0000016076.V353312.R01.S.doc Version 5.2 Page 8 The acting manager must look at the dependency of people living in the home and assess if the staffing levels are sufficient to meet their social, health and care needs in a way that allows residents to have some control over their daily lives and have access to stimulating activities within and outside the home. All staff must undertake appropriate structured induction training and must complete mandatory training as soon as they start work to make sure that they have the skills and knowledge to provide a good standard of care. The accident book must record any treatment given if a resident has fallen or sustained an injury. Serious consideration should be given to reviewing the system that means that individual residents personal finances cannot be audited as monies are pooled. 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. Portcullis House DS0000016076.V353312.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 Portcullis House DS0000016076.V353312.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): 1,2 and 3. Standard 6 is not applicable to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service user guide and statement of purpose give clear relevant information. Prospective residents are given the opportunity to spend time in the home. Pre Admission assessments are undertaken but practice is not always consistent or well applied. Each resident is provided with a clear statement of terms and conditions that sets out the terms and conditions of residency. This gives a clear understanding of what residents can expect. EVIDENCE: Portcullis House DS0000016076.V353312.R01.S.doc Version 5.2 Page 11 The organisation forwarded a service user guide that tells readers that it is available in accessible formats if required. It gives a brief description of the accommodation and services provided and meets the national minimum standards. It included a copy of seeking your views on how to make a complaint and a copy of the terms and conditions of residency. The organisation also forwarded a copy of the homes statement of purpose. It included general information about the home, the number of places available, information that residents can continue to pursue religious observance if they want to, how residents can maintain contact with their families and friends, the way in which reviews will be done, It did not include details of the fire precautions and associated emergency procedures although it states that all staff are trained in fire safety, or make it clear that the home is registered to provide personal care only in the main house. All prospective residents are seen and assessed by a senior member of the management team before they move into the home. The pre admission assessment covers all the topics recommended in the national minimum standards. These were in place on the files checked. However, on Rose Garden a file was checked that the admission details had not been fully completed. On files checked in the main house there was no evidence that residents were involved in the assessments and admission processes and not all records were dated or signed by staff. Prospective residents and their families are encouraged to visit the home and are able to spend time there before they make a decision on residency. All admissions on a trial basis and are subject to review after six weeks. A copy of the funding authorities assessment was kept in the individual residents care file and used to inform the homes care planning. The home has a contract of the terms of conditions of residency that meets the national minimum standards. The contract makes clear what is included in the fees and what separate expenses residents are responsible for. Copies of the contract were seen on selected residents files and residents surveyed were aware of the terms and conditions of residency. Portcullis House DS0000016076.V353312.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): 7,8,9,10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care planning and review processes are poor with a lack of relevant information and lack of involvement and consultation with residents and their relatives/representatives. Staff do not adequately record health care issues within some individuals care plans. Residents have appropriate access to medical and healthcare professionals. The home has a medication policy that is accessible to staff but improvements need to be made to make medication practice safer for residents. Resident’s rights to privacy and respect are generally respected but this can be compromised by staff routines. EVIDENCE: Portcullis House DS0000016076.V353312.R01.S.doc Version 5.2 Page 13 The inspectors looked at three care plans in the main home and 3 care plans in Rose Garden. One care plan did not contain a life history and had only a care plan for personal care, which did not give staff sufficient information, or guidance on how to meet all the residents assessed needs. Risk assessments dated October 2007 were in place in relation to nutrition, moving and handling, falls and pressure sores. There was a record of G.P visits, a weight record and a copy of the hospital discharge information. There was no evidence that the resident had been involved in the care planning process and the care plan had not been written until twelve (12) days after the person had moved into the home. It did not contain a diabetic care plan or give advice for staff about diabetes, a care plan for specialist foot care or what to do if the person became unwell. A second care plan had a moving and handling assessment dated 12th February 2007 that had never been reviewed although the person had fallen in August 2007.There was a care plan and risk assessment in relation to diabetes but the risk assessment had not been reviewed since February 2007 and as detailed previously did not contain sufficient detail on diabetes or give clear guidance and advice to staff on how to meet the persons specialist needs. The person had become unwell in July 2007 and Paramedics had attended the home and given appropriate treatment ‘post hypo’ but this had not been used to update the information on the homes care plan or risk assessment. A falls risk assessment was in place, which had been reviewed but not updated following a recent fall. A nutritional assessment and pressure sore assessment was in place that had been reviewed monthly. Care plans were in place covering the person’s abilities, personal care, night care, personal well being, social activities, eating and drinking and communication. Daily records were in place that showed good details of what happened to people and how care was delivered. Weight records were in place this showed a weight loss of 9.4kg during a period of eight months, there was no evidence that this weight loss was considered of no concern or that it had been investigated or that there were measures in place to monitor and take action if necessary when residents weight changed. The life history was blank. A third care plan covered personal hygiene, continence, communication, health and safety, eating and drinking, sleeping pattern, mobility and emotional and social needs. These had been reviewed monthly although there was no evidence that the person or their relatives/representatives had been involved in this. The daily record had been completed and included good detail of what had happened on that day to the person concerned. A falls risk assessment and weight record was in place. Portcullis House DS0000016076.V353312.R01.S.doc Version 5.2 Page 14 Selected care records were looked at in Rose Garden, the files contained basic information but the care needs on one file were not fully completed and did not cover all the recommended topics and did not give clear guidance for staff on how to meet peoples assessed needs. The nutritional assessment had not been fully completed. One professional commented that the home ‘provides excellent person centred holistic care’. The care in Rose Garden was observed to be considerably more person centred than in the main house. On a second care file the social history was very brief with no information recorded about the person’s likes or dislikes. On the care plan relating to continence it had a record that it had been reviewed. However, it was clear from the records that the person’s continence needs had changed but the care plan had not been amended to take this into account and information and guidance for staff was out of date. On all care plans checked they were noted to have been reviewed but no changes to plans or expected outcomes had been made. Some had additional information added but there was no evidence that the ‘need’ had ever changed. This would suggest that reviews are not being used effectively and are a ‘paper exercise’ meant to evidence that the process has taken place. Care plan didn’t give information on individual’s likes and dislikes. Records were in place to record when residents had seen their G.P and a district nurse and what treatment/advice was given.G.Ps surveyed said that felt that communication between them and the home was effective and that there was always a senior member of staff available to consult with when necessary and confirmed that they were always able to see their patients in private. One resident said that they had seen the optician who visits the home as they had been unable to visit the local optician without assistance, but had not been satisfied with the service. The organisation informed the inspector that residents are able to visit the local optician although it was unclear if there was any assistance available for residents who did not have family or friends to take them. Two residents at the home are planning to get married and the home has offered practical and emotional support for them and their families in how they wish to live their lives together at the home. A relative surveyed also said that people living there ‘were seen and treated as individuals’. Medication practice was looked at. On some medication administration records (MAR) sheets there was no rationale for some medicines prescribed to be used as required (P.R.N). There was also a code used on the MAR sheets that was Portcullis House DS0000016076.V353312.R01.S.doc Version 5.2 Page 15 not detailed or explained. On some hand transcribed entries there was only one signature. For one resident there was no opening or expiry date on a liquid medicine. This resident was prescribed a medication that the G.P. had agreed could be given covertly. The home had asked a relative to sign their agreement with this practice although the form used was one used to record physical intervention. The acting manager was advised to consider the implications of the Mental Capacity Act in relation to this practice. Controlled drugs were checked and found to be correct. These were seen to be stored correctly. The home has clear policies and procedures given guidance and advice to staff on how to treat residents with respect and how to make that their right to privacy and dignity was respected and taken into account during care interventions. Residents spoken to said that staff treated them with respect and knocked on the door of their private room before entering. However, please refer to the next outcome group in relation to some current practices at the home that restrict individuals rights to make choices about their daily life. Portcullis House DS0000016076.V353312.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): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The routines in the main home for some people are rigid and do not take into account individuals choices and preferences but are organised to suit staffing levels. There are limited opportunities for activities in the main home. The routine within Rose Garden is person centred and linked to individual’s abilities, choices and preferences. Visitors are made welcome in the home and contact by residents with families and friends encouraged. The majority of people surveyed and spoken to were satisfied with the food served at the home. EVIDENCE: The atmosphere in Rose Garden was relaxed but lively with considerable staff interaction with residents in a wide variety of ways including helping with daily Portcullis House DS0000016076.V353312.R01.S.doc Version 5.2 Page 17 tanks such as laundry. The atmosphere in the main home was less lively with little interaction observed between staff and resident unless they were undertaking a care task. The home does not employ an activities organiser. However, the terms and conditions of residency states that ‘each home has its own activities organiser’. It also says that ‘external trips to the theatre or similar’ are available. None of the residents surveyed or spoken to said that they had the opportunity to go out on trips. However, the acting manager stated that it is planned to appoint a designated person to work on Rose Garden and that interviews would be held the following week. Activities in the rest of the home are undertaken by care staff that has received training in this area from an external activities specialist. The acting manager stated that Secret World has visited with their animals, an entertainer has been to the home and that some visitors bring in pet dogs that the residents enjoy. Of the residents surveyed three said that was only ‘sometimes’ suitable activities available, three said there ‘usually’ was and two said that there was ‘always’ something suitable for them available. One resident said it was ‘a very long day’. A professional commented that they felt that the home could do ‘more activities and outings’. Two residents spoken to said that ‘there’s not a lot going on’ and both would like opportunities to go out on trips especially opportunities to go out and buy their own gifts for family or personal shopping for themselves. Whilst the routines of the home seemed to be flexible for some people living there those that were more dependant on staff had less choice or control over their lives. One resident said that they had to go to bed at 7.30. p.m. as this suited the staff and commented that ‘they tell me when to get up’. They went on to say that ‘if I could do more for myself I could choose’. Another resident said that ‘I don’t control my own life like I used to. Some professionals surveyed said that staff treated residents with dignity and respect One relative surveyed commented that they felt that their relative would benefit from being supported to retain independent living skills by tasks such as ‘laying tables and preparing vegetables’. The relative also commented that they were not always told about events held at the home so couldn’t arrange to attend. A hairdresser visits the home regularly; a resident said that she’ was a very nice lady’. It was observed that one resident’s nails were long and dirty. A new resident was recently admitted to Rose Garden whose first language is not English. The staff have made considerable efforts to met his needs and improve communication between themselves and the person concerned. Bi lingual signs were seen on a toilet door. Portcullis House DS0000016076.V353312.R01.S.doc Version 5.2 Page 18 Two residents spoken during lunchtime said that the food was ‘very good’ and they both liked that the food was in serving dishes and that ‘you can help yourself’. One resident commented that if they could change anything in the home they would like ‘nice, hot food’. There was a good variety and plenty of fresh, dried and canned food. The home has as rotating menu that includes home cooked meals and cakes. Residents have a home made decorated cake on their birthday. The inspectors saw the lunchtime meal and the vegetables were taken to the tables in serving dishes so people could help themselves although discreet assistance from staff was available when necessary. A relative surveyed said that the home was ‘always welcoming to visitors’. Residents spoken to said that staff treated them with respect and knocked on the door of their private room before entering. Portcullis House DS0000016076.V353312.R01.S.doc Version 5.2 Page 19 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): 16,17,18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a complaints policy and the majority of people surveyed and spoken were aware of and comfortable with how to raise concerns. The homes advocacy policy needs minor amendment to give clear good practice advice to residents, their relatives, representatives and staff about what advocacy means and how to use such services. The home has a whistle blowing policy that needs minor amendment to give appropriate information. The home has policies and procedures to safeguard people living at the home. EVIDENCE: The home has a complaints policy that meets the national minimum standards. All the residents surveyed knew how to make a complaint with the majority always ‘ knowing who to speak to about a complaint should they need to. However, one resident spoken to said that they wouldn’t say anything if they were unhappy as ‘I’d get into trouble’. Neither the home nor the Commission for Social Care Inspection have received any complaints since the last Portcullis House DS0000016076.V353312.R01.S.doc Version 5.2 Page 20 inspection. The information about complaints was no included in the service user guide. The home has an advocacy policy but this does not include the Commission for Social Care Inspection contact details or those of local advocacy agencies. However, leaflets about Age Concern and the Residents and Relatives Association are on display in the home. The telephone number of the Commission for Social Care Inspection is also displayed. The policy does not detail why resident or relatives may need to consider using advocacy services and that ‘self advocacy’ may not always be possible or the best option for people. A policy giving clear guidance and advice to staff on managing physical and verbal aggression by residents was in place. The home has policies and procedures in place to safeguard residents financial interests. The home has a whistle blowing policy that includes the contact details of the Commission for Social Care Inspection but does not include the contact details of Public Concern at Work. There was information available about the Mental Capacity Act and a copy of the locally agreed Somerset wide safeguarding adult’s procedures should an allegation of abuse be received and the organisation has an adult protection policy. Appropriate POVA First and CRB checks are undertaken before staff start working at the home so people living there are safeguarded from the risk of abuse. Portcullis House DS0000016076.V353312.R01.S.doc Version 5.2 Page 21 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): 19,20,21,22,23,24,25,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a well-maintained environment, which provides aids and equipment to meet the care needs of residents. The shared areas provide a choice of communal space with opportunities to meet relives and friends in privacy or in their own room. Infection control polices and procedures are in place but are not always followed by staff. EVIDENCE: Portcullis House DS0000016076.V353312.R01.S.doc Version 5.2 Page 22 All residents’ rooms were clean, tidy and had been personalised to reflect its occupant’s tastes and preferences. People are able to bring in personal, possessions within the space constraints of their own room. The home was clean, tidy and free from odours on the day of the inspection. Residents’ accommodation is provided over two floors. There is a passenger lift, assisted bathroom and call system available to residents. The home has a range of communal areas. There is a large lounge, dining room and conservatory on the ground floor. A separate lounge / dining room is provided for Rose Gardens. There is an additional dining room and lounge on the first floor and further seating areas throughout the home. One professional commented that they felt that improvements to the décor and garden furniture would improve morale amongst residents. Appropriate adaptations have been provided to meet service users’ needs. Eight residents rooms have en suite facilities. There are communal toilets located throughout the building. Radiators have been guarded, and window openings restricted on upper floors. Emergency lighting is provided throughout the home, this was tested monthly as recommended in the last report. Hot water outlet temperatures were tested and found to be within appropriate limits. The laundry was clean and tidy with sufficient laundry machines available. Alginate bags were in use for soiled items. However, there are no hand washing facilities for staff and soiled clothing was soaking in a bowl, despite a notice telling staff that this was not good practice. Portcullis House DS0000016076.V353312.R01.S.doc Version 5.2 Page 23 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): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staffing levels at the home appear to restrict the choices available for the more dependant residents in the main home. The staffing levels in Rose Garden appeared appropriate to the residents needs. None of the newly employed staff have started or completed formal induction training. Mandatory training is poorly organised leading to delays in staff obtaining the skills necessary to provide safe care to people living in the home. Recruitment practices safeguard the people living at the home. EVIDENCE: Duty rotas are maintained. Some members of staff told the inspectors that they were always busy and that the home was ‘short staffed’. Some residents commented that ‘there wasn’t enough staff to do activities’. However, the inspector noted that a post to undertake activies was being advertised. It was evident from talking to some residents that the routines in the home are not flexible particularly for the resident’s dependant on staff to assist them to get Portcullis House DS0000016076.V353312.R01.S.doc Version 5.2 Page 24 up or got to bed and that some people had little control over what happened to them as the care was not person centred but task orientated. One member of staff told the inspectors that all residents ‘had to be up and ready for breakfast by 9a.m.’. Staff interaction in the main house appeared to be limited to care interventions and the atmosphere was subdued and unstimulating. The inspectors observed that staff interaction with people living in Rose Garden was lively and positive, leading to a relaxed but stimulating environment. The acting manager stated that a new post was going to be created that would be responsible for care from 7.30am to 9.30am and then would be involved in activities. Two members of staff were working at night. One member of staff said that it was a ‘nice place to work’. One member of staff said that staff worked ‘as a team’. The organisation has taken steps to improve recruitment by employing overseas staff and supporting them with their accommodation needs. The home employs 27 care staff, 70 of whom are qualified to NVQ level 2 or above. Rose Garden is staffed by designated workers which seems to work very well and they are able to develop the skills and experience to provide a good standard of care. It was evident from talking to residents that the routines in the home are not flexible particularly for the resident’s dependant on staff to assist them to get up or got to bed and that people had little control over what happened to them as the care was not person centred but task orientated. Three staff files were checked. All contained an application form, interview record, two references, evidence of satisfactory POVA First and CRB checks, obtained before people started work, all staff had completed moving and handling training. All staff surveyed confirmed that they had had a CRB check undertaken when they applied to work at the home. Job descriptions and the General Social Care Council code of conduct are sent to applicants when they apply. The organisation has a structured induction programme linked to the Skills for Care programme. However, there was no record that any of the new staff had undertaken this induction programme. Two staff had not completed fire safety or health and safety training. The person who had completed fire training had not done so until they had worked at the home for two months. The references on one file were not dated by the writer or the home when received. The acting manager stated that care planning training was booked for 20th November 2007. Staff undertake training in dementia care mapping. Portcullis House DS0000016076.V353312.R01.S.doc Version 5.2 Page 25 Some residents described staff as ‘very kind’. Some staff spoken to said that there is an expectation by the organisation that they are ‘expected’ to offer to work more than their contracted hours to make sure all the shifts were covered. Some staff felt that staff morale was poor due to a lack of support for the home from the organisation in recent months leading to a ‘lack of direction’. This lack of leadership had led to ‘some staff not following policies and procedures and not being challenged’. The acting manager was aware of these issues and intended to address them in a proposed internal improvement plan for the home. Portcullis House DS0000016076.V353312.R01.S.doc Version 5.2 Page 26 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): 31,33,34,35,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Training, development and supervision of staff is inconsistent and staff have been lacking in leadership. Management support has now been put into the home by the organisation. The home has clear health and safety policies and regular checks take place to ensure that the home is a safe environment. The home has policies and procedures devised, reviewed and updated by the organisiaon. The way in which resident’s finances are managed should be reviewed to make sure individual auditing could take place. Portcullis House DS0000016076.V353312.R01.S.doc Version 5.2 Page 27 EVIDENCE: The registered manager is on long term sick leave and an acting manager, Karen Jackson had been appointed with designated managerial support two days a week from the organisation. A member of staff spoken to said that the management team ’were approachable’. The home has internal quality assurance systems devised by the organisation but these have not been fully used by the home in 2007. Some residents surveys were undertaken in October 2007 the results of which were forwarded to the inspectors, these showed that all the respondents felt they were treated well and that the home met their needs. There have been four staff meetings since the last inspection, two for senior staff, one for night staff and one for housekeeping staff. Minutes were taken and staff felt free to express their opinions and be heard. The home manages personal finances for many residents. Records are kept of income and expenditure and these are double signed by staff and accessible only by senior staff or the administrator. However, all monies are kept in a central account in the name of the home and individual accounts cannot be audited. The hairdresser’s bills detail all residents’ names and expenditure, which breaches data protection. There was no evidence that staff receive regular formal supervision in a way that meets the national minimum standards on the three staff files looked at. The acting manager told the inspectors that she was aware that not all staff had received formal supervision of their practice and that this would be addressed in the action plan. COSSH risk assessments had been reviewed and update where necessary. A maintenance record was kept by the handy person and signed off as jobs were completed. Records were seen to evidence that equipment at the home was kept in a state of good repair and regularly serviced. Appropriate health and safety records were kept and were seen to be up to date. The accident book was checked. One record showed that the person had sustained an injury that needed treatment but the treatment given was not recorded. The organisation has a monthly internal accident audit which had been completed and gives the management team the opportunity to analyse accidents and to look at control measures to reduce risk. Portcullis House DS0000016076.V353312.R01.S.doc Version 5.2 Page 28 Policies and procedures are drawn and reviewed by the organisation; all staff surveyed felt that they were clear and accessible to them. A training matrix was requested on the day of the inspection but this had not been received at the time of writing this report. It was evident from staff files looked at that not all staff have completed mandatory training or have undertaken up dates so that their qualifications are current. Portcullis House DS0000016076.V353312.R01.S.doc Version 5.2 Page 29 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 2 3 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 2 18 2 3 3 3 3 3 3 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 X X 3 3 2 1 X 2 Portcullis House DS0000016076.V353312.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation Schedule 1 (11) 12(1)(b) Requirement The statement of purpose must include details of the fire and emergency procedures in the home. Care plans must cover all aspects of residents assessed needs in sufficient detail and give staff clear advice and guidance on how such needs will be met. All residents must have a care plan as soon as they move into the home so that staff can meet their assessed needs. Residents and their representatives must be involved in the care planning and review process. Staff must make sure that residents fingernails are clean and of a suitable length to reduce the risk of self injury. Care plans for residents with diabetes must contain specific information about diabetes and clear advice and guidance for staff on how to meet these residents’ specialist needs. All care plans should be reviewed DS0000016076.V353312.R01.S.doc Timescale for action 28/02/08 2 OP7 28/02/08 3 OP7 15(1) 31/12/07 4 OP7 12(3) 15(2)(c) 12(1) 28/02/08 5 OP7 31/12/07 6 OP7 OP8 12(1) 31/12/07 7 OP7 15(2)(b- 28/02/08 Page 31 Portcullis House Version 5.2 d) 8 OP9 13(2) 9 10 11 OP26 OP26 OP27 13(3) 13(3) 18(1)(a) 12 13 14 OP30 OP36 OP38 OP30 18(1) 18(2) 23(4)(d) 15 OP38 Schedule 3 (3)(j) and updated as necessary and should reflect residents current needs The registered person shall make arrangements for the safe recording and administration of medicines. Soiled clothing must not be left to soak in the laundry. Hand washing facilities must be provided for staff in the laundry. The home must look at the assessed needs of the people living at the home and assess if the staffing levels are sufficient to meet their needs. All new staff must undertake appropriate structured induction training. All staff must be appropriately supervised. All staff must undertake mandatory training, including fire safety as soon as they start work at the home. The accident book must record any treatment given to a resident who has had an accident or sustained an injury. 28/02/08 31/12/07 28/02/08 28/02/08 28/02/08 28/02/08 28/02/08 31/12/07 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 2 3 Refer to Standard OP1 OP3 Good Practice Recommendations The service user guide should include the fee levels. All pre admission information should be fully completed before people move into the home. Care plans should cover all the topics recommended in national minimum standards 3.3. DS0000016076.V353312.R01.S.doc Version 5.2 Page 32 OP7 Portcullis House 4 OP9 Two members of staff should sign all hand written entries on MAR sheets. All codes used on MAR sheets must be recorded. The advocacy policy should be revised. It should include the contact details of the Commission for Social Care Inspection and other local advocacy agencies. It should make clear that ‘self advocacy’ is not always possible and the use of external agencies is good practice. The whistle blowing policy should include the contact details of Public Concern at Work. Serious consideration should be given to keeping residents monies separately so that they can be individually audited. It is recommended that staff are provided with formal oneto-one supervision at least six times a year. All references should be dated when received. 5 OP17 6 7 8 9 OP18 OP34 OP36 OP29 Portcullis House DS0000016076.V353312.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Taunton Local Office Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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. Extracts may not be used or reproduced without the express permission of CSCI Portcullis House DS0000016076.V353312.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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