Inspection on 10/10/07 for Rastrick Hall

This inspection was carried out on 10th October 2007.

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

The inspector 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

Rastrick Hall 15/04/09

Rastrick Hall 17/04/08

Similar services:

Abbey The

Snydale Care Home

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Rastrick Hall Close Lea Avenue Rastrick Huddersfield HD6 3XB Lead Inspector Paula McCloy Key Unannounced Inspection 09:30 10th October 2007 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 Rastrick Hall DS0000070125.V347346.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. Rastrick Hall DS0000070125.V347346.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rastrick Hall Address Close Lea Avenue Rastrick Huddersfield HD6 3XB 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) 0845 6037752 rastrickhall@orchardcarehomes.com www.orchardcarehomes.com Orchard Care Homes.Com Limited ****Post Vacant**** Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Rastrick Hall DS0000070125.V347346.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC; to service users of the following gender: Either; whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category - Code OP. The maximum number of service users who can be accommodated is: 40 This was the first inspection of the home since it opened in June 2007. 2. Date of last inspection Brief Description of the Service: Rastrick Hall is a new purpose built home. It offers residential care for 40 older people. The accommodation is arranged over three floors. All of the bedrooms are single and have en-suite toilets and showers. There are lounges and dining rooms on each floor. All of the rooms are comfortable and nicely decorated. There is a garden area at the side of the building that can be used in fine weather. There is a car park to the front of the building. The current weekly charges range from £485 - £535 per week. Additional charges are made for hairdressing, chiropody, dry cleaning, newspapers, personal toiletries and private phone installation and calls. Rastrick Hall DS0000070125.V347346.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first inspection of the home since it opened in June 2007. The registered manager left the home very shortly after it opened. This inspection was carried out to assess the quality of care provided to people living at the home. We carried out the inspection over two days and spent approximately 13.5 hours in the home. During the visit we spoke to 13 people who live in the home, 3 relatives, 7 staff and the manager. We observed care staff delivering care, looked at various records and looked around the home. The home completed a self assessment form, which provided us with some very detailed information about the service. We have used some of that information in this report. Comment cards were sent to 14 people living in the home, 25 relatives, 23 staff, 6 GPs and 3 social workers; these cards provide an opportunity for people to share their views of the service with us. Information received in this way is shared with the home without identifying who has provided it. Six people living at the home, ten relatives and five members of staff wrote to us with their comments. Their comments have been used in this report. What the service does well: Relatives are made to feel welcome when they visit. The meals at the home are good offering choice and variety. The home is new, nicely decorated and furnished. The lounges are comfortable and everyone has their own single bedroom with an en-suite toilet and shower. Rastrick Hall DS0000070125.V347346.R01.S.doc Version 5.2 Page 6 Staff are properly checked before they start work in the home. This makes sure staff are suitable and safe to work with older people. We asked people living in the home, relatives and staff what the home does well. These are some of their comments: ‘They make residents feel it is their home.’ ‘We are made to feel welcome when we visit.’ ‘The food is excellent and well presented and served.’ ‘Rooms are first class (as you would expect with a new establishment.).’ Staff who have been in post from the outset have worked very hard.’ ‘The staff are always smiling and helpful towards residents and families. I think it is a lovely friendly home.’ ‘The care of the staff is very good. Care staff are genuinely interested in the people and their lives.’ What has improved since the last inspection? What they could do better: The management of the home is poor, which means that people are not receiving the care and support they require. The information in the service users guide should be accurate and tell people about the service they can expect if they move into Rastrick Hall. Rastrick Hall DS0000070125.V347346.R01.S.doc Version 5.2 Page 7 People who live at the home and their relatives, should be consulted about their care. They should be given the opportunity to say if it suits them or could be improved in any way. Information in the care plans should give clear instructions to staff about what they must do to make sure people’s needs are met. The home should provide some stimulating activities for people to take part in. People are spending most of their days sitting in the lounge with nothing to occupy them. There should be sufficient time set aside for staff to be able to chat to people as well as focusing on their daily tasks. Staff must make sure that they listen to people’s complaints and concerns and tell them what they are going to do to sort problems out. Staff must make sure that they understand and use the adult protection procedures. This will make sure that people are kept safe. More staff must be employed to make sure that people’s needs are met. There is not always a member of staff on hand to deal with people’s requests. Following this inspection a letter has been sent to the Company requiring them to increase the staffing levels by 19 October 2007. We asked people living in the home, relatives and staff how they thought the care home could improve. These are some of the comments we received: ‘Information given in the brochure is inaccurate.’ ‘Due to lack of staff residents are not taken out for walks or trips as advertised in their brochure.’ ‘Communication – staff need more time to read and understand care plans.’ ‘When the handover is done some staff don’t even come in for it. Sometimes it is done 10 minutes before you start work and then you don’t get told anything. Also when new service users come in they don’t tell you about them, when you have had 3 days off.’ ‘Communication between the home and family is poor and needs addressing.’ ‘By listening and acting on the concerns of families, not just being dismissive of their concerns.’ ‘There are many concerns about the care of the residents, which were raised at a meeting in September with the management company. The main concern was shortage of staff and inappropriate staffing levels for the needs of the residents, some with enormous physical disabilities. These concerns were Rastrick Hall DS0000070125.V347346.R01.S.doc Version 5.2 Page 8 dismissed. It was made clear that if residents or families were not satisfied they could move. Despite suggesting that the needs of many of the residents in Rastrick Hall were great and that staffing levels should reflect this, the management refused to look at increasing staffing levels despite several requests to do so. The management agreed that they had continued to admit residents to the three floors despite not being appropriately staffed.’ ‘A constant concern is that they are unable to operate an effective laundry system.’ ‘We feel generally that needs are not met. There are many physically disabled people at Rastrick Hall who need a very high level of attention and care and can do nothing for themselves. These needs are not met because of insufficient staffing levels. Toileting and bathing needs are not met most of the time based on our own observations.’ ‘Ensure appropriate staffing levels at all times. Get to know individuals better.’ ‘Comprehensive training with effective monitoring of such training.’ One relative said ‘although there are promises of improvement in day to day matters – staffing levels, laundry problems, bathing routines etc. none has been noted so far. There is still a long way to go before this home meets the needs of the residents. The Chief Executive stated that he wished to score highly with the Commission for Social Care Inspection, but it is difficult to see how he can when there are so many shortfalls in day to day routines.’ 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. Rastrick Hall DS0000070125.V347346.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 Rastrick Hall DS0000070125.V347346.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, 3, 4 & 5 (standard 6 does not apply) People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People are not given accurate information about what the service provides. There is no assurance that the home can meet people’s assessed needs. EVIDENCE: There is a service user guide available, which gives people important information about the service. We saw copies of the guide in people’s bedrooms. In the surveys people told us that they had visited the home before it opened and had been given the service user guide. One person said ‘information given in the brochure is inaccurate.’ Another person said ‘it’s a pack of lies.’ For example, the service users guide lists a selection of activities that are available on a daily basis and outings that can be arranged. People said that there was very little on offer in the way of activities and no outings Rastrick Hall DS0000070125.V347346.R01.S.doc Version 5.2 Page 11 had been arranged. The service user guide also states that family and friends will be invited to monthly reviews of their relatives care plan. None of the relatives we spoke to had been involved in such reviews. The company must make sure that they are delivering the service that is described in the service user guide. This will make sure that people receive the service they expected. We asked people living in the home if they had a contract. Six people returned the surveys. Three people said they had received a contract, one person said they hadn’t and two people didn’t know. One person told us ‘the contract is poor and lacks relevant information. It is badly drafted and therefore needs redrafting.’ Two people living at the home and one relative were unhappy that they received a letter from the company in September advising them that the fees at the home were going up. They were not told about this at the time of admission. One person said ‘‘I was somewhat dismayed at receiving a letter increasing fees by £35 per week after only 3 months in operation. However, this was discussed at an open meeting on Tuesday 11 September 2007 and the increase in fees is going to be delayed for 3 months until the home is more stable/fully operational.’ A copy of the residents contract is in the service user guide. This gives people important information about their rights and responsibilities. The current contract does not give details of the room to be occupied. This was discussed with one of the managers for Orchard Care Homes who said that the contracts had been revised and this will be included in any new contracts that are issued. We looked at some of the care plans and we saw that people were assessed before they moved into the home. Although the assessments have been completed too many people have moved into the home too quickly, without the proper staffing levels or the needs of the people already living in the home being taken into consideration. This means that people have moved into the home and there are not enough staff to meet their needs. The home does not provide intermediate care. Rastrick Hall DS0000070125.V347346.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 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People’s health, personal and social care needs are not being met. The care plans are not up to date and do not contain enough information about people’s needs. The medication system is poorly managed. This is leaving people at risk of not getting their medication at the right times. EVIDENCE: We looked at a selection of care plans because we wanted to see what individual needs had been identified and what action staff are expected to take to meet these needs. We asked people living in the home if they receive the care and support they need. From the surveys one person said sometimes, four people said usually Rastrick Hall DS0000070125.V347346.R01.S.doc Version 5.2 Page 13 and two people said never. One person said ‘the care and support is dangerously lacking.’ We asked people if they felt the home was meeting the needs of their relative. They said the following: ‘We feel that the care home usually meets the needs of our relative, but not always. There is a problem within the home of insufficient staff. The staff who work there are very good – especially the deputy manager – but there are insufficient numbers to care for residents on three floors, and often it is extremely difficult to find a member of staff.’ ‘We feel generally that needs are not met. There are many physically disabled people at Rastrick Hall who need a very high level of attention and care and can do nothing for themselves. These needs are not met because of insufficient staffing levels. Toileting and bathing needs are not met most of the time based on our own observations.’ We asked people living in the home if they receive the medical support they need. One person said always, three people said usually and two people said never. One person said ‘ I often have to rely on my daughter to make arrangements as staff here are working long hours (due to lack of staff) and either forget or just fail to make the requests.’ We could see from some of the plans that people are receiving health care from a range of people such as doctors, district nurses and opticians. There was no record of two people’s admission to hospital, what the admission was for or what treatment they had received. There was also no record of when people had been seen by a chiropodist. These records are poor and it is not easy to track the treatment people are receiving. We asked staff if they are given up to date information about the needs of the people living in the home. Staff made the following comments: ‘I don’t get time to sit and read the care plans.’ ‘Sometimes the care plans are not filled in. There are some that are not filled in at all.’ ‘Because we are so short staffed things are getting forgotten. The staff are rushed.’ The care plans should provide staff with some information about people’s needs and tell them what they must do to meet their needs. We felt that the plans we looked at needed to be more detailed. For example: One person is an insulin dependent diabetic. The district nurse visits every morning to give them their insulin. There was no care plan in place regarding his diabetes. For example there was nothing about what action staff should take if this person went into a diabetic coma or the importance of them getting their breakfast at the right time. This person told us that they didn’t think Rastrick Hall DS0000070125.V347346.R01.S.doc Version 5.2 Page 14 staff understood diabetes. He also said that staff had been late assisting them to get up in the mornings, which means that he doesn’t get his breakfast at the right time. Staff had only partially completed the pressure sore risk assessment for one person. This person has a special mattress on her bed and from the notes on her file we also saw that she had received a special cushion to sit on. She was not sitting on this cushion on either of the two days we were at the home. There was no care plan in place regarding the care of her pressure areas. This means that she is at risk of developing pressure sores. The district nurse assessed one person who has continence problems for pads. There is no care plan in place to tell staff how often they should assist her to the toilet or how frequently the pads should be changed or what night staff should do. There was also an entry on the daily records that stated she had run out of pads and staff had borrowed some from another person living in the home. Staff need clear information about what support they should be giving and how many pads are to be used each day. This will mean that the person is kept comfortable and will not run out of pads. One relative told us that her mother is prone to becoming dehydrated and this has been a problem in the past. She has asked staff to make sure that her mother gets hourly drinks. There is nothing in the care plan about this or anyway of checking that this is happening. One person is at risk of falling and has fallen and fractured her femur since she moved into the home. The daily records show that she is often getting up at night and wandering. Staff have not put any measures in place to lessen the risk of her falling. For example staff should consider putting a pressure pad at the side of her bed so that when she gets out the emergency call bell would ring. This would let staff know she was getting up and they could offer assistance quickly. There were also examples of staff not following care plans that are in place: One care plan we looked at stated that staff should make sure this person had her glasses on and that they were clean. On the two days we were at the home she was not wearing her glasses. One person’s care plan identified that she had lost weight and that staff should monitor her closely at mealtimes and prompt her with her meals. The care plan also states that staff should make sure she has the correct utensils, although there is no detail of what these are. From observation on the first day this person struggled to eat her boiled potatoes and broccoli because no one had cut them up for her. The broccoli ended up on the floor and eventually a member of staff cut her potatoes up for her when prompted by Rastrick Hall DS0000070125.V347346.R01.S.doc Version 5.2 Page 15 another person living in the home. On the second day the member of staff on duty was so busy trying to serve meals to the people in the dining room and deliver meals to people that were in their own rooms, she had little time to offer assistance. This person dropped her fork and became very upset and was crying. The member of staff just did not have time to sit with her. No ‘special’ utensils were in use on either day. Relatives told us that they knew about the care plans but had not been involved in any reviews of their relatives’ care. People should be consulted about their care. Some people living at the home are able to say if the care and support they receive suits them or if it can be improved in any way. Some people may not be able to comment, but have relatives who visit regularly who may wish to be involved. We asked people living in the home if staff are available when they need them. Four people said usually and two people said never. One person said ‘I am unable to go to the toilet, get dressed/undressed, get in and out of bed without assistance. This assistance is never forthcoming. Other residents and residents families including my own have had to take care of me including dressing/undressing and toileting.’ Another person said ‘there are times when they are too busy and then I get upset.’ One person told us that on one occasion she had to wait 25 minutes before someone came to take her to the toilet. We asked relatives if they were kept up to date with important issues affecting their relative. One relative said ‘we have been advised of events when visiting, but on one occasion our relative fell and we were not informed at the time of the event. We feel it would have been more appropriate to telephone immediately after the event. On two occasions the doctor has been asked to visit and we were not told until sometime later.’ We did not observe a full medication round. We did see that the medication trolley was left unattended in a lounge with the keys in it and a rack of medication left on the top of the trolley. The member of staff who was giving out medication was also trying to deal with a person who was not very well and was called away from the medication round because of this. The member of staff returned to the trolley and was well aware of her mistake. On the two days we were at the home the manager completed the medication round on the ground floor and another senior member of staff completed the medication rounds on the other two floors. At the weekends staff told us that there is only one person on duty who can give out medication to everyone and sometimes it is nearly lunchtime before people get their medication. We looked at the medication records and were concerned about the following: Rastrick Hall DS0000070125.V347346.R01.S.doc Version 5.2 Page 16 The medication rounds are taking a long time to complete. We saw that some people were not getting their morning medication until after 11.00am. It is important that people receive their medication at the times it is prescribed to make sure it has time to work properly. Two people had been prescribed eye drops. There were no signatures on the medication records to show that these had been given. One person had been prescribed antibiotics. Staff had documented that 26 tablets had been received. On the medication administration record 24 tablets had been signed for as being given and staff had written course completed. This leaves two tablets unaccounted for. One relative told us that she had found a lot of tablets in her mother’s pocket. When she asked staff they told her that her mother was taking 11 tablets in the morning. The relative contacted the GP and a review of her mother’s medication took place. In the care plan it states that that staff must ensure that she swallows her tablets. This is another example of staff not following a care plan. Staff must make sure that people get their medication at the prescribed times and that medication review take place with the GP. This will make sure people’s health care needs are met. Rastrick Hall DS0000070125.V347346.R01.S.doc Version 5.2 Page 17 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. People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. There is a lack of stimulating activity and staff do not have time for much meaningful interaction with people. This means that individuals can be left for long periods without anyone talking to them. Relatives are made to feel welcome and can visit at any time. The meals are good offering choice and variety. EVIDENCE: The care plans we looked at all contained a life history for the person. These contained valuable information for staff to help them understand the person and what their life has been like. There was no information written down about people’s preferred routines, that would help staff to understand how they like to live their day to day lives. The assessment information contains information about people’s interests, this is in a ‘tick box’ form, which is not Rastrick Hall DS0000070125.V347346.R01.S.doc Version 5.2 Page 18 particularly helpful. For example one care plan stated a person’s social interests as TV, music and cats. There was no detail about what sort of TV programmes they liked or what sort of music. It also stated that her religion was church of England and that she would like to attend religious services in the home. This person has lived at the home since June 2007. No Church of England services have been held at the home to date. This was discussed with the acting manager who told us that she has now arranged for a local church to visit and that these visits should start in November 2007. In the self assessment we received, we were told that: ‘The home has a well planned activities programme, which all residents and representatives are encouraged to take part.’ We were also told that ‘religious beliefs are identified in the care profile. Residents are actively encouraged to participate in their religious belief and appropriate resources are sourced to deliver this. The home has invited ministers from different denominations to attend the home to deliver services to residents.’ From this visit we found little evidence to support these claims.. The service user guide lists a range of activities that are available on a daily basis. For example going out for walks with staff and that staff will assist people to maintain their lifelong hobbies. We asked people living in the home if activities are arranged for them to take part in. Four people said sometimes, one person said ‘only bingo’ and two people said never. One person said ‘I feel insecure with some staff. Arrangements usually made for some activities on other floors. I am frightened of the lift and do not like to go in it. Activities are lacking generally and there doesn’t appear to be any moves towards making any changes.’ One person told us that she would like to go out for a walk, but the staff didn’t have time to take her. We asked relatives if the home lets people live the life they choose. Relatives said the following: ‘Our relative likes to sing hymns as a regular church goer. This is encouraged, and residents join in at these times.’ ‘Due to lack of staff residents are not taken out for walks or trips as advertised in their brochure.’ ‘There is no facility for taking residents out. No wheelchairs to take them for a walk. We have been told by the Chief Executive this is not a policy at the home as they are unable to let staff out of the building due to being short Rastrick Hall DS0000070125.V347346.R01.S.doc Version 5.2 Page 19 staffed.’ ‘My mothers life has improved since she moved to Rastrick Hall, but sometimes there are set backs. This is due to poor communication at the home. For example my mother does not want male staff to give personal care, but at night there is limited staff and she has been offered a male carer. The male carer is very good but it is a choice she wishes to be respected. It is stated in her care plan and therefore she should not be put in the position of refusing the male carer when he comes into her room.’ The home was very warm during our visit. The temperature in one lounge was 25.8°C. There were some people sleeping in the lounges. The rooms being too warm may be contributing to people sleeping during the day. The temperature should be maintained at around 21°C. Staff need to monitor the temperature on a regular basis to make sure the rooms are not too hot. Some staff interacted well with people and there were clearly some good relationships that had been built up between staff and the people living there. People living in the home said that one problem area is that staff work on different floors and this means that they can have different staff looking after them each day. This makes it difficult for them to get to know the staff looking after them. Relatives we spoke to said that they were made to feel welcome when they visit. People said ‘we are made to feel welcome when we visit.’ ‘Inviting families to eat with their relatives on occasions is hugely beneficial.’ All of the people living at the home, relatives and staff said that the food was good. There are choices available for every meal and there is plenty of food available. On the second day of our visit some people living at the home said there had been a problem with the delivery of food. Two people said that the home had run out of eggs the day before. Another person said there was no white bread for breakfast and two people told us there had been no marmalade for 4 days. Staff need to make sure that food deliveries are on time and they do not run out of the food people want. On the second day we observed the lunchtime meal being served in the ground floor dining room. There was only one member of staff on duty who struggled to meet everyone’s needs. She was trying to serve meals in the dining room, deliver meals to bedrooms and offer support and assistance to one person. (See section of health and personal care). People were making various requests about what food they wanted, drinks etc. and she was unable to meet these in a timely way. Rastrick Hall DS0000070125.V347346.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Complaints and adult protection issues have not been dealt with appropriately, which means people at the home are not protected. EVIDENCE: The home’s complaints procedure is in the service user guide and on display in the front entrance. We asked people living at the home if they knew who to talk to if they are not happy. One person said always, two people said usually, one person said sometimes and two people said never. One person said ‘this depends on staffing levels. There is not always somebody here of a senior level to discuss issues, and even when raised, nothing is done about it.’ We asked people living in the home if they knew how to make a complaint. Three people said they did and three said they didn’t. One person said ‘although the service user guide states the complaints procedure, it is not followed due to lack of staff being available or no one at a senior management or persons in charge of the home.’ Another person said ‘I usually go through my son, so he can take it up and follow its progression and outcome.’ Rastrick Hall DS0000070125.V347346.R01.S.doc Version 5.2 Page 21 From talking to relatives it was clear that they have raised concerns about the staffing levels, laundry and cleanliness of the home. We asked relatives if they knew how to make a complaint. All ten of the relatives who completed a survey said that they knew about the complaints procedure. We also asked them if the home had responded appropriately if they had raised any concerns. Relatives said: ‘ We were not made aware that there are complaints forms to complete until last week. Until then we have been writing to the management company.’ ‘There are many concerns about the care of the residents, which were raised at a meeting in September with the management company. The main concern was shortage of staff and inappropriate staffing levels for the needs of the residents, some with enormous physical disabilities. These concerns were dismissed. It was made clear that if residents or families were not satisfied they could move. Despite suggesting that the needs of many of the residents in Rastrick Hall were great and that staffing levels should reflect this, the management refused to look at increasing staffing levels despite several requests to do so. The management agreed that they had continued to admit residents to the three floors despite not being appropriately staffed.’ ‘The laundry has been an eternal problem from day 1. Residents clothes are not laundered quick enough, and not returned to residents. This means that often residents have no clothes to wear on a regular basis. Although promises have been made to resolve this, no evidence has yet been seen. On numerous occasions we have had to request searches to be made to provide clean clothes for our relative to the extent that we have requested home washing to avoid this problem.’ The home’s complaints log shows that three written complaints have been received. Only details of the responses to two of these were on the file. Two of the relatives verbal complaints have been logged. From talking to people living in the home and relatives it was clear that they have raised concerns about the staffing levels, laundry and cleanliness of the home. Only some of their concerns have been logged. People don’t think that they are being listened to or that their complaints have been taken seriously. One of the people living at the home also raised concerns about the staffing levels in the home during the formal review of his placement at the home with his social worker. His concerns were not dealt with. The home does not have a copy of the local adult protection procedures. It is important that staff have these to make sure that they are keeping people in their care safe and protected from any form of abuse and that they know exactly what to do if an allegation of abuse is made. One relative told us that her mother had been admitted to hospital with a shoulder injury and that this could have been caused by poor moving and Rastrick Hall DS0000070125.V347346.R01.S.doc Version 5.2 Page 22 handling practice. This incident was not notified to the adult protection coordinator or us. There was also no record in the person’s file of any investigation taking place to establish what had taken place. Staff need to have more training to make sure they know what incidents they should be reporting and to which departments. Rastrick Hall DS0000070125.V347346.R01.S.doc Version 5.2 Page 23 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, 21, 23, 24 & 26 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People live in a safe, comfortable, well maintained home. EVIDENCE: Rastrick Hall is a new home that opened in June 2007. The accommodation is arranged over three floors. Each floor has its own lounge and dining area. There is a kitchen area in each dining room. People living at the home relatives and staff made the following comments about the environment: ‘The set up i.e. the layout is excellent, the rooms are of a good standard and the lounges are set out well too.’ Rastrick Hall DS0000070125.V347346.R01.S.doc Version 5.2 Page 24 ‘Rooms are first class (as you would expect with a new establishment.).’ ‘The surroundings and environment are excellent.’ ‘Only one plug to share between 3 baths.’ We asked about this on our visit. Staff said they had borrowed another plug from Rastrick Grange, which now leaves them with one bath with no plug. Staff must make sure that there is a plug available for each bath. ‘The home is purpose built therefore accommodation for a variety of service users.’ We spoke to one person living at the home who is a wheelchair user. He told us that he finds the access very good and has no problems getting around the home. All of the bedrooms are singles with en-suite toilets and showers. The bedrooms are well decorated and comfortably furnished. There is a TV in each bedroom and lockable space, so people can keep their possessions safe. There is an assisted bathroom on each floor and an additional shower room. The kitchen and laundry are shared with Rastrick Grange a care home, owned by the same company, on the same site. The kitchen has been inspected by environmental health since the home opened and was awarded 5 stars for hygiene. We asked people living in the home if it was kept fresh and clean. Five people said always and one person said sometimes. One person said ‘cleanliness of the rooms is very poor.’ The laundry is well equipped. There is only one laundry assistant who works three days on and three days off. She is expected to wash, dry and iron all of the laundry for the two homes. On the first day of this visit the laundry assistant was working and was on top of the washing and ironing. On the second day she was not on duty. There were large amounts of dirty laundry waiting to be dealt with. Other staff were trying to deal with this on top of their own jobs. This was discussed with the managers who said that someone from one of their other homes was coming to cover the laundry on the next two days. They had recruited a second laundry assistant but they had left. More laundry staff must be appointed if the home is going to make any progress. There is a large amount of clothing that is not named and the laundry staff do not know who it belongs to. Relatives have complained about laundry going Rastrick Hall DS0000070125.V347346.R01.S.doc Version 5.2 Page 25 missing. The laundry system must be improved to make sure that people’s clothing is returned to them. Rastrick Hall DS0000070125.V347346.R01.S.doc Version 5.2 Page 26 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 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. There are not enough staff on duty to meet the needs of the people using the service and this is having an impact on their welfare. Staff are not receiving the training and support they need to do their job properly. EVIDENCE: Most of the people living in the home, relatives that completed a survey and those we spoke to all said that they didn’t think there were enough staff on duty to meet the needs of the people living there. This was also the view of the staff that we spoke to. These are some of the comments they made: ‘Staff turnover appears to be high; long shifts for carers; no holiday or sickness cover.’ ‘The staff who were employed when the home first opened in June 2007 were very caring and experienced. Most of these staff have now left or are leaving because of lack of support from their management and overwork. Most of the staff now employed appear inexperienced and lacking in knowledge of dealing with older people.’ ‘I’ve manned floors regularly by myself. Some residents need 2 carers to assist them. On occasions I have run 2 floors.’ Rastrick Hall DS0000070125.V347346.R01.S.doc Version 5.2 Page 27 ‘I don’t think there are enough staff at night. There are only 3 members of staff, one is doing medication and 2 looking after 3 floors, some residents need 2 carers so it means that 2 floors are unattended at some point, which is not fair on the residents if someone has an accident.’ ‘No there aren’t enough staff, they are all run into the ground, feel unsupported as management don’t seem to understand our concerns, if so nothing seems to be done.’ At the time of the inspection there were two care staff working on the first and second floor, and one care assistant on the ground floor. When care staff take their breaks this leaves only one carer to supervise 12-15 people. Care staff also put away all of people’s personal laundry. When there is just one senior care assistant on duty in the home they have to give out medication on each floor. They are included in the staffing numbers. This means that if they are one of the two carers allocated to the floor, when they go to another floor to give out medication one of the carers from that floor goes downstairs to cover. Whilst the member of staff is giving out medication they cannot offer direct care. This means that for the hour (on each floor) medication is being given out there is just one care assistant available to meet people’s needs. The staffing levels at the home must be increased, to make sure that people’s needs are met consistently. The manager also needs to look at the continuity of people’s care. If staff are working on a different floor every shift it is not helping people living in the home get to know them and build up a relationship. We asked staff if the necessary checks with the criminal records bureau and references were taken up before they started working in the home. The five members of staff that completed a survey both said they had. We looked at two files. Recruitment procedures are good, references are always taken up and checks are always made with the Criminal Records Bureau to ensure that new staff are suitable to work with older people. This means that people who live there are being appropriately protected. We asked staff if their induction training covered everything they needed to know when they started work. One person said yes, two said partly and two said that it didn’t. Staff made the following comments: ‘I have been working at the home for about 3 months and I haven’t had any training at all apart from moving and handling. It would have been nice to do my induction training though. I have never done caring before and I think it would have helped me. I didn’t do my moving and handling until I had been here a month.’ ‘I did not have an induction. I used my initiative, I had to.’ ‘I still have not had an induction. I have had no training at all.’ Rastrick Hall DS0000070125.V347346.R01.S.doc Version 5.2 Page 28 Staff that started work at the home before it opened received a lot of training. One member of staff told us that the training lasted a month. Staff that have been appointed since have not received the same level of training. This was acknowledged by the managers, who agreed that staff must have proper induction training. We asked staff if they get support from their manager and have the opportunity to discuss the way they are working. Two members of staff said that they find the deputy manager very supportive. One person said ‘I’ve worked under the deputy and she is the salt of the earth always willing to show me the correct way of doing the care work.’ The other member of staff said ‘if I have a problem I talk to the deputy manager. The manager hasn’t been here long but hasn’t tried to help or get to know us.’ Three members of staff said that they didn’t feel at all supported. They made the following comments: ‘We have just got a new manager in place now, I have not had a meeting with anyone in relation to my working relations or suitability. There has been no time allocated due to staff shortages and deputies are also being counted as care staff to manage a floor.’ ‘I only see the manager at handovers in the morning. They never seem to understand.’ There are 13 care staff working in the home, 6 have completed their NVQ (National Vocational Training) level 2 in care. This means that these staff are trained and competent to do their job. Rastrick Hall DS0000070125.V347346.R01.S.doc Version 5.2 Page 29 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, 35 & 38 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The home is not well managed. People living in the home and their relatives need to be consulted about the way the home is managed. This will make sure that the home is run in the best interests of the people living there. EVIDENCE: There is no registered manager at the home. The company have appointed an acting manager who has been in post for about 4 weeks. She needs to apply for registration with us. Rastrick Hall DS0000070125.V347346.R01.S.doc Version 5.2 Page 30 The manger needs more time to be working directly with staff and people living in the home, observing care practice and making sure that care plans and reviews are up to date. It is important that this happens to make sure that the issues highlighted in this report are addressed. At the end of the inspection the possibility of getting administrative support was discussed with the senior managers. They agreed that they would look at this, so that the manager can spend more time looking at practices in the home. Too many people have been admitted to the home too quickly without enough staff to look after them. Staff have started working in the home without completing the induction training. Complaints that have been made have not been taken seriously or resolved to people’s satisfaction. Care plans have not been completed or reviewed properly. The management of the laundry system has been poor. The company have quality assurance systems in place to make sure that people living in the home and their relatives are consulted about the way the home is managed. No surveys have been sent out yet as the home has only been open for a relatively short period of time. At the end of the inspection this was discussed. The managers agreed that surveys should be sent out at the beginning of January. This will give the acting manager time to start addressing the problem areas such as staffing levels, staff training activities and laundry and give people the opportunity to comment on improvements they have seen. The acting manager holds money for some of the people in the safe. The records seen were well maintained and accurate. There have been accidents when people have required hospital treatment. We have not been told about these. Staff need training about what things they need to tell us about. All of the equipment in the home is new and not due for servicing yet. The fire test records showed that there have been no fire alarm tests. These tests must be completed every week to make sure that the system is working properly. Rastrick Hall DS0000070125.V347346.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 1 1 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 3 X 3 X 3 3 X 2 STAFFING Standard No Score 27 1 28 3 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 X X 2 Rastrick Hall DS0000070125.V347346.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 5 Requirement Timescale for action 30/11/07 2 OP3 14 3 OP7 15 4 OP7 15 The service user guide must be reviewed to make sure that the information that is being given to people reflects the service that is being provided. This will make sure people receive up to date information about the service. When assessing people before 09/11/07 they move in the staffing levels and the needs of the people already living there must be considered before a place is offered. This will make sure that people can be assured that the home can meet their needs. People who live at the home or 28/11/07 their representatives must be consulted about their care plans. This will make sure that people have the opportunity to comment on the care and support provided and say if it could be improved. Care plans must be brought up 14/12/07 to date and give staff clear guidance about what they need to do in order to meet individual’s needs. This will make sure that people’s needs DS0000070125.V347346.R01.S.doc Version 5.2 Rastrick Hall Page 33 5 OP9 13 6 OP12 16 are met in a consistent way. Medication must be given at the 14/11/07 times it is prescribed and the medication administration record signed accordingly. This will make sure that people’s health care needs are met. Activities must be provided that 14/12/07 meet the range of needs and abilities of the people who live there. Wherever possible people must be consulted about the sort of activities they wish to be involved in. This will enable them to take part in activities of their choice. A record of all complaints received by the home, both verbal and written, must be maintained together with the action that was taken to resolve the complaint and the outcome. This will make sure that people know that their complaint has been taken seriously and acted upon. The adult protection procedures must be followed and staff must know what incidents must be reported. This will make sure that people are kept safe. The laundry system must be improved. To make sure that people get all of their personal clothing returned to them Staffing levels must be increased. Staff must be available at all times in sufficient numbers to meet the assessed needs of people who live at the home. This will make sure that the needs of each person are met. Staff must receive induction training when they start work at the home. This will make sure DS0000070125.V347346.R01.S.doc 7 OP16 17 28/11/07 8 OP18 13 28/11/07 9 OP26 16 14/12/07 10 OP27 18 19/10/07 11 OP30 13 31/10/07 Rastrick Hall Version 5.2 Page 34 12 OP32 10 13 OP38 23 that they are able to do their job properly. A manager must be registered 31/12/07 with the Commission for Social Care Inspection. This will make sure that the home is run in the best interests of the people living there. The fire alarms must be tested 28/11/07 every week and details of these tests recorded. This will make sure the fire alarm system is working properly. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Rastrick Hall DS0000070125.V347346.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Brighouse Area Team First Floor St Pauls House 23 Park Square Leeds LS1 2ND 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 Rastrick Hall DS0000070125.V347346.R01.S.doc Version 5.2 Page 36 - 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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