Inspection on 20/03/07 for Rathside Rest Home

This inspection was carried out on 20th March 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Rathside Rest Home 05/12/08

Rathside Rest Home 17/12/07

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

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 Rathside Rest Home Gainsborough Lane Scawby North Lincolnshire DN20 9BY Lead Inspector Mrs Jane Lyons Key Inspection 20th March 2007 09:00 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 Rathside Rest Home DS0000068229.V326462.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. Rathside Rest Home DS0000068229.V326462.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rathside Rest Home Address Gainsborough Lane Scawby North Lincolnshire DN20 9BY 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) 01652 652139 Mr Sukhuinder Marjara Position Vacant Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Rathside Rest Home DS0000068229.V326462.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24,25 and 26th January 2007 Brief Description of the Service: Rathside is well established home, which provides residential care support for up to thirty service users in the category of older people. It is situated on the outskirts of Scawby a small village three miles from the town of Brigg and close to local amenities. The accommodation is over two floors, and there is a passenger lift available to the first floor. There are 26 single rooms in the home, and 2 shared rooms; 22 of the bedrooms have en- suite facilities. A garden room was provided to the front of the building in 2005, which has significantly improved the range of communal areas the home provides. There were three further sitting rooms and a dining room in the home. The home has a good range of bath and shower facilities. The front garden has been improved with a large paved area with plenty of seating and shade; a ramp with rails has been provided for access from the garden room. There is a pleasant, well maintained rear garden and ample parking space to the side of the home. It is a privately owned home, and the proprietor is Mr S Marjara. The home is currently recruiting a manager. Weekly fees are: £327 - £385.The home operates a system whereby the fees include a third party contribution. Additional charges are made for the following: toiletries, newspapers/ magazines, hairdressing and chiropody. Information about the home can be found in the statement of purpose and service user guide, both these documents are available from the owner at the home. Rathside Rest Home DS0000068229.V326462.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced key inspection and took place over 1 day in March 2007.The inspector was accompanied by Mrs J. Campbell; Regulatory Manager. • • • The visit to the home lasted from 9 a.m. until 7 p.m. Twelve residents and four relatives spent some time chatting to the inspectors. The inspectors also talked to five care staff, two domestic staff, three visiting district nursing staff, the acting manager, the owner and the management consultant. The inspectors also looked around the home and looked at lots of records including resident care plans, staff recruitment records and other records about the running of the home. Information received by the Commission over the last few months was also considered in forming a judgement about the overall standards of care within the home. The inspectors observed how staff and service users worked together throughout the day. People’s views about the home and what was found during the visit have been used to write the report and make judgements about the quality of care. The home has recently had problems with the management arrangements, a new manager started but thee were some problems. The owner has dealt with these problems but if the improvements which are now happening do not continue then the commission may need to take action. • • • What the service does well: The home was welcoming and had a relaxed and homely atmosphere. Residents were observed to be very settled and comfortable in their surroundings. Residents spoke positively about the way in which the care staff treat and care for them. Residents said their family and friends are made to feel welcome by staff when visiting the home and that they can visit when they please. Rathside Rest Home DS0000068229.V326462.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Resident’s assessments and care plans must improve; individual resident’s assessments and plans were available however some records did not have enough information about all the needs of residents. This means the home was not able to show that all aspects of the health and personal care needs of resident’s are identified and planned for. The home must report all serious incidents to the Commission to ensure appropriate action has been taken to ensure resident’s safety and welfare. When residents have accidents such as falls, it is important that appropriate records are completed to ensure the correct action for the resident has been taken. Staff can then look and see if they can do anything to help reduce the risk of falling. The previous manager has not always followed good practice when recruiting and selecting new staff by not ensuring all required checks on prospective Rathside Rest Home DS0000068229.V326462.R01.S.doc Version 5.2 Page 7 employees are carried out before they start work in the home. This potentially places residents at risk of harm. The home needs to make sure there is enough staff on duty so the service users are looked after properly. The management need to talk with the residents more to make sure they are satisfied with and can influence services provided at the home such as care support, meals, activities and if they would like anything to change. Carpets and furnishings with stale odours must be cleaned more regularly to ensure that the residents live in a home which is pleasant and comfortable. The supervisory arrangements for the home must improve to provide staff with the necessary guidance, leadership and support to ensure residents living in the home are safe and well cared for. 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. Rathside Rest Home DS0000068229.V326462.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rathside Rest Home DS0000068229.V326462.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Not all residents have had their needs fully assessed prior to moving in to the home or returning to the home from hospital; this potentially places them at risk of not receiving all the support they may need. EVIDENCE: A random inspection visit was carried out in January 2007, the commission accompanied the local authority who have investigated an allegation made to the adult protection team, this identified a number of areas where a change in standards had occurred. The registered provider agreed to a voluntary closure to admissions on the 1st February 2007 due to ongoing management difficulties. As a result there have been no new admissions to the home since Rathside Rest Home DS0000068229.V326462.R01.S.doc Version 5.2 Page 10 that date; although one of the existing service users was admitted to hospital for treatment and readmitted back to the home. A number of staff at the home raised concerns to one of the care managers during a visit she made on the 1St March 2007 that they were struggling to cope with the service users needs and a district nurse interviewed during this inspection visit told the inspector that she considered the service user should not have been readmitted to the home from hospital following her stroke; given the significant changes to the level of her needs; the service user has since been transferred to a nursing placement. Assessment documentation examined at the inspection in January identified that the quality of the recording remained inconsistent. From case tracking at this visit there was no evidence that improvements to the assessment documentation had been made; however the new acting manager in post confirmed that she would be implementing her own documentation which had been tried and tested through the consultancy. The home does not provide intermediate care support. Rathside Rest Home DS0000068229.V326462.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Resident’s needs and choices are better provided through care planning and risk assessments, however some of the care records remain inadequate and therefore places residents at risk of not receiving the care they need. The way staff have been administering and recording resident’s medication is unsatisfactory and this also puts residents at risk of harm. EVIDENCE: At the previous inspection visit in January serious deficiencies with the quality of the care plan documentation and risk assessments were identified; the service manager from the local authority had provided a member of her staff to visit the home and give support to staff in completing risk assessments for service users with identified high needs in areas such as tissue viability, mobility and falls. The officer from the local authority had visited the home on Rathside Rest Home DS0000068229.V326462.R01.S.doc Version 5.2 Page 12 a number of occasions, worked with the acting manager and senior staff and also provided copies of the local authority risk assessment format to use; at her last visit on the 13th February she had reviewed some of the paperwork and identified that significant gaps still remained. Four residents were selected for case tracking; there was evidence that overall, improvements had been made to the quality of the care plans, risk assessments, evaluation records and records of daily care however the standard remained inconsistent and gaps were identified in a number of areas. The following issues were identified: • Plans not in place to support all areas of need identified on assessment for example: confusion, mobility, faecal incontinence, rashes, constipation and wandering. • Care plans had not been developed where service user’s needs had changed for example: one service user had developed problems associated with chest infections on two occasions and muscle spasms which had not been identified on plans of care; another service user now needed to have assistance with feeding which was not reflected in the care plan. • Care plans did not clearly identify the care support required for example: pressure area care, mouth care and catheter care. • Where risk assessments had been reviewed and updated not all high risk areas such as mobility and falls had had associated care plans developed, for example one service user’s falls risk assessment had been completed on the 3/03/07 which detailed that she required hoisting for all transfers and required the use of a wheelchair which had not been documented on a care plan. • Gaps remained in the completion of supplementary records such as food/ fluid and turn charts. Records showed that staff had not completed records at all for a number of days and there were also gaps when staff on a particular shift had not completed records. • Gaps remained with the completion of a number of daily records. • Evaluation records were inconsistent; one of the care plan files had not been evaluated, of the remaining three files where evaluation records detailed changes in care provision the plan had not always been amended. • Inconsistencies remained with the recording of service user’s weights, for example: one service user’ s plan identified that her weight should be checked weekly however this had not been checked since the 6/02/07. • Accident records were now completed however records of slips/ falls were not always detailed in the daily records. • Bowel monitoring charts had been reintroduced in January however they were poorly completed; the chart for one service user with identified problems with constipation had only been completed seven times in February and once in March yet the daily records evidenced more frequent bowel actions. Rathside Rest Home DS0000068229.V326462.R01.S.doc Version 5.2 Page 13 At the previous inspection in January there was evidence that service user’s health needs were not being met due to a lack of monitoring and referral to relevant health care professionals. There was evidence in the records and from discussion with the staff that referrals have been made to the community falls co-ordinator and that concerns had been more expediently referred to the G.P. and district nursing staff. Discussions during the visit were held with two of the visiting district nursing teams; they confirmed that the standards of care had improved in recent weeks and the senior care staff maintained good levels of communication by informing them of any changes; however issues still remained as the district nursing staff confirmed that one service user’s recent problem with blistering and soreness around his catheter had been caused by poor catheter care; staff interviewed during the visit did not have a clear understanding of current catheter care procedures and the care plan had not detailed any clear care support guidance for staff. Issues around the staff competence with the use of the “profiling bed” identified at the previous inspection in January had been addressed. Records showed that fourteen staff had received instruction on the 01/02/07 and 08/02/07 from the acting manager on how to operate and correct use of the equipment. Staff interviewed during the inspection confirmed that they had received training and felt confident with using the equipment. Improvements since the last inspection have been made to the staff’s moving and handling practices. Five staff attended a training session on the 08/02/07 where they watched a video and completed risk assessments. Nine staff (two attended previous session) attended a practical training session on the 15/02/07. Case tracking identified that all the moving and handling risk assessments for four service users had been reviewed and updated where necessary. Staff spoken to during the visit said that they always used the equipment identified on the risk assessments and did not consider that any of their colleagues took short cuts. Service users were more accepting of the equipment and now understood why it had to be used. Improvements were noted to some of the standards of care provided by the staff; the service user named in the complaint in January had been reassessed at that time and met the criteria for nursing placement although the move had not yet taken place. The resident told the inspector how pleased he was with the care provided by the staff and how kind they were; he went on to say that his weight had improved and the problems he was having with sores around his mouth and lips had settled which was evident. All other residents seen during the visit appeared well dressed and cared for with the exception of two of the female residents who were observed not to have received support with their facial hair; one of the resident’s sons told the inspector that his mother liked staff to support her with this but she didn’t have a razor and staff had not informed him of this when he had asked them if Rathside Rest Home DS0000068229.V326462.R01.S.doc Version 5.2 Page 14 there was anything he needed to bring in. Staff told the inspector that when they had asked the previous acting manager for razors she had told them that residents would have to buy them now; the registered provider stated he was not aware of this and razors were available in the home. Service users spoken to during the site visit explained the lack of confidence they had in the previous manager, her ability to deal with their health care needs. They said they were much happier now as they felt the acting manager listened to them and responded in an appropriate and timely fashion. The medication policies and procedures had not been updated to cover all areas of the medication systems. Following the previous inspection in January the acting manager had implemented a medication audit record however this had not been completed regularly and did not record all issues identified. A new medication fridge had been provided which was locked and records of the temperature maintained. There was evidence from examination of the controlled medication book and medication administration records that controlled medication administration had not been recorded properly and that medication errors had occurred. The medication error had not been followed up formally nor reported to the commission. A medication error on the 27/02/07 had been followed up by the manager and also reported to the commission. A record in the staff communication book on the 6/02/07 identified that a service user’s medication had been found on the floor, however, this was not identified on the administration chart. Examination of the administration records identified that staff were not recording the amount of medication received nor the amount carried over which meant there was no accurate record of the stock level; the acting manager confirmed that she had identified this issue and due to the complexity of the problem had arranged with the pharmacy provider to return all medications at the end of the month to ensure a clear record of all medications could be made. Staff must also make sure that when they are transcribing by hand new prescriptions that they have their signature countersigned by another colleague. The progress report received for February 2007 from the acting manager identified that individual clients medication evaluation records had been completed and put into care plans. Evidence from the inspection identified that the two of the medication records case tracked were not accurate and did not reflect the current medication prescribed for the service user. The management consultant is also arranging for the home to obtain their medication via a monitored dosage system and has arranged meetings with the practice managers at the local G.P. practices. Rathside Rest Home DS0000068229.V326462.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13, 14 and 15. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents can participate in activities however these are limited and involvement in the local community is dependent on staff availability. The quality and choice of meals has fallen although most residents generally said that they enjoyed their meals. EVIDENCE: Observation during the visit indicated the home supports flexible routines these include the time the service users get up, go to bed, where they eat their meals and how they spend their time. Service users preferences around times they liked to get up and retire to bed were detailed in the care plans. Relatives and friends visiting during the inspection confirmed that they are made to feel welcome and can visit at any time. Rathside Rest Home DS0000068229.V326462.R01.S.doc Version 5.2 Page 16 An activity co-ordinator is employed to work in all three of the registered providers homes; she visits Rathside for two mornings each week. During the inspection the activity co-ordinator visited the home and spent time with a number of female residents doing manicures and chatting. The activity programme included Bingo, games and crafts for Easter, however residents spoken to during the visit were not sure when the co-ordinator visited the home or what activities had been planned. The majority of residents were observed to spend their time sitting watching the television, chatting to each other and sleeping. Service user files contained personal profiles and histories. Social needs assessments/plans were in place but these did not detail the service user’s current preferences or capabilities regarding social, recreational or emotional needs. Staff had commenced records of activities provided but these had not been maintained consistently. Service users religious needs were detailed in the plans; one service user told the inspector that she would like to attend the local church service but relied on staff to take her, although communion services were held in the home. Trips to a concert and garden centre had been arranged however the service users have limited use of the local amenities, as this is dependent on staff availability to take them out. Those who had relatives do go out on a more regular basis. Service users told the inspectors that the standard of the meals was not as good as it used to be, however most agreed that when one particular cook was on duty the meals were generally good. Complaints and issues raised by the staff and service users to the inspectors during the visit included: • Hot meals served on cold plates. • The vegetables are always overcooked. (The home is now using only frozen vegetables) • No hot meal provided for one service user on one occasion, he was given corned beef as the hot choice had run out. • Very small portions of meat served in the casserole. • Powdered milk used in coffee drinks and custard. • A service user received a portion of fish which she discovered was just batter and contained no fish meat. • The management had informed the residents that the menus would be changed a number of weeks ago however this had not happened. The alternative meal at lunchtime was always baked potato or omelette. Staff told the inspectors that some of the issues had been reported at the time to the registered provider who on one occasion had taken action such as purchasing fish and chips for residents from a local chip shop. Rathside Rest Home DS0000068229.V326462.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents were not confident that their concerns were listened to and acted upon by the previous acting manager however the appointment of new management consultants and a new acting manager in the last two weeks have made significant improvements in this area. The arrangements for the management of staff supervision and standards of care have meant residents have not been protected from harm. Current recruitment practices are also potentially placing residents at risk of harm. EVIDENCE: Following the homes change of ownership in October 2006 the commission received two anonymous complaints in November 2006; a random inspection was carried out to consider the issues. Further concerns were raised in January by a district-nursing sister regarding the standards of care in the home and issues around communication with the acting manager. A relative also contacted the commission at that time, concerned that the home was going to be closed down. Rathside Rest Home DS0000068229.V326462.R01.S.doc Version 5.2 Page 18 The home’s complaint records showed that the home had received two complaints in November and one in December; although formal responses to the complainant were clear there was little recorded evidence that the management had followed issues through and taken steps to prevent reoccurrence. From discussions with the staff and residents there was evidence that a number of issues had been raised to the previous manager, however, they had not been documented formally. In the previous section of the report numerous issues regarding the quality of the meals had been raised and from discussions with a relative serious concerns regarding her mothers care following a fall, and admission to hospital without her medication or documentation had not been recorded or followed up. Another concern had also been raised by nursing staff at the hospital following a service users admission; although the service user’s diabetes had been unstable, no records of the service users current insulin prescription and administration records had been provided by the home and they had had to be obtained from the district nursing service. Discussions with service users during the visit confirmed that they had not felt confident that the previous acting manager would deal with issues and they did not see the owner very much and would not feel comfortable discussing concerns with him. However service users told the inspector that they liked the new acting manager and felt more confident that she would take action if they reported any problems or concerns. Discussions with staff confirmed that they also felt more confident that the new acting manager would deal with issues and complaints effectively. An allegation that a staff member had verbally abused a resident was referred to the adult protection team at North Lincolnshire local authority in October 2006. An investigation was carried out by the care management team and findings supported that the care assistant had verbally abused a resident. The care assistant was dismissed from the home. Further allegations were referred to the adult protection team in January 2007 that a service user had suffered neglect in the home; these issues which were investigated by the commission and care management team. The investigation findings supported that the service user had suffered neglect and also that institutional abuse had taken place. The acting manager has subsequently resigned and management consultants have been employed to improve the services and protect the health, safety and welfare of the residents in the home. Following the adult protection investigation in October, the adult protection coordinator from North Lincolnshire local authority had visited the home and provided two training sessions for staff on safeguarding adults. Rathside Rest Home DS0000068229.V326462.R01.S.doc Version 5.2 Page 19 Examination of newly employed staff records at the previous inspection in January identified that the home had not been following good practice when appointing new staff. There was further evidence at this visit that these matters remain outstanding. This is not acceptable practice as it puts residents at risk of harm. Please refer to page 24 of this report. Recent events that have occurred since the acting manager has been in post has demonstrated an understanding and willingness to follow the correct procedures and thus protect service users. Rathside Rest Home DS0000068229.V326462.R01.S.doc Version 5.2 Page 20 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 and 26 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The standard of décor and furnishings within the home provide residents with an attractive and homely place to live in, although improvements have been made to the home in the last few months outstanding issues around odour control impact on the overall quality of the environment. EVIDENCE: Rathside provides a homely environment with furniture and décor of a good standard. There is evidence that maintenance, refurbishment and redecoration is ongoing. Resident’s rooms were personalised to the extent chosen by the Rathside Rest Home DS0000068229.V326462.R01.S.doc Version 5.2 Page 21 individuals. There is a good range of communal areas in the home and they were all well utilised during the visit; residents sitting in the garden room told the inspectors how much they enjoyed sitting there watching the world go by and chatting to the other residents. Odour management issues in the home had been identified at the previous inspection visit; one of the ground floor bedrooms had a very strong odour of stale urine. At this visit the problem was still evident and also in another of the residents rooms, although domestic staff confirmed that the carpets in both rooms were cleaned regularly. The registered provider told the inspectors that he had arranged for a specialist cleaning company to visit the home the following week to tackle the issues. If the problems persists further then new carpets must be provided. Other areas of the home were seen to be clean and tidy. Rathside Rest Home DS0000068229.V326462.R01.S.doc Version 5.2 Page 22 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 and 30 People who use this service experience poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users are cared for by a group of staff who demonstrate a very caring manner however changes to the management structure have highlighted their over reliance on leadership and continual guidance and supervision. Recruitment procedures do not afford sufficient protection for service users. EVIDENCE: Twenty-three residents were living at the home at the time of the visit. The home is utilising the Residential Staffing Forum Guidance to calculate staffing hours; there was evidence in service users files that the dependency scores had been changed to a lower score for a number of the residents however their needs appeared to have become greater. It is important that the dependency records that the home utilises support the RSF and that they are consistently maintained. Staff reported that since the last inspection there had been a small number of shifts where there had been a shortfall of staff but that agency was now provided which was evidenced in the rotas. Rathside Rest Home DS0000068229.V326462.R01.S.doc Version 5.2 Page 23 The management consultant confirmed to the inspectors that they had authorised the change in staffing levels and these had been implemented the previous day; four staff continued to work in the mornings and three were now rostered on the afternoon shift, the management had maintained three staff on night duty. Staff who had worked the previous evening shift told the inspectors how busy they had been and especially as the tea time kitchen assistant was off sick and that they had to prepare and serve the evening meal as well. One care assistant told the inspector that they were so busy that they could not answer the doorbell promptly and many visitors were left waiting on a very cold night, which they felt was unacceptable. During the inspection visit one of the service users needs had deteriorated and she required one to one support from the care staff to monitor her closely; on discussion, the management confirmed that they would be rostering four staff again on the afternoon shift. The inspectors also discussed effective rota management to ensure that newly employed staff working with a POVA First check were supervised on shift when working with service users and that this could only be achieved if they were supernumerary. Evidence from discussions with residents during the visit confirmed that they were satisfied that the care they received met their needs; they commented on how kind and supportive the staff were and that they generally answered the call bells promptly. At the previous inspection visit in January there was evidence of poor recruitment practice by the acting manager and registered provider; there was evidence at this visit that the registered provider had taken little action to improve the records and poor practice had continued. However, the management consultant confirmed this was an area of priority and he would be auditing all recruitment records and obtaining all the required checks and records to ensure full compliance would be achieved. The following issues were identified: • Staff employed prior to the previous inspection did not have records in place which complied with Schedule 2 of the care homes regulations. There remained gaps with written references, identification documentation, health declarations and CRB checks. For staff employed since the previous inspection, verbal references had been obtained and written references were not always obtained from the previous employer. There were also gaps in identification records and health declarations. No work permit in place for the overseas worker recruited. Four staff members were working in the home with Pova First checks in place; the CRB checks had not yet been provided. There was little • • • Rathside Rest Home DS0000068229.V326462.R01.S.doc Version 5.2 Page 24 • • evidence that these workers were supervised when working with service users, which is the current guidance. Records of CRB checks were still being destroyed; the provider was made aware of current guidance which advises that these records are held by the home for longer periods to ensure that regulation authorities can examine them. Induction records were not in place for all newly recruited staff. The week prior to the inspection visit one of the care managers from North Lincolnshire local authority had visited the home and identified a new care assistant working on shift. Discussions with the staff member and registered provider identified that she had started work that day however there were no recruitment records in place or police/ reference checks carried out. The management consultant had been informed and the staff member was sent home until her recruitment checks were completed. The management consultant assured the inspectors at the visit that this was unacceptable practice and he would ensure that all future recruitment of new staff would comply with current legislation and guidance. There was evidence that since January staff had accessed training in safeguarding adults, moving / handling, medication and use of the profiling bed. The acting manager confirmed that she would be completing a training needs analysis identifying what training the staff had accessed and what the current training priorities were. Given issues that have arisen in the home over the last few months and identified during the visit, courses on supervisory skills, catheter care and care planning would be beneficial. Records showed that 55 of staff were trained at level 2 NVQ. Rathside Rest Home DS0000068229.V326462.R01.S.doc Version 5.2 Page 25 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): 31,32,33,35,36 and 38 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has over previous months not always been managed in the best interests of service users, however management consultants have been brought in and there are early signs of improvement. EVIDENCE: The home has undergone very significant management upheaval since the new ownership in October 2006. Rathside Rest Home DS0000068229.V326462.R01.S.doc Version 5.2 Page 26 When the management took over in October 2006 they made changes to the management and staffing of the home; the posts of deputy manager and care supervisor were taken away, the laundry assistant was given a full time post however kitchen assistants were no longer employed at tea time which was later reviewed and an administrator has since been recruited. There was clear evidence at the inspection visit in January that the new management style had resulted in a significant deterioration to the majority of administration and management systems. The inspector informed the registered provider following the first day of the visit in January of the serious concerns that had been identified, regarding the current management of the home; immediate requirement notices were issued to ensure effective management of the home be put in place and to assess the competence of the acting manager. As a consequence the registered provider took the decision to employ a management consultant to work in the home supporting and directing the manager to make the required improvements. Regular meetings have been held with the commission, local authority and the registered provider since the previous inspection in January to closely monitor the management of the home and service provision. In that time further concerns had been raised to the local authority and identified by the care management team around recruitment practices, standards of care, staff management/ communication, medication practices and care documentation records which raised serious concerns that the acting manager’s competence in her management of the home was not improving and the safety and welfare of service users were being put at risk. The management consultants employed from the 25/01/07 had their contract terminated on the 15/02/07. The new management consultants employed by the registered provider did not commence work in the home until the 05/03/07, which left the acting manager managing the home without support and supervision within that time. The acting manager was suspended from duty and subsequently resigned on the 15/03/07. It is clear that the new management consultants have a proven track record in supporting homes that are undergoing crisis; they have attended strategy meetings with the registered provider at the local authority and have provided the commission with a clear action plan which identifies the areas of priority. Weekly written updates will be provided to the commission which will detail all improvements made in all key areas. The management consultant company have provided the home with an acting manager who is a registered nurse and has many years experience in managing care homes and caring for older people. Although she had only been in post fifteen days before the inspection visit took place there was clear evidence that she had already made improvements to a number of areas; significant improvements had been made to staff moral, staff told the inspector Rathside Rest Home DS0000068229.V326462.R01.S.doc Version 5.2 Page 27 that they now felt they could approach the management with issues and that she listened to them, gave them advice and took action when necessary. Service users also told the inspectors that they liked the new manager and she knew what she was doing; one service user said that the new manager was marvellous, she had been asking the previous manager to sort out her problem with constipation for weeks and although the manager had said she would, nothing had been done whereas the new manager contacted the district nurses straight away and sorted everything out. The acting manager had also completed an audit of the medication systems and arranged medication training for all the senior staff, arranged formal review meetings for all the privately funded service users and has begun to review and update care programme documentation. The acting manager has introduced handover sheets for the senior staff to complete for each shift to ensure key issues and changes are passed on. The management of the home have commenced recruitment procedures for a new home manager. There was evidence from two of the staff interviewed that they had been formally disciplined by the previous acting manager and registered provider and had received “verbal warnings” for issues which they felt had been dealt with very unfairly. One of the staff felt very traumatised by the experience and told the inspectors that she was concerned about approaching the management in future. These issues were passed on to the management consultants who confirmed that they would revisit the disciplinary action taken against the staff members. The quality assurance programme had not been maintained over the last five months. The Quality Development Scheme Gold award for the home was suspended on the 9th February 2007 following the joint investigation of the adult protection allegations and subsequent findings in January 2007. There was evidence that there has been a lack of formal consultation with staff and service users; the registered provider was advised to hold a residents and relatives meeting which was held in February. Two of the relatives visiting the home told the inspector that they had not been informed of the meeting and would have liked to attend. The home does not manage any service user finances; these are all managed by the residents themselves or their representatives. No improvements had been made to the staff supervision programme; the majority of staff have not accessed any sessions since October 2006. The management consultants are aware of the importance of restarting the programme given all the upheaval and difficulties many of the staff have experienced over the last five months. Rathside Rest Home DS0000068229.V326462.R01.S.doc Version 5.2 Page 28 Examination of maintenance records identified that checks and certificates were in place for installations and equipment. The fire safety equipment and checks were all in place and up to date however there was no fire risk assessment available. Although some improvements have been made to staff completing accident documentation there remain inconsistencies, for example the accident record had not always been completed or staff had not always recorded the incident in the record of daily care. The home has accessed the support from the community falls co-ordinator for a number of service users. The previous acting manager had not maintained an audit of all accidents to review further action taken to reduce risk of re-occurrence; given the number of falls that a number of the service users have experienced, closer management of this area is essential. Rathside Rest Home DS0000068229.V326462.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 X X 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 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 1 X X 1 X 2 Rathside Rest Home DS0000068229.V326462.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14(1)a,b and c Requirement Timescale for action 01/05/07 2. OP3 14(1) d 3. OP7 12(1) and (2)15 The registered person must ensure that pre- admission assessments are carried out for all potential new admissions. Where visits cannot take place relevant assessment information must be obtained and documented prior to admission. All records must be dated and signed. Previous timescale 15/03/07 not met. The registered person must write 01/05/07 to potential new service users following assessment to confirm the home can meet their needs. Previous timescale 15/03/07 not met. 15/05/07 The registered person must ensure that the care plans for all service users are reviewed, updated identifying all current needs and have been evaluated. All care record amendments must be signed and dated. Care plans must be signed by the service user/ representative to demonstrate agreement. Previous timescale 01/03/07 not met. DS0000068229.V326462.R01.S.doc Version 5.2 Rathside Rest Home Page 31 4. OP7 15 5. OP8 12(1)a and b 6. OP7 15 7. OP7 12(1),(2) and (3) 8. OP9 13 9. OP9 13 10. OP9 13 The registered person must ensure that supporting care records such as food/fluid charts, turn charts, bathing records, bowel records and continence records are completed to support the care identified in the care plans. Previous timescale 01/03/07 not met. The registered person must ensure that service user’s weights are accurately, consistently and regularly recorded. Systems need to be developed which identify any significant or cumulative weight gain/ loss and referral to relevant health care professional made as necessary. Previous timescale 15/03/07 not met. The registered person must ensure that a daily record of care is maintained. Previous timescale 25/02/07 not met. The registered person must ensure that all service users are consulted about their bathing preferences and that these choices/ support needs are identified in their individual care plans. Previous timescale 15/03/07 not met. The recording of medication administration must accurate and consistent. Previous timescale 26/02/07 not met. Alterations to the MAR charts and handwritten entries must be accurate. Previous timescale 26/02/07 not met. The registered person must ensure that the administration of DS0000068229.V326462.R01.S.doc 15/05/07 15/05/07 01/05/07 15/05/07 01/05/07 01/05/07 01/05/07 Page 32 Rathside Rest Home Version 5.2 11. OP9 13 and 37 12. OP38 17(1)a 13. OP38 17(1)a 14. OP10 12(4)a 15. OP8 12 (1) a and b. 16. OP16 22 17. OP18 1913(4)c controlled medication is recorded accurately. The registered person must ensure that all medication errors are investigated thoroughly and reported to the commission. The registered person must ensure that appropriate accident documentation is completed following all accidents in the home. Previous timescale 01/03/07 not met. The registered person must ensure that falls are monitored more closely and systems are developed to review all further action taken to reduce the risk of reoccurrence. Previous timescale 15/03/07 not met. The registered person must ensure that the standards of personal care are improved to ensure that the dignity of service users is maintained at all times. Previous timescale 01/03/07 not met. The registered person must ensure that the personal and health care needs of the service users are met. Previous timescale 25/02/07 not met. The registered person must ensure that all complaints are formally documented and investigated. Previous timescale of 31/03/07 extended. The registered person must ensure that all newly employed staff have a CRB clearance in place before they commence work. If the management are requesting POVA First clearances these must also be in place before the new staff member can DS0000068229.V326462.R01.S.doc 01/05/07 01/05/07 01/05/07 01/05/07 01/05/07 15/05/07 21/03/07 Rathside Rest Home Version 5.2 Page 33 18. OP26 16(2)k 19. OP27 18(1)a 20. OP29 19 21. OP29 19 22. OP30 18 (1) 23. OP36 18(2) commence work and the staff member must be supervised when working with service users. Previous timescale 29/01/07 not met. The registered person must ensure that the carpet in the identified room is cleaned regularly and replaced if it remains odorous. Previous timescale 15/03/07 not met. The registered person must ensure that appropriate numbers of care staff are employed at the home and rostered to meet the service users individual needs. Previous timescale 29/01/07 not met. The registered person must ensure that two written references are obtained prior to new staff commencing work. Previous timescale 29/01/07 not met. The registered person must ensure that recruitment files for new staff contain all relevant documentation to comply with Schedule 2. Previous timescale 15/03/07 not met. The registered person must ensure that newly employed staff complete induction training and are appropriately supported by senior staff until competent to work independently. Previous timescale 29/01/07 not met. The registered person must ensure that the staff supervision programme is re- implemented. Supervision records must be completed in ink and be dated and signed by the supervisor and staff member on completion of the session. All care staff to have DS0000068229.V326462.R01.S.doc 31/05/07 21/03/07 01/05/07 15/05/07 01/05/07 01/05/07 Rathside Rest Home Version 5.2 Page 34 24. OP30 18 (1)and 13(5) 25 OP8 12(1) 26 OP33 24 27 OP12 16(2) m and n 28. OP30 18 accessed at least one session by: Previous timescale 20/03/07 not met. The registered person must ensure that all existing and new staff access practical training in moving/ handling. Previous timescale 15/03/07 not met. The registered person must ensure that all service users with urinary catheters have a care plan in place which clearly describes the care support required. Care staff require training and guidance to provide them with up to date knowledge on current catheter care practices. The registered provider must ensure that the quality assurance programme is restarted and maintained. Staff and residents must be consulted on a more regular basis about the running of the home. The registered provider must consult with the service users about their social interests; make arrangements to enable them to engage in local, social and community activities. The registered person must ensure that a training needs analysis is carried out for all staff employed at the home to ensure that an appropriate training programme can be developed which will meet the collective and individual needs of the staff team. 15/05/07 01/05/07 15/06/07 15/05/07 15/05/07 Rathside Rest Home DS0000068229.V326462.R01.S.doc Version 5.2 Page 35 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. 4. Refer to Standard OP9 OP9 OP9 OP9 Good Practice Recommendations A reminder system should be used during the medication round to identify when residents have asked for their medication at a later time. The medicines policy needs to be updated. Advise should be taken from the prescriber to detail in the care plan and on the MAR chart when medication with unusual doses should be given 5. 6. 7. OP7 OP27 OP32 The registered person should ensure that an accurate record is maintained of all medications received by the home and all medications carried over to the following month. The registered person should ensure that all high risk areas identified through risk assessment have associate care plans in place to describe the care support required. The registered person should ensure that the dependency calculations for service users are consistently maintained and recorded. The registered provider should revisit recent disciplinary decisions for staff to ensure appropriate and fair action was taken at the time. Rathside Rest Home DS0000068229.V326462.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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 Rathside Rest Home DS0000068229.V326462.R01.S.doc Version 5.2 Page 37 - 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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