Inspection on 16/06/08 for Regents Court Care Home

This inspection was carried out on 16th June 2008.

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

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

Other inspections for this house

Regents Court Care Home 31/01/09

Regents Court Care Home 06/11/07

Regents Court Care Home 23/11/06

Regents Court Care Home 20/10/04

Regents Court Care Home 30/04/04

Regents Court Care Home 12/01/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Regents Court Care Home 128 Stourbridge Road Bromsgrove Worcestershire B61 0AN Lead Inspector Andrew Spearing-Brown Key Unannounced Inspection 16th June 2008 18:00 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 Regents Court Care Home DS0000004151.V365736.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. Regents Court Care Home DS0000004151.V365736.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Regents Court Care Home Address 128 Stourbridge Road Bromsgrove Worcestershire B61 0AN 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) 01527 879119 01527 872631 c.wood@alphacarehomes.com www.alphacarehomes.com Alpha Health Care Limited Vacant Care Home 37 Category(ies) of Dementia - over 65 years of age (37) registration, with number of places Regents Court Care Home DS0000004151.V365736.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th November 2007 Brief Description of the Service: Regents Court is located close to Bromsgrove town centre and provides personal and social care to a maximum of 37 older people with dementia. Accommodation is on two floors. Access is provided to both floors by way of either stairs or a central passenger lift. A garden including a patio area is available. Car parking is available to the rear of the property. The home is part of a group of homes owned by Alpha Health Care limited. Information regarding the current level of fees was not included within the Service Users Guide. The reader may therefore wish to contact the service directly for up to date information. Regents Court Care Home DS0000004151.V365736.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. We, the Commission, carried out this key inspection without any prior notice. A key inspection is one in which we look at all the aspects of the service that are most important to people using it. This inspection was undertaken over a period of three days. The lead inspector was joined by two separate colleagues from the Commission on two of the visits. Shortly before this inspection the registered manager resigned and had left her employment within the home. The deputy manager, who was present throughout most of the time we spent in the home, was working as acting manager. This inspection takes into account information we have received since the last inspection as well as the visits to the home. Following the previous random inspection (April 2008) we issued a Statutory Requirement Notice in relation to care planning and reviewing of care plans. Part of this inspection was to check upon the homes compliance to that notice. During the inspection, discussions were held with the acting manager, the area manager, the head of care, a number of staff members, some people using the service and some visitors to the home. We had a look around the home and observed what was happening. In addition, we viewed the care documents regarding some people using the service such as care plans, risk assessments and daily records. We also viewed medication records and staff training records. Because people with a dementia are not always able to tell us about their experiences, we have used a formal way to observe people in this inspection to help us understand. We call this a Short Observational Framework for Inspection (SOFI). This involves us observing up to five people who use the service for two hours and recording their experiences at regular intervals. This includes people’s state of well-being, how people interact with staff members and other people as well as the environment. Regents Court Care Home DS0000004151.V365736.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Some amendments to the information available to people are necessary such as ensuring that people are aware of the fees payable for the service. Assessments of care needs need to be more detailed in order that people can be assured that their needs can be met. We saw evidence that medical follow ups or requests for intervention had not happened. These can seriously affect the well being of people using the service. We observed occasions whereby staff were not aware of the situation we found or had not taken appropriate action to find out or investigate why an incident had occurred. These shortfalls can potentially place people at serious risk. Regents Court Care Home DS0000004151.V365736.R01.S.doc Version 5.2 Page 7 There needs to be better security and management of some medication, especially controlled medication. As a result of our concerns we left two immediate requirements and asked the registered provider to respond in writing upon the action they intended to take. There should be more respect shown for the privacy and dignity of people receiving care. A full review of staffing levels needs to take place to ensure that people receive the support they need. Carers’ knowledge about safeguarding and whistle blowing needs to be improved and systems for who would report any referrals to the PoVA (Protection of Vulnerable Adults) list needs to be addressed. A review of staff training achieved needs to be undertaken. Following the review an action plan needs to be drawn up to show how the shortfalls are to addressed Some management procedures need of improvement to ensure that a quality service is provided to ensure that people are kept safe while having their needs met. 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. Regents Court Care Home DS0000004151.V365736.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 Regents Court Care Home DS0000004151.V365736.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): Standards 1, 3 and 5. Standard 6 is not applicable. Quality in this outcome area is adequate People who may use the service can look at information about Regents Court and visit the Home before they move in. However, staff do not find out enough about their care needs so people cannot be fully confident that these will be met when they are admitted. This judgement has been made using available evidence including a visit to this service. Regents Court Care Home DS0000004151.V365736.R01.S.doc Version 5.2 Page 10 EVIDENCE: A copy of the home’s Service Users Guide, dated February 2008, was noticed within one bedroom. The acting manager was able to access copies of this document and gave us a copy. On the cover of the document it states that ‘This service user guide can be made available in large print if required.’ The document contains useful information about Regents Court for people who may choose the service or who already reside within the home. A further review of the guide is necessary to reflect the recent changes within the management structure at the home. The guide does not include any views of people using the service or the fees charged; these points should be reflected in future versions. We viewed the assessment of a person who was recently admitted to the service. The assessment was carried out by the acting manager when the potential service user and her representative visited the home. Staff confirmed that people visited the home prior to admission and that the acting manager would carry out an assessment. During our visit we observed some people visiting the home prior to making a decision as to whether it would suit the needs of a member of their family. The assessment viewed was not dated. The information in it was scant in detail with minimal information such as ‘poor sight’. As no detailed care plan was drawn up until 1 month after the date of admission, little information was available to care staff to ensure that identified needs could be met in a consistent manner. Regents Court does not provide intermediate care and has no plans to do so in the future. Regents Court Care Home DS0000004151.V365736.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): Standards 7, 8, 9, 10 and 11. Quality in this outcome area is poor. People’s needs are now written down in care plans but personal care and healthcare treatments are not being given consistently. Medications are not being managed safely. People are not always treated with respect for their privacy and dignity. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each person residing within Regents Court had a written care plan. This is a written document designed to guide staff about the level of care required by each individual to ensure that identified needs are meet and people receive the support they require. Regents Court Care Home DS0000004151.V365736.R01.S.doc Version 5.2 Page 12 We have previously had concerns regarding the accuracy of care plans and the reviewing of care plans to ensure that they are up to date. As a result of our concerns following the last random inspection we issued the registered provider with a Statutory Requirement Notice stipulating the improvements that needed to be achieved in order to prevent us from considering legal action. As a result of us issuing the Statutory Notice we assessed care plans as part of this visit to establish whether the requirement was now met. We found that in general care plans were significantly better than previously identified. An acute care plan was in place following a visit by a GP and treatment had commenced. We saw evidence that family members are involved in care plans and risk assessments. Risk assessments seen covered pressure care prevention, moving and handling, falls and dependency. There was evidence of risk assessments being reviewed or up dated. We saw conflicting information regarding the frequency of weighting the individual concerned on one care plan, however on another the records were in order. The acting manager stated that she would address a concern brought to her attention regarding the end of life wishes of one person to ensure that everybody involved was content with the care plan. Despite the overall improvement in care plans, we were however concerned regarding some potentially poor outcomes for people using the service. We noted that records regarding falls management and auditing had improved. The acting manager informed us that somebody had had a fall and she was able to tell us how many falls that person had had over the previous month. We were informed that a doctor was consulted, although a senior carer was not able to inform us whether a medication review had taken place. On reading the notes it was discovered that the doctor had requested certain action to take place in order that tests could happen. The required action had not taken place some 7 days later and as a result a possible diagnoses and treatment had not happened. We saw somebody with a skin tear on her arm. Although this was recorded, we could not see any evidence to suggest that somebody had tried to establish how this incident had occurred. This was particularly of concern as later the same day we discover another separate skin tear on the same person. We were also concerned regarding a dressing on a toe and the fact that although the dressing had been in place for many weeks nobody had established what, if any, further treatment was required. We found conflicting information regarding the location of some soreness on a person’s body. We had a number of serious concerns during our visit in relation to the management and storage of medication. As a result of our concerns we issued two separate immediate requirement notices as the issues became apparent. Regents Court Care Home DS0000004151.V365736.R01.S.doc Version 5.2 Page 13 Our first concern was in relation to an unlocked and unsecured medication trolley. Anybody could have potentially had access to all medication prescribed to people on the ground floor. It was of further concern to discover that the keys to both the trolley and the controlled drugs cabinet were handed over to a carer who then passed them on to a colleague. This therefore meant that no audit trail could be carried out if medication, including controlled drugs, had gone missing. Our second visit to the home coincided with a visit from a pharmacist visiting on behalf of the local Primary Care Trust. As a result of this, some elements of the inspection were carried out in partnership while other areas were left to the pharmacist who then informed us of her findings. Some areas of good practice were identified, however improvements are needed to ensure that the medication procedures are followed and regulations are met, for example by ensuring that the Medication Administration Record (MAR) sheets are always fully completed. This area will be reviewed again as part of a future inspection by us. We did discover some serious concerns regarding the management and recording of medication within the controlled drugs cabinet. As a result of our concerns we issued a second immediate requirement notice. We found some medication within the controlled drugs cupboard that not booked in to the controlled drugs register. As the date of opening was not recorded it was possible that the date of expiry had passed. This medication was not currently in use and therefore needed to be returned to a pharmacy for destruction. The controlled drugs register indicated that on one occasion a dosage higher than the amount prescribed was deducted from the balance held in relation to a named person using the service. Although not detailed upon the immediate requirement form, it was noted that medication was discontinued on the 1st April 2008; however the medication was administered at 20.00 that evening. Further entries were made within the register (although no further dosages administered) prior to reference that the medication was discontinued. It was noted that the stock held on behalf of one named person was high due to continual re ordering taking place. We highlighted at the time that this was of further concern following the findings on the 16th June 2008 whereby it was evident that unauthorised staff had access to the controlled drugs cabinet keys. The date of opening was recorded on bottles or boxed medication in the upstairs trolley, but this was not always the case downstairs. We saw two Regents Court Care Home DS0000004151.V365736.R01.S.doc Version 5.2 Page 14 tubes of cream in one bedroom, one of which was empty: neither had the date of opening recorded on them. The Head of Care and Area Manager undertook to investigate our findings regarding the shortfalls in the storage, administration, recording and management of medication. Following the inspection but prior to compiling this report we received a written response and an action place in relation to these matters detailing what the company was doing to improve and meet the required standard. As part of this inspection we observed a small group of people using the service over a period of two hours. During this time we recorded the interaction they had with staff and others as well as their general well-being. During the observation three out of five people spent the majority of the time in a positive state. One person spent approximately the same amount of time in positive, passive, withdrawn and sleeping states of well being. The fifth person spent half the time in positive state and half either passive or withdrawn. We viewed the care plan of the person who spent 50 of the observation in either withdrawn or sleeping state and found that the GP had changed her medication as she was sleepy. The GP had asked to be contacted if no improvement in the situation took place, this had not happened. The acting manager took steps to action this once we brought it to her attention. While we were observing, the majority of staff interactions with people using the service were good. About 18 of interactions were neutral i.e they were neither positive nor negative. We did not witness any negative interactions during this time. On another occasions during this inspection we heard some members of staff making a number of inappropriate comments. Although some could be seen as terms of endearment, others showed a lack of up holding peoples individualism and dignity. Conversations heard included: ‘Sweet heart’ ‘this way my darling’ ‘they are all up now’ ‘good girl’ and ‘Come on my darling’ We also observed a carer talking to somebody residing in the home who was trying to open a locked door, saying: ‘Come on, don’t be stupid, use your brain’. The carer then went into another person’s bedroom and said: ‘Pooh, what a smell, let’s get you cleaned up’. Regents Court Care Home DS0000004151.V365736.R01.S.doc Version 5.2 Page 15 Some of the terms used in some care documentation were also inappropriate or labelling people rather than treating them as individuals: this needs to be reviewed. A member of staff was seen tapping on a bedroom door but did not wait for any reply. On another occasion we saw a member of staff and agency member of staff getting a gentleman out of bed with the door open. On another occasion we observed a carer assisting somebody to her room. The carer concerned approached the person calmly and kindly and spoke to the person appropriately while supporting her. We saw other carers showing kindness and offering reassurance to somebody who was upset in relation to a member of her family and her pet. The majority of people residing within the home appeared to be dressed appropriately taking into account gender and weather conditions. We brought to the attention of the acting manager the appearance of one person who appeared unkempt. During the course of the inspection we noted a number of people without any footwear, some of whom were walking around the home and therefore potentially at increase danger of falling. The acting manager took appropriate action in relation to our observations. Regents Court Care Home DS0000004151.V365736.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15. Quality in this outcome area is adequate. Activities are currently limited as a result of staff changes and the fact that there is no activities coordinator in place. People using the service are able to keep in touch with family, friends and representatives. Meals are nutritious and attractive; however the way in which people are served their food and assisted with feeding is not always hygienic or respectful of personal dignity. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time we visited the home the activities coordinator was acting up as deputy manager. We were informed that recruitment for replacing the coordinator was underway. Some staff from another home also managed by Alpha were visiting two days per week to provide some stimulation while the recruitment process was taking place. During our visit we saw some armchair exercises taking place, however only a couple of people out of the group were actively taking part. Regents Court Care Home DS0000004151.V365736.R01.S.doc Version 5.2 Page 17 We were told by a relative that trips out have taken place in the past to places such as the theatre, a local public house and shopping. In discussion with a visitor we were told: ‘On the whole, everything’s fine’ During our visit staff told us that they would like to see more activities taking place. We were told that things tended to take place in the afternoon and that these tend to be associated with music. On a notice board in the lounge it stated that knitting was due to take place, but staff confirmed that this did not happen. We are aware that one person using the service attends a local walking group and is learning computer skills. While at the home we saw a number of people visiting relatives or friends. Staff were seen to be friendly and welcoming to people. The acting manager informed us that links with the community are limited. We asked the acting manager how the religious care needs of people are met. We were informed that it seemed to be some time since any representative from a local church had visited the home. As a result the acting manager undertook to follow this matter up to ensure that people can have the opportunity to take part in religious activity if they wish. Carers told us that in their opinion the food offered within the home was of a good standard. Nobody using the service raised any concern during our conversations about food. During our visits we saw staff offering people drinks and a choice of food although prompt cards to assist people with dementia were not available. We saw staff taking a trolley round to people with cookies and fresh fruit available. During one lunch time carers were seen standing up while feeding people, this is not conducive to good practice and could be intimidating. This practice should be reviewed if commonplace. A certificate dated September 2007 was on display showing the home to be assessed as ‘Good’ by the local District Council in relation to food hygiene standards. We were however concerned to observe carers handling food such as biscuits and sandwiches without gloves or tongs. Regents Court Care Home DS0000004151.V365736.R01.S.doc Version 5.2 Page 18 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): Standards 16 and 17. Quality in this outcome area is adequate. People are aware of their right to make a complaint and they can be confident that complaints are investigated. The home makes efforts to safeguard people from abuse and takes action to follow up any allegations. Staff knowledge about their responsibilities in relation to safeguarding people does however need to be improved, to ensure that people are safe and fully protected against abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: As part of our visit we reviewed the information available to people using the service regarding complaints and how complaints are dealt with. The complaints procedure is displayed in the reception area of the home. Due to the coded doors to access this area it is unlikely that this procedure will be seen by anybody using the service. The font used on the procedure is small. A collection of cards complementing the service are also on display in the same area. Regents Court Care Home DS0000004151.V365736.R01.S.doc Version 5.2 Page 19 Information regarding complaints is included within the most recent version of the Service Users Guide. The procedure explains the steps to be taken in the event of somebody wishing to make a complaint about the service provided. The procedure takes into account our recent change of address; however it does not make it clear to the reader that complaints can be raised with us at any stage. We also saw in one bedroom a booklet called ‘How To Make A Complaint’. The booklet is designed to be used across all Alpha care homes. The booklet was designed to have local information added to it such as the address of our office. The page in the copy we saw was blank. We viewed the complaints records held within the home. The records showed two complaints made directly to the service since our last key inspection (November 2007). The first complaint was in relation to personal care. Although the records indicated action to prevent a reoccurrence, they did not evidence that a suitable investigation had occurred. The second complaint was in relation to oral care needs and missing clothing. The records gave an account of the action taken to resolve the matter. Since the last key inspection we have received two anonymous complaints regarding Regents Court. We forwarded the information supplied to us to the provider and asked them to investigate using their own complaints procedures. The matters were investigated and a response was supplied to us within the set timescale. The organisation has over recent months reported to us a number of matters that needed to be considered under the local procedures for safeguarding vulnerable adults, because of risks to certain people. We are aware that the organisation has informed the local authority as necessary regarding some matters. During our visit it did however become apparent that there was a lack of understanding regarding the local procedure and who should take action in the event of a potential referral for inclusion on the PoVA (Protection of Vulnerable People) list. We asked staff members what they would do in the event of them suspecting actual or potential abuse. Although staff stated they were aware of procedures and that they would report the matter, some concerns remained regarding people’s knowledge. One person stated that she would speak to the potential abuser first and if the matter carried on would then report it. Staff believed it was then the responsibility of head officer to investigate; therefore people were not aware of a multi agency approach to these matters. We viewed the training records held on some members of staff, as well as a training matrix. It was evident that some staff had undertaken training on safeguarding. Alpha also provides training in Customer Care and Dignity. As it was not totally clear who has and who has not attended training, and in the light of some of the findings from this inspection, a review of training needs to Regents Court Care Home DS0000004151.V365736.R01.S.doc Version 5.2 Page 20 take place. Following this review an action plan should be devised as to how the shortfall in awareness is to be addressed. Regents Court Care Home DS0000004151.V365736.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26. Quality in this outcome area is poor The home is comfortable and tidy. The décor of the home does not assist people with a dementia illness to find their way around the home. People’s health is not being properly protected because of poor infection control practices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: As part of this inspection we viewed communal areas of the home and a random selection of bedrooms. Our previous random inspection report highlighted the fact that the majority of bedrooms doors were unidentifiable due to the lack of signage other than a number on the door frame. This is still the case, although bathrooms and Regents Court Care Home DS0000004151.V365736.R01.S.doc Version 5.2 Page 22 toilets do have some signage. Most bedroom doors are painted white which is the same colour as doors leading to toilets, bathrooms and storage cupboards. Some bedroom doors are stained brown but again they have no identification. The walls along the corridors are painted cream throughout the home, therefore do not act as a visual prompt to guide people around the home. The lack of visual aids and signposting is not conductive to good quality dementia care and it is concerning that no action has taken place to improve the environmental stimulation. Communal areas such as lounges and dining areas seemed to be comfortable. Lighting within these areas was sufficient, apart from the small dining room on the ground floor. Downstairs there are two lounges and two dining areas while on the first floor there is one lounge / diner. There are bathrooms on each floor which give a choice of bath or shower. We saw evidence within bedrooms that people residing within the home are able to bring in their own items to make their rooms more personal. We noted that the bed linen in some bedrooms had not been ironed. At the time of the previous inspection we had a number of concerns regarding the laundry. We were assured at that time that improvements would take place. Shortly after the last inspection we received an anonymous complaint which made reference to the laundry. This complaint was investigated by the organisation. During our time within the home we noted significant improvements within the laundry and had no concerns regarding the processes within this area. The acting manager has introduced a system in relation to one person following a complaint regarding clothing going missing. We have heard of a further concern about missing laundry. As a result of this information the acting manager and the registered provider should make further efforts to improve the laundering of peoples clothing. We have previously had concerns about infection control within the home and the standard of hygiene within some areas particularly communal bathrooms and toilets. At the start of this inspection we were informed that a number of people had diarrhoea. Taking into account our previous concerns and the recent outbreak it was of serious concern that we found examples of poor standards of infection control. Throughout our visit we found disposable gloves discarded in open bins. This was in direct conflict with the home,s own policy on infection control. We spoke to staff about infection control measures and they informed us of the correct procedures, however we continued to find examples of gloves in open bins. We also found an incontinence pad within a disposable bag on a toilet floor, urine stained flooring and toilets without toilet rolls. We checked liquid soap and paper towel dispensers and found them generally to have a sufficient supply available. Hand washing facilities are available for staff within areas such as bathrooms and sluices. Staff do not have antibacterial hand wash Regents Court Care Home DS0000004151.V365736.R01.S.doc Version 5.2 Page 23 available to them and visitors are not encouraged to wash their hands on entering the home. These measures are particularly recommended when infections are prevalent within the home. Whenever we brought matters to the attention of the acting manager action was taken immediately. Furthermore we were given assurances that suitable bins would be obtained within a short time of our visit. Despite the immediate action it was nevertheless of concern that we needed to bring these matters to the attention of the home and that staff were failing to safeguard people from potential infections. We did not detect any malodour during this inspection. The grounds to the rear of the home were well maintained. A small patio is available for people to sit and enjoy the warm weather. Regents Court Care Home DS0000004151.V365736.R01.S.doc Version 5.2 Page 24 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): Standards 27,28, 29 and 30 Quality in this outcome area is poor There are not always enough staff on duty to ensure that people using the service have an appropriate level of support. Recruitment procedures are in place but are not always sufficiently robust to ensure that people are safe. Shortfalls in training could potentially place people at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at the staff rota and discussed staffing levels with people working in the home. The acting manager works between Monday and Friday each week. Generally six carers including the senior carers are on duty each morning and five in the afternoon. The deputy manager was not included in these figures. After 6.00 pm staffing levels reduce to five people. We found occasions when staffing levels fell below these levels and cover was either not arranged or not found. On one occasion the rota showed that the home was on one shift short of two carers. We had not been notified of this shortfall in staffing. Following the previous inspection, Alpha have increased night staff levels and now have four care assistants on duty. The night shift commence at 8.00 pm through to 8.00 am the following morning. While we were carrying out our observation we noticed a significant period of time when no carers were in the Regents Court Care Home DS0000004151.V365736.R01.S.doc Version 5.2 Page 25 lounge. This time frame coincided with the change over and the start of the new shift. During this time we saw an increase in people showing signs of passive, withdrawn or sleep states of well being. Since the last inspection the registered provider has employed two domestic assistants to cover the laundry 7 days per week. In addition 2 new activity persons were due to commence working at Regents Court. We sought the files of some recently appointed members of staff. The file regarding one person could not be found. Although other files were found to be generally acceptable some shortfalls were found. It was not always clear who references had come from and in what role the referees had known the applicant. We also found gaps in an application form. The manager did not have any proof that full CRB (Criminal Records Bureau) clearance had been obtained as this is handled by the home’s Head Office. During this inspection we endeavoured to assess the training undertaken by staff members. The training records were however either incomplete or disjointed and a full audit was not possible. It was evident that some recent training had taken place in house carried out by somebody from the mental health team. This was attended by some staff on duty at the time leaving 3 carers to attend to the needs of people using the service. Although the records could not be relied upon it was of concern that they suggested that some night staff had not attended any moving and handling training. The acting manager spoke to her Head Office about this, who advised that the staff identified must undergo training at the earliest possible opportunity. The acting manager assured us that some other night staff had attended training. However, the training day also included other topics such as ‘elder abuse’, health and safety and infection control, and therefore the registered provider needs to be confident that the training is both suitable and sufficient to ensure people are safe. We observed two members of staff using a hoist with somebody. Although the staff could have given the person using the service more information as to what was happening, the actual technique was safe. At the time of this inspection just under 50 of care staff had completed their NVQ (National Vocational Qualification). We were informed that more staff are undertaking this training. Regents Court Care Home DS0000004151.V365736.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 and 38. Quality in this outcome area is poor. The acting manager has, with the support and backing of staff members, started to make improvements in the home. People using this service cannot yet be confident that they are safe because so much more work is needed by the manager and the Company to make sure that the home is run reliably and consistently. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Shortly before this unannounced key inspection we were informed by Alpha’s Head of Care that the registered manager had resigned and left her position. As a result the deputy manager was working as acting manager on a three Regents Court Care Home DS0000004151.V365736.R01.S.doc Version 5.2 Page 27 month trail period. At the time of this inspection no application to become the registered manager had been made. As a result of the deputy manager becoming acting manager another member of staff was working as acting deputy manager. A number of staff made positive comments regarding the acting manager. Staff were aware that she has a considerable amount of work to do to bring the home up to the required standard and beyond. Staff stated that the acting manager really cares about the home and that she was ‘trying to make improvements’. We were informed that the acting manager holds the RMA (Registered Manager’s Award) which is a level 4 NVQ (National Vocational Qualification). The acting manager told us that she is due to attend a four day training course regarding dementia care. Other training needs are due to be considered within the organisation to ensure that the required level of training is in place. There was evidence that, since the previous random inspection (April 2008), improvements have taken place in relation to some areas such as care planning. These improvements need to be sustained and worked upon as well as spread to other areas within the home to ultimately improve outcomes or potential outcomes for people using the service. Systems are in place to monitor the quality of the service. Following the random inspection we were told that senior managers within Alpha would be visiting the home regularly. These visits have taken place in order to offer the acting manager support and guidance as well as a means to improve the service. Written reports from a senior manager under Regulation 26 were available for inspection. Quality assurance documents were available, however the acting manager accepted that these need to be reviewed in order that any identified improvements are recorded and suitable action takes place. A quality statement was on display in the reception area; however, this was dated March 2006. It is therefore recommended that this statement is reviewed as part of the review of systems within the home. We looked at the records regarding money held in safe keeping on behalf of some people using the service. We found that the money held matched the written records maintained in the home. Procedures and practices could be improved as it was evident that the hairdresser was signing the sheets showing details of the individual balances held. The amount of cash at a person’s disposal should be confidential information and therefore systems need to be amended to ensure this does not take place while also ensuring that a full audit trail of who has received money exists. It was also apparent that the home was holding in safekeeping other items such as bank cards without any records of either there existence or when they were temporarily taken out of home by other persons. Regents Court Care Home DS0000004151.V365736.R01.S.doc Version 5.2 Page 28 The acting manager confirmed comments made by staff members that supervision sessions were not taking place as frequently as they should. A matrix in the office demonstrated that the last time staff received supervision was during March 2008. Taking into account the number of concerns regarding practice and training shortfalls within the home, supervision, as a means of reviewing and reflecting an individual’s performance, is an essential way of improving the service and maintaining improvements. Since the previous inspection the acting manager has reviewed the recording and monitoring of accidents within the home. While we were present the acting manager was able to inform us of the number of falls sustained by one person and demonstrated suitable action following a further fall. As reported earlier within this report it did however become evident that action required by a doctor following a previous visit did not take place. We viewed a sample of health and safety service records. These records, including a gas safety report and hoist servicing, were generally found to be in good order. The previous key inspection report highlighted some concern regarding an electrical safety report dated March 2006. During this visit we saw a document dated May 2008 which stated that the work was completed in all areas except one where it stated that it needed further investigation. The fire records relating to weekly and monthly checks were briefly viewed and seemed to be in good order. We also saw a letter written by a fire officer from Hereford and Worcester Combined Fire Authority at the end of February 2008. The fire officer required improvements in policies and procedures in relation to evacuation and an emergency plan. Although we were told that this work was carried out we did not see any evidence of it. The procedures held on file predated the time when the fire officer had originally visited the home. This means that we did not see any reviewed documents to ensure the health, safety and welfare of people in the event of fire, despite input from the fire service. Since this inspection and following telephone discussions with the fire officer we have received verbal confirmation that these documents are in place. As reported previously within this report we had serious concerns regarding some aspects of infection control within the home. We also had concerns about the lack of evidence that staff had attended training especially covering areas such as moving and handling. Regents Court Care Home DS0000004151.V365736.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 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 Score 2 X 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X x 1 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 2 X 2 Regents Court Care Home DS0000004151.V365736.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 OP1 Regulation 14 (1) Requirement A full needs assessment must be carried out and available prior to admission into the care home. To ensure that care needs are identified and that they are able to be met. Timescale for action 31/08/08 2 OP8 12 (1) Staff must be aware of the 31/08/08 personal and health care needs of people and care must be given in a reliable and consistent way. This is to ensure that people are supported to maintain their dignity and health. Medication must be stored, 31/08/08 administered and recorded accurately and safely at all times in order to safe guard people and maintain their well being. All people using the service must be treated in a manner which respects their privacy and dignity. Previous timescale for action by 16/06/08 3 OP9 13 (2) 4 OP10 12 (4) Regents Court Care Home DS0000004151.V365736.R01.S.doc Version 5.2 Page 31 31/01/08 was not met 5 OP12 16 (2) (m) and (n) People must be consulted about their social interests, and arrangements must be in place to enable them to engage in local, social and community activities. This is to ensure that people’s social needs and expectations are met. Previous timescale for action by 31/03/08 was not met 16/06/08 6 OP26 13 (3) Suitable arrangements must be in place to prevent infection and the possible spread of infection, and to maintain satisfactory standards of hygiene. This is to safeguard people’s health and safety. Previous timescale for action by 31/03/08 was not met 16/06/08 7 OP26 23 (2) (d) All parts of the home must be kept clean. This is to safeguard people’s health and comfort. Previous timescale for action by 31/03/08 was not met 16/06/08 8 OP38 18 (1) Staff must receive training appropriate to the work they are to perform. In particular, a staff training and development programme which meets Skills For Care requirements must be in place. This is to ensure that staff are able to meet people’s needs in a holistic manner and DS0000004151.V365736.R01.S.doc 16/06/08 Regents Court Care Home Version 5.2 Page 32 provide care in a safe way. Previous timescale for action by 31/03/08 was not met 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 Refer to Standard OP1 OP12 Good Practice Recommendations A review of the Service Users Guide should take place and this should include information about fee levels. The potential benefits of signage and visual aids should be considered in order to improve people’s quality of daily living and ability to make choices. The complaints procedure must reflect the needs of people using the service. Staff must be aware of the procedure and ensure that any complaint made is fully investigated and feedback is given to the complainant in an appropriate format. This is to ensure that people’s concerns are addressed promptly and effectively. Changes to the décor and fabric of the home should be considered to assist people with a dementia type illness orientate themselves around the home. Staffing levels should be reviewed to ensure that the home is staffed in accordance with the needs of the people using the service. Recruitment systems should be robust to ensure that no new members of staff are employed in the home prior to having the documents referred to in schedule 2 which match information upon the application form. The current quality assurance system should be reviewed to ensure that it takes into account the experiences of people using the service. DS0000004151.V365736.R01.S.doc Version 5.2 Page 33 3 OP17 4 5 OP19 OP27 6 OP29 7 OP33 Regents Court Care Home 8 OP35 It is recommended that a review of current practices regarding valuables held on behalf of people using the service is carried out to safeguarding people’s interests. Care staff should receive supervision at least 6 times per year in order to identify training needs and develop practices. 9 OP36 Regents Court Care Home DS0000004151.V365736.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Regents Court Care Home DS0000004151.V365736.R01.S.doc Version 5.2 Page 35 - 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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