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Inspection on 22/03/08 for Regents House Rest Home

Also see our care home review for Regents House Rest Home for more information

This inspection was carried out on 22nd March 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The service encourages people to live the life they would choose and to make independent decisions about their day-to-day activities and life. The meals provided are varied and offer a well balanced diet, whilst the mealtimes are social occasions, which bring the resident group together. The service meets the needs of the people residing at the home and provides them with a safe and friendly environment, where they can socialise and express themselves without restrictions. One person`s comments summing up what the service provides: `I am happy here and I can`t add anymore really, I get all I need here`.

What has improved since the last inspection?

General risk assessments are being produced. These documents provide a reasonable account of the potential risk to residents and how they can be managed. The manager has introduced residents` surveys with the response to those completed reviewed during the fieldwork visit, it is now important that the manager use this quality auditing process on a regular basis and uses the information gathered in a meaningful and practical way. A new flat screen television, with freeview and surround sound has been brought and installed within the main lounge. A specific smokers lounge has been developed.

What the care home could do better:

The manager`s approach to record storage and filing is poor and should be reviewed, as a more structured and methodical records management process would aid the day-to-day running of the home. The manager needs to extend the range of the risk assessment process to include activities that are personal to the person and general to the client group, for example, the risks posed by people smoking within the home or peoples` abilities to cope whilst away from the home when out shopping or socialising. The storage and management of residents` medications could and must be improved, as the current system of medication storage is poor, the arrangements for staff training, on medication management, is also inadequate and should be reviewed. Improvements could be made to the home`s safeguarding procedures, as the copy of the Local Authority (LA) guidance documentation, retained by the home, was out dated and the home`s in house training and development limited. The training and development opportunities of the staff are limited with the records provided by the manager indicating that some training around subjects like `abuse` have not been updated since 2004. The manager has made efforts to improve the home`s recruitment and selection process, however, it is still not being robustly operated, with the records of a staff member, whose file was reviewed at the previous inspection, still only containing one reference and the only person recruited since that inspection having two character reference, despite the employee providing details of two recent employers.

CARE HOMES FOR OLDER PEOPLE Regents House Rest Home 206 Regents Park Road Southampton Hampshire SO15 8NY Lead Inspector Mark Sims Unannounced Inspection 22nd March 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Regents House Rest Home DS0000012319.V359417.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 House Rest Home DS0000012319.V359417.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Regents House Rest Home Address 206 Regents Park Road Southampton Hampshire SO15 8NY 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) 02380 322 101 Mr Ian Newson Mrs Jean Newson Mrs Sandra Pearl Anaszko Care Home 17 Category(ies) of Dementia (3), Dementia - over 65 years of age registration, with number (17), Mental disorder, excluding learning of places disability or dementia (3), Mental Disorder, excluding learning disability or dementia - over 65 years of age (17), Old age, not falling within any other category (17), Physical disability (3), Physical disability over 65 years of age (7) Regents House Rest Home DS0000012319.V359417.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service users in the DE, MD or PD categories may not be accommodated under the age of 55 years A total of not more than 7 service users may be accommodated in the PD and PD (E) categories Not more than 3 service users in total may be accommodated under the age of 65 years Date of last inspection Brief Description of the Service: Regents House is a large period property that has been adapted to provide residential care for up to 17 older people. The accommodation is both single or shared bedrooms available on the ground and first floors with a passenger lift to the first floor. None of the bedrooms have en-suite facilities but do have a wash hand basin. There is a lounge, dining room and garden with patio area for residents to use. The building is accessible. The home is close to local shops and amenities. The home currently charges local authority rates of approximately £395 per week. There are no additional charges. Regents House Rest Home DS0000012319.V359417.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. This inspection was, a ‘Key Inspection’, which is part of the regulatory programme that measures services against core National Minimum Standards. The fieldwork visit to the site of the agency was conducted over seven hours, where in addition to any paperwork that required reviewing we (the Commission for Social Care Inspection) met service users, staff and management. The inspection process involved pre fieldwork activity, gathering information from a variety of sources, surveys, the Commission’s database and the Annual Quality Assurance Assessment information provided by the service provider/manager. The response to the Commission’s surveys was fair, with four service user, and three relatives surveys returned, prior to the report being written. What the service does well: What has improved since the last inspection? General risk assessments are being produced. These documents provide a reasonable account of the potential risk to residents and how they can be managed. The manager has introduced residents’ surveys with the response to those completed reviewed during the fieldwork visit, it is now important that the Regents House Rest Home DS0000012319.V359417.R01.S.doc Version 5.2 Page 6 manager use this quality auditing process on a regular basis and uses the information gathered in a meaningful and practical way. A new flat screen television, with freeview and surround sound has been brought and installed within the main lounge. A specific smokers lounge has been developed. What they could do better: 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 House Rest Home DS0000012319.V359417.R01.S.doc Version 5.2 Page 7 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 House Rest Home DS0000012319.V359417.R01.S.doc Version 5.2 Page 8 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): Standard 3 & 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service and their representatives are on occasions provided with the information needed to choose their accommodation. EVIDENCE: At the last inspection the manager stated that: ‘she was in the process of updating the information about the home for residents and their relatives’. During the fieldwork visit the manager again stated that she was updating the service user’s information, although when the provider returned to the home he produced a copy of a combined ‘Statement of Purpose / Service Users Guide’ document, which was extremely large and not user friendly. The admission details of the last person admitted to the home, in the November of 2007, were reviewed and found to provide basic information Regents House Rest Home DS0000012319.V359417.R01.S.doc Version 5.2 Page 9 about the person’s needs and wishes, the in house assessment was also not signed or dated. Records show that the person referred to above undertook a pre-admission visit in the company of their care manager. The homes’ pre-admission information was supplemented by the care managers’ assessment, which the service received one day prior to the resident moving into the home. Feedback provided by the resident and their relative, via the surveys, indicate that people believe they were provide with ample pre-admission information all seven surveys ticked ‘always’ in response to the question: ‘did you receive enough information about this home before you moved in so you could decide if it was the right place for you’ & ‘do you and/or your friend or relative get enough information about the care home to help you make a decision’. The residents also unanimously ticked ‘always’ in reply to the question: have you received a contract’. Regents House Rest Home DS0000012319.V359417.R01.S.doc Version 5.2 Page 10 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. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs. People are not responsible for their own medication, however the medication management system is poorly operated and provides inadequate safeguards for service users. The principles of respect, dignity and privacy are put into practice. EVIDENCE: Four care plans were reviewed during the fieldwork visit, each contained details of the residents immediate care needs based on a modified activities of daily living model, which is a care planning model used within nursing. The plans contained a personal history and information under the following headings: communication, relationships, interests, spiritual needs, medical, memory, sleeping, food preferences, medications, personals risk assessment, Regents House Rest Home DS0000012319.V359417.R01.S.doc Version 5.2 Page 11 general risk assessments, continence, moving & handling assessment, mental health needs and the running records. The general risk assessments were found to be reasonably well structured documents, which provided details to the staff on how to manage basic risks, however, the personal risk assessments require expansion to include consideration of risks possessed by activities like smoking and/or going out of the home unaccompanied. The manager also needs to consider the mental health issues that are likely to impact upon the care of the residents’, especially given some of the peoples’ personal histories and associated cognitive impairments. The care records also had no review dates documented and so we could not check when the records were last updated, although the manager stated that the plans were new and had only recently been implemented following the receipt of the last inspection report. Some records are aspirational rather than factual, as they state what the home would like to achieve and not what is being delivered, an example being one persons moving and handling plan, which indicates that the staff should use the hoist to ensure safety during moving and that the manager is to check monthly to ensure the equipment is safe. However, in conversation the manager confirmed that she does not know when the hoist was last checked or serviced, says that she has been trying to get a company to service the hoist. Information provided by the residents, via the surveys, indicate that all four people to respond, find the care they received to be good, with two people ticking ‘always’ and two ‘usually’ in reply to the question; ‘do you receive the care and support you need’. The view of the relatives’ is that ‘the care home meets the needs of their friend/relative’, with all three people ticking ‘always’ in response to the question posed. Additional comments, made via the surveys, include: ‘goes out of the way to help with his dietary wishes, staff ask for medical help if he has any pain that they can’t deal with’. The latter part of the comment, in respect of health care, support by the response to the residents’ surveys with two people ticking ‘always’ and two ‘usually’ in reply to the question: ‘ do you receive the medical support you need’. Regents House Rest Home DS0000012319.V359417.R01.S.doc Version 5.2 Page 12 During the fieldwork visit the manager was observed talking to a local General Practitioner (GP) regarding a residents’ complaints of pain. A request for a review or increase in their pain control was made and the GP agreed to send a new prescription to the pharmacy, which the manager immediately arranged to have collected/delivered. The home’s records produce a varied picture, in respect to the support provided to residents, with some records evidencing good practice, for example, one care plan documenting how a person was involved with their GP throughout a recent illness, which resulted in the staff calling out an ambulance due to their shortness of breath and the person being admitted to hospital. Whilst other records establish shortfalls in the staffs management of people’s health care needs, an example being, a resident who fell twice in their bedroom in February but the staff failed to document this within the accident log or to review the persons’ risk assessments. However, the general impression is that the service is meeting people’s immediate health care needs; a view strengthened by a professional’s recent decision to support a resident, whose health is deteriorating, to remain in the care of the staff of Regents House. This decision is documented in the persons’ care plan, as is the involvement of the residents’ family/representatives in making this decision. No service users are currently self-medicating, with the service managing all aspects of the process. On reviewing the home’s approach to the management of people’s medications a number of concerns were identified. Firstly the medications were not being safely or securely held, with the medicines cabinets being modified kitchen cabinets that were held shut by clasps. These fixings failed to provide a secure or effective seal and we (the Commission) managed to slip our hand inside the cabinet and remove a packet of tablets (paracetomal) without unlocking or opening the cabinets. The controlled drugs cabinet is a safe, which the provider has been encouraged to ensure is fit for purpose and complies with the requirements of the ‘Medicine Act’ and the ‘Safe Custody Regulations’. The safe will also need to be appropriately secured using the fixings prescribed within the above regulations and any governing ‘British Standards’, as currently the safe is screwed to a work surface in the kitchen. Regents House Rest Home DS0000012319.V359417.R01.S.doc Version 5.2 Page 13 The medications stored within the controlled drugs cabinet were not all items that required storage in accordance with controlled drug guidance despite the guidance clearly indicating that only controlled medications should be stored in these cabinets. Medications that did require storage within a controlled drugs cabinet (temazepam) were discovered mixed in with other non-controlled medicines stored within the kitchen cupboards. The home’s medication fridge has no lock and no thermostat for monitoring the temperature of the fridge (maximum and minimum daily temperatures should be taken), which should remain within tight parameters to ensure the medications are effective. It was also noted that there was a large build-up of ice around the top of the fridge, which could suggest it is not working appropriately. During a review of the medication administration records it was noticed that ‘tramadol’ (a pain killer derived from morphine but not a controlled medicine) was being signed for within the controlled drugs register. When this was brought to the attention of the manager, she rang the local pharmacist to confirm this information was accurate. This is important, as it questions the manager’s knowledge of the medicines being used within the home and their correct storage. Two staff have completed a distance learning programme on the handling of medications, however, the manager states that she generally oversees and deems staff competent to administer medicines safely. However, the above information does not reflect competency on the part of the manager, when considering and understanding safe practice in relation to medication and this raise questions over her ability to deem staff competent. The service provides single occupancy accommodation for its residents. During the tour of the premise those rooms visited were noticed to have locks fitted and several rooms had been locked by the occupant, the manager stating that people held keys to their rooms. All communal facilities were fitted with locks. The home does not provide a separate quiet lounge, however, they have created a smoking lounge/room, which meets the needs of the current client group and service the home better than a quiet area. Comments provided by the relatives indicate that the staff treat people with both respect and dignity, stating: ‘respect and dignity of the people they care for. Make them feel important and that this is a home in the truest sense, care is given here out of a sense of love not merely duty’. Regents House Rest Home DS0000012319.V359417.R01.S.doc Version 5.2 Page 14 The manager continues to have her office in the dining room, which does not encourage or promote privacy either for the residents’ when eating or the manager when completing important paperwork or communication with professionals / families, etc. Records are also stored within this area and access to personal information is possible, due to the managers’ poor storage and management of client data. Regents House Rest Home DS0000012319.V359417.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): Standards 12, 13, 14 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use services are able to make choices about their life style, and supported to develop their life skills. Social, educational, cultural and recreational activities could be improved. EVIDENCE: The home has no structured activities programme, however, during the fieldwork visit and conversations with the people residing at the home, this did not seem to be an issue. The residents’ discussed their satisfaction with the way the home operates and stated that they were happy to entertain themselves, one person commenting via the surveys that: ‘I’m happy with a daily newspaper and the television’. Information taken from the relative surveys tends to mirror the feedback obtained during the fieldwork visit, with all three surveys ticked ‘always’ in response to the question: ‘does the care service support people to live the life they choose’. Regents House Rest Home DS0000012319.V359417.R01.S.doc Version 5.2 Page 16 During our time in the home three residents’ were observed going out, either with friends or unaccompanied, as reflected earlier the manager should look to complete risk assessments for people going out without support or company. The manager discussed during the tour of the premise that the home has purchased a flat screen digital television with surround sound and a digital receiver, which provides access to ‘freeview’. Once a week it is understood that a visitor from the local church visits the home to perform religious observances and provide spiritual support to the residents. Whilst no visitors were seen around the home during the fieldwork visit, one residents’ friend did arrive to take them out, returning later having completed some shopping and having visited a local pub for a drink, according to the resident. The records, maintained by the home, contain information that establishes that relatives are involved in the care of their next-of-kin, as mentioned earlier one resident’s relatives have been involved in making decisions about the persons long-term care needs. Information taken from the surveys indicates that the families feel they are kept in touch or involved with the care of their relative, all three ticking ‘always’ in reply to the question: ‘are you kept up to date with important issues affecting your friend/relative’. One person adding the comment: ‘full and free access at all times to the home and the staff’. In discussion with the manager it was established that the home has no set visiting times and that people are welcome to undertake visits at any time of the day, as long as it suits the resident. Food preparation is completed by the staff team, as the home does not employ a cook, which could have implications for the care staff team, especial when the manager is not present, as time taken up by cooking is time that could be spent providing care and/or stimulation. The kitchen was visited during the tour of the premise and found to be in a reasonably poor state of repair, with work surfaces not extending the full length of the units and unit floors collapsing inward. Chemicals that should have been stored in accordance with the ‘Control Of Substances Hazardous to Health’ (COSHH), were also found within kitchen Regents House Rest Home DS0000012319.V359417.R01.S.doc Version 5.2 Page 17 units, the manager stated there are no COSHH data-sheets available, as the home does not change its cleaning products. The dining room is large enough to sit all of the residents’ in one sitting, although as the manager’s office is located in the dining room she does have to ensure any records or documents being used have been cleared away. Lunch was observed being served and dished up by the care staff, which demonstrated a very good awareness or knowledge of the resident’s preferences, each meal individually served and differing in portion size, etc. Mealtimes’ were observed to be social occasions with the residents chatting to each other and the staff throughout; they were also noticed assisting each other, passing around condiments and utensils, as required. Feedback from the residents on the day of the visit and information taken from the survey responses indicate that the food served at Regents House is considered good, people commenting: ‘quiet varied’ and ‘ go out of their way to help with their dietary wishes’. Regents House Rest Home DS0000012319.V359417.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 & 18. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns, but have limited access to a complaints procedure; and inadequately protected from abuse. EVIDENCE: The home does have a complaints procedure, which the manager states she provides to all new residents or their representatives at point of admission to the home. As mentioned earlier, we were told during the visit that the home did not have a ‘statement of purpose’ or ‘service users guide’, however, on his return to the home the provider produced a very complex document, which he says is the home’s combined ‘statement of purpose’, ‘service users guide’. This document is not user friendly and the provider has been advised to revisit the appropriate regulations and standards and produce more simplistic, easier to read documents. Information provided by the residents indicate that they are aware of the home’s complaints process, all four respondents ticking ‘yes’, in replay to the question: ‘do you know how to make a complaint’. Regents House Rest Home DS0000012319.V359417.R01.S.doc Version 5.2 Page 19 The relatives to complete surveys also indicate that they are generally aware of how to raise concerns, two ticking ‘yes’ and one person ‘I cannot remember’, in response to the question: ‘do you know how to make a complaint about the care provided by the home if you need to’. All three ticked ‘always’ in reply to the question: ‘has the care service responded appropriately if you or the person using the service has raised concerns about their care’. Work is required to improve the home’s safeguarding practices, as during the fieldwork visit the Local Authority (LA) safeguarding procedure, currently in use at the home, was out of dated and was an edition produced in 2003. The training records indicate that staff are not regularly accessing updated safeguarding training, the last documented date that training was provided was in 2004. The manager did state that she provides awareness sessions for staff and takes them through the home’s ‘prevention of abuse policy and procedure’, however, as this document refers continuously to the LA policy, which as established is out of date, the benefits or effectiveness of this training will therefore be limited. The indication from the residents and the relatives is that they do not have any concerns with regards to the care and treatment they receive at Regents House, people adding comments like: ‘it was a lucky day for our relative and for the family when he moved to Regents House. The care he has received has not only prolonged his life, it has improved the quality of that life’. Despite the above comments it is our belief that the residents are protected from abusive situation more in part to the diligence of the care staff than any active interventions or planning by the management. Steps need to be taken to address this situation and establish appropriate training, guidelines and procedural instructions for staff. Regents House Rest Home DS0000012319.V359417.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): Standards 19 & 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables residents to live in a reasonably safe, well-maintained and comfortable environment. EVIDENCE: A tour of the premise was undertaken with the manager, during the tour the manager pointed out were improvements to the environment have been made, including: ‘The creation of the smoking lounge and the purchase and provision of the flat screen digital television, with surround sound and an in built ‘freeview’ receiver’. New carpets have been fitted in the hallway and along the first floor corridor, a new dining room set has been provided and new garden furniture purchased, although not used due to the current time of year. Regents House Rest Home DS0000012319.V359417.R01.S.doc Version 5.2 Page 21 The manager was also heard talking to a relative about a leak that had damaged a residents ceiling, assuring the relative that this was booked for repair, although on checking later the ceiling had been repaired during the manager’s day off. Some issues, identified during the last inspection, were noticed to be ongoing at this visit, with toilets and bathrooms not stock with paper-towels, despite the dispensers having been fitted, one bathroom not supplied with liquid soap and towelling towels visible in all communal settings. The toilet in the first floor bathroom and the ground floor bathroom, were both awaiting a visit by a plumber to correct faults, the provider calling the plumber during the fieldwork visit to establish when they could visit. The laundry remains unchanged since the last inspection report was written, the floor is in a bad state of repair, the door to laundry unlocked and accessible by service users and chemicals controlled under COSHH stored in the laundry but not secured. In addition to the above items, which mirror issues identified during the previous inspection this visit also established that in the downstairs bathroom cabinet the home were storing packs of razors (unused), two shaving brushes one of which was easily identified as used, a tin of shaving foam (used), a roll on deodorant (used), a sponge on top of cabinet and two bars of soap in the sink, which were in use, despite the guidance that indicates liquid soaps should be used in communal settings. Cracked and loose fitting electrical boxes / box covers in the dining room and corridor, pictures on the floor of the ground floor corridor, which the manager stated required storage, a diving cylinder in front dining room, which the manager stated belonged to the provider, a mattress, boxes and a pull up device all left outside the first floor bathroom, causing a fire hazard and damage or staining to a first floor toilet ceiling and a frayed emergency call bell lead, which could not be reached by the residents. The home does not employ domestic staff and the care staff are required to undertake cleaning duties in between caring for the residents and performing catering duties. During the tour of the premise it was noted that the home was reasonably clean, although dust was apparent on top of picture frames, light fitting and fire extinguishers. The information provided by the residents, via their surveys, is that the home is clean and tidy throughout, all four people ticking ‘always’ in response to the question: ‘is the home fresh and clean’. Regents House Rest Home DS0000012319.V359417.R01.S.doc Version 5.2 Page 22 The staff training records do not provide any evidence of the staff having completed infection control training, however, personal protective clothing is supplied, staff observed wearing aprons and gloves. Regents House Rest Home DS0000012319.V359417.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 & 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff lack training opportunities and are provided in insufficient numbers to appropriately support the people who use the service. EVIDENCE: Feedback obtained from the residents’ surveys suggests that the people residing at the home are experiencing a varied response from the staff when they require their assistance, one person ticking ‘always’, two ‘usually’ and the fourth ‘sometimes’ in reply to the question: ‘are the staff available when you need them’. As mentioned above, care staff are required to perform care, domestic and catering duties, during their shifts, which when the manager is not around to provide cover reduces the amount of time they have available to spend with the client group, which may explain the above response’. However, the view of the residents relatives is that the: ‘staff go that extra mile, nothing is to much trouble for them’ and ‘all staff make my relative laugh, giving him the help he needs’. Regents House Rest Home DS0000012319.V359417.R01.S.doc Version 5.2 Page 24 The duty roster indicates that two care staff are on duty throughout each day shift and that the manager provides supernumerary cover throughout the day and is on call when not at work. The provider, who lives in a flat attached to the property, provides night duty cover, performing the role of a sleep in carer in support of the waking night staff. Staff training records are poorly maintained, although they provide sufficient evidence for us to determine that their training opportunities are inadequate. In total seven staff work at the home, although currently one person is absent due to maternity leave. The records of all seven staff were reviewed during the fieldwork visit. As an example the training records of a senior staff member showed that they have completed the following courses on the following dates: ‘Moving & Handling - April 07, fire safety - Nov 07, in house abuse training - December 2004, in house induction - October 2004, which is not compliant with the ‘Skills for Care’ induction programme, in house Health & Safety – October 2004 and a food hygiene certificate completed in 2004. The manager was able to produce records that establish the staffs’ enrolment or use of e-skills training, the records documenting the varying stages of the training the staff had completed, three having finished the foundation stage, one the intermediate stage and two the advance stage. The manager was also able to produce a diary entry, which provided evidence of a forthcoming meeting with a local training provider to discuss the staffs training and development needs. The manager also stated that three staff have completed a National Vocational Qualification at level 2 (NVQ), although one of these people was awaiting external verification of their work before the award was officially sanctioned. Once this person has been awarded their NVQ the home will have trained 43 of its staff to the recommended NVQ level, the recommended level currently set at 50 . The service and/or the manager is continuing to struggle with the concept of a robust recruitment and selection process. During the fieldwork visit the files of the two most recently employed staff were reviewed, although one of these people’s records was seen during the last fieldwork visit, when it was discovered that the manager had failed to obtain ‘Criminal Records Bureau’ (CRB) and ‘Protection Of Vulnerable Adults’ Regents House Rest Home DS0000012319.V359417.R01.S.doc Version 5.2 Page 25 (POVA) checks or two satisfactory reference before commencing the person employment. On reviewing this persons’ file it was established that the CRB and POVA clearance was now available, however, only one of the two required references had been received and due to the ambiguous writing paper and illegible signature, the manager was unsure who the referee was or how they new the employee. The second persons’ file contained both a CRB and POVA check and had two references, all of which had been taken up before they commenced employment. However, the references were both character references supplied by an employ of the home and the next-of-kin of an employee. The application form, provided by the employee, clearly identifies a hotel in Poland, as a reference and a hotel in Wales, where they had worked for five months prior to their employment at Regents House. It was also noted that the application form did not contain a full and detailed employment history, despite this being a requirement of the Care Homes’ Regulations’. Regents House Rest Home DS0000012319.V359417.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 adequate. This judgement has been made using available evidence including a visit to this service. The management and administration of the home maybe based on openness and respect but it is neither effective nor robust and whilst a quality assurance systems has developed the manager is unsure of how to use the information to improve the service. EVIDENCE: One person told us via their survey that: ‘the manager is very caring and helpful’. Regents House Rest Home DS0000012319.V359417.R01.S.doc Version 5.2 Page 27 Whilst another person considers that the home provides: ‘respect and dignity for the people they care for. Make them feel important and that this is a home in the truest sense, care is given here out of a sense of love not merely duty’. The staff spoken with during the fieldwork visit also consider the manager to be caring and friendly, her relationship with them observed to be democratic, as apposed to autocratic, the manager seeking the staffs views or asking for information before making decisions. At the last inspection it was established that the manager had yet to complete the NVQ level 4 in care, at the time of writing this report the Commission have no evidence to indicate that this has changed. Whilst the manager may be a caring and friendly person the findings of the inspection are that she lacks managerial competencies, she has failed to sustain or make the necessary improvements to the service following the previous inspection. She lacks knowledge, as shown by her management of the service users medications and the need to call a pharmacist to check on the storage of a non-controlled substance. Her lack of organisation, especially when it comes to records and documents management, leads to information being unavailable or means that considerable time has to be spent looking for items, as observed when pulling together one of the new staffs recruitment records and locating people’s supervision records. The manager has introduced a questionnaire and/or survey into the home, which has been shared with the residents’ and produced responses such as: ‘excellent run home’ and ‘I like it here it’s okay’. However, in conversation the manager had no real idea of how often she intended to use the survey to seek people’s opinions or how to use the information, either to improve the service or help promote worth/value within the staff team. The home has no system for documenting when care records are updated and the management of the staffs training files, as mentioned is poor. The manager stated that an informal system, of residents meetings, is in place and that minutes of these meetings are not maintained. The manager, located staff’s supervision records after a lengthy search through her documents, these show that supervision is provided on an ad-hoc basis and that a routine system of regular supervision does not exist. Regents House Rest Home DS0000012319.V359417.R01.S.doc Version 5.2 Page 28 Staff meetings are also provided on an ad-hoc basis, with minutes showing that meetings occurred in the June & July of 2007 and the May of an unspecified year, no other records were available. The home does not become involved in managing or securing residents finances, the residents’ either managing their own monies or supported by relatives and/or representatives. The home does however, purchase and provide all toiletries and personal items for the residents, at no additional charge, the provider and the manager stating that they feel the weekly allowance provided to people via their benefits is not sufficient for them to provide these items themselves and still enjoy their hobbies or interests. Health and safety is a problem, with the tour of the premise raising concerns over the storage of COSHH items and the safety and management of peoples’ medicines, whilst staff training on infection control training, moving and handling, health and safety all needing updating. The manager’s uncertainty, as to when the hoist was last serviced is a concern, as such equipment, should be regularly checked and maintained to ensure people’s safety and wellbeing. Individual risk assessments are required for any activity the residents undertake that poses a danger to their health and wellbeing, smoking unobserved, going out unaccompanied, etc. Regents House Rest Home DS0000012319.V359417.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 2 8 3 9 1 10 3 11 X 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 2 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 1 X 2 X 3 X X 2 Regents House Rest Home DS0000012319.V359417.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 OP7 Regulation 13 (4) Requirement Residents must be protected from unnecessary risks. Any risks to residents must be assessed and risk management plans recorded and reviewed as to how risks will be minimised or as far as possible eliminated. This requirement is a repeat of the requirement raised at the last inspection. Service users plans must be kept under regular review, ensuring any changes in their care are appropriately reflected. The recording and storage of controlled drugs in the home must comply with the Misuse of Drugs (Safe Custody) Regulations 1973. This requirement is a repeat of the requirement raised at the last inspection. Medications must be safely and appropriately stored at all times. The manager must ensure that the home’s safeguarding DS0000012319.V359417.R01.S.doc Timescale for action 25/05/08 2. OP7 15 (2) 25/05/08 3. OP9 13 (2) 25/07/08 4. 5. OP9 OP18 13 (2) 13 (6) 25/05/08 25/06/08 Regents House Rest Home Version 5.2 Page 31 6. OP19 23 (2) practices are robust and ensure people’s safety and that the staff are equipped with the necessary skills and knowledge to effectively respond to an incident of abuse. The manager must take steps to 25/06/08 ensure the laundry area is revamped and that minor maintenance issues are identified and addressed in a timely manor. That equipment supplied by the home, for use with the service users, is maintained in good working order. Staff recruitment procedures must ensure that staff are suitable to work in a care home. These must include at least a full job history, two satisfactory written references and satisfactory criminal record and protection of vulnerable adults checks before the post is agreed. This requirement is a repeat of the requirement raised at the last inspection. The manager must review the home’s training and development programme ensuring that staff are both appropriately qualified and competent. The manager must undertake from time to time such training as is appropriate to ensure she has the experience and skill required to manage the home effectively. There must be an effective system of quality assurance that measures how well the service is meeting the needs of the residents and monitors compliance with the home’s legal DS0000012319.V359417.R01.S.doc 7. OP29 19 and Schedule 2 25/05/08 8. OP30 18 (1) 25/06/08 9. OP31 10 (3) 25/06/08 10. OP33 24 25/05/08 Regents House Rest Home Version 5.2 Page 32 and statutory requirements. This requirement is a repeat of the requirement raised at the last inspection. The manager must take steps to ensure chemicals and pieces of equipment are maintained appropriately ensuring the service users welfare. That staff receive appropriate training on the identification and management of health and safety concerns. That risk assessments consider the risks to individuals whilst they maintain their independence. 11. OP38 13 (4) 25/06/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP3 Good Practice Recommendations The manager and provider should produce more usable versions of their ‘statement of purpose’ and ‘service user guide’ documentation that could then be appropriately shared with the service users. The home should seek to develop and expands the range of in house activities available to residents’. The ‘statement of purpose’ and ‘service user guide’ should be used to convey information relating to the home’s complaints process. The manager should review how the staff are deployed to ensure sufficient hours are dedicated to the care of the service users, whilst cleaning and catering duties are not neglected. 2. 3. 4 OP12 OP16 OP27 Regents House Rest Home DS0000012319.V359417.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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