Inspection on 03/07/06 for Reminiscence Neighbourhood

This inspection was carried out on 3rd July 2006.

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

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

Other inspections for this house

Reminiscence Neighbourhood 10/03/09

Reminiscence Neighbourhood 07/10/08

Reminiscence Neighbourhood 19/09/07

Reminiscence Neighbourhood 06/01/07

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

CARE HOMES FOR OLDER PEOPLE Reminiscence Neighbourhood Sunrise Senior Living Edgbaston Church Road Edgbaston Birmingham B15 3SH Lead Inspector Alison Stone Unannounced Inspection 03th July 2006 13:00 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 Reminiscence Neighbourhood DS0000066581.V293625.R01.S.doc Version 5.1 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. Reminiscence Neighbourhood DS0000066581.V293625.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Reminiscence Neighbourhood Address Sunrise Senior Living Edgbaston Church Road Edgbaston Birmingham B15 3SH 0121 450 8930 0121 455 6689 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) Sunrise Operations Edgbaston Limited Ms Rosanna O`Mara Care Home 25 Category(ies) of Dementia - over 65 years of age (25) registration, with number of places Reminiscence Neighbourhood DS0000066581.V293625.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The residential home provides accommodation for 25 elderly persons over the age of 65 years with Dementia. The manager completes accredited training in Dementia within 12 months of registration. First inspection Date of last inspection Brief Description of the Service: The home is located in Edgbaston on a main road close to central Birmingham. It benefits from being close to public transport link. The home is a new build and was purpose built. The care home is located on the first floor of this building and offers large spacious accommodation for 26 people. The home is situated in the main building; the ground floor offers flats for independent living a bistro, dining room and large communal lounges. The home exceeds the National Minimum Standards in the space it offers and is in excellent decorative order and is beautifully furnished. Reminiscence Neighbourhood DS0000066581.V293625.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The fieldwork for this inspection was carried out over a four-week period and included a site visit. A visit to the service was carried out over the afternoon and late evening of one day by one inspector. A further separate inspection was undertaken by CSCI’s Pharmacy Inspector and her findings are recorded in the report in the outcome area “Health and Personal Care.” The inspector collected information to form the basis of judgements in this report in a number of ways. She spoke with people’s relatives, three people who live at the service, also other involved professionals, the manager, the responsible individual and several members of staff. Some records relating to people and staff were looked at, along with records relating to the management of the home, some aspects of health and safety, medication, training and some policies. This was the first inspection to this service as this is a new service. The inspection was a “key Inspection” The key standards are identified in the main body of the report under each of the outcome areas. The inspection identified many positives outcomes for people, however a number of very serious concerns were also raised. These are detailed in “What they could do better” and as appropriate throughout the report. CSCI has worked with Social Care and Health and the organisation to ensure these are resolved. The inspectors would like to thank everyone who contributed towards the inspection process. What the service does well: The environment is exceptionally well furnished and decorated and provides an extremely spacious and comfortable place for people to live in. Meals are of a good standard and people are supported to have a pleasant area to dine in, with a choice of nutritional well-balanced meals. People are supported with high staffing levels to help and support them with their needs. The organisation operates vigorous recruitment procedures and offers the staff team comprehensive training. Reminiscence Neighbourhood DS0000066581.V293625.R01.S.doc Version 5.1 Page 6 There are opportunities for people to take part in a wide variety of activities. The service is supported by a number of departments like the Wellness Service, Catering, Housekeeping and Maintenance meaning when these departments are working well together the manager can spend her time supporting peoples’ care needs. It was noted during the inspection that there were many positives about the care at Sunrise. Staff interaction with people was positive and respectful. Staff support was seen to be discreet. Staff were observed to be encouraging people to be as independent as possible. Where people became agitated or confused staff were able to support them with distraction techniques, through chatting or offering alternative activities for people to do. Meal times for people were very pleasant and the people were seen to be enjoying their meals times, making choices about food and chatting and laughing with each other whilst dinning. What has improved since the last inspection? What they could do better: The service is supported by lots of departments like Maintenance, Wellness Nurse’s, Catering, Activities and Housekeeping, these could be positive additions to the service. When working well together they would support the manager of the service in her role and allow her to concentrate on the care needs of the people living there. However it was noted that there had been a number of issues that had led to some confusion between departments and this had meant some things had gone wrong, like not ordering the right medication for people, information about peoples’ care needs not being passed on to the manager so she could make sure they saw the relevant health professionals. Sometimes relatives said problems and issues they brought up with staff didn’t get dealt with. The service needs to concentrate on how they communicate between departments and make sure all information is passed on to the manager of the service. Support services like the ‘Wellness Nurse Department’ needs to be closely supervised. The Wellness nurses’ need to be clear about what their job is and that they are working with the manager in a supportive and advisory role. It is very important in residential homes that the manager has all the necessary information to ensure people are looked after, the involvement of Reminiscence Neighbourhood DS0000066581.V293625.R01.S.doc Version 5.1 Page 7 lots people in a persons’ care can lead to issues about peoples’ health and wellbeing not being passed on and/or missed and as a result people care could suffer. Immediate requirements were left in respect of concerns as to how service users health needs had been managed. All staff should be regularly supervised by a relevant manger, who has the experience and skills to be able to tell when there are concerns with individuals’ practices so that the necessary steps can be taken to ensure staff are managed appropriately and any problems identified in their work quickly resolved. This is of particular importance when it affects peoples’ health and wellbeing. It is important that when people need medical assistance a doctor or ambulance is contacted so that people get the support they need immediately. It is important people and families are made aware of all costs that may be involved in their care, like having to pay for meals and going to the hospital with a member of staff. People not knowing about all the things they have to pay for means that they can get confused and feel cross when they find out this sort of information at more stressful times like when they are ill and need to go to hospital. An immediate requirement was also left in respect of the hot water tap in the service users laundry area, as this was found to be extremely hot and much hotter than the recommended safe temperature of 43 o C. This area was immediately made secure. The organisation has responded quickly to the immediate requirements left and sent in an action plan detailing all the things they are going to do to make sure the problems identified during the inspection are dealt with quickly. The Responsible Individual and the Registered Manager had a meeting with CSCI (the regulatory body that is responsible for inspecting services like Sunrise) to discuss some of the issues raised in the inspection. Steps are now being taken by the organisation to ensure that all the problems identified will be dealt with. From this inspection the organisation has expressed a commitment to take on board all the concerns raised and ensuring that they put in place practices that mean the problems identified will not happen again. 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. Reminiscence Neighbourhood DS0000066581.V293625.R01.S.doc Version 5.1 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 Reminiscence Neighbourhood DS0000066581.V293625.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5, 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Not all the relevant information needed is given to prospective service users to make an informed choice about the service. Each service users has a written contract/statement of terms and conditions within the home but not all information is included. Service users are supported to have an assessment before moving into the home so they can be assured their needs will be met. Relatives and friends of prospective service users have the opportunity to visit the service and assess the quality, facilities and suitability of the home. EVIDENCE: Reminiscence Neighbourhood DS0000066581.V293625.R01.S.doc Version 5.1 Page 10 The Statement of Purpose and Service Users Guide were reviewed as part of the inspection. It was noted that the Service User Guide and Statement of Purpose had been recently updated 02 June 2006 to include costs relating to taxis and staff costs associated with escorting service users to hospital and/or activities. One family raised concerns that they felt they had not been told about all the costs initially, like paying for taxis to go to hospital to attend appointments, or having to pay for costs associated with staff providing an escort. The home has a practice where ‘Founder Members’, those are the first service users to move in, can enjoy added benefits like free hair dressing appointments for the first 10 appointments or benefits like free meals for relatives joining service users, for a limited number of times. This has led to confusion amongst one service users family and they felt that they were not clear about the things they have to pay for and the things they don’t. The Service Users Guide and Statement of Purpose need to be updated to ensure each and every cost is presented in this document, including the benefits to ‘Founder Members’ and when these benefits finish. This should be done in a clear and simple way so service users and their families are well informed about all costs, supporting them to make informed decisions and preventing any future confusion when this issue is raised at more difficult times, like when a service users needs to go to hospital. The Service Users Guide needs to include the relevant qualifications and experience of the manager and staff. It is important to include this information as it informs services users and their families about whether the manager and staff are suitably experienced and qualified to provide care to people. An agreement of service users terms and conditions/contract at the home was reviewed and this was found to contain all the relevant information and had been signed by all parties. However it was noted to not include all the relevant information about costs. The service provides a comprehensive programme of assessment carried out by the manager and supported by the ‘Wellness Nurse’ all aspects of service Reminiscence Neighbourhood DS0000066581.V293625.R01.S.doc Version 5.1 Page 11 users needs are assessed and this is further supported by letters from, GP’s, psychiatrists, psycho geriatricians, social workers and community psychiatric nurses where appropriate. From these assessments care plans are completed by the manager, these are completed in conjunction with service users families. However it was noted that, recently there had been an incident in the community where staff had to intervene to prevent a service user from putting herself at risk. The care plan did not reflect this need and there wasn’t a risk assessment in place. Initial service user assessments are reviewed after 30 days or before if required and then there are formal monthly reviews. Reviews take place in consultation with all involved parties as appropriate and include service users families. The service actively encourages families and friends to come to the service prior to any admission and staff spend long periods of times with service users and their families supporting them to familiarise themselves with the surroundings, facilities and gain an insight in to the suitability of the service. Currently the service does not provide intermediate care. Reminiscence Neighbourhood DS0000066581.V293625.R01.S.doc Version 5.1 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. 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 not fully met by the service, which has resulted in some serious concerns about how service users health care is managed. The home does not have adequate checking procedures installed to check all new service user medication received into the home. Service users can feel confident that they their right to privacy is upheld. EVIDENCE: As part of the inspection two service users records were looked at. Reminiscence Neighbourhood DS0000066581.V293625.R01.S.doc Version 5.1 Page 13 These were found to be very detailed. Care plans described the care to be provided and detailed service users preferences. Also work had been undertaken through the personal plan to identify a service users interests & hobbies, their life history and their friends and family relationships. There were weight charts in place, assessments had been undertaken of skin care and there were records detailing the assessments undertaken in relation to service users dementia. Records of regular reviews were also seen on service users files. The manager was able to demonstrate that relatives are involved in service users plans of care and are regularly consulted with. However relatives of one service users raised concerns that they felt they were not always involved in issues around service users plans of care, like changes in medication. Relatives of one service user felt that service users social needs were not met and activities based in the home were not being carried out by staff and service users were not encouraged to take part in activities. Daily records were very detailed and included information about how the service user had spent their day. All the relatives that were involved in the inspection process made positive comments about standards of care for their family members around personal care. It was noted that service users were all well dressed and looked nicely presented with styled hair and their appearance was clean and tidy. There were serious issues noted around service users health needs. Practices that involved contacting the wellness nurse service in a medical emergency as opposed to a GP and/or ambulance were concerning. Service users must be supported to have the specialist equipment they need in relation to their moving and handling needs. It was noted that up until recently requests for moving and handling equipment went through the Wellness Nurses’ and in one case the request for necessary assessed equipment for a service users had not been agreed. Where a trained moving and handling assessor decides that a person needs a piece of equipment to support them with their needs this must be arranged for them immediately. Reminiscence Neighbourhood DS0000066581.V293625.R01.S.doc Version 5.1 Page 14 In all medical emergencies an ambulance must be called in the first instance and the wellness nurses who provide an advisory supportive role should be informed of what action staff have taken. It is very important that when samples are needed, like urine samples to help with the diagnosis of illness, that these are sent off immediately so that there is no delay in any treatment a service user may require. It was noted on one service users file that a urine sample was not sent off to the laboratory before the bank holiday weekend and a relative raised concerns that a sample for her mother that should have been taken and sent off that day still had not been sent two days later. In the case of service users health being a concern staff should contact a GP in the first instance, if the service users condition continues to deteriorate then a GP should be contacted again. It is not appropriate in the circumstances of a service user being very unwell for a sustained period of time, that staff delay GP involvement for any reason. The manager must ensure that all staff, including the Wellness Nurse Department are supported to take appropriate action in the case of service users health needs A specialist pharmacy inspector reviewed medication administration and management. Her comments were. Pharmacist Report. “Systems have not been installed to check the prescribed medication received into the home. Medication had not been confirmed with the prescriber for new service users. One medicine had been administered from an unlabelled bottle and the dose administered did not match the prescribed dose. All audits undertaken confirmed that they had been administered according to the written instructions on the Medicine Administration Record (MAR) chart but these doses could not be verified in all instances. Storage facilities were inadequate. There were not enough storage cupboards for excess medication in the medication room. The registered manager does not undertake any audits to confirm staff competence in medicine management.” There has also recently been a drug error. The GP made a change in a service user prescribed medication. This information had not been passed on to the manager and the medication administration sheet had not been fully amended, so staff continued to give the “stat” dose of medication as well as giving the increased dose. This was therefore not given as the GP had prescribed. It was noted that service users were treated with respect and their right to privacy up held. Staff were observed to be knocking on doors before entering rooms. All interactions observed between staff and service users were appropriate. Reminiscence Neighbourhood DS0000066581.V293625.R01.S.doc Version 5.1 Page 15 One-service users said about a carer, “I like her very much, she is kind to me”. Relative’s feedback about staff was mixed. Some relatives said that the staff were “excellent, caring and fantastic with their relatives.” Others felt some staff were disinterested and questioned their training, particularly in the area of activities and felt some staff were not proactive in encouraging their family members to take part in things and do as much for themselves as they could. A social worker spoken to said the feed back from relatives about the service user they had placed was very positive, the family felt they were regaining skills they had seemed to have previously lost and was taking much more of an interest in their appearance. There had been concerns about their appetite at her previous placement, but it was noted since moving into Sunrise they had a much better appetite and were eating well. Reminiscence Neighbourhood DS0000066581.V293625.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 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. Service users are supported to have a lifestyle in the home that matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests. Service users are supported to 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. EVIDENCE: A lot of work is undertaken by the manager to assess individuals’ personal preferences as to what activities they enjoy prior to admission. Service users and their families are supported to complete a profile that details information about individuals cultural, social and leisure interests. Reminiscence Neighbourhood DS0000066581.V293625.R01.S.doc Version 5.1 Page 17 The home benefits from having an activities coordinator, who is responsible for supporting service users to enjoy an active social life and take part in a range of activities of their choice. The choice of activities on offer to service users are detailed in a weekly updated programme and include a daily stroll, church services, coffee and crossword club, knitting club, tea and cake with the vicar, an outings like The Botanical Gardens and The Opera, music nights, flower arranging and comedy classics in the activities room. During the inspection service users were noted to be encouraged to take part in activities, one service user was helping with light housework another service user was being supported to take part in activities available in the home which she seemed to particularly enjoy. Again relative’s feedback was mixed, one family said that there were lots of opportunities to take part in activities and her mother was going to the opera shortly, which was something she enjoyed immensely. Another family commented on the lack of activities available for service users to take part in, particularly in the evenings and on weekends. The manager said that it was sometimes difficult to support service users with activities, as some would decline an offer of involvement by staff. Some service users did this on a regular basis. Which led to families feeling service users were not offered activities. It was suggested to the manger that she records in daily records when activities are offered and the choices service users make in this respect. It was noted during a tour of the premises that there were lots of activity equipment on display in relation to supporting service users with their needs around dementia, however these appeared to still be in very good condition and didn’t appear to have been used, some videos were noted to still be in their wrapping. The service encourages regular family and friends contact and supports family involvement. Service users are also encouraged to be part of the local community with activities specifically targeted at local community events and activities. One-service user was noted to maintain regular contact with her friends through the church service she attends each week. The manager said that families and friends are encouraged to join service users for meals and can regularly attend the activities provided by the home, like music evenings. Service users are encouraged to entertain their friends and relatives in the communal areas and/or in their rooms. The facilities provided in service users rooms are very pleasant and provide a comfortable well-furnished space to receive guests. Reminiscence Neighbourhood DS0000066581.V293625.R01.S.doc Version 5.1 Page 18 Service users and their families are regularly involved in the development of personal support plans, they are also involved in all reviews and changes made to these plans. However it was noted in one service users file that a family had not been informed of a medication change. The home benefits from a catering department and a lot of effort is taken to ensure service users dietary needs are taken account of. Service users are offered a choice of meals, including starters, main courses and deserts; all meals are severed with a choice of drinks, which include alcoholic beverages. The meals are well balanced and well presented. Two meal times were observed during the inspection these were noted to be very pleasant social experiences, where service users were supported by staff to enjoy their meal times, staff spent long periods of time encouraging service users to make choices for themselves and were seen to offer service users discreet support where required. Service users seemed to really enjoy their meal times, chatting amongst themselves and laughing. Meals were unhurried and service users were supported to take part in meal times if they wanted by clearing away plates and cutlery. Two staff members spoken to were able to talk knowledgeable about service users diets and were aware of service users special needs in this area. Reminiscence Neighbourhood DS0000066581.V293625.R01.S.doc Version 5.1 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users and their relatives and friends cannot be confident issues relating to complaints are appropriately managed. Service users are not fully protected by staff practices from neglect. EVIDENCE: It was noted that information relating to concerns about service users health and well-being were not always passed onto the manager. It was noted that where relatives had raised concerns about the care of a service user with different members of staff, it was apparent in discussion with the manager she was not always aware of the concerns relatives had raised. Information pertaining to service users health had not always been passed to the manager of the service in an appropriate time scale. The presence of a wellness nurse department had led to some confusion amongst staff. It was noted staff had contacted this department sometimes in medical emergencies in the first instance, which had resulted in untimely delays in medical treatment for service users. Reminiscence Neighbourhood DS0000066581.V293625.R01.S.doc Version 5.1 Page 20 Concerns were such that an immediate requirement was left for the organisation to fully investigate all areas relating to the clinical practices of the Wellness Nurses department where it had been noted that some non actions may have put service users at risk. The current Sunrise policy and procedure in relation to adult protection Procedures in now under review, as it was noted that the advice contained in this policy contradicts the local Social Care and Health agreement on actions to be taken in this event. There were a number of safe guarding referrals made during the fieldwork part of this inspection, it was noted that the manager in this instance took all the appropriate action necessary to safe guard service users and followed the Adult Protection policies appropriately. Reminiscence Neighbourhood DS0000066581.V293625.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users live in a homely, spacious, exceptionally well furnished and decorated home. The failing of the water valve system in the laundry room, puts service users at risk. EVIDENCE: The home is provided on the first floor of a large new build. The building was purpose built and is exceptionally well decorated and furnished. Room sizes all exceed the National Minimum Standards in this area and the service benefits from a maintenance department who have overall responsibility to ensure issues relating to maintenance are well managed. Reminiscence Neighbourhood DS0000066581.V293625.R01.S.doc Version 5.1 Page 22 However it was of serious concern that the hot tap in the service users laundry area, which was openly accessible to all the service users, was found to be extremely hot, well above the recommended safer temperature of 43 o C temperature. It was of a particular concern as one of the service users complained to the inspector that the water was too hot. This was addressed with the manager immediately and remedial action was taken straight away, this room was locked and kept locked until this issue was rectified. The manager said from this incident the checking of the water temperatures had been reviewed and would be undertaken more frequently in light of this issue. The manager said this was a one off incident and the fail-safe installation of the cold water coming on as a second measure didn’t happen in this case. This problem had been taken up with the contractors within 48 hours and measures had been taken to ensure this situation could not happen again. On the day of the inspection the home was found to be clean and tidy. However during the inspection a relative raised concerns about the cat litter tray, this was observed to have been frequently used over the day and it was noted that there was cat urine up the wall. It was concerning that a full cat litter tray was left in easily assessable reach of service users, this presented a serious risk to service users health and well being. This was taken up with the manager and she was asked to remove the tray and complete a risk assessment for having a cat in the building. Relatives also raised concerns that the cat was allowed free movement within the home including service users rooms. One family said their mother particularly disliked the cat regularly sleeping on her pillow. The manager is required to ensure adequate measures are taken in response to all the health risks the cat presents and the cat must be restricted from service users bedrooms at their requests. It is advised that the manager consults with existing service users and their families and any new service users as to whether they would like to share their home with a cat. Reminiscence Neighbourhood DS0000066581.V293625.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users needs are supported by high staffing levels and the skill mix of staff. There have been issues in the service that affect service users safety. Service users are supported by the home’s recruitment policy and practices. There are concerns about staff being trained and competent to do their jobs. EVIDENCE: During the inspection there were four staff on duty, the manager, a lead carer, and three care managers. Relatives of one service user commented “there were always lots of staff on duty to support people” Three staff files were reviewed as part of the inspection, these demonstrated good training. Although it was noted not all staff had received statutory training in some areas like Infection Control, First Aid, Health and Safety and COSHH Reminiscence Neighbourhood DS0000066581.V293625.R01.S.doc Version 5.1 Page 24 Staff are supported to undertake in-house training which results in them being awarded “Star Levels” from level one to five if successful. These cover areas like, induction, basic care, helping people wash, dress brush their hair and oral hygiene. One day on dementia care, a further day on activities and supporting people with dinning and laundry services, there is a four-day programme on medication training including training from the supplying pharmacy. The organisation also provide in depth training for their senior staff in a three day residential course, covering leadership skills. This is training is further supported by regular mini-modules, which are provided by the manager and other co-ordinators like the wellness nurses, these are two hour training sessions for staff in areas like hazards in the kitchen, refocusing people’s attention, the importance of life skills and communicating with people. Staff are also trained in COSHH, Manual Handling, First Aid, Protection of Vulnerable Adults, Fire Safety, Infection Control and Food Hygiene. It was noted that staff training records needed updating to reflect all the training they had received. The manager said this was because they were waiting for some certificates to come through. It is very important for service users health and well-being that where staff are recruited to undertake a more specialist role, that the organisation is satisfied that the person has the relevant experience, skills and training for the role they are to undertake and that they are supervised as part of the staff team. When training is of a good standard it means staff are supported to know everything they need to and staff work in a way that protects service users best interests. Poor training and giving incorrect advice in important areas like health care can lead to situations where service users are potentially and actually put at risk. A family of one-service user commented that they felt new staff were not trained to manage service users with more difficult needs around dementia. They felt staff needed more training in the area of distraction techniques, this means being able to support people to calm down when they are upset or agitated by calmly talking to them or distracting them with other things, like going for a walk or doing an activity. Of the three staff files reviewed during the inspection these all demonstrated robust recruitment practices. Reminiscence Neighbourhood DS0000066581.V293625.R01.S.doc Version 5.1 Page 25 The organisation operates generally good recruitment practices, with staff having to attend three in-depth interviews before they are successfully appointed. It is recommended that staff interview information be kept on individual staff files, to demonstrate the processes that they went through before being successfully employed. This would support the organisation further to demonstrate robust recruitment practices. Reminiscence Neighbourhood DS0000066581.V293625.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. More work is required to ensure the home is run and managed more effectively, where it can be seen service users benefit from the leadership and management of the home. Service users’ financial interests are safeguarded. The health, safety and welfare of service users is not promoted and protected. EVIDENCE: The organisation has several mangers on site who are called coordinators, these are in departments like maintenance, catering, the care home and in the wellness nurse department, the Responsible Individual for the care home is also based on site, he is also the executive director and facilities manager. Reminiscence Neighbourhood DS0000066581.V293625.R01.S.doc Version 5.1 Page 27 To have lots of managers on site can be beneficial to the running of the care home as it means the manager is released from work in areas like health and safety checks and planning meals and they are able to concentrate on managing the care home and the service users needs. However for staff and service users to see and feel the benefits of this it requires excellent communication between departments and lots of joint working. It was noted during the inspection and the fieldwork that there are major issues in this area and communication between departments. This has lead to important information about service users care not being passed on to the correct people and this has led to problems that have affected the health and wellbeing of service users. These have included information about relatives concerns has not always been passed on to the manager by other staff. Medication changes made in conjunction with the wellness nurse and GP were not passed to the manager so changes to how this person was given their medication were not made. Medication changes made by other health professionals were not passed onto concerned family members. Communication had broken down at one point between two departments. Staff are confused as to what the role of the responsible Individual is in the building and it was noted that he got involved in individual service users and staff issues. This had led to real role confusion, where staff and relatives saw the Responsible Individual as the manager of the home. It is important that the organisation provides clear roles and responsibilities to each individual manager/coordinator and they are supported to work in a cohesive way with clear lines of accountability and communication. Good organisation and communication are very important to service users, it means they benefit from a well-managed service where their best interests are supported and protected. Staff also need to be supported by a well-organised management team which will enable them to do their jobs effectively. A well-managed, well-led organisation supports service users and relatives to feel they can have confidence in the care provided. Service users finances are well supported by good policies and procedures and service users benefit from having locked facilities in their rooms to store any money and or precious belongings. The manager said that the service users money is kept in an office safe, which she has access to, so service users can be supported to access their own money when it is required. Reminiscence Neighbourhood DS0000066581.V293625.R01.S.doc Version 5.1 Page 28 It is important service users have access to their money as it supports their independence and dignity enabling them to be as independent as possible whilst ensuring their money is kept safely. Two staff records reviewed indicated that staff receive regular and comprehensive supervisions, this meet fully with the National Minimum standard in this area, and ensures staff are supported to undertake their job role. It was noted that there were supervision agreements in place and any staffing issues with staff’s practices were tackled during supervisions sessions. However all staff who are part of the organisation and deal directly with service users care should be regularly supervised and this includes nurses that form part of the care team. It was noted on one of the staff files reviewed that there was no evidence that this member of staff had not been regularly supervised, from a management or clinical perspective. It is very important staff are regularly supervised so that they are clear about the organisations expectations of them, so that their work can be monitored by an appropriate manager and any issues/problems that may arise in the performance of their duties can be reviewed and the appropriate action taken. As outlined in the main body of the report in the outcome areas of Health and Personal Care and Complaints and Protection there are currently a number of serious concerns around service users health, which has led to concerns around how service users health, safety and well-being is protected and promoted. Reminiscence Neighbourhood DS0000066581.V293625.R01.S.doc Version 5.1 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 3 1 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 1 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 1 17 X 18 1 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 1 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 1 X 1 Reminiscence Neighbourhood DS0000066581.V293625.R01.S.doc Version 5.1 Page 30 Are there any outstanding requirements from the last inspection? N/A STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 5 6 Requirement The registered manager must ensure The Service User Guide and Statement of Purpose are updated to include all cost made to individuals and the qualifications experience of the registered manger and staff. The registered manager must ensure that all service users needs are recorded on their personal plans and detail the care needed in this respect to support them. The registered manager must ensure that personal plans, include all service users needs are up date at least monthly and/or more frequently if required and are completed in conjunction with the service users and/or where this is not possible the service users family/representatives. The registered manager must ensure all service users have access to the immediate appropriate medical support when required. A system must be installed to DS0000066581.V293625.R01.S.doc Timescale for action 03/08/06 2. OP4 12(1) 03/07/06 3. OP7 15 Sch 3 (1)(b) 03/08/06 4. OP8 12 (1)(a)(b) 03/07/06 5. OP9 13(2) 17/07/06 Page 31 Reminiscence Neighbourhood Version 5.1 6. OP9 13(2) 7. OP9 13(2) 8. OP9 13(2) 9. OP10 12(4)(a) 10. OP12 14(1)(a) 11. OP16 17(2) 12. OP18 13(6) 13. OP19 24(4)(5) check all new medication received into the home from new service users. Systems must be installed to check the prescribed medication, dispensed medication and MAR chart received into the home. Appropriate action must be taken when discrepancies are found. All medication must be administered from a container labelled by a pharmacist at the dose prescribed by the doctor. Staff drug audits must be undertaken before and after a drug round to confirm staff competence in medicine management. The installation of further storage cabinets for the safe storage of excess medication is required. The registered manager must ensure staff appropriately support service users at all times. The registered manager must ensure activities offered to service users are recorded and their responses to activities regularly reviewed. The registered manager must ensure that there are clear lines of accountability within the home that ensures they are aware of all complaints and concerns raised. The registered manger must ensure all staff involved in the protection of vulnerable adults are aware of procedures in this area and ensure in cases where service users are put at risk the appropriate action is taken to safe guard services users immediately. The registered manager must DS0000066581.V293625.R01.S.doc 17/07/06 17/07/06 03/08/06 03/08/06 03/08/06 03/08/06 03/08/06 03/07/06 Page 32 Reminiscence Neighbourhood Version 5.1 14. OP26 12(1)(a) 15. OP28 18(1)(a) (c) 16. OP30 12 (1)(a)(b) 9(1)(3) 17. OP31 18. OP33 12(1)(a) 19. OP36 18(2) 20. OP38 12(1)(a) ensure hot water temperatures remain at the safe level of 43 o C, in all water outlets accessible to service users. The registered manager must address the health hazard presented by keeping a cat on the premises. The registered manager must ensure all staff involved in service users health and well being are suitable qualified to offer the correct support, advice and guidance. The registered manager must ensure all staff are fully trained and competent to carry out their duties. The registered manager must ensure there are clear lines of accountability and organisational process between them and the other departments in the organisation. The registered manager must ensure that the service is managed in a way that reflects the best interest of the service users at all times. Closer and direct contacts is required with family members to ensure the manager is fully informed of all and any concerns in relation to the service users. The responsible individual must ensure that all staff who have a direct role in the care and support of service users are appropriately supervised at all times, that a record is kept of all supervision sessions and that they are supervised by an experiences and qualified member of staff. The registered manager must ensure that the health, safety and welfare of service users are protected at all times. DS0000066581.V293625.R01.S.doc 03/07/06 03/08/06 03/08/06 03/08/06 03/08/06 03/08/06 03/07/06 Reminiscence Neighbourhood Version 5.1 Page 33 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 OP9 OP29 Good Practice Recommendations It is recommended all page numbers on the MAR charts must be sequential (e.g. page 1 of 2, 2 of 2) It is recommended that the manager ensure copies of all staff’s interview notes are kept on the individual staff files. Reminiscence Neighbourhood DS0000066581.V293625.R01.S.doc Version 5.1 Page 34 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: 0845 015 0120 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 Reminiscence Neighbourhood DS0000066581.V293625.R01.S.doc Version 5.1 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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