Inspection on 18/10/07 for Rose Martha Care Centre

This inspection was carried out on 18th October 2007.

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

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

Other inspections for this house

Rose Martha Care Centre 03/04/09

Rose Martha Care Centre 02/04/08

Rose Martha Care Centre 23/04/07

Rose Martha Care Centre 27/04/06

Rose Martha Care Centre 18/10/05

Rose Martha Care Centre 24/05/05

Rose Martha Care Centre 05/02/05

Rose Martha Care Centre 05/07/04

Rose Martha Care Centre 10/02/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Rose Martha Care Centre 64 Leigh Road Leigh On Sea Essex SS9 1LF Lead Inspector Michelle Love Unannounced Inspection 18th October 2007 08:30 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 Rose Martha Care Centre DS0000015465.V353672.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. Rose Martha Care Centre DS0000015465.V353672.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rose Martha Care Centre Address 64 Leigh Road Leigh On Sea Essex SS9 1LF 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) 01702 482252 01702 716887 rose.martha@ashbourne.co.uk www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited vacant post Care Home 76 Category(ies) of Dementia - over 65 years of age (76), Old age, registration, with number not falling within any other category (76) of places Rose Martha Care Centre DS0000015465.V353672.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Number of service users for whom personal care is to be provided shall not exceed 76. (Total number not to exceed seventy six). Personal care to be provided to no more than seventy six service users over the age of 65 years. (Total number not to exceed 76). Personal care to be provided to no more than seventy six service users with dementia over the age of 65 years. (Total number not to exceed 76). 23rd April 2007 Date of last inspection Brief Description of the Service: Rose Martha Care Centre is a purpose built establishment situated in Leigh on Sea. The home is close to local amenities and access to local bus and train routes is good. The home provides residential care for up to seventy six older people. The registration category also permits the home to provide care for older people who have dementia. The home also offers `step down`, a scheme whereby arrangements exist with the local hospital where beds are contracted for those patients who are assessed as suitable for residential care. All bedrooms have en-suite facilities for residents. The communal areas consist of two lounge and dining areas on both the ground and first floors. The home also provides a designated smoking area, visitors/hairdressing room and an activities room. Access to the first floor is via a passenger lift. The gardens are well maintained. The home offers parking to the front of the property. Inspection reports are readily available for visitors to the care home and are displayed in the main reception area. Upon request, prospective residents and/or their representatives can have a copy of the last report. A copy of the homes Statement of Purpose and Service Users Guide is also readily available and accessible. The range of fees is £379.00 to £421.00 for a social services bed and £525.00 to £700.00 for a private bed. Rose Martha Care Centre DS0000015465.V353672.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two Regulation Inspectors undertook this unannounced key inspection over a period of approximately 11 hours. This inspection was conducted with assistance from the home’s newly appointed manager. Additionally the home’s Operations Manager was also present throughout the majority of the inspection. As part of the process a number of records relating to residents, care staff and the general running of the home were examined. A partial tour of the premises was undertaken throughout various times of the day. The management of the home completed an Annual Quality Assurance Assessment and information from this document was used to inform the inspection and to contribute to the report. During the visit residents and members of staff were spoken with and their comments are used throughout the report. Following the inspection relative’s surveys were forwarded to seek peoples views. It was positive to note that several were completed and returned to the Commission for Social Care Inspection. Comments from these surveys are documented throughout the main text of the report. Due to the number of regulatory requirements and areas of judgements identified as poor at the home’s first key inspection, this necessitated a further random inspection on 14th August 2007 and a further key inspection so as to examine progress to meet regulatory requirements. Some improvements are noted at this key inspection but these are limited and evidence continues to indicate key areas where the home is not meeting National Minimum Standards or compliance with regulations. A copy of the random inspection report can be made available on request. At this site visit two Immediate Requirement Notices and a subsequent Serious Concern letter were issued in relation to unsafe hot water temperatures, non operational bathing equipment and insufficient numbers of bathing facilities available within the home for the number of residents residing at Rose Martha Care Centre. The provider responded detailing the action to be taken in order to deal with the above issues. What the service does well: Visitors are made to feel welcome and can see their member of family/friend at any reasonable time. In general, comments from visitors were observed to be positive and staff working within the home were noted to have a good relationship with them. Rose Martha Care Centre DS0000015465.V353672.R01.S.doc Version 5.2 Page 6 Some members of staff were able to demonstrate a good rapport with individual residents and knowledge of their basic care needs. What has improved since the last inspection? What they could do better: The home’s Statement of Purpose and Service Users Guide makes little reference to the home being able to cater for those people who have a diagnosis of dementia. Further work is required to ensure that these have specific information about the range of needs that the care home is intended to meet and how those needs will be met. Further work is required to ensure that individual care plans for residents are detailed and comprehensive and include all information relating to residents health, social, emotional and physical care needs. Detailed risk assessments must be devised for all areas of assessed risk. Work is needed to ensure that care staff understand the concept of person centred care and the importance of delivering care in line with people’s individual care needs and the impact that this has if not carried out. The healthcare needs of residents must be monitored more rigorously to ensure that individual’s wellbeing is maintained and their care needs met. Care must be taken to ensure that the needs of those residents who have complex needs are also met. Rose Martha Care Centre DS0000015465.V353672.R01.S.doc Version 5.2 Page 7 The management of the home needs to be more effective so that residents have sufficient staff to care for them. Continued effort must be given to ensure staff have the necessary skills, information and leadership to help them to provide better quality care outcomes for individual residents. Some procedures for the safe management of medication remain outstanding from the random inspection and must be improved upon. A number of serious health and safety issues were highlighted at this inspection and information relating to these areas is documented within the environment section of the report. The management of the home must devise a robust and effective system so as to ensure that residents are not placed at risk and the home environment remains appropriate and safe at all times to meet individual’s needs. 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. Rose Martha Care Centre DS0000015465.V353672.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rose Martha Care Centre DS0000015465.V353672.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst the management has a system in place to ensure that residents are properly assessed prior to admission, information relating to the services offered in the home is limited and could affect informed choice. EVIDENCE: The registered provider has produced a comprehensive Statement of Purpose and Service Users Guide which, provides’ details of the services provided at Rose Martha Court Care Centre. Consideration should be given by the registered provider to review both documents so as this includes information relating to the range of needs the care home is intended to meet and how it specifically provides support to those people with dementia. A copy of both documents, were readily available and located within the home’s main reception area. Rose Martha Care Centre DS0000015465.V353672.R01.S.doc Version 5.2 Page 10 At the random inspection of 14th August 2007, improvements were noted in relation to the management of assessing prospective residents prior to admission. The home does not provide intermediate care. Rose Martha Care Centre DS0000015465.V353672.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Shortfalls in the provision of care at the home means that residents receive a basic standard of care that does not always meet their individual needs. EVIDENCE: A random sample of care plans were examined at this inspection. It was positive to note that the home’s care planning processes have been reviewed and updated. Care records show that further development of the care planning and risk assessment processes is needed. Staff have to ensure that individual resident’s needs are fully recorded, and detail the interventions required so as to ensure the appropriate delivery of care. Care records must be regularly reviewed to reflect individual resident’s changed needs. Particular attention must be afforded to those people who have a diagnosis of dementia and the care plan must include details of how this affects their daily living skills. Rose Martha Care Centre DS0000015465.V353672.R01.S.doc Version 5.2 Page 12 Following the last key inspection the Commission for Social Care Inspection was made aware of concerns relating to the nutritional management of one person. The registered provider investigated the complaint and gave assurances to both the complainant and the Commission that the management of individual’s nutrition would be better managed with appropriate steps taken to monitor action taken by staff and to ensure positive outcomes for residents. It remains disappointing that issues relating to nutrition as stated by the registered provider had not been addressed and this was evidenced within the care records. Records for one person recorded that over a 3-4 month period that they lost 6.20KG. Although nutritional assessments indicated that they were at risk, their assessments and care plans had not been sufficiently reviewed and updated. Care plans recorded that dietician’s had visited residents. Records showed that the advice given had not been followed through and the provision of supplement drinks and food intake monitoring were inconsistent. From discussion and records it is also evident that where residents are taking insufficient diet and fluids, these concerns are not proactively raised with the GP. On the day of the site visit, one inspector observed that one resident’s lunchtime meal was provided for them in their bedroom. The inspector observed that this was left untouched by the resident for a period of 10 minutes and the food had turned cold. When discussed with staff, the resident’s plate was removed with no explanation given to the person and no alternative meal provided. As a result of the shortfalls in resident’s nutritional care an Immediate Requirement Notice was issued. There is evidence that shortfalls relate to several residents and clearly demonstrates a lack of understanding by staff to meet the nutritional needs of older people. Of those care plans inspected there was little evidence to suggest that these had been devised with the resident and/or their representative. From discussion and records it was evident that residents’ care needs in relation to pain control were not always being met. Records showed insufficient monitoring of residents experiencing pain and insufficient use of the medication prescribed for resident use, when required. From discussion, observation and records it was noted that care staff are not reviewing residents who have fallen in the home, after the initial incident. This is leading to residents suffering unnecessary discomfort and pain. One resident expressed unhappiness to the inspector regarding the care that they had received following a fall. The professional visitors record also evidenced that advice was not being followed up by care staff in relation to residents’ mental health needs This Rose Martha Care Centre DS0000015465.V353672.R01.S.doc Version 5.2 Page 13 relates to referrals to community psychiatric nurses. In addition to this, care plans were not in place and risk assessments had not been completed in order to give staff guidance as how to deal with and monitor specific behaviour. Relative surveys recorded mixed comments relating to information sharing about individual residents. For example one survey stated they were always given enough information about their family member, whilst many others stated that they usually or sometimes received information. Some surveys said that it was “dependent on who manages the home. There has been three changes of manager since my relative entered the home-some better than others in keeping me informed of issues”, “the staff are very good, but depending who I speak too, I do not always get full information. My relative is now prone to falls, but the staff have not let me know lately if she has one”, “we believe we are only informed if they gain an injury from a fall” and “they have improved communications recently but more could still be done to improve this. We have been asked if we want to be involved but this hasn’t been followed up yet”. Other surveys recorded comments relating to actual care provided at the care home and these included “provide appropriate care and attention to people irrespective of their infirmity or mental capacity”, “staff interaction with individuals is generally very good”, “generally speaking I am very satisfied with the care given to my relative” and “the staff are very helpful and pleasant to my mother and myself”. One staff survey made comment in relation to the staff member feeling rushed, especially in the mornings. The homes medication records and medicines round, was observed during the day. It was positive to note that medication was administered properly to residents. It was also positive to see medication profiles had been completed for individual residents, however these had been laminated and it was unclear as to how staff would update the information recorded. Some shortfalls were noted and these relate to some residents receiving medication as PRN (as and when required), however this is not being administered in line with the prescriber’s instructions, where the prescription states 1 or 2 tablets to be administered, the actual dose administered was not always recorded and for one person, one of their medications was recorded as being out of stock. On a positive note some residents were observed to administer their own medication. Risk assessments of competency were available for individual residents however these were only reassessed after a period of three months. Following discussion with a CSCI pharmacy inspector, consideration should be made within the care plan to record an agreement between the resident and home as to the frequency of review. Staff also need to be proactive in requesting medical intervention for pain relief after falls and accidents. Rose Martha Care Centre DS0000015465.V353672.R01.S.doc Version 5.2 Page 14 On inspection of the manager’s training plan and in conjunction with the list of staff deemed competent to administer medication, all but two members of staff have undertaken training relating to the above. The training matrix does not provide any evidence that these two staff have attained the above training. Rose Martha Care Centre DS0000015465.V353672.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The activities programme is limited in areas, which means that not all residents have their social care needs met. The meals service is satisfactory but shortfalls in nutritional care, adversely affects outcomes for some residents. EVIDENCE: It was positive to note that since the last key inspection, the number of hours provided to residents for activities has increased from 30 to 60 hours per week. The home employs two activities co-ordinators and both were observed to have a good rapport with individual residents. Residents were noted to respond favourably and residents who commented confirmed that the homes activity programme had improved. A weekly programme of activities was observed to be displayed within the main reception area. The range of activities recorded included trolley shop, knitting, collage and card making, board games, bingo, external trips out, sing-a-longs, DVDs, gentle exercises, flower arranging etc. On the day of the site visit several residents were noted to have lunch at the local Indian Rose Martha Care Centre DS0000015465.V353672.R01.S.doc Version 5.2 Page 16 Restaurant. Residents spoken with confirmed that they enjoyed the experience. The manager must continue to review activities, to ensure that all residents have access to suitable activities that meet their individual needs. Interaction provided to residents by some staff members was observed to be poor with some residents not spoken to by staff. Other interactions were positive and some staff members were observed to speak with individual residents, providing warmth and inclusion. One agency member of staff was observed to provide very good interactions with residents and this resulted in positive responses e.g. smile and co-operation with tasks. The manager operates an open visiting policy whereby visitors are welcome at Rose Martha Care Centre at any reasonable time and this was confirmed by those people spoken with. The home uses a four week rolling menu. The menu for the day was displayed within each of the home’s four dining areas, however some residents when asked, were unable to advise what was on offer for lunch/tea. The manager and registered provider were advised to consider devising a larger/simple print and/or pictorial menu. The menu indicated there were two choices of main course available, savoury mince, mash potato and mixed vegetables or quiche. For desserts residents had the choice of lemon cheesecake or ice cream. Both inspectors observed the lunchtime meal within all four dining rooms. Dining tables were laid with tablecloths and condiments and a choice of drinks were readily available. In general terms the dining experience for the majority of residents, was observed to be appropriate. The inspector noted on the ground floor (Leigh Unit) that residents’ comments relating to food were positive. Actual staff support was seen to be inconsistent with some residents receiving good support whilst with others it appeared rushed as a result of insufficient numbers of staff readily available. One member of staff expressed concern that there was not enough staff always readily available during the lunchtime period. On Beach Unit one resident was observed to struggle to cut their food up and this was not helped as a result of the table being unstable. This dining area was noted to be very hot and some residents were observed to sit within this area wearing sunglasses. Residents spoken with felt the care home provided sufficient quantities of food, however some negative views were expressed in relation to the quality of food provided. Within Hillside Unit (First Floor) lunch was provided promptly for residents, however on Elm Unit the first resident did not receive their lunch until 1.00 p.m. and several residents were noted to have been sat at the dining table for some time. One resident was Rose Martha Care Centre DS0000015465.V353672.R01.S.doc Version 5.2 Page 17 observed to lick/eat the tablecloth whilst waiting for their dinner. Residents were observed to be sitting in the lounge/dining area, with the area left unsupervised by staff and vulnerable residents left unsupported. Whilst we appreciate that residents are not funded for high levels of intervention, the management need to ensure that lounge/dining areas are adequately covered to ensure the safety and wellbeing of residents. The operations manager was overheard to advise the chef/kitchen assistant “don’t forget your seconds”. This refers specifically to residents being offered second helpings of food. Second helpings of food were offered but not consistently and staff did not prompt or remind the chef/kitchen assistant to undertake this task. As a result of concerns already highlighted in relation to poor nutrition/loss of weight for some residents, both kitchen staff and care staff must consider offering additional food portions to people. Breakfast was observed on both Leigh and Elm Unit. Residents commented that they had not received a hot drink since the previous evening and had been waiting an unacceptable length of time in the dining room. Another resident within this dining room was observed to have poured salt into their breakfast bowl and was eating it. The inspector intervened and advised a member of staff as it was felt this may have gone unnoticed if not pointed out. Other residents also expressed concern that one resident always put condiments in their mouth and they did not want to use them. On Elm Unit one resident was observed to have poured sugar in their breakfast bowl and was spooning this into their mouth. Residents appeared somewhat displeased that breakfast was 30 minutes later than usual and that no explanation had been given. Rose Martha Care Centre DS0000015465.V353672.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): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of complaints is satisfactory. Whilst safeguarding procedures are good, training in the area of managing challenging behaviour would improve outcomes further for residents and staff awareness of individuals assessed needs. EVIDENCE: The home has a clear complaints policy and procedure. Staff spoken with were able to demonstrate a basic understanding of the organisations procedures and advised that if they received a complaint they would direct relatives/other parties to information located within the main foyer and/or a senior member of staff. Information cards on how to make a complaint were not readily available from the foyer. The home has not received a high incidence of complaints since the last inspection and of those complaints received, records were available detailing the investigation and actions taken. The manager was advised that outcomes should also be recorded. Records of compliments were readily available and these were seen to be positive. Rose Martha Care Centre DS0000015465.V353672.R01.S.doc Version 5.2 Page 19 Staff, were also able to demonstrate a basic understanding of safeguarding issues and the home were noted to have a copy of local safeguarding policies and procedures. The home’s training matrix indicated 92 of staff had undertaken safeguarding training, however only 33 of staff had undertaken training relating to challenging behaviour. The Commission recognises this as an improvement on previous inspections, however several residents within the home are known to present with challenging behaviour and outcomes for residents are not positive and do not provide the best safeguards for individual residents. Rose Martha Care Centre DS0000015465.V353672.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 24, 25 and 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although some aspects of the home environment are recognised as satisfactory, some health and safety issues were highlighted that do not safeguard residents and could adversely affect outcomes for them. EVIDENCE: A partial tour of the premises was undertaken by one inspector throughout the day. The home was observed to be clean and tidy. The environment is homely, comfortable and reasonably well decorated. On inspection of a random sample of resident’s bedrooms, all were observed to be personalised and individualised with many personal items displayed. Communal areas within the home were seen to be satisfactory in that there were sufficient lounge/dining areas Rose Martha Care Centre DS0000015465.V353672.R01.S.doc Version 5.2 Page 21 available for the number of residents. Since the last inspection 3 bedrooms have been newly decorated and residents were given the choice of colour. Areas of serious concern were highlighted and discussed with the management during feedback. The issues related to, there only being three accessible bathrooms for 66 residents, bath chairs were either not working or providing unsafe manual handling practices and procedures. Some areas of the home were noted to have an insufficient hot water supply and cold and hot water taps within one resident’s bedroom could not be turned on and one bedroom was noted to have no accessible water and staff were transporting hot water in jugs. An Immediate Requirement Notice and Serious Concern Letter were issued in relation to the above. The registered provider must ensure that there are sufficient bathroom facilities available for the numbers of residents residing at the care home, that equipment in the home is in full working order and that risks to residents are minimised. The manager advised that the home has been without a maintenance person for some time and that they only recently recruited to this post. Maintenance records did not indicate that the above issues required attention. Additionally it was noted that the sink used by the hairdresser to wash residents hair could pose a health and safety risk as it is rigid, there are no chairs, which can tilt residents backwards to enable this task to occur safely and there is no neck pad available. No risk assessment has been devised. In addition to the above some items of furniture were observed to have door handles missing and within two bedrooms, curtains were noted to be hanging off their rail. A strong odour of stale urine was noted within 2 residents bedrooms. The manager stated that measures had been undertaken to try and resolve the issue, but this was still proving difficult. Rose Martha Care Centre DS0000015465.V353672.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The level of staffing on occasions restricts the ability of the service to deliver person centred care and to ensure that residents needs, can be met and that they are safe. EVIDENCE: The manager advised the inspector that the home’s staffing levels remain at 2 senior staff and 9 members of care staff between 07.00 a.m. and 15.00 p.m., this reduces to 2 senior staff and 8 members of staff between 14.30 p.m. and 20.30 p.m. and 5 waking members of night staff between 20.30 p.m. and 07.30 a.m. On inspection of four weeks staff rosters, it was evident that staffing levels as detailed above had not always been maintained. The outcome is this has had a detrimental affect on actual care delivery and resident’s wellbeing, as highlighted throughout the main text of the report. On some occasions no regulation 37 notifications had been forwarded to us detailing a reduction in staffing levels and measures undertaken by staff to deploy staff to the care home to meet residents needs. Rose Martha Care Centre DS0000015465.V353672.R01.S.doc Version 5.2 Page 23 The staff roster indicates that some staff had been undertaking long days and/or double shifts on occasions and some staff are working up to 55 hours per week. One relative survey made comment in relation to how the home could improve by stating “possibly with a bit more staff and therefore more time for the inmates”. Other survey comments relating to staffing included “more permanent staff”, “I feel at times there is a shortage of staff, and I would like to think that my relative had regular carers, who they were used to and who knew of their problems, otherwise we feel they are well looked after and seems reasonably content” and “sometimes they appear to be understaffed with staff asked to do longer shifts to cover”. One staff survey made comment in relation to were there enough staff to meet the individual needs of residents by stating “agency staff take time to learn procedures/needs, so one agency staff doesn’t equal one full pair of hands available. This means that the numbers present are not the same as when permanent staff are used”. Another staff survey recorded “carers and seniors are usually rushed”. Another survey recorded “as dependency levels of resident’s goes up so should staff levels. This will enable good practice at all times”. Staff also advised that they often find themselves having to choose between completing paperwork or providing care to residents. One survey recorded “I often find myself choosing between paperwork and clients. Clients always come first. There’s not always realistic workload. Paperwork is often as important as clients themselves and sometimes a choice has to be made. My own work often falls as I’m not able to walk away from clients”. Staff recruitment files were sampled. The majority of records as required by regulation were in place. The manager was advised that although one file contained a POVA 1st notification, there was no evidence to indicate that a Criminal Record Bureau check had been received or that the newly appointed employee was being supervised. No recruitment file was available for the manager, however information relating to their experience and qualifications was readily available. No evidence was available, pertaining to their Criminal Record Bureau check or that they had received an induction to the care home. A record of induction was evident within those recruitment files examined and this was in line with Skills for Care. One staff survey recorded “I was thrown in the deep end, put onto a unit on my first day as carer”. A copy of the homes training plan/training statistics for staff was provided for inspectors. Evidence suggested that 94 of staff have attained fire safety training, 83 of staff have attained training relating to fire drills, 75 of staff have attained training relating to food hygiene, 96 of staff have received training relating to moving and handling and 83 of staff have received training relating to nutrition. It is disappointing to note that only 48 of staff had received training relating to dementia awareness and little evidence to Rose Martha Care Centre DS0000015465.V353672.R01.S.doc Version 5.2 Page 24 suggest that staff had received training relating to those conditions associated with the needs of older people. The Annual Quality Assurance Assessment detailed that 38 of staff had attained an NVQ Level 2 or above qualification. Rose Martha Care Centre DS0000015465.V353672.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Inconsistent and sometime ineffective management of some aspects of the home is adversely affecting outcomes for residents. EVIDENCE: The manager has been employed at the care home since early September 2007. The manager is a Registered General Nurse and other qualifications include, a Certificate in Management Studies (NVQ Level 4) and a A1 National Vocation Assessor Certificate. The manager has extensive experience in working with older people within a residential care setting. The manager is aware of shortfalls highlighted at previous inspections. The manager is committed and keen to erase poor practice and to raise the home’s Rose Martha Care Centre DS0000015465.V353672.R01.S.doc Version 5.2 Page 26 standards. It was evident that the manager is trying to communicate a clear sense of direction and leadership for residents and staff, however the manager recognises that some staff practices and attitudes remain regimented and routine based and it will take time to change. The management team as a whole are not working cohesively and this is having a major impact on the day-to-day running of the home and actual care delivery to residents. The registered provider must provide sufficient support and time to enable the manager to address identified statutory requirements and recommendations. Comments from staff in relation to the management of the home were generally very positive and staff believed matters were improving. Some concern was expressed in relation to confidential issues sometimes being openly discussed and that staff are allegedly deterred from speaking out on occasions. Additionally one staff survey made the following comment “there should be no favouritism shown either to service users or staff” and “support comes as criticism”. Training provision in relation to the needs of older people, needs to be reviewed so as to ensure positive outcomes for those people living at the home. The registered provider has demonstrated an inability to maintain consistent positive outcomes for those residents who reside at the home. This has resulted in the high number of repeat regulatory requirements. We recognise that this is not helped by the changes to the home’s management over the past 18 months, however it is the registered providers responsibility to ensure that the calibre of the manager is foremost and that there is a positive and supportive relationship developed between the management of the home and care staff to ensure that residents receive the most appropriate care that meets their needs. Regular staff supervision is planned for the foreseeable future, however this has only just commenced since the manager’s appointment. A random sample of records as required by regulation pertaining to safe working practices, were inspected at the key inspection of April 07. No issues were highlighted therefore a decision was made not too look at this standard on this occasion. On inspection of the Annual Quality Assurance Assessment, this recorded that a number of certificates relating to maintenance of equipment at the home had been completed this year. This document also states that policies and procedures were readily available and were last reviewed in 2006. Rose Martha Care Centre DS0000015465.V353672.R01.S.doc Version 5.2 Page 27 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 X 1 X X 3 2 2 STAFFING Standard No Score 27 1 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 X X X 2 X X Rose Martha Care Centre DS0000015465.V353672.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4 and 5 Requirement The Statement of Purpose and Service Users Guide needs to be reviewed and updated to reflect the range of needs the care home is intended to meet and how it intends to do this. This refers specifically to the category of dementia so that people have the information they need to make an informed choice. Residents care plans need to be more individual/person centred and include details of the residents care needs and how these are to be met by care staff. Care plans need to be regularly reviewed and reflect changes to the residents care needs and the impact that this has if not carried out. Previous timescale of 7.12.05, 1.7.06, 14.6.07 and 14.10.07 not fully met. Risk assessments need to be devised for all areas of assessed risk so that where possible risks to residents are reduced. Previous timescale of 7.12.05, Rose Martha Care Centre DS0000015465.V353672.R01.S.doc Version 5.2 Page 29 Timescale for action 01/12/07 2. OP7 15(1) 18/10/07 3. OP7 13(4) 18/10/07 4. OP8 12(1)(a) and (b) 6. OP9 13(2) 7. OP9 13(2) 1.7.06, 14.6.07 and 14.10.07 not fully met. Residents’ healthcare needs must be fully addressed. Proper records must be maintained at all time and outcomes/ interventions recorded to reflect how resident’s needs are met. The appropriate arrangements must be made for the recording of medication to ensure the safety of residents. All residents must receive their prescribed medication to ensure that their healthcare needs are met and not adversely affected. Previous timescale of 21.9.07 not fully met. All residents need to receive/have the opportunity to participate within a meaningful activity programme. This refers specifically to those people who have complex needs, dementia, are immobile and who may display challenging behaviour. 18/10/07 18/10/07 18/10/07 8. OP12 16(2)(m) and (n) 01/01/08 9. OP14 12(2) and (3) 17(2), Sch 4(13) 10. OP15 11. OP15 16(2)(i) Previous timescale of 1.1.06, 1.7.06 and 1.7.07 not fully met. There needs to be clear evidence 18/10/07 to demonstrate how residents are enabled and/or empowered to make decisions and choices Records of the food provided for 18/10/07 residents needs to be recorded in sufficient detail to enable any person inspecting the record to determine whether or not the diet is appropriate and meets the resident’s needs. All residents must receive 18/10/07 adequate quantities of food, which is varied and nutritious and meets their dietary requirements and promotes wellbeing. This refers specifically to those people who are at risk DS0000015465.V353672.R01.S.doc Version 5.2 Page 30 Rose Martha Care Centre 12. OP19 13(4)(a) 13. OP19 23(2)(c) 14. OP21 23(2)(j) 15. OP27 18(1)(a) of poor nutrition and/or weight loss. All areas of the home must be free from hazards to residents’ safety and wellbeing. This refers specifically to some wash hand basins emitting hot water at above 43° centigrade and some items of equipment not being safe for residents use and providing poor/unsafe manual handling procedures. All equipment provided at the care home for residents use must be maintained in good working order to ensure residents safety. This refers specifically to three bath chairs, shower equipment and there being an appropriate supply of hot and cold water readily available from residents wash hand basins. There must be sufficient numbers of shower/bathing facilities available for the number and needs of residents residing at the care home so their needs can be met. This refers specifically to only three baths being available for 66 residents. Sufficient numbers of staff must be on duty at all times which meet the numbers and needs of residents. 18/10/07 25/10/07 01/12/07 18/10/07 16. OP29 19 Previous timescale of 14.6.07 and 21.9.07 not met. All records as required by 18/10/07 regulation need to be available and robust recruitment procedures adopted and adhered to at all times so as to protect residents. This refers specifically to a record of the manager’s CRB being available, ensuring that any newly appointed manager to the care home receives an DS0000015465.V353672.R01.S.doc Version 5.2 Page 31 Rose Martha Care Centre induction and where someone is appointed with only a POVA 1st check, there is documented evidence to confirm that they were supervised whilst awaiting their CRB. Previous timescale of 14.6.07 and 21.9.07 not met. Staff working at the care home must receive the appropriate training to the work they perform so as to best meet residents needs. This refers specifically to training relating to those conditions associated with the needs of older people. All staff working at the care home need to receive regular supervision so that they feel supported and able to undertake their job effectively. Previous timescale of 14.8.07 not fully met. 17. OP30 18(1)(c) and(i) 01/01/08 18. OP36 18(2)(a) 18/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard OP14 OP15 OP15 OP16 OP18 Good Practice Recommendations Care staff should interact with residents in an appropriate manner, which ensures that individual resident’s feel valued, included and promotes their sense of wellbeing. Consider devising the home’s menu in large print and/or pictorial. Care staff should make sure that residents receive drinks/meals in a timely manner. The record of complaints should also include specific information relating to outcomes. Staff working at the care home receive training relating to dealing with peoples aggression and/or challenging DS0000015465.V353672.R01.S.doc Version 5.2 Page 32 Rose Martha Care Centre 6. 7. OP26 OP28 behaviour. Any offensive odours within the home should be dealt with satisfactorily. Monitor the number of hours that some staff members work so as to ensure that staff, remain competent and able to do their job and to ensure residents health and wellbeing. Rose Martha Care Centre DS0000015465.V353672.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Colchester Local Office Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Rose Martha Care Centre DS0000015465.V353672.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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