Inspection on 10/09/08 for Scaleford Retirement Home

This inspection was carried out on 10th September 2008.

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

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

Other inspections for this house

Scaleford Retirement Home 17/11/09

Scaleford Retirement Home 03/03/09

Scaleford Retirement Home 14/08/07

Scaleford Retirement Home 02/08/06

Scaleford Retirement Home 02/02/06

Extracts from inspection reports are licensed from CQC, this page was updated on 17/12/2008.

CARE HOMES FOR OLDER PEOPLE Scaleford Retirement Home Lune Road Lancaster Lancashire LA1 5QU Lead Inspector Marian Whittam Unannounced Inspection 10th September 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Scaleford Retirement Home DS0000064565.V371819.R02.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. Scaleford Retirement Home DS0000064565.V371819.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Scaleford Retirement Home Address Lune Road Lancaster Lancashire LA1 5QU 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) 01524 841232 Scaleford Care Home Limited Mrs Lynette Anne Owen Care Home 32 Category(ies) of Dementia - over 65 years of age (32) registration, with number of places Scaleford Retirement Home DS0000064565.V371819.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only. Care home only - code PC, to service users of the following gender:Either. Whose primary care needs on admission to the home are within the following categories: Dementia over 65 years of age - Code DE (E) Up to 3 named service users can be accommodated in the category of OP. The maximum number of service users who can be accommodated is: 32 Date of last inspection 14th August 2007 Brief Description of the Service: Scaleford Residential Home is owned and managed by Mr & Mrs Owen who have over 15 years experience of managing a care home. The home is registered as a limited company. Scaleford is situated in a residential area of the Marsh in Lancaster and overlooks the River Lune. It is close to local amenities. There are three lounges and a dining room, these are used for a variety of purposes and provide residents with a choice of where to sit and who to sit with. Bedrooms are situated on both the ground and first floor and the upper floor can be accessed either by stairs or by a stair lift. All residents have their own General Practitioner who are responsible for medical needs. Those residents requiring nursing input have the services of the District Nurses made available to them and other healthcare professionals as required. The current weekly fees range from £407.50 to £420.00. There are additional charges for hairdressing, dry cleaning, private chiropody, public transport, escorts for appointments, incontinence aids and toiletries. This information and information about the service is available in the service user guide and statement of purpose. Scaleford Retirement Home DS0000064565.V371819.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 stars. This means the people who use this service experience poor quality outcomes. This site visit to Scaleford Retirement Home forms part of a key inspection. It took place on10.09.08 and we (The Commission for Social Care Inspection, CSCI) were in the home for seven and a half hours. The CSCI pharmacist inspector also visited with 2 inspectors on the same day and assessed the handling of medicines through inspection of relevant documents, storage and meeting with the nursing staff and residents. The pharmacy inspection took five and a half hours. Information about the service was gathered in different ways: • Annual Quality Assurance Assessment document completed by the manager identifying what the service does well and what could be improved. This was returned to CSCI before the visit. The service history. Interviews with residents and staff on the day of the visit. Observations made by us in the home during the visit. Also a ‘short observation framework for inspectors’ (SOFI) was carried out. This observational tool is used to observe interaction between residents and staff and gain information and insight into how well people’s needs are being met. Completed questionnaire survey forms from people living in the home and from medical professionals coming into contact with the service. • • • • During the visit we spent time with people living in the home and talking to them about their experiences. We looked at care planning documentation and assessments to ensure the level of care provided met the individual needs of those living in the home. We made a tour of the building to inspect the environmental standards. Staff personnel and training files were examined and a selection of the service’s records required by regulation. What the service does well: The home provides a homely atmosphere and most people living there are able to bring in their own things from home such as pictures, ornaments and suitable items of furniture to make their rooms more homely and personal. Scaleford Retirement Home DS0000064565.V371819.R02.S.doc Version 5.2 Page 6 Activities records showed that a range of activities have been developed, including, weekly visits from the hairdresser, table top skittles, organ music, quizzes, games, music, walks, sing-a-long-a-Geoff musical entertainment, craftwork, use of musical instruments and bingo. People are supported to follow their hobbies and interests. Records indicate that the service has an effective recruitment procedure and security checks to help make sure the home gets the right staff. What has improved since the last inspection? What they could do better: We looked at care plans and found that better recording should take place for personal care and bathing of residents. To promote people’s health the service should always assess the risk of pressure sores, do nutritional screening and keep a record of nutrition. This is to ensure that people have healthy and appropriate diets and that action is taken if needed. People’s psychological health and behaviours were not being assessed and should be recorded and systems in place to effectively monitor behaviours and preventative and restorative care provided. We found that records for receipt, administration and disposal of medicines were not always complete and accurate and must be to protect people from errors that could affect health. Staff must also be suitably trained and competent in the handling of medication so that medicines are administered safely. Staff administering medication using specialised techniques must also have appropriate recorded training from a healthcare professional to protect residents from harm. Scaleford Retirement Home DS0000064565.V371819.R02.S.doc Version 5.2 Page 7 All medication must be administered as prescribed so that people receive safe and effective treatment. Medication must also be kept secure at all times to keep people safe. Regular audits of medication should be done to monitor the management of medicines and help to keep people safe. The service should consider reviewing the effectiveness of its overall audit process as medication errors and mismanagement has occurred and not been discovered and addressed. We also found medication not in its original package. Medication should be administered from the original dispensed container and should not be packed down to prevent errors being made. Care plans relating to medicines such as “when required” medicines should contain clear detail of how they are managed to ensure people receive safe and consistent treatment. To improve social inclusion the manager should work with staff to find ways to improve care planning for social needs and staff interaction with people with more complex communication needs. This will give people more variety in their daily and social lives and improve the quality of interactions. We saw people were not being offered a choice of drinks with their meals and they should be so they can exercise choice in this respect. The service should consider using pictorial formats for menus to promote people’s understanding and choice of food available to them. The manager must ensure that people living in the home are protected from being harmed or suffering abuse by appropriate reporting of incidents, by acting in accordance with written guidance and have plans in place to manage identified behaviours that may affect the welfare and interests of other people living in the home. We also recommend that the service keep separate more detailed records of the investigation of complaints and the actions they take to prevent reoccurrence. This will make the process more transparent and clear. We found that home needed to have more care staff on duty and deployed within the home to ensure that people living there are supervised in communal areas and supported to protect their safety and welfare with regard to individual needs and behaviours at all times. The manager should make sure that all staff have up to date training on safeguarding adults and keep records of this to promote resident’s welfare and safety. As the service states in its information that it provides care for people who are suffering from dementia all care staff should have up to date training on dementia awareness. This will help ensure they all follow best practice and understand the condition and how to support people suffering from it. Scaleford Retirement Home DS0000064565.V371819.R02.S.doc Version 5.2 Page 8 One stair lift has been removed and it is a long walk along a corridor for some people to use the other one. This could have an effect upon people’s independence as they move around the home. The manager should look at ways to support individuals to maintain their independence according to their needs. The service needs to make sure that it does not allow timescales to slip as they complete the improvement work, as this has been required at previous inspections to improve the environment for residents. The service should review its laundry procedures to minimise the risk of cross infection present in their current system. To ensure the health, safety and welfare of residents the manager should make sure that moving and handling training and food hygiene training is up to date for all staff and clearly recorded. 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. Scaleford Retirement Home DS0000064565.V371819.R02.S.doc Version 5.2 Page 9 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 Scaleford Retirement Home DS0000064565.V371819.R02.S.doc Version 5.2 Page 10 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): NMS 1, 3, 4 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. An assessment of people’s needs is done before they come to live in the home to make sure they can be met and information is available to help people make an informed decision about living there. EVIDENCE: The home has a statement of purpose and service user guide that can be provided to anyone thinking of using the service to help them in making a decision about living there. The information it contains is clear and sets out the services aims and objectives. Scaleford Retirement Home DS0000064565.V371819.R02.S.doc Version 5.2 Page 11 It was not on display in the home on the day of the visit but it is kept at the reception desk and is available for anyone who wants it. The latest inspection report is also kept on reception for anyone to see if they want it or when looking around the home. This way prospective residents and their families can have access to information about the service. The manager confirmed that the service can make the information available in different formats if needed to suit individual need but there were no other formats in use. Half of those responding to our survey said they did not feel they had enough information about the service before they came in. Often it is family members who do this on their behalf and they are given the service information. The registered manager confirmed that she or senior care staff visit people to do pre admission assessments so that an informed decision can be taken over whether the home can meet identified needs. The service uses pre admission booklet to record information about people and their needs. In addition the service retains any care management plans provided by social services and works with other healthcare professionals, who provide information about individual needs. Prospective residents and their relatives are able to visit and look around if they want to and spend some time there meeting staff and other residents. This service does not provide intermediate care. Scaleford Retirement Home DS0000064565.V371819.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 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. People living in the home have individual care plans but these are not always accurate reflections of needs and behaviours, which may put people at risk. The records for receipt, administration and disposal of medication are poor and put peoples’ health at risk from errors. EVIDENCE: All residents have an individual care plan, based on initial assessments and risk assessments. We looked at five care plans in detail to assess if people’s need were being assessed, planned for and met. Scaleford Retirement Home DS0000064565.V371819.R02.S.doc Version 5.2 Page 13 Care plans included assessments for moving and handling, falls and basic information on dietary needs. We found from the care plans we looked at that not all people had evidence of pressure area risk assessments and consistent psychological and behavioural monitoring despite recorded issues in these areas for some people. There was no evidence of management plans for identified behavioural problems in the plans we looked at although daily records and our observations confirmed that several people exhibited challenging and unpredictable behaviours. This lack of planning and monitoring of behaviours could put vulnerable people living in the home at risk. When observed behaviours were in the daily records and staff were instructed to “observe” there was no evidence of systematic monitoring, detailed recording and follow up or that protection agencies and specialist professionals had been involved. There were no detailed records of what personal care had been provided to people, such as how they wanted bathing and showering and what people wanted to do for themselves. The manager should make sure records are kept of the personal care people receive and if it is refused. Nutritional screening was lacking in detail, although weights were being done and recorded. We found that the daily care plan report was not completed each day to update information that may need changing in the care plans. In some cases there were gaps of 2 to 3 days with no report from carers. We saw staff administer oral liquid medication from a syringe into a person’s mouth without explaining or speaking to them. This caused the person to cough and become distressed. We discussed this incident with senior staff, as there was no care plan explaining this approach. There was no evidence that covert medication had been discussed with anyone and agreed as a These approaches did not management plan in that person’s best interests. indicate a person and rights centred approach to managing care needs and behaviours. We observed behaviours that could affect the rights and safety of others. There had not been any exploration of issues of consent and information in care plans about individual’s perspectives and understanding and how to manage different behaviours, monitor and report back on them. Information was on occasion contradictory and not a true reflection of what we observed or for example as stated in the services policy on sexual relationships. We discussed with the manager that care plans are working documents and must be updated as needed to reflect the individuals perspective and management strategies for behavioural matters so all staff know what to do to support people and how to record and ensure action is taken to manage behaviours and protect others. Records for receipt, administration and disposal of medication were poor and put peoples’ health at risk from errors. Scaleford Retirement Home DS0000064565.V371819.R02.S.doc Version 5.2 Page 14 Records of administration of medicines were not always signed. Some “when required” medicines were not listed in people records. Staff may not be aware that they are prescribed and people may go without the treatment they need. We checked care plans for people receiving “when required” medication and these did not provide staff with clear instructions on their proper use. This may result in people receiving inappropriate or inconsistent treatment. For example we did not see any care plans for the use of “when required” medication to treat angina and there were no instructions for staff to follow or what to do if treatment did not work. We were told of two people who had recently received different rectal “when required” treatments. These looked very similar but were for two different medical conditions. There were no records to show which medication each person had received or whether they had the correct treatment. On one occasion a carer showed us one of the medications and then put it back in the wrong box that contained a completely different medication. This lack of knowledge and care of medication places people at real risk of receiving the wrong treatment that would be very dangerous. A sample of medicines were counted and compared with records. This showed that some medicines were not administered in the prescribed doses. Some medicines could also not be accounted for. Most medicines were dispensed by the pharmacy into monthly trays. However, on occasions people brought in their medicines in original boxes and bottles. On these occasions staff packed the medicines into weekly cassettes to make it easier to administer. However, insufficient checks were done to make sure that this was safe for both residents and staff. For example, we saw a medicine that was inappropriately packed down and mixed with other tablets and capsules. This medicine had special handling requirements but there were no warnings displayed and staff would be unaware when handling it that extra protection is needed to keep them safe. We watched medicines being administered and were concerned that medicines were not transported about the home in a secure manner. There was no way of ensuring the security of medication and therefore the safety of residents, if an emergency situation arose. The service should consider doing medicines checks more regularly to identify problems and errors so that action can be taken promptly. This should include regular assessments of staff to show that they are, and continue to be, competent and follow good practice at all times when handling medicines. The seriousness of the concerns found at this inspection show that, even though staff had received training in the safe handling of medicines, further training with assessment of competence including the administration of rectal medication is essential in order to protect the health and well-being of the people who live at the home. Scaleford Retirement Home DS0000064565.V371819.R02.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): NMS 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 service provides some opportunities for recreation and supports family and community involvement but a lack of individualised support and assistance means some people may not have routines of daily living and activities that suit their expectations and capacities. EVIDENCE: Activities records showed that a range of activities have been developed and are provided, including, weekly visits from the hairdresser, birthday party celebrations, table top skittles, organ music, quizzes, games, music, walks, sing-a-long-a-Geoff musical entertainment (twice a month), drawing, craftwork, use of musical instruments, bingo and individual attention, when possible. One person showed us how they made cards for their family and friends and told us how much pleasure they got from doing this. Scaleford Retirement Home DS0000064565.V371819.R02.S.doc Version 5.2 Page 16 Examples of people’s painting were on display and one lady was colouring in pictures in the dining room and was happy to show us her work. Another person liked to help out and was able to help staff set the tables for lunch in the dining room. They also liked to polish the tables and were encouraged in these activities that were meaningful to them. The home recently had ‘French day’, with a French menu. There are people living there who are French so they were able to be involved in creating the menus and activities for the day. Individual trips to Sainsbury’s or for tea/shopping have been combined with some people’s hospital appointments. The manager says they usually hire vehicle for summer group outings but there has been none this year as the weather has been so poor. We spent time with people in the lounge and in the dining room at lunchtime and used the Short Observational Framework for Inspection tool (SOFI) to assess staff interaction and people’s involvement. The television was on in the lounge during our observations with most people spending time asleep in the lounge. Two people played dominoes on and off. Staff came into lounge to do care tasks, for example to give medication and take people into dining room. We did not see staff visit to supervise or engage in activity or conversation. Two male residents were grumbling about being bored and having nothing to do. We saw that residents who were chatty and easy for staff to talk to and joke/sing with got most attention. Staff need to be seeking ways to include and interact with people with more complex communication needs. We discussed this with the manager as what we observed suggested to us that the level of supervision, support and assistance in communal areas needed to be improved, especially given the complex behaviours and communication needs of some residents. This will give people more choice and variety in their daily lives, improve social interaction and importantly to make sure behaviours are monitored and other residents kept safe. We talked to some people who were in their bedrooms. One person told us they preferred to stop in their bedroom and watch television there or “read the paper in peace”. They said that, “Staff are busy, you are left pretty much on your own”. With only three members of care staff and the provider on duty with people with a range of complex and challenging needs there was little time for staff to spend on interacting on a social level or supervising. Scaleford Retirement Home DS0000064565.V371819.R02.S.doc Version 5.2 Page 17 We spent time with people in the dining room during lunch. We saw minimal communication and several missed opportunities for some really positive communication with people. We observed the whole lunchtime but did not hear any staff describe what was for dinner, or offer any choices. There was a menu on display and this showed a choice of meals in a written format that some people might have found difficult to understand. The service should consider using pictorial formats to promote people’s understanding and choice of food. People were given either tea or cold juice, without being asked what they wanted to drink, which does not allow for choice. One person told us that they could not have a cooked breakfast and “ I always get the same thing, no one asks if I would like a change”. This does not indicate a focus on the individual and their choices and preferences. We talked with the cook and they showed us the menu and food plan in the kitchen and these catered for special dietary needs. The kitchen was clean and tidy and the cook kept appropriate records. Scaleford Retirement Home DS0000064565.V371819.R02.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, 17 and 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The service has procedures for dealing with complaints that are accessible. Staff lack an understanding of the safeguarding procedures and of how to manage challenging behaviours. This means that the care of some people is inconsistent and this can put vulnerable people at risk. EVIDENCE: The manager keeps a record of any complaints, incidents and events using a system that is part of their ‘ISO 0991’ quality assurance system. The forms for recording the complaint are in the foyer. The service has a complaints procedure that is in a written format and displayed in the hall, it is also in its service user information. The manager logs complaints on their system but it is not easy to monitor the actions taken by the service in response to any complaints or if timescales are being met to address them. We recommend that the service keep separate more detailed records of the investigation of complaints and the actions they take to prevent reoccurrence. This will make the process more transparent and clear. Information requested on complaints was not included in the services annual assessment. Overall survey responses suggested that more people knew how to make a complaint than did not. Scaleford Retirement Home DS0000064565.V371819.R02.S.doc Version 5.2 Page 19 The service has information on advocacy services and contact numbers and keeps this information in reception. The service has a policy statement on responding to and protecting people from abuse and has a copy of the Department of Health guidance, ‘No Secrets’. From records available and speaking with some staff there are a number of staff who have not had training in protecting vulnerable adults (POVA). This should be addressed promptly so all staff are familiar with this and know how to recognise abuse and respond appropriately. The safeguarding procedures needed to make it clear who any safeguarding referral should be made to and the manager attended to this during the visit and updated the procedure. Information from the manager was that 1 referral had been made to social services under safeguarding for investigation by the appropriate agencies. There is also a policy on sexual relationships to protect people’s interests and safety. This states the relationship should be brought to manager’s attention and a risk assessment should be completed on each resident involved. We found no evidence of this in case of 2 residents we saw. We saw a male resident kissing a female resident who was sat in the lounge. Daily records indicated that the man was “ over friendly with female staff and strangers at times, to discourage”. There was no management plan in either care plan for staff on how to manage this behaviour, nor was there any information on the ability of the lady to consent, what discussions or actions had been taken in her best interests. The lady’s care plan said she “ prefers not to sit with men”. We saw there was an evident lack of supervision and support in communal areas, which was a concern given that some residents needed particular support, supervision and assistance due to their behaviours. Daily care records showed there had been incidents of residents hitting other residents. There were no management plans or follow up for this to protect people from such behaviours. We found no evidence of consistent monitoring of behaviours, time and dates and names of people involved in aggressive incidents were not recorded in detail and there were no records of the actions taken when these events were written in daily records. CSCI was not informed of these aggressive incidents that could affect the welfare of people living there. Care plans did not give details on how these different behaviours were managed or how consent is obtained. There were no staff in or near the lounge to observe either of these events and take action during our observations. It was a matter of concern that the manager was not taking prompt action to protect vulnerable people, assessing the risks, managing situations and referring onto the appropriate agencies to follow up. Safeguarding procedures were not being put into practice. Scaleford Retirement Home DS0000064565.V371819.R02.S.doc Version 5.2 Page 20 GP’s and other healthcare professionals confirmed that the home has responded appropriately if they have raised any concerns. Scaleford Retirement Home DS0000064565.V371819.R02.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 19, 20, 22, 24, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The building is being maintained and being updated but the laundry facilities could undermine infection control and the location of the stair lift make some parts of the building less accessible for some people living there. EVIDENCE: The ongoing redecoration and refurbishment of the home is continuing and one of the lounges is being refurbished and new more easily cleanable furniture is being purchased. The service needs to make sure that it does not allow timescales to slip as they complete this work and environmental improvement, as this has been required at previous inspections. When completed this will improve the environment and improve access to the safe garden area for people. Scaleford Retirement Home DS0000064565.V371819.R02.S.doc Version 5.2 Page 22 This lounge is not in use whilst work is being done and residents are using the smaller lounge and reception areas. Windows in the lounge have been replaced and a door put in to allow residents safe access into the enclosed garden. The owners have also purchased new garden furniture for the garden area for people to use. There is a large and light dining room that is attractive and suitably furnished. We saw that residents also used the dining area for doing their drawing and crafts with plenty of space for them to work in. All the bedrooms are single occupancy and some are in the process of being redecorated. The décor in some bedrooms was in need of updating and when the redecoration of bedrooms has been completed the environment will be improved for people and make it more homely. People may bring in some of their own personal items if they wish to help personalise their rooms and we saw that many people had done this. The majority of bedrooms do not have en suite facilities but all rooms have a wash basin for people to use. The stair lift has been removed from one part of the building. There is another one at the other end of the building but this may mean that some people have a longer walk along the corridor to use the other one. This could have an effect upon people’s independence as they move around the home. The manager should look at ways to support individuals to maintain their independence according to their needs. We found that most areas of the home were generally clean and tidy with a slight smell of urine only in the small lounge. Resident’s surveys indicated that the home is “usually” and “sometimes” clean and fresh. The laundry area was however cluttered, untidy and badly organised. One resident told us that there laundry “sometimes” went missing and staff had to search for it. Care staff attend to the laundry as part of their duties and we saw laundry waiting to be done and people passing back wards and forwards through the room. Staff and residents were seen to use it as a thoroughfare as they went to the manager’s office or outside to smoke. There was no ‘flow through’ system in use so that dirty laundry can arrive through one door and be removed to a clean storage area in line with Department of Health infection control guidance. This would help minimise cross infection risks to people. The service should review its laundry procedures to minimise the risk of cross infection in the present system. The service does have infection control policies. The service has taken on a cleaner who works 30 hours over 5 days. This is a large home for one person to keep clean and tidy. They have a cleaning rota and the cleaner records what is done in a cleaning log. They try to thoroughly clean one room a day but their work may be interrupted if they need to attend to ‘accidents’. The 2 night staff also have a cleaning schedule of work. We saw that day care staff were also attending to some general cleaning duties as they went about their work in people’s bedrooms. Scaleford Retirement Home DS0000064565.V371819.R02.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 27, 28, 29 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. At present the level of staffing and the way staff are deployed restricts the ability of the service to deliver person centred support and meet the needs of the people living there and their welfare may be adversely affected. EVIDENCE: We looked at staff rotas and observed the deployment of staff during the visit, the layout of the home, observed staff interactions and spoke with people living in the home. The manager was on the rota and there were two carers, Mr Owen and the ‘floor manager’ on duty during the visit attending to personal care needs, laundry, activities, medications and supervising the residents. There were 2 carers and a senior staff member in the afternoons and staff confirmed this was usual. Staff we talked to confirmed that they had an additional carer when the number of residents was higher than at present. There are 2 waking night staff, who also have some light cleaning duties. There is one cleaner who works five days a week from 9am until 3pm. Scaleford Retirement Home DS0000064565.V371819.R02.S.doc Version 5.2 Page 24 We saw that staff did not spend much time in the communal areas supervising and supporting people but entered to carry out tasks. Surveys suggest staff are generally available when people need them. One person told us, “Staff come but you have to wait a while” but did say that, “the people who work here are alright”. Observations throughout the day showed that there were incidents taking place between residents which staff seemed unaware of. For example, we saw one resident shouting at and slapping another resident whilst they were in the lounge. Given the layout of the home and the recorded and observed information on some resident’s aggression and verbal and physical behaviours there are not enough staff deployed around the home in a way that ensures residents activities are observed and their behaviours monitored. This was a concern as we observed behaviours that may put people at risk going unobserved or unreported. At present the way staff are deployed restricts the ability of the service to deliver person centred support and meet the needs of the people living there and their welfare may be adversely affected. There has been some staff turnover in the last 12 months and we examined the recruitment procedures and records for the new staff. Overall these were satisfactory with staff having references taken and Criminal record Bureau (CRB) checks and Protection of Vulnerable Adults checks (POVA) in place. We discussed training with the manager who says she provides the in-house dementia training, having attended an Alzheimer’s Society training course. We spoke to a staff member who had been working there a year and they had yet to have dementia awareness training. From the records available some staff had attended external dementia training. We saw certificates for 1 person, in 2002 and ½ day in 2006. The training matrix shows 9 people did this ½ day training but does not show the dates they did it, 6 people have not done it yet. The manager says the training is due and will be repeated later this year. As the service states in its information that it provides care for people who are suffering from dementia all care staff should have up to date training on dementia awareness. This will help ensure they follow best practice and understand the condition and how to support people suffering from it. The in house training papers seen were dated 2002. Records show that most staff have had training in handling challenging behaviour. There was no evidence to show that care staff administering medication by specialised techniques had training from a healthcare professional on this and this could result in harm if given incorrectly. Senior staff administering medication using specialised techniques must have appropriate training. Records indicate that a high percentage of care staff have completed NVQ level 2 in care and the ‘floor managers’ have NVQ level 3 qualifications in Care. Scaleford Retirement Home DS0000064565.V371819.R02.S.doc Version 5.2 Page 25 Scaleford Retirement Home DS0000064565.V371819.R02.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 31, 32, 33, 35, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Procedures are in place to safeguard resident’s financial interests and gain people’s views of the service. There is a lack of overall monitoring by management, which could leave people at risk. EVIDENCE: The home has a manager, Mrs Lynette Owen, who is registered with CSCI, has relevant experience working with older people is and has achieved the Registered Manager’s Award. The manager returned the service’s Annual Quality assurance assessment (AQAA) to us but evidence to support the information was minimal and did not give a reliable picture of the service. Scaleford Retirement Home DS0000064565.V371819.R02.S.doc Version 5.2 Page 27 The service has staff meetings and informal monthly residents meetings and these are recorded. The home gives out an annual “customer satisfaction survey” to relatives and advocates to get their feedback on the service. The manager should consider the ways they can feedback any actions they take as a result of views expressed from the surveys and meetings so people can see what effect their views have had on the service. Policies and procedures are being reviewed and updated in the home when needed and this was last done, according to records, in November 2007. The service has achieved compliance with the quality assurance standard ISO 9001 and uses these systems to audit its own systems and monitor their performance against ISO 9001. Their system audits training, administration medication and purchasing as well as security and domestic processes. However the service should review the effectiveness of its audit process as medication errors and mismanagement has occurred and not been discovered and addressed. Records show that servicing and maintenance of equipment is being done, that electrical testing of portable appliances lifts and hoists, and alarms are being serviced, and that periodic electrical testing has been done. Records and talking to staff indicated that formal supervision is being done regularly with staff. To ensure the health, safety and welfare of residents the manager should make sure that moving and handling training and food hygiene training is given to all staff. Records indicate that some night staff need moving and handling training updates and number of staff need food hygiene training. A number of staff need to do infection control training as well and this has been organised for later this month. The home is responsible for small amounts of residents’ monies used to pay for personal items. Records are kept with all receipts held on file and expenditure signed out by two members of staff as a safeguard for the residents. It was a matter of concern to us that the management was not following safeguarding procedures and ensuring the monitoring and management of challenging behaviours. They need to communicate to staff a clear sense of direction and leadership relating to the aims and purpose of the service. Scaleford Retirement Home DS0000064565.V371819.R02.S.doc Version 5.2 Page 28 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 3 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 1 2 3 X 2 X 3 X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 X 3 3 X 2 Scaleford Retirement Home DS0000064565.V371819.R02.S.doc Version 5.2 Page 29 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 OP9 Regulation 13 (2) Requirement Records for receipt, administration and disposal of medicines must be complete and accurate to protect people from errors that could affect health. Staff must be suitably trained and competent in the handling of medication so that medicines are administered safely. All medication must be administered as prescribed so that people receive safe and effective treatment. This was to be done by 14.8.07 Medication must be secure at all times to keep people safe. The manager must ensure that people living in the home are protected from being harmed or suffering abuse by appropriate reporting of incidents, by acting in accordance with written guidance and have plans in place to manage identified behaviours that may affect the welfare and interests of other people living in the home. DS0000064565.V371819.R02.S.doc Timescale for action 18/10/08 2. OP9 18 (1) 18/12/08 3. OP9 13 (2) 18/10/08 4. 5. OP9 OP18 13 (2) 13 (6) 18/10/08 18/10/08 Scaleford Retirement Home Version 5.2 Page 30 6 OP27 18(1) 7. OP30 13 (2) The home must have enough care staff on duty and deployed within the home to ensure that people living there are supervised and supported in communal areas to protect their safety and welfare with regard to individual needs and people’s behaviours at all times. Senior staff administering medication using specialised techniques must have appropriate recorded training from a healthcare professional to do so to protect resident’s from harm. 18/10/08 18/12/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. Refer to Standard OP7 OP8 OP8 OP8 OP9 OP9 Good Practice Recommendations Better recording should take place for personal care and bathing of residents. To promote and ensure people’s heath the service should always assess the risk of pressure sores. Nutritional screening should be undertaken and a record kept of nutrition to make sure people have healthy and appropriate diets and take action if needed. People’s psychological health and behaviours should be recorded and systems in place to effectively monitor and preventative and restorative care provided. Regular audits of medication should be done to monitor the management of medicines and to keep people safe. Medication should be administered from the original dispensed container and should not be packed down to prevent errors being made. Scaleford Retirement Home DS0000064565.V371819.R02.S.doc Version 5.2 Page 31 7. OP9 8. OP12 9. 10. 11. OP14 OP15 OP16 12. 13. OP18 OP19 14. 15 16. OP22 OP26 OP30 17. OP33 Care plans relating to medicines such as “when required” medicines should contain clear detail of how they are managed to ensure people receive safe and consistent treatment. The manager should work with staff to find ways to improve care planning for social needs and staff interaction with people with more complex communication needs so they are able to participate socially and be included in daily. This will give people more variety in their daily and social lives and improve the quality of interactions. People should be offered a choice of drinks with their meals so they can exercise choice in this respect. The service should consider using pictorial formats for menus to promote people’s understanding and choice of food available to them. We recommend that the service keep separate more detailed records of the investigation of complaints and the actions they take to prevent reoccurrence. This will make the process more transparent and clear. The manager should make sure that all staff have up to date training on safeguarding adults and keep records of this to promote resident’s welfare and safety. The service needs to make sure that it does not allow timescales to slip as they complete the improvement work as this has been required at previous inspections to improve the environment for residents The manager should look at ways to support individuals to maintain their independence according to their needs given that one stair lift has been removed. The service should review its present laundry procedures and use of facilities to minimise the risk of cross infection to residents and staff. As the service states in its information that it provides care for people who are suffering from dementia all care staff should have up to date training on dementia awareness. This will help ensure they all follow best practice and understand the condition and how to support people suffering from it. The service should consider reviewing the effectiveness of its audit process as medication errors and mismanagement has occurred and not been discovered and addressed. Scaleford Retirement Home DS0000064565.V371819.R02.S.doc Version 5.2 Page 32 18. OP38 To ensure the health, safety and welfare of residents the manager should make sure that moving and handling training and food hygiene training is given to all staff and clearly recorded. Scaleford Retirement Home DS0000064565.V371819.R02.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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 Scaleford Retirement Home DS0000064565.V371819.R02.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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