Inspection on 14/05/07 for Scarsdale Grange Nursing Home

This inspection was carried out on 14th May 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

Scarsdale Grange Nursing Home 11/02/08

Scarsdale Grange Nursing Home 24/10/07

Scarsdale Grange Nursing Home 14/08/06

Scarsdale Grange Nursing Home 10/04/06

Scarsdale Grange Nursing Home 17/01/06

Scarsdale Grange Nursing Home 17/05/05

Scarsdale Grange Nursing Home 08/12/04

Scarsdale Grange Nursing Home 06/04/04

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Snydale Care Home

Hawkhills

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

CARE HOMES FOR OLDER PEOPLE Scarsdale Grange Nursing Home 139 Derbyshire Lane Sheffield South Yorkshire S8 5EQ Lead Inspector Ms Shelagh Murphy Key Unannounced Inspection 14th May 2007 09:40 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 DS0000021804.V333293.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. DS0000021804.V333293.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Scarsdale Grange Nursing Home Address 139 Derbyshire Lane Sheffield South Yorkshire S8 5EQ 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) 0114 258 0828 0114 258 0828 scarsdalegrange@onetel.com None. Mr John Martin Foster Mrs Elaine Pearl Adams Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places DS0000021804.V333293.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Three service users aged 60 years and over may be accommodated at the home. 14th August 2006 Date of last inspection Brief Description of the Service: Scarsdale Grange is a purpose built home, providing care for up to 40 older people, some of who require nursing care. The home is in a residential area of Sheffield, with good access to public services and amenities, such as public transport, shops and public houses. The home has two floors, accessed by a passenger lift. Each floor has communal lounge, dining rooms and bathing facilities. All of the bedrooms are single, each with en-suite toilet facilities. The home has gardens and a car park. Information about how to raise any issues of concern or make a complaint was on display in the entrance hall. The range of monthly fees from 10th April 2006 were £410.00 - £475.00 per week. Additional charges included newspapers, hairdressing and private chiropody. Further detailed information about fees is available form the home. DS0000021804.V333293.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Shelagh Murphy and Mike O’Neil carried out this inspection. This visit was unannounced; it took place between 9:40 am and 3:00 pm. This was a key inspection and the inspectors checked all the key standards for which, records/ information was available. The inspectors sought the views of six people who live at the home, four relatives, two qualified nurses, a care worker and a domestic worker. Elaine Adams, the registered manager was on long-term sick leave. The qualified nurses in charge of each floor assisted with the inspection. Mr and Mrs Foster, the owners were present for a short time during the visit. During the visit the inspectors looked at the environment, and made observations on the staffs’ interactions with and attitudes towards people. We checked samples of documents that related to peoples’ care and safety. These included three needs assessments and care plans and medication records. Numerous other records were not available for inspection as the manager and administrator were not at work and therefore staff did not have access to the records. The owners did not know where some of the records were stored, and were unable to assist in producing the information. The inspectors checked other information before visiting the home. This included the pre-inspection questionnaire, which the Commission for Social Care Inspection (CSCI) had requested. We also used evidence from the last random inspection. Two people who live at the home and four staff returned surveys about what they thought of the service. The random inspection visit took place on 28th February 2007; numerous requirements were made at this time to improve the care standards. The inspector would like to thank the people who live at the home, relatives and staff for their welcome, help and contribution to this inspection. What the service does well: People who live at the home had their needs assessed. People had care plans and the staff had signed to say they had reviewed these. DS0000021804.V333293.R01.S.doc Version 5.2 Page 6 People were very happy with the way staff treated them. This is what people said about the staff; “They are lovely, very kind”, “I get very well looked after”, “The staff are very nice, there are enough staff on duty to help me” A relative said, “Staff are good, they treat my father very well” of one staff in particular they said “Nothing is too much trouble for them”. Most people received health care and personal care based on their individually assessed needs. Risk assessments and medication practices were sufficient to meet people’s needs. Overall, people found the lifestyle at the home matched their expectations and preferences. People were generally satisfied with the amount of activities at the home. People were supported to maintain relationships with family and friends as appropriate and visitors were made welcome. People liked their meals. People could express their concerns and feel that staff would listen to them. People who live at the home are satisfied with their environment. . They said they felt the home was clean and the furniture was comfortable. People said they found it easy to speak to staff and felt they could raise a concern and staff would listen and take action. What has improved since the last inspection? The statement of purpose had been reviewed and updated. This ensured that people knew which services the home could offer. People had their needs reviewed and this included nurses assessing the risks associated with pressure care. This is good practice and potentially prevents people from developing pressure sores. The home had a safe system to store, administer and record medication. These systems protect people. Hazardous substances were being stored securely, to ensure people’s safety. Peoples wishes regarding death and dying had been recorded in their care plans to ensure their wishes can be followed. DS0000021804.V333293.R01.S.doc Version 5.2 Page 7 What they could do better: At present people are living in a home where the staff offer them good standards of care but this is despite the fact that the service is not well organised or managed at the present time. A requirement for the home to apply for a variation to their certificate to enable them offer care to people with Dementia has been made at the last two inspections and has not been complied with. Some people’s needs assessments showed that they should not have been admitted to the service, as the home is not registered to care for people with Dementia. In relation to the way staff treated people some bad practices were observed, which did not protect peoples dignity, e.g. people were fed and moved away from the dining tables without staff talking to them. Some people could have better care plans that reflect their present needs better. The mealtimes needed to be better organised to meet people’s needs and maintain their dignity. The first floor needs to be better staffed at mealtimes to meet people’s higher dependency levels. People said they felt that the laundry service was generally good but that the ironing of clothing was poor. Staff need to make sure people in wheelchairs are safe by making sure they have footplates attached to wheelchairs when moving people. Some people need better access to social activities and visits to the local community. One complainant felt they had not been dealt with in accordance with the complaints procedure. This meant that the complainant was frustrated with the process and had led to them taking independent legal advise. Adult protection Procedures and some training records were not available for inspection. Because these records could not be checked it was unclear whether the service has good procedures for safeguarding people. Staff training records, could not be checked as they were not available for inspection as the owner could not find them. This was due to a lack of organisation and management of records in the home. This does not promote peoples safety. Fire safety practices were seen which could place people at risk. DS0000021804.V333293.R01.S.doc Version 5.2 Page 8 Some décor, furnishings and flooring do not promote good standards of cleanliness and some areas of the home need redecoration or repair, to ensure people are living in a clean and homely environment. Staff need up to date training to make sure people are offered safe support and consistent care practices. Some of the homes working practices, policies and quality assurance practices do not protect and promote people’s safety and welfare. This was due to poor management systems and a lack of leadership at the home. The home can improve how it monitors the quality of care to people by having a development plan and making a monthly report on the homes progress to meet this plan. 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. DS0000021804.V333293.R01.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 DS0000021804.V333293.R01.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): Standards 1 and 3. The home had no referrals for intermediate care. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given information about the home in the form of a statement of purpose before they decide whether to live at the home. People who live at the home have their needs assessed. Some people’s needs assessments showed that they should not have been admitted to the service, as the home is not registered to care for people with Dementia. EVIDENCE: The homes statement of purpose had been updated since the last key inspection. The staff said this information is given to people or their representatives before they decide whether to live at the home. People had local authority needs assessments. The nurses said that they or the manager checked these before deciding if Scarsdale Grange could offer them a placement. There was evidence that the homes manager also carried out DS0000021804.V333293.R01.S.doc Version 5.2 Page 11 assessments before offering people a place at the home. This was good practice, however, the homes assessment tool was basic. The home could improve this to help them get better information about peoples lives, their aspirations and their care needs. Two people said they were satisfied that staff understood and could meet their needs. One relative confirmed that the manager checked information about their relatives needs before they came to live at the home. Three peoples needs assessments were checked. Two of the needs assessments were good and showed how peoples needs should be met at the home. However, one persons assessment showed that the person’s primary need was Dementia care and it was not clear why the home thought they could meet this persons needs at this service. Therefore, this person had been admitted out of category, which is a breach of the regulations/legislation. Scarsdale Grange is only registered to care for older people and the staff had not completed training on the care of people with Dementia. This could place the person at risk, as their needs may not be fully understood by the staff. A requirement for the home to apply for a variation to their certificate to enable them offer care to people with Dementia has been made at the last two inspections and has not been complied with. DS0000021804.V333293.R01.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): Standards 7, 8, 9 and 10. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were generally happy with the way staff treated them. However, some bad practices were observed by the inspectors, which did not protect people’s dignity. Most people received health care and personal care based on their individually assessed needs. However, the care plans did not fully reflect all of the present needs of people, which, could place them at risk. Risk assessments and medication practices were satisfactory to meet people’s needs. EVIDENCE: Two people surveyed said they always received the care and support they needed. Other people spoken to said that they were happy with their health care and that staff treated them with dignity and respect. One person said, “its o.k. here, the staff are really kind and look after me”. Someone else said, “the staff are caring” and … “the care is good”. DS0000021804.V333293.R01.S.doc Version 5.2 Page 13 Another person said, “Staff are nice, I’m o.k. here, the staff treat us well”, they treat me with respect especially when you’re getting changed”. A third person said “the staff treat me with courtesy”. One relative said they were “satisfied with the care”, received by their father. “The staff are respectful and helpful”, they went on to name one carer as “special” and “extremely good”. Another relative said she was satisfied with her Mothers care and felt her physical health had improved since she moved in to the home. The quality of the care plans varied. The content of some people’s care plans had improved. They showed that needs assessments had been incorporated in to the plans. There was generally adequate information within them for staff to know how to meet an individuals needs. There was evidence of people’s involvement in drawing up their plans and on occasions that their relatives had been involved. Other good practice examples included the fact that care plans had been formulated as a matter of course, if for example any person had a problem with their skin, which may lead to a pressure sore. This is good practice and showed that the nurses had responded to the inspector’s comments from the last inspection in order to improve the care offered to people. The nurses had reviewed the plans on a regular basis, however, the adequacy of these reviews were called in to question as there was very little evidence that the care plans had ever been adapted after a review. This was highlighted in the case of a service user whose care plan, which, had been reviewed less than three weeks ago stated they did not need support to feed themselves. This person was then observed to need full support to be fed by a carer. The nurses completed a daily record about each persons care and this included information about visiting professionals, for example visiting health professionals. This was good practice and helped the staff monitor people’s conditions. People had basic risk assessments that included restraints for example bed sides or lap belts, for falls and for pressure care. Two peoples risk assessments were checked and contained adequate information for staff to safeguard people. Two people at the home and two relatives confirmed the home made sure there was access to health services. Both people who completed service users surveys said they received the medical support they needed. People were observed to be dressed in clean clothing and had received support to maintain good standards of personal care, this had improved since the last DS0000021804.V333293.R01.S.doc Version 5.2 Page 14 inspection, however, some ladies were observed not to be wearing tights or socks and when the staff were asked why not, we were told they did not have any. This practice did not promote those people’s dignity. The inspectors both spent time observing care practices. Most of the staff spoke to people in a dignified manner; the staff were positive and professional in their approach. They appeared to have friendly relationships with people. Some bad practices were observed which did not protect people’s safety or dignity and these were reported to the nurses in charge. For example people were seen wheeled around in wheelchairs without footplates and this could injure people. A carer placed an apron on a person and began to feed them without speaking to them or asking their permission to do this. This was not respectful of the person. An issue several people mentioned but did not really wish to make a formal complaint about, was the fact that clothes were not ironed properly at the home. This was an issue raised by four separate people or their relatives and if addressed would show the homes willingness to address people’s concerns to improve standards within the service. The inspector checked a medication round. Medication was stored appropriately. The nurse followed good practices, this included providing drinks with tablets, talking to and encouraging people to take their medicines. The medication record sheets showed that medication had been recorded as administered appropriately to protect people. DS0000021804.V333293.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall, people said the lifestyle at the home matched their expectations and preferences. People were generally satisfied with the amount of activities at the home. However, there were no records to show what activities were planned for people on a regular basis. People were supported to maintain relationships with family and friends as appropriate and visitors were made welcome. People liked their meals, however, the mealtimes needed to be better organised to meet people’s needs and maintain their dignity. EVIDENCE: All of the people asked said there were activities provided by the home. On the day of the visit some people were baking and cooking. One person said that an entertainer had been at the home the week before. Another person said that Bingo was sometimes organised by the activities co-ordinator, but this was not regular. Staff said there was no recorded evidence to show to the inspectors that regular planned activities had been taking placed or that this information had been given to the people who lived at the home. This may be something the home could do to ensure people know of the activities available to them. DS0000021804.V333293.R01.S.doc Version 5.2 Page 16 Two relatives confirmed the staff were welcoming and they could visit at any reasonable time. Numerous relatives were observed visiting people at the home. Two people who replied to the survey said the home “always” arranged activities, one person said, “I join in what I can do. Sometimes I can’t do because of my sight”. People at the home, staff and relatives confirmed that people did not get much opportunity to go out for short walks, to the pub, on a trip to the countryside or even to the local shops. This would greatly enhance some people’s experience of care in the home if they could have these opportunities. One person said they needed support to go for a cigarette outside and that staff were too busy to take them out in the mornings. They said they waited for their relatives to visit in the evenings. However, they did not wish to make a fuss about this as the staff were “lovely”, this did not offer this person choice and control over their lifestyle. Generally people said they were satisfied with their meals. One person said, “The food is very good” and another said, “the food is o.k. I quite like it, it’s better than hospital food”. One relative said, “my father is well looked after and well fed.” The menus checked showed that nutritious and varied meals were offered to people including cooked breakfasts, two choices of main courses at meal times as well as desserts and sandwiches. The inspectors observed a breakfast time and lunchtime on both floors. There was some very good staff practices observed and most staff treated people with dignity and were kind. Some staff asked people their preferences, offered people help and all of these acts showed staff respected people. However, upstairs, staff said the breakfast had started around 8:30 am and was observed to finished at 11:05 am. This was because of the numbers of staff on duty to meet the high dependency levels of the people who needed one to one support from staff to be fed. The breakfast did not appear to have been well organised. The tables had cloths on, but there were no condiments, people were observed to be eating toast without plates. Out of 13 people eating breakfast in the dining room 11 people were in wheelchairs. The nurse said this was usual practice but it meant that people could not choose if they wanted to remain in their wheelchairs or transfer to a dining chair at mealtimes. This did not promote choice and it also meant that the dining room was very crowded. DS0000021804.V333293.R01.S.doc Version 5.2 Page 17 Some people were observed to be trying to feed themselves and needing staff support. These practices did not protect people’s dignity. There were three carers and a nurse available to support people. It appeared that there are not enough staff to offer the appropriate levels of support to all of the people who needed it. Upstairs Lunch was then served at 12:15 pm (only one hour later than breakfast had finished) and was not completed until 2:00 pm. This was again due to the lack of staff to support the number of people who needed to be fed at the same time. People upstairs needed far more staff support to feed than the people who lived downstairs. However, there were two more staff helping out downstairs than upstairs. The organisation of this had not been managed appropriately to meet the needs of individual people. This is a management issue, which needs to be addressed to ensure people receive appropriate levels of support at meal times to eat their meals with dignity. Other poor practices observed during the mealtimes included; • • • One person was observed to be put an apron on and fed without the carer speaking to them. Other people were observed to be moved away from the tables in their wheelchairs without staff speaking to them. Some people have to sit in the dining area for a long time before staff can feed them their meals. One person waited over 40 minutes for their lunch to be served to them. These practices did not treat people with dignity. Some people had their meals in their own room because they preferred it. DS0000021804.V333293.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18. People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can express their concerns informally and feel that staff would listen to them. However, one complainant who had used the complaints procedure was not satisfied of the time taken to address the issues, as this did not meet the homes timescales as laid out in the complaints procedure. Adult protection procedures and some records were not available for inspection due to poor record keeping and lack of organisation of records and management of the unit. This did not promote peoples safety. EVIDENCE: Most people said they could raise concerns and complaints and that staff would listen, one person said, “The staff listen to me, I would speak to the nurses if I wasn’t happy”. The homes complaint procedure is available for people to see in the entrance hall. One complaint is still not resolved and appears not to have been addressed within the timescales, laid out in the homes complaints procedure, therefore it has passed on to a legal representative and therefore cannot be commented on until an outcome is found. DS0000021804.V333293.R01.S.doc Version 5.2 Page 19 The owner confirmed they had not had any adult protection referrals at the home, since the last inspection. None of the staff spoken to or surveyed said they had completed adult protection training over the last year. Staff training records, could not be checked to confirm this as they were not available for inspection as the owner could not find them. The adult protection procedure was also not available for inspection as it could not be located. This situation is entirely unsatisfactory and is indicative of poor organisation and management within the home. DS0000021804.V333293.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home are satisfied with their environment. Some décor, furnishings and flooring did not promote good standards of cleanliness or homeliness. Fire safety practices were observed, which could place people at risk. EVIDENCE: People said they were happy with their environment. They said they had comfortable furniture and were happy with their bedrooms. People said they were satisfied with the cleanliness of the home. One person said “I am happy with my room, I have everything that I need”. Another person said, “my bedroom is lovely”. DS0000021804.V333293.R01.S.doc Version 5.2 Page 21 One relative confirmed they always found the home clean and their family members bed was always clean. Several people said the laundering of clothes was OK but the clothes could be ironed better. The inspector checked a sample of rooms. Most rooms were clean and homely, people had personalised bedrooms and most bathrooms were clean. Some rooms needed redecoration, for example walls in the toilets and lounges were dirty and scuffed. In bedrooms and bathrooms there were dirty skirting boards, paint was chipped, aged or stained. The flooring in several toilets and bathrooms were badly stained and needed cleaning or replacing. This did not promote the good standards of hygiene. In the bathrooms there are walk in showers without any curtains around them, there were obscured windows but these did not have any blinds or curtains on them. This did not protect people’s dignity. In the upstairs lounge the walls were bare, the room needed cleaning, as there was food debris on the coffee tables/floor. There were no pictures or ornaments in the room. It looked really bare and many of the chairs were damaged and stained. This did not provide a homely environment for people. Fire doors were observed to be wedged open with carpet tiles in both the ground floor dining and lounge areas. This practice can place people at risk. The staff removed these immediately. DS0000021804.V333293.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): Standard 27. Standards 28, 29 and 30 could not be checked, as the owners did not make the records available for inspection. People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Because the registered manager and the administrator were not at work and the owner could not find the relevant records the following standards could not be checked: Standard 28 – qualifications, Standard 29 – recruitment and Standard 30 –staff training. This situation is entirely unsatisfactory and is indicative of poor organisation and management within the home. Most people, who live at the home, and their relatives, are satisfied with the home’s staff. However, the homes staffing availability, recruitment and training procedures and practices do not protect and promote peoples welfare. EVIDENCE: This is what people said about the staff, “They are lovely, very kind”, “ I get very well looked after”, by the staff. “The staff are very nice, there are enough staff on duty to help me” DS0000021804.V333293.R01.S.doc Version 5.2 Page 23 “ There are not enough staff on today, they are rushed off their feet, there are three staff on duty and there should be four staff, it’s been like this for about three weeks” A relative said, “Staff are good, they treat my father very well” Of one staff in particular they said “Nothing is too much trouble for them”. Two people in the surveys said staff are “always” available. Overall, most people said they were happy with the staffing levels. The staffing levels met the minimum agreed with the registering authority. However, it was how the staff had been deployed that was causing the problems. The inspectors noted that although all staff were generally focussed on people’s care and support needs, upstairs the staff were much busier than downstairs and this was reflected in the standards of care practices, e.g. at meal times. One staff said, “we’re always busy up here”. The inspectors felt that numbers of staff on each floor were not reflecting the dependency levels of the people on those floors. There should have been more staff working on the top floor. However, because there was no one person in charge of the home then the nurses had worked independently to manage their units. People who lived at the home, relatives, staff and the manager all agreed that staff did not have much time to support people to go out of the home on leisure and social activities (see information in Daily Life and Social activities) this impacts on the quality of peoples lives and the home needs to look carefully at how it can release staff time to improve social outings and opportunities. DS0000021804.V333293.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 32, 33, 35, 36, 37 and 38. People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. At present people are living in a home where the staff offer them adequate standards of care but this is despite the fact that the service is not well organised or managed at the present time. There appears to be very little leadership of the home and this does not benefit people. People’s finances were kept secure but the account for one person did not tally. Overall, the record keeping procedures were extremely poor; many records were not available for inspection. Some of the homes safe working practice policies and quality assurance practices do not protect and promote people’s safety and welfare. DS0000021804.V333293.R01.S.doc Version 5.2 Page 25 EVIDENCE: The home had met some of the previous requirements made at the random inspection. However, this was solely due to the dedication of the nurses, carers and other staff carers who work in the home. The nurses, carers and ancillary staff have worked really hard to improve the quality of care at the home for people. Example of this were the nurses had implemented some new care plans to improve the care of people for example for those at risk from pressure sores. People were no longer all sat in one lounge all crowded together, two lounges were used and this provided a much better environment for people. Several people looked better than on the last random inspection and a relative confirmed one person’s health had greatly improved. The registered manager was absent due to long-term sickness at the time of our visit and had been off for over five weeks. However, the owners had not informed the Commission for Social Care Inspection of the manager’s absence, as is required by the regulations after 7 days. No one had been put in post to manage the home in her absence. A requirement to address this issue within a short timescale has been made within this report. The owners had carried out provider visit reports and submitted them to the Commission for Social Care Inspection since the last inspection. However, they did not reflect the findings of the inspectors and showed that all was well at the home, therefore the relevance and accuracy of the reports could not be relied upon. The owner said she was calling in to the home on a regular basis but had not replaced the manager. However, an acting manager is what this home needs to ensure the staff have clear leadership and that the home is managed appropriately to meet peoples needs. The owner confirmed the home had a system for handling people’s money and valuables and where possible they encouraged people’s family to manage their relatives’ finances if the people were unable to do it themselves. Three peoples monies, which, were kept in a safe at the home were checked, two of these totals tallied with finance sheets one had £5.00 too much in the moneybag. This indicated that the arrangements were not working properly, this failed to safeguard people’s finances. Staff supervision records were not available for inspection but staff told us they had not received formal supervision for some time. One member of staff said she had concerns as some domestic staff had left the home on several occasions before the end of their shift and this had been reported to the manager but no action was taken. They went on to say the home was not being managed well and that there were rumours that the home was to be sold DS0000021804.V333293.R01.S.doc Version 5.2 Page 26 but that the staff had not been told any of this information. Other staff confirmed staff members concerns about lack of leadership from the manager. The inspectors noted that on three occasions staff pushed people in their wheelchairs without footplates attached. This was pointed out to staff at the time of the visit and remedial action was taken. This is a dangerous practice as it can cause injury to the person. Two fire doors were seen wedged open by carpet tiles, this was brought to the attention of the nurse in charge and they were then removed. This practice could place people at risk. The inspectors asked to see records of fire safety checks and drills. Some fire records were given to us but these did not contain relevant information. We did find some health and safety risk assessments in the manager’s office; however, these were out of date and did not reflect the present circumstances in the home. This practice prevents the home from minimising possible risks to people, staff and visitors at the home. DS0000021804.V333293.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 3 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 1 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 2 X 2 1 1 1 DS0000021804.V333293.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 OP3 Regulation Care Standards Act Section 24 Requirement Timescale for action 30/06/07 2 OP3 3 OP7 OP8 No service user must be admitted to the home that is ‘out of category’, as the staff have not been trained to meet the person’s needs. (Previous timescale of 14/08/06 and 31/03/07 not met) At the expiry of this timescale the registered provider must write in to the local CSCI office and confirm what action has been taken. The The home must apply for a Care variation to their registration, in Standards order to continue to care for the Act people with specialised needs. Section 24 (Previous timescale of 01/09/06 and 31/03/07 not met) At the expiry of this timescale the registered provider must write in to the local CSCI office and confirm what action has been taken. 15 (2) (b) Information within all care plans must be reviewed and updated. The plans must reflect each person’s current personal care, health and social care needs. (Previous timescale of DS0000021804.V333293.R01.S.doc 30/06/07 14/06/07 Version 5.2 Page 29 4 OP10 12 (4) (a) 5 OP12 16 (2) (n) 6 OP13 16 (2) (n) 7 OP14 12 (3) 8 OP15 18 (1) (a) 9 OP16 22 (3) 22(4) 10 OP18 13 (6) 01.08.06, 01/10/06 and 31/03/07 not met). At the expiry of this timescale the registered provider must write in to the local CSCI office and confirm what action has been taken. Staff must be instructed that people must be treated with respect and their dignity must be protected at all times, therefore staff must ask permission from people before they feed or move people. Routines of daily life and activities must promote choice for people therefore people must be offered the opportunity to take part in regular activities of their choosing. People must be offered opportunities to maintain contact with or go in to the local community if they so wish. Peoples preferences and wishes must be taken in to consideration, therefore if someone needs support to exit the home to have a cigarette each morning this must be facilitated by staff to meet the persons needs. Staff must be better deployed at meal times to meet the individual’s needs to eat their meal in a congenial setting at a flexible time of their choosing. The homes complaints procedures and timescales must be kept to or an explanation for a delay must be forwarded to the complainant to explain the delay. People at the home must be safeguarded from abuse: Therefore, • The local “Safeguarding people”, procedure must be made available for staff DS0000021804.V333293.R01.S.doc 14/06/07 14/06/07 30/06/07 30/06/07 14/06/07 30/06/07 30/06/07 Version 5.2 Page 30 11 OP19 OP26 16 (2) (c) 23 (2) (b) 12 OP19 OP26 16 (2) (c) 23 (2) (b) 13 OP26 16 (2) (f) at all times. The homes adult protection policy and procedures must be made available for staff at all times. • All staff must be trained in adult protection. • Safeguarding policy, procedures and staff training records of this, must be made available for inspection. All areas of the home must be 31/07/07 well maintained therefore: • Communal areas must be checked and action taken to ensure the home is well decorated and homely. • All areas of the home must be kept clean. 31/07/07 All areas of the home must be well maintained therefore: • Bathroom floors must be thoroughly cleaned or replaced. (Previous timescale of 01/08/05, 1/12/06 and 31/03/07 not met). • Curtains/blinds must be fitted to all bathroom windows. Bathrooms must not be used for storage. (Previous timescale of 01/08/05, 1/12/06 and 31/03/07 not met). At the expiry of these timescale the registered provider must write in to the local CSCI office and confirm what action has been taken. • Shower curtains must be supplied to all shower areas to protect people’s dignity. People’s clothes must be 30/06/07 laundered and ironed to a satisfactory standard to ensure peoples dignity. • DS0000021804.V333293.R01.S.doc Version 5.2 Page 31 14 OP27 18 (1) (a) 15 OP28 18 (1) (c) (i) 16 OP29 19 (1) (b) (i) 17 OP30 18 (1) (c) (i) 18 OP31 9 (2) (i) 19 OP32 38 (2) Staffing levels must be reviewed to ensure the higher dependency levels of people needs that live upstairs can be met. 50 of the care staff must be trained to NVQ level 2 in care. (Previous timescale of 01/08/05 and 01/12/06 and 31/03/07 not met). At the expiry of this timescale the registered provider must write in to the local CSCI office and confirm what action has been taken. All staff employed at the home must undertake a CRB check at the correct level. (Previous timescale of 01/10/06 and 31.3.07 not met). At the expiry of this timescale the registered provider must write in to the local CSCI office and confirm what action has been taken. Staff recruitment files must be made available for inspection at all times. All staff must undertake training in COSHH and Health and Safety. (Previous timescales of 01/03/05, 01/09/05, 31/03/06 and 01/08/06 and 31/03/07 not met) At the expiry of this timescale the registered provider must write in to the local CSCI office and confirm what action has been taken. The manager must be trained to NVQ level 4 in management. (Previous timescale of 31.3.07 not met). At the expiry of this timescale the registered provider must write in to the local CSCI office and confirm what action has been taken. The owners must notify the local DS0000021804.V333293.R01.S.doc 14/06/07 30/06/07 14/06/07 14/06/07 30/06/07 04/06/07 Page 32 Version 5.2 (a-e) 38 (4) 20 OP33 26 (1-4) 21 22 23 OP35 OP36 OP37 16 (2) (l) 18 (2) 17 (2) (3) 24 OP38 13 (4) 23 (4) (a) CSCI office of the following information: The date the manager has been absent since, the reason for the absence, expected length of absence and the arrangements that have been put in place for the running of the home during this absence. The name, address and qualifications of the person responsible for the care home during the managers absence A record of the monthly monitoring visits to the home carried out by the owner must show that they had spoken to people who live at the home, staff and peoples relatives in order to form an opinion of the standards of care within the home. Peoples financial accounts must kept up to date and accurate to protect their rights. Staff must be supervised to ensure they are supporting people appropriately. Records must be kept up to date, secure, and at all times be available for inspection in the care home. The health, safety and welfare of all service users must be promoted and protected at all times, therefore fire doors must not be propped open. (Previous timescales of 31/03/07 not met) At the expiry of this timescale the registered provider must write in to the local CSCI office and confirm what action has been taken. 30/06/07 15/06/07 14/06/07 30/06/07 14/05/07 DS0000021804.V333293.R01.S.doc Version 5.2 Page 33 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP12 Good Practice Recommendations Up to date information about activities should be circulated to all service users in formats to suit their capabilities. DS0000021804.V333293.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR 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 DS0000021804.V333293.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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