Inspection on 30/01/08 for Seabourne Residential Home

This inspection was carried out on 30th January 2008.

CSCI found this care home to be providing an Adequate 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

Seabourne Residential Home 12/01/09

Seabourne Residential Home 20/08/07

Seabourne Residential Home 14/03/07

Seabourne Residential Home 01/12/05

Seabourne Residential Home 02/06/05

Seabourne Residential Home 02/11/04

Seabourne Residential Home 09/06/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Seabourne Residential Home 1 Clifton Road Southbourne Bournemouth Dorset BH6 3NZ Lead Inspector Anne Weston Key Unannounced Inspection 30th January 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Seabourne Residential Home DS0000003978.V358685.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. Seabourne Residential Home DS0000003978.V358685.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Seabourne Residential Home Address 1 Clifton Road Southbourne Bournemouth Dorset BH6 3NZ 01202 428132 01202 420050 orange07974@yahoo.co.uk www.luxurycare.co.uk Mr Sookdeo Gunputh Mrs Shobha Luxmee Gunputh ****Post Vacant**** Care Home 48 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) Category(ies) of Old age, not falling within any other category registration, with number (48) of places Seabourne Residential Home DS0000003978.V358685.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th August 2007 Brief Description of the Service: Seabourne is a care home registered to provide accommodation for up to 48 older people who do not have nursing needs owned by Mr and Mrs Gunputh. The home has been without a Registered Manager since 05 August 2007. Mr and Mrs Gunputh are now having less involvement with the management of the home and their son Kevin Gunputh is now taking an increasingly active role in the management of the home. The home is located in the Southbourne area of Bournemouth. It is a short walk from the home to the beaches of Southbourne. Shops and other community amenities are within walking distance. Accommodation is provided on 3 floors, which are accessible by either stairs or two passenger lifts. There are 48 rooms. Most rooms have en suite facilities. There is a large communal lounge and dining area on the ground floor. There is another large sitting room and dining area on the second floor. The garden is reached through patio doors from the lounge. There is a small car park at the front of the home. There is further parking at the side of the building. The weekly fees range from: £305.00 - £650.00. Additional charges include hairdressing, chiropody and newspapers. For further information on fee levels and fair contracts you are advised to refer to the Office of Fair Trading website: www.oft.gov.uk. We have published ‘A fair contract with older people? A special study of people’s experiences when finding a care home’ and this can be accessed on our website www.csci.org.uk. Seabourne Residential Home DS0000003978.V358685.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The unannounced visit to the home on the 30th January 2008 and the announced visit on the 19th February 2008 were carried out as part of a statutory key inspection which included reviewing the thirteen requirements and three recommendations made during the previous inspection. The pharmacy inspector reviewed the medication systems. A total of 30 hours was spent on the inspection process, this included planning for the inspection, the inspection visits, evaluation and report writing. An ‘expert by experience’ helped us during the first day of the inspection. An ‘expert by experience’ is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. He spoke with residents and staff to gain their views of the home, which are included in this report. The premises were inspected, this included communal areas and a sample of bedrooms. A range of records and related documentation were examined. Time was spent in discussion with both Kevin Gunputh and the Operations Manager and staff. People living in the home (and their relatives) were spoken with and observed, some people were spoken with in their own rooms and some people were spoken with in the communal areas. People were observed as a group, having their lunch. Contact was also made with people who use the service, and others through return of ‘Have your say’ surveys: 7 surveys returned from staff members 5 surveys returned from people using the service 3 surveys returned from health and social care professionals What the service does well: Investment is continuing to be made to extend and refurbish the home to a high standard. The home stores medicines securely in people’s own rooms to personalise medicines administration. People are able to keep in touch with family and visitors, as they wish. Visiting is open and flexible and visitors are welcomed into the home. Seabourne Residential Home DS0000003978.V358685.R01.S.doc Version 5.2 Page 6 People have nutritious and attractive meals and snacks, at a time and place to suit them. Examples of positive experiences from people included: ‘The care and support has always been excellent from day one, staff are very kind and approachable’ ‘The food is always very good’ ‘Wonderful food – home cooking’ What has improved since the last inspection? People can be confident that the home has developed assessment procedures to enable them to be supported. Progress is being made with care planning systems to make sure that people receive the care they need and to make sure that their health and welfare is protected and promoted. Immediate requirements made at the last inspection about: ensuring medicines are available for administration; having clear directions for, recording administration of, and safely storing medicines were met to protect residents and meet their healthcare needs. Progress is being made with supporting people to follow personal interests and activities. The activities programme must be further developed and consolidated so that people are consistently supported to follow personal interests and activities, both individually and communally. The home are pro-actively working with Bournemouth Borough Council, the Primary Care Trust and us to make sure sustainable improvements are made so that people are properly safeguarded. Recruitment practices had improved. More care still needs to be taken with staff references so that people can be confident that staff have been properly checked and are suitable to care for them. A staff training and development plan has been implemented. Arrangements are being made to make sure that staff have the right training so that they are competent to care and support people who use the service. The change in the management structure means that people have started to benefit from direction and leadership. Seabourne Residential Home DS0000003978.V358685.R01.S.doc Version 5.2 Page 7 Quality monitoring systems are being developed and good progress is being made with staff supervision. Quality monitoring systems have not yet been embedded. The home are sending us the required notifications so that we know about the management of significant events in the home. What they could do better: The home must continue with the development of care plans and risk assessments so that there is an accurate and comprehensive care plan and risk assessment for each person using the service to enable staff to have the right information to properly care for each person. Some information in the care plans was repetitive and we discussed the benefit of reworking the care planning structure to give concise information and to promote efficient care practice. We discussed the importance of using care plans as a working tool with staff and how a pen picture of preferences and needs for each person would assist staff to deliver care more efficiently and effectively. The Operations Manager has subsequently demonstrated the home are in the process of implementing a key action plan to complement the full care plan so that staff have easily accessible and concise information to underpin care delivery. Health care needs and how health needs are protected and promoted must be fully documented in each person’s care plan and daily observation log. Information must include how health, including mental health, is to be monitored and who is responsible for the monitoring. The home must develop a nutritional procedure so that good practice is carried out with assessment and monitoring of nutrition and dietary needs. The medicines policy needs further updating to give staff clear instructions to follow and the home needs an effective quality assurance system for medication so that improvements seen are maintained and further developed to safeguard residents. Staff must have additional training in principles of care so that they better understand how to treat each person as an individual by offering a personalised service. Training must have a focus on values, attitudes and promotion of dignity. The induction programme for sub-contracted agency staff and ancillary staff should make sure that agency and ancillary staff are inducted to treat people in a way which respects their privacy and dignity. All complaints must be logged and the actions taken in response to them must be fully recorded. Seabourne Residential Home DS0000003978.V358685.R01.S.doc Version 5.2 Page 8 All staff must receive safeguarding adults training so that they are enabled to recognise signs and symptoms of abuse and know how to deal with any suspicion or allegation of abuse. Some complaints have been made about the smell of urine in some rooms. This indicates some rooms are not always kept hygienic and free from offensive odours. The home must be kept free from offensive odours. An effective system for management of laundry should be developed so that items of clothing are not lost and so that people do not have the wrong clothes given back to them or are dressed in other people’s clothes. Some people using the service said it would be helpful if the home had more staff. Staffing arrangements must be reviewed to make sure that staff are effectively deployed so that people living in the home have their needs met. The home must be able to demonstrate that peoples’ financial interests are safeguarded. Not all health and safety practices are carried out. There must be evidence to show that staff have been trained in fire safety and there must be a statement of the procedure to be followed in the event of a fire, or where a fire alarm is given. There must be evidence to show that fire safety systems have been regularly checked and maintained. 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. Seabourne Residential Home DS0000003978.V358685.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 Seabourne Residential Home DS0000003978.V358685.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): 3 Standard 6 is not applicable Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People can be confident that the home has developed assessment procedures to enable them to be supported. EVIDENCE: As no new people have been admitted since 15 November 2007 it was not possible to examine any recent care needs assessments. The revised assessment documentation was examined. Assessment procedures included an admission sheet so that relevant personal details such as next of kin and GP contact details can be clearly recorded; life history; risk management and assessment of all relevant health, personal and social care needs. Seabourne Residential Home DS0000003978.V358685.R01.S.doc Version 5.2 Page 11 Discussion with the Operations Manager and information in the AQAA confirm that the service intend to offer prospective residents a range of visiting options so people are able to experience daily life in the home at different times of the day. For example, visits may include time spent in the home over the lunch meal or the evening meal before a decision is made to move into the home. These arrangements will be made to make sure the person is happy and comfortable with the environment, the staff group and other people who use the service. The outcomes of the revised assessment procedures and planned visit options will be evaluated when new people have moved into the home. Seabourne Residential Home DS0000003978.V358685.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): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Progress is being made with care planning systems to make sure that people receive the care they need and to make sure that their health and welfare is protected and promoted. There is improvement with some aspects of medication, the home does not have effective quality assurance to make sure people are safeguarded with robust medication systems. People’s right to privacy is not always respected and the support they get from staff is not consistently given in a way that maintains their dignity. EVIDENCE: On the first inspection visit care records of six people were examined and found to be of generally poor standard, frequently without relevant risk assessments forming the basis for care plans, and with many care plan components out of date, thereby inaccurate and not reflective of separately recorded descriptions of condition of each person. The failure to provide Seabourne Residential Home DS0000003978.V358685.R01.S.doc Version 5.2 Page 13 reliable and thorough plans of care for these people placed them at risk of poor and inappropriate care because their needs and circumstances had not been fully assessed and thereby were not recorded in the care plans, and may not be known to staff. From examination of records and discussion with the Operations Manager there was evidence that the rapidly changing condition of a particular person had not been adequately reported to the doctor; in consequence the person had not been examined in these regards and no specific health treatment prescribed until the sudden onset of severe ill-health. With particular regard to people with diabetes, the care records provided very little evidence to guide staff in their work, and provided no information on the likely signs of related instability and the actions to be taken by staff in that event. On the second inspection visit we examined two out of the four care plans and risk assessments that had been revised following the outcome of poor care plans from the first inspection visit. The two care plans showed significant improvement giving accurate and detailed information about people’s health, personal and social care needs including management of risk. Some information in the care plans was repetitive and care plans were over lengthy. We discussed with the Operations Manager the benefit of reworking the care planning structure to give concise information and to promote efficient care practice. We discussed the importance of using care plans as a working tool with staff and how a pen picture of preferences and needs for each person would assist staff to deliver care more efficiently and effectively. The Operations Manager has subsequently demonstrated the home are in the process of implementing a key action plan to complement the full care plan so that staff have easily accessible and concise information to underpin care delivery. Not all care records evidenced management of nutritional care. The Operations Manager talked about how the home is using the ‘Malnutrition Universal Screening Tool’ (MUST) with two people who have nutritional needs. The home is intending to use the MUST with people who are returning from hospital to the home so that their nutritional needs are properly monitored following hospital discharge. We looked at the new observation and recording daily communication log that had been implemented since the first inspection visit. This daily log is now being more effectively used so that it is clear what action has been taken following a change in a person’s condition and what outcome has been achieved. The weekly audit of the daily communication log must be more robust as not all actions and outcomes were evident. For example there was no information about the outcome of monitoring with a person who had become incontinent of faeces. Seabourne Residential Home DS0000003978.V358685.R01.S.doc Version 5.2 Page 14 Some improvement was seen in the handling and recording of medication but the home needs an effective quality assurance system to ensure that staff follow correct procedures for storing, administering and recording people’s medication to safeguard their wellbeing. We were told that one resident was self-medicating one medicine but they also had another medicine with them and there was no clear care plan and risk assessment for this, or records of medicines supplied to them. We saw a risk assessment when we re-visited three weeks later but it needed to address risks of all the storage arrangements. We were told that five carers had medication training in house and from an external provider and will have further training from the new supplying pharmacy. At lunch time we saw the carer giving medicines with several people’s medicines prepared in pots, which is not good practice as it increases the risk of people having the wrong medicine. When we re-visited three weeks later lunchtime and teatime medicines were in a trolley to improve administering medicines when people are in the dining room. There was an audit trail for most medicines and the amounts in stock of medicines in the monitored dosage system indicated that they were given as prescribed but for others there were discrepancies indicating errors in recording and /or administration. For example staff had signed for giving three more doses of two antibiotics than they had received and one person had two more tablets left than expected. There is currently no system for monitoring medication to check that it is given as prescribed and accurately recorded. The quantities in stock of two medicines requiring special storage and recording agreed with the records. There were outstanding balances for two other medicines but no stock. Sometimes the name of the medicine and the person it belonged to were not recorded at the top of the page so it was not clear what the records of administration referred to, and there were gaps in the records. There were still gaps in the records three weeks later although the manager said this had been addressed. One person had been given a medicine they were allergic to. “None known” was printed in the allergies section of their Medicine Administration Record (MAR) chart but in their notes there was a record that they were allergic to three medicines, including the one given. There was no record on or with some other MAR charts of medicines that residents were sensitive to, or “none known” as appropriate, to prevent them from receiving medicines they were allergic to. Some medicines handwritten on MAR charts were not signed as checked by a second authorised carer to protect people. Seabourne Residential Home DS0000003978.V358685.R01.S.doc Version 5.2 Page 15 Staff had not recorded the date of opening some residents’ eye drops but none seen had passed their ‘use by’ date. There was a locked medicines fridge but the temperature was not monitored. A maximum and minimum thermometer was obtained for this before the end of the visit but when we revisited three weeks later temperatures outside the recommended range were recorded without any evidence of action taken. Some aspects of medication handling were not included in the updated medication policy, which the manager sent a week later. Observation and discussion with people who use the service evidenced that many staff were courteous and showed patience and humour when supporting residents. Most residents were called by their first name, but a few had requested to be addressed by their surname, and this was being done. A social care professional visiting a person in January 2008 reported concerns about the way the person’s dignity and privacy was compromised. This was discussed with the Operations Manager who said this lack of respect was from a staff member sub-contracted through an agency. The Operations Manager confirmed she made a complaint to the agency and requested that the staff member was not sent to work at the home again. Another incident was reported about observation of a member of ancillary staff knocking on a bedroom door and entering before a response was given from the person occupying the bedroom. This indicates that ancillary staff do not have a full understanding of principles of care in relation to respect and promotion of privacy and dignity. Some care practices showed that some staff need additional training in principles of care so that they better understand how to treat each person as an individual by offering a personalised service. For example one person who wears dentures was left without their dentures and care staff had to be asked to help the person so they could properly have their dentures in so that they were able to eat lunch properly. Seabourne Residential Home DS0000003978.V358685.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 – 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Progress is being made with supporting people to follow personal interests and activities. Open visiting arrangements are in place, people are able to keep in touch with family and visitors, as they wish. People have nutritious and attractive meals and snacks, at a time and place to suit them. EVIDENCE: The ground floor lounge has been redesigned so that there are separate areas for people who wish to watch the television and for people who wish to engage with other daily pastimes. There is another lounge on the second floor where people can choose to go and relax if they wish to have more peace and quiet. The two people using the second floor lounge on the first day of the inspection said how nice it was to be able sit and chat without the television and expressed appreciation with the quiet atmosphere. These two people were offered the choice of joining other people in the ground floor lounge for the afternoon musical entertainment so Seabourne Residential Home DS0000003978.V358685.R01.S.doc Version 5.2 Page 17 that they had the opportunity to join in with arranged communal activity, should they wish to do so. Examination of quality assurance documentation showed that people had been consulted about their personal interests and choices, including religious observance, and any preferred activities. People talked about how the home had just started to introduce more activities and how much they appreciated the opportunity to participate with recreational activities such as bingo and musical entertainment. One resident said that the bingo cards were too small to use easily, and that a card that had slides to cover up the numbers when they were called would be very helpful. On the first day of the inspection there was a musical entertainer who was clearly providing enjoyable entertainment for people using the service, this was followed by a buffet. One person using the service spoke about how “the buffets are beautiful”. Inspection of the premises showed there was provision of a range of books and videos, a mobile library service also visits once a month. A range of games had been purchased, for example a magnetic dartboard, karaoke machine and poker set. Kevin Gunputh explained that an activities co-ordinator was being recruited who will work part time in the home so that the activities programme can be further developed and consolidated. Management said that small groups of residents were taken out for shopping trips and a visit to the airport. However this seemed to be the exception rather than the rule. We recommend that more regular visits should be organised, such as outings to gardens, shops, pubs and the theatre. People would benefit from links with the local community, for example listening to a school choir. The AQAA, observation, contact with people who use the service and contact with visiting relatives confirmed that people kept in touch with family and friends, as they wished. Visiting is open and flexible and visitors are welcomed into the home. People said they are able to exercise choice in their lives at the home, for example, spending time on their own, or with others and choosing what they eat. People said that they were asked about their daily menu choices and inspection of the premises evidenced a wipe clean board displaying the menu of the day which offered choices in meal provision. Examination of food records, sampling of lunch and discussion with people and observation confirmed that people are offered a balanced and varied diet. Some people ate their lunch in the ground floor dining room; other people had their meal in the quieter second floor dining room and others preferred to eat in their own rooms. Individual wishes are respected. The communal dining Seabourne Residential Home DS0000003978.V358685.R01.S.doc Version 5.2 Page 18 areas were attractively and thoughtfully presented with linen tablecloths and linen napkins in a pastel and white colour theme. Breakfast was usually cereals, toast and fruit, but cooked breakfasts were also available. After mid-morning tea or coffee the ‘expert by experience’ sampled lunch with the residents. Lunch was soup was followed by a choice of either roast chicken or cod, with several vegetables. The food was hot and nutritious, and the portions were generous. There was also a choice of fruit juice, which was regularly topped up. This was followed by either rice pudding or jelly, and then tea or coffee. Observation showed staff to be friendly and attentive to all the residents before and during the meal. Great care was taken to assist residents to the table of their choice. One person couldn’t be tempted with any of the food on offer, and staff showed patience in taking this person back to a comfortable chair in the lounge, where they brought the person tea and biscuits, and then some rice pudding. People said they were generally satisfied with the standard of catering in the home. One resident complimented the quality of the food as “beautiful home cooking” and others rated it as “very good”. One resident, who had their meal in the second floor dining area, did say that they spent too long waiting for their meal to be served, but this was not found to be a general complaint. After mid-afternoon tea or coffee, residents talked about how there was a choice of snacks or sandwiches for supper. On the first inspection visit there was a buffet late afternoon after a violinist had entertained the residents in the lounge. Concerns about adequate nutrition with some people have been reported on, and addressed under health care needs in Standard 8. Seabourne Residential Home DS0000003978.V358685.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 – 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People know how to make a complaint and complaints and concerns are looked into, and action taken to put things right. There are no robust recording systems to show how complaints and concerns are investigated and to show the outcomes of complaints and concerns. Systems are being developed and implemented to make sure that the home safeguards people from abuse and neglect. EVIDENCE: The home has an accessible complaints procedure. All returned service user surveys showed that people knew how to make a complaint. We examined the complaints book, this showed one recorded complaint which was in the process of being investigated. Not all complaints had been logged, this meant records were incomplete, with timescales, actions and outcomes not being properly recorded. Management told us about the action and outcomes with complaints where details of the investigation, and any action taken were absent. Discussion with management and with people who use the service indicated that the home was responsive to issues raised. There has been a Safeguarding Adults investigation carried out since the last inspection. The investigation substantiated neglect with some people. Seabourne Residential Home DS0000003978.V358685.R01.S.doc Version 5.2 Page 20 The home are pro-actively working with Bournemouth Borough Council, the Primary Care Trust and us to make sure sustainable improvements are made so that people are properly safeguarded. The provider is referring one member of staff to the PoVA List, this referral has not yet been completed. Examination of training records showed some staff had not received safeguarding adults training. The Operations Manager made immediate arrangements for further staff training in safeguarding adults. Seabourne Residential Home DS0000003978.V358685.R01.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): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is generally clean and well maintained. Systems are not in place to make sure hygiene standards are consistently maintained. EVIDENCE: Inspection of the premises and discussion with Kevin Gunputh showed that investment is continuing to be made to extend and refurbish the home to a high standard. Protective covering had been fixed on wall corners to prevent walls being scuffed and chipped. The lounge and dining area has been redesigned resulting in a comfortable and homely environment. Dining tables were attractively presented in pastel colours with linen tablecloths and napkins and new curtains had been purchased. Seabourne Residential Home DS0000003978.V358685.R01.S.doc Version 5.2 Page 22 Building work was in progress to improve the front entrance and to create a new managers office, training room and staff room with its own kitchenette. One person said that when they moved into the home “It was very well presented, nice furniture and fittings, but with little heart or warmth. Now it’s getting better”. Inspection of the premises demonstrated that the home was clean. Contact with people who use the service confirmed the home was routinely clean. Some people have complained about the smell of urine in some rooms. This indicates some rooms are not always kept hygienic and free from offensive odours. Laundry facilities are in place, the washing machine has a disinfection programme. There has not been a system to ensure effective management of laundry. This means that some clothes have been lost, some clothes have been given back to the wrong people and some people are dressed in clothes belonging to other people. A dedicated laundry assistant has now been appointed so that laundry can be effectively managed. Seabourne Residential Home DS0000003978.V358685.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are not always appropriately supported by the staff duty arrangements. More care needs to be taken with staff references so that people can be confident that staff have been properly checked and are suitable to care for them. Not all staff have received training to make sure that they are fully competent to care and support people who use the service. EVIDENCE: The staff rota showed that there are five or six care staff working in the mornings, four care staff in the afternoons and three waking staff during the night. Observation showed a good relationship has been developed between residents and staff. Staff were described as “nice girls” and “always friendly”. Some people who use the service felt there was not always sufficient staff to meet their needs and said that it would be helpful if the home had more staff. Several people said that staff sometimes took rather a long time to answer the call bell. One person spoke about how they felt they had to sometimes wait too long for assistance to use the toilet. Another person spoke about how staff “seem to be rushing sometimes”. Another person stated ‘Sometimes there is not always enough staff’. One person said “the medicine was late coming each evening” and that “sometimes it was difficult to understand what staff were Seabourne Residential Home DS0000003978.V358685.R01.S.doc Version 5.2 Page 24 saying”. One staff member stated ‘Sometimes we are short on floor and not meet the individual needs’. The staff files of two recently recruited staff were examined. One member of staff had not yet started working in the home. Recruitment procedures included completion of an application form, interview, health check, proof of identity, obtaining references and PoVA First and Criminal Record Bureau checks. One person did not have a valid reference from their previous employer. The importance of obtaining valid references was discussed with management. Interview records did not demonstrate that a robust interview had been carried out with potential staff members. Discussion with management and staff and examination of training records showed that the home have implemented a staff training and development plan. Staff said that more training was now being offered. For example one member of staff said ‘The training we have been offered recently has made a big difference to my understanding’. Concerns have been raised about continence care, this is in the process of being addressed and staff attended training in continence care in January 2008. Not all staff had received the right training, for example manual handling, first aid and food hygiene. There was no evidence to show that staff had been trained so that they were competent to accurately complete food and fluid monitoring charts. The outstanding training was discussed with the Operations Manager who immediately made arrangements for first aid training for staff. Kevin Gunputh confirmed that a Training and Development manager has been appointed to start working in the home in March 2008. The Operations Manager confirmed that five staff members have completed National Vocational Qualification (NVQ) Level 2 and six staff members are starting NVQ Level 2. Seabourne Residential Home DS0000003978.V358685.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People have started to benefit from direction and leadership. Evidence was not available to show peoples’ financial interests are safeguarded. Not all health and safety practices are carried out. EVIDENCE: Since the last inspection an interim Operations Manager has been managing the home since November 2007. A deputy manager started work in the home in January 2008. A permanent manager is expected to start employment in March 2008. The interim management arrangements mean that the home has Seabourne Residential Home DS0000003978.V358685.R01.S.doc Version 5.2 Page 26 started to benefit from direction and leadership and improvements have been made with safeguarding people. The home have started to use quality monitoring systems and good progress is being made with staff supervision. Quality monitoring systems have not yet been embedded. Examination of supervision records showed that supervision contracts have been agreed with staff and most staff have received support and supervision under the new contracts. Staff spoken with said they felt well supported by management and that management responded quickly with issues raised by staff. One member of staff spoke about how Kevin Gunputh had been personally supportive when they were experiencing personal difficulties. It is the policy of the home not to have any involvement in peoples’ personal finances. People spoken with said that their family dealt with all their finances, and purchasing everyday items for them. Observation showed some visitors doing exactly this kind of transaction with one of the residents. The Operations Manager talked about how families were invoiced direct for any services or goods provided. The financial management section of the care plans had not been completed so it was not possible to establish that peoples’ financial interests were being safeguarded. Systems are in place for regular maintenance of electrical equipment, for example hoists had certificates of inspection that showed that maintenance checks had been carried out in February 2008. There was insufficient evidence that all accidents to people are thoroughly investigated and findings reflected in the care plan, to ensure that future risks are minimised. A record of accidents is maintained, accident monitoring and evaluation was not available to show prevention of accidents. There was no evidence available to show that fire systems are regularly checked or that staff have received fire training. The Operations Manager immediately made arrangements with Dorset Fire and Rescue Service for a Fire Safety Officer to give staff training for fire evacuation. Exit doors are alarmed to make sure people leave the home in a safe manner. The door alarm was checked and was in working order. Refer to Standard 30 for shortfalls with staff training in manual handling, food hygiene and first aid. Seabourne Residential Home DS0000003978.V358685.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 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 X X 1 Seabourne Residential Home DS0000003978.V358685.R01.S.doc Version 5.2 Page 28 YES Are there any outstanding requirements from the last inspection? 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 14 Timescale for action People must not be admitted into 31/03/08 the home until a needs assessment has been obtained or carried out. This requirement is carried forward as the service is not currently admitting any new people. The previous timescale of 28/08/07 has been revised. The home must continue with 31/05/08 the development of care plans and risk assessments so that there is an accurate and comprehensive care plan and risk assessment for each person using the service to enable staff to have the right information to properly care for each person. Health care needs must be fully 31/05/08 documented in each person’s care plan and daily observation log. Information must include how health, including mental health, is to be monitored and who is responsible for the monitoring. This requirement is carried forward. Progress is being DS0000003978.V358685.R01.S.doc Version 5.2 Page 29 Requirement 2 OP7 13 (4) (b) (c) & 15 (1) 3 OP8 12(1) (a) & (b) Seabourne Residential Home made with compliance. The previous timescale of 31/10/07 has not been fully met. The home must develop a nutritional procedure so that good practice is carried out with assessment and monitoring of nutrition and dietary needs. The Registered Person must make arrangements for the recording, safe administration and storage of medicines received in the care home including: Recording details of any medicine sensitivity or ‘none known’ on or with the MAR chart to protect residents from receiving medicines they are allergic to. Recording the quantities of medicines supplied to residents who self-medicate. Updating the medicines policy to provide clear instructions for staff on all aspects of medication handling so that residents are protected. Previous timescale of 31/10/07not met. Ensuring that refrigerated medicines are stored at the correct temperature to maintain their effectiveness. Having an effective quality assurance system for monitoring medication to ensure that it is stored and handled correctly, given as prescribed and accurately recorded. Arrangements must be made to make sure that the care home is conducted in a manner which respects the privacy and dignity of people who use the service. DS0000003978.V358685.R01.S.doc 4 OP9 13(2) 30/04/08 5 OP10 12 (4) (a) 31/03/08 Seabourne Residential Home Version 5.2 Page 30 6 OP16 22 7 OP18 13(6) 8 OP26 16(2)(k) 9 OP27 18(1)(a) 10 OP29 19 11 OP30 18(1) (c ) 12 OP31 8 Staff must have additional training in principles of care so that they better understand how to treat each person as an individual by offering a personalised service. Training must have a focus on values, attitudes and promotion of dignity. All complaints must be logged and the actions taken in response to them must be fully recorded. All staff must receive safeguarding adults training so that they are enabled to recognise signs and symptoms of abuse and know how to deal with any suspicion or allegation of abuse. Previous timescale of 30/11/07 not met. The registered person must ensure that the home is kept free from offensive odours. Previous timescale of 30/09/07 not met. Staffing arrangements must be reviewed to make sure that people living in the home have their needs met. Previous timescale of 30/09/07 not met. Two references must be obtained before staff members start working in the home, including, where applicable, a valid reference from the previous employer. All staff must receive training appropriate to the work they perform, for example manual handling, food hygiene, first aid and record keeping. An application for the post of Registered Manager must be submitted to the Commission. The previous timescale of DS0000003978.V358685.R01.S.doc 31/03/08 31/03/08 31/03/08 31/03/08 31/03/08 31/03/08 30/04/08 Seabourne Residential Home Version 5.2 Page 31 13 OP33 24 14 OP35 20 15 OP38 23 Schedule 4 (14) (15) 31/10/07 has been revised. Quality monitoring systems must show evaluation of the quality of the services provided at the care home. Medication systems must be included with quality assurance. The home must be able to demonstrate that peoples’ financial interests are safeguarded and demonstrate that persons working at the care home do not act as the agent of people using the service. There must be evidence to show that staff have been trained in fire safety and there must be a statement of the procedure to be followed in the event of a fire, or where a fire alarm is given. There must be evidence to show that fire safety systems have been regularly checked and maintained. 31/05/08 31/05/08 31/03/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations When medicines are handwritten on the medicine record chart a second competent person should check the details are accurate and countersign to protect residents. The induction programme for sub-contracted agency staff and ancillary staff should make sure that agency and ancillary staff are inducted to treat people in a way which respects their privacy and dignity. The home should evidence that the activities programme has been further developed and consolidated so that people are consistently supported to follow personal interests and activities, both individually and communally. 2 OP10 3 OP12 Seabourne Residential Home DS0000003978.V358685.R01.S.doc Version 5.2 Page 32 4 OP26 5 OP28 6 7 OP29 OP38 An effective system for management of laundry should be developed so that items of clothing are not lost and so that people do not have the wrong clothes given back to them or are dressed in other people’s clothes. The registered person should continue to work towards achieving 50 care staff with NVQ level 2 qualification. This recommendation has been carried forward from the previous two inspections. There should be evidence that a robust interview has been carried out with potential members of staff. The home should carry out regular accident analyses and use the information obtained to minimise the risk of further accidents happening and to inform the individual care planning for residents. Seabourne Residential Home DS0000003978.V358685.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 Seabourne Residential Home DS0000003978.V358685.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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