Inspection on 26/10/07 for Seacliff Care Home

This inspection was carried out on 26th October 2007.

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

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

Other inspections for this house

Seacliff Care Home 23/01/09

Seacliff Care Home 29/07/08

Seacliff Care Home 28/01/08

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

CARE HOMES FOR OLDER PEOPLE Seacliff Care Home 9 Percy Road Bournemouth Dorset BH5 1JF Lead Inspector Marjorie Richards Unannounced Inspection 26th October 2007 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 Seacliff Care Home DS0000068785.V353931.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. Seacliff Care Home DS0000068785.V353931.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Seacliff Care Home Address 9 Percy Road Bournemouth Dorset BH5 1JF 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) 01202 396100 gerryseacliff9@hotmail.co.uk Mr Munundev Gunputh Mrs Dhudrayne Gunputh Mr Gerard Thomas Care Home 24 Category(ies) of Dementia (24) registration, with number of places Seacliff Care Home DS0000068785.V353931.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Dementia (Code DE) The maximum number of service users who can be accommodated is 24. Not applicable Date of last inspection Brief Description of the Service: Seacliff Care Home is a large, detached property, situated in a residential area of Boscombe, Bournemouth. The main shopping area of Boscombe with all its amenities including bus services is less than half a mile away. The home is also situated less than half a mile from the cliff top and promenade at Boscombe, where there are a number of pleasant walks. The property is set back a little from the road and there is a small parking area for visitors. Additional parking is available on roads outside or in the vicinity of the home. Seacliff Care Home is registered to accommodate up to 24 persons with dementia. The accommodation is arranged over three floors, with stairs or a passenger lift to aid access between the floors. There are two double and twenty single bedrooms. Approximately half of the bedrooms are equipped with en-suite W.C.s. There are five communal bathrooms/shower rooms available to residents, but no assisted bathing facilities at the present time. The home has a dining room with adjoining sitting area and large conservatory as well as a second lounge, all situated on the ground floor. The conservatory has views over the rear garden, which includes a lawn and paved patio area surrounded by mature trees and shrubs. Twenty-four hour care is provided. Laundering of personal clothing etc is carried out on the premises. Some activities and occasional entertainments are arranged. Meals are freshly prepared and cooked within the home. Although no choice of menu is offered, a variety of alternatives are always available to suit individual taste and preference. Seacliff Care Home DS0000068785.V353931.R01.S.doc Version 5.2 Page 5 The fees for the home, as confirmed to us at the time of inspection, range from £490 - £575 per week. Additional charges include hairdressing, chiropody, dry cleaning, toiletries and newspapers. The Office of Fair Trading has published a report highlighting important issues for many older people when choosing a care home, e.g., contracts and information about fees and services. We have responded to this report and further information can be obtained from the following website: http:/www.csci.org.uk/about_csci/press_releases/better_advice_for_people choosing a care home. aspx The home says a copy of the inspection report will be made available to anyone wishing to read it, once published. Seacliff Care Home DS0000068785.V353931.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 18.75 hours on the 26th October and 1st November 2007 and was carried out by two Inspectors. Because of concerns noted at this time, the Commission for Social Care Inspection Pharmacist Inspector also spent time looking at the home’s arrangements for the safe handling of medicines on 7th and 27th November. The main purpose of this first inspection of a new service was to review all of the key National Minimum Standards and check that the residents living in the home were safe and properly cared for. At the time of the inspection twelve residents were accommodated, but some of these were receiving respite care and would be returning to their own homes in the coming weeks. Tours of the premises took place at various times during both days and records and related documentation were examined, including the care records for four residents. Time was spent observing the interaction between residents and staff, as well as speaking with residents to obtain their views wherever possible. The daily routine was also observed during the inspection, including mealtimes and activities. On the second day of the inspection, one hour was spent observing the care being given to a small group of people in the lounge. All observations were followed up by discussions with staff and examination of records. Discussions took place briefly at the start of the first day with Mr Gerry Thomas, the registered manager, then later at length with both Mr Munundev Gunputh and Mrs Dhudrayne Gunputh, the registered providers. We also spoke with some members of staff on duty. For the purposes of this report, people who live at Seacliff Care Home are referred to as residents as this is the term generally used within the home. The Inspectors were made to feel welcome in the home throughout the inspection process. What the service does well: Mrs Gunputh and her staff were observed throughout the inspection to be treating residents with courtesy, kindness and respect. Residents say they are well looked after at Seacliff Care Home and confirm they have opportunities to enjoy privacy if they wish. Residents are encouraged to maintain contact with family and friends and to choose their own lifestyle within the home. Individual preferences and Seacliff Care Home DS0000068785.V353931.R01.S.doc Version 5.2 Page 7 routines are respected. They are able to bring their own possessions into the home to personalise their bedrooms. Open visiting arrangements are in place and residents are able to maintain contact with family and friends. Residents confirm that their visitors are well received. The home has a complaints policy and procedure in place. Residents expressed no concerns and one commented, I am happy here and have no complaints. The standard of accommodation is generally good, providing residents with comfortable surroundings in which to live. We observed the relationship between residents and staff to be relaxed, friendly and supportive. Residents say they are well looked after and staff treat them with kindness. Comments include, They are very good to me, they are nice people here. The people here are kind to me. This is a nice place, I like it here. The home does not have any involvement with residents personal finances. Residents have a relative or other representative to deal with their finances etc. The home pays for services such as chiropody and hairdressing and this amount is then invoiced to residents, relatives or representatives for payment each month. What has improved since the last inspection? What they could do better: The poor management of Seacliff Care Home is of concern to the Commission for Social Care Inspection. The home does not currently have the leadership required to ensure all residents are safe and their care needs are met. Before a new resident is admitted to Seacliff Care Home, a pre-admission assessment must be carried out to ensure that the home is able to meet the prospective resident’s needs. When the pre-admission assessment has taken place, the home should confirm in writing to prospective residents that Seacliff Care Home is suitable to meet their assessed needs, so that they may feel fully assured their care needs will be met. Considerable work is needed to ensure that care plans provide all of the information required so that the health and personal care provided is safe and meets the resident’s individual needs. Wherever possible, the resident or their representative should be involved in care planning and reviews. Seacliff Care Home DS0000068785.V353931.R01.S.doc Version 5.2 Page 8 Appropriate risk assessments, e.g. falls, wandering and nutrition, must be put in place wherever necessary. Where risks are identified, appropriate action must be taken to minimise those risks. The home needs to have a relevant comprehensive medication policy so that staff are aware of correct procedures to follow. Some aspects of storage and recordkeeping need improving and information in care plans should include details about medication, to safeguard residents and ensure that their healthcare needs are met. There is only minimal information available about residents’ background and interests. This makes it difficult to arrange activities based on residents needs or preferences. There are only limited materials available for the provision of activities. There is very little in the way of fruit and vegetables shown on the menu. The home has an Adult Protection policy, but this is for another care home and some of the information it contains does not relate to Seacliff Care Home. Not all staff have received Adult Protection training, to ensure a proper response to any suspicion of abuse. Some of the equipment provided in bedrooms is not easily accessible to residents, for example televisions and bedside lighting. It was difficult for some residents to access the call bell in their bedroom, so they could summon staff assistance if required. At present, there is no assisted bathing available for those residents who may find difficulty in accessing a bath. We found that toilet paper, soap and towels or not all is available in bathrooms, toilets and ensuite facilities. Further work is needed to improve infection control measures within the home. For instance, soap and paper towels were not available in the laundry room so that staff could wash their hands after handling dirty laundry. Similarly, sluices are not always equipped with soap and paper towels. Soiled bed linen had not been changed in some bedrooms. We found that the staffing roster did not accurately reflect the actual staffing in the home. Therefore, we have concerns about staffing levels and whether they are sufficient to meet the needs of residents. The home was unable to provide any information about the agency staff being employed, to ensure that suitable employment checks had been carried out and that staff had the training and skills necessary to meet the needs of residents. The home has not achieved the minimum ratio of 50 per cent trained members of care staff at National Vocational Qualification (NVQ) level 2, to help ensure that residents are in safe hands. Seacliff Care Home DS0000068785.V353931.R01.S.doc Version 5.2 Page 9 Recruitment procedures are not sufficiently robust to ensure that residents are protected from the risk of unsuitable staff working in the home. The majority of staff have no previous experience of working in a care home. There are no training plans or individual staff training profiles in place to ensure that staff have the skills and knowledge they require to carry out their work. We have concerns about the management of the home. Management responsibilities are not being fully discharged at the present time, which means that Seacliff Care Home is not operating as a safe service. Some of the working practices do not always ensure that the health, safety and welfare of residents and staff are promoted and protected. At present there is no system for a) reviewing and b) improving the quality of care provided, to include internal quality audits of care plans and accident records etc. The views of residents, relatives, staff and visitors to the home have not been sought, for example through anonymous questionnaires. Care staff should receive formal supervision at least six times a year as a means of an ensuring good practice, emphasising the philosophy of care within the home and looking at individual career development needs etc. A formal staff supervision system has not yet been introduced at Seacliff Care Home. More attention is needed to ensuring that all parts of the home to which residents have access are kept free from any hazards to their safety. This includes removing tripping hazards and ensuring potentially harmful substances, such as fabric softener, denture cleaning tablets, antibacterial surface cleaner, rinse aid and dishwasher cleaner are held securely, out of the reach of vulnerable residents. A fire risk assessment and action plan detailing what to do in the event of fire must be developed and implemented. The home must ensure that staff have access to fire training and fire drills, so they are aware of the action to take in the event of fire. 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. Seacliff Care Home DS0000068785.V353931.R01.S.doc Version 5.2 Page 10 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 Seacliff Care Home DS0000068785.V353931.R01.S.doc Version 5.2 Page 11 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 at Seacliff Care Home.) Quality in this outcome area is poor. This judgement has been made using available evidence including visits to Seacliff Care Home. Sufficient information is not always available prior to admission, to ensure that only those prospective residents whose needs can be met are offered places at Seacliff Care Home. EVIDENCE: The providers say that the home always carries out its own detailed preadmission assessments for all prospective residents, to determine whether Seacliff Care Home can meet their care needs. The records we looked at demonstrate that the content of pre-admission assessments is very variable. They do not consistently provide sufficiently detailed information and sometimes the documentation used is not fully completed. On one file the majority of the pre-admission assessment form had not been filled in. It did not contain sufficient information to allow an informed decision to be made as to whether the home could meet this Seacliff Care Home DS0000068785.V353931.R01.S.doc Version 5.2 Page 12 resident’s needs. The pre-admission assessment had not been signed or dated by the person completing it. In some cases there is no evidence of consultation with the prospective resident’s relative or representative and other professionals, such as hospital nursing staff. Following any pre-admission assessment there is nothing documented to demonstrate that the home confirms the outcome in writing; therefore prospective residents are not assured that their needs can be met at Seacliff Care Home. Seacliff Care Home DS0000068785.V353931.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including visits to Seacliff Care Home. Shortfalls in care planning and carrying out appropriate risk assessments have the potential to place residents at risk, because the care provided may not always be safe and able to meet the resident’s individual needs. Some aspects of medicines storage and record keeping need improving to safeguard residents and ensure that their healthcare needs are met. Some of the practices we observed did not ensure that residents are treated with respect and their dignity preserved at all times. EVIDENCE: Care plans are intended to provide staff with the information they require to meet the health, personal and social care needs of residents. Following examination of four of these, it could not be evidenced that sufficient or relevant information is always available to clearly direct the care staff. Many of the care plans that are in place have not been appropriately reviewed. There is only limited evidence that residents make any contribution to the care Seacliff Care Home DS0000068785.V353931.R01.S.doc Version 5.2 Page 14 planning process, or, where this is not possible, that a relative or their representative is involved in care planning or in reviews. Care plans are often not completed until well after admission and not always signed. One care plan we looked at had not been written until nearly five weeks after the resident came into the home. This meant that staff did not have sufficient information available to them about the resident’s care needs and how these were to be met. Documentation demonstrates that information is not always transferred between pre-admission assessments, assessments on admission and care plans. For instance, the pre-admission assessment for one resident identifies a history of falls, but the care plan makes no mention of this and there is no falls risk assessment in place. Where risks are identified, e.g., wandering, there is a lack of consistency in ensuring appropriate risk assessments are implemented, to demonstrate how this is to be managed and the risk minimised. A pre-admission assessment identifies a nutritional risk and a dieticians report provides a suggested meal plan, supported by additional fortified drinks. However, the care plan says, Has good appetite, enjoys food” and there is no evidence of an appropriate nutritional assessment being implemented or special dietary requirements being met. The daily notes written by staff often demonstrate that this resident has only a small dietary intake. Where assessments have been carried out, they lack sufficient detail. For example, “Requires assistance of one care assistant for all aspects of personal care.” There is no further information for staff about how the resident likes their personal care to be delivered, or what the resident may be able to do for themselves, e.g. wash their own face and hands. One assessment states that the resident’s weight should be monitored, but no evidence was available to demonstrate that weight measurements had been recorded. Some records contain conflicting information, for instance identifying that a resident does not like company, when daily records written by staff show that there have been times when the company of others had been enjoyed. One care plan indicates that the resident experiences occasional incontinence but the assessment says the resident is continent. There is evidence to demonstrate that appropriate intervention is not always sought in a timely manner from General Practitioners and other health professionals. Where health professionals have visited residents in the home, such visits and their outcomes are not always recorded. Seacliff Care Home DS0000068785.V353931.R01.S.doc Version 5.2 Page 15 We could not evidence that residents’ social, psychological or religious needs have been meaningfully assessed and appropriate support provided, where necessary. We looked at medication during both days of the inspection and found a number of concerns around the safe handling, recording and storage of medicines. Our Pharmacist Inspector therefore visited the home on 7th November 2007 and found there were gaps on five of the Medicine Administration Records (MAR) charts seen where staff had not recorded whether medicines were given or not. One person’s MAR chart was handwritten but not countersigned as checked by a second person to safeguard them. The quantities of medicines that one person brought into the home were not recorded to provide an audit trail. There was no information in the care plan about whether they could self-medicate or needed their medication given to them, or to indicate what they were taking medicines for. At a second visit on 27th November the Pharmacist Inspector found an improvement in recording the quantities of medicines received in the home and given to residents but staff had not recorded whether two antibiotic doses were given or not. There was a good audit trail and quantities of tablets in stock agreed with the records indicating that medicines were given as prescribed. One person was prescribed a calming medicine “when required” but there was no information in the care plan to guide staff as to when this could be given and how often. Another care plan seen did include information about the person’s medication and what it was for. Some residents do not have a photo with their medication record to help ensure that medicines are given to the right person. There is a medication policy but it is not fully relevant to the home or sufficiently comprehensive to give staff clear guidance to staff on procedures to follow. Some aspects regarding the storage and security of medicines need improving to safeguard residents. The home needs to monitor maximum and minimum, rather than actual temperatures of the medicines fridge to ensure that medicines are stored at the correct temperature to maintain their effectiveness. Staff do not record the date eye drops are started so that they can be replaced after 28 days to prevent infection but the two in use seen were obtained in the last month. During the inspection, the relationship between residents and staff was observed as being relaxed, friendly and supportive. Staff clearly work very hard and have a good relationship with residents. Two residents confirmed that they were able to enjoy privacy when they wanted to be on their own. However, some practices were noted that did not uphold the key principles of ensuring that residents are treated with respect and their dignity preserved at all times. Seacliff Care Home DS0000068785.V353931.R01.S.doc Version 5.2 Page 16 For example: • • • • • • • • An unpleasant odour is noticeable in a few bedrooms and bathroom/shower rooms. (This was discussed with the provider and we found improvements on the second day of our inspection.) An empty fabric conditioner bottle containing urine was found in a sluice, apparently being used as a male urinal. Some bedrooms contain no soap, flannel or towels. Many items of clothing in wardrobes are poorly presented, resulting in clothing being very creased. Clothing in some chests of drawers, including underwear, is not named to ensure correct ownership. Items of clothing, such as jumpers and skirts, are often left inside out or screwed up in drawers, resulting in clothing being very creased. The majority of clocks in bedrooms had stopped or did not give the correct time. Some beds had been covered over, rather than properly made and soiled bed linen had not been changed. It is important that all residents are afforded the dignity and respect they have a right to expect, at all times. Seacliff Care Home DS0000068785.V353931.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including visits to Seacliff Care Home. The home aims to provide flexibility in its approach to the provision of activities and meals and works to enable residents to retain some control over their lives wherever possible. Open visiting arrangements are in place and residents are able to maintain contact with family and friends. EVIDENCE: During the first day of inspection a small group of residents were observed for an hour during the morning in the lounge. The following points were noted: • Staff were kind and considerate. • There was always a presence in the lounge so residents were not left unsupervised. • The activity that took place that morning involved jigsaw puzzles. The tables provided were small coffee tables, which were too small to spread the pieces out on and also complete the puzzle. There was no picture available to show residents what the finished puzzle should look like. Residents also had to sit on the edge of their armchairs and lean forward to be able to see, which did not look comfortable. Seacliff Care Home DS0000068785.V353931.R01.S.doc Version 5.2 Page 18 • • • One resident read the newspaper quite happily and others chatted with staff. One resident was asleep and missed coffee being served. A drink was not offered later when the resident woke up. One resident said they felt bored at times. There is only minimal information available about residents’ background and interests. Little of this information is then used to identify social needs and enhance the daily lives of residents. The choice of activities is therefore not based on residents’ needs or preferences. The home does not employ an activities co-ordinator and the staff group share the responsibility for leisure activities between them. Staff comment that they have only limited materials available to them for the provision of activities and very little that is suited for people with dementia. However, they say that residents enjoy watching television and some games are also available. Staff also sit and talk with residents and this was witnessed during the inspection. The home has an activities programme in place, but this did not correspond to what was actually happening on the days of inspection. There is no record maintained to show which activities residents have participated in. One resident commented, There is nothing much to do here so I prefer to go to my room.” Other residents said, “It’s boring here.” “I would like to go outside for a walk, the garden always looks nice. We never go out.” Observation and contact with residents confirms that they are able to maintain contact with friends and family, as they wish. Visiting is open and flexible and visitors are welcomed into the home. Residents are able to see visitors in their own rooms or in the lounge/dining areas. Two residents commented that their relatives are always well received. During the inspection we saw some residents being offered choices e.g., what they wanted to do, where and when they wanted to eat, if they would like a drink or if they needed any assistance. Most residents seem able to express themselves in some way and staff appear generally to be responsive to their needs and wishes. One member of staff works part-time as a Cook and also as a care assistant. Mrs Gunputh and other care staff also assist with the cooking of meals. There is only a minimal use of fruit and vegetables shown on the menu. Food stocks were low, but Mrs Gunputh stated that she was about to arrange the weekly shopping. The evening meal on the first day of inspection was chicken fingers with spaghetti, bread and butter and followed by fruit yoghurt. The menu also states that sandwiches and fresh fruit are available. The care assistant preparing the meal confirmed that bread and butter, not sandwiches had been provided and a few residents had been given a banana. Seacliff Care Home DS0000068785.V353931.R01.S.doc Version 5.2 Page 19 Residents commented, I miss having home-made cakes, we dont have much cake here.” I enjoy the food, I eat well.” We get the same old thing all the time.” Seacliff Care Home DS0000068785.V353931.R01.S.doc Version 5.2 Page 20 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 poor. This judgement has been made using available evidence including visits to Seacliff Care Home. A complaints policy is in place, but the Adult Protection policy and procedure is in need of modification to ensure that any allegations of abuse are managed effectively. It could not be evidenced that all staff have received Adult Protection training to ensure a proper response to any suspicion or evidence of abuse. EVIDENCE: The home has a complaints policy and procedure in place and the complaints record shows that one complaint has been received by the home and is currently being investigated. Residents expressed no concerns and one commented, I am happy here and have no complaints. The home also has an Adult Protection policy and procedure in place. However, this is for another care home and some of the information it contains does not relate to Seacliff Care Home. We could not evidence that all staff have received Protection Of Vulnerable Adults training, so that they are able to identify different forms of abuse and know how to deal with any suspicion or allegation of abuse. As part of the recruitment procedure staff must have a Criminal Records Bureau (CRB) disclosure and be checked against the Protection of Vulnerable Seacliff Care Home DS0000068785.V353931.R01.S.doc Version 5.2 Page 21 Adults (POVA) list held by the Department of Health, before commencing employment. The CRB application for one member of staff working in the home had not been submitted and therefore a POVA check had not been completed. Mr Gunputh undertook to ensure that all of these issues would be rectified as soon as possible. Three Safeguarding Adults referrals relating to the care of residents are currently being investigated by Bournemouth Borough Council Adult Community Care Services. Seacliff Care Home DS0000068785.V353931.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including visits to Seacliff Care Home. The standard of accommodation is generally good, providing residents with comfortable surroundings in which to live, although there is no assisted bath available at present. Further work is needed to improve infection control measures within the home. EVIDENCE: The accommodation at Seacliff Care Home is arranged over three floors. The lounge and dining areas are situated on the ground floor, off of the spacious entrance hall. Bedrooms are available on all three floors and residents may use the stairs or a passenger lift to access them. The standard of accommodation is good, with rooms comfortably furnished and decorated. Many bedrooms are well personalised by their occupants. Seacliff Care Home DS0000068785.V353931.R01.S.doc Version 5.2 Page 23 Some of the equipment provided in bedrooms is not easily accessible to residents. For instance, televisions and additional lighting, such as bedside lamps, that are not plugged in ready for use. Some bedrooms have over-bed lights fitted but, depending on the position of the bed, these are not always within easy reach of the resident. Not all residents had easy access to a call bell in their bedroom, so they could summon staff assistance if required. In some rooms, there was no call bell extension near the bed. In one room, there was a pressure pad on the floor to alert staff if the resident got out of bed. However, this was plugged into the call bell system so the call bell extension was not working. In one bedroom, a resident was watching television but the quality of the picture was poor. The home has five bathroom/shower rooms, but at present there is no assisted bath available for those residents who may find difficulty in accessing the bath. Mr Gunputh and Mrs Gunputh provided a letter of undertaking upon registration to complete a schedule of work within agreed timescales. It was agreed to review the assisted bathroom provision and take action to improve the facilities within three months of the home opening in July 2007. Mr Gunputh says that an assisted bathroom will be provided in the near future. We found that toilet paper, soap and towels are not always available in bathrooms, toilets and ensuite facilities. Several toilets were soiled and in need of cleaning. Some communal bathrooms/shower rooms contain shampoo, hair conditioner and foam bath etc, also a shower mitt and “scrunchie” for washing with, apparently for general use rather than residents using their own personal toiletries and flannels etc. The home has a small laundry room equipped with a washing machine and tumble dryer. Soap and paper towels were not available at the wash hand basin so that staff could wash their hands after handling dirty laundry. A clinical waste bin, incontinence pads, vacuum cleaner and hoist slings are also situated in the laundry room and the area was generally cluttered. All areas of the home that were seen during the tour of the home were generally in a clean condition, with the exception of a few toilets. Further work is needed to improve infection control measures within the home: • • • • A male urinal containing a small amount of urine was left in the laundry room, rather than being taken to one of the sluice rooms to be cleaned appropriately. An empty fabric softener bottle is also being used as a male urinal. Soiled bed linen has not been changed in some bedrooms. One of the commodes is heavily stained and rusty. This commode had not been emptied when the room was seen at 10:20am. Seacliff Care Home DS0000068785.V353931.R01.S.doc Version 5.2 Page 24 • • Sluices are not always equipped with soap and paper towels, so that staff may wash their hands after dealing with soiled items. Staff do not have easy access to supplies of hand hygiene gel to help prevent the risk of any cross-infection. Seacliff Care Home DS0000068785.V353931.R01.S.doc Version 5.2 Page 25 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 poor. This judgement has been made using available evidence including visits to Seacliff Care Home. Staffing levels must be reviewed to ensure the care needs of residents can be met. Poor recruitment practice and shortfalls in staff training within the home do not consistently protect the residents to ensure that they are in safe hands at all times. EVIDENCE: Two versions of the staffing rosters are available for the month of October, (one of which says November) but neither accurately records the actual staff on duty. The rota does not identify which members of staff are responsible for cooking and cleaning. The rota for the first day of inspection shows three staff on duty in the morning and two in the afternoon. Many of the residents have complex needs and this staffing ratio is insufficient, particularly as one care assistant also has to prepare and cook the meals. The rota shows that on frequent occasions, there are shifts where only two staff are on duty. Mr Thomas says two wakeful staff are employed at night. However, the rota shows only one member of night staff on duty on a number of occasions throughout the month. Mr Thomas explained that an agency is used to provide additional staffing at night. However, this is not always recorded on the rota. Seacliff Care Home DS0000068785.V353931.R01.S.doc Version 5.2 Page 26 The home was unable to provide any information about the agency staff being employed, to ensure that suitable employment checks had been carried out and the staff had the knowledge and ability to meet the needs of residents at Seacliff Care Home. In response to the concerns expressed about staffing levels, Mr Gunputh agreed to recruit additional staff as a matter of urgency. Until this can be achieved, Mr Gunputh will deploy experienced staff from his other care homes to assist at Seacliff Care Home. Residents say they are well looked after and staff treat them with kindness. Comments include, They are very good to me, they are nice people here.” The people here are kind to me. This is a nice place, I like it here.” The home has not achieved the minimum ratio of 50 trained members of care staff at National Vocational Qualifications (NVQ) level 2 or equivalent, to help ensure residents at Seacliff Care Home are in safe hands. Only two of the current care staff have National Vocational Qualifications, one in care and one in catering. Documentation demonstrates that the home is not operating a thorough recruitment procedure to ensure the protection of residents. We examined the files for all staff and none contained all of the necessary documentation, e.g., a Criminal Records Bureau (CRB) disclosure, Protection Of Vulnerable Adults (POVA) check, full employment history, a statement by the person as to his/her mental and physical health, photograph, proof of identity and two appropriate written references. To ensure the safety of residents, it is essential that all of the required documentation is in place prior to the commencement of employment. Very few training records were available at the time of inspection. Training certificates are held in a few staff files, but these are for training undertaken by staff before commencing working at Seacliff Care Home. The majority of staff have no previous experience of working in a care setting. They appear very enthusiastic and keen to learn. However, most have received only a brief orientation and induction period lasting one or two days. There is no evidence of a full induction taking place, in line with the Skills for Care Common Induction Standards. There are no training plans or any individual staff training profiles in place, to ensure that staff have the knowledge they require to be able to care for residents and meet their needs. One of the care plans viewed clearly indicates that a resident may exhibit aggressive behaviour. There is no evidence that staff have been appropriately trained to deal with this. We were not able to evidence that those involved in cooking meals at Seacliff Care Home have received basic food hygiene training, or that they had been trained in meeting the nutritional needs of the elderly or people with dementia. Seacliff Care Home DS0000068785.V353931.R01.S.doc Version 5.2 Page 27 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, 36 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including visits to Seacliff Care Home. Management responsibilities are not being fully discharged at the present time, which means that Seacliff Care Home is not operating a safe service. Working practices do not always ensure that the health, safety and welfare of residents and staff are promoted and protected. EVIDENCE: The quality of care provided in any care home is strongly influenced by the calibre of the registered manager and their relationship with the registered providers of the home. The manager should communicate a clear sense of direction and leadership, which staff and residents understand and are able to relate to the aims and objectives of the home. The registered providers should Seacliff Care Home DS0000068785.V353931.R01.S.doc Version 5.2 Page 28 support the manager in this role. There is little evidence to suggest this is being fully achieved at Seacliff Care Home. Mr Thomas is the registered manager and Mrs Gunputh, one of the providers, works as a member of staff when on duty, usually as a care assistant and also as cook. Some staff are not clear about whether Mr Thomas or Mrs Gunputh is in charge of the day-to-day running of the home. Because the care staff also carry out other duties, such as cleaning, laundry and cooking, they do not have clear guidelines about their role in the home. Staff commented, “We never know what we will be doing when we turn up for work each day.” “If the manager sees a toilet needs cleaning, someone is told to do it. No-one is going to clean the toilets unless they are told to do so, because it is not really their job. We are supposed to be carers.” We discussed this lack of structure and accountability with Mrs Gunputh and she told us she was now trying to recruit domestic staff, so that job roles could be more clearly defined. Policies and Procedures are available but these need to be reviewed to ensure they offer accurate guidance to staff. For example, the whistle blowing policy informs staff where they can obtain advice, but this section has not been filled in with the contact information. No evidence was available to demonstrate that Quality Assurance and quality monitoring systems are in place, to measure success in meeting the aims and objectives and Statement of Purpose of the home. Regular auditing of care plans, medication etc has not yet been commenced. There is no system in place for seeking the views of residents, relatives and other visitors to the home, for example through anonymous questionnaires. The home prefers not to have any involvement with residents personal finances. Therefore, all residents who do not wish to handle their own affairs or are unable to do so have a relative or other representative to deal with their finances etc. The home pays for services such as chiropody and hairdressing and this amount is then invoiced to residents, relatives or representatives for payment each month. Regular staff supervision must be carried out as a means of ensuring good practice, emphasising the philosophy of care within the home and looking at individual training and career development needs etc. There is no evidence that any supervision and appraisal has taken place for any of the staff employed in the home Some measures are in place to promote the safety of residents. For instance, radiators are guarded to ensure residents do not come into contact with hot surfaces. There was only limited evidence available during the inspection to demonstrate the servicing of equipment. Seacliff Care Home DS0000068785.V353931.R01.S.doc Version 5.2 Page 29 After touring the premises, looking at records and having discussions with staff, we found a number of issues which have the potential to compromise the health, safety and welfare of residents and sometimes staff at Seacliff Care Home: • At the start of the inspection, potentially harmful substances such as anti-bacterial concentrate, fabric softener, denture cleaning tablets, antibacterial surface cleaner, rinse aid and dishwasher cleaner were observed left unattended in some areas of the home. All substances that could be potentially hazardous to health must be handled and stored securely to ensure the safety of residents. (These items were immediately removed and locked away during the inspection.) The garden area was not secure and during the first day of inspection, the gate from the garden was not locked. This meant that residents could potentially wander away from the home and onto the busy road outside. (This was rectified immediately when brought to the attention of Mrs Gunputh.) Alarm call bell extension leads are not always within reach of residents, so that they can summon staff assistance if required. The standard of accident recording is generally poor. The home does not carry out any auditing of accidents and is not fully recording incidents. Where residents have particular nutritional needs, there is little evidence of appropriate nutritional assessment and screening. It could not be evidenced that staff have received the training required to meet the needs of residents, including moving and handling, infection control, first aid and the prevention of abuse. Some joins in carpets are not secure, creating potential tripping hazards. The window limiter in one bedroom is not working. (This was rectified immediately when brought to the attention of Mrs Gunputh.) There is a difference in flooring levels in some corridors, but these are not signed to identify them as potential tripping hazards. There is evidence of Portable Appliance Testing (PAT) being carried out to ensure the safety of electrical appliances, but this took place over two years ago under the previous ownership. It is not possible to evidence that staff are receiving fire training, so that they are aware of the action to take in the event of fire. (See below) • • • • • • • • • • Suitable arrangements are in place for specialist servicing of the fire warning system, emergency lighting and fire fighting equipment. However, two fire risk assessments are in place. The first was completed when the home was previously registered. The second may also have been completed under the previous management but was not dated or signed. This risk assessment was incomplete. Mr Gunputh said he would take immediate action to complete and update the fire risk assessment to ensure it was fully relevant to Seacliff Care Home. Seacliff Care Home DS0000068785.V353931.R01.S.doc Version 5.2 Page 30 The home was unable to supply any evidence to demonstrate that staff had received fire training or taken part in fire drills. A member of staff confirmed that they had not received any fire training since a brief induction when commencing work at Seacliff Care Home. Mr Gunputh undertook to ensure that all staff received fire training and participated in a drill within 48 hours. (Confirmation has subsequently been received, confirming that all staff have received training and now know the procedure to follow in the event of fire.) In order to ensure that the health, safety and welfare of residents are both promoted and protected at all times, improvements must be made in the overall management of the home, the recording, safe handling and administration of medicines; infection control, health and safety issues, staff recruitment practice, staff training and record keeping, as detailed in the body of this report. A number of requirements and recommendations have been made and we will continue to monitor the situation until we are satisfied that the necessary improvements have been made. Feedback about the outcome of the inspection was discussed with both Mr Gunputh and Mrs Gunputh. It is of concern that many of these issues had not previously been identified and acted upon by the manager, or by the providers. However, the home responded promptly and very positively in addressing the issues raised. Additional staffing, including management support, has been provided and progress is being made in implementing the necessary improvements. Seacliff Care Home DS0000068785.V353931.R01.S.doc Version 5.2 Page 31 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 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 2 X 2 X X X X 2 STAFFING Standard No Score 27 1 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 1 X 1 Seacliff Care Home DS0000068785.V353931.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? N/A STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14(1) Requirement Timescale for action 01/01/08 2. OP7 15(1) The registered persons must ensure that residents are admitted only on the basis of a full assessment. There should be appropriate consultation with the prospective resident or their relative or representative. Pre-admission assessments undertaken by the home must be fully documented and contain detailed information. The registered persons must confirm in writing to prospective residents that, following assessment, the home is suitable to meet their care needs. The registered persons must 01/01/08 ensure that care plans are drawn up as soon as possible after admission. These must include consideration of information from other sources, such as preadmission assessments, and demonstrate fully how care needs are to be met. All aspects of each residents health and welfare needs, including social, psychological or religious needs, should be recorded. DS0000068785.V353931.R01.S.doc Version 5.2 Seacliff Care Home Page 33 3. OP8 12(1)(a) 13(4)(c) 4. OP8 12(1) and 13(1) 5. OP9 13(2) The resident or their representative should agree care plans and any subsequent reviews, wherever possible. The registered persons must ensure that, wherever necessary, risk assessments are completed, e.g., in respect of wandering, nutrition and falls. Following assessment, detailed records must be kept showing the action taken to minimise any risks. The registered persons must ensure that all residents are given access to medical, nursing and support services whenever necessary, without delay. The registered persons must record medicines received, given, returned, or sent for disposal so that all medicines can be accounted for, to safeguard residents. There must be clear instructions for giving medicines, which are prescribed, “when required,” to guide staff in meeting the resident’s healthcare needs. Medicines must be stored in accordance with legal requirements and access restricted to authorised staff. Maximum and minimum temperatures of the medicines refrigerator must be monitored to ensure that medicines are stored at the correct temperature (2-8°C) to maintain their effectiveness. The medication policy must be updated so that staff have clear procedures to follow to safeguard residents. 01/01/08 01/01/08 31/01/08 Seacliff Care Home DS0000068785.V353931.R01.S.doc Version 5.2 Page 34 6. OP10 12(4)(a) 7. OP12 16(2) (m) and (n) 13(6) and 12(1)(5) 8. OP18 Staff must record the date of opening eye drops and other medicines with a limited life so that they can be replaced when expired to prevent infection. The registered persons must ensure that suitable arrangements are made to ensure that the privacy and dignity of residents are always respected. Issues identified in this report must receive attention. (See Standard 10 for details.) The registered persons must consult residents about their interests and provide a suitable programme of activities. The registered persons must ensure that residents are safeguarded from all possible forms of abuse, e.g., physical, financial, sexual, psychological, discriminatory or neglect. 31/01/08 31/01/08 01/01/08 9. OP19 16(2)(c) 10. OP21 23(2)(a) The policy and procedure giving guidance to staff must be updated to ensure it is relevant to Seacliff Care Home. Staff must receive training in Adult Protection issues, to ensure a proper response to any suspicion or allegation of abuse. The registered persons must 01/01/08 ensure that residents have easy access to equipment in bedrooms, such as bedside lights and televisions, also call bells so they can summon staff assistance when needed, unless a risk assessment clearly identifies why this is not possible, e.g., for safety reasons. The registered persons must 31/03/08 ensure that the design and layout of the care home can meet the needs of residents. Consideration must be given to DS0000068785.V353931.R01.S.doc Version 5.2 Page 35 Seacliff Care Home 11. OP26 13(3) 12. OP27 18(1)(a) 13. OP28 18(1)(a) 14. OP29 19(1) 15. OP30 18 ensuring that residents have access to an assisted bath, (as agreed prior to registration). The registered persons must make suitable arrangements to prevent infection and the spread of infection in the care home. Issues raised in this report must receive attention. (See Standard 26 for details.) The registered persons must employ suitably qualified and experienced staff, in sufficient numbers to meet the needs of residents. The registered persons must increase the proportion of staff that has gained a nationally recognised qualification in care, e.g., National Vocational Qualification (NVQ) level 2. The registered persons must not employ staff to work with residents until satisfactory recruitment checks have been fully completed and all necessary documentation has been received. This includes obtaining sufficient information in relation to Agency staff, ensuring that suitable employment checks have been carried out and that staff have the knowledge and ability to meet the needs of residents at Seacliff Care Home. The registered persons must ensure that all staff receive training appropriate to the work they are to perform, such as dementia awareness and dealing with challenging behaviour. Training must also include mandatory subjects, such as Moving and Handling and provide access to structured induction training. It is required that a detailed DS0000068785.V353931.R01.S.doc 31/01/08 01/01/08 31/03/08 01/01/08 01/01/08 Seacliff Care Home Version 5.2 Page 36 16. OP31 10(1) and 12 17. OP33 10(1) and 12(1) 18. OP33 24(1) 19. OP36 18(2) 20. OP38 13(4)(a) audit of training be carried out and a training programme drawn up and implemented, to ensure that all staff are provided with the knowledge and skills necessary to carry out their work. A copy of this audit and training programme must be forwarded to the Commission for Social Care Inspection. The registered persons must manage the care home with sufficient care, competence and skill and communicate a clear sense of direction and leadership. The registered persons must ensure that policies and procedures are reviewed and updated to provide accurate guidance to staff and ensure the safety of residents. The registered persons must establish and maintain a system for a) reviewing and b) improving the quality of care provided. This should include internal quality audits of care plans and accident records etc. The views of residents, relatives, staff and visitors to the home should be sought, for example through anonymous questionnaires. The registered persons must ensure that staff working in the care home are appropriately supervised. The registered persons must ensure that all parts of the home to which residents have access are, so far as reasonable, free from hazards to their safety. This includes ensuring that potentially hazardous substances are not left accessible to DS0000068785.V353931.R01.S.doc 01/01/08 01/01/08 31/01/08 01/01/08 01/01/08 Seacliff Care Home Version 5.2 Page 37 vulnerable residents; that the rear garden is made secure to prevent residents from wandering into the busy road outside and removing any tripping hazards. For full details, see Standard 38. 21. OP38 23(4)(c) and (d) The registered persons must ensure, so far as is reasonably practicable, the health, safety and welfare of residents and staff. All staff must receive suitable fire training and fire drills at appropriate intervals. A fire risk assessment, which is relevant to Seacliff Care Home, must be put in place. You must also develop and implement an action plan to be followed in the event of fire. 01/01/08 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 Care plans should include information about medication to help staff meet residents’ healthcare needs. When medicines are handwritten on the Medicine Administration Record (MAR) chart, a second competent person should check the details are accurate and countersign. It is recommended that, where possible, further information about each residents background, social history, previous hobbies and interests etc. is recorded, to ensure that the activities on offer at Seacliff Care Home will be meeting the individual needs, preferences and expectations of residents. DS0000068785.V353931.R01.S.doc Version 5.2 Page 38 2. OP12 Seacliff Care Home 3. 4. OP14 OP15 It is recommended that a review of televisions provided in bedrooms is carried out, to ensure they are in full working order and there is adequate picture quality. It is recommended that the home should offer a nutritious diet that includes a greater variety of fruit and vegetables. Residents should be consulted about the menu to ensure it meets their individual preferences. Seacliff Care Home DS0000068785.V353931.R01.S.doc Version 5.2 Page 39 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 Seacliff Care Home DS0000068785.V353931.R01.S.doc Version 5.2 Page 40 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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