Inspection on 15/05/07 for Sedlescombe Park Residential Home

This inspection was carried out on 15th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Sedlescombe Park Residential Home 22/05/08

Sedlescombe Park Residential Home 26/06/06

Sedlescombe Park Residential Home 28/12/05

Sedlescombe Park Residential Home 23/09/05

Sedlescombe Park Residential Home 26/08/04

Sedlescombe Park Residential Home 01/04/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Sedlescombe Park Residential Home 241 Dunchurch Road Rugby Warwickshire CV22 6HP Lead Inspector Michelle O’Brien Unannounced Inspection 15th May 2007 09:40 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Sedlescombe Park Residential Home DS0000004295.V335232.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. Sedlescombe Park Residential Home DS0000004295.V335232.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sedlescombe Park Residential Home Address 241 Dunchurch Road Rugby Warwickshire CV22 6HP 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) 01788 813066 01788 813066 Pinnacle Care Ltd Mr A Dytham Mrs Anna Josephine O Connor Care Home 24 Category(ies) of Dementia - over 65 years of age (22), Old age, registration, with number not falling within any other category (2) of places Sedlescombe Park Residential Home DS0000004295.V335232.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered manager (Anna O`Connor) must obtain a suitable management qualification (equivalent to NVQ 4) by December 2006. 26th June 2006 Date of last inspection Brief Description of the Service: Sedlescombe Park is a large detached dwelling set in its own grounds, off the main Dunchurch Road in Rugby. The home is approximately ¾ mile from the town centre. There is a local bus route into the town along Dunchurch Road. A small range of local shops are near by. The Care Home is registered to accommodate up to 24 older persons with dementia. The accommodation is over two floors accessed via a passenger lift. Accommodation is mostly single rooms with some shared rooms. There are 2 lounges and a large conservatory has recently been built to the rear of the property, which serves as a dining room. The corridors throughout the home are narrow which makes it difficult for wheelchair users. The front entrance to the home is via two steps but there is alternative access for wheelchairs from the side and back of the home. Gardens to the front and rear of the property are landscaped. A drop off and turn area for cars with a small parking area is at the front of the property. The services provided for service users at Sedlescombe Park are on a personal care basis only for people with dementia. Nursing care is not provided in this home, nursing needs are met by the district nurse services. The current weekly charge for a person living in the home is £508 Sedlescombe Park Residential Home DS0000004295.V335232.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection visit which addresses all essential aspects of operating a care home. This type of inspection seeks to establish evidence showing continued safety and positive outcomes for people living in the home. This report uses information and evidence gathered during the key inspection process which involves a visit to the home and looking at a range of information. This includes the service history for the home and inspection activity, notifications made by the home, information shared from other agencies and the general public and a number of case files. The visit to the home was made on 15th May 2007 between 9.45am and 5.15pm. 21 people were living in the home on the day of the visit. It was the assessment of the home manager that most of the people living in the home had high dependency needs. A pharmacist inspector spent two hours in the home on 14th May 2007 assessing the home’s management of medicines. Documentation maintained in the home was examined including staff files and training records, policies and procedures and records maintaining safe working practices. A tour of the building and several bedrooms was made. The inspector had the opportunity to meet most of the residents by visiting them in their rooms, spending time in the communal lounges and talking to several of them about their experience of the home. There was an opportunity to chat socially when the inspector joined residents for their midday meal. General conversation was held with others, along with observation of working practices and staff interaction with the people living in the home. The home manager was present throughout the day. The inspector also spoke to several care staff. The care of three people living in the home was identified for close examination by reading their care plans, risk assessments, daily records and other relevant information. This is part of a process known as ‘case tracking’ where evidence of the care provided is matched to outcomes for the people using the service. The manager completed and returned a pre inspection questionnaire before the inspection visit. Two survey forms from people living in the home and 5 relatives’ survey forms were returned; their comments are included in this report. Sedlescombe Park Residential Home DS0000004295.V335232.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Care plans must be available for each of the identified needs of people living in the home and contain details of the actions required to meet each need. Care plans must be reviewed and at least monthly or when there is a change in need. This is ensure that people get the care they need. Systems must be in place to identify any risk to the health or well being of people living in the home and must include details of how any identified risk Sedlescombe Park Residential Home DS0000004295.V335232.R01.S.doc Version 5.2 Page 7 can be reduced. This must include the risk of developing pressure sores and the use of bedrails. This is to make sure that risks to the health or well being of residents are identified and reduced. Arrangements must be made to ensure that any allegation or suspicion of abuse is referred for investigation under local Joint Agency Guidelines. All staff must have abuse awareness training in how to recognise and respond to allegations or suspicion of abuse. This is to ensure that people living in the home are safeguarded from abuse. Systems must be in place to ensure that staff do not start working in the home until satisfactory pre employment checks, including CRB and PoVA, have been obtained. This is to ensure that people living in the home are protected from the risk of abuse. Arrangements must be made for all staff to have a current mandatory training. This is to include food hygiene, fire safety, abuse awareness, infection control and moving and handling. This is to ensure that residents and staff are protected from the risk of harm due to incorrect moving and handling techniques. 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. Sedlescombe Park Residential Home DS0000004295.V335232.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sedlescombe Park Residential Home DS0000004295.V335232.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 and 3 were assessed. Quality in this outcome area is good. People who are considering moving into the home benefit from having their care needs assessed so that they can be sure the home can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s statement of purpose has been updated since the last inspection and contains information about the service people can expect to receive when they move in. The case files of three people identified for case tracking were examined to assess the pre-admission assessment process. The manager said that it was usual practice for a senior member of staff to visit people who are considering moving into the home to undertake an assessment of their needs and abilities. Sedlescombe Park Residential Home DS0000004295.V335232.R01.S.doc Version 5.2 Page 10 Each of the files examined contained information about all of the person’s needs and abilities and confirms that the home can meet their needs. Files also contained pre-admission information provided by professional health and social care agencies. Information gathered about the needs and abilities of people living in the home is used to develop care plans to meet these needs. Sedlescombe Park Residential Home DS0000004295.V335232.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 were assessed. Quality in this outcome area is adequate. People living in the home are treated respectfully. They each have a plan of care and are protected from harm by improvements in the management of medicines. However, care plans do not consistently describe what staff have to do to meet the identified needs of people living in the home which puts them at risk of not having their needs met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Observations during the key inspection visit found that people living in the home looked well cared for and were clean, their hair had been combed and nails were trimmed and clean. They were well presented and wore clothes that were suited to the time of year. One relative commented, ‘The residents always appear to be happy when we visit, so we can only assume they are doing everything well.’ Sedlescombe Park Residential Home DS0000004295.V335232.R01.S.doc Version 5.2 Page 12 It was evident from observation that the personal care needs of people living in the home are met and those residents with more strengths and abilities are provided with a good quality of life. The majority of people living in the home at this inspection visit looked well and happy and are supported to maintain their abilities. One relative commented, ‘They are good at taking care of each individual’s needs.’ However, it was also evident that as the needs of residents become more complex the service does not consistently respond to the changes in need to reflect them in appropriate care plans. Three people were identified for case tracking. Each person had a care plan, daily records and monitoring records. Care plans were generally based on information secured during the initial care needs assessment. The ethos of the home is to build on the strengths and abilities of each individual. Each case file contained details of the strengths and abilities of the person and identified needs. However, care plans do not consistently describe the actions staff need to take to meet each individual need. For example, one resident has leg ulcer dressing changes by the district nurse. The care plan contains no details of the frequency that the district nurse calls to change the dressings or other care required, such as whether the person can bath or shower. Another resident was identified on assessment as having a challenging behaviour and although a risk assessment was available there were no directions for staff about how to manage the incidents of challenging behaviour. A third resident is receiving treatment from the district nurse for a sever pressure sore; the care plan and assessment was not updated to reflect this. A Dynamic airflow mattress is in use but this is not detailed in the care plan. A ‘turn chart’ was available for this person for repositioning but there was no details of how frequently the person should be re positioned to reduce pressure to their pressure areas. The inspector asked a member of the care staff about the frequency of ‘turns’ and the response was, ‘I think it’s hourly.’ The ‘turn chart’ recorded hourly or two hourly repositioning but on 14th May there is no record of the person being repositioned between 12 midday and 11 pm at night. This puts this person at an increased risk of developing further pressure sores or a deterioration of the existing sores. Review of care plans is evidenced by a staff signature indicating they have reviewed the plan. It was evident that this is undertaken every three months. Care plans must be reviewed and updated where necessary at least monthly or when there is a change in need to avoid an oversight of care. There is evidence of relatives being invited to attend a review of care for their loved ones but no evidence of any reviews actually taking place. Sedlescombe Park Residential Home DS0000004295.V335232.R01.S.doc Version 5.2 Page 13 People living in the home have their weight monitored monthly and two of the people case tracked were noted to have sustained their weight; the third person became too poorly to use the weighing scales. Access to other healthcare professionals such as the district nurse, GP and optician are recorded in the case files of people living in the home. One relative said, ‘Hospital appointments have been kept.’ However, the case file of the resident with a grade 4 pressure sore did not record a GP visit since last year despite an obvious deterioration of the person’s health. Risk assessments are available for falls, nutrition and moving and handling but care plans are not consistently developed for identified risks. For example, one resident required a soft diet to maintain their nutritional needs and, although staff were aware of this, it was not recorded in a care plan. The service does not use a tool to identify residents who are at risk of developing pressure sores. This means staff are not aware of those people who have an increased risk of developing pressure sores so there are no care plans developed to reduce any risk. This means that people living in the home have a greater risk of developing a pressure sore. The use of bed rails is implemented without a risk management strategy that details the reason for their use or the potential of restraint or entrapment. This puts people living in the home at an increased risk of harm. The pharmacist inspector assessed the medicine management in the home on 14th May 2007. General procedures were inspected together with randomly chosen medicine charts, their corresponding medication and daily records. On entry to the home the medication room door was wedged open allowing free access to all the people who live in the home, any visitors and staff. The district nurse had left this open while dealing with a resident. Medicines were freely available to all people who had access to the room as some of the medicines held inside were not secured in a locked cabinet or medicine trolley and medicines awaiting return to the pharmacy were left in open boxes. The medicine charts containing confidential information were also freely available to read on entry to the room. Currently one member of staff prepares the medicines for administration and signs the medicine chart and another member of staff takes this to the person for them to take. The actual person who signs the medicine chart does not actually witness the administration or undertake this role. The medicine chart does not truly reflect what has occurred. The person who administers the medication does not have sight of the medicine chart to check against. This increases the risk of a medication error, which may affect the well-being of the people who live in the home. Sedlescombe Park Residential Home DS0000004295.V335232.R01.S.doc Version 5.2 Page 14 The home has no trolley to transport the medicines to the people who live in the home. This increases the risk to the residents because there is nowhere to secure to the medicines in the event of an emergency. Audits were undertaken to see if the medicines had been administered as prescribed and whether records reflected practice. Some medicines had been recorded as administered when they had not been and others had been administered but not recorded. However these were in their minority and the majority of medicines had been administered as prescribed and recorded as such. The home has a system to check the medicines received into the home. This needs to be improved to ensure that all the medicines are available to administer at the beginning of the cycle. Problems exist where the prescriptions are not written in enough time to ensure a continuous supply. The manager has tried to address this with the surgeries in question. The majority of medicine charts are computer printed by the pharmacist but a few were hand written. A few discrepancies were found, where the details recorded on the medicine chart did not match the printed label on the medicines and one medicine chart had no date so information recorded as meaningless. All staff have received accredited training in the medication process from the local pharmacist. Further training is required to ensure that the staff know what the medicines are for and their general side effects. All the controlled drug balances were correct, accurately recorded in the CD register and stored correctly. Further good practice was seen. Medicines prescribed for occasional use had an individual protocol detailing their use. All medicine charts had a facing page with an identification photograph of the person. A system to confirm when the district nurse is due to administer medicines every one to three months is in place. Daily records reflected the medicines that are administered and any healthcare appointment is recorded. All new people who come to live in the home are immediately booked a medication review with their doctor and further medication reviews are regularly sought. The manager has installed a quality assurance system by undertaking regular audits to assess whether the staff administer medicines correctly. The manager was keen to improve the medicine management further and this is commended. People living in the home were observed to be treated with respect and their dignity maintained; for example, personal care was provided in private and residents were spoken to respectfully. During observation of working practice it Sedlescombe Park Residential Home DS0000004295.V335232.R01.S.doc Version 5.2 Page 15 was evident that staff are knowledgeable about the likes and dislikes of people living in the home and were kind, caring and attentive towards them. Sedlescombe Park Residential Home DS0000004295.V335232.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): Standards 12, 13, 14 and 15 were assessed. Quality in this outcome area is good. People living in the home are supported to maintain their independence and enduring interests which enhances their quality of life. Mealtimes are celebrated as a social occasion and residents benefit from a varied and nutritious choice of food. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has an ethos of building on a person’s strengths and abilities. This is reflected in the case files of each person where a ‘life history’, interests, important relationships and personal preferences are recorded to assist staff in providing ‘person centred’ care. One relative commented, ‘They treat my relative very well, I have seen evidence that they take the time and trouble to have conversations with him to make him feel important.’ The home does not have a planned programme of activities but staff support people living in the home to participate in activities and plan how to spend their time on a day to day basis, depending on their preferences for that day. On the day of this unannounced visit, a reminiscence therapist visited the home in the morning and several of the residents participated in the session. A musical entertainer provided a sing-a-long enjoyed by many residents in the Sedlescombe Park Residential Home DS0000004295.V335232.R01.S.doc Version 5.2 Page 17 afternoon and an extra member of staff came on duty for several hours to escort a small group of residents to the local pub. The hairdresser visited in the morning and the female residents, in particular, enjoyed having their hair ‘done’. Staff spoken to were familiar with the preferences of residents and the type of activities that might engage and stimulate each individual. A record of group and individual activities is maintained in the home. The home has an open visiting policy. People are encouraged to maintain links with their family, friends and local community. One relative said, ‘My relative likes to go to church and the carers always have them ready to be collected on a Sunday morning and save their lunch for them when they return.’ The inspector joined residents at 1pm for their midday meal. Staff invited residents to have their meal in the bright, pleasant surroundings of the conservatory dining area but some chose to remain in the lounge area or their own rooms. Tables were beautifully set with linen tablecloths and slip cloths which lent a ‘restaurant type experience’ to the social occasion of people coming together to enjoy their meal. It was observed that even the most physically dependent residents in the home were supported to use ‘proper’ cups and saucers as opposed to plastic cups or beakers to promote their self esteem and dignity. Staff told the inspector that he midday meal is always three courses. Residents were offered a starter of soup followed by a choice from Sausages in onion gravy, cheese and potato pie or lamb chops accompanied by cabbage, carrots, new or mashed potatoes and gravy. Dessert was a choice of chocolate sponge and custard or fruit salad and cream. Staff offered each resident a choice of meal at the table; those people who found it difficult to choose were assisted by staff who brought the meal to them as a visual prompt The meal was served from a heated trolley from the kitchen and was beautifully presented, nutritious and tasty. Residents made positive comments about the food they were offered in the home and told the inspector that if any choice of the main meal was not their preference an alternative was offered. Food was plentiful and ‘seconds’ were offered. A cooked breakfast is offered twice a week. Staff offered assistance to those people who required it in a sensitive and discreet manner. The most recent Environmental Health Officer’s inspection of the home’s kitchen awarded a Silver Standard for Food Hygiene in July 2006. Sedlescombe Park Residential Home DS0000004295.V335232.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 were assessed. Quality in this outcome area is adequate. People living in the home can be confident that their concerns will be listened to and acted upon but the lack of abuse awareness training does not safeguard people from potential harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a formal complaints policy which is accessible to people living in the home and their families. People are encouraged to raise their concerns with the manager. We have received one complaint about this service since the last key inspection. This concerned the safe storage of medication and was referred to the manager to investigate and respond to. Evidence was available of a timely and objective response. The home maintains a record of complaints and their response. This could be enhanced by recording verbal concerns received so that the home can actively demonstrate how they respond to the concerns of people living in the home. Comments from relatives about the way the home responds to concerns included: • ‘Good lines of communication.’ • ‘I have not raised any concerns but I would feel happy to approach the manager.’ Sedlescombe Park Residential Home DS0000004295.V335232.R01.S.doc Version 5.2 Page 19 • ‘Have no complaints about anything. Staff are all helpful and answer any concerns that we have about our parents.’ Since the last Key Inspection in June 2006 there has been one referral for investigation under Adult Protection Procedures in response to information shared about an allegation of possible abuse. The concerns raised related to the challenging behaviour of one resident impacting on the safety of other people living in the home. The primary care trust provided funding for one to one supervision of the person with challenging behaviour until the matter was resolved. It is of concern that the home was aware of the challenging behaviour of the person but did not have a care plan recording strategies for the management of this. The service did not recognise the behaviour as potentially abusive; the information was shared by another health professional visiting the home. Discussion with the manager evidenced that she was familiar with local Adult Protection Procedures and how to refer allegations of abuse. However, staff training records show that 50 of staff employed in the home have not had training in recognising and responding to signs of abuse. Staff must have abuse awareness training so that people living in the home are safeguarded from potential harm. Sedlescombe Park Residential Home DS0000004295.V335232.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26 were assessed. Quality in this outcome area is adequate. Residents benefit from homely and ‘lived in’ surroundings but some working practices do not protect people from the risk of infection. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager accompanied the inspector on a tour of the home. All of the bedroom doors have been painted and numbered since the last inspection and residents were given a choice of ‘door knocker’ for their bedroom door. This should help residents who have dementia to identify their own rooms more easily. In addition, some of the rooms have a photograph of the occupant on the door to further identify who the room belongs to. There are pictures on each communal toilet to enable residents to identify where they are, but there is no further signage throughout the home. Accommodation is Sedlescombe Park Residential Home DS0000004295.V335232.R01.S.doc Version 5.2 Page 21 provided over two floors with lots of narrow corridors and ‘nooks and crannies’ which a person with dementia may find difficult to navigate. The communal lounges of the home are homely and lived in; there are lots of items such as games, dolls, magazines, books and soft furnishings available and easily accessible to residents. Independently mobile residents ‘pottered’ around the home freely. Decoration in corridors is tired and worn in places. Bedrooms varied in the quality of decoration and furnishings provided. Some contained matching furniture with carpets and soft furnishings to match the décor; other rooms were more sparse. Residents are encouraged to personalise their rooms with their own belongings such as photos, small items of furniture and ornaments. One person living in the home has their own individual phone line installed with a cordless phone enabling them to take personal calls in any part of the home they choose to use. The visiting hairdresser was using one person’s room as a ‘hairdressing salon’ during her visit. Although the manager said the home had obtained the permission of the person’s relatives this practice does not uphold the privacy and dignity of the person who is giving up their room to accommodate other residents having their hair done. Consideration must be given to allocating the hairdresser to a communal area or making individual visits to each resident in their individual rooms. A new bath hoist has been fitted in the upstairs bathroom to ensure there are sufficient bathing facilities accessible to people living in this part of the home. The laundry room was unlocked which could allow residents access to the detergents and other cleaning materials stored there. The laundry room is very small and there appeared to be no system for identifying separate areas for clean and dirty laundry. This presents a risk of cross infection. During the inspection visit residents were observed to wear appropriate and well laundered clothing. Commode pans are washed in the sink in the laundry room and the inspector was told they were washed with disinfectant. There was no policy available in the home to describe how commode pans should be cleaned or with what cleaning solution, so we cannot be sure that commode pans are cleaned effectively. The commode pans are not individually named so we cannot be sure that the pan is returned to each individual after it is cleaned. Comments from relatives about the environment in the home included: • ‘The infection control needs to be improved.’ • ‘Some of the decoration could be improved around the home.’ Sedlescombe Park Residential Home DS0000004295.V335232.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28 29 and 30 were assessed. Quality in this outcome area is adequate. There are sufficient numbers of staff on duty most of the time to meet the needs of people living in the home but further training is needed to make sure people are cared for by competent staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager confirmed that the usual staffing complement for the home is: 7.30am – 2.30pm 2.30pm – 9.30pm 9.30pm – 7.30am 3 or 4 Care Staff 3 Care Staff 2 Care staff (who are awake throughout the night) The manager’s hours are supernumerary. There is a member of catering staff in the kitchen between 8am and 2pm each day to prepare breakfast and the main midday meal. Kitchen staff prepare the evening meal but it is heated and served by care staff. The home has one person undertaking cleaning duties Sedlescombe Park Residential Home DS0000004295.V335232.R01.S.doc Version 5.2 Page 23 between 8am and 2pm daily which includes some general domestic tasks in the kitchen during the midday meal service. Care staff undertake laundry duties. The home does not use agency staff to cover unplanned absence such as sickness but relies on permanent staff working overtime. This means that people living in the home have some continuity and are cared for by staff that are familiar with their needs. Three weeks of the home’s duty rota between 24th February and 16th March 2007 was examined and demonstrated that the staffing levels set by the home (in the table above) are consistently achieved. One resident said, ‘There is the odd circumstance when the staff member required is not available until later. However, there is never a time with no staff. Also, the principal’s office is next door to the lounge we occupy.’ One member of care staff said, ‘Most of the time there are enough staff to attend to residents and do the laundry or help with the meals, but sometimes it’s really hard. It only takes one thing to go wrong and it puts us behind’ Three of the 12 care staff employed in the home have a National Vocational Qualification in Care (NVQ) at level 2 which, at 25 , is well below the National Minimum Standard for 50 of staff to be qualified. However, a further four members of care staff are currently working towards this award which should mean that people living in the home are cared for by competent staff. The personnel files of two recently recruited staff were examined and both contained evidence of satisfactory checks such as Criminal Record Bureau (CRB), Protection of Vulnerable Adult (PoVA) and references. However, records evidenced that both staff members started working in the home before a satisfactory CRB or ‘PoVA First’ was obtained. This practice does not protect people living in the home from the risk of abuse. Staff training records demonstrate that up to 50 of staff do not have up to date mandatory training in food hygiene, fire safety, abuse awareness, infection control and moving and handling. This is not sufficient to safeguard people living in the home from the risk of harm. Comments from relatives include: • The mature staff are good, the young ones look indifferent’ • ‘Everyone has always been very helpful.’ • ‘Staff are always helpful’ • ‘Staff are professional and caring in their attitude’ • ‘New staff are integrated well.’ Sedlescombe Park Residential Home DS0000004295.V335232.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33 and 38 were assessed. Quality in this outcome area is adequate. The manager is qualified to run the service but some working practices and absence of staff training fails to ensure the safety of people living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has been in post for just over two years and is registered with the Commission. She is experienced in the care of older people and has completed the Registered Manager’s Award (NVQ Level 4). There was some evidence of surveying the opinion of people living in the home, their relatives and other health care professionals by using questionnaires covering a different aspect of the service received each month. Sedlescombe Park Residential Home DS0000004295.V335232.R01.S.doc Version 5.2 Page 25 There was no evidence that the responses are collated, analysed or used by the manager to develop action plans where this is necessary. The manager must be able to demonstrate that there is a regular review of the quality of care and services being provided and the results of any quality exercise are published in the home with details of actions taken to address any concerns raised. The service does not hold service users’ personal monies or valuables for safe keeping so standard 35 is not applicable and was not assessed. Service users are invoiced for additional costs such as hairdressing or chiropody. A sample of service and maintenance records were examined and found to be up to date; hoists were serviced in April 2007, Fire alarm systems are checked weekly, hot water outlet temperatures are recorded weekly and were noted to be within recommended limits and Electrical Portable Appliance Testing was completed in January 2007. The Fixed Electrical Installation Certificate (‘5 year electrical check’) was not available during this inspection visit or the previous inspection visit. Cleaning chemicals were left unattended in an upstairs corridor which presents a health and safety risk to people living in the home. This hazard also was noticed during the inspection visit of June 2006 indicating that it has not been addressed by management. A person living in the home sustained a broken leg following a fall in the home in December 2006. There was no evidence available that this incident has been reported to the Health and Safety Executive under RIDDOR (Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995). The home’s programme of mandatory training needs to include all staff to ensure the safety of people in the home. Sedlescombe Park Residential Home DS0000004295.V335232.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 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 N/A X X 2 Sedlescombe Park Residential Home DS0000004295.V335232.R01.S.doc Version 5.2 Page 27 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 OP7 Regulation 15 Requirement Timescale for action 31/07/07 2 OP8 12 3 OP9 13(2) Care plans must be available for each of the identified needs of people living in the home and contain details of the actions required to meet each need. Care plans must be reviewed and at least monthly or when there is a change in need. This is ensure that people get the care they need. 31/07/07 Systems must be in place to identify any risk to the health or well being of people living in the home and must include details of how any identified risk can be reduced. This must include the risk of developing pressure sores and the use of bedrails. This is to make sure that risks to the health or well being of residents are identified and reduced. Systems for transporting 14/06/07 medicines around the home for administration must be reviewed. This is to make sure medicines are stored and transported safely and securely. Sedlescombe Park Residential Home DS0000004295.V335232.R01.S.doc Version 5.2 Page 28 4 OP9 13(2) 5 OP9 13(2) 6 OP18 13 The care assistant who administers the medication must check the medicine chart before any administration and sign the chart following the transaction and accurately record what has taken place. The medication room must be kept locked when not in use and all medicines must be held in a locked facility inside the room including items awaiting return to the pharmacy for destruction. Arrangements must be made to ensure that an allegation or suspicion of abuse is referred for investigation under local Joint Agency Guidelines. All staff must have abuse awareness training in how to recognise and respond to allegations or suspicion of abuse 14/06/07 14/06/07 30/06/07 7 OP29 18 8 OP30 18 This is to ensure that people living in the home are safeguarded from abuse. Systems must be in place to 15/06/07 ensure that staff do not start working in the home until satisfactory pre employment checks, including CRB and PoVA, have been obtained. This is to ensure that people living in the home are protected from the risk of abuse. Arrangements must be made for 31/07/07 all staff to have a current mandatory training. This is to include food hygiene, fire safety, abuse awareness, infection control and moving and handling. This is to ensure that residents and staff are protected from the risk of harm due to incorrect moving and handling techniques. DS0000004295.V335232.R01.S.doc Version 5.2 Page 29 Sedlescombe Park Residential Home RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP9 OP9 Good Practice Recommendations It is recommended that new service users medication is checked with the doctor on entry to the home immediately whilst awaiting the medication review. It is recommended that the home sees all prescription before they are dispensed and a photocopy is taken to check the medicine chart and medicines received against and all details hand written on the medicine chart are transcribed from the original prescription and checked for accuracy. The medicines should be transported around the home in a lockable medication trolley which can be secured in the event of an emergency It is recommended that further training is sought which includes the indications and side effects of the medicines that are prescribed and administered by the staff. Arrangements must be made for the cleaning and disinfecting of commode pans which should include instructions about the cleaning solutions and method to be used by staff. This should reduce the risk of cross infection and safeguard residents from harm. Arrangements for the management of soiled laundry should be reviewed to prevent mixing clean and dirty laundry. This should reduce the risk of cross infection and safeguard residents from harm. A system should be implemented to make sure that the numbers of staff required to meet the needs of residents are available on duty at all times. The service must be able to demonstrate that the needs of residents are considered when deciding the number of staff required. This is to ensure that the needs of people living in the home are consistently met in a way that is acceptable to them. 3 4 5 OP9 OP9 OP26 6 OP26 7 OP27 Sedlescombe Park Residential Home DS0000004295.V335232.R01.S.doc Version 5.2 Page 30 8 OP28 9 OP33 10 11 OP38 OP38 The service should be able to demonstrate that 50 of care staff have a National Vocational Qualification in Care at level 2 or equivalent. This is to ensure that people living in the home are cared for by competent staff. The service should be able to demonstrate the review of working practices and quality of care delivered to people living in the home. This should ensure that the home is run in the best interests of people living in the home. Cleaning materials such as detergents and disinfectants should be stored securely to prevent access for residents. This should ensure the safety of people living in the home Systems should be in place to ensure the effective maintenance of equipment and services in the home and records should be available for inspection. This should promote the safety of people in the home. Sedlescombe Park Residential Home DS0000004295.V335232.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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. 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