Inspection on 14/08/07 for Seymour House

This inspection was carried out on 14th August 2007.

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

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

Other inspections for this house

Seymour House 13/09/06

Seymour House 27/09/05

Seymour House 25/04/05

Seymour House 19/01/05

Seymour House 19/08/04

Seymour House 10/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Seymour House Monkton Park Chippenham Wiltshire SN15 3PE Lead Inspector Sally Walker Key Unannounced Inspection 09:20 14 & 16th August 2007 th 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 Seymour House DS0000028133.V338568.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. Seymour House DS0000028133.V338568.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Seymour House Address Monkton Park Chippenham Wiltshire SN15 3PE 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) 01249 653564 www.osjct.co.uk The Orders Of St John Care Trust Mrs Kathryn Maslen, proposed manager Care Home 42 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (8), Old age, of places not falling within any other category (34) Seymour House DS0000028133.V338568.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th September 2006 Brief Description of the Service: The home is situated on the outskirts of Chippenham near to the park. The building was originally built by the local authority in the 1970s and is the subject of an ongoing programme of redecoration and refurbishment. Residents’ accommodation is on the ground and first floors accessed by a lift and two staircases. Forty-two registered beds provide accommodation for older people, eight of whom may have a mental disorder. The home provides one of these beds for respite care. All of the residents’ accommodation is single bedrooms. The home also provides a 12-place day service during the week, which is separately staffed. The staffing rota provides for a minimum of 4 care staff and a care leader for the mornings, 3 care staff and a care leader for the afternoon and evenings, and 3 waking night staff. Staffing levels are reduced at weekends. Mrs Kathryn Maslen is the proposed manager and her application to register is in progress. The fees for the home are between £390.00 and £460.00 per week. Seymour House DS0000028133.V338568.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out on 14th August 2007 between 9.20am and 4.30pm. Mrs Maslen was out at a meeting on this day. The care records, menus, risk assessments, medication administration records and staffing records were inspected. Six residents were spoken with and four staff. The inspection continued on 16th August 2007 from 1.50pm to 6.50pm. Heather Mudie, Locality Manager, came to hear the feedback to Mrs Maslen. As part of the inspection process survey forms were sent to the home to distribute to residents, families, staff and healthcare professionals. Ten replies were received and comments can be found in the relevant part of this report. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: Residents and staff have good relationships. Residents are treated with dignity and respect. The system entitled ‘resident of the day’ enables staff to consider residents’ care, support and other needs in more detail. Residents have good access to healthcare professionals. The organisation provides a good range of inter-home activities and local celebrations of events during the year. The home provides a good range and choice of meals suited to the tastes of older people. Housekeeping staff are keeping the home clean and smelling fresh. The grounds are well kept. Significant efforts have been made to upgrade the building for the comfort of residents. Further improvements are planned. A robust recruitment procedure is in place. No new staff member commences duties without a check of the Protection of Vulnerable Adults list to make sure they are suitable to work with vulnerable people and a negative Criminal Records Bureau certificate. All staff are properly inducted to their role and a good range of training is provided by the organisation. Staff are aware of reporting procedures if allegations of abuse are made. The organisation has an ongoing plan of improvement of the environment for the benefit of residents. Seymour House DS0000028133.V338568.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Consideration should be given to requesting more up to date care management assessments when people are referred to the home in an emergency. All care plans must identify residents’ current care and support needs. This must include how those assessed needs are to be met and how they are monitored. Residents must have assessments of their risk of developing pressure damage. Residents must have a say in whether their intimate personal care is provided by staff of a different gender. This issue was raised at a previous inspection but a suitable policy has not yet been put in place. If healthcare professionals delegate specialised procedures, the responsibility for the procedure remains with the district nurse. All staff who carry out the procedure must be trained individually by the nurse and have their continued competency assessed by the nurse. Care staff must never cascade the training to other staff. Medication errors must be notified to the Commission without delay. Notifications must also be made of any staff misconduct or reduction in staffing levels. The home should keep records of how they respond to complaints about the service. Housekeeping hours are only available in the mornings. Laundry hours are only available in the mornings from Monday to Friday. Organised activities are available for 20 hours a week. At other times care staff are expected to do these duties as well as care. Seymour House DS0000028133.V338568.R01.S.doc Version 5.2 Page 7 Staff should be trained in areas that are relevant to those residents to whom they are providing care, particularly mental health issues and tissue viability. 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. Seymour House DS0000028133.V338568.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 Seymour House DS0000028133.V338568.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): 3 (Key standard 6 is not applicable to Seymour House) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff endeavour to find out as much as possible about potential residents so that the residents can know how their needs will be met. Intermediate care is not provided. EVIDENCE: Action had been taken to address the recommendation that pre-admission assessments were dated and showed the source of the information. The organisation was piloting a new format for assessments in other homes. It was reported that this would then be introduced to all homes. Staff were using a range of documents to gain as much information as possible about a prospective resident before a placement was offered. Seymour House DS0000028133.V338568.R01.S.doc Version 5.2 Page 10 One of the residents who had been admitted on an emergency basis had been accepted with a care management assessment which was dated two years prior to their admission. The home were carrying out their own assessment of the resident since their admission. The home provides respite care and will take emergency admissions. Intermediate care is not provided. One of the people who was using the respite service said they thought the home was ‘lovely’ and that they had had a good time during their stay. In comment cards one of the residents said: “I knew all about Seymour House before I came in because my [relative] was here and was very happy. We used to come in every weekend and knew how they did things and we used to speak to a lot of the staff.” Discussions were held about the categories for which the home is currently registered. The inspector identified that the home trains staff in dementia care rather than mental health for which the home is registered. The inspector advised that the home could continue to support those long-term residents who may develop some form of dementia as part of the ageing process. There would be no requirement to vary the category of registration as long as those residents’ primary needs were similar to other residents in the category of older people. However the home is not registered to provide care and support for anyone who is assessed or diagnosed as having dementia prior to considering admission. Seymour House DS0000028133.V338568.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): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents complex care needs are not always identified in their care plan. The care plans do not always direct the care. Residents had good access to healthcare professionals. The arrangements for the control and administration of medication were satisfactory. Staff upheld residents’ privacy and dignity. Some residents experience was that they wanted more support from staff. EVIDENCE: Some progress had been made in meeting the requirement that care plans are reviewed and revised as care needs changed. Mrs Maslen had been seconded last year from her previous post of head of care at another care home to ensure that this work was started. Since her promotion to manager, one of the care leaders had continued with this work. Seymour House DS0000028133.V338568.R01.S.doc Version 5.2 Page 12 Whilst it is recognised that much effort has gone into ensuring that all care plans are more detailed, more work is needed in some areas to ensure that the care plans are reviewed and revised as needs change. Care plans varied in the level of detail. Not all care plans stated how assessed needs were to be met. This was discussed with the staff on duty. One daily report had little detail about a medication when in fact the arrangements for this medication were complex. There was no further report as to whether the arrangements written about had actually been achieved. There were statements in some daily reports which needed a follow up. One record stated “please observe” after an incident, but there was no written guidance on what this meant. Another stated that a resident’s glasses could not be found, but there was no conclusion. Other care plans stated that the resident’s diabetes was controlled by diet. There was no information at to what this meant in terms of what the resident could and could not eat or what they enjoyed eating or drinking. One resident had a pessary but this was not recorded in their care plan. However there were good details in oral care and residents’ preferred routines. The organisation was piloting new care plan and recording formats to be introduced in the near future. There was no evidence of any progress to meet the requirement that all residents have their risk of developing pressure damage assessed. It was also required that the outcome of assessments and action to be taken was identified in care plans. None of the case notes inspected had assessments with regard to those residents risk of pressure damage. Mrs Mudie said that she had instructed care staff in assessing tissue viability using the organisation’s new format. Mrs Maslen in her Annual Quality Assurance Assessment supplied to the Commission, had identified that a more comprehensive tissue viability tool was needed. Food supplements were available where indicated. Residents had good access to healthcare professionals. All of those residents spoken with said they had never experienced difficulties with accessing their GP or the district nurse. They said that any of the care staff would make a call requesting a visit. Most of the residents were generally well groomed. However one resident had a pair of glasses that had not been recently cleaned, on their side table. They were also in need of some mouth care. The drink that had been left on this table for them was out of their immediate reach. One resident said they would like more help. They said that staff were very good and did help them but they were often busy. Staff were seen to engage with residents, chatting as they were going about their work and answering any queries. Any personal care was carried out discretely behind closed doors. Seymour House DS0000028133.V338568.R01.S.doc Version 5.2 Page 13 One of the district nurses said in a comment card: “The district nursing team attend the home Tues/Fri to provide care to residents. The majority of staff utilise their time effectively. However there are times when the staff do not refer appropriately/timely. This is often due to poor communication within the team. Where clients’ needs are more complex the care staff find this challenging and have been found to overlook simple practices such as ensuring hypostop/sweets available to diabetics in their care. I am not aware of clients self medicating at Seymour.” Mrs Maslen reported that there was a communication book for district nursing visits and referrals. The requirement that a policy was in place with regard to the giving of intimate personal care by staff of different gender was reported to be in progress. Mrs Mudie reported that the organisation was producing a policy. However none of the care plans identified that residents had been asked about whether they had been consulted about who should provide their care. There was previously a recommendation that a certificate of competence was sought from the district nurse who trained staff in taking blood glucose levels from residents who had diabetes. This had not been actioned and has now been made a requirement. Care plans were varied in the detail of diabetes management. One of the care leaders explained the arrangements for the administration and control of medication. Residents can administer their own medication following a risk assessment. Care staff only administer medication after having been assessed as competent to do so. Staff are given training in medication administration. The home operates a monitored dosage system put up by the supplying pharmacist. All medication is checked by two staff when it is received with both signing the medication administration record. The inspector advised that as a matter of good practice, all medication that is to be returned to the pharmacist should be documented at the time that it is not required rather than wait until it is returned. It was also advised that where medication is administered in body patches, clear guidance is written in the care plan and the medication administration should show which site is used. A drawing of the sites could be used. Further advice was given about requesting actual prescribing details rather than “As directed”. In a comment card, one of the residents said: “I am in pain for 24 hours a day & all I get is a few pain killers no doctor calls and I have to ask and ask for stronger tablets.” One of the relatives said: “They have to call in the nurse for [the resident] on a regular basis. This arrangement suits us all extremely well. Any very small problems have been sorted as soon as possible. No major problems have arisen at all.” Seymour House DS0000028133.V338568.R01.S.doc Version 5.2 Page 14 One of the relatives said: “Always advised in being admitted to hospital. Not always advised if [the resident] has had a fall but can learn about it sometime after the event. Not sure of Seymour’s policy on informing next of kin when a fall takes place but no lasting damage done.” One of the relatives said: “Supply of pads to residents can vary and I often have to ask for [the resident] to be supplied with a pad. Little niggles like there is not always a kyle sheet put on [their] bed which is needed. But one is always supplied when I point this out.” In a comment card one of the GPs said “A large home but well managed, caring and a good atmosphere. I would be happy ending up there!” One of the residents said that their medication was always given to them in the middle of lunch and they were given in such a hurry. It was noted that there had been a medication error that had not been notified to the Commission as required by regulation. There was no copy in the home’s file of notifications under regulation 37. It was reported that this was investigated by a previous locality manager but there was little evidence on file. It appeared that Mrs Mudie had not been informed of the error when she had been given the responsibility for the home. Mrs Mudie said she would examine the home’s central file to establish the outcome of the investigation and report to Mrs Maslen. The home has a system called ‘resident of the day’ where focus is paid to that individual during the day to make sure that various aspects of their care and support are reviewed. This would include review and revision of their care plan, thorough cleaning of their bedroom, arranging any appointments or talking with them about any issues. There was a list of pointers for staff to follow and make notes. Seymour House DS0000028133.V338568.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents had differing experiences of what they could do during the day. Some residents had to rely on staff for direction. A good programme of activities was on offer but only 20 hours specialist staffing were provided for organised activities. The organisation provides a good range of inter-home activities. Visitors were encouraged. Those residents who could decide were making choices but this was not always evident in the records. A good range of home cooked meals is provided with a choice of menu. EVIDENCE: The majority of the residents spoken with chose to stay in their bedrooms during the day. Some said they went to the dining room for meals or to join in with any activities. It was clear from talking with residents who could decide that they exercised some decision-making on a daily basis. However this was not always evident in the care plans. Seymour House DS0000028133.V338568.R01.S.doc Version 5.2 Page 16 Some progress had been made to action the requirement that residents’ social interests and access to the community facilities are maintained as per their wishes. An activities co-ordinator commenced work in December 2007. There was a weekly activities programme that publicised an activity to take place each morning, afternoon and evening, seven days a week. Some of the activities advertised included: armchair exercises, bingo, a memory walk, video night, beauty sessions and quizzes. The services held in the home by local churches was advertised for the rest of the year on a notice board. The number of staff hours for activities does not match this extensive programme. The organisation is very good at providing inter home and central functions for residents. There were regular visits to other homes in the organisation to join in competitions and have meals. There was recently a garden party at Bowood Country House and a dance in the county town. There were photographs of recent activities and events displayed on notice boards around the home. A relative organises a quiz evening once a month. Local school children regularly go to the home to provide singing events. There was a local Phab club that residents could go to. Mrs Maslen said some residents had been to the Chippenham folk festival held in the park, within easy walking distance from the home. One of the residents said there were two hairdressers who came to the home each week. There were photographs of a recent visit of animals from a donkey sanctuary who came to visit some of the residents in their bedrooms and around the home. Many of the residents talked about the pleasure that this had given them. The activities co-ordinator publishes a regular newsletter of events. A portable computer with internet and webcam facilities is being ordered for residents use. In one of the comment cards, a residents said: “I never take part in activities in here they always have the things I don’t like. They do have darts which I like but I can’t play because I can’t stand up on my own.” Another said: “[I’d like] more entertainment, more trips out, swimming cinema.” A relative said: “My [relative] is well looked after. Food very good. Staff are all very good. They give me time if I have any questions or queries. My [relative has a birthday] and they are going out of their way to make sure [the resident] has a good day with family and friends for tea to share with us and residents.” One of the district nurses in a comment card said: “ The home is always welcoming and residents appear able to choose activities in and around the home. The home makes effort to vary activities available to residents.” Those residents spoken with had different experiences of occupation during the day. Those who could choose spent their day as they wished. Other residents relied on staff for direction. Some residents said they would join in with the activities provided by the day service if there was nothing going on in the home. Seymour House DS0000028133.V338568.R01.S.doc Version 5.2 Page 17 One resident was disappointed to hear that a donkey had visited the home and they had not been told. They said they had also not been told about the recent church service. However they did show the inspector the weekly activities programme that they had been given. Neither of these events were listed. This resident said they had also not had a visit from one of the staff who had left recently to say goodbye. Visitors were encouraged and residents could meet with visitors in one of the many seating areas or privately in their bedrooms. One resident was sitting in their bedroom in front of a television with a very grainy picture. Mrs Maslen later said that because over the years, various spurs had been put on the aerial system it was not delivering proper signals. She went on to say that this was being addressed with a new system replacing the old. The home operates a 5-week menu. There were 2 choices for each course at lunch and for the evening meal. The home offers a range of mainly traditional dishes suited to the tastes of older people. The daily menu was written on a board next to the dining room. Most of the residents spoken with did not know what they were going to have for lunch. They said they did not mind because the meals were good. Serving of meals starting with a different table each time following discussion with residents about some always being served first. During the meal there was a lot of loud discussion between staff about the process of serving. Some staff shouted to residents from the servery. This was discussed with Mrs Maslen and Mrs Mudie who both agreed that staff already knew that they should make meals a pleasurable experience for residents. It was also noted that six residents who were brought to the dining room in wheelchairs were left in those chairs for the duration of the meal. There was no reasonable explanation for this. Staff said that these residents did not stay in the wheelchairs for the whole day. The inspector advised that these residents should be offered a dining chair which would allow them to sit nearer to the table to eat. Some residents had chosen to have their lunch in their bedroom. Staff were seen to chat with the resident rather than just leave the meal. One of the relatives said that they the choice of menu was limited and they did not think that pizza, burgers, faggots or bubble and squeak were suitable for older people. In a comment card, one of the residents said: “I can’t eat a lot of the meals because they are not what I like and other times I can’t eat it because its not cooked enough. We get some good food like cheese and butter and the puddings are good. Some things we have I have never heard of so we got to make the best of it. We also get good meat and good jams.” Seymour House DS0000028133.V338568.R01.S.doc Version 5.2 Page 18 Another resident said: “I’ve got to move chairs at mealtimes before I can sit down at the table there is no one about to help me.” One of the relatives said: “the food is excellent better than most hotels. We feel as a family my [relative] is looked after and cared for in a very special way.” Two residents who were having their lunch described their enjoyment of the good quality meat provided, particularly the roast dinner the previous Sunday. One of them talked about the faggots they were eating and how tasty they were. They also said the vegetables were well cooked. The other resident had not liked either of the choices offered so they asked for an alternative. They were offered sausages which were provided immediately. Another resident said the meals had improved; there was not so much minced beef. They went on to say that the cook was trying new things which they enjoyed. They said they if they did not like the choices “they would always turn up with something tasty”. Another resident said that the cook always knew what they liked and would provide them with small servings as they were put off by large amounts. Seymour House DS0000028133.V338568.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home responds to complaints and any allegations of abuse. However records do not always show how outcomes have been achieved. Staff are familiar with reporting procedures and have been trained in the local Safeguarding adults procedure. EVIDENCE: The home works to the organisation’s complaints procedure which is included in information given to residents and relatives on admission. There were no complaints recorded in the home’s log since the last inspection. Yet the Annual Quality Assurance Assessment stated that there had been 6 in the last year. It was clear from discussion with Mrs Maslen that she deals with any concerns brought to her attention as they occur but the outcomes are not always recorded in the complaints log. The outcome of an investigation into concerns copied to the inspector was not evident in the home’s complaints log. The copy letter and comment card was sent to Heather Mudie, locality manager, after the inspection for her investigation and response to the person. Seymour House DS0000028133.V338568.R01.S.doc Version 5.2 Page 20 In a comment card, one of the residents said: “There is only one top carer that I can speak to. I always speak my mind if there is anything I don’t like I tell them.” Another said: “Not sure who to see if unhappy.” New staff attend training in the Safeguarding Adults procedure as part of their induction. All staff had received a copy of the local reporting procedure booklet. One of the care leaders was asked about reporting any allegations of abuse and it was evident that they were familiar with reporting procedures. Mrs Maslen reported that interview candidates are also asked questions about Safeguarding Adults. Recent allegations reported through the Safeguarding Adults and whistleblowing procedures had resulted in an internal investigation by the organisation and action taken. Seymour House DS0000028133.V338568.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are offered a clean, comfortable and well-maintained environment. Efforts are being made to upgrade the building and this is ongoing. The number of hours provided for processing laundry are only available during weekday mornings. EVIDENCE: The plan to re-decorate all of the bedrooms and communal areas is in good progress. New carpets had been laid to the corridors and some staircases. Bedrooms were re-decorated and re-carpeted as they became vacant. New chairs are to be purchased for the sitting rooms. The installation of a new bathroom is planned for this year. Seymour House DS0000028133.V338568.R01.S.doc Version 5.2 Page 22 The hairdressing room is to be relocated to a larger room with new equipment installed. It is planned that the old hairdressing room will be fitted out to provide a small kitchen where residents and their visitors can make tea and coffee. The day centre is to be moved to a smaller sitting room to enable this area to be used for residents’ activities some of which currently take place in the dining room. Outside, the garden is to be improved with a barbeque and more sturdy garden furniture. The care office and one of the bedrooms were in the process of being decorated at the time of the inspection. The staffing hours for the laundry had been increased from 17 to 25 hours each week. This extra allocation had been taken from the housekeeping hours. The laundry person only worked during the mornings, Monday to Friday. This means that care staff are expected to carry out laundry duties at other times. The person working in the laundry had a good system for ensuring that laundry was processed according to colour, delicacy and soiling. All laundry was put in individual named boxes and returned to residents. The person said they worked 9.00am to 2.00pm. They were asked about how laundry was processed at other times, given various comments about the laundry service. Reluctantly they agreed that care staff did their best but often the laundry would build up if care staff were busy, particularly after the weekend. Ironing was often done by night staff. The laundry person kept the accessible part of the laundry very clean. However there was a build up of dust around the back of the machines. Mrs Maslen agreed to arrange for the handymen to deep clean these areas, as they pose a hygiene risk. The laundry person said they had been inducted into their role and had received training in moving and handling. They had also trained in food hygiene for their previous post in the kitchen. Cleaning hours are only allocated to the mornings and this is reduced at weekends. This means that care staff are also expected to attend to any cleaning that needs attention in the afternoons. One of the relatives said that laundry had been mislaid, given to the wrong residents or damaged. In a comment card, one of the residents said: “They do their best with the few cleaners. It always looks nice and clean. We have just had new carpet everywhere and they have done a lot of painting and a lot of improvements. We have also had a nice new bathroom done on the first floor.” One of the relatives said: “Difficult to think of any improvement, except for laundry is always missing. I do feel they have to waste a lot of time at the security door.” Another relative said: “The decor and curtains would benefit from attention. I have not asked for this.” There was a strong smell of urine coming from one of the sluices. The clinical waste bin lid was raised by the bin being too full and the smell was coming from this. There was also a strong urine smell coming from one of the bedrooms. Seymour House DS0000028133.V338568.R01.S.doc Version 5.2 Page 23 One of the staff was later seen to be supporting this resident with their personal care in a sensitive manner, offering a bath and change of clothing. The GP notes showed that complex care needs were being managed. As a matter of good practice it was noted that all commode pots were numbered by room, ensuring that the pots were returned for the same person to use. All of the toilets were cleaned to a good standard including those areas underneath raised seats. Mrs Maslen commented on the recent appointment of housekeeping staff who had proved to be very hard working with regard to cleanliness. She went on to say that she was recruiting for a 25-hour housekeeping post that was vacant. A separate room had been put aside for those residents who smoked. Mrs Maslen said that none of the current residents smoked. She was advised to consult the Department of Health website for guidance to care homes on the smoke free legislation. Alternatively it would be an opportunity to adopt a no smoking building policy. Staff who smoked were directed to a designated area in the grounds. Seymour House DS0000028133.V338568.R01.S.doc Version 5.2 Page 24 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 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care staff are expected to cover cleaning, laundry and some activities because these hours are not covered throughout the day or at weekends. This impacts on residents, record keeping and other administrative duties. A robust recruitment process is in place for residents’ protection. Staff have access to mandatory training provided by the organisation. All staff had access to NVQ training. EVIDENCE: Some action had been taken to meet the requirement that consideration must be given to the staffing hours to ensure that residents’ care needs were met. It was required that this included full provision of care and support staff with management and administrative duties exclusive of the care hours. Mrs Maslen said that it had been the home’s priority over the last 8 months to recruit to all the vacant posts. Eight staff had been appointed with 2 of those waiting to start. There had been an increase of 30 care hours each week. Mrs Maslen also intended to recruit more bank staff. On duty on the first day of the inspection were 2 care leaders with 2 care staff and an agency staff. Seymour House DS0000028133.V338568.R01.S.doc Version 5.2 Page 25 Staff said there were normally 6 carers in the mornings and 5 for the afternoons and evenings. At night there are 3 waking night staff. It was noted on the staffing rotas for the previous Monday that only 3 care staff and a care leader were on duty during the day. Mrs Maslen and Mrs Mudie were advised of the duty to notify the Commission when staffing levels were compromised. Staff said that there was no kitchen assistant for the afternoons at the weekend so they had to serve the evening meal. They said that the cook did prepare the meal. There were a number of comments from residents, relatives and visitors about how staffing levels had affected the support to residents. However there were some positive comments about the staff’s relationships with residents. One resident said that staff always came when they rang their call bell and that they always knocked on their bedroom door before being invited in. One relative, in a comment card, said that a new keyworker had not been allocated to the resident until four weeks after the other one had left. They said that the staff were too busy to make the resident’s bed, clean the bedroom, provide help with washing and dressing or pass on telephone messages. On one occasion tea in the resident’s bedroom had been refused by one staff member yet prior arrangements had been made earlier with another member of staff who had not passed on the message. One resident said that their bed had not been made or their breakfast tray collected. This was at 10.45am. They said they were not going to complain and they did not want the inspector to comment. However a neighbour of theirs also said the same thing to them as they met in the corridor. One resident said: “I could sit here all day and they don’t come”. A relative said: “Extremely approachable staff. Will always listen and act if possible on any issue small or important to the very best of their abilities. The home contacts us immediately if they need to. At every visit someone tells me how [they] are and of any issues that may have arisen. Wonderful to [them] even though [they] can be quite hard work they all love [them] and think [they are] wonderful.” Another relative said: “Staffing levels can be a problem. Obviously standards will suffer with staff shortages. The need to keep staff long term is important to elderly people’s confidence.” Another relative said: “The staff have really made [the resident] welcome. They chat the best they can. As a family we appreciate everything that is done for [the resident]. Communication is good. I for one always feel welcome there and never in the way.” Another relative said: “The staff show kindness and consideration to residents and their families at all times. I am very satisfied with the care given to date.” Seymour House DS0000028133.V338568.R01.S.doc Version 5.2 Page 26 In a comment card one of the residents said: “The staff don’t do a lot for me because I do all my own things for myself. I don’t bother them much only a few things like bathing and changing my bed. I even keep my room clean myself, I also do other little jobs and do the tray at teatime. We have not got very much staff at the moment and the ones we have are very young. I don’t think they understand their job.” One of the relatives said: “Overall the carers are friendly towards residents. Noticeably a number of care staff have left recently and morale amongst them has been low at times. Care staff can seem rushed off their feet. More staff resources are required.” Another relative said: “Generally I think the staff who are there do the best they can but there is not time for them to have a chat with residents.” One of the district nurses in a comment card said: The home appears to have undergone a number of changes in management over the last few months. This combined with increasingly needy clients has placed more demands on carers. The senior carers have vast experience. However it is disappointing that the carers declined several D/N teaching sessions. [The home needs to improve] communication within the team to improve continuity in residents care.” The Annual Quality Assurance Assessment stated that 27 residents needed help with dressing and undressing and 39 with washing and bathing. There was a robust recruitment procedure in place. No staff commenced duties without a negative Criminal Records Bureau certificate in place. The home also checks new staff’s status with regard to the Protection of Vulnerable Adults list. This is to confirm that they are suitable to work with vulnerable people. All of the documents and information required by regulation were on file, except a recent photograph. Mrs Maslen said that she was in the process of re-organising the staff files with the administrator. New staff were registered onto the organisation’s e-learning programme, linked to NVQ Level 2. All new staff were inducted into their role and care staff would ‘shadow’ a more experienced member of staff for 3 days. Twelve of the 33 care staff had attained NVQ Level 2 or above. Some progress had been made to meet the requirement that staff are trained in working with people who have a visual impairment. Four of the 41 care staff had received a days training. Mrs Maslen reported that all staff will be expected to undertake this training. All staff were undertaking a dementia care course. It was expected that all staff would undertake training in equality and diversity. The home has its own trained trainer for moving and handling. The organisation offers internal mandatory training course for all staff. Training needs were discussed in individual supervision. Seymour House DS0000028133.V338568.R01.S.doc Version 5.2 Page 27 The organisation was in the process of setting up a system where all staff records, including training profile, would be available on the manager’s computer. Hard copies of training details would be transferred to this system. It would enable Mrs Maslen to plan staff training needs and set up programmes at a glance. Mrs Maslen was collating recent training certificates so that they could be entered into these records. The old training records listed essential and desirable training that staff were expected to attain. The list included dementia as essential training. The home is registered for 8 mental disorder places but this was not included in the essential training required. Mrs Maslen reported that a local undertaker had recently provided training to staff. The purpose was to reduce any fears regarding death and dying. It was reported to be very beneficial to those staff attending. Seymour House DS0000028133.V338568.R01.S.doc Version 5.2 Page 28 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 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Mrs Maslen comes from a background of working with older people. She is clear about how she expects to develop the service. The organisation audits the quality of the service. Proper arrangements are in place for safekeeping of any monies kept on residents’ behalf. Systems are in place to ensure the health and safety of residents and staff. Seymour House DS0000028133.V338568.R01.S.doc Version 5.2 Page 29 EVIDENCE: Mrs Maslen was originally seconded to the home from her post of head of care in another home, to ensure that all the care plans were reviewed and revised. She has been manager since January 2007. Mrs Maslen had previously worked in 4 of the organisation’s homes. She holds the NVQ Level 4 in care and is enrolled to complete the Registered Managers Award. Her application to register as manager is in progress. Mrs Maslen said she keeps herself up to date with current good practice with courses provided by the organisation. She had recently been updated on the Mental Capacity Act 2005 at a managers meeting. She had also attended training in management of budgets, attendance management, fire marshal, health and safety and the organisation’s computing systems. It is recognised that Mrs Maslen comes to a home that has only had one registered manager for a period of a year in the last three years. One of the relatives said that the home had had “lots of different managers”. However it was clear from discussions with Mrs Maslen that she is clear about her priorities in her plans to develop the home further. During her time as secondment as head of care she has been able to get to know the residents and staff. All the care leaders had delegated areas of responsibility, for example, medication, staffing rota, continence management, infection control and fire prevention. Mrs Maslen has set up regular staff supervision and staff meetings. Mrs Maslen showed the initial results of the annual survey of residents to gain their views on the service. The results are sent to the organisation and the manager then develops an action plan to address any issues arising from the survey. A facility is provided for residents to hold small amounts of cash in the home’s safe. Records and receipts are kept of all transactions. The manager and administrator regularly audit the system. Access to the safe keeping arrangements were limited to the manager, the administrator and care leaders. Residents could access their money at any time. The environmental risk assessments were undertaken by a representative of the organisation and Mrs Mudie. Risk assessments were generic or local to the specific findings at the home. Mrs Mudie was undertaking the fire risk assessment. The organisation contracts with suppliers for the maintenance and regular checking of equipment and services. Seymour House DS0000028133.V338568.R01.S.doc Version 5.2 Page 30 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 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Seymour House DS0000028133.V338568.R01.S.doc Version 5.2 Page 31 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement The person registered must ensure that care plans are reviewed and revised as care needs change. The care plans must direct the care. (In some progress. This has been outstanding since September 2005). A new compliance date has been made, as Mrs Maslen was new to post. The person registered must ensure that service users social interests and access to the community facilities are maintained as per their wishes. (In progress but 20 hour post could not provide the published programme. This has been outstanding since September 2005). New compliance date made, as Mrs Maslen was new to post. The person registered must consider the allocation of staffing hours to ensure that service users care needs are met, with full provision of care and support staff. DS0000028133.V338568.R01.S.doc Timescale for action 14/10/07 2. OP12 16(2m&n) 14/10/07 3. OP27 18(1)(a) 14/10/07 Seymour House Version 5.2 Page 32 Management and administrative duties must be excluded from the caring hours. (30 extra hours had been allocated but care and housekeeping hours continued to be reduced at weekends. This has been outstanding since September 2005). New compliance date made, as Mrs Maslen was new to post. 4. OP8 13(4)(c) The person registered must ensure that all residents have their risk of developing pressure sores assessed with outcomes and action to be taken identified in their care plan. (No assessments being made. This has been outstanding since September 2005). New compliance date as Mrs Maslen was new to post. The person registered must ensure that staff are trained in working with people who have a visual impairment. (4 of the 41 staff had received a days training. This has been outstanding since September 2006). New compliance date set as Mrs Maslen was new to post. The person registered must ensure that a policy is in place with regard to the giving of intimate personal care by a person of a different gender to the resident. Male staff must know the parameters of their role. (This has been outstanding since September 2006. A policy is reported to be in progress. None of the care plans identified residents’ preferences.) New compliance date set. 14/09/07 5. OP30 18(1)(i) 14/11/07 6. OP10 12(2)(3)& (4)(b) 14/09/07 Seymour House DS0000028133.V338568.R01.S.doc Version 5.2 Page 33 7 OP8 12(1)(a)& 18(1)(i) The person registered must 14/08/07 ensure that if specialised procedures are delegated by a district nurse or other healthcare professional, that named staff who are willing to carry out the procedure are trained by the district nurse. This training must never be cascaded to other staff. The district nurse retains responsibility for ensuring continued competence of those staff. The person registered must ensure that medication errors, allegations of staff misconduct and reduction in staffing levels are reported without delay to the Commission. 14/08/07 8 OP9 37(1)(e)& (g) 9 OP16 17(2), Schedule 4 para 11 &22(3) The person registered must 14/08/07 ensure that a record is kept of all complaints and actions taken to address each complaint. 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 OP3 Good Practice Recommendations Consideration should be given to whether out of date care management assessments are valid when admitting people in an emergency. Records should be made of any unwanted or unused medication when it is discontinued rather than just before it is returned to the supplying pharmacist. 2 OP9 Seymour House DS0000028133.V338568.R01.S.doc Version 5.2 Page 34 3 OP9 Care plans should identify application sites for medication administered via an adhesive patch. Rotating sites should be recorded in the medication administration record at each application. Consideration should be given to requesting medication’s exact administering requirements from the prescriber rather than ‘as directed’. Consideration should be given to contractual arrangements for the collection of clinical waste bins to ensure that they are more regularly replaced if they become full and create odour or risk of infection. 4 OP9 5 OP26 Seymour House DS0000028133.V338568.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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 Seymour House DS0000028133.V338568.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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