Inspection on 23/08/07 for Sharnbrook Lodge

This inspection was carried out on 23rd August 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Sharnbrook Lodge 31/01/08

Sharnbrook Lodge 21/09/06

Sharnbrook Lodge 30/05/06

Sharnbrook Lodge 22/11/05

Sharnbrook Lodge 24/05/05

Sharnbrook Lodge 18/11/04

Sharnbrook Lodge 18/05/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Sharnbrook Lodge 17a Park Road North Houghton Regis Bedfordshire LU5 5LD Lead Inspector Leonorah Milton Unannounced Inspection 10.20a 23 August 2007 rd 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 Sharnbrook Lodge DS0000014966.V343455.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. Sharnbrook Lodge DS0000014966.V343455.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sharnbrook Lodge Address 17a Park Road North Houghton Regis Bedfordshire LU5 5LD 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) 01582 866708 Mr John Philips Mrs Miriam Philips Mrs Jean Flanagan Care Home 24 Category(ies) of Dementia - over 65 years of age (12), Old age, registration, with number not falling within any other category (12), of places Physical disability over 65 years of age (12) Sharnbrook Lodge DS0000014966.V343455.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st September 2006 Brief Description of the Service: Sharnbrook Lodge was a privately owned residential care home. The service could provide for twenty-four older people who may also have dementia and/or physical disabilities. The building was a detached property situated on a main thoroughfare that provided direct access from Luton, Dunstable and Houghton Regis. The home was in close proximity to local shops and other amenities. There was parking for several cars to the front of the premises and a large garden at the rear of the building that was be accessible to people who lived in the home. The premises had undergone major building works to increase the number of bedrooms and facilities throughout. Twelve additional bedrooms with ensuite toilet and washbasin facilities, additional bathrooms, and a lounge/diner had been added to the premises along with a new entry, kitchen and additional parking spaces. Communal facilities consisted of a large lounge/diner in the old wing of the home and another in the new wing. Bedrooms were distributed on both floors of the home, which were accessible via a passenger lift. At this inspection it was noted that the proprietor had not received the Certificate of Registration for the increased occupancy. The Commission will take action to remedy this situation. Fees for accommodation were between £443.75 and £510. Sharnbrook Lodge DS0000014966.V343455.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report sets out the significant evidence that has been collated by the Commission for Social Care (CSCI) since the last visit to and public report on, the home’s service provision in September 2006. Reports from the home and other statutory agencies, and information gathered at the site visit to the home, which was carried out 23rd September 2007 between 10.20 and 18.00 hours, were taken into account. The inspection included a review of the case files for three people living in the home, conversations with three people, two visitors, two members of staff and the manager. Much of the time was spent with people in the lounge/diners, where the daily lifestyle and the practice of staff was observed. A tour of the building was carried out and other records were reviewed. Also taken into account were responses received by the Commission to questionnaires circulated to people living in the home and also to staff in preparation for this inspection. What the service does well: What has improved since the last inspection? The commissioning of the new extension had greatly improved the environment and provided spacious private and communal accommodation. Action had been taken on requirements from the previous report to: Sharnbrook Lodge DS0000014966.V343455.R01.S.doc Version 5.2 Page 6 Provide a suitable set of scales to ensure that each person can be weighed on a regular basis. To store medicines required to be kept under refrigerated conditions in secure conditions. To provide suitable door locks for toilets and bathrooms. For the manager to undertake training in relation to the management of a service to those with dementia. To introduce a hygienic system to transport meals from the kitchen which ensures that food is served at safe and appropriate temperatures. What they could do better: Whilst the home had provided kindly care and in most instances satisfied people using the service with the routines of daily life, the service had failed to develop its professional operational systems, as is expected of a service of this size. Record keeping in some instances was not sufficient to evidence practice, as is required and there were worrying gaps in essential practice to ensure that people were properly cared for and safe guarded from harm. The report of the previous inspection had commented on the need for further training and support for the manager to enable her to run an operation that was scheduled to double in size with the commissioning of the new extension. This had not happened in full. The proprietor must support the manager properly. His quality assurance systems must be sufficiently robust to enable people using the service to comment fully on its operation and so that risks to their well being are identified and dealt with promptly. Some requirements from the previous report had not been met, however the registered provider assured us that these would be dealt with as a matter of priority. The following requirements were outstanding: Fire doors must be fitted with fire retardant sealants that comply with safety requirements. Staffing arrangements and the written guidance to the home must be adjusted to reflect the changes in the operation of the home at the registration of additional places and admission of people to those places. To obtain information about previous employment history before new personnel are appointed. Urgent attention must be given to these matters so that further regulatory action does not become a necessity. Sharnbrook Lodge DS0000014966.V343455.R01.S.doc Version 5.2 Page 7 At this inspection the arrangements for the storage of medicines, record keeping in relation to the receipt and administration of medicines and evidence of staff training in safe medication procedures were inadequate. There were too many spare medicines in the home because unused medicines had not been returned to the pharmacist promptly. It was also noted that care staff were still serving and clearing away breakfast in the mornings because the cook did not commence work until mid-morning. Such action did not give care staff sufficient time to carry out their care duties in an unhurried fashion and compromised hygienic food handling procedures. The hours scheduled to the catering team must be increased so that they are on site for the preparation of breakfast. People must be supported to achieve all aspects of their care plan. This must include prompt referral for audiology treatment, assistance with continence needs and support for recreational needs by ensuring that those who are immobile and have expressed a need to read are provided with reading materials. People’s dietary needs must be met by basing the provision of meals on assessments of nutritional need and preference and introducing corresponding planned menus. Meals should be appetising in appearance to promote appetite. This means that liquidised meals should be presented with each portion having been liquidised separately, rather than all together which presents as unappealing. The home should develop strategies for consultation with people using the service on a more frequent basis to ensure the service is meeting their expectations. Bedrooms must be maintained to an acceptable standard of hygiene. One was seen to have stains on the carpet and two to have soiled linen on the beds. Evidence must be maintained in the home to show that checks have been obtained from the Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) register before employment commenced. Evidence must also be on site to show that the home has checked on the identity of candidates for employment. A notice to take urgent action was issued at the inspection with regard to fire safety, medication procedures and staffing arrangements. Sharnbrook Lodge DS0000014966.V343455.R01.S.doc Version 5.2 Page 8 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. Sharnbrook Lodge DS0000014966.V343455.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sharnbrook Lodge DS0000014966.V343455.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1,3,6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had obtained information about people’s needs before admission to ensure the home had the capacity to properly care for them. EVIDENCE: A copy of the Statement of Purpose was given to the inspector. It provided an easy read guide to the service. The numbers of registered places was stated as 26 rather than the actual numbers agreed by the Commission at the addition of the extension of 24. Three cases files were assessed at this inspection. Each showed that detailed pre-assessments of need had been carried out before people had been admitted. These had included information from placing authorities, and health care providers where people had been admitted from hospital. The home had an established admissions procedure that included its own written assessment Sharnbrook Lodge DS0000014966.V343455.R01.S.doc Version 5.2 Page 11 of need that was also used unless people were admitted under an emergency situation. In most instances, people moving into the home had been reliant on their relatives to visit and assess the home on their behalf. One person living in the home stated that they had relied on their family to choose this home and had not been disappointed with the choice. “I am very happy to live here”. The home did not provide an intermediate care service. Sharnbrook Lodge DS0000014966.V343455.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9,10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Unsafe medication practice and failure to follow care plans had put people living in the home at risk of harm. EVIDENCE: Three case files were assessed. Plans covered people’s personal, physical, health, recreational, social and emotional needs. The plans seen had been personalised to indicate individual need and had been reviewed on a regular basis. Assessments had been carried out in relation to the risks for each individual. In most instances this was in relation to moving and handling procedures and the risks of falls. Observation of practice however showed that members of staff were not fulfilling these plans in all instances: The inspector spent almost four hours in the lounge used by one of the people whose lifestyle in the home was included in the case tracking methodology. Sharnbrook Lodge DS0000014966.V343455.R01.S.doc Version 5.2 Page 13 Their plan of care showed them to have dementia, to have continence problems and to require transfer with the use of a hoist because they were unable to walk. It was noted that this person was not offered the opportunity to visit the toilet from commencement of the inspection at 10.20 hours until the inspector suggested it at 14.30 hours. Throughout this time this person sat apart from others and was not engaged by the staff except when their midday meal was served to them. They were not transferred to the dining table. The reason why they ate in the armchair was not detailed in the care plan, although their distress at transfer with the hoist had been noted. This person was mostly unoccupied throughout this time, with the exception of a brief conversation with their visitor and also with the inspector. The television was switched on throughout this time but this person was unable to see it from their position in the lounge. Their care plan showed that they liked to read. This was not possible during the inspection because they had not been provided with anything to read. The manager felt that the members of staff may have been inhibited by the inspector’s presence because this person called out when transferred with the hoist. She was advised that the inspection process must not prevent people from receiving the level of care they require. It was also noted that the numbers of staff on duty as the inspection commenced were below requirements. The care plan for another showed them to have poor circulation and associated problems with tissue viability to their feet. They were prescribed a Controlled Drug for the pain in their feet. Their care plan showed that they should be encouraged to elevate their feet to promote circulation. This did not happen throughout the four hours spent in the company of this person. People who contributed to the inspection at the visit were positive about the conduct of staff, stating, “I get on well with staff. They are friendly and treat me well”. “ We have a laugh with the staff, its good here”. A visitor remarked that they thought the staff “Did a good job”. There was evidence to show that people had been supported to access health care appointments for routine treatments such as chiropody, optical tests and had been referred to their doctors and other specialists. One person however, who had lived in the home for eight months and had hearing impairment had yet to be referred to the audiologist. A senior member of staff was observed as they administered medicines at lunchtime. They explained that the home used a monthly monitored dosage system for the majority of medicines. They were diligent in ensuring that medicines were given to the people for whom they were prescribed. During conversation they showed an awareness of their responsibilities for safe medication procedures and record keeping. They were, however, unsure about records required to show how many tablets have been administered when the prescription states, “1 or 2 when required”. Records in relation to these prescriptions had been merely signed and didn’t signify the dosage given. The Sharnbrook Lodge DS0000014966.V343455.R01.S.doc Version 5.2 Page 14 senior was also unclear about the reason for administering analgesia. A prescription for Co-Dydramol was to be given, 1 or 2 tablets, four hourly, when required. The record showed that Co-Dydramol had been administered routinely 3 times each day. The senior wasn’t sure why the medicine had been given routinely but said that the person had headaches. She was also unsure whether a referral had been made to this person’s doctor with regard to continuous headache. The senior explained that the manager at a pervious employment had showed them how to administer medicines and they had also received instruction from the manager at Sharnbrook Lodge. Their personnel record did not show the level of guidance they had received or contain any evidence that their competency in the administration of medicines had been assessed. Records seen at previous inspection showed that other seniors had received training in safe medication procedures through distance leaning courses. Another administration record showed that the dosage of a medicine had been changed during the monthly cycle but did not show on what date this change had occurred. The change of dosage had not been transferred to a separate record. It was not possible therefore to judge from this record when the medicine had been given at the original dosage. Medicines were stored for administration around the home in a purpose built metal, lockable trolley. Controlled Drugs for daily use were stored in a freestanding metal cash box within this trolley. The box was overfull so that it was not possible for it to be closed and locked. The systems for the storage of the trolley and the storage of spare medicines had changed since the previous inspection. The trolley and spare medicines were now housed in a walk in cupboard in the new extension. This was an internal room/cupboard. A refrigerator had been purchased since the last inspection for the storage of medicines at lower temperatures. Systems to monitor the temperature of this refrigerator or the ambient temperature in this room to ensure that medicines were kept at required temperatures were not assessed at this inspection. Assessment of the cupboards in this room showed that they were not fitted with locks and did not comply with the construction required to secure medicines. The cupboards showed overstocking of medicines and late return of unused medicines to the pharmacist. In amongst other medicines for return to the pharmacist in an unlocked cupboard was a box of Oxycontin 20mgs, which is a Controlled Drug. A record in the Controlled Drugs register showed a balance of 34 tablets of Oxycontin 20mgs. The actual number counted at the inspection was 48 tablets. The record shows Oxycontin 20 mgs being given as prescribed until the date on which the doctor stopped it. The manager was not able to provide an explanation at the inspection for these excess tablets. The manager was contacted several days after the inspection. She explained that she had Sharnbrook Lodge DS0000014966.V343455.R01.S.doc Version 5.2 Page 15 carried out an audit in response to the immediate requirement notification and had discovered further supplies of Oxycontin 20mgs. These, she explained, had been entered on an ordinary administration record because staff had not realised that Oxycontin was a Controlled Drug. The manager stated that there had been a mistake when the record had been transferred to the Controlled Register, as another box of this drug had been overlooked. This accounted for the number of tablets seen at the inspection in excess of the recorded balance. She was advised to enter this further stock in the Controlled Drugs Register. Records in the Controlled Drugs register showed that the times at which medicines had been administered had not been recorded. The most recent record for the administration of Oxycontin 20mgs had not been signed on seven entries to witness administration. Receipt of new stocks of Controlled Drugs had not been entered or witnessed in the register as required. Sharnbrook Lodge DS0000014966.V343455.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 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There were risks that people’s dietary needs would be overlooked because meals had not been based on assessments of need and corresponding planned menus. EVIDENCE: Feedback from people living in the home showed that they were predominantly satisfied with the routines for their daily lifestyle, comments included, “I always make my own decisions”, “I can do what I want”. Responses to questions about the provision for stimulating activities were less positive, “ There’s not much to do”, “ I sometimes ask to go out into the garden, but this is often not possible”. Visitors to two people living in the home felt there was not enough to engage those in the home with dementia. As illustrated previously this was noted during the inspection. It was noted however that some staff were engaged in conversation with people living in the home in the late morning and also provided some opportunities to participate in armchair games in the late afternoon. The lounge in the new build Sharnbrook Lodge DS0000014966.V343455.R01.S.doc Version 5.2 Page 17 contained a television which was switched on even though no one showed any interest in it for the at least two hours. There were also some materials for recreational activities in this room but no radio or other equipment for music. An audio player was seen in the other lounge. Visitors had been welcomed into the home. It was explained by a person living in the home that their visitors could come into the home at anytime and could come to their bedroom for more privacy. A visitor who came to the home at least twice each week remarked on the welcome they had received and confirmed that there were no restrictions on visiting. Bedrooms seen showed that people had been able to bring items of a personal nature into the home. The home did not hold money on behalf of people. Lockable facilities for those who wished to secure monies or valuables were available in bedrooms in the new build. People were provided with a choice of two hot meals or a salad on the day of the inspection. People remarked that they enjoyed their meals and that there was always plenty to eat. Food stocks were plentiful. The cook on duty was knowledgeable about people’s preferences. There were however no menus to demonstrate planning to meet assessed nutritional needs. Case files seen did not contain detailed nutritional needs assessments. The manager stated that she had taken the menus home to update them but also stated that she didn’t really like menus because people living in the home should have what they want. Other members of staff commented that menus were not available. Given that the responsibility for meals other than the mid-day meal had been left to the care team, because the cook was only scheduled to work from 10.00 to 14.30 there must be planned menus for staff guidance. These must include information about special diets. A member of staff was seen to assist to assist a person with their mid-day meal, which had been liquidised. This was not consistent their plan of care, which showed that they required food to be cut up. The manager explained this person could eat foods that were minced. The meal looked unappetising because it all of the portions had been liquidised together so that the whole meal presented as a khaki coloured substance. Sharnbrook Lodge DS0000014966.V343455.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, 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints and safeguarding procedures were in place to enable people living in the home to raise concerns and to safe guard them from abuse. EVIDENCE: Previous inspections had established that the home had satisfactory written complaints and safeguarding procedures. The manager reported that there had been no complaints about the service since the last inspection. One had been made to the Commission anonymously but had not been substantiated. People living in the home confirmed that they felt able to raise concerns. “I would speak to the manager if I was worried”. “I always make my views known, but do not have anything to complain about and am generally happy.” Records indicated that personnel had been informed about safeguarding issues. A carer spoken to showed understanding of safeguarding issues. Three personnel files were assessed. Two contained records to show that robust recruitment practice had been followed that included the checking of employment history through references and checks via the Criminal Records Bureau and the Protection of Vulnerable Adults Register. The record for a Sharnbrook Lodge DS0000014966.V343455.R01.S.doc Version 5.2 Page 19 recent employee did not contain such documentation. The manager explained that this was still centrally by the proprietor. She was advised that this evidence must be noted on this employees file. Sharnbrook Lodge DS0000014966.V343455.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 19,26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Whilst the environment had been improved by the commissioning of the extension and other refurbishment works this had been negated by the failure to ensure the safety of all who lived, worked and visited the home because action had not been taken on previous requirements about fire safety. EVIDENCE: An extension to the side of the building had been completed to a high specification that had taken account of the National Minimum Standards for space and facilities. All of the bedrooms in the new build were spacious and had roomy ensuite toilet and washbasin facilities. One of the bedrooms was large enough to accommodate a married couple or siblings wishing to share. The building works had included the provision of a new kitchen, laundry room, combined staffroom/hairdressing room, office and the refurbishment of an existing lounge, bathroom and some bedrooms, one of which was enlarged and Sharnbrook Lodge DS0000014966.V343455.R01.S.doc Version 5.2 Page 21 could also accommodate a married couple or siblings. These works had been carried out to a high specification in the kitchen and especially the bathrooms, which included a “wet room”. The majority of people living in the home were satisfied with their accommodation, describing it as “Beautifully kept, always tidy and clean.” The home is “Always kept clean and fresh”. “My room is very nice”. A visitor to the home expressed concerns about the cleanliness of the carpet in their relative’s room, stating that it had been soiled for several weeks. This room was included in the tour of the building. The tour showed that the home was clean and orderly in the majority of its rooms. The carpet in the room mentioned above had several stains, the wall by the bed was also soiled and the bed had been poorly made. On closer assessment the linen on the bed was seen to be soiled and to have an unpleasant odour. The bed in another room had also been poorly made and the linen was slightly soiled. The manager explained that the home did not have a carpet shampooer. The furniture in some of the original bedrooms was rather worn and need in replacement or refurbishment. The report of the previous inspection had included a requirement for the proprietor to “ensure that fire doors throughout the home are fitted with fire retardant seals that comply with fire safety requirements.” The lounge door and bedroom door seen at that inspection were still without sealants at this inspection. An immediate requirement notification was issued at this inspection in relation to this failure to take action to limit the spread of fire. Sharnbrook Lodge DS0000014966.V343455.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 27,28,29,30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The numbers of care staff on duty and the hours scheduled to the catering team were not sufficient to meet people’s needs. EVIDENCE: People using the service passed positive comments about the conduct of staff, “Staff are always very kind and help with my personal care needs”, “I never have any problems and I am well looked after”, “ Very friendly and I haven’t found a bad one”. A relative of a person living in the home wrote, “As a family we are very pleased with the care and support. The home is well run and the staff are kind and gentle. We are confident that XXX is looked after in a professional manner. We can’t imagine what we would do without them”. Discussions with staff, observation of their practice and their responses to questionnaires showed that they were aware of the responsibilities of their roles and that they had a commitment to welfare of the people living in the home. They were seen to show respect to people and were particularly sensitive in their approaches to people with dementia. Sharnbrook Lodge DS0000014966.V343455.R01.S.doc Version 5.2 Page 23 It was a pity therefore to see that they were very rushed on the morning of the inspection. There were insufficient numbers of care staff on duty in the morning to care for twenty-one people, seven of who required the assistance of two staff to get up and wash and dress. Three of these people also required transfer with a hoist. This level of dependency meant that assistance was time consuming. The morning staff also had to serve and clear breakfast. A senior carer and two carers were on duty as the inspection commenced. Their shifts had started one hour before the two waking night shifts finished. Others scheduled on duty that day were four care staff after 14.00 hours and a cook from 10.00 to 14.30 hours and a laundry assistant for 3 hours and a domestic assistant for 5 hours. The manager was off duty. The inspector was informed this was because she was scheduled to carry out the cook’s role at the weekend. She later came to the home to attend the inspection. The manager explained that there was usually four care staff on duty but this level had reduced recently because of staff leave. The rota showed only three care staff on duty on in the mornings of 14, 15,16,17,18 August 2007. A new employee had commenced on 14 August on a 09.00 to 16.00 shift that was additional to these arrangements. Thereafter her shifts were included in the minimum staffing numbers. She had worked five shifts on the day of the inspection when she was included in the staff ratio of three only on duty. This level of induction into the role was worrying even if, as explained, she had experience of care work elsewhere. Records indicated that staff had received a basic level of training. The manager stated that induction had been carried put to required standards. Records of this training were not available as the inspection because personnel held them. Induction, as demonstrated by rotas as mentioned above, had not allowed sufficient supernumerary time for personnel to be become familiar with people’s needs and the home’s daily routines. The most recent employee had only worked one shift before she had been included in the minimum staffing arrangements. The personnel record for a recent employee did not contain any evidence of a CRB or POVA check. There were no documents to verify checks on identity other than a note stating that these had been seen when gathering information for a CRB check. The manager stated the proprietor held these documents. This and another personnel file did not contain records of interview questions or notes to show investigation of employment history and any gaps in the same. The files did not contain any records to show dates for the commencement of employment other than a basic tick list “one day inductiontype” document which, it was explained, was completed on the day employment had commenced. Sharnbrook Lodge DS0000014966.V343455.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, 35,37,38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Despite the satisfaction expressed by people using the service, the inspection showed that there were worrying failures in the management and administration of the service that had put people at risk of harm. EVIDENCE: Reports of previous inspections had noted, “The manager had held a certificate in management for a number of years and had worked in a management capacity for several years. She explained that she had undertaken a half-day course in understanding dementia care along side her staff. Given the home’s registration to care for those with dementia and indeed the number of service users with cognitive impairment living in the home, the manager must under take more comprehensive training to manage the delivery of such a service. It is also recommended that she undertake other management training to ensure Sharnbrook Lodge DS0000014966.V343455.R01.S.doc Version 5.2 Page 25 that she is fully prepared for the management of a larger operation when the home doubles its size at the registration of the new build…..At this inspection the manager stated that she planned to commence training in the management of a dementia care service in the near future.” At this visit to the home the manager explained that she had almost completed a detailed training course in the care of those with dementia but not undertaken any other management training. At this inspection positive feedback was given again about the conduct of the manager, “She is nice and we can talk to her”, “ Very approachable”. Members of staff wrote that they had been well supported and had received supervision. In conversation with the inspector it was evident that the manager was aware of people’s needs and had a commendable loyalty to the home. She, as at previous inspections, was seen to be carrying out all of the on-call duties, despite previous recommendations that she be relived of some of this responsibility each week. It was evident that some of the failures to act on requirements from the previous inspection lay with the proprietor who controlled budgets. Quality assurance systems/ visits carried out under Regulation 26 were inadequate. Such systems should have highlighted the progress on requirements from previous reports and the need to take action on record keeping in relation to medicines and the inadequate staffing levels. Formal consultation with people using the service had continued to have a low priority. Meetings with people had not been introduced. The manager stated that the proprietor had received a few responses to a recent customer satisfaction questionnaire and was planning to schedule a meeting with relatives. Systems for holding personal monies for people living in the home had changed since the last inspection. The manager stated that the home no longer held monies on behalf of people. Relatives or others acting on behalf of people were invoiced directly in relation for fees for hairdressing, chiropody and similar services. Lockable facilities were available in the bedrooms in the new build for the secure storage of money and valuables. Record keeping as identified previously in relation to the receipt and administration of medicines and recruitment processes was inadequate. Systems were in place to ensure the safety of equipment through regular servicing by qualified contractors. Visual checks during the inspection showed that this had been carried out regularly. Staff had received training in various aspects of health and safety such as fire safety, manual handling, food hygiene, and first aid. Omissions to safety as detailed previously were the failure to fit all fire doors with fire retardant seals. It was also noted that the Sharnbrook Lodge DS0000014966.V343455.R01.S.doc Version 5.2 Page 26 date of the last fire drill recorded in the fire logbook was 19th September 2006. There should be at least two fire drills each year. Sharnbrook Lodge DS0000014966.V343455.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 1 x x x x x x 1 STAFFING Standard No Score 27 1 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 1 x 3 x 1 1 Sharnbrook Lodge DS0000014966.V343455.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 12(1),15, 18(1)(a) Requirement The registered person must ensure that members of staff are aware of and working to fulfil people’s individual needs as identified on their care plans. The registered person must ensure that people are referred for healthcare specialist treatment promptly so that there will be no cause for delay in achieving appointments. The registered person must ensure that medication procedures are followed properly so that people receive medicines as required. This must include: People must be given their medicines as prescribed. Care plans must show why and when medicines for administration on an “as required” basis are to be given. Records for the administration on a variable dosage must record the actual dosage given on each occasion. Sharnbrook Lodge DS0000014966.V343455.R01.S.doc Version 5.2 Page 29 Timescale for action 31/10/07 2. OP8 12(1)(a) 13(1) 31/10/07 3. OP9 12(1)(a) 13(2) 10/09/07 Records for the administration of Controlled Drugs must record the time at which they have been taken and be signed by two members of staff. 4. OP12 12(1)(a) 16 (2)(m) Arrangements must be made to ensure that all service users receive adequate stimulation to ensure they are motivated. (Progress noted but previous timescales of 30/01/06, 30/07/06 and 31/12/06 had not been met in full) The registered person must ensure that people’s dietary needs are met by basing the provision of meals on assessments of nutritional need and preference and corresponding planned menus. The registered person must ensure that people live in comfortable, hygienic surroundings. Floor coverings throughout the home must be maintained in a clean and hygienic condition. Beds must be properly made and linen replaced as required Staffing arrangements must be increased at the admission of anymore than twelve service users. Sufficient care staff must be scheduled during the day and night to care for service users. This must include two waking night staff and a cook to prepare all meals. (Previous timescale of 30/10/06 had not been met. An immediate requirement notification was issued at this inspection) Sharnbrook Lodge DS0000014966.V343455.R01.S.doc Version 5.2 Page 30 31/10/07 5. OP15 12(1)(a) 16(2)(i) 31/10/07 6. OP19 12(1)(a) 16(c)(j) 31/10/07 7. OP27 12(1)(a) 18(1)(a) 10/09/07 8. OP33 12(1)(a) 24,26. 9. OP38 12(1)(a), 23(2)(4) (c)(i) The registered person must 31/10/07 ensure that quality assurance systems are sufficiently robust so that people using the service can comment fully on its operation and that risks to their wellbeing are identified and dealt with promptly. The registered person must 10/09/07 ensure that fire doors throughout the home are fitted with fire retardant seals that comply with fire safety requirements. (Previous timescale of 30/10/06 had not been met. An immediate requirement notification was issued at this inspection) 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 OP1 Good Practice Recommendations The statement of purpose should be amended to include the changes to the home’s registration that were agreed after the inspection. The statement should show the number of bedrooms that can accommodate wheel chair users. The manager and staff should undertake training in the provision of recreational activities for older people, to include appropriate activities for those with dementia. (Carried forward from the previous two inspections.) The manager should not be scheduled to carry out all of the on call duties. These responsibilities should be shared with other senior personnel. (Carried forward from the previous inspection) Sharnbrook Lodge DS0000014966.V343455.R01.S.doc Version 5.2 Page 31 2. OP12 3. OP27 4. 5. OP30 OP31 Recruitment practice should evidence that of interviews via questions and notes to show equal opportunity practice and the exploration of previous employment. The manager should consider undertaking training to achieve the Registered Manager Award. (Carried forward from the previous two inspections.) There should be at least two fire drills each year. 6. OP38 10. OP33 It is suggested that regular meetings with service users and/or their representatives be introduced. (Carried forward from the previous inspection) Sharnbrook Lodge DS0000014966.V343455.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF 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 Sharnbrook Lodge DS0000014966.V343455.R01.S.doc Version 5.2 Page 33 - 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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