Inspection on 13/01/09 for Sherwell

This inspection was carried out on 13th January 2009.

CSCI found this care home to be providing an Poor service.

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

Other inspections for this house

Sherwell 16/07/08

Sherwell 17/12/07

Sherwell 12/09/06

Sherwell 03/03/06

Sherwell 25/04/05

Sherwell 22/11/04

Sherwell 25/05/04

Sherwell 05/04/04

Sherwell 17/02/04

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 19/06/2009.

CARE HOMES FOR OLDER PEOPLE Sherwell St Ives Road Carbis Bay St Ives Cornwall TR26 2SF Lead Inspector Ian Wright and Melanie Hutton Unannounced Inspection 13th January 2009 09:30 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 Sherwell DS0000009163.V373780.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. Sherwell DS0000009163.V373780.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sherwell Address St Ives Road Carbis Bay St Ives Cornwall TR26 2SF 01736 796142 01736 798621 carricklodge@btconnect.com 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) Mr Ronald James Cottam Manager post vacant Care Home 9 Category(ies) of Old age, not falling within any other category registration, with number (9) of places Sherwell DS0000009163.V373780.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th June 2008 Brief Description of the Service: Sherwell is double fronted Victorian style property, situated on the main road between Carbis Bay and St Ives. The care home offers accommodation and personal care for up to nine elderly people. All people who use the service have their own bedrooms, and all bedrooms have an ensuite toilet and wash hand basin. There is a lounge / conservatory at the front of the care home, which looks out on to the road with the sea in the distance. There are car parking spaces and there is also a lawned area at the front of the property. A small garden has been developed at the rear of the home. Mr Cottam, the registered provider does not currently employ a registered manager. He manages the home on a day to day basis directly with the assistance of a senior carer. However, an application has just been approved (27.1.09) for the senior carer to be registered as the manager, and a new certificate of registration will be issued shortly. A copy of the inspection report is available from management on request. A copy of this or previous inspection reports can also be obtained from CSCI on 0845 015 0120 / 0191 233 3323 or via our website at www.csci.org.uk. The range of fees at the time of the were £301-£340 per week. There are additional charges e.g. for hairdressing, chiropody, and newspapers etc. Sherwell DS0000009163.V373780.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This unannounced key inspection took place in ten hours in one day. Two inspectors completed the inspection. All of the key standards were inspected. The methodology used for this inspection was: • To case track four people who use the service. This included, where possible, interviewing the people who use the service about their experiences, and inspecting their records. • Informal discussion with staff and other people who use the service. • Observing care practices. • Discussing care practices with management. • Inspecting records and the care environment. Other evidence gathered since the previous inspection such as notifications received from the home (e.g. regarding any incidents which occurred) were used to help form the judgements made in the report. What the service does well: What has improved since the last inspection? What they could do better: This inspection has resulted in the issuing of eleven statutory requirements. This is an improvement since the last key inspection in June 2008. In brief, improvement is required to: • Ensure further development of the care planning system. • Ensure records (or copies) are stored at the home and available at all times for inspection. Sherwell DS0000009163.V373780.R01.S.doc Version 5.2 Page 6 • • • • • • • Ensure medication procedures and handling practices are satisfactory. Improve some aspects of the environmental standards in the home. Improve the policy regarding the management of allegations of abuse. Improve staffing levels. Improve staff training Improve quality assurance systems in order to demonstrate management is effective. Keep better records regarding the management of residents’ monies. The Commission will monitor suitable action is taken in these areas. Compliance with the statutory requirements issued is required in the timescales set. The commission is concerned that some of the requirements issued have been renotified from previous reports. Action to be taken regarding these concerns is being considered by our enforcement team. 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. Sherwell DS0000009163.V373780.R01.S.doc Version 5.2 Page 7 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 Sherwell DS0000009163.V373780.R01.S.doc Version 5.2 Page 8 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): 1, 2, 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information provided to people who use the service, and their representatives, is satisfactory. People who use the service receive appropriate information about the service they can expect. Assessment procedures are satisfactory. This ensures people’s needs are appropriately assessed. EVIDENCE: The registered provider has developed a satisfactory service user guide. A copy of this is available in each person’s bedroom, and a copy is also on display in the main part of the home. It is advisable a copy is sent to the representatives of people who use the service, for example when admission is agreed. Pre admission assessment procedures are satisfactory. One person has been admitted to the service since the last inspection in June 2008. There is a record of the pre admission assessment completed by a senior member of staff. This is supported by a care plan outlining the person’s needs from the placing authority. Sherwell DS0000009163.V373780.R01.S.doc Version 5.2 Page 9 We inspected copies of contracts of care for people who use the service. These are satisfactory. They are currently stored at the office of the registered provider’s other home. These documents (or a copy) need to be stored in the files of people who use the service, at Sherwell, as outlined in the Care Homes Regulations 2001. Sherwell DS0000009163.V373780.R01.S.doc Version 5.2 Page 10 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. Improvement is required regarding care planning, staff training regarding the management of medication and ensuring the downstairs bathroom cannot be entered if people are using it. Improvement in these areas will give people using the service further assurance that their health and personal care needs are being met in a respectful and dignified manner. EVIDENCE: Care plans for most people who use the service were inspected. Care plans have been rewritten and have subsequently improved since the last inspection. We pointed out that there should be some further developments: • More detail, regarding some issues on some of the care plans so staff have improved information. • Pages of each care plan should be numbered or include the person’s name. • There should be information regarding people’s individual leisure / educational interests. • People using the service and/ or their representatives should be involved in the care planning process. The person using the service and / or their representative should sign the care plan. Sherwell DS0000009163.V373780.R01.S.doc Version 5.2 Page 11 • There should be more detailed daily notes kept regarding the delivery of care plans for individual people using the service. The senior carer said she would arrange for these matters to be implemented. People who use the service, who we spoke to, said they were happy with the care provided. They said care was delivered according to their wishes and needs. All people living in the home looked clean, well dressed and well cared for. People who use the service spoke positively regarding the attitude of staff. However, we are concerned regarding staffing levels at Sherwell. There are times when there is only one member of staff on duty during the waking day at the home. Staff cover at night is only from a sleep in member of staff. From the evidence within care plans we think staffing levels are insufficient to meet the needs of some of the people accommodated. For example there are some people accommodated who need physical assistance from staff with e.g. continence and mobility issues. We think the current staffing levels do not enable people’s needs to be met. This subsequently presents an unsatisfactory level of risk to the people accommodated in the home for example of falls. We are also concerned regarding the adequacy of training delivered to staff. We think this results in staff not being sufficiently competent to carry out their caring tasks and also puts people who use the service at risk. We outline these issues further in the ‘staffing’ section of the report. Health care support appears to be to a satisfactory standard. People who use the service said they could see a doctor or other medical practitioner when this is necessary. The medication policy inspected is satisfactory and appears to contain appropriate information. The medication system was inspected. Storage is satisfactory and records regarding the operation of the system are to a good standard. However we are concerned about administration procedures. We understand that only the registered provider and senior carer have received formal training regarding the administration of medication. We were told that either of these staff will individually ‘pot up’ an individual’s medication. The medication is then immediately taken to the person using the service and administered by a care assistant. We understand from this that the care assistant does not check what is dispensed from the blister pack. However they administer the medication and sign the medication sheet. Subsequently they cannot be sure what they are administering and signing for, was correctly dispensed. Such practices need to be avoided. It is essential that staff are equipped with the correct skills to administer medication, if senior staff are not present. For example if pain relief is required at night. We do understand that some staff were present when a pharmacist met visited to discuss medication procedures. We also understand that the senior carer Sherwell DS0000009163.V373780.R01.S.doc Version 5.2 Page 12 has completed some internal training with some members of staff. However, it is essential that all staff involved in the administration of medication receive full training. The previous report dated 16th June 2008 contained an internet link to CSCI guidance regarding this. The privacy and dignity of people who use the service is generally well maintained, although we did observe staff enter people’s bedrooms, without knocking, on a couple of occasions. Improvements have been made, since the last inspection, to improving privacy in bathrooms and toilets. There is still a connecting door between the downstairs bathroom and the laundry room. A bolt needs to be fitted to this door (on the bathroom side) to prevent people entering the bathroom, if the bathroom is being used. The registered provider said staff do not generally enter the bathroom from the laundry, but said he would arrange the fitting of a lock. People who use the service did not say they had any concerns regarding regarding the respecting of their privacy and dignity. Sherwell DS0000009163.V373780.R01.S.doc Version 5.2 Page 13 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. Routines are generally satisfactory to meet the needs of people who use the service, however more opportunities to improve activities and social interaction need to be offered. EVIDENCE: We arrived at the home at 9:30 am. People living in the home had just had their breakfast, and/ or were in the process of getting up. Routines appeared relaxed and people seem to be able to spend their time as they wish. People can spend their time either in the lounge / conservatory at the front of the house or in their bedrooms. An activities organiser, from the registered provider’s other home in St Ives, visits weekly on a Thursday morning. Activities on offer include gentle exercise, quizzes and other activities to get people to interact as a group. The registered provider said people are also offered the opportunity to go over to Sherwell’s sister home to attend events there. Staff and the registered provider said staff do try to organise other activities but it is difficult to motivate people to participate in these. People we spoke to said they are happy how they spend their time. We stated in previous reports that there needs to be more staff in the afternoon. In regard to activities this would enable there to be more opportunity for more Sherwell DS0000009163.V373780.R01.S.doc Version 5.2 Page 14 activities / social interaction between staff and people who use the service to occur. This matter is discussed further in the ‘staffing’ section of this report. People who use the service have said they felt they could exercise choice over their lives; for example where to spend their time in the home, what they could wear etc. People can look after their own money, although there is some need for improvement regarding record keeping, if they receive assistance, as outlined later in the report. It was evident people who use the service could bring their own furniture and belongings into the home. For example bedrooms are individualised with people’s personal belongings such as photographs and ornaments. Relatives and friends can visit people who use the service when they wish. The registered provider has developed a satisfactory policy regarding meals and mealtime arrangements. The main meal is served at lunchtime. People who use the service said they enjoyed the food provided. The registered provider said people who use the service are told what the main meal will be first thing in the morning. They are offered an alternative if they do not like what is going to be provided. It is advisable that a menu is kept and displayed; however records of food provided are satisfactory. The registered provider said in the evening a light tea is provided. The registered provider said either sandwiches or a hot alternative e.g. cheese on toast is offered. We were told by Mr Cottam people are asked what they would individually prefer, before the tea is prepared. Recent records of food provided show this is mostly the case. On the day of the inspection all people who use the service appeared to have ham sandwiches followed by cake. Sherwell DS0000009163.V373780.R01.S.doc Version 5.2 Page 15 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 adequate. This judgement has been made using available evidence including a visit to this service. The registered provider has a suitable complaints procedure. However the adult safeguarding procedure still needs further development. This measure will help to give further assurance that people who use the service have greater protection from poor and abusive practice. EVIDENCE: Information regarding what people can do if they have a concern or complaint is in the service user guide. There are also notices in the communal part of the home stating how people can make a complaint. People who use the service were positive about staff practices and said they were not aware of any poor or abusive practice. We spoke to one member of staff who said she was not aware of any poor or abusive practice. She said she would be confident approaching senior staff, or the registered provider, if she had any concerns about care practices or attitudes of other members of staff. The registered provider has developed a folder regarding adult safeguarding which contains lots of information regarding abuse, safeguarding and related matters. There are currently three policies which are contradictory. There needs to be a clear, definitive statement outlining what action will occur if an allegation is made i.e. the matter is reported to the Department of Adult Social Care (Cornwall Social Services) who will arrange for a strategy meeting to occur, which will decide how to investigate the matter, and what other agencies will be involved. This has been discussed with the registered provider. Sherwell DS0000009163.V373780.R01.S.doc Version 5.2 Page 16 The inspector is happy to comment on a draft copy of the policy if this is submitted to the commission. Records show that the senior carer has attended adult safeguarding (protection) training. She has also arranged for other staff to attend when places become available. We suggested a copy of Cornwall County Council’s ‘No Secret’s’ video/ DVD be obtained, and this could be shown to staff as part of their induction. The registered provider said no allegations of abuse had been made. No exstaff had been referred to the Protection of Vulnerable Register (POVA) list (A list of people who are considered unsuitable to work with the vulnerable). All staff currently employed have received a POVA First check and / or a full CRB/ POVA check (Criminal Records Bureau / Protection of Vulnerable Adults check which help to check the person is deemed as suitable to work with vulnerable adults). Sherwell DS0000009163.V373780.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 26 Quality in this outcome area is adequate. Sherwell offers a generally pleasant environment for the people who use the service, although some improvement are still required to bring facilities up to the National Minimum Standards. EVIDENCE: The building was inspected. The building was warm, clean and hygienic on the day of the inspection. Decorations, fixtures and fittings are generally in good condition. As the home is currently only registered for nine people this helps to provide an intimate setting for people accommodated. Facilities consist of a lounge / conservatory at the front of the home. A kitchen and dining room are situated at the rear of the home. There is a downstairs bathroom and a separate downstairs toilet. There is a very small office for the storage of files etc. A stair lift connects the downstairs with the upstairs to enable those with walking difficulties to get up and down the stairs. There is an upstairs bathroom which is equipped to a good standard. There is however some finishing off to do regarding this facility e.g. a small amount of tiling / grouting, and the provision of a shower curtain / door. Sherwell DS0000009163.V373780.R01.S.doc Version 5.2 Page 18 The downstairs bathroom needs to have a lock on the door which connects it to the laundry. This is highlighted under National Minimum Standard 10 in regard to ‘privacy and dignity’. The registered provider has developed a small garden area at the rear of the home. The registered provider said he plans to put a conservatory on the rear of the home. An extension at the rear of the home has been completed. There is a leak by the rear door, which the registered provider said he is in the process of fixing. The extension could provide up to two further en suite bedrooms. Work appears to be to a good standard, although we have commented in our previous report regarding that floor surfaces should be carpeted rather than vinyl. The registered provider said he was not sure if he will increase the number of people the home is registered to provide care for. He said he may convert two existing bedrooms to increase communal space, and the home would continue to provide accommodation and personal care for nine people. We think this is a good idea, as the current conservatory /lounge may not be a particularly homely and private setting to use for example in the evenings during the winter. All bedrooms are of a satisfactory size; all are decorated and furnished to a good standard. Currently locks are not fitted to bedroom doors. These need to be fitted if required by people who use the service. People who move into the home should also be offered a lock on their bedroom door. There are some improvements which need to occur. For example: 1. The front door bell needs to be fixed as it does not work. 2. There should be a lock on the front door. We were able to enter the building, and walk to the rear of the home without being stopped by any body. This could present a serious health and safety risk to people living in the home. As stated in the previous inspection report: 3. There may be a need for blinds in the front conservatory, or for an electric fan. This room must get very bright and warm on a summer’s day. 4. There should be locks on the doors of en suite facilities (with an over riding facility as necessary). 5. The laundry room should be improved. The floor and wall surfaces should be impermeable. Matters 3-5 have not been attended to since the last inspection. Sherwell DS0000009163.V373780.R01.S.doc Version 5.2 Page 19 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 poor. This judgement has been made using available evidence including a visit to this service. Staffing levels need improvement to ensure they are satisfactory to meet the care needs of people who use the service. Recruitment procedures have improved and are now satisfactory. Although there has been some improvement regarding the provision of staff training, this is not sufficient to meet the needs of people who use the service. For example the failure to provide staff with moving and handling and first aid training could put staff and people who use the service at significant risk. Subsequently people who use the service cannot be assured they will be supported by enough staff, and by staff who are competent to carry out their duties. EVIDENCE: On the day of the inspection the following staffing levels were provided: • Two members of staff on duty from 08:00 to 13:00 • One member of staff from 13:00 to 16:00 • Two members of staff from 16:00 to 19:00 • One member of staff on duty from 19:00 until 08:00 A cook is currently not employed although Mr Cottam said the post is advertised. No cleaning / laundry staff are employed, and care staff undertake these duties. Mr Cottam said he is currently undertaking cooking the main meal each day, and care staff prepare the evening teas. On the day of the inspection Mr Cottam and the senior carer came to the home for the day, due Sherwell DS0000009163.V373780.R01.S.doc Version 5.2 Page 20 to the inspection. The senior carer was originally rostered to commence duty at 16:00. We did ask the registered provider to provide us with a review of current staffing in our inspection report dated 17th December 2007, and this was not completed. In the last inspection report dated 16th June 2008, the Commission for Social Care Inspection issued a statutory requirement that two members of care staff needed to be on duty throughout the waking day. This is to ensure there was satisfactory opportunity for people who use the service to pursue leisure, therapeutic and educational activities; that there is suitable assistance available for people who use the service to have help with continence and other personal care, moving and handling and other needs to keep them safe. We also met with Mr Cottam, as part of our regional improvement planning process on 26th September 2008 to discuss the inspection report, and reiterated why we had set the requirement. Mr Cottam questioned the validity of this and other requirements, and we provided a verbal and written response to his comments. Mr Cottam requested the home’s ‘poor’ rating was reviewed by our quality rating review service, and they responded on 21st October 2008 that the report was ineligible for review. The previous inspection report stated we wished for revised staffing arrangements to be confirmed in writing. This has not been received. Mr Cottam provided us with an Improvement Plan dated 8th November 2008, which was received by CSCI on 1st December 2008. This stated that staffing levels ‘are more than adequate to ensure the safety of service users (and the home) conform(s) to the necessary standards/regulations’. Mr Cottam has maintained that staffing levels are satisfactory in the home. He states people who use the service are difficult to motivate to pursue additional activities, and the current staffing provides satisfactory assistance for people with personal care. Mr Cottam has said to us that if a person using the service has a fall, staff have been instructed to telephone him. He will then come to the home and assist staff with any moving and handling which requires two people. When we spoke to people using the service and staff and on this occasion they did not raise any concerns regarding staffing levels. People who use the service were positive regarding the support they receive from care staff. Comments were made that staff were caring and supportive. Staff practices observed by us were positive and helpful to people living in the home. However, the Commission for Social Care Inspection still remains concerned regarding current staffing levels. We are concerned about the periods of time when there is one member of staff on duty i.e. before 0800, between 1300 and 1600, after 1900. We think this does not provide enough support for people who use the service with personal care, mobility and opportunities for Sherwell DS0000009163.V373780.R01.S.doc Version 5.2 Page 21 stimulation. We detailed these concerns further in our previous inspection reports dated 17th December 2007 and 16th June 2008. We remain concerned about night staffing arrangements. We raised concerns at the last inspection whether the member of staff remained awake all night. At the time Mr Cottam said there had always been a sleep in member of staff. We also spoke to the senior carer after the inspection regarding night staff arrangements. She confirmed that once the care needs of people living in the home are attended to, the staff on night duty sleeps in. She said the night staff are on duty from 20:00 to 08:00. She said they would only go to sleep once people’s needs had been attended to. She said staff would attend to the needs of people using the service, during the night, if staff were woken up. She said either Mr Cottam or herself would provide ‘on call’ support to staff on duty at night. Mr Cottam has also written to us about these arrangements. He stated staff have to be up at 0600 to attend to people’s needs. He stated in emergency he can go to the home as he lives two minutes away from Sherwell. He stated there is also a member of staff at Carrick Lodge in St Ives (his other care home) who could visit Sherwell, at night, in an emergency. He has said waking night staff would be provided if people were ill, or possibly if the home accommodated more than the current 7 people (it is registered for nine and has two vacancies). The Commission’s understanding is that there should always have been a waking night member of staff. This is outlined in our previous reports. We have never been notified, by the registered provider, regarding any proposed changes to night staffing. We remain concerned about this matter due to, for example, people’s personal care and mobility needs-which we outline below. Subsequently we conclude that it is essential there is a waking night member of staff on duty in the home. At this inspection we reviewed current care plans to ascertain the needs of the seven people currently accommodated at the home. This assessment showed: 1. Three people need physical assistance with continence /personal care 2. Two people need physical assistance with mobilisation / mobility. 3. One person needs physical assistance with mobilisation / mobility. 4. Three people have some form of behavioural / psychological problems which may present a risk to the person themselves and subsequently could present staff with difficulties providing support to the person. 5. Three people appear to be very vulnerable and there is some safety risk if they are left without appropriate levels of staff support. For example serious injury due to fall. From the records we reviewed we think at least five of the people who use the service need to live somewhere, where there is higher staffing levels. Sherwell DS0000009163.V373780.R01.S.doc Version 5.2 Page 22 Considering the profile of people now being admitted to care homes, we think it is unlikely this home would be able to accommodate enough people requiring a service where only one member of staff is on duty during the waking day. The current staffing levels present a significant risk to people living in the home for example from falls if they are not supported by appropriate numbers of staff on duty. For example from the care plans we note: • One person is described as needing carers to put their walking frame in place ‘at all times’ as they can ‘forget to use it.’ They will ‘attempt to walk within the home without it’ and ‘mobilise them(selves and go) down the steps at the front door…’ (and) ‘staff to encourage (them) to return to the safety of the building’. • Another person is described as needing assistance from one carer with personal care and walking. This person requires two carers to assist if they fall. Records show this person has had two falls since 1st January 2009. • A third person is described as ‘at risk of falls and /or serious injury without appropriate supervision whilst transferring and walking’ and the carer subsequently needs ‘ to ensure wears appropriate shoes /slippers whilst mobilising’. We are concerned about staff’s ability to satisfactorily respond to accidents and incidents if they are asleep at night. For example we obtained copies of records for several people. From records dated from 1/1/09 we note: • One person was found on the floor at 06:15 on 11/1/09, but was described as ‘could not have been there too long cause (sic) she was not very cold. Checked her over and she has grazing and bruising over her spine.’ • One person has a record of two disturbances on 2/1/09 (01:00) and 3/1/09. In these incidences the person was described as ‘in extreme pain’, ‘distressed’, ‘crying’. In one incident pain relief was delayed by one hour, although we were told by the registered provider and senior carer this was because the person refused to take it immediately. There is however no record of the reason for delay, and the registered provider and senior carer were not present at the time of the incident. Subsequently we think people individually, and collectively, need more staff support and supervision so they have appropriate care and safeguards from risk. Subsequently at least two carers need to be on duty throughout the waking day to assist with personal care, mobility and supervision. There must also be at least one waking night carer on duty i.e. once people who use the service have gone to bed. This is because our regulations clearly state there must be a suitable number of staff, and people’s health and welfare needs must be met. The regulations are also clear regarding the need to provide opportunities for the provision of activities for people who use the service. Sherwell DS0000009163.V373780.R01.S.doc Version 5.2 Page 23 As we are concerned regarding the lack of compliance regarding the requirement regarding staffing levels. Subsequently we obtained copies of relevant documentation under paragraph 6.7 of Code B of the Police and Criminal Evidence Act 1984. The inspection team have subsequently referred the matter to our Regional Enforcement Team for further action. The registered provider appears to have a suitable approach to enabling staff to have the opportunity to obtain a national vocational qualification (NVQ) in care. We understand the majority of staff are currently undertaking various levels of NVQ training. However, we have not been provided with a percentage of people who are currently qualified to at least NVQ level 2. There is only evidence, on staff files, that only one person has an NVQ in care. It is important that staff bring in, at least, a photocopy of their certificate evidencing they have an NVQ in care. We inspected the recruitment records maintained regarding staff employed at Sherwell. These were satisfactory. For example each person had an application form and two references were taken up and received by the registered provider. We would advise the registered provider to expand the section in the staff application form regarding physical and mental fitness. A Protection of Vulnerable Adults ‘First’ check has been obtained for new staff employed since the last inspection (This check ascertains if newly appointed staff are not on a list of unsuitable people to work with vulnerable people). A full Criminal Records Bureau (CRB) check was subsequently obtained to ascertain if these people had any criminal convictions. We are therefore satisfied that the Statutory Requirement Notice issued on 13th August 2008 is currently being complied with. Employment records are still kept at the registered provider’s other home in St Ives. The records have always been made available to us when requested, but as we have stated, these records should be maintained at Sherwell. We have agreed that a summary of the information, or relevant photocopies can be maintained at Sherwell. The registered provider agreed to arrange this using the form developed by the Commission. We re-inspected training records. By law all staff must have: • Regular fire training in accordance with the requirements of the fire authority. • There must always be at least one first aider on duty (at least at appointed person level) and / or in line with a risk assessment. • All staff must have manual handling training. • All staff must have basic training in infection control. • If staff handle food they must receive training regarding food hygiene. • All new staff must have an induction and there should be a record of this. Sherwell DS0000009163.V373780.R01.S.doc Version 5.2 Page 24 Due to repeated non-compliance with the regulations, we issued the registered provider with a Statutory Requirement Notice on 4th September 2008 regarding this matter. The notice required the registered provider to provide formal and certificated training to all staff in the home in order to meet and protect their needs by no later than 10th November 2008. The notice detailed where the registered provider had failed to deliver the above training to staff employed at that time. We inspected the training records for six staff that are currently working at the home. Of these three staff have commenced employment since the last inspection. In regard to the three staff that were employed at the time of the last inspection, the following training has been delivered: • Induction-the Senior Carer has recompleted the induction checklist with these staff. • Fire –all staff have received training delivered by the registered provider. • Manual Handling- all staff have received training delivered by the registered provider. • Infection Control- all staff have received training delivered by the registered provider. • First Aid- One of the staff has a first aid certificate. This was obtained in July 2008. There is no record the other two staff have a first aid certificate-even though both staff work alone on waking night shifts. • Food Handling. One of the staff has attended this training. There is no record the other two staff have any food handling training. We understand the registered provider completes some shifts including working nights at the home. We only saw evidence that he had undertaken fire training. Records of training for the registered provider need to be maintained at the home, and available for inspection if he is to continue to work in the home. We conclude from this analysis that the Statutory Requirement Notice issued has not been fully complied with e.g. staff have not received the required training regarding First Aid. The failure to deliver this training puts people who use the service at significant risk, for example if they need emergency first aid prior to an accident and emergency hospital admission. We also question whether the manual handling training delivered by the registered provider is satisfactory. We were told training received by one person took about one hour. Our understanding is appropriate manual handling training should take between half to one day. We have said to the registered provider that he needs to check with the person who is delivering this training that it is to a satisfactory standard. Reference should be made to appropriate guidance issued by the Health and Safety Executive, and their regulations. (i.e. HSE publication L23, Manual Handling Operations Regulations 1992, 2002) Sherwell DS0000009163.V373780.R01.S.doc Version 5.2 Page 25 These issues raise significant concerns regarding whether staff employed are competent to carry out care duties. The lack of appropriate training does not equip the people concerned with appropriate knowledge and skills. This could put people living in the home at significant risk. The Senior Carer has attended some external training courses regarding safeguarding adults, medication, infection control, first aid, mental capacity, health and safety and dementia. Three staff have been employed since the last inspection. They have received the following training: • Induction-the Senior Carer has completed the induction checklist with these staff. However it has so far only been completed in part for one of the staff that commenced employment in October 2008. We spoke to one member of staff who commenced employment since the last inspection who confirmed they had received an induction. Fire –all staff have received training delivered by the registered provider. Manual Handling- One of the staff has received training delivered by the registered provider. The other two staff commenced employment in October 2008 and November 2008. As staff spend time working alone we would have expected this training to have been completed, and the failure to do so could put staff and people who use the service at risk. Infection Control- all staff have received training delivered by the registered provider. First Aid- One of these staff has a first aid certificate, obtained from a previous employer but this expires in March 2009. Food Handling. Although basic awareness is covered in induction, none of the staff have received follow up training e.g. via the ‘Better Food, Better Business’ training pack. • • • • • The Senior Carer has located some other external training from the NHS which either she or other staff could attend. She has developed an individual risk assessment for each member of staff, which states what training is required for individual staff. However, the training identified does not necessarily address the shortfalls above. We are not satisfied satisfactory progress has occurred to improve training provision. We clearly pointed out following the inspection reports written in December 2007 and June 2008 that a training programme needed to be developed and implemented. We have said urgent action needed to be taken to ensure training regarding manual handling and first aid be prioritised for example firstly by 01/04/08, and then by 10/11/08. Our previous reports clearly evidenced the shortfalls in training delivery, and noted that we have had concerns dating back to at least April 2005. Our reports have clearly Sherwell DS0000009163.V373780.R01.S.doc Version 5.2 Page 26 outlined what was required. We also outlined that failure to do so put people who use the service, and staff, at serious risk. Due to the concerns that staff are therefore not competent to carry out their duties (due to lack of acquired skills and knowledge), we have referred this matter to our Regional Enforcement Team to decide what further action should be taken. It is essential the registered provider takes urgent action to ensure that all staff on duty receive required training. This is essential so staff can carry out their jobs, and there is an appropriate skills and knowledge mix on each shift. Sherwell DS0000009163.V373780.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37, 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The registered provider is not effective in ensuring the service is managed to meet regulatory requirements. Subsequently management systems need significant improvement and failure to do so could put people who use the service at significant risk. EVIDENCE: An application has been submitted to the Commission for Social Care Inspection for Rhianne Stephens to be registered as manager of the home. This application was subsequently approved on 27th January 2009. We note there have been some improvements since the last inspection. For example care planning has improved, there is more choice of food available, there have been some improvements to facilities available at the home, recruitment procedures are much better, some quality assurance surveys have Sherwell DS0000009163.V373780.R01.S.doc Version 5.2 Page 28 been completed and health and safety precautions have improved. This is very encouraging, and a positive move forward. However, due to the non-compliance regarding our requirements regarding staffing levels and staff training, we must maintain the current ‘poor’ rating regarding the management of the home; and subsequently this means the overall rating of the home remains ‘poor’. Now there is the appointment of a registered manager, we hope the registered provider will enable this person to develop the service further; particularly in the areas where we have raised concerns. The registered provider has a policy regarding quality assurance policy. This remains unchanged since the last inspection. There are blank spaces regarding designated responsibilities, and it does not appear the procedures outlined within the policy have been implemented. However since the last inspection a survey of people who use the service and their relatives has taken place. The results were generally positive, although some improvements were suggested. This is a positive development, although it is disappointing the results have not been collated, an action plan developed or implemented. We also cannot state we are satisfied this standard is met because although there has been some positive development to address shortfalls in the National Minimum Standards, we cannot ignore the on going failure to comply with some of the regulations, and that this may now result in further enforcement action. Some money is looked after on behalf of one person who uses the service. They money kept tallied with the record kept, and receipts had been obtained for expenditure carried out on behalf of the person. The records kept however were on the back of the envelope where the money is kept. Although this record was clearly kept it should be on a sheet, and kept within the persons file. The senior carer said she would arrange this. The registered provider said he or staff do not act as appointee for government financial benefits, for any of the people who use the service. The registered provider said records are kept of fees paid, although these were not inspected on this occasion. The registered provider said currently valuables are not looked after on behalf of people who use the service. We discussed with the registered provider regarding the storage of records for example the contracts / statement of terms and conditions of residency of people who use the service, and staff recruitment and personnel records. These are still kept at the registered provider’s other home. They have always been made available to us when we have completed an inspection at Sherwell. However, the regulations and the Commission’s interpretation of them is clear Sherwell DS0000009163.V373780.R01.S.doc Version 5.2 Page 29 that the records need to be stored at the home. We have agreed with the provider that a copy of the records could be kept at the home, and/or a summary of personnel information. The registered provider has a health and safety policy. An accident book is maintained. However some accidents, for example falls were not recorded here (although there was a record in the individual’s daily notes). There is a service agreement in place for the fire system, and the system has been serviced. There is a contract regarding the servicing of fire extinguishers. A fire risk assessment has been completed. There are satisfactory records of the testing of fire equipment by staff e.g. call points and emergency lighting. Health and safety risk assessments have been completed. There is a policy and procedure regarding the prevention of legionella. A system of checks was implemented in November 2008. However there is no record of checks were completed in December 2008. The registered provider said he would discuss this with the maintenance man to ensure checks were completed on a monthly basis. Suitable records are kept of water temperatures when people have a bath (a procedure necessary to reduce the risk of scalding). The bath chair and stair lift has been serviced. Gas appliances were serviced in January 2008, and this is now due. An electrician has examined the electrical circuit. An electrical hardwire certificate has been obtained and this deems the system as satisfactory. Portable electrical appliances were tested in January 2008, and retesting is now due. The Environmental Health Officer has visited the home regarding food hygiene on 8/7/08 and said standards were generally satisfactory. The Environmental Health Officer also visited regarding health and safety on 14/8/08 and noted satisfactory improvements had occurred since the CSCI report in June 2008. Training in various aspects of health and safety needs to take place so the registered provider meets legislative requirements (e.g. moving and handling training, first aid training, food hygiene training). This is outlined in the previous section of the report. Sherwell DS0000009163.V373780.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 3 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X 2 X X X X 3 STAFFING Standard No Score 27 1 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 2 X 2 2 Sherwell DS0000009163.V373780.R01.S.doc Version 5.2 Page 31 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 15 Requirement Timescale for action 01/07/09 2. OP9 13(2) 3. OP21 OP14 12 4. OP18 12 Continue to develop careplanning system. The issues outlined in the body of the report need to be addressed. These measures will ensure care plans contain appropriate information to enable individual needs to be met. There must be suitable 01/04/09 arrangements for the handling and safe administration of medicines in the home. For example staff must have suitable training. This will ensure people who use the service can be confident their medication is handled appropriately. Fit a bolt to the connecting door 01/04/09 between the bathroom and the laundry. This will provide people using the bathroom with more privacy and dignity. The registered provider must 01/04/09 have a clear and comprehensive adult safeguarding (protection) procedure. This will ensure there is clear guidelines what staff should do if there is an allegation of abuse. DS0000009163.V373780.R01.S.doc Version 5.2 Sherwell Page 32 5. OP19 23 6. OP27 12 Attend to the issues raised in the ‘environment’ section of the report. (e.g. security, privacy in bedrooms, laundry flooring etc.) This will improve decorations, privacy and facilities offered in the home. The registered provider must make proper provision for the care and where appropriate treatment, education and supervision of service users by having suitable numbers of staff available at all times through the waking day and night. Previous timescale of 01/11/08 not met. Second Notification This will ensure there are satisfactory numbers of staff on duty, to assist in meeting the needs of people who are currently accommodated at the service. You are required to ensure that there are sufficient numbers of staff at all times and ensure that all staff receive formal training appropriate to meet the needs of the service users - namely first aid, fire safety, manual handling, food handling and infection control. This will help ensure people who use the service receive care and support from suitably trained staff. (Timescale of 10/11/08 not met 3rd Notification.) 01/07/09 02/03/09 7. OP30 OP38 18 01/04/09 8. OP38 OP30 18 Review manual handling training to ensure it is to an appropriate standard. This will help to ensure people who use the service receive support with moving and handling in a safe manner DS0000009163.V373780.R01.S.doc 01/07/09 Sherwell Version 5.2 Page 33 9. OP33 OP31 24 10. OP35 17(2) The registered provider must develop and implement a suitable quality assurance system. This will help to ensure the service meets the expectations and needs of the people who use the service, and help ensure regulatory standards are met. (Previous timescale of 01/11/08 not met- Fourth Notification) Improve record keeping of valuables and monies kept held on behalf of people who use the service. This will ensure appropriate records are kept on behalf of people who use the service, and enable a suitable audit trail to be possible. The registered person must ensure all records, as required by the regulations, are maintained in the care home. For example: 1.Service user contracts / statement of terms and conditions of residency 2.Staff recruitment and personnel records. This will ensure these records are maintained and available for inspection at all times. (Timescale of 01/11/08 not met-3rd Notification) 01/07/09 01/04/09 11. OP37 OP2 OP29 17(2)(3) (b) 01/04/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Sherwell Refer to Good Practice Recommendations DS0000009163.V373780.R01.S.doc Version 5.2 Page 34 Standard Sherwell DS0000009163.V373780.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Sherwell DS0000009163.V373780.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. 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