Inspection on 13/08/07 for Sidegate Lane Nursing Home

This inspection was carried out on 13th 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

Sidegate Lane Nursing Home 17/08/06

Sidegate Lane Nursing Home 02/11/05

Sidegate Lane Nursing Home 07/02/05

Sidegate Lane Nursing Home 10/11/04

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

CARE HOMES FOR OLDER PEOPLE Sidegate Lane Nursing Home 248 Sidegate Lane Ipswich Suffolk IP4 3DH Lead Inspector Deborah Kerr Key Unannounced Inspection 13th August 2007 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000024487.V348810.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. DS0000024487.V348810.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sidegate Lane Nursing Home Address 248 Sidegate Lane Ipswich Suffolk IP4 3DH 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) 01473 274141 01473 715245 michelle.webster@orbit.org.uk Orbit Housing Association Mrs Michelle Webster Care Home 24 Category(ies) of Dementia (24), Mental disorder, excluding registration, with number learning disability or dementia (24) of places DS0000024487.V348810.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th August 2006 Brief Description of the Service: 248 Sidegate Lane is a purpose built care home, providing accommodation and nursing care for up to 24 people over the age of 55 with dementia or mental health needs. The home is owned by the Orbit Housing Association and is situated in a residential area of Ipswich, close to local amenities and a short bus or car journey from Ipswich town centre. Orbit Housing Association is a non-profit making organisation run by voluntary committees and provides a cross section of housing throughout the country. The home is operated in conjunction with Social Care Services and as such admission can only be accessed via this agency. Accommodation is divided into three living units, two on the ground floor and one on the first. These are separated into zones. Each zone has eight bedrooms and its own open plan dining and kitchen area and communal bathrooms. All bedrooms are for single occupancy and have the benefit of ensuite shower and toilet facilities. Access between floors is via a passenger lift. A statement of purpose and a service user guide provides detailed information about the home, the services provided and access to local services. Information obtained from the statement of purpose/service user guide reflects that the range of fees charged by the home is £755 to £855 per week. This was the information provided at the time of the inspection, people considering moving to this home may wish to obtain more up to date information from the care home. These charges cover all care, accommodation, heat, lighting, meals, laundry and continence products. They do not cover additional services such as the dentist, optician, hairdresser, personal items such as toiletries, clothing, or daily newspapers. DS0000024487.V348810.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over eleven and three quarter hours, over two days. This was a key inspection, which focused on the core standards relating to older people. The report has been written using accumulated evidence gathered prior to and during the inspection, including information obtained from the Annual Quality Assurance Assessment (AQAA), issued by the Commission for Social Care Inspection (CSCI). A Short Observational Framework (SOFI) was used as part of the inspection, to gain an insight into the experience of people living in the home. This was undertaken on the second day of the inspection, where time was spent in Zone 5 watching how staff supported people during their midday meal. Additionally a number of records were inspected, relating to people using the service, staff, training, the duty roster, medication, health and safety and a range of policies and procedures. A tour of the home was made and time was spent talking with five staff, one visitor and four people living in the home. The Registered Manager was on annual leave, however the deputy manager was present throughout the inspection and fully contributed to the inspection process. What the service does well: Staff spoken with were asked what they thought the service did well. They all considered the home offers specialised care to people with complicated needs, where other services have felt the individual’s were too challenging. Observations throughout the inspection confirmed that staff treats each person as an individual, allowing them the flexibility in their daily routines to help create a relaxed atmosphere and enhance their well being. Care plans clearly reflect the individual’s health needs and provide a plan of care that is responsive to the varied and individual needs and preferences of the people living in the home. The home is nicely decorated, warm and comfortable offering a good standard of accommodation. The home is surrounded by beautifully landscaped and enclosed gardens with a range of shrubs, trees, flowers and vegetables, which people living in the home help to plant and maintain. A relative spoken, with commented, “ the home is a lovely place there are no smells and the en-suite rooms make such a difference, the home have done wonders for my relative”. DS0000024487.V348810.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The service users guide and other information about the home should be available in a format suitable for the people with a visual and other sensory impairments. A ‘quick glance and easy to read summary’ should be produced to make the complaints procedure simple, clear and accessible to people using and working in the service. Although files confirmed that people have a placement contract by Social Care Services with the home, not all people living in the home have a copy of the terms and conditions of residence between themselves and Sidegate Lane. A previous requirement was made for care plans to be reviewed on a monthly basis and amendments made where necessary. Examination of the care plans identified that reviews are taking place, however entries in the care plans showed this was inconsistent. Regular reviews must take place to ensure that the care plan provides accurate details of the current and up to date needs of the individual. DS0000024487.V348810.R01.S.doc Version 5.2 Page 7 Previous inspections, identified shortfalls to the recording on Medication Administration Records (MAR) charts. It is of concern that staff members responsible for the administration of medication continue to make omissions, preventing an appropriate audit trail of administered medications to be established. The home must establish robust procedures to monitor the safety and accuracy of medication systems. Staff responsible for administering medication must attend training to ensure they have a basic knowledge of handling and keeping records relating to medication. The home must be conducted in a manner that ensures that people living in the home are treated with respect and their right to privacy is upheld. The home must ensure that they adhere to their own policies and procedures with regards to the catering arrangements, which states that there must be appropriate consultation with people using the service regarding choice of meals. People must have a choice of two main dishes, and where neither of these choices are liked an alternative is provided. Staff must receive ongoing training to ensure they have the skills and knowledge to meet the individual and complex needs of people using the service. This must include, infection control, Control of Substances Hazardous to Health (COSHH), dealing with difficult and challenging behaviours and administration of medication. At least 50 of staff should be trained to the National Minimum Standard and hold a recognised qualification such as National Vocational Qualification (NVQ), level 2 or above. The home must have a quality assurance system in place, which takes into account the views of family, friends and other professionals associated with the home. This will confirm how the home is meeting the aims and objectives set out in the statement of purpose. The manager must ensure that there are safe working practices in place, which safeguard the health, safety and welfare of people living and working in the home. Regular testing of fire equipment must be undertaken and a record kept of the date, the test was carried out. Appropriate storage must be found to store equipment when it is not in use. All cleaning materials, which are potentially hazardous, must not be decanted into unlabelled bottles in line with the (COSHH) regulations. Regular maintenance and testing of Portable Appliances must be undertaken and food must be correctly stored, labelled and dated. There must be agreed consent and risk management strategies in place where the use of restraint is used to secure the welfare of any individual living in the home, such as lap belts in wheelchairs and the use of bedrails. Please contact the provider for advice of actions taken in response to this DS0000024487.V348810.R01.S.doc Version 5.2 Page 8 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. DS0000024487.V348810.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 DS0000024487.V348810.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): 1, 2, 3, 4, 6, People who use the service experience good quality outcomes in this area. People who may use this service can expect to be provided with comprehensive information about Sidegate Lane and be confident that they will have their needs fully assessed to ensure their unique and individual needs are met. However, they cannot be assured that they will be issued with a copy of the terms and conditions of residence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a detailed statement of purpose and service user guide, which contains a copy of the organisations complaints procedure. These documents make up a ‘Residents Information Handbook’, which is provided to each new person moving into the home and their relative or visitors on request. However, consideration should to be given to how information about the service is provided to people with a sensory and /or hearing impairment. DS0000024487.V348810.R01.S.doc Version 5.2 Page 11 Information provided in the Annual Quality Assurance Assessment (AQAA) states that all placements at the home are made under a block contract with Social Services. However they do promote and market the home where people show an interest through the statement of purpose and service user guide on request. Information provided in the AQAA and observed during the inspection, confirms the home’s ability to offer a service with the expertise to provide a safe and homely environment for people with mental health problems who present behaviours that can be challenging. Examination of two peoples’ files confirmed that prior to moving into the home a detailed pre-admission needs assessment had been completed by Social Care Services. One file contained a copy of the home’s assessment of the individuals needs. This was in the form of a detailed written analysis about the needs of the individual, including all information about their health, social and personal care needs. The assessment confirmed that the individual met the criteria for admission to the home and that they would benefit from nursing care offered by the service. The home’s admissions process, supports people to move from long stay hospital settings into a residential and nursing environment. This process incorporates visiting the individual and careful planning of their care to support them to move into a very different environment. To ensure that staff have the skills and experience to meet peoples needs, the deputy manager confirmed that staff had visited individuals and had spent time with them at their previous long-term care placements, getting to know the person prior to moving into Sidegate Lane. A previous requirement had stated that staff must receive appropriate training to meet the needs of the people for whom the home is intended. The staff notice board had a memo advertising a series of dates for Dementia Awareness training, which all staff are expected to attend. The home has a copy of a booklet produced by Orbit Housing Association, called ‘Caring for Clients with Alzheimer’s and Dementia’. This provides excellent information about the causes and varying types of dementia and the progressive stages of the condition. Both files seen contained proof that each individual had been issued with a placement contract by Social Care Services, however only one file contained a copy of the terms and conditions of residence between the person using the service and Sidegate Lane. The home does not provide intermediate care; subsequently this standard is not applicable. DS0000024487.V348810.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): 7, 8, 9, 10, 11, People who use the service experience adequate quality outcomes in this area. The personal care that people using this service receive is of a high quality, however the current arrangement for the administration of medication does not ensure their safety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The AQAA states that the home has excellent individualised care plans, which are agreed with individuals and their relatives. Staff are alert and quick to identify where changes in individuals needs are required. Key working and named nurses means staff are able to utilise their in-depth knowledge and experience to identify changes in the individuals behaviour that require attention. This is particularly prevalent in people living in the home that are less mobile, identifying the use of pressure relieving equipment at an early point to prevent later problems. Information seen in care plans reflected the information stated in the AQAA. Information obtained through the pre-admission process provides a plan of care tailored to meet the individual needs. Each plan contained their personal DS0000024487.V348810.R01.S.doc Version 5.2 Page 13 details including next of kin and other important contacts, however these should have a photograph of the individual for identification purposes and to reflect the individuals ownership of their plan. A twenty-four hour summary at the front of the plans provides detailed information, covering all aspects of the individual’s daily living needs. These give clear guidance to staff of the actions they need to take to ensure that all aspects of the person’s health, personal and social care needs are met. Relevant health charts and assessments are in place, relating to moving and handling, wound assessments, pressure care, nutrition and continence management. Generally these are being reviewed to reflect the individual’s current and changing needs. However, it was noted and discussed with the deputy manager that the recording and reviewing of information could be improved as this was intermittent and did not in all cases monitor the individuals health and well being. For example an individual had moved to the home in January 2007, their initial weight had been recorded, with no further entries to monitor their weight. There pre admission assessment stated that although they were able to feed themselves well, they required a soft food diet, but had behaviors associated with eating. Care Plans confirmed that people are supported to access their General Practitioner (GP) and other local health services relevant to them. For people who are not well enough to leave the home arrangements are made for health professionals to visit them. The AQQA states that the home has a good relationship with the Primary Health Team, working together to provide a service that both treats the symptoms and seeks to find the cause of changes in an individual’s health and well being. Information seen in the care plan of one person confirmed this. A request was made via the GP for the support of a consultant psychiatrist due to the behaviours of the individual, which were causing concern to staff and other people using the service. As a result a series of workshops were held at the home with the staff and the individual to understand their behaviours. Recommendations were made to keep them engaged in activities of interest, to keep them occupied and minimise the affect their behaviour has on other people living in the home. A previous requirement was made for care plans to be reviewed on a monthly basis and amendments made where necessary. Examination of the care plans identified that reviews are taking place, however entries in the care plans showed this was inconsistent. The AQAA states that reviews are held annually including the individual, their relative/and or advocate as applicable, which enables all to comment about the service and where changes may be required. During the inspection, staff demonstrated a genuine empathy, care and concern for each person. People’s choice is respected, regarding their age and frailty as to whether they wish to join other residents or remain in their room. The interactions between the individuals and staff were observed to be friendly and appropriate. All people living in the home are provided with their own DS0000024487.V348810.R01.S.doc Version 5.2 Page 14 room, which includes en-suite toilet facilities, which promote privacy. However, during a tour of the home, a member of staff invited the inspector into the bathroom where a person living in the home was having a bath. Although the carer supporting the individual made an attempt to cover them with a towel, this action does not promote people’s privacy and dignity. All bedroom doors are fitted with a privacy lock, although staff in the case of an emergency can override these. The deputy manager was in the process of administering the breakfast medication when the inspector arrived. Each of the three living units has its own secure, fit for purpose, medication trolley. Medication is administered via a Monitored Dosage (blister pack) System (MDS). Each blister pack had a front sheet with the individuals’ details and a photograph for identification purposes. Previous inspections have identified shortfalls to the recording on Medication Administration Records (MAR) charts. The MAR charts examined identified that there continues to be a significant number of missed signatures and a failure to use the codes to identify where medication is refused. It is of concern that staff responsible for the administration of medication continue to make omissions, preventing an appropriate audit trail of administered medications. This was first identified as a concern at the inspection on the 2nd November 2005. The deputy manager showed the inspector the system for the storage and administration of controlled drugs. The controlled drugs register confirmed there are currently four people prescribed the drug Temazepam. Two people are currently being reviewed by the GP to reduce or stop the medication. The deputy confirmed that one person has since stopped their Temazepam, which is to be returned to the pharmacy, who has a licence to receive and dispose of these medicines. The stock of controlled medication was checked and found to be accurate. Care plans examined did not contain information about the end of life needs of people using the service. Information needs to be ascertained, agreed and recorded in each persons care plan to ensure that at the time of death or dying the individual is supported to manage degenerative and terminal illness through an established plan, which constantly monitors pain, distress and other symptoms. Time was spent with the deputy manager discussing their intention to implement the Liverpool Care Pathway, used in the treatment of palliative care, which will cover all of these issues. DS0000024487.V348810.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, People who use the service experience adequate quality outcomes in this area. People living at the home are supported to follow their chosen interests and are provided with wholesome and appealing food, however they are not offered a choice of meals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The AQAA makes reference to a regular activities programme that makes use of the skills of an activities co-ordinator, including art, music and gardening. An individual showed the inspector a number of watercolour paintings they had completed confirming that people are supported to continue with their individual hobbies and interests. The activities co-ordinator is currently taking time off from work, which has left a void in activities. Staff spoken with felt providing time for activities is something the home could do better. The AQAA confirms that the home is seeking ways to provide small group activities, including trips out. They have recently been offered the use of a mini bus, from a local charity. Photographs were seen on the notice board of people enjoying recent trips out to Felixstowe, Shotley and Bury St Edmunds. The AQAA highlights that there have been limitations for people living at the home in accessing the wider community due to transport problems, however, DS0000024487.V348810.R01.S.doc Version 5.2 Page 16 visitors are welcome at any time and entries in the visitors book confirmed that friends, relatives and family visit on a regular basis. People of different nationalities are accommodated and the home has made an attempt to ensure they are able to communicate in their preferred language. This has been extremely difficult in some cases, with family as the only access for support. The deputy advised the inspector they are in the process of recruiting staff that are able to speak foreign languages. Staff have also been leaning key words and phrases to be able to communicate with the people concerned. Information in the AQAA states that people are able to access all parts of the home. However, during the inspection, it was noted that locked doors restrict areas of the home. These concerns were discussed with the deputy manager who advised that a number of people using the service are on continuing care orders and that some areas of the home are restricted for the individual’s safety. People do have unrestricted access around the zones and corridors, however it was noted that the doors to the conservatory were locked on both days of the inspection. People have access to the kitchen and dining eating areas on each zone, where they are able to access snacks and refreshments if required. However, Zone 5, which is on the upper floor, has a fastening fitted to the door, which deters people leaving the Zone, although the door can be opened. There are concerns as the door leads out onto the stairs. The door is fitted with a sensor so that if they do manage to lift the lock and leave the unit, staff are alerted. The home should consider the needs of individuals as part of the pre admission assessment when admitting people into the home to ensure that only suitable people are residing on the top floor. As part of the inspection, one and a half hours was spent on Zone 5 observing how staff supported people during their midday meal. Two staff were allocated to Zone 5 to support the seven people who reside in this unit. Individuals have the choice as to whether they wish to join other people in the dining room or remain in their room for their lunch. At the beginning of the observation there were two people sitting in the lounge and dining area, a third person joined the group after half an hour. Throughout the observation the staff demonstrated a genuine empathy, care and concern for each person. The interaction between staff and people living in the home was relaxed and at a pace suitable for the individual. Where people required the support of staff to eat their meal, staff encouraged them to undertake this task for themselves, enabling the individual to participate in eating their meal. Staff demonstrated that they were aware of the unique and individual needs and preferences of the each person living in this zone. One negative aspect about the way an individual was being supported to eat their meal was observed which was fed back and discussed with the deputy manger. All three units were visited whilst people were having lunch. People commented, “ It is nice living here, the food is good” and “food is lovely”. DS0000024487.V348810.R01.S.doc Version 5.2 Page 17 Meals are ‘home-cooked’ using mainly fresh ingredients. The food store seen confirmed that the home has a good range of quality food. Meals are served from a hot trolley, which is taken to each zone. The main meal on the first day of the inspection consisted of beef stew and dumplings, with vegetables, followed by stewed apple and custard. Some meals were puréed for people requiring a soft food diet. The meat and vegetables had been puréed separately so that the individual could taste the individual flavours as well as identify the food by colour and texture. A previous requirement was made to ensure that people are offered a choice of options at mealtimes. On both days of the inspection it was noted that there was no alternative choice of meals available. The catering policy reflects that there is a 6-week rolling menu, which changes completely every 6 months. The policy identifies that supporting individuals to make food choices is very difficult, however staff must recognise peoples likes and dislikes. The policy states that the home should ensure that there is appropriate consultation with people using the service regarding choice of meals. It also states that people should have a choice of two main dishes, and where neither of these choices are liked an alternative is provided. DS0000024487.V348810.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): 16, 18, People who use the service experience adequate quality outcomes in this area. People using the service and / or their relatives can expect to be supported to express their concerns and to be protected from potential situations of abuse, however to further protect people and staff in the home, all staff must receive up to date training for dealing with difficult and challenging behaviours. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The AQAA contains information setting out the homes policies and procedures for people using the service or their relatives to complain about the service they receive and for protecting people from potential abuse. In addition to the formal complaints and concerns process the manager offers regular informal discussion with both relatives and people using the service to highlight concerns or changes that might be necessary. The home has a complaints log, which has a clear mechanism for logging complaints. The home’s approach is to deal with issues at the ‘niggle’ stage and prevent them from becoming formal complaints. The home sees concerns raised as a way of improving the service. There have been no complaints in relation to this service received by neither the home nor the Commission for Social Care Inspection (CSCI) since the last inspection. The complaints procedure was displayed within the home and is also included in the Statement of Purpose, Service User Guide and Resident’s handbook. DS0000024487.V348810.R01.S.doc Version 5.2 Page 19 The complaints procedure, which has been produced by Orbit Housing Association, is a very detailed and complex procedure, with varying steps for people to follow if dis-satisfied with any aspect of the service and if unhappy with the outcomes of their complaint. Staff spoken with, were unaware of the content of the procedure. The layout, content and written format would make it very difficult for a person using the service to navigate their way around the complaints procedure. It was disused with the deputy manager that an in house ‘quick glance and easy to read summary’ may prove more accessible to people using and working in the service. The home was able to evidence that it has a clear procedure for the Protection Of Vulnerable Adults. Staff personnel files seen at the time of the inspection, confirmed that all newly employed staff are subject to Criminal Records Bureau (CRB) and Protection Of Vulnerable Adults (POVA) check. Additionally, information taken from the AQAA confirmed that all staff have attended training on the recognition and reporting of abuse and understand the importance of staying alert to potential situation where abuse could occur. However, staff spoken with were not clear that allegations should be referred to Social Services, Customer First team. As already mentioned in the report, the home provides accommodation to people with complex mental health needs, who can at times present behaviours that are physically challenging to other people living and working in the home. Staff spoken with were clear about what constituted as abuse and that restraint should only ever be used as a last resort, however, they felt vulnerable as they had not received recent or up to date, formalised training to deal with behaviours that can be challenging. DS0000024487.V348810.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): 19, 20, 21, 22, 23, 25, 26, People who use the service experience good quality outcomes in this area. The physical design and layout of the home enables the people who use this service to live in a safe well maintained and comfortable environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Sidegate Lane is purpose built home, which spans two floors. Accommodation is divided into three living units, two on the ground floor and one on the first. These are separated into zones. Each zone has eight bedrooms and its own open plan dining and kitchen area and communal bathrooms. All bedrooms are for single occupancy and have the benefit of en-suite facilities, incorporating a toilet and wash hand basin. Access between floors is via a passenger lift. Additional communal areas include a large reception area, lounge and a conservatory. The home is surrounded by beautifully landscaped and enclosed gardens with a range of shrubs, trees, flowers and vegetables. An individual with a keen DS0000024487.V348810.R01.S.doc Version 5.2 Page 21 interest in gardening showed the inspector an area of the garden that they have helped to plant and maintain. The home is nicely decorated, warm and comfortable offering a good standard of accommodation. The AQAA suggest there are plans to undertake some work to improve the environment. Due to the uncertainty of the future of the home, refurbishment of the communal and personal parts of the home, have until now been withheld, however there are plans to upgrade the décor and furnishing over the coming year. All three units were seen, these were all decorated differently, each providing homely and comfortable accommodation, with furnishings and lighting that are domestic in character and are suitable for their purpose. Information provided in the AQQA states the home has been designed to make good use of the facilities, walking loops have been created, so that people are able to wander around the home. The enclosed gardens provide people the opportunity to experience the natural environment in safety. Bathrooms throughout the home are warm and comfortable, with appropriate aids for safe moving and handling. Zone 5 bathroom had a range of slings for communal use hanging on the wall. Concerns were raised with the deputy manager about the risk of cross infection occurring through the communal use of these items. The deputy advised these are for people who require the assistance of hoist in minimal circumstances. People who require the use of slings for intimate personal care have their own personal slings assessed to suit their needs by the company providing the slings. Evidence was seen that people are provided with aids and equipment for the prevention of pressure areas, where required. All corridors, bathrooms and toilets are provided with grab rails for people’s safety and to promote independence. A number of commodes, bath aids and wheelchairs were being stored in the bathrooms, making them cluttered and a risk to people trying to access the bathroom, this was a particular issue on zone 5. The AQAA states each zone has their own individual space and teams of designated staff, which have significantly benefited the people living in the home. Each person and their relatives are invited to actively take part in choices of how they personalise and decorate their rooms. A selection of people’s rooms seen, were nicely decorated with personal items, including small items of their own furniture, photographs, ornaments and paintings. Many of the rooms were equipped with people’s own televisions and music centres. All bedrooms are fitted with a call bell, door lock and lockable cabinet for personal items, on request. All areas of the home are maintained to a good standard and were found to be clean and tidy with no unpleasant odours. Air fresheners are discreetly placed around the home, which give off a nice smell, and add to the ambience of the DS0000024487.V348810.R01.S.doc Version 5.2 Page 22 home. The laundry facilities seen were clean and tidy with appropriate equipment to launder clothing and bedding. The washing machine has a sluice facility for dealing with soiled linen. Appropriate hand-washing facilities of liquid soap and paper towels are situated in all bathrooms and toilets where staff may be required to provide assistance with personal care. Random testing of water temperatures reflected that the water supply is within the recommended 43 degrees centigrade, which minimises the risk of people living in the home scolding themselves when taking a bath or shower. DS0000024487.V348810.R01.S.doc Version 5.2 Page 23 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, People who use the service experience adequate quality outcomes in this area. People using this service are supported by a staff team that are available in sufficient numbers, however the lapse in training does not ensure that staff have the skills and knowledge to meet their individual and complex needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staffing levels and training were examined using information taken from the completed AQAA and during the inspection. The duty roster showed that a qualified nurse, plus six care staff cover the daytime shifts and a qualified nurse and three staff cover the night shifts. In addition to these numbers, mid and twighlight shifts have been introduced to provide extra staff support at peak times of the day. The roster reflected that a number of staff work double shifts. The deputy manager confirmed that the hour’s staff work is monitored to ensure they are not working excessive hours. The home also provides opportunities for student nurses, from the local hospital to experience working in a care home as part of their community placements. Apart from occasional problems of sickness, staff spoken with felt that staffing levels were sufficient to meet the health and personal care needs of the people living in the home. However, they did not feel that staffing levels provided enough time for additional recreational and social activities. DS0000024487.V348810.R01.S.doc Version 5.2 Page 24 The AQAA states there have been improvements made to the recruitment system. A previous requirement was made to ensure that two satisfactory references are obtained prior to any member of staff commencing employment. Examination of staff files confirmed that all the relevant documents and recruitment checks, including two references, a Criminal Records Bureau (CRB) and a Protection of Vulnerable Adults (POVA) check had been undertaken for new employees. A previous requirement was made for the manager to have a system in place, which provided documentary evidence that each member of staff has undertaken training and on what date. There has been some improvement, the deputy provided a diary of training that had taken place, however a system must be in place, which ensures the training is carried out on a regular basis and updated as appropriate. The AQQA states that the home has well trained staff and a stable staff team who maintain a commitment to the high quality of service. Whilst the commitment of the staff is not in question, a lack of training was raised as a concern at the previous inspection. The deputy manager advised the inspector the shortfall in training for the pervious year was due in part to a lack of funding. The home had not been provided with a training budget from the owning organisation. However, they confirmed that the budget for this year does include training. They were able to provide details of planned training, including, care of older people with dementia, moving and handling, fire safety and food hygiene. They have also identified that staff need to attend training to acquaint themselves with the Mental Capacity Act, which relates to the group of people living in the home. This will ensure that staff have the knowledge and information and know what procedures to implement to meet the recommendations of the act to ensure the best interest of people using the service at all times. The training diary confirmed that some training has already taken place, which has included bereavement counselling, end of life and palliative care, moving and handling updates, food hygiene, equality and diversity and adult protection. Two staff are booked to complete a two-day refresher course for first aid. Staff spoken with felt vulnerable at times as they had not received recent or up to date, formalised training to deal with behaviours that can be challenging, which are some times presented by individual’s living in the home. A previous requirement was made for staff to have training to cover infection control, there was no record of this training taking place. The AQAA reflects that the home employ nine qualified nursing staff and thirtysix full and part time care staff, supported by thirteen ancillary staff. Figures in the AQAA reflect that seven care staff have achieved a recognised National Vocational Qualification (NVQ) level 2 or above, these figures confirm that the home does not currently meet the National Minimum Standard (NMS) target of 50 of care staff to hold a recognised qualification. DS0000024487.V348810.R01.S.doc Version 5.2 Page 25 Staff files confirmed that the new employees complete an in house induction, which is a guide familiarising the employee with the layout and health and safety arrangements of the home. They had also completed the Skills for Care Induction, which covers all six standards relating to the principles of care, the role of the worker, health and safety, effective communication, recognising and responding to abuse and develop as a worker. DS0000024487.V348810.R01.S.doc Version 5.2 Page 26 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, 32, 33, 34, 35, 36, 37, People who use the service experience adequate quality outcomes in this area. Where concerns have been identified which compromise the health, safety and welfare of people working and living in the home action needs to be taken to minimise these risks. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Manager of the home has been in post since December 2003 and was registered with the Commission in January 2005. They are a Registered Mental Health Nurse and have undertaken training in the care of older people with dementia. The Registered Manager was on annual leave, but the deputy manager was present throughout the inspection and fully contributed to the inspection process. DS0000024487.V348810.R01.S.doc Version 5.2 Page 27 The mental health needs of people using the service make it difficult for the home to have regular residents meetings, however relative’s meetings take place frequently to keep them up to date about the future of Sidegate Lane. This was confirmed in discussion with a relative visiting on the day of the inspection, who felt they have been fully consulted about the care of their relative and the future management of the home. Staff spoken with felt that communication could be improved, so that they were kept more up to date on decisions taken about the day-to-day management of the home. The AQQA states that the home has monitoring systems in place, which actively seeks the views of people living in the home and their relatives about the service they provide, however they have identified that these need to be more effective. Currently they do not have a co-ordinated approach to quality assurance to carry out an in-depth evaluation of the service to reflect how the home is meeting the aims and objectives set out in the statement of purpose. The home’s financial procedures are monitored through line management supervision. The AQAA reflects that there have been some financial limitations imposed on the service, due to the uncertainty about the future of the home. The focus has primarily been on change management and maintaining morale. Long-term uncertainty has created an impact on staff, however, despite these issues the home have maintained a high standard of service delivery. The home offers an extremely specialist service with proven expertise in providing a safe and homely environment for those with mental health problems, who present behaviours that have not always been managed elsewhere. The AQAA reflects that the day-to-day operational costs of the service are competitive and value for money given the small number of beds. A number of records, policies and procedures were viewed during the inspection. These included, catering arrangements, caring for clients with dementia, adult protection, complaints, infection control and restraint. The organisation also has a clear confidentiality, data protection and access to information policy. This states files relating to people living and working at the home are maintained in secure conditions so that only those with a legitimate right have access to information. The home does not act as appointee for any of the people residing at the home. Although the home does not manage people’s finances, for their convenience the manager does hold a small amount of personal cash. If people choose to have cash held in the office, monies are securely held in separate DS0000024487.V348810.R01.S.doc Version 5.2 Page 28 folders and all transactions made on behalf of the individual are recorded and tallied with corresponding retained receipts. Conversations with staff and staff files confirmed that there is a lack of formal recorded supervision. The AQAA identifies there is a need to improve supervision and appraisal and development to identify training requirements to ensure the skill base of staff is maintained. During the tour of the home a few issues relating to the safety and welfare were discussed with the manager. Bathrooms are being used to store, moving and handling equipment when not in use, making them cluttered and not easy accessible. Inspection of the cleaner’s cupboard identified that surface disinfectant had been decanted into a smaller plastic spray containers. The manager was advised that labels with the health and safety information should be attached to the bottle in accordance with the Control of Substances Hazardous to Health (COSHH) regulations, in case of accidental spillage when being used by staff in other parts of the home. The fire logbook seen identified that the weekly fire tests, including the fire alarms and emergency lighting had not been completed for the weeks of the 31st July and 7th August. A previous requirement was made for the home to evidence that mandatory safety checks are carried out. Examination of records confirmed that electrical wiring and gas safety checks had been carried out. Certificates were also seen confirming that moving and handling equipment and assisted baths are regularly checked and serviced. The Portable Appliance Test (PAT) certificate was dated July 2003; there was no evidence to suggest that a more recent inspection has taken place. The AQAA states that risk assessments and risk management systems enable and facilitate people using the service to live as independent as possible. A previous requirement was made for risk assessments to be updated to include the use of lap belts when people were mobilizing in their wheelchairs. Examination of records did not reflect that the assessments had been updated, neither did they have agreed consent and risk management strategies for the use of bedrails. A recent visit by the Environmental Health Officer (EHO) raised concerns that appropriate records relating to food safety were not being completed. Examination of the Better Food, Safer Business pack confirmed that basic temperature checks of fridges/freezers and food were not being completed, DS0000024487.V348810.R01.S.doc Version 5.2 Page 29 neither was the diary of opening and closing checks to ensure adequate arrangements are in place for the cleanliness and hygiene of the kitchen. Generally the home has good procedures in place for the safe storage, preparation and cooking of food, however it was noted that dry goods, such as custard powder and rice, are being emptied into plastic containers from their original packaging. These containers are refilled as they are used, therefore it is difficult to establish if the contents are being used in line with the recommended use by dates. DS0000024487.V348810.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 2 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 3 2 3 X 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 3 3 2 3 2 DS0000024487.V348810.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 OP2 Regulation 5 Requirement Timescale for action 21/09/07 2. OP7 15(2)(b) 3. OP8 12 (1-3) 4. OP9 13(2) There must be a contract between the people using the service and Orbit Housing Association. This will ensure that people are aware of the terms and conditions of residence. People using the service must be 07/09/07 involved in a review of their care plan. These reviews must take place on a regular basis. This will ensure that the care plan provides accurate details of the current and up to date needs of the individual. The recording and reviewing of 31/08/07 health charts must be improved. This will ensure that people’s health and well-being is being monitored. Medication Administration 14/08/07 Records must be completed whenever prescribed medication is administered to a person living in the home. This will ensure that people receive the correct levels of medication. This is a repeat requirement from 02/11/05 and 17/08/06. DS0000024487.V348810.R01.S.doc Version 5.2 Page 32 5. OP9 13(2) Where an individual refuses their medication the correct code must be entered on the MAR chart. An explanation must be recorded on the reverse of the MAR chart. This will ensure there is an audit trail of medication and will ensure the safety of the people living in the home. This is a repeat requirement from 02/11/05 and 17/08/06. 14/08/07 6. OP9 13(2) Staff responsible for 21/09/07 administering medication must attend training to ensure they have a basic knowledge of handling and keeping records relating to medication. This will ensure the safety of people living in the home. Arrangements must be in place to ensure that people receiving personal care, including bathing are treated with respect and their right to privacy is upheld. People using living in the home must be offered a choice of options at mealtimes. This is a repeat requirement from 17/08/06. 14/08/07 7. OP10 12 (4) (a) 8. OP15 16(2)(i) 31/08/07 9. OP18 18(1) (c) (i) 13 (6) All staff must receive up to date training for dealing with difficult and challenging behaviours. This will protect people living and working in the home. 21/09/07 10. OP19 23 (2) (l) Appropriate storage must be 31/08/07 found to store equipment when it is not in use. This will ensure the safety of people using the service and enable them to move DS0000024487.V348810.R01.S.doc Version 5.2 Page 33 freely and independently around the home, which is free from obstruction. 11. OP30 Sch.2 A record must be kept of training 31/08/07 undertaken by each member of staff and on what date. This will demonstrate that staff receive ongoing training to ensure they have the skills and knowledge to meet their individual and complex needs of people using the service. This is a repeat requirement from 17/08/06. 12. OP30 13(3) & 18(c)(i) Care staff must receive training on infection control procedures. This will reduce the risk of cross infection and ensure the safety of the people using the service. This is a repeat requirement from 17/08/06. 13. OP33 24 The quality assurance systems must take into account the views of family, friends and other professionals associated with the home. This will confirm how the home is meeting the aims and objectives set out in the statement of purpose. All cleaning materials, which are potentially hazardous, must not be decanted into unlabelled bottles in line with the (COSHH) regulations. This will protect the health and safety of people living and working in the home. The registered manager must make adequate arrangements for testing fire equipment at regular intervals and ensure that a record of these tests is kept. DS0000024487.V348810.R01.S.doc 21/09/07 26/10/07 14. OP38 13 (4) (a) (c) 31/08/07 15. OP38 23 (4) (c) (v) 31/08/07 Version 5.2 Page 34 This will ensure the safety of people living and working in the home. 16. OP38 13(7) Agreed consent and risk management strategies must be in place where the use of restraint is used to secure the welfare of any individual living in the home, such as lap belts in wheelchairs and the use of bedrails. This will ensure people living in the home are protected from abuse. The registered manager must ensure that regular maintenance and testing of Portable Appliances is undertaken. This will ensure the safety of people living and working in the home. Food must be correctly stored, labelled and dated. This will ensure the health, safety and welfare of people living in the home. 31/08/07 17. OP38 13 (4) (a) (c) 31/08/07 18. OP38 13 (4) (c) 31/08/07 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 service users guide and other information about the home should be available in a format suitable for the people with a visual and other sensory impairments. Consideration should be given to the accommodation available and the individual needs of the person as part of the pre admission assessment when admitting people into the home. This will ensure that only people assessed as DS0000024487.V348810.R01.S.doc Version 5.2 Page 35 2. OP3 safe are residing on the top floor. 3. OP7 The care plans of people using the service should have a photograph of the individual for identification purposes and to reflect the individual’s ownership of their plan. The Liverpool care pathway needs to be completed to ensure the end of life needs of people living in the home obtained to ensure that at the time of their death or dying they will be treated with dignity and respect and in accordance with their wishes. People of ethnic minorities should are offered culturally appropriate food. An in house ‘quick glance and easy to read summary’ should be produced to make the complaints procedure simple, clear and accessible to people using and working in the service. To ensure people using the service are in safe hands at all times a minimum of 50 of care staff should hold a recognised qualification such as National Vocational Qualification (NVQ). Staff supervision sessions should be undertaken at least six times a year. 4. OP11 5. 6. OP15 OP16 7. OP28 8. OP36 DS0000024487.V348810.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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 DS0000024487.V348810.R01.S.doc Version 5.2 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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