Inspection on 14/02/08 for Simonsfield

This inspection was carried out on 14th February 2008.

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

Simonsfield 08/07/08

Simonsfield 29/10/07

Simonsfield 22/01/07

Simonsfield 21/10/05

Simonsfield 21/10/04

Simonsfield 26/04/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Simonsfield 1a Sunbury Road Liverpool Merseyside L4 2TS Lead Inspector Julie Garrity Key Unannounced Inspection 14th February 2008 02:10 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 Simonsfield DS0000059308.V357321.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. Simonsfield DS0000059308.V357321.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Simonsfield Address 1a Sunbury Road Liverpool Merseyside L4 2TS 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) 0151 260 7918 0151 260 0319 simonsfield@europeanwellcare.com European Wellcare Homes Ltd Diane Moon Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places Simonsfield DS0000059308.V357321.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 36 nursing beds and 36 personal care in the overall number of 36. Two named adults (18-64 years) may be accommodated. Date of last inspection 29th October 2007 Brief Description of the Service: Simonsfield is registered with CSCI to provide nursing care and personal care for 36 individuals aged 65 or over. Although registered for nursing care the home does not currently provide nursing care, as they do not have sufficient nursing staff employed within the home to provide this service. It is a purpose built care home with several sitting areas for individuals to socialise, sit quietly or entertain visitors and friends. A separate smoking lounge is provided. Bedrooms are located on all three floors in the home and there is a passenger lift that provides access to all the floors. There are gardens located at the rear and side of the home and large parking area at the front of the building. Simonsfield is located on a quiet residential road near to Stanley Park. There are bus stops within 10 minutes walk on a main bus route to and from Liverpool. The home is owned by European Wellcare Homes Ltd, which owns several homes that provide a variety of care and support to people living in them. The manager has worked in the home for several years and is registered with CSCI. The fees for the home are at Local Authority rates. Simonsfield DS0000059308.V357321.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 no star. This means the people who use this service experience poor quality outcomes. The site visit was carried out over a period of one day. We (the commission) arrived at the home at 10:00 and left at 18.20. The inspectors spoke with 12 people who live in the home, 4 visitors, 6 staff and the manager. We completed the inspection by a site visit to Simonsfield, a review took place of many of the records available in the home and CSCI offices. These included individuals care plans, assessments, accident records, staff rota, staff files, maintenance records, menus, staff rota, questionnaires, staff training, medications, information sent to CSCI by Simonsfield and a self-audit completed by the home. This site visit included discussions with people who live in the home, visitors, staff and management. A pharmacy inspector, who specialises in the management and safe practice of medications, reviewed medications separately. Questionnaires were sent to the home for staff and people who live in the home. Questionnaires from staff were received, however none were returned for the people who live in the home. We also received information from Social Services and this is also used within this report. We followed an inspection plan that was written before the start of the inspection to make sure that all areas identified in need of review were covered. All of the Key standards were covered in this inspection, these are detailed in the report, additional standards were identified before and during the inspection these were also reviewed and detailed in the report. Feedback was given to the manager and the operations manager during and at the end of the inspection. The arrangements for equality and diversity were discussed during the visit and are detailed throughout this report. Particular emphasis was placed on the methods that the home used to determine individual needs, promote independence and support to make informed decisions in line with individual choices. Simonsfield DS0000059308.V357321.R01.S.doc Version 5.2 Page 6 The service has previously been rated as a poor service. As part of our role to promote improvement the service had sent us a plan detailing how they would improve the quality of the service. The plan covered all the issues identified in the previous report and the service was reviewed as to how much progress they had made. What the service does well: What has improved since the last inspection? What they could do better: There is no structured quality assurance in place that identifies the strengths and the weaknesses of the service and puts into place plans to address these. This has impacted on the quality of the service, although there has been some improvement in some areas, this has not been sufficient to increase the quality of the service provided. Several members of staff have good skills and a good approach to providing support, however this is not consistent amongst the staff or in their approach. The management of the home has not addressed several issues that remain outstanding from the previous report. The plan submitted to us has not been completed as agreed. The manager has not been able to fully recognise or deal with the poor quality areas in the service. Simonsfield DS0000059308.V357321.R01.S.doc Version 5.2 Page 7 Medicines must be given to individuals as prescribed by their doctor. If people who live in the home get their medicines at the wrong dose, wrong time or not at all it can seriously affect their health and well being. Accurate records of medicines arriving in the home, given to people who live in the home and disposed of must be made. Poor record keeping can lead to serious mistakes when giving medicines and put the people who live in the home at risk. Care staff need to have suitable training and supervision to make sure they are able to deal with medicines safely. Information to individuals is inaccurate and does not explain what needs the service can meet. It gives a false impression of the daily life and routine of the people who live in the home. A variety of activities are written in the information that are not occurring and have not occurred for sometime. The lack of clear information that is inaccurate is misleading to individuals and can result in people moving into the service whose needs cannot be properly meet. Not everyone who moves into the home has a proper assessment that identifies his or her needs. A lack of a proper assessment means that individuals will be admitted to the homes, whose needs the staff can not meet. There is a reliance on verbal communication with written records being inaccurate or not having the full details of individual needs. This has impacted on the health and welfare needs of the people who live in the home. Attempts have been made to consult with the people who live in the home and to help them influence their own routines in the home. A meeting with the people who live in the home has occurred. Their suggestions have as yet not been included in their own written care plans, activities are not in place and individuals who are less able to say what their wishes are often have staff make decisions for them. A lack activities and staff making decisions for individuals without clearly understanding individual choices means that some people who live in the home do not have their choices and needs meet. Complaints and concerns are not always addressed, records regarding complaints are not always available. Information that explains what the manager will do to prevent this happening again is not available. This means that the manager will not be aware of individual concerns and does not always make sure that these situations are prevented from happening again. Staff training, supervision, amount of staff available and their skills are in question. Training is incomplete, staffing levels are not monitored and in some instances absent staff are not replaced. Supervision that makes sure that staff are aware of their role and how to support the people who live in the home is not occurring and therefore staff skills are not developed. Simonsfield DS0000059308.V357321.R01.S.doc Version 5.2 Page 8 The manager has not made sure that the quality of the service has increased, audits on areas such as medications have not been done regularly and are not effective in identifying gaps in the quality of the service. Questionnaires and meeting for the people who live in the home are inconsistent and not used to make sure that the service meets their needs and choices. 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. Simonsfield DS0000059308.V357321.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 Simonsfield DS0000059308.V357321.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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There has been no improvement in the ways in which individual’s needs are assessed and planned for before they move into the home. A recently admitted individual did not have their admittance to the home managed in a safe manner and was placed at risk by a lack of good assessments. EVIDENCE: Information available to the people who live in the home has been updated and is a lot easier to read. This document remains inaccurate and does not fully explain the services that the home can deliver. People who live in the home did not have their own copy of information about the home. One resident said “i’ve never seen anything about the home”. All new individuals have to pay a “top up fee”, this is additional money above the fees paid by social services. There was no information available to say that this had been discussed with the individuals or their relatives, contacts were not available that detailed this fee. The manager said it is discussed with individuals but is not in writing. Simonsfield DS0000059308.V357321.R01.S.doc Version 5.2 Page 11 The manager said that all individuals have an assessment before they move in. Copies of assessments were seen in all but one record looked at. None of these had been updated since the individual had been admitted. Information received from the home said that all the people who lived in the home would have their needs looked at again. There was no evidence that this had occurred. With regularly updated assessments the staff will not have a true idea of the people who live in the homes needs and may be giving care that no longer meets their needs. In one case an individual was admitted to the home without an accurate assessment a new assessment was not done once they arrived at the home. A number of areas including how staff were to reduce the risk of falls for this individual were not looked at. Not having a proper understanding of the individuals needs placed them at risk and their admission to the home was not managed in a safe manner. We spoke with people who live in the home and their relatives they confirmed that they had been given an opportunity to discuss their needs before they moved in. One resident said, “ I had a nice talk with a man from the home, he asked me some questions”. All the people who live in the home have a copy of Social Services assessment sent to the home before they are admitted. Copies of these were seen in the individual’s records files. This is good practice as it helps inform the service of individual needs. The assessments from the home viewed were not always completed fully or accurately. Information received from the home before the site visit explained that individual social needs and personal preferences would be assessed. The assessments viewed did not contain any of this information. Discussion with people who lived in the home, their relatives and staff One of the members of staff said that the assessments covered too much about the individuals physical needs and although areas such as social needs was available this was a very small section and very little information could be written in it. Without fully completed and accurate assessments staff and individuals will find it difficult to decide if the home can meet their needs. Simonsfield DS0000059308.V357321.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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There has been no improvement in the ways in which the service meets the health and welfare needs of the people who live in the home. The service continues to place individuals at risk of not receiving care to meet their needs. The management of medications is also unsafe and places the people who live in the home at risk. EVIDENCE: Six care plans were looked at. These plans did not have any evidence that they had been written with the individuals or their relatives’ input or agreement. All the individuals spoken with had not seen their care plan. Staff spoken with did not read the plans and relied on the verbal conversations that they had with each other to tell them the different needs of the individuals. Care plans did not describe how staff were to meet individual needs and describe a summary of the individuals needs without instruction to staff as to how to meet their needs. Of particular concern was an individual who had been admitted to the home the day before. There was no information available to the staff as to how Simonsfield DS0000059308.V357321.R01.S.doc Version 5.2 Page 13 to this individuals needs, as a care plan had not been done. Another two individuals had wounds (pressure ulcers) that were being dealt with by the District nurses. The homes records and care plans did detail that the district nurses were dealing with these wounds. The care plans did not have any information to staff as to what they were to do to help prevent these wounds getting worse. Without accurate care plans that give clear instructions to staff individuals care will not be consistent and will not meet their individual needs. People who live in the home are supported to choose their own Doctor or stay with their current Doctor. Staff do contact external advice when needed such as dieticians, GP’s and District Nurses. Records of these visits were confusing and not always accessed by the staff to make sure that they knew how to care for the people who live in the home properly. A recently admitted individual did not have a GP allocated on admittance. Information from Social Services also detailed that this was not the first occasion in which the service had not made arrangements to help make sure that people who live in the home always had access to a Doctor. Although the service is accessing external professionals they are not making sure that this information is used properly for them to support the people who live in the home and places them at risk. We looked at the recording of medicines and we found some minor improvements. The records of receipt, administration and disposal still showed a lot of mistakes. The records of one recent medication round were not signed for at least seventeen people who live in the home. We checked the records and stock and could not confirm whether these medicines had been given out correctly. We also checked the stock and records immediately after the morning medicines round and found several medicines had not been given out. The manager was giving out the medicines and agreed that she had forgotten to give them. Not getting their medicines as they are prescribed places the people who live in the home at serious risk. Handwritten records and medicines dose changes were looked at. One medicine had changed the amount that the individual had was to have had been increased by the doctor. The manager did not recognise that the medication was recently increased and failed to give the correct amount. Further checks on the stock and records of this medicine showed that the wrong amount had been given on at least three occasions. This is poor practice and places the people who live in the home at serious risk. We looked at the timing of medicines and found some had been given after food instead of before. Instructions available to staff in information leaflets (instructions that come with all medicines) were not always being taken into account. This meant that some of the medicines were not being given at the correct time. This can affect the way that medicines work and in some cases can mean that can make an individual ill. Simonsfield DS0000059308.V357321.R01.S.doc Version 5.2 Page 14 The management of controlled drugs (stronger medicines, such as very strong pain killers) and how the service deals with them were looked at. Controlled Drugs were stored and recorded safely. A pain relief patch was not given on the previous day, the individual confirmed this and we had to tell the manager about it. Failing to replace this patch could have resulted in this individual suffering unnecessary pain. We looked at how medicines were checked and audited by the manager. We saw evidence of weekly checks. These were limited to only a few medicines and did not look all areas of medicines handling. Having good audits helps make sure that medicines are given and recorded correctly. Good audits also help make sure staff’s ability to give out medicines safely can be checked. The manager said three out of the five regular staff who give out medicines had attended a safe handling of medicines training session. The manager said she had observed staff administer medicines but no records of this were shown to us. The two remaining staff did not have any arrangements in place as to when they would have the training. Evidence from the site visit showed that all staff including the manager had been unable to give out medicines safely. Additionally due to a lack of senior trained staff there were several nights a week, from 10pm until 8am were no staff member was available to give out medications. This meant that any individual who need painkillers as an example overnight would not be able to have them. Simonsfield DS0000059308.V357321.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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There has been no improvement to people who live in the home. Although meetings are now available these have not used their points of view to influence their daily lives. Individuals less able to say what their choices are do not always have their preferences detailed in order that staff can meet their needs. EVIDENCE: The manager stated that menus have been altered as people who live in the home requested changed. People who live in the home and relatives meeting took place in January, fourteen individuals were involved. There has not been another meeting since. The minutes of the meeting were not given out to those that did not attend. Four of the people who live in the home were asked had they seen the minutes or attended the meeting, none of those spoken with were aware of a meeting or of the minutes. The people who live in the home at this meeting made a number of suggestions regarding menus and decorations. None of these have been put into practice yet. The minutes do say that the suggestions will be used but not when. Simonsfield DS0000059308.V357321.R01.S.doc Version 5.2 Page 16 The company has social assessments that can be used to help determine individual choices and preferences. Of the six care plans viewed, one had this completed but it had not been updated since it was first written Menus do not detail any special diets such as diabetes, the manager stated that the cook and herself decide the meals at the request of the people who live in the home but the menu has not had any professional review. People who live in the home spoken with did say that, “the food is enjoyable”, “lots of time there is a good choice”, and “I like the food”. Observations over the lunchtime showed that all the majority of the individuals were offered a choice. Staff had a variety of methods to do this including showing two different meals to the individual. Two individuals who were less able to express a choice where not given one. A staff member choose for both those individuals. They were unable to say why they made those choices except that they “thought”, that’s what the individuals liked and had not seen any records that explained what the people who live in the homes choices were. Staff were observed supporting a resident to eat and this was done in a considerate manner. Not taking the opportunity to formally discuss and detail people who live in the homes, preferences, choices and needs means that the staff will rely on verbal communication and assume they know what individuals like. This can lead to not supporting individual choices particularly for those less able to say what they would or would not want. There have been no activities at all for sometime, the activities co-ordinator left and was not replaced. No additional staff have been allocated to arrange activities for the people who live in the home. The manager said that the redecoration programme has also impacted on this and as such they have not been able to put activities in place. There have not been any arrangements for activities in any of the rooms after they have been redecorated or whilst other areas are being redecorated. There have not been any arrangements put into place for activities to take place outside the home. One individual is very independent and can go out and about of the home, as she wants to. Other people living in the home need the support of the staff. Several of the people living in the home spoken with said, “there is nothing to do but watch the television”, “I can be bored”, “I am happy just watching the telly” and “I really would like to get out more”. The individual wishes to have a more active life have not been put into place and does not support them to have choice and control over their own lives. On the day of the site visit the manager had supported a family to use one of the lounges for a family event. This was greatly appreciated by the family members and is good practice. Simonsfield DS0000059308.V357321.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There has been no improvement in the ways that the home deals with complaints or serious concerns. The people who live in the home are not always sure that their complaints will be dealt with EVIDENCE: Records were reviewed regarding complaints. The manager had not looked at one complaint from a member of staff. There was no investigation around this or a review of the homes own policies and procedures such as whistle blowing (a policy that supports staff to raise concerns) that related to this complaint. Without investigations it will be difficult for the home to prevent a reoccurrence. Speaking to people who live in the home, relatives and staff they raised a number of concerns that included in areas such as a lack of activities. Individuals spoken with were not aware of any actions been taken one said, “it makes no difference”. All the people who live in the home spoken with had not seen a complaints procedure. They did say that they would speak to the staff but were unsure as to whether “anything would happen”. One relative was clear that she had to complain on several occasions before anything changed. “It took weeks of effort and felt like a hard fight. I worried all the time. Things are much better now and I feel much happier but it shouldn’t have taken so long”. Simonsfield DS0000059308.V357321.R01.S.doc Version 5.2 Page 18 There have been two investigations from social services for serious concerns, since the last key inspection. In both instances this was reported by external parties to the home and investigated by social services. Records regarding one of these concerns were not available in the home for review. Staff have received training in recognising potential abuse, however in discussion they were not aware of the responsibility of social services or of the social services policy. Their lack of knowledge ran the risk of preventing a proper investigation into serious concerns. The homes policy and procedures in these areas also did not detail how complaints of this nature should be dealt with, the policy in the home did not support the manager to deal with complaints of this nature in the same manner as detailed in social services policy. As an example it guided the manager to undertake an investigation. This may result in damaging any potential investigation and making evidence invalid. Discussions with the manager and staff detailed that they had no training in investigating complaints and there was no procedure in place to guide them. Simonsfield DS0000059308.V357321.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service has started to redecorate the home. This is appreciated by the people who live in the home, as it will mean that they have a more comfortable, welcoming and homely environment to live in. The main communal areas have plans for redecoration and as yet none of the people who live in the home are aware of any plans to redecorate their own personal spaces. EVIDENCE: A review of the environment showed a number of areas in need of repair and redecoration had begun to be addressed. The main corridors on the ground and third floor were being redecorated and there are plans to replace a number of furniture items. There is no plan in place that informs the individuals about any redecoration or consults them about their views. Minutes of a meeting with Simonsfield DS0000059308.V357321.R01.S.doc Version 5.2 Page 20 people who live in the home had a number of suggestions from them that have not been used. People who live in the home and relatives spoken with were unaware what plans were in place but made a number of comments about the environment in general. These included “its looking better”, “bathrooms smell, not nice places to go”, “I know they are trying to fix lots of stuff” and “nobody has said anything about my bedroom”. The home does not have policies available that details the prevention of infection, it was noted that some areas in the home were in need of cleaning including the dining room floor. Staff were observed over lunchtime to use protective clothing such as plastic aprons and this is good practice. There are liquid soap dispensers in each of the bathrooms however these were all empty hard soap had been made available and disposable hand towels to help prevent the spread of infection. There are no records available that staff have received training in the prevention of infection. A mop and mop bucket full of dirty water was left in one of the bathrooms, the manager said that it was to be changed daily. However even changing the water it is still contaminated and present a risk of infection. During the day it was noted that one resident was unable to sit comfortably in the chairs available in the home and the staff frequently had to attend to move the resident in the chair to maintain their safety and dignity. This was noted at the last site visit and had not been addressed. Wheelchairs were used by staff without footrests and this runs the risk of causing injury to the resident. In discussion staff said that the Individuals observed refused to use the footrests but there was no documentation or risk assessments to support this action. Additionally the wheelchairs were noticed to be in need of cleaning and not well maintained. Simonsfield DS0000059308.V357321.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although all new staff now have proper checks before they start, staff do not have enough skills or training to be able to meet the needs of the people who live in the home. EVIDENCE: A recently recruited staff member’s file was viewed. This was better organised than those seen in previous site visits. All relevant checks were in place but there was little evidence that the member of staff had received a full induction. There was no evidence that they had been informed of the people who lived in the services needs and how to meet them. Not all of the staff files had two references and gaps in individual working history had not been explored. Staff spoken with listed training that they have received and the majority have completed or are attending a training course in care, others have undertaken diabetes, others have done training in Alzheimer’s. However the home has Individuals with a variety of needs including Parkinson’s, epilepsy, dementia and behavioural needs as examples. There was no training plan in place that identified what training staff needed and when they would receive the training. Several staff spoken with said that they would like training in a number of areas such as those detailed above. Simonsfield DS0000059308.V357321.R01.S.doc Version 5.2 Page 22 Three of the five senior staff have had training in medications including the manager. The other two were due to go but did not attend. No other dates were arranged for them to receive the training. Evidence in other areas of this report such as medications shows that staff are not competent in many areas such as medications, meeting health and welfare needs, planning and delivering care, assessing and determining the needs of individuals and making sure those less able to communicate have their personal choices taken into account. The manager explained that the home does not have enough senior staff to make sure that the people who live in the home can access their medications, as they need. Three nights a week there are no staff available who are trained or experienced in meeting this need. On the day of the site visit and the previous day the deputy manager had been scheduled to work but was not available. On both these days the manager had not replaced the deputy manager with a senior care staff who was trained for the role. Additionally on the day of the site visit another member of staff was also absent. It was after 10am before the manager replaced either of the members of staff. This meant that one the previous day and the day of the site visit absent members of staff had not been replaced. It was also noted that the absence of the deputy manager may continue for the rest of the week and no attempts had been made to cover his shifts. Staff spoken with said most times there was enough staff but not always. People who live in the home said “sometimes we have to wait, but not often”, “sometimes I go to bed when staff ask as its easier and they might not be back for ages” and “the staff are lovely they work so hard, there’s not always enough of them”. The activities co-ordinator has left their post and has not been replaced no provision has been put into place to meet this need. Staff were observed during the day to be unhurried and relaxed in their approach. People who live in the home spoken with said that “staff are very nice”, “caring people” and “really good, they work so hard, but are always smiling”. Staff said that they had no time to read care plans, do activities and were not always able to make sure that someone was available in the lounge for the people who live in the home. Simonsfield DS0000059308.V357321.R01.S.doc Version 5.2 Page 23 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The manager has not made sure that the quality of the service in the home has increased. People who live in the home do not have their health and welfare needs meet and are placed at risk by a lack of staff skills, training and poor management. EVIDENCE: The manager of the home has a qualification in nursing but no training in management. She did start a course in management but has not completed it and is not attending any management courses. The manager has made no progress towards meeting outstanding requirements and on the day of the site visit her own competency with giving out medications was questioned as she made several mistakes. The information she sent to the commission before this Simonsfield DS0000059308.V357321.R01.S.doc Version 5.2 Page 24 site visit contained a number of statements that were not accurate. There was very little information in identifying areas within the home that needed developing and despite having a formal plan in place from CSCI was little information as to what improvements were to be made and how. There are no records available that show the supervision and support that the manager has had in order that she can develop her skills. Staffing files were looked it with regard to supervision from the manager to do their jobs and develop their skills. There were no records available that detailed what support staff had received to understand and develop their skills. There is no quality assurance in the home that identifies the strengths and the areas that need developing. There is a self-assessment available that the manager can use to look at the areas of quality, however this has not been completed. An improvement plan was issued by CSCI following the last site visit in which the home was rated as poor. Very few areas within this plan had been done despite extending time scales to allow the service time to develop. The manager has failed to make sure that the service has increased in quality and has not safeguarded the individuals in the home. There is no plan in place from the service that is discussed with the people who live in the home. This plan needs to show the home will improve the quality of the service that it provides and keep all interested parties up to date. Some of the practice areas of the home are being audited, but this is not prompting an increase in quality and the audits in place are not working. The home has not been able to make or sustain improvements in any area other than redecorating some of the areas of the building. One meeting for the people who live in the home has been held, none of their wishes have as yet been put into place. A senior staff meeting has been held this discussed the management of medications only and no action or date of another meeting was put into place. European Wellcare is the company that owns the home and as such needs to undertake monthly visits to review the home and consult with the resident’s. Copies of these reports were not available in the home. There are no policies and procedures in the home regarding resident’s money. Additional fees are not detailed in the Individuals’ contracts and it is impossible to determine with the information provided at this site visit what arrangements are in place to safeguard resident’s personal funds. People who live in the home cannot access their individual finance records are unless requested and a record of individual spending is unclear. Further confusion is in place as all the Individual funds are held in bank accounts together and records provided did not detail the distribution of interest to the Individual. The company is reviewing these arrangements and intends to develop arrangements that safeguard individual funds. Simonsfield DS0000059308.V357321.R01.S.doc Version 5.2 Page 25 Areas of risk have not been identified, such as self-medication, development of pressure ulcers, and use of equipment, general environment, smoking, and fire risks as examples. A new individual had moved into the harm and had not had any assessments done that would help reduce risks it was identified by Social Services before this individuals admission that they were at risk of falls. The service had not looked at this risk nor taken any actions to reduce this. This placed the individual at significant risk of injury. Falls have been recognised but management plans and clear written structures that inform staff as to how they reduce the resident’s risk are not in place. Simonsfield DS0000059308.V357321.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 1 1 1 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 2 1 2 1 2 2 2 2 STAFFING Standard No Score 27 1 28 1 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 1 X 2 1 1 1 Simonsfield DS0000059308.V357321.R01.S.doc Version 5.2 Page 27 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 (1) (2) (a) (b) (c) (d) Requirement Each resident needs a plan of care that is written in consultation with each resident or their representatives. The care plans need to detail how the People who live in the home needs will be met by the staff. This needs to be in sufficient detail for staff to provide consistent support to meet all the People who live in the home assessed needs. Outstanding from 30/11/05 2. OP9 13 (2) Staff need to give medications correctly at all times. People who live in the home need to have their medications given as they are prescribed by the GP Outstanding from 22/02/07 3. OP1 4 (1) (a) (b) (c), 5 (1) (a) (b). The information in the home such as the statement of purpose and service users guide needs to be reviewed. An accurate and up to date description of the home needs to be in place. This needs to DS0000059308.V357321.R01.S.doc Timescale for action 28/02/08 14/02/08 28/03/08 Simonsfield Version 5.2 Page 28 support prospective People who live in the home to make an informed choice. Management will need this in order to make sure that they can supply, monitor and develop the services detailed in this information. A copy of this needs to be sent to the Commission whenever it is reviewed and changed. 4. OP2 5 (1) (b) (c) (3) Outstanding from 15/12/07 All People who live in the home 28/03/08 need an up to date contract that details what services the fees pay for. Including the amounts and methods of payment from all parties contributing to the fees. Clear information needs to be available in order to make sure that People who live in the home and their supports can make an informed choice and be aware of the services provided. Outstanding from 15/12/07 5. OP3 14 (1) (a) All pre-assessments and (d) (2) (a) assessments undertaken need to (b) be completed by individuals trained to do this. All relevant areas of the assessment needs to be completed in order to make sure that the resident and the management of the home can make an informed choice. Outstanding from 29/11/07 6. OP12 16 (2) (m) (n) Arrangements need to be made 28/03/08 to determine resident’s personal preferences, choices and equality and diversity needs and daily routines. These should be clearly recorded in order that all staff are aware of them and do not rely on verbal communications to make choices for People who live DS0000059308.V357321.R01.S.doc Version 5.2 Page 29 14/02/08 Simonsfield in the home. This is particularly relevant for those People who live in the home less able to voice their opinions in order that staff can support them in a consistent manner that meets their needs. Outstanding from 15/11/07 7. OP16 22 (1) (2) (3) (4) (6) (8) Where concerns, complaints or allegations are raised with staff in the home these need to be dealt with in accordance with the relevant policies and procedures. A full record of the complaint, the investigation and the outcome needs to be available. Outstanding from 29/10/07 A plan of maintenance needs to be drawn up, shared with the People who live in the home and their requests included in the redecoration and refurbishment. A copy of the plan needs to be available for all interested parties. Outstanding from 29/10/07 9. OP27 18 (1) (c) (i) All staff need to receive training 28/03/08 to meet the assessed needs of the People who live in the home that they care for. Records of the training planned and when completed needs to be in place in order to make sure that staff receive the training that they need in order to support and safeguard the People who live in the home appropriately. A plan of training for staff needs to put into place taken from the People who live in the home assessed needs and monitored to make sure that training is undertaken. 14/02/08 8. OP19 23 (1) (a) (2) (b) (c) (d) 28/04/08 Simonsfield DS0000059308.V357321.R01.S.doc Version 5.2 Page 30 Outstanding from 29/10/07 10. OP28 18 (1) (a) (2) Staff need to be competent to undertake the support and care that they give. The management needs to make sure that staff are given the opportunity to develop competency. Staff supervision, reviews and audits of their work and clear descriptions of their role needs to be in place in order to monitor and develop staff competency. Outstanding from 15/11/07 11. OP31 9 (1) (2) (i) (c) (i) The manager needs to receive appropriate supervision, support and training in order to develop the necessary skills to fully manage the service. Outstanding from 15/11/07 12. OP33 24 (1) (a) A quality assurance system 28/04/08 (b) (2) (3) needs to be developed and put into place. This needs to include the expressed views of the People who live in the home a review of the services provided and identification of areas for development. A plan as to how the management intends to develop the quality of the service needs to be made available for all the People who live in the home and their supporters. Outstanding from 15/12/07 13. OP35 20 (1) (a) (b) (3) The current arrangements for 28/05/08 the management of resident’s finances and personal finances needs to be reviewed. Clear information needs to be available that details the entitlement of personal allowances, where that money is kept, the interest DS0000059308.V357321.R01.S.doc Version 5.2 Page 31 28/03/08 28/03/08 Simonsfield earned and how that is distributed. Additional arrangements need to be commenced for People who live in the home to have individual separate accounts and not an account that is owned by the company. An exploration as to the funds contained in the social fund that was from the interest of People who live in the home funds needs to be undertaken and determination as to what purpose this money is held for and how it will distributed. Information that provides a full explanation needs to be forward to the commission. Outstanding from 29/11/07 14. OP38 13(4) (a) (b) (c) Where risks are identified for people who live in the home, such as wheelchairs without footrests, self-medication, falls, smoking as examples. Full assessments and plans need to be in place that are negotiated with the People who live in the home and detail any restrictions in place. Outstanding from 29/10/07 14/02/08 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 OP7 Good Practice Recommendations The current audits for care plans need to be reviewed in order to determine the quality of the plan as apposed to DS0000059308.V357321.R01.S.doc Version 5.2 Page 32 Simonsfield 2. OP9 whether all the documentation is available Staff who write care plans need advice and guidance. The home needs to review its policy and procedure and include best practice guidance available, all medications need to have full instructions to staff, handwritten instructions need to be double checked and have two signatures, changes to medications need official written notification from the prescriber, medications need to be stored at correct temperatures, audits need to identify the gaps in medication management and address the issues, staff need to be updated regularly in medications management and the policy and procedure needs to be readily available to staff who give out medications. The assessments and social care plans available in the home need to be completed, kept up to date and used to influence the People who live in the home lifestyle choices. Complaints and whistle blowing policy and procedure need to be reviewed, made readily available and reflect the practice that the manager needs to take in order to address any complaints. Training for manager in recognising and dealing with complaints would benefit the People who live in the home. Staff need to be supported to understand the roles and responsibilities of all the services that would be involved in any potential protection of vulnerable adults investigation. Staffing levels need to meet the assessed needs of the People who live in the home and not determined on the basis of how many people are living in the home. Information that details how individuals are able to access their own funds needs to be available to them. Arrangements for the regular review of accident records and putting into place risk assessments for those People who live in the home identified as at risk. Consideration should be made in making the information in the home such as menus, statement of purpose, service users guide, care plans, fire instructions and activities information when available more easily accessible by all People who live in the home. The assessment and admittance policy in the home needs to identify the arrangements for emergency admissions and the criteria for admissions to the home in order that staff can determine if they can meet the needs of the People who live in the home. Recruitment policies need to be adhered too and staff files need to be organised sufficiently to make sure that all checks, training, induction and supervision is in place. DS0000059308.V357321.R01.S.doc Version 5.2 Page 33 3. 4. OP12 OP16 5. 6. 7. 8. 9. OP18 OP27 OP35 OP38 RCN 10. OP3 11. OP29 Simonsfield Commission for Social Care Inspection Merseyside Area Office 2nd Floor South Wing Burlington House Crosby Road North Waterloo, Liverpool L22 OLG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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