Inspection on 14/01/09 for Sir Jules Thorn Court and Mary Court

This inspection was carried out on 14th January 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 25 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sir Jules Thorn Court and Mary... 10/01/08

Sir Jules Thorn Court and Mary... 21/11/06

Sir Jules Thorn Court and Mary... 09/02/06

Sir Jules Thorn Court and Mary... 15/08/05

Sir Jules Thorn Court and Mary... 20/12/04

Sir Jules Thorn Court and Mary... 10/06/04

Sir Jules Thorn Court and Mary... 15/01/04

Sir Jules Thorn Court and Mary... 21/10/03

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Sir Jules Thorn Court and Mary Court 29-35 Prince Of Wales Drive Battersea London SW11 4SL     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sandy Patrick     Date: 1 4 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 42 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 03000 616161 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 42 Information about the care home Name of care home: Address: Sir Jules Thorn Court and Mary Court 29-35 Prince Of Wales Drive Battersea London SW11 4SL 02077380280 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : martin.lewis@servitehouses.org.uk Servite Houses care home 31 Number of places (if applicable): Under 65 Over 65 30 30 31 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: 0 0 0 One named service user is to receive personal care only by one allocated member of staff. Variation of Registration Under the High Court judgement, the service shall be named Sir Jules Thorn Court and Mary Court. The variation is for such a time until the named service user assessed needs change or they leave the home. Date of last inspection Brief description of the care home Sir Jules Thorn provides nursing care for up to thirty people who have mental health needs or dementia. The home provides accommodation in single rooms with ensuite facilities. Mary Court adjoins Sir Jules Thorn and has one residential bed. Sir Jules Thorn has two floors, the home is divided into three units, known as clusters, which each have their own day room. The home has a large dining area and access to a small garden. The home is situated in Battersea, close to Battersea Park. There are Care Homes for Older People Page 4 of 42 Brief description of the care home accessible road and bus links to north and south London. Fees range from £444-48 to £827-12 per week. Care Homes for Older People Page 5 of 42 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. The inspection included a visit to the service on 14 January 2009. We met people who live at the home, staff on duty, the acting manager and the area manager. We spoke to them about the service. We looked at records, the environment and observed practice at the home. We also wrote to the people who live at the home, their representatives and staff and asked them to complete surveys about their experiences. 2 members of staff and 1 person who lives at the home completed surveys for us. Care Homes for Older People Page 6 of 42 In June 2008 the acting manager completed a quality self assessment for us. We looked at all the other information which we had received since the last inspection, including notifications of accidents and incidents. The majority of people living at the home were not able to tell us what they felt about living there. However, some people were. One person told us that they were very unhappy at the home. Visitors who spoke to us said that they were generally happy. One visitor told us, I cannot find fault and the staff are very kind. What the care home does well: What has improved since the last inspection? What they could do better: The findings of the inspection were discussed with the area manager who has agreed to take action to address some of the concerns we had. The staff need to support each individual to make choices and live the life they chose. People who need medication must be given support in a safe and risk free way. The information written about people needs to reflect their wishes and likes so that the staff can use this to give them the right support and care. The staff need to have a better understanding of how to support people who have dementia and are confused. People need to be dressed appropriately, fed warm and appetising food in a dignified way and be able to get up and go to bed when they chose. People need to be offered varied, interesting and stimulating activities which they would like to participate in and enjoy. Care Homes for Older People Page 8 of 42 The environment needs to be improved so that it is more homely, offers stimulation, comfort and is attractive for the people who live there. The organisation needs to employ a suitable permanent manager who will lead changes and will support staff to understand the importance of these. The organisation needs to consult more with people living at the home and their representatives so that they can continuously monitor and improve the service. We are concerned about the number of National Minimum Standards this service has failed to meet and we are considering enforcement action where failure to meet Regulations puts people at risk. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –03000 616161. Care Homes for Older People Page 9 of 42 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 42 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given the information they need to help them make a decision about moving to the home. Their needs are assessed to make sure these needs can be met at the home. Evidence: The acting manager visits people who are interested in moving to the home in hospital or their own home. He talks to them and people who are important in their lives and makes a recorded assessment of their needs. We saw copies of assessments he had made on people. The assessment includes information from relevant health professionals and social workers. People are invited to visit Sir Jules Thorn to see if they like it before they make a decision to move there. Everyone has their needs reassessed after a few weeks of living at the home. They are able to decide whether the home is the right place for Care Homes for Older People Page 11 of 42 Evidence: them and whether their needs can be met there. Servite Housing have created new terms and conditions of residency. The acting manager told us that copies of these had been given to all the people who live at the homes representatives and that he was waiting for them to return signed copies. The terms and conditions include information on some procedures and policies and the fee range. Two visitors we spoke to said that their relatives were supported when they moved to the home and that they had been given the information they needed to help them make a decision to move there. Care Homes for Older People Page 12 of 42 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is information about how to meet peoples health and care needs and the staff support people to stay healthy. However, people are not able to make choices and the staff appear not to have the understanding and skills to work with people who have dementia. Some of the practices are inappropriate and some put people at risk. There are not enough checks on medication storage and records to reduce the risk of errors. Evidence: Each person has their care and health needs recorded in a plan. This is so that the staff know about the person and the things that they should do to support and care for them. The acting manager has made improvements to these plans to make sure information is more clearly recorded and to make sure they are regularly reviewed and updated. We saw that some care plans included good practice guidelines about choice however we did not see peoples choices and preferences recorded and we did not see many examples of staff giving people choices throughout the day. Care Homes for Older People Page 13 of 42 Evidence: All the care plans are stored in the administrators office. We saw that the staff spent time working in the rest of the home not the office. The care plans should be in a place which is accessible to them during their working day so that they can check they are following these. People living at the home did not have a copy of their care plans in their rooms and should do. We found that care plans did not record peoples individual needs well. Many of them had general statements, particularly around peoples social well being, wishes, likes and dislikes. Information about peoples lives before they moved to the home was very basic or there was none recorded. Where specific interests had been identified there was no evidence that the staff supported them to pursue these interests. Some information was inaccurate, for example a description about one person said that they enjoyed smoking. However, there was no mention of this in their care plan or risk assessments. We saw that some risks people face had been assessed and these had been recorded. However plans to support people to take risks were basic and did not give details about how to meet individual needs and choices. There was information about some peoples lives before they moved to the home. However, this was very basic and in some cases not present at all. It is important for the staff to build up a picture and understand a bit about people before they moved to Sir Jules Thorn. The staff should be proactive in seeking information from relatives and other representatives so that they can understand the people they are supporting better. The care plans we looked at did not include a photograph of the person they were about and should do. Some of the things people wrote in care plans were not appropriate. For example one care plan referred to someone by the wrong name. Another care plan about a woman referred to he when talking about specific needs. Some information in different parts of care plans we looked at contradicted itself. It is important that care plans are accurate, reflect individual needs, wishes and are written in a clear and easy to understand way so that the staff can find the information they need easily and understand how to support each individual person. Peoples health needs were recorded in their plans. The staff we spoke to showed that they had a good understanding of how to keep people healthy. Care Homes for Older People Page 14 of 42 Evidence: A doctor visits the home each week. The nursing staff told us that they had a good relationship with the GPs and other health care professionals and worked together to support people. The acting manager has recently introduced a monthly audit of medication storage, records and practices. However we found a number of practices that could put people at risk. The day before our visit a new supply of medication had arrived. This had been stored in the medication room but not checked by staff. The nurse on duty said that there had not been enough time or staff to check the medication. Some of the old supply was still being used and some of the new supply had been started. Because no one had checked the new supply was correct nor recorded it, it was difficult to audit this and this could lead to problems and errors. We looked at some of the medication records and supplies and we observed staff administering medication. Nursing staff who are responsible for administering medication are trained to do so and the acting manager told us that he plans to introduce assessments to check their capability. Most of the medication records we saw were accurate. We saw a list of staff sample signatures and we saw that there were photographs to accompany administration records. However we saw some gaps where people had not completed administration details. We saw that someone had used correction fluid to change details on one administration record. We saw that there was no information about peoples allergies on their administration records. This was recorded elsewhere for some, but not all, the people living at the home. The amount of medication in stock was not recorded on peoples administration records and therefore it was impossible to audit some peoples medication. We felt that the room for storing medication was poorly organised and this could lead to errors. We saw that different batches of medication had been mixed up. This means that it was difficult to audit and this practice could put people at risk. We saw that some medication for people who no longer lived at the home was stored with medication for people who do. We found items such as someones test results and peoples glasses stored with medication. We found that the records for one persons medication did not tally with the amount held. The fridge used to store some medicines was very cold and a thick layer of ice covered the inside. Some medicines were touching this and therefore were below the recommended temperature for storage. Care Homes for Older People Page 15 of 42 Evidence: The day of our visit was a cold one. We found that many of the people living at the home were not appropriately dressed for the temperature. For example we saw 5 ladies in one lounge who had no tights on. Some of them had no socks either. The window to the lounge was open. The staff seemed unaware that these people may be cold. We over heard one person saying that they were cold on several different occasions. Their body language also indicated that they were cold. However, none of the staff offered this person extra clothing or responded to her at all until we asked a member of staff to attend to her. Some of the things that we heard the staff saying to people were inappropriate. We heard one member of staff raising their voice to someone and telling them to sit down. We heard another member of staff telling someone that they were a good girl. One person told us that some of the staff told them off. We saw lots of people who were trying to walk around being told to sit down or being guided back to their seat by staff. We did not see any examples of staff supporting people to make individual choices or express themselves. During a discussion between staff we heard one member of staff tell another that they had to get a certain person out of bed because it was mid morning. One member of staff told us that they had to start putting people to bed after supper. None of the staff demonstrated an understanding that people should be able to chose when they go to bed or get up. In several different areas of the home we heard a pop music station playing. We did not see anyone being consulted about this music or whether they would like to hear something different. We saw that some staff left bedrooms where they had been helping people with personal care still wearing plastic aprons and gloves. They walked around the home continuing to wear these. The staff must remove protective clothing immediately after they have finished supporting people with personal care and dispose of this appropriately. New items of protective clothing must be used when they care for a different person. We saw another member of staff wearing disposable gloves to help someone stand from an arm chair and move into a wheelchair. The staff should not wear protective clothing unless it is needed. In the example given this seemed clinical and impersonal. We saw the staff undertaking tasks without speaking to people. For example one member of staff adjusted the cushion behind someones head without speaking to them. Another member of staff supported someone to eat their meal without any communication. Care Homes for Older People Page 16 of 42 Evidence: We saw that some people had their names written on their clothing with a marker pen. The staff must label clothes in a more discrete way. We saw one person wearing a very stained and dirty item of clothing. The staff should support people to be clean and well presented. We saw that some people were unable to get out of their chairs because the staff had pushed tables right up to the chair and this prevented them from getting up. A hairdresser visits the home each week. We over heard one person telling the staff they wanted to spend a penny. The staff did not understand what the person meant by this and kept telling them to sit back down. We had to tell the member of staff what the person meant by this. Many of the staff, including this particular person, are from other countries and English is not their first language. The organisation has a responsibility to help these staff to understand the culture and commonly used terms of the people living at the home so that they can give them the support they need. One person told us that they were unhappy at the home and that some staff were rude and uncaring. They told us that some of the staff did not give them help at night time. They said that the some staff refused to take them to the toilet. We asked the area manager to refer this to the local authority as a safeguarding concern. We saw that in some peoples care plans the staff had written that the person needed to accept death as an inevitable end to their life. This statement is not appropriate. The staff have no right to tell people that they need to accept this. We are concerned about the number of National Minimum Standards this service has failed to meet and we are considering enforcement action where failure to meet Regulations puts people at risk. Care Homes for Older People Page 17 of 42 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to receive visitors whenever they wish and visitors and family members are valued as important in their lives. People are not supported to pursue individual interests and they are not given a wide range of stimulating activities to participate in. Although the food appears to be varied and nutritious, people are not always given a choice about what they eat and it is not always fresh and hot when served to them. People are not able to exercise choice and control over their lives. Evidence: There is a full time activities officer, she was on leave at the time of our visits. Care staff told us that they were responsible for organising activities in her absence. On the day of our inspection the advertised activity was exercise. Six people were brought to the dining room to take part in the activity of the day. The activity did not start at the advertised time and was not the advertised activity. The member of staff played some music and supported some of the people to sing along to this. The people in the dining room were sitting at three different tables and the member of staff engaged them, sang and talked to them as she sat at each table. However, when she moved away from people to join another table, they fell silent and some of them appeared to fall asleep. At 11.30 am the chef brought the lunch trolley into the dining room and other Care Homes for Older People Page 18 of 42 Evidence: staff came into the room and stood around the trolley chatting with each other. Some staff started to lay tables and more people were brought to the dining room and some were served food. There was no obvious distinction between the end of the activity and the start of lunch service. The activities were wrongly advertised and poorly organised. Only a small number of people participated and each person was only engaged for a small time during the activity. People were not informed about what was happening or when the activity had ended and lunch had begun. The member of staff was enthusiastic and positive when speaking to people but was unable to keep a momentum or engage people she was not directly sitting with. Throughout the rest of our visit we did not see the staff supporting anyone with any other activity. Throughout the day, pop music stations were playing on radios in the lounges and we did not hear people being given a choice about this. There was no communal games, magazines, books, craft materials or anything for people to help themselves to. Most people spent the day in their rooms or lounges sitting in the beds or chairs. Organised activities are not well advertised. The posters and notices for these are small print and do not attract attention. The posters state that each week there are two sets of organised activities for two different groups of people. People are not aware of which group they are in. The groups do not include all the people living at the home and it was unclear why this distinction had been made. The organised activities each week were, relaxation, beauty, story tape, bingo, quiz and arts and crafts. Records of activities which had taken place in December and January indicated that a maximum of 7 people had participated in any one activity. With 5 or 6 people joining in the majority of activities. There were no other records of any other peoples activities. Daily care notes did not record what people had done during the day and only recorded care tasks. The only recorded activities for December and January were arts and crafts, dance, ball games, sing along, exercise and bingo. There was also a Christmas party. Throughout the day we saw that most staff were kind but their communication with people was limited to care tasks. We did not hear the staff chatting to people or supporting them to pursue an interest. We saw that visitors were made welcome at the home and those that wanted to were able to care and support their relative. For example we saw some visitors supporting their relatives at lunch time. Visitors told us that they were made welcome and that Care Homes for Older People Page 19 of 42 Evidence: they could use facilities to make themselves hot drinks. They said that the staff kept them well informed and told them about changes in their relatives health and wellbeing. We felt that it would be useful to have more information for people visiting the home about dementia, advocacy and local services and perhaps a display of relevant leaflets which they could access. There was a large notice board designed to give people information in one of the corridors. This had the wrong date on and did not tell people what activities or food was planned for the day. Other information about activities on display was incorrect. The staff did not wear name badges and there were no photographs of staff on display. Therefore people living at the home may find it difficult to identify individual staff. For example one person told us that they were unhappy about one member of staff but they did not know their name. They said that they would be able to recognise them from a picture. There was no menu on display and people we spoke to did not know what they were being offered to eat that day. The menu should be on display and accessible to people living at the home. The staff should also make sure they discuss the menu with people so that they are aware of the meals planned each day. It would be good practice to use other resources such as photographs to make the information more accessible to people. We did not see anyone being offered snacks or fresh fruit. The acting manager told us that people could request this, but people may not be able to or know that they can ask for these. It would be good practice to offer snacks and fruit periodically. The main meal of the day was brought to the dining room at 11.30am. The chef started to serve this onto plates at this time. Some people ate in the dining room and some meals were taken to people in the lounges or their own rooms. The staff told us that they had to support more than one person with lunch. One member of staff told us that they supported 3 different people. All meals were plated up and transported around the home on unheated trolleys. We saw that some of these meals were left unheated until a member of staff was free to support the person eating this meal. Therefore the food was cold by the time some people were served. Some of the desserts were left uncovered for over an hour before they were served. The staff showed some awareness of peoples likes and dislikes, for example we hear staff asking for extra portions of some food for people who liked that. However, all the desserts were plated up and served with cream. No one was offered condiments or choices at the point of service. Everyone in the dining room was served orange squash and was not given a choice of drink. The table cloths in the dining room did not match. The crockery was a mixture of Care Homes for Older People Page 20 of 42 Evidence: different types. The dining experience would be more pleasant if these matched. Staff should also consider the different needs of people who may require special crockery to help them be more independent and to help them see their meals more easily. Many of the staff we saw supporting people during their meals did not spend time talking to the people they were helping. One member of staff started supporting someone by standing next to them before they got a chair to sit with them. Staff put bibs and aprons on people without telling them what they were doing. We told the area manager about our concerns around mealtimes. He has contacted us since the inspection visit to tell us that he has met with staff and the catering company and asked them to make changes to improve the service people have at mealtimes. Care Homes for Older People Page 21 of 42 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are procedures designed to protect people and the staff have had training in these. Evidence: There is a complaints procedure and this is displayed in the main foyer. The acting manager told us that a copy was given to people when they move to the home. The acting manager had copies of some letters relating to complaints. However, it was hard to audit all of the complaints and exactly what had happened to investigate these. There needs to be a more detailed log of all complaints which clearly tracks the complaint from beginning to end. The organisation has procedures for protection of vulnerable adults and whistle blowing. There is also a copy of the local authority safeguarding procedure. The acting manager told us that all staff had been given training in this area. However, there were a number of issues which we felt showed that some staff lacked awareness and did not adequately protect people. For example, people were not dressed appropriately for the weather, the staff did not always respond to peoples needs, the staff tried to restrict peoples movement and freedom to express themselves and people were not able to make choices about the things they did or ate. The organisation needs to make sure all staff understand about these procedures and their responsibilities in keeping Care Homes for Older People Page 22 of 42 Evidence: people safe from harm. Care Homes for Older People Page 23 of 42 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in an environment which needs improvements so that it is more attractive, safer and easier to orientate themselves. Evidence: The building is within a larger complex which includes sheltered housing flats. There are two gardens which Sir Jules Thorn share with the sheltered housing. All bedrooms in the home have en suite WC and sinks. People are able to bring their own belongings and furniture to personalise their rooms if they want to. We saw that some people had done this. The home is divided into four interconnecting units. Each unit has a lounge and small kitchenette. There have been some improvements to the building since we last visited, these include the decoration of some areas, new lighting in the dining room and new pictures in communal areas. Further improvements are needed. The area manager told us that the organisation had allocated money for the building to be improved over the coming year. Areas of the home need to be redecorated as the paintwork and woodwork are marked and damaged. There needs to be safety handrails along corridors. We saw some Care Homes for Older People Page 24 of 42 Evidence: furniture was broken and this must be replaced. One window could not shut properly. The furniture in lounges did not match and some of it was not attractive or homely. The way the lounges were decorated was not attractive or homely. For example, there were no pictures or soft furnishings, furniture was mismatched and plastic looking, there were no coffee tables and in one lounge there was a filing cabinet. In one lounge we noticed that the volume button on the TV was missing. The volume on this could not be adjusted. The acting manager told us that different areas of the home had been painted different colours to help orientate people. Although this was not altogether obvious and may not have helped some people to identify a particular area as the one they lived in. Apart from this there was nothing to help people identify their rooms, the area of the home they lived in, bathrooms or other areas. The environment needs to be improved so that it better supports people who have dementia. The organisation should research best practice to help them in planning how the money should be allocated for the improvements. In general the home was clean throughout, although some areas were rather dusty. We found that there were no paper towels in some of the WCs. The home was fresh with no unpleasant odours throughout. In one area of the home we saw that a Christmas decoration was still on display. In other areas we saw that blue tac with bits of tinsel still attached were left on the ceiling. These should have been removed. The stairway and area directly outside one of the fire exits was blocked with newspapers and leaves. We told the acting manager about this and he said that the area was immediately cleared. However all fire exits need to be checked regularly to make sure they are clear and accessible. Care Homes for Older People Page 25 of 42 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are not always cared for well by the staff. Staffing levels need to be reviewed because people are being put at risk. The deployment of staff may need to be adjusted to make sure peoples needs are met. Evidence: There are some staff vacancies and the acting manager told us that agency staff were employed for these. He said that they tried to use the same agency staff to help with continuity and that the amount of temporary staff used had recently been reduced. Some of the staff told us about practices which indicated that staffing levels or the deployment of staff needs to be reviewed. For example we were told that in the evenings two members of staff often had to support people to go to bed and this left no staff available for people who were still in some communal areas. The staff also told us that they had to start getting people ready for bed immediately after supper in order to make sure they had enough time to help everyone. They said that people did not have a choice about when they wanted to go to bed. One member of staff said, it is difficult and dangerous. Another member of staff told us that a new supply of medication had been left unrecorded and unchecked because there was no time to do this. Care Homes for Older People Page 26 of 42 Evidence: The organisation provide training for the staff and the acting manager told us that the London Borough Wandsworth have offered some training. We saw records to show that staff had attended training relevant to their roles and that this was updated. The staff told us that training was good and useful. The acting manager told us that he and another manager conducted staff interviews and had recently recruited 3 new carers who were due to start work once reference checks and criminal record checks were complete. Staff attending for interview have to complete a written assessment. The acting manager should think about ways they can involve people who live at the home in the recruitment and selection of staff. The acting manager is in the process of auditing all staff files to make sure they contain the correct information. We looked at some staff files and saw evidence of thorough reference and criminal records checks as part of recruitment. The acting manager told us that all staff have started to have regular individual meetings with their manager. We saw a record which showed when meetings had been held and when future meetings were planned. The acting manager has introduced regular team meetings. He could not locate the minutes to these. Minutes of team meetings need to put in place which staff can access. The acting manager should get staff to sign these as a record that they have attended the meeting or read the minutes. Care Homes for Older People Page 27 of 42 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service needs to have a permanent manager who can lead changes and make improvements. People living at the home have benefited from some improvements in the way health and safety is managed. Evidence: The acting manager has been in post since July 2008. There have been two temporary managers since the registered manager stopped working at the home at the beginning of 2008. Interviews for a permanent manager were taking place shortly after the inspection. The area manager told us that he hoped to recruit someone and that this person would help bring about some of the changes needed at the home. A new post of deputy manager has been created and interviews for this took place before the inspection. The area manager said that they had successfully recruited to this post. The acting manager has worked hard since he has been in post to update and improve Care Homes for Older People Page 28 of 42 Evidence: record keeping, monitoring and resolve staffing issues and disputes. He has updated many of the records and made this better organised and easier to access. Some of the staff told us that they felt things at the home had improved under his management. The area manager overseas a number of care homes within the organisation. He regularly visits Sir Jules Thorn. He demonstrated a good understanding of some of the issues at the home and showed a commitment to resolving these. Since our visit to the home he has taken action to address some of the concerns which we had. The acting manager has introduced new paperwork to help monitor and record aspects of the service. These are good. The organisation needs to think about ways they can ask the people who use the service and other stakeholders what they think. Changes at the home should reflect the opinions of these people. People are able to leave small amounts of money with the acting manager for safe keeping. He showed us that this was stored securely and that records of all expenditure were kept. We also saw that some cash was stored in an envelope in the medication room. There was no record for this and there should be. We saw that records were generally accurate and that there was a clear audit trail of expenditure including receipts. However one record was inaccurate and this mistake had not been picked up despite the fact the balance had been checked since the mistake was made. Records must be accurate and checks on these must be thorough to make sure errors are picked up. The acting manager has set up systems to make regular checks on health and safety, including water, fire and general safety. We saw evidence of these checks and action taken to address problems. The certificate for insurance which was on display had expired. The area manager told us that there was appropriate insurance in place. The certificate to show this needs to be displayed. Since our last inspection the environmental health officer and fire officer have visited the home and found good standard of hygiene in the kitchen. They wrote a report of their findings. Care Homes for Older People Page 29 of 42 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 19 23 (2) (b) The registered person must 30/08/2008 ensure that communal areas are redecorated to enhance the environment for residents. Care Homes for Older People Page 30 of 42 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 The Registered Person must make sure risk assessments record how people can be supported to take risks. Risk assessments did not record how people would be supported to take risks. 31/03/2009 2 7 15 The Registered Person must make sure: Care plans record individual wishes, choices and preferences where these are known. People have a copy of their own care plan so that they know what is written about them. Care plans must be accurate. Care plans should include information about peoples lives before they moved to the home so that the staff 31/03/2009 Care Homes for Older People Page 31 of 42 have a better understanding about each individual and not just their care needs. Care plans should contain a photograph of the person they are about. Care plans must not reflect the opinions of the staff writing them they should be unbiased and there must not be an expectation that the person they are about should think or do things a certain way. Care plans did not describe individual wishes, likes or interests. Some care plans contained the opinions of staff and some were inaccurate. 3 9 13 The Registered Person must make sure: All medication received at the home is checked and recorded. Medication administration records are completed accurately at all times. Peoples allergies are recorded on their administration records. There is a record of all medication held at the home so that this can be used to help audit medication administration. 20/02/2009 Care Homes for Older People Page 32 of 42 Medication awaiting disposal must be stored separately to medication in use and there must be a record of this. All medication must be stored at the correct temperature. The way in which some medication was stored and recorded put people at risk. 4 10 13 The Registered Person must make sure staff remove protective clothing when they have finished supporting people and only wear protective clothing which is appropriate to the situation. Some staff did not remove protective clothing when they had finished supporting people with personal care or wore protective clothing at other times. 5 10 12 The Registered Person must 02/03/2009 make sure that suitable arrangements are in place to ensure that every service user, giving consideration to their individual choice, is dressed appropriately for the weather and that staff are responsive and aware when someone may be too cold or too hot. The Registered Person make sure that suitable arrangements are in place to 20/02/2009 Care Homes for Older People Page 33 of 42 ensure that service users are given prompt support to change from stained or dirty clothing. Enforcement action is being considered. Some people were not dressed appropriately. 6 10 12 The Registered Person make 02/03/2009 sure that suitable arrangements are in place to ensure that the care home is conducted in a manner that respects the dignity of service users by ensuring that:(i) staff talk to service users and explain what they are doing when they interact with service users. (ii) staff do not talk to the service users in an aggressive or patronising way. (iii) staff take service users to the toilet as and when asked by any service user. Enforcement action is being considered. Some staff did not show respect to the people they were caring for. 7 12 16 The Registered Person must make sure each person living at the home is supported to pursue 30/04/2009 Care Homes for Older People Page 34 of 42 individual interests that they choose. Their interests and likes should be recorded and these should be reflected in the care and support they are given. People should be supported to follow their own interests and hobbies. 8 12 16 The Registered Person must make sure there is a varied programme of organised activities, which is well advertised, accurate and reflects the likes and interests of people living at the home. The Registered Person must make sure records of activity participation and enjoyment are used to plan new activities. People should be given the opportunity to particiate in a variety of different organised activities. 9 14 12 The Registered Person must make sure the staff offer people choices and communicate clearly with them when they are supporting them. Staff need to communicate clearly so that people can make informed decisions about their own lives. 10 14 12 The Registered Person must make sure people living at the home are free to 20/02/2009 20/02/2009 30/04/2009 Care Homes for Older People Page 35 of 42 express themselves, to make choices and to move around their home as they wish, supporting them to be safe wherever needed. People should be supported to make choices and live the life they chose. 11 15 12 The Registered Person must make sure people are offered fresh fruit, snacks and drinks throughout the day and whenever these are requested. People should be able to eat and drink whenever they wish throughout the day. People may not be able to ask or may feel they are not entitled to extra food and drinks therefore the staff must be proactive and offer these. 12 15 16 The Registered Person must make sure people are offered choices at meal times, are given information about the meals offered and are served fresh and hot food. People should be able to chose from a variety of well prepared, freshly served and hot food. 13 16 22 The Registered Person must make sure there are accurate and detailed records of all complaints, including the investigation 28/02/2009 20/02/2009 28/02/2009 Care Homes for Older People Page 36 of 42 and outcome so that these can be audited. Records of complaints were not organised and some information needed to audit each complaint was not available. 14 18 13 The Registered Personmust offer the staff further training and support so that they have a better understanding of safeguarding issues. Because people are at risk if the staff can not recognise when they are not being protected or allowed to express themselves or make choices. 15 19 24 The Registered Person must make sure fire exits are unblocked and accessible at all times. People should be safe and be able to escape in event of a fire. 16 19 23 The Registered Person must decorate and furnish the home in a way which meets the needs of people living at the home and supports better orientation. People should live in an environment which meets their specific needs. 17 19 23 The Registered Person must make sure the building is decorated and furnished in an attractive and homely 30/06/2009 30/06/2009 20/02/2009 30/04/2009 Care Homes for Older People Page 37 of 42 way. Broken furniture and equipment must be repaired. People should live in an attractive and well maintained environment. 18 26 23 The Registered Person must 20/02/2009 make sure all areas are dust free and that old Christmas decorations are removed in a timely fashion. Because people should live in a clean and well mainatained environment. 19 26 13 The Registered Person must make sure all WCs are equipped with liquid soap and paper towels. This reduces the risk of infection spreading. 20 27 12 The Registered Person must review staffing levels and deployment to make sure these are appropriate to meet the needs of people living at the home. People living at the home should be involved in choosing the staff who support them. 21 31 8 The Registered Person must 31/03/2009 recruit a permanent manager for the service and this person must apply to be registered with the Commission for Social Care Inspection. 31/03/2009 20/02/2009 Care Homes for Older People Page 38 of 42 The service should be managed by a suitably fit person. 22 33 26 The Registered Person must send the reports of the monthly quality inspections of the home to the CSCI. Because we need to see evidence that the home is being regularly monitored and improvements are taking place. 23 33 12 The Registered Person must think about ways to monitor customer satisfaction and gather the opinions of people who live at the home and other stakeholders to help them improve the service. People living at the home should have a say in how it is run. 24 34 25 The Registered Person must 28/02/2009 make sure the home has appropriate insurance and that the certificate for this is displayed. The organisation must show evidence that they are appropriately insured. 25 35 13 The Registered Person must 20/02/2009 make sure money held on behalf of people living at the home is stored in an appropriate place, balances are recorded and are accurate and that checks on these are thorough. 31/07/2009 28/02/2009 Care Homes for Older People Page 39 of 42 People should be safeguarded by the homes procedures. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 3 4 5 7 9 9 10 10 Care plans should be stored somewhere where they are accessible to staff who support and care for people. Batches of medication should not be mixed up or moved from the orginal container. The medication room should be neatly organised to reduce risks of error. The Registered Person must make sure people are not restrained by the position of furniture. The organisation should support the staff to understand the culture and commonly used phrases of the people living at the home so that they can support them appropriately. There should be a range of resources for people to access and use throughout the day not just during organised activities. The organisation should consider having more information for people visiting the home about dementia, advocacy and local services and perhaps a display of relevant leaflets which they could access. The staff should make sure their communication with people is not just task based. There should be information for people living at the home on display. This should include the organised activities, menu and photographs of staff. The organisation should consider purchasing new table cloths and crockery that match. Crockery which makes meals easier for people to eat and see should be used wherever possible. The organisation should make sure staff regularly discuss their knowledge around safeguarding during individual supervision and team meetings. The organisation should consider ways to involve people Page 40 of 42 6 12 7 13 8 9 14 14 10 15 11 18 12 29 Care Homes for Older People who live at the home in the recruitment and selection of staff. 13 30 Minutes for team meetings should be kept in a place accessible to staff. The acting manager should keep a copy of these which are signed by all staff to indicate that they have read them. Care Homes for Older People Page 41 of 42 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 42 of 42 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!