Inspection on 01/08/08 for Somerville House

This inspection was carried out on 1st August 2008.

CSCI found this care home to be providing an Adequate 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

Somerville House 29/02/08

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Abbey The

Snydale Care Home

Larchfield Manor

Hawkhills

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Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

CARE HOMES FOR OLDER PEOPLE Somerville House 262-264 The Boulevard Kingston upon Hull East Yorkshire HU3 3ED Lead Inspector Beverly Hill Key Unannounced Inspection 1st August 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Somerville House DS0000070519.V369534.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. Somerville House DS0000070519.V369534.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Somerville House Address 262-264 The Boulevard Kingston upon Hull East Yorkshire HU3 3ED 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) 01482 210368 somervillehouse@somervillehouse.karoo.co.uk Mr John Mark Beyer Manager post vacant Care Home 18 Category(ies) of Dementia - over 65 years of age (18), Old age, registration, with number not falling within any other category (18) of places Somerville House DS0000070519.V369534.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - Code PC, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Dementia - Code DE(E), Old age, not falling within any other category - Code OP. The maximum number of service users who can be accommodated is: 18 29th February 2008 2. Date of last inspection Brief Description of the Service: Somerville House is situated at the Hessle Road end of the Boulevard approximately 1½ miles from Hull city centre. This location is at the centre of the Hessle Road shopping area and near to major bus routes into Hull. In addition to the shops there are local pubs, churches, a health centre, a library and a community centre. Somerville House is registered to provide care and accommodation up to 18 people aged over 65years, some of who may have needs associated with dementia. Accommodation is on three floors with a passenger lift accessing all three floors. The home has eight single and five shared bedrooms, none with en-suite facilities. Communal space consists of a large lounge, arranged into two separate areas, a small seating area for two or three chairs and a dining room. Bathing facilities consist of a shower room and unassisted bathroom on the first floor and a bathroom with a manual hoist on the top floor. There are three additional toilets to the ones located in the bath and shower rooms. There is an enclosed patio/garden area to the rear of the home. Visitors would have to park cars on the road at the front of the house. The current scale of charges is £348.50 per week. Additional charges include hairdressing, chiropody, toiletries, newspapers/magazines and taxis for personal use. The home purchases weekend newspapers. Information about the home is included in the statement of purpose and service user guide, which are located in the home and distributed to potential residents. Somerville House DS0000070519.V369534.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 1 star. This means that the people who use this service experience adequate quality outcomes. This inspection report is based on information received by the Commission for Social Care Inspection (CSCI) since the last key inspection of the home on 29th February 2008, including information gathered during a site visit to the home, which took approximately nine hours. At the last inspection the quality rating was reduced due to inadequate overall management of the home but since then a new manager has been in post and we have seen improvements in all areas. Throughout the day we spoke to people that lived in the home to gain a picture of what life was like for them at Somerville House. We also had discussions with the manager and care staff members. Information was also obtained from surveys received from six people that live at the home, five relatives, two staff members and one visiting professional. Comments from the surveys have been used throughout the report. We looked at assessments of need made before people were admitted to the home, and the home’s care plans to see how those needs were met while they were living there. Also examined were medication practices, activities provided, nutrition, complaints management, staffing levels, staff training, induction and supervision, how the home monitored the quality of the service it provided and how the home was managed overall. We also checked with people to make sure that privacy and dignity was maintained, that people could make choices about aspects of their lives and that the home ensured they were protected and safe in a clean environment. We observed the way staff spoke to people and supported them, and checked out with them their understanding of how to maintain privacy, dignity, independence and choice. The providers had returned their annual quality assurance assessment, (AQAA) within the agreed timescale. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We would like to thank the people that live in Somerville House, the staff team and management for their hospitality during the visit and also thank the people who completed surveys. Somerville House DS0000070519.V369534.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Most of the requirements from the last inspection have been met and it was clear the proprietor, the manager and staff had worked hard to improve things. The environment has continued to improve with areas of the home deep cleaned, redecorated and in some areas refurbished. There are refurbishment plans still to be completed but it is recognised that this is an ongoing process. The laundry room has been moved to the ground floor, which is better for staff and less noisy for residents. The general management of the home has improved and better systems are in place to ensure the services provided are monitored. The information the home provides to prospective service users has been updated, although there are still some gaps in this. The complaints policy gives clearer information about where to refer any complaint should the complainant not be satisfied with the homes investigation. The risk assessments and care plans have more information about the needs of people, although they are still not quite right and more work is still required. Somerville House DS0000070519.V369534.R01.S.doc Version 5.2 Page 7 The home now makes sure that it obtains assessments completed by the local authority prior to any admission for people funded by care management. Only specialised beds with integrated bedrails are now used in the home. The home provides more stimulation for people, especially those with dementia care needs. The home has employed more domestic and catering staff so care staff can devote more time to caring roles. Care plans are now locked away when staff members are not referring to them. Staff members only move and handle people using safe techniques. They have had training in how to do this properly. They have also received training in how to safeguard people from abuse. The manager has improved communication with the Commission and now sends us reports of any incidents that affect peoples’ wellbeing. What they could do better: The home’s statement of purpose and service user guide, which gives people information about the home, still requires some input to make sure it contains all the important information people need about the home before they make a decision. The care plans and risk assessments need to have all the information about what the person needs help with so staff members know exactly what to do and how to support people. They also need to be signed consistently by staff and by the resident to evidence that they agree to them. Staff should be checking the care plans more thoroughly to make sure they are still meeting needs. If they do this thoroughly they will be able to spot when they need updating. The way the home records medication needs to done more thoroughly so that we know people are receiving the medication as prescribed for them. The manager has recruitment information for staff but it is not organised into proper files. Well-organised files make it easier to check things. Also there were some staff photographs missing from the files. The home consulted with residents on a day-to-day basis and had developed a quality monitoring system of questionnaires and audits. However they hadn’t sent these out to people yet. It was important to gain people’s views about how the home was managed so shortfalls could be addressed. Somerville House DS0000070519.V369534.R01.S.doc Version 5.2 Page 8 Staff training has improved in some areas but there are still some gaps in mandatory and other area, such as conditions affecting older people. It is important that staff have the right skills to be able to support people in their care. All care staff members are enrolled on a national vocational qualification (NVQ) at either level 2 or 3, which will improve their skills and consolidate their knowledge. The manager had started to provide care staff with formal one to one supervision. This needed to happen at least six times a year for all care staff. This will give the staff an opportunity to speak to the manager about issues and also assist the manager in recognising people’s strengths and development needs. 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. Somerville House DS0000070519.V369534.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 Somerville House DS0000070519.V369534.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home still had not produced full information about the services it provided which meant that people would not be able to make an informed choice about the home. The home ensured that people had assessments of their needs prior to admission. This helped them to decide whether they were able to meet the persons’ needs in the home. EVIDENCE: We examined four care files during the visit. For new admissions to the home since the last inspection, there was evidence of assessments and care plans completed by care management. The home had received these prior to Somerville House DS0000070519.V369534.R01.S.doc Version 5.2 Page 11 admission and used them to assist in the decision-making process regarding whether the home could meet the persons’ needs. For planned admissions, the process remained unchanged. People were encouraged to visit the home to look around, and the home provided them with information about services. The first four to six weeks of any admission were seen as a trial period after which a review was held to discuss the stay and whether permanent residency was required. The home offered a respite service and the manager stated this gave people the opportunity to try the home and get to know staff and the homes way of working during regular visits before making any final decision about permanent residency. The latest person to be admitted had not received a formal letter after their assessment stating that having regard to the assessment the home was able to meet their needs. The home had produced a statement of purpose and service user guide to give people information about the services the home provided. Copies of these were given to us on the day but there does not appear to be any change other than an improved complaints process, since the last inspection. Sections of both these documents need further information. The statement of purpose still requires information on the provider’s qualifications and experience and it must have a clear statement about whether or not nursing care is provided. There needs to be more information about the range of needs and level of dementia the home is able to support. It is not clear exactly how service users are consulted about the running of home, for example via meetings, care plan reviews and quality surveys nor what involvement if any, the service users, family members and professionals have in the review of care plans. The size of individual and communal rooms is not indicated and the section on what the home has put in place to manage emergencies such as fire and accidents needs expansion. The service user guide has a heading for the description of accommodation but the text continues to just focus on the care plan that will be provided and there is no mention of the actual facilities other than eight single and five shared bedrooms. The service user guide refers to how many staff members are employed and in what capacity but does not indicate the qualifications and experience of the provider, manager and staff. The service user guide also needs a sample of the views of people living in the home attached to it. These can be taken from any recent service user survey conducted by the home. The home does not provide intermediate care services. Somerville House DS0000070519.V369534.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People were provided with support in ways that promoted their privacy, dignity and independence. However some gaps in care planning, risk assessing and recording means that staff may not have full information about specific tasks and care could be missed. The recording of medication was not sufficiently robust to evidence good management and ensuring all people received the medication as prescribed for them by their physician. EVIDENCE: Four care files were examined and although there were improvements noted in the planning of care for people the standard was not quite met yet. Somerville House DS0000070519.V369534.R01.S.doc Version 5.2 Page 13 There were still some needs identified at the assessment stage that needs to be included in the care plans. For example one person had specific dietary needs and behaviour that could be challenging to others but these were not included in any plans of care. Similarly another person had a care plan that addressed personal care issues well but it had been mixed up with another persons when printed off the computer and some information did not apply to them. They also self-medicated some of their prescribed topical products and the care plan needs to reflect this. One care plan produced since the last inspection was more comprehensive and it was clear the home were trying to put in place a new more comprehensive system. The care plans reminded staff to promote dignity and privacy and independence were possible. When the new system is fully in place, it will address some of the shortfalls. Care plans were not signed by the resident or their representative or by the person formulating it. This means that we could not be sure people had agreed to their plans of care. Also care plans were not evaluated thoroughly to check if they remained valid and still meeting needs. Shortfalls would have been identified if there were a thorough evaluation system in place. The home completed some risk assessments but there were areas of risk that still needed attention. For example falls, moving and handling, nutrition and skin condition were missing in some of the files and should be standard when initially admitting people to the home. Despite the shortfalls in care planning and risk assessment staff spoken with were very knowledgeable about peoples needs. They described ways in which they would promote independence, privacy and dignity and this was confirmed in discussions with people. Five of the six surveys received from residents stated their needs were met, ‘always’, one person said this was, ‘sometimes’. All five relatives surveys stated that their loved ones’ needs were met, ‘always’ and comments were, ‘definitely, the service is excellent’, ‘my sister who is 84years could not be better looked after – she is very happy and contented’ and ‘my friend is a changed person since she has lived at the home, she has regained her sense of fun’. People had access to a range of health services and there was evidence that their health and social care needs were met in ways that promoted privacy and dignity. Health professionals also stated that needs were met and privacy and dignity respected. The home still does not have any sitting scales so are unable to weigh people unable to weight bear. The manager advised that they had just organised access to sitting scales from another source. A new system of separate day and night recording had been set up. Some gaps in recording were noted, as some staff members were more diligent in Somerville House DS0000070519.V369534.R01.S.doc Version 5.2 Page 14 completing it than others. This needs to be more thorough in places to ensure a full picture of the care provided to people. The home had just changed their pharmacy supplier and support. There was a separate medication area with a sink and controlled drugs cupboard, although there were no residents receiving controlled drugs at present. The medicines trolley was secured to the wall and the room was kept clean and tidy. Since the last inspection new storage arrangements had been made for external products. When medication administration records were examined there were some shortfalls noted that must be addressed to ensure correct recording of administration for people: • Some people did not have prescribed creams signed for when administered so we were unsure if they had received them. • Hand written entries onto the medication administration record did not consistently have two signatures. • One person was prescribed medication to alter their mood ‘as needed’, but staff did not have any clear guidance plan to guide them in how often and when to administer it. This needs to be discussed with health professionals involved in the persons care. • Not all residents had photographs in the medication file to help identification when administering medication. • One persons’ Lactulose medication was prescribed twice daily but staff had been administering it when required. This needs to be checked out and if it is only to be administered when required the label needs adjusting. • One person was prescribed a weekly dose of a specific medication but this had not been signed for on one of the doses given. The packaging suggested it had actually been given though. • The dates on one persons’ medication had been inputted wrongly and staff had carried on. This meant that they had already signed for medication for the next day. Care must be taken with recording. • One person self medicates a part of their medication. Whilst this is good practice in supporting the person to be independent a thorough risk assessment needs to be in place and information included in the care plan as to how this is to be overseen by staff. Somerville House DS0000070519.V369534.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use the service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provided a happy and relaxed atmosphere and staff helped people to live fulfilled and occupied lives. The home continued to have flexible routines and promoted choice and individual decision-making for people. The home provided well-balanced meals, which met peoples’ nutritional needs. EVIDENCE: People spoken with during the day and surveys received from them and their relatives all stressed how happy they were with the atmosphere provided by staff in the home. This is a very good achievement and shows how hard staff members work to create it. Some of the comments received from people are, ‘it’s great here, I like everything about it’, ‘they don’t half look after us well’, ‘I’ve been here since 1992, one of the longest here and they treat me very well’, ‘I wouldn’t change anything’, ‘I like it very much here’, ‘she finds it very friendly in there and friends that visit find it very welcoming – they also make a good cup of tea’, ‘she’s had a hard life and it’s nice to see her relaxed, Somerville House DS0000070519.V369534.R01.S.doc Version 5.2 Page 16 enjoying herself and safe’, ‘my sister is very happy there – I think as an observer when I visit everyone is treated as an individual and the staff don’t act as if it is just a job but they really care’ and ‘I think this care home goes above and beyond the call of duty and it is a big comfort knowing that my mum is being cared for by caring, friendly staff’. There were lots of signs of wellbeing in the home. People were chatting to each and bantering with the staff, one person said, ‘I like a bit of cheek with them’. A visiting professional spoken with on the day stated that it was noticeable that when they could staff would always sit with residents in the lounge. There were no fixed routines and people told us that they made decisions about aspects of their lives. There was no set times for rising and retiring and visitors were welcomed at any time. There was evidence of links maintained with family, friends and the local community. Local clergy hold monthly services in the home. Staff and the manager explained how they tried to make sure people retained as much independence and individuality as possible. One person had a season ticket for the ‘Tigers’, his life long football team, and continued to attend the local KC (football) stadium for all the home games. Some people were still able to visit local shops unescorted and some continued to manage their own finances. Staff told us about a new community centre that six residents and one staff were to attend next week for coffee mornings, lunches and tea dances. They were hoping this was to be a regular occurrence for people. The activity log had likes and dislikes for each person identified and information about the activities they participated in. These included, visits to the local pub, four people go to the local library, some people go out shopping independently on Hessle Road, two people attend a day centre on Wednesdays, arranged by the manager, to have lunch and a chat with other people and the manager is trying to extend this for other people in the home. Eleven people went to the recent re-opening of the fountain on the Boulevard. The manager advised that when the new carpet is due to be laid in the lounge he has arranged a pub lunch out for everyone. People told us they joined in some activities provided in the home such as quizzes, bingo, skittles, board games, painting and crafts, nail care, gents pampering hour, ‘so they don’t feel left out’, charades and group discussions. Seasonal events are organised, birthdays celebrated and visiting entertainers are arranged occasionally. The home had a garden party in July. One person spends a lot of time in bed but has started to get up most days and will sit in the lounge for a short spell. Somerville House DS0000070519.V369534.R01.S.doc Version 5.2 Page 17 Staff members provide a movement to music session for people and the residents told us how the manager sings to entertain them, ‘Dean’s great, my type of bloke, he sings now and again – there is plenty to keep us occupied’. The manager and staff team appear to be thoughtful and energetic in ensuring people live as fulfilling a life as they can whilst in residential care. The home has recruited a second cook since the last inspection and the menus had been extended to cover a four-week period. The home ensured two choices at the main meal and evening meal and people spoken with described a good selection of breakfast choices including a full cooked breakfast once a week and poached eggs or kippers twice a week. People spoken with were very happy with the meals provided and those seen on the day were well presented and well prepared. They stated they had plenty to eat and drink. Comments about the meals from people spoken with and surveys were, ‘the food is blooming good’, ‘I like the food, you get a good breakfast and a good dinner’, ‘the meals are alright thank you’, ‘you get all you need to eat’, and ‘good selection of food’. All six surveys from residents had ticked that they liked the food, ‘always’. The home had scored ‘B’ with the local authority’s scheme, ‘scores on the doors’ for food safety management. A cold water dispenser has been installed in the lounge and residents were seen helping themselves to drinks. The manager advised it was installed to aid independence but also to ensure people got enough to drink. Somerville House DS0000070519.V369534.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home continued to provide an environment where people and their relatives felt able to complain. The home ensured vulnerable people were safeguarded from abuse by staff training and adherence to policies and procedures. EVIDENCE: The home had a complaints policy and procedure that was on display in the entrance. It had been updated since the last inspection and contained full details of what people could do and to whom they could speak to if they were unhappy with the service provided in the home. The homes complaints policy stated timescales for resolution of the complaint and there were complaint forms for people to fill in and give to staff members or the manager if people wished to make a formal complaint. The manager stated that they tried to deal with any complaints quickly before they reached a formal stage. Since the last inspection there has been one complaint received by the Commission. This was passed to the manager to address, which they did so. We did receive a further concern, which we checked out at the inspection but was unable to substantiate. Somerville House DS0000070519.V369534.R01.S.doc Version 5.2 Page 19 People spoken with stated they felt able to complain if they were unhappy and they continued to see the manager and proprietor on a regular basis, ‘Dean (the manager) is very nice – I would complain if I needed to’ and ‘I would see Dean, I’m happy living here’. We received six surveys from people living in the home and three stated they knew how to make a complaint, however all six stated they knew who to speak to if they were unhappy about something. Surveys from relatives stated they were aware of how to complain and that any issues raised were dealt with appropriately. Some commented they had never had to complain. Staff members stated they were aware of what to do if people raised concerns with them. The manager and four care staff had received local authority training in how to safeguard vulnerable people from abuse. Other staff were booked on the course. In discussions staff were very clear about what to do should they witness or suspect abuse had occurred. Staff had also received briefings on mental capasity legislation. The home used the multi-agency policy and procedure regarding safeguarding vulnerable adults from abuse and the new manager, via discussion, was fully aware of the referral and investigating procedures. Somerville House DS0000070519.V369534.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s comfort and wellbeing were enhanced by continued improvements to the environment, which were progressing according to plan. EVIDENCE: The environment in the home has continued to improve and the provider was generally managing to keep to his redecoration and refurbishment plan. The home was looking much brighter and cleaner and several bedrooms have been redecorated, re-carpeted and provided with new furniture. The next major item to be replaced is the lounge carpet. Quotes had been received and the work is to be completed in the near future. A new carpet for the top floor corridor was also on order. Residents and their relatives were happy with the improvements, ‘the care home is improving continuously with in-house Somerville House DS0000070519.V369534.R01.S.doc Version 5.2 Page 21 improvements implemented by the new owner’, ‘I wouldn’t change anything – we’re getting a new carpet soon’ and, ‘I’ve got a very nice bedroom’. Bathing facilities consisted of a shower room and unassisted bathroom on the first floor, the latter of which is due for some re-plastering work and repainting. There is also bathroom with a new manual hoist on the top floor. This room has been repainted, has had new flooring fitted and dispensers for liquid soap, paper towels and alcohol gel have been installed. There were three additional toilets to the ones located in the bath and shower rooms. Some of the facilities were still in need of updating. Refurbishment of the ground floor disabled toilet was underway. The home had eight single and five shared bedrooms; none had en-suite facilities. The shared bedrooms had portable privacy screens but one had been recently fitted with a curtained divider and the manager advised in time all the shared rooms were to have the same. Lockable facilities had been ordered and were to be fitted in each bedroom for people to store their valuables. The previous manager had asked people about privacy locks to their bedroom doors but most had said they were not bothered about them. The proprietor should put these on as standard when the bedrooms are vacated or if anyone changes their mind. People were encouraged to bring in small items of furniture, pictures and ornaments to personalise their bedrooms and this was seen to varying degrees. People spoken with were happy with their bedrooms. The laundry room and managers office has exchanged rooms. New flooring has been laid in the laundry and it gives more space for staff in a more convenient location downstairs with also less noise disturbance for residents. During the visit there was a slight odour in the entrance and in one of the bedrooms. The staff members were aware of these and were working to resolve them. Somerville House DS0000070519.V369534.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Gaps in mandatory and service specific training mean that staff members may not have the required skills to meet peoples’ diverse needs. The home’s recruitment processes were sufficiently robust to safeguard vulnerable people but files lacked organisation and specific information. EVIDENCE: Discussions with care staff members indicated that there were two care staff members, and the registered manager on duty during the day, and two care staff at night. On some days of the week an extra care staff member provided care in the mornings. The manager calculated the home provided between 330 and 360 care hours a week, which meets the current needs and numbers of residents in the home. Some of the residents have quite low level needs. The home has two resident vacancies at present and the manager will need to look at how dependency levels are calculated so that care hours can be adjusted accordingly, should they be filled. Since the last inspection the home had recruited more catering and domestic staff. Somerville House DS0000070519.V369534.R01.S.doc Version 5.2 Page 23 People were complimentary about the care received from staff, ‘the staff do well, they answer bells quickly’, ‘friendly staff and look after us very well’, ‘the staff are lovely’ and ‘the carers could not be more helpful’. All surveys received stated staff listened to people and acted on what they had to say and a health professional spoken with on the day said the home had a very friendly atmosphere. Staff members spoken with stated they had a nice team to work with and said, ‘we are working hard and improving – the relatives are happy and the residents are happy that’s the main thing’. There was a good skill mix of staff and no turnover since the last inspection. Staff knew the residents well. The manager has had a lot of systems to improve and staff training was just being planned. A new staff training and development record form had been produced for each individual, which indicated training completed and when updates are due and the manager keeps an overall log for their planning process. The home has access to a range of training provided by the local authority but also uses other external trainers and distance learning. Since the last inspection all staff have completed fire training, and moving and handling for those without a valid certificate. Most have completed training in safeguarding vulnerable adults from abuse with the local authority and attended mental capacity briefings. There were gaps in other mandatory training such as first aid, health and safety and basic food hygiene (apart from the cook) and the manager was unsure if this was actually a lack of training or misplacement of certificates by previous management. These areas are to be planned for and addressed. According to information supplied by the manager at the last inspection, four staff had completed a medication course, three, first aid, four had health and safety certificates and two had completed basic food hygiene. There was still little evidence of training to cover the conditions of older people, for example dementia care, Parkinson’s disease and strokes and the manager has been looking at including these areas in the training plan. For example all staff have been booked onto a diabetes awareness course at the local hospital on two dates in September and November. All ten care staff members are enrolled on national vocational qualifications (NVQ) at levels 2 or 3. When completed the home will exceed the target required of 50 of care staff trained to this level. There has been no new care staff members employed since the last inspection to go through an induction process allied to skills for care standards but the manager was advised at the last inspection that induction for new staff had to conform to these standards. Somerville House DS0000070519.V369534.R01.S.doc Version 5.2 Page 24 Existing staff recruitment files had not been organised sufficiently yet and the only people recruited since the last inspection was ancillary staff – one person three months ago and another three weeks ago. These two files were checked and both had application forms and written references. Both had criminal record bureau checks and although not seen, as the manager was unable to access their computer due to technical difficulties with the local server, both had checks against the protection of vulnerable adults register. Start dates of employment and photographs of staff were missing and files were disorganised. Neither had received a contract yet, however the manager explained that staff worked a three-month trial period before contacts were issued. Somerville House DS0000070519.V369534.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There have been improvements in the way the home is managed which has impacted positively on the welfare and safety of people living in the home. EVIDENCE: The new manager had fourteen years experience in the care sector as a team leader in a nursing home, and also in a community care centre. They had gained a National Vocational Qualification in care at levels 2 and 3 and had started their Registered Managers award. They stated they had settled into their new position well and felt the proprietor was very supportive visiting the home regularly to complete maintenance tasks, decoration, support the staff Somerville House DS0000070519.V369534.R01.S.doc Version 5.2 Page 26 team and chat to residents. The manager has not yet applied for registration with the Commission and this needs to be completed as soon as possible. The staff described the manager as, ‘lovely – he really gets things done’, ‘you can talk to him’, ‘standards have improved especially the environment’ and ‘its more professional now’. Staff members were happy with their new uniforms and felt they looked smart. Morale was high and the atmosphere relaxed in the home, which was down to good management. People said they were kept informed and up to date about things with regular meetings and had a handover diary to pass on information to each other. People that lived in the home knew the managers’ name, which told us he made his presence felt about the home. There had been some improvements in the management systems in the home and although a little disorganised in their approach, perhaps due to the overwhelming management tasks that needed to be done, the manager was getting things done slowly. A deputy manager had just been appointed and was to offer support to the manager. At the last inspection care staff were not receiving any formal, documented supervision, there was no documented evidence that service users, their families, staff and visiting professionals were consulted about how the home was managed and the recruitment of staff was not as robust as required for the safety of service users. All these areas have seen some level of improvement. The quality assurance system had been reorganised and new surveys produced for people that live in the home, their relatives and professional visitors. These were to be sent out to people soon to start off the process. Audits of the environment were undertaken and the manager audits training and medication. Any repairs or maintenance issues were dealt with as they occurred. The home had completed the annual quality assurance assessment (AQAA) required by the Commission but the information included was still rather brief in parts and could be improved upon to evidence the manager was fully aware of what the service does well and how they evidence this and what shortfalls needed to be addressed. According to information received from the manager all care staff and most ancillary staff had received a formal documented supervision session since the last inspection. The standards require that care staff receive at least six sessions a year that covers the philosophy of the home, care practice and staff training and development. Now there is a new deputy manager they may be able to take over some of the staff supervision arrangements. In discussions staff stated they felt supported and in surveys stated they met with the manager regularly. Somerville House DS0000070519.V369534.R01.S.doc Version 5.2 Page 27 People were encouraged to look after their own financial affairs, however the home continued to keep small amounts of personal allowance for most people and assisted some people to budget their amounts. Individual records were maintained and receipts obtained for any purchases made by staff at peoples’ request. The health and safety issues mentioned in the last report have been addressed and the home was a safe place for people to live in and staff to work in. The manager should audit accidents for trends to enable early intervention. The AQAA document evidenced that equipment used in the home was serviced as required. Somerville House DS0000070519.V369534.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 3 Somerville House DS0000070519.V369534.R01.S.doc Version 5.2 Page 29 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 OP1 Regulation 4&5 Requirement The registered person must ensure that there is an up to date Statement of Purpose and Service User Guide available to prospective service users. This will ensure that prospective service users have the required information to make an informed choice (previous timescale of 30/06/08 not met). The registered person must ensure that all assessed needs are addressed in care plans with clear guidance for staff on how to meet the needs. Care support plans must be consistently updated as a result of evaluations and changes in peoples’ needs. This will ensure that care staff have the most up to date information in how to care for people (previous timescale of 31/05/08 not met). It is acknowledged that some progress has been made but the Somerville House DS0000070519.V369534.R01.S.doc Version 5.2 Page 30 Timescale for action 31/10/08 2 OP7 15 31/10/08 standard is not met yet. Care plans must be signed and dated by the person formulating them and the resident or their representative to evidence their agreement to them. The registered person must ensure that service users with identified areas of risk, for example, falls, moving and handling, nutrition and pressure areas (previous timescale of 30/09/07 and 31/05/08 unmet) Adequate arrangements must be put in place for the handling of medicines and for the accurate recording of all medicines received and administered. This helps to ensure that medicines are given correctly in order to protect people’s health and wellbeing The registered person must ensure that all staff members complete mandatory training in line with the homes training plan and investigate training courses in conditions that affect older people such as dementia, strokes, Parkinson’s disease etc. This will ensure staff members are skilled and competent for their roles. The registered person must ensure that the new manager applies for registration with the Commission. The registered person must ensure that the quality assurance system is re-started to allow further resident consultation and formulation of action plans to address any shortfalls DS0000070519.V369534.R01.S.doc 3 OP8 13(4) 30/09/08 4 OP9 13(2) 12/09/08 5 OP30 18 31/12/08 6 OP31 8 30/11/08 7 OP33 24 31/10/08 Somerville House Version 5.2 Page 31 (previous timescale of 31/10/07 and 30/06/08 and not met). It is recognised that the new system of questionnaires is now ready to be started. 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 2 Refer to Standard OP8 OP9 Good Practice Recommendations The registered person should purchase sitting scales or develop alternative means of monitoring the weight of people unable to weight bear. The manager should ensure photographs of residents are in the medication files as an aid to the administration of medicines and updated medicines information should be available for staff. The manager should ensure one persons’ medication prescribed for modifying their behaviour and prescribed, ‘when required’, has clearer guidance for staff. This should be discussed with health professionals. The registered person should continue with the good progress made in environmental upgrading as per the redecoration and refurbishment plan. The home should continue to work towards 50 of care staff trained to NVQ level 2 and 3. The manager should organise staff recruitment files more efficiently and ensure they include the start date of employment and a photograph of the individual. The new manager should continue to work towards the Registered Managers Award. Care staff should receive a minimum of six supervision sessions a year in line with national minimum standards, which should cover all aspects of practice, philosophy of care in the home and career development needs. The manager should audit accidents for trends to enable early intervention. 3 OP9 4 5 6 7 8 OP19 OP28 OP29 OP31 OP36 9 OP38 Somerville House DS0000070519.V369534.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Somerville House DS0000070519.V369534.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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