Inspection on 29/02/08 for Somerville House

This inspection was carried out on 29th February 2008.

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

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

Other inspections for this house

Somerville House 01/08/08

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Snydale Care Home

Larchfield Manor

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

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 29th February 2008 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Somerville House DS0000070519.V361462.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.V361462.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 sumervillehouse@sumervillehouse.karoo.co.uk Mr John Mark Beyer Mrs Norma Ford 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.V361462.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 14th August 2007 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 £338 per week. There is an additional top-up fee for the larger single bedroom. Additional charges include hairdressing, chiropody, toiletries, newspapers/magazines and taxis for personal use. 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.V361462.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means that the people who use this service experience poor quality outcomes. There were positive comments from the service users about the care they received which is not reflected in the 0 star rating. The rating reflects the current overall poor management and organisation of the systems that need to be in place to ensure the safety and welfare of people that live there. As the section on management is considered to be a key area, this has affected the overall score of the home. We will complete another visit to the home within six months to ensure that the management of the home has improved. 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 14th August 2007, including information gathered during a site visit to the home, which took place over one day. Throughout the day we spoke to service users to gain a picture of what life was like at Somerville House. We also had discussions with the proprietor, the new manager, the cook and care staff members. 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. We received surveys from four service users, four relatives and eight staff members. Comments from discussions and surveys have been used throughout the report. We would like to thank the service users, staff and management for their hospitality during the visit and thank everyone that completed a survey. Somerville House DS0000070519.V361462.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: There were several requirements still outstanding from the last inspection. These need to be addressed within the timescales. The general management of the home must improve to ensure systems are in place to monitor the services it provides. The information the home provides to prospective service users needs to be improved and the complaints policy could give clearer information about where to refer any complaint should the complainant not be satisfied with the homes investigation. Somerville House DS0000070519.V361462.R01.S.doc Version 5.2 Page 7 The risk assessments and care plans need to have more information so that all needs are addressed and staff have clear guidance on how to support people. Also the home needs to make sure it consistently obtains assessments completed by the local authority when they fund people in the home. Some people need to have bed rails on to stop them from rolling out of bed at night. The manager had obtained up to date information and guidance on how to assess people for bed rails but they had not put this into practice. Some people had a risk of falls but this had not been assessed properly, which means that staff may not have all the information needed to try and prevent the falls happening. Although the home does provide some activities for people, those service users with dementia could to have their needs assessed thoroughly so activities can be tailored for them. The home needs more domestic and catering staff. The home needs to consult with people via surveys, for example to service users, relatives, staff and professional visitors about how the home is managed. The records the home maintains needs to improve. Care plans need to be stored securely and all care file information must be kept in the home. The manager must improve communication with the Commission by sending in reports of any incidents that affect service users wellbeing. Staff members need to be checked out properly before starting employment, they need to receive appropriate induction and training to ensure they are skilled for their role and they need to be supervised properly. A training plan needs to be produced to plan what is required to include training in how to safeguard vulnerable people from abuse, mandatory training and conditions affecting older people. 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.V361462.R01.S.doc Version 5.2 Page 8 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.V361462.R01.S.doc Version 5.2 Page 9 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, 3 and 5 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 did not produce full information about the services it provided and assessments of need completed by commissioners of services were not obtained for emergency admissions. This means that full information about the home would not be available to prospective users of the service and full information about the service user may not be available to the home. This could potentially affect the decision-making about whether they could meet needs. EVIDENCE: We examined four care files during the visit. There was evidence the home generally obtained assessments and care plans completed by care management prior to admission. However this was not in evidence for the most recent person admitted to the home. They had been admitted in an emergency but the local authority had not supplied an assessment. The manager had completed very basic information about the service users needs. Somerville House DS0000070519.V361462.R01.S.doc Version 5.2 Page 10 The registered manager was unavailable during the day but the new manager, who was completing his induction, confirmed that the process would be to visit people at home or in hospital to complete the homes in-house assessments prior to admission. Although the information gathered during these visits was generally quite basic it was sufficient to enable the home to decide whether they could meet peoples’ needs. To improve further it could contain more information on the degree or severity of the issues affecting the person. The home should insist on full information from the local authority when people are placed in the home in emergencies. For planned admissions, 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. At the last inspection the registered manager stated the assessment documentation was copied for the person or their relative and included a written statement that the home was able to meet the assessed needs. We could not see this in the care files examined. The manager needs to re-start this process or formally write to the service user or their representative stating the homes capacity to meet the assessed needs. The home produced a statement of purpose and service user guide. Sections of both these documents need further information. The statement of purpose requires information on the providers qualifications and experience and more clarity regarding these points for staff members. It also 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 complaints procedure needs to have information on how to refer complainants to the local authority if they are unsatisfied with the outcome of the homes investigations. 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 this is not included in the text. The qualifications and experience of the provider, manager and staff and a selection of service user views gained via discussions or from surveys are required. Somerville House DS0000070519.V361462.R01.S.doc Version 5.2 Page 11 The home does not provide intermediate care services. Somerville House DS0000070519.V361462.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. Care plans and risk assessments did not fully reflect all the needs the service users had and the tasks staff needed to complete to meet them. This could mean that important care could be missed. Care was provided in ways that promoted privacy and dignity. EVIDENCE: The new manager advised that the home was currently updating the format of care files for each service user. This process had started at the last inspection and still has to be completed. Sections were missing from some files as the manager had taken them home to work on. All records need to remain in the home so staff members have information available. Four care files were examined and the plans of care varied in how comprehensive they were. Generally they included assessed needs but there were examples when needs had been identified in risk assessments that had not been fully planned for. For example one person had needs associated with swallowing food, pain control and pressure area care but the care plan was not Somerville House DS0000070519.V361462.R01.S.doc Version 5.2 Page 13 clear how they were to be fully addressed. The same service user had communication needs but the care plan was basic stating they communicated using non-verbal means but there was no indication what these were. Some were more comprehensive than others in the details about staff tasks. However one person required a plan to advise staff in how to manage behaviour that was challenging in order to establish a consistent approach. The care plans reminded staff to promote dignity and privacy and independence were possible. There was some evidence that care plans were updated when needs changed but this was not the case in all the care plans examined and an evaluation of the plan needs to take place monthly. Not all were signed by the person formulating them or the service user to show they agreed with the contents. Reviews were held every six months, with staff preparing by completing a summary of the care plan and how it meets needs. Daily recording covered all the care plan areas. The documentation guided staff to tick a box regarding each care plan element at each shift and there was a space for comments. Some staff members were more diligent in completing the comments section than others and the manager needs to discuss this with the team, as it was an issue seen at the last inspection. Some sections of daily records were missing from the files and the new manager thought senior staff members were working on them at home. Again all records need to remain in the home so staff members have information available. The home completed some risk assessments but there were areas of risk that needed attention. For example falls and moving and handling for one person, the need for bedrails for others and nutritional issues for a third. An immediate requirement notice was issued to ensure the manager assessed the need for the use of bedrails and to check the beds had the correct rails fitted. 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. Staff had a good understanding of how to promote this and people spoken with were very complimentary about the care staff and how they supported them. The home does not have any sitting scales so are unable to weigh people unable to weight bear. The staff team needs to find other ways of monitoring fluctuations in weight and record these. Medication was generally well managed. The home had a separate medication area with a sink and controlled drugs cupboard. The medicines trolley was secured to the wall. Some creams needed to be stored away and some had not been documented when administered. On two of the records examined what was written as prescribed for an inhaler and a food thickener was not actually what was administered. This discrepancy could cause confusion and needs to be addressed with the doctor or pharmacy. Somerville House DS0000070519.V361462.R01.S.doc Version 5.2 Page 14 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 good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home had flexible routines and promoted choice and individual decisionmaking for people. However more work around the provision of stimulating activities for people with dementia will further enhance their lives and wellbeing. The home provided well-balanced meals, which met peoples’ nutritional needs. EVIDENCE: People spoken with stated that routines were relaxed and they made decisions about aspects of their lives. There was no set times for rising and retiring and visitors were welcomed at any time. This was confirmed in surveys from relatives, ‘you can visit anytime and are always made to feel welcome’. 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 continued to have employment at the local KC (football) stadium and attended all the home games. Some people were still able to visit local shops unescorted and some continued to manage their own finances. Somerville House DS0000070519.V361462.R01.S.doc Version 5.2 Page 15 People told us they joined in some activities provided in the home such as quizzes, bingo, skittles, board games, painting and crafts. Staff and relatives told us about seasonal events that had been held such as ‘Hull fair in the home’, which consisted of a variety of games, Christmas and birthday parties and bonfire celebrations. Some service users had dementia and required assessments of their increasing needs. This would enable staff to tailor activities to meet them and ensure they receive appropriate stimulation. There were some very positive comments from service users, relatives and staff about the atmosphere in the home. Some comments were, ‘they make the old people feel wanted, I have no worries about leaving my wife in their care’, ‘it’s a happy and friendly environment’, ‘I wouldn’t want to live anywhere else’, ‘I’m very happy here, it’s a lovely home and the staff are kind’, ‘I’m very, very happy here, I look after myself’, ‘the staff are always nice and cheerful’. The home has one cook and recruitment is underway for a second cook for the weekend shifts. 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. The cook stated the home had menus that rotated over a twoweek period but they were working on a third week to give people more choice. They catered for special diets such as low fat and diabetic and one person had their meals liquidised and another softened. We observed lunch in the dining room, which was nicely set out with individual tables and the occasion seemed to be a social event. Members of staff were attentive and checked if people had had sufficient to eat and drink. 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, ‘I really enjoy the food’, ‘the food is lovely, you have choices and its cooked well’, ‘the food is excellent, its fish and chips today – you get choices’, ‘the food is always cooked fresh’ and ‘the food is very good, always home baking’. The home had scored well at the last environmental health inspection. Somerville House DS0000070519.V361462.R01.S.doc Version 5.2 Page 16 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 adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provided an environment where people and their relatives felt able to complain. Not all members of staff had received training in how to safeguard vulnerable adults from abuse. This could mean that signs could be missed and incidents not reported appropriately. EVIDENCE: The home had a complaints policy and procedure that was on display. It still required some adjustment to include information about the commissioning agency, who were responsible for investigating complaints regarding the care provided to people it funds, if they cannot be resolved at local level. It also requires updating with information about the Commission. 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 complaint form could be improved with information about complainant satisfaction with the outcome of investigation. The manager stated that they tried to deal with any complaints quickly before they reached a formal stage. There were no documented complaints since the last inspection. People spoken with stated they felt able to complain if they were unhappy and they saw the manager and proprietor on a regular basis. Surveys from relatives stated they were aware of how to complain and some commented Somerville House DS0000070519.V361462.R01.S.doc Version 5.2 Page 17 they had never had to. Staff members stated they were aware of what to do if people raised concerns with them. The manager had received local authority training in how to safeguard vulnerable people from abuse. The new manager and two care staff were due to attend a course in March. This training needs to be cascaded to other staff in the home and was a requirement from the last inspection. Those spoken with were able to explain what they would do should they witness or suspect abuse had occurred but training would consolidate this knowledge. 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.V361462.R01.S.doc Version 5.2 Page 18 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. Improvements to the environment are progressing according to plan. A lack of attention to cleanliness in some areas could compromise service users comfort and wellbeing. EVIDENCE: There had been some noticeable improvements in the environment since the last inspection and some service users commented on this to us. The new proprietor had begun refurbishing and redecorating areas of the home. The exterior of the home had been re-painted, carpets in the main entrance and stairs had been replaced and the hallway redecorated. Some bedrooms had been re-carpeted and redecorated and most maintenance issues highlighted in the last report had been addressed. The proprietor needs to produce a new refurbishment and redecoration plan with timescales and forward to the Commission. Improvements to the home should also be commented on within Somerville House DS0000070519.V361462.R01.S.doc Version 5.2 Page 19 the reports produced for visits to the home by the registered person, in line with regulation 26 of the Care Homes Regulations. Communal space consisted of a large lounge, arranged into two separate areas, a further small room (a thoroughfare) for two or three chairs and a dining room. All the rooms needed brightening up and redecorating to varying degrees and so far the proprietor has completed the small quiet room. This has been re-carpeted and redecorated, the boiler boxed in and new chairs provided making the room look clean and fresh. There is a plan to provide new carpets to the larger communal rooms. Bathing facilities consisted of a shower room and unassisted bathroom on the first floor and a bathroom with a manual hoist on the top floor. There were three additional toilets to the ones located in the bath and shower rooms. Bathing and toilet facilities were in need of updating. Some sinks were missing plugs. The home had eight single and five shared bedrooms; none had en-suite facilities. The shared bedrooms had privacy screens but none of the bedrooms had privacy locks on the doors and lockable facilities for people to store personal items. The registered 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. Two of the screens still had wheels missing, which could make them unsteady. 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 home had a separate laundry room with a commercial washing machine and drier. There was also a small room with a sink used for storage and to clean commode pans. There was sufficient protective clothing and cleaning products in the home. The laundry needs to be inaccessible to people when not in use. During the visit it was noticed that some areas in bedrooms and one of the bathrooms required cleaning attention. It was noticeable that the home had been without domestic staff that week. Somerville House DS0000070519.V361462.R01.S.doc Version 5.2 Page 20 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. The lack of a training plan meant that the home was unable to keep track of training needs and plan for updates. Some gaps in training and recruitment procedures could mean that staff are not fully equipped with the skills required to care for people and checks are not fully completed prior to them starting shifts. EVIDENCE: There were fifteen service users with two care staff, a cook, the new manager and the proprietor present in the home during the visit. The atmosphere in the home was relaxed and we observed staff talking to people in a friendly and courteous way. They continued to be supportive at mealtimes and had some time to sit and chat to people. People spoken with were complimentary about the staff and the way they looked after them, ‘the girls treat me well’, ‘I’m very happy here, I love the home and the staff are very kind’, ‘I wouldn’t want to live anywhere else’ and ‘the staff are lovely, you can have a laugh and a joke with them – they are always nice and cheerful’. Relatives stated in surveys, ‘they go beyond their roles of duty’ and, ‘I can’t believe how good they are with mum’. The home was short staffed in catering and domestic areas but the new manager was in the process of reorganising existing domestic staff and Somerville House DS0000070519.V361462.R01.S.doc Version 5.2 Page 21 recruitment was underway for a new cook for the weekend shifts. The current registered manager had been filling in as cook and carer, however this detracted from their duties and management tasks had suffered as a consequence. See next section on management. On each shift during the day there was a senior carer, a carer and the manager. Two care staff members were on duty at night. The home currently had fifteen service users and this staffing level was sufficient to support them, however as the home was short staffed in other areas care staff would complete tasks outside their caring role, for example laundry. The needs of some service users had increased since the last inspection and they required more support especially with moving and handling. The home also did not employ an activity coordinator and again care staff completed this role. This meant that if they were called away to support someone, the activity they were facilitating would be disjointed. Despite the lack of staff in some areas the people spoken with enjoyed coming to work and took pride in their reputation for providing good care. Staff surveys confirmed this with comments such as, ‘it’s a stable and enjoyable environment’, ‘we have a good reputation with relatives and outside visitors’ and ‘it’s a happy and friendly place’. The home still did not have an up to date training plan for the coming year and the new manager was currently auditing staff files to plan accordingly. There was little evidence of training to cover the conditions of older people, for example dementia care, diabetes, Parkinson’s’ disease and strokes and the manager needs to look at including these areas in the training plan. There had been some staff changes since the last inspection and this had affected training records and achievements. There was evidence that training courses had been planned for fire awareness (all staff) and mental capacity legislation (three staff) in March and safeguarding adults from abuse (three staff) in April. According to information supplied by the manager, four staff had completed a medication course, three, first aid, four had health and safety certificates and two had completed basic food hygiene. All staff had been given a booklet about respecting people’s rights under the Mental Capacity Act. No staff had up to date moving and handling training and, as two staff members were observed using a draglift no longer in use, an immediate requirement notice was issued to ensure all staff quickly received this training. Out of ten care staff, four (40 ), had completed a national vocational qualification in care at level 2 with a further three staff registered and due to start. The home is required to aim for a target of 50 of care staff trained to this level. Somerville House DS0000070519.V361462.R01.S.doc Version 5.2 Page 22 Staff induction tends to be an orientation to the home, working alongside other staff members and observation by the manager. Members of the care staff team need to complete Skills for Care induction standards and evidence their competence before induction is signed off by senior staff. This was a requirement from the last inspection. There had been some slippage in the way staff members were recruited. Two people only had one reference and staff members had started employment after the return of the povafirst (protection of vulnerable adults register) check but before the criminal record bureau check had returned. In exceptional circumstances this is acceptable but the home must put in place stringent supervision arrangements and we could not see evidence of this. Staff files were disorganised and difficult to audit and povafirst checks were not immediately available for examination. Somerville House DS0000070519.V361462.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 and 38 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There continues to be deficiencies in the way the home is managed in areas of recruitment, staff training and supervision, quality monitoring and the management of documentation. This has been due to a lack of time dedicated to management hours and could affect service users welfare and place their safety at risk. EVIDENCE: At the time of the visit the registered manager of the home was the former proprietor who had agreed to remain as manager until the new proprietor recruited a replacement. Recruitment and selection had been completed and, during the visit, a new manager was four days into their induction. However the registered manager was unavailable on the day and the new manager had been left in charge of the home. Despite their existing skills and knowledge Somerville House DS0000070519.V361462.R01.S.doc Version 5.2 Page 24 this was not accepted as good practice. 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 completed one unit of the Registered Managers award. Apart from the recruitment of the new manager there had been no improvement in any of the management systems that showed a shortfall at the last inspection. The new manager confirmed that management had continued to work care shifts due to staff recruitment difficulties and this had affected the time available for management tasks. 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. Care staff members were observed using a draglift to move a service user. This lift is no longer considered safe to use as it could hurt the person’s shoulders. Records also indicated staff required moving and handling and other mandatory training. An immediate requirement notice was issued for staff to be provided with the correct moving and handling skills quickly. There had been three staff meetings since the last inspection and the new manager had planned a service users meeting. People spoken with said they chatted to members of staff and the manager, and confirmed they were able to make suggestions. The series of audits and surveys regarding the quality of the service provided needs to re-start. The home had completed the annual quality assurance assessment required by the Commission but the information included was rather brief in parts and could be improved upon to evidence the manager was fully aware of what the service does well and what shortfalls needed to be addressed. Staff members spoken with, however, were complimentary about the current manager, the new manager and the proprietor stating they were approachable and would listen to suggestions. Records showed that the proprietor visited the home regularly and he was observed assisting a service user into the lounge and chatting to them. It was obvious he knew the person well and they were familiar with him. 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. Some records showed a deficit, however the homes petty cash system supported the service user until relatives were contacted or visited with more supplies. Somerville House DS0000070519.V361462.R01.S.doc Version 5.2 Page 25 There were also some issues with the storing and recording of information. It was noted during the visit that although care files were held in a specific cupboard in the staff desk, this was not secured in line with data protection legislation. There were also notifiable incidents documented in daily records but when cross-referenced, there was evidence that the Commission had not been informed. There were sections of daily records missing from the care files. The new manager could not locate the homes fire risk assessment although there was evidence of fire alarm and equipment checks. Various maintenance and service certificates were seen for gas safety, water storage and moving and handling equipment. The new proprietor had also addressed some of the safety issues mentioned in the last inspection report such as the replacement of some light wardrobes and a window frame and the covering of some radiators. There were still some areas of health and safety that required attention: •People with bed rails insitu need to have a thorough risk assessment to ensure the bedrails are required and they remain a safe system for preventing people from rolling out of bed. Guidance needs to taken from the Medicines and Healthcare products Regulation Authority regarding the safe use of bed rails. An immediate requirement notice was issued for this to be completed quickly. • The laundry room, which has hot water and cleaning products, was still accessible to people when not in use. Staff members need to be reminded to secure the door. All the above shortfalls have had an impact on the score in this section of the report and because the section on management is considered to be a key area, this has affected the overall score of the home. Somerville House DS0000070519.V361462.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 1 1 1 Somerville House DS0000070519.V361462.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard 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 The registered person must ensure that the home consistently obtains assessments completed by care management for service users funded by them. 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. The registered person must ensure that service users with DS0000070519.V361462.R01.S.doc Timescale for action 30/06/08 2 OP3 14 28/04/08 3 OP7 15 31/05/08 4 OP8 13(4) 31/05/08 Somerville House Version 5.2 Page 28 5 OP8 15 6 OP9 13(2) 7 OP12 16 8 OP16 22 9 OP18 13(6) identified areas of risk, for example, falls, moving and handling, nutrition, pressure areas, and the need for bedrails have them planned for with clear steps in how to minimise the risks. This must include ongoing maintenance checks for bed rails (previous timescale of 30/09/07 unmet) The registered person must ensure that a behaviour management plan is devised for a specific service user with clear guidance for staff in how to manage the challenging behaviour. This will ensure staff have a consistent approach. The registered person must ensure that prescribed creams are stored appropriately and recorded when administered. The discrepancy noted on the MAR for two service users must be checked out with the prescriber or pharmacist and documented correctly to avoid confusion for staff. The registered person must ensure that people with dementia receive social stimulation. Assessments of their needs in this area will enable staff to tailor activities to their needs, wishes and abilities. The registered person must ensure that the homes complaint policy and procedure is amended to include information on the various avenues a complainant can use to register a complaint (previous timescale of 30/09/07 not met). The registered person must ensure that all staff receive training on how to safeguard vulnerable adults from abuse (previous timescale of DS0000070519.V361462.R01.S.doc 11/04/08 11/04/08 31/05/08 30/04/08 30/06/08 Somerville House Version 5.2 Page 29 10 OP19 23 11 OP26 23 12 OP27 18 13 OP29 19 31/10/07 not met) The registered person must ensure that a redecoration and refurbishment plan is produced with timescales for the planned completion of work. The plan to be forwarded to the CSCI and they are to be kept up to date with progress via regulation 26 reports. The registered person must ensure that shortfalls in hygiene seen on the visit are addressed and adequate domestic staff is provided. The registered person must ensure that the home has sufficient domestic and catering staff to maintain cleanliness and meal preparations in the home (previous timescale of 30/09/07 not met) The registered person must ensure that in the exceptional circumstances when staff members are needed to start work after a clear povafirst check but prior to the return of the CRB stringent supervision arrangements be in place (previous timescale of 30/09/07 not met) Two written references must be obtained for all new staff members to assist in the recruitment process. The registered person must ensure that a training plan for the coming year is produced based on information gathered during supervision sessions or appraisals. The plan to include service specific training, for example, dementia care, challenging behaviour and conditions affecting older people as well as mandatory training DS0000070519.V361462.R01.S.doc 30/04/08 31/03/08 30/04/08 30/04/08 14 OP30 18 30/04/08 Somerville House Version 5.2 Page 30 15 OP30 18 16 OP31 8 17 OP31 10 18 OP33 24 19 OP36 18 20 OP37 17 (previous timescale of 31/10/07 not met). The registered person must ensure that staff induction meets Skills for Care standards where evidence of competency is assessed and documented (previous timescale of 30/9/07 not met). The registered person must ensure that the new manager applies for registration with the Commission. The registered person must ensure that the manager fulfils their management duties and that they have sufficient time in which to this. The registered person must ensure that the quality assurance system is re-started to allow further service user consultation and formulation of action plans to address any shortfalls (previous timescale of 31/10/07 not met). The registered person must ensure that care staff are supervised appropriately in line with national minimum standards i.e. supervision covers all aspects of practice, philosophy of care in the home and career development needs. All care staff to have one supervision session covering these points by timescale for action date (previous timescale of 31/10/07 not met). The registered person must ensure that care files with personal information are stored securely in line with data protection legislation and all records relating to the home must remain in the home and available for inspection. DS0000070519.V361462.R01.S.doc 30/04/08 31/05/08 31/03/08 30/06/08 31/05/08 31/03/08 Somerville House Version 5.2 Page 31 21 OP37 37 22 OP38 13(5) The registered person must ensure that the Commission is made aware of all notifiable incidents that occur in the home. The registered person must ensure that staff use safe moving and handling techniques when assisting people and are equipped with the skills and knowledge to do this safely. Immediate Requirement Notice issued – timescale agreed as 17/03/08. 31/03/08 17/03/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP8 OP28 OP31 OP38 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 home should continue to work towards 50 of care staff trained to NVQ level 2 and 3. The new manager should continue to work towards the Registered Managers Award. A bed rail check should be included in the general maintenance checks to ensure their ongoing safety. Somerville House DS0000070519.V361462.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.V361462.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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