Inspection on 27/02/09 for Canwick Court Care Home

This inspection was carried out on 27th February 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Canwick Court Care Home 09/07/08

Canwick Court Care Home 14/11/06

Canwick Court Care Home 10/05/06

Canwick Court Care Home 24/10/05

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: South Park Care Home 78 South Park Lincoln Lincs LN5 8ES     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Douglas Tunmore     Date: 2 7 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: South Park Care Home 78 South Park Lincoln Lincs LN5 8ES 01522544595 01522544230 southpark10@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Guardian Care Homes (UK) Limited care home 31 Number of places (if applicable): Under 65 Over 65 31 dementia Additional conditions: 0 The home is registered to provide personal care with nursing for service users of both sexes whose primary needs fall within the following categories:- Dementia - over 65 years of age (DE)(E) - 24 (Nursing) Dementia - over 65 years of age (DE)(E) - 7 (Personal Care) The maximum number of service users to be accommodated is 31. Date of last inspection Brief description of the care home South Park Care Home is registered to provide nursing care and personal care for 31 people over the age of 65 with dementia and up to 4 people with dementia under 65 years of age. The home has an acting manager in place who is not registered. The home is situated to the south of Lincoln city and is served by a bus route and is within walking distance of the town centre. The property is a large detached Victorian building laid out over 4 floors. The top floor is for staff and an administration area. The first floor comprises of resident bedrooms and the ground floor has bedrooms and communal areas. The lower ground floor has Care Homes for Older People Page 4 of 29 Brief description of the care home the main kitchen and the residential care unit, which can accommodate 9 residents. This unit is called Heathlands and has its own entrance. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This was an unannounced visit and it formed part of a key inspection, focusing on key standards, which have the potential to affect the health, safety and welfare of people who use the service. Throughout this report the terms we and us refer to The Commission for Social Care Inspection (CSCI). We took into account previous information held by us including the previous inspection report, their service history and records of any incidents that we had been notified of since the last inspection. The link inspector Mr Doug Tunmore was joined by Mr Duncan Howells Regulation Manager at this inspection visit. Care Homes for Older People Page 6 of 29 Before we made our visit the provider had returned the Annual quality Assurance Assessment (AQAA). This gave us information about their own assessment of how well they are meeting standards and their plans to improve aspects of the service. The main method used to carry out the inspection is called case tracking, this includes following the care of a sample of people through their records and assessing their care. We spoke with two staff members, the administrator, the acting manager, the senior nurse on duty and the cook. We spoke with one visitor as part of the information gathering process. The acting manager and senior nurse on duty were informed of the general outcomes of this visit. We were told that the current fees for a weeks stay at the service range from three hundred and fifty one pounds to seven hundred and twenty eighty pounds depending on the level of care required. Extras charged for include chiropody, hairdressing toiletries and newspapers. The providers Service Users guide and the last inspection report is available from the acting manager. The inspectors issued what is called a Code B Notice, under the Police and Criminal Evidence Act. This is a legal document allowing the commission to either take evidence away with us or search the premises or photocopying documents, which are deemed relevant to our inspection. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Older People Page 8 of 29 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The process for assessing residents is not undertaken thoroughly enough nor is the information recorded in sufficient detail to enable an accurate decision to be made on whether the needs of the new residents can be met. Residents may not be making the right choice, as the information provided to them is not up to date. Evidence: The service user guide printed off from the computer by the administrator on the day of the inspection was not up to date. The admission forms seen were not fully completed, dated or signed. The entries were brief and did not refer to specific and significant/specialist areas of care, which were needed. A letter is sent to prospective residents stating that the home can or cannot met their needs. This is retained in the administration office. Care Homes for Older People Page 11 of 29 Evidence: Copies of assessments from Social Service departments are obtained and kept on residents files. Intermediate care is not provided. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care planning and recording system is inadequate and residents are at risk of not having their needs met. Care practises that automatically include all residents irrespective of their wishes violate their rights to be treated with dignity and respect. Evidence: We looked at five residents files, which included assessments and care plans. One preadmission assessment had the date missing, no signature, and limited information in terms of the assessment. There was no reference to risk. A relative signed a consent form, but it was not known whether that relative had lasting power of attorney. The Waterlow risk assessment (for assessing risk of pressure sores) had a score of 12 but there was no corresponding care plan. The falls risk assessment showed a score of 16 and there was no corresponding care plan. The daily routine care plan had insufficient information data to show that the residents needs, wishes, interests and planning about how care was to be delivered. Care Homes for Older People Page 13 of 29 Evidence: In another residents file abbreviations were used in the pre-admission assessmentwith no explanation (COPD). There was a short reference to self-harm but no further information as to what this was. The resident was described as not having capacity, but had signed a consent form. The general risk assessment was not completed but had been reviewed three times saying it remains the same. The malnutrition universal screening tool (MUST) was not completed. The weight chart shows a loss of weight but there was no care plan or monitoring of the weight loss. There was no assessment or planning recorded in another care plan for bowel movements to enable that person to use the toilet. The daily life and social activities planning and information only showed radio and singing. We looked at night records from the 13/02/09 to 18/03/09, they did not evidence that any resident had been incontinent, changed or were wandering during these dates. These records had been signed off by the senior night nurse and no evidence was available to show that she had raised any concerns. Three other residents files who were being case tracked were seen. We found that two of the three residents were still living at the home and care plans showed that their Waterlow risk assessment was 11. A carer confirmed that these residents were put to bed after lunch and stayed there until breakfast the next day. The care plans did not record what care they received or required during this period. The senior nurse confirmed that tea is given in bed but no information about their care requirements is available in care plans. We examined medication records and stocks in the upper ground floor office. These showed that dates were added when medication was started or bottles opened. Medication is provided in blister packs and kept in a locked cupboard. Controlled drugs are kept in a locked cupboard and written records maintained with two staff signatures when administered. The medication record sheets had photos, dates of birth and explanations for medication which was used when needed, rather than regularly. There were no gaps, where staff sign to confirm that medication had been administered. The company had updated the medication policy, including the self-medication policy and sent them to the home, where staff sign when they have read it. The system does not refer to the Mental Capacity Act, and there is only one sentence relating to capacity. Care Homes for Older People Page 14 of 29 Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The activities provided for residents meet some of their needs, however, they are based on group activity rather than individual choices and preferences. Evidence: We looked at social care assessments for five residents and two had not been completed. The care plans only recorded a few comments and preferences, but there was no detailed information on personal interests, life styles or daily routines. The nurse did discuss a person centred care approach to caring for people with dementia. A record was maintained of group activities and the nurse and the manager referred to group activities. The care plan for one resident said,Although I cannot join in activities I enjoy being part of it, I enjoy listening and just being there. I like it when we have singers in the home and I like listening to music. When I am in bed I like to have the television on or a radio. I like it when people talk to me even though I dont always say much. There is nothing in the care plan which advises or instructs staff what to do and how to Care Homes for Older People Page 16 of 29 Evidence: respond to this or any other interests this person may have. The nurse and the manager said that the care plans (written in the first person) had not always been done with the resident, or with confirmed information and they agreed that some of it was assumption. A visitor confirmed that an entertainer came in last week and though he was a regular visitor he commented that he has not seen any activities during his visits. The activities organiser explained that I enjoy working here and I like working 1-1 with residents. She stated that I took a resident out as she hadnt been out of this building for years. She also confirmed that staffing levels have improved recently. Two carers stated that the activities lady went shopping with residents last week and sight seeing. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of safeguarding vulnerable adults issues are not managed and therefore put residents at risk. Evidence: The providers AQAA confirms that all staff have POVA training as mandatory. Open door for relatives and residents to discuss any concerns. Complaints policy and procedure in place. Whistle blowing policy in place and staff are aware. All complaints are documented and are dealt with by the Manager. Regional Manager kept informed. Thirteen safeguarding allegations have been made in the last twelve months to the social services safeguarding team concerning this home. A number of investigations relating to safeguarding vulnerable adults is currently ongoing, with a meeting held by the social services departments safeguarding team on the 04/03/09 in which the provider will be invited. Two carers confirmed that they have not had any safeguarding vulnerable residents training and had been in post for six months and three months. We looked at their personnel files, which did not evidence that this training had been given. One carer confirmed that she knew what to do if a concern about the care of residents came to her attention. She was also aware of whistle blowing but was unsure of who Care Homes for Older People Page 18 of 29 Evidence: to tell. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a comfortable, warm and clean environment that meets their individual needs. Evidence: This inspection found the home to be clean, tidy and free from obstructions to mobility; the decor and furnishings were well maintained. Hoists, a specialist bath and specialist mattresses are in place in accordance with care plans. Call bells are in reach of people in all areas of the home. However, one bedroom contained very few personal items such as photographs or ornaments. The senior nurse stated that the family do not bring in any mementos for this resident. A visitor confirmed that the home is kept clean and his wifes room is alright, although its a shared room. Care Homes for Older People Page 20 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is adequately staffed but not all employees are adequately trained. People are protected by the homes robust employment procedures. Evidence: A previous inspection visit recommended that staff shortages be closely monitored so that any issues can be dealt with immediately. We looked at the rota and it evidenced that both day care staffing and night care staffing was appropriate for the numbers of residents in the home. The home is registered for thirty one residents and at the time of this inspection there was twenty residents in the home. Two carers and the senior nurse confirmed that recently there had been no staff shortages, they stated that there was one member of staff downstairs and 4 carers and a senior nurse working in the main unit. The administrator commented that the manager works a day shift and that day staff work from 7:30 am to 7:30 pm, with a senior nurse available at all times. Other staff include one bank nurse, one handyman, two cooks two laundry staff, three domestics and a kitchen assistant. There are also two carers at night and a nurse. Care Homes for Older People Page 21 of 29 Evidence: Both carers confirmed that they have undertaken employment checks carried out by the provider. This included obtaining two references, a criminal record bureau check (CRB), protection of vulnerable adults check (POVA) and a formal interview. We looked at the providers training file, which evidenced that carers are receiving training, that enables them to carryout their care tasks. The training included, fire awareness training, food handling, moving and handling and infection control. However, there was no evidence that either carer had undertaken the providers induction training, which would have covered safeguarding residents. The administrator confirmed that this had not been undertaken although one carer said that her induction form was at home. Care Homes for Older People Page 22 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There has not been consistent management of this home to ensure its smooth running or the safety of people. Accurate accounts are kept of residents monies and valuables. Evidence: Previous reports have shown that in the last two years there has been three unregistered managers at this home. The current acting manager has not applied for registration, having been in post since May 2008. She has resigned her post and is now working through her notice period. The provider has not kept the commission informed of events especially what provision they are making regarding the the vacant managers post. We looked at records of residents monies and found that an accurate record is kept with receipts available for monies spent. We looked at two carers personnel files and found that they had not received any Care Homes for Older People Page 23 of 29 Evidence: supervision from a senior member of staff since they commenced work at this home. We also looked at peoples valuables forms, which showed that a record had been made of clothing brought into the home. This included peoples watches and rings, which can be kept in the providers safe on request. A visitor stated that he had attended residents and visitors meetings and felt comfortable in expressing his views. Care Homes for Older People Page 24 of 29 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 12 16 (2) (i) A system must be 08/09/2008 established to ensure that people who live in the home access activities with a check made by the manager to ensure that low staffing levels do not impinged on the activities workers time with residents. The provider must appoint a 08/08/2008 manager who must register with the Commission. This requirement was made at the previous inspection on 05/07/06. 2 31 8 Care Homes for Older People Page 25 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 A system must be established to ensure that there has been appropriate consultation regarding the assessment of the service user or a representative. This will ensure that the service users needs will be met. 22/05/2009 2 7 15 A system must be established to ensure that after consultation with the service user or a representative of his, revise the service users plan of care and notify the service user of any such revision. This will ensure that those service users confined to their beds have a care plans that addresses their needs. 22/05/2009 3 8 12 A system must be established to promote and make proper provision for the health and welfare of service users. 22/05/2009 Care Homes for Older People Page 26 of 29 This will ensure that all checks relating to residents needs are undertaken during the night. 4 10 12 A system must be established to ensure that the home is conducted in a manner which respects the privacy and dignity of service users. This will ensure that all residents are assured of being treated with dignity and their privacy is maintained by care staff. 5 18 13 A system must be established to ensure that arrangements are made by training staff or by other ,means, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. Training carers will make them aware of their duties and policies and procedures regarding safeguarding vulnerable adults. 6 30 18 A system must be established to ensure that persons employed by the registered person to work in the care home receive, training appropriate to the work they are to perform. 22/05/2009 22/05/2009 22/05/2009 Care Homes for Older People Page 27 of 29 This would ensure that residents would be well cared for by trained and experienced carers. 7 31 8 A system must be established to ensure that the registered provider shall appoint an individual to manage the care home. This will ensure continuity of management and the smooth running of this home. 8 36 17 A system must be 22/05/2009 established by the registered person which will ensure that persons working in the care home are appropriately supervised. This will ensure that staff are aware of their duties and also training needs would be identified. 22/05/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!