Inspection on 21/08/07 for Southminster Residential Home

This inspection was carried out on 21st August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Southminster Residential Home 18/08/08

Southminster Residential Home 20/07/06

Southminster Residential Home 29/09/05

Southminster Residential Home 26/05/05

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Southminster Residential Home Station Road Southminster Essex CM0 7EW Lead Inspector Bernadette Little Unannounced Inspection 21st August 2007 09.45 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 Southminster Residential Home DS0000063215.V347251.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. Southminster Residential Home DS0000063215.V347251.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Southminster Residential Home Address Station Road Southminster Essex CM0 7EW 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) 01621 773462 southminsterrh@tiscali.co.uk Top Care Homes Ltd Mrs Elizabeth Wynn Care Home 29 Category(ies) of Dementia - over 65 years of age (15), Old age, registration, with number not falling within any other category (29) of places Southminster Residential Home DS0000063215.V347251.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 29 persons) Persons of either sex, aged 65 years and over, who require care by reason of dementia (not to exceed 15 persons) The total number of service users accommodated in the home must not exceed 29 persons Minimum daytime staffing to include five carers on duty Date of last inspection 20th July 2006 Brief Description of the Service: Southminster Residential Home provides residential and personal care for up to 29 older people, fifteen of who may have a diagnosis of dementia. The home is run by an organisation named Top Care Homes Ltd. Southminster R.H. is located in the rural village of Southminster a few miles from Maldon, Essex. The premises were originally built as the village Manor House. There are two floors to the home, accessed by stairs and a passenger lift. In total there are thirteen single bedrooms and eight double bedrooms between the two floors, with two lounge/dining rooms on the ground floor. There are gardens to the front and side of the property that are attractive and accessible. Southminster is accessible by road and rail. The nearest station is in the village, approximately 300 metres away from the home. Visitors’ car parking is available to the front, side and rear of the property. The fees for the home range between £ £374.50 and £ £665.00 depending on the accommodation provided, who is funding the care and the level of dependency of the resident. Additional charges are advised as being made for hairdressing, chiropody, a fixed £5 pounds per month charge for general toiletries and extra charges for extra items. Southminster Residential Home DS0000063215.V347251.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit was undertaken over an eight hour period. A tour of premises was undertaken and residents chatted with. Records, policies and procedures were sampled and copies of some documents were kindly provided for perusal in writing the report. Care files for two residents were case tracked and two others were sampled. Time was also spent in the dining room at lunch and several staff and a visitor were spoken with. The manager was on annual leave at the time of the site visit. The administrator/senior carer and the registered provider were present during the day and were most helpful. Other staff also assisted with various aspects of the site visit. The assistance of all those at Southminster Residential Care Home was greatly appreciated. There were 28 people resident at the home at the time of this site visit and some residents have varying degrees of confusion/dementia. Information on the views possible to obtain as well as observations made during the inspection are reflected throughout the report. Five residents surveys, four relatives surveys and two staff surveys were completed and returned to the commission and comments and outcomes are included in various sections of the report. What the service does well: What has improved since the last inspection? Some records about residents’ medication had improved and this protects residents. The premises was seen to be clean, bins that are used for hazardous waste had lids, the fire door in the laundry was not wedged open, and the bathroom was not cluttered and used for storage and so this made a safer and nicer environment for the residents. Southminster Residential Home DS0000063215.V347251.R01.S.doc Version 5.2 Page 6 What they could do better: 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. Southminster Residential Home DS0000063215.V347251.R01.S.doc Version 5.2 Page 7 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 Southminster Residential Home DS0000063215.V347251.R01.S.doc Version 5.2 Page 8 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, 2, 3, 5, Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Users of the service can expect some information about Southminster to help them to make a decision about living there and an assessment of their needs to make sure that these can be met by the home. EVIDENCE: Southminster provide a statement of purpose and service user guide. It was recommended that these be dated on each review so that it is clear that the most up-to-date copy is being used. The statement of purpose, service user guide and a copy of the most recent inspection report should be made more freely available in the home. The statement of purpose does not contain all the information required, for example on the number of staff employed by the home, adequate information about their relevant experience and qualifications, there was no information on Southminster Residential Home DS0000063215.V347251.R01.S.doc Version 5.2 Page 9 how service users are to be consulted or the arrangements made for service uses to attend religious services of their choice. The service user guide was written in large print that made it easier to read. The document included a number of detailed policies and codes of practice, which were more appropriate for staff, including the one for staff to implement if a resident dies, that did not make it a user-friendly document. It did not include a summary of the complaints procedure, reference to the most recent inspection report, a description of the standard services offered by the care home, for example laundry or information on hairdressing services etc and the information on fees identified by the change to Regulation of September 2006. All comments received from relatives or residents indicated that they felt that they had received enough information about the home before they moved in. Comments also confirmed that they were able to see the home before making a decision, for example we were made welcome and allowed to look round and all our questions were answered well. Files were sampled for two more recently admitted residents. These demonstrated that the home had undertaken an assessment prior to admission and had also taken information from other sources, for example the local authority COM5 form. The registered person confirmed that the home do not provide written confirmation to the person, as required that, based on the assessment, the home could meet their needs. One of five surveys confirmed that they had received a contract while another had received a contract from social services. The home’s service user guide states that all residents will receive a contract on admission, which is considered good practice. Contracts were not seen on two files of recently admitted residents. The registered person said that, in practice, contracts are issued after the four weeks trial period or after the first review, and not on admission. Changes to the commissions approach to conditions of registration were advised to the registered provider, along with the expectation that where a provider registers to offer a particular category of care, they must evidence at all times that they are meeting the needs of all the residents. Southminster Residential Home DS0000063215.V347251.R01.S.doc Version 5.2 Page 10 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, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents have some, but not all, aspects of their personal/health care needs clearly set out in a plan of care to support staff to provide them with individual, safe, quality care outcomes. Residents are not best protected by the homes management of medication. Users of the service can expect to have their privacy respected. EVIDENCE: Care management documentation was tracked for two residents and sampled for two others. A care plan folder was available for all residents, including those more recently admitted. Photographs were not available of all residents as required to assist with identification. A life history had been obtained with the support of relatives, which provided interesting information on the persons life. There was no evidence that residents or relatives were involved in the planning of their care, but it was noted positively that relatives had been invited to care reviews. Southminster Residential Home DS0000063215.V347251.R01.S.doc Version 5.2 Page 11 The AQAA states the managers awareness that care planning needs to be improved. Care plans contained a lot of information, but did not include detailed actions for staff to follow in practice to ensure consistency of care. An example of this is where diabetic was the identified need and the plan of management for this was tablet controlled”. Care plans did not include issues such as foot care, medication, finance or communication as standard, or even where communication was identified as an issue for that person. Residents’ wishes and preferences for end of life care were not recorded. Care notes were written at the end of each of the three shifts, which is good practice. Assessment and care notes indicated where residents were exhibiting aggressive or challenging behaviours but there was no risk assessment or care plan on how this was to be effectively managed to ensure the well-being of both residents and staff. Care notes did not indicate how staff had managed this. Discussion with staff indicated that some were aware of strategies that worked, for example talking about something from their previous life history could distract them, or knowing what things tended to upset people and avoiding those were possible, Moving and handling assessments were in place, which is positive, but they did not identify how all transfers were to be safely managed and did not identify for example which particular sling or hoist was to be used for each person. An assessment on the use of bed rails did not demonstrate that all relevant factors had been taken into account and that there was routine monitoring of the equipment. Risk assessments were not routinely undertaken for all residents in relation to nutrition, falls, or tissue viability. Part assessment had been recently completed for a resident on falls, but this was not followed up by a care management plan. A tissue viability assessment was being maintained for one resident sampled. This identified that the person was at very high risk of developing pressure sores, but there was no clear plan of care on how this was to be managed in everyday care practice. There was evidence in the files that residents were supported to access health care services such as the GP, district nurses, chiropodist and optician. Both the new residents filed sampled demonstrated that they had had an initial check with the GP. Staff confirmed that no resident currently had a pressure sore. Surveys received confirmed satisfaction with the care and support provided at Southminster and included care is given in a easygoing manner but of the highest quality, is a very caring place full of carers who have the time to ensure that the old folk are well cared for. There was also confirmed satisfaction that residents received medical support they need and one comment read doctor and nurse were called immediately a problem arose. Senior staff confirmed that the early morning medication round starts at 7:45am and it was noted that it had been completed prior to the start of this site visit. The AQAA advised that medication training was being arranged for Southminster Residential Home DS0000063215.V347251.R01.S.doc Version 5.2 Page 12 June/July. The registered person advised that this had been postponed as so many staff were on leave but no new date was available. A senior staff member assisted with the inspection of the medication system and advised that their training had been provided by the deputy manager approximately 6 months ago. A small fridge was now available in the medication room for the storage of drugs. This did not lock nor contain a thermometer to indicate safe storage temperatures were being maintained. There was no thermometer in the medication room and so no daily recording of temperatures was maintained. There was no photograph of some residents held with the medication/MAR to enable the correct person to be identified. For one resident where there was a choice of administering one or two tablets, the number given was not recorded. This was identified in the last inspection report. The medication sampled for another resident did record the number of tablets given. Where a resident was prescribed a medication on an ‘as required’ basis, there was no protocol or guidance for staff on when this was to be given to ensure consistency and aid the monitoring of effectiveness. Where creams were prescribed to be used as required, they were not recorded as used on the medication administration records (MAR) and cream charts were not maintained. Medication audited for a more recently admitted resident was not yet included in the monitored dosage system. This could not be audited accurately. Medication was sampled for another resident and the medication remaining tallied with the records. Staff were seen to speak to people with respect and this was confirmed with the visitors spoken with. Staff were also observed to knock on doors, keep doors closed where personal care was being offered and also to attend tactfully to covering a resident to maintain their dignity. Southminster Residential Home DS0000063215.V347251.R01.S.doc Version 5.2 Page 13 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, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ opportunities in the home varied in aspects of daily living, with visitors welcomed but with meaningful and appropriate activities lacking for many residents. Residents had a varied diet with good choice of meals but had had some limitations on other choices. EVIDENCE: Southminster employ an activities coordinator for 15 hours each week who was on annual leave at the time of the site visit and no arrangements had been made to provide activities during this time. The AQAA provided quite limited information on the homes approach to this important aspect of resident care. They would like to provide a more sensory type environment in the small lounge mainly for the residents with dementia, but it was advised that this would cost a lot of money. The home had obtained a large TV for the large lounge and during lunch this was on for one group of residents while the music was being played at the other side of the room. A prime need for a resident was recorded as requiring more social interaction. The care plan identifies that the person needs social interaction and the management plan to achieve this states “encourage (resident) to interact. The Southminster Residential Home DS0000063215.V347251.R01.S.doc Version 5.2 Page 14 daily care notes show that the person stays in their room most of the time, which of course is their choice, but it records no activities or interactions with the person other that they went out with a relative or had their hair done. Information on religious needs was not available in the care plans sampled. The activities coordinator had maintained a daily record of activities for each resident, but the last available evidence of this was for January and February this year. These included playing ball, reading, singalongs, bingo, games, listening to music, talking or watching television. The activity coordinator is advised as visiting each resident each day to see if there is anything particular they would like to do. The statement of purpose advises that a general activities plan is devised monthly to accommodate both choice and needs. The registered person confirmed that this was not accurate in practice. Information on some routine activities could be made more readily available to residents and relatives, for example relating to hairdressing, nail painting, religious services etc and should be considered in easier to read or pictorial formats to support those residents who need this. A relative commented that they were not at all sure what was on offer, and another relative felt that staff needed to be better trained so that they would interact with the residents. One of the service user surveys thought there were always activities arranged by the home that the resident could take part in, two thought there usually was and one thought there sometimes was. The registered person was advised to ensure that the activities coordinator is provided with adequate support, for example there is no evidence that they have had any training in dementia care or in providing appropriate activities for people with this condition. A member of staff was reassured that they were not considered as sitting down doing nothing because they were sitting and talking to a resident, which was actually viewed as a very positive activity. Comments from staff, visitors, relatives and residents confirmed that visitors are positively welcomed in the home and this was seen in practice, from the visitors’ book and from care recordings. Visitors are provided with drinks, and a meal if required. One resident had been able to choose the colour that their bedroom was painted. Another resident had had boiled eggs for breakfast and confirmed that this was their choice. It was noted positively that residents were routinely offered the choice of tea or coffee, even though the member of staff explained that very few people ever had coffee. One resident had been able to bring their cat. Residents do not have the choice to sit and eat their meals at a dining table. The service user guide states that breakfast is served in residents’ bedrooms but staff advised that some residents can eat this meal in the lounge. The practice of providing general toiletries does restrict choice and does not necessarily demonstrate respect for peoples dignity. A resident was Southminster Residential Home DS0000063215.V347251.R01.S.doc Version 5.2 Page 15 being sat in a bucket chair and had a table placed in front of them. Staff advised that this was to make it more difficult for the person to get up as they were at a risk of falls. There was no care plan identifying this as the most effective management for this person and no acknowledgement or recording that this restraint was a limitation on the person’s rights and choices. Southminster operate a four-week rotating menu. The chef confirmed satisfactory food stocks and that they had recently updated their food handling training. Information on the days lunch choice was written on a whiteboard on the white door of one of the lounges. This could be reviewed to ensure that the menu is more easily seen by residents and perhaps could be supported by some pictorial formats. On the day of the site visit, residents had a choice of chicken in white sauce or sausage toad as well as a vegetarian meal for a particular resident. The food was brought to the lounge on an unheated trolley and was served directly by the chef and brought to residents by staff. It was positively noted that the chef could then identify how residents enjoyed individual foods and confirmed that this helped to inform the menu plan. It was also noted particularly positively that residents were offered a choice at the time of serving, rather than having to choose the day before, and the chef confirmed that this is was more satisfactory for residents particularly those with dementia who may have forgotten what they had chosen. Staff asked residents if they had had enough to eat and also sat with them when offering support with feeding which is good practice and shows respect for the person. A coded record of the choices made by residents was maintained on the care file. Neither this nor, in the majority of instances, the care notes identified how much food residents were eating, to support monitoring of a nutritional assessment and care plan. Southminster Residential Home DS0000063215.V347251.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at Southminster will have their views listened to and acted upon. They would be better safeguarded by clearer strategies to manage areas of their care needs and updated information and training being available to all staff in relevant topics. EVIDENCE: Southminster provide a complaints procedure that was displayed in the home and should be included in the service user guide. The registered person was recommended to clarify the information so that people understood that the commission do not investigate individual complaints but that these could be taken to the local/funding authority if felt appropriate. The AQAA stated that the home could do better in recording the small complaints for example, missing clothes. The home had recorded that one complaint had been received since the last inspection and this related to a relative seeing another person wearing their relatives’ cardigan. Discussion indicated that another resident had recently made a complaint regarding being kept awake at night. While some action had been taken in response to this it had not been recorded, nor an outcome recorded as reached. Guidance was provided on using a logging system with a confidential system for recording detail, rather than the current collective record. Southminster Residential Home DS0000063215.V347251.R01.S.doc Version 5.2 Page 17 All comments from residents and relatives demonstrated that they knew how to make a complaint. One survey commented complaints form available, this was pointed out to me upon application to the home. Southminster had a Abuse Policy that was provided on request and referred to the whistleblowing procedure. A separate policy and procedure was available on handling suspected/abuse that included sectarian abuse but did not refer to sexual abuse. Guidance was provided to the registered person on obtaining current guidance, protocols and contact information on Safeguarding (previously known as protection of vulnerable adults). The homes own procedures need to be amended to comply with this for example in relation to reporting procedure is and to provide staff with information on who to contact should they wish/need to take the referral directly to the Safeguarding Team. The manager has a training certificate that qualifies her to train staff in the protection of vulnerable adults. The homes training matrix indicates that 10 of the 22 care staff have had training in protection of vulnerable adults and that none of the kitchen or housekeeping staff have been provided with this. This training needs to be provided to all staff. Staff spoken with and those who commented in surveys confirmed that they knew about the procedure for safeguarding adults. Please also see the section in this report on staffing in relation to recruitment and the issues relating to care planning, management of behaviour that challenges and restraint in the section on health and personal care. Southminster Residential Home DS0000063215.V347251.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, 20, 24, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at Southminster will find a comfortable, homely environment that would benefit from some upgrading. They will not have enough communal space to have the active choice of eating at a dining table. EVIDENCE: Southminster is an older style, character property that has the benefit of its own gardens. There are also small internal courtyard gardens where seating is available for residents. There are two lounges for residents to sit in, and while they provided adequate seating space around the walls, there was no additional space for dining tables. Residents therefore had no choice but to eat sitting in the armchair that some has already spent much of their day sitting in, which is not good practice and does not offer people variety and choice. Southminster Residential Home DS0000063215.V347251.R01.S.doc Version 5.2 Page 19 The home was seen to be clean and there were no odours noted. The home has a high percentage of double rooms, which limits residents’ choice of a single room to some degree. There has been some redecoration and recarpeting of bedrooms. The home in general requires updating and continued refurbishment. The AQAA acknowledges the limitations of the premises and advises that there are plans to extend the premises to allow increased communal space and an overall increase in the number of single rooms in both the proposed and older part of the premises. There was limited evidence that the premises had been considered to best support the needs of people with dementia in line with the up-to-date guidance, for example in relation to signage or the use of colour to help with orientation. A member of staff stated that while for example bedlinen and curtains may not be matching, they do provide a homely environment and focus on the quality of the care provided, and that improving the premises would cost a lot of money. Residents have been encouraged to personalise their own room and some residents have their own telephone or fridge for example. Surveys demonstrated that the home is kept fresh and clean. Relatives’ comments included in an environment such as this I think all staff do a fantastic job and home is the operative word, the atmosphere is happy and relaxed. Southminster Residential Home DS0000063215.V347251.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at Southminster can expect to be supported by caring staff, many of whom are provided with basic training. They may not always be enough staff on duty and residents may not always be safeguarded by the homes recruitment practices. EVIDENCE: The AQAA advises that the homes strive to have five carers on the morning shift, reducing to four staff from 2pm to 5pm and increasing again to five staff between 5pm and 9pm. Observation and discussion with staff indicated that this is the minimum necessary/required due to dependency levels and the AQAA identifies that 20 residents need two or more staff to help with their care both day and night. The AQAA indicated a night staffing level of three staff, although occasionally reducing to a minimum of two, with no clear reason. Rotas confirmed this level but indicated some nights when there were two care staff on duty and no senior. This is not good practice and minimum night staffing levels of one senior and to carers should be maintained at all times as dictated by the residents needs and the premises. The rotas provided for the month of August did not identify any shifts to be undertaken by the activities coordinator. Southminster and the staff who work there have a very positive approach to NVQ training. The AQAA advises that 13 staff have completed NVQ level 2 or Southminster Residential Home DS0000063215.V347251.R01.S.doc Version 5.2 Page 21 above and an additional six staff are working towards NVQ and this was confirmed in discussion with staff. Recruitment files were sampled for three more recently appointed staff. Photographs were not available on all files. None of the files contained a job description. For one staff member who had worked at the home previously, no up-to-date application form or employment history was available, no new written references had been obtained, no declaration of health or offences and no criminal record bureau check was available. There was no evidence of induction/training on this file. Two other members of the staff had been working at the home for some months prior to a criminal record bureau check having been obtained. This poor recruitment practice was identified as a concern in the last inspection report. References had not been obtained from the most recent employer and there was no reason recorded as to why they had left. Previous employment histories were for a very limited period. Skills for care induction logs had been started some months previously and had some updates. Training certificates were recorded for both staff in moving and handling and fire safety. There was no evidence of training for either staff in dementia care, safeguarding (protection of) vulnerable adults, safe food handling, managing challenging behaviour or health and safety. Both of the staff work regularly at night and rotas show occasions where they are the only two staff on duty. The manager is trained to provide training to staff on safeguarding (protecting vulnerable adults), moving and handling and first aid, and the training matrix indicated that several staff have been provided with this training. Training on issues such as safeguarding and moving and handling should be made available to all staff including care and ancillary staff. Only two of the several staff who work in the kitchen are noted to have safe food training and none of the care staff have this training. The matrix indicates that numerous staff have not had any training on dementia which is a concern as the home provides care to people who have this identified need. There was also confirmation that staff have not had training on issues such as managing behaviour that challenges or conditions that affect older people such as Parkinsons disease, diabetes, continence management or sensory impairment and this should be reviewed. The provider and the administrator/senior carer advised that more training would be provided for staff but that this costs money. Discussion with staff and surveys indicated that they felt they received regular supervision, support and access to training. Staff were seen interact with residents in a positive and respectful way. The surveys received included comments such as all care is done with respect and kindness or “I have always found the staff interested and helpful”. Southminster Residential Home DS0000063215.V347251.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at Southminster will be able to approach the manager and will be asked their views on the home and care provided. Residents’ best interests were not always evidenced in the management of the home in relation to care planning/outcomes, staffing levels/training and robust recruitment practices. EVIDENCE: The manager has completed NVQ level 4 in Care, Registered Managers Award. Certificates displayed in the home confirmed that she is qualified as a trainer in moving and handling, first aid and safeguarding people. She has also attended training in dementia care, health and safety, supervision of staff in social care and fire. It was disappointing to note that not all staff have received training in safeguarding people and in moving and handling. Additionally, the unsafe Southminster Residential Home DS0000063215.V347251.R01.S.doc Version 5.2 Page 23 recruitment practice was a concern as this had previously been identified and was a requirement in the homes last inspection report. All comments received, including from staff advised that the manager is approachable and supportive and committed to providing good quality care for the residents. Staff demonstrated a real loyalty to the manager and the home. Southminster advised that they undertake their own quality surveys with residents and these had been considered at the last inspection. The manager had completed and returned the AQAA and dataset to the commission in a timely manner. The administrator advised that the home pay directly for services such as hairdressing, nail painting and chiropody and then invoice the relatives on a monthly basis. Invoice sheets were sampled and also included the five pounds per month for toiletries for each of the residents or the cat food for an individual resident. The AQAA advises of a routine and established supervision system. Supervision agreements were seen on some of the files sampled and staff spoken with confirmed that they are provided with routine and regular supervision sessions. Current safety inspection certificates were available relating to the gas, fixed electrical wiring, fire alarm, emergency lights, fire equipment, call bells and emergency lights. A lift maintenance certificate was available as was a current certificate relating to the water system and legionella. Southminster Residential Home DS0000063215.V347251.R01.S.doc Version 5.2 Page 24 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 2 2 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 2 X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 3 X 3 Southminster Residential Home DS0000063215.V347251.R01.S.doc Version 5.2 Page 25 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. Standard 1. OP1 Regulation 4&5 Requirement Residents must be provided with detailed and accurate information within the statement of purpose and service user guide. Copies of the amended documents must be sent to the commission. 2 OP7 OP11 15 21/09/07 So that residents are cared for safely, individual care plans must identify all their assessed needs and care preferences. Care plans and associated documents must provide staff with enough information so that they can offer residents consistent care and assistance. This includes preventative pressure area care management and management of behaviour that challenges as well as wishes and needs for end of life care. So that residents are 21/08/07 safeguarded medication must be safely managed, for example , * MAR sheets must be completed to record the amount DS0000063215.V347251.R01.S.doc Version 5.2 Page 26 Timescale for action 21/09/07 3. OP9 13 (2) Southminster Residential Home administered. *temperatures of medicines storage areas are monitored and recorded regularly to ensure a suitable environment exists * protocols must be kept for drugs taken on an ‘as required’ basis. The first issue is outstanding from the last report. 4. OP12 16(2) m n 18(1)a All residents, particularly those who have dementia, cognitive impairments or sensory needs, must be offered appropriate and alternative ways to engage and interact in relevant, meaningful and stimulating occupational activities, and staff must be provided with the time, training and facilities to support residents to achieve this care outcome. To safeguard residents and respect their dignity and rights as a person, restraint must only be used to secure the welfare of residents in exceptional circumstances and where this occurs, appropriate records must be maintained. To safeguard residents and staff, all staff need to be provided with training on safeguarding and the homes policies and procedures must be updated as amended to include relevant information. To ensure residents’ needs are met, there must be enough staff on duty at all times and the staff must be provided with required and appropriate training. This includes for example medication, safeguarding, management of DS0000063215.V347251.R01.S.doc 21/09/07 5. OP14 13 (7)(8) Sch 3 (3) 21/08/07 6. OP18 13(6) 21/09/07 7. OP27 OP30 18(1) 21/08/07 Southminster Residential Home Version 5.2 Page 27 challenging behaviour, dementia, and conditions associated with the needs of older people. 8. OP29 19, 17(2) Sch 2 & 4 So that residents are 21/08/07 safeguarded the home must evidence robust and safe recruitment procedures and have all the required records and checks in place before staff start working at the home and have these available at all times for inspection. Previous timescales from 20.07.06 not met. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP2 Good Practice Recommendations All residents should be provided with a contract/statement of terms and conditions on entry to the home. This should include information on the trial period. The home to write to prospective residents to confirm that, based on the assessment, the home can meet their needs. The registered person should consider the use of the maximum/minimum thermometer to record the temperature of the refrigerator used for the storage of medicines and ensure a procedure is in place for its use. To provide residents with an active choice and a pleasant dining experience, opportunity should be provided for residents to sit at a dining table to eat their meals. To support good nutrition for residents, greater detail should be maintained, not just of the food served but of DS0000063215.V347251.R01.S.doc Version 5.2 Page 28 2. 3. OP3 OP9 4. OP15 OP20 5. OP15 Southminster Residential Home how well/how much residents have eaten/drunk. 6. OP16 To protect residents’ privacy and confidentiality, a system of logging complaints but recording all other information separately for each individual complaints should be introduced. The home should develop a plan for ongoing redecoration and maintenance. The management team, both internal and external, should review the issues raised in this report and develop a plan to ensure they meet all requirements to better demonstrate effective management of the home and ensure better outcomes for residents. Recommendations should also be implemented. 7. 8. OP19 OP31 Southminster Residential Home DS0000063215.V347251.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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