Inspection on 16/07/08 for Southover Care Home

This inspection was carried out on 16th July 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

Southover Care Home 15/09/09

Southover Care Home 24/06/09

Southover Care Home 07/05/09

Southover Care Home 20/01/09

Southover Care Home 03/10/08

Southover Care Home 06/08/07

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 05/12/2008.

CARE HOMES FOR OLDER PEOPLE Southover Care Home 397 Burton Road Derby Derbyshire DE23 6AN Lead Inspector Tony Barker Unannounced Inspection 16th July 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Southover Care Home DS0000069489.V369280.R02.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. Southover Care Home DS0000069489.V369280.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Southover Care Home Address 397 Burton Road Derby Derbyshire DE23 6AN 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) 01332 295428 White Doves Residential Home Limited Mrs Ann Mauracheea Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Southover Care Home DS0000069489.V369280.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered provider may provide the following categories of service only: Care Home only - PC To service users of the following gender: Either Whose primary care needs on admission to the home fall within the following categories: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is 22 6th August 2007 Date of last inspection Brief Description of the Service: Southover is a two-storey building situated on the Burton Road, approximately a mile and half from Derby city centre. A passenger lift allows access for residents all around the Home. There is ample dining space, and leading from this large room are two sitting rooms. From one of these rooms there is access to a glass conservatory and from there to the large garden. Tables and seating are also provided in the garden. Ample parking space is available outside. Southover Care Home DS0000069489.V369280.R02.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 the people who use this service experience poor quality outcomes. The time spent on this inspection was 8.75 hours and was a key unannounced inspection. Survey forms were posted to service users, their relatives, staff and external professionals before this inspection and 16 people responded. The Manager, one care assistant, the cook on duty and one visiting relative were spoken to. Six residents were also spoken to - one in some detail. Records were inspected and there was a tour of the premises. Two residents were case tracked so as to determine the quality of service from their perspective. This inspection focussed on all the key standards and on the progress made towards achieving the requirements and recommendations made at the last key inspection in August 2007 and random inspection in November 2007. The pre-inspection, Annual Quality Assurance Assessment (AQAA), questionnaire was reviewed prior to this inspection. The Manager informed us that the Service’s fees ranged from £353 to £365 per week. Since the last key unannounced inspection on 6 August 2007, a ‘random’ unannounced inspection of Southover on 28 November 2007 has been carried out. This was undertaken to assess whether the Service was following the National Minimum Standards following a complaint. Details appear later in this report. A copy of the last key unannounced inspection report from the Commission for Social Care Inspection (CSCI) was available in the office and a notice in the entrance hall stated this. What the service does well: What has improved since the last inspection? What they could do better: The staff group must be provided with adequate training in a range of health and safety matters, and in keeping residents safe, in order to meet residents’ assessed needs and reduce their exposure to risks. Care planning documents must be kept up to date to reflect residents’ current needs. Medicines must be securely and appropriately stored to ensure they are not stolen and residents Southover Care Home DS0000069489.V369280.R02.S.doc Version 5.2 Page 6 are not placed at risk. A varied range of activities must be provided to meet residents’ need for mental and physical stimulation. Residents must have a nutritious and varied diet to ensure their health needs are met. Potential risks to residents must be minimised by attending to environmental defects and health and safety hazards. Adequate staff must be provided at all times to ensure the safety of residents. The Provider must undertake monthly, recorded audit visits to the Service to identify matters requiring attention. Staff must be adequately supervised to ensure the Service’s policies and procedures are put into practice and residents’ needs met. All records required by Regulation to be maintained by the Service must be kept secure to ensure confidentiality. Residents must only be moved by staff who are competent to move and handle vulnerable adults, for their own and for residents’ safety. Equipment provided must be maintained in good, safe working order. 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. Southover Care Home DS0000069489.V369280.R02.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 Southover Care Home DS0000069489.V369280.R02.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): 1,3,4 & 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Service Users’ Guide did not provide people with full information on which to base their choice of care home. Some residents felt they did not receive the care and support they needed. EVIDENCE: The Service Users’ Guide did not contain details of the fees payable by residents, as required by Regulation. This document therefore did not provide people with full information on which to base their choice of care home. Two of the four residents who completed postal surveys said they had not received enough information about the home before they moved in. One recently admitted resident was case tracked and their file was examined. A pre-admission written assessment of this person’s needs was on file and provided staff with information about the individual’s particular needs and preferences so these could be met. Of the four residents who completed the postal surveys only two agreed that they receive the care and support they Southover Care Home DS0000069489.V369280.R02.S.doc Version 5.2 Page 9 needed. The others said they only ‘Sometimes’ receive the care and support they needed, with one adding, “Staff don’t learn from mistakes…my (relative) is constantly having to sort problems out”. There was also evidence from this inspection, and from complaints received since the last key inspection, that the service was not always able to meet residents’ assessed needs. This was due to low staffing levels, lack of staff experience, inadequate training and to insufficient staff supervision. Not all residents were unhappy with their care: one case tracked resident told us, at the inspection, that staff “are wonderful to me…I’m well looked after”. The Service was not providing intermediate care. Southover Care Home DS0000069489.V369280.R02.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 poor. This judgement has been made using available evidence including a visit to this service. Unsafe storage of medicines means that they are at risk of theft and service users may not receive their medicines as prescribed. EVIDENCE: Two residents were case tracked so as to identify the standard of care provided by the Service from their own perspective and from individual records and discussions with the Manager and staff. These two residents each had a written plan of care, drawn up by the Service, that recorded their needs. However, there was no record of how these needs were to be met – for example, through a set of goals. Care plans were holistic: indicating that each individual’s physical, social and emotional needs were considered. Files showed that care plans were being reviewed monthly and six-monthly. These reviews provided an opportunity to monitor the care provided in order to reflect residents’ changing needs. Care plans and risk assessments were being dated – an improvement on the previous key inspection. However, there was evidence of care plan documents, such as risk assessments, not being completed. The Manager agreed she found difficulty “keeping on top of staff Southover Care Home DS0000069489.V369280.R02.S.doc Version 5.2 Page 11 not completing care planning documents…as they are inexperienced”. Three of the four staff who returned completed surveys felt they usually received up to date information about the needs of residents. However, one member of staff commented, “Most of the care plans are not up to date” and another said there was now insufficient staff to keep care plans up to date. There was some recorded evidence of individuals’ preferred lifestyle in one case tracked resident’s file – through a document that referred to a preference for a cup of tea at 6am. However, it was noted at this inspection, as at the last, that most care planning records did not reflect a ‘person centred’ approach. The Manager said that “staff have not been here long enough to get to know individual residents’ preferences”. Recorded risk assessments, and periodic reviews of these, provided evidence of individuals’ on-going needs being monitored. These risk assessments covered areas such as residents’ risk from falling, moving and handling, tissue viability, and nutrition and provided a means of measuring and minimising these risks. Residents’ health needs were generally being met by appropriate contact with external health professionals. Evidence of this was from recording examined in the Home and by residents who completed survey questionnaires. However, one resident felt that staff did not provide a consistently good service with regard to meeting this person’s personal health care needs and gave examples to support this. This issue had been raised in a complaint which is referred to in the Complaints and Protection section of this report. Records of health professionals’ involvement were being made on two different documents which was confusing. Administered medication was being recorded accurately and medicine records contained a photograph of each resident in order to minimise mistakes. Medicines were not all being securely and appropriately stored. A bottle of promazine hydrochloride was stored in the kitchen refrigerator, not in the dedicated medicine refrigerator which the Service does have. Also, this bottle had been opened but its opening date had not been recorded on the bottle so as to indicate when the 28-day expiry had occurred. An opened eye drops container, being kept in the dedicated medicine refrigerator, had also not been marked with the opening date. Temazepam was being stored in a metal wall cabinet but not one specifically designed for the secure storage of controlled drugs. In this same room, secured boxes of newly delivered prescribed medicines were being stored. The door to the room, although kept locked, was not secure on its catch and could easily be forced open. The receipt, administration and disposal of Temazepam was not being recorded in a controlled drugs register, which is recommended in order to provide a more robust audit of its use. One case tracked resident spoken to said staff respect their dignity and privacy. This person said, as an example, that staff knock on the bedroom door and wait before entering - adding, “they are very good to me”. This person, and another resident spoken to, were satisfied with the Service’s Southover Care Home DS0000069489.V369280.R02.S.doc Version 5.2 Page 12 laundry system. One care assistant spoken to described how she met residents’ dignity and privacy and showed awareness and sensitivity on these matters. One room contained a payphone although this was disconnected. The Manager said she offers residents a cordless phone if they wish to contact friends or relatives. Most residents who responded to the postal survey confirmed that staff listen and act on what they say. One said that, “If I ask for something, sometimes it gets done but other times they forget…it appears they are always short staffed”. The surveys showed that residents were not very happy with staff availability when needed. One said, “Sometimes they are busy and can’t come straight away”. Another felt that staff are sometimes available when needed – “depends on how busy/short staffed they are”. This issue is further discussed in the Staffing section of this report. Southover Care Home DS0000069489.V369280.R02.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 poor. This judgement has been made using available evidence including a visit to this service. The Service was not providing activities to residents so their need for mental and physical stimulation was not being met. Residents were not being provided with meals that were wholesome, nutritious and varied. EVIDENCE: The Manager said there was very little in the way of activities provided to residents. She said that due to low staffing numbers and staff inexperience it was not possible to motivate residents to take part in stimulating activities. Residents, in their completed survey questionnaires, made comments that reflected this position. One stated that, “It would be nice if staff could encourage the clients to take part in more activities and also provide more activities than they do”. The Manager said that there was, on average, a weekly game of bingo or a sing-song or a board game initiated by care staff. A group of church visitors lead prayers and hymn singing every other Sunday and other church visitors come monthly, she added. One case tracked resident said there were no activities available and this person said they watch television and read a book. Two other residents, when asked about the level of activities, said they could not recall when they last had activities. They added that there were no organised trips out of the Home. The Manager said Southover Care Home DS0000069489.V369280.R02.S.doc Version 5.2 Page 14 four residents had gone to a local show six weeks ago: this was the only trip this year. One case tracked resident spoken to said that they receive visitors regularly who can stay for as long as they wish. The visitors’ book confirmed that there were frequent visitors to the Home and evidence of this was observed during this inspection. The Manager said that she had attended a one-day course on the Mental Capacity Act. She added that three care assistants had attended a half-day course on this topic and a further six were booked to do. This training would help staff to be aware of the right of residents to make their own decisions and choices. Following a complaint about the deteriorating quality of food provided at Southover a ‘random’ unannounced inspection was made in November 2007. That inspection found that residents were not being provided with a wholesome, nutritious and varied diet to ensure their health needs and preferences are met. These issues were found to be still in place at this inspection and the levels of concern expressed to us had increased. The Cook said that inadequate food stocks made it difficult to offer adequate portions and choice to residents at mealtimes. She confirmed that milk was still being watered down for all uses. She added that powdered milk was used recently when, during the Manager’s absence, the Provider had not brought in milk. No butter was offered to residents – only vegetable fat spread. Food stock levels were relatively low at the time of this inspection. The care assistant spoken to thought there was not enough food for residents and confirmed the Cook’s statement regarding milk being diluted with water. She said there was often no vegetables and the food provided was “cheap”. This latter point has also been raised by other people. The care assistant said that residents complain about the food. The Cook said that menus were created a day at a time to reflect food stocks available for the following day. She said two choices of meal are offered to residents and this was confirmed on the menu displayed in the dining room. The Cook added that the Provider had told her six weeks ago to remove the third and fourth choice from the teatime menu. Residents spoken to gave a range of opinion about meals. Some said they were very good while others were clearly not happy. A similar range of opinion was expressed in the postal surveys completed by residents. Two of the four residents added comments to support their view that they only ‘sometimes’ like the meals at the Home. Both gave examples where their preferences were not being met. One said, “Food is not as good as it used to be”. An Urgent Action letter was sent to the Registered Provider on 17 July 2008 concerning these matters. Southover Care Home DS0000069489.V369280.R02.S.doc Version 5.2 Page 15 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 & 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The Provider has not shown she takes complaints about the Service seriously and acts upon them. The Service has put residents at risk by responded inappropriately to an incident of abuse within the Home and by providing insufficient staff at night. EVIDENCE: The Service had an up to date complaints procedure that was displayed at the foot of the stairs in the dining room. The Manager stated in the AQAA that one upheld complaint had been received by the Service within the previous 12 months. This was regarding one resident’s personal health care needs not being consistently met by care staff. Recently, we had received complaints from two people who wished to remain anonymous. They were concerned about the unsafe storage of medicines, environmental defects and a staff group that were inexperienced and low in numbers. We wrote to the Provider, in early July 2008, about these complaints asking her to investigate them using the Service’s complaints procedure. We are still awaiting a response from her, more than one month later. The continuation of concerning issues raised by one previous complainant, that gave rise to the ‘random’ inspection in November 2008, indicates that the Provider has not taken these issues seriously and acted upon them. Residents spoken to, and those who responded to the postal survey, knew who to speak to if they were not happy and how to make a complaint. Southover Care Home DS0000069489.V369280.R02.S.doc Version 5.2 Page 16 We were notified by the Manager, soon after the last key inspection, that a member of care staff had verbally abused a resident. The Service had not followed recognised ‘safeguarding adults’ procedures and had potentially put other residents at risk, within Southover and other care homes... • we were alerted eight days after the incident occurred, • the incident was notified to us as a regulatory notification rather than a ‘safeguarding adults’ alert, • Social Services, as lead agency in matters of ‘safeguarding adults’, were not alerted by Southover, • the member of staff who abused the resident had been known to have previously shouted at a resident and neither Social Services or ourselves had been alerted, and • the member of staff had been immediately dismissed rather than suspended pending the outcome of a ‘safeguarding adults’ strategy meeting. The person was later known to have applied for other carer posts. The Manager did refer this person for inclusion on the Department of Health’s Protection of Vulnerable Adults (POVA) register. The POVA team are still investigating the matter. We received a letter in late June from a relative of a Southover resident who had been informed that their elderly relative had fallen in their bedroom in the early morning hours of 21 June 2008. The night staff had tried to contact the Provider on her mobile phone but could not raise her. This resident was left on the bedroom floor for five hours, before being helped up, because of insufficient staff to safely move the person. The issue of insufficient staff is addressed in the Staffing section of this report. An alert was sent to Social Services and they are still investigating the matter. This relative was spoken to, at this inspection, and we were informed that three residents, including this person’s elderly relative, had fallen during the night of 16/17 June and had been helped up by a “man who lives close by”. There were no further details about this man. The Manager said that staff had been provided with ‘safeguarding adults’ training in September 2007 but most of these staff had since left Southover. At the time of this inspection five of the twelve care staff had not been provided with this training in order to ensure they were fully aware of how to respond to evidence of abuse. The care assistant spoken to was, at first, not aware of what ‘whistle blowing’ meant. When it was explained to her she said she had read the Service’s ‘Whistle Blowing’ policy. The list of staff signatures, confirming they had read the ‘Whistle Blowing’ policy, showed that only five of the twelve care staff had read it. A copy of Derbyshire’s Safeguarding Adults’ procedures was being kept within the Home although the Manager could not find the alert forms to send to Social Services in the event of suspected abuse. The Service’s own written policy/procedure on keeping residents safe was examined and found to be generally satisfactory. Southover Care Home DS0000069489.V369280.R02.S.doc Version 5.2 Page 17 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 & 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. A significant number of serious health and safety problems in, and around the Home, created many potential hazards for residents and staff. EVIDENCE: A tour of the Home was undertaken and a number of very concerning health and safety matters were found... • the second floor bathroom had no ceiling light and an exposed electric cable was hanging from the light fitment. One resident explained that a torch was necessary at night to give enough light to use the toilet in this bathroom. There had been no lighting in there “for months” the resident said, • exposed electric cables were also found in an en-suite shower room within an occupied bedroom, • in the dining room were two electric power sockets that were unsafe due to burn marks on one and a damp crumbling wall surround on the other, Southover Care Home DS0000069489.V369280.R02.S.doc Version 5.2 Page 18 • a first floor bathroom had a broken toilet seat making this facility unusable, • the other first floor communal toilet had an insecure raised toilet seat. All these matters had been noted by the Environmental Health Officer during a health and safety inspection on the day previous to this inspection. This Officer left the Provider with immediate requirements to rectify these matters. Therefore we have not made requirements on these particular matters. Additional to these defects there were other health and safety concerns found and many examples of a poor environment... • there was no restrictor in place at a large first floor window in bedroom 7. This could place the health and safety of the resident using that room at risk. An Urgent Action letter was sent to the Registered Provider on 17 July 2008 concerning this matter, • the first floor bathroom had a cracked ceiling and other cracks in the walls, which were unsightly, • corridor walls were also cracked in places, • carpet joins in the dining room were coming apart and fraying, causing a potential trip hazard, • there was no alarm on either of the two fire escape doors and so residents could leave the building without staff being aware, • the wooden step immediately beyond these two fire escape doors were a potential trip hazard, • algae growths on these two sets of fire escape steps could be slippery in wet weather, • the magnetic hold-back devices, linked to the fire alarm system, on both lounge doors were not working and wooden wedges were being used. This was a potential fire hazard, • one first floor corridor, with no natural light, was insufficiently lit by an emergency light – creating a potential hazard for residents. Several concerns were found outside the premises... • the wooden eaves of the roof above the entrance to the Home were rotting, • the wooden eaves of the roof halfway along the rear of the premises were rotting, • the exterior wooden window sills on the dining room extension were rotting, • discarded items, including a carpet, four zimmer frames, television and clothes rack had been left at the side of the premises causing a potential health and safety hazard and an eyesore, • six clothes lines were strung across the tarmac area at the side of the premises causing a potential obstruction and hazard to residents, • the ‘flower bed’ to the side of the premises, and the rear lawn, were overgrown and unsightly, and the front of the premises was full of weeds, • joints in the rear stone patio were full of weeds, creating potential slip and trip hazards. The Service’s maintenance book was examined. This was mainly a record of work done and had no dates recorded from which an assessment could be made of the time taken to rectify defects. Southover Care Home DS0000069489.V369280.R02.S.doc Version 5.2 Page 19 At this inspection the interior of the Home was clean and there were no unpleasant odours. The AQAA indicated that all the staff had completed Infection Control training. Residents who responded to the postal survey mostly thought that the Home was kept fresh and clean. One commented, “It does not smell – which is good...the place can be shabby though”. Southover Care Home DS0000069489.V369280.R02.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 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Inadequate levels of staff, who are inexperienced and untrained, place residents at significant risk. EVIDENCE: Evidence from staffing rotas, and from discussion with the Manager and staff, indicated that staffing was not being maintained at safe levels for residents at all times. There was no sleep-in staff on the premises – leaving one waking staff on duty each night. The Provider lives next door and the member of night staff is expected to telephone her if needed. A recorded risk assessment was examined that referred to the need for a sleep-in member of staff to be in place should the Provider be away from her home between 9pm and 7am. There had been occasions when the Provider has been away and no sleep-in staff have been provided, leaving residents at risk with only one staff member. An Urgent Action letter was sent to the Registered Provider on 17 July 2008 concerning this matter. Mention has already been made, in the Complaints and Protection section of this report, to a resident being left on the bedroom floor for five hours because of insufficient staff to safely move the person. The Manager said that she aims for three staff to be on duty during early and late shifts. However, the staffing rotas showed there to be several morning shifts with only two staff on duty and some of these were the Manager plus one carer. On the morning of 29 June only the Manager was on the early shift. Southover Care Home DS0000069489.V369280.R02.S.doc Version 5.2 Page 21 The care assistant spoken to described a “very rushed” morning shift when there were only two staff on duty. She spoke of staff members having 30–40 minutes to each help 10 residents to get up, adding that she then had to start administering medication at 7:30am. She said that, currently, care staff were having to prepare breakfast too as one cook was on two week’s leave. She pointed to the absence of sleep-in staff, who would normally be working between 7 and 8am, being part of this problem. This member of staff very clearly felt there were inadequate numbers of staff employed. An Urgent Action letter was sent to the Registered Provider on 17 July 2008 concerning the matter of inadequate morning staff numbers. The Manager spoke of two care staff members who she felt able to leave in charge of the Service during her absence. She accepted that there were occasions when neither she nor these two staff were on duty and, on these occasions, there was no one in charge and no one to immediately supervise or support care staff in their duties. It has already been mentioned in this report that the surveys showed that residents were not very happy with staff availability when needed. Staff surveys also supported this view. One staff member commented, “They are always short of staff... sometimes it’s only one carer on duty and cook and manager... residents are complaining about this all the time”. The Manager confirmed her comment in the AQAA that there has been a “very high staff turnover”. She said no members of the current staff group have worked at Southover longer than 12 months and many have only been in post a few months. She added that no staff member was working in excess of 45 hours a week average. The Manager, herself, works between 40 and 50 hours a week. She said that currently, vacancies of 60 hours day care staff, and 20 hours night care a week were being held. The Manager reported, in the AQAA, that 50 of care staff had obtained a National Vocational Qualification (NVQ) in Care at level 2, at least. This met the 50 level required by the National Minimum Standards. The Manager had added that six more staff were working towards this qualification. The file of a recently appointed member of staff was examined. Safe recruitment practices were found to have been followed. Staffing records confirmed that less than half of the staff group had been provided with mandatory training, in order to ensure adequate skills and competence for the job... • six of the total staff group of 16 had been provided with training in fire safety in February 2008, • three staff only had received training in Basic Food Hygiene, • two staff only had received training in First Aid, and • seven staff were trained in safe Moving and Handling of residents. This was particularly concerning given the incidents of residents falling. Southover Care Home DS0000069489.V369280.R02.S.doc Version 5.2 Page 22 The Manager produced a document she had been given by the Provider to use to record the induction training provided to new staff. This document did not meet the specifications laid down by ‘Skills for Care’ and did not show that a thorough induction was being provided to new staff. The care assistant spoken to said she had a NVQ qualification in Care at level 2 before she came to the Home and her limited induction reflected this. Southover Care Home DS0000069489.V369280.R02.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): 31,33,36,37 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The Service was being poorly managed so that residents were at risk and their best interests were not being promoted by the systems in place. EVIDENCE: The Manager said that she had attained an NVQ level 4 qualification in Care and Management and had 30 years experience of working with older people nine as a manager. She has a Certificate in Business Management Coaching and has been a member of the Chartered Management Institute since 2004. There was a range of mixed opinions, expressed by residents in their completed postal surveys, about the quality of the service they receive. Comments from staff were fairly or very negative and included references to short staffing, poor food, poor teamwork and an unsupportive owner. We Southover Care Home DS0000069489.V369280.R02.S.doc Version 5.2 Page 24 examined recently completed surveys sent out by the Service to residents, relatives and external professionals. These provided mainly a ‘satisfied’ view of services with some ‘average’ and some ‘poor’ ratings. The latter referred mainly to lack of activities, insufficient staff and the poor environment. These findings had been analysed and incorporated into a 2008/09 Business Plan that was well compiled with objectives that reflected aims and outcomes for residents. However, there were no records of any monthly, monitoring visits to the Home, undertaken by the Registered Provider. Staff meetings had taken place in January and in May 2008 – a small number given the rapid turnover of staff and need to ensure they were following a consistent approach to their work. The systems for managing residents’ personal money were not assessed on this occasion. At the last key inspection residents’ personal money was being securely held and there was a robust system in place for recording all transactions, with regular balance checks being made. The Manager said she had managed to provide one supervision session each to six new staff during the past 12 months. This falls far short of the required six sessions a year in order to ensure staff competence and development is being monitored and discussed. No records were being kept of supervision sessions. A complainant had reported that residents’ confidential records were being stored in an unlocked cupboard. The Manager confirmed that the cupboard lock handle had broken six weeks previously and had not been repaired. As already mentioned in this report we were informed that a member of the public was asked by the Provider to help raise residents from their bedroom floor on at least two mornings in recent months, due to insufficient numbers of night staff. There is no evidence that this person was competent to safely move & handle vulnerable older people. An Urgent Action letter was sent to the Registered Provider on 17 July 2008 concerning this matter. The Manager spoke to us about seeing staff, the previous week, manually lift a resident and she had told them to use a hoist. This reinforces the need for staff training in Moving and Handling. The Manager also confirmed information given in the AQAA: that the Service’s hoists had not been serviced and there was no contract to carry out a service. This, again, was particularly concerning given the incidents of residents falling. The AQAA indicated that neither the heating system or gas appliances had been serviced within the past 12 months and the Manager confirmed this. She also confirmed that the chair lift, bath lifts and wheel chairs had no service contracts. She said that only four staff had been provided with Health & Safety training. Such training is particularly important in view of the risks identified at this inspection. Food hygiene practices in the kitchen were satisfactory. There was a comprehensive set of environmental risk assessments in place. Southover Care Home DS0000069489.V369280.R02.S.doc Version 5.2 Page 25 The AQAA was brief and gave few examples of how the Service could improve. There was considerable evidence that the Manager was unable to adequately manage the Service in order that residents had a good quality of life, given... • low staffing numbers and high rate of staff turnover, • the inexperience, and poor standards of training, of staff, • lack of a varied range of activities for residents, • the Service’s inability to provide a wholesome, nutritious and varied diet for residents, • a poor and unsafe environment, • a potentially unsafe range of equipment. Southover Care Home DS0000069489.V369280.R02.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 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 X 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 1 X X X X X X 3 STAFFING Standard No Score 27 1 28 3 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X 2 2 1 Southover Care Home DS0000069489.V369280.R02.S.doc Version 5.2 Page 27 Yes Are there any outstanding requirements from the last inspection? 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 OP4 Regulation 18(1)(a) Requirement Residents’ assessed needs must be met by a staff group which has the necessary skills and experience. Care plans and risk assessments must be kept up to date to ensure they reflect residents’ current needs. All medicines must be securely stored at all times to ensure that they are not stolen or accidentally taken by a resident. Medicines requiring refrigeration must be stored in a dedicated medicines refrigerator. The door catch to the room where medicines are stored must be repaired to make it fully secure. Controlled drugs must be stored in a wall cabinet specifically designed for their safe storage to ensure that they are not stolen or accidentally taken by a resident. There must be a date of opening recorded on all medication with a reduced expiry once opened to ensure the safety of service users. DS0000069489.V369280.R02.S.doc Timescale for action 01/09/08 2. OP7 15(2)(b) 01/09/08 3. OP9 13(2) 01/09/08 4. OP9 13(2) 01/12/08 5. OP9 13(2) 01/09/08 Southover Care Home Version 5.2 Page 28 6. OP12 16(2)(n) 7. OP15 16(2)(i) 8. OP18 13(6) 9. OP18 13(6) 10. OP19 13(4)(a) 11. 12. OP19 OP19 13(4)(a) (c) 13(4)(a) (c) 13. OP19 13(4)(a) (c) Residents must be provided with a varied range of activities that meet their need for mental and physical stimulation. Residents must be provided with a wholesome, nutritious and varied diet, in adequate quantities, to ensure their health needs and preferences are met. A running weekly set of menus must be compiled that reflect these needs and preferences. (Previous timescale was 01/01/08) All care staff must be provided with ‘safeguarding adults’ training in order to ensure they are fully aware of how to respond to evidence of abuse. Staff must be made aware of the Service’s ‘Whistle Blowing’ policy and it must be reinforced with those that have already read it. This will ensure staff speak up about any abuse they suspect. The opening of large first or second floor windows must be restricted by physical means while allowing adequate ventilation, so as to reduce the risk of residents falling out and harming themselves. The dining room carpet must be repaired or replaced to remove potential trip hazards. A risk assessment must be produced that addresses the risk to residents through there being no alarm on either of the two fire escape doors. This will ensure the safety of residents who may wander out of these doors. A highly visible strip must be placed on the wooden step immediately beyond the two fire escape doors in order to minimise the potential for residents to trip and harm DS0000069489.V369280.R02.S.doc 01/09/08 21/07/08 01/11/08 01/09/08 23/07/08 01/10/08 01/09/08 01/09/08 Southover Care Home Version 5.2 Page 29 14. OP19 13(4)(a) (c) 23(4)(c) (i) 15. OP19 16. OP19 23(2)(p) 17. OP19 23(2)(b) 18. OP19 13(4)(c) 19. OP19 23(2)(o) 20. OP19 23(2)(o) 21. OP27 18(1)(a) 22. OP27 18(1)(a) themselves. Algae growths on the two sets of fire escape steps must be removed to prevent residents slipping in wet weather. The lounge fire doors must not be wedged open. The magnetic hold-back devices, linked to the fire alarm system, on both these doors are needed to contain any fire that may break out. They must be repaired or other alternatives sought. Adequate lighting must be provided in all areas of the Home used by residents, to reduce the risk of them falling or otherwise hurting themselves. Wood rot in the eaves of the roof and the exterior window sills must be treated, to ensure the soundness of the building is not compromised and residents and staff not put at risk. The discarded items at the side of the premises are a potential health and safety hazard and must be removed. The clothes lines, strung across the tarmac area at the side of the premises, must be moved so they no longer cause a potential obstruction and hazard to residents. Weeds must be cleared from the joints in the rear stone patio to make this area safe for the use of residents. A member of sleep-in staff must be provided, on the premises, each night in addition to waking staff, in order to keep residents safe. A risk assessment must be provided that relates to the number of staff required on the morning shift. The Service must then be staffed to this DS0000069489.V369280.R02.S.doc 01/10/08 01/11/08 01/09/08 01/02/09 01/09/08 01/09/08 01/10/08 21/07/08 23/07/08 Southover Care Home Version 5.2 Page 30 23. OP27 18(1)(a) 18(2) 24. OP27 18(1)(a) 25. OP30 23(4)(d) 26. OP30 16(2)(j) 27. OP30 13(4) 28. OP30 13(5) 29. OP33 26 30. OP36 18(2) assessment. This will ensure that residents’ needs are met and they are kept safe. There must at all times be a person in charge who is able to adequately manage the shift and supervise staff in their care duties. This will ensure that residents’ needs continue to be met and they remain safe. There must be adequate staff on duty to ensure, at all times, the safety of residents. (Previous timescale was 01/01/08) All staff must be provided with fire safety training to ensure that the safety of residents is not compromised, particularly at night. All staff must be provided with training in basic food hygiene to ensure that residents’ health is not put at risk when staff handle their food. All staff must be provided with training in first aid so they can act appropriately in the event of an accident to a resident. All staff must be provided with training in moving and handling residents. This will ensure that staff can safely work with residents who have difficulty in moving. Monthly audit visits to the Service by the Registered Provider, as required by Regulation 26, must take place and be recorded. This will provide an oversight of the Service and identify matters requiring attention, to ensure that residents’ needs are met. A copy of this report must be supplied, each month, to the Commission. Staff must receive formal supervision to ensure that the DS0000069489.V369280.R02.S.doc 01/09/08 01/09/08 01/11/08 01/11/08 01/11/08 01/11/08 01/09/08 01/09/08 Page 31 Southover Care Home Version 5.2 31. OP37 17(1)(b) 32. OP38 13(5) 33. OP38 23(2)(c) Service’s policies and procedures are put into practice and residents’ needs met. All records required by 01/09/08 Regulation to be maintained by the Service must be kept secure. This will ensure that residents’ personal and confidential documents are not read by persons who may abuse this information causing harm to residents. Residents must only be moved 18/07/08 by staff who are competent to move and handle vulnerable adults, for their own and for residents’ safety. Equipment provided must be 01/10/08 maintained in good, safe working order. This includes hoists, the chair lift, bath lifts, wheel chairs, the heating system and gas appliances. This will protect residents from any unnecessary risks. 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. 5. Refer to Standard OP1 OP7 OP7 OP8 OP9 Good Practice Recommendations The Service Users’ Guide should contain details of the fees payable by residents. Care plans should set out a record of how residents’ needs are to be met – for example, through a set of goals. Care planning records should reflect a ‘person centred’ approach to ensure that residents’ preferred lifestyles are identified. Records of health professionals’ involvement should be made in one place to prevent confusion. The receipt, administration and disposal of controlled drugs, such as Temazepam, should be made in a DS0000069489.V369280.R02.S.doc Version 5.2 Page 32 Southover Care Home 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. OP15 OP15 OP15 OP16 OP18 OP19 OP19 OP19 OP30 OP36 OP38 controlled drugs register in order to provide a more robust audit of their use. The use of diluted milk and vegetable fat spread should only be considered if expressly requested by a resident. Liquid milk should be obtained in adequate quantities to ensure that there is always enough for residents’ use. A rolling menu should be developed, based on residents’ assessed needs and expressed preferences. The Provider should, within 28 days of the Commission submitting details of a complaint and requesting a response, notify us of the action to be taken. Residents should not be moved by people who have not had proper checks as to their suitability to work with vulnerable adults. Cracks in the ceiling and walls of the first floor bathroom, and of corridor walls, should be appropriately dealt with and redecorated. The ‘flower bed’ to the side of the premises, and the rear lawn, should be tended and weeds removed from the front of the premises. The Service’s maintenance book should have dates recorded from which an assessment can be made of the time taken to rectify defects. The induction and foundation training of new staff should meet the current specifications laid down by ‘Skills for Care’. Staff should receive formal supervision at a frequency of six times a year and records of this supervision should be maintained. All staff should be provided with training in Health & Safety. Southover Care Home DS0000069489.V369280.R02.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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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