Random inspection report
Care homes for older people
Name: Address: Southview Woodside Lipson Plymouth Devon PL4 8QE one star adequate service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Megan Walker Date: 2 6 0 2 2 0 1 0 Information about the care home
Name of care home: Address: Southview Woodside Lipson Plymouth Devon PL4 8QE 01752667853 01752667853 southview@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Anna Louise Chapman Type of registration: Number of places registered: Conditions of registration: Category(ies) : Ashley Residential Care Ltd care home 19 Number of places (if applicable): Under 65 Over 65 19 19 dementia old age, not falling within any other category Conditions of registration: 0 0 The categories of registration are OP and DE(E). The home may accommodate a maximum of 19 older people (over the age of 65) who may also have dementia. Date of last inspection Brief description of the care home Southview is a care home that is registered to provide accommodation and personal care for up to 19 older people, aged over 65, who may also have a dementia care need. The home is not registered to provide nursing care or intermediate care.
Care Homes for Older People Page 2 of 13 Brief description of the care home Southview is privately owned by Ashley Residential Care Ltd. The Responsible Individual is Mrs Anna Chapman. The present owners took over the running of the home on 7th March 2006.The home is a single storey detached property situated in the residential area of Lipson, Plymouth. It is close to local amenities and transport links. Southview offers 17 single bedrooms and one double bedroom: eight of the single bedrooms have en-suite toilet facilities. There are two bathrooms and four toilets for communal use. The home has a large lounge and a dining room. Accommodation is centred around a courtyard and garden and all areas are accessible to the residents. There is a small area of on-street parking available outside the home. The current weekly fees for the home range from £313 to £345 dependent upon individuals care needs. Information relating to the services provided at Southview can be obtained directly from the home. Care Homes for Older People Page 3 of 13 What we found:
This unannounced inspection took place on Friday 26th February 2010 between 0615 and 0830. The visit was undertaken by two regulation inspectors to check compliance with regulation. Since the last key inspection we have received information from other organisations as well from other people with an interest in the service that gave us concern about how well outcomes are being met for the people using this service. The purpose of our early visit was to find out if the night staff get people up before they go off duty; if the day staff do not give people their morning medications because people get up late; if there is a reduction in the staffing numbers, and if so what are the current staffing levels and staff deployment. On our arrival we found three people were up and dressed, two of whom had independently got up, washed and dressed, while one other was assisted by the night staff. We spoke to one of these people who confirmed that they all choose to get up about 0500 every day. The same person also told us that there is a cup of tea about 0730 however there is nothing to eat until breakfast is served at about 0800. We witnessed one person ask three times for something to eat but the staff either ignored this request or tried to divert the person about other things. At about 0730 this person was told that a cup of tea had been put in their bedroom even though they were in the dining room (opposite the kitchen where the tea was made). A staff member told us that most people get up about 0730 and that breakfast is served at 0800. She also told us that people are left to sleep and they are not woken before the day shift starts. Another staff member told us that people are left in bed and are allowed to get up when they wish. They are missing breakfast and then do not want lunch because they have only just woken up. They are eating tea that is served at 1600, and tea and biscuits at 1900. We saw evidence in the daily care notes of people being up and having snacks and hot drinks during night. The staff confirmed that they regularly make people sandwiches if they ask for something to eat. The staff also told us that there are regulars who have snacks during the night because they are hungry. We were also told that people drift off to their bedrooms and some go to bed not long after tea. When we left at 0830 breakfast had not been served and there was little sign of anyone being up or staff assisting people to get up. We looked at the medications and the medication records. We found that one person had a medication prescribed to be given when required. This was not being given however the medication record was being signed with a 0, which on the chart indicated other. Staff confirmed this should be refused as the person had not needed the medication. We found that the holes punched through the medication administration sheets were in some places through the prescription itself. The name of the drug could not be fully and clearly seen. In the staff Communications Book we found several recordings about tablets being found on the floor around the home. Care Homes for Older People Page 4 of 13 When we left at 0830 the administration of medication had not started so we did not observe how medication is handled or administered. We looked at a sample of care plans and the daily care records. We found evidence of some rating/statistical info in one persons care file from Dementia Care Mapping but no information on what this was about or what it meant. The staff had no idea and told us they thought it was something the manager did. When we arrived we found one staff member on duty. She informed us that the staff member who sleeps was getting up and would be on duty shortly. We found that this staff member had been sleeping on a Z bed in the dining room. We were told that two members of staff would be on duty from 0730 until 1500. The person who had been on the waking duty overnight was returning back to work again at 1500. They told us this was because they were covering staff shortages and happened quite often. We were told that the cooks hours have been reduced two hours to 0800 until 1400. The care staff have to prepare tea. We were also told that the cook is responsible for preparing and serving breakfast that is served at 0800 (although the cook does not start work until 0800), and mid-morning drinks in the lounge. The kitchen is left open and unattended with food being prepared and cooking. We witnessed one staff member put on an apron in the hallway and enter the kitchen. She used hand gel when she came out. She did not wash her hands or use hand gel before putting on the apron or entering kitchen. We observed that a staff members footwear was inappropriate as she was wearing shoes with approximately 6cm heels. We were told by the staff that the manager usually arrives for work about 1130. The main office is kept locked and only the manager has a key. No other staff member is allowed access and this causes problems for staff when they need access to files and records. We spoke to the manager about this after this visit. She advised us that her time of arrival is variable, for example, if she had to pick up prescriptions on her way into work. The location of the managers office was also acknowledged as being problematic for staff and visitors to know if the manager was in. We were told that there is an option in the future to move the office. We discussed ways in which both issues could be overcome until such time as a new office can be created. We looked at the Communications Book and found that the manager regularly wrote messages to the staff. These were aggressive in tone. The staff described them as orders. They told us they are given Bits of paper about dos and donts from the deputy manager. There was never any discussions or staff meetings to look at issues to find a way to rectify them. The staff told us that the manager shouted at them and they felt undervalued because they were never praised only picked up on what they were doing wrong. One staff member told us We need a manager with leadership skills. The current staff could be much better with nurturing and clear guidance about working as a team. The staff also told us that nothing is followed through. One example was keeping a diary of what people eat. Some staff do this, others have stopped because they do not know what it was for and the manager is not checking it. We found that there were requests in the Communications Book for blue plasters for use by the kitchen staff. We saw another later explanation from the kitchen staff explaining
Care Homes for Older People Page 5 of 13 that it was necessary to have blue plasters not skin tone or transparent for the kitchen staff. There was another request for blue plasters. We looked at the kitchen Communications Book. We found that the first aid box was reported monthly as needing to be refilled. This was outstanding every month from 09/09/09-10/02/2010. We checked the First Aid box. It had no blue catering plasters or any other types of plasters. It was very messy. What the care home does well: What they could do better:
We found that care staff were respectful towards individuals however this was task and time orientated rather than focusing on individual needs. Our concern is that for those people who may lack mental capacity, choice is not always positively encouraged, and self esteem is not promoted through every day routines and practices that are adapted to suit individuals to improve their daily life so it is meaningful to her/him and people are at risk of harm. We saw evidence in one care plan of someone who has been identified as having lost significant weight, indicating a high risk rating for malnutrition. We did not find any evidence of a clear care pathway for managing this issue. We also witnessed one person ask three times for his breakfast. This request was not met because it was not breakfast time, i.e. 0800. We were also told that people are left in bed, getting up when they choose so are missing meals, and going to bed after tea because the staff are busy doing jobs instead of spending time with them. This may be an example where person centred care has clashed with task focused care, and may benefit from a review to ensure that people have the opportunity to enjoy their food and meals within routines that are focused on their needs. The three meals are served at 0800, 1200 and 1600. This means that people have sixteen hours between a light tea and a light breakfast with the main meal at midday. There is significant risk of harm for anyone who does not eat sufficiently or regularly a balanced diet that is nutritious and varied. There is an increased risk for anyone who regularly misses meals and who is taking medicines that are prescribed for them as they may be taking medication against contra-indications. This also means if they should be taking morning medication before or with food they may take it at the wrong time, or not take it at all. There was no evidence in the care plans to show that behaviour patterns such as sleeping late during the day and being up hungry at night, had been identified, were being monitored and appropriate action being taken to review and consider if or why peoples behaviour may have changed.
Care Homes for Older People Page 6 of 13 A staff member told us that the staff have no clear expectations about peoples personal grooming. This means that the staff are not pro-active in encouraging and assisting people to have their hair brushed, teeth cleaned and their clothes not looking crumpled, or putting in place personalised daily personal grooming plans including shaving. Medication is not correctly recorded so it is not possible to verify if medication is refused or not taken for other reasons. We found that for one person a pain relief medicine had not been administered (it was a prescribed medicine to be given when required).The staff were able to tell us that it had been refused but the daily evaluation sheets did not record that they had not suffered any increase in pain over this time. There was no rationales in their care plan to explain why this is to be used. Also when these medicines are administered no record of the use is recorded in the daily evaluation. This means that it is not possible to be certain why these medicines are used and if they have the desired effect for the person receiving the medicine. In the staff Communications Book we found several recordings about tablets being found on the floor around the home. This means that people are at risk because they are not being monitored to ensure they are taking prescribed medications. The holes punched through the medication administration sheets were in some places through the prescription itself. The name of the drug could not be fully and clearly seen. This means that it would be difficult for staff to verify if they did not know the medicines. Staffing hours are being cut but staff are still expected to achieve the same tasks in less hours. This means that staff have limited engagement with the people living at the home and this is usually to do something to them rather than with them. People are left to make their own decisions and choices about their lifestyle. This means that for someone who lacks capacity they may not have any orientation about time or purpose. People who have capacity are bored. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 7 of 13 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 2 9 38 13(2) 13(4) No information supplied No information supplied 31/08/2009 30/11/2009 Care Homes for Older People Page 8 of 13 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 7 13 Care plans must 30/04/2010 contain accurate information to enable staff to provide care in a safe and consistent way. This will ensure that any risk of harm is reduced or removed. 2 8 12 Systems must be in place to ensure people receive the finer details of care that allows them to make decisions about their lives. This will ensure that care staff involve people in their care. 30/04/2010 3 9 13 There must be clear 30/04/2010 directions present on how to use medicines prescribed to be administered when required. This is to ensure that people receive medicines appropriately and that their response to these medicines
Care Homes for Older People Page 9 of 13 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action is documented. 4 9 13 Arrangements must be made 30/04/2010 to develop a system to audit the medication records. This is to ensure that appropriate records are made and products available are suitable for use. 5 12 18 Staff must be deployed in 30/04/2010 such a way that there is time for people living in the home to engage in meaningful and appropriate activities. This will ensure that all people are able to participate in meaningful activities and lead a more fulfilling life. 6 12 15 Staff must consult with people living at the home about their social interests and make arrangements to enable them to engage in a range of activities according to their ability. This includes people less able and those spending considerable time in their bedrooms. This will ensure that everyone living at the home will have a good quality of life and be able to participate in things they enjoy. 7 14 12 Staff must be deployed in such a way to have enough time to enable and encourage people living n the home to make decisions 30/04/2010 30/04/2010 Care Homes for Older People Page 10 of 13 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action with respect to their care and so far as it is possible to ascertain take into account their wishes and their feelings. This means everyone living at the home will have a good quality of life and feel valued as an individual. 8 27 28 Staff deployment and skill mix must be monitored to show that people who use the service are getting their needs met and not having the level of care affected. This will mean that there are sufficient staff in numbers and skill mix to meet the needs of people in the home. 9 34 25 The home must be managed 30/04/2010 in such a manner that it is financially viable for the purpose of achieving the aims and objectives set out in the statement of purpose. This will mean that the people using this service and their families can be confident that they are safeguarded by the accounting and financial procedures of the home. 30/04/2010 Care Homes for Older People Page 11 of 13 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 8 Work practices and routines should be reviewed to ensure they are in the best interest of people who use the service and not for the benefit of staff. The people using this service and their families, and the staff working there should benefit from an ethos, leadership and management approach of the home that is open, positive and inclusive. 2 32 Care Homes for Older People Page 12 of 13 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 13 of 13 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
