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Inspection on 15/01/07 for Stambridge Meadows

Also see our care home review for Stambridge Meadows for more information

This inspection was carried out on 15th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Residents confirmed that they like living at Stambridge Meadows and that most staff working at the care home are nice and hard working. The home environment for residents continues to be homely and comfortable for residents. Individual bedrooms are personalised and offer private space for resident`s to enjoy. The home environment is decorated and furnished to a high specification. Food provided to residents continues to be of a high standard. Residents are offered a varied choice, food is attractively presented and the quantity of food provided is appropriate. Those resident`s who require assistance with eating, were supported by care staff, with sensitivity and appropriate care. Of those residents spoken with, all were very complimentary regarding the food provided. It is evident that the head chef has a good understanding of individual residents needs and issues surrounding the nutritional needs of older people. Of those residents spoken with and from evidence of a number of surveys completed by relatives/residents representatives, comments relating to the care home environment, care provided and staff working at Stambridge Meadows were positive.

What has improved since the last inspection?

All newly admitted residents to the care home were observed to have had a pre admission assessment undertaken. Additionally of those care files randomly inspected all were noted to have an individual plan of care. Rapport between residents and care/nursing staff was noted to be positive. Residents were clearly at ease with individual members of staff and those staff spoken with demonstrated a good understanding of resident`s needs.

What the care home could do better:

Improvement must be attained in relation to the home`s pre admission assessments, care planning and risk assessments. Records must clearly evidence staff`s knowledge about individual residents, what care is required and what care is given in relation to all the care they need for their health and wellbeing. Other records relating to complaint investigations/staff conduct, staff recruitment procedures, staff training and staffing levels appropriate to meet resident`s needs, must be appropriate, robust and well maintained. The Statement of Purpose/Service Users Guide must be reviewed and updated in line with regulatory requirements. The activity programme is available and appears to cater manly for more able people living in the home. The programme must also be appropriate to meet the needs of those residents who are complex and who require mental stimulation. The number of hours provided for activities remains woefully inadequate. The registered manager needs to show better leadership and monitoring. The registered manager must take ownership that issues highlighted throughout the main text of the report have not been addressed/improved upon as a result of her poor management/poor monitoring of the home. Again as highlighted following the inspection of 31.1.06, the registered manager`s attitude was very defensive and blame was apportioned to care staff, in particular to nursing staff rather than being reflective of her own practice. Ultimately the line of responsibility on a day-to-day basis lies with the registered manager. It is evident that the registered providers validation audits and monthly manager`s audits do not reflect evidence found at this site visit or reflect accurately the registered manager`s poor performance. The registered provider/manager must be aware that following this site visit, statutory enforcement notices will be issued.

CARE HOMES FOR OLDER PEOPLE Stambridge Meadows Stambridge Road Great Stambridge Rochford Essex SS4 2AR Lead Inspector Michelle Love Unannounced Inspection 15th January 2007 10.50 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 Stambridge Meadows DS0000015554.V324554.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. Stambridge Meadows DS0000015554.V324554.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stambridge Meadows Address Stambridge Road Great Stambridge Rochford Essex SS4 2AR 01702 258525 01702 258229 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) www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited Ms Lorraine Louise Reynolds Care Home 49 Category(ies) of Old age, not falling within any other category registration, with number (49), Terminally ill (2) of places Stambridge Meadows DS0000015554.V324554.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Terminal illness to include persons over the age of 55 Date of last inspection 20th September 2006 (Random Inspection) Brief Description of the Service: Stambridge Meadows is a care home with nursing for up to 49 older people. The home is situated approximately three miles from Rochford Town Centre and is set in pleasant country surroundings. The home has 40 single bedrooms, 33 with en-suite facilities and 5 double bedrooms, 2 of which have en-suite facilities. The home has three lounges, one of which has a designated dining area. The home also benefits from a visitors lounge area on the ground floor. The spacious grounds are well maintained, with several paved areas. The home is in good decorative order with high quality accommodation for residents. Inspection reports are readily available for visitors to the care home and are displayed in the main reception area. Upon request, prospective residents and/or their representatives can have a copy of the last report. The registered provider must ensure that the most recent inspection report is displayed within the homes statement of purpose. The range of fees as provided by the home’s administrator are £588.50 for those residents receiving residential care in a bedroom without en-suite facilities, £635.00 for those residents receiving residential care in a bedroom with en-suite facilities, £650.00 for those residents receiving nursing care and £750.00 for those residents receiving palliative care. Respite care is charged at approximately £96.50 per day. Additional charges to residents include chiropody, hairdressing, newspapers and magazines, personal toiletries and telephone charges. The above information was sought from the registered provider following the site visit. Currently 8 residents are private/nursing funded, 13 residents are private/residential funded, 8 residents are local authority funded and 13 residents are local authority/nursing funded. At the time of the site visit the Commission for Social Care Inspection had not received the pre inspection questionnaire. The registered manager advised inspectors that this had been completed and posted. No photocopy of the document was available on the day of the site visit. Stambridge Meadows DS0000015554.V324554.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 as part of a second key inspection of Stambridge Meadows by two inspectors, Michelle Love and Carolyn Delaney, who together spent 18.5 hours at the home that day. As part of the inspection process 7 residents, 4 staff, the deputy manager and the registered manager were spoken with. A tour of the premises was undertaken and a random sample of records pertaining to care planning, healthcare documentation, staff recruitment, training and policies and procedures were examined. Case tracking was undertaken in relation to seven of the 42 residents living at the home at that time. Following the site visit 11 surveys were forwarded to relatives and 1 survey was forwarded to a doctor’s surgery requesting their views about Stambridge Meadows. Comments documented within survey forms are reflected throughout the report. The Commission for Social Care Inspection has had ongoing concerns about this home and its continued failure to meet National Minimum Standards and Requirements as detailed within the Care Homes Regulations 2001. As part of the Commission’s monitoring of the home a random inspection was undertaken on 20th September 2006. As at previous inspections to the home the registered manager identified that shortfalls were due to others working at the care home and not her poor management i.e. care manager/nursing staff. The registered manager was advised that it is her responsibility to manage the home effectively and to ensure that residents are kept safe, are protected from harm and receive good quality care. There was some evidence at the site visit of 20th September 2006 and at this inspection that some action had been taken to address the number of outstanding requirements and recommendations from previous inspections. This however was limited and National Minimum Standards and Regulations were again not met in the majority of cases i.e. care plans not followed in line with healthcare requirements, risk assessments not devised for all areas of assessed risk, no evidence to indicate that prospective residents and/or their representatives had been involved with the care planning processes, activities for those residents with complex needs/poor cognitive development were not evident, poor and unsafe recruitment practices, poor complaint investigations undertaken, gaps relating to training for staff and poor staff supervision. The Commission for Social Care Inspection is concerned at the number of statutory requirements and recommendations not actioned following the last `key` inspection (3.5.06) and random inspection (20.9.06) and which are repeated at this site visit. Additionally some requirements and recommendations remain outstanding from the inspection of 31.1.06. Stambridge Meadows DS0000015554.V324554.R01.S.doc Version 5.2 Page 6 A meeting was conducted on 23.1.07 between the Commission and the home’s operations director and operations manager to discuss the findings of this site visit. Both the operations director and operations manager expressed surprise at the inspectors’ findings and stated that the feedback received from the registered manager had been contradictory to what they were hearing. Detailed feedback was provided by both inspectors’, to the registered manager and the deputy manager. Following this they were asked if they would like to make any comments pertaining to the inspectors’ findings, the registered manager stated, “I cannot challenge anything”. At this site visit the registered manager expressed hope that an application to vary the home’s registration could be submitted by the registered provider and agreed by the Commission. The registered manager was again advised that agreement would not be sanctioned based on the home’s continuing poor performance. What the service does well: What has improved since the last inspection? All newly admitted residents to the care home were observed to have had a pre admission assessment undertaken. Additionally of those care files randomly inspected all were noted to have an individual plan of care. Rapport between residents and care/nursing staff was noted to be positive. Residents were clearly at ease with individual members of staff and those staff spoken with demonstrated a good understanding of resident’s needs. Stambridge Meadows DS0000015554.V324554.R01.S.doc Version 5.2 Page 7 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. Stambridge Meadows DS0000015554.V324554.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Stambridge Meadows DS0000015554.V324554.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Some elements contained within the Statement of Purpose and Service Users Guide need to be updated and contain the most up to date information. Prospective residents are not provided with up to date information about the service. Prospective residents are assessed prior to admission. It is unclear as to whether or not residents and/or their representatives are involved in the initial assessment process. EVIDENCE: The inspection report for 3.5.06 is displayed within the front foyer of the home, however within the main reception area the Statement of Purpose contains the inspection report of 31.1.06 and not that of 3.5.06 or the random inspection report for 20.9.06. The Statement of Purpose needs to be updated as the front cover still makes reference to Ashbourne Healthcare and the complaints procedure has not been amended to reflect that the Commission for Social Care Inspection no longer investigates complaints. The Service Users Guide for Stambridge Meadows DS0000015554.V324554.R01.S.doc Version 5.2 Page 10 individual residents must include information relating to fees payable for services provided, arrangements for paying and additional costs incurred and whether or not there are different charges for people who have all or part of their care funded by a local authority or primary care trust. Some pages of the Statement of Purpose document had been photocopied and were unclear in places. Pre Admission Assessments were completed for the newest residents however these varied in detail and comprehensiveness and out of three individual documents inspected at random, two had some elements either only partially completed or not completed at all i.e. one assessment did not include information relating to their personal care needs, mobility and eating and drinking. Formal assessments were only fully completed for one person and incomplete for two. In addition to the assessments undertaken by the home, information had been sought from hospitals and/or placing authorities. It was unclear as to whether or not the resident and/or their representative had contributed to the assessment process or been offered an opportunity to visit Stambridge Meadows prior to admission. The home does not provide intermediate care. Stambridge Meadows DS0000015554.V324554.R01.S.doc Version 5.2 Page 11 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 and 11 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home has a comprehensive system/format for recording individual resident’s health, personal and social care needs. Some aspects of the care planning processes have made slight improvements, but in some cases information relating to healthcare were inaccurate and remain of a poor standard. The homes medication procedures and records were seen to be satisfactory. Medication training for staff is poor. EVIDENCE: On inspection of seven individual care plans, it was positive to note that a plan of care was available within each file. Additionally specific elements depicting individual needs were highlighted i.e. personal care, pressure area care, activities, mobility etc. Formal assessments relating to dependency, moving and handling, continence, nutrition, pressure ulcer risk assessment and falls were completed within each care plan. The one area of improvement was noted in relation to daily care records. Entries were recorded for every shift and appeared in some cases to contain more detailed and comprehensive Stambridge Meadows DS0000015554.V324554.R01.S.doc Version 5.2 Page 12 information than previously viewed. However attention must be paid to ensure staff’s interventions/actual care provided to residents is recorded and evidenced. It is disappointing to note that issues/areas of concern highlighted at inspections of 31.1.06, 3.5.06 and 20.9.06 relating to healthcare needs of residents have not improved i.e. the care plan for one resident detailed that they were at risk of malnutrition/needed encouragement to eat/food and fluid intake to be monitored/food to be cut up and for their weight to be monitored monthly. The latter was reviewed and the care plan detailed that the resident’s weight should be monitored weekly. Additionally the care plan made reference to the individual person having a sacral pressure sore. Information recorded to depict interventions by care staff/nursing staff was seen to be poorly completed, incomplete and inaccurate. In relation to the above care plan, the pressure ulcer risk assessment did not reflect accurately the resident’s needs and the resident’s weight was not recorded in line with their care plan (last recorded entry was 20.8.06) with the resident sustaining regular weight loss. The care plan did not detail the resident requiring to be turned during the day or night, however one `turn chart` recorded that the resident should be encouraged to stand up every two hours and turned every four hours during the night. Both `turn charts` and nutrition intake records were inconsistently completed and in some cases left blank. This was not an isolated case and a random sample of several `turn charts` and nutrition intake charts for residents; were inspected by both inspectors. The result was that many gaps and poor recording were noted. On inspection of residents accident records these indicated that one resident on respite had experienced three falls in three consecutive days. The care plan had not been updated in light of the above and no risk assessment had been devised. Daily care records for 7.11.06 and 8.11.06 recorded that the resident was confused and agitated, however no records detailed staff’s interventions. The care plan did not identify confusion and agitation as problem areas and no risk management strategy was devised. On the 9.11.06 daily care records stated that the resident had fallen and banged their head. No records were available to indicate that the resident was monitored following the fall and despite their appearing to be drowsy. One care plan detailed that a resident had sustained two leg ulcers. As part of the care plan a pressure ulcer risk assessment and wound assessment had been completed. As part of the treatment plan, the care plan detailed that a photograph should be taken at every significant change. On the file only two photographs were evident for April and June 2006. No changes had been photographed or documented over the past 6-7 months and there was no evidence to detail changes (positive or negative) to the resident’s progress or care. During feedback to the registered manager, the inspectors were advised that the leg ulcers had healed sufficiently and that the resident was soon to be discharged from Stambridge Meadows to sheltered accommodation within the Stambridge Meadows DS0000015554.V324554.R01.S.doc Version 5.2 Page 13 community. It is disappointing to note that care staff/nursing staff, appear still unable to review and update care plans/risk assessments/daily care records, despite having received care planning training since the last inspection. The registered providers `in house trainer` advised inspectors that 8 staff undertook care planning training in August 06. Risk assessments were observed not to be devised for all areas of assessed risk i.e. the care plan for one person receiving respite care did not include an assessment in respect of their diabetes. Care plans did not consistently evidence residents and/or their relatives wishes pertaining to end of life/terminal care issues. It is concerning that issues relating to care plans/risk assessments were not detected through either the registered provider’s monthly validation audit or the home audit completed by the registered manager. The validation audit completed on 3.10.06 only looked at 1 care plan. The percentages scored indicated that care documentation scored 85 and the review of pressure ulcers audit scored 75 . The monthly home audit completed by the registered manager on 30.10.06 evidenced that care documentation scored 75 and the review of pressure ulcers audit scored 100 . At this audit 4 care plans were inspected and 2x care files for pressure area care were examined. The monthly home audit completed on 22.11.06 highlighted that care documentation scored 100 and the review of pressure ulcer audits scored 75 . As part of the care documentation audit, 4 care plans were inspected however one file was noted to have been checked at the audit of 30.10.06. The validation report of 19.12.06 was completed by another home manager, and evidenced care documentation scored 85.2 and review of pressure ulcers audit scored 100 . At this audit only 1 care file and 2 care files for pressure area care were inspected. It is evident that the information recorded within the audit does not concur with the inspector’s findings at the site visit. The home’s records and safe storage systems for medication were observed to be satisfactory. However, upon arrival to the care home, the registered manager’s office was left unlocked and open. On the table inspectors noticed 2 tablets in a medication pot. When questioned the registered manager advised inspectors that the medication belonged to the deputy manager. Both managers were advised of the possible dangers of leaving medication unattended with easy access for residents. On inspection of medication administration records, no omissions of signatures were observed. It was disappointing to note that controlled drug medications for two residents were only signed by one member of staff and not two (12.1.07 and 14.1.07). Eye drops and other medications, which have a short Stambridge Meadows DS0000015554.V324554.R01.S.doc Version 5.2 Page 14 life span, were not always clearly marked with the date upon which they had been commenced. The list of staff names/initials and signatures of those able and responsible for administering medication, needs to be reviewed and updated, removing the names of staff who no longer work at Stambridge Meadows. On inspection of the training matrix, this details that no senior staff have received medication training. The registered manager advised that this training is not mandatory for senior staff/nursing staff. Having sought advice from the Commission’s pharmacist inspector, the registered manager must ensure that nurses comply with the Nursing and Midwifery Council Code of Conduct for the Administration of Medicines and that they remain competent to do so and that any senior care staff (non nurses) administering medication receive training in accordance with guidelines as detailed by the Royal Pharmaceutical Society of Great Britain. Prior to this inspection the Commission was made aware that in October 2006 the care manager was suspended pending an investigation relating to misadministration of medication procedures. The outcome was that the care manager resigned from their post. Within 7 days of receiving this report the Commission must be provided with written confirmation summarising what action will be taken to address the above training need. Out of 11 surveys sent to relatives, it was disappointing that only three were returned to the Commission. Relative’s comments were positive in relation to residents being treated with dignity and respect. Additionally relatives were complimentary of the care provided to their member of family. Some of the comments received stated “the entire staff work as a team”, “always ready to discuss any problems”, “talk to the elderly not at them” and “I feel confident in the care my husband gets”, “he is treated with kindness and respect” and “all the staff make me feel part of my relatives life still”. Stambridge Meadows DS0000015554.V324554.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. An activity programme is available for residents, and this appears to be varied and to offer choice. The arrangements, for resident’s to maintain contact with family and friends remains appropriate. Meals provided to residents continue to be of an excellent quality. EVIDENCE: The home employs an activities co-ordinator for 30 hours per week. The hours currently provided appear to have reduced by 5 hours since the previous `key inspection` in May 2006. The rationale for this reduction appears unclear. In addition to this person the registered manager advised inspectors that the home’s maintenance person and a volunteer provide additional support. Both the maintenance person and volunteer were observed to provide appropriate support to residents and this was clearly enjoyed and welcomed by all observed. Of those resident’s bedrooms inspected, all were noted to have a copy of the activity programme for January 2007. An additional copy of the programme was displayed within the homes main reception area. Activities noted included quizzes, bingo, scrabble/draughts, trolley shop, coffee morning and magazines, Stambridge Meadows DS0000015554.V324554.R01.S.doc Version 5.2 Page 16 craft club, films/music, reminiscence, art club, religious service reading group etc. Care staff advised the inspector that leading up to Christmas period, carol singers and local school children visited and provided entertainment. Residents spoken with advised that they have the option to participate/not participate within the homes activity programme, with many residents choosing to spend time in their bedrooms reading or watching television. It remains unclear as to what activities and/or meaningful occupation are given to those residents who have complex needs/poor cognitive development. On the morning of the site visit a religious service was held in the homes main lounge. A copy of four weeks menu’s, were provided to inspectors. These continue to be varied and offer choice to residents at all mealtimes. In addition to the planned menu, residents are able to have alternatives i.e. omelettes, soup, sandwiches etc. The meals offered to residents on the day of the site visit were observed to look plentiful and of good quality. Residents spoken with were complimentary regarding food provided. Those resident’s who require assistance from staff to eat their meals were supported sensitively and meals were not rushed. Stambridge Meadows DS0000015554.V324554.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure however systems to investigate complaints robustly have not been adopted by the homes manager. Vigorous procedures to ensure residents are protected from abuse are not adhered to and the registered manager appears to have a limited understanding and knowledge of correct practices. Several staff had not undertaken protection of vulnerable adults or challenging behaviour training. EVIDENCE: Since June 2006 the home’s complaint records indicate that there have been 8 complaints. On inspection of complaint records, evidence reveals several of the home’s complaints have not been dealt with effectively by the registered manager. Although a record of the specific complaint has been documented, it did not always include details of the investigation and any action taken. One record of complaint led the inspector to examine one staff recruitment file. On inspection of this file, a number of incidents were recorded in relation to the conduct of this staff member. It was clearly evident that investigations undertaken by the registered manager had been fragmented, incomplete and not dealt with in an appropriate manner. Evidence also indicated that despite concerns raised and highlighted, the member of staff had not been monitored closely or supervised other than in April and December 2006. Additionally it is concerning that no protection of vulnerable adults alert was raised in relation to an allegation by a resident pertaining to the conduct of this member of staff Stambridge Meadows DS0000015554.V324554.R01.S.doc Version 5.2 Page 18 i.e. records for July 06 detail that a resident felt they were treated like dirt by one member of staff and that they were afraid of the above staff member. Records did not include information relating to statements taken from either member of staff/the aforementioned resident or details of the investigation/outcomes. As stated previously the home’s current complaints procedure needs to be updated to reflect that the Commission no longer has any statutory responsibility to investigate complaints. Any complaints received at the Commission will be referred back to the registered provider or to the local authority if they are contractually involved. As part of the inspection process inspectors will examine how the registered provider has dealt with issues and as to whether regulations are being met. On inspection of the staff training matrix it was evident that 12 care staff are without protection of vulnerable adults training and no staff have received training pertaining to challenging behaviour. On the day of the site visit the registered manager was not present at the care home upon the inspectors arrival as she was delivering protection of vulnerable adults training to staff at a `sister home` of Southern Cross Healthcare. As highlighted at a previous inspection to the home, the Commission remains concerned that the registered managers own practice is poor, yet provides training to care staff within other services. Stambridge Meadows DS0000015554.V324554.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home is decorated to a high specification. Residents live in a safe and well maintained environment. EVIDENCE: Residents live in a safe and well maintained environment. The home is well decorated and all resident’s bedrooms are personalised and individualised. Communal areas remain homely and comfortable for residents. All areas of the home were observed to be clean, tidy and odour free. Where appropriate individual residents are provided with specialist adaptations and equipment. The home has a maintenance person available throughout the week and a scheduled programme of maintenance is documented. No health and safety issues were highlighted at this site visit. Stambridge Meadows DS0000015554.V324554.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. In general terms staffing levels are being maintained. Current recruitment procedures at the home do not protect and safeguard residents. Some aspects of staff training and induction are poor and do not ensure that care staff are best equipped/have the knowledge to deal with resident’s specialist needs. EVIDENCE: On the day of the site visit inspectors were advised that there were 42 residents residing at Stambridge Meadows, with 5 resident vacancies. As a result of this reduction the registered provider has reduced staffing levels. No rationale was available to depict the registered provider’s reasoning or evidence residents dependency levels. Additionally the Commission has received few Regulation 37 Notifications, advising when staffing levels have not been maintained i.e. staff have telephoned in sick. The registered manager, was advised that on every occasion when this occurs a notification must be forwarded identifying what steps have been undertaken by the registered manager/provider to get additional staff/ensure staffing levels are appropriate to meet resident’s needs. The staff rosters indicate on some occasions, staff working in excess of 66 hours per week. The registered manager was advised that there are associated risks involved with staff working long days/excessive hours and that it is her Stambridge Meadows DS0000015554.V324554.R01.S.doc Version 5.2 Page 21 responsibility to ensure that staff, remain able and competent to meet residents needs and to deliver good care. The rosters are not maintained in a clear and accurate manner i.e. it was unclear on 25.12.06 and 26.12.06 that a RGN was available for both the late/early shifts. In addition the staff rosters do not always include the full names of staff working within the care home. The registered manager was also advised to ensure that the roster is accurate/amended at all times and depicts those staff working at the care home on any given shift. This refers specifically to the registered manager being named on the home’s roster but not present at Stambridge Meadows as a result of providing training at another care home. On inspection of 6 staff recruitment files and 3 files for `bank staff`, poor recruitment procedures were noted. The registered manager was advised that thorough recruitment procedures are essential in ensuring that residents are protected from harm and abuse. Gaps were noted in relation to incomplete application forms, inappropriate references i.e. from family and friends, employment histories in some cases not fully explored, 2 verbal references and not written references received, Criminal Record Bureau checks for two people not undertaken by Southern Cross Healthcare but by previous employers and no photograph in some cases. For some prospective employees there was no evidence of interview notes and no record of induction. With regards to one employment file (RGN), the registered manager advised that they were employed as a carer. No rationale was available to indicate why they were only employed as a care worker and not a RGN, however the roster evidenced that on one occasion they were the only qualified staff member on duty. No Nursing and Midwifery Council `pin number` was available for this member of staff. To assist the registered manager a senior carer has been promoted to the position of deputy manager (4.12.06). No evidence of induction/training to the new role was available. During the site visit the deputy manager was very cooperative and helpful and assisted both inspectors. It was evident that the deputy manager is respected and well liked by both care staff and residents. A copy of the home’s staff training matrix was provided for inspectors. The matrix indicated that 3 staff had not had manual handling training and 4 staff require refresher updated training. It was positive to note that all staff had received health and safety training. The matrix also details that 4 staff had not received food hygiene training and 8 staff require refresher training, all but 3 staff have fire awareness training and 12x staff require protection of vulnerable adults training. No evidence was available to indicate that staff had received training pertaining to infection control, care planning (confirmed by registered provider trainer that this had occurred for 8 staff in August/September 06), basic first aid/appointed first aid, medication or specialist training relating to those conditions associated with the care of older people i.e. sensory impairment, Parkinsons disease, pressure area care, nutrition etc. Stambridge Meadows DS0000015554.V324554.R01.S.doc Version 5.2 Page 22 With regards to National Vocational Qualifications (NVQs), the home has 1 qualified assessor, 5 staff have attained NVQ Level 2, 4 staff have attained NVQ Level 3, 3 staff are currently registered to undertake NVQ Level 2 and 1 staff to undertake NVQ Level 1. The home’s validation audit completed on 3.10.06 by the operations manager only looked at 2x staff personnel files. Both staff personnel files and training records scored 75 . The audit stated that both staff training records and the home’s training matrix were also cross-referenced. The monthly home audit completed by the registered manager on 30.10.06, recorded staff personnel files as attaining a score of 75 and training records scoring 100 . At this audit only 1x staff personnel file was examined and this was one that had also been inspected on 3.10.06. The monthly audit completed on 22.11.06 by the registered manager evidenced that staff personnel files scored 50 and training records scored 75 . A validation report on 19.12.06 was completed by another home manager and staff personnel files attained a score of 75 and training records scored 100 . At this audit 2 staff files were examined. It is surprising that with such percentages scored that the home’s records and systems relating to staff personnel files and training records were of a poor standard. Stambridge Meadows DS0000015554.V324554.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 36 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The calibre of management at the care home is poor and there is evidence that the registered manager continues to have a lack of understanding in relation to the requirements and recommendations as set out within the National Minimum Standards and Care Homes Regulations 2001. Staff are not appropriately supervised and supported. EVIDENCE: It is disappointing to note that many issues highlighted throughout this report have been featured at previous inspections undertaken to Stambridge Meadows and these continue to be poor with little obvious improvement. It is concerning that issues found at this site visit were not predicted through either the registered provider’s monthly validation audit or the home audit completed Stambridge Meadows DS0000015554.V324554.R01.S.doc Version 5.2 Page 24 by the registered manager and acted upon. The registered manager needs to improve her leadership/monitoring skills and to have a greater understanding of what is required of her role and the ability to control and manage the home effectively. As stated already it is evident that the information recorded within the audits do not concur with the inspectors findings at this site visit. As a result of the findings and the Commission’s continued concerns enforcement notices will be issued pertaining to care planning, staff recruitment and staff supervision. The registered manager is a qualified nurse and is currently undertaking the Registered Managers Award. This is due to complete by the end of June 2007. On inspection of staff supervision records it was evident that the majority of staff had only received 1 or 2 supervisions since January 2006. Records for December 2006 indicated that 12 supervisions were planned and completed. A staff appraisal folder was located however following discussions with the registered manager inspectors were advised that these have not been undertaken for staff. The validation audit report completed by the operations manager on 3.10.06 indicated that on inspection of three staff supervision records, 75 had been scored. The monthly home audits by the registered manager for 30.10.06 and 22.11.06 detailed a score of 100 and 50 . The validation report of 19.12.06, which was undertaken by another home manager, recorded a score of 100 . A record of staff meetings were readily available. The last staff meeting was held on 9.1.07 and `heads of department` meetings were held in May 06, June 06, July 06, October 06, November 06, with one planned for January 07. Following discussions with the registered manager, inspectors were advised that the registered provider wishes to reduce the number of residents admitted to Stambridge Meadows from 49 to 47. The registered manager was advised that an application to vary the home’s conditions of registration would need to be completed and submitted to the Commission. As required under Regulation 26 monthly reports, have been completed by the registered provider. These reports no longer have to be forwarded to the Commission, but must be available for inspection within the home. A random sample of current safety inspection certificates were available and deemed appropriate. Stambridge Meadows DS0000015554.V324554.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 3 X X X X X X 3 STAFFING Standard No Score 27 1 28 1 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 1 X X 1 X 3 Stambridge Meadows DS0000015554.V324554.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4 and 5 Requirement The registered person must ensure that the Statement of Purpose and Service Users Guide is in line with regulatory requirements and contains the most recent inspection report. Previous timescale of 1.4.06 and 1.7.06 not met. The registered person must ensure that pre admission assessments for residents are detailed and comprehensive. Assessments determine whether or not the home is suitable and can meet resident’s needs. Previous timescale of 14.2.06 and 1.6.06 not met. The registered person must ensure that appropriate consultation has been undertaken between the home, the resident and their representative as to whether or not the care home can meet the individual residents needs. The registered person must ensure that care plans are DS0000015554.V324554.R01.S.doc Timescale for action 01/04/07 2. OP3 14 01/03/07 3. OP3 14(1)(c) 01/03/07 4. OP7 15(1) 01/03/07 Stambridge Meadows Version 5.2 Page 27 detailed and comprehensive and clearly reflect how the needs of residents are to be met and residents supported. Previous timescale of 1.5.06, 21.10.06 and 1.7.06 not met. The registered person must ensure that risks to residents are identified and minimised. Previous timescale of 1.5.06, 21.10.06 and 1.6.06 not met. The registered person must ensure that healthcare records are detailed, comprehensive and include staff’s interventions and outcomes. Previous timescale of 14.2.06, 21.10.06 and 1.6.06 not met. The registered person must document information relating to pressure sores and ensure these are recorded accurately within individual care plans. Previous timescale of 1.1.06 and 1.6.06 not met. The registered person must ensure that suitable arrangements are made for the safekeeping of medicines. The registered person must ensure that those staff who administer medication to residents receive appropriate training. The registered person must ensure that the number of hours provided for activities for residents, is increased to meet demand and needs. Previous timescale of 1.8.06 not met. 11. OP12 16(2)(m) The registered person must DS0000015554.V324554.R01.S.doc 5. OP7 13(4)(c) 01/03/07 6. OP8 12(1)(a) 01/03/07 7. OP8 17(1)(a), Sch 3 01/03/07 8. OP9 13(2) 01/03/07 9. OP9 18(1)(c)& (i) 01/04/07 10. OP12 18(1)(a) 01/04/07 01/04/07 Version 5.2 Page 28 Stambridge Meadows &(n) ensure that activities are provided for those residents who have complex needs. Previous timescale of 1.6.06 and 1.12.06 not met. The registered person must 01/04/07 ensure that any complaint is fully investigated. Previous timescale of 1.3.06, 1.6.06 and 21.10.06 not met. The registered person must ensure that staff working within the care home receive training relating to protection of vulnerable adults and challenging behaviour. Previous timescale of 1.7.06, 1.9.06 and 1.1.07 not met. The registered person must ensure that sufficient numbers of staff are on duty at all times. This refers to staffing levels not always being maintained. Previous timescale of 14.10.05, 1.3.06, 1.6.06 and 21.10.06 not met. The registered person must ensure that Regulation 37 notifications are forwarded to CSCI when staffing levels are reduced. The registered person must ensure that the full names of staff are recorded on the staff roster and that it is maintained accurately reflecting all staff on duty on any given day. The registered person must ensure that robust recruitment procedures are adopted and all records as required by regulation are sought. Previous timescale of 1.1.06 and 12. OP16 22 13. OP18 13(6) 01/06/07 14. OP27 18(1)(a) 01/03/07 15. OP27 37(1)(c) 01/03/07 16. OP27 17(2), Sch 4(7) 01/03/07 17. OP29 17(2)&19 01/03/07 Stambridge Meadows DS0000015554.V324554.R01.S.doc Version 5.2 Page 29 18. OP30 18(1)(c)& (i) 14.2.06 not met. The registered person must ensure that all staff receive appropriate training to the work they perform. This refers to both mandatory and specialist training. Previous timescale of 1.7.06 and 1.1.07 not met. The registered person must ensure that the manager of the home is competent and skilled to carry on the role of manager. Previous timescale of 1.3.06 not met. The registered person must ensure that all staff are appropriately supervised. The National Minimum Standard is for all staff to receive formal supervision at least 6 times a year. Previous timescale of 1.1.06 not met. 01/06/07 19. OP31 10(1) 01/03/07 20. OP36 18(2) 01/03/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP7 OP8 OP8 OP9 Good Practice Recommendations Daily care records should record staff’s interventions and outcomes for residents. Nutritional records and `turn charts` should be completed consistently and in line with individual resident’s care plans. Resident’s accident records should detail staff interventions/care provided. The list of those staff deemed competent to administer medication to residents needs to be reviewed and DS0000015554.V324554.R01.S.doc Version 5.2 Page 30 Stambridge Meadows 5. 6. 7. OP27 OP28 OP30 updated. Staff working at the care home should not be working excessive hours. 50 of care staff should achieve NVQ Level 2 or equivalent. All newly appointed staff should receive a detailed induction according to their qualifications and previous experience. Stambridge Meadows DS0000015554.V324554.R01.S.doc Version 5.2 Page 31 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. Extracts may not be used or reproduced without the express permission of CSCI Stambridge Meadows DS0000015554.V324554.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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