Inspection on 23/08/07 for Stambridge Meadows

This inspection was carried out on 23rd August 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.

Other inspections for this house

Stambridge Meadows 01/04/10

Stambridge Meadows 05/10/09

Stambridge Meadows 16/04/09

Stambridge Meadows 09/10/08

Stambridge Meadows 04/05/08

Stambridge Meadows 09/01/08

Stambridge Meadows 15/01/07

Stambridge Meadows 03/05/06

Stambridge Meadows 31/01/06

Stambridge Meadows 28/09/05

Stambridge Meadows 01/06/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Stambridge Meadows Stambridge Road Great Stambridge Rochford Essex SS4 2AR Lead Inspector Michelle Love Unannounced Inspection 08:00 23 August 2007 rd 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.V345044.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.V345044.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 Vacant Post 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.V345044.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 15th January 2007 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 range of fees as provided by the home’s administrator are £630.00 for those residents receiving residential care in a bedroom without en-suite facilities, £680.00 for those residents receiving residential care in a bedroom with en-suite facilities, £650.00 to £750.00 for those residents receiving nursing care. A shared bedroom without en-suite facilities is £525.00 per week per person and with en-suite facilities is £550.00 per week per person. A large room is charged at £695.00 per week and a large room with en-suite facilities is charged at £800.00 per week. 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. Stambridge Meadows DS0000015554.V345044.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection was undertaken by Michelle Love, Regulation Inspector, over a period of approximately 10.5 hours. The inspection was conducted with the homes newly appointed manager and with the assistance of an Operation Manager from Southern Cross Healthcare. As part of the process a number of records relating to individual residents and care staff were examined e.g. care plans, risk assessments, healthcare records, staff employment files, staff training records, staff supervision records etc. Additionally the homes medication systems were observed and records reviewed. A tour of the premises was undertaken throughout the day. During the visit eight residents and seven members of staff were spoken with. Following the inspection 18 relatives surveys were forwarded to seek peoples’ views and it was positive to note that 10 surveys were completed and returned to the Commission for Social Care Inspection. Comments from these surveys are documented throughout the main text of the report. Since the last key inspection (15.1.07) the home has been subject to Statutory Requirement Notices being issued on the 21st and 23rd March 2007, pertaining to care planning, the healthcare needs of individual resident’s recorded accurately and in line with assessed needs, staff recruited in line with regulatory requirements, staff training deficits and ensuring that a training programme was arranged and implemented. Additional visits to Stambridge Meadows were undertaken on 24th April and 30th May 2007 to check compliance to the Statutory Requirement Notices issued. As a result of failure to comply with one notice a representative of Southern Cross Healthcare was requested to attend a formal interview with the Commission for Social Care Inspection. Details of the reports of 24th April and 30th May 2007 are available upon request by contacting the Southend office of the Commission for Social Care Inspection on 01702 236010. Only 6 of the 20 standards assessed were fully met, and 15 statutory requirements and 7 recommendations have been made as a result of this inspection. In addition, a serious concern letter was forwarded to the registered provider in relation to the homes poor and unsafe medication procedures and practices. An Immediate Requirement Notice was issued as a result of inadequate and poor staffing levels. As a result of the home’s continued failure to meet regulatory requirements, the home will be subject to further inspections. Stambridge Meadows DS0000015554.V345044.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: There continues to be little evidence to suggest that residents are enabled to actively participate and communicate their views to the development of their care plans or their review. The registered provider does not appear to understand the importance of involving residents in all aspects of their care. Additionally care staff do not appear to understand the concept of person centred care and the importance of delivering care in line with people’s individual care needs and the impact this has if not carried out. Procedures for the safe management of medication were poor and of concern. This referred specifically to poor record keeping, some residents not receiving their prescribed medication and one safeguarding issue. This places residents at serious and unnecessary risk. Stambridge Meadows DS0000015554.V345044.R01.S.doc Version 5.2 Page 7 Although the home has a varied activity programme, the needs of those people with poor communication, poor cognitive development and who are immobile remains limited. Additionally some residents felt isolated as a result of care staff not being able to spend `quality` time with them and completing routine tasks. Inadequate staffing levels at the home continue to be prevalent. This has a major impact on actual care delivery to residents and the needs of some residents were seen to be blatantly ignored. Better staff training is required for those conditions primarily associated with the needs of older people. Many of the requirements made as a result of this inspection had been made at previous inspections. The continued breach of these conditions casts doubt as to the registered provider’s ability and commitment to meet regulatory requirements and recommendations. 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.V345044.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.V345044.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): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a good system for assessing the needs of people prior to their admission to the care home. EVIDENCE: The home has a formal assessment process for assessing the needs of prospective residents prior to their admission to the care home. On inspection of pre admission assessments for the two newest people, documentation was observed to be informative and detailed. In addition to the assessments undertaken by the home, information had been sought from placing authorities and/or hospitals. Although assessments were seen as satisfactory, there was no evidence to indicate that the assessment process had included the prospective resident Stambridge Meadows DS0000015554.V345044.R01.S.doc Version 5.2 Page 10 and/or their representative, or that they had been offered an opportunity to visit the care home. No evidence was available to confirm the registered provider had formally written to the resident and/or their representative to confirm it could meet the needs of the prospective person. The action plan from the registered provider, forwarded to the Commission dated 29th June 2007 stated that residents/representatives would be consulted and written confirmation detailing that individual’s needs could be met would be undertaken. The home does not provide intermediate care. Stambridge Meadows DS0000015554.V345044.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 and 10 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 resident’s health, social and personal care needs. Care plans that are in place require further development as some aspects are generic and actual care delivery is not always in line with people’s care needs or documentation. The home’s medication procedures and record keeping are poor and do not safeguard those people who live at the care home. EVIDENCE: At this inspection four care plans were examined. All four people were observed to have a plan of care and there was some evidence to suggest that minor improvements had been made following the last inspection. As part of the care planning process formal assessments relating to dependency, moving and handling, continence, nutrition, pressure ulcer risk assessment and falls were completed within each care plan. Stambridge Meadows DS0000015554.V345044.R01.S.doc Version 5.2 Page 12 It remains disappointing and of concern that issues relating to the home’s care planning processes as highlighted 31.1.06, 3.5.06, 20.9.06 and 15.1.07 have not made significant progress. This refers specifically to some areas of documentation remaining generic, not person centred and actual delivery of care not being provided by care staff in line with individuals care needs/care plans. Individual people’s personal preferences, likes and dislikes were not detailed, specific illnesses i.e. Parkinson’s disease/confusion/poor communication did not record how this impacts on the individual and their daily living skills. The care plan for one person detailed they had very poor mobility, had poor nutritional intake/swallowing reflex and a pressure sore to their sacrum. As a result of their condition the care plan recorded they required two hourly positional changes when in bed and required a soft food diet, assistance with feeding and to be weighed weekly, supplements to be given and food/fluid charts to be maintained. Evidence indicated that the resident was not weighed weekly and on inspection of `fluid/intake` and `nutritional` records these were completed inconsistently and in some cases left blank. This is unacceptable and shows a complete lack of regard for the resident’s health and wellbeing. This was not an isolated case and gaps were noted for other residents. The care plan for the above person pertaining to Parkinson’s disease stated “ educate ……… about their diagnosis”. This was seen as very poor recording and from discussions with staff and the resident’s relative, the inspector was advised that the resident would have very limited understanding of their condition. The care plan for another resident stated that they were at high risk of further falls. Daily care records indicated that they sustained a fall on 2.8.07, however a falls diary was not commenced until 21.8.07. It was unclear as to why this was not commenced sooner in line with the homes own policy. Risk assessments were not devised for all areas of assessed risk. For example this refers specifically to one care plan recording the resident as being diabetic yet no care plan was devised. Another care plan detailed that the resident required oxygen, no risk assessment was devised. Comments from relatives surveys were mixed and included “I am not satisfied that some needs are properly addressed and under review and am constantly having to raise issues” and “I am not always kept informed regarding doctor visits and other appointments and have to ask for news. One carer who was excellent at keeping us informed has recently left”. On a positive note comments stated, “staff are very good and kind”, “as we are not at the home 24 hrs we obviously are not aware of all they do or do not do during the day. Our relative seems well looked after but because of their condition is unable to tell us of anything that may not be right” and “staff always willing to talk about Stambridge Meadows DS0000015554.V345044.R01.S.doc Version 5.2 Page 13 any issue. Treat residents with respect and warmth and concerned that they look their best”. A number of surveys made reference to a lack of communication on occasions between staff and relatives pertaining to healthcare needs of individual residents. The homes action plan following the unannounced visit to Stambridge Meadows on 30th April 2007 detailed there would be a “rolling programme of review” for care planning/risk assessments and these would be reviewed and up dated to ensure that they reflected current concerns. The dates for compliance were recorded as 1.7.07. Two surveys forwarded to the Commission for Social Care Inspection made reference to the withdrawal of private telephones from individual resident’s rooms as a result of a recent upgrade to the homes telephone system. Concern from relatives is that members of their family will be unable to contact them from the privacy of their room and that staff will not always be able to assist individual people to make telephone calls. The home’s storage facilities for medication were observed to be secure and satisfactory. However a number of serious concerns pertaining to medication were highlighted at this inspection and relate to the following: • On inspection of Medicine Administration Records (MAR), several gaps in the records were observed whereby staff had not signed to indicate that medication had been administered to and received by individual residents. On MAR records on many occasions `N` was recorded (not required/PRN), however actual medication was not prescribed as PRN and both qualified and residential care staff are making decisions as to when this is administered to individual residents. No evidence was available to indicate staff had contacted individual resident’s GP to discuss issues. Some residents were noted to not receive their prescribed medication as a result of the dispensing pharmacy being unable to supply certain medications or if the resident was asleep. Systems for obtaining some medications have been poor resulting in some people not having their prescribed medications. The care plan for one resident detailed they were at risk of “malnutrition and reduced appetite”. The care plan further details the person has difficulty chewing and/or swallowing and a food and fluid chart is to be maintained and supplements to be given. The care plan did not include details of the actual food supplements to be administered/prescribed, frequency of food supplements to be administered or that advice had been sought from other healthcare professionals. On inspection of food intake DS0000015554.V345044.R01.S.doc Version 5.2 Page 14 • • • Stambridge Meadows • • charts there was clear evidence to suggest that supplements are being given at staff’s discretion. One resident advised of their concerns pertaining to their wife and the way in which medication is administered. The resident stated that his wife receives several medications in one go and that often all five tablets are administered on a teaspoon, which he feels could be detrimental and dangerous as his wife has a poor swallowing ability. On the day of inspection medication was observed in the morning to commence at 10.00 a.m. and not finish until 12.15 p.m. Lunchtime medication commenced at 2.00 p.m. and completed at 2.25 p.m. The qualified person administering medication advised the inspector that the specific times of the day when the medicine `round` is undertaken had recently been altered and advice/permission granted by the GP. No evidence was available within the home to confirm this agreement. Additionally the time span between the morning medication and lunchtime medication `round` was observed to be short and could result with some residents being `overdosed`. As a result of the issues as highlighted above, a serious concern letter was forwarded to the registered provider requesting a response identifying action to be taken to address the shortfalls. Other issues, which require addressing, include no PRN (as and when required medication) protocols for individual residents being available. The care plan for one resident detailed they received oxygen. The care plan was basic and did not include information relating to when it is required or the frequency and there was no risk assessment. Areas of good practice included appropriate storage facilities and record keeping for controlled drugs. One resident was observed to administer their medication on a daily basis and on inspection of the resident’s care file a risk assessment was completed to indicate that the resident had been assessed as to their competency to complete this task independently. The resident was able to confirm with the inspector details of their medication and evidence appropriate and safe storage facilities within the confines of their room. The homes training statistics/training matrix indicated 83 of staff have received training relating to Safe Handling of Medicines and this was undertaken on 9.5.07. Stambridge Meadows DS0000015554.V345044.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 adequate. This judgement has been made using available evidence including a visit to this service. Not all residents who use the service are given the opportunity to take part in a variety of activities. Meals provided to residents are varied and nutritional. EVIDENCE: The home has an activities co-ordinator employed at the care home for 30 hours per week. An activity programme for the month is displayed within the main reception area for all to see. The registered provider should consider devising this in another format e.g. large print and/or pictorial so as to enable those people who have poor communication/cognitive development to make an informed choice. The activities diary and programme details activities available to residents include church service, bingo, board games (scrabble, draughts and Stambridge Meadows DS0000015554.V345044.R01.S.doc Version 5.2 Page 16 dominoes), art and craft club, coffee and magazines, watching films, listening to music and external community visits. Residents spoken with advised that they have the option to participate/not participate within the homes activity programme, with some residents choosing to spend time in the privacy of their room or some residents being unable to participate as a result of their complex needs. One resident who is mentally alert and who has good communication skills, voiced their sadness with the lack of staff interaction afforded to them. It remains unclear as to what activities and/or meaningful occupation are given to those people who have complex needs (poor communication and cognitive development). This remains outstanding from previous inspections to the home. The homes action plan detailed “the manager will ensure that those residents with complex needs have a care plan that identifies specific needs and wishes. The manager will ensure that links are established with appropriate support groups to meet individual needs”. No evidence to support this statement was available at the time of the inspection. The home continues to operate a 4 week rolling menu, which offers choice and a varied diet. In addition to the planned menu, residents are able to have alternatives e.g. omelette, soup, sandwiches, jacket potatoes etc. Meals provided to residents continue to be plentiful and of a good quality. Residents spoken with were complimentary regarding food provided. Those residents who require assistance from staff to eat their meals were supported sensitively and meals were not rushed. The home’s chef has a very good understanding of current residents needs and personal preferences and has a good rapport with residents at Stambridge Meadows. Stambridge Meadows DS0000015554.V345044.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 adequate. This judgement has been made using available evidence including a visit to this service. The home has appropriate procedures for safeguarding people who live at the care home. Further training in the area of safeguarding and challenging behaviour is required. EVIDENCE: The homes complaints procedure was displayed in the main reception area. The manager and operations manager were advised this still needs to be amended to reflect that the Commission for Social Care Inspection no longer has any statutory responsibility to investigate complaints. Additionally the procedure still makes reference to staff who no longer work at Stambridge Meadows. Since the last inspection (15.1.07) the home has received 8 complaints. It was positive to note that information relating to the area of complaint, investigation and action taken had been recorded. One Safeguarding issue was highlighted following the last inspection. This was referred to the local authority and dealt with satisfactorily. At this inspection one safeguarding issue was highlighted in relation to one person’s medication. The operation manager advised that a safeguarding referral would be forwarded to the local authority with immediate affect. Stambridge Meadows DS0000015554.V345044.R01.S.doc Version 5.2 Page 18 On inspection of the staff training matrix/training statistics it was evident that 76 of staff have attained Safeguarding training in January and April 07. Despite being highlighted at previous inspections, no members of staff have received training relating to challenging behaviour. Stambridge Meadows DS0000015554.V345044.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 good. This judgement has been made using available evidence including a visit to this service. The home is decorated to a high standard. The home environment is appropriate for the needs of those people who reside at Stambridge Meadows. EVIDENCE: The home environment is safe, comfortable and homely for residents. The home remains pleasantly decorated and all resident’s bedrooms are personalised and individualised. Communal areas remain comfortable for residents and these are accessed throughout the day. One relative survey recorded “spotlessly clean, welcoming atmosphere and pleasant airy surroundings”. No health and safety issues were highlighted at this site visit. Stambridge Meadows DS0000015554.V345044.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. Staffing levels do not meet the needs of those people who use the service. Staff recruitment procedures do not protect and safeguard residents. Some elements relating to training and induction remain poor. EVIDENCE: The inspector was advised that staffing levels at the care home are 7 staff between 8.00 a.m. and 2.00 p.m., 5-6 members of staff between 2.00 p.m. and 8.00 p.m. and 4 members of staff between 8.00 p.m. and 8.00 a.m. each day. On inspection of four weeks staff rosters for the period 30.7.07 to 23.8.07 inclusive, evidence suggested that staffing levels are not regularly maintained in line with the above figures and shortfalls do not meet the needs of those people who reside at the care home, compromising their health and wellbeing. Staff rosters do not always clearly define who was scheduled to work throughout the day or night. The rosters currently evidence a high reliance on Stambridge Meadows DS0000015554.V345044.R01.S.doc Version 5.2 Page 21 agency staff, with some staff already working within the care home completing additional shifts. The majority of staff working at the care home regularly complete 12 hour shifts. The inspector was advised that currently there are staff vacancies for 1 full time RGN (Registered General Nurse) and 3 full time waking night members of care staff. Since the last inspection the Commission for Social Care Inspection has received a high number of Regulation 37 Notifications identifying staffing shortfalls. Within the home there was no information to confirm what measures had been undertaken by staff to deploy staff to the care home on any given shift. Following the last inspection there was one occasion whereby there was 1 senior member of staff and 2 members of agency staff on duty throughout the night. The Commission for Social Care Inspection wrote to the registered provider requesting additional information, however it was concerning and disappointing to note that not all information as requested was forwarded by the Operations Director at that time to the Commission and information did not tally with information provided by the external agency. At this inspection, evidence suggested inadequate staffing levels are having a detrimental affect on individual residents wellbeing and the delivery of person centred care. This refers specifically to call alarm bells not answered promptly, the main lounge area left unsupervised for a timed period of 20 minutes (5 residents present), residents not regularly toileted, residents not being regularly `turned` or receiving sufficient fluid/nutritional intake as per their care plan, fluids not actively encouraged throughout the day of inspection, staff unable to spend quality time with residents and rigid routines within the home. An Immediate Requirement Notice was issued at the time of the inspection. Comments from relatives surveys recorded “ The level of staff turnover is now high with reliance on agency staff to fill gaps”, “The stern regime and use of so many agency staff is proving costly to the ethos of the home”, “more staff, those that work at the residential care home are caring and good natured, but they have many pressures on their time; and with the best will in the world do not have masses of time for individual residents” and “at weekends there appears to be a lack of staff”. Another survey detailed, “The home needs to manage staff better, work towards permanent staffing and reduce the need for agency support”. The manager advised the inspector that since the last inspection only one new member of staff has been newly employed. The majority of records as required by regulation had been sought, however both the manager and operation manager were advised of a discrepancy detailed within the applicants application form pertaining to their last place of employment and the subsequent written reference received. No record of induction was available for this person. Stambridge Meadows DS0000015554.V345044.R01.S.doc Version 5.2 Page 22 The manager’s file was also requested. This was unavailable and initially no pro-forma detailing the manager’s employment checks was available, however a copy was faxed to the home from head office. Both the manager and project manager were advised that the pro-forma does not comply with regulatory requirements and to comply with Schedule 4 of the Care Homes Regulations, the following relevant details must be recorded. This refers specifically to the manager’s qualifications, experience, date they commenced employment, date they ceased employment at the home, job title, summary of experience, contracted hours, personnel issues held centrally (grievance, disciplinary action, medical issues etc), details of references received, verification that a CRB/POVA 1st was received and the type of disclosure/reference number, proof of identity and type, details of any registration with a professional body, full employment history with gaps satisfactorily explained, verification as to why previous employment was left and verification that proof of qualifications has been seen. Over recent weeks the majority of agency staff utilised at the care home have been staff who have worked at the home on previous occasions. No agency staff profiles were available for two new members of staff deployed to the care home over the past four weeks. Only one induction had been completed for one of the agency members of staff. This has been highlighted at previous inspections to the care home and remains outstanding. The homes training statistics/training matrix evidences staff have received a lot of training since the last key inspection. Records indicate 81 of staff have received fire safety, 79 have received food hygiene, 76 manual handling, 50 COSHH (Control of Substances Hazardous to Health), 76 safeguarding, 50 health and safety, 60 infection control and all care/senior staff have received training relating to care planning and 8 members of staff had received first aid training. Little evidence was available to indicate that staff have received training relating to those conditions associated with older people e.g. pressure area care, continence, sensory impairment, nutrition etc. This remains outstanding from previous inspections to the care home. Records indicate 2 staff had attained NVQ Level 2 and 1 member of staff has attained NVQ Level 3. Currently 11 members of staff are undertaking NVQ Level 2 and 1 member of staff is undertaking NVQ Level 3. Stambridge Meadows DS0000015554.V345044.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, 33 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is qualified and has the necessary skills to run the care home, however they have only been employed for a short time and have as yet to prove themselves. EVIDENCE: The manager has been in post for only six weeks. Following discussions with the manager, the inspector was advised that she has worked with older people since 1990 and within a variety of medical and residential settings. The manager is a qualified RGN, has attained a Degree in Health and Social Care and is currently completing a Master’s Degree in Health and Social Care. Additionally the manager has completed a teaching and assessors course in Stambridge Meadows DS0000015554.V345044.R01.S.doc Version 5.2 Page 24 clinical settings, diabetes, nursing of the elderly and a Diploma in Management. The Commission recognises that the manager has only been in post for the past 6 weeks and although she has made some impact and changes to processes within the home, realistically requires time and support from the registered provider to address previous identified requirements and recommendations. Comments from staff in relation to the management of the home were mixed with both positive and negative comments. One relative’s survey recorded “The new manager seems to be a strong character with clear well meant objectives but she does not seem to be comfortable dealing with the residents” and “Staff morale seems to be very low. The new manager has introduced a stricter regime but seemingly at the price of losing key experienced and excellent carers”. On inspection of a random sample of supervision records, it was evident that not all staff had received formal supervision in line with regulatory requirements and recommendations, however improvement was noted. Since the manager has been newly employed it was positive to note that in addition to the home’s formal supervision format, `practice observations` have also been undertaken for some people. Records of staff meetings were readily available. It was positive to note that some issues highlighted at this inspection, had been picked up by the manager. This refers specifically to staff shortages, call alarm bells not being answered promptly, some residents not being toileted promptly and poor manual handling practices by some staff. Regulation 26 visits are undertaken regularly and a report compiled and readily available. Stambridge Meadows DS0000015554.V345044.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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 1 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X 2 X X Stambridge Meadows DS0000015554.V345044.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. 2. OP3 14(1)(c) Not inspected on this occasion. 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. Previous timescale of 1.7.07 not met. The registered person must ensure that care plans are detailed and comprehensive and clearly reflect how the needs of residents are to be met and residents supported. Previous timescale of 1.5.06, Stambridge Meadows DS0000015554.V345044.R01.S.doc Version 5.2 Page 27 Timescale for action 01/11/07 01/10/07 3. OP7 15(1) 01/10/07 4. OP7 13(4) 5. OP8 12(1)(a) 21.10.06, 1.7.06 and 1.7.07 not met. The registered person must ensure that risk assessments are devised for all areas of assessed risk and there are clear guidelines depicting how these are to be minimised. The registered person must ensure that healthcare records are detailed, comprehensive and include staff’s interventions. Previous timescale of 14.2.06, 21.10.06, 1.6.06, 1.3.07 and 1.7.07 not met. The registered person must ensure that prescribed medication is recorded and administered safely and appropriately. Residents must be given medication in accordance with the prescriber’s instructions. The registered person must ensure that activities are provided for those residents who have complex needs e.g. poor communication and/or cognitive development. 01/10/07 01/10/07 6. OP9 13(2) 24/08/07 7. 8. OP9 OP12 12(1) 16(2)(m) &(n) 24/08/07 01/11/07 9. OP18 13(6) 10. OP27 18(1)(a) Previous timescale of 1.6.06, 1.12.06 and 1.7.07 not met. The registered person must 01/01/08 ensure that all staff receive training pertaining to safeguarding and senior and care staff receive training relating to managing challenging behaviour effectively. The registered person must 24/08/07 ensure that sufficient numbers of staff are on duty at all times. This refers to staffing levels not always being maintained to meet resident’s needs. Previous timescale of 14.10.05, Stambridge Meadows DS0000015554.V345044.R01.S.doc Version 5.2 Page 28 11. OP27 37(1)(c) 1.3.06, 1.6.06, 21.10.06 and 21.6.07 not met. The registered person must ensure that Regulation 37 notifications are forwarded to CSCI when staffing levels are reduced and these clearly demonstrate what action has been undertaken to address the shortfalls and to meet residents needs. Previous timescale of 21.6.07 not met. 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/shift. Previous timescale of 21.6.07 not met. The registered person must ensure that robust recruitment procedures are adopted and all records as required by regulation are sought. This refers specifically to the manager and to agency staff deployed to work within the care home. Previous timescale of 1.1.06, 14.2.06 and 21.6.07 not met. The registered person must ensure that all staff receive appropriate training to the work they perform. This refers specifically to training courses for those conditions associated with the needs of older people. Previous timescale of 1.7.06, 1.1.07, 21.5.07 and 1.8.07 not met. The registered person must ensure that all staff are appropriately supervised. The DS0000015554.V345044.R01.S.doc 01/10/07 12. OP27 17(2), Sch 4(7) 01/10/07 13. OP29 17(2)&19 07/10/07 14. OP30 18(1)(c)& (i) 01/01/08 15. OP36 18(2) 01/11/07 Stambridge Meadows Version 5.2 Page 29 National Minimum Standard is for all staff to receive formal supervision at least 6 times a year. Previous timescale of 1.1.06 and 1.7.07 not met. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations Daily care records should record how residents spend their day, staff’s interventions and outcomes for residents. This is a repeat recommendation. Nutritional records and `turn charts` should be completed consistently and in line with individual resident’s care plans. This is a repeat recommendation. PRN (as and when required medication) protocols should be devised. Consider reviewing the activity programme format e.g. larger print and pictorial. The complaints procedure should be amended to reflect that the Commission for Social Care Inspection no longer investigates complaints. Staff working at the care home should not be working excessive hours. This is a repeat recommendation. 50 of care staff should achieve NVQ Level 2 or equivalent. 2. OP8 3. 4. 5. 6. OP9 OP12 OP16 OP27 7. OP28 Stambridge Meadows DS0000015554.V345044.R01.S.doc Version 5.2 Page 30 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.V345044.R01.S.doc Version 5.2 Page 31 - 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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