Inspection on 31/08/06 for Stanwell Rest Home

This inspection was carried out on 31st August 2006.

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

Stanwell Rest Home 25/03/08

Stanwell Rest Home 27/09/07

Stanwell Rest Home 18/04/07

Stanwell Rest Home 25/01/06

Stanwell Rest Home 26/01/05

Stanwell Rest Home 07/07/04

Stanwell Rest Home 09/03/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Stanwell Rest Home 72/76 Shirley Avenue Southampton Hampshire SO15 5NJ Lead Inspector Christine Hemmens Unannounced Inspection 31st August 2006 10:00a 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 Stanwell Rest Home DS0000012167.V312087.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. Stanwell Rest Home DS0000012167.V312087.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stanwell Rest Home Address 72/76 Shirley Avenue Southampton Hampshire SO15 5NJ 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) 023 8077 5942 Stanwell Rest Home Limited Mrs Margaret Haug Care Home 34 Category(ies) of Dementia - over 65 years of age (26), Mental registration, with number disorder, excluding learning disability or of places dementia (26), Mental Disorder, excluding learning disability or dementia - over 65 years of age (26), Old age, not falling within any other category (34) Stanwell Rest Home DS0000012167.V312087.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service Users in category MD not to be admitted under 55 years of age. The eight service users to be accommodated in the separate apartments must be in the category of OP and in need of personal care only. The apartments may only be used by service users whose assessed needs can be met within that environment. 25th January 2006 Date of last inspection Brief Description of the Service: Stanwell Rest Home is a care home that is registered to provide personal care and accommodation for a maximum of thirty-four older people. The home is situated in a residential area of Southampton close to Shirley shopping centre and within easy access of public transport. Accommodation is split between two buildings. Twenty-six residents may be accommodated within the main building. This building consists of three former residential properties that are linked internally. Accommodation is spread over two floors. Eight further residents who only require assistance with personal care needs can be accommodated in self-contained apartments situated at the rear of the main property. Stanwell Rest Home DS0000012167.V312087.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and undertaken over two days. Two inspectors visited the home on the first day, and a second visit was made on 8th September 2006 by the pharmacy inspector and the lead inspector, in order to follow up immediate requirements and concerns raised on the first day. During the visit the inspector met with residents and relatives and staff. In addition the inspectors received comment cards from relatives and from general practitioners. Prior to visiting the home the Commission for Social Care Inspection had received two complaints in respect of the care of two of the residents. These were referred social services under the local Adult Protection Procedures. It was agreed that the areas of concern would be reviewed through the inspection process. The findings of the first visit were reported back to the adult protection team. Four immediate requirements were issued following the first visit to the home on the 31st August and a further four issued by the pharmacy inspector following the second visit on the 8th September 2006. During the second visit the previous immediate requirements were reviewed and it was established that only one was met and decision will be made if further action will be taken. This is a service where there are significant concerns for the health, welfare and safety of the residents. What the service does well: The home does well to provide an environment where the residents and their relatives feel that it is homely, friendly, and where the staff and the manager are very nice. This was reflected in the comment cards received by the inspectors from relatives on behalf of the resident. Some of the comments received were: • “My dad and I went to look around Stanwell we were very impressed with what we saw”. “All the staff are really friendly and look after mum really well, very nice, clean and comfortable”. “If we need to ask them anything about our father the staff do listen and act on what we say”. DS0000012167.V312087.R01.S.doc Version 5.2 Page 6 • • Stanwell Rest Home • • • • • • • • • “There is always someone to ask if you have a problem”. “There is always someone around to talk to and keep an eye on things”. “The staff are always very cheerful and helpful, I ring up every morning and they are always very nice”. “Staff are very sensible about calling the GP etc or use their initiative if a GP refuses to call”. “My mother is encouraged to join in activities, she enjoys going to the seaside in the van”. “I have never been unhappy about mum’s care”. “I never had to complain, but I would go to Mr Conway first”. “My mum seems to be happy at Stanwell, if she wasn’t I would know about it”. “They never know in advance when I am coming and mums room is always clean and tidy with fresh towels”. These comments demonstrate the home is doing its best to make the residents feel comfortable and happy. Staff feel they are well supported and they are encouraged to undertake a national vocational qualification (NVQ). What has improved since the last inspection? What they could do better: Comments made by relatives and residents have been taken into account in making judgements about the service. However standards at the home are of significant concern to CSCI. Improvement is required in assessing residents both prior to admission to Stanwell and when their needs change. This will ensure that the home can fully Stanwell Rest Home DS0000012167.V312087.R01.S.doc Version 5.2 Page 7 meet their needs and determine whether there are sufficient staff who are appropriately trained. The ethos of the home is task orientated and does not address the residents as individuals with specific needs. A person centred approach should be developed for care planning. Changing needs must be documented and where professional advice and assistance is required this should be obtained without delay. Concerns regarding the fluid and nutritional needs of the most frail residents were of a great concern, the manager had not considered seeking advice from a dietician. Information provided in the care plans is very limited and does not inform the staff how to appropriately and specifically care for the residents. A comment made by a member of staff was “ If there is anything I could change about the home it would be the information held in the care plans and have them in the residents rooms”. The plans lack photographs and a clear valuing description, this is especially important for those residents who try to leave the home unescorted and place themselves at risk by doing so. Risk assessments should be undertaken for all residents and subsequent action taken to minimise assessed risks. Staff practice in relation to medication is very poor, and of particular concern, including receipt, handling and administration. The CSCI pharmacy inspector undertook a full audit of the medication procedures and issued four immediate requirements. The current practice places the residents at risk of harm. The home is especially advised to address the area of dementia to ensure it is fully meeting their unique behaviours, communication, orientation around the home and to develop and an understanding of how and why the resident may present in the way that they do. Wandering residents were repeatedly told or assisted to sit down without finding out what they wanted. The manager gave a very good example the behaviour of a resident who liked to take things apart he was a civil engineer, however the manager was not able to develop ways in which this behaviour might be channelled appropriately. The home could do better to ensure residents are truly provided with choices and are supported in what ever way is required to assist the residents to understand the choices being offered to them. The residents are not provided with information about what is on the menu until the day, there was little evidence that residents can spend their day as they wish and join in activities of their choosing. The manager informed the inspectors that she prefers residents to come down from their rooms so that she knows where they are. The inspectors observed three ladies being abruptly told to go back to their lounge when they said they were fed up with looking at the same four walls. Stanwell Rest Home DS0000012167.V312087.R01.S.doc Version 5.2 Page 8 The home could do better to provide an environment where residents are protected from potential risk of harm, residents are being placed at risk by poor recruitment procedures, poor medication procedures, poor assessments and care planning, poor deployment of staff and the layout and safety of the environment. The manager in particular must familiarise herself with the local policy and procedures on protecting vulnerable adults. The home could do better provide an environment that meets the needs of residents with dementia. The number of corridors, busy patterned carpets, lack of direction and signage cause confusion and do not allow the residents to maintain their independence. There was an unpleasant odour in parts of the home, which must be addressed. The manager must ensure staff are wearing appropriate clothing and can work safely, such as removing excessive jewellery and keeping fingernails to a reasonable length to avoid injury to the residents. One relative commented: • “It’s very difficult to keep on top of cleaning toilets etc. They can get messy especially by the evening” Staffing levels must be reviewed to ensure the needs of the residents are met, a comment received by relatives reflects this: • “Stanwell retains a large number of staff over many years, they work well together in often trying and difficult situations. The number of needy residents has increased and with three separate houses it seems difficult to know where all the residents are. This is very hard work by the evening as many residents are confused and wandering from room to room”. “There are not enough staff in the morning or early evening, only 2 on and in a crisis this is not enough”. • The inspectors further evidenced this on the day of the inspection when in a half hour period the inspectors observed residents placing themselves at risk and being placed at risk by the lack of supervision and observation from staff. The home must improve its recruitment procedures. The home was issued with an immediate requirement in January 2006 in respect of poor recruitment practices and were informed then of what they were required to do when recruiting in the future. On this occasion it was found that one new member of staff had been employed without taking out the appropriate checks. Further action will be considered in respect of this. The performance of the manager was of a concern to the residents; although friendly and approachable the manager did not appear to be aware of her role and responsibilities as a registered manager. Her terminology, lack of respect Stanwell Rest Home DS0000012167.V312087.R01.S.doc Version 5.2 Page 9 shown to residents, awareness of adult protection and her poor medication procedures were all of concern. The home could do better to actively seek the views of the residents in order to quality monitor and develop the performance of the home. The home could to better to risk assess environmental factors that could pose a potential risk to the residents such as appropriately storing COSHH substances, making windows safe and ensuring residents who share a room are compatible and safe. 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. Stanwell Rest Home DS0000012167.V312087.R01.S.doc Version 5.2 Page 10 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 Stanwell Rest Home DS0000012167.V312087.R01.S.doc Version 5.2 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to this service. The home fails to obtain suffient information on prospective residents to establish if they can fully meet their need. The home does not provide intermediate care. EVIDENCE: Following the previous visit to the home undertaken in January 2006 the home was issued with two requirements in respect of assessment. The manager was required to undertake full assessments and obtain a care management assessment prior to admitting the prospective residents into the home, and to keep a record of these. The inspectors viewed the assessment of one resident who has been admitted since January 2006. There was evidence to demonstrate that the registered manager Mrs Haug had undertaken an assessment using a pro forma that she Stanwell Rest Home DS0000012167.V312087.R01.S.doc Version 5.2 Page 12 has developed. This was very basic and provided very little detailed information about the resident on which to assess whether the needs can be met at the home. The manager continues to fail to obtain assessments from care managers and appeared apathetic about the process stating that Social Services will not send them. The experience of the inspectors is that this is not the case. Mrs Haug informed the inspectors that you do not always get a true picture of how someone is until they come in the home, the inspectors agreed that this is sometimes the case but emphasised how important it is then to undertake a thorough assessment, and obtain information from Social Services even before agreeing to visit the resident, and if the residents needs change significantly then ensure their assessment is reviewed and reflects the changes. Mrs Haug also said that she is pressurised to fill the beds and is not always informed of who is moving into the home. It was not possible to speak with all residents due to their cognitive and sensory disabilities, however it was observed that the home supports a high number of very confused and dependent residents. Stanwell Rest Home DS0000012167.V312087.R01.S.doc Version 5.2 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to this service. The home fails to ensure the residents’ health, personal and social care needs are fully and appropriately met, and people are not treated with dignity and respect. The handling and recording of medication was not adequate and could put at risk the health and well being of the people using the service. EVIDENCE: Through observations, discussion with the staff and the manager and viewing six residents’ personal plans the inspectors established that the quality of the care provided in the home was poor and places the residents at potential risk of harm. Individual information is held for all residents who live in the home. The level and quality of the information is poor and does not allow staff to have a full Stanwell Rest Home DS0000012167.V312087.R01.S.doc Version 5.2 Page 14 understanding of the needs of each individual and how to carry out their plan of care. The care plans are poorly written. The concern regarding poor care planning and monitoring the health and welfare of the residents was discussed at length with the manager. Concerns had been reported to CSCI before the inspection visit by a healthcare professional. Throughout the course of the inspection it was established that the home could not evidence that they were meeting the health and welfare needs of some of the residents. Of particular concern was one resident of the four who required total care. This resident appeared comfortable, but with dry mouth and sticky eyes. There was no evidence of recorded eye or mouth care, fluid intake or output or a turning chart. An immediate requirement to develop and implement a care plan and monitoring charts in respect of this resident was made following the first day of the visit to the home. At the second visit records showed that staff were not following instructions given in the key worker’s log with regard to turning, and with ensuring fluids were given. The resident was turned every four or five hours rather than every two hours as instructed. Only very small amounts of fluid taken were recorded by staff, and these were given at mealtimes, mid-morning and afternoon. Amounts were recorded in millilitres by staff and fluid ounces by the manager. The manager informed the inspectors that the resident drinks very well, gulping a whole mug full down in one go and she thought the staff must be writing it down wrong, “ I thought there was something not right about the record, I was going to tell them”. A week had passed by the time of the second visit and there was no evidence to suggest that the manager had addressed this with staff. Another resident who repeatedly tried to leave the building was observed to be very unsteady on their feet and suffered a fall during the inspection visit. Concerns had been raised with CSCI in respect of this resident by a member of the public, who had found the resident wandering the street one evening and took them back to the home only to be greeted by a member of staff who said that was always happening, and went on to share confidential information. The resident’s face was badly bruised and they had recently come out of plaster following a broken wrist. Mrs Haug informed the inspector that the resident was very clever at working the locks, sleeps in an upstairs room and does not have a restrictor on the window. The inspector observed this resident for approximately ½ hour wandering the home unsupported or observed, and trying repeatedly to leave the premises. There was no evidence of the risks to this resident being identified, minimised or managed. The follow up visit found this resident to be very drowsy and remaining in a chair. Another example of poor management of care was the resident identified as having difficulty with their continence, resulting in a strong and unpleasant Stanwell Rest Home DS0000012167.V312087.R01.S.doc Version 5.2 Page 15 odour in their bedroom which could be smelled throughout the home. The manager said that a continence advisor was involved but they “padded” the resident because “what else can you do”. This resident was also identified as leaving the home on a number of occasions. There was risk assessment in place, but inspectors observed that this was not followed by staff. These concerns were discussed with the manager at the time of the inspection, and were referred to social services under the provisions of the local adult protection procedures. The above evidence does not fully reflect all the concerns raised during the inspection process on the first day but focuses on the immediate concerns raised. During the first visit to the home the inspectors observed poor practice in the administration of medication and viewed medication administration records that had been poorly written. The manager informed the inspectors that the training was “second to none”, however her practices in particular were observed to be very poor. An immediate requirement was issued in respect of medication and the CSCI pharmacy inspector visited on 8th September to undertake a specialist pharmacist inspection following concerns regarding the handling of medication in the home, which were raised at a the first site visit on 31st August 2006. The pharmacist inspection involved looking at medication handling procedures, watching some medications being given to service users, looking at medication storage and records. The medication administration records showed that that a significant number of medicines were or had been out of stock or had not been given, as staff had not been able to find the medication. Additionally three medicines for three residents had not been given since the start of the chart on 28.8.06. The home could not demonstrate that two additional service users were receiving the medicines as prescribed for them by their doctors. The inspector witnessed the following poor practices in the administration of medication: • medication was prepared for administration without reference being made to the record charts • medication prescribed for one resident was given to another resident with no record made of the administration • analgesic medication was recorded as refused but it had not been offered to the resident. • The medication administration record charts were not accurately kept. This was evidenced by the following findings: Stanwell Rest Home DS0000012167.V312087.R01.S.doc Version 5.2 Page 16 • • • • • There were a number of omissions in signing the medication administration record charts when medicines should have been given. Medicines were signed as given but were found to still be in the blister packs. When a variable dosage of medicine was prescribed the actual dosage given was not being recorded. Handwritten additions or alterations to medication administration record charts were not signed nor dated by the carer making the addition, nor were they checked by a second carer for accuracy. Handwritten charts did not all include details of the dose prescribed nor the dose frequency. Medication was stored securely for the protection of the service users. However some of the medicines were dirty and not fit for use. The requirements are listed at the back of this report. The home has recently appointed one of their staff as a “dignity nurse”. The staff with whom the inspectors met said they thought this was a good idea. Mrs Haug informed the inspectors that the role was adopted in order to observe for bad practices, however the inspectors observed several events that question the staff understanding of respect, confidentiality and choice. The manager was heard to call the residents collectively by an inappropriate and devaluing name that did not describe them as people in their own right, or as unique individuals. The manager was observed to ask in front of four other people a very nervous resident to tell inspectors why they attended a particular clinic, the resident informed the inspectors later that they attend this particular clinic to assist their confidence. The manager informed the inspectors that she prefers residents to come down for their breakfast so she knows where they all are, which demonstrates that resident choice is not promoted. However the manager is happy for one resident who can clearly advocate for them self to remain in their room if they wishes. This resident was described as adamant and defiant. The inspectors established that the residents are not made aware of what is on the menu and asked on the day, the cook said an alternative would be provided if requested. Three of the double bedrooms observed by the inspectors did not have adequate screening to preserve the resident’s dignity and privacy, and one did not have any screening at all, said to be because of the behaviour of one of the residents. There was no evidence that this was being addressed in a constructive way. Stanwell Rest Home DS0000012167.V312087.R01.S.doc Version 5.2 Page 17 Residents living in the flats are not able to have keys to their own doors or the door to the building, although they are assessed as living in their flat as they are independent. The inspectors saw evidence to demonstrate that the home breaches the confidentiality of the residents. A daily diary is kept accessible for staff in the kitchen, which holds personal information about the individual residents from how they have slept, their behaviour, if they have been visited or seen by the GP or attended a hospital appointment. This information should be recorded in the individual file. During the evening three residents who had not been engaged with by staff were observed to be abruptly spoken to and told to sit down. Later the manager referred to one of the residents as a “troublemaker”. Stanwell Rest Home DS0000012167.V312087.R01.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15. Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to this service. This is a service where activities and routines are not based on the needs and wishes of residents, and where the manager and staff show little insight into the needs of people who have dementia. EVIDENCE: Some residents with whom the inspector met said they were happy that they could spend their day as they chose with no restrictions as to when to get up and go to bed. Although the home has a mini bus and some residents appear to go out regularly as confirmed by a relative and a staff member it was hard to establish if the choice of destination was made by the residents or the member of staff. A member of staff with whom the inspectors met said they usually went for a drive to the forest as this was easier and commented that she has told the driver not to go anywhere that might be too windy and mess up her hair. Stanwell Rest Home DS0000012167.V312087.R01.S.doc Version 5.2 Page 19 A range of entertainment is available, however on the first day of the inspection the inspectors observed residents sitting for long periods of time not engaged in any form of activity or stimulation. The TV in one lounge was on a channel with loud music. Some residents were observed wandering aimlessly and in some circumstances placing themselves at risk. One resident when asked by staff to go and sit back down in the lounge was “I am sick and tired of looking at the same four walls!” This resident was later described by the manager as being a troublemaker. There was little evidence that the cognitive and sensory needs of individual residents are considered when planning activities. Comment cards received from relatives said their relative did not engage in activities either because they couldn’t or because they have dementia. The manager, although stating she is very interested in dementia did not appear to have any insight on how to stimulate and divert inappropriate behaviours through activity or improving the environment. Commenting on a resident who had his trousers down she said “why is it always men that do that?”. The home has a clear visitors policy and visitors are asked to sign in. There is not a private area for visitors to meet with their relatives, one relative half joked that he would like to have a private moment with his wife but she is in a shared room. Visitors meet with their relatives in one of the entrances to the home. Although this is not used as the main entrance it is a busy thoroughfare for staff and wandering residents. The manager said visitors could meet with residents in the staff room if they wished; however this room holds confidential information and is cluttered. The inspectors met with the cook who said she was fully aware of the likes and dislikes of the residents and when asked did not know that a resident had a particular allergy. The daily menu is recorded in a specific diary but does not identify what residents have eaten. The inspector was informed that an alternative is provided if they don’t like what is on the menu, residents are only provided with information about the menu when they ask. Assistance is provided when required, however one lady was observed to be inappropriately seated and chasing her meal around the plate. Mrs Haug should ask for input from an occupational therapist. Most of the residents the inspector met appeared to enjoy their meal and those who were able to communicate clearly confirmed this. Notes regarding a of the resident who is bed ridden and referred to as “terminal”, and “frail and elderly but who can be stubborn at times”, to make sure she receives Complan and Fortisips and plenty of fluids. • 28/06/06 - recorded concerns about weight loss. • 15/07/06 - recorded as needing liquidised foods and to be weighed fortnightly due to weight loss. Stanwell Rest Home DS0000012167.V312087.R01.S.doc Version 5.2 Page 20 • • 25/08/06 - further concerns about weight loss and the need to weigh fortnightly. 15/08/06 - staff must try to give lots of fluids. The inspector did not find any evidence that the areas of concern were being addressed. A dietician had not been considered to address the resident’s diet, there was no evidence of monitoring fluid intake and output or monitoring what the resident had eaten. There was no evidence of weight monitoring, as the manager said “its difficult to weigh her”. There was no evidence of fluids in the room and the resident’s mouth was dry. Complan or fortisips had not been scribed on her medication records and all the resident’s medication on the administration record had been crossed through stating, “not scribed”. Stanwell Rest Home DS0000012167.V312087.R01.S.doc Version 5.2 Page 21 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to this service. The home does well to provide an environment where residents and staff feel happy to complain and be heard, however the complaints procedure requires reviewing. The home fails to fully protect residents from potential risk of harm and abuse. EVIDENCE: The residents who were able to communicate said they were happy with the service. Two relatives spoken with said they were happy with the home and knew who to speak to if they had a complaint. The majority of the comment cards received from relatives and completed on behalf of the residents said they were very happy with the home and did not feel the need to make a complaint, some also confirmed they would be happy to approach the manager and the deputy as they are very friendly and the staff are very kind. The manager is advised to review the complaints procedure as it gives the name of the regulatory body as the National Care Standards Commission and not the Commission for Social Care Inspection. The home fails to fully protect residents from potential risk of harm. Poor staffing levels especially in the evening, poor recruitment procedures and the layout of the building contribute to the potential risk. Stanwell Rest Home DS0000012167.V312087.R01.S.doc Version 5.2 Page 22 Three residents were observed to have bruising to their faces and body, the manager did not know how one resident had received the bruising to his eye. Another resident informed the inspectors that she had had a fall but couldn’t remember when or how, the fall had badly bruised her face and resulted in paper stitches to a cut above her eye. Another resident described earlier in this report was reported as recovering from a recent broken wrist, this resident had a badly bruised face and suffered a fall whilst the inspectors were in the home. This same resident was later observed for approximately ½ hour wandering unobserved or escorted trying to leave the building on several occasions. A resident was observed climbing the stairs on her hands and knees and was almost at the top of the stairs before staff were able to assist. Through viewing six residents’ personal plans the inspectors established that the risks to residents observed through the course of the day and identified in the body of the report had not been individually risk assessed. The staff with whom the inspectors met described what constituted abuse and what they would do if they discovered an abusive act. Staff said they had not received abuse awareness training in the home. Through discussion the manager did not appear to be aware of her roles and responsibilities, or what constitutes abuse and who she would contact if an allegation was made. There was no copy of the local adult protection procedures in the home. The home does have a whistle blowing policy. During the course of the second visit to the home allegations were made to CSCI which were subsequently referred to social services, and a member of staff was removed from duty until an investigation was completed. Stanwell Rest Home DS0000012167.V312087.R01.S.doc Version 5.2 Page 23 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to this service. The home, although generally clean does not provide a suitable environment for people who have dementia. EVIDENCE: The home comprises three separate houses, with three lounges, dining rooms and staircases. There are not enough staff on duty to sufficiently cover the different areas of the home, including upstairs, however the manager likes all residents to be downstairs in order to know where they are. The home’s carpet has a busy pattern which confuses residents, as confirmed by the manager and one of the staff. The home does not allow for residents to move themselves independently and safely around the home. There are no handrails. There are some signs on Stanwell Rest Home DS0000012167.V312087.R01.S.doc Version 5.2 Page 24 doors and a blackboard in each lounge informing the residents of the month, date and day, however the home has not considered the sensory and cognitive needs of the residents with dementia. A gentleman resident was observed throughout both inspection days entering rooms and requesting to know where the toilet was. The call bell identified as not working on the first day of the inspection about which an immediate requirement was issued was found to be working satisfactorily on the second visit. The home appeared relatively clean and tidy, comment cards received in respect of the home cleanliness were very encouraging and the majority of the comment cards stated they feel the home is very clean and tidy. There were areas of the home that require further attention, such as: • • • Dirty untidy cupboards especially in one of the upstairs bathrooms; Mouldy and cracked sealants around baths; The laundry was very untidy and unclean. The one washing machine does not appear adequate to meet the demand and does not indicate that it has a sluice action and works to 95oc. Staff were asked but appeared unsure. Staff are issued with gloves and aprons, however a member of staff was observed with long painted nails, large earrings and rings. The manager said she had noticed this. • Stanwell Rest Home DS0000012167.V312087.R01.S.doc Version 5.2 Page 25 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to this service. The home does well to encourage and support staff to undertake a National Vocational Qualification (NVQ) and to provide basic training, however the home must look at the specific needs of the residents and provide training to support staff to be confident in carrying out their duties. The home does not provide sufficient numbers of staff to meet the level of need and numbers of the residents in their care. Residents are placed at risk through lack of robust recruitment checks. EVIDENCE: Through the body of the report the health, welfare and safety of the residents has have been raised as serious concerns. Insufficient staffing levels and staff who lack confidence in supporting the residents are significant factors in those concerns. This was established through observation, speaking with the manager and staff and viewing staff records. A separate report has been forwarded to social services in respect of the concerns raised under the provisions of the local adult protection procedures. The proprietor has received a copy of this report. On the morning of the first visit the home was very busy. Two cleaners were working, one of whom was a volunteer, and a cook. Stanwell Rest Home DS0000012167.V312087.R01.S.doc Version 5.2 Page 26 The duty rota indicated that there should be four care staff on duty in the main home, including Mrs Haug, however the deputy was escorting a resident to hospital for an appointment with another member of staff who had come in on her off duty. The inspectors were informed that the off duty member of staff had originally agreed to take the resident but then had decided on the day that she wouldn’t be able to manage on her own. This left the home with three staff including the manager to cover three areas of the home. The manager was advised to carry on with what ever it was she needed to do during the inspection. Two staff were working in the flats, which is for semi independent residents. At the time of the visit there were only six residents and it was questionable if this was good deployment of staff when the main home had 26 residents with high dependency to three staff. The deputy manager returned around lunchtime. The inspector was informed that four residents require feeding. The duty rota four staff on duty in the afternoon until 16.00 when the manager goes home, however on the day of the visit the manager remained on duty until the inspectors left at 20.20. One member of staff informed the inspectors that she was part time and contracted to work fifteen hours a week however would very often work up to forty-eight hours to cover shifts. Two staff on duty at night, however the manager said the workload at night is getting very heavy. Two staff were asked, “If you could change one thing to improve the way the home works, what would it be”? They said more staff, one said “we are really stretched, its very hard work to make sure everyone is up, has breakfast and their medication given to them on time”. At the second visit there were four staff on duty including the manager, however one member of staff had to go into the kitchen as the cook had failed to turn up for a second day, leaving three staff to cover the home. The duty rota showed that staff working the waking night duty would often come on at 14.00 and work through until 08.00 the next day. It is the view of CSCI that staff competence, and therefore the welfare of the residents is compromised by individuals working an eighteen hour shift. A member of staff who covers a lot of shifts and works nights was suspended on the day following an allegation of abuse. Following an inspection in January 2006 the home was issued with an immediate requirement as staff were employed without protection of vulnerable adult (POVA) check having been undertaken. Stanwell Rest Home DS0000012167.V312087.R01.S.doc Version 5.2 Page 27 On this occasion the manager was not confident of the process and said she didn’t normally get involved with undertaking Criminal Record Bureau (CRB) and POVA checks. However she did state that the home uses the job centre and they will not employ staff who do not have good English. Potential staff are asked to complete an application and they have a chat about why they want the job. They bring references with them and they normally wait for CRB and references. This process was checked by looking at files of two newly employed staff. For one member of staff references were not received before she started. One reference was on file, from the staff member’s mother. There was some confusion over other carer as she had returned to working in the home after a long absence and getting married. The staff meeting minutes showed she was at the home in March 2006, a POVA check was received in April 2006,and the CRB check in May 2006. The inspector spoke with the member of staff who confirmed she did not start until after her CRB had been received. No new references have been obtained for this carer after her absence. Further poor recruitment practices were observed such as no photo ID, or a record of when the member of staff had started, and the manager was advised to keep notes of interviews. Inspectors concluded that the home is still failing to undertake required checks on new staff, despite an immediate requirement in January 2006, and a statutory requirement notice will now be issued. There is a commitment to qualifications, with 50 of staff having a national vocational qualification (NVQ). The two staff with which the inspector met with said they had undertaken an NVQ and had found the course interesting and helpful. The manager informed the inspector on the second visit to the home that she had been dealing with bickering between staff. When asked what this was about she said some staff who have their NVQ think they are better than the others and this is taken objection to. The home provides staff with mandatory training and there was evidence on the notice board in the staff room of up and coming training. Two staff with which the inspectors met said they had received an induction, which included fire safety, moving and handling, and first aid. The manager informed the inspectors that the home provides dementia care training and that it would be coming up soon. One member of staff said she had received dementia training another said she had not and didn’t feel very confident in supporting people with dementia and diabetes. This is a particular area of training the home must focus on to ensure staff are confident in supporting, caring and managing the complex needs of the residents in the care of the home. Not all staff have received abuse awareness training. Stanwell Rest Home DS0000012167.V312087.R01.S.doc Version 5.2 Page 28 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38. Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to this service. The home does well to support its staff, however the home could do better to improve its management and administration practices, ensure service users are safeguarded from harm and be provided with opportunities to share their views on the quality of the service. EVIDENCE: The inspector spent a considerable amount of time with the manager observing her practices and how she conducts herself as a manager. The registered manager informed the inspectors that she has worked in the home approximately four years and has achieved an NVQ4. Through observation, discussion and the quality of records held by the home it was identified that the manager lacks authority and leadership, management and administration Stanwell Rest Home DS0000012167.V312087.R01.S.doc Version 5.2 Page 29 skills and a sound knowledge of the needs of the residents. There is little evidence to show that she understands her roles and responsibilities as a registered manager. Her medication practices in particular were observed to be very poor and the deployment of staff was observed to be also poor. There was little evidence to suggest that the home actively seeks the views of the residents and relatives. The proprietor Mr Conway carries out monthly audits of the service where he has opportunities to speak with residents and staff. Reports of these visits are sent to CSCI as required, but these provide very little information. All the residents and relatives the inspectors spoke with and received comment cards from said they were happy with the quality of the service, however the manager is advised to carry out a quality review and forward a report of the findings with an action plan to the Commission for Social Care Inspection. The information regarding the regulatory body for the home included in the Statement of Purpose is significantly out of date and requires updating. The document says an occupational therapist visits twice a week. This is not so, and this should be removed. The manager and her deputy carry out staff supervision and Mr Conway holds regular staff meetings. The inspectors sampled two residents’ monies with the assistance of the manager. The manager said Mr Conway deals with the residents’ monies and she was not familiar with how many residents are supported with their money and if the home acts an appointee for any of the residents. On a day-to-day basis the manager will ensure residents have enough money to pay the hairdresser and the chiropodist. The manager stated they would ask relatives to top up their money when required. Records checked against balances were correct. All service records for utilities and equipment were in good order and up to date. Fire records demonstrate that staff receive regular training and all appliances and equipment such as fire alarms, door closures, emergency lighting and extinguishers are well maintained. There are health and safety risks that must be addressed - such as a hazardous substance found in a resident’s bedrooms, and denture cleaning tablets easily accessible to residents. One resident did not have access to a call bell. The comment of the manager that the resident doesn’t need one because he is okay is unacceptable. The resident in questions shares a room with another whose behaviours are complex and challenge the understanding of the manager and the staff but could also potentially place the other resident at risk, therefore the manager was issued with an immediate requirement to ensure the resident has access Stanwell Rest Home DS0000012167.V312087.R01.S.doc Version 5.2 Page 30 to a working call bell. It was observed during the second visit to the home that the call bell had been repaired and was accessible to the resident. The inspector asked resident how he felt about sharing a room and replied that he was happy to share. Stanwell Rest Home DS0000012167.V312087.R01.S.doc Version 5.2 Page 31 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 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 1 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 1 X X X X X X 1 STAFFING Standard No Score 27 1 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 3 X 2 Stanwell Rest Home DS0000012167.V312087.R01.S.doc Version 5.2 Page 32 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. Standard Regulation 14 (1)(a)(b) Requirement The registered manager must undertake full assessments, on each service user prior to admitting them to the home. This requirement has been repeated. A further failure to comply will result in further action being taken. 2. OP3 14 (1)(a)(b) The registered manager must obtain a care management assessment prior to admission for any resident who is fully or partially funded by the local authority. The registered manager must ensure all care plans are reviewed and provide specific details of the needs of the residents. This requirement has been repeated. A further failure to comply will result in further action being taken. 30/09/06 Timescale for action 30/09/06 1. OP3 3. OP7 15 (2) (b) (c) 30/09/06 Stanwell Rest Home DS0000012167.V312087.R01.S.doc Version 5.2 Page 33 4. OP7 15(1) The registered manager must ensure the individual care plans provide specific detail on how the needs of the residents must be met, and ensure assessed needs are met. The registered manager must ensure that on each resident’s personal plan and medication record there is photo identification. The registered manager must ensure care is given in line with the care plan for the resident requiring total care, and that full records are maintained. 30/09/06 5. OP7 OP9 17(1)(a) 30/09/06 6. OP7 OP8 12 (1)(a)(b) 19/09/06 7. OP7 13 (4)(a) (b)(c) 30/09/06 The registered manager must ensure that each individual resident has a full risk assessment undertaken on them, including the risk of falls, risk of falls from windows, risk of leaving the home. All risk assessments must detail the specific risk to the residents and clearly states how the risk will be minimised. The registered manager must undertake a full audit of the medication administration records. This requirement has been repeated. A further failure to comply will result in further action being taken. 19/09/06 8. OP9 12(1)(a) 13(2) 9. OP9 12(1)(a) The registered manager must request a General Practitioner to review and clarify the medication for two specific service users in her care, on the advice of the pharmacist inspector. DS0000012167.V312087.R01.S.doc 08/09/06 Stanwell Rest Home Version 5.2 Page 34 10. OP9 12(1)(b) The registered manager must put systems in place to ensure that medication is are ordered and received at appropriate times to ensure it is always available to the service users. The registered manager must ensure medication is administered at the dose and frequency as prescribed by the doctor. The registered manager must ensure medication is only given to the person for whom they were prescribed and not used as general stock. The registered manager must ensure complete and accurate records are kept of all medications administered or not. A reason must be given why the medicine was not given. The registered manager must have a documented risk assessment for all service users who undertake to self-administer their own medication. The registered manager must ensure a complete and accurate record is kept of all medications received into the home from whatever source. The registered manager must ensure that relevant policies and procedures are in place to underpin the practice in the management of medication. The registered manager must ensure residents are consulted and supported to make choices, are involved in DS0000012167.V312087.R01.S.doc 18/09/06 11. OP9 12(1)(a) 08/09/06 12. OP9 13(2) 08/09/06 13. OP9 13(2) 08/09/06 14. OP9 13(4)(b) 30/09/06 15. OP9 17(1)(a) 18/09/06 16. OP9 13(2) 30/09/06 17. OP12 OP14 12(2)(3) 30/09/06 Stanwell Rest Home Version 5.2 Page 35 decision making including their health and welfare, and day-today activities etc. 18. OP10 12(4)(a) The registered manager must ensure that the privacy and dignity of the residents is upheld at all times. The registered manager must ensure that practice in the home respects the residents right to confidentiality. The registered manager must ensure residents risked assessed and deemed able and safe to live independently are issued with keys to their own flats. 30/09/06 19. OP10 12(4)(a) 30/09/06 20. OP10 OP14 12(1)(a) 12(2)(3) 12(14)(a) 13/10/06 21. OP15 17(2) The registered manager must 13/10/06 keep a record of food provided to each resident in sufficient detail to determine if the diet is satisfactory. The registered manager must ensure the complaints procedure provides the correct name and address of the regulatory body. The registered manager must provide the Commission for Social Care Inspection with a development plan detailing how the home will make changes to the environment to support residents to move independently and safely around the home. The registered manager must ensure privacy curtains in shared rooms are in place at all times and are of a quality that fully upholds the resident’s privacy. Action must be taken to ensure the home is kept free from DS0000012167.V312087.R01.S.doc 22. OP16 22(7)(a) 13/10/06 23. OP19 23(1)(a) 23(2)(a) 31/10/06 24. OP10 16(2)(c) 31/10/06 25. OP26 Stanwell Rest Home 16(2)(k) 30/09/06 Page 36 Version 5.2 offensive odours. 26. OP26 13(3) The registered manager must ensure staff dress appropriately to prevent the spread of cross infection. The registered manager must ensure all staff receive training in adult protection, the manager must include herself in this training. The registered manager must ensure staff are fully competent to meet the complex needs of the residents. The registered manager must develop a quality monitoring system for seeking the views of the residents and their relatives/friends ensure they receive a copy of the outcomes and forward a copy of the outcome of the report to the Commission for Social Care Inspection. The registered manager must ensure all COSSH substances are safely locked away at all times and after use. 30/09/06 27. OP30 OP18 18(1)(a) 10(2) 13(6) 30/09/06 28. OP30 OP3 18(1)(a) 31/10/06 29. OP33 24(1) (2)(3) 08/01/07 30. OP38 13(4) (a)(c) 19/09/06 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 OP10 Good Practice Recommendations The registered manager must ensure residents risked assessed and deemed able and safe to live independently DS0000012167.V312087.R01.S.doc Version 5.2 Page 37 Stanwell Rest Home are issued with keys to their own flats. 2. OP13 Consideration must be give to how residents will be provided with a private, comfortable place to meet with their relatives. Stanwell Rest Home DS0000012167.V312087.R01.S.doc Version 5.2 Page 38 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 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 Stanwell Rest Home DS0000012167.V312087.R01.S.doc Version 5.2 Page 39 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!