Inspection on 15/01/07 for Stoneham House

This inspection was carried out on 15th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Stoneham House 02/12/09

Stoneham House 28/11/08

Stoneham House 05/12/07

Stoneham House 25/05/07

Stoneham House 28/04/06

Stoneham House 01/09/05

Stoneham House 13/04/05

Stoneham House 19/10/04

Stoneham House 12/05/04

Stoneham House 14/01/04

Stoneham House 11/07/03

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 Stoneham House 4 Bracken Place Chilworth Southampton Hampshire SO16 3NG Lead Inspector Mrs Pat Hibberd Key Unannounced Inspection 15th January 2007 09:25 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 Stoneham House DS0000012356.V325428.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. Stoneham House DS0000012356.V325428.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stoneham House Address 4 Bracken Place Chilworth Southampton Hampshire SO16 3NG 023 8076 8715 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) stonehamhouse@aol.com Mrs W L Bellett To Be Confirmed Care Home 37 Category(ies) of Dementia - over 65 years of age (37), Old age, registration, with number not falling within any other category (37) of places Stoneham House DS0000012356.V325428.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th April 2006 Brief Description of the Service: The home is located on the outskirts of Southampton with easy vehicular access to local amenities. The home was opened in 1995 and is a large detached property standing in extensive grounds. There is a car parking area at the front and the side of the building. The building stands on a slight hill, so has three floor levels, which can be accessed with a shaft lift. The home has some shared bedrooms, but the present philosophy of the home is to operate at less than full capacity, thus ensuring that current residents have a single room. Communal space is provided by way of a large lounge, a dining room and a conservatory area. There are also two patio areas, with some furniture. The current level of fees is £410.00 to £520 per week. This information was provided by Mrs Bellett the Registered Provider on 22/01/07. Stoneham House DS0000012356.V325428.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Throughout this unannounced visit to the Home the inspectors were assisted by the Registered Provider Mrs Bellett and the manager. A tour of the home was undertaken and the majority of bedrooms were viewed. Paperwork including assessments, care plans, policies and procedures and staff records were viewed on the day. The paperwork of the last two residents to enter the home was looked at in more detail and the inspectors spent time talking to both of these residents. Whilst walking around the home the inspectors spoke to and observed a number of other residents. Staff were also spoken with. As part of this unannounced inspection the quality of information given to people about the care home was looked at. Confirmation was gained from both residents and relatives, to see if they could understand this information and how it helped them to make choices. The information included the service users guide (sometimes called a brochure or prospectus), statement of terms and conditions (also known as contracts of care) and the complaints procedure. The commission sent comment cards to the Home to distribute to residents and visiting relatives prior to the inspection of which a number were returned and views are detailed within this report. Comment cards were also sent to care managers of Adult Services (formerly Social Services) and District Nurses. Feedback received is also included within this report. 22 residents were accommodated on the day of inspection. What the service does well: Feedback received from comment cards returned to the commission and from discussions held with residents and relatives indicated satisfaction with the service and care provided in the Home. Stoneham House DS0000012356.V325428.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: There were three immediate requirements made on the day of the inspection. Medication prescribed to residents must be appropriately documented on the Medical Administration Record (MAR sheet) and stored in a secure environment at all times. A broken reinforced glass window in a fire door on the ground floor must be replaced. No staff must be working in the Home without a Protection Of Vulnerable Adult (POVA) First check. Staff without a Criminal Record Bureau (CRB) clearance, must work under supervision at all times. The Registered Provider Mrs Bellett was required to confirm in writing to the commission within 48 hours of the inspection as to how the three immediate requirements will be met. A response was received within the timescales required. Further areas of improvement were identified which include: residents care plans and other relevant documentation being easily accessible to staff who are delivering care, healthcare needs that have been identified must be documented to evidenced what treatment is to be given, by whom and when with a clear outcome recorded. All discussion held with visiting professionals must be recorded by the Home and signed by the staff member involved. The Home’s medication policy and procedure must be in line with relevant legislation and is written to reflect the practices and procedures in the Home. All staff must receive medication training. A system needs to be put in place to ensure staff are aware of and are monitoring residents needs at all times. All visitors to the Home must sign the visitor’s book. The Laundry and infection control policies and procedures must be reviewed to reflect the care practices in the Home. There needs to be a written policy and procedure relating to the cleaning of commodes and raised toilet seats. Their needs to be a system in place to ensure all parts of the Home are kept clean including the dining room. There needs to be sufficient hand washing and bins in the Home in areas that are used for toileting/personal care. There must be a record kept of a programme of routine decoration of the internal and external areas of the premises. Staff files must hold details of the initial induction undertaken by all new staff employed including agency staff. Maintenance records must be kept up to date, to include the date a request was reported and when the work was completed and by whom. Stoneham House DS0000012356.V325428.R01.S.doc Version 5.2 Page 7 Accident forms must be stored in line with the Data Protection Act 1998 with recurring themes analysed and action taken where required. There must be a quality assurance system in place that demonstrates that residents are receiving the care they require and, that the home is run in their best interests. The Registered Provider and manager must ensure they are familiar with the new Fire Regulations and, that any new procedures are implemented in the Home. 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. Stoneham House DS0000012356.V325428.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 Stoneham House DS0000012356.V325428.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The pre assessment process demonstrates that residents moving into the Home have had an assessment of the majority of their needs. It is unclear as to whether all prospective residents are able to make an informed choice about whether the Home can meet their particular needs. The Home does not provide intermediate care. EVIDENCE: There have been 14 admissions to the Home in the last 12 months with the Home currently accommodating 22 residents. The home has an admissions policy, which requires residents to be assessed before accepting a place at Stoneham House. Stoneham House DS0000012356.V325428.R01.S.doc Version 5.2 Page 10 The residents spoken with explained that family members were able to visit the home before making their decision to stay. Three relatives spoken with confirmed this. The manager visits the prospective client and undertakes an interview with them and their family or carer. He completes a full assessment of needs and aspirations. Records of these completed assessments were seen on the files tracked. The manager confirmed that all new residents undergo a full assessment of their needs to establish if the home is able to meet their needs. These cover the necessary areas including, personal care, physical well being, dietary preferences and records of regular weights. The files of two residents recently accommodated were viewed. There was a copy of the Adult Services care management assessment on one file. Information was seen on each file that described issues with sight, hearing, mouth and foot care. There was information on the level of mobility and dexterity and a history of falls, continence and behaviour. There were no recorded life history’s or details of likes or dislikes. The Home did not have any information surrounding the persons past/present relationships. This was discussed with the manager who indicated that this information would be obtained, recorded in files and care plans amended as relevant. A requirement was not therefore made on this occasion however, this will be followed up at future visits. Three relatives spoken with said that they considered that the Home looked after the residents well. However, another indicated that although the statement of purpose indicated that there was a variety of activities taking place this did not appear to be the case. One recently admitted resident spoken with was able to recall their admission and stated that they were made very welcome. One said “I like it here”. A number of other residents who were able to verbally communicate their needs indicated that they were satisfied with care provided. A further 10 comment cards received from residents also supported this view. Stoneham House DS0000012356.V325428.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): Standards 7,8,9 and 10 were inspected. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The arrangements for care planning are not sufficient to ensure that the residents’ physical and emotional health needs are met. Medication practices and procedures do not ensure residents are protected. Working practices in the home do not always promote privacy and independence for residents. EVIDENCE: Four residents’ files were viewed with each resident having a separate file that includes details about them, a copy of their admission form, a personal contact sheet detailing entries about the individual, an assessment of need, a risk assessment, medication details and the care plan. The care plan detailed activities of daily living and their needs during the night. Some staff had received training in dementia as well as managing “challenging” behaviour. The care plans viewed gave staff guidance as to how to manage behaviours with staff indicating some understanding of the practice and care needs required. Restraint is not used in the Home. Stoneham House DS0000012356.V325428.R01.S.doc Version 5.2 Page 12 Residents have access to all health care as required including Doctors, dentists, opticians. The pre inspection questionnaire received prior to the inspection and completed by the manager said that there were no residents with a pressure area. This was verbally confirmed by the manager on the day of the visit to the Home. However, comments received on the day after the inspection from two District Nurses indicated that following a visit to the Home the previous week six residents were found to have pressure areas to whom they and other GP practices are now providing clinical nursing support. A discussion was held with two District Nurses who indicated that when the pressures areas were discussed with the Home’s manager he said he was unaware of anyone having a pressure area. Care detailed in the four files was tracked by both inspectors and discussions held with the manager and staff to confirm whether the records gave a clear indication of the care required. It was evident from those discussions and from observations of care practices throughout the inspection that staff were not aware of all residents’ needs. For example one resident spoken to indicated that they were not comfortable sitting in the chair that was by their bed, they had a sandwich provided for their breakfast but this had been left on a tray with no assistance provided by staff to enable the individual to eat the sandwich although they required such support. A staff member was informed of this who then proceeded to lift the resident in the chair although they indicated that two staff were required to undertake such a task. The Registered Provider Mrs Bellett was informed and preceded to support the individual with eating their breakfast and assist the care worker to safely move the resident to a more comfortable position. Mrs Bellett said to the care worker “ you know this resident requires two people to lift her and you must ask for help”. Two staff spoken to were unable to explain the duties they had been given to undertake during their shift and appeared to be providing support as the need arose rather than in any planned and systematic way. They said they read care plans and were seen going into the office and complete daily records. During the visit a call bell was heard to ring for 5 minutes. This was not responded to until one of the inspectors asked the manager if staff were aware of the residents’ needs or, if there was any system in place to answer calls bells. The manager indicated that staff were addressing residents’ needs but on this occasion proceeded to support the resident who required the toilet. Later in the day the inspectors observed a number of residents sitting in the lounge. There were no staff seen in the vicinity for 15 minutes with one resident spoken to indicating that they would alert staff if any less mobile resident needed support. Two staff were designated to the lounge area after the inspectors asked the manager as to whether there were any staff monitoring the needs of those residents the majority of whom required regular personal care support. Stoneham House DS0000012356.V325428.R01.S.doc Version 5.2 Page 13 In discussion with the manager he indicated that shift handovers do take place but these sessions were used to inform staff of any immediate needs of residents rather than of all residents, as it would take too long to discuss all of the 22 residents accommodated. There did not appear to be any system in place for delegating care workers to undertake tasks detailed in residents care plans with individuals throughout the day. Further discussions were held with the manager with regards to how the information in relation to care needs of individuals was stored and how “user friendly” and accessible the information was to staff delivering care. For example there was no order to how the information was stored in the file with staff having to read through the whole file before obtaining specific information required. Further concern was raised as to the documenting of discussions held with Health Professionals for example District Nurses (DN’s) and Social workers. The manager indicated that DN’s did not leave written notes as to any discussions, guidance given to the Home or clinical practices they were to provide to residents and this was evident from files sampled. However, the manager had not attempted to record discussions held with visiting professionals and was only able to give the inspectors an overview verbally of care the Home or DN’s were providing. The manager indicated that he considered communication with one Primary Care Team to be poor and that he often received mixed information. The manager further confirmed that not all health professionals signed the visitor’s book that resulted in further difficulty in ascertaining when they had visited and given any advice or guidance. The manager was informed that it was his responsibility to ensure all visitors signed the visitor’s book for fire evacuation purposes and safety of residents. Requirements were made for all discussions undertaken to be recorded and relevant information shared with all staff, residents care plans and other relevant documentation being easily accessible to staff who are delivering care, healthcare needs that have been identified must be documented to evidenced what treatment is to be given, by whom and when with a clear outcome recorded. A system is also required to be put in place to ensure staff are aware of and are monitoring residents needs at all times. In general the care planning system was difficult to audit trail, information was not easily accessible to staff, reviews had not been signed and it was difficult to see outcomes of any of the care plans viewed. There was no written evidence that residents had been involved in their care plans or reviews. Residents who were able to communicate their needs appeared to be happy with the care provided and 23 relative comment cards returned to the commission by the manager indicated satisfaction with the service. Comment cards were sent to Health Professionals and Care Managers. Four Care Managers responded as follows: Stoneham House DS0000012356.V325428.R01.S.doc Version 5.2 Page 14 1. All indicated that staff demonstrate an understanding of residents’ needs. 2. 2 said there was a service plan for the resident they had placed in the home that was being followed 1 said there was not. 3. 3 said they could meet with their client in private and that a senior member of staff was always available.1 said a senior member of staff was not always available. 4. 1 said they were kept informed of their clients well-being 2 said they were not and another made no comment. 5. All said they were satisfied with the overall care provided. Although one care manager commented that they had concern regarding the management of their clients behavioural needs with reference to personal care and that the manager seemed dismissive and unwilling to explore alternative strategies to care. As previously detailed one comment card was returned and signed by two District Nurses the day after the inspection. A number of concerns were expressed including residents not having access to fluids, staff were observed not always moving and handling residents appropriately and pressure areas remain a problem with six residents. The District Nurses also commented that the manager does not communicate clearly and work in partnership with them, there is not always a senior member of staff to confer with, staff do not demonstrate a clear understanding of residents needs, specialist advice is not incorporated into residents’ care plans, residents medication is not appropriately managed by the home, management do not take appropriate decisions when they can no longer manage the care needs of the residents and, that they are not satisfied with the overall care provided to residents in the home. A discussion was held with the District Nurses following receipt of these concerns. The District Nurses confirmed that they are endeavouring to offer regular advice and guidance to the home and, visit residents as necessary to provide any clinical intervention. Concerns regarding the management are being shared with their manager and the Primary Care Trust. The medication system was discussed with the manager and the inspector observed one staff member administering medication. It was evident that the practices in the Home are poor. For example the manager had signed to indicate he had given a resident their morning medication when in fact he had not and another member of staff had at a later time. The manager agreed that he had not administered the medication and had falsely signed the record and, that this was common practice. Further concerns were raised as to medication held for a number of residents in a dirty box that contained a loose tablet with no indication as to who it belonged to. This was discarded and the manager was required to ensure the safe and sanitary storage of all medication at all times. This is clearly creating a secondary dispensing system with the manager unable to confirm as to Stoneham House DS0000012356.V325428.R01.S.doc Version 5.2 Page 15 whether he had seen medication he had placed in pots had been given to residents. A requirement was made for the registered provider to ensure all medication is administered directly from the original labeled container to the resident and not placed into any secondary container for administration by another care worker. Later in the day medication was found in a residents file. It was unclear as to whom the medication belonged to. It became evident following a discussion with a staff member that a Locum GP had been called to the Home over the weekend to a resident who was unwell. The GP had proceeded to give some medication to the staff member to administer if the residents health deteriorated. There was no written script from the GP to indicate that the medication had been prescribed and for whom. The medication was destroyed and the manager was asked to contact the surgery immediately to discuss the situation. The staff member said they had received medication training since commencing work at Stoneham House but had undertaken such a practice in a former home and had thought it acceptable to do in the circumstances. It was evident that the manager did not know the whereabouts of the medication or circumstances leading to the staff member placing the medication in a resident’s file. An immediate requirement was made for all medication prescribed to residents to be appropriately documented on the Medical Administration Record (MAR sheet) and stored in a secure environment at all times. All staff must receive training in the administration of medication by a trained professional. The Home must ensure the medication policy and procedure is in line with the relevant legislation and that it reflects care practices in the Home that are safe and protect residents. From observation throughout the day it was evident that for those residents who had communication needs their dignity and privacy was not always upheld. One example being of a basic need to go to the toilet not being responded to for one individual despite a call bell ringing for some time and, observations of a confused resident wandering the Home with his clothes undone. Staff were observed talking to residents in a respectful manner during the inspection. Stoneham House DS0000012356.V325428.R01.S.doc Version 5.2 Page 16 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): All standards were inspected. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social activities are arranged in the home with residents having the freedom to join in or not. Visitors are made welcome to the home and they can see residents in private. A varied menu is available and good quality food is served to service users. EVIDENCE: Stoneham House has a weekly programme of activities that residents can participate in, including musical entertainment. Some residents prefer to make their own entertainment. One resident has their own car and enjoys weekly trips out. Several residents expressed the view that there was a relaxed atmosphere in the home and that they had the freedom to be independent. Visitors can visit at any reasonable time and residents can see their visitors in the privacy of their bedroom or in the communal areas of the home. There is a lounge on the lower ground floor, which is not used much by residents, but is Stoneham House DS0000012356.V325428.R01.S.doc Version 5.2 Page 17 equipped with a small kitchenette area for making drinks. Visitors can use this area for celebrating special occasions such as birthdays. It was evident that residents can bring their own ornaments and furniture into the home. The home’s statement of purpose refers to residents making choices in their lives. Residents can manage their own money if they are able, and can choose how to spend it. There is a written menu displayed on the notice board in the hallway with residents also being verbally informed by staff as to what was for lunch on the day of the inspection. Residents can come down for breakfast and, those spoken to, confirmed that there is a choice and the meal is not rushed. However, as detailed in the Health and Personal Care section of this report one resident was not seen to be receiving the support they required to eat their breakfast in their bedroom. Residents are offered a choice for the midday meal although there was not a choice on the day of inspection. This was due to the cook being off sick that day and a member of staff undertaking the duties at short notice. The inspectors observed the lunch that was seen to be unhurried, with appropriate assistance being offered where necessary. The meal was plated and residents had corn beef hash and fresh vegetables and apple crumble with fruit as an alternative option. Residents, spoken to, said that the food was good in Stoneham House. Special diets can be catered for although the manager indicated that there are currently no residents who require their food to be liquidised although one resident is a diabetic and the cook informed the inspectors that an alternative option was provided. The cook has worked for six years as a cook and twelve years in all in Stoneham House. The kitchen was clean and tidy. Food and refrigerator temperatures are routinely recorded. An Environmental Health report viewed following an inspection undertaken at the beginning of 2006 instructed the Home to remove, discard and replace chopping boards that were considered a health hazard. Although new ones had been purchased the old ones were continuing to be used. The Registered Provider Mrs Bellett removed these during the inspection. Comment cards received from 10 of the 22 residents indicated that they receive the care and support they need, can choose where they take their meals and that the meals are usually ok. Most felt that there were sufficient activities. Stoneham House DS0000012356.V325428.R01.S.doc Version 5.2 Page 18 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): Standards 16 and 18 were inspected. Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure although it may not be accessible to all residents. The home’s adult protection procedure does not protect or safeguard residents from abuse. EVIDENCE: The complaints procedure was displayed on the hall notice board, with the last inspection report and statement of purpose located by the visitor’s book in the reception area. Residents, spoken to, were aware of whom to complain to should they have a need to raise a complaint or issue. However, it was unclear as to whether residents with limited communication needs would have an understanding as to how and who to complain to with the complaints procedure only being provided in a written format. The manager indicated that in this event relatives would be given a copy of the procedure. This was confirmed from comment cards received by the commission prior to the inspection and from discussions held with three relatives on the day. There has been one complaint received by the commission since the last inspection in April 2006 from health professionals and related to the current manager. This related to the manager and was investigated by the Registered Provider Mrs Bellett who wrote to the commission that the complaint was not substantiated. Stoneham House DS0000012356.V325428.R01.S.doc Version 5.2 Page 19 Stoneham House has an adult protection policy and staff, spoken to, were aware of the issues involved. Staff have received adult protection training and certificates were held on the four staff files viewed. Since the last inspection there have been two adult protection investigations of which the commission have been kept informed as to the concerns raised by Adult Services (formerly Social Services) and the action they have taken. All referrals have been received from visiting health and social care professionals. There have been no concerns raised by relatives or residents. However, the issues raised have been of a serious nature and indicate that issues of neglect and poor care have been experienced by residents with complex needs and who may not be able to advocate for themselves or recognise that they are receiving poor quality care. The Registered provider Mrs Bellett and the manager indicated that they would work with Adult Services and were keen to improve care practices where needed. From information viewed, discussions held and observation of care practice it was evident during this inspection that the Home is not endeavouring to protect residents. One of the investigations remains open to Adult Protection. Stoneham House DS0000012356.V325428.R01.S.doc Version 5.2 Page 20 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): Standards 19 and 26 were inspected. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Communal areas of the Home do not ensure residents live in a clean, safe and pleasant environment. Most bedrooms have been individualised, to meet residents’ needs. EVIDENCE: The inspector viewed all areas of the building including the garden. Although the home is registered for thirty-seven residents, Stoneham House has thirty-four bedrooms and the current philosophy of management is to operate at less than full capacity, ensuring that residents have a single room. Twenty-six bedrooms are provided with en suite facilities and one bedroom has an en suite bath and another a small bath an en suite shower. Stoneham House DS0000012356.V325428.R01.S.doc Version 5.2 Page 21 There is a large dining room, separate lounge and conservatory and a lounge with kitchenette on the lower ground floor. The latter, is not used much by residents but can be used for small functions and by visitors. Residents, spoken to, were satisfied with their rooms. There was evidence of residents’ personal belongings in the majority of bedrooms viewed. Some of the bedrooms overlook the garden and were spacious, well lit and ventilated. There were no adverse smells noted. The home has a separate laundry room, which is situated away from food preparation. The room has two industrial washing machines and an industrial dryer, which is sufficient to keep up with the laundry requirements of the residents. A number of issues were identified at the site visit. These related to the general cleanliness of the communal areas of the home and infection control policy and procedures that were not being implemented. For example there was evidence of dried food seen around the chair leg of a table in the dining room that had clearly been there for some time. Cutlery trays were dirty and cutlery in the trays seen to have food dried on. Plastic glasses on tables were chipped, one was cracked and all were discoloured. These were brought to the attention of Mrs Bellett who removed them, cleaned areas as necessary and replaced glasses with clean plastic glasses. Two of the communal toilets on the ground floor next to the reception area were inspected and seen to have dirty toilet brushes and raised toilet seats which had not been cleaned that day despite being used by a number of residents. A number of the residents’ bathrooms and communal toilets did not have waste bins to discard pads/gloves or other waste and one adjoining bathroom between two residents’ bedrooms had no washing facilities. Staff indicated that they would provide personal care in this instance and then return to the bathroom on the ground floor to wash their hands and discard any waste i.e. pads in the appropriate bin. The manager and Registered Provider Mrs Bellett were informed that this posed a risk of cross infection and was a practice that must not continue. It was agreed that Mrs Bellett would obtain sufficient bins and new toilet brushes were placed in toilets as required during the day of the inspection. Alternative washing products were to be purchased to enable staff to clean their hands after giving personal care. This will be followed up at future visits to the Home. Staff indicated that they were supplied with gloves and aprons and were seen to wear them during parts of the day. Gloves and aprons were only placed in a number of toilets after this had been brought to the attention of Mrs Bellett by the inspectors. A number of dirty fans in toilets and bathrooms without window ventilation were also required to be cleaned. There was no policy and procedure relating to the decontamination of commodes and the Registered Provider Mrs Bellett was required to ensure a policy was written and shared with staff. All policies and procedures must be kept under review. Stoneham House DS0000012356.V325428.R01.S.doc Version 5.2 Page 22 The Laundry policy and procedure was also required to be reviewed to reflect the care practices in the Home. It was evident that the policy referred to the washing machine having a sluice programme. The machine being used did not and the staff member on duty told the inspectors that soiled linen was often left in a bucket in the laundry room over night until the Laundry staff member was on duty. There was no reference to hand washing within the policies reviewed. One resident said that they had experienced a problem with their laundry although this had been addressed. The staff member overseeing the laundry duties indicated that there were issues with laundry going missing but that she was endeavouring to sew name tags on all garments. This was brought to the attention of the Registered provider Mrs Bellett who said she would ensure the name tags were sewn on within the next two days. This will be followed up in future visits to the Home. The manager explained that the Home does have a cleaner who is designated to work 36 hours a week. However, the staff member informed the inspectors that she did not clean the dining area and the schedule appeared to remain the same each day and did not necessarily focus on key areas for example the well used communal toilets next to the main lounge. It was required that there is a system in place to ensure all parts of the Home are kept clean. Some of the communal areas were seen to have chipped paint on skirting boards, grubby walls and were in need of redecoration. There was no programme of routine decoration of the premises. There was a record of some maintenance in the Home but no evidence of a work schedule to include the date a request was reported and when the work was completed and by whom. One example being a cracked fire door seen on the ground floor. The registered provider was unable to confirm when this had cracked and when it was to be replaced. An immediate requirement was made for this to be replaced. Stoneham House DS0000012356.V325428.R01.S.doc Version 5.2 Page 23 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): All standards were inspected. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Lack of systems in the Home for the deployment of staff does not ensure there are sufficient staff on duty. Recruitment practices do not protect residents. Lack of records relating to the induction undertaken of new and agency staff members does not demonstrate how new staff are aware of residents needs. Staff training does not ensure that residents’ needs are met. EVIDENCE: Stoneham House employs eleven care assistants, a maintenance staff member, one domestic, a laundry staff member, a cook, two administrators and a manager who is currently applying for registration. The Registered Provider Mrs Bellett lives on the premises and indicated she works in the Home most days. Since the last inspection five staff have left and five new staff members have been recruited. On the day of the inspection there were three care assistants on duty, one domestic, a cook, admin support and the manager. Mrs Bellett was also in the Home throughout the inspection and assisting with care as required. From rotas viewed there are always a minimum of three staff on duty throughout the day and two night staff on duty to support the 22 residents Stoneham House DS0000012356.V325428.R01.S.doc Version 5.2 Page 24 accommodated. The manager and Mrs Bellett are often supernumerary to the staff team. However, it was evident from observations and discussions held with staff that there was not a system in place for the deployment of staff. For example call bells were heard ringing from residents rooms but they were often left to ring with no staff seen to answer them. Staff were seen to respond to tasks but often as they were asked to do with no clear structure or system as to what they should be doing. Staff said that they always worked in this way but, that they always tried to meet residents’ needs. This was also discussed with the manager who indicated that he considered there to be sufficient staff and needs were met. Residents did not indicate that there were a lack of staff but said they were “often busy” “ ill go and find a staff member if I see that someone needs help”. This example was given by a resident in the main lounge and who told the inspectors that when there were no staff in the lounge and another resident needed support she would offer to go and get a care worker. A requirement was made for a system to be put in place to ensure staff are deployed appropriately and are monitoring the needs of residents at all times. Comment cards received from 23 relatives and 10 residents indicated that they considered there to be sufficient staff on duty and that they were helpful and responsive to their needs. There is currently one staff member who has a National Vocational Qualification with a number of other staff undertaking or due to commence the course. Four staff records were viewed. Three of the files contained an application form that had been completed prior to an interview, proof of identity and the name of two referees for a reference and the completion of the CRB [Criminal Records Bureau check] and POVA first check [Protection of Vulnerable Adults]. However, it was evident from the fourth file viewed that a care worker was on duty in the Home during the afternoon of the inspection without having a Protection Of Vulnerable Adults First (POVA) Check or Criminal Record Bureau Check (CRB). When this was brought to the attention of the manager he said that he was awaiting the return of the individual’s CRB check and POVA First check that had been sent off in December 2006 when the staff member commenced work in the Home. The Registered Provider Mrs Bellett said that she was aware of the need to ensure that all staff had a minimum of a POVA First check and were supervised at all times until a satisfactory CRB check was returned. She indicated that she was not aware of the staff member working in the Home without any checks at all. Mrs Bellett indicated that the staff member would not work in the Home until satisfactory checks had been received and would be sent home immediately. Written confirmation was received from Mrs Bellett to this effect. A requirement was made for all staff to undertake the relevant recruitment checks that must be held in their personal files prior to commencing work in the Home. Stoneham House DS0000012356.V325428.R01.S.doc Version 5.2 Page 25 Two staff spoken to indicated that they had undertaken a thorough recruitment process including an induction into the Home that had included fire safety, health and safety, moving and handling, infection control and a general over view of residents needs. Both indicated that they received supervision and that staff meetings were held monthly. Since the last inspection the manager has implemented a training programme with courses having taken place on health and safety, food hygiene, manual handling, first aid, fire safety, infection control, medication awareness, adult protection, managing abusive behaviour and dementia awareness. The home uses outsider trainers to do the training in-house. The manager reported that the courses had been checked with Skills for Care and Development [formerly TOPSS – The National Training Organisation for Social Care] to ensure they were relevant to the care practices in Stoneham House. Several staff members, spoken to, said that they had undertaken the training and that it was helpful. Stoneham House DS0000012356.V325428.R01.S.doc Version 5.2 Page 26 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): Standards 31,33, and 38 were inspected. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The manager does not provide leadership, which ensures staff are supported and residents’ health, safety and welfare are promoted and protected through the home’s practices. EVIDENCE: The manager has been in post for six months although initially on a temporary basis. His appointment was made permanent in November 2006. The Registered Provider Mrs Bellett advised that an application for registration is to be made to the commission by the manager. Stoneham House DS0000012356.V325428.R01.S.doc Version 5.2 Page 27 Much discussion was held with Mrs Bellett on the day of the visit as to the concerns identified, the lack of systems implemented and lack of leadership of the Home by the new manager to ensure the Home is run in the best interests of residents accommodated. Mrs Bellett expressed concern as to the issues identified and indicated that the new manager “ must help me improve”. Discussions were also held with the manager who considered that he was working hard to make sure the paper work was up to date and, that residents were happy. He did not consider the care provided in Stoneham House to be poor but, agreed that this visit had identified areas that required improving. As a consequence of the number of short falls identified and poor practices recorded in this report a requirement was made for an effective quality assurance and quality monitoring system to be in place that demonstrated how the service, environment and care practices are being run in the best interests of the residents. Financial records were not inspected on this occasion although the manager explained the procedures for safe guarding monies held and no concerns were raised from feedback received from residents or their relatives/representatives as to monies or valuables held by management on resident’s behalf. This will be followed up at the next visit to the Home. The pre inspection questionnaire received by the commission indicated that health and safety, moving and handling, fire safety, first aid, food hygiene and infection control training is undertaken by staff. COSHH (Control of Substances Harmful to Health) assessments have been carried out and were available in the office. Cleaning fluids were seen to be kept locked away. A range of policies and procedures were in the home, which were available to staff although as detailed in a number of sections of this report some require reviewing or rewritten to reflect the care practices in the Home. The fire logbook was seen, which demonstrated the necessary tests were being carried out in the agreed timescales. Staff were receiving adequate sessions in fire issues in a twelve-month period and were able to confirm their understanding of the fire evacuation procedures in the Home. Servicing records were available demonstrating all the necessary equipment had been regularly serviced. The kitchen area was clean and well equipped. Fridge and freezer temperatures were maintained. All food in the fridge was appropriately stored being covered and dated. The cupboards were well stocked. An accident book was available but confidential information required to be removed remained in the book for all staff to see. The manager was advised to ensure that the information was stored appropriately and in line with the data protection Act 1998. The manager was further required to ensure an analysis was made of all accidents e.g. falls to ensure recurring themes were monitored and care plans and risk assessments reviewed as appropriate. Whilst records were kept of fire checks and training neither the manager nor registered provider were aware of the new Fire Regulations that came into force in October 2006. The Home was required to ensure they contacted Stoneham House DS0000012356.V325428.R01.S.doc Version 5.2 Page 28 Hampshire Fire and Rescue to obtain a copy of the new regulations and, ensure any new procedures were implemented in the Home. Stoneham House DS0000012356.V325428.R01.S.doc Version 5.2 Page 29 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 2 X 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 2 14 2 15 2 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 2 28 1 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X X X X 1 Stoneham House DS0000012356.V325428.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? N/A 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 OP9 Regulation 13 (2) Requirement The Registered Provider must ensure medication prescribed to residents is appropriately documented on the Medical Administration Record (MAR sheet). The Registered Provider must ensure medication is stored in a clean and secure environment at all times. The Registered Provider must ensure a broken reinforced glass window in a fire door on the ground floor is replaced. The Registered Provider must ensure that no staff are working in the Home without a protection Of Vulnerable Adult (POVA) First check. Staff without a Criminal Record Bureau (CRB) clearance, must work under supervision at all times. The Registered Provider must ensure all healthcare needs that have been identified are documented in residents’ files to evidence what treatment is to be given, by whom and when with a DS0000012356.V325428.R01.S.doc Timescale for action 15/01/07 2. OP9 13(2) 15/01/07 3. OP26 13 16/01/07 4. OP29 19, schedule 2 15/01/07 5. OP7 13,15 19/01/07 Stoneham House Version 5.2 Page 31 6. OP7 15 clear outcome recorded. The Registered Provider must ensure all discussions held with visiting professionals are recorded by the Home and signed by the staff member involved. The records must be held in residents’ files and be available for staff at all times. The Registered Provider must ensure all staff receive medication training. The Registered Provider must implement a system to ensure staff are aware of and are monitoring residents needs at all times. The Registered Provider must ensure the infection control policy and procedure is reviewed and reflective of the care practices in the Home. The Registered Provider must ensure there is a written policy and procedure relating to the cleaning of commodes and raised toilet seats. The Registered Provider must ensure there is a system in place to ensure all parts of the Home are kept clean including the dining room. The Registered Provider must ensure there are sufficient hand washing facilities in the Home to meet the needs of residents and staff. In the interim staff must be provided with alternative means of washing their hands. The Registered Provider must ensure staff files hold details of the initial induction undertaken by all new staff employed including agency staff. DS0000012356.V325428.R01.S.doc 19/01/07 7. OP9 13,19 29/01/07 8. OP27 18 15/01/07 9. OP26 13 22/01/07 10. OP26 13 22/01/07 11. OP26 13 17/01/07 12. OP26 13 15/02/07 13. OP30 19 29/01/07 Stoneham House Version 5.2 Page 32 14. OP19 13,23 The Registered Provider must ensure a plan is in place and available to the commission in relation to a programme of decoration of the premises. 15/02/07 15. OP33 24 The Registered Provider must 15/03/07 ensure there is documented evidence of a quality assurance system in place that demonstrates that residents are receiving the care they require and, that the home is run in their best interests. The Registered Provider must ensure all accidents reported are analysed to monitor recurring themes and take action where required. The Registered Provider and manager must ensure they are familiar with the new Fire Regulations and, that any new procedures are implemented in the Home. The Registered Provider must ensure maintenance records are kept up to date, to include the date a request was reported and when the work was completed and by whom. The Registered Provider must ensure all medication is administered directly from the original labeled container to the resident and not placed into any secondary container for administration by another care worker. 19/01/07 16. OP38 13 17. OP38 13 22/01/07 18. OP26 13,23 22/01/07 19. OP9 13 (2) 22/01/07 Stoneham House DS0000012356.V325428.R01.S.doc Version 5.2 Page 33 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 OP38 Good Practice Recommendations The Registered Provider must ensure accident forms are stored in line with the Data Protection Act 1998. Stoneham House DS0000012356.V325428.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Stoneham House DS0000012356.V325428.R01.S.doc Version 5.2 Page 35 - 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. 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