Inspection on 10/11/06 for Strathmore House

This inspection was carried out on 10th November 2006.

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

Strathmore House 08/09/08

Strathmore House 11/10/07

Strathmore House 18/04/07

Strathmore House 19/04/06

Strathmore House 07/11/05

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Strathmore House Friday Bridge Road Elm Near Wisbech Cambridgeshire PE14 0AU Lead Inspector Mrs Jenny Cangy Key Unannounced Inspection 10th November 2006 10:15 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 Strathmore House DS0000066352.V318331.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. Strathmore House DS0000066352.V318331.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Strathmore House Address Friday Bridge Road Elm Near Wisbech Cambridgeshire PE14 0AU 01945 860569 01945 860202 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited Care Home 46 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (46), of places Terminally ill over 65 years of age (25) Strathmore House DS0000066352.V318331.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Maximum of 25 TI(E) beds Maximum of 20 DE(E) beds Maximum of 46 OP Date of last inspection 19th April 2006 Brief Description of the Service: Strathmore House is situated in secluded mature gardens set back from the road between the villages of Elm and Friday Bridge. It is a large 18th century house that has been extended beyond its original to provide the present facilities. Accommodation in the old house is on two floors with the first floor being accessed by a shaft lift There is a variety of sitting areas and a dining room. The extended area of the house is single story and within this area is a self contained unit for older people with dementia. A detached bungalow next to the main house has accommodation for six people. Current weekly fees range from £340 for local authority funded residential care to £624 for service users receiving privately funded nursing care. Additional charges are made for newspapers, hairdressing and private chiropody. The inspection report is available on request from the manager. The home does not currently display the current report, make it available to the service users or discuss the contents with the service users. This was discussed with the appointed manager. Strathmore House DS0000066352.V318331.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection by two CSCI inspectors. The inspection commenced at 10:15 with the inspector walking around the outside of the building and checking the state of the grounds and pathways. The inspectors were then able to enter the building through a rear door via the dining room unchallenged. It was noted immediately that the building was unacceptably cold and there was no heat coming from radiators in lounges and in the main entrance hall. The appointed manager was on duty and the situation was discussed. She stated she had notified her line manager the previous day but had no response yet. She had put thermometers at various points around the home and these were found to range from 11 degrees centigrade in a bathroom to 20 degrees in service user lounges. Service users felt cold to touch and the appointed manager instructed her staff to close windows and get knee rugs out for every one. During the course of the inspection the appointed manager spent time making phone calls to the estates department to get action taken and gain permission to hire portable heaters. The inspectors left at 5.15 pm and they had not yet arrived. The temperature remained unacceptably low throughout the home, with the exception of Snowdrop Cottage, all day. The inspectors spent time discussing the requirements from the last inspection, the standards being inspected at this inspection and records required to be kept. A tour of the buildings followed when staff, service users and relatives were spoken to and activities observed. Care plans were seen and medication records checked. The inspection concluded at 17:15 following feed back on the inspection findings to the appointed manager. What the service does well: The home is well staffed with a qualified nurse on each shift in addition to the appointed manager who is also a nurse. The dementia care unit (Jasmine Wing) has a senior care worker who takes lead responsibility for the unit and organises appropriate activities for this client group. A senior carer has lead responsibility for the care of service users without nursing care needs and a qualified nurse has lead responsibility for service users with nursing needs. There is a dedicated staff member to organise activities and she ensures all service users have the opportunity to participate in activities or have one to one time if they are too frail. Strathmore House DS0000066352.V318331.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Strathmore House DS0000066352.V318331.R01.S.doc Version 5.2 Page 7 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 Strathmore House DS0000066352.V318331.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 6 Quality in this outcome area is good. Service users have an assessment of their needs before moving into the home and those admitted in emergency situations have an assessment on arrival. The home does not provide intermediate care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service user records contain the initial assessment of needs and this forms the basis of their care plan. Any service users admitted in emergency situation have a social service assessment in place and the home then does their own assessment on admission. A letter is sent to the service user or their representative stating that their needs can be met, a copy of this is on their file. Strathmore House DS0000066352.V318331.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is poor All service users have care plans that gives detail of their care needs however some gaps in information were found. Medication procedures are not being followed adequately leaving service users at risk. The majority of service users are treated with respect and dignity however it was noted not to be the case at all times This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service user care plans are on the whole detailed and informative. However there is insufficient detail with regard to service users being nursed in bed with regard to the change of position regime. Some service users have turning charts in their bedrooms that show gaps of up to 6 hours when it is stated they should be turned every four hours. There was no care plan in place for at least two service users with regard to the need to be turned despite there being a turning record in their bedroom. Strathmore House DS0000066352.V318331.R01.S.doc Version 5.2 Page 10 During the course of the inspection a large quantity of recently received medication blister packs was seen to be left unattended in an unlocked room despite there being mobile service users in the area and an outside contractor doing maintenance work in the area. This continued despite the situation being highlighted by the inspectors. The nurse responsible treated the situation lightly and took no action. The controlled drug record book does not give the address of the prescribing pharmacist as required. Other wise the recording of medication was found to meet the standards. Prescribed creams were found in unlocked service users bedrooms. In the dementia care unit it was observed that staff used inappropriate expressions not befitting the age of the service user. The same service user was being pressured to do things she did not want to and the staff approach indicated a lack of understanding of dementia care. However observation around the home in general indicated a respect for privacy and dignity. Strathmore House DS0000066352.V318331.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. Routines of daily living are flexible to the needs of the service users and service users are encouraged to exercise choice in all aspects of their daily lives and meal are selected from menus the service users help to compile. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a dedicated activity co-ordinator who organises daily activities. A programme of these activities was seen displayed on the notice board. Frail service users who are unable to join in community activities have one to one time that includes being read to. Service users spoken to stated they are happy with the activities and do not get bored. Service users are taken out shopping or to community events. Outside entertainers visit the home. Family and friends are free to visit and to take service users out. There are regular service user meetings and minutes of these are kept. The chef attends the meetings and menu planning is incorporated. Service users are able to select from a choice of menu for the following day. Service users spoken to in the dining room were able to tell staff what they were having for lunch and spoke Strathmore House DS0000066352.V318331.R01.S.doc Version 5.2 Page 12 highly of the quality of the food. Meal times are well spaced and snacks and drinks are available at all times. One service user stated she always had her meals in her room but did not know why and would prefer to join others in the dining room. Strathmore House DS0000066352.V318331.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is poor. Complaints are recorded and acted on. Service users are not adequately protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a clear complaint procedure contained in the service user guide. The complaint log is monitored by the appointed manager and her line manager. On inspection there were no recent complaints but those recorded had been appropriately responded to. It was clear that the appointed manager was not clear about reporting suspected abuse to the PoVA team and that both she and her staff team need further training. Observations during the inspection highlighted poor moving and handling techniques and inappropriate behaviour toward a service user with dementia. It was also noted that no action had been taken regarding a service user with significant weight loss. The care plan contained no comment on the weight loss or planned action to investigate or resolve it. Strathmore House DS0000066352.V318331.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 24, 25 26 Quality in this outcome area is poor. The service users do not have a safe well maintained environment. Bedrooms are suitable but the lack of a reliable call system leaves the occupants at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The heating system is not satisfactory and the only area of the home that was of a suitable temperature was Snowdrop Cottage. It is the understanding of the inspectors that the heating presented problems last winter and the providers were advised that the system needed to be drained and overhauled. No action was taken over the summer months. The inspectors spoke to a contractor who attended in the afternoon and he stated that the boilers were firing up with no problem but that the heat was not circulating and that this was an ongoing problem. Service users spoken to complained of being cold and Strathmore House DS0000066352.V318331.R01.S.doc Version 5.2 Page 15 one couple said they were in the habit of getting into bed in the afternoons to keep warm. Other service users were wearing jackets to keep warm. Bathrooms were found to be below 11 degrees centigrade making them too cold for use. These problems have never been reported to CSCI as required under regulation 37 (1e) It was further noted that the nurse call system does not have sufficient call boxes to be in reach of all service users. An outside contractor stated that he was condemning the system after his annual inspection and servicing as he had done on his last inspection one year ago. The nurse call system has been unsuitable for purpose for a year. He further stated that the fire alarm and smoke detector system were in working order but that they did not meet the current requirements and are in need of replacement/upgrading. Bedrooms are pleasantly furnished and personalised. However the lack of an adequate call system may put service users in their bedrooms at risk. It was noted that redecoration and re-carpeting is taking place throughout the home and planned improvements to the area from the foot of the fire escape to the car park are yet to take place. The home was noted to be clean and fresh throughout. Strathmore House DS0000066352.V318331.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is poor. Staffing levels are good during the day but due to the geography of the home less than adequate at night. Staff training and supervision needs to be improved. The homes recruitment procedures do not guarantee the service users are in safe hands. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff were observed using unacceptable moving and handling techniques. Staff were observed inappropriately managing a service user with dementia causing further agitation. It was noted from staff files that not all staff had two written references and one did not have a reference from her last employer. Staff training records show induction training and statutory training but these were not all up to date. It was clear that there is a lack of understanding with regards to Protection of Vulnerable Adults. Despite all staff having moving and handling training poor techniques were observed indicating a lack of supervision and review. The acting manager agreed that staff supervision is not up to standard but demonstrated a lack of understanding of the term supervision, regarding it only from a clinical point of view. It is clear that training in supervision is needed by all senior staff. Strathmore House DS0000066352.V318331.R01.S.doc Version 5.2 Page 17 The qualified nurses demonstrated a need for training in the safekeeping of medication. Strathmore House DS0000066352.V318331.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 38 Quality in this outcome area is adequate. Although the appointed manager works hard to maintain a high standard the failings of the provider has made this very difficult. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The appointed manager is not registered with the CSCI and this has been outstanding for almost a year. She completed her application and sent it to head office where it was lost so she has to start the process again. Poor maintenance of the heating and nurse call system is putting service users at significant risk. The home’s administrator manages service users finances and this was found to be efficiently done. Formal staff supervision is poor with only group supervision in the form of staff meetings being recently recorded. The Strathmore House DS0000066352.V318331.R01.S.doc Version 5.2 Page 19 homes deputy has been seconded to another home leaving the appointed manager to do all the staff supervision and try to solve all the maintenance problems together with the general management. The provider needs to review the overall staffing establishment of this home to ensure that the senior team is sufficient to deal with all the problems associated with a home established in an old premises and all the associated problems of this. The provider should consider reviewing the role of the area manager and the level of support being given to this home. Strathmore House DS0000066352.V318331.R01.S.doc Version 5.2 Page 20 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 1 X 2 X X 1 1 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 1 X 1 Strathmore House DS0000066352.V318331.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 15 Requirement The registered person must ensure that care plans contain sufficient detail to ensure that all their care needs are known and carried out. The registered person must ensure that medication is stored in a safe way. An immediate requirement notice was left on the day of inspection. The registered person must ensure that the name and address of the dispensing pharmacist is recorded thecontrolled drug register. The registered person must ensure that staff are trained in the correct moving and handling techniques and that they continue to practice them The registered person must ensure that staff treat service users with respect and dignity at all times regardless of the level of their disability. The registered person must ensure that staff have appropriate training in regards to preventing and recognising DS0000066352.V318331.R01.S.doc Timescale for action 30/11/06 2 OP9 13(2) 10/11/06 3 OP9 13(2) 20/11/06 4 OP10 13(5) 30/12/06 5 OP10 13(6&7) 20/11/06 6 OP18 13(6) 28/02/07 Strathmore House Version 5.2 Page 22 7 OP19 23(2)(p) 8 OP19 12(1)(a) 9 OP19 23(2)(b) 10 OP21 23(2)(p) 11 OP24 23(2)(p) 12 OP25 23(2)(p) 13 OP28 18 14 OP29 7,9,19 & schedule 2 15 OP30 19(5)(b) abuse of the vulnerable elderly The registered person must ensure that there is adequate heating to all parts of the home occupied by service users The registered person must ensure that the welfare of the service users is met by having a fully working nurse call system that is accessible to service users wherever they are in the building. All areas of the home must be well maintained and decorated. This is ongoing from the last inspection The registered person must ensure that bathrooms are suitable for use and of an acceptable temperature. The registered person must ensure that individual bedrooms are maintained at a temperature to keep the service users comfortable The registered person must ensure that the heating system for the home is well maintained and any problems responded to promptly to ensue that all areas of the home used by service users are maintained at an acceptable temperature. The registered person must ensure that all grades of staff have adequate training to provide appropriate care to the service users in their care. The registered person must ensure that all staff have 2 written references and PoVA first check and a CRB enhanced check before being permitted to work unsupervised. The registered person must ensure that all staff have training appropriate to needs of the service users and this training is DS0000066352.V318331.R01.S.doc 10/11/06 28/02/07 30/12/06 10/11/06 10/11/06 10/11/06 28/02/07 30/11/06 28/02/07 Strathmore House Version 5.2 Page 23 16 OP31 8 ongoing and reinforced. The appointed manager must submit an application to register with the CSCI. This is ongoing from the last inspection with a date of 30/09/06 not being met. A new date has been set and failure to meet this date will result in legal advice being sought. The registered person must ensure staff have regular formal supervision at least 6 times per year and the supervisors are appropriately trained to conduct this supervision. The registered person must ensure that the senior staffing levels of this home are reviewed to ensure that there is adequate management in place to ensure to safe running of this home. 12/12/06 17 OP36 18(2) 30/01/07 18 OP38 18 30/01/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Strathmore House DS0000066352.V318331.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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 Strathmore House DS0000066352.V318331.R01.S.doc Version 5.2 Page 25 - 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!