Inspection on 08/09/08 for Strathmore House

This inspection was carried out on 8th September 2008.

CSCI found this care home to be providing an Adequate service.

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 11/10/07

Strathmore House 18/04/07

Strathmore House 10/11/06

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 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Strathmore House Friday Bridge Road Elm Near Wisbech Cambridgeshire PE14 0AU Lead Inspector Janie Buchanan Unannounced Inspection 8th September 2008 09:00 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.V371000.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.V371000.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 strathmore.house@ashbourne.co.uk www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited 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) 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.V371000.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 3rd December 2007 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 residents 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. Strathmore House DS0000066352.V371000.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. For this inspection we (The Commission for Social Care Inspection) looked at all the information that we have received. This included the annual quality assurance assessment (AQAA) that was sent to us by the home. The AQAA is a self-assessment that focuses on how well outcomes are being met for people living in the home. It also gave us some numerical information about the service. We also received 24 surveys from people living in the home, their relatives and from staff. We spoke with four residents, three members of staff and the project manager, and looked at a range of policies and documents. We undertook a brief tour of the home to check the environment and health and safety matters. The home has been subject to additional inspections since its last key inspection to check on compliance with requirements and also because of concerns about its adult protection procedures. Social services contracts department have suspended placements at the home as a result. We have also issued a statutory requirement notice in relation to staff training. Six legal requirements have been made as a result of this inspection. What the service does well: What has improved since the last inspection? What they could do better: • The Statement of Purpose and Service User Guide should include details of how the needs of residents with dementia can be met at the home. DS0000066352.V371000.R01.S.doc Version 5.2 Page 6 Strathmore House For example; how the home’s environment will enable people with dementia to remain independent, how care planning will be person centred, what increased level of support and staffing there will be, what specific activities there will be for people with dementia, and what the security of the building will be. This was raised at the last inspection. • Medication practices need to be tighter to ensure that residents receive their medication as prescribed, and that there is a clear record of what they have received. The quality of activities has declined since the last inspection and more must be done to provide residents with meaningful stimulation and entertainment. Complaints must be dealt with promptly and efficiently so that residents and their relatives know their concerns are taken seriously. Residents live in poorly maintained and shabby home, areas of which smell of stale urine. Considerable work needs to be undertaken so that residents live in a pleasant and safe environment. Supervision for staff is poor and must improve so they have the opportunity to discuss their work with residents, receive feedback about their working practices and identify their training needs Strathmore House is in desperate need of strong management to raise its standards, provide much needed guidance to staff and to start tackling the many shortfalls still evident in this home: as one relative reported; ‘I feel that Strathmore House could be a really great place with stronger leadership at the top’. • • • • • 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.V371000.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.V371000.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): 1,2,3,5 Quality in this outcome area is good. Residents have information about the home to help them choose if it is the right place for them. They have their needs assessed and a contract that gives details of the service they will receive. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has produced a statement of purpose and service user guide that give good information about the philosophy of care, accommodation, care and nursing services, staffing structures, health and safety and how to complain. However, the home is registered to accommodate people with dementia and more detailed information is required in these documents to show how the home can meet the specific needs of these residents. We have not made a requirement on this occasion and expect the home to update its information. Prospective residents are able to visit the home before moving in however, one resident told the inspector she came to the home straight from hospital, following a stroke, and had no idea where she was going to, or what it was going to be like. Strathmore House DS0000066352.V371000.R01.S.doc Version 5.2 Page 9 The files of two recently admitted residents were viewed and all contained satisfactory pre-admission information about their needs. The files also contained contracts that gave details of the fees to be paid by residents, the accommodation and care to be provided, and the proprietor’s obligations. Strathmore House DS0000066352.V371000.R01.S.doc Version 5.2 Page 10 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, Quality in this outcome area is adequate. Residents’ health needs are monitored at the home but their care plans do not always accurately reflect their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A sample of residents’ care plans was viewed. The information they contained was generally detailed, up to date and reviewed regularly, allowing care staff to offer support consistently. However some information in the plans was confusing and didn’t accurately reflect residents’ actual needs at the time. In one plan it clearly stated that the resident must be turned 2-hourly during the night using a sliding sheet. However there was no turn chart available in this resident’s bedroom, and no sliding sheet to be found. Care staff were unsure of the person’s night time routine. Two of the plans contained no information about the residents’ past life, their social history, family and hobbies, and the plans were not in a format that residents could easily access or understand. There was evidence that residents’ health care needs were met at the home with their weights, dependency levels, nutrition, falls risk and pressure sore Strathmore House DS0000066352.V371000.R01.S.doc Version 5.2 Page 11 risk monitored monthly. Plans also contained evidence that they saw a range of health care professionals. However one GP reported in one of the home’s surveys; ‘more staff are required to enable appropriate levels of care, staff need more training and support as our district nursing team is heavily involved in patient’s care’ We checked medication storage and a sample of residents’ medication administration record (MAR). We noted the following shortfalls: • • • In a number of cases staff were not administering medication according to the instructions on the MAR sheets and residents were receiving less than was actually prescribed. There was no explanation why this was A number of hand written additions to the printed MAR sheets had not been signed or dated The date on which liquid medication bottles had been opened had not been recorded Strathmore House DS0000066352.V371000.R01.S.doc Version 5.2 Page 12 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): 12,13,15 Quality in this outcome area is adequate. Mealtimes at the home are a pleasant and relaxing affair, however more could be done to provide residents with stimulating activity. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The only activities advertised on the main notice board were Jeremy Hillyard (musician) on 14/09/08 and a Church Service in October. There was an activities schedule on the home’s dementia care unit but staff told us it was out of date, no longer relevant and needed to be removed. The home does employ a specific activities co-ordinator but despite this one relative wrote; ‘in the important area of daily activity Strathmore House is badly let down and deserves better’. Another: ‘sometimes the time goes so slow for the residents, do they need more activities’. Another relative commented that the activities provided were not really appropriate for all residents. Staff themselves described the activities as ‘poor’ with only a very few residents getting the chance to go outside the home. Visitors and relatives who completed our surveys reported that the home did keep them in touch with important issues affecting their friend or relative. One commented; ‘staff always keep us informed of any problems’ and residents told us that their visitors are made to feel welcome by staff. Strathmore House DS0000066352.V371000.R01.S.doc Version 5.2 Page 13 Lunch on the day we visited consisted of sausage and mash or gammon with pineapple, with a choice of boiled potatoes or chips. The quality of the food was satisfactory and residents were given a genuine choice of what to eat and drink. Staff supported residents to eat well and lunch was a relaxing, pleasant affair with residents given plenty time to eat and those needing help given it sensitively and discreetly. Strathmore House DS0000066352.V371000.R01.S.doc Version 5.2 Page 14 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 adequate. Residents have access to the home’s complaints procedure but their concerns are not always taken seriously. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information about how to complain is on display on a notice board in the hallway of the home and we viewed laminated copies of the complaints procedure in residents’ bedrooms, allowing them easy access to it. Both residents and relatives told us they knew how to make a complaint but when they did it wasn’t always resolved satisfactorily. For example one relative told us: ‘it took six months to sort a dentist out when laundry staff washed dentures in washing machine. The dentist says it is too long a time without them to do anything’. Another: ‘I have many concerns about the sort of activities provided by the designated activities person. I have repeatedly voiced these concerns both to the activity supervisor and the care home management. Little has been done to remedy this’ Staff receive training in protecting vulnerable adults and those we talked to showed a satisfactory awareness of the different types of abuse an older person can face and reporting procedures. Despite this, however, there have been a number of incidents in the last year which have highlighted serious shortfalls in how staff at the home recognise, report and investigate adult protection issues, the most recent concerning two residents who were found by a neighbour wandering along the road outside the home. The local authority has provided the home with additional training in adult protection as a result. Strathmore House DS0000066352.V371000.R01.S.doc Version 5.2 Page 15 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): 19,20,26 Quality in this outcome area is poor. Residents live in a home that is badly maintained and looks shabby and neglected from the outside. This judgement has been made using available evidence including a visit to this service EVIDENCE: The home’s dementia care unit had many good features: chairs and tables were arranged to allow residents to sit together in small groups and communicate more easily with each other; large arrows pointing to the lounge area had been put up to help residents find their way about and bedrooms doors had been personalised and decorated with door knockers and letterboxes. However on this unit the TV was on in one corner of the room, a radio on loudly in the other and numerous bells kept sounding (including the home’s front door bell, the office phone and residents’ calls bells which can all be heard loudly). This continual cacophony of noise must be very confusing and distracting for residents on this unit. Strathmore House DS0000066352.V371000.R01.S.doc Version 5.2 Page 16 Many of the doors, both internal and external, were in need of repainting. The flooring in the main dining room looked dirty and was bubbling up in some places. In one upstairs toilet there was exposed pipe work, a loose toilet seat and dirt in the bathtub. We found 2 jugs of badly smelling and rancid milk in one the kitchen fridges, it was clear that the fridge had not been working (we recorded its temperature as 10oc, which is well above the maximum temperature it should be) but this had not been spotted by staff. One relative told us: ‘some of the furniture is well passed the sell by date. The exterior still needs some work to make it more inviting and having a better garden to stimulate their occupants’. Some areas of the home smelled strongly of stale urine. The exterior of the home continues to look shabby and neglected. Paint is peeling away from many of the external window frames and facia boards. In the dementia care unit’s garden there were large wooden structures left out on the grass causing considerable trip hazards for residents. Strathmore House DS0000066352.V371000.R01.S.doc Version 5.2 Page 17 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 good. Residents are looked after by caring and well trained staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One relative described the staff as: ‘always bright and cheerful and seem to know what tack to take to get the best out of people’. The quality of interaction between staff and residents on the dementia care unit was particularly good, with staff treating residents with genuine respect and understanding. Staffing levels appeared to be adequate, with 7 staff on in the morning, six staff on in the evening and four staff on during the night to meet the needs of 30 residents. One resident told us: ‘I only have to ring my bell to get attention’. However on two occasions during our visit the residents’ call bell rang out for long time. We checked the training files for three members of staff that showed they had undertaken a range of appropriate training, although two of the night staff had not received any training in first aid. According to the home’s AQAA over 50 of staff hold an NVQ level 2 in care. We checked the personnel files for three recently recruited staff and all appropriate checks and references had been received by the home before the person started working there. Strathmore House DS0000066352.V371000.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): 31,33,36,38 Quality in this outcome area is adequate. There continues to be unstable management arrangements in place that is unsettling for staff and residents and does not ensure the effective leadership and running of the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has been without a registered manager since September 2007 and a requirement to register a manager by 1 January 2008 has not been met. The home did have an acting manager for a number of months but she has now resigned and, once again, interim management arrangements in place. This has been confusing and unsettling for staff and one member told us that different managers work in different ways: ‘you just get used to how one works then another comes along and changes everything’. Another member reported that communication between managers and staff could be improved. For example, she reports that nobody tells the laundry assistant when a Strathmore House DS0000066352.V371000.R01.S.doc Version 5.2 Page 19 resident moves room, resulting in the wrong clothes being delivered to them. However a project manager is currently spending additional time at the home: she had a good understanding of many of the shortfalls and is working hard to improve standards. Staff do receive supervision but the quality of it is very poor: on several occasions all that was recorded by both supervisor and supervisee was ‘nothing to discuss at present’. This shows a poor understanding of the importance of good supervision for staff and its role in monitoring their working practices, identifying their training needs, dealing with problems and giving staff a chance to air their views. We checked a number of records in relation to health and safety (including portable appliance testing, gas, list and hoist servicing) that showed that the home regularly maintains and checks the safety of its equipment. We looked round the kitchen: it was clean and all foodstuffs were labelled and stored appropriately. The home has recently been awarded 4 stars (very good) after a visit from the environmental health officer. Strathmore House DS0000066352.V371000.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 2 3 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 1 1 2 x x x x x 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 2 x x 1 x 3 Strathmore House DS0000066352.V371000.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 OP9 Regulation 12(1) Requirement Residents must be given their medication according to the prescribed instructions so that their health is maintained. Activities for residents must improve so they have access to stimulation and entertainment. Complaints must be dealt with promptly and efficiently so that residents and their relatives know their concerns are taken seriously The premises must be kept in a good state of repair so that residents live in a well maintained and safe environment An application to register a permanent manager must be received by CSCI to ensure effective running and leadership of the home. Previous timescale of 01/01/08 not met. CSCI may Strathmore House DS0000066352.V371000.R01.S.doc Version 5.2 Page 22 Timescale for action 01/10/08 2 OP12 16(2)(n) 01/11/08 3 OP16 22 (3) 01/11/08 4 OP19 23(2)(b) 01/02/09 5 OP31 8 01/12/08 consider taking legal action 6 OP36 18(2) Supervision must improve so there is an opportunity to give staff feedback about their working practices, identify their training needs dealing with problems and give them a chance to air their views. 01/11/08 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 OP1 Good Practice Recommendations The Statement of Purpose and Service User Guide should include details of how the needs of residents with dementia can be met at the home. For example; how the home’s environment will enable people with dementia to remain independent, how care planning will be person centred, what increased level of support and staffing there will be, what specific activities there will be for people with dementia, and what the security of the building will be Strathmore House DS0000066352.V371000.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team 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. 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