Inspection on 14/12/07 for Stratton House [Burnham-on-Sea]

This inspection was carried out on 14th December 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

Stratton House [Burnham-on-Sea] 22/04/08

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Stratton House 15 Rectory Road Burnham-on-Sea Somerset TA8 2BZ Lead Inspector Kathy McCluskey Unannounced Inspection 14th December 2007 10:00 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 Stratton House DS0000070059.V356535.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. Stratton House DS0000070059.V356535.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stratton House Address 15 Rectory Road Burnham-on-Sea Somerset TA8 2BZ 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) 01278 787735 Angels (Stratton House) Ltd ****Post Vacant**** Care Home 24 Category(ies) of Dementia (24), Old age, not falling within any registration, with number other category (24) of places Stratton House DS0000070059.V356535.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home providing personal care only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Dementia (Code DE) The maxmimum number of service users who can be accommodated is 24. N/A 2. Date of last inspection Brief Description of the Service: Stratton House is a large and extended detached property which is situated in a pleasant residential area not far from the town of Burnham-on-Sea and the sea front. The home was sold earlier this year and in June 2007, the Commission approved an application from Angels (Stratton House) Ltd, to be the registered provider. The responsible individual in Mr M Pattani. The home does not currently have a registered manager. The home is registered with the Commission to provide personal care only to a maximum of 24 people who require care by means of old age or dementia. The home is not registered to provide nursing care. The Commission was provided with the following information about the home’s fee range and charges. Fees are between £373 & £395 per week. Extra charges are met by service users for hairdressing, personal toiletries, chiropody, newspapers, private opticians/dentist. Full details can be found in the home’s brochure. Stratton House DS0000070059.V356535.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of this inspection visit was to inspect relevant key standards under the Commission’s ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are; - excellent, good, adequate and poor. This was the home’s first inspection since the provider was registered by the Commission in June 2007. This unannounced key inspection was conducted over one day (7.5hrs) by regulation inspector Kathy McCluskey. The home’s registered manager left her post in September 2007. The acting manager was available for the majority of the inspection but had to leave before the inspection was completed. As part of this key inspection, the home completed an Annual Quality Assurance Assessment (AQAA), which was forwarded to the Commission. The Commission sent comment cards to service users, relatives, staff and healthcare professionals. Comments have been included in this report as appropriate. At the time of this inspection 23 service users were living at the home, which included 1 service user who was in hospital. The inspector was able to meet with the majority of service users and staff during the inspection. Records were examined relating to service users, staff and health and safety and a tour of the premises was carried out. The inspector would like to thank service users and staff for their time and cooperation with the inspection process. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. What the service does well: Stratton house provides service users with a comfortable and homely environment. Stratton House DS0000070059.V356535.R01.S.doc Version 5.2 Page 6 The home has produced a Statement of Purpose and Service User Guide which provides people with good information about the home and services offered. Staff were heard communicating with service users in a kind manner. Service users were positive about the meals at the home stating, ‘there is always plenty to eat’. Service users who were able to express a view informed the inspector that they liked their bedrooms. It was evident that service users are encouraged to personalise their bedrooms. What has improved since the last inspection? What they could do better: This inspection resulted in 27 requirements being raised. The home needs to review its’ arrangements for the assessment of prospective service users to ensure that it has sufficient information and only offers placements to service users whose needs they can fully meet. The home is not always ensuring that service users have care plans in place which identify all of their assessed needs and how these should be met. Care plans do not currently promote a person centred approach to care and there was no evidence that service users and/or their representatives had been involved in or consulted about the care planning process. Care plans and assessments had not been reviewed since September 2007 and the home is not ensuring that the weight of service users is monitored on a monthly basis. Records do not demonstrate that service users are assisted to bath more frequently than once a week. The home’s procedures for the management and administration of service users medication is generally good though they need to ensure that the amount administered for variable doses of medication is recorded. They also Stratton House DS0000070059.V356535.R01.S.doc Version 5.2 Page 7 need to make sure that the maximum daily dose for paracetamol is clearly identified. The home does not employ an activities co-ordinator. Activities are carried out by a senior carer and care staff as part of their care hours. Service users were not positive about the activities available and records demonstrated that activities were ‘sporadic’. Staff interaction was noted to be limited during this inspection. The home has a complaints procedure though this is not displayed. Comments received indicated that people did not always feel confident in raising concerns. The home needs to improve its procedures for reducing the risk of harm or abuse to service users. This relates to the home’s staff recruitment procedures, staff training and updating the home’s Safeguarding Adults Policy. The home is generally comfortable but is showing signs of wear and tear. The home does not employ a maintenance person. Not all areas and bedrooms have the provision of a call bell system. On the day of this inspection it was noted that some areas of the home were not heated to a comfortable temperature. Currently the home’s layout and lack of signage is not ideal for service users with dementia. Not all staff have received training in how to care for people with dementia. Staffing levels need to be reviewed to ensure they are sufficient to meet the needs of service users at the home. In the absence of a registered manager, the registered person must ensure that effective management systems are in place. During the inspection, staff morale was noted to be low and this was also confirmed by staff. Records relating to staff supervision, training and health and safety were poor and did not demonstrate that the home was following correct procedures. 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 Stratton House DS0000070059.V356535.R01.S.doc Version 5.2 Page 8 be made available in other formats on request. Stratton House DS0000070059.V356535.R01.S.doc Version 5.2 Page 9 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 Stratton House DS0000070059.V356535.R01.S.doc Version 5.2 Page 10 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 and 4. Standard 6 is not applicable as the home is not registered to provide intermediate care. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home has produced a Statement of Purpose and Service User Guide which provides information about the home. The home’s arrangements for assessing the suitability of prospective service users requires review. Not all staff have been trained in how to care for people with dementia and the home’s environment is not in line with best practise for service users with dementia. EVIDENCE: Stratton House DS0000070059.V356535.R01.S.doc Version 5.2 Page 11 The new provider has produced a Statement of Purpose and Service User Guide which were made available to the Commission at the point of the home’s registration. Both documents provide information about the home and services offered. Two service users returned comment cards to the Commission which confirmed that both had received sufficient information about the home to enable them to make an informed choice about moving there. Three care plans were examined at this inspection and one contained a contract/statement of terms and conditions. In comment cards completed by service users, one stated that they had received a contract. Pre-admission assessments were available in two of the three care plans examined. These assessments, completed by the home were a very basic ‘tick box’ style and provided very limited information about the assessed needs, aspirations or preferences of service users. One pre-admission assessment had not been fully completed. Neither assessment had been signed and only one had been dated. No assessments were in place from other healthcare professionals, though it could not be ascertained whether this was because they weren’t available or hadn’t been obtained. The home must review its arrangements relating to the assessment of prospective service users so that the home can be sure that it can fully meet the assessed needs of prospective service users. The inspector was informed that of the 23 service users currently at the home, 21 had varying degrees of dementia. From staff training records examined, it could not be ascertained whether all staff had received any training in dementia care. Staff confirmed that they were experiencing difficulties in meeting the mental health needs of one service user, but the inspector was able to see evidence in the care plan, that the home had requested a re-assessment. Out of the 5 completed comment cards from staff, in response to the question, ‘Do you feel that you have the right support, experience and knowledge to meet the different needs of service users?’, 3 responded, ‘Usually’ and 2 ‘Sometimes’. Six relatives completed comment cards for the commission and in response to the question, ‘Do the staff have the right skills and experience to look after people properly?’ 2 indicated ‘Always’, 3 ‘Usually’ and one no response. Other comments included; ‘I have no idea, some seem quite young’, ‘My feeling is that morale is low and the home lacks leadership’, ‘I have no knowledge about this’. The home’s environment is not ideal for service users who have dementia (refer to standard 20) Stratton House DS0000070059.V356535.R01.S.doc Version 5.2 Page 12 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 This judgement has been made using available evidence including a visit to this service. The home’s care planning procedures require review to ensure that care plans are up to date and reflective of an individual’s assessed needs. The home is not able to demonstrate that it is meeting the health and personal care needs of service users. The home’s procedures for the management and administration of service users medication need some improvements. EVIDENCE: Three care plans were examined at this inspection and the findings were as follows; Care plans were not up to date. The last review recorded took place in Stratton House DS0000070059.V356535.R01.S.doc Version 5.2 Page 13 September 2007. To ensure the healthcare and emotional needs are kept up to date, care plans should be reviewed at least monthly. No assessments or care plans were in place for a service user who had moved to the home a week prior to the inspection and no assessments were available from other healthcare professionals, so it was not clear how staff were aware of or met the service users needs. Daily records indicated that the service user was experiencing difficulties mobilising, was unsettled at night, had a reduced dietary intake and required assistance to wash and dress. No weight had been recorded on admission. This is more concerning given that the home are currently using agency staff to cover shortfalls. Two further care plans had not been updated since September 2007. This was also the case for assessments relating to the prevention of pressure sores, falls, nutrition and moving and handling needs. Only one of these care plans contained evidence of service user’s weights though from May 2007 to date, only one weight had been recorded. It is recommended that weights are recorded at least monthly. Personal care records seen indicated that service users were only assisted to bath on a weekly basis. This ‘generic’ practise should be reviewed to ensure a person centred approach to care. A relative has expressed some concerns regarding the home’s ability to meet the personal care needs of their relative. Care plans were not in place to meet the oral hygiene needs of service users. Toothbrushes were seen in service users bedrooms but these were noted to be dry and hard so there was no evidence that they had been used that morning. There was no evidence that service users or as appropriate, their representatives, had been involved in the care planning process or had been consulted about the plan of care. The inspector was informed that no service users are currently able to manage their own medication. The home’s procedures for the management and administration of medication was examined at this inspection. The home uses the Boots monitored dosage system (MDS) with pre-printed medication administration records (MAR). All medicines were found to be securely stored and there was no evidence of excessive stocks. MAR charts were generally well completed. There were no gaps in signing and hand written entries had been confirmed by two staff signatures. The home must ensure that the amount administered for variable doses is recorded on the MAR chart as this was not always the case. The maximum dose for allowed for paracetamol must also be recorded. Staff were heard communicating with service users in a kind and respectful manner. Stratton House DS0000070059.V356535.R01.S.doc Version 5.2 Page 14 To ensure that the dignity of service users is fully respected, it has been recommended that the home reviews the current arrangements for the storage of continence aids. Large quantities of incontinence pads were seen to be stored in full view in service users bedrooms. Stratton House DS0000070059.V356535.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 – 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. Service users lack appropriate stimulation and the home’s provision of activities requires improvement. Service users are offered a wholesome and plentiful diet but the home could further improve the lunchtime experience for service users. EVIDENCE: The home does not have an activities co-ordinator. The inspector was informed that activities were undertaken by a senior carer and care staff as part of their care hours. No programme of activities was available but the inspector was able to view a record of activities which had taken place. This indicated that activities were sporadic. For a number of service users their last recorded activity of a ‘manicure’ was dated 13th September 2007. During the inspection two service users who were able to express a view, informed the inspector that there was ‘not much going on’ at the home and Stratton House DS0000070059.V356535.R01.S.doc Version 5.2 Page 16 that they would ‘sit in the lounge’ or ‘go to their room’. One service user stated that they would ‘really like to play bingo’. Throughout the day the inspector was able to observe service users who, due to their dementia and communication difficulties, were unable to occupy themselves. Some service users were observed wandering around the home, two service users became distressed when they could not open the locked front door. The majority of service users were observed sitting in the main lounge. Throughout the day, staff interaction with service users was noted to be kind but limited and no activities took place. Staff spoken with indicated that they ‘found it difficult to find time to spend with residents’. Some staff also stated that they were sometimes ‘unsure’ how to interact with some service users. Comments received from relatives included; ‘I am not sure if emotional and spiritual needs are met’, ‘After living at the home for 4 months, care staff were unaware of relatives social history or her love of singing and music’, relative is ‘very isolated in her room and staff try to take time to go in and have a chat and she needs this interaction’. The inspector noted that following lunch staff locked the door to one of the lounges. This was discussed with the acting manager who was unable to give an explanation for this. This practise restricts the freedom of movement and choice for service users and must be reviewed. The inspector did not meet with any visitors at this inspection but in its Statement of Purpose, the home states that visitors are made welcome at the home ‘at all times’ in accordance with the service users wishes. Meals are prepared at the home. The inspector was able to observe lunch being served in the dining room. The meal appeared wholesome and plentiful and service users confirmed that ‘the food is good’ and ‘there is always plenty to eat’. Choices were seen to be offered to service users. The mealtime experience for service users could be further improved. As appropriate, condiments and jugs of drinks should be made available on tables for service users and the home could further promote choice and independence by introducing serving dishes rather than offering plated meals. When assisting a service user to eat, staff should ensure that they sit with the service user rather than stand over them as observed during the inspection. Stratton House DS0000070059.V356535.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 – 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 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 though this needs to be displayed in the home. People are not always confident in raising concerns. The home’s procedures for reducing the risk of harm or abuse to service users requires improvement. EVIDENCE: The home has a satisfactory complaints procedure but this should be displayed in a prominent position in the home. The inspector was informed that this was ‘currently in the drugs cupboard’ and was ‘waiting to be put up’. The inspector was informed that the home has not received any complaints since it was registered. Staff indicated that they were not confident in raising concerns; ‘nothing would get done’. Comments from relatives also indicated that they were not always confident in raising concerns; ‘If I complained it would be perceived that I was adding to Stratton House DS0000070059.V356535.R01.S.doc Version 5.2 Page 18 the pressure on the care workers’, ‘I have voiced concerns and some care staff have listened and responded or suggested I contact the owners – It just feels very impersonal’. The home’s procedures for ensuring that service users are protected from the risk of harm or abuse require improvements. The home does not have a copy of Somerset’s Safeguarding Adults Policy (May 2007) and records examined did not confirm that staff had received training in the prevention of abuse. The home’s procedures for staff recruitment do not fully protect service users from the risk of harm or abuse (refer to standard 29). Stratton House DS0000070059.V356535.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 25 & 26 Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. The home is comfortably furnished but the environment needs to be improved in order to meet the needs of service users with dementia. The home does not employ a maintenance person and parts of the home require attention. Call bells are not available in all areas utilised by service users. The temperature within the home was not comfortable in all areas. Improvements are needed to reduce the risk of the spread of infection. EVIDENCE: Stratton House DS0000070059.V356535.R01.S.doc Version 5.2 Page 20 The inspector was able to view all communal areas and the majority of service user bedrooms at this inspection. It was noted that the inner door at the main entrance was locked with a key which was kept in a ‘key safe’ near the door. The inspector observed that staff had to enter a ‘pin number’ to gain access to the key before they could unlock the door. The door is not linked in to the fire detection systems so is not automatically released in the event of the fire alarms sounding. It was also noted that a fire alarm ‘smash point’ is located in the lobby area on the other side of the locked door. As the entrance is a designated fire exit, it has been required that the home consults with the local fire authority to ensure that this arrangement is suitable and safe in the event of a fire. Some areas of the home appeared ‘tired’ looking and would benefit from redecoration. Paintwork in some areas was noted to be badly chipped. Bedrooms were generally comfortably furnished though in one bedroom the headboard was damaged and the front was missing off of a chest of drawers. In another bedroom, the headboard was not fixed to the bed. The paintwork around one upstairs window was badly cracked and the seals around the metal framed window were cracked and mouldy. The inspector was informed that the home does not employ a maintenance person. It has been required that the registered person supplies the Commission with a copy of their maintenance and redecoration programme. Communal areas are located on the ground floor and comprise of two lounges and a dining room, which are comfortably furnished. The inspector was informed that only one of the home’s two bathrooms is currently in use as the fixed hoist in one bathroom is awaiting repair. In addition to the two bathrooms, there is a shower room with a ‘step in’ good sized shower. The home’s Service user Guide states that of the 24 bedrooms, 20 are fitted with en-suite toilet facilities and 3 of these benefit from the added provision of a step in shower. The bedrooms without en-suite facilities are fitted with a vanity unit containing a wash hand basin. The home’s environment is not ideal for service users who have dementia. No signage was seen in the home and three service users were observed walking around the corridors of the home apparently ‘lost’. The majority of bedrooms did not have numbers or names displayed. Signage that was in place on bedroom doors could be improved to assist service users with dementia. Bathrooms and toilets, lounges and the dining room were not identified with signage. Current décor and furnishings are not based best practise for service users with dementia. Carpets are heavily patterned, doors are painted the same colour which means that toilets are not easily recognisable to service users. Stratton House DS0000070059.V356535.R01.S.doc Version 5.2 Page 21 Grab rails are located in corridors and the home has a passenger lift and stair lift to give access to the first floor. Seven bedrooms located on the first floor could only be accessed by service users who are mobile as, this corridor can only be accessed by steps. The home has a call bell system installed though it was concerning to note that in three bedrooms (not all bedrooms were viewed) call bells had been removed. The acting manager informed the inspector that they were ‘broken’ and ‘would be sent for repair’. In two bedrooms, there were no call bell points. The home’s Service User Guide states that ‘all rooms are fitted with nurse call systems’. A requirement has been raised. Some communal areas, bathrooms and bedrooms were noted to be quite cold. Two service users informed the inspector that one lounge was ‘always cold’. This was brought to the attention of the acting manager who advised that there were ‘problems’ with the heating systems. It has been required that the registered person takes appropriate action to ensure that all areas occupied by service users are maintained to a comfortable temperature. A free standing radiator was found in one bedroom which was excessively hot to touch. The acting manager confirmed that they had not completed a risk assessment in relation to this. At the time of this inspection, the acting manager confirmed that she would take appropriate action to ensure that the service user was not at risk of scalding (refer to standard 38). The inspector was informed that care staff carry out all laundry duties as part of their care hours. Staff indicated that they ‘found this hard especially when residents needed them’. This arrangement should be kept under review to ensure that the needs of service users can be met. Staff spoken with stated that they had not received training in infection control. The laundry was in a poor state of repair. Tiles were missing from the wall and floor and this has implications for the control of infection. Supplies of disposable gloves were observed throughout the home. It has been strongly recommended the home ensures that plastic bags, aprons and gloves are securely stored given the possible risk to the high number of service users with dementia (refer to standard 38). Stratton House DS0000070059.V356535.R01.S.doc Version 5.2 Page 22 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. This judgement has been made using available evidence including a visit to this service. Staffing levels need to be reviewed to ensure that they are appropriate to the needs of service users. Staff have not been appropriately trained in meeting the needs of service users with dementia. The home’s procedures relating to staff recruitment are not robust and potentially put service users at risk. The home does not ensure that staff receive a programme of induction on commencement of employment. EVIDENCE: The acting manager informed the inspector that the home was currently accommodating 23 service users, including 1 service user that was in hospital. The inspector was advised that staffing levels were as follows; Morning – 1 senior carer and 3 care staff Stratton House DS0000070059.V356535.R01.S.doc Version 5.2 Page 23 Afternoon/evening – 1 senior carer and 2 care staff with ‘sometimes an extra carer between 1830 and 2100hrs’ Night – 2 waking care staff Kitchen staff and domestic staff are employed but care staff are responsible for all laundry duties. Staff spoken with indicated that they found it ‘difficult trying to do the laundry as well as looking after the residents’ Five staff completed comment cards for the Commission and in response to the question, ‘Are there enough staff to meet the individual needs of all the people who use the service’, 3 responded ‘usually’, and 2 ‘sometimes’, ‘sometimes we are short of staff and have to use agency’. The home’s Annual Quality Assurance Assessment completed for the Commission highlighted that 1 service user was ‘bedfast’ – records identified that this person required regular turns, 21 required help with dressing/undressing, 23 required help with washing/bathing. In addition, a high number required staff assistance to use the toilet. At the time of this inspection, 21 of the 23 service users living at the home have dementia. It has been recommended that the home reviews the dependency levels of service users at the home and increases staffing levels as appropriate. The current arrangements of care staff carrying out laundry duties should also be reviewed. The acting manager confirmed that the home was using two registered care agencies to cover some care hours. In the home’s completed Annual Quality Assurance Assessment, it stated that the home currently employed 18 permanent care staff and in the last 3 months, 6 shifts have been covered by agency staff. The inspector examined staff training records and spoke with staff and it was apparent that not all staff have received any training in dementia care. Given the high number of service users with dementia living at the home, it has been required that the registered person makes appropriate arrangements to address this. The home stated in its’ Annual Quality Assurance Assessment that out of the 18 care staff employed, 9 have achieved a minimum of an NVQ level 2 in care. This equates to the recommended 50 as stated in the National Minimum Standards. The inspector examined the home’s procedures for staff recruitment and noted that robust procedures were not being followed. Four staff recruitment files were examined. Two files did not contain a photograph of the employee. Employment history’s supplied in all files were poor. The application form only prompts the applicant to provide details of Stratton House DS0000070059.V356535.R01.S.doc Version 5.2 Page 24 their most recent and previous employer. In all cases, complete start and leave dates had not been entered. It is recommended that a 10-year employment history is requested and that full dates of employment are recorded as this will enable any gaps in employment to be discussed. Two files did not contain a contract. The recruitment file for a member of staff employed in December 2007 did not contain a criminal records check (CRB) or a protection of vulnerable adults check (POVA). The acting manager confirmed that these had been requested but not received. It was also ascertained that, although the staff member was being ‘supervised’ the home had not requested a POVAfirst check. The acting manager completed this request during the inspection and confirmed that the staff member would not be on duty until this had been received. It was also concerning that only one reference had been obtained and the employment history provided was poor. Current staff application forms should be reviewed to ensure that they comply with the Employment Equality Age Regulations (2006) as currently the form is requesting the applicant’s date of birth. The registered person needs to ensure that the application form contains a statement relating to the exemption from the rehabilitation of Offenders Act which prompts the applicant to declare whether they have ever been convicted of a criminal offence. Induction and training records were poor. The most recently appointed member of staff had worked at the home since the beginning of December and had not yet commenced an induction programme. The inspector was able to speak with the staff member who had been employed as a cleaner. The staff member’s command of the English language was limited but it was confirmed that an induction had not taken place. A requirement has been raised. There was no evidence that the member of staff had received any training in moving and handling, infection control, control & storage of substances hazardous to health (COSHH) or fire safety. Three further files relating to staff employed prior to the provider being registered by the Commission identified that staff required training in moving and handling, fire safety and first aid (refer to standard 38) Stratton House DS0000070059.V356535.R01.S.doc Version 5.2 Page 25 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): 32, 33, 34, 36 & 38 Quality in this outcome area is Poor This judgement has been made using available evidence including a visit to this service. The home does not have a registered manager. Staff morale is low and the home is not effectively managed. The home does not have effective quality assurance systems in place. Staff are not appropriately supervised. The home’s arrangements for ensuring the health & safety of persons at the home requires review. EVIDENCE: Stratton House DS0000070059.V356535.R01.S.doc Version 5.2 Page 26 The home does not currently have a registered manager as the post holder left employment in September 2007. Therefore this standard could not be assessed. An acting manager was employed in October this year but is currently only working two days a week. On the day of this inspection staff morale was noted to be low. This was confirmed by staff spoken with and by comments received from relatives. Staff indicated that they did not feel supported and that they found it difficult during the period the home was without a manager. ‘Staff do not work as a team’ and ‘some seem to do what they like’. Staff spoken with were aware that this has an impact on the service users, ‘If we are not happy, they are not happy’, ‘How can residents laugh or be happy when we are all so fed up’. The registered person needs to make arrangements to ensure that the home is effectively managed in the absence of a registered manager. The home’s quality assurance arrangements for seeking the views of service users and other stakeholders was not examined at this inspection as the provider has only recently been registered by the Commission. This will be followed up at the next inspection. As part of home’s quality assurance programme, the inspector requested copies of the registered person’s monthly reports. The acting manager was unable to locate these and stated that she had was not aware of any reports. The registered person is required to make unannounced visits in accordance with regulation 26 of the Care Homes Regulations 2001 and is required to complete a report which must be maintained at the home and made available to the Commission as requested. The home displays an up to date employers liability insurance certificate which expires on 14/06/08. The inspector was informed that the home does not manage any monies on behalf of service users. Therefore standard 35 is not applicable. The inspector examined files relating to three staff members and there was no evidence that staff were receiving regular supervision sessions. One file contained one supervision conducted in September 2007, another contained no supervisions for 2007 and the third contained evidence of one supervision session conducted in March 2007. There was no evidence that the home had developed a system for addressing this and there were no planned supervisions. The home’s arrangements for ensuring the Health & safety of persons at the home was ascertained by a tour of the premises, discussion with staff and examination of records. The findings were as follows: Stratton House DS0000070059.V356535.R01.S.doc Version 5.2 Page 27 FIRE SAFTEY – The inspector was unable to ascertain whether all staff had received up to date training in fire safety. Four staff training records examined confirmed this. Two files contained no evidence of fire training and two identified out of date training which last took place in January 2006. A training certificate confirmed that an outside agency had supplied the home with recent training but the acting manager was unable to confirm which staff had attended. It has been required that the registered provider provides evidence that all staff have received up to date training in fire safety. Fire records indicated that the home’s fire detection systems had last been serviced on 21/11/07. The home is conducting in-house checks on the fire detection systems every 3 months and not the recommended weekly basis. The acting manager confirmed that in-house checks were not being made on the home’s emergency lighting systems. This is recommended at monthly intervals. The acting manager was not aware if the home had completed a fire risk assessment. It is a requirement that this is completed and kept under review. ELECTRICAL SAFETY – The home has an up to date electrical hardwiring certificate dated 26/10/05 and valid for 5 years. Records demonstrated that annual checks on portable appliances last took place on 04/10/07. GAS SAFETY – The acting manager could not locate an up to date annual Landlords Gas Safety Certificate. It has been required that this is forwarded to the Commission. MOVING AND HANDLING – SERVICING AND TRAINING – The home has two mobile hoists and two fixed bath hoists. Records confirmed that 6 monthly servicing was up to date having been carried out on 26/11/07. As previously mentioned in this report, one fixed bath hoist failed its’ servicing and is not currently in use. The bathroom door is kept locked but it is recommended especially as the home uses agency staff, that a clear notice is placed on the hoist to ensure that it is not accidentally used. The passenger and stair lift were last serviced on 26/11/07. As mentioned in standard 30, the home was unable to demonstrate that all staff had received up to date training in moving and handling. HOT WATER OUTLETS/SURFACES – Records made available to the inspector indicated that not all bath hot water outlets were being checked. Temperatures were only available for the two upstairs bathrooms. The acting manager confirmed that shower hot water outlets were not being checked. To ensure the safety of service users, the home must ensure that all bath hot water outlets and all showers are checked at least monthly to ensure that temperatures do not exceed the Health & safety safe upper limits of 44c for bath outlets and 42c for showers. Stratton House DS0000070059.V356535.R01.S.doc Version 5.2 Page 28 To reduce the risk of injury to service users, radiators are fitted with a guard. In one bedroom, it was concerning to find a free standing radiator which was excessively hot to touch. The acting manager confirmed that a risk assessment has not been completed. This poses a risk not only to the service user accommodating the room, but other service users who may ‘wander’ in to the unlocked room. REDUCING THE RISK OF LEGIONELLA - The acting manager confirmed that the home was not currently flushing through cold taps and showers which were not frequently used. The home must ensure that it has systems in place to reduce the risk of legionella. The Health & Safety Executive (HSE) recommends that this is carried out on a weekly basis. CONTROL OF SUBSTANCES HAZORDOUS TO HEALTH (COSHH) – As previously mentioned in this report, it could not be ascertained whether staff had received training as part of their induction programme. During the inspection the inspector noted two occasions where service users could have been placed at risk by the practise of staff. On one occasion a cleaning trolley, which was well stocked with cleaning solutions including bleach, were found unattended in a downstairs bathroom/toilet which was not locked. An upstairs cleaning cupboard also well stoked with the afore mentioned items, was found to be unlocked. Both incidents were brought to the attention of the acting manager at the time of the inspection who took immediate action to address. To ensure the safety of service users, all upstairs windows have restricted openings and wardrobes are secured to the wall. Supplies of disposable gloves, aprons and plastic bags were observed throughout the home. It has been strongly recommended the home ensures that these items are securely stored given the possible risk to the high number of service users with dementia. Stratton House DS0000070059.V356535.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 3 3 1 1 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 x 18 1 2 3 3 2 x x 2 2 STAFFING Standard No Score 27 2 28 3 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x 1 1 3 N/A 1 x 1 Stratton House DS0000070059.V356535.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 OP3 Regulation 14(1) Requirement The registered person must not offer a placement to a prospective service user unless the person has been fully assessed by a person competent to do so. Pre-admission assessments must contain sufficient information about the prospective service users and assessments from other professionals must be obtained where available. The registered person must ensure that care plans are in place to address/meet the assessed needs of service users living at the home. Timescale for action 31/12/07 2. OP7 12(1) & 15(1) 31/12/07 3. OP7 15(2) 4. OP9 12(1) & 13(2) The registered person must 31/12/07 ensure that as appropriate, service users and/or their representative, are involved in the care planning and review process. To ensure the health & well 31/12/07 being of service users, the registered person must ensure that the amount administered for variable doses of prescribed DS0000070059.V356535.R01.S.doc Version 5.2 Page 31 Stratton House 5. OP12 12(4)(b) & 16(2)(n) 6. OP14 12(2) & (3) 7. OP16 12(1)(a) & 24(1)(b) 8. OP18 13(6) 9. OP19 13(4) & 23(4)(b) & (c)(ii) & (iii) 10. OP19 23(2)(b) & (d) medication is recorded and that the maximum daily dose for paracetamol is recorded. The registered person must ensure that service users are offered a regular and appropriate programme of activities which takes into account their preferences and ability. Special attention must be given to the ability of service users with dementia. The registered person must review the arrangements of restricting the choices of service users. This relates to the practise of locking a lounge door. The registered person must take appropriate action to ensure that service users, staff and visitors feel confident in raising concerns and feel confident that concerns will be acted upon. The registered person must make arrangements to ensure that all staff receive appropriate training in the prevention of abuse. A copy of Somerset’s revised policy (May 2007) on Safeguarding Adults must be available at the home. The registered person must consult with the local fire authority regarding the home’s arrangements of locking the inner front door and regarding the arrangements for accessing the key as this door is a designated fire exit. Confirmation from the fire authority must be forwarded to the Commission. The registered person must ensure that all parts of the home are kept in a good state of repair and reasonably decorated. A copy of the home’s planned DS0000070059.V356535.R01.S.doc 01/02/08 31/12/07 31/12/07 20/02/08 31/12/07 14/01/08 Stratton House Version 5.2 Page 32 11. OP22 12. OP22 13. OP25 14. OP26 15. OP27 16. OP29 17. OP30 maintenance and redecoration programme must be forwarded to the Commission by the given date. 12(1)(a) The registered person must take & appropriate steps to ensure that 23(1)(a) the home is suitable to meet the & needs of service users as stated 23(2)(a) in the Statement of Purpose. This relates to ensuring that signage is available and appropriate for service users with dementia. 16(2)(c) & The registered person must 23(1)(a) ensure that call systems are & 23(2)(c) available in all rooms occupied by service users. 12(1)(a) The registered person must take & appropriate action to ensure that 23(2)(p) all areas occupied by service users is maintained to a comfortable temperature at all times. 13(3) To reduce the risk of the spread of infection, the registered person must ensure that the wall and floor tiles in the laundry area are replaced. 18(1)(a) The registered person must & (c) (i) make suitable arrangements to ensure that staff have the skills and competence to meet the needs of service users at the home. This relates to the training of staff in dementia care. 13(6) & The registered person must not allow a person to work at the 19 & Schedule home unless all required 2 information identified in this regulation has been received and deemed satisfactory. This is with immediate effect for future staff employed and by the given date for the staff member identified. 12(1) & The registered person must 18(1)(a) ensure that all staff receive an DS0000070059.V356535.R01.S.doc 31/01/08 31/12/07 31/12/07 14/01/08 29/02/08 24/12/07 30/12/07 Page 33 Stratton House Version 5.2 & (c) 18. OP32 12(1) & 12(5) 19. OP33 26 20. OP36 18(2) 21. OP38 13(4) & 23(4) 22. OP38 12(1)(a) & 13(4) 12(1)(a) & 13(4) 23. OP38 24. OP38 12(1), 13(4), 13(5) & 24(d) & (e) appropriate induction on commencement of employment. The induction programme should meet with the Skills for Care Common Induction Standards. In the absence of a registered manager, the registered provider must make suitable arrangements to ensure that the home is effectively managed. The registered person is required to conduct monthly unannounced visits to the home in accordance with this regulation and to prepare a written report to be maintained at the home and made available to the Commission on request. The registered person must ensure that systems are in place to ensure that staff are appropriately supervised. Staff should receive formal supervision at least 6 times a year with records maintained. After consultation with the fire authority, the registered person must complete an appropriate fire risk assessment which shall be maintained at the home and kept under review. The registered person must forward to the Commission an up to date Landlords Gas Safety Certificate. To ensure the health and wellbeing of service users, the registered person must ensure that monthly checks are made on the temperatures of bath and shower hot water outlets to ensure that they do not exceed the HSE safe upper limits. The registered person must provide the Commission with a training matrix which confirms that all staff have received appropriate and up to date DS0000070059.V356535.R01.S.doc 31/12/07 31/12/07 30/01/08 30/01/08 07/01/08 24/12/07 14/01/08 Stratton House Version 5.2 Page 34 25. OP38 12(1)(a) & 13(4) 26. OP38 12(1)(a) & 13(4) 27. OP38 12(1)(a) & 13(4) training in moving and handling and fire safety. The registered person must complete an appropriate risk assessment for the identified free standing radiator which will; (a) identify any risk to the service user or other service users at the home and; (b) identify any action taken or required to reduce the risk The registered person must take appropriate action by training or other means, to ensure that all staff are aware of and follow the correct procedures for the control of substances hazardous to health (COSHH) The registered person must ensure that systems are in place to reduce the risk of legionella. Infrequently used water outlets must be flushed in accordance with HSE guidance. 24/12/07 14/01/08 24/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP7 OP8 OP10 OP15 Good Practice Recommendations To ensure that the needs of service users are up to date, care plans should be reviewed at least monthly. To ensure the health & well-being of service users, service users weights should be recorded at least monthly. To ensure the dignity of service users, the registered person should review the current storage arrangements for continence aids. The registered person should as appropriate, consider the use of serving dishes at meal times. Condiments and jugs of drinks should be made available at meal times and staff DS0000070059.V356535.R01.S.doc Version 5.2 Page 35 Stratton House 5. 6. OP16 OP27 7. OP29 8. OP29 9. OP38 10. 11. OP38 OP38 should ensure that that assist service users to eat in an appropriate manner. The registered person should ensure that the home’s complaints procedure is displayed in a prominent position in the home. The registered person should ensure that the dependency levels of service users at the home are reviewed and that staffing levels are increased as appropriate. The arrangements for care staff undertaking laundry duties should also be reviewed. After consultation with appropriate bodies, the registered person should ensure that the staff application for employment form is updated to comply with the Employment Equality Age Regulations (2006) and the Rehabilitation of Offenders Act 1974. The registered person should ensure that the staff application form requests a 10 year employment history and that full dates are provided, so that any gaps in employment can be fully explored and documented. In line with fire authority recommendations, the home should ensure that in-house checks are conducted on the home’s fire detection and alarm systems on a weekly basis. Emergency lighting should be checked monthly. To reduce the risk of injury to service users, clear signage should be placed on the bath hoist currently awaiting repair. It is strongly recommended the home ensures that disposable gloves, aprons and plastic bags are securely stored away from service users, given the possible risk to the high number of service users with dementia. Stratton House DS0000070059.V356535.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Taunton Local Office Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Stratton House DS0000070059.V356535.R01.S.doc Version 5.2 Page 37 - 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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