Inspection on 08/10/07 for Summerfield

This inspection was carried out on 8th October 2007.

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

Summerfield 10/04/08

Summerfield 24/04/07

Summerfield 27/11/06

Summerfield 12/06/06

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

CARE HOMES FOR OLDER PEOPLE Summerfield 42-43 Wellington Road Dudley West Midlands DY1 1RD Lead Inspector Mrs Cathy Moore Key Unannounced Inspection 8th October 2007 06.40 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 Summerfield DS0000066864.V349135.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. Summerfield DS0000066864.V349135.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Summerfield Address 42-43 Wellington Road Dudley West Midlands DY1 1RD 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) 01384 239331 Merron Care Ltd Mrs Janet Oakley Care Home 38 Category(ies) of Dementia - over 65 years of age (18), Old age, registration, with number not falling within any other category (12), of places Physical disability over 65 years of age (8) Summerfield DS0000066864.V349135.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Manager should source and undertake further training in dementia care. 24.4.07 Date of last inspection Brief Description of the Service: Summerfield was originally two semi-detached residential properties that have been linked and extended to its present form. The home is registered to provide personal care for up to 38 people with up to 18 places accommodating older people who have dementia, up to 12 places for older people who do not fall within any other category and up to 8 places for people who are over 65 years and have a physical disability. The home comprises of three floors. The basement is used to house the boilers and is also a storage area. The ground floor has a number of bedrooms, two offices, the kitchen, communal areas and hygiene facilities. The first floor accommodates further bedrooms, bathrooms, sluice and toilets. Summerfield Care Home is located near to central Dudley and is situated on a main road, which is also a main bus route. Opposite is the Dudley Leisure Centre, there is a carvery next door and a number of shops are in the local vicinity, a small car park is available to the front of the home. Fees for this home range from £344 - £390 per week. Summerfield DS0000066864.V349135.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector carried out this unannounced inspection on one day between 06.40 and 17.00 hours. On 10 October 2007 a Commission pharmacist carried out a full inspection of medication at the home. Findings from this inspection have been included in this report. Prior to the inspection an Annual Quality Assurance Assessment ( AQAA) was sent to the manager for completion in order for us to get up to date knowledge about the service the home provides. Questionnaires were sent to a selection of residents, relatives and staff. Most of the inspection day was spent in living areas where we could observe routines and interaction between staff and residents’. During the inspection we focussed on three residents in detail. This included us looking at the records of care provided, observing and speaking to them. We looked at their bedrooms and spoke to one of their relatives. We spoke to three visitors, three staff and three residents to get their views about the service provided by the home. We looked at meal times and activity provision. We randomly looked at the premises to include; the rear garden, three bedroom, toilets, bathrooms, the shower room, laundry and living areas. Infection control processes in these areas were assessed when looking at the premises. We looked at staff files and records to assess the standard of recruitment, supervision and staff training. We looked at health and safety records including fire safety and servicing and maintenance of equipment. What the service does well: The home provides a warm and welcoming atmosphere. Staff were welcoming, friendly and co-operative. Summerfield DS0000066864.V349135.R01.S.doc Version 5.2 Page 6 Living areas within the home are comfortable and homely. Contact with family and friends’ is very much encouraged. We received comments from relatives and staff about what they feel the home does well; “ Quality and presentation of food, fresh local produce”. “ We are free to speak our minds. Service users’ are treated individually”. “ Communication between staff is good”. What has improved since the last inspection? One staff member commented’ “ Staff and our residents’ are now smiling . Residents’ are talking and getting to know each other”. The most fundamental improvement that has occurred since the last inspection is that, a new experienced manager has been employed. To support the manager a new full time senior has also been employed. The manager and senior are both enthusiastic and determined to get the home to an overall good standard. Relatives and staff made the following comments about the new manager; “My manager is always there to help if I am not sure of anything. She also encourages all staff to work together”. “ There has been great improvement since the appointment of the manager”. “ Recently the home has improved quite a bit”. “ I am impressed with the drive and determination of the manager to provide a safe and homely environment”. Incidents of abuse and aggression between residents’ has decreased. The manager has a good knowledge of the definitions of abuse and what should be done if concerns were to arise. The garden is being worked on at the present time. Gates have been provided at the bottom of the garden steps to prevent accidents. Two new televisions have been provided in both lounges. These have been mounted on the wall so that all residents’ can have a good view. Lounges have been changed around, with chairs positioned in small groups rather than around the room which makes the environment feel more ‘ Summerfield DS0000066864.V349135.R01.S.doc Version 5.2 Page 7 homely’. A clock with a big face has been provided in the dementia unit in an attempt to increase orientation concerning time. Moves have been made to improve activity provision in that outside entertainers have been secured on a monthly basis. An activities person is in the process of being appointed. An activities area has been provided in a quite space. Moves have been made to improve meal planning and menus. Part pictorial menus have been produced which are on display within the home. Quality assurance processes have been implemented the in terms of the managers monitoring of service provided. What they could do better: Care plans need to be expanded upon to ensure that all needs, risks and goals are included. We identified a lack of care planning associated with dementia care needs. Some aspects of health care such as moving and handling and recording of personal care need improvement. Medication safety although improved in some areas was concerning in others particularly the numerous gaps on medication records to confirm safety. Staffing levels are not adequate to meet the number and specific needs of the residents’. No less that five care staff should be provided during day- time hours. Staff recruitment processes must be improved upon to ensure that residents’ are safe. The home provides care to a number of residents who have dementia. Staff have received dementia training but no staff have received accredited dementia training which would ensure better outcomes for the residents. Summerfield DS0000066864.V349135.R01.S.doc Version 5.2 Page 8 Many bedrooms in the home are in a poor state with ripped wallpaper and carpets and furniture that have seen better days. The bedrooms we saw can only be described as being ‘ tired’ and ‘ shabby’. The kitchen was dirty particularly the floor, pantry and the small fridge. There was a lack of evidence of food and stock rotation and inconsistent vital record keeping. The following were comments from residents, staff and relatives about improvements needed in the home; “ We could do with more staff on shift at all times”. “ Have more staff on ( 5 ) on each shift. “ Could do with more staff in the lounge at all times. Sometimes there is no-one there when you want to go to the toilet”. “ Maintain the level of staff training”. Staff EMR and dementia training” “ I don’t like sandwiches at tea time”. “ Continue to improve the physical environment”. “ Continue to extend the range of activities to engage and stimulate”. 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. Summerfield DS0000066864.V349135.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 Summerfield DS0000066864.V349135.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): 3. Quality in this outcome area is good. Generally information is available to help residents’ decide if the home will be right for them. No resident moves into the home without having their needs assessed or being given assurance that their needs can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We asked three residents and two relatives their views about the home and was told the following; “ The home is alright. It is ideal. Nothing better”. “ Nice home but I have been in better. Due to layout can not walk around much”. “ The home is improving. In a short space of time there has been a lot of changes”. Summerfield DS0000066864.V349135.R01.S.doc Version 5.2 Page 11 Feedback from questionnaires completed by relatives and residents told us the following; Three of three service users confirmed that enough information was given to them before their admission to enable them to decide if the home would be right for them. Two of three relatives confirmed the same. We looked at three residents case files concerning their admission process to the home. All three contained a completed assessment of need form which included information about their health care and other needs. Information about two of the three residents had been obtained from their funding authorise to compliment information obtained by the home for each resident. We saw a letter addressed to one resident inviting them to spend a day at the home to help them decide if it would be the right place for them. One relative we spoke to confirmed that the visited the home to assess it suitability before her mother was admitted. We saw that a letter was on file addressed to each of the three residents confirming that the home could meet their needs. Summerfield DS0000066864.V349135.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): 7,8,9,10,11. Quality in this outcome area is poor. Care plans do not contain enough information about all specific needs, which could place residents’ at risk. Aspects of health care provision such as poor moving and handling, the non weight monitoring on admission and lack of or inconsistent personal care records could place residents’ at risk. Medication systems need improvement as short the shortfalls identified could potentially place residents’ at risk. Residents’ in general are treated with respect. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at case plans for three residents and identified shortfalls with two of the three. For CT there was a lack of instruction and risk management to Summerfield DS0000066864.V349135.R01.S.doc Version 5.2 Page 13 prevent and deal with potential choking which could place her at risk even though a swallowing difficulty had been written into her assessment of need document and was also in information provided by her funding authority. There were no care plans in place relating to HT liver complaint or signs and symptoms of this for staff to be aware of. We were pleased however, to see that a new care plan style has been introduced within the home. Care plans are being produced in type, which makes them easier to read. We looked at records for three residents’ concerning health care provision, access and risk assessment. We were pleased to see that input is being secured from the doctor and other health care professionals for example the district nurses. Whilst we were on site a professional came to assess and treat one female resident’s feet. We saw records to confirm that service users’ weights are being taken and recorded. We did note however, that resident HT between the dates of 29.8.07 and 24.9.07 had lost 5 llbs yet there were no instructions for staff on how to deal with this if weight loss continued. We saw that risk assessments were in place for a range of areas such as; tissue viability, mental health and falls which is positive. We were surprised to see the way that staff moved one resident EG as it was unsafe. Staff moved EG from a wheelchair to a recliner using a ‘ moving belt.’ EG was not able to put her feet on the floor and we saw that her body- which was of small frame- was hanging from the lifting belt. We looked at the moving and handling risk assessment for EG and saw that on 25.9.07 she had been assessed as being ‘medium dependency’ which could not be correct as she is not able to weight bear. We noted that daily personal care records are not being completed with consistency. There was no personal care record on CT file and infrequent records of oral care for EG around the 8 October 2007 time. Medication The pharmacist inspector assessed the control and handling of medication in the service and spoke to the new Deputy Manager. In June 2007 the home changed to a new pharmacy and have built up a good relationship. Medication was secure and locked within a designated medication room. Medication was stored neatly in both medicine trolleys, which made it easy to locate the right medicine in order to administer to the residents. Some of the countertops in the medication room were cluttered with old medicine charts; medication that was no longer required and some medication that had been refused by residents. The medication had not been properly disposed of or Summerfield DS0000066864.V349135.R01.S.doc Version 5.2 Page 14 recorded, which meant that there was a risk of some unwanted medication being put back into the medicine trolley and administered to residents in error. An updated medication policy was available, dated 4th June 2007, which was signed by the new Manager. The Deputy confirmed that all staff who administer medication had read a copy of the policy. The majority of the medicine record charts seen were pre-printed by the supplying pharmacy. Handwritten medicine charts for new medication or for changes to existing medication was checked and countersigned by two members of staff. There was evidence of some good practice with times of medication administration clearly highlighted and relevant medical information relating to residents was documented onto the charts. Medication audit could be completed due to an improved system of recording the date of opening of containers and also the start date and time of opening of new bottles of medication were marked on the medicine charts. This meant that it was possible to check medication administration and to monitor medication supplies for residents. The improved audit was commended as good practice. It was disappointing to see that were many omissions on the medicine record charts with no signature recorded for the administration of medication or an appropriate code recorded to explain why medication had not been administered. Examples of poor medicine records included medication that had been prescribed for the following medical conditions: blood pressure control, behaviour management and glaucoma. This was discussed with the Deputy Manager who agreed that this was poor practice and also explained that this had previously been noted by both the Manager and Deputy Manager in an internal audit. Following the audit all staff had been informed that this was unacceptable practice and that it would result in disciplinary action. A follow up audit undertaken by the Deputy Manager did show that there was an improvement, however another audit was due to be undertaken on the day of the pharmacist inspector visit (10/10/07). The evidence highlighted that the medicine records were again not being maintained to safe or agreed standards. One resident had gone out with relatives and had not received their medication. The medicine chart was documented with the code ‘D’ for ‘social leave’, however the tablet was still in the blister pack and had not been given. The care plan did not explain why the medication had not been made available or given to the resident. This means that the service is not safeguarding residents when they leave the home because their medication needs are not being met. This is poor practice. Some medication was recorded as out of stock for one resident, this means that there was no medication available to administer and therefore the health and welfare of the resident was not safeguarded. This had been seen at the Summerfield DS0000066864.V349135.R01.S.doc Version 5.2 Page 15 previous inspection on 24th April 2007. The Deputy Manager did explain that the Doctor had increased the amount of medicine to administer but another prescription was not available to obtain a new supply. Two residents care plans were seen. Visits made by a healthcare professional were recorded and documented in a ‘Professional visitor record’, which was good practice and ensured that the residents medical information was kept up to date. There was some information regarding residents’ current medication requirements documented in the care plans, however there was no information relating to medication in the behaviour management plans for some of the residents. We were pleased to see that measures are taken to ensure privacy, dignity and respect are maintained within the home. When we looked at the three resident case files we saw that each had their preferred form of address recorded. During the inspection we heard staff using these preferred forms of address for each resident. Also we saw that preferences concerning care being provided by opposite gender staff had been determined for each resident. During the inspection we heard staff speaking to residents’ in a respectful manner, they were friendly and polite. We noted from looking at case files that there was a lack of instruction about the ‘ last wishes’ of each resident. For example; it was documented that EG follows a Catholic faith yet there was no information on file to tell us whether or not she would want a priest to be contacted for last rites. There was no information on residents’ files about burial or cremation or preferred funeral directors. Summerfield DS0000066864.V349135.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is adequate. There is insufficient activity provision in the home to provide the necessary stimulation. Residents ‘ are very much encouraged to maintain contact with family and friends. Efforts are made by the home to increase the choice and control in residents’ lives. More staff needs to be available at meal times to ensure that service users’ are supervised and take adequate meals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We were told by the senior on duty T that an activities person is in the process of being appointed. He was unable to confirm exactly when this activities person was due to start work. Summerfield DS0000066864.V349135.R01.S.doc Version 5.2 Page 17 We saw that improvements have been made in respect of activities. For example; a nice area has been made available in the rear lounge for activities. The walls have been nicely painted with pictures and on one wall there is a painting of a tree with a bench underneath for residents’ to sit on. We saw that a collage was being made for the one wall with a Halloween theme. We saw during the inspection that a number of residents’ were being encouraged to colour in cauldrons to add to the Halloween collage. We saw a notice by the front door advertising forthcoming outside entertainers which, was not there during the previous inspection. We were also told by staff and relatives that ministers from various religions visit the home regularly and hold services. A quite area of the lounge is used for these services which the residents’ enjoy. We received a number of comments from relatives about the improved activity provision which included the following; “ Recently the home has improved quite a bit… activities for the residents”. “ Seem to have a bit more activity”. However, we observed in the lounge areas for 3 hours and for long durations there was no activity provision. Residents’ in the dementia lounge such as M and C were wandering and at times distressed. We saw that apart from meal time resident EG had no stimulation or interaction from staff. One resident told us; “ Not much to do, stay like this until mealtime- that’s all”. We looked at records and there were no care plans for activity specifically aimed to promote stimulation or well- being for those residents’ who have dementia. This evidence shows that although it is positive that improvements are being made concerning activity provision, further improvement is needed. We have never been alerted to any concerns regarding restrictions on visiting. During this inspection residents told us they received visitors. One resident told us; “ My husband is in another home but he comes to see me in a taxi”. A relative confirmed that she visits the home regularly and is always made to feel welcome by staff. We looked at three residents’ bedrooms and saw that all held a range of personal belongings such as televisions, pictures and ornaments making the rooms feel homely and personalised. We saw displayed in the home information about external advocacy services which relatives and residents’ can access if they wish. These examples prove that the home does strive to ensure that residents can maintain control of their lives. We were pleased to see that work has been carried out concerning meals and menus. New menus were on display on the walls in the lounge areas. The menus have been produced partly in picture form to increase resident understanding. After breakfast we observed a staff member going to each resident and giving them a choice of meals for lunch time. Summerfield DS0000066864.V349135.R01.S.doc Version 5.2 Page 18 We observed breakfast and lunchtime. On the dementia unit some residents ate at the table others remained in their chairs. What we did observe was the lack of staff to supervise particularly at breakfast time. This particularly concerning as one resident is known to be at risk of choking. We saw that one resident had fallen asleep over their toast. A staff member did notice this and brought some more toast however, the same happened again the resident did not eat the toast. We saw that there was a vast range of foods available for breakfast consisting of a number of cereals. Menus confirmed that hot options were available everyday. We heard one resident ask for toast, bacon and beans. This was brought to him. It was nicely presented. Lunch consisted of chicken stew or curry. With rice, potatoes and mixed vegetables followed by rice pudding or fruit and cream. This meal was well presented and smelt appetising. We asked three residents about the food and was told the following; “ Meals are bland. No salt cellars on the tables, no salt in the cooking. Lack of fresh fruit- although I have got some today”. “ The food is pretty good”. The food is very good”. We did receive comments about teatimes in that mainly sandwiches are offered when not all residents like sandwiches and would prefer something hot. We did see that fish fingers and chips were served at teatime on the day that we were at the home. Summerfield DS0000066864.V349135.R01.S.doc Version 5.2 Page 19 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. Not all residents’ and relatives know how to make a complaint which could prevent them being able to address areas where they are not happy. Adequate safeguarding processes are in operation within the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We have not received any complaints about the service since before the last inspection. The questionnaire completed by the manager prior to the inspection was confusing as it stated that six complaints have been received in the last twelve months and eight upheld. We looked for the complaints log in the office to check this but could not find one. We asked the person in charge T to provide us with the complaints log. T did look but could not find it. This concerning as T was in charge of the home at this time. We saw that copies of the complaints procedure were on display in the front entrance hall and copies in the bedrooms. However, when we asked two relatives if they knew about the complaints procedure one told us that he did not the other said; “ I have not got a clue”. Another relative however, Summerfield DS0000066864.V349135.R01.S.doc Version 5.2 Page 20 confirmed that she did know about the complaints procure and was comfortable to approach the manager J with any concerns she has. The complaints procedures we saw during the inspection were all in written print. We asked T who was in charge of the home if these have been produced in other formats as the home caters for people who have dementia and may have limited understanding. T response was “No”. Over the last twelve months at least two incidents have occurred that should have been reported to social services to start protection processes but were not. Since the new manager has been employed this has improved. The home has reported a recent incident. It must be stressed that the home was not responsible for this incident. From talking to the manager J at a vulnerable persons’ meeting it was clear, that she is very aware of what should be done if concerns are identified in the future which means that residents will be better safeguarded. During the inspection we asked relatives, staff and residents if they had seen or experienced anything concerning and gave examples of hitting, shouting or rough handling. We were given the following answers; “ No!”. “ No definitely not”. “ No concerns, no abuse. Nothing untoward here”. “ No abuse, if there was I would report it straight away”. A recommendation was made in the previous report dated 24.4.07 for staff to receive social services protection training. To date this has not been addressed. Summerfield DS0000066864.V349135.R01.S.doc Version 5.2 Page 21 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): 19,26. Quality in this outcome area is adequate. The homes living areas are bright, comfortable and homely however, a number of bedrooms need some redecoration work and refurbishment. More improvement is needed concerning infection control to minimise potential infection outbreak risk in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Improvements have been made during the last twelve months to the living areas of the home. These are adequately decorated, with good floor coverings and nice curtains making these areas feel comfortable and homely. We were Summerfield DS0000066864.V349135.R01.S.doc Version 5.2 Page 22 pleased to see that a large face clock was on the wall in the dementia lounge which helps in promote reality in terms of time. Each lounge is provided with a large screen television on the wall for residents to watch. The staff have tried to promote the ‘ homely feel’ more by changing seating arrangements in the lounge. Instead of the chairs being placed around the outer walls they are in little groups. Staff told us that this arrangement has increased contact and conversation between the residents’. On the day of the inspection we observed work being carried out in the rear garden. T who was in charge told us that the garden is being made safer with new slabs and raised beds . We saw that green gates have been placed at the bottom of the steps in the garden to increase safety and prevent accidents. We looked at three bedrooms. These rooms we saw were in a poor state of repair. The décor and carpet passed their best. Making the rooms feel uninviting and shabby. Window- sills in these rooms are badly in need of repainting. One bedroom held a strong offensive odour. We looked at bathrooms, toilets and the laundry in respect of infection control processes. The shower room on the first floor had an offensive odour, which we were told by the person in charge T could be the drainage. We saw that the floor in the laundry is in need of recoating and the sink was not adequately clean. We were pleased to see that disposable gloves, liquid soap and paper towels were available in toilets and bathrooms. We discussed with T who was in charge of the home the benefits of storing gloves in a cupboard or other appropriate place as being in toilet rooms they were at risk of being contaminated with bacteria or spores. We saw that hand wash signs were on display in toilets. We discussed with T the possibility of these being produced in pictorial format to increase the understanding of people who have dementia. Summerfield DS0000066864.V349135.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is poor. Staffing levels are not adequate potentially placing residents at risk. At present the home is not meeting the required ration of 50 of the care staff team attaining NVQ level 2 or above in care. Recruitment processes need to be improved to prevent risk to residents. The home must seriously consider securing accredited dementia training for all staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Although staffing levels have improved since the last inspection in that four care staff are now provided on every day time shift this is still not adequate. On the day of this inspection twenty five residents were accommodated at least ten of whom had dementia needs. As with the last inspection we observed in the lounges and saw long periods of time when there were no staff present to supervise and support the residents. We saw one resident M wandering and get very distressed. One staff member was doing the medications and she told M twice to sit down. M again became very distressed because she did not want to sit down. A staff member told us that M requires one to one staffing because of her dementia and short Summerfield DS0000066864.V349135.R01.S.doc Version 5.2 Page 24 concentration span. We saw another resident EG only have any interaction or stimulation when staff moved her from the table to her recliner chair. During the evenings there are only four staff in total to do teas, medication and put people to bed. Feedback from a range of different people including staff, residents and relatives indicate that staffing levels are not adequate as follows; “ Could do with more staff in the lounge all the time and night. Sometimes there is noone there when you need the toilet. They are very busy when putting people to bed”. “ A few times there have been times when the home has been understaffed or workers not doing their jobs effectively-working as a team , so it’s a waste of time them being present”. “ I feel it is too much on staff”. “ We could do with more staff on shift at all times”. “ Have more staff on each shift ( 5 )”. “ Some residents M and H can be challenging. Not having enough staff causes us stress and stresses the residents’”. “ We are understaffed and have to wait”. Of the nineteen care staff employed only six have achieved NVQ level 2 or above which means that only six staff in total have been assessed as being competent to undertake their work. We are pleased however, to be informed that twelve further staff are currently working towards their NVQ awards. As with the last inspection carried out in April 2007 shortfalls were identified concerning staff recruitment processes. We identified two staff MN and TS who had been allowed to commence employment before their full Criminal Record Bureau ( CRB) clearance had been received. Although a satisfactory check of the Protection Of Vulnerable Persons (POVA) list had been carried out other safeguards had not such as; undertaking a risk assessment and nominating a supervisor for these staff on each shift that they worked. There were a lack of dates of employment for MS and her professional reference stated that she had only known her for one month. We identified a discrepancy with one staff members GC health declaration. In that the reason given for leaving her previous post was concerning health but there was no mention of this on her health declaration. We were please to see that a new training matrix has been produced and that where gaps have been identified this is being addressed. The senior on duty T and comments received from staff and relatives as follows confirmed this; “ Training is frequent and up to date”. “ I am being provided with relevant training I need to keep both me and the service users safe”. “ Train staff well according to job role within the organisation”. “ Staff training is a very important priority now”. We saw evidence on staff files to confirm that they receive induction training. This was confirmed by comments received by staff as follows; “ I was given formal induction training and then a written more in-depth one”. “ It was a good induction everything was explained clearly”. Summerfield DS0000066864.V349135.R01.S.doc Version 5.2 Page 25 We felt from observation and speaking to staff that their knowledge on caring for people with dementia is limited. For example; the staff member telling M to sit down twice which distressed her was not appropriate as her understanding and attention span is limited. We looked at training records and saw that dementia training received by staff to date consisted mostly of a one day session. From observing the complex needs of residents accommodated and the numbers of residents’ accommodated better care may be provided if all staff receive accredited dementia training. A relative made the following comment; “ Not all staff appear to have training in dementia care”. Summerfield DS0000066864.V349135.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38. Quality in this outcome area is adequate. The Commission as a fit person to be in charge of the home has previously approved the manager. She has considerable experience in managing a care home and looking after older people. Further development is needed to ensure that management monitoring and quality assurance processes are totally fit for purpose and prevent shortfalls detailed in this report. Money held for residents’ is safe and secure. More work is needed concerning some aspects of health and safety to ensure that there are no risks to residents’. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Summerfield DS0000066864.V349135.R01.S.doc Version 5.2 Page 27 The manager was appointed by the home in the Summer of 2007. She previously was registered by the Commission for another care home. She has considerable experience in management and looking after older people. Very positive comments were received about the manager from relatives and staff which include; There has been great improvement since the appointment of the new manager”. “ I am impressed by the drive and determination of the manager J to provide a homely and safe environment”. “ J is brilliant. Feel comfortable to go to her and the owners”. J is really trying and making changes for the better”. We looked at quality assurance monitoring processes in the home. We saw that a structured process has been established which is positive. However more emphasis should be placed on management monitoring and corrective action processes to prevent the shortfalls identified within this report. We noted that it has been at least two months since we have received a monthly Regulation 26 report from the owners. The monthly monitoring and report from the owners is required by law and tells us how well they are monitoring the home again to prevent shortfalls. We looked at money held in safe keeping for three residents. One had no money held as she had only just been admitted. For the other two, money balanced against records. There were two signatures for each transaction and receipts for expenditure. As previously stated there were some gaps in training relating to health and safety. Twenty five names were on the newly produced staff training matrix but only the following had received training; food hygiene 15, first aid appointed 4, first aid basic 14, infection control 10 and moving and handling 13 ( 2 additional staff were due to have training that day). Records of fire drill training told us that these need to be increased. From speaking to the person in charge T and other staff we were assured that training is being arranged where needed. We looked at records concerning maintenance checks and servicing of equipment. We were concerned that a certificate for the five year fixed electrical wiring has not been issued since the last inspection as a requirement was made for this to be done. The owner provided us with written information saying that a lot of work has been undertaken but it is near to completion. As the lack of a current five year fixed electrical wiring test could pose as a risk we reported this to Dudley Council’s Environmental Health Department for them to look into and inform us if there is or is not a risk at the present time. We saw that evidence to confirm that monthly in-house checks of the emergency lighting are not being carried out as they should the last record made was March 2007. We saw evidence to confirm that a service of the passenger lift had been carried out in September 2007 a recommendation had been made for emergency lighting to be provided in the motor room. Summerfield DS0000066864.V349135.R01.S.doc Version 5.2 Page 28 We were pleased to see that the recent services of equipment have been carried out; Parker bath June 2007. Emergency lighting and fire alarm system September 2007. We saw that bedrails were in use in bedroom 26a. These bedrails looked looser than they should be to prevent entrapment. I asked T who was in charge of the home to show me the records of daily checks of these bedrails to ensure safety. He was not able to as they had not been produced. T told us; “ I did not know that they have to be checked”. In H bedroom we saw a television and electrical radio. H told us that she uses both of these appliances. When we checked there was no label attached on these appliances to tell us that they had been checked by an electrician and deemed to be safe. We looked at the electrical appliance testing records and saw that these had been carried out on 4.5.07 well before H was admitted to the home on 29.8.07. We were concerned when we looked at the kitchen. The ‘cook for the day’ did not have a certificate to confirm that she had received food hygiene training. She did tell us that she was due to receive this training the following week which, was confirmed by T who was in charge of the home. We saw that the pantry was dirty with a build up of dust and debris. The floor was dirty. We saw a large container of oil stored on the pantry floor. Spillage from this container was on the floor. We saw two packets of cereal on a shelf both the inner and outer packets were open. We saw cakes on the fridge by the open kitchen door that were not covered. We saw food products in the pantry that held best before dates that had gone by such as; pink food colouring best before Dec 06. Three packets of ‘Greens orange jel’ best before Feb 07. Peppermint flavour best before Aug 06. We saw a sack of stabilised oats stored directly on the pantry floor. We saw big red bins containing flour and sugar in the pantry that did not have best before dates attached. We saw hot food temperature recordings for 8.10.07 but no others for October 2007. When asked the cook for the day M was unable to provide us with these. We saw that the small fridge by the back door was very dirty and that the seal on the chest freezer in the pantry was not working. We saw that the kitchen floor was dirty and that there was considerable debris under units. We saw that eggs were stored on the top shelf of the small fridge by the back door and raw bacon stored in cling film that had come apart stored directly on the margarine lid. These shortfalls could all place residents at risk. Summerfield DS0000066864.V349135.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 2 x x x x x x 2 STAFFING Standard No Score 27 1 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 x x 2 Summerfield DS0000066864.V349135.R01.S.doc Version 5.2 Page 30 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 13(2) The registered person must ensure that there is a protocol available which describes the care to be given to residents who could become agitated or aggressive. This must include details for the administration of medication prescribed ‘when required’ for behaviour management. Timescale of 31.7.07 not fully met. The registered person must ensure that medicine is available in the home to administer to the residents as prescribed by a GP. Timescale of 31.7.07 not fully met. Arrangements must be made to ensure that trained staff record and document medicine records accurately in order to ensure that the healthcare requirements of the residents are safeguarded. Immediate requirement issued. DS0000066864.V349135.R01.S.doc Requirement Timescale for action 15/11/07 2 OP9 13(2) 15/11/07 Summerfield Version 5.2 Page 31 3 OP9 13(2) 4 OP27 18(1)(a) Arrangements must be made to ensure that medicine is available for residents’ who leave the home for social leave in order to ensure that the healthcare needs of residents’ are being met and that they are safeguarded. Care staffing levels should be no lower than five during the homes day time hours which are 06.459pm these to exclude the manager and ancillary staff). This requirement has been made to ensure that needs are met and that residents are safe. 15/11/07 20/11/07 5 OP29 17(2) 19sch2 sch4 The registered person must not allow workers to commence employment without required information being obtained, PoVAfirst, CRB. The registered person must ensure that where CRB has been applied for new workers there are appropriate safeguards in place. Appoint a member of staff to supervise the new worker. Ensure that the member of staff is on duty the same time as the new worker. The registered person must ensue that all of the required information in respect of staff is obtained and kept on their file. Requirement first made 01/12/06. Immediate requirement letter issued. 17/10/07 Summerfield DS0000066864.V349135.R01.S.doc Version 5.2 Page 32 6 OP38 13(4)( c) The work concerning the fixed electrical wiring must be completed as soon as possible. Timescale of 20.5.07 not met. The kitchen must be in good working order at all times. This to include; Staff not being allowed to serve or prepare food unless they have been suitably trained. The kitchen and pantry being adequately clean at all times. Fridges and freezers to be clean and in a good state of repair. Records such as for those temperatures to be maintained. Adequate stock rotation and audit to prevent foods exceeding their best before dates. Correct storage of food in fridges and freezers. 20/11/07 7 OP38 13(4)( c) 15/11/07 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 Refer to Standard OP7 Good Practice Recommendations We strongly recommend that care plans reflect all needs, risks and goals. This to include dementia and religious needs. Summerfield DS0000066864.V349135.R01.S.doc Version 5.2 Page 33 2 3 OP8 OP8 4 5 OP8 OP11 We strongly recommend that residents are weighed on admission as a baseline guide for future monitoring and that all residents should be weighed on a monthly basis. We strongly recommend that an urgent review of EG moving and handling needs is carried out by a competent person and appropriate, safe moving and handling techniques are employed and equipment used. We strongly recommend that risk assessments for tissue viability should always be repeated when known deterioration has occurred. We strongly recommend that care plans should contain detail of the last wishes of each residents taking into consideration all aspects including religion for example; if last rites are wanted by persons’ following a Roman Catholic faith. We strongly recommend that a risk assessment should be carried out in relation to CT eating different foods. A care plan to prevent or deal with the chance of choking should be put into place. We strongly recommend that a complaints procedure should be produced appropriate to the needs of the residents for example pictorial. We strongly recommend that all staff should be made aware of the complaints procedure and where the complaints book is located. We strongly recommend that in addition to current adult protection training staff attend the local social services protection training. We strongly recommend that the refurbishment of the kitchen is carried out as a matter of priority. We strongly recommend that a programme to refurbish bedrooms that have not been done already is implemented quickly. We strongly recommend that infection control processes are tightened as follows; Appropriate hand wash signs ( pictorial) provided in all toilets and bathrooms. Strict mop control to ensure adequate cleaning and disinfecting. Not leaving mop heads wet in buckets or dirty water. A second sink in the laundry . Regular cleaning of the laundry sink. Recoating of the laundry floor. Protection of gloves and aprons in high- risk areas to 6 OP15 7 8 9 OP16 OP16 OP18 10 11 12 OP19 OP24 OP26 Summerfield DS0000066864.V349135.R01.S.doc Version 5.2 Page 34 prevent spore and other contamination. The prevent of odour in the bedroom identified during the inspection. 13 OP38 We strongly recommend that a competent person should undertake a visual check of bedrails in the home on a daily basis to ensure that they are safe. A record must be made of these checks. We strongly recommend that adequate precautions should be taken to ensure that all electrical appliances brought into the home by residents are risk assessed and proven to be safe. 14 OP38 Summerfield DS0000066864.V349135.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Halesowen Local Office West Point Mucklow Office Park Mucklow Hill Halesowen B62 8DA 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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