Inspection on 29/04/09 for Summerhill

This inspection was carried out on 29th April 2009.

CQC 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 CQC 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

Summerhill 19/08/08

Summerhill 29/08/07

Summerhill 02/05/06

Summerhill 12/10/05

Summerhill 15/04/05

Summerhill 29/11/04

Summerhill 12/07/04

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 15/11/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Summerhill 46 Glenwood Road West Moors Ferndown Dorset BH22 0ER Lead Inspector Martin Bayne Unannounced Inspection 29th April 2009 10:00 DS0000026878.V375206.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Summerhill DS0000026878.V375206.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Summerhill DS0000026878.V375206.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Summerhill Address 46 Glenwood Road West Moors Ferndown Dorset BH22 0ER 01202 870935 NONE summerhillwestmoors@hotmail.com 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) Mrs D K Farrar Manager post vacant Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places Summerhill DS0000026878.V375206.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th August 2008 Brief Description of the Service: Summerhill residential home is registered to provide personal care and accommodation to 15 people older people. The home is situated in a quiet residential area of West Moors with a level walk to the local shops and bus routes to the nearby towns of Poole and Bournemouth. The home is a detached property with a car park to the front and a secluded garden to the rear. All of the bedrooms are for single occupancy and are provided with en-suite WC facilities. A passenger lift provides access to the first floor. Residents share communal areas of a large lounge that leads to the garden and a small conservatory. The home has a separate dining room. Mrs Farrar, the registered provider lives in a property adjacent to the home. In August 2007, the weekly fees were between £438 - £500. Additional charges were made for hairdressing, chiropody, etc. and are detailed within the Terms and Conditions of Residence. Summerhill DS0000026878.V375206.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. We, the Commission, carried out an unannounced key inspection of Summerhill on the 29th of April 2009 between 10am and 5:20pm. The inspection was carried out by two inspectors, but throughout the report the term ‘we’ is used, to show that the report is the view of the Commission for Social Care Inspection. We were accompanied by three Dorset Social Services officers who were investigating allegations under safeguarding adults’ procedures. The aim of this inspection was to evaluate the home against the key National Minimum Standards for older people and to follow up on concerns raised through a safeguarding adults referral. Mrs Farrar, the registered provider, was unavailable on the day of the inspection so we were assisted by staff working at the home throughout the day. We were provided with records about how the care and support of residents was managed at the home. During the inspection we spoke with some of the residents accommodated at the home, and three members of staff. Information was also gained from the returned Annual Quality Assurance Assessment document, AQAA. As part of the inspection we also carried out a tour of the premises. What the service does well: People spoken with during the inspection stated ‘it’s very good here’. There was also some very positive feedback from relatives of people living at the home. There were activities taking place on the day of inspection and evidence that outings take place for residents away from the home. The home has a well publicised complaints procedure. Summerhill provides a comfortable and ‘homely’ environment for its residents. Summerhill DS0000026878.V375206.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Care planning needs to be improved to inform staff how all assessed health and care needs are to be met. Medication administration must be improved as we found staff and residents to be at potential risk, by staff not being trained and carrying out a nursing intervention. The home’s procedures for medication administration were also not being followed. We found that some residents were provided with soiled mattresses, which undermines their dignity. Various health and safety issues were identified during the inspection that require action. Kitchen hygiene must be improved. Staff recruitment practices must be improved to comply with Regulations and standards, so that residents are better protected. Duty rosters must be maintained as a record of staffing at the home. Staff training in mandatory subjects must be provided. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Summerhill DS0000026878.V375206.R01.S.doc Version 5.2 Page 7 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Summerhill DS0000026878.V375206.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Summerhill DS0000026878.V375206.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area, (rating from previous inspection). The home was not evaluated against these standards on this occasion. EVIDENCE: Since the last key inspection in August 2008 no new residents have been admitted to the home and therefore we did not evaluate the service against these standards. At the last key inspection it was found that all residents referred to the home had had a pre-admission assessment of their needs carried out, to ensure that the home could meet these, before an offer was made to accommodate the person at the home. The home does not provide an intermediate care service. Summerhill DS0000026878.V375206.R01.S.doc Version 5.2 Page 10 Summerhill DS0000026878.V375206.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning could be improved to better inform staff on how to meet residents’ health needs. Medication administration must be improved as residents and staff are placed at risk by staff carrying out procedures for which they have not been trained. Residents’ dignity is undermined by soiled mattresses either not being adequately cleaned or replaced. EVIDENCE: We looked at the care plans for the majority of the residents living at the home and we identified areas where care planning could be improved. Summerhill DS0000026878.V375206.R01.S.doc Version 5.2 Page 12 Concerning one resident who suffers from epilepsy, we found that they were prescribed rectal diazepam. There was no care planning relating to their epilepsy or for the event of rectal diazepam needing to be administered. The only instructions for staff were recorded on the person’s medication administration records, which stated ‘in the event of sustained seizure’. One member of staff spoken with said that they had a verbal instruction, ‘To see Denise in this event’ but to date this had not been required. The district nurses informed us that no staff had been trained to administer rectal diazepam and that a care plan in the event of a prolonged seizure, should have informed staff to seek medical assistance. We also found that this resident was insulin dependent and again there was inadequate care planning for the administration of their insulin. A care plan dated in May 2006 informed that the resident could administer their own insulin. In Oct 2006 this changed to inform that the resident could no longer manage their own insulin and 3 named staffed were to administer insulin. By Jan 09 the care plan gave instructions for staff to check sugar levels but there was no mention of how insulin was to be administered and by whom. From the staff records, all but two of the previously named staff had ceased working in the home. District nurses confirmed that three named staff were trained in 2006 but that no subsequent staff had been trained and deemed competent to carry out this procedure. We talked with two members of staff, who we saw from daily records had signed that they had administered insulin injections although no training from the district nurses had been provided. One of these staff told us that they had been shown by other staff in the home how to give the injection and the other person told us that they had been shown by staff at the home how to give the injection and then had been witnessed by district nurses giving the injection. We told these staff that they must not administer insulin injections until they had been deemed competent by the district nurses to carry out this procedure. We saw that staff were recording this resident’s sugar levels and that the GP was being called as directed when sugar levels were out of a specified range. Concerning another resident, their care plan stated that they were ‘mildly diabetic’ due to obesity but this was not reflected in their nutritional assessment. In respect of another resident, daily records evidence that they had suffered a fall during the night that resulted in them banging and cutting their head. Records state that their forehead was ‘very swollen and bruised…called Denise who dealt with’. There is no evidence of medical advice being sought regarding the head injury. Two people at the home require catheter care. There was evidence of advice being sought from the District Nursing team as appropriate. At 11am it was found that within one en suite bathroom that there was a catheter night bag half full of dark coloured urine. A cap had not been fitted to the bag, posing risk of infection. By lunchtime this has been addressed and the night bag Summerhill DS0000026878.V375206.R01.S.doc Version 5.2 Page 13 removed. The care plan for this person states that staff should ‘remove Xs night bag so that they can move freely’. Staff should also ensure that the bag is emptied and the cap fitted to ensure that this remains hygienic. For one person daily records evidenced that their continence needs still were not fully met and further intervention is required. It was noted that their bedroom and en suite bathroom were malodorous. Information within the care plan stated that they are prone to urinary tract infections and bladder stones, but fluid charts had not been maintained to monitor their fluid intake or reduce the risk of infections. One person at the home has bedrails. It was found that these were loose and posed a possible risk of entrapment. Bumpers had been fitted, but these did not cover all of the bed rails and were not appropriate. Within this persons room the mattress was heavily stained and had dried debris on it. This was alerted to staff members on duty. Within care records there was a consent form for bedrails signed by this person’s relative. This practice should be reviewed in light of the Mental Capacity Act and an appropriate risk assessment completed. In a second persons room the mattress was also stained and staff members informed. There was a box on the bedside cabinet containing nitro lingual spray. This had a brown substance on it and must be thoroughly cleaned or discarded. We observed the interaction between staff and residents and it was evident that there were good relationships between the two. Residents we spoke with told us that they were treated with respect and their right to privacy was upheld, however poor attention to hygiene and soiled mattresses undermine the provision of dignified care. We looked at how medication administration was managed within the home. We found that the medication administration records had a photograph of each resident at the front of their medication records, so that a new member of staff could easily identify them; and we saw that residents with any known allergies had these recorded at the top of their medication records. We found errors in the recording of medication administered earlier on the morning of the inspection. In the case of one person, their morning medication had been recorded as being given on 30-4-09 as previous dated entries had been completed for days up to 29-4-09. In the case of another person there was no recorded entry for their prescribed medication as having been administered that morning, although they had been given this medication. We found that some entries that had been entered by hand had been checked and signed by a second member of staff but not in all instances as they should be. As detailed earlier in the report, we found issues relating to administration of insulin. We talked with the member of staff who had administered medication that morning. We were told that medication was decanted into a pot and the records signed before medication being taken to the person to be Summerhill DS0000026878.V375206.R01.S.doc Version 5.2 Page 14 administered. This is not good practice and is counter to the home’s procedures. In the event of the person refusing their medication, the records would be invalidated by their having been signed as medication administered and taken. Within the kitchen there was a cupboard containing prescribed dressings. Staff spoken with confirmed that the two people these had been prescribed for no longer had pressure sores. These dressings must be returned to the pharmacy when a person no longer requires them. Opened dressing packets are not sterile and must be disposed of. Summerhill DS0000026878.V375206.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are provided with activities and to meet their social and recreational needs. Visitors are welcome at the home. Though residents were generally happy with the standard of food provided, standards of kitchen hygiene must be improved as reported in later sections of the report. EVIDENCE: We were told that the occasional outing is arranged, as the home has a minibus for taking residents on outings. Since the last key inspection some of the residents were taken out to go to a pantomime and for a Christmas meal. We were told that an outing had been organised to take people to see a show Summerhill DS0000026878.V375206.R01.S.doc Version 5.2 Page 16 in Ferndown. On the afternoon of our visit, one of the staff was organising a cake baking afternoon with some of the residents. People living at the home confirmed that family and friends are able to visit them. We saw that detailed records were provided in the daily diary of the food provided to residents from which one could determine what each individual had been provided with. We saw that some nutritional assessments had been completed for residents who had lost weight. One person spoken with stated that the food could be ‘erratic’ and depended upon who was cooking that day. We observed staff offering people a choice of foods. Some people advised us that they are not always made aware of what the main meal or choice will be. An alternative was prepared for a person who did like either of the choices available that day. People spoken with during the inspection were generally satisfied with the meals provided. Summerhill DS0000026878.V375206.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 18 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Relatives and residents are informed of how to make a formal complaint, as the complaints procedure is detailed within the Service User Guide and also the Terms and Conditions of Residence. The complaints procedure includes contact details for the Commission. Since the last key inspection an adult protection matter was investigated by the Registered Manager, police and social services, after two residents had significant amounts of money stolen by a member of staff at the home. There had been a failure of the home to comply with recruitment Regulations in the taking up of a Criminal Record Bureau check (CRB) before the person started working at the home. Had this procedure been followed, the CRB would have informed of the risks of employing this person as a carer, as they had a history of serious convictions. Following the investigation, Mrs Farrar agreed to Summerhill DS0000026878.V375206.R01.S.doc Version 5.2 Page 18 referring the staff member concerned to Independent Safeguarding Authority (ISA), the body whose role is help prevent unsuitable from working with vulnerable adults. We saw at this inspection that this person had been referred as agreed. However, we also found at this inspection other examples of where staff had started working at the home before a CRB had been returned. This potentially puts residents of risk of unsuitable people working at the home. This inspection was triggered by concerns being brought forward by a person who wished to remain anonymous. Following this inspection, Mrs Farrar wrote to relatives of residents requesting they provide feedback to the Commission about the care received in the home. Attached to the letter was a copy of a letter of dismissal concerning a member of staff who had worked at the home, indicating that they had raised concerns about the home. Trying to identify who has raised concerns about the home and then circulating confidential information regarding any such person is contrary to the ‘whistle blowing’ procedures that are in place to protect people living at the home and runs contrary to adult protection training. Further details are reported in the Staffing and Management and Administration sections of this report. Summerhill DS0000026878.V375206.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Summerhill provides a ‘homely’ and comfortable environment for its residents; however various infection control and health and safety issues were identified as needing attention. EVIDENCE: As reported at the last inspection the front drive has been tarmaced and provides a safer surface to the gravel drive it replaced. The front gardens have been re-landscaped making a more welcoming entrance to the home. The Summerhill DS0000026878.V375206.R01.S.doc Version 5.2 Page 20 home has a garden and patio area leading from the lounge and conservatory at the back of the home. We were told at the last key inspection that there were plans to have the back garden re-landscaped with residents being involved in choosing the layout. This has yet to be carried out. Communal areas comprise of a large lounge, dining room and sun lounge. Communal areas have been decorated and furnished to an appropriate standard. Tables had been laid with tablecloths and flowers as a centrepiece in preparation for the meal. People are able to spend time within communal areas or their room as they prefer. Within the kitchen it was noted that part of the front of the fridge was broken and dirty. The top shelf of the fridge door had been used to store urine samples. On the shelf below butter had been stored. One packet had been left open with the butter exposed to the air. Bodily fluids must not be stored in a fridge that also houses food stuffs. There were spillages within the freezer that had not been cleaned and it was noted that milk was dripping on to vegetables. The cook was advised of this and addressed this. Meat that was defrosting had been stored above fresh vegetables, and there was a risk that liquid from this could contaminate food stored below. Plinths were missing at the base of kitchen units, meaning that the kitchen floor areas could not be thoroughly cleaned. Within the kitchen hand washing facilities of liquid soap, paper towels and a foot operated flip top bin must be provided. The tablet of soap should be removed as this may pose a risk of cross infection. The paint work surrounding this area requires renewal. Bedrooms had been personalised to reflect individuals’ tastes and preferences. All bedrooms have en suite bathrooms. Bedrooms are situated on the ground and first floor, and there is a passenger lift to assist people. Within several bedrooms it was found that there were wardrobes that had not been fixed to the wall. These may pose a risk of falling onto people. A risk assessment must be completed and actions taken as necessary. The en suite bathroom for one person has currently been closed off as the floor is uneven and requires attention. They are using the bathroom situated next door instead. It was noted that an uncapped razor had been stored in the toothbrush holder. Care must be taken to ensure that this person does not cut themselves when taking or returning the toothbrush. It is recommended that the razor is stored separately or a cap fitted. Within some peoples room it was found that their pillows and the divan base were stained. Pillows were very flat and covers stained and ripped. Summerhill DS0000026878.V375206.R01.S.doc Version 5.2 Page 21 Within the ground floor bathrooms there were two tablets of soap and several bottles of toiletries and two pump dispensers of Doublebase cream. Toiletries and creams must be for use by an individual person and must not be available within communal areas. One of the Doublebase creams had an expiry date of May 2007 and must be removed. There was no liquid soap, paper towels or foot operated bin within the bathroom. The radiator had been covered, but not yet painted, so it was porous. There was debris in the plughole and the shower head was covered with limescale. The laundry has two domestic style washing and drying machines. Staff advised that one dryer requires repair. The wood stand surrounding the washing machines is water porous and has started to warp and disintegrate. There was washing powder surrounding the area. The wood must be treated so that it is waterproof and that that area can be thoroughly cleaned. The basin was stained and the plughole contained debris. There was no liquid soap or paper towels for staff to wash their hands. Staff advised that they would bring any soiled items down in a black bag and wash them separately. Advice was given that staff must not hand sluice items and the use of alginate bags was discussed. Risk assessments have been carried out concerning uncovered radiators and those deemed a high risk have been covered. The home has thermostatic mixer valves installed to hot water outlets of baths and showers to protect residents from scalding water. Summerhill DS0000026878.V375206.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Failure of the management to comply with staff recruitment regulations places of residents being supported by unsuitable staff. Staff duty rosters are not adequately maintained to provide a record of suitable levels of staff working to support residents. EVIDENCE: At the last key inspection we were told that during the daytime, from 8 am to 10pm there were always two carers on duty as well as domestic staff; and that during the night-time period there is one awake member of staff on duty and one person who carries out a sleep-in duty. Staff generally work to a fixed shift pattern so usually work the same shifts each week. We recommended at the last key inspection that better records are maintained of the duty rosters, as it was found that the roster included the name of a person who had ceased working at the home and was therefore not an accurate record. We asked for Summerhill DS0000026878.V375206.R01.S.doc Version 5.2 Page 23 copies of the duty rosters at this inspection. We were given rosters for the current week and also the three previous weeks. These did not reflect an accurate record of who had worked at the home. Only the roster for the current week was dated and this did not reflect who was carrying out the night sleep-in duty. The roster also informed that Mrs Farrar had worked on the Monday and Tues of the week, although we had been told that Mrs Farrar was on holiday from the previous Friday. When we arrived at the home for the inspection there two staff on duty. Another member of staff soon joined them and we were told that this person had been to the GP surgery to deliver samples. Later in the day the roster informed that an agency member of staff was to be working at the home. The home has a poor track record of compliance regarding staff recruitment. At a key inspection in May 2006 a requirement was made regarding staff recruitment as no CRB had been taken up in respect of a cleaner. In Feb 2007 at the next key inspection it was found that no new CRB was taken up regarding a new member of staff, Mrs Farrar stating that she thought the one from her previous employer would suffice as this had been issued shortly before employment at Summerhill. At the next key inspection in Aug 2007 it was found that new staff had CRBs, however the staff had started working at the home before the return of this check. It was also found that gaps in peoples’ employment history had not been investigated and one folder had only one reference. At the next key inspection two newly recruited staff files were seen and it was found that all required checks and documentation was in place, although the start date for person working at the home was not clearly documented. As detailed earlier in the report, Mrs Farrar reported a theft of significant sums of money from two residents at the home. This was investigated under vulnerable adult safeguarding procedures by the police and social services. As a result of this, a member of staff was referred to the Independent Safeguarding Authority (ISA) by Mrs Farrar. During the investigation it was found that one staff member had been at the home since November 2007 although a CRB had not been returned until May 2008. The returned CRB informed of 10 criminal convictions including theft, fraud, actual bodily harm and possessing a prohibited firearm with a period of imprisonment. This staff member is no longer employed at the home. At this inspection we looked at the staff recruitment records for staff employed at the home since the last key inspection. In the case of one person we found that a CRB had been returned on 14th Nov 2008 with their signed Terms and Conditions informing of a start date of 17th Nov 2009. However, we looked in the daily diary, where staff record the shifts that they work and found that this person had been working at the home since 23rd Sept 2008. In the case of another member of staff their CRB was returned on 14th Oct 2008 with a recorded start date in their Terms and Conditions of 20 Oct 2008. The daily diary had entries for this member of staff as working from 29th September 2008. For a third member of staff their CRB was dated 12th June 2006, however they ceased working at the home with the daily diary informing that Summerhill DS0000026878.V375206.R01.S.doc Version 5.2 Page 24 this person re-started work at the home on Dec 11th 2008 but there was no evidence of new CRB having been undertaken. Concerning the agency member of staff who had been working at the home all week, we asked for the letter from the employment agency to inform that this person had been subject to all the recruitment checks required by the Regulations. Staff were unable to provide us with such a letter. We looked at a sample of staff training records. Since the last key inspection courses have been arranged for staff in emergency first aid, client handling, health and safety, loss and grief, and protection of vulnerable adults. Concerning one member of staff we could see no evidence of induction training having taken place. At the adult protection strategy meeting on May 11th 2009, Mrs Farrar informed that she would be arranging training for the staff in record keeping. We recommend that training also be arranged in infection control and that Mrs Farrar ensures that all staff have received training in mandatory subjects. The returned AQAA informed us that home had reached a level of 50 of the staff team being trained to NVQ level 2 or above. Summerhill DS0000026878.V375206.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 38 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although residents were happy with the way the home is conducted and also a large proportion of relatives, poor management of the home places residents at risk of potential harm. EVIDENCE: Summerhill DS0000026878.V375206.R01.S.doc Version 5.2 Page 26 Mrs Farrar, the registered provider has the required qualifications and has many years experience of running Summerhill. At the time of our inspection Mrs Farrar was on holiday for the week and a senior member of staff had been delegated to manage the home in her absence. Serious failures of management identified within this report, such as: • Failure to ensure that medication is administered safely, • • • • Care planning insufficiently informing staff on how to care for residents, Poor infection control management, Failure to comply with staff recruitment regulations and ‘whistle blowing’ procedures, health and safety issues, are reflected in the poor rating for this section of the report. As part of the adult protection investigation carried out with Social Services a list of calls to the home made by the ambulance service were seen. We found that there were eight instances where residents were admitted to hospital that the Commission should have been informed of under Regulation 37 but were not. We were also not informed under Regulation 37 of the dismissal of a staff member in April where there were allegations of misconduct. Within the en suite bathroom of an empty room on the ground floor there was a two litre bottle of bleach. This had not been stored securely. Several wheelchairs were seen without footplates fitted. Staff must ensure that footplates are fitted when wheelchairs are in use. The sticker on the hoist stated that the next service had been due on 27/10/08. Those records provided during the inspection did not evidence that this had taken place. Staff advised that soiled incontinence products are put in two black bags then placed in the refuse bins. The home must ensure that a clinical waste is handled appropriately and in accordance with legislation. Summerhill DS0000026878.V375206.R01.S.doc Version 5.2 Page 27 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 1 2 X X X X X X 1 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 2 X 1 X X 2 Summerhill DS0000026878.V375206.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No 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 OP7 Regulation 15 (1) Requirement Timescale for action 26/05/09 2. OP9 13 (2) 3. OP26 13 (3) You are required to ensure that care plans are developed to inform of how assessed care needs of residents are to be met by the staff. You are required to ensure that: 22/05/09 • Procedures for administration of medicines are followed. • Administration of insulin is only carried out by staff who have be authorised to do so following training under the direction of the district nursing team. • Medicines are returned to the pharmacy when no longer required. You are required to ensure that 26/05/09 suitable arrangements to prevent infection, toxic conditions and the spread of infection are in place. • Urine samples must not be stored in the fridge together with foodstuffs. • The fridge must be kept clean and foodstuffs stored correctly. • The laundry room requires works to make surfaces DS0000026878.V375206.R01.S.doc Version 5.2 Summerhill Page 29 • • 4. OP27 Schedule 4 (7) 19 readily cleanable. Residents mattresses are kept clean or replaced. Catheters are maintained hygienically. 22/05/09 5. OP29 6. 7. 8. OP30 OP37 OP38 18 (c) 37 13 (4) You are required to maintain an accurate duty staff rota and a record of who has actually worked. You are required to ensure that new members of staff do not start work at the home until the return of their CRB. You are required to ensure that all staff receive induction training and other mandatory training. You are required to inform the Commission of deaths, illness and other events in the home. You are required to ensure that the home is kept so far is reasonably practicable, free from avoidable hazards: • Bedrails and ‘bumpers’ are appropriately fitted. • Wardrobes must be fixed to the wall to prevent their toppling onto residents. 22/05/09 26/05/09 22/05/09 26/05/09 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 OP9 Good Practice Recommendations We recommend that where hand entries have to be made to the medication administration records, a second member of staff checks and signs that the record has been completed correctly. We recommend that to promote good infection control the following issues should be addressed: DS0000026878.V375206.R01.S.doc Version 5.2 Page 30 2. OP26 Summerhill 3. OP38 Plinths missing at the base of kitchen units must be replaced. • Within the kitchen hand washing facilities of liquid soap, paper towels and a foot operated flip top bin must be provided. • The tablet of soap should be removed in the kitchen. Some paintwork in the kitchen requires renewal. • Toiletries and creams must be for use by an individual person and must not be available within communal areas. • Communal bathrooms must provide liquid soap and paper towels We recommend that resident’s razors are stored separately or a cap fitted. • Summerhill DS0000026878.V375206.R01.S.doc Version 5.2 Page 31 Care Quality Commission South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Summerhill DS0000026878.V375206.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!