Inspection on 15/08/07 for Summerville House

This inspection was carried out on 15th August 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

Summerville House 29/09/09

Summerville House 23/10/08

Summerville House 05/02/08

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Summerville House Fenway Heacham Kings Lynn Norfolk PE31 7BH Lead Inspector Kim Patience Unannounced Inspection 15th August 2007 10:30 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 Summerville House DS0000068947.V349313.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. Summerville House DS0000068947.V349313.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Summerville House Address Fenway Heacham Kings Lynn Norfolk PE31 7BH 01485 572127 01485 572548 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) ARMS Associates Ltd Manager post vacant Care Home 24 Category(ies) of Dementia - over 65 years of age (24), Old age, registration, with number not falling within any other category (24) of places Summerville House DS0000068947.V349313.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27.03.07 Brief Description of the Service: Summerville is large detached, two storey, converted barn in the village of Heacham. The seaside town of Hunstanton is approximately five miles away. The home provides care for up to twenty-four older people with dementia. The home has sixteen single and four shared bedrooms. There is a large lounge and separate dining room. The home has a passenger lift and a chair lift for access to the first floor. There is a secure garden, which the residents have access to. The current fee rates are between £380 and £393. There are additional charges for items such as hairdressing and private chiropody. People are advised verbally of the relevant charges before the person is admitted to the home. Summerville House DS0000068947.V349313.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took approximately 8 hrs to complete and included a site visit. During the site visit, records relating to residents, staff and management of the service were inspected. Staff and residents were spoken with and observations of daily life in the home were made. 6 resident and relative surveys were completed and returned to the Commission and comments from the surveys have been incorporated in the relevant outcome areas in the report. This is the first key inspection conducted since ARMS Associates Ltd took over the home in April 2007. What the service does well: What has improved since the last inspection? What they could do better: Choice of home - pre admission assessments were poor and there was a lack of accurate information in order to demonstrate that on admission people’s needs can be met effectively. Summerville House DS0000068947.V349313.R01.S.doc Version 5.2 Page 6 Health and personal care - here there were issues with poor care planning, risk management, record keeping, responding appropriately to health needs and medication management. Daily life and social activities - social care plans need to be developed in order to meet people individual needs in this outcome area. The dining area needs further improvement to make it more homely and conducive with dining. Complaints and protection – the complaints procedure should be updated to ensure the information relating to other agencies is accurate. There were some concerns with how the home identifies and deals with issues of protection, some staff had limited knowledge in this area and the home must ensure that staff are provided with adequate training here. Recruitment practice also gave rise to some concerns about the protection of vulnerable adults. Environment – the home must eliminate offensive odours and address the health and safety issues highlighted in this report. The nurse call system needs to be updated and cannot be heard in all areas of the home, in addition, people must have effective means of contacting staff when needed. People would benefit from the introduction of assistive technology, which will serve to protect people’s privacy and maximise independence. Some issues with privacy have been identified and privacy is not promoted in some rooms that are visible from the outside. The laundry system must be reviewed and improvements made so that people always wear their own clothes. Staffing – the number of staff on duty is unacceptably low at times and the low number of staff result in an inability to meet people’s holistic needs. Care staff are responsible for laundry and catering when the cook is not available and the home does not have designated staff in these areas. The management hours are not supernumerary and care coordinators named as temporary managers are included in the rota, therefore the home cannot be managed effectively. Staff are not provided with adequate training and the home does not have a training plan. Some recently employed staff have had a basic induction but very little further training. The recruitment practice is poor and staff have been employed without the proper pre employment checks in place. Management – at the time of this inspection, the home was not being adequately managed. Two care coordinators had been allocated the management responsibilities but not provided with management time or training to enable them to fulfil the responsibilities effectively. There is no recognisable quality assurance system in place and no consultation with stakeholders. A number of health and safety concerns have been identified in this report and must be addressed in order to ensure that people are protected from harm as far as possible. Summerville House DS0000068947.V349313.R01.S.doc Version 5.2 Page 7 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. Summerville House DS0000068947.V349313.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 Summerville House DS0000068947.V349313.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is poor. Not all people moving into the home can be assured their needs will be met due to poor quality pre admission assessments that do not gather sufficient information about the range of needs and how they should be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a policy and procedure for new admissions. A service users guide is supplied to all people who express an interest in the service and a pre admission assessment is completed. The file relating to one person who was admitted to the home in July 2007 was inspected. The file contained a pre admission assessment, however, it had not been completed in full and did not contain sufficient information relating to the individuals needs. For instance, where asked for details of the residents physical and mental needs the assessment states not known, yet it is known that the resident has a diagnosis of dementia and there was no information Summerville House DS0000068947.V349313.R01.S.doc Version 5.2 Page 10 relating to social care needs. There was a summary of need but again it was not completed correctly and did not provide sufficient information as to how the individuals needs should be met. Two care coordinators are currently managing the home as the unregistered manager has been on long-term sick leave. The care coordinators are responsible for conducting the pre admission assessments, but state they have not been provided with any training in order to do this effectively. One resident survey was returned to the Commission and indicated that sufficient information was provided by the home in respect of the facilities and services offered. The last inspection identified similar issues in respect of the pre admission process and a requirement was made, the requirement, which expired on the 24/04/07 has not been met and is now repeated for the second time. See requirements. The home does not provide intermediate care services. Summerville House DS0000068947.V349313.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is poor. People who use the service cannot be assured that their health, care and psychological needs will be met due to poor assessments of need and concerns about the homes management of medication. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The records relating to four residents were inspected. The home has asked family members to provide life story information for each individual and some files contained information relating to personal history this is good. However, this information needs to be translated into care plans to ensure life in the home is consistent with peoples previous experiences and maximises independence. Summerville House DS0000068947.V349313.R01.S.doc Version 5.2 Page 12 The file for one resident admitted on the 25th July 07 did not contain any care plans or associated records. The pre admission assessment was not completed fully and did not contain sufficient information as to how the individuals needs should be met. Therefore care staff had no guidance as to how this persons care and health needs should be met and how risks to health and welfare should be minimised. A new care plan and health assessment format has been introduced and the care coordinators have been asked to transfer all information to the new records. The care coordinators have not received any training on how to do this effectively and did not fully understand how some assessments should be completed. In addition, they did not fully understand what information should be recorded in each section. The files looked at, showed that admission details were not complete and some information from admission assessments had not been transferred effectively to the new care records. Some health assessments had been completed such as nutritional needs assessments and pressure care assessments but the care plans were not completed correctly and did not set out preventative measures. One file contained care plans for nutritional needs, moving and handling and falls only. One nutritional need assessment stated that the resident ate well and did not need any support, but when observed the resident did eat well and clearly enjoyed the food but placed too much food in their mouth and ate very quickly causing coughing and choking. Care staff indicated this was a regular occurrence but this was not written into her records and there was no risk assessment to minimise the risk of choking. Care plans lacked person centred information, which is essential when caring for people with dementia and did not provide clear guidance for care staff as to how individualised care should be delivered. Risk assessments were written for some risks but only identified the risk and not what measures should be taken to minimise the risk. For instance, for one resident, a risk of aggression from other residents had been identified yet no risk assessment had been written in order to address the behaviours that elicit the aggression from others. See requirements. Falls diaries have been introduced but are not being put to good use. Falls are being recorded but where the record shows people are having repeated falls, no action has been taken to reduce the falls. The falls intervention team are to provide staff with some falls training in the near future and this is good. Daily records were examined and as found at the last inspection they offer brief information about the individuals daily life events. The one resident survey returned indicated that the person always receives the support and medical care they need. Five surveys were returned by relatives and three of the five indicated that the home usually meets the needs of their relative and two indicated that needs were always met. Summerville House DS0000068947.V349313.R01.S.doc Version 5.2 Page 13 The findings in relation to care planning are similar to those at the last inspection, the requirement made then, has not been met and is repeated for the second time. See requirements. The inspection of the medication standard was conducted by the Commissions pharmacist inspector Mr M Andrews on 16/08/07, the day following the key inspection. He found there to be widespread concerns relating to the homes management of medicines placing the health and welfare of residents at risk. The home has a satisfactory system of medicine administration in place but the inspector found that this was compromised by the availability of both medicines that had been discontinued and second containers of actively prescribed medicines in the medicine trolley. These had not been promptly removed for disposal. The inspector was concerned to find that some other medicines had not been obtained in time for their administration as scheduled. In relation to medicines of a psychoactive (and sedative) nature prescribed to manage residents psychological agitation, it was noted that some medicines were being prescribed at higher doses without satisfactory rates of reviews by prescribers. Some residents are prescribed these medicines for use at the discretion of care staff. For these, there was no written guidance in place for their use and also when given to residents, associated care note records did not indicate that residents behavior or mental state justified their use. It was found that medication records could not be reliably used to demonstrate that medicines are given to residents in line with prescribed instructions. There were omissions in records where it could not be determined if prescribed medicines were given as prescribed. Where records could be audited, there were found to be discrepancies where medicines could not be accounted for. This included medicines that had been discontinued and so were no longer in use. The inspector also found that ophthalmic medicines were not being safely handled by staff and temperatures at which medicines requiring refrigeration were being kept were not recorded. He found that improved security of medicines in storage was needed. Whilst it was reported that staff handling and administering medicines had all recently completed medication-related training the home could not provide documentary evidence of this at the time of the visit. The home has since provided evidence that staff have completed a distance-learning course. However, there is no monitoring and assessment of the competence of members of care staff in undertaking medication-related tasks. See requirements and recommendations. Summerville House DS0000068947.V349313.R01.S.doc Version 5.2 Page 14 A separate and more detailed report on the pharmacy inspection has been sent to the provider and is available subject to request. During the site visit a number of concerns arose in relation to dignity. Some good practice was seen, staff were heard to approach residents in a respectful manner and one care assistant was seen to encourage a resident to wipe her mouth following dinner and this is promoting dignity. However, there were also a number of observations that suggest dignity is not always promoted. For instance, when standing at the main entrance outside the home there is a clear view into the two residents rooms either side of the front door. Residents could be seen in the room and in one room pads were clearly visible. This does not promote privacy or dignity. In the lounge area staff were seen to assist people to the toilet and were putting on latex gloves when walking through the lounge. The members of staff came in and out of the toilet with various residents and were not seen to change the gloves, which raise some concerns about infection control (see standard 38). Also in the lounge one resident was seen only partly dressed and clearly did not have some undergarments on. Staff could not give a reason why the lady was not wearing her undergarments, as she did normally. In addition, there was an unpleasant odour surrounding some residents throughout the day and staff were not seen to identify this as an issue. Staff must be more aware of the issues with privacy and dignity, this is particularly important for people, who because of their physical or cognitive limitations cannot maintain these needs independently. A requirement in relation to dignity was made at the last inspection and is repeated for the second time here. See requirements. Summerville House DS0000068947.V349313.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is adequate. People who use the service can be assured that they will be offered some activity and stimulation, but they may not have control over their lives and their experiences may not entirely meet their preferences and expectations. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the inspection there was little activity taking place in the home. Throughout the morning people were seen to sit in the lounge with little or no stimulation or interaction with staff. Staffing levels were low and meant that staff did not have time to engage with people, however, when staff had the opportunity it was not used to benefit the resident. As found at the previous inspection, most people were disengaged from their surroundings or displaying behaviours that were challenging to others. Most residents were being contained in the lounge and those that moved to other areas were asked to go back. This may be due to the lack of staff available to supervise people effectively in other areas of the home. Care plans contained some information relating to peoples social needs but again was limited and did not link to peoples previous experiences to form a Summerville House DS0000068947.V349313.R01.S.doc Version 5.2 Page 16 plan that meets the individuals social and emotional needs. In addition, there was little evidence of meaningful activity. One of the care coordinators has responsibility for activities and has arranged a weekly plan that includes activities such as card games, a quiz and a sing along. The home must develop individual social care plans and develop a plan of activity that is meaningful to the individual. A requirement was made at the last inspection and is made for the second time. See requirements. The mealtime experience was observed. Since the last inspection the home has reorganised lunch into two sittings. The first sitting is for people who can eat independently and for those that need assistance to dine and the second is for people who need a little more support and prompting. The first sitting was quiet and calm, staff were seen to offer choices of where to sit, what to drink and what support people might need. Assistance with dining was provided sensitively and discretely and good practice was seen here. The cook had knowledge of residents and their individual dietary requirements, which is good and resulted in food being prepared to meet the individual’s needs in advance of the plate reaching the table. It was a concern that there was a low number of staff on duty over the lunch period and while two care assistants were in the dining area that left only one to supervise people in the rest of the home. During the changeover to the second sitting it was not possible to assist residents to the toilet as the number of staff was insufficient. The second sitting was for people who needed increased supervision and support and therefore the number of staff in the dining area needed to be increased to three, again raising concerns about how well people were being assisted and supervised in the rest of the home. See requirements. The cook was interviewed, and the menus were discussed. Two meal choices are offered each day and care assistants talk with residents the day before to ask what they would like to eat. The cook prepares the menus and decides what people would like to have on the menu, information relating to likes, dislikes and any dietary needs are passed to the cook by the senior staff and incorporated into the menus, which is good. A record of people’s dietary intake is maintained. Since the home has been taken over by the new owner some changes to the suppliers of food have been made and it was said that the food purchased now is not the same quality as before. On the day of the visit the meal looked appetising and people appeared to enjoy the food. The cook is employed to work 9 days in 14 and another person is employed to cover Tuesdays of every week. That leaves 3 days in 14 to be covered by staff working in the home. Care staff also cover teatimes, although the cook prepares some of the food before she leaves. This again raises concerns about the number of staff available at this time of the day. In addition, care staff do not hold food hygiene certificates. See requirements. Summerville House DS0000068947.V349313.R01.S.doc Version 5.2 Page 17 In the dining room staff were observed to go in and out off the kitchen without putting on aprons to cover clothing that was used for cleaning and to complete care tasks. This is of concern as it indicates poor hygiene practice and there is a risk of cross infection. See requirements. Since the last inspection some improvements have been made to the dining room. Staff said that the furniture has been replaced and new laminated flooring has been fitted. The tables did not have tablecloths on them nor did they have napkins, menus or condiments. The laminated flooring increases the noise levels. The one resident survey returned indicated that the food was always good. Summerville House DS0000068947.V349313.R01.S.doc Version 5.2 Page 18 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 and 18 Quality in this outcome area is poor. People who use the service can be assured that their complaints will be listened to, however, they cannot be assured that the home adheres to policies and procedures that serve to protect them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints policy and procedure, which is on display in the entrance hall and in the service users guide. The details relating to the Commission for social care inspection need to be amended to make the information accurate. See recommendations. On the day of the site visit a complaint was made by a resident and was recorded in the complaints book. The complaint had been taken seriously and appropriate action had been taken, which is good. No other complaints have been made since the last inspection. Of the six surveys returned, five indicated that they knew how to make a complaint and one indicated they did not. There have been no adult protection concerns since the last inspection. However, when inspecting staff files a note was found in one file relating to the conduct of this person when on duty. A concern had been raised by another member of staff and this shows that some staff are aware of adult protection Summerville House DS0000068947.V349313.R01.S.doc Version 5.2 Page 19 issues. It was alleged that the person shouted at a resident and used offensive language. The resident was described as distressed and fearful following the incident. There was no record of this being addressed or of any action taken. When questioned the care coordinator said that the member of staff was employed on a casual basis only and they have not used her since. This is of concern as the member of staff could go on to work in another establishment when she may not be suitable to work with vulnerable people and this was explained to the coordinator. The home has been asked to investigate this fully, take action in accordance with the adult protection policies and procedures and provide the Commission with a report. See requirements. Two members of staff were interviewed, one had some knowledge of adult protection but the other had no understanding of adult protection issues. In addition, a number of new staff have been employed and the home cannot provide evidence of any adult protection training. See requirements. There are also concerns about recruitment practice that do not promote the protection of vulnerable people. (See standards 27-30) Summerville House DS0000068947.V349313.R01.S.doc Version 5.2 Page 20 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, 22 and 26 Quality in this outcome area is poor. Whilst many improvements have been made people who use the service still cannot be assured that the home maintains an environment that promotes safety, dignity, independence due to concerns identified during this site visit. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection many improvements have been made to the environment, door locks have been fitted to some rooms, some new furniture has been purchased, the flooring has been replaced in some rooms and dining tables and chairs have been replaced. Keypads have been fitted to the kitchen and laundry doors and locks have been fitted to the outside storage areas as required at the last inspection and this is good. Magnetic fire safety catches have been fitted to some bedroom doors as required. Summerville House DS0000068947.V349313.R01.S.doc Version 5.2 Page 21 Some of the carpets have been replaced with laminated flooring and while this makes it easier to keep clean, it does not promote a homely feel and increases the noise levels. The home should carefully consider the use of laminated flooring as good practice guidance says this may not be the most appropriate flooring for people with dementia A tour of the premises was completed and some odours could be detected around the home. The home must eliminate the odours and properly address peoples personal care and continence needs. See requirements. Domestic staff are employed to work 8-2 on six days a week. Most areas were seen to be clean and tidy. Residents’ rooms were comfortable and homely and there was evidence that people had brought their own belongings in with them. One room had a life story chart on the wall using a combination of pictures and text and this is good as it aids memory and recognition but also stimulates conversation. One bathroom on the ground floor was very cluttered and the pipes leading from the bath were exposed creating a health and safety hazard. A resident was seen going into the bathroom to use the toilet, which was concerning given the amount of clutter in this area. See requirements. In the bathrooms, unnamed toiletries could be seen and this indicates that communal toiletries are used which does not promote choice and autonomy. See requirements. Products similar to these were also seen in resident’s rooms and the home could not provide evidence that risk assessments had been carried out. See requirements. The nurse call system in the home is dated and staff said the alarm can’t be heard in all parts of the home. In the residents rooms entered call bells were not accessible and did not have extensions fitted so they could be reached from the bed. Call bells must be accessible or the home must install other equipment that will meet the needs of the residents accommodated. See requirements. Some residents were seen to walk around the home and into other people’s rooms. The home does not have any door sensors fitted or any other equipment such as pressure mats, to protect each resident’s privacy and belongings. See requirements. Some directional signage and signs have been placed on toilet doors and residents rooms. This is good as it promotes peoples independence and helps people to orientate around the home. However, improvements could still be made here. On the upper floor some of the bedroom doors are fitted with a small observation window and while some of the windows have a light curtain Summerville House DS0000068947.V349313.R01.S.doc Version 5.2 Page 22 covering the window, one can still see inside the room and this does not promote privacy and dignity. The home must consider blocking the windows completely. See requirements. The laundry arrangements were assessed. Care assistants are responsible for doing the laundry throughout the day, as the home does not have a designated laundry assistant. (See standard 27) One survey returned by a relative contained a comment in relation to clothing. While the relative said that ‘the cleanliness of clothing is satisfactory’ they also said that ‘more attention is needed to dressing appropriately, i.e. wearing own clothes not random clothing’ and ‘keeping clothing marked with a name’. When clothing is washed it is transported to a small room on the first floor and sorted into individual named baskets. When examining some of the clothing it was found that a number of items were unnamed and therefore it would be impossible to identify to whom they belong. The small room used to store clean laundry was not locked and the light was on inside. The room has a fire door fitted and the sign clearly states the door must be kept locked. When the inspector tried to close the door it would not close properly, the care coordinator said the door does not fit the frame but they can lock it. This is a fire safety hazard and must be addressed. It was also said that residents have been found in the room and therefore exposed to several risks, such as being trapped and hot pipes. See requirements. The laundry procedures need to be reviewed in full and the home must employ a laundry assistant to make improvements here. See requirements. Risk assessments relating to the environment were not seen during this site visit. Summerville House DS0000068947.V349313.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 and 30 Quality in this outcome area is poor. People who use the service cannot be assured that the home has sufficient numbers of trained and competent staff on duty at all times and that recruitment practice promotes their safety and protection. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Copies of the staff rosters were taken during the site visit and later analysed. At the last inspection the inspector reported that staff rosters were unclear and it was difficult to extract accurate information. The rosters have now been improved and provide clear easy to read information. It was also reported that the staffing levels were low and the needs of residents were not being met. This inspection shows that staffing levels are still too low and the home cannot demonstrate that the needs of residents are being met to an acceptable standard. At the time of this site visit the home was accommodating 22 residents, all with a diagnosis of dementia, resulting in medium to high dependency needs. The home has conducted their own dependency assessment and assessed a number of people as low dependency, which is unlikely considering the increased needs of people with cognitive impairments. However, the home has Summerville House DS0000068947.V349313.R01.S.doc Version 5.2 Page 24 assessed the staffing levels as 4 care assistants in the morning, 4 in the afternoon/evening and 2 during the night. In July 2007, the Commission was informed that the manager of the home was on long term sick and the management of the home would be temporarily covered by the two care coordinators (See standard 31). The rosters show that the majority of the hours worked by the care coordinators are included in the staffing levels and therefore there is either little time for management of the home or reduced staffing levels. The care coordinators confirmed that they have responsibility for management tasks and for care and often have to be out ‘on the floor’ to complete duties such as cooking, activities, medication and general care tasks. Analysis of the rotas show that at times the home has not had a senior care worker or manager on duty. At other times the staffing levels have been reduced to unacceptable levels. For instance on 01/08/07 the afternoon shift was covered by 3 care assistants and on 09/08/07 the whole day was covered by 3 care assistants, this included the care coordinator and two of those staff were working a 13.5 hr day and would have needed to take a break, reducing the number to two at those times. Care assistants also have the responsibility for serving and preparing some of the teatime meal and are allocated for laundry duties during the day. Five members of staff were interviewed and two were surveyed. It was clear that there was little time to do anything other than care for peoples basic care needs. There is also strong evidence in standards 7-11 and 12-15 that people’s needs are not being met. The home must review the dependency assessments and increase staffing levels to ensure that people’s needs are being met. A requirement is made for the second time. See requirements. The files relating to five new members of staff were inspected and omissions were found in all files. New members of staff had commenced work without the proper pre employment checks, such as POVA clearances and references. Two files did not contain an application form or any record of interview. The recruitment practice was found to be extremely poor and places the health and welfare of people who use the service at risk. See requirements In three of the files there was no evidence of an induction and the induction seen in the other files was limited and did not appear to meet the common induction standards. See requirements One new member of staff was interviewed and showed very little understanding of people with dementia. She had not received any training but had started the basic induction. When observed ‘on the floor’ some concerns arose in relation to her practice, which demonstrate that she had little knowledge of care work. She was heard to give residents instructions i.e ‘go to the dining room’ and ‘sit down’, her suitability was discussed with the care coordinators who said they were supervising her closely. Summerville House DS0000068947.V349313.R01.S.doc Version 5.2 Page 25 Another member of staff who has worked at the home for a few months had received some training in moving and handling, adult protection, dementia awareness and first aid. However when we discussed how she meets people’s individual needs she had very little knowledge of care plans or their value and did not know the individual routines of any resident. During the site visit, it was observed that staff did not move and handle residents in a safe manner, staff did not always promote dignity, staff had little knowledge of the value of positive engagement with people with dementia, the importance of meaningful activity and stimulation, care planning, good record keeping or hygiene and infection control. The care coordinators report that the home does not have a training programme and they have been trying hard to identify free training for staff as requested by the provider. The home must ensure that staff are equipped with the knowledge and skills necessary to ensure that peoples health and wellbeing is met and promoted at all times. See requirements. Summerville House DS0000068947.V349313.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,and 38 Quality in this outcome area is poor. People who use the service cannot be assured that it is being managed in a way that promotes their best interests at this time. This judgement has been made using available evidence including a visit to this service. EVIDENCE: As mentioned in standard 27, the unregistered manager is on sick leave at present and at the time of the inspection had been absent for 5 weeks. In July 2007 the Commission was informed that the home would be temporarily managed by the two care coordinators (previously known as senior care assistants). It is clear from the evidence set out in this report that the social care aspects of the home are not being managed properly and can be attributed to the lack Summerville House DS0000068947.V349313.R01.S.doc Version 5.2 Page 27 of training for the care coordinators in management tasks and the lack of management time available to them. See requirements. Both Mr Sehgal and his mother do spend time in the home helping with the care tasks and business administration. There are currently serious deficits in service users records, meeting peoples health and care needs, staff practice, staff training, staffing numbers, recruitment and management systems. See requirements. The care coordinators were not able to provide any evidence of a quality assurance process or consultation with residents and other stakeholders. See requirements. The home no longer deals with residents’ finances. In relation to health and safety, there are a number of concerns set out in this report that relate to health and safety that need to be resolved. See requirements. Fire safety records were checked and records show that regular checks are made on fire safety systems such as fire alarms. Staff are trained in fire safety procedures as part of the induction and refreshers have been provided. The care coordinators were not able to produce a fire safety risk assessment on this occasion and were not clear as to whether it had been completed. Summerville House DS0000068947.V349313.R01.S.doc Version 5.2 Page 28 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 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 2 X X 1 X X X 1 STAFFING Standard No Score 27 1 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 X X 1 Summerville House DS0000068947.V349313.R01.S.doc Version 5.2 Page 29 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 13.213.4 Requirement People who use the service must have their medicines properly secured to ensure they cannot be accessed by unauthorised persons Timescale for action 07/09/07 2. OP9 13.213.4 People who use the service must 07/09/07 have their medicines requiring refrigeration stored within the appropriate temperature range and this is demonstrated by daily temperature records People who use the service must have their medicines that have been discontinued promptly removed for disposal by staff so that they are not given to people in error People who use the service must have their medicines administered only to them and not to other residents prescribed the same medicine. 07/09/07 3. OP9 13.213.4 4. OP9 13.213.4 07/09/07 Summerville House DS0000068947.V349313.R01.S.doc Version 5.2 Page 30 5. OP9 12.113.21 3.4 People who use the service must have medicines promptly obtained so that they can be given as scheduled. The nonavailability of medicines must be avoided at all times People who use the service must have their medicines of limited life on opening safely handled by staff to ensure they are not used following their expiry times People who use the service and are prescribed medicines of a psychoactive nature on a PRN (as required) basis must only be given these medicines when it is clinically appropriate. This must be demonstrated by the home’s record-keeping practices People who use the service must have records of medicine administration completed by staff immediately following their administration to ensure safe practice is adhered to at all times People who use the service must have their medicines administered by staff in line with prescribed instructions at all times. This must be demonstrated by the home’s record-keeping practices 07/09/07 6. OP9 13.213.4 07/09/07 7. OP9 13.213.4 07/09/07 8. OP9 13.213.4 07/09/07 9. OP9 13.213.4 07/09/07 10. OP9 13.213.4 People who use the service must 07/09/07 have their medicines no longer in use and disposed of recorded by staff at all times so these medicines can be accounted for in full. DS0000068947.V349313.R01.S.doc Version 5.2 Page 31 Summerville House 11. OP3 14(1) 12. OP7 15(1,2) 13. OP8 13(4c) 14. OP10 12(4a) 15. OP18 13(6) 16. OP26 16(2k) 17. OP14 12(2) 18. OP22 23(2n) 19. OP26 16(2ef) People who use the service must have their needs properly assessed prior to moving into the home. So that people are assured their needs will be met. People who use the service must be assured that their health, care and social needs will be set out in an individual plan that provides staff with guidance as to how those needs should be met. So that peoples health and welfare is safeguarded. People who use the service must be assured that all risks to their safety and welfare are identified and action taken to minimise as far as possible. So that the health and welfare of people is safeguarded. People who use the service must be assured that their privacy and dignity is promoted at all times. So that their health and well being is promoted. People who use the service must be assured that they will be protected from abuse. So that they are safeguarded from harm. People who use the service must be assured that the premises will be free from offensive odours. So that their health and welfare is safeguarded. People who use the service must be assured that autonomy and choice will be promoted at all times. So that their health and well being is promoted. People who use the service must be assured that equipment that is suitable for their needs will be provided. So that their health and welfare is safeguarded. People who use the service must be assured that an effective laundry service is provided. DS0000068947.V349313.R01.S.doc 26/09/07 26/09/07 26/09/07 26/09/07 26/09/07 26/09/07 26/09/07 26/09/07 26/09/07 Summerville House Version 5.2 Page 32 20. OP27 18(1abc) 21. OP29 19(1-5) 22. OP31 10(1) 23. OP33 24(1,2,3) 24. OP33 26 People who use the service must be assured that suitably qualified, competent, experienced staff are working in sufficient numbers at all times. People who use the service must be assured that the home has a robust recruitment process. So that their health and welfare is safeguarded. People who use the service must be assured that the home will be adequately managed by a person who has been assessed as fit to do so and has sufficient skills and competence. So that their health and welfare is safeguarded. People who use the service must be assured that the home is run in their best interests and that they and their representatives are consulted about the quality of the service. So that their health and welfare is promoted. People who use the service is continuously self-monitored and regulation 26 visits are conducted monthly. So that their health and welfare is promoted. 26/09/07 26/09/07 26/09/07 26/09/07 26/09/07 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 OP9 Good Practice Recommendations It is recommended that a separate and locked area is created for medicines no longer in use and awaiting disposal to the pharmacy Summerville House DS0000068947.V349313.R01.S.doc Version 5.2 Page 33 2. OP9 It is recommended that clear annotations are made to MAR chart medicine entries for medicines not supplied in or administered from MDS containers It is recommended that additional approval is obtained from a social worker and relative for a resident administered medicines by crushing and placing in foodstuffs It is recommended that further reviews of medication are requested of prescribers or their representatives particularly where residents are prescribed high doses of psychoactive medicines It is recommended that care plan guidance is developed for the management of resident psychological agitation including exact circumstances when medicines of a psychoactive nature prescribed on a PRN basis should be considered for use. It is recommended that regular and frequent audit trailing of medicines is undertaken by senior members of care staff to promptly identify and resolve medicine discrepancies arising It is recommended that further training is provided for members of care staff authorised to access, handle and administer medicines and their competence when undertaking medication-related tasks is monitored and assessed on a regular basis. This is also to include staff administering of insulin by injection It is recommended that people who use the service are provided with a complaints procedure that provides accurate information about the other agencies to contact if unhappy with the way their complaint is handled. 3. OP9 4. OP9 5. OP9 6. OP9 7. OP9 8. OP16 Summerville House DS0000068947.V349313.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Summerville House DS0000068947.V349313.R01.S.doc Version 5.2 Page 35 - 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. 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