Inspection on 23/10/08 for Summerville House

This inspection was carried out on 23rd October 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Summerville House 29/09/09

Summerville House 05/02/08

Summerville House 15/08/07

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 30/01/2009.

CARE HOMES FOR OLDER PEOPLE Summerville House Fenway Heacham Kings Lynn Norfolk PE31 7BH Lead Inspector Kim Patience Unannounced Inspection 23rd October 2008 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.V372927.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.V372927.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 570640 raj.sehgal@btinternet.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) 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.V372927.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd April 2008 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.V372927.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection report includes information gathered since the last inspection and a site visit. The site visit was conducted by 2 regulation Inspectors. We completed a tour of the premises and looked at records relating to residents, staff and the business. We also spoke with residents, staff and visitors to the home and completed some observations of daily life. What the service does well: What has improved since the last inspection? What they could do better: Further improvements are needed in care planning and risk assessments. The home must ensure that records are accurate and kept up to date. Risk assessments must be written for all risks identified and Medication audits should be conducted more frequently to identify and eliminate errors. Hazards in the environment must be minimised and steps should be taken to ensure that all products that could be a risk to people are stored in a safe place. Summerville House DS0000068947.V372927.R01.S.doc Version 5.2 Page 6 Staff recruitment practice must be reviewed to ensure it is robust and the home needs to demonstrate that pre employment checks are in place before new staff start working in the home. The number of staff on duty each shift must be increased to ensure that people’s needs are met and staff training also needs to be reviewed to ensure that staff are trained to do their job effectively. The manager must introduce a plan of staff supervision. 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.V372927.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Summerville House DS0000068947.V372927.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. People’s needs are assessed prior to moving into the home so that they can be assured the service can meet their needs. People are provided with information about the service and are invited to view the accommodation. However, this may not be the same when admitted at short notice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection the agreement not to admit new residents has been lifted and the home is now in a position to admit people to the home. The home has a policy and procedure in place for admitting new people to the home. This includes providing people with information about the services and facilities and inviting people to view the accommodation before making a decision to move in. Summerville House DS0000068947.V372927.R01.S.doc Version 5.2 Page 9 We looked at the records relating to two people recently admitted. One person had been transferred from another home owned by the same provider and the file contained assessments and care plans written at the previous home. New care plans were in the process of being developed to ensure that information was up to date. However, there was sufficient information showing what the person needs are and how they should be met. We looked at the records of another person admitted to the home as an emergency the previous day. There was a needs assessment provided by the health establishment where the person was transferred from that offered some information. However, there were no other records in place. The manager said the person was only admitted for one night and therefore had not had the opportunity to write any other assessments. Summerville House DS0000068947.V372927.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is adequate. People living in the home have their needs assessed and met. However, some improvements are needed in care planning and medication before it can be said the outcomes are good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection in February further improvements have been made to care plans and associated records. We examined the care records relating to five residents and found that they were well-organised and contained sufficient information to guide care assistants as to how people’s needs should be met. Reviews are being completed regularly and there is evidence that relatives are involved in the reviewing process. Some improvements are still needed to ensure that records are completed in full for all residents and that they are kept up to date. For instance, in the records relating to one person an entry was made in the daily care notes that they had MRSA but there was no care plan in place to address their needs in this respect. Another person was being treated for a sore on their heel but there was no care plan in place. Summerville House DS0000068947.V372927.R01.S.doc Version 5.2 Page 11 Risk assessments were written in most cases and this is an improvement on what was seen at the last inspection. Again further improvement is still needed to make sure that risk assessments are written in all cases. For instance, one person did not have a pressure care assessment, falls assessment or moving and handling assessment. Social care plans contain more detailed information and are more personcentred. These can be further developed by gathering life history information and ensuring that activity provided is based on people’s previous interests and hobbies. We looked at medication management practices and found these to be satisfactory. We observed a care assistant administering medicines at lunchtime and their practice was good. The facilities for the safe storage of medicines are satisfactory. We looked at medication administration records and crosschecked these with medicines remaining in stock. We found that there was good practice in relation to record keeping and instructions for the administration of medicines were clear. There were some discrepancies in the number of tablets remaining when crosschecked with the charts, however the number of errors was not significant. The manager could increase the medication audits to identify how the errors occur and take action to eliminate them. The home has a refrigerator for the storage of medicines requiring a low temperature. The temperature is monitored but showed that at times this falls below the range required for most medicines. The home needs to monitor this more closely to ensure that adjustments are made where necessary. Summerville House DS0000068947.V372927.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is adequate. People living in the home are being given the opportunity to live life in the way that they wish to. Meals are provided in a nice homely environment and people are supported to maintain a good diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: As written in the health and personal care section, some improvement is needed in social care plans so that person-centred activity can be provided. When we looked at records of activities undertaken the records did not demonstrate that meaningful activity had been provided. Some records just stated ‘asleep’ and ‘walking around’. However, during the visit we saw staff engaged in games with the residents and one resident was reading a newspaper. Another resident was helping to prepare food in the kitchen and was clearly getting a lot of enjoyment from having a role in the daily routines of the home. Two members of staff were spoken with and stated that they are responsible for providing activities every day. Sometimes they will play games and other times they will sit and talk to residents depending on what people prefer to do. Summerville House DS0000068947.V372927.R01.S.doc Version 5.2 Page 13 We observed the mealtime experience and found that this was a positive experience for most people. Staff engaged well with residents and the whole experience was calm and relaxed. The dining room was nicely laid out and the new conservatory is a good addition to the dining room. People were offered choices and staff supported people in a kind and sensitive way. The cook showed good knowledge of people’s dietary needs and likes and dislikes. The meal was appetising and people appeared to enjoy their food. Residents spoken with said they enjoyed their meal. Summerville House DS0000068947.V372927.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. People can be assured that their complaints and safeguarding issues will be handled effectively. However, we cannot be sure that all staff are trained in safeguarding matters. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has policies and procedures in place for handling complaints. The complaints policy is displayed in the entrance hall along with a suggestions box. The manager said that one complaint has been received since the last inspection and when we looked at how that complaint was handled we found it was satisfactory. The Commission has been aware of some adult protection concerns since the last inspection that have been fully investigated and are now closed. The provider responded well to the concerns and took action to ensure that the matters were resolved. We were not able to fully assess staff training in respect of safeguarding, as the manager was unable to produce the training records. The home was given the opportunity to provide the training records following the inspection but at the time of writing the report they had been received. This will be assessed more fully at the next inspection. Summerville House DS0000068947.V372927.R01.S.doc Version 5.2 Page 15 Summerville House DS0000068947.V372927.R01.S.doc Version 5.2 Page 16 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 and 26 Quality in this outcome area is adequate. The home provides a clean, comfortable and homely place for people to live. However, it is not necessarily safe in all areas. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection there have been many improvements to the physical environment. The work on extending the dining room and lounge to create conservatories has been completed and the carpets and floorings throughout the ground floor communal areas have been replaced. The conservatories are a good addition to the communal space and residents were enjoying sitting in those areas and looking out over the well-kept gardens. On entering the building we did not detect any odours and the home looked clean and tidy. New furniture has been introduced in the lounge to make it more homely and comfortable. Summerville House DS0000068947.V372927.R01.S.doc Version 5.2 Page 17 There is more signage to assist people to orientate independently around the building and to their rooms. When looking in the communal bathrooms and some resident’s rooms we still found toiletries and products that could be hazardous if used incorrectly. We also found some unnamed toiletries, which may indicate they are for communal use. This does not promote dignity and choice. One bathroom identified as having a broken lock at the last inspection still had a broken lock and on this occasion the door could not be closed properly. We raised this with the manager who asked the handyman to deal with it immediately. Some bedroom doors were propped open with commode chairs and this does not promote dignity or safety. Fire door closures need fitting to doors that need to remain open. Resident’s rooms appeared comfortable and homely with personal belongings. We inspected the laundry arrangements and found them to be well organised. The home employs a member of staff specifically for laundry. We spoke with the laundry person who told us that the home has procedures in place to prevent cross infection. Dirty laundry is kept separate from clean and any items requiring special treatment are placed in red soluble bags that go into the washing machine to reduce cross contamination. We noted that the laundry room floor was cracked and in need of some repair. We also noted that there were no hand washing facilities in the laundry room but there was hand soap and paper towels. Summerville House DS0000068947.V372927.R01.S.doc Version 5.2 Page 18 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 living in the home cannot be assured there will be a sufficient number of trained and competent staff available to meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of this inspection visit we were told by the manager there were 22 residents living in the home. We were also told that on each daytime shift there are 4 care assistants and 2 waking night staff. In addition, the home employs a cook, laundry person and a maintenance person. We looked at the staffing rosters for the 4 weeks preceding the inspection visit and found that the home maintains staffing levels at 4 care assistants in the morning, 3 in the afternoon and two at night. There are occasions when an extra person is brought in at teatime. Considering the number of residents accommodated and their higher level needs, this is not a sufficient number of staff. Staff told us that at teatime there is no cook and they are often asked to prepare and serve meals. At this time medication is also being administered reducing the number of staff even further. In addition, the rosters show at times the number of staff on duty has fallen below the above numbers due to sickness. Summerville House DS0000068947.V372927.R01.S.doc Version 5.2 Page 19 We examined files relating to staff employed since the last inspection and found that two of the three files contained all the necessary information and demonstrated safe recruitment practice but one did not. This file did not contain 2 references or a criminal records check. The proprietor said he had received the criminal records check but it was not yet available in the home. We were not able to assess staff training fully on this occasion, as the training records were not available. The manager was asked to provide the records after the inspection but at the time of this report they had not been received. We spoke with some staff who confirmed they had received all the mandatory training. However, the laundry person said she had not received any infection control training as yet. One staff file showed that training had been provided this year in areas such as dementia awareness, adult abuse, care planning, COSHH, infection control and medication. Summerville House DS0000068947.V372927.R01.S.doc Version 5.2 Page 20 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, 36 and 38. Quality in this outcome area is adequate. People living in the home can be assured the home is managed in a way that promotes their best interests. However, improvements are still needed in some management areas before it can said that the outcomes are good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection the manager at the home has left and a replacement manager has been appointed. We have not yet received an application for registration but the provider informed us that they intend to submit one when all the necessary information is ready. The organisation now has an operations manager, who is also the manager for another home in the group. Regulation 26 visits are now being completed on a monthly basis. Summerville House DS0000068947.V372927.R01.S.doc Version 5.2 Page 21 The manager said that the home has a quality assurance system in place and this includes consultation with stakeholders. The surveys had just been sent out to people and the results were not yet available. The manager said the programme of staff supervision has not yet started but it was anticipated this would commence soon. We looked at records relating to health and safety and found that all the necessary checks are being carried out on equipment to verify they are in good working order. However, the manager could not locate the fire safety records to demonstrate that fire safety checks are being carried out. Summerville House DS0000068947.V372927.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 1 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X 1 X 2 Summerville House DS0000068947.V372927.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13.2 Requirement People who use the service must have their medicines safely managed so that their health and welfare is safeguarded. 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 suitably qualified, competent, experienced staff are working in DS0000068947.V372927.R01.S.doc Timescale for action 30/12/08 2. OP7 15(1,2) 30/12/08 3. OP8 13(4c) 30/12/08 4. OP27 18(1abc) 30/12/08 Summerville House Version 5.2 Page 24 sufficient numbers at all times. 5. OP27 18(2) People who use the service must be assured that there needs will be met by staff who are adequately supervised. So that their health and welfare is promoted. 30/12/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP9 OP9 OP26 Good Practice Recommendations It is recommended that the home increase the medication audits to identify and eliminate errors. It is recommended that the temperature of the medicine fridge is monitored and adjusted accordingly to maintain the correct temperature. It is recommended that the laundry floor be repaired to meet good infection control requirements. Summerville House DS0000068947.V372927.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Summerville House DS0000068947.V372927.R01.S.doc Version 5.2 Page 26 - 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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