Inspection on 29/09/09 for Summerville House

This inspection was carried out on 29th September 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

Summerville House 23/10/08

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 17/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Summerville House Fenway Heacham Kings Lynn Norfolk PE31 7BH Lead Inspector Jane Craig Key Unannounced Inspection 29th September 2009 09:30 DS0000068947.V377876.R01.S.do c Version 5.3 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. Summerville House DS0000068947.V377876.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 Summerville House DS0000068947.V377876.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.V377876.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd October 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. Information about the home, including the last inspection report, is available from the manager The weekly fees range from £400 to £495. 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.V377876.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 that people who use the service experience adequate quality outcomes. The last key inspection of this service was carried out on 23rd October 2008. This key (main) inspection includes information we have gathered since the last inspection and an unannounced visit to the home. The visit was carried out on 28th September 2009 by one regulatory inspector. At the time of the visit there were twenty two residents living at the home. We met with some of them and, wherever possible, asked about their views of Summerville House. We spent time observing daily routines in the home and how staff interacted with residents. Three residents were case tracked. This meant that we looked at their care plans and other records and talked to staff about their care needs. We talked to the person in the company who is responsible for the home, who is called the responsible individual. We also held discussions with the acting manager, members of the staff team and visitors to the home. We looked around the home and viewed a number of documents and records. As part of the key inspection surveys were sent out to residents and staff. Most residents were assisted to complete theirs with the help of family members. Responses from the surveys have been taken into account when making judgements about the service. This report also includes information from the annual quality assurance assessment (AQAA), which is a self-assessment report that the manager has to fill in and send to the Commission every year. What the service does well: People who returned surveys told us that they had received enough information about the home to help them to make a decision about moving in. Prospective residents were assessed to make sure their needs were understood and could be met before they were offered a place at the home. This reduced the risk of failed placements. Family members told us that their relatives seemed to be happy in the home and one resident said, “It’s very pleasant here; people are nice with each other.” Staff encouraged people to make whatever choices they could about their daily lives. They told us the routines in the home were flexible and Summerville House DS0000068947.V377876.R01.S.doc Version 5.2 Page 6 revolved around the people who lived there. Residents we spoke to said they liked the meals and the lunchtime meal on the day of our visit was a relaxed and social occasion. There was open visiting, which meant that people could see their families and friends at times that were convenient to all. Visitors said that they were made to feel welcome. The service had a clear complaints procedure, which was available to residents and visitors. People who returned surveys indicated that they knew who to speak to if they were unhappy about the service. Records showed that complaints were handled well. We received several complimentary comments about the staff from residents and relatives. One wrote, “The carers are very kind to residents,” and another told us, “They are very caring.” Over half of the care staff held an NVQ, which is a nationally recognised qualification in care. What has improved since the last inspection? What they could do better: There must be care plans to support residents who have mental health needs or who display behaviour that could cause harm to themselves or others. This is to ensure that all staff understand how to provide a consistent approach to assist the resident. All care plans must be kept under review and altered if the resident’s needs change. This is to make sure that staff have up to date instructions about the support they should be providing. After the last inspection we made a requirement that staff assess risks to residents’ health. Although these assessments had been carried out, they were not always kept up to date and staff did not always draw up care plans to minimise identified risks. We made a requirement to improve the risk assessments. We made a requirement that staff must ensure that residents’ rights to privacy and dignity are upheld. We also recommended that staff receive training in Summerville House DS0000068947.V377876.R01.S.doc Version 5.2 Page 7 the mental capacity act so that they are aware of and can promote residents’ rights. There must be more individual or group activities to ensure that residents social and recreational needs are met. Staff must have guidance and training in safeguarding adults in order to ensure that any suspected or actual abuse is dealt with appropriately. The staffing numbers should be kept under review. Staffing numbers sometimes fell below the planned levels and some residents, relatives and staff told us that there were not always enough staff. One relative told us, “The care is there but there should be more staff to spend time with the residents.” Staff training and supervision must be brought up to date to ensure that staff have the necessary knowledge and skills to care for the residents and to protect their health and safety. There must be a formal system, which takes into account the views of residents and families, for monitoring the quality of the service provided at Summerville House. This is to ensure that the manager is able to identify and address any areas that need to be improved. 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. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Summerville House DS0000068947.V377876.R01.S.doc Version 5.3 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.V377876.R01.S.doc Version 5.3 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): 3 and 6 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. The admission process helped to ensure that the home was suitable to meet the needs of the people who moved in. EVIDENCE: The manager told us that the information about the home was continually revised to ensure it was up to date and accessible to residents. Most people who completed surveys indicated that they received enough information to help them decide whether Summerville House was the right place for them. One relative told us that they had been made to feel very welcome when they went to look around the home and said staff spent time with them answering their questions. Summerville House DS0000068947.V377876.R01.S.doc Version 5.3 Page 10 People thinking of moving into the home were assessed by the manager before being offered a place. The manager also obtained copies of health and social care assessments. This helped to ensure that people were not admitted unless their needs were understood and could be met. The annual quality assurance assessment (AQAA) told us that there had been no placement breakdowns in the past year. The people we case tracked had copies of pre-admission assessments on their files and the information had been used to draw up initial care plans. Standard 6 was not applicable. Summerville House does not provide intermediate care. Summerville House DS0000068947.V377876.R01.S.doc Version 5.3 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 and 10 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. Lack of up to date care plans and risk assessments could pose future risks to residents health and safety. EVIDENCE: The standard of care plans varied. There were some very detailed plans, which included information about the resident’s preferences and instructed staff how best to help the resident to maintain their independence and dignity. These plans helped to ensure that staff provided consistent care, which matched the resident’s wishes. Other plans we saw lacked individual information and could have been applied to anyone living at the home. Most plans showed evidence that the resident, or their relative, had been consulted and agreed with the planned care. Although this was not an ongoing Summerville House DS0000068947.V377876.R01.S.doc Version 5.3 Page 12 process, a relative told us that they were kept informed about changes in care and medication and looked at the plans from time to time. The planned monthly evaluations of care plans and associated records were not up to date. There were no notes to summarise the care given or to show the residents’ progress towards meeting their goals. Most review notes indicated that there were no changes to the plan, even when there was information to show that the resident’s needs had changed. A member of staff told us that they were aware that the care plans were in need of updating and said there were not always enough staff to allow time for updating paperwork. Despite the shortfalls in the care plans, staff told us that there were good verbal handovers and staff who completed surveys indicated that they were usually given up to date information about residents. Residents or relatives who completed surveys indicated that they always or usually received the care and support they needed. Each care file included a brief mental health assessment. Care plans generally addressed residents’ physical and personal care needs relating to dementia. However, there were few plans to direct staff how to support residents with regard to needs associated with memory loss and disorientation. There was no plan to support a resident whose notes indicated they occasionally displayed aggressive and disinhibited behaviour. This lack of direction could result in lack of staff intervention and other residents being harmed. Another resident was anxious and constantly requested staff attention and help. Some staff dealt with this by ignoring the person and others approached but did not know how to respond to the negative content of the conversation. There was no care plan to encourage a consistent approach. Following a previous requirement, care files included risk assessments associated with manual handling, pressure sores, falls and nutrition. However, none of the files we looked at had corresponding plans to direct staff how risks could be minimised. For example, one resident was assessed as being at high risk of developing pressure sores but there was no strategy to show how staff could minimise the risk. The assessments were not kept up to date. One person had lost a significant amount of weight in six weeks. Their nutritional risk assessment had not been updated and there was no care plan to monitor or address the weight loss. Residents who returned surveys indicated that staff always made sure they received medical attention when they needed it. A relative told us that the level of care in the home was, “fine.” Care files showed that residents with health care needs were usually referred to outside agencies for advice and treatment. None of the residents were able to manage their own medication. All staff who had responsibility for handling medicines had received training and had their competency assessed by the manager. We observed two members of staff Summerville House DS0000068947.V377876.R01.S.doc Version 5.3 Page 13 administering medication and found their practice to be safe and hygienic. Medicines were stored safely and at the correct temperatures. There was no excess stock. There were complete records of medicines received and disposed of, which helped to provide an audit trail. There were no gaps on the medication administration record (MAR) charts. Appropriate codes and notes were used when medicines were omitted. However, staff had twice signed for tablets that had not been given. This could be an indication that staff did not thoroughly check and sign the chart at the time they administered the medicine. There were some handwritten entries on MAR charts. These were not double signed to show that they were checked for transcribing errors. Some residents were prescribed medication to be given, ‘when required’. There were no care plans or instructions to ensure that staff had guidance as to when individual residents needed this medicine. This is especially important if residents are not able to verbally communicate their need, for example, for pain relief. Medicines that were prescribed with a variable dose had been recorded, which continued the audit trail and helped to evaluate the efficacy of the dose. One person sometimes received their medication covertly. This had been agreed with their GP and family members after the resident had an assessment to show that they lacked the capacity to make a decision about taking their medicine. However, there were no instructions for staff about what to disguise the medicine in and there had not been any consultation with the pharmacist to ensure that the medicine was safe to take in food or drink. During the course of our visit we found that there were a few practices that did not uphold residents’ rights to privacy and dignity. For example, there were still some unnamed, communal toiletries in the bathrooms. Having to ‘borrow’ toiletries from others does not promote dignity or choice. One of the shared rooms did not have a privacy curtain in place. We were told that it had been taken down to wash over the weekend but the minutes of a staff meeting indicated that the lack of privacy curtains could be an ongoing problem. We observed that most staff were polite and respectful when speaking to residents. However, we overheard some staff referring to residents as “good girl,” or “good boy”. Although this was meant as praise and encouragement, addressing adults in a similar way to children is not dignified or respectful and may be an indication of lack of training about supporting people with dementia. Summerville House DS0000068947.V377876.R01.S.doc Version 5.3 Page 14 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 and 15 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. The level of activities and occupation did not meet residents’ social and recreational needs. EVIDENCE: Most residents had a life story, written by their families. Staff told us it helped them to understand about important people, events and activities throughout the resident’s life and was also used for reminiscence. Care assessments included a list of residents’ past interests. However, this information was not built upon and there were no care plans to direct staff how to meet residents’ social and recreational needs. There was an activity programme on display but staff and relatives told us that this was not usually followed. There were regular sessions from outside entertainers and staff said they tried to do some activities when they had the time. On the day of the visit a few residents were engaged playing a game of skittles and staff spent some one to one time with other residents. There were a large number of people unoccupied for long periods of time. Activity records confirmed that residents only occasionally Summerville House DS0000068947.V377876.R01.S.doc Version 5.3 Page 15 engaged in planned activities. A relative told us that the lack of activities was the one place where they felt the home fell down. Another said, “There is not much stimulation, just sitting.” A member of staff who completed a survey said that staff needed some training to help them to be able to provide meaningful activities for people with dementia. This was discussed with the manager at the time of the visit. There was open visiting, which helped residents to be able to stay in touch with their family and friends. Visitors we spoke to all said they were made to feel very welcome and also said they were kept informed of any important issues about their relative’s care. Care plans included some information about residents’ preferred daily routines, such as times they liked to get up and go to bed. Staff said residents had choices about all aspects of their daily lives and most residents had the ability to make their wishes and needs understood. We observed residents being given choices about meals and drinks and where they wanted to spend their time. Family members we spoke to said they felt their relatives were happy at Summerville House and a resident told us, “It’s very pleasant here; people are nice with each other.” We observed the lunchtime meal. The dining room was well laid out, giving people using wheelchairs and walking aids plenty of space. There was a relaxed and social atmosphere throughout the lunchtime period. People who did not require assistance to eat their meal were not hurried. However, we observed that not all staff were skilled in providing support in a dignified and sensitive manner. This was brought to the attention of the manager who rectified the problem immediately but the situation may be reflective of lack of training in basic care. Residents had a choice of two main meals. The cook told us that she knew residents’ likes and dislikes and could choose for them if they were not able to. On the day of the visit the cook had made separate puddings for people who she knew did not like fruit sponge. The menus showed that people were offered a varied diet. We were told that residents were provided with fresh vegetables and fruit. Those residents we asked said they enjoyed their lunch. Most people who completed surveys said they usually liked the food. One wrote, “The food is normally alright.” Summerville House DS0000068947.V377876.R01.S.doc Version 5.3 Page 16 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 and 18 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. The complaints procedure ensured that formal complaints would be investigated and acted upon. The lack of staff training and clear guidance in safeguarding could result in abuse being undetected or mismanaged. EVIDENCE: There was a large print copy of the complaints procedure on display in the home and the manager told us that people were given their own copy in the service user’s guide. Relatives who completed surveys on behalf of the residents indicated that they all had someone to speak to if they were unhappy and most were aware of the formal complaints procedure. Although none of the relatives we spoke to had made a formal complaint, one told us that staff had listened to, and were taking action about, some concerns they had. Staff who completed surveys indicated that they knew what to do if anyone raised concerns about the service. Since the last inspection there had been one complaint made directly to the service. This was about lack of staff attention. The complaint had been investigated and an apology had been made on behalf of the company. Summerville House DS0000068947.V377876.R01.S.doc Version 5.3 Page 17 The majority of staff working in the home at the time of the visit had not received training in safeguarding adults. Of the staff we spoke to, one was not clear about the limitations of their role in investigating safeguarding incidents. Another was not sure about reporting suspected or alleged abuse outside the home. The service had an adult abuse policy and a whistle blowing policy but neither were completely clear about reporting an incident, or about the role of social services in the safeguarding process. We were told that the policy was being reviewed at the time of the visit. In the past year the Care Quality Commission had received an allegation that some residents at Summerville House were not receiving the care they needed because of low staffing levels. This had been investigated by the adult protection team in line with safeguarding procedures. Although the allegations were found to be untrue, there were concerns about low staffing levels. Following a recent strategy meeting the planned staffing levels had been increased. The training matrix showed that none of the current staff had received training in the mental capacity act or deprivation of liberty safeguards. The lack of training could result in staff not being aware of residents’ rights or whether any of their day to day practices contravened the legislation. Summerville House DS0000068947.V377876.R01.S.doc Version 5.3 Page 18 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 and 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. Most areas of the home were clean, comfortable and homely. EVIDENCE: A tour of the building showed that the home was in a good state of repair. Safety measures, such as low surface temperature radiators and window restrictors, were in place. There were several signs around the home to assist people with dementia to find their way around. However, some of these were obscured by other documents and leaflets displayed on the walls. There was an ongoing programme of redecoration and renewal. The AQAA told us that since the last inspection new flooring had been laid in many areas of Summerville House DS0000068947.V377876.R01.S.doc Version 5.3 Page 19 the home and bedrooms had been redecorated and had new furnishings. Residents were asked whether they had a preference for colours when their room was decorated. A relative said, “It is the small things like that that make all the difference.” Another relative told us that they found the communal rooms of the home bright and airy. However, there were no blinds in the conservatories which made the rooms too hot for comfort on certain days. The staff were monitoring the temperature in the rooms and residents were moved out if necessary. This meant that the largest part of the dining space would be unusable. A member of staff commented in their survey, that window coverings in the conservatories were something the service could improve upon. The majority of residents had personalised their bedrooms with ornaments and small items of furniture, which made them more homely and familiar. Residents we spoke to said they were happy with their bedrooms. One wrote, “My bedroom is nice, plenty of light going through.” There were some shared rooms although one was used as single occupancy. None of the bedrooms had en-suite facilities. There were sufficient toilets and bathrooms in close proximity to bedrooms and lounges. There was equipment and adaptations to assist people with limited mobility to maintain their independence. Following a previous requirement, all residents had a risk assessment which showed that their toiletries and prescribed creams must be locked away. None of the residents had lockable storage in their rooms and locks had been fitted to their wardrobes to provide safe storage. However, this meant that some residents were not able to access their wardrobes at all. At the time of our visit the home was clean and most areas were fresh smelling. There was an ongoing problem with odour control in one of the bedrooms, which the manager was trying to address. The AQAA told us that most staff had received infection control training but this was not verified by the training matrix. Following a recommendation at the last inspection the laundry room had new flooring, which helped to maintain hygienic practices. There were immediate plans to fit a new sink to ensure that staff could wash their hands after handling dirty laundry. Summerville House DS0000068947.V377876.R01.S.doc Version 5.3 Page 20 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 and 30 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. There were not always sufficient staff with appropriate training to meet residents needs. EVIDENCE: Following the recent complaint about staffing levels there were always four care staff rostered during the day and evening. Due to unexpected sickness and absence, the numbers sometimes fell below the planned levels. The company does not use agency staff and we were told that the shifts were usually be covered by the manager or staff from another home in the group. However, the rosters showed there were still occasions when there were only three care staff on duty. We heard mixed views about staffing levels. Some residents, relatives and staff said that even with four staff there was not sufficient time to spend with residents in a social capacity. One relative wrote on behalf of a resident, The staff are all very kind but just don’t have enough time to spend with residents. Staff told us that they had time to provide the basic care and relatives said that the residents always seemed to be bathed and well cared for. Summerville House DS0000068947.V377876.R01.S.doc Version 5.3 Page 21 During our visit we noted that there were periods of time when there were no staff in the lounge area. We observed two incidents between different residents which, had they escalated, could have created risks to the residents safety. We discussed these with the manager who said it was unusual for the lounge to be left unsupervised. We also noted that around the teatime period there were less staff in evidence. One of the care staff finished off, served and cleared away the evening meal. The senior concentrated on medication, which left only 2 carers to supervise and assist residents. A number of people who returned surveys and those we spoke to praised the staff. One told us, They are all caring. We looked at the files of two recently employed staff. Both had satisfactory CRB checks and two written references before starting work at the home. However, the checks were not thorough enough to safeguard residents as thoroughly as possible. For example, one applicant had supplied a reference from a friend, which was not an unbiased source. The other had not requested a reference from either of her last two employers. The manager had not explored the reason for this during interview. The induction programme for new staff did not cover the topics included in the common induction standards, which is the programme recommended by the national training organisation. The records showed that one new starter, who had no previous experience, had only 2 days induction shadowing a senior member of staff before working with residents. The training records were not available on the day of the visit and were forwarded to us later. They showed that a high percentage of staff had not completed mandatory training in the safe working practice topics. Only a few staff had training in dementia care, which is reflected in a number of shortfalls highlighted elsewhere in this report. However, there were confirmed dates for training in all the subjects and a commitment from the manager and the company to ensure that everyone had at least this minimum level of training. The training records also showed that a new induction programme had been sourced. The AQAA indicated that over the next year the manager will be introducing a training plan for all staff, which should help to reduce gaps in training. Over half of the staff had achieved NVQ at level 2 or above and others were enrolled on the course. Summerville House DS0000068947.V377876.R01.S.doc Version 5.3 Page 22 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, 36 and 38 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. Management and administration systems were not effective enough to ensure that the home was always run in the best interests of the people living there. EVIDENCE: The current manager had been acting in the position for over a year but had only sent his application for registration the week before our visit. He had several years experience of managing services for older people and was nearing completion of the NVQ 4 in leadership and management. The manager received support from the operational manager and the responsible individual. Summerville House DS0000068947.V377876.R01.S.doc Version 5.3 Page 23 Residents and relatives spoke well of the manager and one told us that they would feel comfortable talking to him if there was something wrong. Staff said the manager was approachable and those who completed surveys indicated that he was supportive. Staff said they received informal supervision from the manager. On the day of the visit we observed the manager mentoring and assessing a new member of staff and generally overseeing the day to day running of the home. However, staff had not had formal supervision sessions for the past year. This limited the opportunities for staff to discuss their work and training needs with the manager. The annual quality assurance assessment was completed when we requested. Some of the information was brief, especially in the areas of what the home does well and what could be improved upon. The manager told us that the company had purchased a new quality assurance programme, which should be up and running in the very near future. A member of staff had been nominated to take the lead in quality assurance. The manager carried out a few internal audits, for example of accidents and falls. However, those we saw were not all up to date and important information had not been transferred to care plans or included in strategies to minimise risks. The shortfalls identified and the high number of requirements made at this key inspection could be reflective of the lack of systems for monitoring and developing the service. The manager did not act as agent or appointee for anyone at the home. Residents were assisted to manage their money by their families or other representatives. Some residents had small amounts of money held for safekeeping. Each had an individual cash sheet to record money received and withdrawn and to keep a running balance. There was a brief description of what purchases had been made and in most cases there were corresponding receipts. The accounts we checked were accurate. There was a complete fire risk assessment but the review was overdue by several months. The training matrix indicated that only two staff had received updated fire safety training in the past year but further training was planned next month. The fire alarm and other fire safety equipment was regularly tested and serviced. The AQAA showed that maintenance of other equipment, installations and appliances was up to date and we verified a random sample of certificates during our visit. There were some risk assessments with regard to the use of equipment. For example, all residents who used bed rails had an appropriate assessment and the rails were checked when they were fitted. However, there were no records to evidence ongoing safety checks. During the course of our visit we noticed a number of residents were being transported in wheelchairs without footplates. This practice creates a risk of injury if residents legs are caught under the chair or their feet are dragged Summerville House DS0000068947.V377876.R01.S.doc Version 5.3 Page 24 along the floor. It should only happen if there is a valid risk assessment to show good reasons. There were no risk assessments on the files we checked. Summerville House DS0000068947.V377876.R01.S.doc Version 5.3 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 2 X 2 Summerville House DS0000068947.V377876.R01.S.doc Version 5.3 Page 26 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 Requirement Care plans must be kept under review and amended as and when the resident’s needs change. This is to ensure that the resident receives appropriate care to meet their needs. There must be care plans to support residents with mental health needs or behaviour which could cause harm to themselves or others. This is to promote the health and safety of all the residents. There must be care plans to address identified risks associated with moving and handling, falls, nutrition and pressure sores. The assessments and plans must be kept under review and amended as the resident’s needs change. This is to promote and protect the resident’s health and safety. Residents must be offered their medication as it is prescribed and records of administration DS0000068947.V377876.R01.S.doc Timescale for action 30/11/09 2. OP7 15 30/11/09 3. OP8 13 30/11/09 4. OP9 13 31/10/09 Summerville House Version 5.3 Page 27 must be accurate. 5. OP10 12 The privacy and dignity of people 30/10/09 using the service must be respected. This would include: Ensuring privacy curtains in shared rooms. Ensuring that residents have their own toiletries and do not use communal stock. Ensuring that staff use peoples preferred term of address. To ensure that residents are safeguarded staff must have training in safeguarding issues and they must have accurate and up to date guidance to refer to. 31/12/09 6. OP18 13 7. OP27 17 The duty rosters must provide an 30/10/09 accurate record of which staff were on duty at any time. Staff must receive sufficient training and supervision to meet the needs of the residents and to ensure their practice is safe. This includes: Induction training, fire safety training, training in safe working practice topics and dementia care. There must be a system for regularly monitoring and improving the quality of the service. This should include seeking and acting upon the views of people using the service. Unnecessary risks to residents health and safety must be assessed and wherever possible eliminated. This would include: Regular checks to ensure bedrails remain safe. DS0000068947.V377876.R01.S.doc 8. OP30 18 31/03/10 9. OP33 24 31/01/10 10. OP38 13 31/10/09 Summerville House Version 5.3 Page 28 Regular review of the fire risk assessment. Footplates used on wheelchairs unless individual risk assessments show otherwise. 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 Handwritten entries on MAR charts should be witnessed in order to reduce the risk of transcribing errors. There should be clear guidance for staff to alert them when to give when required medication. 2. OP9 Following consultation with the pharmacist, there should be a care plan to direct staff how to disguise medication that is to be given covertly. Staff should have training to help them to provide an appropriate programme of meaningful group and one to one activities that meet residents social and recreational needs. The manager and staff should have training in the mental capacity act and deprivation of liberty safeguards to ensure that they are clear about and uphold residents’ rights. Improvements to the environment should include: Appropriate lockable storage for toiletries to ensure that residents are able to access their wardrobes when they wish. Blinds / window coverings in the conservatories to maintain a comfortable temperature. The staffing levels should be kept under review to ensure that there are sufficient staff at all times to carry out the planned care to meet residents health, personal and social care needs. DS0000068947.V377876.R01.S.doc Version 5.3 Page 29 3. OP12 4. OP18 5. OP19 6. OP27 Summerville House Summerville House DS0000068947.V377876.R01.S.doc Version 5.3 Page 30 Care Quality Commission Eastern Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.eastern@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. 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