Inspection on 26/11/08 for Sutton House Nursing & Residential Home

This inspection was carried out on 26th November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sutton House Nursing &... 15/01/08

Sutton House Nursing &... 22/06/06

Sutton House Nursing &... 09/11/05

Sutton House Nursing &... 26/04/05

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Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Sutton House Nursing & Residential Home Kingfisher Rise Ings Road Sutton, Hull East Yorkshire HU7 4FL     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Beverly Hill     Date: 2 6 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Sutton House Nursing & Residential Home Kingfisher Rise Ings Road Sutton, Hull East Yorkshire HU7 4FL 01482784703 01482377881 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Barry Potton Type of registration: Number of places registered: care home 38 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home Sutton House is a large elegant looking period building set in extensive grounds. It is located in the village of Sutton and is tucked away discreetly from the main road. The home is a registered care home that is also able to provide nursing care to people. Accommodation is provided over three floors serviced by a passenger lift and stairs. The ground floor has communal areas consisting of a large lounge divided into two distinct areas, a small sitting room, a large dining room and a quiet sitting area in the foyer. The home has a large garden with mature trees and shrubs, a patio area with furniture and ample space for parking. The home has eight shared bedrooms and three single bedrooms on the first floor and seven shared and five single on the second floor. Care Homes for Older People Page 4 of 33 Over 65 38 38 38 38 0 38 Brief description of the care home All bedrooms have a separate room with en-suite facilities consisting of a toilet and washbasin. The home has two bathrooms and a shower room on the first floor and one bathroom and a shower room on the second floor. Equipment and aids/adaptations are in place to ensure people are cared for in a safe manner whilst allowing them to be as independent as possible. Information about the home and the services it provides can be found in the statement of purpose and service user guide. Both these documents as well as the latest inspection report are on display in the foyer and copies are available from the manager. The fee level advised at the time of the visit was 345 pounds per week with a top-up of 20 pounds per week for a shared bedroom and 40 pounds per week for a single bedroom. Nursing clients also pay their nursing band determination on top of the basic fee. There are additional charges for hairdressing, private chiropody treatment, toiletries, outings and newspapers/magazines. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this home is 1 star. This means that the people that use this service experience adequate quality outcomes. This inspection report is based on information received by the Commission for Social Care Inspection (CSCI) since the last Key unannounced inspection on 15th January 2008 including information gathered during a site visit to the home, which took approximately nine and a half hours. Throughout the day we spoke to people that lived in the home to gain a picture of what life was like at Sutton House. We also had discussions with the two deputy managers, the responsible individual that oversees the home, and care staff members. Care Homes for Older People Page 6 of 33 Information was also obtained from surveys received from residents, a relative and staff members. Comments from the surveys and discussions have been used throughout the report. We looked at assessments of need made before people were admitted to the home, and the homes care plans to see how those needs were to be met while they were living there. Also examined were medication practices, activities provided, nutrition, complaints management, staffing levels, staff training, induction and supervision, how the home monitored the quality of the service provided and how the home was managed overall. We also checked with people to make sure that privacy and dignity was maintained, that people could make choices about aspects of their lives and that the home ensured they were protected in a safe and clean environment. We observed the way staff spoke to people and supported them, and checked out with them their understanding of how to maintain privacy, dignity, independence and choice. We would like to thank the people that live in Sutton House, the staff team and management for their hospitality during the visit and also thank the people who spoke with us and completed surveys. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the services are not being put at significant risk of harm. In future if a requirement is repeated it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? What they could do better: The homes statement of purpose and service user guide had not been updated so did not contain all the information it required to give people full information about the services provided. The two documents need to be kept under review. The homes own assessment for one person could have been completed more fully with how the persons condition affected their daily life. This would ensure that staff have full information about people, especially when they were self-funding their care and an assessment by the local authority was not available. Care Homes for Older People Page 8 of 33 People had plans of care written to give guidance to staff on how to support them. However, not all assessed needs were covered in the plans and some did not have clear tasks for staff. Some were not signed and dated and had not been evaluated and updated when needs had changed. The way medication was managed must be improved to make sure that all medication is recorded as received into the home. Stock control could be managed more efficiently to prevent a build up of some medication and to ensure they do not run out of others. The home provided some activities for people to participate in but the range on offer could be expanded to ensure people with dementia and those spending large portions of the day in their bedrooms receive an appropriate level of stimulation. People should also be able to have their meals in any of the lounges if they choose. Some care staff have not received training in how to safeguard vulnerable adults from abuse, and the deputy managers had not completed the local authority training specifically for managers. This would consolidate their knowledge about local procedures. As the home has been without a supernumerary manager since March 2008, some management task have slipped. Areas affected were care planning, quality assurance, some elements of risk assessment, staff induction and training, and staff supervision. A new appointed manager will need to improve these areas. Also there were some health and safety issues found during the visit. All were addressed straight away but the manager will need to put in place a system of checking the home to ensure it continues to be safe. 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 33 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Potential residents did not have full and up to date information to make a decision about whether the home was right for them, as the statement of purpose and service user guide had not been completed fully. The home ensured that people had their needs assessed prior to admission. Gaps in the completion of the homes in-house assessment for one person recently admitted, may have meant that full information was not available about the person in order for the home to be sure their needs could be met. Evidence: The home still had to update the statement of purpose and service user guide to ensure that people had information about the home in order for them to make a decision about admission. Care Homes for Older People Page 11 of 33 Evidence: Five care files were examined during the day, two of which were for people recently admitted to the home. There was evidence that all residents had their needs assessed prior to admission and those funded by the local authority had care management assessments in place. The homes own assessment documentation covered health, social and psychological needs and had scope for a full and thorough assessment. There was evidence that in two of the care files examined the homes assessment had been updated. Those recently admitted had in-house assessments, although one had not been signed and dated, and was not completed fully. This was particularly important as the person was privately funding their care and an assessment completed by the local authority was not available. The second file did contain both an assessment completed by the local authority and the homes own assessment. The home does not formally write to people or their representative following the assessment stating their capacity to meet the identified needs. Currently this is completed verbally. People could have trial visits and respite stays in order to form an opinion about the home before a final decision about permanent residency was made. The home does not provide intermediate care services. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Deficiencies in recording and care planning means that staff may not have full guidance in how to support people and care may be missed. The management of medication is not sufficiently robust to ensure safe practice and accurate recording. Evidence: Five care files were examined during the visit. One was for a newly admitted resident and care staff were still in the process of formulating the care plan. The other four files all contained care plans produced from information gathered at the assessment stage. Some care plans contained good information about peoples needs an how they were to be met but this was not consistant in all the care plans examined. To improve care plans need to include all the needs identified at the assessment, have clear tasks for staff, have more consistency regarding the inclusion of preferences and wishes, and detail what the person is able to do for themselves thereby promoting and Care Homes for Older People Page 13 of 33 Evidence: encouraging independence. For example one resident with dementia care needs experienced unsettled nights, confirmed in daily records, but there was no care plan to address their anxieties. They also did not have a plan for their nutritional needs or how they were to be stimulated to prevent a deterioration in their mental health. Similarly another resident had behaviours that could be challenging to others but there was no plan to enable staff to manage them consistently. Care plans for personal hygiene support did not detail preferences or what the person was able to do for themselves. Care plans were not always updated when needs changed. For example one person had been seen by a dietician due to loss of weight but they did not have a care plan detailing how the change in their nutritional needs was to be observed and met. There was also an inconsistency regarding signatures on care plans. Some plans were not signed by the person formulating them or by the resident or their representative as agreeing to them. Some were evaluated on a monthly basis but others were not. Some staff were more vigilent in recording than others. For example some monitoring charts examined had gaps in recording and it was difficult to audit whether the person had received turns to relieve pressure at the appropriate intervals stated in their care plan. The home only had one resident with a pressure ulcer, gained whilst they were in hospital, so this could be just a matter of poor recording. People had their weight monitored monthly or more frequently as required. Again a recording issue was noted in one of the files examined. There were huge fluctuations in weight recorded, which appeared to be errors but there was no follow-up weight to check this out. Care must be taken with recording to ensure it is consistent and reflects the care provided. There was evidence that people had access to a range of health care professionals when required. Risk assessments were completed for moving and handling, falls, skin integrity, isolation, incontinence and specific health issues. The risk assessment for the use of bed rails did not fully take into account health and safety guidance and the homes risk assessment for this area needs extending. This was mentioned to one of the deputy managers to address. Since the last inspection the home had ensured that those residents using kirton chairs, which restrict capacity to mobilise in and out freely, have had their seating needs assessed by an occupational therapist. People spoken with were generally happy with their care and told us staff respected their privacy and dignity. One person did state that younger staff members often Care Homes for Older People Page 14 of 33 Evidence: spoke over them to each other during personal care tasks and they sometimes felt a little rushed. Another person said that although staff were kind and caring they felt some could be, chatterboxes. The last comments were mentioned to the deputy manager to address in team meetings and training sessions. Usually qualified nurses administered medication to people admitted for nursing care and senior care staff administered medication to people admitted for residential care. However, a lack of senior care staff due to staff turnover meant that nurses administered medication to all people living in the home. This extended the times of the medication rounds and impacted on other duties. This was confirmed in a discussion with a resident who stated, tablets are sometimes late but they are never forgotton. The home had a separate room were medication trolleys and stock were stored. There were some issues regarding the management of medication that required attention. These included ensuring the medication keys were secured at all times, the medication fridge was locked when not in use and better control of stock to prevent stock-piling of particular items. Conversely one person told us they had ran out of medication on one occasion and they had to go without. Six medication administration records were examined and it was noted that three did not have the medication signed into the home. Medication was signed on administration. Care Homes for Older People Page 15 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were small gaps in how the provision of social stimulation and peoples right to excercise choice was provided. Peoples nutritional needs were met by well prepared and well presented meals. Evidence: People told us that routines were flexible and visitors were seen coming and going. One relative had their lunch at the home with a resident. One person did comment that staffing numbers in the evening sometimes meant they did not retire at the time of their choice. The home employed an activity coordinator four days a week and they have completed a training course with the local authority regarding the provision of activities. Part of their role was also to assist residents at lunch and with their evening meal. A weekly calender of events was on display, which consists of nail care, in-house shopping trolley, sing-a-longs, one to one with residents, bingo and individual outings to local shops. One resident was assisted to the hospital to visit their relative and library books were procured for another person. There was a monthly visiting entertainer and Care Homes for Older People Page 16 of 33 Evidence: reminiscence therapy. According to records those residents who are most able tend to get more out of the activity programme. Comments about activities were, yes there are some things to do but I dont always join in, the entertainment is too loud and I like my own company, I sometimes go down to the clothes sales. Three surveys received from residents stated there were activities available, always. Although a positive start the range of activities could be broadened to include more occupational pursuits for people. For example assisting those who want to, to participate in small household tasks, preparing their own sandwiches for tea, baking or making their own drinks. People with dementia care needs and those who spend large portions of the day in bed could receive more tailored stimulation suitable to their needs and capabilities. Generally people were assisted to make choices about aspects of their lives. Two people managed their own finances and one person told us they preferred to sleep in a recliner chair, which was respected. Peoples bedrooms were personalised with their own belongings and some residents had their own telephones to keep in touch with relatives. However, a poster on the door of the small lounge stated that residents were not allowed to have their meals in the room. This restricted choices for people in what is their home. Staff told us they promoted choice by ensuring they read care plans to get to know what people were like and by asking them what they want rather than telling them what they were going to do. The meal provided on the day looked well prepared and presented. People spoken with enjoyed their meals, the food is excellent, very enjoyable and the food is fine, we get plenty to eat and drink. Special diets were catered for and the cook had prepared a buffet-style tea to say farewell to two residents leaving the home. The dining room was set out with individual tables and chairs, which were nicely presented with table cloths and napkins. Residents were observed using special equipment as required. Breakfast was served up until 10am and included a range of hot and cold choices. Two choices were available for lunch and the evening meal. The home had scored an, A in Hull city councils, score on the door assessment scheme for food management, which was a commendable achievement. They had also obtained the Healthy Heartbeat Award for providing healthy alternatives. Care Homes for Older People Page 17 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this 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 home provided an environment were people felt able to complain. People living in the home may not be completely safeguarded from abuse due to gaps in training and insufficient knowledge about multi-agency policies and procedures. Evidence: The home had a complaints policy and procedure which was on display. There was a complaint form for staff or the complainant to complete and a complaint handling checklist for the manager when auditing any complaint through the process. This has scope to record complainant satisfaction. There had been three recorded complaints since the last inspection and all had been resolved. Staff spoken with knew what to do if concerns or complaints were raised with them and residents spoken with stated they felt able to complain if they needed to. One person said, I can only complain to the nurses, as there is no-one in charge overall. The home had copies of the multi-agency safeguarding policies and procedures regarding safeguarding vulnerable adults from abuse and there had been one safeguarding referral made since the last inspection. The deputy managers were aware of the procedure but there was a gap in practice noted when a delay in contacting Care Homes for Older People Page 18 of 33 Evidence: social service, as the lead agency for any investigation, and a delay in informing the Commission, had occurred. The two deputy managers had not completed the local authority training in safeguarding adults regarding local procedures specifically for managers, and it is suggested this is arranged for them to consolidate their knowledge. Staff training records also indicated that not all staff had completed training in how to safeguard vulnerable people from abuse. In discussion staff were aware of some of the different types of abuse and all stated they would report any concerns to the nurse in charge. However, three of the nurses were also recorded as not having completed any training. This lack of knowledge could affect the way issues of concern are dealt with and staff training needs to be completed quickly. The safeguarding incident mentioned above was investigated by the local authority and unsubstantiated. Care Homes for Older People Page 19 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this 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 home provided a clean and comfortable environment for people. Evidence: The home was generally well maintained and had a rolling programme of redecoration and refurbishment. Since the last inspection a small lounge had been completely redecorated and carpeted. All bedrooms had gone through the cycle of redecoration. Two new profile beds and air mattresses, and a standaid hoist had also been purchased. Staff reported that when they requested replacement items these were provided, although the current management system restricted decisions about expenditure and delayed provision at times. The stairways were in need of redecoration and one bedroom carpet was in need of cleaning. There were also several areas, bathrooms, the landing, hairdressers room and some bedrooms that were a bit cluttered with equipment and in need of a general tidy. It appeared that storage areas were of a premium. However, overall the home was clean and free from any malodours. People had a large lounge to use that was divided into two distinct parts via seating arrangements. A large television was at one end and a music centre at the other. There was also a separate seating area just outside the lounge in the foyer for people Care Homes for Older People Page 20 of 33 Evidence: to see their relatives in private. Other communal rooms consisted of a separate dining room and a hairdressers room. Bedrooms were pesonalised to varying degrees dependent on the choice and taste of the occupant and shared bedrooms had dividers in place. People spoken with were happy with their home and bedrooms, Im happy here, I have my own things around me and the cleanliness is very good. The laundry was well supplied with equipment and suitable for the size of the home. Care Homes for Older People Page 21 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Gaps in induction and training means that not all staff are equipped with the skills and knowledge required to meet peoples diverse needs. Evidence: The home had one nurse and five care staff on duty in the mornings and an additional care staff member Monday to Friday between the peak time of 8am to 12.30pm. The afternoon shift had one nurse and four care staff and the night shift had one nurse and two care staff. On three evenings a week an additional person worked from 6-10pm to oversee residents in the lounge when care staff were supporting people to retire. In discussion with a resident they commented that their preference time for retiring could not always be met, as there did not always seem to be enough staff in the evenings and they sometimes felt, rushed. They also said at times they had to wait too long to use the toilet, it can be up to three quarters of an hour. This is an unacceptable lenth of time for people to wait and must be addressed. Staff told us there were usually eighteen or ninteen residents still to retire when the night staff came on duty at about 8pm. As this is the time that staffing numbers reduced to three in total, when the additional staff member was not on duty between 6-10pm, and the nurse would have to complete medication, it would be appear that this is where a shortage is. Care Homes for Older People Page 22 of 33 Evidence: The home had recently employed catering staff to fill vacancies, although one position filled had not worked out and recruitment was underway again. The home also had a vacancy for a night nurse. One senior carer was working their notice, which would leave a gap that management said would be filled from existing care staff. People spoken with stated that staff were kind and caring. One person said, the staff are hard working and capable but giving a more personal service is not always possible. In surveys and discussions staff also stated that sometimes there was not always sufficient staff. The home did not have a training plan for the coming year and examination of the training matrix indicated that there were gaps in mandatory training such as, first aid, infection control, safeguarding adults from abuse, health and safety and basic food hygiene. Most staff had completed fire safety and moving and handling training but thirteen care staff were in need of updates in the latter. Only one care staff had completed a training session in dementia awareness. All catering staff had completed basic or intermediate food safety and most staff had completed a COSHH course regarding keeping harmful substances safe. Some care staff had completed other courses, for example, mental capacity legislation, continence products and intensive interaction awareness. Three nursing staff had not completed training in how to manage percutaneous endoscopic gastostomy sites (PEG), which had led to the deputy manager on call being contacted one night when the feed tube blocked for a specific resident. All nurses need to complete the training to equip them with the skills required to manage such incidents. Limited service specific training had taken place and it was difficult to see how qualified nursing staff could keep to the requirements of their registration regarding training and updating skills. New staff members completed an orientation to the home, as part of their induction but there was no evidence that they worked through skills for care induction standards, which assessed their competence and was signed off by senior staff. The home had six out of nineteen care staff that had a national vocational qualification (NVQ) in care at level 2 and 3. This equated to 31 percent. The home should aim for 50 percent. A training plan needs to be produced to address shortfalls. The home had good recruitment practices. People completed application forms and Care Homes for Older People Page 23 of 33 Evidence: were selected via an interview process. References and criminal record bureau checks were in place prior to employment. Some staff files had photographs missing. This was mentioned to the deputy manager to address. Care Homes for Older People Page 24 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this 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 has been a slippage of management tasks, which has impacted on consultation with residents and support for staff. Evidence: The home has been without a supernumerary manager since March 2008. It was apparent that despite the best efforts of the two deputy managers, who have continued with their usual shift duties as well as sharing the management role, there has been slippage of some management tasks. Staff in discussions and surveys reported that morale has fluctuated, decisions have been delayed and sometimes conflicting advice has been given. Some staff members commented on the lack of team spirit but were confident this would be resolved when a permanent manager was in post. A manager from another home in the company did support once a week for a short while and the provider informed the Commission recruitment was underway, but this had proved difficult. It is important for the home that a manager is recruited quickly or a system of releasing the deputy managers from shift work to carry out Care Homes for Older People Page 25 of 33 Evidence: management tasks is arranged. It was clear from documentation that most care and nursing staff had not received formal supervision for some time. This was confirmed in discussions with people. The standards require that care staff receive a minimum of six supervision sessions per year. The deputy managers did state that their door is always open, but as one of the deputy managers works two night shifts and two day shifts each week, and the other, three day shifts, they may not always be available for advice. The homes administrator has been offering crucial support to the deputy managers during this time. They also sent out questionnaires to residents and their families as part of the quality assurance process. Returned questionnaires were analysed and data collected but action planning the identified shortfalls had not taken place. Some audits were completed monthly, for example finances, and maintenance personnel had a workbook they completed when issues were identified as needed repair or replacement. Housekeeping had cleaning schedules they adhered to. The quality assurance system needs to be fully implemented with a range of audits, and other stakeholders such as staff and professional visitors to the home, need to be surveyed for their views and suggestions about how the home is conducted. Documentation confirmed there had been three full staff meetings in 2008, in January, July and November and one senior care staff meeting in Febuary. There had not been any residents meetings since October 2007. This means that formal consultation with people that live in the home has been limited to the questionaire that was sent out in August of this year. A newsletter is produced every three months keeping people informed of events. The management of residents finances was well organised and had not changed since the last inspection. Money for safekeeping was maintained in individual wallets and each resident had an account log. A copy of the account log was forwarded to relatives every four weeks to enable them to check what has been withdrawn and to top up the account if required. A record was seen, which confirmed the process. There were some issues of health and safety noted in the home that required attention. The training records indicated gaps in health and safety, first aid and infection control training, which means that staff may not have the full skills required to deal with incidents that occur. One staff member was observed pushing a resident in a wheelchair without using the footrests, which could cause injury. Other wheelchairs did not have footrests in place. One of the windows on the landing did not have a restrictor and one bed was found to have a very unsafe bedrail that was not fitted securely. Staff were unsure why the resident had the bedrail and it was removed Care Homes for Older People Page 26 of 33 Evidence: immediately. A system needs to be put in place to check bedrails that are not integrated with the bed. Maintenance personnel carried out fire safety checks and equipment used in the home was serviced as required. It was noted that the five year fixed electrical circuit test had expired and was in need of updating. Care Homes for Older People Page 27 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 People living in the home must have a care plan that reflects all their assessed needs, have detailed guidance for staff and be updated when needs changed. This will ensure that staff are fully informed about peoples needs and prevent care from being missed. 31/01/2009 2 9 13 All medication must be 31/12/2008 signed as received into the home and stock controlled in a more effective way. This will evidence good recording and enable staff to manage medication more effectively. 3 18 13 All staff must receive training in how to safeguard vulnerable adults from abuse. 31/01/2009 Care Homes for Older People Page 29 of 33 This will enable staff to be confident of policies and procedures in order to protect people in their care. 4 30 18 Staff must be provided with 31/03/2009 the training required to meet the diverse needs of people that live in the home. This will ensure that people will be confident their needs will be met by knowledgeable staff. 5 38 13 People with bedrails insitu must have thorough risk assessments that determine the need for them and the appropriateness of the bedrail for the person and the bed. This will ensure that residents are not restricted unduly and risk of harm is eliminated as far as possible. 31/12/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The homes statement of purpose and service user guide should be updated to include full information about the home to enable potential residents to make an informed choice about whether the home can meet their needs. Once the initial assessment has been completed, potential residents should receive written confirmation that their needs can be met within the home. The homes own in-house assessment should be completed in a more thorough way to enable staff to have a full picture of needs to decide whether the person can be 2 3 3 3 Care Homes for Older People Page 30 of 33 supported in the home and also to assist in planning their care. 4 5 7 8 Monitoring charts, obviously in place for a reason, should be completed accurately and consistently. Staff should re-check peoples weight when large fluctuations occur to be sure the equipment has not malfunctioned. The medication keys should always be kept secure and the fridge locked when not in use. The manage should stress with staff the importance of appropriate conversation during assisting residents with tasks. The range of stimulation provided in the home could be broadened, especially for people with dementia care needs and those who spend portions of the day in bed. A weekly or monthly at a glance log would alert staff to those residents that had not participated in anything so this could be addressed. The staff should ensure that residents have more choice about where they wish to have their meals and provide the necessary support should they wish to use the small lounge. The deputy managers in charge of shifts should complete the local authority safeguarding training that includes the referral and investigation parts of the process. This will help to consolidate their knowledge about safeguarding procedures. The stairwells should be included in the redecoration plan and efforts should be made to de-clutter some of the communal areas, bathrooms and bedrooms. Management should dicuss with staff the perception of there being insufficent staff at times and whether this is a matter of deployment at peak times or the dependency levels of residents requiring a reassessment of staffing numbers. The position of twilight shift 6-10pm, in place for three evenings a week, should be extended to seven nights to ensure peoples preferences for times of retiring are met. The home should continue with the national vocational qualification training programme to reach a target of 50 percent of care staff trained to this level. A training plan should be produced for the next twelve months that takes account of shortfalls identified via the training matrix, staff supervisions and appraisals. It should 6 7 9 10 8 12 9 14 10 18 11 19 12 27 13 27 14 28 15 30 Care Homes for Older People Page 31 of 33 cover mandatory training and conditions affecting older people including, dementia care, strokes, Parkinsons disease, diabetes etc. The training plan should support nursing staff to complete further training in line with their registration requirements. 16 31 A manager should be appointed quickly or the deputy managers provided with supernumerary hours in order for them to carry out management tasks. People living in the home and staff should be provided with more opportunities, via meetings and supervision, to voice their views and suggestions about the way the home is conducted. Action plans with evaluation dates should be produced to address shortfalls identified in questionnaires. This will help to complete the quality assurance cycle. The quality assurance system should be expanded with questionnaires sent to staff and visiting professionals to obtain their views on how the home is conducted. Care staff should be provided with a minimum of six formal supervision sessions per year. A ongoing system of checking bedrails that are not integrated with the bed should be implemented in order to ensure they are safe to use. 17 32 18 33 19 33 20 21 36 38 Care Homes for Older People Page 32 of 33 Helpline: 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 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) Commission for Social Care Inspection (CSCI). 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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