Inspection on 03/10/05 for The Close

This inspection was carried out on 3rd October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

The Close 18/09/08

The Close 01/11/07

The Close 05/12/06

The Close 12/06/06

The Close 26/04/05

The Close 17/01/05

The Close 07/07/04

The Close 24/02/04

Similar services:

Fairfields Country Rest Home

Fairfax House

Claremont Nursing Home

Doveridge Care Home

Dunmore

Chatsworth

Dunraven Lodge

Eastleigh Care Homes, South Molton

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Close (The) The Close Littleton Panell Devizes Wiltshire SN10 4ES Lead Inspector Mrs Jacqui Burvill Unannounced Inspection 3rd October 2005 09.30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Close (The) DS0000028334.V255442.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Close (The) DS0000028334.V255442.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Close (The) Address The Close Littleton Panell Devizes Wiltshire SN10 4ES 01380 812304 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) Mr John Roche Mrs Aurora Roche Mrs Aurora Roche Care Home 12 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (12) of places Close (The) DS0000028334.V255442.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named service user under the age of 65 in the category (DE) Dementia, until 22 November 2004 as requested in the application dated 28 October 2004 26th April 2005 Date of last inspection Brief Description of the Service: The Close is a privately operated home. It provides personal care and accommodation for up to 12 people with dementia. One of the owners also manages the home. Both of the owners have close involvement with aspects of the home on a daily basis. The home is situated in the village of Littleton Panell, which is close to Devizes. There are local shops, pubs and a GP surgery nearby. The Close is a detached house set in it’s own grounds. It has been extended in the past. Service user’s bedrooms are on the ground and first floor. There is a passenger lift. There is a lounge that doubles as a dining room. Access to a smaller dining room and conservatory is either through the kitchen or off the main hallway. The conservatory is also a smoking area and can be used to receive visitors. There are eight single bedrooms and two shared bedrooms. None of the rooms have ensuites. All have hand washbasins. Commodes are provided in all bedrooms. There are three bathrooms, one of which has a hoist. There are six toilets for service users. There are always at least two staff on duty during the day and one waking night staff member on duty. The owners used to be available in the building at all times, but they now live off site. Close (The) DS0000028334.V255442.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 6 hours on 3rd October 2005. The inspector spoke with the owners, Mr and Mrs Roche; three staff members, two visitors and three service users, as well as spending time in the lounge during the afternoon activity period, observing service users and staff interacting together. A range of records were examined. These include care plans, risk assessments, medication and medication records, accident records, fire safety records and staff recruitment and training records. There was a partial tour of the premises. An immediate requirement was issued at the inspection regarding the lack of CRB checks on staff employed some time ago. A separate letter was sent following the inspection about how a quality assurance report can be completed and that accidents involving service users must be reported to the CSCI using regulation 37 notifications. What the service does well: What has improved since the last inspection? The manager has attempted to record and analyse the surveys on quality assurance in the home. Some new furniture has been purchased and some areas of the home have been decorated. Two requirements and two recommendations have been met since the last inspection. Close (The) DS0000028334.V255442.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Close (The) DS0000028334.V255442.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Close (The) DS0000028334.V255442.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Standard 6 does not apply to this home. Assessments are completed before the service user is admitted to the home, so as to ensure their needs can be met. EVIDENCE: One new service user’s records were examined. The service user had been admitted a short time previously and was not fully aware that they were living in the home. The manager had supported the family and service user in adjusting to the admission and helped to ease the settling in process. Records included an assessment by the community mental health team and some background history. The manager had completed an assessment on admission to The Close. Records showed that she had been carefully observed and medical intervention had been sought in order to try and meet the service user’s needs. Risks were identified, but there was no record of how the risks were to be managed or reduced. The care plan showed parts that were deleted, due to changing needs, but this looked confusing, as it is not clear which part of a particular section does not apply. The care plan had not been fully updated as a result of these changes. Close (The) DS0000028334.V255442.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Care plans and risk assessments are not up to date and consistent within the home. This may lead to service users’ needs not being met and could place service users at risk. Service users’ health has been put at risk from inconsistent action, reporting and recording of accidents. Service users take their medication supported by staff. Service users would benefit from staff who have received medication training. EVIDENCE: Standards 7, 8, and 9 were inspected at the last inspection, but due to the requirements that had been set, were inspected again. Two service users who were known from the last inspection had their records examined. These service users were known to have risks affecting their behaviour around the home. Service users have individual care plans that are held together in two files. The care plan for one service user lists updates and changes and dates when the care plan was to be reviewed, even though this was not monthly. All of these entries were in date and reflected the most current care needs of the service user. Some elements of skin care were not included in the detail of the Close (The) DS0000028334.V255442.R01.S.doc Version 5.0 Page 10 care plan. Risk assessments were in place and actions described for staff to follow to maintain the service user’s safety. The other care plan was not up to date and did not fully reflect the care or the risks that may affect the service user. This was discussed with the manager at the time, who had left this to the team leader to ensure that it was updated correctly. The inspector was gravely concerned about accidents that had taken place and had not been reported to the CSCI. There were also some inconsistencies in how the service user had received medical support and interventions. There are two types of accident forms in place. This has been raised before and no action has been taken to rectify this. This appears to have lead to inconsistencies in how and where staff record accidents involving service users. Medication records showed that staff are not routinely using a code to record when medication has not been given. Controlled medication records were in place and in order. Staff were recording changes to medication correctly on the medication administration sheet. Staff have still not received basic medication training as required by the last inspection, as the manager stated she was unable to find a course. Service users were not able to comment on whether staff treat them with respect and dignity, however, visitors interviewed stated that staff considered service users as individuals and treated them with dignity and respect. Close (The) DS0000028334.V255442.R01.S.doc Version 5.0 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 14 Service users would benefit from activities that are more relevant to their level of need. Staff try to ensure that service users have as much choice as is possible. EVIDENCE: Standard 12 was looked at during the last inspection and examined again. The activity record is no longer being kept and staff are recording what activities service users may take part in as part of the daily notes. When daily records were looked at, there appeared to be little evidence recorded. When the activities during the afternoon were observed, the inspector noted that service users found the interactions very difficult and discussed this with the staff member responsible for activities. Some activities seemed to be inappropriate and very child like. Music was on in the background but not focussed on as part of any activity. Staff engaged with service users on a one to one level. Some service users find it difficult to express any preferences they may have. Staff rely on their knowledge of the service user and try to ensure that service users can make choices. The inspector noted that one service user who likes to go for a walk was able to walk in the garden. An alarm system alerts staff who then observe discreetly. Close (The) DS0000028334.V255442.R01.S.doc Version 5.0 Page 12 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Service users are not fully protected by a staff team who have full knowledge of adult protection and signs of abuse. EVIDENCE: Standard 18 was looked at during the last inspection and was revisited as a requirement had been set about staff receiving adult protection training. This requirement had been met in part, with three staff still needing adult protection training. Close (The) DS0000028334.V255442.R01.S.doc Version 5.0 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Service users’ movements, the layout of the home, lack of signage and lack of suitable equipment around the home can place service users at risk. There have been some improvements to the furniture and decoration of the building. It is not clear if service users are aware of this improvement. EVIDENCE: There was a slightly unpleasant odour on entering the lounge on the day of inspection. The manager has kept details of items that have been purchased as part of the upkeep of the premises. The manager explained that one of the comments made during the quality survey, was that the home looked ‘tired’ and needed some refurbishment. This has been mentioned in previous inspections, with recommendations that the owners make a plan of how and when the home is to be refurbished. The record kept is as things are bought and this includes two new lounge chairs, a new washing machine and a three-piece suite in the conservatory. Radiators have been covered in the dining room, a service users Close (The) DS0000028334.V255442.R01.S.doc Version 5.0 Page 14 bedroom and a further three have been covered, although the record does not identify where they are. Areas of the home have been repainted. Currently, one double room is being used as a single room, but charged at a double room rate. None of the signage has changed since the last inspection and service users were still observed to walk through from the lounge to the kitchen. Staff were noted to be observant and follow service users who walked through the kitchen this way. Only one service user and their visitor were seen to use the conservatory area during the inspection. Bedrooms, bathrooms and toilets looked clean and tidy. Service users spend the majority of the day downstairs in the lounge. Close (The) DS0000028334.V255442.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28, 29 Service users would benefit from a staff team who have received regular training in dementia and statutory training including induction and NVQ level 2. Service users are put at risk by a lack of robust recruitment checks. EVIDENCE: Staff records were seen so as to check on the past requirements and recommendations regarding training. The manager is still trying to find medication training. There has been one training session in August, one due in October just a few days after the inspection and one is planned for November. Dementia training is one of these courses, but the plan that listed which staff will be attending could not be found during the inspection. Staff have not had dementia training since 2002 and new staff do not appear to have been trained in the home’s philosophy, described in the statement of purpose. Induction records were not in place. New training certificates were not in the staff files and the manager found these during the inspection, so they could be counted as evidence. Some of these had the wrong dates on and new certificates had not been issued to all those staff affected. There is a lack of evidence related to NVQ training. The manager spoke about one staff member who refused to complete any training in the home. One staff member has an NVQ level 2 and three other staff are still completing this. This is below the 50 required by 2005. Close (The) DS0000028334.V255442.R01.S.doc Version 5.0 Page 16 An immediate requirement was issued regarding CRB checks. This had been a previous requirement. The manager stated that she was unaware of the names of those who was affected by the requirement. An error on a CRB certificate was discussed, as the manager was unaware of how to address and follow up this issue. Three staff did not have completed CRB checks and these had not been pursued. Close (The) DS0000028334.V255442.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 36, 38 There continues to be a serious lack of attention to management tasks and duties by the current registered manager, which places service users and staff at risk. Staff are not being regularly supervised nor are there team meetings. This leads to poor development of the staff team, which reflects onto the level of care for service users. Issues regarding accidents and the way they are reported and recorded have serious implications for the health and safety of service users. EVIDENCE: Management tasks are not being completed regularly or appropriately. The inspector and the manager discussed this. The other owner and a senior staff member are doing the NVQ level 4, rather than the manager. This has been discussed with the owners, who have also received a letter from the CSCI that if this continues, the other owner will need to register as the manager, but Close (The) DS0000028334.V255442.R01.S.doc Version 5.0 Page 18 there are concerns over the level of his care experience and knowledge. None of the management tasks had been delegated to the other owner or the senior, to manage as part of their NVQ level 4, which raises concerns about how the units are being completed. The owner stated that 5 units have been completed, with a further 7 to go, but he did not seem to be familiar with how the registered manager’s award is obtained. A cook has still not been recruited, which would provide extra time for management tasks. Staff are not being supervised and again the inspector discussed the importance of keeping notes as the supervision session takes place, and then having these signed and dated by the person receiving supervision. No team meetings have taken place. Accident records as previously mentioned in this report are not being completed consistently, nor are accidents being reported to the CSCI. A separate letter was sent to the owners following the inspection about this. All staff received fire safety training in the last quarter and all other fire safety records were in place and kept appropriately. Close (The) DS0000028334.V255442.R01.S.doc Version 5.0 Page 19 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 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 2 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 X 28 2 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X X 2 X 2 Close (The) DS0000028334.V255442.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 18 (1) (a) Requirement Timescale for action 30/11/05 2. OP7 15 (b) (2) 3. OP7 13 (4) (b) 4. OP9 13(2) There must be evidence that all staff have received specialist training in Dementia and related conditions. Dementia training due on 7th October 2005. Evidence of staff who would be taking part could not be found during this inspection. (Carried forward for a third time from 17th January 2005 inspection with a deadline of 30th June 2005, extended until 30th August 2005) 30/11/05 Care plans must describe the range of care needs for service users. This must include emotional and behavioural support. (Carried forward from the last inspection due to be met by 30th June 2005) Risk assessments must contain 30/11/05 the range of risks that affect service users, such as any particular activity they would like to take part in, or any behaviour, which puts them at risk. (Carried forward from the last inspection, due to be met by 30th June 2005) All staff must receive training in 31/12/05 DS0000028334.V255442.R01.S.doc Version 5.0 Close (The) Page 21 5. OP18 13(6) 7. OP29 19(b) 8. OP30 17(2)Sch 4.6(f) basic knowledge of how medicines are used and how to recognise and deal with problems of their use, in addition to training in the use of the home’s NOMAD systems and the homes procedures. The manager stated that she had been unable to find a suitable training course for staff. (Carried forward from for a third time from inspection dated 17th January 2005 and due to be met by 30th August 2005) All staff must receive training in 31/12/05 awareness of abuse and the Wiltshire and Swindon ‘No Secrets’ guidance. Evidence of this training must be kept. Met in part as six staff have completed this training with a further three staff due to complete it. 31/12/05 All staff must complete a CRB check and a POVA First check (if they are to be employed prior to CRB check and will be supervised) prior to employment being confirmed. This was made an immediate requirement at the inspection. (Carried forward from the 17th January 2005 inspection. This is the third time this has been carried forward. Continued non- compliance will result in enforcement action. ) Staff employed since the 30/01/06 th inspection dated 17 January 2005 must complete an induction that can be evidenced. This induction must be ‘in house’ as well as a foundation induction linked to Sector Skills Council Workforce. The manager stated that two staff were doing this, although this had not been completed. (Carried forward from inspection 17th January 2005. This is the third time this has been carried forward. ) DS0000028334.V255442.R01.S.doc Version 5.0 Page 22 Close (The) 9. OP33 24(2) 10. OP38 37 30/01/06 The quality assurance process must be completed and a copy of the analysis sent to the CSCI. The manager discussed the findings with the inspector, so as to ask for advice on how it could be made into a report. Guidance on this was sent in a separate letter to the manager following the inspection. (Carried forward from 17th January 2005 inspection, due to be met by 30th June 2005) Accidents involving service users 30/10/05 must be reported to the CSCI within 24 hours of their occurrence. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP7 OP12 OP15 Good Practice Recommendations Care plans should be reviewed monthly with evidence kept. (Carried forward from inspection 17th January 2005) Daily records, care plans and risk assessments should be held in separate files for each service user, rather than all together in two files. The registered manager should consider employing cooks in the home, to alleviate some of the duties completed by the registered manager. (This has been carried forward and this was a recommendation from inspection 12.07.04. At the last inspection this had been met in part as the post has been advertised but not filled. No progress has been made on this recommendation since then.) The complaints procedure should include timescales within which complaints will be dealt with. (Carried forward from inspection 17th January 2005) This has been carried forward for a third time.) The occupational therapist’s report issued on 16/11/02 should be used to assess any equipment service users may need in the home. (Carried forward from last DS0000028334.V255442.R01.S.doc Version 5.0 Page 23 4. OP16 5. OP22 Close (The) 6. 7. OP29 OP38 inspection) Interviews should be conducted in pairs and interview notes kept. (Carried forward for the third time from inspection 17th January 2005) The COSHH file should contain the safety data details on the products in use in the home. These details can be obtained by calling the telephone number on the product. (Carried forward for a third time from inspection 17th January 2005) Close (The) DS0000028334.V255442.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Close (The) DS0000028334.V255442.R01.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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