Inspection on 28/05/08 for The Downs Care Centre

This inspection was carried out on 28th May 2008.

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

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

Other inspections for this house

The Downs Care Centre 20/11/08

The Downs Care Centre 23/08/06

The Downs Care Centre 05/10/05

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE The Downs Care Centre Laburnum Avenue Hove East Sussex BN3 7JW Lead Inspector Elizabeth Dudley Unannounced Inspection 28th May 2008 10:00a 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 The Downs Care Centre DS0000065252.V363745.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Downs Care Centre DS0000065252.V363745.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Downs Care Centre Address Laburnum Avenue Hove East Sussex BN3 7JW 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) 01273 746611 01273 737314 thedowns@schealthcare.co.uk Trinity Care (Hove) Limited Vacant Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places The Downs Care Centre DS0000065252.V363745.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The maximum number of service users to be accommodated is twenty-five (25). Service users must be older people aged sixty-five (65) years or over on admission. Service users requiring nursing care only to be accommodated. That four named service users under sixty-five (65) years of age, are accommodated. 5th October 2005 Date of last inspection Brief Description of the Service: The Down’s Christian Nursing Home is situated in a residential area of Hove. The entrance is shared with the South Downs Health Trust, which provides an inpatient facility in a separate area of the building. The home, which was purpose built in 1999, is set out over three floors and a passenger lift enables access to each floor. Nursing and personal care are provided in single room accommodation for up to twenty-five residents. All rooms have en-suite facilities and there is a lounge and dining room on the two floors where there is resident accommodation. All areas are accessible for those with limited mobility and the home has hoists and bath hoists for those who are less mobile. There are also grab rails and disability aids in the bathrooms and toilets. Well-maintained gardens surround the building and the relatives’ room and garden room provide additional relaxation areas for residents and their visitors. There is a large parking area to the front and side of the building. The home welcomes prospective residents or their representatives to view the premises, discuss their needs with the Registered Manager and spend time with the staff and residents. Weekly fees, as at 28th May 2008 are £579 to £840 for full nursing care. The fees do not include hairdressing, chiropody, residents’ telephone calls and any sundries, such as newspapers: these are charged as extras. Information about the service is available on the organisation’s website (Southern Cross Healthcare Limited) and from the home’s Manager. The Downs Care Centre DS0000065252.V363745.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 0 star. This means the people who use this service experience poor quality outcomes. This unannounced key inspection took place on the 28th May 2008 over a period of eight and a half hours. The manager and area manager were able to be present for around two hours, and the administrator and members of staff provided further information. Thanks are extended to staff and residents for their help, courtesy and hospitality. Methods used to inform the judgements made in the report included conversations with residents, staff and visitors, examination of information which the CSCI has received since the last inspection and looking at documentation necessary for the smooth running of the home. Documentation that was examined included care plans and information regarding medication administration, menus, personnel files and staff training records. All residents in the home were seen on the day, and this included six residents who were being ‘case tracked’ on this day. Case Tracking is a process whereby the CSCI examines the care plans and other documents relating to specific residents and hold in depth conversations, where possible, to ascertain that the care and services provided by the home are suitable for their needs. Prior to the inspection, surveys were sent out to residents, relatives and staff, but few of these have been returned. Thanks are extended to those who responded as their views provide valuable insight into daily life within the home and the formation of this report. The home has had two changes of management since the last inspection, the current manager having being in post since December 2007. He is not yet registered with the CSCI. The changes of management led to some instability in the home in the past year and the current manager is addressing issues resulting from this. Residents and relatives spoken made variable comments about the home: ‘The home is always very clean’. ‘ There is a new activities person and we do some interesting things’. ‘ Food is variable and sometimes its too hot and sometimes too cold’. ‘ Most of the staff are very kind and the care is good’. The Downs Care Centre DS0000065252.V363745.R01.S.doc Version 5.2 Page 6 The Annual Quality Assurance Assessment, required by the CSCI, which gives an overview of what has been achieved in the home and issues to be addressed, was received by the CSCI in October 2007. This was not used as part of the current inspection process as, due to change of management, it would not give a true reflection of what was happening in the home at the present time What the service does well: What has improved since the last inspection? What they could do better: There have been thirteen requirements made following this inspection, and one requirement from the last inspection was not met. This related to care planning and a further requirement has been made. Care plans generally were not of the standard that would be expected in a care home with nursing and need additions and improvements to ensure that residents receive appropriate care. Documentation of the care required needs The Downs Care Centre DS0000065252.V363745.R01.S.doc Version 5.2 Page 7 to be substantially improved to ensure that all staff are giving the same level of care to the resident. Medication administration is not fully protecting the residents or the staff that are administering the medication. Residents said that they were fearful of making complaints against the staff and this must be addressed. The safeguarding adults policy does not reflect the current reporting protocols in the national ‘Multi agency guidelines’. The presentation of pureed meals is not of a standard, which would encourage residents to eat a full and nourishing diet, and meals in general were poorly presented. Nutritional care plans did not fully reflect whether residents were receiving sufficient nutrition. The home has not achieved the desired ratio of staff that have attained National Vocational Qualification level 2 in care and the current induction course provided by the home is not inline with national guidelines. Not all staff are receiving regular formal supervision. The manager should review staffing to ensure that there are sufficient staff at busy times of day. An immediate requirement was made regarding liaising with the fire authority regarding a means of allowing residents to exercise their choice in having their doors left open. The CSCI have since received information that this was complied with in full by the compliance date required. As a result of the quality rating attained at this inspection the home will be sent an improvement plan with the final report and will be expected to respond on this with how they intend to address the issues raised. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Downs Care Centre DS0000065252.V363745.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Downs Care Centre DS0000065252.V363745.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5,6 People who use the service experience good quality outcomes in this area. Prospective residents receive sufficient information about the home to enable them to reach a decision over whether they wish to live at the home. The manager or the deputy manager assesses prospective residents to ensure that the home can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Service Users Guide and the Statement of Purpose have been reviewed and currently reflect the management situation in the home. Some statements in the documents require amending to show current practice in the home. All residents have a copy of the Service User Guide and the Statement of Purpose is displayed in various areas around the home. The Downs Care Centre DS0000065252.V363745.R01.S.doc Version 5.2 Page 10 The home provides prospective residents with an information pack, which includes a brochure and Service User Guide and they and their relatives or representatives are encouraged to visit the home to look around before making a decision over whether they wish to live there. Prospective residents are assessed by the manager or a registered nurse prior to being accepted for admission to ensure that the home is able to meet their needs. Three preadmission assessments were examined, these were fairly comprehensive but not all had been signed and dated by the assessor. There was no evidence of any written confirmation to inform the prospective resident or their representative that the home is able to meet their needs and offer them a place in the home. The majority of residents have a copy of the home’s Terms and Conditions of Residence, which includes a contract, but some residents admitted under a ‘spot contract’ by the Local Authority do not have one of these. The area manager said that this would be put in place; therefore a requirement has not been made. Residents are admitted for respite care but not for intermediate care. The Downs Care Centre DS0000065252.V363745.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 People who use the service experience poor quality outcomes in this area Care plans did not adequately reflect the current and changing needs of the residents. The care of the residents in some areas was inadequate. Resident’s dignity and choice is not always upheld. Medication administration does not fully safeguard the resident. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In order to assess the current standard of care documentation and the care given to residents in the home, a sample of five care plans was examined. Where possible, discussions took place with the resident involved to determine whether the care given met their current health and social care needs. Whilst there was good practice and attention to detail noted in some parts of the care planning, there were some areas that required attention. The Downs Care Centre DS0000065252.V363745.R01.S.doc Version 5.2 Page 12 None of the five care plans had been formed in consultation with the resident or their representative. Information including preferred manner of address, preferred times of rising and retiring or arrangements about end of life care, were not included in the care plans viewed. The local authority quality review nurses had reviewed the care plans in January 2008 and made recommendations, these had not always been followed up in a timely manner- one resident who had returned from hospital with pressure damage did not have a care plan made up for this until over a month after the reviewers had noted that it was not in place. There was an issue regarding pressure damage on a resident in the past year where sufficient preventative treatment was not given. Whilst there was evidence of monthly review of the care planning, much new information had been documented on the care plan evaluation sheet or in the daily records. This should be added to the actual plan of care to ensure that the care given is both current and correct. Some information in the daily records had not been transposed onto the care plan, therefore issues requiring attention could be missed. When specific treatments were no longer required these had often not been discontinued on the care plans and where they were discontinued, did not always have a signature of the nurse making this decision, in place. Nutritional care plans did not generally give sufficient information to ensure that residents with nutritional problems were having correct nutrition. One resident on supplement feeds did not have this mentioned in the care plan. A relative said that generally the food provided by the home was not sufficiently high in fibre for the particular residents needs and therefore she brought in high fibre food to supplement his diet. The need for a high fibre diet was not included in the plan of care seen on the day of the inspection. Staff said that one resident had not been eating well for a few days; this was not identified in the care planning. A resident who had a Percutaneous Endogastric (PEG) feed in place (where the person is fed by an indwelling tube) but was having liquidised normal diet to supplement this, was not raised high enough in the bed to prevent risk of choking. The carer attending to this resident was not aware of the full name of the resident and indicated that she had not used correct moving and handling techniques to position the resident. Nutritional care plans did not always address extra nutritional needs of the residents, or actions taking place when residents lost weight. Residents were not being weighed regularly during the latter end of last year due to the scales being inaccurate. These have since been replaced. The Downs Care Centre DS0000065252.V363745.R01.S.doc Version 5.2 Page 13 The care plan of a resident who had become unwell the previous day, 27th May 2008, did not have this identified in the main body of the care plan but in the daily records. The care to be given was not identified and whilst the nurse had done the correct observations there was no documentation to address the issue or give guidance to other staff and The General Practitioner was not informed until 28th May 2008. Staff were not giving the care that would be expected. Risk assessments were formed from a generic risk assessment and were not sufficiently detailed to show the issues that put individual residents at risk, and explain what the total risks were. Continence care plans did not sufficiently identify the care that was required or indicate what type of continence aid was being used. Continence aids were referred to as ‘nappies’, an example of infantilisation, which does not uphold resident’s dignity. Residents nursed in bed appeared comfortable and were nursed on pressure relieving mattresses where applicable. Although a mattress audit, which had been undertaken by the specialist wound care nurse, identified that some mattresses required replacing, the manager said he had not yet looked at this. Subsequent to the inspection, information was given that verbal recommendations given by the specialist nurse had been addressed following the audit. Nursing intervention charts such as fluid charts and turning charts, did not show that the relevant care had been taken place regularly, but staff said that although this care was given, they sometimes forgot to fill them in. One resident said that she sat in her wheelchair all day and would not be taken out of the wheelchair or lifted to prevent pressure damage until the evening. Staff said that this was the general practice and that as the resident had a catheter, this was not required. Care staff spoken with said that they were not encouraged to read care plans. One member of staff said that ‘ they were too scared to read the care plans’ The care plans should be put in place to be read by all staff who are caring for the residents. Residents spoken with said that their privacy was usually respected but that on occasion staff did not knock the door, or had left the door open when they were being attended to. A resident said “The staff sometimes leave the door open when washing me which makes me cross because people can see in and its not very nice for me or them”. The Downs Care Centre DS0000065252.V363745.R01.S.doc Version 5.2 Page 14 Most residents said that their bells were answered within a reasonable time although 2 residents said it was often left to ring for longer at night. During the day of inspection bells were not ringing for undue amounts of time. One resident said that they had been spoken to in a harsh manner by a member of staff for ringing the call bell several times; this was seen by the registered nurse who had not addressed the incident. Staff said that some residents who have agreed to get up early, are got up in the morning by the night staff, this was not identified in respective care plans and the times of this taking place was not identified in the care plans. The manager must ensure that this is not occurring at an unreasonable hour and that staff are not rushing the care in order to get residents ready prior to the day staff coming on duty. It was noted that there were three residents only in the ground floor lounge at five pm and one upstairs with a resident saying “Staff like you in your rooms by six pm, some people can stay a bit longer but its frowned upon- I just go to my room now”. This was not identified as being residents wishes in the care plans. There was evidence of General Practitioners being called in but it was impossible to evidence whether this was in a timely manner. Other health care professionals have been accessed. The standard of medication administration was adequate. Medications received by the home had not been signed in, a handwritten prescription for change of Warfarin dosage had not been signed by the nurse writing it in. other handwritten scripts had not been signed by the nurses writing them and medications that had been discontinued had not been signed. A supplement feed prescribed once a day had been given three times a day. Staff must refer to the Nursing and Midwifery Guidelines for the administration of medication and also to the CSCI guidance on the “Administration of Medications in Care Homes”. Controlled drug records were accurate but the controlled drugs cupboard contained three items of resident’s valuable possessions. Items other than controlled drugs should not be kept in the controlled drugs cupboard. Two pots of prescribed cream were seen in the manager’s office, which had the name of the original resident it had been prescribed for either overwritten or torn off, and other resident’s names put on them. Subsequent information given to the CSCI following the inspection is that these had been kept to use in training as examples of bad practice. The Downs Care Centre DS0000065252.V363745.R01.S.doc Version 5.2 Page 15 The nurse in charge said that homely remedies were given; however there were no drugs kept as homely remedies and no letter from General Practitioners to identify that these could be given. A resident that had become ill the previous day was being given medication prescribed for another resident due to the lack of a homely remedy, the nurse in charge had to be reminded that following two doses of a homely medication the General Practitioner must be informed and that it was against pharmaceutical regulations to give a medication belonging to another resident. A bottle of Senna liquid also described by the nurse as a homely remedy had had its label torn off and she agreed it had been prescribed for another resident. There were no dates of opening on the liquid medicines and no indications of when the ‘as required’ medications should be given. The home accepts residents who are reaching the end of their lives for terminal care, there were no end of life care plans in place, and only one care plan identified the resident’s wishes for arrangements following death. Some staff have attended end of life training and the deputy manager has received training in ‘ The Liverpool Care Pathway’ or ‘ Gold Standards Framework’ (nursing tools to assist pain relief and ensure total care is given). The manager has undertaken an accredited course in palliative care. The Downs Care Centre DS0000065252.V363745.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. People who use the service experience adequate quality outcomes in this area. There is a varied programme of activities, which are popular with residents and provide interest and stimulation. Residents that stay in their rooms do not get the benefit of the activities co-ordinator. A varied menu is provided but meals are not generally well presented therefore some residents may be prevented from receiving the full benefits of a balanced diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has an activities co-ordinator and a good variety of activities are on offer for those residents able to participate. Activities include crafts, (which include glass painting, making butterflies and cards) art, music and gardening and some outings. Records are kept of who takes part in the various activities and a programme is displayed in the main areas of the house. Residents are also given a copy of the activities programme and newsletter. Records include the type of activity enjoyed by residents at the current time but could be further enhanced by past activities being noted. The Downs Care Centre DS0000065252.V363745.R01.S.doc Version 5.2 Page 17 Residents who participated in the activities said that there were ‘interesting things to do’. ‘ I enjoyed making the cards’. And ‘ Its good that we have a newsletter’. One resident who still works, has his room set up to enable him to carry on his work from the home, he said that the staff were very helpful in facilitating this and whereas he used to go out to work most days this he has found it better to work from his room. Residents who stay in their rooms would benefit from more one to one activities and conversation with the activities person. Residents said that usually they could make choices about how to spend the day, but one said that they have to be in their rooms by six pm to help the night staff. Most residents said that they get up at a reasonable time but all said that they did not know whether they would be allowed to stay in bed later or could have cups of tea outside designated times, “ We could ask but whether we would get one is another matter”. There are weekly religious services taking place on a Wednesday, and there is an open visiting policy. Two visitors were spoken too, they said that the staff were helpful and most of them friendly and communicative. The meals are provided on a five-week rolling menu and these showed that there was a good variety of menu available with choices at all meals. The chef said that at the current time a cooked breakfast was not generally available. Residents said that fruit was sometimes available at breakfast time but relatives usually brought in fruit for them. ‘If you want fruit you have to bring it in yourself’. The presentation of food was not an incentive to encourage some residents to eat, one resident was seen trying to eat her food from a side table and the pureed meals were brought from the kitchen with all elements of the meal pureed together and served in a small dessert bowl. Elements of a meal should be pureed and served separately on plates in order to stimulate appetite. Mealtimes appeared rushed; staff did not have sufficient time to assist all who needed it with their food. Some resident’s meals went cold whilst waiting for staff to assist them. Main courses and desserts were put on the tables at the same time; this is not attractive and could lead to confusion in those residents who are not as cognitively able as others. It was noted that no residents sat at the table for the supper meal, care staff were seen taking the supper meal and putting it from the tray onto the The Downs Care Centre DS0000065252.V363745.R01.S.doc Version 5.2 Page 18 bedside tables, soup was served in mugs which one resident said felt heavy. There was no evidence of trying to ensure that the meals were presented in a manner conducive to stimulation of appetite. No resident was seen to be given a pot of tea and residents confirmed they were only given a cup of tea. Some residents said that they did not believe that they could have a cup of tea when they wanted one outside designated times. Most residents said that they liked the food although there were ‘Good days and bad days’. ‘ Weekends are hopeless’. A visitor said that they had to give their relative’s lunch back on one occasion as it was cold and many residents said that meals and drinks were sometimes cold. Several residents were seen to be not eating their lunch meal, and observation of the supper meal showed some residents with their suppers in their rooms, not eating due to staff being busy assisting other residents and the quantity of the food offered at supper appeared to be less than would be expected. Staff appeared rushed and unable to deal with taking meals to the rooms and assisting with meals. Staff said that the residents would not eat more than this, but did not appear to be encouraging them to eat at this meal. Currently there is only one cook working at the home due to the relief cook being off sick, the area manager said that a kitchen assistant was being trained up to do relief weekend cooking. Staff said that a hot drink was provided at night but several residents in the lounge said that this didn’t always happen and when it did it was often cold. There has been a made to the home about the temperature of the meals served received by the home. Two residents said that sometimes they had dirty china or cutlery and the home has previously received a complaint about the standard of washing up in the home. Staff said that this is now resolved. The Downs Care Centre DS0000065252.V363745.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18. People who use the service experience adequate quality outcomes in this area Residents do not feel confident about making complaints. The safeguarding policy does not identify the correct reporting protocols as required by the multi agency guidelines, which could result in residents not being adequately safeguarded. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a comprehensive complaints policy, which is displayed in the home and included in the service user guide. There have been six complaints received by the home in the past year; the manager has addressed these. Records of complaints and methods used to address these have been recorded and kept in a secure manner. Three of the residents spoken to at the inspection said that they did not feel confident that complaints against staff would be treated confidentially and said that they had stopped making these as they ‘get into trouble from the staff’, ‘ staff come back and tell you off’, ‘ the staff find out and come and see you’. Management must ensure that staff are aware of the residents right to make a complaint and that complaints are treated in a professional manner by all grades of staff. Management should reassure residents that all complaints would be treated fairly. The Downs Care Centre DS0000065252.V363745.R01.S.doc Version 5.2 Page 20 There have been three safeguarding adults incidents in the past year, all of which were upheld and one is still in the process of being resolved. The present manager, who followed correct reporting protocols, reported these to the investigating authority. The current adult safeguarding policy in the home does not conform with the reporting protocols as required by social services and the inspector has previously contacted the company regarding this being amended, this has not yet taken place. A requirement will be made around this. The training matrix showed that not all staff have yet received adult safeguarding training. The Downs Care Centre DS0000065252.V363745.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,10,21,22,24,25,26. People who use the service experience good quality outcomes in this area Residents live in a clean and well-maintained home. Care staff and visitors permitted to enter the kitchen without protective clothing could impact on food hygiene with implications for residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is well maintained and pleasantly decorated. It is set out over two floors and there are lounge / dining areas on each floor, with the garden being accessed from the lower ground floor. The garden is set out in a manner that allows all residents to use it. A relative’s room and a garden room provide extra communal space. Resident’s accommodation is in single rooms and there is one double room. All of the rooms have an ensuite facility. Residents are able to bring in their The Downs Care Centre DS0000065252.V363745.R01.S.doc Version 5.2 Page 22 personal possessions to make their rooms more comfortable and homely. Rooms have a lockable drawer provided and windows above ground floor have restricted opening. Hot and cold water temperatures to resident’s facilities are checked regularly and are within recommended parameters. The home provides two assisted bathrooms and two shower rooms. The assisted bath on the ground floor is unable to be used at present and staff said that this had been the case for some time, the underneath of the bath seat was in need of cleaning and there were clothes and a newspaper scattered in the room. The staff, therefore, only have one assisted bath that they can use for residents at the present time, and this could impact on resident’s dignity. There were sufficient aids and equipment to allow residents to maintain their independence. The standard of cleanliness in the home was generally good, there was a slight odour on the lower ground floor corridor but management was aware of and are addressing this. It was noted that care staff who enter the kitchen are not expected to wear protective clothing such as a protective apron which would prevent bacteria from their clothing from giving care contaminating kitchen areas, this must be addressed. The cook was unsure over whether kitchen assistants that provide food at weekends have their food hygiene; the manager must ensure that this is in place. Infection control policies are in place and some staff have undertaken the relevant training in infection control. A recent Environmental Health Authority inspection awarded the home four stars on their scores on doors initiative. Some requirements were made at their last inspection, most of which have been addressed. The Downs Care Centre DS0000065252.V363745.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. People who use the service experience adequate outcomes in this area. Staffing numbers have been increased but there is insufficient staff at peak times to ensure that the needs of the residents are met. Staff receive sufficient training to enable them to care for the current residents in the home. Robust recruitment systems safeguard the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staff rota shows that one registered nurse is on duty throughout the twenty-four hours. The registered nurse is supported by five care staff in the morning, four in the afternoon and evening and two at night. Catering and domestic staff support the care staff. The manager said that there appears to be sufficient staff on duty at night although the inspector has doubts that given the geographical size of the home that there is sufficient give observation on both floors on a continuing basis. Staff spoken with said that there were sufficient staff on duty generally due to the manager having put a fifth member of staff on in the mornings who floats between the floors, but the busy times were meal times and in the evening The Downs Care Centre DS0000065252.V363745.R01.S.doc Version 5.2 Page 24 which were quite rushed. Mealtimes are difficult as there are three people needing assisting with feeding on the ground floor and four on the lower ground floor. They said that a twilight shift or someone coming in at mealtimes would be helpful. New staff undertake the home’s own induction policy and the nationally approved ‘ Skills for care’ has not yet commenced. All staff are given a copy of the General Social Care Code of Conduct. The manager was currently unsure of how many staff have the National Vocational Qualification level 2 or 3 in care currently but that it was less than stated in the Annual Quality Assurance Assessment and was below 50 . The training matrix shows that some staff require to update their moving and handling training, but generally staff are receiving sufficient general and mandatory training for the work they have to perform. Registered nurses are encouraged to take extended roles and some have phlebotomy skills. All registered nurses have received updating in syringe drivers and the majority of them have a full range of skills in catheterisation. No specific end of life training has taken place. Six personnel files were examined and these included all the documentation including Criminal Records Bureau checks as required by the regulations. The Downs Care Centre DS0000065252.V363745.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,37,38. People who use the service experience adequate quality outcomes in this area The overseeing of management issues prior to the appointment of the current manager did not ensure the safety and well being of the residents in the home. The current manager has several issues to address in order to ensure that the home maintains the safety and well being of service users and that their expectations are being met. The absence of automatic door closures in the home to be used in case of fire, puts residents and staff at grave risk This judgement has been made using available evidence including a visit to this service. The Downs Care Centre DS0000065252.V363745.R01.S.doc Version 5.2 Page 26 EVIDENCE: The manager has been in post since December 2007, he is an RGN and in the process of completing the Registered Managers Award but is not yet registered with the CSCI and this must be addressed. He has previous experience of managing other care homes. There are no records in place to evidence that the CSCI was notified about the resignation of the previous manager and the commencement of the new manager. The parent company must ensure that CSCI are notified of changes in manager. Staff said that there were improvements in the home since the new manager commenced and that they felt that their work was valued. However staff said that although staffing levels have been reviewed this was insufficient to address peak times. Residents said that they see the manager frequently and found him approachable and that he would listen to them. A recent quality monitoring survey has taken place, this involved sending out questionnaires to staff, residents and relatives. There are no results from this survey at the present time. The previous survey was 2006 and positive results were obtained. Ten surveys were sent out to staff, residents and relatives prior to the inspection. At the time of writing this report five have been received back with no specific comments made. The Annual Quality Assurance Assessment was sent to the CSCI in October 2007 and as there has been changes of management this was disregarded as not being relevant for this inspection. The Statement of Purpose identifies that there are three monthly relative and residents meetings but there has not been one since January 2008. Staff meetings took place in March and April 2008. Regulation 26 visits have taken place monthly and records of these were seen in the home, however these did not always address problems that were occurring when there was no manager in the home, or identify ways of addressing these. Staff supervision is not taking place on a two monthly basis as directed by the standard. Records such as care planning require updating in many cases. The Downs Care Centre DS0000065252.V363745.R01.S.doc Version 5.2 Page 27 The home does not act as appointee for residents. Monies deposited for residents are kept in a bank account specific to each resident. Records were seen and were satisfactory. The financial records for Southern Cross were not examined at this inspection. Health and safety checks identify that servicing of equipment and utilities has taken place, but there was no evidence of hoist servicing having taken place, assurances that this has been undertaken was given by the area manager. Bed rail checks have taken place but these are not backed up by substantial risk assessment. The majority of the resident’s room doors were wedged open or supported open by waste bins etc; with staff saying that when the fire alarm goes off they have to run around and close all the doors. An immediate requirement was made relating to this. Information has since been received from the home prior to the compliance date that all aspects of the requirement have now been met. The Downs Care Centre DS0000065252.V363745.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 1 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 3 2 3 3 3 3 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X 3 2 2 2 The Downs Care Centre DS0000065252.V363745.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation Reg 4(1)(b) Requirement The Statement of Purpose and Service User guide must accurately reflect the events taking place in the home. That service users or their representatives are informed in writing as to whether the home can meet their needs The care plans must be updated to reflect changes in care recorded in the Daily Report, thereby remaining contemporaneous. This was a previous requirement compliance date 30/09/06 Care plans must show the current care given at any given time and be expanded to include all information as required in the main body of the report. Residents and/or their representative should be involved with drawing up their care plan and where possible should sign that they agree with it. Timescale for action 01/08/08 2 OP4 Reg 14(1)(d) 15 (2)(b) 01/08/08 3. OP7 01/08/08 The Downs Care Centre DS0000065252.V363745.R01.S.doc Version 5.2 Page 30 4 OP9 Reg 13(2) 5 6 OP14 OP10 OP15 Reg 12(2)(3) Reg 16 (2) (i) 7 OP16 Reg 22 (2) That the administration of medication is in accordance with the guidelines and regulations identified in the main body of the report. That the home is run in a manner which respects service users dignity, choice and wishes. That the presentation of meals ensures that service users who receive liquidised diets appetites are stimulated by the appearance of the food served. That service users are offered a diet which includes fresh fruit. That meals are served in an unhurried manner. That the temperature of the food served is suitable for the service user. That the manager must ensure that complaints from service users are treated in a confidential manner and that staff are aware of the service users right to complain without fear of recrimination. That the safeguarding policy meets the reporting protocols as identified in the ‘Multi agency guidelines’. That bathrooms are kept in a suitable state of repair to enable them to be used by the service users. That the manager ensures that issues impacting on infection control as identified in the main body of the report are addressed. That staffing levels are reviewed to ensure that there are sufficient staffing levels on duty at peak times to ensure that service users needs are met. The provider shall give notice in writing to the CSCI when a person ceases to carry on or DS0000065252.V363745.R01.S.doc 01/08/08 01/08/08 01/08/08 01/08/08 8 OP18 Reg 13(6) 01/08/08 9 OP21 Reg 23(2)(j) Reg 13(3) 01/08/08 10 OP26 01/08/08 11 OP27 Reg 18 (1)(a) 01/08/08 12 OP31 Reg 39 (b) 01/08/08 The Downs Care Centre Version 5.2 Page 31 13 OP38 Reg 23(4) manage a care home. Service users had their doors held open by random objects in the home. The registered person shall (a) liaise with the Fire Authority to ensure that safety is maintained (b) ensure that there is a policy in place to ensure service users safety and make arrangements to allow service users to have choice of whether to have their room doors open whilst ensuring that fire safety for service users and staff is maintained. This is an immediate requirement. 05/06/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP27 OP28 Good Practice Recommendations That staff undertake a recognised induction course. A minimum ratio of 50 trained members of care staff (NVQ level 2 or equivalent) should be achieved. The Downs Care Centre DS0000065252.V363745.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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