CARE HOMES FOR OLDER PEOPLE
The Georgiana 10 Compton Avenue Luton Beds LU4 9AZ Lead Inspector
Leonorah Milton Unannounced 2nd June 2005 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 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 Georgiana I51 S44852 Georgiana V223195 020605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service The Georgiana Address 10 Compton Avenue Luton Beds LU4 9AZ 01582 570650 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Heritage Care Homes Ltd Care Home 44 Category(ies) of OP Old Age - 44 registration, with number of places The Georgiana I51 S44852 Georgiana V223195 020605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 04.03.05 Brief Description of the Service: The Georgiana was located in a residential suburb of Luton within walking distance of a train station. The amenities of the town were a short car journey away. The home had been purpose built almost three years previously to meet the environmental standards detailed by the National Minimum Standards 2001 for the care of fourty-four frail older people. The proprietor was Heritage Care Homes Ltd that also operated two other care homes in the vicinity. Mrs Adewuyi had been the acting manager since the previous manager retired at the end of Febraury 2005. Mrs Adewuyi had recently submitted her application to be registered as the manager at the home to the CSCI. The accommodation was distributed over three floors that were accessed via staircases and a shaft lift. The upper floor was used for administrative purposes, food storage and preparation. The building had been designed to provide four distinct living areas. Each had a lounge/diner and convenient access to toilet and bathing facilities. Small kitchenette facilities for the use of service users were located on the ground and first floor. The home had a hairdressing room that could also be used for chiropody treatment. All of the bedrooms, which were for single occupation, were fitted with call bells and had ensuite toilet and washbasin facilities. The building has been decorated and furnished to a high standard and provided an attractive and comfortable environment.
The Georgiana I51 S44852 Georgiana V223195 020605 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over 5.5 hours. Mrs Adewuyi the acting manager was present to assist throughout. The inspection included a review of the records in relation to the care of two service users; a review of sundry other documents; conversations with four service users, a relative of a service user, two members of staff and an agency care assistant and the manager. A partial tour of the building was also carried out. The home had been through an unsettled period as the previous manager had been absent from the home through ill health for a while before her retirement. Some aspects of the standard of the operation had deteriorated and it was Mrs Adewuyi’s task to address these issues. This inspection identified that she had strived to do this but there was still some improvements required to achieve an acceptable service. What the service does well: What has improved since the last inspection? What they could do better:
Records to show individual service user’s progress and how they had been cared had not been completed in sufficient detail to show the sequence and
The Georgiana I51 S44852 Georgiana V223195 020605 Stage 4.doc Version 1.30 Page 6 continuity of care. Moreover the incidents of unexplained bruises and injuries had not been properly recorded or more importantly, investigated. It was evident that the manager required the assistance of her senior team to complete the overdue task of accurately recording service users’ needs and what must happen to meet them. As such other members of the senior team must be rostered with time that is not included in the minimum care staffing arrangements, in order that they can assistant the manager to make accurate records about service users’ care needs and the risks to their individual health and safety. Recruitment procedures for the protection of vulnerable adults had not been sufficiently robust. New personnel must not commence duties in the home until satisfactory checks via the Criminal Records Bureau have been carried out. It was concerning that there was no written evidence to show that the proprietor had properly supported Mrs Adewuyi in this, her first management role. The proprietor had failed to recognise that Mrs Adewuyi needed time to establish herself as the manager of this team. A few members of staff had been reluctant to accept Mrs Adewuyi’s promotion from her former role as an assistant deputy at the Georgiana. There must also be a review of the arrangements for the management of health and safety in this large home to ensure that they are based on thorough and professional monitoring systems. Immediate requirement notifications were issued at this inspection about inadequate written care planning records, accident records and the need to investigate unexplained injuries and the proprietor’s legal obligation to compile reports of his monitoring visits. 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 Georgiana I51 S44852 Georgiana V223195 020605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection The Georgiana I51 S44852 Georgiana V223195 020605 Stage 4.doc Version 1.30 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 standard(s) 3,4, The home had solely relied in some instances on the pre-admission assessment of need supplied by funding authorities. As a consequence the home had not adequately ensured that it was able to meet service users’ needs before they had been admitted to the home. EVIDENCE: Whilst placing authorities had supplied the home with assessments of need, these had not detailed personal preferences in relation to social or recreational pursuits, cultural or religious needs. Some assessments of healthcare needs were a little brief. The Georgiana I51 S44852 Georgiana V223195 020605 Stage 4.doc Version 1.30 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 standard(s) 7,8,10,11. Members of staff were more reliant on anecdotal information and service users’ daily progress logs for information about service users’ needs rather than their central plan of care. As such there was a risk that some aspects of care needs would be overlooked. EVIDENCE: Whilst daily records of individual progress were well maintained, the actual care planning documentation did not identify how assessed needs would be met in total: the recent daily records for one service user indicated that a district nurse had attended to change dressings and that a series of serious bedsores had developed. The care plan however had not been updated sufficiently to show what interventions were required in relation to skin care and indeed the care of someone who was terminally ill. The last review of the care plan dated February 2005 had noted “ No problems with health”. It was evident that the manager was attempting to introduce systems to monitor practice but there was no evidence to show what was to happen next: a list commenced on 02.04.05 that showed that sixteen service users had sustained bruises or skin tears. These incidents had not been properly reported in the home’s accident logs or investigated for cause or subject to any assessment of risk. The manager stated that service users’ GPs had been
The Georgiana I51 S44852 Georgiana V223195 020605 Stage 4.doc Version 1.30 Page 10 consulted about some injuries but she was unsure whether this had been recorded. Care plans required further development to identify individual preferences, limitations to personal liberty and must take account of the details regarding assessment of need as specified by standard 3. Care plans must be updated to show how significant changes in need will be met. Requirements about the need to introduce comprehensive care plans had been outstanding from several reports. It was unclear whether there was anyone with sufficient expertise in the home to carry out this task. The Georgiana I51 S44852 Georgiana V223195 020605 Stage 4.doc Version 1.30 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 standard(s) 12,13, The daily routines in the home were as flexible as could be expected when a large group of people live together and had afforded service users with choices about their every day lifestyles. EVIDENCE: The home had mostly adopted a small group living model of care as is preferable in a home of this size. Routines were mostly centred on mealtimes but these could be varied to meet individual need and the preferences of those in the individual lounges. Service users had been encouraged to take part in a variety of stimulating activities. An activity organiser (temporarily absent through ill health) provided organised activities three times weekly. Staff provided ad hoc diversions at other times. A visitor stated that she had been welcomed into the home. Others were observed to come and go without restriction. The Georgiana I51 S44852 Georgiana V223195 020605 Stage 4.doc Version 1.30 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 standard(s) 16,18 The home’s written complaints and protection procedures were through. However, there had been a failure to fully ensure the protection of service users by following robust recruitment procedures. EVIDENCE: The written procedures to inform staff about protection issues were detailed and had been developed with reference to the Department of Health’s “No Secrets” guidance. Training in protection issues had been provided for key personnel and the majority of care staff. The complaints procedure was comprehensive. A summary of the procedure was advertised in the foyer of the home. Records indicated that service users’ complaints had been properly investigated and acted upon. Recruitment procedures for the protection of vulnerable adults were not sufficiently robust. Records showed that a member of staff had commenced induction in the home before a satisfactory check had been obtained from the Protection of Vulnerable Adults Register or the Criminal Records Bureau. The Georgiana I51 S44852 Georgiana V223195 020605 Stage 4.doc Version 1.30 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 standard(s) 19,20,23,24,25,26. The premises provided a comfortable and well-adapted environment that was suitable for provision of residential care for frail older people. These arrangements had been a little marred by some recent lapses to the management of safety that had posed some risk of injury to service users. EVIDENCE: The Georgiana I51 S44852 Georgiana V223195 020605 Stage 4.doc Version 1.30 Page 14 The layout of the home provided comfortable and convenient accommodation. The building was designed to meet the National Minimum Standards. The exception to the standards was the restricted views from two bedrooms and the fire safety arrangements for the bedrooms on the third floor. Service users could not use these rooms until the requirements of the fire safety officer had been met. In the interim these rooms could be used in safety for administrative purposes. These rooms had not been registered for use as bedrooms. Areas of the building seen at this inspection were clean and orderly and well decorated and furnished to a high standard. Bedrooms seen contained many personal items of the occupants to create a homely appearance. The requirement to meet fire safety arrangements by closing service users’ bedroom doors at night had been met. However the weekly testing of fire alarms had not been carried out since 09.05.05. The bolt on the laundry door was unsecured. Service users could therefore access this room, which housed 6 gas-heating boilers, and 3 large water tanks the exposed pipe work of which was extremely hot and presented a risk of accidental burn. The Georgiana I51 S44852 Georgiana V223195 020605 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30. The team as whole had the skill to meet service users’ needs but the reluctance of a few individuals to follow the direction of the senior team had had some adverse impact of the quality of the service. EVIDENCE: Satisfactory numbers of care and ancillary personnel had been rostered each day to meet the minimum staffing requirements but the need for additional time to complete statutory records had not been taken into account. Training records indicated an improvement in the training provision but also that it had been provided on a piecemeal basis rather than based on an analysis of individual training needs. There was evidence to show that staff meetings had taken place and that the manager was striving to develop the senior team. This unfortunately was somewhat depleted as the deputy had been transferred to administrative duties. One member of staff had been dismissed for failing to act on the manager’s directions. The proprietor must ensure that the members of the senior team properly support the manager and that they have sufficient time to direct and supervise personnel.
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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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,35,36,37,38 The manager was evidently committed to her task but had not been in post long enough and was not sufficiently qualified as yet to manage a home of this size. There was no organised overview of the management of health and safety. As a result there was a risk that this could lead to a serious incident. EVIDENCE: Mrs Adewuyi held an NVQ in care at level 3 but had yet to commence work to achieve a qualification in care management. Mrs Adewuyi had evidently worked extremely hard to build this team. It also must be recognised that she took over the management of the home when its performance was deteriorating and indeed those members of staff who contributed to the inspection were appreciative of her support. Mrs Adewuyi had tackled some challenging staffing issues in relation to poor practice and the harmony amongst the team. She had also not received the required level of support from the senior team as illustrated previously in this report.
The Georgiana I51 S44852 Georgiana V223195 020605 Stage 4.doc Version 1.30 Page 17 It must also be recognised however that the lack of an organised approach to the management of safety in this large home was concerning. There must be systems in place to ensure that the safety systems throughout the home are monitored on a regular basis. The manager should have an overview of them. The monthly manager’s checklist seemed to have disappeared with the departure of the previous manager. The manager must also be able to demonstrate some recognisable expertise in the assessment and management of risk. Health and safety training to the level required for care staff is not sufficient. Supervision for staff was in hand but there had been problems because previous records of supervision were inconsistent. Supervision was still scheduled with the deputy for some personnel. The manager was advised that this was not appropriate, as the deputy had been transferred to an administrative position. There had been some improvements to record keeping, particularly in relation to monies held on behalf of service users. The Georgiana I51 S44852 Georgiana V223195 020605 Stage 4.doc Version 1.30 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 x 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 x
COMPLAINTS AND PROTECTION 2 3 3 x 3 3 2 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 2 x x x 3 2 2 2 The Georgiana I51 S44852 Georgiana V223195 020605 Stage 4.doc Version 1.30 Page 19 No Are there any outstanding requirements from the last inspection? 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 7 Regulation 15(1)(2) Requirement The registered person must ensure that care plans include the details as specified by the assessment of need. Plans must be signed as agreed by the service user or their representative (Previous timescales of 31.03.04 and 30.09.04 had not been met. The timescale from the previous report of 30.06.05 has been extended) Care plans must show how assessed needs will be met and must be updated with any significant changes of need.(The previous timescale of 30.06.05 has been extended. Pre-admission assessments of need must take account of service users preferences and detail social, cultural and religious needs. Care plans must take account of assessments of risk, including those in relation to an unexplained accident. Recruitment procedures must include an updated CRB check and two recent references(Previous timescale of Timescale for action 30.08.05 2. 7 15(1)(2) 02.08.05 3. 3 14(1)(2) 30.06.05. 4. 7 13(b)(c) 02.08.05 5. 18 19(1)(a) (b) 30.06.05. The Georgiana I51 S44852 Georgiana V223195 020605 Stage 4.doc Version 1.30 Page 20 31.03.05 had not been met) 6. 7. 19 25 23(4) ( c)(ii) 13(4)(a) Fire alarms must be tested each week. Service users must not have access to the homes heating boilers or any hot exposed pipe work that poses a risk of accidental burn. In this instance the laundry door must be locked when the room is not occupied. The home must have an effective senior team that has been allocated sufficient time to direct and supervise the rest of the team. The registered person must introduce a training programme that includes individual assessments of training needs and foundation training to NTO targets. Senior personnel must receive an appropriate induction into post (Previous timescales of 31.03.04 and 31.10.04 had not been met in full) The person managing the home must hold or be working towards a suitable qualification in care management. The manager must undertake training in the assessment and management of risk. The registered person must monitor the performance of the service by visiting the home each month, compile reports of these visits and forward copies of these to the CSCI. 30.06.05 30.06.05 8. 27 18(1)(a) 31.07.05 9. 30 18(1)(a) ( c) 31.08.05. 10. 31 9(2)(b)(i) 30.09.05. 11. 12. 31 24 18(1)(a) 26(2)(3) (4)(5) 31.08.05. 30.06.05. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations
I51 S44852 Georgiana V223195 020605 Stage 4.doc Version 1.30 Page 21 The Georgiana 1. 2. 3. Standard 15 36 38 The registered person should serve beverages from the kitchenette facilities rather then the central kitchen.( Not actioned) The registered person should introduce a timetable to identify staff supervision schedules.( Not actioned) The registered person should maintain an audit of routine safety checks as per the manager’s checklist.( Not actioned) The Georgiana I51 S44852 Georgiana V223195 020605 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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