Inspection on 01/02/06 for The Old Library

This inspection was carried out on 1st February 2006.

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 Old Library 22/01/09

The Old Library 09/01/08

The Old Library 31/01/07

The Old Library 22/06/05

The Old Library 10/03/05

The Old Library 16/08/04

The Old Library 26/03/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Old Library Isaac`s Hill Cleethorpes North East Lincs DN35 8JR Lead Inspector Mrs Kate Emmerson Unannounced Inspection 1st February 2006 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 The Old Library DS0000002908.V282749.R01.S.doc Version 5.1 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 Old Library DS0000002908.V282749.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Old Library Address Isaac`s Hill Cleethorpes North East Lincs DN35 8JR 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) 01472 601364 Mr Charles William Jackson Position Vacant Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places The Old Library DS0000002908.V282749.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd June 2005 Brief Description of the Service: The Old library is a 30-bedded care home registered for older people. The accommodation is set in a Victorian style building, retaining much of its original features. It is set in the seaside town of Cleethorpes, with views of the main thoroughfare to the sea front. The home’s ownership has remained stable for a number of years and many staff have been retained by the home, which has given a great deal of stability to the service users. There are eighteen single rooms and six shared rooms; one of the shared rooms has en-suite facilities. The home has two lounges and an adjoining dining area; all rooms are decorated and furnished to a good standard. There are bathroom and WC facilities located on each floor. The home has equipped itself with a variety of aids to accommodate the dependency of the service users’ in the home. The Old Library DS0000002908.V282749.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over one day in February 2006. To find out how the home was run and if the people who lived there were pleased with the care they got the inspector spoke care staff working in the home at the time of the inspection and people who lived in the home. Some of the records kept in the home were checked. This was to see how the people who lived in the home were being cared for, that staff were safe to work in the home, that they had been trained to their job safely and to make sure that the home and the things used in it were safe and were checked regularly. The home was checked to see if it was kept clean and tidy. The home provided a very friendly atmosphere and a good standard of individualised care. The service users expressed satisfaction with the care provided. The manager had been very proactive in improving the home and meeting the requirements from previous inspections. She informed the inspector that she was leaving the home in the week following the inspection. The two deputy managers who have worked closely with her during the last year will be taking a shared management responsibility in the short term. What the service does well: The manager visited residents before they arrived at the home to see if their needs could be met and then a detailed care plan was developed so the staff knew what care the person needed. The residents said that there were plenty of things to do at the home and there were regular outings. The staff were very keen to be involved in the activities at the home and were raising money through sponsored events for a summerhouse and a green house for the residents. . The home provided very comfortable and clean and tidy accommodation. The home provides lots of training for the staff and has gained the Investors in People award. The Old Library DS0000002908.V282749.R01.S.doc Version 5.1 Page 6 The manager made sure that the health and safety of the residents and staff were protected through staff training and procedures in the home. What has improved since the last inspection? 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. The Old Library DS0000002908.V282749.R01.S.doc Version 5.1 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 The Old Library DS0000002908.V282749.R01.S.doc Version 5.1 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): None of the above standards were assessed at this inspection. Please refer to previous inspection reports for information. EVIDENCE: The Old Library DS0000002908.V282749.R01.S.doc Version 5.1 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 and 10 There were detailed care programmes in place to support the care that was given in the home. A lack of detailed, consistent and regular evaluation of care plans may put service users health and welfare at risk. The service users were enabled to self-administer medication and the homes policies and procedures supported safe handling of medication. The service users felt they were treated with respect and privacy was upheld. EVIDENCE: The management were committed to providing good standards of care planning and all care plans had been audited since the last inspection and 3 seniors had received care plan training. Random selections of care plans were examined. The care programmes comprehensively covered the majority of needs identified from assessment, There was evidence in the programmes that individual risk management was generally good; risk assessments for moving/ handling, tissue viability, falls, The Old Library DS0000002908.V282749.R01.S.doc Version 5.1 Page 10 nutrition, bed rails and general issues were in place and reviewed regularly. Daily diary records were well maintained and detailed. Evaluations of the care plan had not been completed monthly in all cases and records in this area lacked detail and did not always cross reference to other areas such as weight loss/gain. There was evidence that service users weight had not been monitored on a consistent and regular basis. One service user had not been weighed since February 2005 until January 2006 then they had been weighed twice in one month. This does not assist in monitoring the health and welfare of the service users. There was evidence that care plans had been discussed with the service users and they had signed to agree them. The home had well developed procedures in place for the safe handling of medication, which included self-administration of medication and accredited training for the staff responsible for handling medication. Records were clearly maintained and controlled drugs were appropriately stored. The storage for medication to be held in the refrigerator was broken and could not be secured safely. The manager stated that there was no medication that required refrigeration at the time of inspection. The service users felt they were treated with respect by the staff and their privacy was respected. The induction programme covered service users rights to privacy and dignity. These areas were also reinforced in the NVQ standards. To encourage service users privacy and dignity to be respected terms of address were indicated on the care programmes, a telephone was available for service users to use in private, service users personal mail was handed directly and unopened to the service user, unless otherwise agreed and privacy locks had been provided on the service users private accommodation. Observation of staff during the inspection identified that they were patient and courteous at all times. The Old Library DS0000002908.V282749.R01.S.doc Version 5.1 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): 14 Service users felt they were able to exercise control and choice over their lives. EVIDENCE: The home had a policy on choice and advocacy in place. Service users spoken to felt they were able to make choices about their daily routines and activities within the home. There was evidence that people had been encouraged to personalise their rooms. In the reception area there was information on advocacy services and solicitors and how to access records. There was also information regarding planned activities and how to make a complaint. The homes management was proactive in ensuring that service users were enabled to maintain contact with their local community and peers and had joined a local group of care homes to provide joint activities. The Old Library DS0000002908.V282749.R01.S.doc Version 5.1 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 were not adequately protected from abuse due to deficiencies in recruitment procedures. EVIDENCE: The home had a copy of the reviewed multi agency policy and procedures on protection of vulnerable adults; there was also a detailed homes adult abuse policy, which linked in with this document. The manager had obtained leaflets for the service users that explained the procedures and these were displayed in the home. Staff had accessed adult abuse training and training was given to new staff with the first six weeks of employment. Staff interviewed displayed good knowledge of procedures to report suspicion of abuse. There were policies on restraint, dealing with aggression, whistle blowing and managing service users finances in place. There had been one allegation of abuse referred to the Social Services for investigation this had been investigated and was unfounded. Service users were not adequately protected by the recruitment procedures in the home. (Standard 29) The Old Library DS0000002908.V282749.R01.S.doc Version 5.1 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, 25 and 26 The home provided a very comfortable and homely environment. It was clean and tidy and well maintained. The home and gardens were accessible to all the service users accommodated. The hot water system in the home were still a cause for concern, with regard to sufficient temperature for the kitchen outlets. EVIDENCE: The Old Library DS0000002908.V282749.R01.S.doc Version 5.1 Page 14 The home was located in a very central area, close all the local amenities and sea front. The home had three floors that were accessed via stairs or passenger lift. The general condition of the furnishings and decoration was of a good standard; redecoration and refurbishment was ongoing. All areas seen as part of this inspection were clean and tidy, including the grounds. There was evidence that the manager had discussed the provision of privacy locks with the service users and risk assessments had been completed. Locks had been fitted for the 8 service users rooms that wished to have them. Discussions with the manager and a letter provided by the proprietor indicated that the water system in the home was a pressurised system and hot water was not stored, minimising the risk of Legionella. To ensure that the hot water temperatures were at safe levels for service users the water temperature was maintained at 43 deg C throughout the home through the use of individual temperature control valves. However the manager stated that a plumber was due to visit the home the week following the inspection to deal with the hot water temperatures that were recorded at 50°C in the homes own records of checks in bedrooms 12 – 28 and could not be adjusted to a safe temperature. The bathrooms hot water temperatures were within acceptable limits on the day of inspection. Policies and procedures were in place for control of infection; this was covered in the induction-training programme for new staff. Staff confirmed that they had adequate supplies of protective clothing. The Old Library DS0000002908.V282749.R01.S.doc Version 5.1 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): 27, 28, 29 and 30 The staffing levels were adequate to meet the needs of the service users and staff were trained to do their jobs. The recruitment procedures had improved but there were still some deficiencies providing inadequate protection for the service users. EVIDENCE: The home is registered for 30 service users and at the time of the inspection there were 27 service users accommodated. The manager stated that 3 service users were high dependency 5 were medium and 19 were low dependency. The manager provided evidence that staffing levels in the home met the minimum guidelines set out by the Residential Forum. Staffing was arranged so there were 4 carers on duty between 8 and 11.30 and 4 and 5 pm and 3 carers on duty during other periods during the day. Monday to Friday there was the manager and deputy manger on duty until 5pm. At night there were 2 carers on duty. In the opinion of the staff interviewed as to whether there was sufficient staff on duty they felt that there should be 4 on duty at all times in the day as at least 4 or 5 service users required the assistance of two carers. The Old Library DS0000002908.V282749.R01.S.doc Version 5.1 Page 16 Adequate numbers of staff were employed in catering, domestic, maintenance and administration capacities. There was evidence from staff training records and discussions with staff that home had an active training programme, which included induction and foundation training and mandatory and service specific training. There was a deficiency noted in the provision of fire training, which showed that except for two, none of the staff had received fire training since November 2004. This may put the service user at unacceptable risk. An immediate requirement notice was served and this had been met prior to writing this report. The home was also committed to provision of NVQ training and of the 25 staff employed 2 had achieved NVQ level 2 and 5 had achieved NVQ level 3. A further 8 staff were in the process of completing NVQ 2 training and 4 senior staff were completing NVQ 4. The two deputy managers had commenced the Registered Managers Award. Although there was some improvement in the recruitment procedures there were still some deficiencies that must be addressed to ensure adequate protection for service users. POVA 1st checks had been completed in all cases except one prior to employment. Previous employment history was not checked and wasn’t recorded on the application forms in two cases. It could not accurately checked if two written references had been obtained prior to employment as in two cases references were not dated or signed. The Old Library DS0000002908.V282749.R01.S.doc Version 5.1 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): 33, 35 and 38 There was a limited system to monitor the quality of the services but this did not include the service users. The service users financial interests were safeguarded. The manager positively promotes the health and safety of the service users and staff. EVIDENCE: The manager stated that there was no consistent active system of monitoring the quality of the service. She stated that she had recently surveyed the staff regarding the training and development in the home and daily checklists with regard to the cleanliness of the home were completed. She stated that the service users were last surveyed on the quality of the care in 2005 but there had been no action plan developed from this. Monthly audits of medication were completed but as there were the same issues recorded for at least 6 The Old Library DS0000002908.V282749.R01.S.doc Version 5.1 Page 18 months with no evidence that there had been any action taken to address these, these were totally ineffective. There were good systems in place for the management of service users finances that were maintained by the administrator. Cash held balanced with the records. Receipts were maintained for all transactions made on behalf of the service users. The manager was advised that she should complete regular management checks of the records, as she is ultimately responsible for the management of service users finances. The manager was aware of the legislation to protect the health, safety and welfare of service users and staff in the home. One of the senior care staff had lead responsibilities in this area and had accessed a health and safety course through the local college. There was evidence that staff had undergone moving and handling, infection control, basic food hygiene, health / safety, COSHH and first aid training. There was a deficiency noted in the provision of fire training, which showed that, except for two of the current staff group, none had received fire training since November 2004. An immediate requirement notice was served and this had been met prior to writing this report. Records to support fire safety and records of fire alarm and emergency lighting checks were in place and up to date. There was no certificate to evidence that the fire equipment had been checked although the manager stated that this had been completed in January 2006 and would send a copy of the certificate to the Commission. At the last inspection the inspector noted that the Appollo bath had last been serviced by the registered provider in July 2004; advice was given to the manager to ensure that the bath seat was checked for load bearing capacity and not just” working order”. The provider provided a letter stating that he had completed this. Accident reports were followed through and individual risk assessments reviewed accordingly; the manager audited all accident records monthly and maintained records of all further action taken. The Old Library DS0000002908.V282749.R01.S.doc Version 5.1 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 3 X X X X X 2 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 1 X 3 X X 3 The Old Library DS0000002908.V282749.R01.S.doc Version 5.1 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 2 Standard OP7 OP8 Regulation 15 12(1) Requirement The registered person must ensure that the care plans are reviewed monthly. The registered person must make arrangements for the service users weight to be monitored regularly and records of loss/gain and actions taken maintained. The registered person must ensure that at outlets accessible to service users hot water temperatures are at safe levels, the hot water temperature must be maintained at or close to 43 deg C. The registered person must ensure that all the information required in Schedule 2 of the care home regulations is obtained prior to the employment of staff. (Previous timescale – with immediate effect - not met) The registered person must ensure that a system to review and improve the quality of care and services in consultation with the service users and their DS0000002908.V282749.R01.S.doc Timescale for action 01/02/06 01/02/06 3 OP25 13(4) 01/04/06 4 OP29 19 01/02/06 5 OP33 24 01/06/06 The Old Library Version 5.1 Page 21 representatives is implemented. A report of the review is to be completed and made available to the service users and the Commission. 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 OP9 OP29 OP24 Good Practice Recommendations The registered person should replace the secure storage for medication requiring refrigeration. The registered person should ensure that employment history is recorded and gaps in employment are explored prior to employment. The registered person should ensure room audits detail if the furniture is removed removed through choice or risk. The Old Library DS0000002908.V282749.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Hessle Area Office First Floor 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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 The Old Library DS0000002908.V282749.R01.S.doc Version 5.1 Page 23 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!