Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 23/05/07 for The Old Rectory

Also see our care home review for The Old Rectory for more information

This inspection was carried out on 23rd May 2007.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

What has improved since the last inspection?

What the care home could do better:

CARE HOMES FOR OLDER PEOPLE The Old Rectory Spring Lane Lexden Colchester Essex CO3 4AN Lead Inspector Marion Angold Key Unannounced Inspection 23rd May 2007 10:25 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 Rectory DS0000017974.V341370.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 Old Rectory DS0000017974.V341370.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Old Rectory Address Spring Lane Lexden Colchester Essex CO3 4AN 01206 572871 01206 573198 theoldrectory@schealthcare.co.uk www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited 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) Ms Paula Maddams Care Home 60 Category(ies) of Dementia - over 65 years of age (21), Old age, registration, with number not falling within any other category (60) of places The Old Rectory DS0000017974.V341370.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 60 persons) Persons of either sex, aged 65 years and over, who require care by reason of dementia (not to exceed 21 persons) The total number of service users accommodated in the home must not exceed 60 persons 6th November 2006 Date of last inspection Brief Description of the Service: The Old Rectory is a large fully detached property that was originally built as the rectory for the local church in Lexden. The property has been considerably extended over the years to provide accommodation for up to sixty elderly people (over the age of 65) on three floors although, more recently, none of the bedrooms on the less accessible top floor have been in use and so the maximum number of residents has declined to 55. Most bedrooms are for single occupancy, although there are four double rooms. Communal space is provided with three lounges and three dining rooms situated on the ground and first floors of the home. A further small resident smoking lounge is provided on the first floor. Access between floors is provided via two passenger lifts. To the front of the home there are extensive, mature gardens. One small fully enclosed patio garden is provided to the side of the home with a second patio to the rear. Limited car parking for visitors is available inside the main entrance gate; further public car parking is available close by in Spring Lane. Bus services run along the main road at the top of Spring Lane, which provide access to/from Colchester town centre. The home provides personal care and support for residents with varying levels of dependency. Since the last inspection the registration has been varied so that the home may accommodate up to 21 people with dementia. The Old Rectory DS0000017974.V341370.R01.S.doc Version 5.2 Page 5 The current weekly charge for a room ranges from £350.00 to £650.00. Fees do not include chiropody, hairdressing, incidental items such as newspapers and staff time to accompany people to hospital. Past inspection reports are available from the home, and from the CSCI internet website. The Old Rectory DS0000017974.V341370.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection, covering the key National Minimum Standards, took into consideration all recent records and contacts relating to the service, including surveys completed by residents and their relatives. It also included a site visit to the home on 23/05/07, lasting just over 9 hours. This visit involved speaking with residents, a relative, the manager and staff, as well as a partial tour of premises, observation of care practice and the sampling of records. Since the last inspection, CSCI has approved an application to vary the registration to include 21 people with dementia. Of the 23 Standards inspected, 9 were met, 10 presented minor shortfalls and 4 gave cause for serious concern, with 3 warranting immediate requirement notices. Management’s initial responses to the findings of this inspection have been constructive. The Commission has been advised in detail of work completed to address the requirements. What the service does well: What has improved since the last inspection? • The manager had responded in writing to all the issues raised by the home’s annual survey of views (what people and their representatives thought of living there). DS0000017974.V341370.R01.S.doc Version 5.2 Page 7 The Old Rectory What they could do better: • Recruit enough care and ancillary staff to meet the needs of people living at the home and provide a relaxed and happy environment. This inspection has shown that a number of negative outcomes for people were linked to staffing arrangements. Provide a sufficient number of working hoists so that people do not have to wait for assistance and to promote the safety of those giving and receiving support with transfers. Restore all the bathrooms to full working order with hot and cold water, so that people may have baths and showers. Ensure that people have their prescribed medication by taking appropriate action if delivery is delayed. Ensure that supplies of things like drinking glasses, towels and flannels are maintained so that people have what they need for their comfort and convenience. Maintain the premises and gardens so that people can fully enjoy their surroundings. Have a manager, whose time is fully employed at The Old Rectory, promoting good outcomes for the people living there. Ensure that anyone coming to live at the home has had their needs assessed and been assured in writing that their needs can be met. Develop care plans in respect of people’s interests and how they would like to spend each day. Record the food provided to people living at the home in sufficient detail to show what each person has eaten. • • • • • • • • • 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 The Old Rectory DS0000017974.V341370.R01.S.doc Version 5.2 Page 8 be made available in other formats on request. The Old Rectory DS0000017974.V341370.R01.S.doc Version 5.2 Page 9 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 Rectory DS0000017974.V341370.R01.S.doc Version 5.2 Page 10 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): 3. NMS 6 did not apply at The Old Rectory at the time of inspection. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People thinking about coming to live at The Old Rectory would usually have their needs fully assessed but the information about the home could be misleading. EVIDENCE: Checklists in residents’ files showed they had been given a Service User Guide. The current Service User Guide, amended in line with changes to the home’s registration (The Old Rectory now has 21 places for people with dementia), contained all the required information. However, evidence from the site visit indicated that the quality of care and level of activities described in the Service User Guide were not consistently available. Two out of six respondents to the Commission’s postal survey (people experiencing the service) felt they had not The Old Rectory DS0000017974.V341370.R01.S.doc Version 5.2 Page 11 received adequate information to inform their decision about moving into the home. Records were sampled for 3 residents, two of whom were relatively new to the home. Their needs had been assessed before admission and upon their arrival at the home. These assessments had formed the basis for their care plans and included comments from the people concerned to show they had been involved. One person who spoke with the inspector had not had an assessment until they arrived at the home. Although they indicated that they had been happy for their relative to talk with the home beforehand about their needs and make a decision as to the suitability of the home, such a process does not ensure that the home is fully prepared or able to meet the person’s individual needs. Letters confirming that the home could meet the needs of prospective residents had not been sent to the people, whose records were sampled. The manager said that, more often than not, people came from hospital and discharge procedures did not allow time for letters of confirmation. The Old Rectory DS0000017974.V341370.R01.S.doc Version 5.2 Page 12 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 and 10 People who use this service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Plans to meet people’s care were explicit but could not always be followed due to insufficient numbers of staff and working hoists. Sometimes people had to wait for their basic needs to be met. EVIDENCE: Care plans were sampled for 3 people living at the home. They were based on 12 standard areas of assessment and any additional needs that had been identified. In most areas they gave clear instructions to staff as to how the individual was to be supported. One key area of assessment, covering the person’s work and leisure interests, was not linked to a care plan. This meant that staff lacked guidance as to how they could improve the quality of people’s lives through meaningful activity and stimulation. This showed in the way people sat through the day, unoccupied. The Old Rectory DS0000017974.V341370.R01.S.doc Version 5.2 Page 13 Individual risk assessments were included in the care management plan, covering a range of issues, such as moving and handling, pressure areas, falls, weight and nutrition. Food and fluid intake were monitored where associated risks had been identified. Daily records were being kept on the progress of each person. Records showed that care plans were evaluated monthly or following hospital discharge and that health issues were identified and acted on. Accident records were kept with care plans and linked to risk assessments. People living at the home, and relatives responding to the Commission’s survey, were mostly positive about the medical support they received. One relative said this was an area of excellence. A person living at the home felt that people should be informed when the chiropodist would be visiting. The care plans inspected contained a record of medication. Staff administering medication put on a red tabard, advising people that they must not be disturbed. They found it helpful not having distractions and believed it reduced the risk of mistakes. Individual Medication Administration Records included a photograph and personal details for identification, as well as medication profiles and guidance to staff about administering PRN (as needed) medication. In line with the home’s procedures, the person administering medication counted and recorded the number of tablets remaining in packets after each administration. This was to avoid misappropriation of medicines. The senior administering medication at lunchtime said that the manager and deputy manager conducted a monthly audit of stock and records. People were appropriately consulted about PRN medication before it was administered. However, it was noted that there was only one drinking glass available for a group of people on the middle floor, which indicated that not everyone was given a drink to take their medication. Antibiotics were given at 8.00, 12.00 and 20.00 hours. The senior on administration duty said these times were set by the pharmacy. However, although they followed the home’s standard times for medication administration, people were not getting their antibiotics at regular intervals throughout the day, as prescribed, to help their recovery. One person’s medication administration record showed they had not had their prescribed medication from 17 to 21/05/07. The senior said that the pharmacy did not send this person’s medication with the monthly order. Although the errors leading to this omission lay with the surgery and pharmacy, the home took insufficient action on the person’s behalf to ensure they got their medication promptly. The Old Rectory DS0000017974.V341370.R01.S.doc Version 5.2 Page 14 The manager had been absent and unaware of the situation and her monthly audit had not identified the omission. A sample of staff records and discussion with management showed that staff administering medication had received appropriate training in how to use the monitored dosage system and were required periodically to complete in house competency assessments (these carried out between March and May 2007). A number of staff had also completed, or were engaged in, a higher level of training specifically covering medication practice. The list of signatories of people authorised to administer medication and sign Medication Administration Records had been updated 9/2/07. One person living at the home indicated that staff were responsive to their needs and that the help they received suited them. They also felt that their privacy was respected as staff always knocked before entering their bedroom. Although staff were very busy throughout the inspection and had little time for social interaction with residents, they were observed to show kindness and respect to the people they were helping. Staff said they found it frustrating the amount of time they spent looking for one of the 4 hoists. They felt they had too few staff and hoists to meet the needs of the 20-25 people who needed them, especially as one was not in full working order, and there could be 3 or 4 people waiting for assistance at any one time. Their comments were supported by the constant sound of call bells being activated during the morning. This experience of having to wait for assistance to the toilet undermined people’s dignity and, as staff identified themselves, increased the risk to people with fragile skin or pressure areas. One person, having to manage the hoist single handed, was clearly rushed and flustered and although they spoke kindly to the person they were helping, they did not talk them through the process or do all that was necessary to promote their dignity. The lack of a second person to assist also compromised the safety of the person being transferred and the member of staff. Insufficient staff and hoists may have been contributing factors to the number of people seated in wheelchairs, who had not been transferred into comfortable armchairs. One person was not able to see the television because a fan had been placed in their line of vision. This lack of personalised care was indicative of staff being rushed to keep up with the routines of the day. The lack of flannels and towels and drinking glasses reported by staff, and in evidence during this visit, served to undermine the dignity of people living at the home and impair the quality of the service they received. One person told the inspector that the home was always losing their flannel. The Old Rectory DS0000017974.V341370.R01.S.doc Version 5.2 Page 15 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 and 15 People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Low staffing levels affected the quality of people’s lives. Some people lacked stimulation and mealtimes were not a positive experience for everyone. EVIDENCE: Records, observation and discussions showed that people could go to bed and get up when they preferred. At 19.30 on the day of inspection, some people were in bed, others were being offered drinks and snacks or supported to watch a chosen programme on television. An activity coordinator was employed 21 hours a week over 4 days but not working around the time of the site visit. The manager said that much of the activity coordinator’s time had been spent in one to one contact with residents and that two seniors were providing support with activities, outside their normal working hours, during the activity coordinator’s absence. The Old Rectory DS0000017974.V341370.R01.S.doc Version 5.2 Page 16 Several people said they were not aware of much in the way of activities or that the activities were not really suitable for them. Others were more positive about the activities offered and what been done to support their chosen lifestyle. The activity schedule for the week was displayed in various locations about the home. However, no activities took place on the day of inspection. Staff were hard pressed even to cover people’s basic needs. Care plans sampled were not well developed in respect of individual interests and lifestyle preferences and there was little evidence from observation that people benefited from a person-centred approach to how they spent their time. Most people sat all day in the same spot, with little stimulation. They did not have a change of scene. Three people told the inspector that they would like to go into the garden, but staff did not have time to take them outside. Information sent to the Commission showed that details of how to contact an advocate had been made available to people living at the home and their representatives. However, shortfalls relating to staffing levels and other resources, such as bathing facilities, impacted negatively on people’s capacity to exercise personal autonomy and choice. Several visitors were observed with people living at the home. Relatives indicated that they were welcomed. One person said they could look forward to visitors every day. A relatively newly created quiet lounge was available for people who wished to read or listen to the radio or spend time with their visitors. It was not seen to be used on the day of the site visit. People’s comments about meals varied but were generally fairly positive. They said they mostly got what they had chosen from the menu the previous day and could request an alternative. However, one person thought there was not enough variety in the weekly menu, another commented on a lack of fresh green vegetables and a third on their dislike of the canned vegetables. Menus were discussed periodically at residents’ meetings and the menu of the day was displayed in various places around the home. Meals were prepared and cooked on the premises and taken in trolleys to the various dining areas. This meant that people could be consulted about what they were served. Lunch was the main meal of the day but tea, on the day of the site visit, included a hot option and a pudding, and there was a choice of drinks, including milk. The only records of what people had eaten were the tick lists of their chosen meal from the menu. As these did not specify all the components of the meal, such as vegetables, or the content of sandwiches, it was not possible to track what individuals had eaten. The Old Rectory DS0000017974.V341370.R01.S.doc Version 5.2 Page 17 As breakfast was served 8.30 to 10.00, lunch around 12.30 and tea from 16.50 some people could be having their 3 main meals within 6.5 hours. Supper was being served at around 19.15 on the day of inspection but some people were already in bed and, therefore, experienced well in excess of the recommended 12 hours between the last meal of the day and breakfast. This could have an impact on their appetite, weight and general health. Minutes of a staff meeting, held on 16/04/07 flagged up the nutritional risk of people getting up early but not the more general risk associated with the interval between meals. Not all the arrangements for meals were congenial. In the middle lounge there was only one table, seating 4 people. Two others had lunch in their armchairs, not having a change of position or a chance to come together with others. The tablecloth was scattered with crumbs and the cutlery was not laid properly. There was a jug of squash on the table but no drinking glasses. One person was heard to say they wanted a drink with their meal. When this was pointed out to staff, cups were found, instead of glasses. Staff acknowledged that the shortage of glasses presented a problem. A similar shortage was observed at teatime in the dining room nearest the kitchen Five care assistants could not properly attend to people having lunch in the four main dining areas as well as a number of others remaining in their rooms, particularly as information provided by the home showed that 15 people needed help, supervision or prompts to eat their meals. No one had noticed that one person was struggling to manage because they were too far away from the table. Call bells continued to ring over the lunch period. The Old Rectory DS0000017974.V341370.R01.S.doc Version 5.2 Page 18 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 and 18 People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home were listened to but could not always be confident that the issues they raised would be acted on by the home. EVIDENCE: The home’s Service User Guide contained a clear complaints procedure and most people indicated that they knew who to speak with if they had concerns. Respondents to the Commission’s survey said that staff listened to them and acted on what they said. Entries in the complaints register could be linked to correspondence between the home and the complainant, in line with the home’s complaints procedure. Issues raised by complainants and respondents to the Commission’s survey were the lack of hot water in bathrooms, insufficient care staff and the impact of the manager being seconded to other homes. One person said that, despite the subject of new boilers being raised many times, the home had not had hot water for baths since Christmas and people had had to make do with strip washes. CSCI considers that the organisation was slow to respond to the situation with the baths or to take alternative The Old Rectory DS0000017974.V341370.R01.S.doc Version 5.2 Page 19 action when remedial work was delayed and that this led to the welfare of people living at the home being compromised. Following an allegation that a member of night staff smelt of drink and was not providing appropriate levels of support to people living at the home, the home took appropriate action by informing Social Services and suspending the person, pending the outcome of investigations. The matter had not been resolved at the time of writing this report. Staff covered the protection of vulnerable adults as a part of their core training. Discussions with staff throughout the inspection showed that they were keen to promote the welfare of people living at the home and that they were frustrated by their own limitations and lack of resources. This inspection identified that people were sometimes at risk through the unavailability of staff and suitable equipment. The inspector received mostly positive comments from people living at the home about the attitude of staff and the way they were treated. For example, one person said that staff were cheerful and all very nice. However, people also showed awareness of how busy staff were all the time and one said that, because of this, residents needed broad shoulders and couldn’t be sensitive. They also said they would like to be more independent in some ways but staff did not have time to promote this. The Old Rectory DS0000017974.V341370.R01.S.doc Version 5.2 Page 20 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, 20, 21, 22 and 26 People who use this service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The number of ancillary and maintenance staff employed at the home was insufficient to keep the premises safe and clean. People living at the home lacked suitable bathing facilities. EVIDENCE: The maintenance person was responsible for general inside and outside maintenance, which included small decorating tasks in the winter and gardening in the summer as well as routine daily, weekly and monthly checks. The garden was extensive and well established with plenty of seating in different spots. It was in need of considerable attention but the maintenance person said they would undertake the work. It was evident that, with one The Old Rectory DS0000017974.V341370.R01.S.doc Version 5.2 Page 21 person responsible for such a wide range of tasks, things had to be prioritised and take their turn. Information from the Commission’s survey indicated that the garden had been neglected for some time and that people had been told this was due to insufficient money in the budget to employ a gardener. A report from the environmental health officer in April 2007 indicated that the home was shabby and showed a lack of maintenance. This was confirmed during a tour of premises. A number of parts of the home needed decorating and refurbishment including communal areas, such as the dining room adjoining the kitchen, bathrooms and toilets. Some of this work was urgent, especially where cracked and stained walls and ceilings in bathrooms and toilets presented a health hazard. A person, who had an en suite toilet with a curtain instead of a door, was also using the hand basin in a bathroom, which, among others, needed to be cleared of storage and decorated. Some furniture needed cleaning or replacing, including armchairs in the lounge nearest the kitchen. Staff reported that they still had no working bathrooms or showers for 49 residents. They indicated that the showers had presented a problem when they were working because the personal protective clothing provided was inadequate to avoid them getting drenched. The manager said they had only been completely without baths and showers for 2 weeks. The environmental health officer reported on 24/04/07 that there was only one assisted bath in use but problems with bathing facilities predated the last inspection and the situation has led to several recent complaints and negative comment from respondents to the Commission’s postal survey of relatives’ views. One respondent said that people had not had hot water for baths since Christmas. Several people indicated that they would like to spend time in the garden. However, only the main entrance to the home was accessible but, given the size of the home, this was some distance from other parts of the building. One person, seated near to one of the home’s other exits, said they would like to go outside but could not manage the doorsteps. A relatively newly created quiet lounge was available for people who wished to read or listen to the radio or spend time with their visitors. People were positive about their individual accommodation and the rooms inspected were suitably furnished, homely and personalised although some would benefit from redecoration. One person did not have anywhere in their room to secure their belongings and dealt with this by ‘keeping their eye on things’. Two people had problems with their mattresses and the home replaced them. However, in one case, the home should have been more proactive in dealing with the protruding spring. The Old Rectory DS0000017974.V341370.R01.S.doc Version 5.2 Page 22 The environmental health officer had identified toilets that were smelly. The home was adequately clean in most areas inspected on 23/05/07, although shortfalls were noted in respect of kitchen ovens, the dining table in the middle lounge (table cloth covered in crumbs before lunch was served) and armchairs in the dining room. No unpleasant odours were noted. Domestic staff indicated that they found it difficult between them to maintain more than adequate standards of cleanliness in the home. They felt the home needed more cleaners and that existing domestic staff should not to be diverted from cleaning to help with other tasks, such as serving meals. They also felt the home would be easier to keep clean if it were in better decorative order. The laundry was fit for purpose, with suitable floor, walls and machines. The laundry assistant described appropriate handling of soiled linen. Paper hand towels and liquid soap were provided in bathrooms and bedrooms with instructions for washing hands to avoid infection. The Old Rectory DS0000017974.V341370.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 and 30 People who use this service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home were safeguarded by the process for recruiting and training staff but the quality of their lives and their safety were compromised by insufficient numbers of care and ancillary staff and low staff morale. EVIDENCE: The home had 49 residents out of a possible 55. They were no longer using the top floor rooms, due to difficulties with access. The operations manager for Southern Cross said that staffing levels had been calculated using Residential Forum guidance and that they were providing more than the recommended number of staff. A number of staff said that 6 care assistants and 2 seniors (at best) was not enough staff to provide people with the necessary support and that sometimes they had as few as 4 care assistants. This was concerning, particularly as, according to information provided by the home, 23 out of the current 49 residents, needed two staff to support them with care. Staff indicated that seniors tended to be busy with paperwork much of the time, so that in effect it was the care assistants, who provided the direct care and support. The Old Rectory DS0000017974.V341370.R01.S.doc Version 5.2 Page 24 The staff roster for the week beginning 14/05/07 showed that the above ratios were being maintained most of the time but that the home was relying heavily on agency staff. In the week beginning 14/05 the home had used agency staff 40 times to cover shifts, and the night shifts had been exclusively or three quarters covered by agency staff. Established staff acknowledged that they could not manage without agency cover but indicated that it was not equal to having people who knew the home and residents well and they also had to spend time showing agency staff what to do. Existing arrangements did not allow for extra staff at peak times, such as when people were getting up or at lunchtime. The pressures on staff and negative effect on people living at the home were observed over the lunch period when call bells continued ringing and there were not enough staff (5 care assistants) to attend to people in the 4 dining areas as well those, who remained in their rooms. Another indication of low staffing levels was a person lying on a bare mattress because staff had not had time to make the bed. Another person living at the home commented that staff were ‘lax on bed making’. The inspector went several times to the lounge in the dementia area to find it unstaffed. One person said they were uncomfortable in their wheelchair and waiting for someone to help them transfer to an armchair. Staff acknowledged that there was only one person on duty on the lower floor and they were waiting for assistance from staff elsewhere. (Senior staff said they had been unable to get cover through the agency or from other Southern Cross homes.) One person, on the morning shift, having to manage the hoist single handed, was clearly rushed and flustered and although they spoke kindly to the person they were helping, did not talk them through the process or do all that was necessary to promote their dignity. Another member of staff, found in tears, explained that they were having to go in search of a working hoist, moving hoists between floors, as needed, and they were unable to apply moving and handling guidelines because there were not enough staff to work the hoists in pairs. Care staff spoke about the numbers of lone residents in the home, who needed time that staff did not have to give. Others said things like, ‘It is so hard working here’; ‘We don’t have enough time to spend with residents’; Staff spoke of having to reduce their hours as they couldn’t keep up the pace or having to take time off sick to recover from exhaustion. People living at the home were aware of how busy staff were all the time and one said that because of this people couldn’t be sensitive, they needed broad shoulders. They also said they would like to be more independent in some ways but staff did not have time to promote this. The Old Rectory DS0000017974.V341370.R01.S.doc Version 5.2 Page 25 People living at the home, and their relatives commented on the low staffing levels and high staff turnover. One person said this particularly affected people with dementia. A person living at the home wrote on their survey that it was ‘Sometimes difficult to get staff to attend (their) room during the day’ with ‘delays sometimes up to 30 minutes’. Another wrote, ‘More staff needed, as current staff always seem to be run ragged.’ Staff said that staff did not stay because it was a large home and work was hard. They indicated that problems with staffing had worsened in the last couple of months having an impact on staff morale and the former happy atmosphere in the home. Rosters of domestics, cook, kitchen and laundry assistants showed a variation from day to day which would impact on the amount of work each was required to do and the extra responsibilities of care staff. The roster for ancillary staff for the week beginning 14/05/07 showed that the number of domestic staff ranged from 2 to 5, laundry staff from 0 to 1, kitchen staff 2 to 3. On 15/5/07 there were 3 domestics and 2 kitchen assistants only (no chef, no laundry personnel). Ancillary staff (domestic and laundry assistants) indicated that they were not able to do their jobs as well as they would like, or take pride in their work, because low staffing levels meant they had too much to do in the time. They mentioned the difficulties of keeping areas that needed refurbishment looking clean and the loss of time when they were taken off domestic duties to help with breakfasts. They spoke of insufficient hours to handle all the laundry, ironing, pressing and delivery of clothes to people’s rooms. They made comments like, ‘We are pushed to the limit’; ‘I have applied for another job’; ‘Everyone is so stressed’. Three staff files were sampled, one for a person who had been recruited since the last inspection. Records showed a robust recruitment process with all the required documentation in place. Initial in house training included they key health and safety topics and protection of vulnerable adults and there was some evidence that learning was assessed. Records for one person showed that their induction was delivered in a short space of time and not extended over a period of 6 weeks. This suggested that it would not have been covered in sufficient depth. The inspector was advised that Southern Cross was revising the induction training in line with Skills for Care programme. Staff were not wearing identity badges and this included agency staff. This meant that people did not necessarily have the assurance of knowing who was caring for them or a name, if they wished to make a complaint. The home maintained a computerised matrix to keep track of individual progress with health and safety and safeguarding adults training. Colour coding of the data made it easy to identify when refresher training was due. The manager and deputy manager stated that 75 staff had completed dementia training and all staff would attend a further 2-day course run by the The Old Rectory DS0000017974.V341370.R01.S.doc Version 5.2 Page 26 Alzheimers Society. Staff who spoke about training said they thought the opportunities were good. The number of people with National Vocational Qualification in care, Level 2, was not verified on this occasion but, at the last inspection, the home was on course to exceeding the required ratio of trained staff. The Old Rectory DS0000017974.V341370.R01.S.doc Version 5.2 Page 27 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, 33, 35 and 38 People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The absence of the manager had impacted negatively on outcomes for people living and working at The Old Rectory. EVIDENCE: The manager had been deployed to help out at another Southern Cross home, leaving the deputy manager in charge. The administrator had also taken on additional tasks. Staff indicated that the removal of their manager to help out other homes and the increasing use of agency staff had impacted negatively on the quality of The Old Rectory DS0000017974.V341370.R01.S.doc Version 5.2 Page 28 service and staff morale. Information from the Commission’s postal survey showed that people felt there was a noticeable drop in standards when the manager was seconded to another home. The inspector also identified shortfalls arising from management being under pressure. These have been covered elsewhere in the report but, in summary, complications with people’s medication, the lack of working baths and other resources such as towels, flannels and drinking glasses might have been resolved sooner had the manager been available to attend to them. The manager said that standard Southern Cross surveys of satisfaction had been distributed during the week before this site visit. She had collated and followed up by phone or letter all the issues identified by last year’s survey. She spoke about proposed weekly surgeries for residents, relatives and representatives to supplement existing periodic residents’ meetings. Records and discussions showed that the home also held regular staff meetings. Staff indicated that some of the issues they had raised had not been resolved. However, management’s initial responses to the findings of this inspection have been encouraging. The Old Rectory did not take responsibility for people’s financial affairs; this was left to them or their families and representatives. The person in charge of arrangements for the safekeeping of small amounts of personal money said it was policy not to hold in the home more than £40 for any one person. Any money in excess of this was transferred to a general (no interest) account. All transactions were recorded, countersigned, reconciled following every visit to the bank and audited once a month by the manager or deputy manager. Copies of the transaction records were sent to families on request or if the home asked for additional money to pay incidental expenses. Records, receipts and the balance of money held in the safe tracked for one person were in order. This inspection found that shortages of staff and sound working hoists compromised the health and safety of people living and working at the home and led to breaches of various health and safety legislation including the Manual Handling Operations Regulations 1992 and Provision and Use of Work Equipment Regulations 1992. The Old Rectory DS0000017974.V341370.R01.S.doc Version 5.2 Page 29 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X 1 1 X X X 3 STAFFING Standard No Score 27 1 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 The Old Rectory DS0000017974.V341370.R01.S.doc Version 5.2 Page 30 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 OP3 Regulation 14 Requirement People must have their needs assessed prior to admission to the home and receive confirmation in writing that their needs can be met. All necessary action must be taken by the home, if delivery of people’s medication is delayed. The cracked/holed bath on the ground floor must be repaired and made fit for use. This requirement has exceeded timescales agreed following the last inspection. People living at the home must have suitable and adequate facilities for bathing or showering, with hot and cold water. The home must have sufficient working hoists for the safe moving and handling of people who need them. The premises and gardens must be appropriately maintained for the wellbeing and safety of people living at The Old Rectory. The home must have sufficient numbers of care and ancillary DS0000017974.V341370.R01.S.doc Timescale for action 30/06/07 2. 3. OP9 OP19 OP21 13 (2) 23 (2) 28/05/07 07/06/07 4. OP10 OP22 OP38 OP19 13 (5) 28/05/07 5. 23 (2) 31/08/07 6. OP27 OP15 OP18OP38 18 (1) 28/05/07 The Old Rectory Version 5.2 Page 31 staff to meet the needs of people living there and keep them safe. 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 OP7 OP12 OP15 Good Practice Recommendations Care plans should be developed in respect of people’s interests and how they would like to spend each day. Records of food provided should be developed to show what each person has eaten. People should not have their main meals too close together as this can lead to reduced intake and malnutrition. The manager should be fully employed at The Old Rectory promoting good outcomes for the people living there. 3. OP31 OP33 The Old Rectory DS0000017974.V341370.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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. Extracts may not be used or reproduced without the express permission of CSCI The Old Rectory DS0000017974.V341370.R01.S.doc Version 5.2 Page 33 - 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!