Inspection on 28/04/08 for The Suffolk Private Retirement Home

This inspection was carried out on 28th April 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Suffolk Private Retirement... 01/07/09

The Suffolk Private Retirement... 01/10/08

The Suffolk Private Retirement... 30/04/07

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

CARE HOMES FOR OLDER PEOPLE The Suffolk Private Retirement Home 9 Sea Road Felixstowe Suffolk IP11 8BB Lead Inspector Julie Small Unannounced Inspection 28th April 2008 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 Suffolk Private Retirement Home DS0000068303.V363266.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 Suffolk Private Retirement Home DS0000068303.V363266.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Suffolk Private Retirement Home Address 9 Sea Road Felixstowe Suffolk IP11 8BB 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) 01394 282972 01394 274485 traceybright@btconnect.com SJR Care Limited Mrs Tracey Bright Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (23) of places The Suffolk Private Retirement Home DS0000068303.V363266.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th April 2007 Brief Description of the Service: Suffolk Private Retirement Home is a care home for older people. The home is located on the sea front at Felixstowe. It can accommodate up to a maximum of 23 older persons. The home has no garden area for recreational purposes, but there is a small paved area immediately outside the front door, where service users sit in fine weather. Immediately opposite is the sea front, which includes an esplanade, seating, and gardens. The home is spread out over five floor levels - a basement comprising laundry, staff area, and storage. The ground floor comprises of a kitchen, 2 lounges, dining room, 2 toilets, and a small office. A further three floors have bedrooms, bathrooms, toilets, a sluice room, and the Manager’s office. Either staircases, or a shaft lift accesses the floors above ground floor level. Details of current fees were noted from the Service Users Guide and ranged from £341 to £420 per week. The Suffolk Private Retirement Home DS0000068303.V363266.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. The unannounced inspection took place on Monday 28th April 2008 from 09.30 to 19.20. The inspection was a key inspection, which focused on the core standards relating to older people and was undertaken by regulatory inspector Julie Small. The report has been written using accumulated evidence gained prior to and during the inspection. The provider was present for part of the inspection. During the inspection three staff recruitment records, training records, the care plans of five people who lived at the home and accident records were viewed. Further records viewed are detailed in the main body of this report. Three staff members, one visitor and eight people who lived at the home were spoken with. Prior to the inspection an Annual Quality Assurance Assessment (AQAA) was sent to the home and was returned to us. Relative, staff and service user surveys were sent to the home to provide people with an opportunity to share their views about the service. Five service user and two staff surveys were returned to us and a letter was received from an unspecified number of staff members the day after the inspection. What the service does well: What has improved since the last inspection? The Service User’s Guide had been amended and included information about the fees of the home and how people would be asked to pay them, to ensure that people knew what they were expected to pay. Eight staff members had been provided with risk assessment training, which supported the safety of people living at the home. The Suffolk Private Retirement Home DS0000068303.V363266.R01.S.doc Version 5.2 Page 6 There had been some environmental improvements made since the last inspection, which provided an improved environment for people to live in. Some toilets had been redecorated and there were plans to redecorate all of the toilets and bathrooms in the home. All toilets had working locks and new toilet seats, which had met with requirements made at the last inspection. The kitchen had been refurbished. It was noted that fire doors were not wedged open during the inspection, which ensure people’s safety in case of a fire. What they could do better: A requirement was made at the previous inspection that checks of the fire alarm systems must be carried out to ensure that the environment was safe for people living in it. Weekly fire safety checks had been undertaken following the last inspection until 29th February 2008, however there had then not been a fire safety check made until 21st April 2008. An immediate requirement letter was sent to the home following the inspection. Enforcement action will be considered if the issue is not rectified. A requirement was made during the last inspection that staffing levels must be reviewed to ensure that they have sufficient staff throughout the 24 hour period to meet people’s physical and social care needs. The provider stated that they had addressed the issue. There had been recent safeguarding referrals leading to several staff members being suspended from the home, which resulted in changes in staffing levels. Agency staff were being used to ensure that adequate care staff numbers were available in the home, which was two care staff on duty at all times to support the twenty people who lived at the home. However, staffing levels were not sufficient to ensure that sufficient stimulating activities were available for people to take part in. Staffing levels should be adequate to support people in their chosen activities. There was also insufficient domestic staff cover to ensure that the home be effectively cleaned throughout the week. Evidence was not available during the inspection to show that people were protected by the home’s recruitment procedures. Evidence that satisfactory Criminal Records Bureau (CRB) checks had been undertaken, were not available in the home for inspection of two of the three staff recruitment records viewed. An immediate requirement was sent to the home following the inspection and evidence of the CRB checks was forwarded to us the following day. One staff member had a CRB check from another place of employment, we were informed that they would not be working at the home until they had obtained a satisfactory CRB check for Suffolk Private Retirement Home. People cannot be assured that they are protected by staff acting appropriately on safeguarding concerns and that notifiable incidents are routinely forwarded to the Commission for Social Care Inspection (CSCI). It had recently come to our notice, from social care safeguarding referrals, that two incidents had The Suffolk Private Retirement Home DS0000068303.V363266.R01.S.doc Version 5.2 Page 7 occurred, since the last inspection, which warranted safeguarding referrals. The referrals were not made and we had not received notifications of the incidents. At the time of the inspection the local authority safeguarding department was making investigations into the issues. The issues could not be checked fully during the inspection due to the manager being absent from the home. The home’s policies and procedures were dated 2005, they needed updating to ensure that staff were provided with up to date information about their roles, responsibilities and meeting the needs of people living at the home. Care plans would benefit from increased detail to ensure that staff are aware of how to meet people’s individual needs, such as the support that they required when bathing and if they need support with changing incontinence pads. A person who lived at the home was spoken with and it was noted that their spectacles were very dirty, staff should be made aware of how to ensure that people’s needs are met. There were several environmental issues that needed attention to ensure that people were provided with a safe, clean and hygienic home to live in. It was noted that there was an offensive smell on the top floor of the home, a person’s bedroom was noted to be in need of refurbishment, the fence at the front of the home was damaged, there was plaster at the entrance to the home that was flaking, the medication room was dirty and the desk was unsteady and the window frames on the top floor were rotten. Consideration should be made regarding the use of the two lounges on the ground floor, one was crowded and the larger of the two was used as a designated smoking room and installing a shower in the home to provide people with a choice of bathing facilities. Further details about the environment of the home can be found in the Environment section of this report. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Suffolk Private Retirement Home DS0000068303.V363266.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Suffolk Private Retirement Home DS0000068303.V363266.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect to be provided with information they need to make an informed choice about where to live and to be provided with a written statement of terms and conditions with the home. The home did not provide an intermediate care service. EVIDENCE: People were provided with detailed information about the home in the Statement of Purpose and Service User’s Guide, which explained the services that they could expect to enable them to make decisions about if the home was appropriate to meet their needs. The Statement of Purpose was viewed and included information such as aims and objectives and philosophy of the home, staffing, staff training, manager qualifications, details about the provider of the home, who the home provided The Suffolk Private Retirement Home DS0000068303.V363266.R01.S.doc Version 5.2 Page 10 a service for, admissions, arrangements in case of a fire, details about the rooms at the home and a summary of the complaints procedure, which included CSCI contact details, however, the CSCI details needed updating to reflect the address and telephone number changes. The Service User’s Guide was viewed and included details about the fees at the home and how people were expected to pay them, staffing, management and provider details, room sizes, quotes from people who lived at the home and a summary of the complaints procedure including CSCI details, which also needed updating to affect the address change. The service user survey asked if they had been provided with enough information about the home to help them to decide if it was the right place for them. Four answered yes and one answered no, and commented ‘had no other option’. The records of five people who lived at the home were viewed, which held needs assessments that had been undertaken prior to moving into the home. Each of the records included a care plan which identified how people’s assessed needs were met. The AQAA stated ‘We have a very comprehensive initial assessment, which incorporates many of the key factors, diet and weight, foot care, cultural beliefs and many more. We ensure that we are in touch with what the client wishes to receive in the way of care at the home and that we know their needs before they move into the home’. A copy of a written statement of terms and conditions of the home was in each person’s records that were viewed. The person and the home’s manager had signed the document. The service user survey asked if they were provided with a contract. Three answered yes and two answered no. The Suffolk Private Retirement Home DS0000068303.V363266.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People can expect to be treated with respect and to be protected by the home’s medication procedures. They cannot be assured to have their personal and health care needs fully identified or met. EVIDENCE: The care plans of five people who lived at the home were viewed, which included details of the support that they required to meet their needs, including communication, interests and support that they required in areas such as with personal care. However, they would benefit from increased detail, for example there were statements ‘assisted in and out of bath’ and ‘assistance to wash and get ready for bed’. The care plans did not detail the type of assistance that people required and if so what and areas that they could do for themselves, for example if people needed help with washing certain areas of their bodies and how they needed the assistance. The Suffolk Private Retirement Home DS0000068303.V363266.R01.S.doc Version 5.2 Page 12 The care plans were regularly updated to reflect people’s changing needs and the changes were recorded, such as changes in care due to a short-term illness. The records included risk assessments such as in areas of mobility, which identified the risks and methods of minimising the risks. Daily records were maintained, which identified the support that each person had been provided with during each shift. The staff survey asked if they were given up to date information about the needs of the people that they supported, one answered always and one answered usually. The service user survey asked if they received the care and support that they needed and three answered always and two answered usually. People could not be assured that their health care needs were met or that their dignity was respected. There had been two recent incidents where people had not been supported to change their incontinence pads, the care plans did identify that they used pads, however there were no details of support that they required with changing them. One person was not provided with drinks or food during the morning shift, this was discovered by afternoon staff that started their duty at 14.00pm. One incident resulted in medical treatment due to the state of their skin following their pad being left unchanged. An investigation was into the issues was being undertaken and this is further discussed in the ‘Protection’ section of this report. During a discussion with a person who lived at the home it was noted that their spectacles were very dirty. A staff member and the provider was spoken with about this and it was suggested that the support that people required, such as keeping spectacles clean could be included in their care plans, to ensure that people were supported in a manner that respected their dignity. A person spoken with said that they were supported to have a bath on a weekly basis, which they said that they were happy with and that they washed on a daily basis. They said that they were sure that if they asked for a bath more frequently that they would be supported to do so. Three people who lived at the home were spoken with and said that they bathed when they wanted to and that there were no times that they felt that they could not have a bath. A staff member was spoken with and confirmed that most people chose to bathe weekly, but would be supported if they wished to bathe more often. It was noted that not all people bathed as often as weekly from the care plans that were viewed, which recorded the dates that each person bathed. One person had a bath on a monthly basis, one person had bathed at one to two month intervals and one person had bathed between two week to two month intervals. A staff member spoken with said that people did not always want to bathe and were encouraged by staff to do so, it was suggested that the The Suffolk Private Retirement Home DS0000068303.V363266.R01.S.doc Version 5.2 Page 13 refusals be recorded to show that people were offered with the opportunity. Information regarding people’s preferences regarding the frequency of taking a bath was not included in the care plan. The provider was spoken with about the possibility of providing a shower in the home to ensure that people had a choice of washing facilities. One person spoken with stated ‘I’m sure everyone would like a shower’. There were details of when each person had received health care treatment, such as visits from the chiropodist, district nurse and doctor and weight checks were maintained in their individual records. The service user survey asked if they received the medical support that they needed and two answered always, two answered usually and one answered never. During the inspection the district matron for the area was observed visiting people in the home who needed medical support. It was noted during the inspection that people’s privacy was respected, staff were observed knocking on bedroom and bathroom doors and waiting to be invited in, before entering them. During the inspection staff were observed to be attentive to people’s needs and they were observed asking them if they would like drinks and if they were comfortable. People who lived at the home that were spoken with reported that the staff treated them well and always treated them with respect. The AQAA stated ‘We treat all clients with respect and dignity, we ensure they live their life the way they want to live it, we help clients feel that this is their home and ask them to treat it as such, we enable a person to make choices and respect their choices’. The storage and administration of medication was noted to safeguard people who lived at the home. Medication was stored securely in a medication trolley in MDS (monitored dosage system) blister packs. The outside of the trolley was sticky and would benefit from a good clean, to prevent the risks of cross infection. The lunchtime medication round was viewed and a staff member shadowed the person undertaking the administration of the medication. They explained that they were watching the day time medication procedures to ensure that they administered medication safely in the future. The medication administration records (MAR) were viewed and all medication was accounted for, records were signed when medication had been administered and codes indicated reasons for non administration, such as when the medication was refused and when the person was in hospital. At the last inspection it was noted that the manager was preparing photographs of each person who lived at the home to be included in the medication records, The Suffolk Private Retirement Home DS0000068303.V363266.R01.S.doc Version 5.2 Page 14 which was good practice. However, the photographs were not present during this inspection. Training records were viewed and evidenced that staff that were responsible for administering medication were provided with medication training. The Suffolk Private Retirement Home DS0000068303.V363266.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, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People can expect to be supported in maintaining contacts, to be supported to exercise choice and control over their lives and to be provided with a balanced diet. They cannot be assured that they will be provided with opportunities to participate in appropriate activities. EVIDENCE: Five people’s care plans were viewed, which included a record of what activities that they had participated in. The last inspection report identified that the provision of stimulating activities to people who lived at the home could be improved on. Since the last inspection there had been improvements in the provision of activities provided to people who lived at the home, which included bingo, games, manicures and quizzes on a regular basis. However, the frequency of the activities had lessened since January 2008. It was noted at this inspection that people were not provided with the opportunity to participate in stimulating activities. A staff member was spoken with regarding how people could be provided with materials and activities that were available from the local community services, such as libraries. The Suffolk Private Retirement Home DS0000068303.V363266.R01.S.doc Version 5.2 Page 16 During the inspection three people were observed to be sitting in their bedroom’s watching television of looking out of the window. The people that were using the communal areas were chatting, watching television or just sitting. One person went out to the shops during the inspection. People spoken with said that they played bingo at the home sometimes and that at other times they chatted to each other. One person said that they had suggested that they go out for a walk on the sea front and that they needed support to do so. They said that no one had got back to them about it. One person was spoken with who had eyesight loss, they said that they may be interested in obtaining ‘talking books’ but thought that they were only provided by the ‘blind home’, when they were asked about what types of activities they might enjoy. A person said that they enjoyed bingo and that they used to play it regularly but it had been reduced to playing it monthly because there was not enough staff. The service user survey asked if there were activities arranged by the home that they could take part in. Two answered always, two answered sometimes and one said that they did not participate in activities. A person spoke with said that there was a religious service at the home on a two weekly basis, which they attended and enjoyed. A person’s care plan was viewed and evidenced that a friend took the person to church every Sunday. People spoken with said that they always chose what they wanted to do in their lives. The AQAA stated ‘We incorporate many activities in the day to day routine of the home, we try to involve residents as much as possible and listen to their views on what they wish to be doing at the home’. It stated that they had improved in the last twelve months by providing ‘a staff member who has set hours for activities, there has been much more for the residents to do, we have a lot more activity wise going on the home’. A staff member was spoken with and reported that they had previously been responsible for organising activities but had to spend more time providing care. Care plans included information of contacts with family members and friends that people maintained. People spoken with said that family members visited regularly and that they were welcomed into the home by staff, who always offered them a drink. There was an area between the kitchen and the dining room where people who lived at the home and their guests could make drinks. There were bowls of fresh fruit in the home, which people could help themselves to, a staff member said that the bowls were refilled every other day. In the kitchen there was a good range of fresh vegetables. We had recently been informed that the food quality at the home had deteriorated and that frozen food, rather than fresh food was provided. A staff member reported The Suffolk Private Retirement Home DS0000068303.V363266.R01.S.doc Version 5.2 Page 17 that they had been shopping and bought lots of fresh vegetables and that at least two fresh vegetables would be provided each day. The menu was viewed, which listed what each person had eaten each day, which was either the main meal or an alternative choice, such as salad, omelette or soup. The menu book did not always clearly identify what was provided, such as ‘roast beef’ or ‘a roast’ was listed as the main meal. It was recommended that the accompaniments and vegetables be included in the menu book to ensure that people were provided with a balanced diet. People who lived at the home who were spoken with said that they enjoyed the food and that they had enough to eat. They said that they could choose what they wanted to eat and always had a choice of a cooked breakfast. One person said that the meat was hard to chew and cut during the previous days meal. One person said that the meals were not as good as they used to be and they said that the cook that they had a year ago was very good and that they had ‘spoiled them’. The service user survey asked if people enjoyed the meals provided by the home, two answered always, one answered usually and two answered sometimes. Comments included ‘dinners are not what they used to be’, prefer traditional meals instead of tinned or frozen food’, ‘very good meals’, ‘would like fresh meals’ and ‘find the meat not cooked enough in meals’. Lunch time was observed to be calm and well organised. Before lunch, tables were laid with paper napkins, cutlery, a choice of cold drinks and salt and pepper. People were observed to sit where they chose to and staff checked that they were happy with their choice of meal. The cook during the inspection was a carer who had agreed to go into work to undertake cooking duties for the day. The meal was homemade cottage pie and fresh cauliflower and banana custard for desert. Some people had chosen soup as an alternative. People said that they had enjoyed their meal. The AQAA stated that they had listened to people’s views about the provision of meals in the home and that they had made changes to the menu. The Suffolk Private Retirement Home DS0000068303.V363266.R01.S.doc Version 5.2 Page 18 The Suffolk Private Retirement Home DS0000068303.V363266.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People can expect to have their complaints listened to and acted upon. They cannot be assured that they will be protected from abuse. EVIDENCE: The home had a detailed complaints procedure, which provided contact details of CSCI and what people could expect when they made a complaint. A summary of the complaints procedure was included in the Statement of Purpose and Service User’s Guide for the attention of people who used the service. The contact details for CSCI needed updating to reflect our change of address. The complaints book was viewed and evidenced that complaints and concerns were resolved in a timely manner. One complaint had been made about the unacceptable state of one person’s bedroom, the records did identify actions that had been taken but did not identify who the complaint had been received from and how they had been informed of the actions taken as a result of their complaint. The AQAA stated ‘We deal with complaints quickly and appropriately’. It stated that there had been two complaints received since the last inspection and that both had been resolved within twenty eight days. The Suffolk Private Retirement Home DS0000068303.V363266.R01.S.doc Version 5.2 Page 20 Two staff surveys said that they knew what to do if a resident, relative, advocate or friend had concerns about the home. The service user survey asked if they knew how to make a complaint, four answered yes and one answered no. People who lived at the home that were spoken with all said that they knew how to make a complaint if they were unhappy about the service that they were provided with. Staff were informed of their responsibilities in safeguarding adults who lived at the home. The local authority guidance for safeguarding adults was present in the home for the attention of staff. Training records viewed evidenced that staff were provided with safeguarding of adults training during their induction and a staff member explained that they were provided with training from a training video. Staff records viewed included questionnaires on safeguarding, and they had answered the questions, such as what they would do if they had a concern about a person’s safety. A staff member spoken with said that they were aware of the actions that they should take if they were concerned about the safety of people, they had a clear understanding of the whistle blowing procedures. Safeguarding procedures were viewed and clearly evidenced actions that should be taken and incidents that should be reported. Safeguarding referrals made to social care and to CSCI had resulted in the suspension of the manager and the deputy manager, pending further investigations, which were to be undertaken by the provider. Further information received by CSCI identified concerns that confidentiality regarding the investigations was not being maintained. The provider was spoken with about the need for confidentiality to be maintained. They said that the staff were aware of the confidentiality procedures. Recent safeguarding issues showed that incidents were not appropriately investigated, recorded and reported by staff at the home. There were two issues of neglect that had recently been reported to social care safeguarding that had occurred in the home February and March 2008. The safeguarding referrals received included two people who lived at the home that had not been supported to change their incontinence pads, one resulting in medical treatment. One of the people had not been provided with food and drink during the morning shift. The daily records for the incidents were viewed and clearly showed how a staff member had discovered the incidents. There were records of how the Registered Manager had investigated one of the incidents in the complaints book. The records stated that there had been a safeguarding referral made. However, no safeguarding referrals were made and the incidents had not been reported to CSCI, which is set down in Regulation 37 notifiable incidents. Records of an investigation into the other incident could not be found during the investigation. However, copies of letters to a staff member who had been on duty during one of the incidents were found in their personal records. One staff member who had been working during the both incidents had been dismissed, again no information about the incident had been submitted to CSCI or to the local authority safeguarding team. The Suffolk Private Retirement Home DS0000068303.V363266.R01.S.doc Version 5.2 Page 21 The care plans of the two people that were involved in the incidents were viewed and there had been no amendments to the care plans since the concerns were identified to ensure that they are not subject to similar incidents in the future. The Suffolk Private Retirement Home DS0000068303.V363266.R01.S.doc Version 5.2 Page 22 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, 24, 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People cannot be assured to be provided with a safe, hygienic, well maintained and pleasant environment. EVIDENCE: A tour of the building was undertaken and it was noted that the home was in need of some improvement to ensure that people were provided with a homely, safe and well maintained environment. There had been some improvements since the last inspection, which included the refurbishment of toilets, bathrooms and the kitchen. The kitchen had been refurbished and was noted to be clean. A letter had been received from ‘staff’ at the home that stated that the floor in the kitchen was slippery when wet, however, the letter had been received the day after the inspection and this was not checked during the inspection. There had been work to improve the quality of the bathrooms The Suffolk Private Retirement Home DS0000068303.V363266.R01.S.doc Version 5.2 Page 23 and lavatories, some of which had been entirely refurbished, including new toilets, sinks and tiles, and the others were due to be refurbished. The home did not provide a shower facility to provide people with a choice of bathing methods. Four people were visited in their bedrooms, all people spoken with said that they were happy with their bedrooms. Three people’s rooms contained their personal memorabilia, such as photographs and ornaments. The AQAA stated ‘The rooms are homely, warm and comfortable, they are personal to the resident and we like them to have their own belongings in their environment, and we encourage this’ and ‘we have had many rooms redecorated and carpeted, to make them more relaxing and comfortable’. It was noted that in two of the bedrooms, there was a chair provided for the person, and no seating, other than the bed for visitors to use. One person offered that the inspector could either sit on their bed or on their commode, they said that the family member always sat on their commode when they visited. One person’s bin was overflowing and had rubbish on the floor around where the bin was, this was emptied during the day as the domestic staff member undertook their duties. Another person’s bin was also full, which was emptied during the day, and they said that they thought that the domestic staff had been off work and that no one had emptied their bin. They said that the domestic did a ‘very good job’ when they were on duty, but that they did not work every day. One bedroom was in need of refurbishment, to ensure that the person was provided with a comfortable and clean bedroom that met their needs. However, the person said that they were happy in their bedroom. A new hand wash basin had been installed, which left the larger shape in the room’s decoration of the previous sink. There had been reports made to CSCI from visitors to the home that the towel rail had been used by the person to pull themselves up from the bed and that it was coming away from the wall. The towel rail had been removed and there had been no grab rail installed to support the person. The carpet was dirty, a staff member said that a new carpet was to be delivered the week after the inspection. There had been reports that the mattress on the bed was stained and dirty, this was not checked because the person was in the room and they said that they were happy with their room and that the person and a staff member said that a new bed was to be delivered the following week. A staff member said that the mattress ‘sagged’ in the middle and that a new bed had previously been ordered, but the order had been cancelled by the manager, they did not know the reasons for this. There was an offensive smell in the room and on the landing near to the room. The provider reported that the staff had done their best to minimise the smell and would continue to do so. The window frames in the bedroom and in the next bedroom were rotten, and the glass was loose when touched. The Suffolk Private Retirement Home DS0000068303.V363266.R01.S.doc Version 5.2 Page 24 Visiting health professionals had reported that there were bedrooms of a similar standard that people were accommodated in, which included stained mattresses and no headboard on beds. Bedrooms must be maintained to the standards identified in the National Minimum Standards relating to older people to ensure that people are provided with a safe and homely environment. It was noted that the communal areas on the ground floor of the home were ‘tired’ and in need of some attention. The dining area was provided with sufficient seating for people to enjoy their meals, a staff member reported that the room was due to be redecorated. There were two lounges that were available for people to use. There were eleven people sitting in the front lounge, which was at the front of the home, it was crowded and consisted of a television set and seating. The lounge was in an L shape with a bay window and due to the shape of the home the television set and window could not be seen from some areas of the room. The second larger lounge was to the side of the home, and three people were observed to be using the lounge at different times throughout the day. The room was the designated area for smoking for people who lived at the home. However, a staff member reported that there was only one person who smoked. The lounge door was open throughout the inspection and the medical room was accessed through the lounge. The smell of smoke was present in the entrance area to the home and in the medical room, which could be of some effect to those who did not smoke. The provider was spoken with about the designated smoking area and the use of communal areas. They said that people had been provided with the opportunity to change the lounges, but people had said that they preferred to sit at the front of the home to allow them to look out of the window. There had been previous concerns from visiting professionals about staff smoking in the basement area of the home. Staff were no longer permitted to smoke anywhere inside the building. The medical room was in need of some attention with regards to cleaning and ensuring that the furniture was safe to use. It had not been cleaned and vacuumed for some time. The carpet was littered, the medication trolley and the table were sticky. There was a bin bag inside the door, which was full. The bin bag had a hole in it and the waste inside was empty packaging and used disposable gloves. A staff member was spoken with about the bin bag and the possibility of cross infection, the bag was removed immediately. The desk in the medical room was unsteady and could be rocked from side to side. There was a toilet next to the medical room, which had a dirty sink and the hand wash liquid bottle was dirty and the contents had dripped onto the bottle. At the front entrance to the home, it was noted that the ceiling plaster was flaking. A staff member said that there had been quotes obtained to undertake the repairs, which had occurred by a flood of water from the room above. The fence around the front of the home was damaged and some parts were removed completely and were leaning against the wall. A staff member said The Suffolk Private Retirement Home DS0000068303.V363266.R01.S.doc Version 5.2 Page 25 that quotes had been obtained to repair the fence, which had been blown down by the wind. The provider confirmed that the fence would be repaired. There was garden furniture at the front of the home, where people could sit if they chose to. People spoken with said that the home was comfortable and clean. The service user survey asked if the home was fresh and clean. Two answered always and three answered usually. The laundry was viewed, which was in the basement of the home. The laundry was large and had a large washing machine that provided a sluice facility and a drying machine. There was no hand washing facilities provided in the laundry, a staff member said that there were gloves and aprons provided and that they washed their hands on the ground floor of the home. There were some risks of cross infection. On entry to the basement it was noted that a small amount of dirty laundry was scattered on the stairs, a staff member got some gloves and removed the items immediately. Staff were observed using infection control procedures during the inspection, which included washing their hands and wearing protective clothing when working with food, which protected people from cross infection. The Suffolk Private Retirement Home DS0000068303.V363266.R01.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People can expect to have their needs met by staff that are trained and qualified to do their jobs. They cannot be assured that to have their needs met by the numbers and skill mix of staff and to be protected by the home’s recruitment policy and practices. EVIDENCE: Three staff recruitment records were viewed and contained documents that included their work history, identification and two written references. At the last inspection the manager had reported that they would include photographs of staff in the recruitment records. This had not been done, however, there were copies of their driving licence and passport, which held their photograph. The recruitment records did not hold evidence that satisfactory CRB checks had been undertaken by the home. A staff member located six CRB documents in a drawer, all of which were viewed. One of the CRB checks was for one of the staff whose recruitment records that were viewed. One of the checks had been undertaken at another work place in 2005. A staff member spoken with explained that a CRB check and POVA (protection of vulnerable adults) first check would be applied for and the person would not work at the home until The Suffolk Private Retirement Home DS0000068303.V363266.R01.S.doc Version 5.2 Page 27 satisfactory checks had been received. They were aware that the person could work supervised in the home when a POVA first check had been received. An immediate requirement letter was sent to the home stating that evidence of CRB checks must be maintained at the home to evidence that people were protected by the home’s recruitment procedures. A fax of the reference numbers and dates of issue of the two CRB checks that were not seen during the inspection was forwarded to us the following day. The provider was spoken with and said that they thought that the evidence had been included in the recruitment records and that they would ensure that was done as soon as possible. Two staff surveys stated that their employer had carried out checks such as CRB and references before they started work at the home. A requirement from the last inspection was that the home reviewed the staffing levels, and skill mix, to ensure that they have sufficient staff on throughout the 24 hour period to meet people’s physical and social care needs. The improvement plan stated ‘they have been reviewed and we are continuing to ensure we have sufficient staff with required skill level’. The staff rota was viewed and there was two staff members working on each shift. The provider was spoken with and they said that they thought that the staffing levels were appropriate to meet the needs of people, which was one staff member to ten people. Since the last inspection the manager, one of the two cooks and the deputy manager had been suspended, which increased the pressure of staffing at the home. The provider said that they had advertised for care and kitchen staff, that staffing levels were maintained by the use of agency staff and a prospective night staff carer was interviewed on the day of the inspection. It was noted that there was not a designated staff member to ensure that people were provided with stimulating activities. If people wished to go out, there would not be sufficient staff to provide support out of the home and if care staff would be required to administer medication then one staff member would be available to support people. During the inspection the acting manager administered the medication and was shadowed by a carer. There was one domestic staff member that worked four days a week, the provider was asked to consider providing increased domestic hours to ensure that the home was kept appropriately cleaned throughout the week. People who lived at the home that were spoken with said that they felt that there was sufficient staff on duty to meet their needs and they said that staff responded promptly when they were called using their call bells. The service user survey asked if staff were available when they needed them. Three answered always, two answered usually and one commented ‘would like more attention’. The staff survey asked if there was enough staff to meet the individual needs of people. One answered always and one answered never and commented ‘for the amount of residents we have I feel that there is not enough staff on. At present we have two carers on between 7 – 2, we have two carers on between 2 – 9 and two night staff on between 9pm – 7am. We The Suffolk Private Retirement Home DS0000068303.V363266.R01.S.doc Version 5.2 Page 28 have 19 residents (there were 20 people who lived at the home during the inspection). I feel we cannot give the residents the time that they need’. Staff working at the time of the inspection were observed to be attentive to people’s needs and staff were respectful towards people’s wishes. They answered call bells promptly and when people asked for assistance, staff were observed to respond to their requests. People met during the inspection stated that they were mostly independent and needed help in areas such as getting in and out of the bath and with mobility outside of the home. One person was observed to have swollen feet and staff assisted them when they were moving from room to room in the home, by holding their arm when using their walking frame. Staff training records viewed showed that newly appointed staff were provided with an induction, which included the Common Induction Standards and the completion of an induction workbook, for which they received a certificate on completion. The staff survey asked if their induction covered everything they needed to know to do the job when they started and two answered very well. Training records of three staff were viewed and evidenced that staff had been provided with training courses which included moving and handling, food hygiene, risk assessment, first aid and medication. Training for safeguarding and fire safety was provided by ‘Regis ctv’ training videos. Two staff surveys said that they were provided with training that was relevant to their role, helped them to understand the individual needs of people and kept them up to date with new ways of working. However, staff may benefit from being provided with updated safeguarding training to ensure that people are protected from abuse. The AQAA stated ‘We have a good range of staff some NVQ trained, but all with the induction standards and the relevant qualifications to do their job well, they have a good knowledge of the job and work well at providing a good quality of care’. The AQAA stated that there were eight full time staff members, five had achieved a minimum of NVQ (National Vocational Qualification) level 2 and one was working on their award. The home had met the target identified in the National Minimum Standards relating to older people that 50 of staff to have achieved a minimum of NVQ level 2 by 2005. The Suffolk Private Retirement Home DS0000068303.V363266.R01.S.doc Version 5.2 Page 29 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, 36, 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People can expect to have their financial interests safeguarded. They cannot be assured the home to be managed by a person who is fit to be in charge, run in their best interests, to have their health, safety and welfare protected and to be supported by staff that are appropriately supervised. EVIDENCE: Following recent safeguarding referrals the manager and the deputy manager had been suspended regarding their fitness to work at the home, pending further investigations by the provider. During the inspection the home was managed by a senior care worker, who was undertaking managerial duties. They had completed an NVQ level 2 in care, however they did not have a The Suffolk Private Retirement Home DS0000068303.V363266.R01.S.doc Version 5.2 Page 30 management qualification or experience. The provider reported that they visited the home regularly and the acting manager stated that the provider was available for support when they needed it. The improvements that had been made by the manager are identified throughout this report, however there were areas when the management of the home had not been effective. Shortfalls in the management of the home are identified throughout this report in areas, such as Regulation 37 notifications had not been made, safeguarding referrals had not been made, staff were not provided with adequate supervision, the evidence of satisfactory CRB checks had not been maintained in staff recruitment records and things that they had said that they would do during the last inspection were not carried out, such as placing photographs of people on their medication records. The AQAA stated ‘Day to day running of the home is done to the best of the managers ability, residents are involved with many changes, the administration in the home is kept up to date recorded and kept in the appropriate place, all mandatory admin is up to date and fed back to the owner of the home’. The information provided in the AQAA was minimal and did not include information relating to all key standards for each outcome area. Regulation 26 visit reports were viewed and were undertaken on a monthly basis by the home’s provider. The Regulation 26 visits included the observation of records and running of the home and discussions with staff and people who lived at the home about the service. Satisfaction surveys about the quality of the food provided at the home that were completed by people who lived at the home were viewed. However, there was no further evidence of how the results for the surveys were used. There were no records available during the inspection that evidenced further quality assurance activities, such as the monitoring of the health and safety of the environment and the home’s record keeping. The home’s policies and procedures were viewed and they had not been updated since 2005. The provider was spoken with and said that they had started to update policies and procedures and they would be available in the home when they were completed. There had been some changes in the requirements of care since 2005 and they needed updating to ensure that staff were provided with adequate information about how they supported people who lived at the home. Staff were not appropriately supervised and supported in their work role to provide a service to people who lived at the home. Three staff records were viewed and they did not evidence that staff were provided with a minimum of six formal supervisions a year as identified in the National Minimum Standards relating to older people. One staff member had received a supervision November 2007, another had received a supervision April 2007 and the third staff member had been provided with supervisions September 2006, November The Suffolk Private Retirement Home DS0000068303.V363266.R01.S.doc Version 5.2 Page 31 2006, June 2007 and April 2008. It was stated in the investigation records identified in the protection section of this report, that staff had been advised about the support that should provide to people in a full team meeting February 2008, records of the meeting could not be located during the inspection. The AQAA stated that they had improved in the past twelve months by providing more frequent supervisions and that they planned to improve by providing staff appraisals. A staff member reported that people who lived at the home looked after their own finances. A person was spoken with and said that they kept their money in the lockable drawer in their bedroom and were happy with their financial arrangements. The health, safety and welfare of people who lived at the home were not fully promoted and protected. Health and safety records were viewed and evidenced that regular safety checks were routinely made, such as water temperature, fridge and freezer temperatures, food temperatures and electrical appliance safety. There was a first aid box in the kitchen area that was well stocked to ensure that the appropriate equipment was available in case of an accident. Fire safety records were viewed and evidenced that regular weekly fire safety checks had been made from the last inspection to February 2008, there was a further fire safety check made April 2008. The home had a fire risk assessment and a fire safety procedure. An immediate requirement was made following the inspection to ensure that people were adequately protected from fire and that fire safety checks were regularly undertaken. Staff training records that were viewed and discussions with staff showed that that they were provided with health and safety related training such as food hygiene and manual handling. The maintenance book was viewed, which evidenced repairs and refurbishments that had been undertaken at the home. There was no evidence of plans of how the home would be kept in good order or how regular health and safety checks were made of the environment. Further information regarding health and safety can be found in the environment section of this report. The home’s policies and procedures were viewed and included health and safety issues such as COSHH (control of substances hazardous to health, smoking, risk assessments, emergencies, first aid, alcohol and health and safety. All procedures were completed in 2005 and were in need of updating. The Suffolk Private Retirement Home DS0000068303.V363266.R01.S.doc Version 5.2 Page 32 The Suffolk Private Retirement Home DS0000068303.V363266.R01.S.doc Version 5.2 Page 33 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 3 3 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 1 1 3 X X 1 X 1 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 1 X 1 The Suffolk Private Retirement Home DS0000068303.V363266.R01.S.doc Version 5.2 Page 34 Are there any outstanding requirements from the last inspection? No 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 OP8 Regulation 12 (1)(a) 12 (4)(a) Requirement People’s health, dignity and welfare must be promoted in areas such as ensuring people are supported to change incontinence pads regularly and keeping their spectacles clean People must be protected from the spread of infection by ensuring that the home is appropriately cleaned and bins emptied People’s bedrooms must be maintained in good order, beds must be clean and suitable for people to sleep in and carpets must be clean Rotting window frames on the top floor at the front of the building must be made good People must be provided with stimulating activities and staff numbers must be available to support people in their chosen daily activities Notifiable incidents must be made routinely to CSCI Safeguarding referrals must be made, when the safety of people living at the home is DS0000068303.V363266.R01.S.doc Timescale for action 30/04/08 2. OP38 OP26 OP27 13(3) 18(1) 23(2)(d) 13(4) 16(2)(c) 23(2)(d) 13(4) 23(2)(b) 18 (1) 16(2)(n) 30/05/08 3. OP24 OP19 30/05/08 4 5 OP20 OP12 30/05/08 30/05/08 6 7 OP31 OP18 OP18 37 13(6) 30/04/08 30/04/08 The Suffolk Private Retirement Home Version 5.2 Page 35 8 OP29 19 schedule 2 9 10 11 OP38 OP26 OP26 23(4) 13(4) 16(2)(k) 13 compromised Evidence of satisfactory Criminal Records Bureau (CRB) checks must be kept in the home to evidence that people are protected by the home’s recruitment procedures. Fire safety checks must be regularly undertaken to ensure the safety of people in the home. Offensive odours must be eliminated Appropriate hand washing facilities must be made available to staff to prevent the risk of cross infection, when working in the laundry 28/04/08 28/04/08 30/04/08 30/05/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 Refer to Standard OP19 OP36 Good Practice Recommendations Consideration to be given to the provision of the designated smoking area and the effects that the smoke may have on non smokers Staff to be provided with regular formal supervision meetings to ensure that staff are appropriately supervised in their work role in meeting people’s needs The Suffolk Private Retirement Home DS0000068303.V363266.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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