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Inspection on 28/11/06 for Therese Care Home

Also see our care home review for Therese Care Home for more information

This inspection was carried out on 28th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 28 statutory requirements (actions the home must comply with) as a result of this inspection.

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

The home is bright and cheerful, clean and hygienic throughout making this comfortable for the residents. Feedback from two professionals is that the service is good.

What has improved since the last inspection?

At the previous inspection there had been ten areas where the home had to improve. The home has taken action on some of these areas that demonstrates some developments to the service. In particular, steps have been taken to address fire safety issues in the home.

CARE HOME ADULTS 18-65 Therese Care Home 144 Gassiot Road London SW17 8LE Lead Inspector Louise Phillips & Sandy Patrick Unannounced Inspection 28th November 2006 10:50a Therese Care Home DS0000010231.V321739.R02.S.doc Version 5.2 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 Therese Care Home DS0000010231.V321739.R02.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 Adults 18-65. 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. Therese Care Home DS0000010231.V321739.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Therese Care Home Address 144 Gassiot Road London SW17 8LE 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) 020 8767 5407 Ms Iolenta Castelino Ms Iolenta Castelino Care Home 3 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (3), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (1) Therese Care Home DS0000010231.V321739.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may provide accommodation and care for one named service user over the age of 65. The category MD(E) must be removed once this service user is no longer accommodated. 27th June 2006 Date of last inspection Brief Description of the Service: Therese Care Home accommodates three residents with a mental disorder. The home is a two-storey terrace house with a small garden to the front, and larger garden to the rear of the home. It is situated close to the busy shopping centre of Tooting Broadway and so within easy access of the public amenities and transport links served by the area. The home is owned and managed by Ms Iolenta Castelino, the Registered Person. Therese Care Home DS0000010231.V321739.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over one day and was carried out by two inspectors. A tour of the premises took place and care records were inspected along with other relevant paperwork. Time was spent talking to one staff member and one resident. The Registered Person was not present for the inspection. Information has also been gained from the inspection record for the home. Questionnaires were sent to four health and social care professionals, with responses received from two of these which have been referred to in the report. Two letters have been received in respect of the service. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Therese Care Home DS0000010231.V321739.R02.S.doc Version 5.2 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Therese Care Home DS0000010231.V321739.R02.S.doc Version 5.2 Page 7 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 5 Quality in this outcome area is poor. Information seen does not reflect the actual service provided and details regarding fees and what these include is not explicit. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a Statement of Purpose/ Service Users Guide that was looked at in detail during the inspection. The information contained states that residents are ‘enabled to do as much as they are able or want to do for themselves in all aspects of daily living eg. household tasks, shopping’; and that ‘the home helps residents to take reasonable and fully thought out risks’. It also contains an inspection report from June 2005. The findings of the inspection (as detailed throughout the report) do not correspond to the activities claimed in the Statement of Purpose and it is required that this is amended to reflect the actual in-house practice, and also include the most recent inspection report. A copy of the updated Statement of Purpose must be supplied to the Commission within the timescale given. The staff member on duty stated that there have been no new residents to the service and there has been no change in the current residents care needs since the last inspection. Therese Care Home DS0000010231.V321739.R02.S.doc Version 5.2 Page 8 The contracts for each resident were examined in detail and found to include no information on the fees for the service, who is responsible for paying these and what the fees actually include. The contracts also contain information relating to the National Care Standards Commission, which needs to be updated to that of the CSCI. Therese Care Home DS0000010231.V321739.R02.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is poor. The resident’s needs are not adequately planned for, appropriate support is not provided and residents are not supported to make informed choices about their care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All the residents care plans were examined in detail. The inspectors found a number of areas that must be addressed by the Registered Person. The care file for one resident contained a Care Programme Approach review carried out in September 2005. The review included comments from the resident that he did not feel he had enough money and issues regarding alcohol consumption. These needs were tracked through to the care plans and there was no evidence that these areas had been followed up or support provided to the resident in such areas as budgeting or details of how they manage their money. Therese Care Home DS0000010231.V321739.R02.S.doc Version 5.2 Page 10 Regarding alcohol and only drink on was based on and to support him in sought. consumption it stated that ‘staff advised (resident) to try a Saturday’, though it is unclear what this type of support there is no evidence that staff have the knowledge or skills this area, or that the advice of outside agencies has been Records for another resident indicate that they had not received a multidisciplinary review of their care since June 2003. In that review it highlights their need for bereavement counselling, their wish to work as volunteer gardener, to return to a social role within the local church and a dementia support group. There was no evidence that any of these areas were followed up or that the resident receives any support with these needs. In addition, the care plan from the hospital states ‘to establish and maintain personal activities of daily living routine using memory compensation strategies’. There is no evidence of this being carried out, and the resident is not allowed out on their own, is not involved with budgeting, or with household tasks etc. The care plan also states, ‘has occasional short-term memory loss due to alcohol consumption in past’, with staff action being ‘to help (resident) accept and adjust to this development’. However, there is no evidence of staff training, knowledge or skills in this area; or of an action plan, involvement of health care professionals or of the actual diagnosis. For this residents’ ‘likes and dislikes’ the care plan stated ‘none known’. The care plans do not contain information about the social needs, likes and dislikes, medical needs, personal needs, abilities, strengths or of any future plans for any of the residents. These findings demonstrate that the residents are not involved in the development of the care plan, or in the review of these. The care plans in place were developed when the resident moved to the home and have not altered since this time. When reviewed by the Registered Person areas are crossed out and information added, where no new care plans have been developed. It is recommended that the format for the care plans is changed to a personcentred approach, as the current one in use contains irrelevant questions such as ‘does resident wander around home?’ and also contains tick boxes instead of encouraging written information to be given. A more appropriate format should be used that is applicable to the service and the residents accommodated. All information relating to each resident is contained in one large file kept on top of a cabinet in the front lounge. During the inspection process the manager stated that a separate file had been commenced for each resident and that these are kept in a secure, locked area to maintain confidentiality. Therese Care Home DS0000010231.V321739.R02.S.doc Version 5.2 Page 11 The previous inspection required that risk assessments and risk management plans are in place for each resident. Written feedback from the Registered Person was that these are place. The care plan for one resident stated that he smokes and that this had reduced since moving to the home. There was no risk assessment or management plan for this, of whether the resident wanted to reduce their smoking or the support provided to them during this time. The cigarettes are held by the staff in the office, each packet being labelled with a different day of the week. The resident was observed approaching the staff member for his morning supply. There was no evidence of the residents agreement with this, of a care plan or risk assessment as to why this occurs. The risk assessment for another resident refers to suicide and self-harm including reference to ‘suicide attempts’. The risk assessment states, ‘staff to monitor (resident) and to report any concerns to Manager’. There was no risk management plan in place or details of the support provided to the resident and there is no evidence of staff training, information or knowledge in this area. The risk assessment for one resident states ‘…likely to get apathetic and have feelings of hopelessness…’. The management plan for this is for staff to encourage them to have ‘regular personal habits ie bathing, shaving and clothes changing’. Another risk assessment states “…(resident) does not go out alone due to H&S (health and safety) concerns for his short term memory loss – needs to be escorted at all times…”. There is no plan to indicate how this is managed by the service, how they support the resident when he wants to go out or how the home works towards the resident being independent in going out. On the previous inspection the resident said that they wanted the opportunity to go out on their own but that they were unable to, and this was documented in the inspection report and requirements made to re-dress this. The resident was not available to talk to during this inspection, as the staff member stated he had gone out on a trip with the hospital. There is no evidence that this resident has been supported to take risks, or that they have been enabled to make informed choices about what they want to do. This requirement is restated. Therese Care Home DS0000010231.V321739.R02.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17 Quality in this outcome area is poor. The service is institutionalised and residents are not supported to develop themselves independently or to take reasonable risks. Residents are not able to eat or drink when they want. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On arrival at the home the inspectors were informed by the staff member that one resident was out seeing friends and another was on a trip “…to Morden with people from Springfield…”. One resident was in the rear lounge watching television. Throughout the inspection the staff member was observed doing the laundry, washing dishes, preparing lunch, cleaning bedrooms, hoovering and carrying out the housework. There were few interactions between the staff member and resident, with all conversations being initiated by the resident. Therese Care Home DS0000010231.V321739.R02.S.doc Version 5.2 Page 13 The care plan for one resident stated that they enjoy visiting art galleries and museums. However, there was no plan in place to support them with this and it is unclear if they are encouraged to pursue this interest. Their care notes also said that they started to attend a day centre in Feb 2006 and stopped going in June 2006, though no other information as to why this stopped or if any alternative activities were sought as a replacement. The social activities for another resident were detailed as: ‘regular visits from brother, roman catholic, interacts well with others’ with no other information about their interests or hobbies. The staff member on duty said that: “…the residents do not have any interests or hobbies except (resident) likes drawing and (resident) likes smoking…” and that “…(resident) spends all day watching television in the lounge...”. When asked about the Christmas activities planned for the residents the staff member replied “…nothing much, just watch TV…”. The care files did not demonstrate that residents are supported to maintain social contacts or to go out of the home. The previous inspection required that the Registered Person demonstrate how the individual needs and wishes of each resident are met. This was particularly in relation to a resident wanting to go out independently. The Registered Person responded in writing that this was ‘in place’. There was no evidence to support that any changes had been made since the last inspection and this requirement has been restated. The staff member on duty stated that a resident had expressed a wish to go on holiday with her and her family to Jamaica in December. She said that she told him to ask his social worker if this was ok. There was no evidence to indicate that this had occurred. The inspector asked how the resident would be supported, where the staff member replied that “…it would be ok…”. There did not seem to be an understanding of the implications of this or how difficult it may be for the resident, or of any planning having taken place. Also, if this is unlikely to occur the staff should not be encouraging the resident to believe that this is a possibility. There was no records to demonstrate that any resident had been on holiday and it is recommended that each resident is offered a minimum seven-day holiday each year, paid for by the service, that the resident is involved in planning. The staff prepare and cook all the meals. No fresh fruit was observed available for residents to help themselves to. The resident said that they are not able to access the kitchen or make themselves drinks or snacks. The resident said that they could ask one member of staff for a drink when they wanted one but that other members of staff refused to give them a drink except at set ‘tea times’. A notice in the kitchen states mealtimes as: Therese Care Home DS0000010231.V321739.R02.S.doc Version 5.2 Page 14 - ‘breakfast 9am lunch 1pm dinner 6pm tea, coffee and biscuits 8.30pm’ The Statement of Purpose states that residents manage their own time and choose when they consume food and drink, however the evidence indicates that this is not the case. The kitchen is locked at night. A risk assessment dated October 2003 states that this is due to ‘health and safety regulations’, due to absent staff, despite the home being staffed at night. A second sheet of paper states that ‘if and when staff are present during the night the kitchen is still locked at 10:30pm for H&S (health and safety) reasons’. There is no evidence that this has been reviewed since 2003. There was also no evidence in the care files that any resident would be at risk if the kitchen was not locked. Therese Care Home DS0000010231.V321739.R02.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is poor. The records do not demonstrate that the personal and healthcare needs of the residents are appropriately met. The medication system at the home is poor and does not follow good practice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans indicate that the residents generally attend to their personal care needs. However the bath rota on display in the office does not indicate that this is flexible, with each resident scheduled to have a bath every third day. The care plans do not contain detailed information on mental health needs or action that staff take to support individuals. For one resident the information on mental health needs states: ‘history of paranoid feelings, alcohol abuse, depressive feelings’, though with no plans on how the service supports the residents with these. One resident’s care plan indicates problems with incontinence. There was no plan in place as to how this is managed by the home and very little information Therese Care Home DS0000010231.V321739.R02.S.doc Version 5.2 Page 16 as to how this has been investigated. The staff have not received training in continence care, and the staff member referred to this as “…wetting…”. Feedback from a healthcare professional is that the home has sought their advice regarding this issue. However the action plans following this advice are not evidenced in the care plan. Another care professional commented that the service follows their instructions regarding care. There was no evidence of this in the care plans at the service, and there was no evidence to demonstrate that plans from Care Programme Approach reviews were followed up and implemented. The previous inspection recommended that the medication chart include a description of each tablet, which had not been done. The medication administration record (MAR) charts were looked at along with the medication stored at the home. A number of discrepancies and areas of bad practice were noted and these are listed below: • Creams and medication labelled with two residents names were found in the medication cabinet, though were not listed on the MAR chart for either resident. There were no directions recorded for the application of these. Paracetamol medication for one resident was held in the tin labelled with another residents name. This medication stated that it is to be given ‘2 every 4 hours’. It does not state that this an ‘as required’ medication, and no record of this is on the MAR chart. There is no information in the care plan as to why they have been prescribed this medication. These were counted and it was found that 32 had been dispensed, with 6 tablets remaining in the container. There was no record of this having been administered. Senna tablets had been prescribed for another resident in February 2006, though there was no record of this on the MAR chart. A packet of Epsom salts was found with no prescription label and no resident’s name. There was no record of this on the MAR chart. This medication had expired in June 2003. The creams and medication for all three residents were held in a tin labelled with one of the resident’s names. The label on the tin detailed two medications, one of which is not being used. A ‘Medi-alert’ bracelet for dementia was found in an envelope in the medication cabinet. All current medication held in the cabinet had been double dispensed into dosset boxes in envelopes with names on. There were no names on the actual dosset boxes or information on what the medication was, dose, description of tablet etc. There was no record of the amount of medication received at the home or records of medications that had been returned to the pharmacy. DS0000010231.V321739.R02.S.doc Version 5.2 Page 17 • • • • • • • Therese Care Home These points are the subject of requirement 10 and must be addressed by the Registered Person within the timescale given. These findings demonstrate that staff have not received training in safe and correct procedures for managing medication. Training records indicate that no medication training has been provided for staff, other than their signing of the medication policy for the home. Therese Care Home DS0000010231.V321739.R02.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. There is a complaints procedure at the home. The service does not demonstrate that the residents are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints policy that provides suggestions of different people that a resident can complain to, such as the home manager, social worker or the CSCI. The previous inspection required that all staff working at the service receive training in the Protection of Vulnerable Adults (POVA). The Registered Person has stated in writing that all staff had received this training. There were only two staff members training records available at the service, where there was a record that only one of these had completed a ‘POVA alerters’ course. This requirement has not been met and has been restated. There were no records available to indicate how the resident’s money is managed or how they are supported with this. There was nothing to demonstrate that residents manage their own money or have their own bank account. The Care Programme Approach review for one resident indicates that staff give him £10 on Monday & £5 on Saturday. There is no written agreement or care plan for this, or reason as to why this occurs. The staff member was not aware of what happens with residents’ money, where she said that when a resident goes out on a trip with eg. the hospital, Therese Care Home DS0000010231.V321739.R02.S.doc Version 5.2 Page 19 the social worker invoices the Registered Person for any purchases made for the resident, and she pays them directly. It is not clear, and there are no records to indicate why this practice takes place and why residents are not supported to manage their own money. There is no policy or procedure at the home to detail the practices regarding resident’s monies and financial affairs. Therese Care Home DS0000010231.V321739.R02.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 28 and 30 Quality in this outcome area is adequate. The home is well-decorated though requiring attention in a number of areas. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is well decorated, bright and clean and hygienic throughout. The previous inspection required that light-shades are provided on all lights throughout the home. There were observed to be no light-shades in any area of the home. The Registered Person stated that this is because the residents have requested these not be supplied, yet this has not been documented in the care plan. This requirement has not been met and is restated. The linoleum in the bathroom was seen to be in need of replacing where it had become creased and raised in areas, which could be a potential trip hazard. Therese Care Home DS0000010231.V321739.R02.S.doc Version 5.2 Page 21 Each bedroom was observed to be well-maintained apart from the window blind in the largest bedroom, two of which were damaged and in need of replacement. A new door had been installed in the rear lounge. This was observed to have a crack in the window. One resident stated that it was a fire door and that “…(the owner) bought it cheap because the glass is cracked, well that’s what she said…”. This door was wedged open, as were all doors throughout the home. The wedges must be removed and consideration given to installing magnetic door stops. The Registered Person stated that the fire officer had agreed to using the type of door wedge at the home and evidence of this advice must be provided. The last inspection found that the ground floor front room at the home had been re-arranged into another lounge. It is unclear if residents are promoted to use this area or whether this is for the sole use of staff. Therese Care Home DS0000010231.V321739.R02.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 and 36 Quality in this outcome area is poor. Proper recruitment checks are not carried out on staff working at the home. Inadequate training means that the staff do not understand the mental health needs of the residents and so are unable to support them appropriately. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On arrival at the home the inspectors were met by the only staff member working who was initially quite uncooperative, turning her back on the inspectors and walking away when they asked her questions. When asked by one inspector about the residents and the service she said: “…the residents do not like to do anything and are not capable of going out, planning menus, shopping, cleaning or cooking although (resident) likes to dust and we let him do this sometimes…”. This comment, along with the interactions observed between this staff member and resident, indicate that they do not have knowledge of mental health needs or how to communicate with people who are mentally unwell. One resident told the inspector that staff were “…officious…bossy…”, further adding that “…staff sometimes do what you ask but not always…”. Therese Care Home DS0000010231.V321739.R02.S.doc Version 5.2 Page 23 These findings indicate a poor attitude of the staff and of their approach towards the residents and their care. Training to address this is required as part of requirement 20. On display was the staff rota up from 30th October 2006 until the 26th November 2006. When asked where the current rota is the staff member replied that “…it is not here…” and that “…I know my shifts…”. There were four staff names on the rota, including the manager, each working different shifts throughout the week. The staff rota states that the shifts are 7am-2pm and 2pm-7pm, it does not detail that sleep-in shifts are worked at the home. The previous inspection required that a Criminal Records Bureau check is carried out on each member of staff. The staff member said that she had completed the form for this. The Registered Person has stated in writing that this has been ‘done’. The staff records are not kept at the service and the receipt of the check could not be verified. The requirement has been restated. A requirement has also been made for the staff records to be kept securely at the home. The previous inspection also required that a POVA First check be carried out on staff before they commence work at the home. It was observed that a newer member of staff was on the rota, whose recruitment records have not been previously inspected. The Registered Person has responded in writing that this has been ‘done’. However due to the files not being held at the home this standard could not be assessed as met and the requirement is restated. The Registered Person has stated in writing that the requirement to provide detailed staff contracts, including the actual hours worked has been ‘done’. However these were not available for inspection and so this requirement has been restated. It was required at the previous inspection that a training programme be formulated to ensure that staff receive five paid training days a year. The Registered Person stated in writing that this had been ‘done according to requirements’. The staff member said that she has not done any training through the home since the last inspection apart from a basic food hygiene course. She said that she is due to do a first aid course soon. The home had training records for two members of staff only. There were no training records to indicate any training had been received by the other member of staff or the Registered Person. One member of staff had done training in a ‘POVA Alerters’ course in March 2006, Mental Health awareness in April 2006, Caring for people with dementia in May 2006 Basic Food Hygiene in July 2006 and October 2006, Infection Therese Care Home DS0000010231.V321739.R02.S.doc Version 5.2 Page 24 Control in September 2006, Health and Safety in October 2006. She stated that the latter three course’s had been provided by her employer at another care home, where she works full-time. The other member of staff had certificates to evidence training in mental health awareness (2006), dementia (2006) and basic food hygiene (2003). Both of the training files for these staff contained a copy of the in-house induction, fire procedure, medication policy and accident policy. However no training has been provided for staff in these areas, nor for other areas identified throughout this report. The requirement from the previous inspection has not been met and is restated. A further requirement has been made for staff to receive training to enable them to meet the needs of the residents. The recommendation for staff to undertake the NVQ level 2 in Care has also been restated. The staff training policy states: ‘all staff must receive suitable training in the following asap – food hygiene, first aid, fire instructions…have appropriate NVQ…’. The first aid policy also states that the service is ‘committed to providing sufficient numbers of first aid personnel to deal with accidents and injuries occurring in the home’. However the findings indicate that this is not the case and that staff are not adequately trained for their role. In addition the Statement of Purpose states that the home ‘offers staff a range of training and induction and foundation’, but there is no evidence to demonstrate that this is the case. The staff training policy states that staff receive regular supervision, however there was no evidence to indicate that staff are supported in their work, with no records of supervision or team meetings having taken place. Therese Care Home DS0000010231.V321739.R02.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 42 and 43 Quality in this outcome area is poor. The service is not conducted in the interests of the residents and significant improvements are needed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The number of requirements from the previous inspection have been restated and subsequently made as a result of the findings of this inspection. This indicates that the service has not proactively progressed towards meeting the National Minimum Standards for Younger Adults. The Registered Person does not demonstrate that they are competent in developing the service to ensure that the needs of the residents are met. It is required that the Registered Person undertakes the Registered Managers Award, or equivalent as a priority. Therese Care Home DS0000010231.V321739.R02.S.doc Version 5.2 Page 26 The staff member on duty said that the Registered Person visits the home most days but did not know when she would turn up. When asked, the staff member on duty demonstrated little knowledge of the individual mental health needs of the residents, of care planning, whether other professionals support residents, financial matters or of the general running of the home. Staff designated to work alone must have the appropriate knowledge, information and support they need to care for the residents. All staff who work alone must receive full training on all aspects of running the home. There is a policy for implementing quality assurance at the service, with a format for a residents survey and questionnaire for relatives and friends to complete. There were no records to demonstrate that this had been carried out. The quality assurance policy also states: ‘the staff can demonstrate a commitment to lifelong learning and development for each service user, linked to ….the individual care plan…’ and a ‘commitment to ongoing training for staff to ensure their ability to continued and balanced support towards service users and their individual needs’. The findings under the ‘Staffing’ section of this report indicate that this does not occur. A number of health and safety issues were identified during the inspection and these are listed below: • Radiators – these were too hot to touch in all areas, along with the hot water dispersed from the kitchen and bathroom taps. The staff stated that no temperature checks are carried out on the hot water dispersed and this needs to be implemented and carried out on a weekly basis. Thermostatic valves need to be installed on all water outlets. The boiler also needs to be checked by a CORGI registered engineer annually, these last having been done in October 2004. A risk assessment was seen for scalding regarding ‘resident and hot things’, and one needs to be developed for the use of radiators and hot water. An ‘assessment for risk of legionella’ form was seen, though this was blank. The home needs to demonstrate that steps are taken to reduce the risk of legionella, eg. daily shower flushes and that the water is disinfected annually by an external company. There is no evidence that Portable Appliance Testing (PAT) had been carried out since May 2004 on some appliances. No PAT stickers were observed on a number of electrical items throughout the home. The Christmas tree lights were seen plugged into three point adaptor which was plugged into four way extension lead, and this could be a potential fire hazard. • • • Therese Care Home DS0000010231.V321739.R02.S.doc Version 5.2 Page 27 • • • • • • The first aid box in the office contains packet of paracetamol. No record of why this medication was in the box. The packet was open and some had been used. Other equipment in the box was sterile bandages/eye pad, with ripped packaging, with old and stained bandages. No plasters were observed. The first aid box needs to be completely refilled with new bandages and equipment. The fridge and freezer checks are carried out daily, with records indicating that this is always the same temperature of the fridge being 5C, and the freezer –18C. When this was checked the fridge temperature was seen to be 3C and the freezer –16C. The food in the fridge included an opened tin of condensed milk and a bowl of tinned tomatoes, neither of these were labelled with the date they were opened. Ham was in a opened packet, not adequately covered. COSHH (Control of Substances Hazardous to Health) products were observed under the kitchen sink in an unlocked cupboard, despite the risk assessment stating that they should be locked away. The COSHH risk assessment is dated October 2003 and does not include data information sheets from the manufacturers (except for one for a particular type of bleach). There is no risk management plan apart from ‘adequate and secure storage and use of gloves, careful use of substance’. Fire exit signage has been put up at the top and bottom of the stairs though do not highlight where the actual fire exits are in the home. A new fire extinguisher has been installed since the last inspection, along with new smoke detectors. A fire risk assessment has not been developed for the service. The business and financial plan for the service was not available for inspection. It is not clear what the budget is for the service and how the residents are involved in this. It is required that the all documentation relating to the financial viability of the home is supplied to the Commission within the timescale. Therese Care Home DS0000010231.V321739.R02.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 2 3 3 X 4 X 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 2 28 3 29 2 30 3 STAFFING Standard No Score 31 3 32 2 33 2 34 1 35 1 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 1 X 1 2 LIFESTYLES Standard No Score 11 1 12 1 13 1 14 1 15 3 16 1 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 1 X 1 1 2 2 X 1 2 Therese Care Home DS0000010231.V321739.R02.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 4(1)(c), Sched 1 Requirement The Registered Person must ensure that the Statement of Purpose contains all information as required in Schedule 4. A copy of the updated Statement of Purpose must be supplied to the Commission within the timescale given. The Registered Person must ensure that the contracts for each resident contain details of the fees for the service, who is responsible for paying these and what the fees actually include. The Registered Person must ensure that the care plans are developed with each resident, that they detail all their needs and the support to meet these. They must include all areas of support and the objective of the care plans in meeting the future plans of the resident. The care plans must be reviewed with the resident and new care plans implemented when necessary. Timescale for action 28/02/07 2. YA5 Schedule 4(8) 28/02/07 3. YA6 YA18 YA19 15 31/01/07 Therese Care Home DS0000010231.V321739.R02.S.doc Version 5.2 Page 30 4. YA7 13(4)(c) The Registered Person must ensure that there are risk assessments and risk management plans in place for each resident. (Previous timescales of 30/04/06 and 31/08/06 not met). The Registered Person must ensure that residents are supported to develop and maintain independent living skills. This must be encouraged in all areas such as going out independently, etc. The Registered Person must demonstrate how the individual needs and wishes of each resident are met. (Previous timescale of 30/09/06 not met) The Registered Person must ensure that residents are able to access the kitchen and prepare food, snacks and drinks at any time. A risk assessment must be carried out for the resident’s use of the kitchen. The Registered Person must ensure that the points outlined on page 17 and 18 of this report are addressed. The Registered Person must implement a system for the recording of all medication received at the home and the handling, safekeeping, safe administration and disposal of all medicines. The Registered Person must ensure that all staff working at the service receive training in DS0000010231.V321739.R02.S.doc 31/01/07 5. YA11 YA18 12 28/02/07 6. YA12 YA13 YA14 12(3), 16(2)(m) 31/01/07 7. YA17 16(h)(i) 31/12/06 8. YA20 13(2) 31/12/06 9. YA23 13(6) 31/01/07 Therese Care Home Version 5.2 Page 31 the Protection of Vulnerable Adults. (Previous timescales of 31/08/06 and 30/09/06 not met) 10. YA24 23(2)(d) The Registered Person must ensure that light-shades are provided on all lights throughout the home, unless it is recorded in the residents care plan that they request this. (Previous timescales of 31/12/05, 30/06/06 and 31/08/06 not met). The Registered Person must ensure that the glass in the door of the rear lounge is replaced, and is fire resistant. The Registered Person must replace the linoleum in the bathroom. The Registered Person must remove the door wedges in use at the home, unless evidence of advice to the contrary from the fire officer is provided. 31/01/07 11. YA24 23(2)(b) 31/12/06 12. YA27 23(2)(b) 31/01/07 13. YA29 13(4) 31/12/06 14. YA34 19(4) & Schedule 2 The Registered Person must 31/01/07 maintain a Criminal Records Bureau check with them as the current employer for each member of staff. A POVA First check must be received for all staff prior to their commencing work at the home. (Previous timescales of 31/03/06 and 31/08/06 not met). The Registered Person must ensure that all staff records are kept securely at the home. Therese Care Home DS0000010231.V321739.R02.S.doc Version 5.2 Page 32 15. YA34 Schedule 4, 6(e) The Registered Person must ensure that the staff contracts detail the actual hours that staff are employed to work each week, including sleep-in duties. (Previous timescales of 30/04/06 and 31/08/06 not met) The Registered Person must ensure that a training programme is formulated to ensure that care staff receive at least five paid training days a year and that this training is evidenced. The training must include fire safety, medication, food hygiene and first aid. (Previous timescales of 01/04/05, 31/08/05, 31/03/06 and 31/08/06 not met). The Registered Person must ensure that a training plan is developed to ensure all staff receive training in continence care, customer service, understanding mental health, alcohol abuse, suicide and self harm as a minimum. The training planned for staff must be evidenced. The Registered Person must ensure that all staff have regular supervision, a minimum of six times a year. The Registered Manager must undertake the Registered Managers Award or equivalent. The Registered Person must implement the system for seeking feedback about the home from relevant stakeholders DS0000010231.V321739.R02.S.doc 31/01/07 16. YA35 18(1) 31/01/07 17. YA35 YA37 18(1) 31/03/07 18. YA36 18(2) 31/01/07 19. YA37 9(2)(b)(i) 31/03/07 20. YA39 24 31/03/07 Therese Care Home Version 5.2 Page 33 involved with the service. 21. YA42 13, 23 The Registered Person must 31/01/07 ensure that the health and safety issues detailed on pages 27 and 28 of this report are addressed within the timescale. The Registered Person must ensure that the business and financial plan for the service it supplied to the Commission within the timescale. This must include details of the budget and how this is broken down into the running costs for the home. 31/01/07 22. YA43 25 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. Refer to Standard YA6 Good Practice Recommendations The Registered Person should change the format of the care plans to one that is person-centred and more relevant to the service and the residents. The Registered Person should ensure that residents are offered a minimum seven-day holiday that is funded by the service, and planned with the involvement of the residents. The Registered Person should ensure that the medication chart includes a description of each tablet. The Registered Person should ensure that all care staff at the home undertake the NVQ level 2 in Care qualification. 2. YA14 3. 4. YA20 YA32 Therese Care Home DS0000010231.V321739.R02.S.doc Version 5.2 Page 34 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG 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 Therese Care Home DS0000010231.V321739.R02.S.doc Version 5.2 Page 35 - 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. 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