Inspection on 28/01/08 for Two Gates House

This inspection was carried out on 28th January 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Two Gates House 26/06/09

Two Gates House 17/04/08

Two Gates House 24/09/07

Two Gates House 01/02/07

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Two Gates House 42-44 Two Gates House Two Gates Lane Colley Gate Halesowen B63 2LJ Lead Inspector Mrs Cathy Moore Key Unannounced Inspection 28th January 2008 07:00 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 Two Gates House DS0000066258.V354071.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. Two Gates House DS0000066258.V354071.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Two Gates House Address 42-44 Two Gates House Two Gates Lane Colley Gate Halesowen B63 2LJ 01384 567448 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) Wellmun Care Limited Ms Lynda Jane Smith Care Home 17 Category(ies) of Old age, not falling within any other category registration, with number (17) of places Two Gates House DS0000066258.V354071.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th September 2007 Brief Description of the Service: Two Gates is a large, detached property, located in a residential area of Colley Gate, Halesowen, providing personal care for seventeen residents. The service does not provide nursing care. Accommodation comprises fifteen single rooms, twelve of which have en-suite facilities and one double bedroom, toilets and bathrooms situated on two floors accessible via a passenger lift. The lounge, dining area, kitchen, laundry, and office are situated on the ground floor. The service has ample car parking space at the front and to the rear gardens with a patio area The fees for this service are £353 -£400 per week. Other services examples being; hairdressing and private chiropody are charged for additional to the weekly fee. Two Gates House DS0000066258.V354071.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out one day between 07.25 and 17.00 hours. One inspector and one pharmacy inspector carried out the inspection. Before the inspection we asked relatives, staff, health professionals and people who use the service to complete one of our questionnaires for us to gain their views on the quality of the service provided. We carried out most of the inspection in communal areas where we could observe daily routines, staff and people who use the service engagement. We spoke to a number of people who use the service and staff. Our pharmacy inspector carried out an inspection of medication systems and medication safety within the home. We observed the main mealtime and some activity provision. We looked at three bedrooms, the kitchen, laundry, and dining and lounge areas. We looked at care records in detail for three people who use the service to see how their care is being managed and delivered. We looked at the staff files of three staff to check on recruitment and supervision processes. We looked at service certificates and the management of health and safety within the service. The Quality rating for this service is 0 Star. This means that the people who use this service experience Poor quality outcomes. Two Gates House DS0000066258.V354071.R01.S.doc Version 5.2 Page 6 What the service does well: Comments received from people who use the service included; “If anyone moans about this place they are one fussy person”. “ If I were the queen I could not be looked after any better”. “ I’m very glad to be here I’m pleased to say”. “The food is excellent”. “ Everybody is wonderful as they say in the Black Country; ‘They are a bostin set of wenches’”. “ We are very pleased with the care mum receives”. “ As an outsider I think that care home does a good job”. Staff we observed during our time at the inspection were friendly, helpful and polite to the people in their care. They told us that they enjoy their work. The environment is well maintained, it is homely, bright and cheerful. The atmosphere is friendly, warm and welcoming. The service encourages people to maintain contact with family and friends. It has open visiting arrangements. One person told us; “ There is a very good atmosphere and visitors are always made welcome”. The service is careful to ensure that new people coming into the service will mix well with others. This has enabled good relationships between the people who use the service. We heard constant conversation between the people, a lot of joke sharing and laughter. One person told us; “ It is nice to see mum enjoying the company of people her own age”. All but three of the staff team have achieved NVQ level 2 or above in care which means a high proportion of the staff have been assessed as being competent to carry out their job roles. We saw evidence to confirm that daily routines are organised to meet the needs of the people who live there rather than the service. One person told us; “ They enable mum to live as comfortably as possible. They give her freedom to move around as much as she can/wishes”. Two Gates House DS0000066258.V354071.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Although the service has improved in many areas and people who use the service are happy, there continues to be a number of areas of concern that could place people who use the service at risk. Two Gates House DS0000066258.V354071.R01.S.doc Version 5.2 Page 8 Care planning processes need further development to ensure that all needs and health care needs are highlighted. Main conditions and diagnosis must be included in care plans so that staff know what to be aware of and how to care for these needs. The management need to ensure that we are informed of all untoward events that occur in the home. The management need to ensure that if staff are suspended that a referral to the ‘list’ is made. Medication management needs to be improved upon to prevent risk to the people who use the service. Staffing levels have improved but need further improvement to ensure that peoples’ full needs are met and that they are safe. Activity provision within the service needs to be increased to ensure that stimulation and personal activity needs are met. One person told us; “ It would be nice to see more events throughout the year, even once a week”. Records concerning staff training must be better organised so that everyone is aware who received what training and when. One person suggested that the service could improve by putting a code lock on the front door so that visitors do not have to disturb staff. One person told us that communication could be better; “ Sometimes the night staff are not fully aware of everything”. Two Gates House DS0000066258.V354071.R01.S.doc Version 5.2 Page 9 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. Two Gates House DS0000066258.V354071.R01.S.doc Version 5.2 Page 10 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 Two Gates House DS0000066258.V354071.R01.S.doc Version 5.2 Page 11 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. Quality in this outcome area is good. Prospective people and their families are provided with information about the service to enable them to make a decision about it’s suitability for them Each person has a written terms and conditions document, which outlines their rights and responsibilities. No person moves into the service without having had their needs assessed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We saw that the service’s registration certificate was displayed on the wall in the front entrance hall. We saw that the information detailed, reflected the needs of the people accommodated. Two Gates House DS0000066258.V354071.R01.S.doc Version 5.2 Page 12 We saw that our last inspection report was available in the ground floor hallway as was a service user guide. We saw that the statement of purpose and service user guide needed some amendments to ensure that people were being given correct, up to date information. The owner on site attended to these amendments immediately. The statement of purpose and service user guide now both detail the fees charged for the service. We looked at files containing information about people who use the service. We saw that a terms and conditions document was included on each. These detailed individual fee rates. We saw that information had been obtained about the newest person to use the service from their funding authority, previous care provider and written assessment information that the home had collated. We spoke to the newest person who told us; “ I did not want to leave my home but I could no longer look after myself. I like it here. It is right for me. I like the company and feel safer than when I lived on my own”. Two Gates House DS0000066258.V354071.R01.S.doc Version 5.2 Page 13 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 Poor. Further improvement is needed to ensure that a clear care plan is in place for each person which captures his or her full needs and identified risks. Some health care needs are not being identified by the service and included in care planning processes to prevent re-occurrence of conditions. Medication management and safety need improvement to prevent risk to the people who live within the service. Privacy and dignity is promoted within the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at the files of three people who use the service. Assessment processes have very much improved and files are better organised than when we saw them in September 2007. One staff member told us; “ We know more about people as individuals now”. Two Gates House DS0000066258.V354071.R01.S.doc Version 5.2 Page 14 We were disappointed to find that there were no care plans as such. This shortfall had been identified in our September 2007 report and although improvements have been made concerning assessment processes, the service has yet to develop a system whereby needs and risks identified from these assessment processes are transferred into a plan of care, which is concise and easy to follow. We were also disappointed that where conditions such as; ‘ prone to urinary tract infections’ and ‘constipation’ had been highlighted by previous care providers the service had missed the opportunity to plan the care for these conditions in order to prevent further occurrences. They had missed a second opportunity to rectify this when these conditions had reoccurred for one person whose records read; 4.10.07 “ Still in discomfort ( bowels)”. 17.10.07 “ Prescribed Anusol”. 20.10.07“. Has now got antibiotics Trimethroprim”. These conditions were not highlighted in records and there were no instructions for staff such as; drinking plenty of fluids and signs to look out for concerning urine infection or diet plans to prevent constipation. We asked one staff member to tell us about problems that had occurred with this person and although she did mention other things she did not mention urine infections or constipation. We saw that a person was taking an; ‘over the counter remedy’. When we asked this person why we were told; “ Because I can’t sleep”. There were no records about this persons poor sleeping. Her assessment records told us; “ Sleeps well”. We saw that there was no plan in place to deal with aggressive behaviour that had been displayed twice in a short period of time by one person, or the dementia needs of another. We did not see any plans in place to deal with personal risk such as falls (apart from assessments) and there was no review of the assessment for one person even though she had a fall on 24.1.08 and sustained severe bruising around her eyes. We were pleased to see that a good range of healthcare services are accessed for the people who use the service. We saw evidence on all files of optician, nurse and chiropody input. One person showed me his new glasses. He said ; “ One pair for reading and one for ‘other everyday use’”. We received many comments to confirm good practice regarding the service’s management of access to health care, which included; “ They are quick to call the doctor and ensure all medication is given correctly”. “ The home always contact us if mum is ill and needs to go to hospital”. “I feel the staff respond well to emergencies”. We saw a set of sit on weighing scales have been purchased since our last inspection. It is good that these have been purchased as they enable the weight of all people who use the service to be monitored safely and to identify concerns. Two Gates House DS0000066258.V354071.R01.S.doc Version 5.2 Page 15 We spent time in communal areas where we could hear conversation between people and staff. Staff were very friendly towards the people who use the service, they were polite and respectful. We saw that toilet and bathroom doors were closed when in use and that staff knocked doors before entering bedrooms. We heard staff using the preferred names of the people. One person who uses the service told us; “ Staff are very polite”. Pharmacist Inspector (Morag Ross) undertook inspection of the control and management of medication within the service on 28/01/08. A new pharmacy had recently started to provide the medication to the service. This means that the service was using a new medication administration process and new medication administration record charts. This was taken into consideration during this inspection. The medication procedure available was not specific to the medication management within the service and was not detailed. For example, a recent medication error had not been reported to CSCI. The medication error had recently occurred and was recorded in the persons care notes. A doctor had been informed and the medication stopped for 2 days to ensure that the person was safe from harm. The care home provider had been made aware of the error on the morning of the inspection but was unaware that this also needed to be reported to CSCI. This highlighted the importance of ensuring that all members of staff have access to a comprehensive medication policy, however there was no medication error procedure available for staff to follow in order to ensure that people who use the service are safeguarded. Medication was stored in a locked medicine trolley in a neat and organised manner, which enabled people’s medication to be easily located. The medication trolley was located next to a radiator, which may affect the storage temperature of the medication, however it was turned off and there were daily temperature records available, which did show that medication was stored within a safe temperature range. Medication was seen stored in a refrigerator, which was not secure or locked, which means that unauthorised people had access to medication and therefore increases the risk of harm to people who use the service. Some medication, which requires special lockable storage arrangements did not meet the required legal specifications, which means that some medication was not stored correctly according to legislation. Also the records available for some of this medication did not match the amount of medication stored in the service. This means that the medication records for medication requiring special storage were not accurate and therefore did not meet the necessary legal requirements. Medication records and documentation were checked to ensure medication was administered correctly. The service did document the date of opening of new Two Gates House DS0000066258.V354071.R01.S.doc Version 5.2 Page 16 containers of medication, which helped to ensure that accurate balances of medication could be counted. This means that accurate checks on medication could be made to ensure that medication had been administered to the people living within the service. The medicine records seen were either recorded with a signature for administration or with a code to explain why the medication was not administered. It was therefore disappointing that some records did not document the amount of medication that had been administered when the quantity was more than one. For example, a sleeping tablet, which was prescribed as ‘one or two to be given’, was signed for administration but there was no record of the quantity actually administered. This means that people who use the service were not safeguarded by accurate medication records and were at an increased risk of harm. Some herbal remedies had been brought into the service by members of people’s family for administration, which had not been confirmed or checked with a healthcare professional. For example, an herbal remedy had been brought into the service and was being administered by the care staff team. It was of concern that the medicine record had been documented as a ‘food supplement’ when the product was an herbal remedy. The individual plan of care did not document if a healthcare professional was aware of the administration or of any adverse affects the herbal remedy may have on the individual particularly as they were also taking prescribed medication. This means that due to a lack of up to date records and information staff would not be able to ensure that people using the service were safeguarded. The service made provision for people to look after their own medicines. One person who looked after a herbal remedy in their bedroom was spoken with who said they were happy looking after it as it ‘really helps me to sleep and I have checked with the doctor that it is OK. I have signed a form to say I will look after it’. The service did have a risk assessment available to ensure the safety of the medication and a signed consent form signed by the person agreeing to look after the herbal remedy. At the end of the inspection we read in the registered providers monthly report that an incident had occurred. We asked about this and the owner and deputy on site gave us details; ‘That a staff member in autumn time 2007 had brought their own tablets ( Tramadol) from home to give to one of the people who use the service because her medication had ‘run out’. The service is in the process of concluding the action they have taken regarding this incident. Our concern however, is twofold in that prescribed medication was not available to give to this person as instructed by the doctor and we were not informed about this incident when it occurred as required by Regulation; ‘ Regulation 37(1) The registered person shall give notice to the Commission without delay of the occurrence of- (e) any event in the care home which adversely affects the wellbeing or safety of any service user. Two Gates House DS0000066258.V354071.R01.S.doc Version 5.2 Page 17 Two Gates House DS0000066258.V354071.R01.S.doc Version 5.2 Page 18 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. Generally the people who use the service are satisfied with the lifestyle they experience which includes having choice and control over their lives. Further development is needed is respect of activity provision. The service encourages visitors and people to maintain contact with family and friends. Food offered is varied and appealing. Further effort is needed to ensure that people are actively encouraged to increase their daily fruit and vegetable intake. This judgement has been made using available evidence including a visit to this service. EVIDENCE: When we arrived at the service we went into the lounge. Only two people were sitting in the lounge. One was reading a daily newspaper he said; “ I like to get up early about 7am. When I was at work I got up at 4am”. During the morning we saw people arriving in the lounge up until mid morning. We were impressed in that two people who use the service, at different times Two Gates House DS0000066258.V354071.R01.S.doc Version 5.2 Page 19 walked independently into the dining room, sat at a table and told staff “ I am ready for my breakfast now”. “ Breakfast please”. This shows that the people who use the service have control over daily routines and that they feel comfortable to tell staff when they want something rather than being restricted by routine. This was confirmed further in records for one person that read; ‘16.1.08 will use nurse call when she is ready to rise. Will ask staff when ready for bed’. Comments received told us that there are shortfalls in terms of activity provision as follows; ‘ Need more outings, more entertainment’. ‘ More entertainment’. We discussed this with the owner on site who told us; “ We know this is an area we need to look at. We are at the present time doing work and asking the residents what they want to do”. He showed us written evidence to confirm this. We did however see evidence to prove that staff do their best to provide some activities. We saw a staff member playing dominoes with one person late morning. We saw a ball game being carried out in the afternoon in which most people joined in and clearly enjoyed. We heard people talking about fish and chips and when asked a staff member told us; “ We have started having a fish and chip supper once a month- they love this”. Some people who use the service overheard our conversation and told us; “ They were beautiful”. “ Really good time”. We looked at activity records for the people whose care we have tracked. We saw that there was a long gap in records from 31.7.07-15.1.08. The new activity folder started on 15.1.08 told us that all three people had participated in some activities exercise, ball or bingo, which is positive. It was one person’s 80th birthday on the day of the inspection banners and balloons decorated the lounge. People were offered a glass of sparkling wine at lunchtime and a buffet party took place during the afternoon. The person was delighted she told us; “ Look what they have done for me”. We were very pleased during the day to hear continual conversation between the people who use the service, joking and laughter. The atmosphere was very positive. We have never received any concerns suggesting that visiting arrangements are not satisfactory. The service user guide on display page 13 read; ‘ Visitors are very welcome at any time but we would appreciate it if mealtimes were avoided. You may invite guest to dine with you provided the home manager has sufficient notice’. People we asked confirmed that they have regular visitors they said; “ My wife and daughter come and visit”. “ My nephew comes”. One person commented; “ I visit my aunt once a week. My aunt could phone me if she wished to”. We looked at three bedrooms and saw that these held a range of belongings making the rooms feel homely and personalised. Two Gates House DS0000066258.V354071.R01.S.doc Version 5.2 Page 20 During the last inspection we saw and were told things about food provision, which concerned us. We saw evidence this inspection to demonstrate great improvement, which was confirmed by staff. One staff member said; “ We have got everything we need, 110 better”. We looked at food stocks and saw that there was fresh fruit, vegetables and salad, and a choice of skimmed or full fat fresh milk. The freezer was full of various meats. There were three really big pieces of cheese, eggs, cold meats, snacks and both white and brown bread. The owner showed us menus, which detailed a choice of two meals. One person who uses the service told us; “ Like toast for my breakfast. Some have bacon. I just like toast”. The main meal we saw consisted of mince meat, potato, mixed vegetables, sprouts and broccoli. Followed by fruit and ice cream. People told us; “ That was lovely”. “ Really enjoyed that”. Sparkling wine was offered at lunch time ( to celebrate a birthday) cartons of cranberry juice were also available. The food we saw was very nicely presented, it smelt appetising and portions were generous. We received positive comments about food, which included; “ Oh the food is great”. “ I have yet to have a meal that I couldn’t eat”. “ Home cooked food is excellent”. We were pleased to see that fruit was available on the sideboard in the dining room. We did have a discussion with staff and the owner suggesting that they could be more pro-active in encouraging fruit and vegetable input by slicing fruit and taking it around, offering to people, or making fruit ‘smoothies’ and offering these, adding fresh vegetable to soups. Two Gates House DS0000066258.V354071.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is poor. Complaints processes are in place for people who use the service to access if they have the need. Referral and reporting processes concerning ‘untoward’ incidents are poor. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We have received two complaints about this service since we last inspected in September 2007. We forwarded both to the registered provider to look into and feedback to us, which she did. The owner on site told us; “No other complaints have been received”. We asked a person who uses the service what they would do if they were unhappy or wanted to make a complaint the person told us;“I would tell one of the girls and they would sort it”. Other comments we received about complaints included; “ I know how to make a complaint 100 , but I don’t think there is any need for a complaint”. “ I would complain to the manager but I have never had to do this”. We saw that Dudley Safeguarding procedures were on shelf in office. We were pleased that the owner has taken some positive action to reduce the risk of harm to people who use the service by purchasing an ‘abuse awareness’ DVD for staff to watch and for training purposes. Two Gates House DS0000066258.V354071.R01.S.doc Version 5.2 Page 22 We were disapointed in that certificates to evidence abuse awareness training were not avaoilable. The training matrix did indicate abuse awareness training had been received 2006/07 but did not give the precise month. The owner told us that the training matrix was soon to be updated. We were concerned to learn of an incident where bad practice that could have placed a person who uses the service at risk of harm had occurred in autumn ( October) 2007. Although the owners had taken action to prevent further risk they had not informed us of this situation as they should have done to comply with Regulation. We made a requirement in our last inspection report dated 24.9.07 when we had identified a none reporting of an untoward event where a staff member had been suspended, this evidence shows that this requirement has not been met. Further, when asked, the owner on site told us;“ We have not referred to Protection of Vulnerable Adults list (POVA)”. We referred the owner to the relevant section of the Care Standards Act 2000, which he found on the internet and we read together. On reading this he said; “ You are right, yes. I will refer tomorrow”. We were concerned in that the issue of non-referring to the POVA list had also been raised in our last inspection report September 2007. The registered owner had responded to this in her improvement plan dated 13 December 2007 saying;‘ The registered person will now take responsibility for any POVA referrals’. Although the registered owner did provide us evidence at a later date to confirm that the referral had been made following our September 2007 inspection, this new evidence shows that she has again, failed to report this other issue. Two Gates House DS0000066258.V354071.R01.S.doc Version 5.2 Page 23 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): 19,20,24,26. Quality in this outcome area is good. People who use the service live in a well-maintained, pleasant and homely environment, which is of a good standard both internally and externally. They have comfortable bedrooms with their own possessions around them. Infection control processes have improved to a good standard. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service provides an environment, which is of a good standard, is well maintained, comfortable and homely. We found the service’s atmosphere to be warm, welcoming and happy. Comments we received confirmed a positive atmosphere as follows; “ We care for our service users, we give a friendly, Two Gates House DS0000066258.V354071.R01.S.doc Version 5.2 Page 24 homely service and atmosphere”. “ Staff are happier and the atmosphere is good”. We found the service to be bright and well maintained. Redecorating work had been carried out since the last inspection or is in the process of being done. We saw that a bedroom was being decorated whilst we were on site. The ensuite in this room had also received the required attention to improve woodwork around the toilet cistern. We did not determine any problems with heating or lighting staff confirmed that any previous problems concerning these areas have now been resolved. One person who uses the service told us; “ I like the lounge and the garden. In the summer I sit outside”. We looked outside and saw that improvements have been made concerning safety as yellow lines highlight steps and railings have been fitted around the patio area. We looked at three bedrooms and found these to be personalised with own belongings, well maintained and comfortable. The occupants of these rooms when we asked about their bedrooms told us; “ Yes nice”. “ Like my bedroom, very comfortable”. “ Like the room”. We did not detect any odour in any part of the home the home looked clean and orderly. We were pleased to learn that the owner is providing laundry and cleaning staff every day. We saw that hand wash signs were on display in toilets, bathrooms and high risk areas, which is an improvement from our previous findings and helps prevent infection transmission. We looked at the laundry and saw that it was much better organised than we had seen in September 2007. We saw that only clean washing was in there, there was less clutter, there were procedures on the wall and the sink was clean. The male owner told us dirty washing is stored up stairs. He showed me a toilet on first floor where skips were stored . We saw that a new commercial dryer had been purchased. The washing machine looked of a domestic type. We raised this with the male owner who told me; “We have changed the dryer to a commercial type and intend to change the washing machine soon”. There were no certificates for us to look at concerning infection control training for staff. Two Gates House DS0000066258.V354071.R01.S.doc Version 5.2 Page 25 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. Improvements are needed to ensure that the numbers of staff provided can meet the needs of the people who use the service. The majority of staff have been assessed as being competent to carry out their work roles. Recruitment processes need some improvement to ensure that people who use the service are protected. Adequate evidence was not available to show us that staff have received all training required. This judgement has been made using available evidence including a visit to this service. EVIDENCE: When we arrived at the service the senior told us that there were three care staff on duty until 08.30 after this only two. She explained that one of the night staff stay over until 08.30 to help with the busy time. The senior told us that the deputy was cooking that day as there was no cook. The male owner gave us a copy of the rota week commencing 28.1.08. He confirmed that this is the rota in use for that week. We saw that the deputy was on the rota to be cook that day 28.1.08. We also saw that the deputy was included as the second carer every day except the Tuesday and Wednesday. Two Gates House DS0000066258.V354071.R01.S.doc Version 5.2 Page 26 We observed during the morning and saw that there were no staff in the lounge area for up to fifteen minutes at a time between 08.00 and 10.00 hours. We were concerned that during this time there were two people in the lounge one of who had a fall a few days previously and had sustained bruising around her eyes. Her assessment carried out by the service dated 17.12.07 says; ‘ Staff to attend to needs immediately, as soon as possible’. This would not have been possible at this time as there were no staff in the lounge with her. Records we looked at told us that people had varied and somewhat complex needs examples being; supervision and support needs. One had displayed aggressive behaviour and had since been referred to a psychiatrist. We observed that one staff member gave the medication out during the morning leaving only one staff member on the floor. One person who uses the service told us; “ Not enough staff. Sometimes that thing is going all the time”(pointing to the call system). We received comments about staffing, which included; “ At times we could do with more on morning shifts but other times not”. “ Just at the moment staffing problems are a small worry but not to the residents”. “ As there are only two staff on an evening there are times when they find it difficult to respond to all residents needs and people have to wait to go to the toilet”. Our previous concerns about staffing levels were highlighted in our last report dated 24.9.07. We discussed the issue of staffing with the male owner and told him we were concerned. He told us that he is trying to sort it out in that he has employed laundry and cleaning staff so that staff do not have additional tasks to do. We found this very positive. He also told us about night staff staying over to help at busy times. We told him that this was not enough and that action needed to be taken. We referred him to Regulation 18(1)(a) which is the regulation that applies to staffing levels. The male owner told us; “ It takes time to recruit staff”. We reminded him that there were short-term solutions to bridge the gap in that he could consider such as, using an agency. We observed staff during our inspection and found them to be helpful and friendly. They were polite to the people in their care. Comments we received about the staff included; “ The care staff on duty are very friendly and queries are dealt with immediately or messages are left for the manager”. “ Most staff we meet have a good attitude and are quick to laugh and joke making it a happy environment”. “ The staff are very caring and act in a professional way”. Over 50 of the care staff team have achieved NVQ level 2 or above in care. This is positive in that this means that a large proportion of the staff group have been assessed as competent to carry out their work. We looked at the files of three staff members to assess recruitment processes and any potential risk to the people who use the service. From these records we did highlight some areas that need to be improved for example; one staff member had been allowed to commence employment by Two Gates House DS0000066258.V354071.R01.S.doc Version 5.2 Page 27 the service before her full enhanced disclosure had been received. Records showed that her enhanced disclosure was dated 13.11.07 but her contract start date and her signed contract stated that she had commenced employment on 9.11.07. We tracked this further and saw written records confirming that she had received induction on 5 and 8.11.07 and the 9.11.07 was her ‘first shift’. There was no evidence of a nominated person to supervise this person. Further, one written reference dated 9.11.07 the day she started her ‘first shift’ was not fully authentic as it was addressed ‘ To whom it may concern’. For another staff member (RT) we could not find evidence of a start date on file. These shortfalls in recruitment processes could place vulnerable people at risk. We did not see any job descriptions on files. We asked one staff member (who had recently changed job role) if she had a new contract to reflect this role change and was told “no”. The training matrix showed that staff received training in 2006, 2007 but did not state the month. The male owner told us that he was aware that the training matrix needs to be updated. We could not assess staff training, as there were no certificates available for us to view. Two Gates House DS0000066258.V354071.R01.S.doc Version 5.2 Page 28 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): Quality in this outcome area is poor. Management processes within the service are weak and are placing people who use the service at risk. Some processes are in place and are being implemented to ensure that the service is being run in the best interests of the people who use the service. The finances of people who use the service are being safeguarded. Some improvement is needed to ensure that people who use the service are safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two Gates House DS0000066258.V354071.R01.S.doc Version 5.2 Page 29 Since our last inspection the registered manager has been on leave. We were very pleased to learn that the male owner of this service, in order to improve it, has suspended his own employment to spend time everyday at the service and is being involved in it’s everyday running. This owner we could tell by what he said to us and from our observations is interested in the service and enjoys being involved. Staff told us; “ Things are much better” and “ Much improved”. We could tell from the way staff spoke about the owners that in a short time a good professional relationship has developed. We were also pleased to see from records and by speaking to staff that it is clear who is in charge when the deputy is not at the service. This means that there is a delegated person at all times to take responsibility for the service. We told the owner that despite these improvements we were still concerned about the management of the service in that we had identified concerns regarding; Care plans in that these were mostly ‘ assessments’ or ‘ review’, there are no documents to confirm clear care plans. The lack of highlighting medical conditions and risk in care plans. Medication management and safety. The failure to report a situation where by a staff member had been suspended. We highlighted to the male owner that these shortfalls, which could place people who use the service at risk, had been highlighted in our previous inspection report dated 24 September 2007, had been repeated again. We told the male owner that we acknowledge his time and effort into the service in order for improvement but were concerned about his lack of knowledge in these high-risk, care areas. The owner told us that he has appointed a deputy who does have knowledge in these areas. We told the male owner that although this person may have potential she lacks full management experience. We also raised our concern that this person on the day of the inspection was cooking for the day rather than ‘managing’ and suggested that her time would be better spent ‘managing’. The male owner did tell us that he was recruiting kitchen staff to avoid this situation in future. We discussed Department of Health ‘Protection of Vulnerable Adults’ (POVA) guidance 2006, page 13. We told the male owner that in exceptional circumstances he could consider employing before receipt of a full, enhanced disclosure so long as the criteria as described in the guidance on page 13 were fulfilled. The male owner told us he was not aware of this. He told us; “I would be worried if another inspector came and found that we had done that we would be pulled up over that”. We saw from records that one care staff in November 2007 had been employed by the service before her full enhanced Two Gates House DS0000066258.V354071.R01.S.doc Version 5.2 Page 30 disclosure had been received confirming that the service were aware that they could decide to do this if they felt there was a need. We saw from the rota week commencing 28.1.08 that the deputy only has two days per week (8am-5pm) to just concentrate on management issues. The rest of the week she was on the rota as the second carer or on the day of the inspection cook, which does not give sufficient management time to fully address shortfalls. The male owner told us that the deputy would be ‘full time’ from the following week. We were pleased to see that a schedule of meetings for people who use the service had been produced and was on display in the ground floor hallway. We were also pleased to see that the registered owner has been completing a monthly report about her findings when visiting the service. Processes such as these are positive as they give people an opportunity to voice their views on the running of the service. We looked at the quality monitoring process (Mulberry House) that the male owner has on his computer ready for use. We discussed this with the male owner asking him what methods he would use for audit. The male owner told us that he would be using a range of methods, which included; observation, checking records and speaking to people who use the service. This was positive in that it gave us confidence that the male owner had a good understanding of what is needed to identify whether or not the home is being run in the best interests of the people who live there. We checked the money of three people who use the service. One did not have any money and there were no records to identify that she should. The money of the other two was correct against records. We saw that receipts had been provided by the hairdresser to evidence expenditure for hair care. We saw that this money is held in a safe. This evidence showed us that processes are in place to ensure that peoples’ money is being safeguarded. We were pleased to see that most radiators since the last inspection have been fitted with suitable guards to prevent the risk of burns. We looked at staff files but could not find any training certificates. We asked the male owner and a senior to show us where the training certificates were. They both told us; “ Thought they were in the files”. They both looked and could not provide us with any training certificates so we could not check that training is up to date. A training matrix was available but we needed to check the dates on the matrix against training certificates and were unable to. The training matrix was fairly basic in that it only showed the year for example 2006, 2007 not the month and year and it did not highlight when staff needed refresher training. The following comment was received from a staff members completed questionnaire; “ I do not think LS kept training up to date. I mentioned Two Gates House DS0000066258.V354071.R01.S.doc Version 5.2 Page 31 training on many occasions she told me it was ok but I felt training was not up-to-date”. We looked at a range of service certificates to ensure that equipment was safe. We found a number of shortfalls as follows; There were no records of fire drills and the male owner could not provide these when asked. The last service certificate for the passenger lift held the date of 23.1.07, which means that there was no evidence to prove it, had a six monthly check as required by lifting Regulations in order to prevent accident. The male owner could not provide us with evidence to confirm the last time the fixed electrical wiring had been checked which for safety reasons should be checked every five years. As with the last inspection we were not provided with evidence to demonstrate regular checks for the bedrails in room three. These checks should be undertaken to prevent risk of entrapment and injury. We looked at the kitchen and found improvements concerning cleanliness and labelling of short life foods these processes are positive in that risks to people who use the service are reduced. We saw that pre-printed diaries were in the kitchen ready for use. We did highlight to the deputy manager the lack of blue plasters in the first aid box who told us; “ They have run out, I will order some more”. Two Gates House DS0000066258.V354071.R01.S.doc Version 5.2 Page 32 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 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 1 3 3 x x x 3 x 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 2 x 3 2 x 2 Two Gates House DS0000066258.V354071.R01.S.doc Version 5.2 Page 33 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(1)(2) (a) Requirement A care plan must be prepared as to how each persons needs in respect of their health and welfare are to be met. Each persons care plan must be kept under review. Unnecessary risks to the health or safety of people are identified and so far as possible eliminated. Suitable arrangements must be made to ensure that medicines are stored securely with restricted access to authorised members of staff to ensure that people who use the service are protected from harm. Suitable arrangements must be made to ensure that medicines requiring special storage arrangements are stored under The Misuse of Drugs (Safe Custody) Regulations 1973 as amended. Timescale for action 13/02/08 2 OP8 13(4)(c) 13/02/08 3 OP9 13(2) 13/02/08 4 OP9 13(2) 13/02/08 Two Gates House DS0000066258.V354071.R01.S.doc Version 5.2 Page 34 5 OP9 13(2) 6 OP9 13(2) Medicine records for the administration of medication must document what has been administered in order to ensure that the people who use the service are safeguarded. A medication policy must be available which is detailed and specific to the service and is accessible to staff to ensure that people who use the service are safeguarded. All allegations or incidence of abuse must be reported to Social Services in accordance with multi-agency protection procedures. Where staff are suspended or dismissed a referral to the Protection Of Vulnerable Adults (POVA) list must be made without delay. Timescale of 24/09/07 not met. 13/02/08 13/02/08 7 OP18 13(6) 11/02/08 8 OP27 18(1)(a) Having regard to the size of the home, the statement of purpose and the number and needs of people who use the service at all times suitably qualified , competent and experienced persons must be working in the care home in such numbers as are appropriate for the health and welfare of people who use the service. Timescale of 15.11.07 not met. 11/02/08 Two Gates House DS0000066258.V354071.R01.S.doc Version 5.2 Page 35 9 OP38 37(1)(2) Notice to the Commission must be given without delay of the occurrence of – (a) the death of any service users including the circumstances of his death. (b) The outbreak of any infectious disease. (c) Any serious injury to any service user. (d) Serious illness of a service user at a care home at which nursing is not provided. (e) Any event in the care home which adversely affects the well-being or safety of any service user. (f) Any theft, burglary or accident in the care home (g) Any allegation of misconduct by the registered person or any person who works at the care home 2 Any notification made in accordance with this regulation which is given orally shall be confirmed in writing. Timescale of 24/09/07 not met. 11/02/08 Two Gates House DS0000066258.V354071.R01.S.doc Version 5.2 Page 36 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 OP9 Good Practice Recommendations Care plans should document up to date medication records. This is in order to ensure that medication records for people who use the service are accurate. We strongly recommend that an activities needs and leisure time analysis is undertaken concerning all residents. From this a structured activity programme should be produced with activities and leisure time pursuits provided as per needs identified. Training certificates must be available at all times to prove training undertaken by each staff member. To make sure people who use the service are adequately safeguarded where the decision has been made to employ a staff member before receipt of their full enhanced disclosure Regulation 19-19(10) must be fully complied with. .2 OP12 3 4 OP27 OP29 Two Gates House DS0000066258.V354071.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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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