Inspection on 15/05/08 for The Manor House

This inspection was carried out on 15th May 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

The Manor House 07/10/09

The Manor House 25/02/09

The Manor House 30/11/08

The Manor House 20/10/08

The Manor House 11/12/07

The Manor House 06/06/07

The Manor House 28/12/06

The Manor House 15/08/06

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/11/2008.

CARE HOMES FOR OLDER PEOPLE Uphill Court 62 Uphill Road South Weston Super Mare North Somerset BS23 4TA Lead Inspector Patricia Hellier Unannounced Inspection 09:30 15th May 2008 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 Uphill Court DS0000067101.V360446.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. Uphill Court DS0000067101.V360446.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Uphill Court Address 62 Uphill Road South Weston Super Mare North Somerset BS23 4TA 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) 0208 5606691 01934 628386 uphillcourt@tiscali.co.uk Shreyas S.A.I.N. Ltd ****Post Vacant**** Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Uphill Court DS0000067101.V360446.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Manager must be a RN on parts 1 or 12 of the NMC register. Staffing notice dated 26 May 1999 applies. May accommodate up to 25 persons aged 65 years and over. That the manager achieve the Registered Manager’s Award within one year of registration. 11th December 2007 Date of last inspection Brief Description of the Service: Uphill Court is a listed building that has been converted to a registered care home with nursing. It provides accommodation for up to 25 older people with nursing needs. Accommodation is provided over two floors with a passenger lift giving easy access to one of the upper floors. The other upper floor is accessed by a stair lift. There are nineteen single rooms, and three that may be shared. Seven of these have en-suite facilities and all have a call bell system. Communal space is provided in a lounge in the main building and conservatory /dining room attached to the lounge. This looks out onto an enclosed garden. Provision is made within the home for some activities and outings, which also enable close links with the local community to be maintained. All local facilities are within easy walking distance but some are closed in winter. Information about the home is available through a brochure that incorporates key information from the Statement of Purpose and Service User Guide. CSCI reports are displayed in the entrance to the home and available for all to read. The fess range from £385 - £701 per week with additional charges being made for hairdressing, chiropody, newspapers, escorts, toiletries and some transport. This information was provided in August 2008. Uphill Court DS0000067101.V360446.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. Since the last Key inspection we have received 2 concerns that have been followed up through the Safeguarding of vulnerable Adults process, which led us to visit the home for a Random inspection in February 2008. At this inspection seven requirements were made to improve care and safety provision for the protection of residents. Since that inspection a serious complaint has been reported to CSCI, the healthcare trust and the Safeguarding Adults Team, regarding pressure sore prevention and wound care management, and this is currently under investigation as part of this Key inspection. This key inspection took place over 18.5 hours on three days and involved up to 4 inspectors at various times. The pharmacist inspector made a subsequent visit to review the medicines management and practices as some concerns had arisen around this area. The appointed manager Ms Susan Marks, who intends to apply to be the registered manager, was present throughout. During the inspection a meeting was held with the provider at which we expressed our concerns regarding the care provision at the home and referral was made to North Somerset Council Safeguarding manager. Before the inspection the information about the home was received from the file held in the office, surveys received from 1 relative, two members of staff and 1 GP. The last two inspection reports were reviewed. The completed Annual Quality Assurance Assessment (AQAA) form, from the provider was also reviewed. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. The information supplied in this document was minimal. We (The Commission) also reviewed all correspondence and regulatory activity since the last inspection. The accumulated evidence for this report comes from the above and also fieldwork that included discussions with 20 residents, 6 relatives, and 8 staff. Practices were observed and documents relating to care, recruitment and health and safety were reviewed. We asked the home to send out surveys to residents, relatives, staff and GP’s. One relatives’ survey was returned and this included comments - “Home does not support people to live the life they chose – basic care only is provided”. Uphill Court DS0000067101.V360446.R01.S.doc Version 5.2 Page 6 “Attempts to improve the environment – work commenced in Dec 07 still ongoing” (May 08). “They need to increase staffing levels”. “Were my relative not so frail I would move her to an alternative home”. None of the resident surveys sent out were returned. One GP returned the survey and comments included “there have been problems over the last few months. There has been a recent change of manager and I think the situation is being addressed with various actions.” Two staff surveys were returned and contained a range of comments including “they need to employ more staff and ensure better skill mix”. Night staff do not feel supported through meetings with management. “The home encourages residents to mobilise and communicate with others”. What the service does well: What has improved since the last inspection? What they could do better: Residents would benefit from a fully person centred approach to assessment and care planning, which would enable their needs to be met in their preferred Uphill Court DS0000067101.V360446.R01.S.doc Version 5.2 Page 7 way. Assessment records must show clearly how needs are assessed and reflect that level of information in care plans. If prospective residents are assessed as being highly dependent, then care plans must reflect fully how their needs are met. With clear and informative assessments, and care plans, care staff would be aware of resident’s physical, psychological and social needs and care needs would be more likely to be met. Clear and accurate information about residents would enable the home to provide activities suitable to their personalities and interests, thus improving the quality of life for residents. Residents’ health and well being would benefit from care plans that clearly showed actions to meet identified needs and were kept up to date to ensure all needs are appropriately met, by informed staff. All residents must be able to reach a call bell, especially when in their rooms, at all times to promote their dignity and safety. A planned activities programme in consultation with residents, and their relatives, would enhance the quality of life for residents and relieve their boredom and feeling of social isolation. Residents who smoke should be provided with an area outside the building that gives them protection from poor weather. Provide the residents’ with a well maintained and decorated environment, which has homely touches, to assist their health and well being. Residents would benefit from reduced risk to contamination of food if the temperature of fridges and freezer in the kitchen were checked daily to make sure they are operating at a safe level. The provision of regular training in key areas of care and protection together with supervision would enable residents to feel safer, well protected and cared for by knowledgeable and competent staff. Residents would feel more relaxed and comfortable if the staffing levels were kept under review according to the needs of the home, and there were enough to enable flexibility to routines. The implementation of a robust recruitment system would enable residents, and their relatives, to know that they are well protected from potentially harmful people being employed. Staff must not be left in charge of the Home unsupervised if they do not have a completed and satisfactory Criminal Records Bureau check carried out on them as this potentially puts residents at risk. Residents would be better protected if health and safety issues were addressed regularly; e.g. radiator temperatures, carpets and areas for slip, trips and falls. Uphill Court DS0000067101.V360446.R01.S.doc Version 5.2 Page 8 Provide clear leadership and management to staff to assist them to provide care in a knowledgeable and competent manner to meet all health and well being needs of residents. 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. Uphill Court DS0000067101.V360446.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Uphill Court DS0000067101.V360446.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Prospective residents may be provided with information about the home in a brochure that has some inaccuracies. The homes assessment process is not thorough and does not ensure that the home can meet the needs of prospective residents. EVIDENCE: The Statement of Purpose and Service User Guide supplied to us for inspection, provides clear information in relation to many of the areas required, from which prospective residents, and their families, can make their choice. Not all the information is correct for example; the Statement of Purpose says the home are able to offer “specialist provision for people with mild to severe Dementia, Learning Disabilities and Physical disabilities”. The home is not registered to provide care to people with these conditions. Uphill Court DS0000067101.V360446.R01.S.doc Version 5.2 Page 11 Staff interviewed and training records inspected did not show us that staff have the specialist skills and experience to provide care for people with these conditions. It also states that that the home provides palliative/ terminal care however we were not able to evidence any staff that had the specialist skills in this area of care. (See staffing section of this report for training evidence). In the hallway of the home a brochure containing a summary of the above two documents is available for anyone to pick up and take away. Two residents spoken with and one relative told us they had not received any information about the home and had arrived following arrangements between the home and Social Services. The resident admitted on day one of the inspection told us “I had no choice to come here, the hospital arranged everything. I did not visit the home beforehand”. Contractual arrangements were seen for one resident and these were satisfactory. The contract seen for one resident had not been signed or dated on behalf of the home, and there was a cross for the resident’s signature. There was a note on the top of the contract saying the son had a copy. We were not able to speak to the son during inspection to confirm that he was satisfied with the contractual arrangements. Three other resident files inspected did not have evidence of a contractual arrangement. The home was not able to easily access information about the funding arrangements of all the residents for us, which indicated a lack of knowledge about the residents. Four care records were inspected in depth and admission assessments reviewed. From the documentation it is not clear if an assessment of needs is undertaken prior to admission to ensure the home can meet the prospective residents’ needs, or following admission. In one of the records the assessment, had clearly been completed prior to admission. In another record there was no pre admission assessment documentation. The assessment records were vague and not detailed. The assessments did not clearly show the resident’s range of physical, mental and social needs had been assessed. The actions taken to support the person were not clearly recorded in the assessment records. The assessment records we read were not being regularly reviewed and updated. Assessment records must be regularly reviewed as this information forms the basis for deciding what sort of care and support residents’ need. On day one of the inspection the manager told us she went to assess a prospective resident. The resident arrived in the afternoon and was unable to access the home in the normal way. The pre-admission assessment did not appear to highlight the fact that with a large wheelchair there could be access difficulties to the home and subsequently to the room allocated. Uphill Court DS0000067101.V360446.R01.S.doc Version 5.2 Page 12 One recently admitted resident did not have any assessment documentation. One resident said, “I had no choice to come here, the hospital arranged everything. I did not visit the home beforehand”. A relative told us that neither they or their relative had met the manager or visited the home prior to admission. Uphill Court DS0000067101.V360446.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. This judgement has been made using available evidence including a visit to this service. Residents cannot be confident that their care plans will contain full, and clear, information to enable staff to meet all their health and social care needs. The health of people living in the home would be better protected through improvements to medicines handling. Residents’ respect and dignity is not always maintained by kind and caring staff. EVIDENCE: In order to determine how each persons needs are assessed and how the care delivery arrangements are determined, we read in depth 7 care files. New care planning documentation was introduced at the beginning of the year however this has not been achieved adequately for a number of people. We found the content of the care plans to be vague and unclear in detail. The care plans failed to identify the individuals nursing needs. Neither did the care plans clearly set out what actions must be taken to meet the nursing needs of each person. Uphill Court DS0000067101.V360446.R01.S.doc Version 5.2 Page 14 As referred to in the previous section of the report the care plans we looked at did not reflect the level of dependency of residents. Specifically we saw assessment records that identified residents as being highly dependant in all areas of their daily lives. However the content of the care plans we read did not reflect this. One person who lived in the home had no current assessment of needs and wholly inadequate care planning documentation, which did not provide the staff with instructions on how the identified care needs were to be met. Not all care needs had been identified clearly, and thus no actions stated to meet these needs. Despite repeated requests for this information, the manager was unable to produce the documentation. These serious shortfalls have the potential to mean that people may not get the care and support that they require and their care needs will go unmet. When staff were asked about how they knew what care they needed to provide, some said they would look at the care books, another described care in a task orientated way describing “we tend to do this, then that, then that”. Improvements must be made so as to ensure that each person receives an individual plan of care, with their specific care needs being met. Risk assessments had been completed in some cases but actions to minimise risk had not been stated, again not enabling safe and consistent care provision. We observed that the staff on duty helped residents with their needs, and spoke to them in a friendly way. However we were concerned to see instances of poor practice when a member of staff was observed moving one resident in the Stand Aid while talking to another resident. This is poor practice and disregards the needs of the resident being moved. Another instance of poor practice was observed when two members of staff were seen using an underarm lift for a resident. This is very uncomfortable for the resident and can potentially cause serious injury. A third instance of poor practice was observed when a carer was seen wheeling a resident through the home in a wheelchair without footplates. This is uncomfortable, undignified and potentially dangerous to the resident. Staff interviewed had some understanding of the resident’s basic needs but not always the knowledge to see other needs not identified, or to meet them effectively. All staff observed have a caring approach and provide care as they see fit for the individual residents. In discussion with staff, while it was clear that regular recording takes place within the documentation we take the view that not all staff understand the care plans to be working documents. Uphill Court DS0000067101.V360446.R01.S.doc Version 5.2 Page 15 Three residents being nursed in their rooms did not have their call bells within reach. This has a direct implication on how residents’ needs are met, if they cannot call for help when they need it. Two of the call bells seen were hanging from the ceiling and appeared that were they used they could present a hazard to the resident, and be ineffective in calling staff to the residents’ aid. This was observed on day one of the inspection and mentioned to the manager. However on subsequent inspection days we still observed these residents without access to a call bell. Residents in the lounge did not have access to a call bell and were dependant on a member of staff passing through, or the manager being in her office, should they require assistance from a member of staff. One partially sighted resident was seen sitting in the conservatory on all three days of the inspection, with no access to a call bell and reliant on shouting for help. It was noted that in one room an arrangement had been set up for the resident to have access to their call bell when in bed as well as when sitting in their chair in their room. Records kept in respects of contact with GP’s and other healthcare professionals were inconsistent and did not always reflect follow up of issues raised. In the records examined it was not possible to track whether staff had taken the appropriate actions to deal with any healthcare events. For two people, staff had recorded concerns about a wound site but not what they did about it or how they should manage the issue. This was also the case for the individual about whom we have received a complaint and are investigating as part of this inspection. From another residents records we observed that they had a deep pressure sore, which they had had for at least 8 months. In discussion with the manager about this, she informed us that she had inherited it from the previous manager and they were doing what they could to heal it. This together with three other residents who have had wounds for sometime, and records indicating that healing was not taking place, led us to call for an urgent Vulnerable Adults review, as this suggests that appropriate care was not being given. The resident when spoken with told us that staff did what they could but they are very busy. In discussion with nursing staff about this we were told that she has strong pain killing patches for the pain from the sore, as well as medication to help her sleep to control the pain and enable her to have some sleep. The other residents were not able to tell us about told us they had information passed on verbally they “do not know where we are as one says one else”. They did not feel they could give the best information. their care. Staff spoken with at handover, but sometimes thing and another something care with this discrepancy of Uphill Court DS0000067101.V360446.R01.S.doc Version 5.2 Page 16 Staff interviewed told us care plans are kept in residents’ rooms and could be referred to if needed. Staff told us that staffing shortages at times has an effect on care provision. (See Staffing section of this report). Wound care management documentation was poor and described use of different wound care products and were not consistent in describing frequency of attention required. Records indicated that dressing decisions for wound care management in two instances had been made by a member of staff with no nursing experience, except for a 1 day course in 2001. In some instances, products are used that may not have been prescribed by the GP meaning that the person may not be getting the most appropriate care. A serious complaint has been reported to CSCI, the healthcare trust and the Safeguarding Adults Team, regarding pressure sore prevention and wound care management, and this is currently under investigation. One person, who was being nursed upon an air mattress, did not have a recorded body weight, which is essential in calibrating the pressure scale for the air mattress. During the inspection this was set at the highest setting which was potentially inappropriate for the individual and would not provide the pressure relief required, thus potentially leading to pressure sore. Another person had a right sided weakness but there was no care plan relating to her right sided weakness. Her need for assistance with eating had not been identified or action stated as to how she would require help, and a risk assessment had not been undertaken for use of appropriate cutlery or to enable her to keep some independence. In the daily care records, but not the care plan, there was some information that the person needed two carers to assist with personal care. In the lounge we observed a sheet of paper relating to the toileting routine for one resident left on top of the piano in the lounge. It had a number of times and signatures on it, and was available for any one to read thus not ensuring the privacy and dignity of the resident. There was no care plan written identifying this need and stating actions to meet the need. The only entry found in the care documentation was in the daily records (on the 19th) ‘Taken to toilet’. Inspectors were satisfied that apart from this incident confidential information relating to residents is stored appropriately. Two residents are smokers and there were no risk assessments in their care plans in relation to this, and no clearly documented action to assist them to meet this need. We observed that cigarettes are kept by staff (see Daily Life section of this report) in the case of one of these two residents this approach is set out in the Social Services care plan but is not included in the homes plan of care. Medications are not always stored appropriately. Prescribed creams and preparations were found in communal bathrooms. Medications were present Uphill Court DS0000067101.V360446.R01.S.doc Version 5.2 Page 17 for people who no longer lived in the home and one product was out of date by more than one year. This evidences that the home does not always dispose of medications that are no longer needed, in the proper manner. An immediate requirement was issued to the registered provider to take remedial action. At the subsequent visit on the 23 May 2008, the products had been removed. The pharmacist inspector visited on 5th June 2008 and the findings are as follows. Most people living at the home are registered with the local doctor’s practice and the doctor visits the home every two weeks. Medicines are supplied by a pharmacy using a monthly blister pack system. The manager identified some difficulties they have had with the system. Some painkillers have not been received with the rest of the regular monthly prescriptions, insufficient blood sugar testing strips have been supplied to last the month and sometimes medicines not asked for by staff have been supplied. The manager said that she has arranged meetings with the doctors’ practice and pharmacy to address these problems. One person living in the home looks after one of his or her own medicines. Nursing staff give all the other medicines used. A homely remedy policy for treating minor ailments has been updated. Staff said they have sent this to the doctor to be approved. All medicines seen were stored securely. A medicine fridge is available and temperatures recorded were in the safe range for medicine storage. Temperature records need to be kept daily. Extra secure storage is available for Controlled Drugs and the stock balances in the register were correct showing that these had been stored safely. An excess stock of a few medicines was seen, particularly medicines prescribed When required, which were not used but were supplied each month in spite of the home requesting non delivery. This can result in considerable waste because unwanted medicines cannot be reused by the pharmacy and have to be safely disposed of. Medicines supplied in the blister packs showed that they had been given as recorded on the medicines administration record sheet. It was not always possible to check medicines supplied in standard packs because it was not clear when the pack had been started, and action should be taken to address this. This is so that staff can check that medicines have been given correctly. When we arrived at the home staff had to check with the owner to find the medication policy. The policy for the home is quite general and does not detail how medicines should be given in the home. It is recommended that a more specific policy explaining the correct medicine procedures to be used in the home should be provided. This should be available for all staff involved with handling medication including bank/agency staff who may need to give Uphill Court DS0000067101.V360446.R01.S.doc Version 5.2 Page 18 medicines while on duty. This is so that all staff are aware of the safe procedures to use for the protection of residents. During the inspection we saw medicines being given to two people at teatime. On this occasion medicines had been put into two unlabelled medicine pots on a tray and taken to the people concerned. This is poor practice because of the risk of the medicines being given to the wrong person. The pharmacy provide printed medicines administration record sheet for staff to complete. There was some confusion with the numbers written at the top of the sheet, which had led to some mistakes where medicines had been signed for on the wrong day. The manager said that she was going to discuss with the pharmacy how they might be able to alter the sheet to reduce the risk of mistakes. Generally the records had been completed fully and showed medicines had been given as prescribed. Some handwritten additions had been made to the printed medicines administration record sheets. It is recommended that these should also be checked and signed by a second person to reduce the risk of mistakes being made. One handwritten entry for a single injection had not been signed, dated or checked and had nothing to show how it should be given. The medicines administration record sheet for one person who moved to the home quite recently showed that one medicine had been out of stock for at least the last three weeks and another for 6 days. The manager said that staff had been requesting prescriptions for these medicines over a period of time but this was not clear from the records made. Since the inspection we have been told that further action has been taken and these medicines have been received. Painkilling medication for another person had also run out at the time of the inspection and staff said that they also had difficulty getting the new prescription for this medicine. The administration record for a medicine applied every three days showed that on some occasions this had not been applied at the correct interval. The manager said that sometimes they had difficulty obtaining this medicine with their regular prescriptions and that this may be the reason. Action is needed to resolve problems with obtaining prescriptions to make sure that prescribed medicines are available and people’s health is protected. We looked at the information written about medication in six care records. In some cases there was insufficient information written to help staff give medicines safely. For example: No information about the use of a medicine prescribed daily When required, very little information about an injection given three monthly, no information about self-medication or evidence of risk assessment. This could mean that medicines are given inappropriately. Records are kept of the receipt and disposal of medicines. Care is needed to make sure that all medicines received into the home are recorded including Uphill Court DS0000067101.V360446.R01.S.doc Version 5.2 Page 19 those from home and hospital. This is to ensure that there is a clear audit trail to show that medicines have been used safely. The home does have an Equality and Diversity policy that recognises the cultural and social needs and differences that are present in society. However during the course of the inspection we observed practices that did not reflect this policy e.g. on wheelchair user not being able to access the home or their room in the chair; or residents having access to call bells. Staff were unaware of these equality and diversity needs that are not race related. Uphill Court DS0000067101.V360446.R01.S.doc Version 5.2 Page 20 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are not consulted or listened to regarding their choice of daily activity; they have become over compliant with the routine of the home. Residents may not benefit from the homes limited understanding of human rights and how this impacts on their lives. Relatives and visitors are always welcomed by friendly staff. EVIDENCE: We saw a notice board on display in the lounge. This displayed information written about a range of low-key social activities that are available for residents. No residents had an opinion relating to these. On the afternoon of the first day of the inspection we saw a musical afternoon take place involving a visitor and a small group of residents who were sitting in the lounge. One staff member was asked ‘who takes the lead for activities’ – their response was ‘no one, although I have introduced someone from Brandon Trust to help with getting residents to their activities such as on the board.” We were told that one resident goes out on their own to visit friends. Another Uphill Court DS0000067101.V360446.R01.S.doc Version 5.2 Page 21 resident “goes to a computer course weekly”. When asked where these details would be documented we were told “only in the daily records if at all”. There were no entries in files under Social and Leisure for residents’ case tracked. The only examples in one daily record state “taken out for cigarette’; ‘out for cigarette’. There was no risk assessment or care plan relating to smoking even though the resident has been in the home more than a month, potentially putting the resident at risk. We ate a portion of the lunchtime meal in the company of residents. This was a choice of freshly made steak and onion casserole with cooked vegetables, or beef pasties and cooked vegetables. There was a choice of homemade apple sponge with custard, or yoghurts for desert. The meal was well cooked and the food appeared to be very good. We looked in detail at the residents menu, to see if choices are well balanced, and traditional. Residents can make a choice of what meal they would like to have each day. Special diets can also be catered for, including people who are diabetic. The residents we met on the first day of the inspection spoke positively about the quality of the meals that are provided. In the lounge there was a large white board leaning on top of piano that had the daily menu written on it. Staff were observed serving this meal in the lounge at 1pm from a trolley wearing appropriate aprons. Staff were also observed taking trays to rooms and assisting two residents with their food. A number of residents received visits from their family and friends during the inspection. We saw two residents taking the opportunity to smoke a cigarette in the garden. However we were concerned to see that it was raining and the two residents had nothing that could be used such as an umbrella to protect them from the weather. We discussed this with the manager who told us that they had nowhere else for the residents to go. Staff were observed smoking in a garden shed nearby. On arrival at 9.30 on day three of the inspection there were two residents in the lounge having their breakfast. The TV was on showing a children’s programme. There was also a CD on in the same room playing country music. The residents were unable to tell us if they had made a choice of these being on. A staff member said ‘the TV is always on for them’. There were no activities observed in the morning. However, there were three residents having their nails done in the afternoon. One lady said ‘I enjoy having nice nails’, the other participants were unable to verbally say if they wanted this done. The expression on their faces indicated that they seemed to be enjoying the experience. A staff member explained that they undertake Uphill Court DS0000067101.V360446.R01.S.doc Version 5.2 Page 22 this activity once a week. There was no reference to this activity in any form of documentation or in care plans. One resident was observed to be sitting in the conservatory all day with no stimulation, and no access to a call bell. The resident was partially sighted and might only be able to know who was nearby by calling out. This is very isolating and potentially frightening for the resident. It was not possible to ascertain their feelings about this. Another resident told us “I am so bored there is nothing to do” We inspected the visitors’ book and found entries from staff and visitors ranging from 7.30am to 8pm. One resident was observed having a visitor in their room in the morning of the inspection. One resident was having a visit from their wife, in the conservatory during the afternoon. The homes policy states ‘that there is an open policy for visitors to come into the home’. Staff when asked said ’visitors can come and go as they like’. During day three of the inspection we observed residents without breakfast and their curtains still pulled. One resident said they were hungry, “breakfast is normally served at 9am but it is 9.35am and I am still waiting”. “We haven’t had anything to eat since tea yesterday”. The service user guide tells us that the last meal of the day is served at 17:00hrs and breakfast the following day at 08:30hrs. This would mean that residents go for more than 12 hours between meals. We asked two residents if they were offered, or could have, a snack in the evening. One resident told us “no” the other resident said, “because I am diabetic can ask for a biscuit if needed”. Staff told us that an evening drink with biscuits is served. A chocolate machine is located by the main entrance of the home, and a bowl of fruit was noted in the lounge. The kitchen was clean and tidy and in order. The kitchen staff have done food hygiene training to ensure they have a good understanding of safe practises for preparing and cooking food. However we were concerned because the urn that is used to boil hot water felt very hot to touch. There was no sign to warn that this is a health and safety hazard potentially causing harm to a member of staff. We were told that currently there is only one thermometer in use for a freezer to check the temperature. The home cannot be sure that food served to residents has been stored appropriately to protect them from potential harm. We advised that there should be a thermometer in the fridge and other freezer, and the temperature should be checked daily to make sure they are working safely. Two residents who smoke were given out cigarettes by staff when they decided the residents could have a smoke. There appeared to be no personal choice and personal packets of cigarettes were not being offered. The social services plan for one of these residents does include that she is vulnerable to others Uphill Court DS0000067101.V360446.R01.S.doc Version 5.2 Page 23 and therefore cigarettes are retained in the office. It shows a lack of respect for the person’s dignity not to allow the individual to take cigarette from his or her own packet prior to this being returned to the office. Staff were overheard saying “she can have one later”. A resident was overheard saying, “I would like a smoke but will have to wait till they let me”. There was a lack of accessible call bells for residents to obtain assistance in lounge, and no such facility in the conservatory. (See previous section of this report). We observed one lady requesting to use the toilet and staff ignored her. Uphill Court DS0000067101.V360446.R01.S.doc Version 5.2 Page 24 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents and relatives are not always confident that their complaints will be listened to and acted upon. Residents are not protected from harm or abuse. EVIDENCE: The home has a complaints procedure that is displayed in the hall and is contained in the service user guide. It contains timescales to inform complainants when they can expect a response. The contact information for CSCI is incorrect and needs updating to ensure residents and their relatives have access to this information, if they feel they need to complain to an independent party. Examination of the homes complaint’s log evidenced that complaints are not consistently dealt with, and there is no evidence of a review process that would assist the service in preventing any recurrence. Since the last inspection there have been three complaints that have been referred to the Safeguarding Adults process as they reflect serious concerns regarding the care provision at the home. One serious complaint is currently being investigated. One of these complaints was seen to be partially upheld in conjunction with the hospital, while the other was upheld. The homes response to the current complaint has not been accepted and has resulted in a Vulnerable Adults strategy meeting to decide how best to address the concerns raised. Uphill Court DS0000067101.V360446.R01.S.doc Version 5.2 Page 25 For a number of entries in this log, it was unclear of outcomes. One entry just contained the statement “see care plan diary”, and in this diary there was a long dialogue recorded, but no follow up. The running daily records for another person evidenced that they had reported many concerns to staff, but these had not been fed into the homes complaints procedure. There was therefore no evidence that the person’s complaints had been taken seriously, acted upon or resolved. Staff do not always record these issues appropriately or with respect for the person raising the issues. One entry read, “he was off the wall again…” A residents’ survey submitted to the inspectors by the home, includes that “100 of residents feel that their complaints are resolved to their satisfaction.” We asked to see a copy of the Homes policy regarding Safeguarding vulnerable adults from abuse. The manager told us that the Home does not have its own policy. A local policy is advised in Care Homes to help to guide staff to take the correct course of action if they ever have to respond to an allegation of abuse. There is however a copy of North Somerset Councils ‘No Secrets’ guidance document on the subject of abuse and the safeguarding of vulnerable people. This document does provide some helpful general information and guidance. As part of a national focus on Safeguarding Adults we spoke to three care staff to find out if they have done recent training to ensure they are up to date about safeguarding residents from abuse. One member of staff said they had done training on the topic of ‘safeguarding’ vulnerable residents, in their previous job in another Care Home in 2007. The other two members of staff had not done any recent training on the subject, although one of the staff said they had watched a DVD on abuse when they had first started work in the Home last year. We looked at the above mentioned staff training records to check if the staff team have done recent training on the principle of ‘the protection of vulnerable adults from abuse’. The records we saw demonstrated that one of the staff had done recent training the other two members of staff had not done recent safeguarding training. Abuse training is arranged “in-house”, although the training plan evidenced that only one staff member had had abuse training, and staff discussions verified that they had had no formal training. The locally agreed protocols for reporting safeguarding issues are displayed in the communal areas of the home – consideration should be given to moving this information to a visible but less highly prominent place We discussed with five staff what their understanding was of ‘whistle- blowing’, and if they know of a policy on this subject. The staff did not know of a ‘whistle blowing’ policy, but they were able to explain to us what the idea Uphill Court DS0000067101.V360446.R01.S.doc Version 5.2 Page 26 behind this was. Specifically that if they report an allegation of abuse in the Home they should be protected from any repercussions for doing so. A number of people who live in the home require walking aids to be able to mobilise. For some people these seem to be left in the bedrooms during the day and may mean that the person is unable to independently move about, and that their ability to choose when to move is restricted. One person, with limited mobility, was noted to be without a means of calling for assistance. Their call bell had been left out of their reach. Many residents’ in the lounge were observed to have a table put in front of them that they were unable to move. Staff appeared to do this as an automatic action. One member of staff when asked told us “it helps to keep them safe”. These instances show further evidence that people are being “restricted” because of the actions of the staff team. In some bedrooms, the call bells are ‘lengthened’ by pieces of bandage, to make sure that they reach the beds or the chair. We were not sure how effective this would be for a frail resident to pull on and ensure the bell was operated. Uphill Court DS0000067101.V360446.R01.S.doc Version 5.2 Page 27 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents are provided with basic accommodation that is not always safe. Health and safety issues are not well managed. The home has suitable equipment to maximise resident independence when used appropriately. Infection control practices do not always protect residents from potential for cross infection. EVIDENCE: The entrance to the home is in the process of being redecorated however at the time of the inspection no work was being undertaken. This does not create a nice first impression of the home and should be redressed as soon as possible. Several other areas of the home were noted to be in a poor state of repair. There was a hole in one bedroom window and the window frames of a number of rooms were rotten and decaying. This does not provide a safe, comfortable and homely environment for residents to live in. Uphill Court DS0000067101.V360446.R01.S.doc Version 5.2 Page 28 The home were not able to show us a maintenance plan to evidence that the home is well maintained for the safety of residents, and refurbished as needed. We did see that the lounge and some bedrooms have recently been redecorated, but the walls were bare. The lounge did not have a homely feel, as there were no pictures or homely touches about. On day one of the inspection we noticed that the dining room area of the Home felt cold when we were in the room. We made the Manager aware of this. We asked residents who were sitting in the dinning room if they felt cold. Two residents told us that they did. When we raised our concerns about this with the manager she remedied this by putting portable heaters into the room. Some parts of the home were extremely over heated e.g. one corridor and some of the bedrooms. The radiators in this same corridor are not guarded however all other radiators in the building are. It was not possible to ascertain why these had not been guarded and no risk assessment was available to indicate why these had been excluded and how the risk is being managed. They were in a corridor where the carpet was seen to be ridged and also an unmarked slope in it, providing a slip trip hazard for residents, relatives and staff. A number of fire doors were observed wedged open and when wedges were removed these did not fit flush to the doorframe to provide the necessary seal for the safety of residents. (Further comment about this is made in the management section of the report). There are a number of toilets and bathrooms located throughout the home, providing enough facilities for the number of residents in the home. In many of these rooms the tiling was in disrepair, and in some instances, tiles had come away from the wall leaving sharp edges. There are three sluice rooms but only one appeared to be in use. An “out of order” note was posted on one of the sluice units, dated December 2007. Adequate facilities must be available to ensure that equipment can be appropriately cleansed to prevent the spread of infection. A variety of specialist equipment was seen in the home for the benefit of residents. Three beds were seen with airflow mattresses however staff seem unaware of how to use these for the best benefit to the resident. In two instances there was no evidence of a body weight having been recorded, which is essential in calibrating the pressure scale for the air mattress. During the inspection these were set at the highest setting which appeared inappropriate for one resident and could therefore render the specialist equipment of limited use. Uphill Court DS0000067101.V360446.R01.S.doc Version 5.2 Page 29 The home has a hoist and a Stand –Aid for assisting residents’ to move their position which we observed in use during our visit. From a review of maintenance records it appears that during April into May this latter piece of equipment was out of order for more than four weeks, thus staff had to manage with other equipment or without. One member of staff interviewed told us they had awaited its s repair for sometime but was unsure for how long. During the inspection we observed poor moving and handling practice when the specialist equipment was not used. Resident rooms for two residents did not suit their needs. One wheelchair user was not able to access their room in the wheelchair, or to go outside the home in it. Another resident has been moved to an upstairs room and told us they are not able to socialise with others as they used to. Thus resident’s diverse needs are not being met by the home. One bedroom has a temporary wooden ramp in place to compensate for a small step – it is old and has split edges. This could cause injury to residents, staff or relatives visiting the home. One shared room, although having a curtain track on the ceiling had no privacy screen in place. It was verified by a relative that this has never been present to preserve the privacy and dignity of residents who shared the room. This means that staff are unable to maintain privacy and dignity whilst assisting with personal care tasks. Residents are provided with a lockable metal cabinet in their rooms for the safe storage of valuables. These were observed installed in all rooms and keys were available. In one room this cabinet was installed over the radiator, subsequently the cupboard and key were hot to touch, putting the resident at risk of potential injury. Infection control procedures are poor. Used linen was observed piled next to clean laundry; the external general waste bins and clinical waste bins are stored by bedroom windows, and by the end of the week can often be full enough to not allow the lids to close. This was observed on day one of the inspection, with cardboard piled up against the windows of resident’s rooms. It was observed that clinical waste is put into the bins without having first been bagged in the appropriate manner, providing greater potential for the spread of infection. On day three of the inspection soiled linen was observed being left in laundry throughout the day and by the staff room. With the activity of the staff they were therefore carrying any spores with them around the home. During our tour of the building we observed toilets, which had not been flushed and had been left for sometime. The odour in one room was very unpleasant. In the en suite of one resident who had been admitted to hospital the previous day the remains of the colostomy were splashed all over the sink. We did not observe any red alginate bags in use for soiled linen throughout the inspection. Soiled linen was therefore being transported in an inappropriate manner and potentially put residents at risk from the spread of infection. Uphill Court DS0000067101.V360446.R01.S.doc Version 5.2 Page 30 Hand washing facilities in communal areas are provided. During the inspection a number of instances were observed where staff did not wash their hands between actions of care provision for one resident, or between helping different residents. Alcohol gel is provided in the home in a number of places but staff were not observed using this either. This has significant health implications for residents due to risks of cross infection. Staff interviewed had some understanding of good infection control practices but admitted they did not always follow the guidance. The training records showed that only one member of staff has received infection control training in the last year. Uphill Court DS0000067101.V360446.R01.S.doc Version 5.2 Page 31 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): 27,29,30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents do benefit from staffing levels that are sufficient to manage their care needs. Residents are not protected by the recruitment practices of the home. Residents cannot be confident staff are competent to meet their needs. EVIDENCE: The staffing rotas were inspected for the last three weeks to ascertain satisfactory staffing levels throughout the day. On day one of inspection there was 1 nurse and 4 care staff on duty, with the manager in a supernumerary capacity. Staff appeared rushed. We observed one resident ask the nurse for the toilet. The resident was also wet from wasted medication and water. This was passed to care staff ten minutes later when one of the care staff passed the nurse, as the nurse was giving out medication. The carer acknowledged this by saying “we’ll do her in a minute”. Thirty minutes later the resident was still in a wet bed and had not been offered the toilet. The resident said, “no one has come”. Feedback from the residents spoken with told us “they are always short of staff”. “They come when they can and do their best but there aren’t enough of them”. Relatives and staff spoken with during the inspection told us “there are not enough staff”; “they are always rushed and busy”. Uphill Court DS0000067101.V360446.R01.S.doc Version 5.2 Page 32 The afternoon shift was rostered to have 1 nurse and 3 care staff and the night shift to have 1 nurse and 1 carer. We discussed the staffing levels with the provider and manager, and expressed our serious concern regarding the night staffing levels of one nurse and one carer. Given the dependency of the residents this was far from adequate. The provider agreed to employ an agency nurse for that evening. On the following day the provider informed us that she would be using agency staff in the coming days to ensure an adequate level of staffing to meet the dependency needs of the residents. Staff surveys returned told us they feel that “better skill mix of staff is needed” and that “the home needs to employ more staff”. Two staff spoken with told us that “there is never enough staff and we just do what is necessary”. One member of staff told us “I am not happy working here, as I see things I do not like”. When asked if they had spoken to senior staff a culture of fear was described and a view was expressed was that this would not be responded to in a positive way. Another member of staff told us “carers work hard, but there has been increased sickness leading to staff shortages”. Staff approached residents with directness and openness. Each of the resident’s with whom we spoke said, “How nice the staff are” and “they do their best” We checked the staff recruitment records to see if the Home carries out employment safety checks on staff before they start work. We checked the employment files of one registered nurse and one care assistant the deputy manager and the manager. One of the care staffs files contained a `Protection of Vulnerable Adults’ Check, a Criminal Records Bureau check, and one written reference. The registered nurse did not have a completed Criminal Records Bureau check in place before they started work. There were not two written references about them, as is legally required. The manager showed us written confirmation that two verbal references had been obtained by telephone about the registered nurse. However the registered nurse was observed left in charge of the Home unsupervised. In the exceptional circumstances that staff do not have a completed and satisfactory Criminal Records Bureau check carried out on them they may work in a supervised capacity. They must not be left unsupervised as this potentially puts residents at risk of harm or abuse. The third record had a completed Criminal Records Bureau check carried out on them before they had started work. However they did not have two written references taken up before they had started work. They also had two verbal references taken up by telephone by the Manager. The manager‘s recruitment file did not contain all the required documentation to ensure that all safeguards are in place prior to commencement of work. Uphill Court DS0000067101.V360446.R01.S.doc Version 5.2 Page 33 New staff do not receive an adequate induction training programme. One new staff member said they had two days shadowing to start with, working with a regular member of staff and then was no longer ‘supernumerary’. “I didn’t have any programme to follow, but the person I was working with had”. Another new member of staff told us “the induction was very light; I did not have anything to follow or sign off”. Staff told us there were no records kept of the induction process. In one file we did see an induction checklist in which some elements had been signed by the manager but not by the member of staff. The registered provider must ensure that the staff team are trained and competent to do the job for the safety and protection of residents and to ensure that their care needs can be met. The training matrix, for the home and all staff, inspected showed dates of recent training courses attended. This showed that three staff had food hygiene training but that does not include the cook, although they said they had received training. Two staff spoken with during the inspection, who were observed working in the kitchen, could not confirm that they had any food hygiene training. Only four of the existing staff team had completed ‘Abuse Awareness’ training, six had received fire safety training in January, one had done infection control, and six had done first aid training in April 2008. Other training sessions identified by the manager included health and safety, person centred care, dementia, equalities and diversity. However, no names were recorded against this training. A training plan of training needs, or audit, had also been completed, to indicate who needed what training but it was unclear when this was undertaken and how much progress had been made. Discussions with staff members evidenced that some have not even received mandatory training. It is clear that there has been a low priority given to staff training and that the people who live in the home are therefore being cared for by untrained staff. Uphill Court DS0000067101.V360446.R01.S.doc Version 5.2 Page 34 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents are not safeguarded by robust management structures that ensure the home is run in their best interests. Residents are not clear how their views are incorporated into the running of the home. Residents can be confident that their monies are handled safely by the home. Residents do not always live in a safe environment. EVIDENCE: As the registered provider is not available for the day to day management of the service she is obliged to ensure a manager is in place. The service and residents would benefit from the attentions of a suitably qualified and competent manager, and it is unfortunate that over the previous 8 months CSCI has not received an appropriate application. Uphill Court DS0000067101.V360446.R01.S.doc Version 5.2 Page 35 Three residents and two relatives spoken with told us that the new manager is making changes and trying to improve the home. One relative told us that the manager is “very kind and helpful.” The feedback from the local GP survey stated “there have been problems over the last few months. There has been a recent change of manager and I think the situation is being addressed with various actions.” We were told by staff that there are sometimes good ideas expressed in the home but that implementation appears to be slow. There is no clear leadership and guidance given to staff to assist them in meeting resident needs appropriately. Management structures and systems are poor, and do not ensure the safety and smooth running of the home for residents as demonstrated throughout this report. Residents feel the manager is approachable and seeks to do what she can when they raise a concern. However one resident said, “she is not always able to help”. The home has a quality assurance policy and evidence of quality assurance activity in the home was seen. The home manager had completed a number of audits and these had identified areas of improvement. We saw an audit about maintenance checks, medications, wound care (these forms were unfilled), falls register (although falls were logged there was no record of any reviews), and a kitchen audit. There were no records of any corrective action having taken place. A satisfaction survey has been completed this year but it was unclear whether this is to be fed into an action plan for the improvement and development of the home. We will require the registered provider to produce an Improvement Plan as an outcome of this inspection. Residents’ pocket monies held by the home were inspected and all three records and monies were checked and found to be correct. Clear records and receipts were present. Since 13th May 08 all entries have been supported by two signatures for any transaction, to ensure the safeguarding of all concerned. The provider said supervision for staff is given through observation, joint working with the nurses and staff meetings. Records of supervision inspected were only available for 2008. Supervision is recorded for everyone in the same bound book. Entries are dated but not signed by either the supervisor or supervisee. Entries show that sickness and performance issues are discussed along with training needs and the interests of staff. Team work issues are also discussed. Some records show discussion about the member of staffs skills and knowledge, but there is little evidence of assessment and action plans with timescales to demonstrate how the home will ensure staff have the appropriate skills and knowledge to meet residents’ needs. The provider told us that there was one entry missing from the book as it “had not been written up yet”. The records show that not all staff have received supervision this year, excluding Uphill Court DS0000067101.V360446.R01.S.doc Version 5.2 Page 36 the missing entry. The provider told us that she is aware that this is a gap in the service provision for the benefit of residents. There is little regard for health and safety of residents as cleaning products were found left unattended in bathrooms toilets and other communal areas of the home. This is evidence that the home does not comply with Control of Substances Hazardous to Health Regulations (COSHH) and an immediate requirement was issued to the registered provider to take remedial action. At the subsequent visit on the 23 May 2008, all products had been removed and were safely stored. During the course of the inspection, unsafe manual handling procedures were witnessed on two occasions. It is concerning that this should happen whilst the inspection team are present in the home and indicates that this may well be common practice. We were told that staff training in safe moving and handling procedures is arranged at induction and on a yearly basis, however one staff member had not received any training at all. They told us “it was cancelled because we were short on the floor”. We were also told that some of the moving and handling equipment had recently been out of action for a period of time. From examination of the maintenance records this could have been for as long as a month. The home uses bed rails for a number of residents. No risk assessments for these were seen and only one person had consent to the use of bedrails signed by their relative. This action does not take account of the Mental Capacity Act 2005 guidance, where it states there is a breach of the individual’s rights if one person consents to actions for them on their behalf. It should be a multidisciplinary approach to ensure the best interests of the resident are maintained. In discussion with the manager no one has undertaken any training regarding the Mental Capacity Act. The bed rails for one person were not securely fitted to the bed and could potentially pose a greater hazard. Another persons bed rails had padded bumpers on to provide some protection, however the plastic covering was peeling of and gave a shabby and uncared for appearance. The weekly maintenance checks including bed rail checks however are not consistently carried out; although in the last few weeks this situation has improved. One such check identified problems with one person’s bed rails, but the issue was not rectified for a further eight days. The accident book was inspected and the record of entries did not tally with recorded evidence in care plans. E.g. one resident had a fall out of bed and sustained a fractured arm for which she had a plaster cast applied. The entry in the accident book read “no injury sustained”. Uphill Court DS0000067101.V360446.R01.S.doc Version 5.2 Page 37 Portable electrical equipment is “PAT” tested and evidence of this was seen. Also there was evidence that the lifts and the Stand Aid were last tested in January 2008. Checks of the fire logbook again evidenced that checks are not being carried out consistently. There were gaps in the recording of visual checks of the fire fighting equipment and the emergency lighting system and tests of the alarm system. Some staff spoken to during the inspection said that they had not been involved in recent fire drills and that they had had only basic fire instruction during their initial training. There was evidence that fire doors were being rendered ineffective through the us of door wedges to hold them in an open position. This practice must cease. Where it is felt to be of specific benefit to a resident for example to have their bedroom fire door held in an open position, this must be achieved through use of an appropriate approved device that will allow the door to self close on activation of the fire alarm. Uphill Court DS0000067101.V360446.R01.S.doc Version 5.2 Page 38 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 1 2 1 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 1 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 1 2 1 3 1 2 2 1 STAFFING Standard No Score 27 1 28 X 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 1 X 3 1 1 1 Uphill Court DS0000067101.V360446.R01.S.doc Version 5.2 Page 39 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 provider/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 OP1 Regulation 4 (c) Requirement The registered provider must ensure that the Statement of Purpose does not include categories of resident catered for, for which they are not registered. The registered provider must ensure that a suitably qualified person admits all new service users only on the basis of a full assessment of their needs. Previous timescale of 27/02/08 not met Timescale for action 12/07/08 2 OP3 14.1 12/06/08 3 OP4 14 1(d) The registered provider must 12/06/08 ensure that following the assessment, the home is suitable and can meet the health and welfare needs of the prospective resident and confirm this in writing to the prospective resident. The registered provider must ensure that a plan of care for each resident is drawn up and provides the basis for the care to be delivered. DS0000067101.V360446.R01.S.doc 4 OP7 15.1 12/06/08 Uphill Court Version 5.2 Page 40 Previous timescale of 27/02/08 not met 5 OP8 12.1 The registered provider must ensure that risk assessments identifying people at risk of developing pressure sores are carried out by a person trained to do so on admission. Previous timescale of 27/02/08 not met The registered provider must make sure that all residents are registered with a General Practitioner of their choice. The registered provider must ensure that all health care events, accidents and incidents are appropriately documented with actions taken and outcomes of these events The registered provider must take action to ensure that prescribed medicines are available for staff to give, so that people’s health is protected. The registered provider must make arrangements for safe administration of medicines: This refers to: A medicine given at the incorrect time interval; insufficient information about how two medicines are to be given; poor administration practice observed. The registered provider must ensure that all medicines are stored appropriately. This relates to medication left in bathrooms An Immediate requirement issued This requirement was met at a DS0000067101.V360446.R01.S.doc 12/06/08 6 OP8 13.1 19/06/08 7 OP8 13.1 12/06/08 8 OP9 13.2 12/06/08 9 OP9 13.2 12/06/08 10 OP9 13.2 12/06/08 Uphill Court Version 5.2 Page 41 Random inspection on 23/05/08 11 OP9 13.2 The registered provider must ensure that all medicines are disposed of appropriately. This relates to medicines found in the bathrooms. An Immediate requirement issued This requirement was met at a Random inspection on 23/05/08 The registered provider must ensure that the home is run in a manner that respects the privacy and dignity of residents. This relates to e.g. the lack of privacy screening in a shared room; lack of footplates on wheelchair 12/06/08 12 OP10 12.4(a) 12/06/08 13 OP16 22 The registered provider must 12/06/08 ensure that all complaints are dealt with in a consistent manner in accordance with the services policy, and outcomes recorded. The registered provider must ensure that all actions by staff cannot be deemed as restricting residents’ choice and freedom. This refers to e.g. leaving frames in rooms, positioning of tables in front of residents and call bells being out of reach. The registered provider must provide more robust safeguarding training to prevent residents being harmed or suffering abuse or being placed at risk of harm or abuse. This refers to activities described in requirement 14 above. The registered provider must maintain a programme of planned maintenance and upgrading to improve the DS0000067101.V360446.R01.S.doc 14 OP18 13.6 12/06/08 15 OP18 13.6 21/07/08 16 OP19 23.2 21/07/08 Uphill Court Version 5.2 Page 42 environment for residents. This refers to the incomplete refurbishment of main stairway. 17 OP21 23.2 (j) The registered provider must ensure that all equipment installed for the management of waste is maintained in good working order. This relates to the broken sluice machine at one end of the building that has been broken since December 2007. The registered provider must ensure that equipment for the necessary moving and handling of residents is repaired promptly so as not to impact upon resident care and safety. The registered provider must review the call bell system and the pull cords to ensure that they are accessible from beds and chairs for all residents The registered provider must ensure that wheelchair users are only accommodated in suitable rooms so that their mobility is not further reduced 21/07/08 18 OP22 23.2(n) 12/06/08 19 OP22 23.2(n) 19/06/08 20 OP23 23.2(f) 19/06/08 21 OP24 16.2 (c) The registered provider must 21/07/08 ensure that rooms have access suitable for residents who are occupying the room. This relates to the damaged wooden ramps in one room that need to be replaced. The registered provider must 19/06/08 ensure that screening is provided in shared rooms The registered provider must review heating in the conservatory and corridors to ensure they are at a suitable DS0000067101.V360446.R01.S.doc 22 OP24 12.4(a) 23 OP25 23.2(p) 19/06/08 Uphill Court Version 5.2 Page 43 temperature for resident’s comfort. 24 OP25 13.4(a) The registered provider must provide suitable guards to radiators in the corridor for the protection of residents. The registered provider must make appropriate arrangements to store both soiled and clean laundry to improve infection control procedures. The registered provider must ensure that there are sufficient numbers of suitably qualified, competent and experienced staff working in the home to meet the needs of all residents at all times The registered provider must ensure that all required information and checks must be undertaken prior to a person commencing employment at the home for the protection of residents The registered provider must ensure that all staff employed in the home have received appropriate training, including mandatory training, for the work they are to perform and to enable them to adequately meet residents’ needs. 21/07/08 25 OP26 16.2(j) 12/06/08 26 OP27 18.1(a) 12/06/08 27 OP29 19.1 Schedule 2 12/07/08 28 OP30 18.1(c) 12/06/08 29 OP31 8 The registered provider must 12/07/08 appoint a person to be registered as manager of the home, to take full time day-to-day charge of the care home. The registered provider must establish and maintain an effective Quality Assurance system for reviewing and DS0000067101.V360446.R01.S.doc 30 OP33 24 31/07/08 Uphill Court Version 5.2 Page 44 improving the quality of care provided at the home. 31 OP36 18.2 The registered provider must ensure that persons working in the home are appropriately supervised to ensure they have the skills and knowledge for the job. The registered provider must ensure that COSHH products are not be left unattended in communal areas of the home where residents have access. An Immediate requirement issued This requirement was met at a Random inspection on 23/05/08 The registered provider must ensure that staff always follow safe moving and handling procedures that have been agreed following a full manual handling risk assessment. Immediate requirement issued. This requirement was met at a Random inspection on 23/05/08 21/07/08 32 OP38 13.4 12/06/08 33 OP38 13.5 12/06/08 34 OP38 13.4(a) 35 OP38 23.4 (c) i & 13.4(c) The registered provider must 19/06/08 ensure that risk assessment are undertaken in regard to the use of bed rails and consent obtained in accordance with the Mental Capacity Act 2005. The registered provider must 12/06/08 ensure that the practice of using door wedges that physically prevent effective operation of fire doors must cease. Uphill Court DS0000067101.V360446.R01.S.doc Version 5.2 Page 45 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 Action should be taken to make sure that staff could audit medicines supplied in standard boxes so that they can check they have been given correctly. A more detailed medication policy that includes the correct medicines procedures to be used in the home should be available for all staff involved with medicines administration. This is so that all staff are aware of the safe procedures to use to protect residents’ health. Handwritten additions to the medicines administration record sheet should be completed in full, signed and dated by the person making the change and checked by a second nurse. This is to reduce the risk of mistakes being made. 2. OP9 3. OP9 Uphill Court DS0000067101.V360446.R01.S.doc Version 5.2 Page 46 Commission for Social Care Inspection South West Regional Office Colston 33 33 Colston Avenue Bristol BS1 4UA 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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