Inspection on 20/10/08 for The Manor House

This inspection was carried out on 20th October 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

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 15/05/08

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 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Uphill Court 62 Uphill Road South Weston Super Mare North Somerset BS23 4TA     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Paula Cordell     Date: 2 1 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 38 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 38 Information about the care home Name of care home: Address: Uphill Court 62 Uphill Road South Weston Super Mare North Somerset BS23 4TA 01934412207 01934628386 uphill.court@virgin.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Shreyas S.A.I.N. Ltd Type of registration: Number of places registered: care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 25 The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home 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 Care Homes for Older People Page 4 of 38 Over 65 25 0 Brief description of the care home 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. Care Homes for Older People Page 5 of 38 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection as part of a key inspection process. The purpose of the visit was to review the requirements from the visit in May, July and September 2008. In addition to monitoring the quality of the care provided to the people living in the home. There have been no complaints received by the Commission for Social Care Inspection since the visit in May 2008. However, the home has been subject to a Safeguarding Strategy Process. This has meant that North Somerset Council are not placing at the home until such times they have been assured that the care has improved. The home has been served with two Statutory Notices in relation to recruitment of staff Care Homes for Older People Page 6 of 38 and wound care management. The provider has demonstrated compliance and no further action will be taken. In addition the home has been served with a Notice of Proposal not to admit individuals to the home by the Commission for Social Care Inspection. The provider has registered an appeal against the Notice of Proposal. The outcome of this is not known. This key inspection was conducted over two days, with three inspectors being involved. One of the inspectors was a pharmacist who reviewed the medication system in the home. The appointed manager is Ms Susan Marks, who intends to apply to be the registered manager. Ms Marks has been in post since November 2007 and there has been an unacceptable delay in Ms Marks making an application. Both the provider and Ms Marks were present during this visit. Information was reviewed prior to this visit which assisted in the pre-planning of the visit. This included one survey from a person receiving a service and two members of staff, the annual quality assurance assessment completed by the provider/manager and regulation 37 notifications detailing incidents that effect the well being of the people living in the home. The visit was conducted over two days and included a full tour of the home, a review of care documentation and other records in respect of the running of a care home and speaking with people who use the service, relatives, staff, the manager and the provider. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Older People Page 8 of 38 The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 38 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 38 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is available to individuals living in the home however this does not reflect the staff that are presently employed in the home. Systems are in place to ensure that an assessment is completed prior to a person is admitted. However this could not be fully explored as the home is unable admit any new persons to the home and the local authority has stopped contracting services with Uphill as an interim safeguarding measure until the standard of care has improved. Evidence: The home has a statement of purpose. This is displayed in the hall way of the home. It was evident that this has not been formally reviewed in light of the changing staff employed in the home. The deputy manager that is described in the statement of purpose has since left the home and has been replaced by a registered general nurse. In addition the statement of purpose states that they will employ a Registered General Care Homes for Older People Page 11 of 38 Evidence: Nurse to manage each shift, however the manager has recently employed a state enrolled nurse for people with a learning disability. This will be discussed later in this report. The statement of purpose has been updated to reflect the care needs of the people the home is registered to support which is older persons requiring nursing care. Previously the statement of purpose made reference to supporting individuals with a learning disability, physical disability and dementia and these areas of expertise fell outside the homes category of registration. The home has demonstrated compliance to a previous requirement. It was noted that the home is not displaying the current certificate of registration. The provider confirmed that she had received a new certificate in January 2008 but this was not the one that was displayed in the hall way of the home. This could be misleading for individuals. The provider stated that this would be rectified as they have a copy of the new certificate. A notice of proposal has been sent to the home by the Commission for Social Care Inspection for them not to admit anyone to the home until standards in the home improve. The provider has appealed against this notice. This process is still ongoing as yet a decision has not been received about the appeal. This is with the Commission for Social Care Inspections legal team. In addition to the above North Somerset has stopped contracting with the home until they are satisfied that the individuals in the home are fully protected and receive a good standard of care. A review has been conducted by the Primary Care Trust for all individuals living in the home. Copies of the reviews were forwarded to the Commission for Social Care Inspection as part of a safeguarding strategy. None of the individuals living in the home were removed as part of this assessment. There was a requirement from the last key inspection in May 2005 for the home to ensure that a suitable qualified person conducted the assessments as part of the admission process. From conversations with the manager and the registered nurse on duty during the visit in August 2008 and this visit it was evident that either the manager or a registered nurse would complete the assessments. It was evident from these conversations that the home intended to comply with this requirement. No further action will be taken and the requirement will not be repeated. However, when the home is able to admit individuals to the home this will be a focus on future visits. The statement of purpose details the admission process the home will undertake to ensure that prospective people moving to the home are appropriately placed. It was Care Homes for Older People Page 12 of 38 Evidence: noted that one individual was admitted to the home during July 2008, and that the persons mobility aids were not suitable to the environment due to the width of doors and corridors. This meant the person was restricted to their bedroom initially. Whilst in part this has been resolved it is evident that the person still spends much of the time in their bedroom partly through choice and the other due to the restrictions the environment poses when the individual is unwell and needs of use their wheelchair. However, from conversations it was evident that the home would explore this with any new persons moving to the home. Contracts were not viewed on this occasion. Care Homes for Older People Page 13 of 38 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Poor care planning processes could potentially put individuals at risk. The homes medication systems do not fully protect individuals. Evidence: Each person had an assessment that was being reviewed on a monthly basis. From the assessment care plans were drawn up based on the needs identified. The assessments covered a wide range of activities including mobility, mental health, personal care, nutrition, wound care management and communication. A concern that is raised about the format presently in use, is that for a carer to fully understand the needs of the individual they have to trawl through both the assessments and the individuals plan of care. It was evident that where needs had changed in the assessment this had not been updated in the plan of care. This could put individuals at risk for example a specialist drinking aid to prevent a person from scalding. This had been identified in the assessment but did not cross reference with the plan of care. On talking with staff it was evident that the individual had not wanted Care Homes for Older People Page 14 of 38 Evidence: to use the drinking aid and in fact a different drinking aid was in place that was not recorded in the plan of care. Whilst it was evident that staff were knowledgeable about this change any new member of staff could read the care plan and put the individual at risk. In addition care staff are not following the plan consistently which is a legal document that must be kept up to date and reflect the changing needs of the individuals. Other areas of concern included a comment in the assessment to weigh a person on a fortnightly basis, however, this had not been transferred to the plan of care. On talking with two staff they were unaware that this needed to be completed. Other areas of concern were discussed with the manager, the deputy and a registered nurse in respect of gaps in the care planning processes. The provider and the manager stated that they were aware that the care planning processes were not effective and there were gaps between the assessment and the drawing up of the care plan. The manager and provider have organised training on a fortnightly basis which will provide staff with training on the writing of care plans and ensuring care that is delivered is person centred. It is evident that the manager and the provider are trying to comply to the legislation. However, the shortfalls in the care planning is putting individuals at risk and the provider has been aware of this for the past twelve months. The provider said that staff have got confused with the present recording system and need additional support and guidance in its use. An immediate requirement was left with the home for them to forward to the Commission for Social Care Inspection a plan on how they intended to address the concerns about the care plans with clear measurable timescale so that this can be monitored by the Commission for Social Care Inspection. Health care documentation has improved since the last visit to the home. Records were being maintained of discussions with health professionals. Although there was a concern that a persons medication had been reviewed and it was not clear from the records when this had happened. A statutory Notice dated 8th July 2008 was served on the home to address serious concerns in relation to the wound care management. Significant improvements had been noted both during this visit and the visit in September 2008. It was evident that the home was working toward compliance. Each person has a wound care risk assessment which is kept under review. Where individuals are supported with wound care management a plan of care has been developed. The manager stated that an independent person has come into the home to assess and work with the staff on improving both staff competence and the practices in the home. This includes routine checking of the equipment. Where individuals were at risk, pressure relieving equipment was in situ. Care Homes for Older People Page 15 of 38 Evidence: The pharmacist inspector looked at the handling of medication in the home. All the people living in the home are registered with a local doctor, who visits the home every two weeks to see anyone who needs this. Staff told us that the doctor would also come at other times if needed. A homely remedies policy is available so that medicines can be given to treat minor ailments without calling the doctor. Staff told us that no-one living at the home is able to look after their own medicines at the moment so all medicines are given by nursing staff. One person we spoke to kept one of their own medicines for emergency use. This medicine was past its use by date and must be replaced. Medicines are supplied to the home using a monthly blister pack system. Staff order repeat prescriptions via the pharmacy. All the medicines we saw were stored appropriately. Medicines needing more secure storage are kept in a suitable cupboard and records show these have been looked after properly. During the inspection we saw that medicines were given safely. Since the last pharmacist inspection action has been taken to improve the handling of medication in the home so that peoples health can be better protected. For example staff have introduced a system that allows them to audit the medicines not supplied in blister packs, so that they can check that these medicines have been given as prescribed. They have also introduced a sheet to record how medicines prescribed to be given when required should be given, this means that staff have guidance to help them give these medicines appropriately. We saw that one person has been prescribed a cream, which has to be used particularly carefully. Clear information has been available to staff to make sure that this cream is used appropriately to protect both the resident and the staff applying the cream. Dressings which have been prescribed for individuals are kept in their rooms. A tissue viability nurse has visited to provide advice about wound care and ensure that suitable dressings are used. The pharmacy provides printed medicines administration record sheets each month for staff to record the medicines they give. We looked at a these records and checked a number of pack of medicines. The administration record agreed with the medicines missing from the packs. This indicates that medicines have been given as recorded. However we saw that one medicine used every three days for pain had been recorded on the administration record as having been given. This did not agree with the record made in the controlled drug register, which showed that the dose had not been given. We saw that one medicine for pain had been prescribed for one person twice daily but records showed that staff were giving this three times a day. Staff told us that the Care Homes for Older People Page 16 of 38 Evidence: dose had been changed, firstly to four times a day and then to three times a day following discussion with the doctor. However no record was seen of the discussion resulting in the change to three times a day. A new prescription of medicine had been received by the home, prescribed with a dose of twice daily, but this had not been queried with either the pharmacy or the doctor to check if this was the right dose. We looked at the records kept in the home and spoke to the person taking the medicine but were not able to confirm the correct dose. An immediate requirement was left for staff to confirm the dosage instructions with the doctor to make sure that this person was receiving the correct dose of medicine. One person is prescribed a medicine which needs blood tests to check the correct dose, which may vary according to the result of the test. Staff told us that they have been told the result of the blood tests and the correct dose of the medicine by telephone. We looked in this persons care plan but saw no record of the results of the blood tests or of the resulting medicine dose. An immediate requirement was made for staff to confirm with the doctor that the current dose was correct. It is good practice for staff to receive written confirmation of the current dose of medicine. This reduces the risk of mistakes being made with verbal instructions, which may result in the wrong dose being given. The home has forwarded information to demonstrate that this requirement has been met. Care Homes for Older People Page 17 of 38 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social activities are available to individuals on a regularly basis. Individuals can maintain contact with friends and family. Individuals have a varied diet. Evidence: Uphill Court has recently employed an activity co-coordinator to assist the care staff with social activities. The person is employed for ten hours per week. From conversations with staff and individuals living in the home it was evident that not all the activities undertaken were being recorded. One individual said the staff occasional take them to the shops but this has not happened for a while, Staff are often busy. A completed service user survey confirmed that activities regularly take place. Staff said that an hour a day is spent doing games, communication, nail care or other activities that the individuals would like to participate in. It was not clear where an individual was regularly refusing to participate what steps were taken to ensure that the activities were meaningful and relevant to the individual. One of the individuals prefers to spend time on their own in their bedroom with little Care Homes for Older People Page 18 of 38 Evidence: staff interaction. There was no indication in the care plan when staff should intervene or access other professionals for support if they were concerned about the persons wellbeing due to the level of isolation. From talking with staff it was evident the individual had staff preferences and they were strategies in place which included certain staff supporting the individual. However, this was not fully captured in the plan of care. Two individuals are supported to attend a day centre on a weekly basis with staff support. This was not always recorded in the daily records or the activity record. The manager stated that she was aware that some improvements were required in the recording of the social activities. Individuals confirmed that on a monthly basis an external entertainer visited the house, a hairdresser and the local church visited fortnightly. The manager said that individuals are offered support to attend church but presently no one has wanted to attend. In addition individuals have available to them reflexology. The hairdresser and the reflexology visited on the day of the visit. It was evident that the individuals had built good relationships with them. Relations were observed visiting throughout the two day visit. One relative had been invited to lunch so they could spend time with their partner, they said this was a really nice gesture. Relatives spoken with said they were happy with the care that was provided. One relative said staff are always busy. Three people were consulted about the meals that were available to them. All stated that they were satisfied with the food. There was a certain degree of choice. From reading care plans it was evident that each person had a nutritional assessment and where concerns had been raised relating to reduction in appetite this was closely monitored. However, as mentioned earlier in this report one persons assessment idenified an fortnightly weigh being monitored, and this was not transferred to care plan. Generally individuals are weighed on a monthly basis. The menu was displayed in the main lounge so that individuals knew what was on offer. One individual said there was always a choice of main meal and snacks were available. Observation of the mealtime was that it was unhurried and a relaxed atmosphere. Where staff were supporting individuals this was done sensitively. Individuals confirmed they could take their meals either in the communal dining area or in their bedroom. Care Homes for Older People Page 19 of 38 Care Homes for Older People Page 20 of 38 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service actively seeks the views of the individuals in the home. Systems are in place to raise concerns and complaints and individuals spoken with were satisfied that the home would respond appropriately. Individuals are better protected by the training that staff have completed in protection. Evidence: The home has a complaint policy which is included in the statement of purpose/service user guide and displayed in the foyer of the home. It contains timescales to inform the complainants when they can expect a response. The details of the Commission for Social Care Inspection have been amended enabling individuals to contact us if they remain unhappy with the way the home has responded to a complaint. The home maintains a record of complaints and compliments. The home was required to ensure that there was a record of all complaints made to the home with clear evidence of how this was addressed. There have been no complaints since August 2008. From reading the information in the complaint file it was evident that complaints were not recorded fully detailing the action taken to address the concern or the outcome for the complainant. The manager and the provider stated that a new complaint book has been purchased which details the action that was taken to address the concern and the outcome. It is felt that this will better evidence how the home is Care Homes for Older People Page 21 of 38 Evidence: responding to complaints. This will be followed up at subsequent visits to the home. No further requirement has been made. Individuals spoken with during this visit evidenced that they were aware of how to complain and felt confident that this would be addressed. Three individuals stated that they felt safe and well supported in the home. A visiting relative stated that they were very satisfied with the care provided and they regularly visit the home. Views are sought about the service provided on a three monthly basis. Questionnaires were seen from visiting professionals, relatives and people who use the service and this will be discussed later in this report. There has been one safeguarding referral which is still ongoing. This has subsequently meant that North Somerset Council have stopped making referrals to the home. The provider has completed their own internal investigation into the concern and has employed an independent expert to assess the care that was given to the individual during this time. The inspector advised that this be forwarded to the Safeguarding Lead in North Somerset. The homes policy on safeguarding was not viewed on this occasion. Copies of the local authoritys safeguarding policy was made available to staff in the office. Staff confirmed in conversation that they had received safeguarding training recently with an external provider. Training records confirmed that staff had attended this training. It was noted that one member of staff had attended this as part of their induction prior to starting care with the individuals living in the home. Staff confirmed that they would report concerns to the registered nurse in charge of the shift and or the manager. It was evident that the care staff were particularly vigilant when providing personal care to individuals ensuring that any changes to a persons wellbeing was recorded including pressure care. It was noted during the visit in May 2008 that some people were unable to fully mobilise due to their walking aids being left in their bedrooms. It was noted during this visit that individuals had access to their zimmer frames within easy reach. In addition call bells were all operating and accessible. Care Homes for Older People Page 22 of 38 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Uphill Court provides individuals with a homely and environment which will be enhanced by the refurbishment plan. The provider has owned Uphill Court for two years it is evident that some remedial repairs have been completed but due to the age of the building this is going to be an ongoing process. Evidence: Uphill Court is a large building with accommodation spread over two floors. There is a passenger lift to the second floor. Individuals have access to a bedroom with many having ensuites, a communal lounge and a dining area. There is a pleasant garden to the rear of the property and to the front a large car park. The home was clean and free from odour. The home employs domestic, catering staff and a minor maintenance man to compliment the care staff. It was noted during the visit in May 2008 that several of the window frames of a number of rooms were rotten and decaying. Some remedial work has been completed. Care Homes for Older People Page 23 of 38 Evidence: The provider shared with us during this visit a maintenance plan that includes a complete refurbishment of all areas of the home. This includes replacement windows, decoration including walls being re-plastered and new carpeting throughout. The provider stated that the contractors have been organised and it is hoped that work will be completed within two years. It is evident that this would be to the benefit of the individuals that live in the home and the working environment for staff. A member of staff said they had seen changes to the environment and this has had an improvement including a new heating system, hot water tanks and minor decoration to the hallway. The provider stated that the plan is to complete the refurbishment in stages with work commencing on the first floor. This will mean that occupants of these bedrooms will have to be relocated in other parts of the home. The provider stated that they would keep us informed once work commences and would consult with individuals about room changes. There are a number of toilets and bathrooms located throughout the home providing sufficient facilities for the number of individuals living in the home. As noted during the visit in May 2008 and July 2008 and this visit the toilets near to the lounge are out of order due to poor state of repair. Some remedial work has been started with tiles being removed from the wall. The manager stated that this is going to change from a toilet to a hair dressing salon and therapy room for reflexology. It was noted that there were other toilets on the ground floor for individuals to use which was in close proximity to the lounge. Some work had been undertaken to make areas safe as it was noted that tiling was loose in a number of bathrooms at the visit in May 2008. The home maintains a maintenance record of minor repairs completed in the home. The home has addressed all areas that were noted during the visit in August 2008. This included ensuring that the external oxygen storage was locked, to replace the fire panel (this was constantly buzzing during the last visit), ensure two fire doors shut securely, ensure call bells are in good working order and accessible and for some deep cleaning to be completed in one of the bedrooms. These have all been addressed and the home has demonstrated compliance. The home has recently completed a fire risk assessment with the assistance of a independent assessor. From these records it was noted that when they visited fire doors were being propped open, doors did not have sufficient seals and fire equipment was not being checked at regular intervals. The independent assessor advised that this should be completed by 30th September 2008. It was evident that checks on the fire Care Homes for Older People Page 24 of 38 Evidence: equipment had been routinely completed on a weekly basis. In addition it was noted that fire doors were no longer being propped open. However there was no evidence that the work had commenced on the fire doors to ensure it offered individuals the protection they needed in the event of a fire. The provider said that this had not been done and no date had been arranged. The risk assessment stated that the doors were not compliant but the provider was of the understanding that they were compliant but she wanted to exceed the standard hence why no immediate action was taken. In response to this the Commission for Social Care Inspection will liaise with the Fire Authority to organise an inspection of the premises solely to look at fire. A variety of specialist equipment was seen in the home for the benefit of individuals, including hoists, specialist beds, pressure relieving equipment and mobility aids. It was evident from looking at records of maintenance that these were routinely being serviced and checked at six monthly intervals. In response to the visit in May and August 2008 the home has sought a company that can both service the equipment and offer training to staff. The manager stated that this person was visiting next week to look at all the equipment in situ and offer staff training. Three pressure relieving beds were examined to ensure that they were in good working order and set at the right levels for the individual. It was found that these were appropriate. A requirement relating to infection control was made in May 2008 and then repeated in August 2008 relating to exposed mattresses, poor disposal of clinical waste and concerns relating to the overflow of the bins (both waste and clinical) to the side of the building. It is evident that these have been addressed and there was no evidence of infection control measures being compromised. The manager stated that the dispenser for hand gel is being moved to a more prominent place with an automatic dispenser so that this can be used both by staff, individuals in the home and visitors. Training records indicated that staff have attended training in infection control. There was a good supply of gloves and staff were observed wearing disposal aprons when serving the lunch. The home has a laundry facility which is used to launder items of clothing, in addition the home sub-contracts work out. The provider stated that this is done so that care staff can concentrate on the care of the people living in the home. Individuals said that they personal possessions were well looked after. A visiting relative said that when they visited the person they were visiting always looked clean and well presented. It was evident this was important to both the relative and the individual. Care Homes for Older People Page 25 of 38 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are potentially at risk at night due to lack of staffing in the event of an emergency. Improvements have been noted in relation to the training and ongoing support for staff. Recruitment practices have improved however, concerns are raised in respect of the qualifications of a nurse employed to be in charge of the home. Evidence: Uphill Court Statement of Purpose states that the home will be staffed according to the needs and the numbers of people accommodated at Uphill Court. Due to the occupancy numbers being reduced and the provider being unable to take any new admissions the staffing numbers have been reduced. The statement of purpose states that a first level registered nurse would be on duty 24 hours a day. The home is staffed with a minimum of four staff in the mornings, three in the afternoon at two staff at night. Concerns were raised at previous inspections about the staffing numbers at night. The building is large and many of the individuals require two staff to support them. The provider submitted a report that included information about the fire risk assessment and the protocol staff should follow if there was an emergency. This included addresses of staff that live close to the home and could Care Homes for Older People Page 26 of 38 Evidence: respond in the event of an emergency. The provider stated that both her and and the manager had worked approximately six nights as part of the staff review and it was determined that two staff were sufficient at night. However, concerns still remain in that the building is large and split over two floors. In addition requirements have been made in respect of the fire protection during this visit. Many of the individuals require two staff to support them which would mean that at times there is no staff available to support the other people in the home. The provider stated that they were happy with the staffing arrangements but would keep this under review. In addition to the care staff, domestic and catering staff are employed and an activity co-coordinator has recently been employed as discussed earlier in this report. The provider stated that care staff rarely have to complete housekeeping tasks which enables them to focus on the care of the people living at Uphill Court. Discussions with individuals about the staff support did not highlight any concerns from them in respect of the care they receive at night. Responses included the the staff cannot do enough for us, they are all kind, they are always willing to help and I feel safe here. One person said staff do not always come as quick as I like but they are very busy. One person said they spend much of they time in their bedroom (their choice) and staff frequently pop in to check that they are alright. One person said I never use the alarm at night, I have no need. Staff recruitment was checked for four of the staff working in the home. Files were well organised and contained the information as required by the Care Homes Regulations. An enforcement notice was served in respect of poor recruitment practices. The home has now demonstrated compliance and no further enforcement action will be taken as the records relating to the law were in place. Where staff have a criminal record risk assessments are in place to demonstrate that the provider is satisfied that the person can work with vulnerable adults. This was still work in progress for one member of staff, but it was evident that the requirement was being addressed, no further action will be taken on this occasion. Concerns are raised in relation to the recent recruitment of a registered nurse. It was noted that this person did not have the desired qualifications as required by the homes statement of purpose which is a registered general nurse. It was noted that this member of staff was not a general nurse but a learning disability nurse. There was no evidence that the provider had assessed the individuals competence, knowledge or transferable skills. The manager did make a call to the Nursing Midwifery Council who stated that the nurse could work in a nursing home and that the individual was a registered nurse. It was not evident that the manager had ensured that the nurse was suitable to the work in home for elderly people requiring nursing care as in the case of Care Homes for Older People Page 27 of 38 Evidence: Uphill Court. It was noted that the nurse did not only have the appropriate qualification, but was not a first level nurse. From talking with the manager it was evident that the person had been employed for their person centred approach but this did not demonstrate that the person was fit to work in the role of a registered general nurse. The manager agreed that the member of staff would not be left in charge of the home and that a registered general nurse would work alongside them until this can be fully clarified in respect of the Care Home Legislation. Staff training was reviewed. It was evident that there was a commitment for staff to have training. The home has demonstrated compliance to a previous requirement. Staff attend training in manual handling, first aid, health and safety, infection control and food hygiene. Certificates were seen confirming this. Training is completed by an external company. In addition staff have attended training in protection of vulnerable adults, pressure care, prevention of falls, person centred care, Parkinsons and specific training about medication. Records were maintained of the training that staff had completed. The manager completes a quality assurance audit on training. Good practice would be that this would be kept in the Training File so that an overview can be seen of all staff training. Presently staff certificates are kept, the overview record in the training file was not current however, it was not till the manager stated that this was now recorded in the Quality Audit file did it become apparent the level of training that was being completed. Staff confirmed that there is a commitment to training. Good practice would be for the home to review how the training is recorded to ensure it better evidences the training that is in place. The manager stated that there is a commitment for all staff to complete an National Vocational Award. However, a number of staff have left so presently three staff have a National Vocation Award at level 2 and four are in the process of completing out of a total of eleven staff. Some staff have completed their NVQ 2 and will be completing an NVQ 3. The manager stated that the cook and the domestic staff are also in the process of completing an NVQ appropriate to their role. Three of the staff are care ambassadors and assist Care Learning in promoting care work to school leavers and young adults. From talking with a member of staff it is evident that the manager and the provider support them in this role and the commitment for them to complete training. Induction training was seen for a number of staff. From talking with the provider and the manager staff are taking on with a POVA first so that they can complete their induction. Reassurances were given by the manager that staff working in the home with only a POVA first do not complete personal care and are never left unsupervised until an enhanced criminal disclosure is received. A member of staff did state that it Care Homes for Older People Page 28 of 38 Evidence: was difficult at times knowing what staff can work independently and those that require supervision especially when it is busy. One member of staff stated that shifts can be difficult when they are the only regular member of staff and the rest are agency staff. However, the manager stated that this is being addressed with a recruitment drive. Staff gave mixed views on what it was like to work in the home. One member of staff stated that due to the level of work being completed in respect of the requirements and recommendations and the enforcement notices served by the Commission for Social Care Inspection in respect of care planning and recruitment it has put added pressure on both the provider, the manager and in turn the staff. From talking with staff it was evident that they enjoyed supporting the individuals but did not always feel appreciated. One member of staff said it can be quite tense for fear of making a mistake whilst another member of staff said that they felt that the manager was supportive and doing her best. Care Homes for Older People Page 29 of 38 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is operating without a registered manager which is contrary to regulations. Individuals safety is being compromised in respect of fire safety. Improvements have been noted in the ongoing monitoring of the quality of the care including seeking the views of people who use the service and their relatives. Evidence: Mrs Susan Marks is the manager for the home. There was a requirement which remains outstanding in that Mrs Marks has been in post since November 2007 and has not forwarded a registered managers application to the Commission for Social Care Inspection. Mrs Marks stated that this was originally due to advice that she did not need to apply until she had completed her probationary period. A requirement was made in May 2008 that an application be submitted by July 2007. The application was received in October 2008 but has been returned to Mrs Marks due to missing information. This remains outstanding and so therefore is repeated. Further noncompliance could lead to enforcement action being considered. Care Homes for Older People Page 30 of 38 Evidence: The home has a Quality Assurance System that includes auditing various aspects of the care service. This has included wound care management, falls, care plan reviews, the environment, training, supervisions to name a few. In addition questionnaires are sent to seek the views on the quality of the service to relatives, people who use the service and professionals on a three monthly basis. Feedback from the last review was positive. It is evident that the provider regularly visits the home to monitor the quality of the service. Monthly reports are compiled by the provider in respect of the monthly regulation 26 visits. It was evident that the provider is actively trying to improve the quality of the care for the individuals and the environment and action plans were seen for the manager to address via the monthly reports. The home has demonstrated compliance to a requirement to ensure that all staff are regularly supervised. However the date for compliance was the 29th August 2008. It was noted that most of the staff did not have a supervision until August and September 2008 even though this requirement was made in May 2008. The manager stated that the plan is for all staff to be supervised at least every six to eight weeks. This will be followed at subsequent visits to the service. The provider completes an audit on the frequency of supervision with an overview being maintained. The manager has responded to a recommendation for the record of supervision to be individual to the member of staff as previously this manager kept one book for all staff. This meant that staff could not have access to their own supervision records and compromised confidentiality. The main focus in relation to health and safety was fire and infection control. As already mentioned in this report improvements have been noted in the management of infection control. The home has demonstrated compliance to previous requirements. Fire safety was an area of concern, records poorly evidenced that staff had ongoing fire training and participation in fire drills. Immediate requirements were left with the home to address this. Further concerns were highlighted in the homes fire risk assessment which was completed by an independent assessor. This report highlighted fire doors being left open, doors not having the appropriate seal to prevent fire spreading, the lack of fire training, participation in fire drills and the lack of checks on the equipment. The assessor said that this should be resolved by the 30th September 2008 however, some of these areas remain a concern. The provider said that the doors did have the appropriate seal but she wanted to exceed the standard. However, this was not clear from this report. The Commission for Social Care Inspection have requested that a fire officer completes an assessment of the building so that this can be assessed by a competent person. The other reason is that the provider wrote in respect of the reduced staffing at night stating that the building complied with all fire Care Homes for Older People Page 31 of 38 Evidence: safety measures and in fact individuals safety was being compromised. Care Homes for Older People Page 32 of 38 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 9 13.2 The registered provider must 12/06/2008 take action to ensure that prescribed medicines are available for staff to give, so that people?s health is protected. Care Homes for Older People Page 33 of 38 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 1 6 Keep the statement of purpose under review to ensure that it reflects the service that is being provided. This will ensure that individuals are informed about the service that is provided at Uphill Court. 21/11/2008 2 9 13 Ensure that correct dose of medicines are given as prescribed by the doctor. As described in letter To protect residents health 29/10/2008 3 37 23 All staff to participate in a 04/11/2008 fire drill at least once in a six month period. To ensure the safety of the people living in the home. 4 37 23 For all staff to participate in 04/11/2008 fire training at least six monthly for day staff, and three monthly for night staff. Ensuring the safety of the individuals living in the home and the competence of staff. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 34 of 38 1 7 15 Ensure that the assessments 21/01/2009 inform the plan of care. Ensuring individuals assessed needs are being met. 2 9 13 Ensure medication is within the expiry date. Protect individuals living in the home. 29/10/2008 3 9 13 Action must be taken to ensure the safe administration of medicines. An immediate requirement has been left. To safeguard individuals living in the home 23/10/2008 4 12 16 For care plans to be 18/12/2008 expanded to include the social interests of the individual and this to inform the activities that are held in the home. To ensure that individuals have structured and meaningful activities that are reflective of the interests of the individual. 5 19 23 For the room where there is a damp patch due to leak in the roof to be decorated. To ensure that the home is a safe and pleasant place to live. 17/12/2008 6 19 23 For the home to continue with the refurbishment of the home. 20/05/2009 Care Homes for Older People Page 35 of 38 Ensuring the home is a pleasant and safe place to live. 7 27 18 To ensure that appropriate staff are employed in accordance with the statement of purpose. Registered General Nurses to be employed to manager shifts ensuring that the needs of the individuals are met by competent staff. Until it is confirmed that this member of staff can be left in charge of the home this member of staff must work alongside an appropriately trained member of staff. 8 29 18 Keep the staffing levels at 03/11/2008 night under review to ensure that the care and safety of individuals is not being compromised. Due to the concern about the fire safety and the needs of the individuals this must be kept under review. 9 31 8 For the manager to submit a 19/11/2008 registered manager application to the Commission for Social Care Inspection. To ensure the home is managed effectively with a person that is competent to fulfill the role and in accordance with the Care Standards Act. 11/11/2008 Care Homes for Older People Page 36 of 38 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 3 7 9 12 For all staff to have direction on the care planning format used in the home. Maintain good records relating to medication changes. Maintain records of activities that are undertaken on a daily basis, including where individuals have refused to participate. Review the training records to ensure it is clear what training has been completed and what further training is required. Each member of staff to have an appraisal which looks at their role, further development and skills required for them to complete their role in the home. 4 30 5 30 Care Homes for Older People Page 37 of 38 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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