Inspection on 07/04/08 for Urmston Cottage

This inspection was carried out on 7th April 2008.

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

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

Other inspections for this house

Urmston Cottage 25/03/10

Urmston Cottage 19/01/10

Urmston Cottage 07/05/09

Urmston Cottage 08/09/08

Urmston Cottage 14/11/07

Urmston Cottage 16/10/06

Urmston Cottage 17/03/06

Urmston Cottage 10/11/05

Urmston Cottage 23/09/04

Urmston Cottage 15/04/04

Urmston Cottage 21/10/03

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Urmston Cottage Greenfield Avenue Urmston Manchester SK3 0TX Lead Inspector Sylvia Brown Unannounced Inspection 7th April & 8th May 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Urmston Cottage DS0000006729.V362073.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. Urmston Cottage DS0000006729.V362073.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Urmston Cottage Address Greenfield Avenue Urmston Manchester SK3 0TX 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) 0161 747 3738 no fax Urmston Cottage (Mcr) Ltd Kerry Griffin (currently unregistered) Care Home 45 Category(ies) of Old age, not falling within any other category registration, with number (44), Physical disability (1) of places Urmston Cottage DS0000006729.V362073.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service users shall be aged over 60 years except for one named person who requires nursing care by reason of physical disability. A maximum of 25 service users who require general nursing care can be accommodated. Staffing levels as specified in the Section 13 (5) Notice dated 9 August 2005, shall be maintained. 14th November 2007 Date of last inspection Brief Description of the Service: Urmston Cottage is an extended Victorian property offering care and accommodation with nursing support to 45 service users. There are several lounges and a dining area for service users communal use. Bedroom accommodation is on two floors and is for single and double occupancy. Some bedrooms have en-suite facilities. A passenger lift supports service users to reach all parts of the home. There are gardens to the rear of the property, which are well used in fine weather and parking space is available to the side of the home. The home is near the centre of Urmston, close to a number of shops and market place. It is close to local bus routes and the Metrolink. The current fees for the home range from £353 to £726, including funded nursing care, per week. Fees are dependant on care need support and individual funding arrangements. Urmston Cottage DS0000006729.V362073.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 would experience poor quality outcomes. The inspection report is based on information and evidence gathered by the Commission for Social Care Inspection (CSCI) since the last key inspection, which was completed on 14th November 2007. The site visits were completed over two days, with the first being unannounced. The registered manager and staff were not told that we would be visiting. Due to the registered manager being unavailable on the first day, we decided we would continue to look at records and arranged to meet with the registered manager on a second visit. Due to unforeseen circumstances, the registered manager remained unavailable. As a consequence, arrangements were made to meet with the operations manager to complete the inspection. We gathered information from a number of people, which included talking with and seeking the views of service users during the site visits. We also sent out surveys to service users, relatives and members of staff. This gave them an opportunity to talk with us about their opinions on the services provided at Urmston Cottage. Comments received are, where appropriate, included within the report. In March 2008 the manager of Urmston Cottage completed a self-assessment form, which is called an Annual Quality Assurance Assessment (AQAA). This should have told us in detail what the home had been doing since the last key inspection to meet and maintain the National Minimum Standards. It should have also told us what they felt they were doing well, how they had improved within the past 12 months and their plans to develop in the next 12 months. The AQAA was not sufficiently detailed to inform us of all those things. We also gathered information through general contact with the home; through their reporting procedures, which are called ‘Notifications’, and through information we received from other people, such as the general public, including concerns and complaints. In January we were notified of an allegation of abuse at the home, which was investigated under the Local Authority’s Safeguarding procedures. In February 2008 we received information from one relative about their dissatisfaction with the standards of care support and hygiene conditions at the home. Urmston Cottage DS0000006729.V362073.R01.S.doc Version 5.2 Page 6 We looked in depth at records and the care support of two people living at the home. We also spent time sitting with service users and observing their dayto-day routines as they received support from care staff. This helped us get a better view about how people living at the home are looked after and supported. This inspection process has identified that service users at Urmston Cottage do not have a consistent standard of care provision. Some service users are very happy with their care, whilst it was observed that, in practice, some service users received support below the required standard. From the information gathered we made the judgment about how the home was meeting the National Minimum Standards (NMS) and we made the overall judgement on the quality of the service. What the service does well: What has improved since the last inspection? Since the last inspection, the registered provider has recruited a new manager. This has been viewed as positive by service users, relatives and staff. The manager has begun to make some changes and has introduced residents and family meetings, which means they have direct access to her and can share their views as a group. The registered provider has also recruited a new operations director, who has responsibility for monitoring and ensuring standards are maintained throughout the company. Urmston Cottage DS0000006729.V362073.R01.S.doc Version 5.2 Page 7 We have been told that plans are underway to upgrade the home and implement many new policies and procedures, which should improve the actual care support the service users receive and their surroundings. We can confirm that a number of fixtures and fitting have been ordered and will be delivered once redecoration and upgrading has commenced and been completed. What they could do better: This inspection process identified a number of areas where care practices and systems were falling below the required standard. Care planning and record keeping were not sufficiently detailed and could not demonstrate that service users have been and continue to be consulted about their individual care needs and how they should be met. This mean that care plans were similar and did not personally reflect the service users’ preferences for how care support should be provided. We also identified that specific records for monitoring service users’ health and support were not completed correctly. Such records as pressure care routines, food and fluid intake monitoring charts and the monitoring of some service users’ weight, and oral health care plans, need to be in much more detail to enable the home to demonstrate practice undertaken to ensure the health, wellbeing and safety of service users. Systems need to be in place to ensure that all prescribed creams and medications are signed for when administered and that records reflect the number of tablets administered when variable dosages are prescribed. Toileting routines need to be more detailed and staff should be trained in how to offer support and be available in a timely manner. One relative told us “People (clients/residents) are ignored when requesting the WC and incorrect record-keeping, such as fluid balance charts, are in place. They are not adhering to turning regimes to prevent sores. Items (personal) are being taken for one resident and given to another”. During the inspection, one service user prevented the inspector from sitting on a soiled chair, saying “they left the lady too long, she could not hold it”. Such occurrences, embarrass service users and make them feel they are less able than they actually are. The manner in which some staff supported service users was disrespectful. They ignored service users’ calls for support, talked across service users with each other when supporting service users to eat and one staff spoke abruptly to a service user when the service user complained about the poor service. Furthermore, some staff conversations were inappropriate, indicating prejudices and assumptions about the way some people live and their religious beliefs. Urmston Cottage DS0000006729.V362073.R01.S.doc Version 5.2 Page 8 Some service users were left to sit for long periods at dining tables. They were placed there some considerable time before serving commenced and left for an equally long time after the meal had been completed. Their request to be moved to the lounge were ignored by most staff, which caused them to become confused and distressed. The manager should introduce systems which promote seeking the service users’ views on their individual routines and promote service users’ independence. Some service users stated that they were woken in the morning, regardless of whether they were awake or not. They were not able to make choices about the portion sizes or variety of food served to them, and they were not able to pour their own drinks and serve themselves at meal times. The report details a number of areas where the home’s environment was not maintained appropriately, including fire safety. We have asked for a detailed plan of all the upgrading and a complete audit of all areas within the home. To safeguard service users, recruitment and selection procedures need to be completed appropriately, ensuring that information received is sufficiently detailed. For the protection of service users, statutory checks should be received prior to staff commencing duty. Training in adult protection and other mandatory and specialised training should be completed by all staff in order to ensure they have the skills to carry out their roles and responsibilities. Staff should not routinely work excessively long hours, as this may detract and reduce the quality of care support. Staff should receive formal supervision at the required frequency and full induction procedures should be in place for new staff which meets the standards set by Skills for Care. We have asked that the manager to complete further training and achieve NVQ training at level 4 and/or the Registered Manager’s Award. A quality audit has not yet been completed, which includes seeking the views of service users, relatives, staff and other stakeholders on the services offered at the home. Once completed, a report of the outcome should be made public and service users kept informed. We must also be kept informed of any significant events which arise in the home, which may affect the health, wellbeing and safety of service user. Urmston Cottage DS0000006729.V362073.R01.S.doc Version 5.2 Page 9 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Urmston Cottage DS0000006729.V362073.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Urmston Cottage DS0000006729.V362073.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3. Standard 6 is not applicable to this service. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Prospective service users are able to receive information about the home and have their needs assessed; this enables them to make an informed decision about moving into the home. EVIDENCE: The manager continues with the best practice of meeting with service users before they make any decisions about moving in, to introduce themselves and assess the service user’s needs. Inspection of two service users’ files confirmed that information had been received from the Local Authority about their care needs and support requirements prior to the service user moving in. Pre-assessment documentation completed by staff was in place and though there still remains an opportunity for further development, they were adequately completed. Urmston Cottage DS0000006729.V362073.R01.S.doc Version 5.2 Page 12 Advice given has been given to clearly document where the assessment took place, and with whom the assessor consulted with. Service users should, wherever possible, be included in the consultation process, in order that their opinions and preferences are recorded and considered. When asked if they were provided with enough information before moving in, eight service to users told us they were. For those service users whose family members act on their behalf, we were told that theyve received enough information to enable them to inform the service user about the home. Urmston Cottage DS0000006729.V362073.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. Service users receive support to maintain their health care needs, however records and some care practice needs to be developed to demonstrate how service users are individually supported. The way support is given to service users showed that not all service users were treated in a respectful and dignified manner, or in ways that would, at all times, meet their care needs. EVIDENCE: We looked at a number of records to evaluate how the care needs of service users were recognised, recorded and met This included looking in depth at service users’ care files. Urmston Cottage DS0000006729.V362073.R01.S.doc Version 5.2 Page 14 There was evidence that the needs of service users had been assessed and recorded within a care plan, however they required further information to ensure that they were personalised. For example, a persons preferred time to rising and retiring should be recorded and, where a service user needs and/or prefers support, records should reflect the service user’s personal preferences for how that support should be provided. This would ensure that staff have a consistent approach, whilst at the same time making sure service users are receiving support services how they would wish. We spoke with and observed a number of service users, throughout the site visit. It was observed that whilst most appeared well care for, some did not. Some service users in bed appeared to need some oral health care, whilst others looked a little dishevelled and appeared to need additional support. From reading some service users’ records, it could not be confirmed accurately what support they had actually received and/or how often they had received additional support throughout the day to make them comfortable whilst in bed. Records for maintaining pressure care need to be more accurate; positional changes should be in detail and include all positional changes. Frequently, records stated ‘left or right’, there is no indication of central positioning, if the service user was sat up or lying down. For those service users who are on feeding regimes, records and care plans need to be in much more detail to ensure that instructions are clear and that care practice can be identified. Individual feeding regimes should be recorded and the specific feeding instructions from the dietician should be included. Care plans should detail if the service user is fully or partially dependant on assisted feeding. Where service users are also supported to eat food orally, their routines and intake should be recorded. The service user’s position should also be recorded, as some people require to be in a sitting position, whilst other should be lay prone. Oral health care plans are essential and each service user, particularly those who require additional support, such as those who have assisted feeding regimes, should have detailed oral health care plans in place. Daily records should also be individualised to reflect the day-to-day routines of service users and recognise their achievements. Such statements as “all needs met”, “slept well”, and “fine” fail to tell the reader sufficient details. Times of rising should be included and the kind of support given should be noted, for example, they should reflect if the service user made their own choice in choosing clothes, supported themselves in washing and received a drink whilst preparing to get dressed. Such personal details indicate how a service user is being individually supported and demonstrates how the staff and the home are meeting the needs of service users and to what standard. Urmston Cottage DS0000006729.V362073.R01.S.doc Version 5.2 Page 15 Medication administration records were looked at. Not all prescribed creams were recorded as administered, food supplements were not routinely signed for as given and, where variable doses for medication apply, the amount administered was not routinely recorded. Stocks for food supplements were observed in the basement area. There appeared to be no system for ensuring stock was used in date order and there was no evidence that the temperature of the area was monitored and complied with storage conditions set by the manufacturer. Service users’ weights were not consistently recorded, some service users’ care plans noted they required more frequent weighing routines, however records did not reflect that the process was followed. It was noted that service users’ weight records were collectively held, rather than being individual on their file. All information belonging to a service user should be held on their file in order to maintain confidentiality. When speaking with service users they appeared generally satisfied with the services offered. One service user told us “I am quite happy, I think the carers do their very best to make us comfortable.” Most service users felt staff were available when required and that they felt listened to. During the course of the inspection site visit, it was observed that a number of staff were disrespectful to service users. One service user was observed in their room at 10:50am, they were sat in their nightwear on a chair with the remains of their breakfast in front of them. When asked if they had enjoyed their breakfast they stated they had not. We were informed that the cereal had not had sufficient milk and was paste like so the service user was unable to eat it. There was also a half cup of tea left. The service user stated it had arrived cold and she could not drink it. Continuing, she stated that she had been sat for a “long time” as she could not call for assistance because the call bell was not within her reach. As a consequence, we summoned assistance on the service user’s behalf. The service user also informed us that the cup had arrived dirty and that she had not been offered any toast. On answering the call point and listening to the service user’s comments, the staff in attendance was observed to be abrupt with the service user. When the hot drink was later returned, it arrived in the same dirty cup. This distressed the service user, however they were reluctant to send it back. On offering to do it on her behalf, the service user gave permission for us to return the drink and request a fresh one in a clean cup. Urmston Cottage DS0000006729.V362073.R01.S.doc Version 5.2 Page 16 During one meal time, it was observed that some service users required support to eat their meal. Whilst staff supported them they continually held conversations with each other across the room, ignoring service users. Their conduct not only identified that they were disrespecting service users in their approach, the conversations held were of a highly personal nature and could be construed as being judgemental and prejudicial about a particular ethnic group and their religious beliefs. Furthermore, a number of service users who required support to leave the table were left in excess of 40 minutes, during which time they repeatedly asked for support from a number of staff to leave the table. The staff totally ignored the service users’ requests and failed to acknowledge that they had spoken. Service users were heard talking amongst themselves, making such comments as “are you taking us back, love?”, “where is everybody?”, “please take me back” and “I am weary, where is everybody?”. Only one staff member acknowledged the service users, whilst she was supporting another, saying “all right, love I will come back as soon as I can”. Some 15 minutes later, the staff had not returned. Urmston Cottage DS0000006729.V362073.R01.S.doc Version 5.2 Page 17 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 poor. This judgement has been made using available evidence, including a visit to this service. Service users have the opportunity to join in social events and receive a varied balanced diet. However, not being consulted regarding their meal choice and not being able to serve themselves, means their independence at mealtimes is compromised. EVIDENCE: Prior to the inspection of Urmston Cottage, service users and their relatives returned surveys and spoke quite positively about the care support at the home. When asked about meals and mealtimes, one relative told us “I can only say I havent tried the food personally but the menu is up on the wall in the dining room and it sounds good. I usually visit at lunchtime and the meals smell good too.” Urmston Cottage DS0000006729.V362073.R01.S.doc Version 5.2 Page 18 During the inspection we had the opportunity of sitting and observing service users and staff as they went about their daily routines. We found that the home operated an inconsistent standard of support and that this directly affected the quality of the service received by some service users and affected how they felt. Standard 10 identifies some poor practices of staff when supporting some service users. The lunch time routines on the first day of the site visit were not good. Some service users were observed being seated by staff and/or being called into the dining room from 11:30am onward and remained there until 1:15pm when the observation stopped. They were also observed starting to sit at the dining room table for tea at 4pm for their teatime meal which did not start being served until 5pm. A number of service users who required support to leave the table were left for in excess of 40 minutes, from first requesting to leave. They repeatedly asked for support from a number of staff to leave the table. The staff totally ignored their request and failed to acknowledge that service users had spoken. Most service users told us that they thoroughly enjoyed the meals served and that there was never any reason to complain. When asked about alternative choices, they told us that, “there was never any need to request anything different than that served as a food was so good.” Another service user stated that the food was “fantastic”. A further service user told us “you are never hungry, theres so much food.” However, this was not the case for the more dependant service users. It was evident that the cook had detailed and extensive knowledge about service users’ likes and dislikes and portion sizes, however meals came ready plated and basically contained the same foods. One service user was observed telling staff that she did not like tomatoes, yet the meal served to her contained tinned tomatoes which she left. Staff observed the service user speaking with the inspector, it was later noted that the cook approached the service user and asked if anything was wrong. The service user informed the cook that she did not like tinned tomatoes and never ate them, the cook indicated that this was not always the case and indicated she was free to leave foods she did not wish to eat. Another service user was also observed leaving the tinned tomatoes; when asked, she stated “I am not keen on them”. Service users are not routinely asked about their preferences when meals are being served. It was clear from the observations that some service users had difficulty in using the style of plates now used, in that, they are oval shaped and food was observed slipping off some edges. When asked about plate guards and adapted cutlery, staff eventually found plate guards, but were unable to attach them due to the design of the plates. Adapted cutlery was not offered or provided to those people who appeared to have difficulty in movement. Urmston Cottage DS0000006729.V362073.R01.S.doc Version 5.2 Page 19 One lady who was only able to use one arm, was given a jacket potato for her meal without being given a knife and/or fork to eat it with. Upon request, she was provided with them, however it was unclear if staff were aware of her needs and did not consult with her regarding whether she required support. It was some considerable time later, after she had attempted to eat her meal and spilling it on the table, did staff offer to cut up the potato for her. Tea tables were not appropriately laid; though soup was served, no spoons were initially provided and no condiments were evident. The service user who received her breakfast in her room, had her independence compromised, she was not provided her with her own teapot, milk jug or sugar bowl. She was not offered a choice of cereals and when the toast arrived, it came ready buttered with jam. A number of service users were observed sitting at the dining room table in their wheelchairs. There appeared to be little encouragement to service users to move on to suitable dining chairs. Furthermore, the layout of the dining room does not facilitate the use of the hoist. Service users are able to join in activities if they wish. The was completed collectively rather than individually. There place to monitor the success of activities or that those wishing to join in group events, or who are more dependent of social occupation. record of activities was no system in service users not receive some form When asked about activities, some service users told us “I enjoy all the activities” and “I will join in activities if I want to”. One relative stated, when asked how the home could improve, “The care home could improve if there was an area for music only. When records are being played the TV is also on at the same time which is most distracting”. We asked some service users about their routines for rising and if they had a choice about what time they got up. One service user told us they have a policy of who they have to get up in the mornings”, “They left me once so I had a lie-in, it was lovely, we have no need to get up early, we go nowhere, do we?” One service user told us that the morning routine was for staff to enter their room and switch on the light and wake them up. Continuing, they said “I was led to believe that this was my home, but you wouldn’t know by some staff”. Urmston Cottage DS0000006729.V362073.R01.S.doc Version 5.2 Page 20 Some service users commented very favourably about the support they received, saying such things as “I am happy and satisfied with the care I get”, “The staff I have come into contact with are friendly, helpful, and will always stop and pass the time of day if possible. They will always ask if everything is okay.” One relative told us “I would like you to know that when my sister became a resident at Urmston Cottage, the staff welcomed her and have looked after her medically and socially ever since. I cannot praise them enough and a heartfelt thanks goes to them.” Urmston Cottage DS0000006729.V362073.R01.S.doc Version 5.2 Page 21 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. Service users told us they know about procedure, however in practice, this Training for staff in safeguarding implemented to ensure service users abuse. and are confident to use the complaints system does not appear to be used. adults and complaints needs to be are protected from poor practices and EVIDENCE: From the information we received from service users and visitors, it was evident that they had been informed of the complaints procedure and trusted the manager to deal with their complaints effectively. The records looked at identified that improved record keeping is advised, if the home is to fully demonstrate how it receives and records complaints, the action they take to investigate and the outcome. Adult protection procedures are in place at the home. Service users stated they felt safe and had someone to talk to should they have any concerns about the care and/or treatment they are receiving. Urmston Cottage DS0000006729.V362073.R01.S.doc Version 5.2 Page 22 However, there are concerns that this would actually be put into practice by service users. During the inspection a number of poor care support issues were observed and service users were not happy, however they were reluctant to complain or raise the matter with the manager. One service user told us that they had been told off for “mithering”. The operations manager gave assurances that all staff have had or would be having formal training and/or updated training in adult protection procedures and how to deal with service users’ dissatisfactions appropriately. Training records could not identify correctly previous training. We will confirm with the home within three months the action taken to ensure that all levels of staff have received adult protection training and are aware of their responsibilities to report any suspicions of abuse. Urmston Cottage DS0000006729.V362073.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24, 25 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Parts of the home are nicely furnished and offer comfort and support to service users. Other parts do not offer such comfort or promote service users’ safety. EVIDENCE: In general, most parts of the home were clean and without odours, however parts of the home appeared uncared for and showed signs of poor maintenance and upkeep. Some of the things we saw were: a bathroom/shower room that had part of a shower cubicle leaning against a wall, the toilet seat was cracked and the room contained a number of stained urine bottles. In addition, wheelchair footrests were noted and a service user’s dressing gown was behind the door. Urmston Cottage DS0000006729.V362073.R01.S.doc Version 5.2 Page 24 Not all bathroom and toilets have call points. attention of the home at a previous inspection. This has been brought to the A service user’s room contained belongings which the service user stated were not theirs and that they were “just being stored”. Other service users’ rooms had dirty bumpers to their bed rails. A service user’s sink was not of an appropriate size. The light was not working over the sink or over the bed. Furthermore, the service user’s clothes for the day were observed to be screwed up on a chair, along with footrest from a wheelchair. This room also contained a large linen trolley, within which were dirty clothes. When asked, staff informed the inspector that they did not belong to the service user, rather it was “a place to put the trolley”. One bedroom had what appeared to be a damp patch with peeling wallpaper evident. Some pillows appeared in a poor condition and offered little support to one service user being cared for in bed. Call points were routinely without cords and/or were placed out of reach from service users when they were in their rooms. Windows were routinely left open, even though the day was cold. A number of service users complained of the draughts and cold. Some skirting boards were very dirty and/or dusty and one service user’s chair and table were stained and showed evidence of dried food. Fire safety was compromised, in that, a number of bedroom doors failed to close smoothly or appropriately into their rebates. The inspector strongly advises the registered provider to again seek the advice of the fire safety officer, regarding this matter, as the information shared with the inspector on the day of the site visit was incorrect. Fire safety doors to linen rooms with signage “fire door, keep shut” were routinely left open. One contained so much linen and other items it could not be closed when tried by the inspector. The lift contained only one light, which meant the lift area was quite dark. This is not suitable for people with failing and/or poor eyesight. All areas should be appropriately lit to support and, where possible, enhance their vision. The lounge areas were clean and well presented. Service users had access to some side tables and some had the use of footstools and cushions. They were nicely decorated and homely. Urmston Cottage DS0000006729.V362073.R01.S.doc Version 5.2 Page 25 The dining area required upgrading to ensure that seating is suitable for all service users, wherever possible. The layout of the room should promote people’s independence and support service users and staff to use a hoist when required. Service users wishing to leave the dining table were observed to be instructed to wait until staff could support others to leave, to allow them access. Urmston Cottage DS0000006729.V362073.R01.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. The registered person has not ensured that robust recruitment and selection procedures have been followed for all staff. The deployment of staff is not monitored and staff training and development are not fully known for all staff. This may have a direct impact on the standard of care support provided at times to service users. EVIDENCE: From examining the staffing rota and feedback from service users, we think that at the time of the inspection there were sufficient staff on duty. The significant delays in providing support to service users, particularly at mealtimes, is thought to be as a consequence of incorrect deployment and lack of monitoring staff. Inspection of three staff files, including the manager’s, identified that the procedures for the recruitment and selection of staff could be improved. All applicants completed an application and provided two references, however one reference failed to contain any relevant information, another was not dated. All applicants had contracts of employment in place and their start date recorded. Urmston Cottage DS0000006729.V362073.R01.S.doc Version 5.2 Page 27 The registered provider allows staff to routinely commence employment on receipt of a POVA first check, rather than waiting for a full CRB. This is not best practice, staff should only commence on a POVA first in cases of extreme staffing shortages and they should not be providing personal care and/or working alone until a full CRB has been received. Furthermore, one staff started before a POVA first check had been received. When we looked at the new manager’s file the information presented to us did not relate to the manager’s current position. Rather, it appeared to be that of a previous post at the home in 2006. At the time of the inspection there was no indication that this manager had been interviewed or was completing a probationary period. There was no indication that she had received supervision, guidance and support in her new role. Whilst the records indicated that some form of induction /orientation had been undertaken by the new staff, they had not commenced an induction which meets the required standard set by Skills for Care. There was no evidence to confirm that staff had been supernumerary or who they had worked alongside when first commencing work. Staff training records did not identify that staff had received sufficient training in such things as moving and handling, infection control and first aid. The home could not provide an accurate up to date training analysis of staff’s training to evidence that all staff have received essential training, to support those with specialised health care issues, such as dementia related conditions. Inspection of a two week staffing rota identified that one week 13 staff worked between 48 and 60 hours per week and the following week ten staff worked between 48 and 72 hours. When staff work such long hours, it is considered highly unlikely that service users will receive an inconsistent standard of care as identified within this inspection process. Urmston Cottage DS0000006729.V362073.R01.S.doc Version 5.2 Page 28 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Service users live in a home which is managed by a new manager, who has their best interest at heart. Systems and management structures need to be improved to ensure that service users receive a good consistent level of care support at all times. EVIDENCE: The appointment of the new manager has been well received by many service users and their relatives. One relative stated “Glad to see Kerry back, so is all the family”. Whilst another told us “Kerry has always rung and let us know if anything has happened to our relative. The only time it didnt was when Kerry was elsewhere.” Urmston Cottage DS0000006729.V362073.R01.S.doc Version 5.2 Page 29 The manager, although a registered nurse, has yet to complete NVQ level 4 training and/or the Registered Manager’s Award. The registered provider has submitted an application for registration of the manager. At the time of writing the report, the registration process had commenced. Though she has made some changes since she became manager, there is some considerable way to go. The operations director informed us that the home is to shortly undergo substantial upgrading which will include a full review of how systems operate. It is the intention of the registered provider to implement corporate procedures, which will mean a significant amount of training and development for the manager, who will then implement training with the staff team as new systems are brought into force within Urmston Cottage. There were no records to support that all staff had received formal supervision at the required frequency. Health and safety records were looked at. Systems are in place for the monitoring of accidents and incidents. Fire safety checks are completed as required and workplace risk assessments were in place, as required. Certificates of insurance and servicing records were in place, which means that, as far as possible, service users’ health and safety have been protected. During the course of the inspection we were informed that the home’s lift had been broken, however we were not notified of this at the time. Furthermore, on the first day of the site visit we became aware that the home had been without hot water. Again, on the second day of the inspection, a service user informed us they had been washed with cold water, as there was no hot water. We were not notified of this issue. The home has a quality audit procedure in place, which indicated that service users have been consulted, however the audit does not appear to be about service provision, rather it is a reviewing of service users’ needs. A quality assurance audit needs completing in line with standards and regulations, which stipulate that service users, relatives and stakeholders should be consulted about the service provision and a quality audit report of the outcome should be produced, made known to the public and be provided to us. Urmston Cottage DS0000006729.V362073.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 2 3 3 X 2 2 2 STAFFING Standard No Score 27 3 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 2 X 2 Urmston Cottage DS0000006729.V362073.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP10 Regulation 12(4)(a). Requirement Action must be taken to ensure that staff treat service users in a respectful and dignified manner at all times. This ensures that service users’ self respect is promoted and that they feel cared for in a safe and appropriate manner at all times. Meals and meals times need reviewing to ensure service users have appropriate support in a timely manner, aids and adaptations and foods they enjoy. Mealtimes should be pleasant experiences for all service users. To ensure that all parts of the home are fit for purpose, comfortable and safe for use by service users, a full audit of the home should be undertaken and an improvement plan developed for the upgrading of the home which includes timescales and which is provided to us. To ensure a good standard of support is provided to service users at all times, a review of the staffing rota must be DS0000006729.V362073.R01.S.doc Timescale for action 15/06/08 2 OP15 16(2)(1) 8.11 15/06/08 3 OP19 23 01/08/08 4 OP27 18 15/06/08 Urmston Cottage Version 5.2 Page 32 5 OP29 8,19 & Schedule 2 6 7 OP30 OP31 9 37 8 OP38 23(4) undertaken. Staff must not continually work excessively long hours and they must receive the training and support required to fulfil their roles and responsibilities such as supervision, training and guidance. For the protection of vulnerable service users, robust recruitment and selection procedures must be followed at all times. (Timescale of 15/11/07 not met) The manager must complete an appropriate managerial qualification. The registered person must keep us informed of all significant events within the home, which may affect people who are living there. (Timescale of 15/11/07 not met) For the safety and protection of service users, action must be taken to ensure that all fire safety doors fit correctly into their rebate and close smoothly, and, where required, remain locked as directed on signage. 15/06/08 01/10/08 15/06/08 15/06/08 Urmston Cottage DS0000006729.V362073.R01.S.doc Version 5.2 Page 33 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 OP7 Good Practice Recommendations Specific care records relating to pressure care, and food and fluid intake and weight monitoring, should be recorded in detail. In order that staff practice can be monitored and that service users receive the support they require at the correct frequency and in a consistent manner. All people using the service should have an individual up to date, detailed care plan. This will ensure that they receive person centred support to meet their needs. Daily care plans should be in sufficient detail to identify care support and the service users’ routines and achievements. The medication records must be signed when medication, including creams, is given to the people living at the home so that all staff are aware that it has been administered to the right person at the right time and correctly. Systems should be in place to ensure all medication is stored at the correct temperature, as detailed by the manufacturer. Service users’ independence should be encouraged and promoted by the provision of appropriately laid tables and trays which enables them to, as far as possible, serve themselves. For the promotion of safety for service users ,all staff should receive training in adult protection. Staff should be appropriately deployed in all areas used by people living at the home, to make sure they are appropriately supervised and support. Quality assurance procedures should be carried out, with a public report being produced about the outcome. A copy of which should be supplied to us. 2 3 4 OP7 OP7 OP9 5 6 OP9 OP15 7 8 9 OP18 OP27 OP33 Urmston Cottage DS0000006729.V362073.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Manchester Local office Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ 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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