Inspection on 04/04/07 for Venn House

This inspection was carried out on 4th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Venn House 02/10/08

Venn House 01/10/07

Venn House 02/08/06

Venn House 01/03/06

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

CARE HOMES FOR OLDER PEOPLE Venn House Lamerton Tavistock Devon PL19 8RX Lead Inspector Helen Tworkowski Key Unannounced Inspection 4th April 2007 8.00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Venn House DS0000065984.V327681.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. Venn House DS0000065984.V327681.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Venn House Address Lamerton Tavistock Devon PL19 8RX 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) 01822 612322 0870 1270388 Venn Care Ltd Vacancy Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Venn House DS0000065984.V327681.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. To accommodate one named individual in the category of DE (E) for an initial period of 3 months, until 13/04/06. To accommodate no more than 25 Service Users To accommodate Service Users who are 65 years or over, who fall in the category OP - old age (not falling within any other category) 2nd August 2006 Date of last inspection Brief Description of the Service: Venn House is a Grade 2 listed house set in its own grounds on the edge of the village of Lamerton. The property consists of the main house that accommodates 16 people and a converted Coach House, a short distance away, that accommodates 9 people. The home is registered for people who are elderly and who fall into the category OP. The main house is of great character, with slate floors and gothic windows, however there are some steps between some rooms. The majority of rooms are en suite or have a bathroom close by. The Coach House Annexe is a short walk from the main house. It has its own lounge and dining room with a small kitchen for snacks and drinks. Like the main house there are bedrooms on the ground and first floor. Meals are brought over from the main house to the Coach house and eaten in the dining room. There are some bath adaptations in some bathrooms and there is a stair lift in the main and coach house. Venn House is not suited nor registered for people who have a significant level of disability. Many rooms look out over the gardens or surrounding countryside. The home is staffed 24 hours per day and has waking night staff. The Statement of Purpose and Service User Guide, which provide information about the home, are available in the office, and copies are in the entrance hall. The fees are between£550 and £600 per week. Items not included are: Chiropody, toiletries, activities, holidays, magazines, newspapers, transport, and hairdressing. Venn House DS0000065984.V327681.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection - and this report includes the finding of two Random Inspections that were completed on 8th September 06 and 29th January 07. This inspection included two visits to Venn House: the first on 4th April 07 (8.00 am till 4.30 pm), and on the 5th April (9.00 am till 4.00 pm). During these visits the Inspector toured the building, looked at records including those related to the care of people, to safety and in relation to the staff employed. As part of this Inspection Surveys were sent to all 19 Service Users: 11 were returned. Surveys were also sent to 21 Care Workers, seven were returned and to seven General Practitioners, two were returned. The Inspector also spoke with most of the Service Users, some of their relatives, to visiting professionals and to many of the staff. What the service does well: What has improved since the last inspection? Improvements have been made in the general organisation of the home. There is now a proper record of the staff employed and each member of staff now has a file containing their information. The management of Service Users’ money, held on behalf of the Service Users by the organisation, has also improved. A record of staff training has started to be established and with time this will give a good over view the training needs of the staff team. Service User Plans, documents that specify what a person’s needs are and how they are to be met have improved; they provide clear guidance to what staff should be doing. The plans need further development, however there is now a sound base for developing plans. Risk assessments (documents that help clarify how to keep people from unnecessary harm) have been revised and are now clear and up date. Venn House DS0000065984.V327681.R01.S.doc Version 5.2 Page 6 Some steps to two bedrooms on the ground floor have been removed and a new slope made. This has improved access to this area. Also a new “spa” type bath has been fitted in one of the bathrooms. What they could do better: Service Users and staff felt that there were insufficient staff at times. Comments from Service Users included “None of the staff has time to come and talk, they are too busy and there are not enough staff”, “Night staff are under great pressure with only two available”. Staff also felt that there was insufficient staff, five out of the six people responding to the staff survey said that they did not have enough time to provide the care required. Relatives spoken with identified that at times where people’s care needs were not being met. The inspector also observed that during the inspection that staff were under great pressure. A further concern identified was that proper recruitment checks were not being made either before an individual started work or before they were left to work unsupervised. There were also concerns at the level of competence of staff employed and their lack of English. One member of staff commented, “Some residents get irate as they cannot understand the foreign workers”. Relatives commented on the frequent changes of staff – and thought that this was one reason why care tasks were not carried out. Service Users, relatives and staff raised a number of concerns throughout the inspection. The inspector was told of how issues had been raised with senior staff, however nothing ever came of it. The Manager had a record of incidentsbut it was clear that not all issues had been recorded and were not treated as complaints. Issues were not dealt with or resolved. This has led to some relatives finding their own ways of coping and to deal with the issues themselves- cleaning carpets themselves or doing all the laundry. It was noted at previous inspections that two relatives had raised complaints; on both occasions the service user was asked to leave. Some service users felt that they were unable to complain. Service Users, staff and visitors to Venn House need to be able to feel that they can raise concerns, that they will be listened to and that where things need to change this will happen. Concerns were also identified around the management of medication. Improvements need to be made in relation to the training of staff in relation to administering insulin, and to ensure that staff are competent to understand and administer medication prescribed correctly. A reoccurring issue raised during this inspection was that laundry was not being returned, and on occasions was returned damaged. The laundry was found to be poorly organised and full of unnecessary clutter and soiled linen. It is important that there is a good system for the management of laundry, not only so that Service Users get their own clothes back but to avoid the spread of infections. Venn House DS0000065984.V327681.R01.S.doc Version 5.2 Page 7 Service Users are not offered the opportunity to join in any activities, and from comments made by staff and service users, staff now have little time to talk. One person commented “It would be nice to have structure to some days, either a flower arranger to visit or some people demonstrating things, there is not enough to do”, and from staff “Since the number of staff have been cut, it is felt by most of the staff that we can’t give the care we would like to, the social and friendly side to caring seems to have gone”. Service Users, staff and visitors expressed little confidence in the Registered Provider, Venn Care Ltd. The opportunities for the Registered Provider to receive feedback and to communicate with Service Users are not being used. The Registered Provider should have arranged for monthly-unannounced visits to the home to take place, these have not happened. There is no quality assurance system. The Care Home has no Registered Manager at present, though the Commission has received an application. Many of the requirements made during this inspection have been made at previous inspections, and whilst there have been some improvements in the service, there have been other areas where the service has declined. 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. Venn House DS0000065984.V327681.R01.S.doc Version 5.2 Page 8 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 Venn House DS0000065984.V327681.R01.S.doc Version 5.2 Page 9 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The information provided to prospective Service Users is out of date, and because pre admission assessments are not adequate, Service Users cannot be confident that their needs will be met. EVIDENCE: Copies of the Service Users Guide and Statement of Purpose were available to the Inspector in the office. Copies were also in the entrance hall. These documents provide prospective Service Users with information about the home, and what people can expect from Venn House. The documents were out of date, and did not reflect the current situation, and did not contain all the necessary information-such as the last Inspection report on the home. The Inspector spoke with two relatives of Service Users about the information their relative had received before the move, they felt they had received sufficient information. Ten people replying to surveys said that they had had sufficient information about the home before a move. The most recent Venn House DS0000065984.V327681.R01.S.doc Version 5.2 Page 10 Inspection report should be included as part of the Service Users guide however from discussions with a relative - this had not been made available. Eight out of the ten people responding to the surveys said that they had received a contract, however no contract was available for the inspector to see as part of this inspection. Contracts must be available to be inspected. Before a person moves to a Care Home, a full assessment must be completed. Service Users and their relatives confirmed that assessments had been completed. The records relating to two people who had recently moved to the home were looked at; the record of these assessments was inadequate. The assessment documents contained a minimum of information. However one useful new form had been introduced, this form allows Service Users to comment on their needs and preferences. It is important that a Care Home knows as much as possible about a person before a move- otherwise there is a risk that needs will be missed and not met. A letter was seen that confirmed that Venn House was able to meet the needs of a person who was about to move to the home, though this was not clear from their assessment. Venn House DS0000065984.V327681.R01.S.doc Version 5.2 Page 11 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’ needs are not always met and Medication is not being safely administered. EVIDENCE: The Inspector spoke with Service Users about the care and the support they received, and in general people felt that their needs were met. The survey of Service Users indicated that ten out of 11 people felt that they always or usually received the support they needed. However concerns were raised through out this key inspection that staffing was very low, particularly at night. At the Random Inspection on 29/1/07 concerns were raised with regard to low levels of staffing in the evening and at night, and a requirement was made to review staffing levels. Documents that specify how care will be given, called Service User Plans, have significantly improved. They now provide clear information about needs. However the documents still lacked detail in some areas- for example there was very little information about personal preferences or background that Venn House DS0000065984.V327681.R01.S.doc Version 5.2 Page 12 might help ensure people received care that was tailored to their needs. Also where individual Service Users have conditions such as diabetes there should be detailed information about how they should be supported, when help should be sought, and what to look for to indicate that all is not well. The Manager was aware of the lack of detail in the plans and said he was working to improve the information. There were also “risk assessments” relating to difficulties with mobility on file, again there were significant improvements in this area. The Manager had also set up a system for monitoring falls, as well as simply recording them. However the care provided does not always reflect what is set out in Service User Plans- for example one relative explained that his/her relative needed to have a catheter bag emptied during the night; this did not always happen. The person had spoken on a number of occasions to a senior member of staff, however the situation had not improved. In looking at daily records it was also noted that there was an occasion where a Service User was not changed appropriately at night. One member of staff commented “As I work at night by myself, often you are struggling to do all that is required and answer the buzzer. Five out of the six people completing the staff survey said that they did not have enough time to do what is required in the Care Plan. Staff were observed knocking at doors during this inspection, and most of the Service Users commented how kind and friendly the staff were. One Service User commented that the frequent staff changes meant that they never knew who was going to come in and that new staff were rarely introduced. It was also noted that one Service User said that she had been shouted at, another said that one member of staff, who has since left, had been very heavy handed and that a Senior member of staff was described as “not very polite”. Much of the medication at Venn House is administered from a “monitored dose system”; this is prepared by the pharmacist. In looking at the system it was apparent that the seals on one lot of medication had been broken. The Senior member of staff explained this was because two additional tablets had been prescribed. The tablets had been added to the sealed pack as staff found these additional tablets confusing. This is of concern; the seals on such medication should not be broken until it is administered, but most importantly staff should have the competence to follow instruction and administer this additional medication. One member of staff expressed concerns that staff whose first language is not English are not always clear regarding administration instructions. A member of staff also identified an incident where a Service User did not receive antibiotics for two days, because of an error. Such errors could seriously jeopardise a Service User’s health. One Service User told the inspector that he/she used an inhaler and on one occasion he/she was unable to use the inhaler, before bedtime, as it had run Venn House DS0000065984.V327681.R01.S.doc Version 5.2 Page 13 out. The only stock of inhalers was kept in the other building and there were not enough staff for someone to go and collect it. He/she had therefore to do without. It was also of concern that some of the staff who are administering insulin injections and testing the blood sugar levels have been taught by another member of staff, and not by the medical professional who has responsibility for care- for example the district nurse or diabetic nurse. Service Users are able to self medicate- and there was a risk assessment completed by the manager to ensure that Service Users received the support they need. The manager said that each person who self medicates has been provided with a lockable container for his or her medication. Venn House DS0000065984.V327681.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Meals are well cooked with fresh ingredients and are for the most part to the taste of the Service Users. Service Users are not offered any social activities or support to maintain interests. EVIDENCE: Nine out of the ten Service Users responding to a survey when asked if activities are arranged by the home that can take part in, replied never or sometimes. Some of the Service Users said that they had no interest in joining in activities however nothing is available should they be interested. Staff commented that they had little time to talk with Service Users. The Inspector met a number of visitors to the home during the Inspection. They felt free to visit, and were welcomed. Some Service Users have friends who live in the nearby Orchard Cottages, and this means that there is an added sense of community. Service Users are able to manage their own finances at Venn House, and the majority of people choose to do this. Where the staff at Venn House are involved in managing any cash for Service Users there is a record of these Venn House DS0000065984.V327681.R01.S.doc Version 5.2 Page 15 transactions. Service Users are able to self medicate if they so choose, and many individuals have brought their personal possessions including items of furniture with them. Nine out of ten people responding to the Service User survey said that they always or usually enjoyed the meals. The Inspector ate two meals with Service Users, one with Service Users in the Coach House and one with Service Users in the Main House. Both meals were well cooked and presented. Service Users were given the opportunity to serve their own food, an important part of maintaining independence and choice. There were bowls of fresh fruit in both dining rooms. The cook showed the Inspector the record of meals; there was a range of meals. One survey and one relative expressed the view that the evening meal was inadequate or did not provide choice. However the record of options offered indicated a wide choice was offered. It is suggested that this matter is discussed with Service Users to clarify if there are issues with this meal. One Service User commented how kind staff were to sometimes cook her an omelette when she was tired and did not feel like other food. Venn House DS0000065984.V327681.R01.S.doc Version 5.2 Page 16 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 and 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service Users cannot be confident that their complaints will be treated seriously and investigated thoroughly. EVIDENCE: Since the last major inspection on 2nd August 2006, the Inspector is aware of two complaints that the Registered Provider has dealt with where the complainant (or their relative) was asked to leave. Whilst it is recognised that in some instances a Care Home may not be able to resolve a concern and may point out to an individual that moving is an option, it is not acceptable practice as a means of dealing with a complaint. All of the people who responded to the Service User surveys said they knew who to speak to if they were not happy and knew how to make a complaint. However comments about complaints included “They are on hand to talk to, but nothing is ever done about it…” The Inspector spoke with three relatives: all three had raised concerns or complaints. One person said “The laundry is a [expletive] mess, items get lost… I’ve mentioned it a dozen times. It’s a longstanding problem... The response I get back is that they are looking for the items. … They don’t consider it a complaint unless it is written down”. Another relative explained how her relative’s needs were not being met at night. The consequences were that the individual was incontinent; the relative said that she had repeatedly raised this issue with senior staff; however there Venn House DS0000065984.V327681.R01.S.doc Version 5.2 Page 17 had been no change. This lack of care meant that the individual suffered this unnecessary indignity, they had risked falling, and the carpet had become wet with urine. As this carpet was not properly cleaned by staff the relative had taken to scrubbing the carpet herself. A third relative said that she had made repeated complaints about laundry, and other matters, and said that on one occasion that her relative said that medication had not been given, whilst the staff said it was. The relative felt that this was not well dealt with, leaving her relative very distressed and that the matter was “brushed under the carpet”. The Inspector also spoke with Service Users about their confidence in raising matters of concern. One Service User spoke about how awful the laundry was and showed the inspector a torn cardigan. She also spoke about one staff who had since left, being “heavy handed”, and feeling that she “can’t say anything”. Another Service User told the Inspector said that she was shouted at and was accused of being a troublemaker or stirrer. The individual was now concerned to raise any issue in case it happened again. This matter was referred under the Safe Guarding Adults Protocol, for investigation and resolution. The Inspector looked through some reports and incident records, which seemed to make up the complaints system. Some of the issues had been responded to and there was a record of a conversation, for others it was not clear what action had been taken. The Manager was also not aware of some of the issues that had been raised with senior staff. The complaints procedure does not appear to be used for these issues or concerns. A requirement was made previously that staff should receive training in relation to the Protection of Vulnerable Adults (POVA), from the information sent by the Provider before the inspection, three of the Care staff received training in relation to the POVA late in 2006. It is recognised that it may take time to ensure that all staff, particularly new staff have received training in this area, however this training is of great importance. Venn House DS0000065984.V327681.R01.S.doc Version 5.2 Page 18 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, 22, 24, and 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Venn House is generally comfortable and well maintained, however there are a number of areas where Service Users are exposed to unnecessary risk. The management of laundry is poor. EVIDENCE: As part of this Inspection the Inspector toured most of the two buildings (the Coach House and the Main House) and spent time with many of the Service Users in their rooms. The home is generally well decorated; many of the Service Users have been able to bring in items of their own furniture and belongings. However only one of the bedrooms has a door lock, it is recommended that each person is provided with a bedroom door lock and lockable space in their rooms, to use if they wish. A slope has now replaced steps to some of the bedrooms on the ground floor and this has improved the access to these rooms. Venn House DS0000065984.V327681.R01.S.doc Version 5.2 Page 19 At one of the last inspections it was noted that some of the window panes of the first floor corridor had broken, some of these have been taped over so that the sharp edge is covered. One still remains uncovered. Broken, taped windows are unsightly and should be repaired. A new “spa” type bath has been fitted to a first floor bathroom in the Main House. Staff said that Service Users really enjoyed using this new bath that has an integral hoist. One relative of a service users raised concerns about the bath hoist in the Coach House. She said that her relative was refusing to use the bath hoist because she is frightened. On close examination the covers to the hoist were not clean. The continued immersion in bath water had left a grey film over the seat and backrest. The bottom of the hoist was rusting. A member of staff told the Inspector that the hoist does not work properly- one of the side flaps flops over. One person in the Coach House was refusing to use the shower because of difficulties with access. The Inspector was also shown a stair lift that was not properly working, so that someone had to manually pull down a heavy rail for it to work. Throughout this Inspection concerns were raised regarding the laundry. The Inspector was told that the person who had previously worked in the laundry, was now solely involved in cleaning. The care staff are now doing the laundry during the day and night, in addition to their other duties. The Manager said he had advised the Registered Provider against this change. Complaints from Service Users were that their laundry was not returned and in one case was returned torn. Staff said it was a problem as items that should be there ready for use were not, for example towels. The Inspector went into the laundry on Thursday 5th April 07, there were black bins full of soiled bedding that a member of staff said had been there since Monday. The room was cluttered, with a new bath, apparently destined for the Coach House, taking up a large proportion of the floor space, and an old TV some of the work surface space. It was difficult to access the hand washing area for bins of washing. This is of concern not only because Service Users are not having their washing done properly, but also because it is an infection issue. The laundry area should not be cluttered, all surfaces should be readily cleanable and there should be a system for ensuring washing is completed quickly with a minimal of contact between clean and dirty laundry. This helps ensure that if there is an outbreak of infection, such as diarrhoea and vomiting, it is not spread to vulnerable people. Venn House DS0000065984.V327681.R01.S.doc Version 5.2 Page 20 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. Service Users are placed at risk because staff recruitment processes are poor, some staff have poor communication skills and there are not enough staff overall. EVIDENCE: Concerns were identified at the last main inspection on 2nd August 06 and in subsequent inspections regarding the level and competence of staff. As part of this inspection the Inspector spoke to Service Users about the staffing at Venn House and how it affected their lives. Some of the Service Users are independent and need very little direct support from staff, others need a significant amount of support in the day and night. Many of the Service Users commented how helpful and kind the staff are and felt that they were being very well looked after. All nine of the Service Users responding to the survey said that they felt that the staff listened and acted upon what was said. There was however some feelings of sadness that staff who they had known for many years were leaving and were being replaced by staff from abroad. One Service User explained that as she had got to know staff and their families over the years, they had become part of her world, and when they left, they were missed. In general Service Users felt that the staff who had recently been recruited were kind, attentive, though concerns were expressed about their ability to Venn House DS0000065984.V327681.R01.S.doc Version 5.2 Page 21 speak English and lack of familiarity with routines. One relative commented that staff difficulties were worse at the weekends. The Inspector met one of the new staff, and the individual had very limited English. A member of staff told the Inspector that the new person had insufficient English to be able to find out what Service Users wanted for their supper. This confirmed the Inspector’s own views. When the Inspector looked at the rota this individual had worked on Sunday 1st April, however their details on the personnel file indicated that they started on 2nd April 07. The most recent recruits to Venn House had been employed via an agency. For this individual the record of employment was not as detailed as required. There were two “testimonials”, not references as required. These had been written four and five months earlier. A Criminal Records Bureau (CRB) had been initiated, however the check of the list of unsuitable people (Protection of Vulnerable Adults List), had not been completed until 3rd April 07. The Inspector spoke with staff about 1st April 07; one person confirmed that the new member of staff had had to be left to work unsupervised in the Main House as the other two staff on duty were needed in the Coach House. This meant that Service Users were left in the sole care of a person who had very limited English and who had not completed the necessary checks to ensure their suitability to work with vulnerable people. New staff should go through a period of induction and shadowing, where they are introduced to the work and learn what is expected from them. A person can only start work when checks have been completed to ensure that they are a suitable person to work in a care home. This applies to all staff wherever they are from, however staff from abroad may need an additional period of orientation to familiarize them with the cultural and language differences. The standard induction at Venn House is 4 days induction; a more in depth induction must be considered, so that staff have sufficient time to familiarise themselves with what is expected of them. The Manager said that new staff “shadowed” other staff for the first few weeks. However as has already been noted this may mean that they are part of the rota, and at times left working alone. Staff commented in surveys that new staff sometimes worked alone at night after only two or three days at Venn House. No criminal records bureau check could be found for a person who had been working alone at night for some months. The Manager explained to the Inspector that he had no involvement in staff selection or promotion and that this was organised by the Registered Provider. The Inspector asked about the competence of staff appointed to be Senior Care Staff, and the Manager expressed concerns. Staff also told the Inspector that one agency member of staff brought her young child to work, when working nights. This is of concern as the member of staff may not be available to meet the needs of both the child and the service users. The care home is not registered to accommodate children. Comments made by staff as part of the staff survey include: “Increase the staff numbers” and “…., improve induction”. Five out of the six people completing Venn House DS0000065984.V327681.R01.S.doc Version 5.2 Page 22 the survey said that they did not have enough time to do what is required in the Care Plan. There are currently three staff on duty during the day time (8am till 10pm). Usually there are two staff on duty during the night (10pm till 8am) however an additional member of staff had been rostered because of the needs of a particular service user. In addition to this there are ancillary staff, and during the week the manager. Requirements have been made in relation to concerns regarding low staffing at the last main inspection and the two following additional inspections. As a result of these concerns the staffing level has been increased between 8pm and 10pm. However it was clear during this inspection that the needs of Service Users were such that even with the Manager providing support, the staffing was barely adequate. One member of staff explained how sometimes when there are inexperienced staff or agency staff on night then tasks that normally get done earlier are left. One staff gave an example that one Service User normally likes a bath at 7.30am, if this is not done by the night staff, then the day staff are trying to cope with responding to people ringing the bell to get up, helping with this bath, and trying to catch up with what had been happening since they were last on duty. The member of staff said that she found it difficult to say anything about the situation. She had on one occasion left a Service User in the bath, whilst trying to respond to someone who was calling for help, something she knew was unacceptable. She said that she didn’t have the time to talk to people and did not feel that service users got the best care. The Inspector discussed with the manager the rota for the forthcoming Easter Bank Holiday weekend. As the Manager would not be working then there would be no additional support available to staff during the day. There would also be fewer ancillary staff, who can provide indirect support to staff. The manager confirmed that in his professional view that this level of staffing was inadequate given the needs of the Service Users. An immediate requirement was made that the staffing levels be reviewed and an appropriate level of staffing provided. The pre-inspection questionnaire sent to the inspector shows that there has been some training in the last 12 months including medication training, fire training and induction training. The pre- inspection questionnaire indicated that staff training would be updated in the future. At the time the questionnaire was completed 22 of staff had a national vocational qualification in care, which is below the 50 recommended level. Only two of the seven staff responding to the staff survey felt that they got enough support to do their job well, and three out of eight said that they had received supervision. The manager said that there was little time to provide supervision to staff. In discussions with staff it was noted that staff had ceased to work at Venn House because of concerns about their performance, and that allegations of misconduct had been made against other members of staff. It is the responsibility of the Registered Provider to deal with these issues however there is a duty to report incidents that seriously affect the well being of Service Venn House DS0000065984.V327681.R01.S.doc Version 5.2 Page 23 Users or any allegation of misconduct, to the Commission. This has not happened. The Inspector asked to see copies of correspondence to staff regarding concerns about their performance, however this was not available, as is required. The effect of these staffing issues varies, some Service Users are very satisfied with the care provided, others however are dissatisfied. As has already been identified in other areas of the report, service users needs are not always being met. Venn House DS0000065984.V327681.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Venn House is poorly managed by the Registered Provider Venn Care Ltd, Service Users, staff and relatives expressed both dissatisfaction and a lack of a sense of security. EVIDENCE: Some improvements have been noted in the day to day running of Venn House. There is more organisation- service user plans have been significantly improved, falls are monitored, and information about staff appointed to work in the home is better organised. There is no Registered Manager at Venn House however there is now a Manager. The Registered Manager is someone who the Commission believes to be competent and suitable to run a Care Home, and who has responsibilities defined in law. Requirements have been Venn House DS0000065984.V327681.R01.S.doc Version 5.2 Page 25 made in relation to the lack of a Registered Manager, and the Commission has now received an application. The relationship between the Registered Manager and the Registered Provider is an important one, each has different a different role and responsibilities. It is of concern that the Registered Provider is making decisions such as the appointment of staff, when the Manager believes that the individuals are not competent. A further improvement since the last inspection is that some staff feel confident to raise some issues with the Manager. However the increased confidence in the Manager does not appear to be matched by an increase in confidence in the Registered Provider, Venn Care Ltd. Staff, Service Users and relatives commented that the well being of the Service Users was not taken into account. There is no quality assurance system in place at Venn House, the Manager did acknowledge the need for such a system, but that there were other areas of development in the home that were of greater importance at present. One thing that the Service Users felt was of great value was a Service Users meeting that had been recently held; this had been set up by the Manager, and is now to happen on a regular basis. At the last inspection there was no adequate system for the management of Service Users’ money, where they are unable to manage it themselves. A new system has been set up and there is a clear record of transactions. The Registered Provider for Venn House is a company: Venn Care Ltd. As a company there is a requirement that a representative from that company should visit the home (unannounced) each month, and report on the running of the home. As part of this visit the person must consult with Service Users. A copy of the report made as a result of this visit must be sent to the Company and to the Commission. Requirements have been made with regard to these visits at previous inspection, however the Commission has received no reports. The Regulations also place a duty on the Registered Provider to inform the Commission of certain types of incidents: this includes any allegations of misconduct by staff or events that adversely affect the well being of any Service User. Not all such incidents have been reported to the Commissionthe Inspector was advised that allegations of misconduct had been made against two staff, and a further member of staff no longer worked at home because of concerns. As part of this inspection some of the health and safety documents were looked at. Risk assessments and records of checks made are an important part of the process of ensuring that people are not exposed to unnecessary risks. There was a Fire Risk Assessment; this had not been reviewed for some time, however the checks of the fire equipment and system are being done. Also the Fire Procedure had also been revised as required. There were also checks Venn House DS0000065984.V327681.R01.S.doc Version 5.2 Page 26 being made of the hot water to ensure that there was no outbreak of Legionella, however the actual risk assessment that would indicate what checks were needed had not been completed. The Inspector was also told that the portable electrical equipment had been tested, though no record of this inspection had been received to confirm this. Venn House DS0000065984.V327681.R01.S.doc Version 5.2 Page 27 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 2 X 1 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 3 X X 1 X 2 X 1 STAFFING Standard No Score 27 1 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 1 X 3 X X 2 Venn House DS0000065984.V327681.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No 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 OP1 Regulation 4, 5 Requirement Timescale for action 01/07/07 2 OP3 14 (1) 3 OP7, OP8 15 (1) The Service User Guide and Statement of Purpose should both be up to date and must include all the information that is specified in the Regulations, so that prospective Service Users can make an informed choice about a move. Prospective Service Users must 01/06/07 be fully assessed and their needs known before they are offered the opportunity to live at Venn House. All Service Users must have a 01/06/07 comprehensive Service User plan that describes in detail the actions staff are to take to meet needs, including particular health issues such as diabetes. This plan must then be implemented, so that Service Users get the help they need. (A similar requirement was made at the inspection on 2/8/06 to be met by 2/10/06) Venn House DS0000065984.V327681.R01.S.doc Version 5.2 Page 29 4. OP9 13 (2) (c) 5 6. OP9 13 (2) (c) 12 (4) (a) OP10 7 OP12 16 (2) n 8 OP16 22 (3) 9 OP18 13 (6) 10 OP22 13 (5) Immediate Requirement: All staff who are administering insulin or testing blood sugar levels must be appropriately trained and that there must be a record of the delegation of responsibility from the relevant medical professional to the specific Care Worker. This is to ensure that Service Users receive the correct levels of medication. Service Users must be given the medication as prescribed by competent staff. Staff must treat Service Users with respect and dignity, and there should be systems in place to monitor that this is happening. Service Users must be offered the opportunity to participate in activities or to follow interests, that suite their interests. (A similar requirement was made at the inspection on 29/1/07 to be met by 1/4/07) Complaints must be fully investigated and be responded to an appropriate manner, to ensure that people’s concerns are addressed. (A similar requirement was made at the inspection on 2/8/06 to be met by 2/10/06, on 29/1/07 to be met by 1/3/07) The Provider must ensure that there are systems in place to protect Service Users from the risk of abuse, either by staff training or by other measures. (A similar requirement was made at the inspection on 2/8/06 to be met by 2/10/06, and on the 1/3/06 to be met by 1/8/06) Hoists and stair lifts must be clean and in good working order. DS0000065984.V327681.R01.S.doc 04/05/07 01/06/07 01/06/07 01/06/07 01/06/07 01/06/07 01/06/07 Venn House Version 5.2 Page 30 11 OP26 13(3) 12 OP27 18 (1) a 13 OP29 19 (1) (b) 14 OP30 19(11) Service Users’ clothes and bedding must be properly laundered and returned to them. Soiled linen must be managed and laundered so that Service Users are not exposed to the risk of infection. (A similar requirement was made at the inspection on 2/8/06 to be met by 1/1/07). Immediate Requirement: The level of staffing must be reviewed, and sufficient staff must be provided to meet the needs of all service users. (Similar requirements were made 2nd August 06 to be met by 6th September 06, on 8th September to be met by 2nd October 06, and on 29th January 07 to be met by 1st March 07). Before a prospective member of staff starts work at the home checks must be made to ensure their suitability. These checks must include obtaining: - a complete work history, with no gaps. - and verifying two pertinent work references. - a “POVA First Check” if the person is to start before their Criminal Records Bureau check has been returned. (A similar requirement was made on 2nd August 06 to be met by 6th September 06). New care staff who have a completed “POVA First Check” but who do not have a Criminal Records Bureau check must only work with supervision. (A similar requirement was made on the 2nd August 06, to be met by 6th September 06) 01/06/07 05/04/07 01/05/07 01/05/07 Venn House DS0000065984.V327681.R01.S.doc Version 5.2 Page 31 15 OP30 18 (1)(c) i 16 OP31 26 17 OP32 OP31 12 (5) (a) 18 OP33 24 (1) 19 OP38 37 New staff must receive a structured induction that will provide them with the competence to carry out the duties that are expected of them when they are eventually left to work unsupervised. (A similar requirement was made on 2nd August 06 to be met by 6th September 06. The Registered Provider must arrange for unannounced monthly monitoring visits to establish the conduct of the home, this must include consulting with Service Users. Copies of reports made during these visits must be forwarded to the Commission. (A similar requirement was made at the inspection on 2nd August 06 to be met by 1st October 06) The Registered Provider must ensure that the home is managed in a manner that maintains good personal and professional relations with Service Users and staff, so that the home promotes the health and welfare of Service Users. This means keeping an honest, open and professional dialogue with all parties. A quality assurance system must be set up that takes account of the views of service users. (A similar requirement was made on 2nd August 06 to be met by 1st December 06) Reports of all incidents, specified in the regulations, such as allegations of staff misconduct or serious incidents (including serious medication errors) that adversely affect the well being of staff must be supplied to the Commission. 01/05/07 01/06/07 01/07/07 01/07/07 01/06/07 Venn House DS0000065984.V327681.R01.S.doc Version 5.2 Page 32 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 OP24 Good Practice Recommendations Service Users’ private accommodation should be fitted with suitable door locks so that they can lock the door if they so choose from both inside and out. Such locks should be readily over ridden in an emergency. Venn House DS0000065984.V327681.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Venn House DS0000065984.V327681.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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