Inspection on 29/10/07 for Wells Court

This inspection was carried out on 29th October 2007.

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

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

Other inspections for this house

Wells Court 10/06/08

Wells Court 21/03/07

Wells Court 13/03/06

Wells Court 26/07/05

Wells Court 02/02/05

Wells Court 15/09/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

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

CARE HOMES FOR OLDER PEOPLE Wells Court Herbert Road Salcombe Devon TQ8 8HD Lead Inspector Margaret Crowley Unannounced Inspection 29th October 2007 10:00 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 Wells Court DS0000003852.V344520.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. Wells Court DS0000003852.V344520.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wells Court Address Herbert Road Salcombe Devon TQ8 8HD 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) 01548 843484 01548 843484 Wells Court Limited Position Vacant Care Home 24 Category(ies) of Dementia - over 65 years of age (24), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (24), Old age, not falling within any other category (24), Physical disability over 65 years of age (24) Wells Court DS0000003852.V344520.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Age 55/65 Date of last inspection 21st March 2007 Brief Description of the Service: Wells Court is a detached property situated in the estuary town of Salcombe in the South Hams area of South Devon. It is registered to provide care for 24 older persons who may also have a physical disability and/or dementia. Accommodation is provided in single and mainly en suite bedrooms on the lower ground floor, ground floor and first floors. There is a spacious lounge, a smaller lounge and a dining room situated on the ground floor. There is a passenger lift, chair lifts and appropriate aids and adaptations to assist people. There is a small garden at the front of the property and car parking at the rear. The current level of weekly fees range from £350 to £415. Written information regarding the home and the services provided is available in the reception area and is given to people considering going to live at Wells Court. A copy of the most recent CSCI inspection report was also available in the reception. Wells Court DS0000003852.V344520.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. The inspection was unannounced and took place on 29th October, 8th November and 5th December 2007. Mrs Nikki Rogers, a director of Wells Court Ltd, was present on the first day of the inspection and during part of the inspection on 5th December. Mr Guy Rogers, the responsible individual and a director of Wells Court Ltd was present during part of the inspection on 5th December. There was no registered manager in post. The former registered manager resigned in October 2007. A new acting manager was present in the home on 29th October and 8th November, but she no longer works in the home. The inspection was conducted over a protracted period of time because of concerns and complaints that arose. The inspector was accompanied on 5th December by the Commissions Regional Lead Pharmacist and an inspector who is a qualified nurse. Prior to the inspection the proprietors were asked to provide written information about how they maintain a safe environment, train and support staff, and seek the views of the people who live at the home to improve the quality of care provided. Surveys were sent to gain the views of people living in the home, relatives, and staff, and also to visiting health and social services professionals. There were twenty-two people living in at Wells Court at the time of the inspection. Most were spoken with, including five in more depth, regarding the lifestyle in the home and the care services they receive. Four relatives were spoken with and surveys were received from two relatives prior to the inspection. Staff on duty were observed and seven were spoken with. Surveys were received from two staff and three health professionals prior to the inspection. A tour of the premises was made and records were inspected. These including staff records and those relating to people’s care needs and medication. What the service does well: People living at Wells Court praised individual members of staff for their kindness and consideration when providing care. People are encouraged to maintain contact with family and friends. Many have lived locally prior to moving to the home. Wells Court is spacious and homely. People like their rooms, most of which are en suite and many have pleasant views. Wells Court DS0000003852.V344520.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Prospective residents did not always have a comprehensive assessment of their care needs recorded, to ensure that care staff are aware and have planned for their needs prior to their admission to the home. Plans of care were not reviewed and updated regularly to provide an accurate and detailed description of the person’s care needs and the action required by staff to meet those needs. People did not always have the equipment provided to ensure that they are comfortable and to prevent the development of pressure areas. Despite a recommendation made at the last inspection, some beds continue to be fitted with plastic mattress covers without any additional cover beneath the sheet. Procedures for the storage and administration of medicines were not robust, which could place people at risk. There were no regularly organised leisure opportunities available to provide interest and stimulation for people living in the home. The complaints book did not contain a full record of complaints received and the action taken. There were not always enough trained and experienced staff working in the home to meet people’s needs in a timely manner. Staff recruitment procedures to ensure the safety of people living in the home were not always followed. There was a lack of attention to health and safety matters, which could place people at risk. There was no clear system to record maintenance tasks to be addressed and when they have been completed. The floor- covering in the laundry was torn. The sink in the medication/treatment room was blocked. Most hot water outlets accessible to people living in the home did not have temperature control valves to restrict the water temperature, which placed people at risk of a scald. The programme to install these has not been proceeded with. There was a lack of attention to fire safety. The fire doors at the entrance of two bedrooms were wedged open. A slow closing mechanism on a bedroom door was broken which meant the door was left ajar. Several storage cupboards labelled “fire door keep locked” were unlocked. Signage within the premises did not assist people who are new, and those with dementia, to find their way around the premises. Wells Court DS0000003852.V344520.R01.S.doc Version 5.2 Page 7 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. Wells Court DS0000003852.V344520.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 Wells Court DS0000003852.V344520.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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People receive information to assist them in choosing to live at Wells Court but admission procedures are not always followed to ensure that people’s needs can be met. EVIDENCE: Two people who had come to stay at the home recently were spoken with. They said that most staff were helpful at the time they moved in, but found some staff unhelpful. For example, one person had been told that it was time to go to bed, and another person did not know what assistance to expect as far as personal care was concerned and did not feel that they were given the help they needed. Written information is available regarding the home and services provided. It is given to people considering moving to the home and is also available in the reception area. The service user guide was updated during the period of Wells Court DS0000003852.V344520.R01.S.doc Version 5.2 Page 10 the inspection. However, it does not give clear information about the ownership and management structure of Wells Court Ltd. Records inspected of people admitted recently showed some evidence of pre-admission assessments undertaken of their needs. The manager usually undertakes these. The assessments seen did not always indicate whether the home’s pre- admission assessment had taken place at the person’s own home, hospital or the care home. The home is beginning to use new assessment and care planning forms and an example was seen a comprehensive assessment undertaken by a relief manager. However, the new format was not used consistently for all new admissions. There was no evidence available that a person admitted for respite had received a pre-admission assessment to ensure there was good planning for the person’s needs on admission. The preadmission assessment of another person made no mention of their pre-existing health condition that had led to the person seeking residential care. Wells Court does not provide intermediate care. Wells Court DS0000003852.V344520.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): Standards 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. Care plans do not contain clear guidance for staff, nor are they reviewed adequately to ensure that people living in the home receive consistent care. EVIDENCE: Some people living in the home, particularly those who had lived there for some time, spoke warmly of individual members of staff and said they were “incredibly kind”, and “ look after me well”. They said that staff tried to provide assistance promptly, but also that staff were “very busy” and “sometimes they are short staffed”. Staff were observed interacting with people living in the home in a warm and friendly manner. However, some people living in the home and relatives said that a minority of staff were not as helpful as others. An example given was in not providing appropriate assistance to help someone to sit up in bed. During the inspection we saw a person who had dementia and difficulties in feeding, left in their room with a part-opened pot of yogurt that the person could not manage to eat without assistance. Wells Court DS0000003852.V344520.R01.S.doc Version 5.2 Page 12 A relative complained during the inspection about the lack of personal care given to address the needs of a person who was incontinent. A further complaint was received from the relative of a person who had developed a pressure sore during a period of respite care. The relative alleged that he had not been informed about the person’s pressure sore at the time of discharge. While the investigation of this complaint undertaken by the company says that the person was informed, there is no record of this in the care records. Concerns about continence care and pressure area care had been raised during the last inspection. Despite a recommendation made at the last inspection, we saw that some beds continue to be fitted with plastic mattress covers without any additional cover beneath the sheet to make the bed comfortable. In addition, some of the sample of beds inspected had crumpled sheets, which indicated that the beds had been hastily made, or with out due care and attention. We inspected a sample of care records, and communication processes and systems within the home. Each person had a plan of care, but those examined of two people admitted recently were lacking in important information and clear guidance for staff in addressing their health and personal care needs. The care plan for a person with a deteriorating health condition did not give any guidance for staff in how to respond to predictable and unpredictable changes in the person’s health. The care plan of the person who developed a pressure area at the commencement of their stay did not give clear guidance and information regarding how this was addressed on a daily basis, including the use of pressure relieving aids. We found that the care plans of people who have lived at Wells Court for some time had not been reviewed regularly and some that were inspected had not been reviewed for more than six months. Similarly risk assessments had not been reviewed regularly, although they had been reviewed immediately prior to the inspection. The care records of a person admitted recently did not contain a risk assessment. Concerns about the lack of up to date information and guidance for staff contained in care plans had been raised at the last inspection and a requirement was made. Unless care plans and risk assessments are reviewed regularly and updated when people’s needs change, the management cannot ensure that people living in the home receive the level of care that they require. The director said that the practice of reviewing care plans on a monthly basis had not been maintained. However, the Annual Quality Assurance Assessment provided prior to the inspection states they provide: “Excellent review of care plans incorporating changing needs”. The director said that each person’s care plan was to be reviewed using a new care planning format and a co-ordinated recording system. We saw an example of this for a person who had recently come to live at Wells Court. The care plan had a more person centred approach and clearer information for staff regarding action that they need to take to assist the person. We inspected the home’s system for the storage and administration of medicines. Medication is stored in a small room off the reception area. At the outset of the inspection this room was very cluttered with supplies. However Wells Court DS0000003852.V344520.R01.S.doc Version 5.2 Page 13 the acting manager, who was then working in the home, subsequently arranged for an audit to be undertaken by the supplying pharmacist. During the inspection a relative complained that she had been asked by care staff to obtain medication from the general practitioner, although the person concerned had been resident in the home for more than two months. We found that the medicines cupboard was secured by a numeric lock and so it was not possible to determine who had had access to the medicines cupboard on any day. This was pointed out to the provider during the inspection and a new lock was fitted. We found that the medicines fridge had a regular temperature recorded of 10C, only the current temperature was being monitored and so it was not possible to determine if the products within the fridge were still safe to use. Action was taken during the inspection to obtain a further supply of the products stored in the fridge. We found that for people looking after all their own medicines there were appropriate risk assessments in place, these had not been done for those people only looking after some of their own medicines. We also found that although a record was made to indicate that something had been given the quantity given and the date of supply was not recorded. For some people who had had their dose of tablets changed during the period of the Medication Administration Record chart it was not always clear about the days the change related to and the supporting records had not all been made in a readily accessible way. Also for one person prescribed an anticoagulant the records made did not clearly indicate the number of tablets that had been given, but they did record the actual dosage that had been given. We also saw that for those people prescribed a variable dose of particular medicine the record only indicated that they had been given some medicine but not the actual quantity. During the inspection we asked to see the training records for people administering medicine. These were not available but a copy of a recent audit did record that all staff administering medicines had received training and the provider agreed that there would be an ongoing assessment of their competency. Wells Court DS0000003852.V344520.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): Standards12,13,14,15. Quality in this outcome area is adequate . This judgement has been made using available evidence including a visit to this service. There is a lack of stimulating leisure opportunities available for people to enjoy at Wells Court, and their preferences are not always sought EVIDENCE: People who live at Wells Court have a range of support needs and there are a number of people who have dementia. The more able people said that they are able to make choices about their daily living routines. They can get up when they like and stay in their room to follow their own interests and enjoy seeing relatives and friends. We spent time in both the main lounge and the small lounge and it was observed that there was a lack of leisure opportunities available for people, and little stimulating interaction for people with dementia. The television was left on in the main lounge, but was not audible and there was no evidence of any equipment for playing music. Staff brought people into the room or assisted others in going to the toilet, but appeared to have little time to talk to people individually. The more able people in the lounge commented “nothing much goes on” and “we used to have music sometimes”. Feedback from Wells Court DS0000003852.V344520.R01.S.doc Version 5.2 Page 15 relatives said that more activities should be provided, including trips out, and more time for staff to be able to “chat”. Care plans currently contain little information regarding people’s interests and social needs. The director said that there was no activities programme available currently and there was no record kept of activities that have taken place. However, the Annual Quality Assurance Assessment states that in the last 12months there have been “improved activities for residents and improved person centred activities”. The director said that she intended that a new manager would develop more interesting opportunities for people. There was no choice of menu offered at lunchtime. The day’s menu was not displayed and people were not aware of what the meal would be in advance of it being served. A new person who had particular dislikes was not aware that he could ask for an alternative if he did not like the meal provided. Few people praised the food. A person who had a small appetite and had requested small portions said the meals were always too large which was off-putting. Special diets are catered for, but there was no specific written information kept in the kitchen regarding dietary requirements and likes and dislikes. The meals provided during the inspection were of an adequate standard. People were provided with tea and coffee and homemade cake and biscuits and slices of fresh fruit between meals. The director said she is encouraging more fruit to be provided. By the second day of the inspection the acting manager had taken steps to ensure that people were offered a choice of menu at lunchtime and that their choices were recorded. Wells Court DS0000003852.V344520.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): Standards 16, 18. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Wells Court has systems in place to deal with concerns and complaints but procedures for recording complaints are not always followed and relatives do not have confidence that their concerns will be addressed. Recruitment procedures are not adhered to which could place people who live at Wells Court at risk. EVIDENCE: The home has a written complaints procedure that is on display and is contained in the service user’s guide. The procedure does not contain clear information. It advises that a complainant can write to “The Directors, The Court Group” rather than to Wells Court Ltd, the registered providers of the care home. The Annual Quality Assurance Assessment states that no complaints have been received in the last 12 months, but the complaints book showed that two were recorded. Moreover this did not represent a full record of complaints received. The complaints book did not record two written complaints received by CSCI and referred to Wells Court Ltd to investigate. One complaint was from a relative, regarding the care of a person now deceased and expressed concerns about the manner of a staff member towards her. The second complaint was from a relative (and is referred to in a previous section of this report) who alleged that important information regarding a pressure sore was not given to Wells Court DS0000003852.V344520.R01.S.doc Version 5.2 Page 17 their carer on discharge. No reply concerning the company’s investigation of the complaint was sent to the complainant. In addition, there was a complaint made verbally by a relative during the inspection, regarding the lack of personal and continence care. The relative said they had also raised their concerns with the former registered manager. The director and acting manager were informed of this complaint at end of the first day of the inspection. A visiting professional also informed us that they had passed on similar concerns. A subsequent examination of the complaints record showed that no complaint had been recorded in the complaints book or the person’s care records. People who live at Wells Court said that they would raise any concerns with a senior member of the care staff, or ask a relative to raise their concerns for them. Because of the recent changes in management they were not always sure who was currently managing the home. Care staff spoken with who had worked in the home for some time said that they had received training in safeguarding adults provided by the training officer from the Court Group. They showed an awareness of their responsibilities should they suspect that a person living in the home is at risk from abuse. No staff training plan was available to show which staff had received the training. An inspection of the recruitment records of people employed recently in the home showed that procedures to protect people living in the home had not been followed. Pre-employment procedures had not been followed, including obtaining 2 written references, checking the Protection of Vulnerable Adults register, and applying for a Criminal Records Bureau disclosure. Wells Court DS0000003852.V344520.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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People live in a home that is comfortable and clean but the lack of attention to some maintenance tasks and safety matters could place people at risk. EVIDENCE: A tour of the premises took place and most rooms were seen. Since the last inspection improvements have been made to upgrade the premises. The main lounge has been redecorated recently and new carpet and chairs provided to make it more comfortable and attractive. The communal toilets and shower rooms have been renovated. Bedrooms are personalised to people’s tastes and many rooms have pleasant views. Signage within the premises did not assist people who are new, and those with dementia, to find their way around the premises. A new person living in the home commented that it was difficult to find her way to her room. On the first day of the inspection two bedrooms did not have a number or a name to identify the room. New room numbers with identifying symbols attached to Wells Court DS0000003852.V344520.R01.S.doc Version 5.2 Page 19 them were fitted subsequently. Unfortunately the system of numbering within the home is extremely confusing. Rooms are not numbered in rotation and there are no signs to indicate where rooms are located and on which floor. Temperature control devices had not been fitted to most hot water outlets accessible to people living in the home, which could place them at risk of a scald. The programme to install the devices commenced prior to the last inspection, but has not proceeded. Warning signs were displayed on some, but not all hand basins. These signs have little impact for people with dementia or a visual impairment. Requirements have been made at previous inspections for this risk to be addressed. The home was found to be clean and free from unpleasant odours other than in one bedroom identified. A contracted cleaning service was cleaning the home on the first day of the inspection. They visit the home one-day per week to give the home a thorough clean. A part-time domestic and the care staff undertake the cleaning tasks during the remainder of the week. There is a small garden at the front of the property with a seating area. The garden is not secure for use by people living in the home with dementia. The front door to the premises was left unlocked, including at 7.30am. We saw visitors to the home enter the premises without ringing the bell and were unobserved if staff were not in the reception or the office. The management is advised to review the security arrangements. There was no clear system to record maintenance tasks needing to be addressed or to record when they have been completed. Matters identified during the inspection included: The floor covering in the laundry was torn The sink in the medication/treatment room was blocked. The slow- closing mechanism on a bedroom door was broken, which prevented the door from closing and was a fire safety risk. Wells Court DS0000003852.V344520.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): Standards 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 number of staff on duty, and their level of skills and experience, is not always sufficient to ensure that people’s needs can be met. Recruitment procedures are not adhered to, which could place people at risk EVIDENCE: Communication seen between staff and people living in the home during the inspection was friendly and courteous. Although people said that most staff were kind, comments were made that some staff had an abrupt manner and were not as helpful as they should be. The director was informed of these concerns. Similar concerns were made at the last inspection and also by a relative who made a complaint in July 2007. We inspected staff records and there was no evidence that the concerns had been addressed. The director said that there were sufficient skilled staff on duty to meet people’s needs by day and night. She said there had been some recruitment problems in recent months but these were now being addressed. No agency staff were employed to cover vacant posts. Feedback received from health professionals and relatives identified the need for more staff to be on duty, particularly at weekends and for staff to have more knowledge of mental health matters. At the commencement of the inspection the staff rota showed that there were four care staff on duty from 8am to 2pm, three from 2pm until 8pm, and one waking and one sleeping-in staff at night time. There were 22 people resident in the home several of whom had dementia and physical disabilities. Wells Court DS0000003852.V344520.R01.S.doc Version 5.2 Page 21 There were several staff changes during November 2007, including the resignation of 4 care staff and the acting manager. At the inspection on 5th December 2007, we found three new night care staff on duty that had begun working at the home on that night. No existing staff member had been present in the home to supervise or assist them between the hours of 10pm and 7am. Two of the staff were aged 18 years and had not been employed in providing care previously. Recruitment procedures to safeguard people living in the home had not been followed in respect of the three staff. Pre-employment procedures had not been followed, including obtaining 2 written references, checks of the Protection of Vulnerable Adults register, or Criminal Records Bureau disclosures. The staff had not received a supervised induction. A further sample of staff records were inspected and showed that recruitment procedures and checks had not been adhered to in respect of the acting manager and four cleaners contracted from a cleaning agency. There were no records or identification kept in the home regarding any of these people. The director said that there were only two contracted cleaners working in the home, but it was confirmed that two new contracted cleaners had also been working there. Criminal records bureau disclosure applications are processed centrally. The manager is notified when enquiries are complete and the serial number is then recorded on the front cover of the staff file kept in the home. A copy of the disclosure is not kept in the home. A subsequent inspection of recruitment records did not show when Criminal Records Bureau checks had been applied for and received. The director said that staff are encouraged to undertake training and staff confirmed they value the opportunities available. Less than 40 of care staff currently holds the National Vocational Qualification in Care at Level 2 or above. Two people have recently commenced the training. The Court Group training officer provides mandatory training in safe working practices at the home. The training plan seen was out of date and did not provide an accurate record of the training that had taken place. There was limited evidence of induction training provided for new staff. Wells Court DS0000003852.V344520.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People living at Wells Court cannot be confident that the management will ensure that their health, welfare and safety will be consistently promoted and protected. EVIDENCE: The home does not currently have a registered manager. The former registered manager resigned in October 2007 and a new manager was appointed but resigned. The Commission was informed that the area manager and a director of Wells Court Ltd are managing the home in the interim until a new manager is recruited. The changes in registered manager and care staff have had an unsettling effect on people living in the home and staff. Feedback received from visiting Wells Court DS0000003852.V344520.R01.S.doc Version 5.2 Page 23 professionals and relatives indicated that the staff team needed more support from the registered providers. The home was lacking in clear leadership. Staff had not received regular individual supervision for many months. The home has an annual quality survey, which is due to take place early in 2008. The Annual Quality Assurance Assessment produced for CSCI states that monthly audits are carried out in the home. However, these were not available in the home during the inspection, nor when we requested copies from the director who carrries out the visits on behalf of the responsible individual. We observed that care records for people living in the home were not stored securely. They are usually kept in the manager’s office, but not in a locked cabinet. On the third day of the inspection the office had been moved temporarily into the dining room while the manager’s office was being renovated. The care records were seen in an openly accessible trolley. Records were kept of incoming and outgoing payments of any money held in safekeeping for people living in the home. We inspected a sample of the records, which were in order. The amount of monies held is limited. People living in the home or their representative manage their financial affairs. The lack of attention to routine maintenance and safety matters were identified in the Environment section of this report. Potential risks to fire safety were seen on the first day of the inspection and had not been addressed on the return visit 10 days later. Two fire doors to bedrooms were seen wedged open on two days of the inspection. The management was advised that an approved hold-open device must be fitted if the person occupying the room wished to have their door held open. The slow closing mechanism on another door was broken, leaving the door ajar. Several storage areas labelled “fire door keep locked” were unlocked and were situated where they were accessible to people living in the home. These included the cupboard containing electrical fuse boxes and various tools, and the boiler room leading off the laundry. Devon Fire and rescue service were informed of our concerns. We inspected accident records and saw that these were not always completed fully and cross- referenced with the person’s care records. The Commission had not been informed of a serious incident when an accident had resulted in the person requiring hospital treatment. Wells Court DS0000003852.V344520.R01.S.doc Version 5.2 Page 24 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 x 18 2 1 x x x x x x 2 STAFFING Standard No Score 27 1 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 2 1 1 Wells Court DS0000003852.V344520.R01.S.doc Version 5.2 Page 25 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 OP1 Regulation 6(a)(b) Requirement The statement of purpose and service user guide must be reviewed to show the ownership and management structure of Wells Court Ltd and contain clear information regarding the complaints procedure Prospective residents must have a comprehensive assessment of their care needs, which is recorded, to ensure the care staff are aware and have planned for their needs prior to their admission to the home. Each person living in the home must have a plan of care that accurately reflects their care needs and that identifies the action required by staff to meet those needs. The plan of care must be reviewed a minimum of monthly and updated when the person’s needs change. This will ensure that a person’s changing needs are assessed and met. Previous timescale of 30/04/07 not met DS0000003852.V344520.R01.S.doc Timescale for action 29/03/08 2 OP3 14(1) a 29/02/08 3 OP7 15(1) 15(2) b, c 29/03/08 Wells Court Version 5.2 Page 26 4 OP9 13(2) 5 OP9 13(2) 6 OP16 22(8) 7 OP24 16(2) c 8 OP19 23(2) c 9 10 OP19 OP19 23(2) a 23(20) a 11 OP27 18(1)(a) Arrangements must be made for the storage of all medicines within the appropriate temperature range as specified by their manufacturers. Arrangements must be made to record the date of supply and quantity supplied of medicines given to people in the home. All complaints must be recorded and include details of the action taken and response to the complainant. This is to ensure that people have confidence that their complaints will be addressed. People must be provided with equipment necessary for their needs including pressure relieving aids and suitable bedding. The slow- closing mechanism on the bedroom door identified must be repaired to prevent a risk to the occupant’s safety. The laundry floor must be repaired to prevent a trip hazard. The sink in the medicationtreatment room must be repaired to prevent the spread of infection The number of staff on duty must be reviewed to ensure that there are always sufficient skilled and experienced staff available to ensure that people’s needs are met in a safe and unhurried manner. 29/02/08 29/02/08 29/01/08 29/01/08 10/11/07 29/01/08 29/01/08 29/02/08 12 OP29 19(1), Schedule 2 25/01/08 You are required to carry out appropriate checks prior to staff starting working at the home namely: 1.Evidence that CRB checks have been applied for in respect of all staff working at the home and that evidence is DS0000003852.V344520.R01.S.doc Version 5.2 Page 27 Wells Court available for inspection to confirm that these have been applied for. 2.Any staff working at the home who do have CRB checks applied for by the provider for the home, at the time of employment have POVA 1st checks prior to commencement of employment 3.For Staff who are employed on the basis of the POVA 1st check prior to receipt of CRB check a clear system in place to ensure appropriate supervision and evidence be available for inspection of this. 4.All staff have two written references obtained prior to the commencement of employment and that evidence is available for inspection to confirm that these have been obtained. Statutory requirement notice issued 14/01/08. 13 OP37 17(1) b Confidential information regarding people living in the home must be stored securely at all times The responsible individual must ensure that a report is made of the monthly monitoring visit to the home and a copy kept in the home and a copy sent to CSCI. The Registered Provider must ensure that design solutions are in place to restrict water temperatures to hot water outlets accessible to people living in the home to prevent the risk of scalds The registered provider must ensure that CSCI are notified of DS0000003852.V344520.R01.S.doc 29/01/08 14 OP37 26(5) a,b, 29/01/08 15 OP25 13(4) a 29/02/08 16 OP38 37 (1) c 29/01/08 Wells Court Version 5.2 Page 28 any serious injury to a person living in the home 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 OP12 Good Practice Recommendations People should have more opportunities for stimulation available through leisure activities, which are linked to their needs, interests and capacities. A clear system should be introduced to record maintenance tasks to be addressed and their completion. Signage should be improved assist people’s orientation within the building A staff training plan should be produced and kept up to date to show training planned and undertaken by all staff The management should risk assess people’s safety in gaining access to and using the garden, and review the security arrangements when people enter and leave the premises. 2 3 4 5 OP19 OP22 OP30 OP19 Wells Court DS0000003852.V344520.R01.S.doc Version 5.2 Page 29 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. 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