Inspection on 14/11/06 for York House

This inspection was carried out on 14th November 2006.

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

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

Other inspections for this house

York House 02/03/10

York House 20/01/10

York House 01/12/08

York House 21/08/07

York House 31/01/06

York House 04/07/05

York House 01/02/05

York House 26/08/04

York House 30/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE York House 8-10 Cauldon Avenue Swanage Dorset BH19 1PQ Lead Inspector Val Hope Key Unannounced Inspection 14th November 2006 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 York House DS0000026895.V318708.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. York House DS0000026895.V318708.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service York House Address 8-10 Cauldon Avenue Swanage Dorset BH19 1PQ 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) 01929 425588 01929 426572 Mr Richard Graham Wylie Mrs Maxine Valerie Toni Jacqueline Wylie Mrs Margaret Street Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places York House DS0000026895.V318708.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st January 2006 Brief Description of the Service: York House is a large, older style, detached property that overlooks a recreational/garden area and is close to the seafront. The home is about one mile from Swanage town centre and the amenities therein, which include a G.P surgery, community hospital, High Street shops and banks, a post office and places of worship. Accommodation is provided over three floors, all of which are serviced by a passenger lift. All communal lounges and dining areas are on the ground floor, along with the kitchen and managers office. There are 30 bedrooms in the home, of which 20 have en suite toilet facilities. Two rooms are currently registered for use as shared rooms. A maximum of 34 service users can be accommodated in the category OP (older persons). Mr and Mrs Wylie, registered providers, have owned York House since 1988. The home has a registered manager, Mrs Street, who is supported by the Deputy Manager, Mrs Dyke and Assistant Manager, Mrs Parham. Information relating to weekly fees was provided by Mrs Street on 11/12/06; these range from £304 to £495. Fees include all care and accommodation costs, including meals, laundry and activities. Additional charges are made for hairdressing and chiropody. People are expected to pay for their own personal items such as private telephone, toiletries and newspapers. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk. York House DS0000026895.V318708.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for Service Users and their views and experiences of the service provided. This unannounced inspection was conducted by the Commission as part of its regulatory duty to inspect all care homes. The purpose of the inspection was to assess the home’s compliance with all the key National Minimum Standards for Older People and to review the requirements and recommendations outstanding from previous inspections. The inspection was conducted over three days by Val Hope [Regulation Inspector] on 14th November and 11th December and Christine Main [Pharmacist Inspector] on 29th November 2006. This inspection took a total of 12.5 hours and included:• A review of the Commissions records; • The premises were inspected including communal areas and most of the bedrooms; • Sampling/examination of a range of the home’s records; • Observing practice and general routines in the home; • Talking with 11 residents and 3 members of staff; • Reading, collation and analysis of 15 surveys and comment cards [3 Care Manager and Health Professionals, 6 relatives/representatives and 6 service users]. What the service does well: York House provides a warm, homely environment for residents. Staff are held in high regard by residents who appreciate the kind, cheerful and professional manner in which they undertake their duties. A good working relationship has been established with the local GP Surgery and primary care team and residents have access to any health care resources that they might need. All staff who administer medication have received formal training. Recent improvements to the home’s activities programme, is meeting with residents approval. There is good contact with the local community and residents are encouraged to remain active, independent and retain control over their own lives. Bedrooms were well personalised with residents own belongings. Meal times are clearly a social event and all the residents spoken with said that they enjoy York House DS0000026895.V318708.R01.S.doc Version 5.2 Page 6 their meals, that their likes and dislikes are well known and that they are satisfied with the food provided. Staff have received in house training on adult protection issues. Staff informed the inspector that they felt well supported by the management and that they could approach any one of the management team for advice and guidance. What has improved since the last inspection? What they could do better: The home should confirm in writing to prospective residents that as a result of the needs assessment the home is able to meet their care needs. Written confirmation of verbally agreed fees could be provided prior to admission. More detailed information should be included in care plans and risk assessments to better inform staff as to how care needs are to be comprehensively and safely met. More regular case notes would provide a better working history of residents overall health and well-being. Accident reporting/recording needs improvement. There was concern about medicines being given on 29th November without recording them on the Medicine Administration Record (MAR) charts and the pharmacist inspector emphasised the importance of staff recording the administration of each resident’s medicines at the time they are taken so that they are not put at risk of their medicines being given twice. Improvement is also needed to ensure that a new resident’s medication is correctly recorded so that their healthcare needs are met. The home’s medicines policy needs further updating so that staff have clear procedures to follow for all aspects of the handling and administration of medicines. The home should give confidence and afford residents respect by taking their complaints seriously by implementing the home’s stated procedures and taking action to rectify the situation. Amendments made in draft to the home’s adult protection policy/procedure as a result of the last inspection should be made final and the updated version made available to staff. York House DS0000026895.V318708.R01.S.doc Version 5.2 Page 7 Redecoration and re-carpeting of communal hallways and stairways would improve the overall presentation of the home. The first floor assisted bathroom needs re decorating and fitting with new non- slip hygienic floor covering. The rear of the home must be cleared of unsightly builders equipment/waste and level access to the rear garden re instated. The programme of fitting radiator guards should be completed and unprotected hot water pipes on stairways should be boxed in. Action to reduce the potential for infection and the spread of infection should be taken. Recruitment practices must be more robust to ensure protection for residents. Staffing levels must be subject to regular review taking into account the geography of the building, the assessed care needs of residents and busy times of the day; reviews should be documented. Individual staff supervision should be undertaken consistently. The registered manager must achieve a qualification in the management of care that is recognised as being equivalent to NVQ level 4 by 30/9/07. She must undertake periodic training in care-related topics in order to evidence that her practice is in keeping with developments in this field. The registered provider must compile a report on the conduct of the home each month and send a copy to the Commission. A formal quality assurance system must be implemented; this should result in the production of an annual development plan for the home. The commission must be notified of deaths at the home. All staff must receive fire training at the required intervals and the home must review the Fire Risk Assessment as specified by Dorset Fire and Rescue Service. Management and administrative systems in the home are poor resulting in poor record keeping and the inability to demonstrate the home meets all National Minimum Standards. 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. York House DS0000026895.V318708.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 York House DS0000026895.V318708.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): 2, 3 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prior to admission, the needs of prospective residents are assessed however they do not receive written confirmation that the home is able to meet their assessed needs. Standard 6: York House does not provide intermediate care. EVIDENCE: A sample of four residents records were examined. There was evidence that assessments of need are undertaken prior to admission into the home. However, prospective residents are not advised in writing that the home is able to meet their care needs. Terms and Conditions of Care Agreements were in place and the manager explained that the home’s fees were given verbally prior to admission. However one comment from a relative indicated that fees were not clearly explained or made clear so it is recommended that when the York House DS0000026895.V318708.R01.S.doc Version 5.2 Page 10 home offers the placement in writing to the prospective resident or their representative the fee quoted verbally is also confirmed in writing and a copy of the terms and conditions enclosed. York House DS0000026895.V318708.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 and 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans and risk assessments need to provide more detailed instruction to staff and be subject to regular monthly review to ensure all residents care needs are satisfactorily and safely met. In most respects service users’ care needs, health, privacy and dignity are promoted and protected but there are a few aspects of poor practice which compromise the well-being of service users. The quality of the outcome for medication was adequate. Records and the audit trails indicated that most medicines were given as prescribed. The medication policy and some procedures for recording and administering medicines need improving to protect residents and ensure that their healthcare needs are met. York House DS0000026895.V318708.R01.S.doc Version 5.2 Page 12 EVIDENCE: Each resident has a care plan developed by staff in consultation with the person in question formed upon the basis of the pre admission assessment. Care plan information is recorded within two pre printed books. One is kept in a filing cabinet in the office, which is not always freely available to care staff. The other which contains record sheets for daily notes and GP/District Nurse/ other health professionals’ is available to staff at all times. However, these are not in use as designed because information is combined and held within one record sheet. The overall content of care plans viewed was poor and would benefit from expansion to contain more detailed instruction to staff as to how identified care needs are to be met by staff. For example care plans viewed failed to relate to specific health care needs i.e. Diabetes, Parkinson’s Disease; nor did they record how general health needs are to be met i.e. oral health and personal care. Risk assessments were not conducted in relation to some health needs e.g. manual handling, Diabetes. Daily case notes had not been consistently completed for example for one resident there was no entry between 22/10/06 and 3/11/06. During this period the resident had had an accident and there was no record of this anywhere on his/her file. Accident recording was of a poor standard; the record/log of accidents had not been completed and used as designed, individual record sheets had not been detached and placed in the individuals file. Additionally, the accident log was not fully completed, failing to record the date and whether the accident happened to a resident, member of staff, visitor or other. On a number of accident forms the actual time that accidents occurred were unclear i.e. 6.20; there was no indication as to whether it was am or pm and it was unclear whether the person recording the accident had actually witnessed it or simply completed the record. The home enjoys good support from the local GP surgery and primary care team. Some residents go to the surgery for GP appointments; in most cases however home visits are made. The GPs conduct regular reviews of service users’ medication. Where nursing input necessary, it is provided by Community Nurses. Members of staff assist residents to attend hospital appointments if relatives are not able to do so. In discussion with the inspector residents confirmed that the home called their GP on their behalf where necessary. Residents have access to any health care resources that they might need, including hearing and sight tests and dental treatment. York House DS0000026895.V318708.R01.S.doc Version 5.2 Page 13 On 29th November the pharmacist inspector checked five residents’ medicines with the records to see if they were given as prescribed and recorded correctly and spoke with the deputy manager and a resident who was self-medicating. When the pharmacist inspector arrived the MAR charts were not signed to record that the morning medicines had been given but the doses were missing from the blister packs. The carer who had given medicines said that this was not usual practice but due to a training session and a particularly busy morning. This also happened for other reasons on the pharmacist’s previous visit so the importance of signing the MAR chart straight after each resident has taken their medicines was stressed. Five residents records were checked with the medicines in stock to see if they were given as prescribed and accurately recorded. The directions and records for 2 medicine tablets were unclear but the quantity remaining indicated that they were given correctly. The balance of other medicines checked confirmed the records indicating that they were given as prescribed. Medicine allergies were recorded on the MAR chart and a second member of staff had countersigned to indicate that handwritten entries were checked. Records of disposal of medicines were incomplete and the quantities of some new medicines received were not recorded to provide a full audit trail. When a choice of dose was prescribed staff did not consistently record the actual dose taken. Procedures for handling medication when one resident first came to the home were checked. The quantities of medicines received were not recorded. There was written confirmation of their medication but one medicine was not recorded on the MAR chart and there was no evidence that this had been given. The GP was contacted straight away to resolve the problem. Although there was a slight lack of clarity in the information provided to the home, staff must take greater care to ensure that medication is correctly recorded at this stage, and follow up promptly anything that is unclear. The pharmacist inspector was told that staff who give medicines have done a medication course and 4 certificates were seen but there were no assessments of competence. The home had reference books on medicines for staff to refer to. Medicines were stored in locked cupboards. Additional security was provided for Controlled Drugs (CDs) and the home keeps records of these medicines in a CD record book. The home’s medicines policy had been updated but further improvements were needed to provide guidance for staff on procedures to follow: when a resident returns from hospital; self-medication; some aspects of administration; in the event of a medication error; for returning medicines for disposal (see guidance provided). One resident who was self-medicating kept their medicines safely and there was a risk assessment on file. York House DS0000026895.V318708.R01.S.doc Version 5.2 Page 14 Residents said that care staff treat them with respect and make efforts to protect their dignity when undertaking personal care tasks. However, three residents said they felt it was disrespectful of the proprietors to use the garden of the home as a “builder’s yard” when they were paying fees to live on the premises and were unable to access the rear garden in the nicer weather [see standard 19] York House DS0000026895.V318708.R01.S.doc Version 5.2 Page 15 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): All the above were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home offers a varied programme of activities providing a stimulating environment for residents. The home encourages residents to pursue their interests and preferred lifestyle where feasible, enabling them to retain some measure of control over their lives. The home makes arrangements that enable residents to have their spiritual needs met. A varied diet is provided meals and are served hot and in sufficient quantity to achieve a satisfactory vote from residents. EVIDENCE: Views expressed to the inspector regarding the activities programme during the inspection were generally favourable although several residents commented that in recent months the frequency of social activities had declined somewhat. The manager said that in recent weeks a concerted effort had been made to increase the occurrence of social activities to a level acceptable to residents. Residents spoken to agreed that activities had been subject to recent improvement. During one afternoon during the inspection staff were observed playing skittles with residents in the lounge. Activities York House DS0000026895.V318708.R01.S.doc Version 5.2 Page 16 offered include board and card games, crafts, painting, quizzes, and on occasions a visiting entertainer. Some outings to places of local interest by minibus have taken place since the last inspection. Several residents pursue their own interests and make their own social arrangements. There is good contact with the local community, e.g. attendance at coffee mornings. Residents are encouraged to remain active and independent. Some take an interest in knitting and sewing. Residents informed the inspector that they felt free to come and go as they pleased. An interdenominational Holy Communion service is held each month and other contact with clergy is arranged on an individual basis, in accordance with residents’ wishes. Residents are encouraged to retain control over their own lives. All have a relative or other person who maintains contact and is in a position to assist or advise regarding financial matters. Residents are able to personalise their bedroom by bringing in items of furniture or other features of interest. Residents may access their personal records but information on this subject is not included in the written information that is provided to residents. Meal times are clearly a social event and all the residents spoken with said that they enjoy their meals, that their likes and dislikes are well known and that they are satisfied with the food provided. York House DS0000026895.V318708.R01.S.doc Version 5.2 Page 17 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. Residents cannot be assured that their complaints will be taken seriously and acted upon. The measures in place for responding to allegations of abuse do not entirely comply with guidance and therefore do not provide residents with full protection. EVIDENCE: The home has a complaints procedure, a copy of which is within the home’s service user guide. There were no complaints recorded since the last inspection however, from contact with residents during the visit it was apparent that several complaints had been made about the storage of building equipment/waste in the back garden of the home. Residents complaints had not been taken seriously as the home’s complaints process had not been implemented, no record had been made of these and no action to remove the equipment/waste had been taken. Although the home’s complaints procedure encourages residents to speak to a senior member of staff or the Manager through discussion and surveys it was clear some residents do not feel able or confident enough to complain. An example of comments received included: • “I don’t like to complain and I find it difficult. Because I am confused at times I can get my words in a muddle it takes a long time to get my confidence up”; York House DS0000026895.V318708.R01.S.doc Version 5.2 Page 18 • • “There is no point nothing gets done”; “I complained and no one took any notice”. [see also standards 10 & 19] It was identified at the last inspection that the home has policies/procedures relating to adult protection (prevention of abuse) and “whistle blowing” and a copy of the “No Secrets” guidance from Dorset County Council, all of which documents are available for staff to read. The adult protection policy/procedure was in need of some amendment to ensure that the advice accords with locally agreed procedures. Mrs Street advised that the amendment is still in draft and has not been printed yet or staff advised of the correct information therefore the requirement is repeated. Staff have received in-house training on this topic and a record of such training had been retained. York House DS0000026895.V318708.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 25 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The accommodation is maintained in a reasonably good condition. The rooms and areas that are accessed by service users are warm, clean and odour-free, providing a comfortable environment for service users. Storage of unsightly builders equipment/waste denies residents of level access to the rear garden. Some improvements would reduce the risk of infection and the spread of infection for the benefit of residents. EVIDENCE: The accommodation is being maintained in a reasonably good condition. Although there is no recorded plan for refurbishment/upgrading the manager said that there is an on-going programme that has included the redecoration of the outside of the building and the refurbishment of bedrooms as they become York House DS0000026895.V318708.R01.S.doc Version 5.2 Page 20 vacant. It is recommended that a programme of routine maintenance and renewal of the fabric and decoration of the premises is produced and implemented with records kept. The décor in bedrooms is of a good standard throughout, with 5 rooms having been refurbished and 6 armchairs recovered since the last inspection. Furnishings are of a good standard, comfortable and clean providing a good homely effect. The décor and carpeting in communal hallways and stairways are in a ‘tired’ worn looking condition with a substantial amount of chipped and scratched paintwork. This was identified at the last inspection during which the previous inspector was advised that this was to be addressed during this current year; to date this has not been achieved. The manager said that it is intended that these areas be decorated but was unable to evidence that this work was planned with a start date arranged due to there being no programme of routine maintenance in place with supporting records. The carpet in the dining room is unsightly with large strips of silver repair tape in a number of places and frayed around doorframes, lowering the generally good overall appearance of the room. There are a sufficient number of wash and toilet facilities. The first floor assisted bathroom is in a very poor decorative condition; it is dark, dull and dank due to stained damp carpeting and is in need of new flooring and re decoration. There were large unsightly cracks in the wall at the end of the first floor corridor and a telephone wiring connection box was broken and wires were exposed. The exterior of the premises has been subject to some decoration improving the aesthetic exterior appearance of the building. The gardens are well kept, however, the rear garden of the property is not accessible to residents due to the large amount of building equipment stored there by the proprietor who owns and runs a business that involves building works. A number of residents expressed their displeasure at the view from their bedroom windows and not being able to get out into the rear garden during the better weather in summer. The driveway to garages in the rear garden area contained quantities of scaffolding, an old bath, an old cooker and a range of pipes and various other builders rubbish and equipment. Comments received included: • “I pay hundreds of pounds a week here to look out on to Steptoe’s yard! I have said about it but nothing has been done, no one listens and no one cares”, DS0000026895.V318708.R01.S.doc Version 5.2 Page 21 York House • • • “It is not a nice view from the window as the garden is used as a builders yard”, “It is no use complaining, it’s been there for months and months” “You cannot get into the back garden as the way is blocked by the rubbish”. The programme of fitting guards to radiators has continued and there are now guards in the majority bedrooms, including where particular service users are considered to be at high risk. Risk assessments are recorded in respect of each service user and his/her bedroom. The assessments do not take into consideration the location of unguarded radiators in corridors. There were pipes that were very hot to the touch on stairways between floors. In the event a resident uses these as a handrail, there is the potential for a fall down the stairs if they release their hand due to being very hot to the touch. These pipes must be made safe by boxing in. Infection control measures in the home need improvement. Shortfalls identified included: • Unsuitable floor covering in the first floor assisted bathroom; • The use of a fabric ‘fluffly’ toilet lid cover in a communal toilet; • Loose wall tiles and stained flooring in the en suite identified to the manager; • The raised toilet seat in communal ground floor toilet was cracked in several places and needs immediate replacement. The manager confirmed that staff have received training in infection control. York House DS0000026895.V318708.R01.S.doc Version 5.2 Page 22 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): All the above were assessed. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Poor recruitment practices potentially puts residents at risk. The home promotes the achievement of nationally recognised care qualifications and has built a staff team that enjoys the confidence of residents. Staffing levels need constant and regular review to ensure sufficient assistance is available to residents at all times. EVIDENCE: It is the perception of some residents and regular visitors to the home that the home is short staffed. Comments received verbally and through surveys ’included: In answer to the question, ‘Do you receive the care and support you need? • “They would always give me the support, but because they are short staffed, they do not always have the time to give me the support”; • “Help with toileting needed more”; • “I feel that the staff could be a bit more visible and perhaps do more chatting with residents although I know this is difficult to do together with the regular jobs which have to be done”; • The staff are delightfully willing and very good but not enough of them”; Others ticked boxes indicating ‘usually’ or ‘sometimes’ in answer to this question. York House DS0000026895.V318708.R01.S.doc Version 5.2 Page 23 In answer to the question ‘Are staff available when you need them?’ • “As a visitor I do wonder sometimes how long the residents are left alone in the lounge especially at the staff break times. I feel that some of them would not be able to get to a bell if an emergency happened or even a trip to the toilet needed it would be better if breaks were staggered”; • “The staff are always willing to do their best you have to wait your turn because they are busy”; Others ticked boxes indicating ‘usually’ or ‘sometimes’ in answer to this question. Overall, staff received a high standard of praise from residents for how they undertake their duties in a kind, cheerful and professional manner Verbal comments included: • “Staff are lovely although they are very busy and you do have to wait quite a while sometimes”; • “Sometimes it seems there are few about and you don’t want to bother them unless you have to”; • “The staff work very hard and they seem so busy all the time, there is no time to talk”; • “The staff are lovely and they work very hard”; • “Staff are wonderful, they want everything to be just right for you”. During discussion with Mrs Street she confirmed that it is practice that staff try to be around the lounges and hall when people enter the home and that staff tea and coffee breaks are staggered. There is a staff rota in place. The management team consists of the registered manager Mrs Street, a deputy manager and an assistant manager. There are 16 social care workers employed in addition to ancillary staff. Night staffing arrangements are 9:30pm to 7:30am 2 carers awake and 1 sleeping in on-call. From 7:30am to 2pm there are 3 carers; from 2pm to 3:30pm there are 2 carers and from 3:30pm to 9:30pm there are 3 carers. Domestic cover is provided for 54 hours per week over 6 days. There is one kitchen assistant 8am-2pm and cook 8am-3pm for 5 days per week and a cook Saturday and Sunday 8am – 2pm. Given the size and geography of the building and the comments received, it is recommended that regular reviews of staffing levels are undertaken (and documented) taking into account the specific care needs of those accommodated and particularly busy times of the day. The manager stated that 50 of care staff have achieved National Vocational Qualification Level 2 in Care, meeting minimum standards. There is a training York House DS0000026895.V318708.R01.S.doc Version 5.2 Page 24 programme in place which the manager is working through to ensure all staff receive formal training. The manager was able to demonstrate that the home has in place the documentation to record induction training that meets National Training Organisation Standards. However the record of induction training was somewhat haphazard as some aspects of induction was recorded in other pre printed booklets and there appeared to be no organisation of a timetable for ensuring delivery of induction topics, specifically matters which should be addressed on day one of employment i.e. fire training. A sample of two staff files were examined. Shortfalls in recruitment practice were identified. Although two written references had been obtained the home was unable to evidence that they had been received prior to commencement of work. POVA First/Criminal Records Bureau Disclosures had not been obtained prior to the commencement of work for two recently recruited social care workers and the start date of one care worker had not been recorded in the records. York House DS0000026895.V318708.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 & 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. No one in a senior role in this home has completed management training or achieved any up to date formal management qualifications to National Vocational Qualification Level 4 in Management and Care [or equivalent], potentially undermining the confidence of potential clients, residents and relatives in the home’s ability to ensure delivery of up to date best care practice methods. The lack of a formal quality assurance system limits the extent to which the home is able to demonstrate how it meets the expectations of residents and achieves its stated aims and objectives. The home has the necessary arrangements in place to safeguard residents’ finances. A few shortfalls with the health and safety provision at the home mean that residents’ welfare is not fully safeguarded. York House DS0000026895.V318708.R01.S.doc Version 5.2 Page 26 Management practices were poor in relation to poor risk assessment processes, recruitment and selection, record keeping, development and supervision of staff potentially placing residents at risk through lack of protection and poor administration and administrative systems. EVIDENCE: The manager has many years practical experience and has the support of residents and staff; her lack of formal qualifications limits her ability to evidence attainment of managerial skills in a care setting. The manager has a job description that reflects her level of responsibility. She shares the day-today management duties with the deputy and assistant managers. The management structure is explained in the home’s statement of purpose. The manager and her colleagues are considered by staff to be “approachable” and to provide good leadership. There are no formal staff meetings but it appears that there is good communication between staff members who work well as a team. A comprehensive formal quality assurance system has still not been fully implemented and carried through to completion. Informally, the management discusses issues with relatives, staff and visiting professionals but at present the results of this have not been recorded. However, views expressed to the inspector from a variety of sources indicated that overall, there is a good level of contentment with the home. The home does not act in any formal capacity on behalf of residents who look after their own affairs or have a representative to assist them. Cash is held in a secure place for a small number of residents. Records are kept of all transactions and receipts are retained, where appropriate. Residents are provided with a lockable facility in their room for the safe keeping of valuables. Staff informed the inspector that they felt well supported by the management and that they could approach any one of the management team for advice and guidance. Staff have not consistently received one-to-one supervision. Shortfalls were identified in:• • • • • • • Care records, accident records and risk assessments [standard 7]; Management of medication [standard 9] Complaints records [standard 16]; Identification and reduction of risk to residents from hot pipes on stairways [standard 25]. Infection control measures [standard 26]; Recruitment and selection [standard 29]; Staff records – no start date recorded [standard 29]; DS0000026895.V318708.R01.S.doc Version 5.2 Page 27 York House • • • Failure to notify the commission of events i.e. deaths [standard 37]; Failure to produce regular reports upon the conduct of the home [standard 37]; Fire drill records and fire training [standard 38]; On both 14th November and 11th December staff were unclear about the number of residents accommodated; on the 14th November the register the home keeps and the list in the office did not tally and on the 11th December the manager had just returned from holiday and the list had been removed from the premises for ‘updating’. On the 12th December the inspector ascertained that there were 23 residents accommodated. There is very little administrative support or equipment available to the manager, the home has no photocopier and no IT [Information Technology] support [computer] is available to enable staff to access up to date best practice guidance relating to the management and delivery of care in care home settings and to assist with general record keeping. This has contributed to the poor standard of record keeping within the home. The commission has not been notified of incidents of death or certain events as required. It is also a requirement that the registered provider produces a report on the conduct of the home each month giving a copy to the registered manager and making this available to the Commission for inspection. The most recent report was dated January 2005. Routine tests of the fire warning and emergency lighting systems had been undertaken and recorded. Fire drills had been undertaken, however the record of fire drills should detail the scenario of the fire. Examination of fire training records found that not all care workers had received fire training at the required six monthly intervals the records of one care worker demonstrated that fire training had been undertaken on 15/11/05 and 10/6/06. A Dorset Fire and Rescue Service inspection on 4th January 2006 required that the home’s fire risk assessment “be reviewed in the near future” there was no evidence that this review had taken place. York House DS0000026895.V318708.R01.S.doc Version 5.2 Page 28 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 x 3 2 x X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 2 1 2 2 x x x 2 2 STAFFING Standard No Score 27 3 28 3 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 2 x 3 2 1 1 York House DS0000026895.V318708.R01.S.doc Version 5.2 Page 29 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 OP3 Regulation 14[1][d] Requirement Timescale for action 14/12/06 2 OP7 13(4) The registered person shall confirm in writing to the resident that having regard to the assessment the care home is suitable for the purpose of meeting the residents needs in respect of his health and welfare. The registered person shall 31/01/07 ensure that unnecessary risks to the health or safety of residents are identified and so far as possible eliminated. [A risk assessment regarding the prevention of falls must be drawn up either prior to the admission of a new service user or as soon as practicable following admission. The assessment must be reviewed in the light of subsequent incidents or accidents]. 3 OP7 13[4] Not met from 31/1/06 The registered person shall ensure that unnecessary risks to the health or safety of residents are identified and so far as possible eliminated. [Individual manual handling risk assessments must be 14/11/06 York House DS0000026895.V318708.R01.S.doc Version 5.2 Page 30 4 OP7 15 undertaken whenever manual handling operations are practiced]. The registered persons shall after consultation with the service user, or a representative of his/hers prepare a written plan as to how the service users needs in respect of health and welfare are to be met. a. Care plans must specify how, when, by whom and with what equipment (if any) care needs are to be met; b. Care plans should be subject to regular monthly review. 27/02/07 5 OP7 15 The registered persons shall after consultation with the service user, or a representative of his/hers prepare a written plan as to how the service users needs in respect of health and welfare are to be met. 27/02/07 6 OP9 13[2] [Specific care plans relevant to health care needs (ie Diabetes, Parkinson’s Disease) with associated risk assessments, relating to identified individuals, must be developed and the residents district/diabetes/ specialist nurse should be consulted about the content]. The registered person shall make 14/11/06 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received in the care home including: a) Recording the administration of medicines at the time they are given and the dose if a choice is DS0000026895.V318708.R01.S.doc Version 5.2 Page 31 York House prescribed. b) Recording the quantity of all medicines received in and leaving the home and those supplied to residents who self-medicated so that all medicines can be accounted for. c) Updating the medicine policy so that there are clear procedures for staff to follow (see guidance provided). 7 OP16 22[3] The registered person shall ensure that any complaint made under the complaints procedure is fully investigated. The registered person shall ensure that unnecessary risks to the health or safety of residents are identified and so far as possible eliminated. [Where radiators are not covered nor have low temperature surfaces, risk assessments must be in place to demonstrate that they reflect the needs and capabilities of current service users and that they are regularly reviewed]. This requirement has been mainly met; previous timescales not met, most recently 4/9/05 and 28/02/06. The registered person shall ensure that unnecessary risks to the health or safety of residents are identified and so far as possible eliminated. Action: Hot pipes along side stairs must be boxed in. 14/11/06 8 OP25 13[4][a] 31/03/07 9 OP25 13 [4][c] 27/02/07 York House DS0000026895.V318708.R01.S.doc Version 5.2 Page 32 10 OP26 13[3] The registered person shall make 31/03/07 suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. Action required:• Replacement of unsuitable floor covering in the first floor assisted bathroom; • Removal of the fabric ‘fluffly’ toilet lid cover in a communal toilet; [with immediate effect] Re-fixing loose wall tiles and replacing stained flooring in the en suite identified to the manager; [by 27/02/07] The cracked raised toilet seat in the communal ground floor toilet must be replaced. [with immediate effect]. 14/11/06 • • 11 OP29 19 Schedule 2 The registered person shall not employ a person to work at the care home unless the person is fit to work at the care home. Action: A] Satisfactory POVAFirst checks and Criminal Records Bureau Enhanced Disclosure Certificates must be received prior to commencement of work; B] The home must be able to evidence that two satisfactory references have been received prior to commencement of work. The registered person shall ensure that staff receive training appropriate to the work they are to perform including structured DS0000026895.V318708.R01.S.doc 12 OP30 18[1] 31/03/07 York House Version 5.2 Page 33 induction training . [There must be documented evidence of the induction programme provided to new staff members (in accordance with National Training Organisation specifications). For new staff who do not hold a care qualification such as NVQ level 2, similar documentary evidence must be in place regarding the foundation programme which should be completed within six months of commencing employment.] 13 OP30 18[1] Not met from 31/1/06. The registered persons shall ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. 31/01/07 14 15 OP30 OP30 13(4) 16(2) 13[4] [This relates to the requirement for a programme of induction training to commence on day one of employment to include fire training]. The registered person shall make 30/06/07 suitable arrangements for the training of staff in first aid. The registered person shall 30/06/07 ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. [The relates to the requirement for all staff who handle food to receive basic food hygiene training]. The registered persons shall ensure that the registered manager shall undertake from DS0000026895.V318708.R01.S.doc 16 OP31 9(2) 30/09/07 York House Version 5.2 Page 34 time to time such training as is appropriate to ensure that he/she has the experience and skills necessary for managing the care home. [Mrs Street must attain the National Vocational Qualification (NVQ) level 4, or equivalent, in the management of care by 30/6/08]. The registered provider must compile a report on the conduct of the home each month; copies must be available for inspection and a copy provided to the registered manager. Not met from 31/1/06. The registered person shall give notice to the Commission without delay of occurrences specified by regulation 37. [This relates to the failure of the home to notify the commission of deaths]. Where the registered provider is an individual, but not in day to day charge of the care home he shall visit the care home in accordance with this regulation [on a monthly basis]. Action: The person carrying out he visit shall prepare a written report on the conduct of the care home. The registered person shall comply with the requirements of the Fire Authority and comply with Regulatory Reform (Fire Safety) Order 2005 and review the home’s Fire Risk Assessment There registered person shall make arrangements for persons working at the care home to receive suitable training in fire DS0000026895.V318708.R01.S.doc 17 OP31 26 28/02/07 18 OP37 37 14/11/06 19 OP37 26[4] 31/01/07 20 OP38 23[4] 31/01/07 21 OP38 23[4][d] 31/01/07 York House Version 5.2 Page 35 prevention. Action: All care workers must receive fire training at six monthly intervals. 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 OP2 Good Practice Recommendations When confirming in writing that as a result of the assessment the home is able to meet the prospective residents needs the home also provides a copy of the Terms & Conditions of Care Agreement with written details of the fee to be charged to that individual. Regular monitoring of service users’ weight should take place in accordance with service users’ wishes and the findings of the nutritional assessment. In the event of a service user not wishing to be weighed or the home not having the facility to weigh a service user appropriately, the matter should be kept under review via risk assessment. Not met from 31/01/06. It is recommended that:a) Staff who give medicines should have an assessment of competence on file. b) Care plans should include relevant information related to residents’ medication and their agreement to staff administering it where this is their choice, or necessary for their safety. Service users should be advised in writing that they may access their personal records within the terms of the Data Protection Act 1998. Such information could be contained in the service user guide, terms and conditions of residence, statement of purpose or other documentation. Not met from 31/01/06 The adult protection policy/procedure should be amended to inform staff not to commence an investigation until advice has been obtained from Social Care and Health. Contact details of both this body and the Commission should be included in the documentation. Staff should attend the training provided by Dorset County Council on the topic of adult protection. Not met from 31/01/06. DS0000026895.V318708.R01.S.doc Version 5.2 Page 36 2 OP8 3 OP9 4 OP14 5 OP18 York House 6 OP19 7 OP19 8 OP27 9 10 OP33 OP33 11 12 OP36 OP38 It is recommended that a programme of routine maintenance and renewal of the fabric and decoration of the premises is produced and implemented with records kept. It is recommended that large cracks in the wall at the end of the first floor corridor are filled and the decoration made good; the broken telephone junction box on the window should be replaced. It is recommended that regular reviews of staffing levels are undertaken (and evidenced/documented) taking into account the specific care needs of those accommodated and particularly busy times of the day. There should be an annual audit and development plan for the home, reflecting aims and outcomes for service users. The home’s policies/procedures should be reviewed at least annually to ensure that the information within them is up-to-date and reflects expected practice. Not met from 31/01/06 Care staff should receive one-to-one supervision on the basis of one session every two months. Not met from 31/01/06 The record of fire drills should detail the scenario of the location of the fire. York House DS0000026895.V318708.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 York House DS0000026895.V318708.R01.S.doc Version 5.2 Page 38 - 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. 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