Care Home: Askham Place

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What the care home does well There were no outstanding requirements from the last key inspection. The home was clean and in a good state of repair. On the day of the inspection the home was adequately staffed and the staff spoken to appeared knowledgeable. Care practices observed were of an acceptable standard. A social activity was provided before lunch and a few residents joined in. There was evidence of staff training taking place in the afternoon. We case tracked two people and saw good evidence that the home were meeting peoples health care needs and involving other health care professionals to ensure their needs were met. What the care home could do better: The care plans seen contained little personal information and focused on health care needs. Information is not updated when a person`s needs had changed. Lots of the information is not dated so it is difficult to establish what is current information. Risk assessments were extremely poor and we did not see any evidence that staff had received any specific training in this area. The risk assessment did not identify specific risks to that person or actions to be taken by staff to reduce the risk. A score had been reached to the like hood and severity of risk with no explanation to how the score was arrived at or justifying comments. The nutritional assessments did not justify the score arrived at. We observed one person sitting in their wheelchair on a sling. There was no justification for the person remaining on the sling in their care plan. During an observation of lunch a number of residents required assistance with feeding. Some staff chose to stand up to assist with this task which is unacceptable. Menu plans are kept, but not all staff fill in the records accurately or record what snacks are offered. Some staff were unaware that some residents were on fortified diets. The catering staff were aware of residents dietary needs. The home should review the nutritional content of snacks being provided and food recording should be more detail. We did not look at the homes complaints procedure, but were concerned that most residents would not be able to raise concerns without support. One person has an independent advocate. Complaints raised recently had not been recorded in the complaints book. Investigations had been carried out but all the identfied actions had not been followed up. The provider in response to the draft inpection report stated that she had investigated complaints and had forwarded on investigative notes and actions to the Care Quality Commission.) Staff were comfortable about raising concerns but stated the procedure would be to report it to a Senior who would decide whether to cascade the concern. Staff told us that there was a bullying culture in the home and poor practices are not always dealt with. The nurse in charge off the shift was taking a telephone call whilst administering medication. In discussion with the manager we learnt that the head of care carries a telephone with them whilst on shift. This should be reviewed. We did not complete a full audit of medication but noted on one persons file that medication had been administered because of concerns about their behaviour and we did not see if any other interventions, approaches had been tried. The home had a pharmacy inspection in the last week and a few recommendations had been made. Staff recruitment checks were in place but of the five files inspected , one was employed with only one reference and another person did not give a reference from their most recent employer. Staff had been employed without a criminal records check although the home had ensured that they had an ISA check which replaces the protection of vulnerable adult (POVA) checks. Supervision for staff was infrequent and we saw no evidence that staff had received appraisals in the last year. Staff induction was poor. We asked how staff were inducted and were told they are shadowed ideally for three days. In practice we looked at two newly appointed staff. One was for a trained nurse on nights.They were shadowed for one night but another trained nurse. There was no evidence of what was covered as part of their induction. We asked the manager if a review of their performance was completed after their probationary period and were told usually. For the other member of staff they had been shadowed for two days and we saw no evidence of induction other than a tick list induction record which covered basic things like fire escapes. We did not see any thing linked to the skills for care framework which covered key skills and competencies for staff. The provider must ensure there is a registered manager for the home. The provider has just employed a deputy manager who we were told will be working between Askham House and Askham Place but the manager was unsure how their hours would be utilized. The manager currently works a number of care shifts and has dedicated management time. She was concerned that her management time and her time off is compromised when they have difficulty covering their trained nurse shifts. This is covered in house whether possible and results in staff working long hours. We saw no evidence that the manager receives regular supervision or that her performance is reviewed and clear objectives are set. We asked if the provider completes monthly audits of the service as required by regulation 26 when the provider is not in day to day control. We were told no. Talking to the staff and the manager gave us the impression that the home is often short of staff, although this was not reflected by the current staffing rotas. Staff and management are working Random inspection report Care homes for adults (18-65 years) Name: Address: Askham Place Benwick Road Doddington Cambridgeshire PE15 0TG two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Shirley Christopher Date: 1 2 0 5 2 0 1 0 Information about the care home Name of care home: Address: Askham Place Benwick Road Doddington Cambridgeshire PE15 0TG 01354740269 01354741996 Telephone number: Fax number: Email address: Provider web address: www.askhamcarehomes.com Name of registered provider(s): Name of registered manager (if applicable) Askham Care Homes Limited Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 15 Number of places (if applicable): Under 65 Over 65 0 physical disability Conditions of registration: 15 The maximum number of service users who can be accommodated is: 15 The registered person may provide the following category of service only: Care Home with Nursing - Code N to service users of the following category: Either whose primary care needs on admission to the home are within the following categories: Physical disability - Code PD Date of last inspection Brief description of the care home Askham Place is a purpose built single storey home providing nursing and personal care for up to 15 service users aged between 18 and 65 with a physical disability. The home was first registered in September 2001, and is close to the small Cambridgeshire village of Doddington near March. The home is in the grounds of Askham House, a Care Homes for Adults (18-65 years) Page 2 of 13 Brief description of the care home service for older people under the same ownership as Askham Place and shares kitchen and laundry facilities. The home provides for up to 15 people under the age of 65 with a physical disability, and is currently full. Fees charged range between GBP975.91 and GBP1127.83 per week, depending on the assessed needs of the individuals. Copies of the most recent inspection reports are available on request from the administration office in the home, and in the reception area. Care Homes for Adults (18-65 years) Page 3 of 13 What we found: We, The Care Quality Commission carried out a random, unannounced inspection to Askham Place on the 12 May 2010. The home last had a key inspection on the 23 July 2008 and it was given two stars, a good rating. It had an annual service review last year on the 18 August 2009. Since the last key inspection the registered manager and the deputy manager have left. The home employed a temporary manager who told us they have been in post for approximately fifteen months. The provider told us they were going to submit a managers application shortly so we have not made a requirement about it. We carried out a random inspection because we have received three complaints about the home since December 2009. We asked the home to investigate the first two complaints within their own complaints procedure. We received satisfactory responses. We received a third complaint which we referred to the local safeguarding team and this was discussed in a multi-disciplinary meeting. Other concerns about the home were raised at this meeting. As part of this inspection we talked to the manager, administrator, kitchen staff and staff on duty. We spoke to a volunteer in the home. We case tracked two residents, observed care practices and medication administration. We did not complete a full audit of medication and may ask the specialist pharmacist who works on behalf of the Care Quality Commission to complete a separate audit. We looked at staffing records and rotas and talked to staff about their employment. We looked at the complaints folder and looked at information received from the last inspection. We looked at a number of standards relating to the management of the home. We looked at two care plans they required information updating. Assessment information was in a simple yes or no format, with very Little supplementary information. There was little social information, but the manager stated this was recorded separately. We would like to see it as part of the care plan. One care plan contained a detailed profile of the person but this was dated two years earlier. The persons needs had significantly changed due to the progression of their disease, but information had not been updated. The home did not have an adequate nutritional screening tool in place although there was good evidence that residents are regularly weighed and are seen by the dietitian and speech and language therapist. The nutritional assessments did not record an initial date and did not identify chewing or swallowing difficulties, although they had been referred to the speech and language clinic. The person was described as confused but there was no evidence of this. The nutritional assessment gave a nutritional score but we saw no evidence of how that score was arrived at, or how it would be reviewed. Problems and needs were poorly described. Menus were being filled in but staff were not routinely recording when they were offering snacks to residents and these were refused. The nutritional content of some of the snacks provided were poor and should be reviewed. Medication practices were acceptable. We observed the lunch time medication and it was administered safely. We looked at the complaints log which did not include any of the recent complaints or their subsequent investigation. Whilst raising a complaint with the home, the home made us aware of a complaint made to them by a resident. Staff named had been interviewed Care Homes for Adults (18-65 years) Page 4 of 13 but the local safeguarding team had not been notified. There have been two occasions where we have asked the home to report under safeguarding depending on the outcome of their investigation. The home had not done this but carried out investigations in to staff conduct which resulted in an action plan. We saw no evidence that the action plan had been completed. We were concerned that staff felt able to report concerns but said they would report them to the Senior who would decide whether to escalate concerns to the nurse in charge who would then decide if they should be reported to the manager. A recent staff meeting minuted a number of concerns about staff practices and the minutes stated that concerns would be deal with internally. There was no evidence that concerns raised about staff had been dealt with effectively. We spoke to staff on duty and were concerned that they raised issues about staffing practices and staff shortages. One member of staff said poor staffing practices are not dealt with effectively and are left to fester. Examples given were staff shouting at residents. We discussed this with the manager who said that staff would be offered training on communication skills. We looked at staffing rotas. Some staff were working extra hours, which included long days, 14 hour shifts throughout the week and on their days off. Other staff felt there was pressure on them to pick up extra shifts. There were a number of bank staff employed and the home use a variety of nursing agencies. Staff told us it was difficult to get agency staff and the expectation was that staff would cover the hours rather than use agency staff. Complaints we have received about the service refer to staff working long hours and subsequently becoming tired and shouting at residents. The manager felt it was up to staff if they want to work extra hours. The home have five staff in the morning and four in the afternoon, however realistically staff told us that sometimes they work with four staff in the morning and can work with two care staff in the afternoon and one nurse. They feel they cannot meet residents needs in a timely fashion. The manager is required to work management shifts and on the floor as the head of care. This was described as difficult. Staff files were acceptable and training records were in different files, but showed that most training was up to date. Poor induction records were seen for all staff. We saw no evidence that induction is linked to skills for care, or that staff are adequately supervised and shadowed so there competence can be tested. Supervision records were up to date for some staff. Appraisals were not up to date on the files we saw. We asked for agency staff records. One agency provide a pro forma for staff which gives details that all recruitment checks are completed fully. They do not give details of the staffs experience or training. The manager stated some agencies do not provide information about staff provided. The agency must not use these staff. What the care home does well: There were no outstanding requirements from the last key inspection. The home was clean and in a good state of repair. On the day of the inspection the home was adequately staffed and the staff spoken to appeared knowledgeable. Care practices observed were of an acceptable standard. A social activity was provided before lunch and a few residents joined in. There was evidence of staff training taking place in the afternoon. We case tracked two people and saw good evidence that the home were meeting peoples health care needs and involving other health care professionals to ensure their needs were met. Care Homes for Adults (18-65 years) Page 5 of 13 What they could do better: The care plans seen contained little personal information and focused on health care needs. Information is not updated when a persons needs had changed. Lots of the information is not dated so it is difficult to establish what is current information. Risk assessments were extremely poor and we did not see any evidence that staff had received any specific training in this area. The risk assessment did not identify specific risks to that person or actions to be taken by staff to reduce the risk. A score had been reached to the like hood and severity of risk with no explanation to how the score was arrived at or justifying comments. The nutritional assessments did not justify the score arrived at. We observed one person sitting in their wheelchair on a sling. There was no justification for the person remaining on the sling in their care plan. During an observation of lunch a number of residents required assistance with feeding. Some staff chose to stand up to assist with this task which is unacceptable. Menu plans are kept, but not all staff fill in the records accurately or record what snacks are offered. Some staff were unaware that some residents were on fortified diets. The catering staff were aware of residents dietary needs. The home should review the nutritional content of snacks being provided and food recording should be more detail. We did not look at the homes complaints procedure, but were concerned that most residents would not be able to raise concerns without support. One person has an independent advocate. Complaints raised recently had not been recorded in the complaints book. Investigations had been carried out but all the identfied actions had not been followed up. The provider in response to the draft inpection report stated that she had investigated complaints and had forwarded on investigative notes and actions to the Care Quality Commission.) Staff were comfortable about raising concerns but stated the procedure would be to report it to a Senior who would decide whether to cascade the concern. Staff told us that there was a bullying culture in the home and poor practices are not always dealt with. The nurse in charge off the shift was taking a telephone call whilst administering medication. In discussion with the manager we learnt that the head of care carries a telephone with them whilst on shift. This should be reviewed. We did not complete a full audit of medication but noted on one persons file that medication had been administered because of concerns about their behaviour and we did not see if any other interventions, approaches had been tried. The home had a pharmacy inspection in the last week and a few recommendations had been made. Staff recruitment checks were in place but of the five files inspected , one was employed with only one reference and another person did not give a reference from their most recent employer. Staff had been employed without a criminal records check although the home had ensured that they had an ISA check which replaces the protection of vulnerable adult (POVA) checks. Supervision for staff was infrequent and we saw no evidence that staff had received appraisals in the last year. Staff induction was poor. We asked how staff were inducted and were told they are shadowed ideally for three days. In practice we looked at two newly appointed staff. One was for a trained nurse on nights. Care Homes for Adults (18-65 years) Page 6 of 13 They were shadowed for one night but another trained nurse. There was no evidence of what was covered as part of their induction. We asked the manager if a review of their performance was completed after their probationary period and were told usually. For the other member of staff they had been shadowed for two days and we saw no evidence of induction other than a tick list induction record which covered basic things like fire escapes. We did not see any thing linked to the skills for care framework which covered key skills and competencies for staff. The provider must ensure there is a registered manager for the home. The provider has just employed a deputy manager who we were told will be working between Askham House and Askham Place but the manager was unsure how their hours would be utilized. The manager currently works a number of care shifts and has dedicated management time. She was concerned that her management time and her time off is compromised when they have difficulty covering their trained nurse shifts. This is covered in house whether possible and results in staff working long hours. We saw no evidence that the manager receives regular supervision or that her performance is reviewed and clear objectives are set. We asked if the provider completes monthly audits of the service as required by regulation 26 when the provider is not in day to day control. We were told no. Talking to the staff and the manager gave us the impression that the home is often short of staff, although this was not reflected by the current staffing rotas. Staff and management are working long hours and the rota showed unreasonable shift patterns. We were told that the activities coordinator is off sick at the moment and residents are unable to get out very often and cannot access the community independently. We did not specifically look at lifestyle or daily life experiences, but staff told us residents independence is compromised because of staffing numbers on shift and staff are task focused and do not always have time to just sit down with residents and talk. Some residents conditions mean they find it difficult to wait for things and some residents have fluctuating skills and may be different amounts of staff support. The staffing rotas do not show any flexibility. Staff said if they take residents out they do not get paid for any additional hours worked and they are unable to get out early because they are meeting residents care needs so inevitable run over their shift if they go out with residents. This makes them reluctant to go out. Staff told us that the committee, friends of Askham Place had been disbanded. The provider told us in response to the draft inspection report that friends of Askham Place is a committee whose mandate is to raise funds and organise events and activities. She stated it has not been disbanded but will be run with new members and chair. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Adults (18-65 years) Page 7 of 13 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 8 of 13 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 15 Service user plans must reflect residents assessed and changing needs. This is to ensure that the home can show how they are meeting individuals needs and helping them achieve defined goals. 30/06/2010 2 9 13 Risk must be clearly 30/06/2010 identified and the home must use recognized risk management strategies which clearly define what the risk is. The severity of the risk and measures to be taken to reduce the level of risk. This will ensure that people using the service are kept as safe as possible without inhibiting their choice and Independence. 3 19 15 Residents health must be clearly monitored so problems or complications are identified. The home must use a recognised 30/06/2010 Care Homes for Adults (18-65 years) Page 9 of 13 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action nutritional screening tool and ensure residents are offered adequate nutrition for their needs. This will ensure residents will have their needs met in respect to their health and welfare. 4 22 22 The home must keep a 30/06/2010 record of any complaints received and include details of their investigation and any actions agreed. This will ensure that peoples view of the service are known and concerns are acknowledged and taken seriously and so the home can show they have open and transparent procedures. 5 33 18 Staff ratios must be reviewed 30/06/2010 according to the assessed and changing needs of the residents. The numbers of staff and the skills mix on each shift must be reviewed. This is to ensure there are sufficent staff on duty to be able to meet residents needs in a timely way and that staff have the neccessary skills and competence. 6 34 19 The home must ensure they have all the necessary recruitment checks in place before they employ staff. This includes when they are employing temporary labour 30/06/2010 Care Homes for Adults (18-65 years) Page 10 of 13 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action from registered agencies. It is there responsibility to ensure agency staff have the necessary skills, experience, and employment checks and that the agency has sent confirmation of this. This is to ensure residents are protected from the homes robust employment practices. 7 35 18 The home must have an 30/06/2010 effective induction for all staff which meets the induction standards for skills for care. This is to ensure staff are sufficiently skilled and competent to meet residents needs. 8 43 26 The provider must provide 30/06/2010 evidence that a monthly visit is being carried out to the home and a written report is provided on their finding after speaking to staff and residents to form an opinion of the standards of care being provided. This is to ensure that the home continues to meet its stated purpose, aims and objectives and improvements identified are acted upon. Care Homes for Adults (18-65 years) Page 11 of 13 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 36 The frequency of staff supervision for all staff should be reviewed, to ensure that National Minimum standards are achieved Care Homes for Adults (18-65 years) Page 12 of 13 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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