Care Home: Catherine Miller House

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What the care home does well The environment within the home was relaxed. The home provided care for residents some with high dependency care levels and the delivery of care was noted to be unhurried and calm. We did not see any residents in an agitated frame of mind. Staff were pleasant, attentive and knowledgeable about residents’ needs.Catherine Miller HouseDS0000015490.V378427.R01.S.docVersion 5.2The manager demonstrated good management skills. This was evidenced within the recording systems, delivery of care and management of staff. The appointment of a team leader had further strengthened the leadership team. The environment was pleasant and clean. The standard of furnishings and décor was of a good standard. We received positive feed back about the manager and staff from residents, relatives and visiting professionals. Within the resident’s survey the following was recorded ‘the carers are always cheerful, polite and helpful and have a good rapport with residents. Residents’ records are carefully filled in every day. The food is good…the manager and her deputy are always ready to discuss the care of (name of resident). The garden is a pleasant, peaceful and well kept area’. What has improved since the last inspection? There had been significant improvements in the day to day management of the home which had benefited residents. The manager had remained in post and the appointment of a team leader had consolidated the leadership team. The core staff team was stable and agency staff had been reduced to a minimum. This had provided continuity of care for residents. It was positive to note that the manager was applying to us to become the registered manager. The manager had reviewed polices, procedures, recording systems and practices within the home. The outcome was that residents live in a home where the day to day management of their care was more effective than at the previous inspection. The environment had been refurbished and decorated. The outcome for residents was that they live in a home which was pleasant and comfortable. What the care home could do better: The manager assured us that the shortfalls noted during the inspection would be addressed with minimal delay. In the main, they were shortfalls in connection with developing existing systems rather than implementing new ones. For example, the recording of medicines administration instructions should be signed by two members of staff if they are handwritten, preadmission assessments should be developed to include all aspects of care, personal information should always be kept within residents’ respective care records and residents should be encouraged to endorse their respective care plans. Full details are noted within the report. The most significant shortfall identified at the inspection was the inadequate staff recruitment system. Staff had been employed without robust checks being made on them. These members of staff were working in the home. The outcome was that residents’ wellbeing and welfare was at risk as they were not protected by the home’s recruitment processes. The process had been undertaken by the provider who assured us at the time of the inspection that immediate action would be taken to safeguard residents. The overall qualityCatherine Miller HouseDS0000015490.V378427.R01.S.doc Version 5.2 rating of the care home, reflects the significant risk that this shortfall posed to residents. Key inspection report CARE HOMES FOR OLDER PEOPLE Catherine Miller House 13-17 Old Leigh Road Leigh On Sea Essex SS9 1LB Lead Inspector Ann Davey Unannounced Inspection 17th November 2009 08:00 DS0000015490.V378427.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought 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. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Catherine Miller House DS0000015490.V378427.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Catherine Miller House DS0000015490.V378427.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Catherine Miller House Address 13-17 Old Leigh Road Leigh On Sea Essex SS9 1LB 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) 01702 713113 F/P 01702 713113 cmhouse@talktalk.net Mr Andrew Howard Stern Manager post vacant Care Home 30 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (30) of places Catherine Miller House DS0000015490.V378427.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th October 2008 Brief Description of the Service: BRIEF DESCRIPTION OF THE SERVICES PROVIDED. Catherine Miller House provides personal care and accommodation for up to thirty older people. The registration category also permits the home to provide care to those service users who have dementia. The home was originally three properties that have been converted into one. This has created a home which has several different levels with two separate living areas. Catherine Miller House has twenty-six single bedrooms and two shared bedrooms, all with en-suite facilities. Catherine Miller House is situated in a residential area of Leigh on sea, close to local shops. There are good bus and train links into the area. The home has a large well-maintained garden to the rear of the property. There are limited parking facilities to the front of the property. There is a current Statement of Purpose and a Service User’s Guide available. A copy of the last inspection report was displayed in the entrance hallway. The weekly charges range from £518.00 - £581.00. The exact fee depends on the type of accommodation available i.e. single or double bedroom. There are additional charges for hairdressing, chiropodist, newspapers, toiletries and transport. Catherine Miller House DS0000015490.V378427.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 care home is 1*, adequate provision The last key inspection took place on 7th October 2008. This inspection took place over approximately 8 hours. The visit started around 8am and finished approximately 4pm. For this inspection there were two inspectors. The registered provider and the manager helped us throughout the inspection. The home’s Annual Quality Assurance Assessment (AQAA) which is required by law had been completed. It was dated 25th October 2009. The document provided the home with the opportunity of recording what it does well, what it could do better, what had improved in the previous twelve months and its plans for the future. There were some details within the document which we needed clarification. These aspects have been referred within the report. We sent questionnaires to the home asking that they be distributed to stakeholders and returned to us so that we could have an understanding of how residents, staff and health/social care professionals felt about the care provision. We received one completed questionnaire from a resident and two from staff. The questionnaire from the resident had been completed by their relative. We have made reference to some of the comments received within the report. During the day we spoke with the registered provider of the home, manager, residents, visitors, visiting professionals and staff. We looked around the home, viewed aspects of various records and observed care practices. We discussed all our findings with the provider and the manager. We asked that they took notes so that immediate development work could be started where necessary. During the inspection we noted that the matter of poor staff recruitment records required urgent attention as this posed a risk to residents. The provider agreed to address this with immediate effect. What the service does well: The environment within the home was relaxed. The home provided care for residents some with high dependency care levels and the delivery of care was noted to be unhurried and calm. We did not see any residents in an agitated frame of mind. Staff were pleasant, attentive and knowledgeable about residents’ needs. Catherine Miller House DS0000015490.V378427.R01.S.doc Version 5.2 Page 6 The manager demonstrated good management skills. This was evidenced within the recording systems, delivery of care and management of staff. The appointment of a team leader had further strengthened the leadership team. The environment was pleasant and clean. The standard of furnishings and décor was of a good standard. We received positive feed back about the manager and staff from residents, relatives and visiting professionals. Within the resident’s survey the following was recorded ‘the carers are always cheerful, polite and helpful and have a good rapport with residents. Residents’ records are carefully filled in every day. The food is good…the manager and her deputy are always ready to discuss the care of (name of resident). The garden is a pleasant, peaceful and well kept area’. What has improved since the last inspection? What they could do better: The manager assured us that the shortfalls noted during the inspection would be addressed with minimal delay. In the main, they were shortfalls in connection with developing existing systems rather than implementing new ones. For example, the recording of medicines administration instructions should be signed by two members of staff if they are handwritten, preadmission assessments should be developed to include all aspects of care, personal information should always be kept within residents’ respective care records and residents should be encouraged to endorse their respective care plans. Full details are noted within the report. The most significant shortfall identified at the inspection was the inadequate staff recruitment system. Staff had been employed without robust checks being made on them. These members of staff were working in the home. The outcome was that residents’ wellbeing and welfare was at risk as they were not protected by the home’s recruitment processes. The process had been undertaken by the provider who assured us at the time of the inspection that immediate action would be taken to safeguard residents. The overall quality Catherine Miller House DS0000015490.V378427.R01.S.doc Version 5.2 Page 7 rating of the care home, reflects the significant risk that this shortfall posed to residents. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Catherine Miller House DS0000015490.V378427.R01.S.doc Version 5.3 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 Catherine Miller House DS0000015490.V378427.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 (standard 6 was not assessed as intermediate care is not provided by the home) People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can expect to have their needs assessed or identified to ensure that their admission would be appropriate. EVIDENCE: The previous inspection report was on display in the entrance hallway. The manager told us that the Statement of Purpose and Service User’s Guide would be made available upon request. On the notice board, we noted that there were a good selection of notices about the home’s provision and information bulletins. The information was helpful and clear. Catherine Miller House DS0000015490.V378427.R01.S.doc Version 5.3 Page 10 We looked at the admission records of two residents who had been recently admitted to the home. The detail within the documentation provided a broad outline of care needs and requirements. The manager said that there had been sufficient information available to make a decision about the suitability of admission to the home. We noted that not all the documentation had been completed. For example, there was no assessment for either the residents’ cultural or religious needs and the personal effects and clothing inventory had not been completed. The documentation had not been endorsed by either resident. We noted that arrangements had been made for a family to visit the home that day to see if it met with their requirements for their prospective relative. This provides opportunity for families and/or the respective residents to see the home and to meet staff before formally making an application for admission. The provider told us that they sometimes carry out pre admission assessments. Our view was that the manager of the home should undertake these assessments whenever possible, as they have overall management for care and responsibility for the home. We noted that within the AQAA, the provider had recorded ‘it may not be possible to acquire adequate information on short term respites to do a full assessment but we would rely on visual inspection and the care plan from hospital/home background to form an assessment’. This practice is not acceptable. Regulation requires a home to carry out a full assessment of care needs to ensure that it can meet those requirements through available resources. We spoke with a relative who had experienced the home’s ‘pre admission process’. They told us that it had been a positive experience and the manager had been very helpful. Catherine Miller House DS0000015490.V378427.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 and 11 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to receive the level of care required to meet their known assessed needs but may find some care practices require development. EVIDENCE: We looked at five care plans and associated documentation such as risk assessments and daily records. We sampled various aspects of these records. Care plans and risks assessments were current and we could see that they had been reviewed on a monthly basis. The information within the documentation provided a fair overview and outline of current care needs and requirements. The manager and staff we spoke with had a good understanding of individual care needs. We noted that religious and cultural needs had been recorded as being assessed, there was no reference to the resident’s end of life wishes, neither had the care pans been endorsed by either the resident or their Catherine Miller House DS0000015490.V378427.R01.S.doc Version 5.3 Page 12 respective families. We also spoke with some residents about the care they were receiving. Their views, wishes and opinions had been reflected within their respective care plans. We observed various aspects of care practice during the day. Care was provided in a sensitive supportive manner and undertaken in a dignified way. The manager told us that since the last inspection the general dependency level within the home had increased. We did not observe any residents in an agitated or distressed frame of mind. One resident came and sat with us during several periods of the inspection. We noted that staff had provided meaningful occupation for them during the time they were with us and throughout, the resident expressed a contented demeanour. We noted that the home had a daily ‘allocation handover sheet’. We understood that this was a very useful and helpful tool for staff. We noted that residents’ personal and private information had been recorded in the communal record. We also noted that some of the terminology used could be viewed as disrespectful within a communal recording setting. Personal information should be kept in the respective resident’s care notes. We did observe three occasions where residents were moved in a wheelchair without the use of footplates. We immediately brought this to the attention of the manager. The two relatives we spoke with were satisfied with the care provided for their respective relatives. We sampled two entries within the accident book and noted that the information had been appropriately transferred to the respective daily care notes. The daily records were clear and informative. We spoke to two visiting health professionals about their view of the home. They said that things ‘had improved’ within the last year and they were satisfied with what they saw. They said that the improvements had been ‘due to the manager’. They also said that in order to improve the quality of care further, there should be better and improved provision for lifting and moving residents i.e. hoists. The manager told us that the home had a good working relationship with all health and social care professionals. We saw records in residents’ files providing detail of where and when a resident had received community health care provision. The home’s team leader showed us how the home medicines administration systems worked. We saw where medicines were stored and we sampled some medicines administration records. The medicines within the trolley we looked at were orderly and with no undue overstocking. The medicine administration records were in good order with no obvious poor recording anomalies noted. We noted that were was only one staff signature beside all handwritten medicines administration instructions. There should be two staff signatures to minimise the risk of errors. The home safe keeps a medicine which is required to be stored in a specific way because of its potency. We discussed this with the provider who was unable to confirm that the current storage facility meets Catherine Miller House DS0000015490.V378427.R01.S.doc Version 5.3 Page 13 with current requirements. We gave advice about this and explained that we will make a recommendation about this and not regulatory requirement at this stage. We do however require written confirmation from the provider that the storage facility has been assessed and is appropriate. Catherine Miller House DS0000015490.V378427.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a varied balanced diet and are able to participate in an activity programme. EVIDENCE: The home’s main cooker had broken down and we saw how versatile the home had been in making sure that the situation had not been detrimental to any resident. On the day of the inspection, one of the chefs had come on duty especially to rearrange the menu to suit the situation. The new cooker was to be delivered the following day. There were detailed nutrition records for each resident. We saw that there had been a choice at each mealtime and the portion size eaten by the resident had been recorded. When we arrived at the home, breakfast was being served. We saw that there was a range of food on offer, for example, toast, porridge, fruit and cereal. We noted that some residents were having breakfast in their bedrooms. Breakfast was unhurried and staff were attentive. Catherine Miller House DS0000015490.V378427.R01.S.doc Version 5.3 Page 15 We spoke to three residents who told us that that they could choose what they wanted to eat for breakfast. We saw lunch being served which looked appetising. We noted that some residents who required assistance had to wait for their lunch as there were insufficient numbers of staff on duty to meet their needs at that time. We observed that for some residents, this meant that their food was left in front of them whilst a member of staff was assisting another resident or was called away to attend to another task. It was positive to note that residents were provided with tea or coffee in cups and saucers, not plastic beakers. Residents we spoke with were very positive about the quality of food. This was also confirmed by the relatives we spoke with. The home employs a trained member of staff to undertake a programme of activities three times a week. The home had maintained good activity records. On the notice board in the entrance hallway there were posters advertising forth coming events such as a Christmas shop, family and resident party, Carol Service and Christmas raffle. We noted that there was social provision for the more dependant residents. The manager reported that the vast majority of residents have active family or friend involvement. The two relatives we spoke with told us that they were always made to feel welcome and enjoyed visiting the home. Within the resident’s surveys it was recorded ‘I think there is a need for more stimulating activities on a regular basis, but this is being addressed by appointing a person to do this as from next week’. The manager confirmed that this appointment had been made. Catherine Miller House DS0000015490.V378427.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that their concerns will be taken seriously but are not fully protected because the staff recruitment process was not robust. EVIDENCE: The complaints procedure was displayed in the hallway. There was no information about our contact details. The manager told us that there had been no formal complaints made since the last inspection and showed us where any complaint received would be recorded. A relative had raised an issue of concern and the manager was able to show us where this had been recorded, how it had been dealt with and the outcome. We asked three residents if they would be happy to raise any matter of concern with a member of staff. They confirmed that they would have confidence to do this. The two relatives we spoke with also confirmed that they too would feel comfortable in raising any matter of concern with the manager. Within the AQAA, the provider had recorded that there had been no safeguarding (safeguarding vulnerable adults from harm) referrals made to the local authority since the last inspection in one part of the document and in another part recorded that a referral had been made. As this information Catherine Miller House DS0000015490.V378427.R01.S.doc Version 5.3 Page 17 differed and we were unable to resolve the matter with the provider, it was agreed that we should we seek clarification with the local authority. The local authority advised us that there was a referral made in September 2009. We have been advised that the outcome was ‘unresolved/inconclusive’ and advice was provided to the home by the district nurse. The matter was in connection with a care practice. As part of the elements we looked at under ‘staffing’, we noted that there was no written evidence to support that three of the most recent staff recruitment records had adequate POVA 1st or Criminal Record Bureau check documentation and there were no robust letters of reference. The provider had taken responsibility for these recruitment processes as the manager had been on holiday at the time. These staff were on duty and caring for residents. Residents were at potential risk because the provider had not ensured that all the appropriate checks required by regulation had been undertaken and therefore were not safeguarded. This is further detailed within the ‘staffing’ section of the report. Catherine Miller House DS0000015490.V378427.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19,24 and 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to live in an environment that is clean and comfortable. EVIDENCE: Following the last inspection, a programme of redecoration and refurbishment had commenced. The home was much brighter and the standard of décor, soft furnishings, furniture and carpets had significantly improved. The outcome for residents was that they live in a home which is pleasant and comfortable. The manager explained that there was further work to be done before the programme was completed. Catherine Miller House DS0000015490.V378427.R01.S.doc Version 5.3 Page 19 In the morning, we looked around various aspects of the home and acknowledged the improvements to the provider. We did not see any obvious environmental hazards. There were no unpleasant odours apart from one bathroom where the waste bags had not been collected. Occupied bedrooms were comfortable and contained personal items. Bedrooms that were empty were ‘made up’ ready for the new occupant. The home was warm. The lounge and dining areas were comfortable and well lit. The large television was on for part of the day but at other times suitable music was played. The entrance hallway contained a lot of useful information and a small seating area for residents. The bathrooms we saw were functional and clean. The rear garden area was accessible to residents and well maintained. Catherine Miller House DS0000015490.V378427.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to be cared for by a team of trained and supervised staff but are at risk because the recruitment process is not robust. EVIDENCE: The staff rota was on display and the detail and information on it was clear. The manager confirmed that staffing levels were the same for Monday – Sunday. The manager confirmed that there were three care staff plus a senior career on duty throughout the day and there were two care staff plus a senior carer on duty at night. In addition the home employs a team of cooking staff, housekeeping staff, a gardener and an activities person. The manager told us that the provider visits the home on a regular basis and undertakes some duties. Their name was not on the rota. The manager told us that the home had one full time care vacancy. The manager advised us that the use of agency staff was minimal and could recall having used them only twice since the summer months. The manager explained to us that since the last inspection the staff team had become more established and a new team leader had been appointment. The Catherine Miller House DS0000015490.V378427.R01.S.doc Version 5.3 Page 21 manager’s view was that this meant that residents were cared for by a team of consistent staff. Staff we spoke with expressed satisfaction with their working conditions and were clear about their respective roles and responsibilities. The delivery of care we observed during the day was undertaken by staff in a calm and unhurried manner. The home is registered to provide care for 30 residents. On the day of our visit, there were 20 residents being accommodated. The manager advised us that the provider was aware that the current staffing levels would be insufficient to fully meet the needs of residents once further admissions take place. We observed certain times during the day when residents had not been supervised adequately as staff had needed to undertake other duties which had taken them away. These incidents have been referred to previously within the report. In addition, the home had a number of corridors and bedrooms which are on various floor levels. In our discussions with the manager about staffing levels and the deployment of staff, we discussed the layout of the building which must be taken into account. The manager showed us a programme of scheduled staff supervision sessions. Staff confirmed that they take place and spoke appreciatively of the support given to them by the manager. We were also shown a detailed programme schedule of staff training. Staff told us that their training sessions had helped them to undertake their work duties better. Staff members we spoke with were knowledgeable about residents’ care needs. We spoke with two relatives who expressed appreciation for the care staff. The visiting health care professionals told us that they had a good rapport with staff. We looked at the recruitment records for two members of staff who had started work in the home since the last inspection. These staff had been recruited from overseas. The manager told us that they had been on holiday at the time and the process had been undertaken by the provider. The provider was not able to demonstrate to us that that they had requested any POVA 1st or Criminal Records Bureau Checks (CRB) and the letters of commendation had not been validated. The provider advised us that CRB’s had not been applied for as they had insufficient information. The provider told us that as the applicants had a police check from overseas, this would be sufficient. We also asked the provider for clarification about the working visas. The provider was unclear about the process and was not able to clarify the situation. The provider told us that they were aware of the Home Office guidance for recruiting staff from overseas but was not able to produce it on the day. The provider was unable to show us any assessment documentation and subsequent judgement to support that the situation posed a minimal risk to the residents who were being cared for by these staff. Resident’s wellbeing and welfare was not safeguarded and protected because adequate checks on these members of staff had not been undertaken by the provider. This matter has been referenced within the complaints and protection section of this report. Catherine Miller House DS0000015490.V378427.R01.S.doc Version 5.3 Page 22 The provider told us that the manager had not been involved in the recruitment process of these staff. We received two completed surveys from staff members. One survey was completed by the use of tick boxes and the only comment made in the second was the view that ‘the home should give more care training to new recruits’. Catherine Miller House DS0000015490.V378427.R01.S.doc Version 5.3 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 and 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to live in a home where their care is managed effectively. EVIDENCE: Since the last inspection the manager had reviewed the majority of the home’s practices, polices and procedures. They demonstrated competence and confidence within the areas of responsibility assigned to them by the provider. The manager was in the final stages of accumulating the required documentation before making an application to us for registration. We saw a significant improvement in the completion of records, the information Catherine Miller House DS0000015490.V378427.R01.S.doc Version 5.3 Page 24 available, management of workload and staff spoke positively about the support they had received from the manager. The visiting health care professionals were positive about the manager. Since the last inspection, the manager had been provided with a computer within their office. They said that this provision had made a tremendous difference to them as they now had direct access to the various websites and was able to communicate via email addresses. The manager said they had been instrumental in the refurbishment and redecoration programme. We saw that the manager had devised a number of management monitoring tools which provided them with a regular overview of practice within the home. For example, staff daily allocation tasks and the staff supervision programme. The manager was receptive to areas of development such as including spiritual/end of life/cultural needs within care plans, ensuring that personal information is not recorded within communal records, ensuring residents endorse their care plan documentation where possible and ensuring the preadmission assessments are completed in full. The provider told us that they undertake pre-admission assessments and staff recruitment procedures. It is important that the manager also has an input into these processes as they are responsible for the day to day management of the home. The provider told us that they undertake the Regulation 26 reports (a report undertaken by the provider or their representative to inform that the home is managed on a day to day basis in accordance with regulatory requirements) bi monthly. Regulation is clear that this function must be undertaken monthly and a report must be provided. The provider visits the home on a regular basis but was not on the rota. We selected and sampled some health and safety records such as fire drills, health and safety policies and fire risk assessment and noted that they were current. We selected and sampled some maintenance certificates such as lifting apparatus and a gas safety visit record and noted they were current. The Essex County Fire and Rescue Service visited the home in June 2009 for a routine safety check. Southend Borough Council carried out a monitoring visit in June 2009. We noted that the home had a good audit trail for looking after residents’ personal allowances. We noted that there were records of residents, staff and relatives meetings in place. The provider advised us that they had surveyed all stakeholders during the summer and were assessing the information received. There was a business plan in place dated 2009/10. Catherine Miller House DS0000015490.V378427.R01.S.doc Version 5.3 Page 25 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 3 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 3 Catherine Miller House DS0000015490.V378427.R01.S.doc Version 5.3 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13 Requirement Handwritten medicines dosage and administration information and instruction must be signed by two members of staff. This is to minimise any risk of error when members of staff make these entries. 2 OP18 13 Arrangements must be made by training staff or by other measures to prevent residents being harmed or suffering abuse or being placed at risk of harm or abuse. A robust staff recruitment process must be put in place. This is to ensure that residents are cared for by staff that have been subject to checks which are detailed within regulation. The provider was to undertake an immediate risk assessment and/or appropriate action to make sure that residents were not at risk. The timescale reflects this action. Catherine Miller House DS0000015490.V378427.R01.S.doc Version 5.3 Page 27 Timescale for action 17/11/09 18/11/09 3 OP29 19 Arrangements must be made for all staff to be subject to a robust recruitment process as detailed within regulation. This is to ensure that residents are safe. The provider was to undertake an immediate risk assessment. and/or appropriate action to make sure that residents were not at risk. The timescale reflects this action. 18/11/09 4 OP33 26 Where the registered person is an individual and not in day to day charge of the home, they must visit the home undertake the duties as detailed in regulation and prepare a report at least once a month. This is to ensure that the owner of the home who is not the manager satisfies themselves and the CQC that the home is managed in accordance with regulatory requirements. We require this report to be sent to the CQC until further notice. 17/11/09 Catherine Miller House DS0000015490.V378427.R01.S.doc Version 5.3 Page 28 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 OP3 Good Practice Recommendations A trained member of staff should ensure that a full and detailed assessment of care needs is undertaken on every prospective resident. This is to ensure that the care needs are known and the home has the skills and resources to meet them. Care plans should include all aspects of care needs as detailed within the national minimum standards. These include cultural, spiritual and end of life care wishes. There should be a review of the storage facility which houses strong medicines to make sure that it is fully compliant with current guidance. We require confirmation in writing that this review has been carried out and of the outcome by 31/12/09. On that basis we have not made this a requirement at this time. 4 OP10 Resident’s personal and private information should be held in a confidential manner and not recorded in a communal book or setting. Care plans should include all aspects of assessed care needs as detailed within the national minimum standards. These include end of life care wishes. 2 OP7 3 OP9 5 OP11 Catherine Miller House DS0000015490.V378427.R01.S.doc Version 5.3 Page 29 Care Quality Commission Eastern Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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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