Care Home: Glendon House

What the care home does well The service offers spacious accommodation with varied communal space and outdoor access. The providers are trying to find ways to improve the service. What the care home could do better: The service needs to continue to make improvements in all outcome areas. In addition, the providers need to appoint and retain a competent manager. The home lacks consistent management and leadership due to the turnover and ability of managers. Inspecting for better lives Random inspection report Care homes for older people Name: Address: Glendon House 2 Carr Lane Overstrand Cromer Norfolk NR27 0PS The quality rating for this care home is: The rating was made on: suspended rating 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 assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. 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: Kim Patience Date: 1 1 1 2 2 0 0 8 Information about the care home Name of care home: Address: Glendon House 2 Carr Lane Overstrand Cromer Norfolk NR27 0PS 01263578173 01263579164 info@glendonhouse.fsnet.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Frances Smart,Mr Rhoderick Smart care home 36 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category 0 0 Over 65 36 36 Conditions of registration: Thirty-six (36) Older People may be accommodated. Thirty-six (36) people with dementia may be accommodated. The total number not to exceed thirty six (36) Date of last inspection Brief description of the care home Glendon House is a care home providing care and accommodation for 36 older people who are suffering from dementia. Mr Rhoderick Smart and Mrs Frances Smart own the home. The original house was built in 1917, and has been tastefully extended and adapted over the years. The home has 30 single bedrooms and 3 double rooms. Twenty-eight of the single rooms have en suite facilities and all of the double rooms Care Homes for Older People Page 2 of 13 have en suite facilities. A large part of the grounds has been made into a safe and secure garden area for service users. The home has the potential to provide comfortable accommodation in an attractive setting in a small coastal village, being very close to the sea. Details of the services offered within the home can be found in the Service User Guide. The fees within the home range from #375-#500. Details of services included within this fee and those excluded are identified in the Service User Guide. Care Homes for Older People Page 3 of 13 What we found: We conducted a random unannounced inspection visit. This was a monitoring visit to ensure that peoples health and welfare was being safeguarded and to assess any progress towards improving the outcomes for people living in the home. In addition, the Commission recently received an anonymous concerns about the service. Elements of the report concerned the way in which peoples health and care needs were being met and others related to staff shortages and general poor practice. The concerns relating to specific residents were referred to the safeguarding adults team for investigation. We took a brief tour of the home, looked at some records relating to residents and made some observations of daily life in the home. We also spoke with the home owner Mrs Smart and some staff. On the day of the visit there were 13 people living in the home and 5 care assistants on duty. On entering the home we did not detect strong odours as previously. However, we did detect unpleasant odours in the front lounge. Lisa Rutter, training and development officer told us that this may be due to a resident throwing their breakfast across the room the day before and it may not have been cleaned up properly. We also detected unpleasant odours in the rear corridor and in at least one bedroom. However, in general the home appeared to be clean and tidy. Most residents were up and sitting in the communal areas when we arrived at 10:45. One resident was sitting with a cup of tea and two slices of toast in front of her on the table. They appeared to be untouched and there was no attempt to eat the breakfast. When we looked again a short time later they had been removed. We made similar observations with this resident at the last inspection. Another resident was sitting without stockings on and one gentleman looked unshaven, but on this occasion we did not look at the residents records to ascertain their wishes in this respect. We looked at the care records relating to 4 residents. We found that there were still shortfalls in record keeping and it was not clear in all cases what action had been taken in response to peoples changing needs. For instance, daily care notes showed that one person had experienced changes in health from November 2008 and the care plans and associated records had not been updated since July 2008. Therefore there was no up to date information as to how the persons needs should be met. In addition, the person needed increased fluids but there was no fluid chart in place to monitor intake. In another case, a resident experienced health changes which resulted in the need for end of life care. However, the care records had not been up dated and there were no plans in place setting out how care should be given at this stage. In addition, the person required assistance to turn and there were no turn charts in place. It was noted in the records of another resident they had been unwell for three days before having a fall. It did not appear from the records that the home had done anything in response to the changed behaviours prior to the fall, which resulted in a broken arm. Two days later the person had another fall resulting in further injury. A care plan had Care Homes for Older People Page 4 of 13 been written for physical health but did not identify why the falls may have occurred nor did it set out any action to minimise the risk of further falls. We were told by Mrs Smart that they were in the process of re writing the care plans as they had not made the progress in improving the records that they expected. We looked at regulation 37 reports. The service is required to report to the Commission any significant incidents that occur in the home. We found that there were at least two incidents that had not been reported in accordance with the regulations. We observed care assistants assisting people with reduced mobility to transfer from one place to another. We saw that a stand aid hoist was used for a person who was non-weight bearing and did not understand that they needed to hold onto the bars of the hoist for support. One care assistant was forcing the residents hands to the bar. The person was very distressed during the transfer. We discussed this with the home owner during feedback and suggested that they seek advice from a professional as to the safest way to assist the person. Mrs Smart thought an occupational therapy assessment had been completed but was unable to find any documented evidence on the persons file. We also saw a person who was non-weight bearing being assisted from a chair by two care assistants using a moving and handling belt. This piece of equipment would normally be used only for supporting a person with limited mobility and not for lifting. It was also noted that care assistants did not communicate effectively with residents during the transfers. It would be expected that care assistants explain what they are doing and offer the person reassurance throughout. It is also particularly important to give people who have a cognitive impairment time to take in information and understand what is happening. We were told by Mrs Smart that all staff have had moving and handling training up dates. We observed the mealtime experience in brief. Care assistants were seated at the tables with residents and provided support in a quiet and sensitive manner. Lunch appeared to be calm and organised. However, one resident was given squash and did not want it so started to shout that they wanted water, which she was provided with. The care assistant had not offered a choice of drinks and this may have been avoided if she had done so. During the visit Mrs Smart informed us that the manager Fran Sweatman who was appointed in February 2008 had resigned from her post. Following interviews they expected to appoint a new manager in the near future. In the meantime, the home is to be managed by Mrs Smart and a new deputy who had been appointed from one of their other homes until the new manager is in place. We were also informed that staff had been transfered from Hicking House to improve the skill mix and standard of care practice. What the care home does well: What they could do better: Care Homes for Older People Page 5 of 13 The service needs to continue to make improvements in all outcome areas. In addition, the providers need to appoint and retain a competent manager. The home lacks consistent management and leadership due to the turnover and ability of managers. 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 Older People Page 6 of 13 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set. No. Standard Regulation Requirement Timescale for action 1 7 15(1) 16(2)(m) Peoples care, health and 13/08/2008 social needs must be assessed and written into individualised care plans, taking into account their personal choices and preferences so that care staff have clear guidance as to how individual needs should be met. This is a repeat requirement and remains unmet. Enforcement action is underway. 2 7 15(2)(b) 13/08/2008 Individualised care plans must be reviewed monthly and up-dated as people?s needs change. So that there is an accurate record of peoples health and care needs. This is a repeat requirement and remains unmet. Enforcement action is underway 3 7 12(1) People?s care and health 13/08/2008 needs must be met in accordance with their care plans. This is a repeat requirement and remains unmet. Enforcement action is underway. Care Homes for Older People Page 7 of 13 4 8 13(4)(a)(b)(c People?s health and welfare 13/08/2008 ) must be safeguarded by a robust risk management strategy. This must include action in response to assessed risks and provide staff with clear instructions as to how these should be minimised. This is a repeat requirement and remains unmet. Enforcement action is underway. 5 8 12(1)(b) People?s health needs must 13/08/2008 be identified and promptly referred to the appropriate health professional so that treatment can be provided where necessary. This is a repeat requirement and remains unmet. Enforcement action is underway. 6 9 13(2) Medicines must be safely managed to ensure that the health and welfare of residents is safeguarded. This is a repeat requirement and remains unmet. Enforcement action is underway. 13/08/2008 7 10 12(4)(a) Privacy and dignity must be 13/08/2008 promoted at all times to ensure the psychological wellbeing of residents is enhanced. This is a repeat requirement and remains unmet. Enforcement action is underway. 8 14 12(2)&(3) Autonomy and choice must be promoted at all times so that people are enabled to 13/08/2008 Care Homes for Older People Page 8 of 13 make their own decisions about how they wish to live their lives. This is a repeat requirement and remains unmet. Enforcement action is underway. 9 14 12.2 12.3 Decisions must not be made 13/09/2008 on behalf of people with dementia without conducting a full capacity assessment in accordance with the Mental Capacity Act 2005. Residents must be provided 13/08/2008 with a varied nutritious diet, which is suited to the individuals assessed and recorded needs. People must be provided with a mealtime experience that meets their individual needs, preferences and choices. This is a repeat requirement and remains unmet. Enforcement action is underway. 10 15 16(2)(i) 11 15 17(2)Schedul Records of resident?s dietary 13/08/2008 e4 intake must be maintained to determine that a nutritious diet and any special dietary needs are being catered for. This is a repeat requirement and remains unmet. Enforcement action is underway. 12 16 12(5), 21 & 22 Staff working in the home must be able to raise any concerns or complaints with the management team and have confidence that they will be dealt with and acted upon. This is a repeat requirement and remains 13/08/2008 Care Homes for Older People Page 9 of 13 unmet. Enforcement action is underway. 13 19 13(4) The environment must be 13/08/2008 safe and free from potential hazards so that people are safeguarded from harm. This is a repeat requirement and remains unmet. Enforcement action is underway. 14 19 23(2)(b)&(n) The premises must be 13/08/2008 suitable for achieving the aims and objectives of the service and equipment and adaptations must be provided so the individual needs of residents can be met. This is a repeat requirement and remains unmet. Enforcement action is underway. 15 26 16(2)(k) The home must be free from 13/08/2008 offensive odours so that people?s dignity is promoted and they can live in a pleasant environment. This is a repeat requirement and remains unmet. Enforcement action is underway. 16 27 17(2)Schedul Accurate staff rosters must 13/08/2008 e 4(7) be maintained so that it can be determined who is on duty on each shift. This is a repeat requirement and remains unmet. Enforcement action is underway. 17 27 18(1)(a) Trained and competent staff must be available in 13/08/2008 Care Homes for Older People Page 10 of 13 sufficient numbers on each shift so that residents needs can be met, taking into account their individual needs and preferences. This is a repeat requirement and remains unmet. Enforcement action is underway. 18 36 18(2) Staff must be supervised and 13/08/2008 supported so that good practice is promoted and outcomes for residents are improved. This is a repeat requirement and remains unmet. Enforcement action is underway. 19 38 13(4) Accidents must be identified 13/08/2008 and recorded appropriately so that the health and safety needs of individual residents are identified and met. This is a repeat requirement and remains unmet. Enforcement action is underway. Care Homes for Older People Page 11 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, Care Homes 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 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 Care Homes for Older People Page 12 of 13 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI 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 Older People 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: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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