Care Home: Inver House

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What the care home does well The home has undergone a major new build and refurbishment and this has been completed to a high standard to provide residents with an attractive and comfortable home environment. The home has a specialist area to provide a higher level of care and support to people who have dementia related care needs. This area is well designed to provide an open and homely environment for people with lots of innovative developments in line with current good practice guidance in providing good quality dementia care. For example, residents have easy access to a level and safe courtyard and garden area. There is evidence of thoughtful and gentle support and stimulation provided for residents with individual `memory boxes` for each resident and we saw evidence of lots of individual support and social activity. Some of the comments that we received from residents confirmed good levels of satisfaction: `it`s very nice here`, `they look after me well`, `the staff are nice`. What the care home could do better: Care plans do not always provide staff with clear and detailed information about what they must do to meet individual care needs and ensure that people receive consistently good outcomes for their health and personal care. In particular, care plans do not contain sufficient detail about the prevention and treatment of pressure areas, the maintenance of good hydration, and specific `end of life care`, where these have been identified in the care plan. Failure to maintain detailed records of care puts people at risk of not receiving the care they need to maintain good health at all times. Care plans do not contain enough information about changing care needs and changes to the care plan. Although the care plans are reviewed each month, there is no information for care staff about changes to the plan of care. This means that some care needs may be overlooked and people do not receive the level of care they need to maintain good health. There is a risk of people not receiving their medicines in the way that has been prescribedby their doctor, because there is no clear guidance for care staff on how some medicines are to be dispensed when they are prescribed to be given `as and when required`. This means that people may be a risk of not receiving their medication when they need them, and different staff may be giving the medicines in different ways. The home is currently employing agency staff to cover gaps in the staff rota. The manager is in the process of recruiting new staff. The manager must ensure that staffing levels are kept under constant review to ensure that there are always sufficient numbers of trained and competent staff to meet the health and care needs of service users. Random inspection report Care homes for older people Name: Address: Inver House Foreland Road Bembridge Isle Of Wight PO35 5UB two star good service 15/04/2009 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: Annie Kentfield Date: 1 0 0 5 2 0 1 0 Information about the care home Name of care home: Address: Inver House Foreland Road Bembridge Isle Of Wight PO35 5UB 01983872312 01983875814 joanne.bennett@islecare.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Joanne Debora Bennett Type of registration: Number of places registered: Conditions of registration: Category(ies) : Islecare Ltd care home 52 Number of places (if applicable): Under 65 Over 65 0 52 0 dementia old age, not falling within any other category physical disability Conditions of registration: 52 0 52 The maximum number of service users to be accommodated is 52 The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Old age, not falling within any other category (OP) Physical disability (PD). Date of last inspection 1 5 0 4 2 0 0 9 Care Homes for Older People Page 2 of 11 Brief description of the care home Inver House is currently registered to provide care for up to 52 older people. The home has just completed a major refurbishment of existing accommodation and the completion of new accommodation. The home has 16 rooms in the specialised dementia unit and 36 rooms in the residential unit at the home. Inver House is a large three-story period building situated next to a GP Surgery. There is some parking available in front of the house, or street parking nearby. The building is accessible and has a passenger lift to access the upper floors. Fees are dependant on the type of accommodation and the care needs of the individual. Full details of fees are available from the home. Care Homes for Older People Page 3 of 11 What we found: Two inspectors made an unannounced visit to Inver House on 10 May 2010 over a period of four hours between 10am and 2pm. The purpose of the visit was to monitor previous regulatory requirements and to monitor practice in the home following recent allegations that people living in the home are at risk of poor outcomes to their health and personal care needs. The concerns are being separately investigated by the Local Authority Social Services Safeguarding Team and the outcomes are not yet known. The visit focused on looking at three plans of care including medication records, and discussion with service users. We also spoke to three members of staff, the manager, and a health and social care professional who was visiting the home. Other service users were involved in the visit when we visited some of the communal areas of the home. The home is registered to provide personal care to 52 residents and at the time of our visit there were 49 residents living in the home. The home has developed a computerised care planning system. When we visited the home in April 2009 this system was newly in place and some staff were not yet confident about using a new system. We spoke to three members of staff during this visit who told us that the system was easy to use. We were also told that additional support and computer training is provided to new staff who do not have computer skills. The system provides a generic care plan for each resident, this is then personalised with specific details following the initial assessment of care needs. The care plan includes information for care staff on health and personal care needs, social and psychological care needs and information about how to manage any risks during the provision of care. However, one care plan that we looked at did not contain clear information for care staff on what they must do to ensure that a resident does not become de-hydrated. The care plan stated that the person should have 6 - 8 glasses of fluid daily; however this information was included on all generic care plans and did not specify the recommended amount of fluids needed for this person. The daily records stated that drinks had been given but a proper record of the amounts of fluid intake had not been kept. This means that the resident may be at risk of de-hydration if staff do not know how much fluids have been given. The lack of detail in the care plan means that different staff may be providing different types of care to this person and care is inconsistent. This puts the resident at risk of their health care needs not being fully met. We also found that the care plan is unclear about the end of life care plan, for example, some staff thought they should be providing specific mouth care but other staff were not doing this, although this was specified in the care plan. The failure to ensure that the care plan is accurate and up to date and that staff are following the plan of care puts people at risk of not receiving the care they need and this affects their health and well being. One care plan contained an assessment tool that had been used to assess whether the person was at risk from developing pressure sores or pressure areas and a pressure relieving mattress was in place. However, although the care plan stated that the mattress should be set at the correct level, staff were not sure what the correct level should be. Care Homes for Older People Page 4 of 11 This means that people may be at risk of not receiving the appropriate care to minimise the risk of pressure sores. The manager told us that pressure care has been identified as an area of further staff training and this is being arranged to take place in the near future. Care staff review or evaluate the plan of care each month, however, the review does not contain any information about whether care needs have changed or if the care plan has been changed. This means that new staff may not have clear guidance or information about changes to the care plan or how care needs are to be met. One care plan did not contain any information about specific medication that has been prescribed to be given as and when required. This medication was prescribed by the GP in January 2010, for pain relief. However, since January, the medication has not been dispensed. The care plan did not provide any guidance for care staff on the specific circumstances when this medicine should be given to the resident. This means that the resident may not receive important medication at times when they need it. Staff had not asked for the medication to be reviewed by the GP when the medication was not given. The medication records showed that three other residents have medication that has been prescribed to reduce the symptoms of anxiety. However, there are no specific plans of care for these medicines; to guide staff on the specific symptoms and circumstances when the medicines should be given. This means that people may be at risk of not receiving their medication as prescribed by their GP and there is a risk that different staff may dispense the medicine in different ways. The manager told us that this has been identified as an area of concern and a protocol and record sheet has been developed for all as required medicines but this has not yet been put into practice in the home. We looked at the records for other medication that has been prescribed for residents and we noted that medicines are securely stored and staff on duty confirmed they have received updates of training in the safe administration of medication. We found two gaps in the medication records for two people. We were able to confirm with a member of staff that the medicine had been given but staff had not recorded this. Some residents have been prescribed creams and lotions and these have not been recorded on the medication records that they have been used, as prescribed. Staff told us that the creams and lotions are kept in individual rooms and used whenever needed. These should be recorded to provide a clear record of evidence that people are receiving the medicines in the way that has been prescribed by their doctor. This will also ensure that all staff are using the creams and lotions in the way that has been prescribed to ensure that people receive their care in a safe, organised and consistent way. We spoke to a visiting health and social care professional who told us that generally, staff follow specific advice and guidance that is provided by health and social care professionals to ensure that health care needs are met. We looked at the staffing rota for the home following recent concerns that there were insufficient numbers of staff to fully meet all of the care needs of people living in the home. The manager told us that the home has recently had a turnover of staff, and Care Homes for Older People Page 5 of 11 shortage of domestic staff, and she acknowledged that this had caused some staffing shortages that had affected the levels of care given to residents. The manager told us that since February 2010 the home has been employing agency care staff to cover gaps in the staffing rota and that she is in the process of recruiting new staff. We looked at the staff rotas and evidence of staff on duty at the time of our unannounced visit. At the time of our visit there were sufficient staff on duty to meet the needs of the people living in the home. We were able to confirm that the staff on duty included sufficient senior care staff who had delegated areas of responsibility in the home. We looked at the recruitment records for two newly appointed members of staff and the records confirmed that appropriate pre-employment checks are in place to demonstrate that staff are suitable to work in the home and ensure the safety of people living in the home. What the care home does well: What they could do better: Care plans do not always provide staff with clear and detailed information about what they must do to meet individual care needs and ensure that people receive consistently good outcomes for their health and personal care. In particular, care plans do not contain sufficient detail about the prevention and treatment of pressure areas, the maintenance of good hydration, and specific end of life care, where these have been identified in the care plan. Failure to maintain detailed records of care puts people at risk of not receiving the care they need to maintain good health at all times. Care plans do not contain enough information about changing care needs and changes to the care plan. Although the care plans are reviewed each month, there is no information for care staff about changes to the plan of care. This means that some care needs may be overlooked and people do not receive the level of care they need to maintain good health. There is a risk of people not receiving their medicines in the way that has been prescribed Care Homes for Older People Page 6 of 11 by their doctor, because there is no clear guidance for care staff on how some medicines are to be dispensed when they are prescribed to be given as and when required. This means that people may be a risk of not receiving their medication when they need them, and different staff may be giving the medicines in different ways. The home is currently employing agency staff to cover gaps in the staff rota. The manager is in the process of recruiting new staff. The manager must ensure that staffing levels are kept under constant review to ensure that there are always sufficient numbers of trained and competent staff to meet the health and care needs of service users. 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 7 of 11 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 Older People Page 8 of 11 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 7 13 Individual plans of care must 10/06/2010 be personalised and set out in detail how staff are to meet the health, personal and social care needs of each service user. Individual plans of care must reflect changing care needs and current objectives for meeting health and personal care needs. 2 8 13 Individual plans of care must 10/06/2010 include clear guidance for care staff about monitoring and recording fluid intake, where this is identified as a care need. To ensure good hydration and maintain good health. 3 8 13 The plans of care must 10/06/2010 identify those service users who are at risk of developing pressure areas. The plan of care must record appropriate intervention needed to prevent service Care Homes for Older People Page 9 of 11 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 users from developing pressure areas and maintain good health. 4 9 13 Ensure that all medication 10/06/2010 prescribed to be given as and when required; is clearly set out in a plan of care. In the interests of people receiving their medicines as prescribed by their doctor, and to ensure that people receive their medication in the same way, from all staff. 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 10 of 11 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 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: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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