Care Home: Masefield Avenue

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Masefield Avenue 12a Masefield Avenue Stratton St Margaret Swindon Wiltshire SN2 7HT zero star poor service The quality rating for this care home is: 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. Lead inspector: Alyson Fairweather Date: 0 2 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) 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 Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Internet address www.csci.org.uk Information about the care home Name of care home: Address: Masefield Avenue 12a Masefield Avenue Stratton St Margaret Swindon Wiltshire SN2 7HT 01793497715 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): masefieldmanager@whct.co.uk White Horse Care Trust Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 6 Number of places (if applicable): Under 65 Over 65 6 0 learning disability Additional conditions: The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) The maximum number of service users who can be accommodated is 6. Date of last inspection A bit about the care home Masefield Avenue was an existing service which was closed by the provider in 2004. The service remained dormant, continuing to pay registration fees, whilst undergoing complete refurbishment. It is now registered to provide nursing care for up to six people with a learning disability. The home is owned and run by White Horse Care Trust (WHCT.) It is in a residential area of Swindon, and has easy access to shops, pubs, and other amenities. It is a detached bungalow, with six single bedrooms, a large communal lounge and a kitchen/dining room. Details of the costs to residents were not available during the inspection, although it was said that fees are paid by various funding authorities. Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: This is what the inspector did when they were at the care home The inspection took place in October. We met with all six residents and one family wrote to us. We met with two nurses and several carers, and the Director of Care spent most of the day with us. We looked at various documents and files including care plans, risk assessments, health and safety procedures, staff files and medication records. We also spoke to staff about residents’ needs and how they are met. The home had previously sent us a copy of their Annual Quality Assurance Assessment (AQAA), although they did not return it on time and we had to give them a bit longer. At the last inspection, it was felt that the service was sufficiently underperforming enough to ask them for an improvement plan. This was so that they could show us how they planned to make things better. The management told us about various improvements they planned to make which would mean that residents would have a better service. Unfortunately, it was found at this inspection that they had failed to implement some of these improvements. Again there were a number of areas of concern noted, some of which were so serious we wrote immediately to the registered provider at White Horse Care Trust, Mr Ian Spalding to tell him he must take urgent action. We are currently taking legal advice on how we should proceed in our work with the home. What the care home does well The home has good quality furnishings, and provides equipment which is appropriate for residents’ needs. Bedrooms are decorated as residents like them to be. There is underfloor heating in the new extension part of the building, and there is a patio area to both sides of the house. Residents are usually referred by staff of other health or social services. This referral includes a detailed application form, risk assessments where present and details of the current care plan. The assessment information which accompanies people helps staff to understand their care needs. Residents can have several visits to the home to see if they can settle there and to give staff time to get to know them better. This helps staff to compile care plans which cater to the needs people have shown after moving in to the home. When asked what the service did well, the family member who wrote to us said: Staff are friendly. I feel that I can approach them if I have any concerns. I am able to make impromptu visits, and am kept informed of my relative’s progress. Personal care provided is excellent. What has got better from the last inspection What the care home could do better There were some areas of such immediate concern that a letter was sent to the providers immediately after the inspection. These related to the health and safety of residents, and included vulnerable people being at risk Care plans, epilepsy profiles, healthcare and risk assessments are some of the areas causing concern. Medication procedures had improved, with staff now taking responsibility for ordering prescriptions, instead of family members. However, care staff had still not been trained in how to administer rescue medication for those people with epilepsy. Once again, records of staff training were missing, making it impossible to verify what had been done. One staff file was not in the home, making it impossible to verify that robust recruitment procedures, including CRB checks, had been done. This means that residents could be at risk of being cared for by untrained staff who have not been police checked. The Commission for Social Care (CSCI) is concerned to find that some of these failings had not been addressed, despite an Improvement Plan. We take it very seriously when providers fail to comply with their Improvement Plan, and we will be deciding shortly how to address this. Meantime, we have again informed the providers about what is expected of them regarding the above concerns. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Alyson Fairweather Colston 33 33 Colston Avenue Bristol BS1 4UA 011 7930 7110 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 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Prospective residents and their families have enough information to make a choice about whether they would like to stay in the home. Their needs and goals are assessed and recorded before they move in to the home. Each resident had an individual written statement of terms and conditions. Evidence: The Statement of Purpose was available in the home and had recently been updated, although it did not contain details of the new management arrangement, and the registered person has been asked to make sure that this is done. All new residents or their families had been given a copy of the Service User Guide. The files we looked at all contained details of the Terms and Conditions, or contracts. There was good assessment information on file from when people were preparing to move in. One file contained information from the transition team at social services, the community nurse and the Strategic Health Authority, and included details of mobility, wheelchair use, safety belts and arm rests needed. This assessment information is added to by staff when the residents come for overnight visits prior to moving in. Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Poor record keeping in care plans means that it is difficult to see that residents needs are being met. People are not always able to make choices and decisions about their own lives, but are helped in this area by staff and families. Failure to record risk assessments and failure to follow up professional guidance relating to risk assessments, means that staff do not have all the information needed to make people safe. Evidence: Each resident has a care plan on file. These contain information about their likes and dislikes and about how each persons care should be managed. This includes information about specific ways in which people must be fed and if they need to use a hoist when they are being moved. These have been improved, although they still need further development to make them more person-centred. Several of the residents of Masefield Avenue have epilepsy. We looked at the care plans for three people with epilepsy. Of these, only one contained a formal epilepsy profile which mean that there was no record of how the others were to be managed if they had a seizure. Staff said they were sure they had been in place, but no-one could find them. The management have been told that all residents who have epilepsy must have an epilepsy profile in place. One person who has mobility problems was noted to have a Waterlow score of 24, which means there is a very high risk of pressure damage because of immobility. Records variously referred to having a red mark and to having excoriated skin. This is potentially a very dangerous situation. It was, therefore, concerning to note that the Evidence: pressure area chart which says the position must be changed every two hours was not always completed, and some days only a few entries were made. Some of the entries stopped at 7 pm when the person went to bed, but one entry stopped at 4.30 pm. The failure to complete turning charts was brought to the managements attention following the last inspection, and they provided us with an Improvement Plan which said that the homes manager and qualified nurses would complete these charts. We were so concerned at this inspection that the matter was still not being addressed that we wrote immediately to the providers telling them that residents turning charts must be fully completed so that there is an accurate picture of how they try to prevent pressure damage. One entry we saw in a care plan which had been written by a staff member said that the person is a case of.... and then went on to describe the medical condition. Good practice would suggest that the person should be described as having a particular condition, and not as a case. It is recommended that care is taken over the language used when recording in care plans in order to preserve peopleS dignity. One resident had a social services review on file which was dated January 2007. Staff on duty said that they were sure that another review had been held, although there was no paperwork to evidence this. It is recommended that staff get a copy of the paperwork following each review which is held for residents. Care plan information for each resident was scattered and kept in various files and folders, as it was at the last inspection. Both the senior nurse on duty and the senior management representative present during the inspection found it difficult to find information when asked to do so. We found this to be the case at the last inspection and we recommended that they should be streamlined and that each resident had one care plan folder where all their information is kept. We again make this recommendation. Masefield Avenue caters for people with complex nursing needs relating to learning disability, and are therefore mainly unable to make informed decisions. They are able to show some preferences, however, and are supported to make decisions by the staff and their families. None are able to manage their own finances, and all have family involvement. Some residents go to day services, and some like to visit their families. There were a number of risk assessments on file for residents. However, we found that these had not always been updated. As noted above, one resident in particular was at high risk of pressure sores because of immobility. In July 2008 a pressure care assessment was done, and a Waterlow scale of 24 was recorded. This means that there is a very high risk of pressure damage. However, there had been no updated risk assessment since the previous one on 4th February 2008. Staff could give no reason for why the risk assessment had not been updated to reflect the serious risk. We were so concerned that there was no up to date risk assessment in place for this resident that we wrote immediately to the providers telling them that they must treat this as a matter of urgency. Evidence: One resident had information on file which said that their wheelchair cushion does not appear to be a good fit and will need further assessment when the person moved to Masefield Avenue. This resident is at serious risk of pressure sores. There was no evidence that any assessment had been completed relating to the cushion. Both the nurse in charge and the management representative present at the time were aware that the resident has seen various professionals, but could not explain why this assessment had not been done. The failure to ensure that all risk assessment information is consistent with any assessment information given by other professionals was brought to the managements attention following the last inspection. They provided us with an Improvement Plan which said that the risk assessments would be completed by the homes manager and others. We were so concerned at this inspection that the matter was still not being addressed that we wrote immediately to the providers telling them that they must do this urgently. As a way of identifying that staff have read the various risk assessments in place for residents, the home asks them to sign the assessment. Many of the risk assessments we looked at had not been signed by staff, although there have been several new staff start work. This means that they will be unaware of the potential risks to residents and how they can best avoid them. The providers told us in their Improvement Plan that they would ensure that all staff would sign risk assessments to say that they have read them. This has failed to happen. The providers have been told that they must do so from now on. Resident risk assessments were all kept together alongside the risk assessments for the house, the use of the vehicle, use of chemicals, etc. and it is recommended that resident risk assessments should be kept alongside their care plans. Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Social and leisure activities appear to be varied, although more interaction with care staff would be beneficial to stimulate people. Residents have a lot of contact with family and friends, and they are encouraged to visit by staff. Residents rights are mainly respected and recognised in their daily lives, and their mealtimes take place in pleasant surroundings with care taken about nutritional needs. Evidence: There were six residents living in Masefield Avenue, one of whom had only moved in recently. When we visited the house, we saw two residents and two staff members in the lounge in their wheelchairs. Both carers were sitting watching television. One resident was facing the television but the other was facing out into the garden. Neither of the carers spoke to the residents. When we asked why someone was facing away from the room, we were told they didnt like too much noise and didnt always want to watch TV. The nurse in charge of the shift then took the resident into the snoozelem room and put music on for them, which they seemed to enjoy. When we spoke to the Director of Care for the organisation about this she agreed that staff should be interacting with residents rather than watching television, and said that she would have remonstrated with them if she had seen this. One resident had gone out in the house bus just for the drive, as the bus was going in for a service, and a carer was going to pick them up from there. A temporary member Evidence: of staff has been seconded from another service to drive the house vehicle so that people can be taken out more regularly. Later in the morning two residents were taken out for a walk and for a cup of tea in their wheelchairs. Throughout the course of the day, we saw staff members talking to each other more than they did to the residents, although this was better during the lunch time meal. The acting manager and the Director of Care have devised activity plans for residents, based on their likes and dislikes. The activity plan is shown on the wall in the hallway, and has various daytime and evening pursuits against each residents name. These include formal sessions like college and hydrotherapy etc. as well as shopping or visiting gardens. Some people go to various clubs, and music is very popular with the residents. We saw people lying in the Snoozelem room listening to music while we were there. Records showed that some activities were curtailed because there were not enough staff to support people. One staff member told us: There are times when residents dont want to do their activities - probably because they were just made up for them and not with them. Staff support links between residents and their family and friends, and they can have as much contact as they wish. All current residents have family and all go home for visits, overnight stays or weekends. One family member told us recently: I am able to make impromptu visits, and am kept informed of my relative’s progress. The needs of the current residents are complex, and they are unable to take any responsibility for household chores. All residents have access to the whole of the house and the garden. The premises are a non-smoking area. The complex nursing needs of the residents means that some of them are unable to swallow or unable to eat enough and need long term artificial feeding. They are fed by means of a percutaneous endoscopic gastrostomy (PEG feeding) For others, staff have compiled a formal menu system with pictures of all the food they like, to enable them to have some choice. There is a large dining table and staff eat alongside residents. We saw some residents being supported to eat, and this was done with patience and without rushing people to finish. Staff spoke to residents throughout the meal, gently encouraging them to eat. Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents do not always receive personal support in they way they require. Their physical and emotional health needs are not met. They are not protected by the homes medication policies and practices. Evidence: All residents have support plans for any personal care required. The information contained in them is gathered from the initial community care assessment, the homes own assessment and staff knowledge of the residents. None of the care plans or risk assessments gave detailed, explicit instructions to staff on how to physically support residents. One care plan said: Needs careful positioning, although no directions were given about what this means. Some had handwritten notes on them by staff or agency staff. One said: How do we support his head? and another said: Why cant he use the bath? The registered provider has been asked to make sure that residents care plans and risk assessments give enough detail to inform staff how to provide personal care for them. All residents are registered with a GP whilst living in the home, and all other medical professionals, such as physiotherapists, speech and language therapists, dentists, opticians, occupational therapists or specialist nurses are seen as and when required. This varies according to the needs of individuals. The home has good links with local learning disability teams, and can call for support if any crisis periods arise. Wheelchairs are all personalised and some people have recently been assessed to make sure they are fit for purpose. All beds have pressure mattresses fitted, and all are profiling beds. Bed rails are used and are padded, and the reasons for this are recorded in care plans. Evidence: One residents file contained a letter from a physiotherapist dated 2nd September 2008 saying that they needed to have postural drainage to help prevent chest infections. This is a particular medical technique which helps to move secretions in the chest. There were specific instructions given about how to tip the bed up from the bottom and that this should be done with the resident lying on each side for 10 minutes. There was no evidence on file which said this had been done. When asked, staff at first thought that the letter had only recently arrived. When it was obvious that it had arrived over a month before, staff then agreed that the procedure was not being used. When asked why this was the case, the nurse in charge said that only some of the staff had been trained and that they were waiting for the rest of them to have it. This was extremely concerning to note. It was pointed out to staff and the management representative that it was potentially very serious if the resident developed a chest infection, particularly with their limited mobility. We were so concerned that this resident was not getting the treatment recommended to them that we wrote immediately to the providers telling them that they must treat this as a matter of urgency. The providers have also been told that all staff must have training in how to use postural drainage techniques. All registered services have a duty to inform the Commission for Social Care Inspection of any accident or incident which affects the welfare of the residents. We read an accident record which said that one of the residents had injured their finger quite badly. The home failed to inform us about this. We have asked them to make sure that they do this in future. All three care plans we looked at had an OK Health Check on them. However, none of them were signed by the person who had completed them, and some of them were incomplete. There were no Health Action Plans in place for any of the residents. Valuing People, the government white paper for people with learning disabilities, recommended some years ago that personal health action plans should be in place for all people with learning disabilities, in order to highlight their health needs and get them met. It is recommended that all residents should have a personal Health Action Plan in place. The home has policies and procedures in place for medication administration, and medication is kept in a locked cupboard in the office. Nursing staff have responsibility for ordering medications, and these are administered by the nurse in charge of the shift. We looked at the medication storage, and saw that it was all in good order. Some medication comes in a monitored dose system (MDS) and is pre-packed, but some is still in bottles and packets. Staff are hoping to have all medication dispensed from the same chemist so that there can be one system of storage in use. Meanwhile, there is no easy way of conducting an audit of when medication was started, so the providers have been asked to ensure that a record is kept of the date when all bottles and boxes Evidence: of medication are opened. We also saw a bottle of feeding supplement lying opened and half used in the kitchen on the work top. The bottle said it should be used within 24 hours. There was no date of opening marked on the bottle. The nurse in charge explained that it had been only opened the previous night, as one bottle is used before 24 hours are up. She agreed that this could be an issue if more than one bottle was opened, and will record the date each bottle is opened. When we first went into the sitting room in the morning, we saw that there were two tubes of medication lying on a side table. These are meant to be locked away. When we asked the nurse in charge why they were there, she said that she had been called away after administering the creams. She had been extremely busy, and had not had time to remove them. The registered person has been told that all medications must be locked away. Whilst the nursing staff have ultimate responsibility for medication procedures, all care staff should be urged to remove any medication which is seen to be lying around. We observed residents being given medication at lunch time. Some of this was given in food in order to help swallow it. The person giving the medication followed correct procedures and spoke gently to residents telling them what was happening and that they were being given their medication. There are times when carers will be taking people out of the house, whether to daily activities or shopping etc. Some residents are known to have seizures and need medication at this time. At the last inspection, we asked the providers to make sure that all care staff were trained to administer medication which might be needed when they are alone with residents. The providers told us in their Improvement Plan that they were looking into support staff being trained to administer rescue medication. There was no evidence that this had been done, so the providers have once again been asked to do provide training. Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 and their families can be sure their concerns are listened to. Residents are protected from abuse, neglect and self harm by the procedures in place, but evidence of staff training would make this more robust. Evidence: There is a complaints procedure in place, and it was also in the Service User Guide which has been reproduced in pictorial format. All residents and their families get a copy of this document. Staff reported that they knew what to do if residents had a complaint, and one family member who wrote to us was clear about how to complain when they had to. They said: I feel that I can approach staff if I have any concerns. The home has copies of the No Secretsdocument, and staff all receive a copy. All staff members are encouraged to report any incidences of poor practice, and a Whistle Blowing procedure is also available. Some staff have had training in supporting vulnerable people, although others are still to do this. At the last inspection, the providers had been asked to make sure that all staff had training in Safeguarding Adults. This was mainly because there were no training records available for inspection, although the manager said many of the staff had done this training. As at the last inspection, there were no training records to see, so it was impossible to verify if staff have had this training, although the providers told us in their Improvement Plan that they would. They have been asked once again to do this. Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this 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 live in a homely, comfortable and safe environment. The home is clean and hygienic. Evidence: Masefield Avenue is located in a residential area of Swindon, and has easy access to shops, pubs, and other amenities. It is a detached bungalow, with six single bedrooms, a large communal lounge and a kitchen-dining room, with room for wheelchair users. It has movement sensitive lighting throughout the building. There is a large communal lounge with TV, stereo, etc and a smaller quiet lounge with bean bags. The old part of the building is heated by radiators will a coolwall system, and the new extension has underfloor heating. There is a patio to both sides of the house. A new sensory room has been introduced since the last inspection, and this seems to be popular with the residents. Each bedroom is individually decorated (one was decorated by a family member) and each contains personal items, furniture and pictures. Staff do the residents laundry. Each person has their own laundry box, and these are transported on linen handcarts or trolleys to the washing machines. This cuts down handling and helps reduce risk of cross infection. The laundry has a large washing machine and separate dryer. Staff use aprons and gloves when performing personal care or doing the laundry, and single use soap and towels are available. As there were no training files available, there was no evidence that staff have had training in food hygiene or infection control, and the providers have been asked to make sure this is done. Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . It was impossible to verify that residents are supported by competent and qualified staff. Not all relevant information was available to verify that residents are protected by the homes recruitment policies and practice. There was no evidence to show that they have their needs met by trained staff. They do not benefit from well supported and supervised staff. Evidence: As Masefield Avenue is a care home with nursing, there is a qualified nurse in charge of every shift. There is also a waking night shift in operation. When we visited, there were one nurse and four care staff working with residents. We were told that there were several staff vacancies although recruitment was underway. It was not possible to discover how many staff had achieved an NVQ or how many were currently studying for one, because there was no record of who had done so in place. The Director of Care Services said that all the staff training records were with the training manager, who was on leave. At the last inspection, the provider was asked to send a copy of staff qualifications to the CSCI. This has not been done, and they have again been asked to do so. Masefield Avenue is supported in its recruitment by the provider organisation, the White Horse Care Trust. Employment checks should include Criminal Records Bureau (CRB) and checks against the Protection of Vulnerable Adults (POVA) register, two written references and a medical declaration. All potential staff should complete an application form, and this should be kept on the individual staff members file. We looked at two staff files, both of which contained all the appropriate information, although one had been brought from the organisations head office, as it had not been stored in the home. However, when we asked to see the file of a new member of staff, we were told that this was not available. There was no evidence of any CRB checks Evidence: being done, or of any references. The failure to have staff files available for inspection was brought to the providers attention following the last inspection. They told us in their Improvement Plan that their personnel manager would ensure that all records were available as required and that copies of relevant documents would be kept in a safe place at the home. They have again failed to do so, and have been asked to do this for the second time. All carers were said to be given an induction pack when they start work at the home. The failure to have this training information available for inspection was brought to the providers attention following the last inspection. They told us in their Improvement Plan that the training manager was booking time to spend at Masefield with staff to sign each persons Common Induction Standards booklet and WHCT Induction booklet as appropriate, and that this would be retained at the home. They have again failed to do so, and have been asked to do this for the second time Previously, one staff member told us: I feel I could have been given a better induction and support. I have fed this back and am working with my manager so other nurses entering the trust do not feel in this position. There was evidence of some training, but there were no full records of the overall training which had been done by staff. This means it was impossible to tell if all staff had done training in manual handling, infection control, medication, food hygiene, health and safety or first aid. The Director of Care said that training summaries were sent to the training manager monthly, but no copies had been kept in the home. The failure to have staff training files available for inspection was brought to the providers attention following the last inspection. They told us in their Improvement Plan that their training manager would ensure that all records were available as required. They have again failed to do so, and have been asked to do this for the second time. Supervision was said to be done every two months, but of the two files we looked at, one person had no supervision recorded for three months and another had none since the end of June. The failure to have supervision files available for inspection was brought to the providers attention following the last inspection. They told us in their Improvement Plan that this would be checked by a senior manager on their bi-monthly care visits. They have again failed to do so, and have been asked to do this for the second time. Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this 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 do not benefit from a well run home. Their views and that of their families underpin the monitoring and review of care practice. Their health, safety and welfare is mainly promoted and protected. Evidence: Since our last visit, the registered manager has retired. A new manager is in post although we have not as yet received an application to register her. As part of their legal responsibilities, the organisation has a duty to inform CSCI of any changes to the management of the home. They had not done so, and we sent them information about how to do this. After the last inspection we asked the providers to give us an Improvement Plan about what they would do to make sure they provided a better service for residents. They wrote to us with the details of the improvements they planned to make. It is concerning to note that some of these improvements have not been made, and we have had to tell them again about some of the things they have to do. The Director of Care, who was present during most of our visit, was keen to tell us that much of the work had been done, although it was not available to us for inspection. We also had such serious concerns for the health and safety of some of the residents that we had to send an urgent letter to the providers. They failed to reply to this letter, so we do not yet know if they have dealt with the matters. White Horse Care Trust have a system of regular internal audits. Part of the responsibility of the senior managers of registered care homes is to visit the home on Evidence: a monthly basis and to write a report about what they looked at and to whom they spoke. This is to ensure that they are monitoring both the health and safety of the residents as well as the quality of the service offered. They have been sending us a copy of these reports at our request, and must continue to do so, until further notice. There were health and safety records in place. The homes fire extinguishers had been serviced: these and other equipment are serviced on a contractual basis. The fridge and freezer temperatures are recorded daily, and other checks are done on a weekly, monthly or quarterly basis. There is a thermometer in the bath to check the ambient temperature, and fire panels are spread throughout the house, including the bathroom. Staff have had fire training, but the homes procedures say that fire drills must be done every three months, and this had not been done over the last quarter. The provider must ensure that fire drills are done regularly, in accordance with the organisations procedures. There is an electrical cupboard in the sitting room which has a sign saying Keep Locked, although this was open. The providers have been told to make sure that if the door needs to be locked then it should be. Are there any outstanding requirements from the last inspection? Yes  No  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, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action 1 1 4 (2) A copy of the home?s 03/07/2008 Statement of Purpose must be made sent to the Commission for Social Care Inspection and must be kept available in the home for inspection at all times. This standard was not assessed at this inspection. The timescale for action was 16/06/08 2 1 5 (1) (b) Each resident must be given 03/07/2008 a copy of the home?s Service User Guide. This standard was not assessed at this inspection. The timescale for action was 04/06/08 3 5 5 (1) (c) All residents must have a contract/statement of terms and conditions on file. 04/07/2008 4 6 17 (1) Where it is necessary to keep 03/07/2008 (a)Schedule 3 records of residents? fluid (m) intake, these records must be fully completed. This standard was not assessed at this inspection. The timescale for action was 04/06/08 5 6 17 (1) Records must detail any 03/07/2008 (a)Schedule 3 action taken in relation to (k) concerns about residents? high body temperature. This standard was not assessed at this inspection. The timescale for action was 04/06/08 6 6 17 (1) Where it is necessary to keep 03/07/2008 (a)Schedule 3 records that residents have (m) had their position moved regularly, these records must be fully completed. This standard was not assessed at this inspection. The timescale for action was 04/06/08 7 6 12 (1) (a) 13 (4) (c) All residents at risk of 03/07/2008 developing pressure sores because of immobility must have a care plan on file which details how this is to be managed. This standard was not assessed at this inspection. The timescale for action was 04/06/08 8 9 13 (4) (c) All risk assessment 03/07/2008 information must be accurate and up to date and must be consistent with any assessment information given by other professionals. They must be fully completed. This standard was not assessed at this inspection. The timescale for action was 04/06/08 9 20 13 (2) All controlled drugs must be 01/10/2008 stored in a cupboard which meets the current storage regulations (The Misuse of Drugs and Misuse of Drugs (Safe Custody) (Amendment) Regulations 2007). The timescale has been extended. 10 20 13 (2) All hand written entries on 11/08/2008 the Medication Administration Record (MAR) must be signed by staff when completed. This requirement had not been met by the previous timescale of 04/06/08 11 20 13(2) Records must be kept of all medicines leaving and returning to the home with residents to ensure a complete audit trail. 11/08/2008 12 20 13 (2) Where residents are to be given homely remedies, eg Nurofen, this must be done in agreement with the person?s medical practitioner. A clear protocol for its use must be in place. This requirement had not been met by the previous timescale of 04/06/08 11/08/2008 13 22 22 (5) All residents and their 03/07/2008 relative/representative must have a copy of the home?s complaints procedure. This standard was not assessed at this inspection. The timescale for action was 04/06/08 14 23 13 (6) All staff must have training in 04/07/2008 Safeguarding Adults. 15 32 18 (1) (a) The registered provider must 03/07/2008 send an up-to-date record of the number of staff with NVQ and the number of staff still studying for NVQ to the CSCI. This standard was not assessed at this inspection. The timescale for action was 04/06/08 16 34 17 Schedule 2 All staff must have evidence 03/07/2008 (7) of an enhaced level CRB and POVA check. This standard was not assessed at this inspection. The timescale for action was 04/06/08 17 34 17 Schedule 2 All staff files must contain 03/07/2008 (1-9) two written references, a full employment history, together with a satisfactory written explanation of any gaps in employment, photographic identification, documentary evidence of any relevent qualifications and training, and evidence of nurses? PIN numbers where relevant. This standard was not assessed at this inspection. The timescale for action was 04/06/08 18 35 18 (1) (c) Specialist training must be provided to make sure that staff have the skills and knowledge to meet the individual needs of people who use the service. 04/07/2008 19 35 18 (1) (c) All staff must have evidence of completed induction training on file. 04/07/2008 20 36 18 (2) (a) All staff must receive supervision on a regular basis. 04/07/2008 21 39 26 Copies of the report of the 03/07/2008 monthly monitoring visits to the home must be sent to the CSCI until further notice. This standard was not assessed at this inspection. The timescale for action was 04/06/08 22 42 13 (4) (a All chemicals must be kept locked up under Control of Substances Hazardous to Health (COSHH) guidelines This standard was not assessed at this inspection. The timescale for action was 04/06/08. 03/07/2008 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 Description Timescale for action 1 6 17 Where it is necessary to keep 26/11/2008 records that residents have had their position moved regularly, these records must be fully completed. Comment: This is the second time this requirement has been made. So that there is an accurate picture of how staff try to prevent pressure damage. 2 9 13 All risk assessments must be 26/11/2008 updated when changes occur in residents circumstances. So that staff are aware of any increased risk of pressure damage. 3 9 13 All risk assessment 26/11/2008 information must be accurate and up to date and must be consistent with any assessment information given by other professionals. Comment: This is the second time this requirement has been made. So that staff take a consistent approach to managing risks identified by health professionals. 4 19 18 All staff must be trained in the use of postural drainage techniques. 26/11/2008 So that residents healthcare needs are met. 5 19 13 Where professional advice is given about medical procedures to benefit the health of residents, this advice must be followed. 26/11/2008 So that residents healthcare needs are met. 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 Description Timescale for action 1 6 12 All residents who have epilepsy must have an epilepsy profile in place. 26/11/2008 So that staff know how best to support them in the event of a seizure. 2 9 13 The registered providers must ensure that all staff read the details of of residents risk assessments. 26/11/2008 So that staff are aware of any risks identified and know how to minimise them. 3 13 16 Residents must be supported 26/11/2008 to take part in age appropriate activities of their choice. So that residents can be part of the local community. 4 13 17 Where residents are unable to say, families must be consulted about their activities. 26/11/2008 So that families know their relatives will be taking part in activities they enjoy. 5 18 15 Residents personal care needs must be documented fully in their care plans and risk assessments. 26/11/2008 So that staff know how they should support them when giving personal care. 6 19 37 All incidents which affect the 26/11/2008 welfare of the residents must be reported to the CSCI. So that they can record and monitor any accidents in the home. 7 20 13 All boxes and bottles of 26/11/2008 medication must have the date recorded when opened. So that there is no danger of using medication after the expiry date. 8 20 18 All care staff must be trained 26/11/2008 to administer medication which might be needed when they are alone with residents. Comment: This is the second time this requirement has been made. So that residents can receive their rescue medication when they need it if alone with care staff not nurses. 9 20 13 All medication must be securely locked away. 26/11/2008 So that residents are safe. 10 23 18 All staff must have training in 26/11/2008 Safeguarding Adults. Comment: This is the second time this requirement has been made. So that staff know how to safeguard the people they work with from abuse. 11 30 18 All staff must have evidence on file of training in food hygiene and infection control. 26/11/2008 So that staff can be aware of how to avoid any cross infection. 12 32 18 The registered provider must 26/11/2008 send an up to date record of the number of staff with NVQ and the number of staff still studying for NVQ to the CSCI. Comment: This is the second time this requirement has been made. So that we can be sure that staff have the qualifications to do the job. 13 34 19 All staff files must contain 26/11/2008 two references, a medical declaration and evidence of a CRB and POVA check and must be available for inspection. Comment: This is the second time this requirement has been made. So that we can see the providers recruitment checks are robust. 14 35 18 All staff must have evidence 26/11/2008 on file of training in first aid, health and safety and manual handling. So that residents can be supported in a safe manner. 15 35 18 All staff must have evidence 26/11/2008 of completed induction training on file. Comment: This is the second time this requirement has been made. So that we can see that new staff have training which will help them support residents. 16 36 18 All staff must receive 26/11/2008 supervision on a regular basis. Comment: This is the second time this requirement has been made. So that staff have one to one time with their line manager to discuss their working practice. 17 37 39 The providers must notify 26/11/2008 CSCI when there are any changes to the management of the care home. So that we are aware of who is supervising the care of the residents. 18 39 26 Copies of the report of the 26/11/2008 monthly monitoring visits to the home must be sent to the CSCI until further notice. Comment: This is the second time this requirement has been made. So that we know that senior management is monitoring the progress of the home. 19 42 13 Doors with signs which say they are to be kept locked must be kept locked. 26/11/2008 So that residents will be safe. 20 42 23 Fire drills must be done 26/11/2008 regularly, in accordance with the organisations procedures. So that staff know what to do in the event of a fire. 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 2 1 6 The homes Statement of Purpose should be updated to include details of the current management arrangements. The registered providers should make sure they get a copy of the residents most recent Community Care Assessments. 3 6 Care should be taken over the language used when recording in peoples care plans in order that staff do not sound judgemental or deprive people of their dignity. Residents care plans should be more tailored to the individual and souled be more person-centred. All residents should have one care plan folder where all their current information is kept. Comment: This is the second time we have made this recommendation. Residents risk assessments should be kept alongside their care plans. Staff on duty should be seen to interact more with residents rather than talking to each other or watching television. All residents should have a personal Health Action Plan. All care staff should be encouraged to support the nurses and remove any medication lying around. 4 5 6 6 6 7 9 13 8 9 19 20 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. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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. 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