Care Home: Primrose

What the care home does well The small core members of staff are working hard to maintain stability and consistency during this difficult time whilst the home is subject to enforcement action. What the care home could do better: Six immediate requirements and fifteen requirements were made at the last key inspection. Three requirements have not been complied with in regard to the recruitment practices, maintaining confidentiality of residents and formal one-to-one staff supervision. The manager was served with a Code B Notice but he refused to sign this important document that is part of the regulations and inspection process. Two requirements have been as a result of this random inspection. The Control Of Substances Hazardous to Health (COSHH) must be kept secure in lockable facilities and hot water must be available in all bedrooms. Inspecting for better lives Random inspection report Care homes for older people Name: Address: Primrose Coley Avenue Woking Surrey GU22 7BT zero star poor service 08/09/2008 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 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: Joseph Croft Date: 0 5 0 3 2 0 0 9 Information about the care home Name of care home: Address: Primrose Coley Avenue Woking Surrey GU22 7BT 01483772344 Telephone number: Fax number: Email address: Provider web address: shahidshanty@aol.com Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : SN Care LLP care home 16 Number of places (if applicable): Under 65 Over 65 0 0 dementia mental disorder, excluding learning disability or dementia Conditions of registration: 16 16 The maximum number of service users to be accommodated is 16. 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) Mental disorder, excluding learning disability or dementia (MD) Date of last inspection Brief description of the care home Primrose is a detached house in its own grounds in Woking, close to the town centre. The home is registered to accommodate sixteen residents in single and double bedrooms that are on two floors. Bedrooms have their own sinks and there is a communal bathroom, shower room and toilets.The first floor is accessible by a passenger lift and stairs. There is a lounge, day room, kitchen and laundry room on the ground floor. The home has its own garden area that can be used in the Care Homes for Older People Page 2 of 15 0 8 0 9 2 0 0 8 Brief description of the care home appropriate weather conditions. The fees at the home range from GBP365.00 to GBP400.00 per week. The organisation changed the name of the home from The Shanty to Primrose on the 12th January 2009. Care Homes for Older People Page 3 of 15 What we found: This home is subject to enforcement action. Notices of proposal to cancel registration of SN Care LLP were issued on the the 16th February 2009. A notice of proposal to cancel the registration of the manager was issued on the 9th March 2009. This unannounced inspection was carried out to monitor the wellbeing of people using the service. Regulation Inspector Mr Joe Croft and Regulation Manager Mrs Rosemarie James undertook the site visit that took over four hours to complete, commencing at 10:10am and concluding at 14:40. The registered manager was not present at the beginning of the site visit, but did attend the home approximately 10:40am, and remained at the home for the rest of the site visit. The inspection process included a tour of the premises that are used by the current four residents, observation of practice and sampling of residents care plans and risk assessments. Other documents sampled included the menu, records of medication, training records, staff duty rota, recruitment files and health and safety records. The Inspectors had discussions with the manager and one member of staff. It was not possible to seek the views of residents as our presence was causing distress to one resident, and the other three residents have Dementia. The Annual Quality Assurance Assessment (AQAA) completed by the manager of the care home has been used as a source of evidence in this report. Surveys were sent to residents, staff and health care professionals, however, at the time of writing this report we had not received any completed surveys. Feedback was provided to the registered manager at the end of this site visit. The manager was reminded that we had not received any surveys, however, we would contact the manager if surveys returned to us raised any concerns or include any compliments about the care provided at the home. Choice Of Home. The home has a Statement of Purpose and Service Users Guide that were viewed during the site visit. This provided the information as required. Evidence was seen of one residents contract and terms of conditions had recently been drafted. During discussions the manager told us that he would provide the same for the other three residents currently living at the home. There have not been any new admissions since the new owners bought the home in April 2008. The manager told us the same as he did at the site visit of September 2008, that he has a tool he uses in his other care home for the purpose of preadmissions. Again this document was not available for viewing at this site visit. The manager told us that he intends to use this documentation when assessing all prospective residents. The two care files sampled on the day of the site visit included initial assessment documentation. Care Homes for Older People Page 4 of 15 The Annual Quality Assurance Assessment (AQAA) informs that there have not been any new admissions to the home. The home has a policy where by prospective residents and their relatives are invited to visit the home, at which time they would be provided with a copy of the Statement of Purpose. Intermediate care is not provided at Primrose. Health and Personal Care. Individual residents files were kept in the office. Two care plans were viewed, both included a photograph of the resident, and a copy of the initial assessment documentation. Other information in the care plans included personal care, social interaction, interests and activities, medication, emotional well-being, food, memory orientation, mobility and religion. Risk assessments for Moving and Handling were included in the care plans viewed, and were being reviewed. From discussions with staff and from viewing records, it was clear that residents have access to all health care professionals as required. These include a General Practitioner (GP), Dentist, Optician and Chiropodist. Records of monthly weights were also being recorded. Daily notes are maintained on each resident, however, these books were observed to be stored in the day room with the visitors book. This does not assure the confidentiality of residents living at the home. The requirement made in the last inspection report in regard to this has not been complied with. The home continues to use the Boots blister packs and Medication Administration Record sheets (MARs) that were viewed during the site visit. The MAR sheets were accurately maintained and no omissions were noted. Any alterations on the MAR sheets were signed by the GP. It was noted that the medication keys were not left in the office. The senior person on duty has the medication keys with them at all times, therefore the requirement made at the last inspection in regard to the medication keys has been complied with. One member of staff told us that all staff have attended training in regard to administering medication. The sampling of six training files provided evidence that three staff had received this training, and three staff were receiving this training during their induction. Discussions took place with the manager in regard to the benefit of having photographs of residents on their MAR sheets. During discussions one member of staff told us that they attend to personal care in the privacy of residents bedrooms, talk to them when attending to their personal care needs and covering them as appropriate. All staff knock on doors before entering residents bedrooms. The AQAA informs that the health care needs of residents are met. Daily Life and Social Activities. Care Homes for Older People Page 5 of 15 On the day of the site visit residents were observed sitting in the lounge. One resident was having their hair done by a hairdresser who visits the home every Thursday. During discussions with one member of staff we were told that activities take place in the morning and afternoon. Activities offered included bingo, exercises, reading, manicures, music, dancing and board games. There was a list of activities in the sitting room, and activities were recorded in the care plans viewed. Staff told us that relatives do visit the home and they can go out if they wish. The visitors book provided evidence that the home has regular visitors. We were told that none of the residents are religious, but a vicar had recently visited the home. On the day of the site visit staff were observed interacting with residents in a professional manner, offering support as and when required. Residents were involved in an activity of listening to music. The home maintains the menu in a diary that is kept in the kitchen. The meal for the day of the site visit matched the meal as recorded in the diary. The menu included fresh meat, fish, pasta, fresh vegetables and fruit. One member of staff told us that they provide both fresh and frozen vegetables in the meals. Food was appropriately stored in the fridge, and included fresh vegetables. This was in compliance with a requirement that was made at the last inspection. Other foods stored in the fridge were labelled and included the date they were opened. On the day of the site visit the food was freshly cooked and residents were observed enjoying their meal in a relaxed atmosphere in the dining room with staff available to provide support as and when required. The sampling of training records provided evidence that staff had received training in regard to food hygiene and handling, and new staff were covering this in the Skills For Care Induction training. The AQAA informs that residents suffer with Dementia and as such they are unable to understand or to give feedback on what they like or dislike. Complaints and Protection. The home continues to have a complaints procedure in place that provides the timescales for responding to complainants. The Commission For Social Care Inspection has received one complaint in regard to the home that was referred to the manager, who promptly provided a response. A second complaint was received from the same anonymous complainant that was discussed with the manager during this site visit. The elements of this complaint were not upheld as evidence was viewed that contradicted the complaint. The manager told us that the home had not received any complaints since he bought the home in April 2008. The complaints book was viewed and there were no recorded complaints. The home has one Safeguarding issue that is ongoing. Care Homes for Older People Page 6 of 15 As reported in the last key inspection report, the manager is aware of the Surrey MultiAgency procedures for Safeguarding Adults, and a copy of the recent Surrey procedures were available at the home. The manager told us that he had undertaken training in Kent that enables him to train his staff in regard to Safeguarding Adults. A requirement was made during the last key inspection that the manager must submit an application to attend the Surrey Multi-Agency training on Safeguarding Adults. The manager told us that he had discussed this with the Surrey Multi - Agency and the Surrey Care Association who advised that this was not necessary for him as the procedures are very similar to those of Kent. The AQAA informs that the home has a Safeguarding and Whistle - Blowing policy that were last reviewed in February 2009. The sampling of staff training files provided evidence that three staff had attended training in regard to Safeguarding Adults, although this was during their previous employment prior to commencing at the home. New staff receive this training during their induction training. Discussions took place with one member of staff in regard to Safeguarding. This person was knowledgeable, knew the different types of abuse and who to report suspicions of abuse to. They were also aware of the responsibilities of the manager and the action they are required to take in response to suspicions of abuse. The recruitment practices of the home are not fully ensuring that residents are safeguarded from abuse as required by Regulation. This is covered under the Staffing section of this report. The home does not hold any monies for service users. The AQAA informs that the home has an adequate complaints procedure that covers all relative topics. The home has all the policies and procedures in place addressing issues of abuse and Adult Protection. Environment. A partial tour of the premises was undertaken. The bedrooms that current residents occupy and the ground floor of the premises were viewed. Bedrooms have their own sinks, a wardrobe, chest of drawers, chairs and a television. Each bedroom included the personal effects of residents. New bed linen had been provided and the bedrooms were clean and tidy. However, there was no hot water coming through the taps in any of the bedrooms. This was discussed with the manager who told us that the taps should be left to run for a while to let the hot water reach them. This was done, but no hot water came through the taps. A requirement in regard to this has been made. On the day of the site visit the bedrooms, including bedroom number seven, were free of malodour. This was in compliance with the requirements made at the last key inspection. There is a lounge, day room, kitchen, laundry, communal bathroom, shower room and toilets. The lounge had been refurbished with new chairs, and the four residents were Care Homes for Older People Page 7 of 15 sitting in this room during the site visit listening to music and taking part in other activities. The laundry room door was again wedged open during the site visit, as were the lounge and diningroom doors. The laundry door clearly displays a sign stating Fire Door Keep Shut. We have reported our findings to the local Fire Safety Officer. The Control Of Substances Hazardous to Health (COSHH), which was brought to the attention of the manager during the site visit of September 2008, were again left on the shelf and the floor in the laundry room, and within easy reach of residents. The lid of the COSHH substance on the shelf was loose. A requirement in regard to this has been made under the Management and Administration section of this report. The shower room still has missing wall tiles and approximately a six-inch gap on the bottom of the door. The manager made it very clear that the residents do not use this shower room, they all currently use the bathroom for their bathing needs. Sampling of training files provided evidence that two members of staff had attended training in Infection Control. The manager told us that this is also included in the Skills for Care induction Standards. Protective aprons and gloves were available for staff to use. The home had new boilers fitted during September 2008. The home has its own garden area that can be used in the appropriate weather conditions. On the day of this site visit the home was clean, tidy and free from offensive odour. The AQAA informs that the home is well maintained and comfortable, and they have been trying to create a homely atmosphere. Staffing. The staff duty rota for the week of the site visit was viewed. This provided evidence that there are two members of staff on duty each shift attending to the assessed needs of the four current residents. It was noted that the requirement made at the last inspection in regard to staff not working twenty fours shifts without a break was being complied with. Staff were working between twelve and forty two hours that week. One member of staff covers the night duties. The manager told us that there is a senior member of staff on duty each shift, and that he is confident that the staff he has appointed as seniors are capable of undertaking that role. The AQAA informs that the home has a Recruitment and Employment Policy that was last reviewed in February 2009. Three recruitment files of new staff were viewed during the site visit. These files had evidence that Protection Of Vulnerable Adult (POVA) First and Criminal Record Bureau checks had been undertaken. This was in compliance with requirements made at the last inspection. The three files sampled including application forms, however, these were only requesting the details of the last two jobs, not a full employment history as required. We could evidence records of two written references for two members of Care Homes for Older People Page 8 of 15 staff, but could only evidence at the home that one written reference had been obtained for one identified member of staff. Records of dates of employment were not recorded at the home, therefore it was not possible to evidence that members of staff had commenced their duties on the dates the manager had told us during this site visit. The manager told us These were approximate dates. A requirement made at the last inspection in regard to the recruitment practices of the home has not been complied with. Evidence that one member of staff had completed the Skills For Care Common Induction Standards was viewed for one member of staff. The manager told us that the other staff files sampled, who were new members of staff, are undertaking their induction, and when completed, copies of these would be forwarded to the Commission for Social Care Inspection. The AQAA informs that of the nine care staff employed at the home, three hold the minimum of an NVQ level two and above, and All our staff are doing their NVQ in social care and have many years experience in care of residents in care home setting. The manager confirmed this during this site visit. The AQAA also informs that recruitment processes and all related information are retained on the files and are up-to-date. Management and Administration. The registered managers company purchased this home in April 2008, and he continues to manage the home. The manager entered the care industry as the provider and manager of another care home in Kent in 1999. He has achieved qualifications relevant to his post as manager of a care home, including the City and Guilds Advanced Management for Care and the Registered Managers Award Sept 2006. These would have been evidenced during his fit person interview for the registered manager in April 2008. However, the manager still did not have his training file at the home on the day of the site visit, therefore it was not possible to evidence the certificates of recent training he has undertaken. Discussions took place with the manager in regard to this and was advised of the benefits of having his certificates displayed at the home. As stated at the beginning of this report, the home is subject to enforcement action. Notices of proposal to cancel registration of SN Care LLP were issued on the the 16th February 2009. A notice of proposal to cancel the registration of the manager was issued on the 9th March 2009. During the last inspection of September 2008, the manager told us that he had prepared a questionnaire to ascertain the views of residents, relatives and other associated professionals, and would be sending them to out by the 15th October 2008. However, during this site visit the manager told us that these would be sent out in April 2009, as that would be the first year completed under the new company. Staff at the home do not manage residents finances. The manager told us during the last key inspection that residents families deal with their finances. Care Homes for Older People Page 9 of 15 The manager is still not undertaking formal one-to-one supervision with staff working at the care home, therefore the manager has not complied with the requirement made at the inspection of September 2008 in regard to this. Staff at the home continue to maintain the confidential Individual daily record books pertaining to residents in the day room with the visitors book. This is not in compliance with the previous requirement made in that confidentiality in respect of residents living at the home must be upheld at all times. The viewing of four staff training files provided evidence that staff had attended most mandatory training that included first aid, manual handling, food handling and hygiene, Infection Control, medication, health and safety and Safeguarding Adults, albeit that this training was undertaken at their previous employment. The Control of Substances Hazardous to Health (COSHH) are not being stored securely, which could lead to unnecessary risks to the health or safety of residents living at the home. The laundry room door was wedged open and there were COSHH substances, one of which had the lid of the container loose, that were accessible to service users. A requirement has been made in regard to this. The AQAA informs that all policies and procedures had been reviewed in February 2009, and the service of maintenance equipment had been undertaken. Evidence was viewed during the site visit that the portable electric appliance testing had been undertaken. The fire extinguishers had been tested on the 3rd July 2009, the gas safety certificate was dated 5th September 2008. Liability insurance expires on the 12th February 2010. What the care home does well: What they could do better: 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 10 of 15 Are there any outstanding requirements from the last inspection? Yes R 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 29 19 The registered person shall 08/10/2008 not employ a person to work at the care home unless the person is fit to work at the care home, subject to paragraphs (6),(8),and (9), he has obtained in respect of the person the information and documents specified in paragraphs 1-9 of Schedule 2. Staff recruitment files must contain all as stated in Regulation 19 and Schedule 2 of The Care Home Regulations 2001. 2 36 18 The registered person shall 08/10/2008 ensure that persons working at the care home are appropriately supervised. The manager must commence and ensure all staff receive formal recorded one-to-one supervision at least six times per year. 3 37 12 The registered person shall 08/10/2008 make suitable arrangements to ensure that the care home is conducted in a manner which respects the privacy and dignity of service users. Confidentiality in respect of Care Homes for Older People Page 11 of 15 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 service users living at the home must be upheld at all times. Care Homes for Older People Page 12 of 15 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 21 23 The registered person shall 31/03/2009 having regard to the number and needs of the service users ensure that there are provided at appropriate places in the premises sufficient numbers of lavotaries, and of washbasins, baths and showers fitted with a hot and cold water supply. Hot water must be available in all bedrooms. 2 38 13 The registered person shall 31/03/2009 ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. The Control of Substances Hazardous to Health (COSHH) that are in the laundry must be kept secure in lockable facilities to prevent unnecessary risks to the health or safety of service users. Care Homes for Older People Page 13 of 15 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 14 of 15 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: 03000 616161 or Textphone: or 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. 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. Care Homes for Older People Page 15 of 15 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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