Care Home: Southview

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What the care home does well Communication between the provider and the Care Quality Commission has improved. The regular updates have informed us of progress that is being made to improve the service for the people who use it. This includes including actions taken to address issues of concern and safety identified during our visit. Staffing levels have improved. At the time of this inspection the registered manager felt she could trust the staff to work together as a reliable team. Visitors told us that they are made to feel welcome and offered refreshments on arrival and when the people living at Southview were given drinks. The provider is making improvements to the home. The outside of the building, forexample, had been repainted just prior to this visit. Bedrooms are also being redecorated and refurbished. Since our inspection the laundry floor has been upgraded and a flat roof is being replaced. What the care home could do better: Care plans must continue to improve to show what individual needs each person has and show how these needs can be met in a person centred way. Communication between staff should also improve to ensure staff are provided with sufficient time to exchange information. This will mean that staff have accurate information on changes and needs of each person. Information about individuals must be recorded on their care files to ensure confidentiality. Changes to work practices and cultures must continue to ensure that people are cared for in a flexible way. Staff must ensure their work practices fit around each person rather than the other way around. Staff must also remember that people less able to express their views are consulted about choices about, for example, the time they were woken up or have their breakfast. Staff must also make sure they do not assume that some people consistently want the same things or routines each day. By ensuring staff cultures change at the home will mean that people will feel able to take more control over their daily lives. The safety of people must continue to be a priority in the home. Staff must remember that people need access to a call bell when they are in communal areas or in their bedrooms with no staff presence. Bedroom doors should be fitted with locks suited to individual capabilities and accessible to staff in emergencies. People should be provided with keys unless their risk assessment suggest otherwise. This was a recommendation at the key inspection in July 2009. Fire safety must be a priority for the provider of this service. We wrote to the Devon and Somerset Fire and Rescue Service about our concerns regarding fire safety at Southview. Consequently the Devon and Somerset Fire and Rescue Service conducted an audit of the premises at Southview. Issues of concern were addressed directly with the registered provider by the Fire Safety Officer at the time of the audit. The Fire Service has advised us that the home`s evacuation plan needs to reflect which doors are likely to be held open by people`s personal items so that a phased evacuation can be implemented in the event of a fire incident. The staff need to work with the person(s) concerned to help them understand why these fire safety precautions must be implemented. We were also informed by the Fire Service that the provider plans to upgrade the fire alarm system, and replace the home`s hold-open devices with more reliable up to date models some time in the future. Not all areas of the home were safe. A tour of the premises both indoors and outdoors found we were able to access COSHH products (Control of Substances Hazardous to Health), sharp tools and paint products. These could all pose a risk to a person with confusion. Since our visit the provider has advised us that the laundry floor has been upgraded and all hazardous substances have been moved into a lockable cupboard. Arrangements are in place to prevent anyone from wandering out to the laundry area. Tools and paint products have been removed from the home or stored appropriately.The two Infection Control Link workers should be encouraged to be pro-active about informal `on the floor` peer training and supervision to encourage all staff to adopt good infection control practices. Staff training in First Aid, Moving and Handling, and Food Hygiene must be completed in the near future. This will ensure staff are up to date with current practice, they assist the people using this service in a way that protects their health and safety, and they are able to respond appropriately in the event of an emergency. Since our inspection the provider has advised us that all staff are now up to date with mandatory training. Random inspection report Care homes for older people Name: Address: Southview Woodside Lipson Plymouth Devon PL4 8QE one star adequate service 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: Megan Walker Date: 1 0 0 6 2 0 1 0 Information about the care home Name of care home: Address: Southview Woodside Lipson Plymouth Devon PL4 8QE 01752667853 01752667853 southview@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Anna Louise Chapman Type of registration: Number of places registered: Conditions of registration: Category(ies) : Ashley Residential Care Ltd care home 19 Number of places (if applicable): Under 65 Over 65 19 19 dementia old age, not falling within any other category Conditions of registration: 0 0 The categories of registration are OP and DE(E). The home may accommodate a maximum of 19 older people (over the age of 65) who may also have dementia. Date of last inspection Brief description of the care home Southview is registered as a care home to provide accommodation and personal care for up to 19 older people, aged over 65, who may also have a dementia care need. The home is not registered to provide nursing care or intermediate care. Care Homes for Older People Page 2 of 14 2 6 0 2 2 0 1 0 Brief description of the care home Southview is privately owned by Ashley Residential Care Ltd. The Responsible Individual and Registered Manager is Mrs Anna Chapman. Southview is a single storey detached property situated in the residential area of Lipson, Plymouth. It is close to local amenities and transport links. It offers 17 single bedrooms and one double bedroom: eight of the single bedrooms have en-suite toilet facilities. There are two bathrooms and four toilets for communal use. The home has a large lounge and a dining room. Accommodation is centred around a courtyard and garden and all areas are accessible to the residents. There is a small area of on-street parking available outside the home. The fees for the home are dependent upon an assessment of individuals care needs. Information relating to the fees and services provided at Southview can be obtained directly from the home. Care Homes for Older People Page 3 of 14 What we found: This was a random inspection undertaken by one regulation inspector to check compliance with regulation. Southview was lasted inspected on 9th July 2009 when it was rated Adequate. The fieldwork part of this inspection was unannounced and took place on Thursday 10th June 2010 between 08:30 and 16:00. An Expert by Experience joined part of our visit. The Care Quality Commission (CQC) considers an Expert by Experience as a person who either has a shared experience of using services or understands how people in this service communicate. On arrival we were met by one of the Team Leaders and the Deputy Manager. The registered manager was not working that day however she arrived at the care home later during the morning. There were two care assistants, a cook and a cleaner also working on the day of our visit. We found that most people were up and having breakfast in the dining room when we arrived. We were told by the staff that some people prefer to lie in and get up later. We were told by the manager that people can choose to have breakfast as late as they wish. Generally people were content that they retired and rose at times of their own choosing. One person said they rose at 5.30am as they had done so all their working life and received a cup of tea at 7.30am followed by breakfast at 8am. This person added that they retired at 5.30pm and settled down at 8.30pm. Another person said that there was not enough staff on duty in the mornings. This meant that delays could occur in assistance with washing and dressing. They also added that in the evening they sometimes had to wait until quite late for help to go to bed. We spent a short period of time sitting in the lounge observing what it was like for the people living there. As people finished breakfast, they either went through to the lounge or returned to their bedrooms. There was little interaction between the people sitting in the lounge and the absence of conversation was noticeable. By mid-morning those who were sitting in the lounge were sleeping or dozing. The television was on. One person wished to change the channel however did not know how to do this. We sought assistance from a staff member who told us that usually another person had the remote control for the television, and operated it. It was unclear if this meant that this person always chose what was watched. The person we observed knew the type of programme they wished to watch and the staff member was able to assist with this. We found that the position of the television means that the people who sit in one area of the lounge cannot see it, only hear it. We have been advised by the provider that one part of the lounge is deliberately separate to allow for conversation or smaller activity sessions. Music from the The Sound of Music played continuously on a loop in the hallway, near the lounge door. The noise levels in this part of the lounge were significant. When we came out of the lounge we experienced a similar volume of noise clashing as a radio was playing in the dining room, the sound from the television coming from the lounge, and the music playing from the music system in the hallway. The provider has advised us that Care Homes for Older People Page 4 of 14 since our inspection this has been raised with the people residing at Southview and they wish the arrangements to continue. We asked people if they have a choice about what they do and where they go. A couple of people recalled playing Bingo. The calendar for June announced a barbecue, a singalong and a harpist. The registered manager confirmed that these events had taken place. She told us that the previous day an entertainer had visited. The Team Leader told us that the staff lead music sessions every morning and these are popular. Before lunch three care assistants led a music session encouraging people to sing songs from the First World War period accompanied by tambourines and recorded music. A few people said they take advantage of the pleasant and sheltered garden containing decking with seating, tables and umbrellas. Staff told us that refreshments are taken in that area from time to time. A visitor from a local church comes each month to lead prayers and to talk. Later this year some people have the opportunity to go to the theatre to watch a show. This is a regular past time organised for those people who enjoy theatre. Some people recalled a recent visit to the Plymouth Marine Aquarium followed by a lunch. We saw a photographic record of the aquarium visit on display in the corridor. The provider told us that individual trips are arranged to reflect individual choice. We found that some people prefer not to join any activity. We were told, I dont go into the lounge now as it is not like it used to be when I first came here. When asked about this they said, Theres a different type of person here now and I dont want to mix with them. Another person said, It can be very noisy in the lounge because the telly or music is so loud as many people are deaf. Another said, In the evening the T/V programmes in the lounge are more what the staff want than what the residents want, too much violence. Fourteen residents took lunch in the dining room and three people chose to eat in their bedrooms. One person spending the day in their bedroom said they were not well enough to eat lunch. The menu of the day was either ham salad or an All Day Breakfast consisting of bacon, egg, sausage, waffle and tinned tomatoes. We observed a member of staff individually asking people for their preference. Some people found the concept of breakfast for lunch confusing. The hot food was freshly cooked and all the meals looked inviting. Few people managed to clear their plates. One member of staff sat at each of the four dining tables eating the same food as the residents and engaging in conversation with their fellow diners. No one was seen to need assistance. Drinks appeared to be freely available in the lounge and in bedrooms. The majority of the people spoke well of the food and were aware that if they did not like either of the two menu items for the main meal an alternative would be available. The registered manager told us that the lunchtime meal is the main meal of the day. People may choose to have this later at teatime. We found that with one exception everyone we asked was satisfied with the call bell response time both day and night. One person told us that in the night a care assistant would arrive and cancel the call bell saying they would return but sometimes failed to do so. We chose four people, both men and women, to look at their care files and care generally. Each care file seen stated the name by which the person preferred to be called. There was a section about who the person wished to be involved with their care. This was not completed on all the files we looked at.There was an assessment of each persons Care Homes for Older People Page 5 of 14 care needs and some instructions for staff about how to provide care. We also found that information provided in social worker support plans was not found in the homes care plan. We were concerned that the detailed plan of care provided by social workers was diminished and its context lost in the homes care plan. For example, one person was identified as at high risk of malnutrition. There was clear information why and how to manage this risk from the social worker however the reasons were not in the homes care plan and the portrayal of the risk was much lower. We found the care plans had charts that would usually be kept by a care home providing nursing care. Care staff are held accountable for gathering information however there was no evidence to show that the care staff followed up on this information. We were concerned that there is an over expectation on the care staff skills of knowing what and how to do things, and the expected outcomes. Since our inspection the provider has consulted the care staff about our concerns and informed us that they are confident about using the charts. We were assured that the staff receive a comprehensive induction explaining the purpose of the charts, and they would ask the provider if they were unsure about something. We found that daily records were variable in their content. For example in one persons notes Fine, and Good diet were repeatedly used with no other information. Another persons daily records were more informative providing a clear picture of how the person had passed their day, and exact record for the food and drink taken over the course of the day. The deputy manager confirmed that styles of recording was something with which he was aware care staff required further training. We found detailed information about individuals recorded in the staff communications book. We advised the deputy manager that staff should record information in the individuals care files to protect confidentiality. During our tour of the premises we found that in several of the bedrooms the call bell was out of reach of the person sitting in an armchair. One call bell was jammed between the wall and under the bed. We were concerned that people would not be able summon help when they need assistance or in an emergency. We found that the home was generally clean, well decorated and furnished although there was evidence of water ingress in several places. The bathroom appears due for renovation. We found the notice on the bath hoist indicated it was due for service in May 2009. Some bedroom doors have memory boxes containing items selected by the resident to assist them to identify their own bedroom. All bedrooms visited contain personal items and look homely. Bedrooms did not have locks on the doors. One person told us that that a resident of the other gender frequently enters their bedroom in the late evening waking them when they have settled down to sleep. The intruder is said not to speak and departs when shouted at. The complainant said they did not feel physically threatened but resented being awoken. Requests to the registered manager for a door lock to be fitted have been fruitless. We found easy access to the laundry through an unlocked door at the back of the home. In the laundry we found hazardous substances stored on an open shelving unit. We were concerned that because the door was not locked or alarmed anyone could gain access to the laundry and to these hazardous substances. We found that the laundry floor was permeable. There was an old piece of carpet in the entrance to the laundry. This means Care Homes for Older People Page 6 of 14 there is a risk of cross infection as well as a trip hazard. We found that the areas on public view are tidy without being austere and the garden is pleasant and secure, however in the back garden we found an area at end of the annexe that was used for dumping unwanted items. It looked unsightly. It was also a potential risk for anyone who may wander into this area as was a hose pipe we found trailing across the path. In the back garden and also outside the laundry we found raised areas with no rail or guard to protect people from falling off the edge. We found there were supplies of gloves, aprons and hand washing equipment throughout the home for staff to use. Antiseptic hand gel was available by the visitors book at the entrance. Staff have had further cross infection training since our inspection, and the Link Workers continue to attend quarterly meetings led by the Infection Control team. We found a number of bedroom doors propped open by various items rather than approved hold-open devices. We have found this on previous inspections. Staff told us that this is a constant battle with these individuals who in some cases put their own door stops in front of approved hold-open devices. On moving these objects, we found that some of the approved hold-open devices did not work. We were concerned that the appropriate measures to ensure approved hold-open devices are maintained in working order is not happening because staff are not aware of the fire safety risks. We found a bedroom door that does not close securely into the latch. This was identified at our last inspection in February this year. This means that in the event of a fire people would be at risk. We advised the registered manager to ensure that as part of the routine maintenance checks all doors close securely so that people are at less risk in the event of a fire. The manager confirmed that fire safety training was carried out at the beginning of June this year, and that most staff had attended this. This training is for staff who work at Southview and staff who work at another care home owned by the same provider. We are concerned that this training is theoretical and general fire safety awareness. There may be a period of several months until a practical fire drill is held at Southview as staff have told us the training is held at either care home, not necessarily their place of work. We found that eight new staff have been appointed since our last random inspection in February 2010. We looked at two staff files, people who have been recruited since the last inspection. We found that they each had all the required checks completed. The registered manager confirmed that any new staff member is supplementary on the staff rota and they do not work alone until they have completed their induction period. New staff undertake the Skills For Care Common Induction programme. We spoke to two new staff members. One told us that she was gradually gaining confidence having shadowed colleagues and was receiving training from them. We found that most of the staff team have completed Safeguarding of Vulnerable Adults training, and all the staff have attended an introduction to the Mental Capacity Act and the Deprivation of Liberties Safeguards. First Aid and Moving and Handling need updating for all staff, as does Food Hygiene for staff who work at night. Most staff completed a dementia care training course in May this year. The home has two members of staff who are Infection Control Link Workers. This means they have responsibility for keeping all the staff up to date with good infection control practices. Care Homes for Older People Page 7 of 14 We found that the people living at Southview and visitors spoke mainly favourably about the staff. Comments included They look after me OK, Staff are very nice, The staff are kind and gentle, The staff are like friends, well they are friends, The staff are very friendly, The staff are marvellous and treat me well and The older staff are better as the younger ones are not yet trained. A visitor told us that when essential tasks had been completed, the staff were more inclined to gather together and chat than lead activities in the lounge or engage one to one with the people living at Southview. We found that not everyone admitted to knowing who the registered manager was. Some mistook the deputy manager for the registered manager. One person said, Im glad to say I dont see them very often, I dont like them or their attitude. A visitor said, I dont find the manager approachable so I dont take any issues to her. The provider has subsequently told us We have spoken to all but one of the visitors who visit the home. They were concerned about the comments raised concerning how approachable management were. Our meetings and confidential survey confirmed that approximately 90 of carers and professionals were more than satisfied with the approach we took to managing the home. Of those who responded, a significant number said that no other home, when they were looking around, gave them the owners personal mobile number as a contact point should they have any concerns. We found that the people who have lived at Southview for a while made reference to what they saw as a very high turnover of staff. Some people said they found found it very stressful to have to get used to new carers all the time. A very regular visitor commented that frequently she is admitted to the premises by another new face. People voiced that in their opinion that the frequent departure of staff was due to management style and/or the management attitude towards staff and quoted instances of issues staff had told them. We were concerned that staff discuss such issues with the people living at the home and their families as this is inappropriate behaviour. Following our previous inspection we discussed similar issues with the registered manager. Since this inspection, we have received assurances that these recent issues were isolated instances, dealt with at the time by the registered manager. What the care home does well: Communication between the provider and the Care Quality Commission has improved. The regular updates have informed us of progress that is being made to improve the service for the people who use it. This includes including actions taken to address issues of concern and safety identified during our visit. Staffing levels have improved. At the time of this inspection the registered manager felt she could trust the staff to work together as a reliable team. Visitors told us that they are made to feel welcome and offered refreshments on arrival and when the people living at Southview were given drinks. The provider is making improvements to the home. The outside of the building, for Care Homes for Older People Page 8 of 14 example, had been repainted just prior to this visit. Bedrooms are also being redecorated and refurbished. Since our inspection the laundry floor has been upgraded and a flat roof is being replaced. What they could do better: Care plans must continue to improve to show what individual needs each person has and show how these needs can be met in a person centred way. Communication between staff should also improve to ensure staff are provided with sufficient time to exchange information. This will mean that staff have accurate information on changes and needs of each person. Information about individuals must be recorded on their care files to ensure confidentiality. Changes to work practices and cultures must continue to ensure that people are cared for in a flexible way. Staff must ensure their work practices fit around each person rather than the other way around. Staff must also remember that people less able to express their views are consulted about choices about, for example, the time they were woken up or have their breakfast. Staff must also make sure they do not assume that some people consistently want the same things or routines each day. By ensuring staff cultures change at the home will mean that people will feel able to take more control over their daily lives. The safety of people must continue to be a priority in the home. Staff must remember that people need access to a call bell when they are in communal areas or in their bedrooms with no staff presence. Bedroom doors should be fitted with locks suited to individual capabilities and accessible to staff in emergencies. People should be provided with keys unless their risk assessment suggest otherwise. This was a recommendation at the key inspection in July 2009. Fire safety must be a priority for the provider of this service. We wrote to the Devon and Somerset Fire and Rescue Service about our concerns regarding fire safety at Southview. Consequently the Devon and Somerset Fire and Rescue Service conducted an audit of the premises at Southview. Issues of concern were addressed directly with the registered provider by the Fire Safety Officer at the time of the audit. The Fire Service has advised us that the homes evacuation plan needs to reflect which doors are likely to be held open by peoples personal items so that a phased evacuation can be implemented in the event of a fire incident. The staff need to work with the person(s) concerned to help them understand why these fire safety precautions must be implemented. We were also informed by the Fire Service that the provider plans to upgrade the fire alarm system, and replace the homes hold-open devices with more reliable up to date models some time in the future. Not all areas of the home were safe. A tour of the premises both indoors and outdoors found we were able to access COSHH products (Control of Substances Hazardous to Health), sharp tools and paint products. These could all pose a risk to a person with confusion. Since our visit the provider has advised us that the laundry floor has been upgraded and all hazardous substances have been moved into a lockable cupboard. Arrangements are in place to prevent anyone from wandering out to the laundry area. Tools and paint products have been removed from the home or stored appropriately. Care Homes for Older People Page 9 of 14 The two Infection Control Link workers should be encouraged to be pro-active about informal on the floor peer training and supervision to encourage all staff to adopt good infection control practices. Staff training in First Aid, Moving and Handling, and Food Hygiene must be completed in the near future. This will ensure staff are up to date with current practice, they assist the people using this service in a way that protects their health and safety, and they are able to respond appropriately in the event of an emergency. Since our inspection the provider has advised us that all staff are now up to date with mandatory training. 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 14 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 11 of 14 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 15 You must ensure that care 31/07/2010 plans and risk assessments are accurate, are reviewed to show changes and contain informative, up to date information to enable staff to provide care in a safe and consistent way. This will ensure staff know at all times what care an individual needs. You must make proper 31/07/2010 provision for peoples care and treatment to ensure that their assessed needs are met and that their health and welfare is maintained at all times. This means that people with dementia type illness accommodated at the home have care plans that describe in detail how their needs are to be met and their support follows current best practice. 2 8 12 3 38 23 All fire doors held open by an 17/07/2010 approved hold-open device Page 12 of 14 Care Homes for Older People 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 must be maintained in working order. This is to ensure that everyone in the home will be less at risk in the event of a fire in the home. 4 38 13 You must ensure that people 17/07/2010 are kept safe by keeping the premises indoors and outdoors tidy, and maintaining equipment in good working order. This means that the health, safety and welfare of everyone who uses this service and staff who work here are promoted and protected. 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 10 You should ensure that information about individuals is recorded in care files for that person. This will ensure peoples personal information is kept confidential and their right to privacy is upheld. 2 24 You should fit locks to peoples private accommodation that are suited to their needs, and allow for staff access in an emergency. This will ensure peoples comfort and privacy. Care Homes for Older People Page 13 of 14 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. 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