Care Home: Summerfield

What the care home does well This random inspection was conducted with full co operation of the proprietor and recently appointed acting manager. The staff were friendly and made efforts to communicate and offer assurances to residents. For example staff were seen talking in a reassuring manner and at a level and pace that the person understood. A married couple living at the home commented that they liked living there, they liked the food and the staff were very helpful and caring. Some improvements had been made to the systems for administering medication to people living at the home, though additional improvements needed to be made to make the system as safe as possible. The staff at the home had made a pro active safeguarding referral to the Lead Agency, Dudley MBC, which means people can be protected from harm. We noted improvements to a bedroom, which at the previous inspection had required immediate attention to deal with a soaking carpet and bed. At this inspection we saw that a replacement bed and a new laminate flooring had been provided. We were alsotold replacement door fronts had been installed in the kitchen. What the care home could do better: The registered manager had resigned since the last inspection and though there was a new manager recently appointed, an application for registration as the manager of the home must be submitted to the CSCI Regional Registration Team. We were concerned that some of the medication practices observed were potentially unsafe. The registered person must make sure that all staff who are involved in the administration of peoples medication are trained and competent, and that everyone living at the home receives their medication as prescribed by their doctor, with safeguards in place to maintain their health and well being. We had considerable difficulty in examining some records, which were disorganised, not properly archived and not readily available. All information relating to how people are cared for and kept safe must be recorded and stored to be secure and easily accessible. There was a strong malodour observed in the home and we highlighted that the Daisy lounge had an exceptionally strong unpleasant malodour. There was evidence that the home was generally not being maintained to high standards of cleanliness. Action must be taken to eradicate all malodours throughout the home with an effective cleaning, infection control and maintenance program implemented without delay. The planned refurbishment of the kitchen, bathing and toilet facilities must be prioritised to safeguard residents from risk to their health and safety and provide a homely environment. There had been a high staff turnover since the last inspection and the registered proprietor and manager acknowledged that there had been staffing shortages at times. The acting manager also admitted that there were no named designated senior carers on the rota to be responsible for the home at night. The registered person must take action to make sure that the home is adequately staff with sufficient numbers of trained, experienced and competent staff at all times to meet the needs of the people living at the home. Inspecting for better lives Random inspection report Care homes for older people Name: Address: Summerfield 42-43 Wellington Road Dudley West Midlands DY1 1RD 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 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: Jean Edwards Date: 0 2 1 2 2 0 0 8 Information about the care home Name of care home: Address: Summerfield 42-43 Wellington Road Dudley West Midlands DY1 1RD 01384239331 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Merron Care Ltd care home 38 Number of places (if applicable): Under 65 Over 65 18 12 8 dementia old age, not falling within any other category physical disability Conditions of registration: 0 0 0 The Manager should source and undertake further training in dementia care. Date of last inspection Brief description of the care home Summerfield was originally two semi-detached residential properties that have been linked and extended to its present form. The home is registered to provide personal care for up to 38 people with up to 18 places accommodating older people who have dementia, up to 12 places for older people who do not fall within any other category and up to 8 places for people who are over 65 years and have a physical disability. The home comprises of three floors. The basement is used to house the boilers and is also a storage area. The ground floor has a number of bedrooms, two offices, the kitchen, communal areas and hygiene facilities. The first floor accommodates further bedrooms, Care Homes for Older People Page 2 of 16 Brief description of the care home bathrooms, sluice and toilets. Summerfield Care Home is located near to central Dudley and is situated on a main road, which is also a main bus route. Opposite is the Dudley Leisure Centre, there is a Carvery next door and a number of shops are in the local vicinity, a small car park is available to the front of the home. A statement of purpose and service user guide is available to inform residents of their entitlements. Information regarding fee levels can be obtained from the home. Care Homes for Older People Page 3 of 16 What we found: Health and Personal Care. We undertook this random inspection visit as a result of a serious complaint from a family, an anonymous complaint, a safeguarding referral as a result of staff concerns about financial abuse involving someones family and concerns from healthcare professionals. We looked at the care records, including those relating to the people identified to us. We also looked at how people were supported and given assistance to meet their daily needs. We were concerned that when we attempted to monitor daily notes, records were disorganised and some were not available or missing. Towards the end of the 5.5 hour random inspection visit a large pile of assorted records were noted on sideboard in quiet room, also used by relatives, which contained some of the missing records. The acting manager, appointed at the end of October 2008, acknowledged the disorganised records, attributing this to the departure of the previous registered manager and 4 senior staff and the long term sickness absence of the deputy manager. We were generally satisfied with the records of care provided for the person whose family had raised concerns and complaints. We noted that this person had been examined and treated by health care professionals, including the GP. We noted that the GP had reviewed this persons medication in February 2008. We did however note that health care risk assessments and screening tools had not been reviewed for several months prior to discharge to another care home, though the current acting manager was not in post at this time. We looked at the care being provided for a person living at the home who had received a health check from a community nurse. She had reported her concerns relating to the persons refusal to take medication and deteriorating condition to the GP. This resulted in this person having an overnight hospital stay and discharge back to the home. We observed this person in lounge, slumped in an armchair. We noted that the person was sitting indirectly on a pressure relieving cushion, which should be used in conjunction with the chair cushion as a means of preventing skin tissue damage, such as pressure ulcers. We were told that this person had refused their nebuliser again, however we were concerned to note that was a tablet left in a medicine tot on the table beside her. We established that this was Adcal D3, which needed to be chewed. We looked at the persons MAR sheet and noted that it had been signed as administered. This meant that the person had not received the medication as prescribed by the GP and additionally medication left unattended presented a risk of harm to other people living at the home who may have taken medication not intended for them. We looked at a sample the medication held at the home. There were some areas of good practice and we undertook some random audits of medication stocks, which were accurate. However a medication audit for Promazine 150 mls, commenced on 14/11/08, with 23 dosages x 5 mls, 150 mls signed for as given, meant there should have been 35 mls left in bottle, we noted approximately 10 mls remaining, which Care Homes for Older People Page 4 of 16 meant that potentially 25 mls was missing. We also saw that another antipsychotic drug dosage of 2.5 mg once daily, was instructed to be measured using a syringe. The syringe supplied was found still unopened in the packet and the senior carer confirmed that she had administered the dose using a medicine tot. This meant that the person might have received an inaccurate amount of medication, either too little or too much to maintain and promote their health and well being. We noted that the staff were not recording carried forward balances of medication stocks on the MAR sheets, which meant that the accurate auditing of medication dispensed in original containers could not be carried out. We also noted that handwritten entries on MAR sheets had not been signed and witnessed by two trained staff, which would demonstrate good practice. From our observations of residents in the lounges they were not all not dressed in accordance with weather and to maintain their dignity. Examples were some people without tights, stockings or socks and three people without footwear such as slippers. Complaints. We undertook this random inspection visit, accompanied by a senior social worker employed by Dudley DACHS to look into complaints, a notification of a burglary and a safeguarding issued raised by staff. The complaints, concerns, notification and allegations were investigated in accordance with multi agency safeguarding procedures. We looked at the information available relating to complaints at the home and noted as at the previous inspection, the homes complaints procedure was in place and displayed, together with contact details of external agencies. We looked at the homes complaints log for any complaints received. We noted that the deputy manager had recorded details of complaint from the relatives of a person living at the home in the complaints log. This persons family had subsequently transferred her to another care home. We saw a letter of acknowledgement in the complaints log, with an apology from registered proprietor. The complainants had also made a formal written complaint, with a number of elements to Dudley DACHS and the CSCI. We discussed all elements of the complaint with the registered proprietor. She told us that she had acknowledged the element of the complaint raised with her about the person having very dirty feet and lack of footwear and had apologised in person and in writing. She told us that the previous manager was working at another care home and had apparently encouraged the family concerned and 2 other families to move people to the home where she was now working. However the family making the complaints were the only ones to transfer anyone. We were told that the family gave only one week notice to Summerfield, though the contract of residence stated one months notice was required. The registered proprietor told us that she had accepted only one week and facilitated the move to take place. We looked into all aspects of complaint made by the relatives and generally concluded that the complaint was partially upheld. There were elements of unacceptable practice already acknowledged by the registered proprietor. The allegations relating to delayed treatment of scabies and inaccurate administration of medication were not upheld. There was no evidence in the persons care records of inattention. For example there were entries dated 18/1/08 and 19/7/08 for treatments Care Homes for Older People Page 5 of 16 for Scabies and also records of medication changes and reviews with the GP in January and February 2008. Notably some allegations related to a time when the previous manager was in post. We were not able to ascertain evidence of general staff shortages, though the deputy manager had acknowledged to the family that there was a short period of time of staff shortage, explaining that the person who should have been on duty had a family crisis. At this inspection there were generally adequate numbers of staff on duty in relation to the numbers of residents accommodated. An additional member of staff had also been rotad to provide an escort for a resident attending a hospital appointment. We upheld concerns about the cleanliness of the home, also discussed at the environment section of this report. We discussed the pervasive malodour observed in the home with the new acting manager and registered proprietor and we highlighted that the Daisy lounge had an exceptionally strong unpleasant malodour. The CSCI received notifications from the registered provider relating to a burglary at the home, which occurred on 15/10/08 resulting in the theft of a large flat screen TV from the home. We also received a notification that a member of staff was dismissed related to the theft because the home was not appropriately secured. We discussed that no safeguarding referral was made until prompted by the notification. During the inspection we were told that the staff member had not been dismissed but had left the homes employ. We discussed the issues with the registered provider and established the gate and patio door Daisy Lounge were not secured by night staff but intruders could not have accessed rest of home from Daisy lounge because of a coded key pad. We highlighted that information provided must be accurate and not misleading. We looked into the care provided for a person the health care professionals had raised concerns about immediately prior to this inspection visit. This included the administration of medication and maintenance of health and well being. Our findings are recorded at the Health and Personal Care section of this report. Following a multi agency safeguarding strategy meeting it was decided that we would look into issues raised by staff about potential financial abuse reported during training provided by Dudley DACHS. The issues concerned a person who had financial resources, dementia and uncertain mental capacity, whose relative controlled their finances and who had not received any of their personal allowance for at least 2 years. We had considerable difficulty in examining records, which were disorganised, not properly archived and not readily available. Information for some recent months could not be found and some information on file was confusing. We were not able to reach a conclusion and it was decided that a Senior Social Worker from Dudley DACHS would investigate these concerns further. Environment. As part of the random inspection conducted to look into complaints and concerns, which included allegations of lack of cleanliness we took a brief tour of the premises. We concluded that there was evidence that the home was generally not being maintained to high standards with an effective cleaning, infection control and maintenance program. Care Homes for Older People Page 6 of 16 At the reception area of the home we were immediately aware of an offensive malodour in the main hallway. We discussed this and the cleaning arrangements with the newly appointed acting manager. We were told that the home had 1 domestic vacancy and there was currently only 1 domestic assistant employed from 9am to 2pm for 6 days each week. She told us that care staff did some cleaning on the domestic assistants day off. We highlighted that this arrangement needed to be reviewed to ensure that there were adequate care staffing hours allocated to meet peoples care needs and that the cleanliness of home did not pose unacceptable risks of cross infection to peoples health and well being. We were seriously concerned to note a very strong offensive malodour in Daisy Unit, where the carpet in the communal lounge was also very dirty and stained. We observed that there were 12 residents and 2 staff allocated to attend to their needs. As identified at the health and personal care section of this report we observed people without tights, stockings or socks and 3 people without slippers for whom the flooring presented risks to their health and safety. At the previous inspection we had issued an immediate requirement relating to the WC flooring on Daisy unit requiring an urgent repair. We saw evidence that the flooring repaired but there was still a protruding ridge posing a hazard. This is highlighted further at the management section of this report. The large Lounge in the main part of house was quite dusty and untidy and the windows needed cleaning. We viewed the ground floor bathroom and saw continence pads stored on the floor, and there were unnamed toiletries, which could be used communally. We discussed the issues of infection control with the acting manager, especially as the home had at least two outbreaks of scabies in past 12 months. We viewed a random sample of bedrooms. Bedroom 1 was a shared room, which was very shabby, but we were told that it was due to be redecorated. In another bedroom, we noted that there should be a pressure relieving mattress in place, however it was not working and the acting manager told us they were awaiting replacement from stores at Russell Hall Hospital. We strongly recommended that the home contacts the district nurses or GP practice nurse to access a speedy replacement to prevent avoidable tissue damage. We also noted that this and other bedroom floors felt sticky when walked on. A first floor bedroom had a wet patch on floor under the commode and it was unclear whether there had been a leakage or spilled fluid. We witnessed that the domestic assistant was summoned to rectify the matter. In bedroom 3 we noted there was no carpet and only a mattress on the floor, with bedclothes touching the flooring. We were told this was because this person had previously fallen and the use of bedrails had been assessed as presenting an additional risk. We noted from records that the person had been admitted to hospital 3/6/08 following the fall and had also been assessed by Dudley DACHS moving and handling team. This person also needed a hoist to be used for transfers. We were assured that the hoist in use was capable of transfers from the floor. However we were concerned about the implications of the mattress and bedding coming into contact with the uncovered floor and the potential risks of infection. The acting manager and registered person agreed to review the situation with appropriate health professionals. Care Homes for Older People Page 7 of 16 On a positive note a bedroom, identified at the previous inspection as requiring immediate attention to deal with a soaking carpet and needing replacement bed, had a new laminate flooring and new bed. We expressed concerns that the treatment room used to store medication and drugs trolley, had flooring, which was sticky when walked on. We looked at the kitchen during the afternoon, which was busy and chaotic with staff going in and out. We asked if the kitchen had been completely refurbished as required at previous inspections. The majority of staff spoken to had only been at the home a short time and were unable to give us information, though one person told us the cupboard doors had been replaced. We informed the acting manager that all previous requirements and recommendations would be assessed at the next full key inspection. We noted that the large chest freezer was extremely rusty and this needed to be replaced to maintain good standards of food hygiene and safety. Staffing. We were told that there were 27 people accommodated at the home. There had been five deaths during the six weeks prior to this inspection visit and the home now had 9 vacancies. From the records we were able to see and our observations we noted a high number of people with diverse needs being cared for in 2 separate units. The details of our discussions with acting manager are recorded at the management section of this report. We were told that the home was experiencing some staffing instability. We were told that the deputy manager had been off sick for 6 months, due to injuries sustained in a serious car crash, and a senior would be acting up into the position of deputy manager. The acting manager told us that 4 staff had recently left the homes employ, since October 2008. These were 2 senior carers and 2 relief senior carers. We were told that the provider was recruiting new staff, and was awaiting 4 POVA and Criminal Record Bureau Disclosure clearances. The acting manager also informed us that the registered proprietor and spouse visited the home daily. We looked at copies of staff rotas, appeared to show adequate staffing levels. For week commencing 29 November 2008 the early shift had 5 carers, including a designated senior, the late shift had 4 carers, including a designated senior. There were 2 care staff and an on call arrangement for night shifts, however the acting manager acknowledged that there were no named designated senior carers on the rota to be responsible for the home at night. Management. The registered provider had informed the CSCI that the registered manager, who had been in post for less that a year, had left the home in July 2008 in order to pursue career development. The new acting manager Gail Walker, had been employed at Summerfield since 27 October 2008. She informed us that she had experience as a senior carer on the residential unit at a local nursing home and she had been encouraged by an inspector to develop her career in care management. She stated she was told she had the skills and potential to be a registered manager. As highlighted at previous sections of the report we discussed the very strong malodour in various parts of the home, particularly Daisy Lounge, with the acting Care Homes for Older People Page 8 of 16 manager and registered proprietor. Although this problem had improved at the last key inspection 10 April 2008, unpleasant malodours in the home had been a recurring concern in the past. We were told that there was a vacant domestic post, which meant that there was only one person available for ensuring levels of cleanliness were maintained in the home between 09:00 am and 2:00pm for six days each week. The acting manager told us that she had some strong air fresheners, which could be used. We expressed our serious concerns that the home was not being maintained to acceptable standards of infection control. This meant that people living at the home were not properly safeguarded from risks of cross infection. At the last key inspection on 10 April 2008 we issued an immediate requirement for the registered persons to make safe the defective flooring in the WC adjacent to the communal areas in the Daisy Unit. This was to minimise the risk of injury to people living in this area of the home, especially as these people had dementia and other sensory disabilities. We received written assurances that action had been taken. We looked at this area during a brief tour of the premises and noted that although the flooring had been rectified, it was not entirely satisfactory because there was a small protruding ridge, which still presented a tripping hazard. We informed the acting manager that further remedial work was required for it to be made safe. We looked at the accident records and noted that there had been 14 falls between October 2008 and 2 December 2008. One person admitted for emergency respite care, who had 10 falls, had their medication reviewed, which was positive, however there was no evidence of a referral to the Local Authority Falls Team. During the same period there were records of 8 accidents and we were concerned that some were recorded as unknown cause. One in particular dated 9/11/08 was noted at 05:55, the location was the persons bedroom and recorded marks and bruises right hand and side face. We did not appear to have received a Regulation 37 notification and there was no evidence of any referral or discussion with other agencies such as Dudley DACHS. What the care home does well: This random inspection was conducted with full co operation of the proprietor and recently appointed acting manager. The staff were friendly and made efforts to communicate and offer assurances to residents. For example staff were seen talking in a reassuring manner and at a level and pace that the person understood. A married couple living at the home commented that they liked living there, they liked the food and the staff were very helpful and caring. Some improvements had been made to the systems for administering medication to people living at the home, though additional improvements needed to be made to make the system as safe as possible. The staff at the home had made a pro active safeguarding referral to the Lead Agency, Dudley MBC, which means people can be protected from harm. We noted improvements to a bedroom, which at the previous inspection had required immediate attention to deal with a soaking carpet and bed. At this inspection we saw that a replacement bed and a new laminate flooring had been provided. We were also Care Homes for Older People Page 9 of 16 told replacement door fronts had been installed in the kitchen. 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 16 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set. No. Standard Regulation Requirement Timescale for action 1 33 26 The Registered Provider or a 01/05/2008 nominated person must consistently undertake monthly unannounced quality monitoring visits as to the conduct of the home with reports available to the home and CSCI in compliance with Regulation 26 of the Care Home Regulations 2001 2 38 13(4)(c) The registered persons must 01/09/2008 take action to ensure the refurbishment of the kitchen is carried out as a matter of priority. This requirement has been made to provide residents? with wholesome safely stored and prepared food. 3 38 13(4)(c ) The registered manager 01/05/2008 must ensure that the risk assessments for bed rails are expanded to incorporate all areas of risk to the resident, including risks of entrapment and incompatibility with the bed and / or mattress Care Homes for Older People Page 11 of 16 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The registered person must 02/02/2009 ensure all staff involved in the management and administration of medication have received accredited medication training and that there are regular assessments of their competency to carry out the safe administration of medication. This is to ensure the health and well being of people living at the home is safeguarded. The registered person must 02/02/2009 ensure that medication is not left unattended at any time. This is to safeguard people living at the home from risk of harm who may not take their medication as prescribed or other people who may take medication not intended for them. 2 9 13 3 9 13 The registered person must ensure staff use equipment provided, such as syringe 02/02/2009 Care Homes for Older People Page 12 of 16 supplied, to accurately measure liquid medication. This is to ensure that the person receives an accurate amount of medication, and not too little or too much to maintain and promote their health and well being. 4 9 13 The registered person must 02/02/2009 ensure that all persons living at the home receive their medication as prescribed by their doctor and the Medication Administration Records must be accurately completed to demonstrate either medication has administered or an appropriate code entered to record the reason for non administration. This is to maintain the health and well being of people living at the home. 5 26 13 The registered person must ensure that there are cleaning schedules for all areas of the home, with sufficient numbers of ancillary staff, to diligently maintain effective standards of cleanliness and infection control. This is to safeguard people living in the home from risks of infection and provide them with a clean and pleasant living environment. 6 27 12 The registered person must 02/02/2009 ensure that there is a named person, qualified, experienced, competent and with up to date training, 02/02/2009 Care Homes for Older People Page 13 of 16 designated on the rota to be responsible for the running of the home at all times, especially during vulnerable, high risk, night time hours. This is to ensure that the health, well being and safety of people living at the home is assured at all times. 7 31 9 An application must be 02/02/2009 submitted to the CSCI for the Registration of the manager within 3 months. This to ensure the home is managed and run to assure the health well being and safety of the people living there. The registered persons must 02/03/2009 undertake further remedial work to make safe the flooring in the communal WC on Daisy Unit. This is to safeguard people living at the home from risks of harm. 9 37 37 The registered person must ensure that notifications are submitted to the CSCI without delay for any event adversely affecting the well being of the people living at the home. This is to safeguard people living at the home from risks of harm. 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 8 37 37 02/02/2009 Care Homes for Older People Page 14 of 16 1 8 It is recommended that the registered manager consider using Antecedent, Behaviour, Consequence (ABC) records to evaluate the effectiveness of strategies and use of PRN medication for residents with challenging or distressed behaviours. That all handwritten entries on MAR sheets are dated signed and witnessed by staff who are trained and competent. That carried forward stocks of medication are recorded on each persons MAR sheet. That all people living at the home, receive personal care and support to be well groomed and appropriately dressed in accordance with their recorded needs and preferences, their age and weather conditions. That efforts be made to ensure female residents leg wear reflects their preferences and age. This was a previous good practice requirement. Not Met at the Random Inspection on 02/12/08. That the registered persons record fuller details of complaint investigations undertaken at the home, with evidence that conclusions are formally notified to complainants, and the outcomes are recorded. It was strongly recommended that the home contact the district nurses or GP practice nurse to access a speedy replacement pressure relieving mattress to prevent avoidable tissue damage for any person assessed at risk of pressure ulcers. It was strongly recommended that the large chest freezer, which was extremely rusty be replaced to maintain good standards of food hygiene and safety. That the Registered person ensures staff maintain a clear record of accidents and incidents in order that effective analysis and actions can take place, reducing risks to residents. 2 9 3 4 9 10 5 10 6 16 7 24 8 26 9 38 Care Homes for Older People Page 15 of 16 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. 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