Inspection on 25/04/06 for Minster Lodge Residential Care Home

This inspection was carried out on 25th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Minster Lodge Residential Care... 22/05/07

Minster Lodge Residential Care... 15/11/06

Minster Lodge Residential Care... 08/03/06

Minster Lodge Residential Care... 22/06/05

Minster Lodge Residential Care... 21/09/04

Minster Lodge Residential Care... 20/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Minster Lodge Residential Care Home Minster Lodge 6 Westminster Road Earlsdon Coventry CV1 3GA Lead Inspector Kevin Ward Key Unannounced Inspection 25th April 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Minster Lodge Residential Care Home DS0000050158.V290392.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Minster Lodge Residential Care Home DS0000050158.V290392.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Minster Lodge Residential Care Home Address Minster Lodge 6 Westminster Road Earlsdon Coventry CV1 3GA 02476 552585 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) R M Health Ltd Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27) of places Minster Lodge Residential Care Home DS0000050158.V290392.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Work is to be undertaken, by 31 March 2004, to convert the bathroom, which is currently used as a sluice room, to an assisted shower/bath facility. A sluice facility, which is independent of bathing facilities, must be provided by 31 January 2004. 8th March 2006 Date of last inspection Brief Description of the Service: Minster Lodge is situated close to Coventry City Centre and can be reached easily using public transport. The home is situated over two floors and can care for 27 older people who are frail. There is one shared room and the remaining rooms are single occupancy, two of the bedrooms have en-suite toilet facilities. Communal toilets and bathrooms are available close to the lounge and dining areas and also near to those bedrooms without an ensuite facility. There is a back garden, which is secure with paved areas and this can be accessed from the dining room. The home does not have its own parking facilities and parking is prohibited on the road. There is a Pay & Display car park close to the home. The current fees at Minster Lodge range between £326 and £340 per week. This does not include personal items, such as toiletries, hairdressing, private chiropody or newspapers. Minster Lodge Residential Care Home DS0000050158.V290392.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and focused on assessing the home’s performance against key inspection Standards and looking at the progress the home is making to meet requirements from the last inspection, which took place, 8th March 06. The inspection involved looking at a range of information, including the service history for the home, such as notifications made by the home to the Commission for Social Care Inspection, monitoring reports carried out by the home and information provided by the manager as part of the inspection. Questionnaires were sent to service users and their relatives as part of the inspection process. Three service user questionnaires were returned and 7 questionnaires were completed by their relatives. 19 service users were living in the home at the time of this inspection and all were seen by the inspectors. The inspection included talking with service users, staff and the manager at the home. The inspection also included sampling a number of important records, that are an indication of how people’s needs are planned for and how well the home is being run, such as care plans, complaints log, staff files and fire safety records. The inspectors also spoke with a community nurse and a relative visiting the home. What the service does well: A number of service users were seen to talk with other people in the home and one person was seen to venture out independently into the community. Where they wish to do so people are enabled to go out alone to maintain their independence. One person said that he prefers to venture to the dentist alone and also likes to go out alone occasionally. The cook demonstrated a good knowledge of people’s mealtime likes and dislikes and the people living at he home were seen to enjoy the main meal of the day provided at the home. There have been no recent complaints made to the home. A complaints log is in place for recording complaints, indicating that complaints are followed up and investigated by the manager. The majority of staff have recently completed adult abuse training to help equip them to recognise and respond to suspicions of abuse. Staff are being supported to gain access to a suitable range of training including NVQ courses and Health and Safety related training. Minster Lodge Residential Care Home DS0000050158.V290392.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: The manager has devised new care plans covering a wider range of needs. This will help to ensure that people’s needs are not missed and are planned for properly. There is a need to ensure that care plans are updated as people’s needs change so that staff are clearer about the care they are expected to provide at any given time. There are instances where people’s risk assessments indicate the need for a care plan to be started to provide advice to staff on reducing the level of risk to the service users concerned, e.g. one persons risk assessment indicated that she was at risk of falling but no instructions were in place in a care plan to help staff to reduce this risk. Positive work is taking place by the manager to audit the lights, and some of the furniture and equipment needed in the home. There is now a need for the Registered owners to confirm an intention to fund these improvements. For this reason a number of requirements have been made for the attention of the owners rather than the manager. There are very few activities or outings arranged at the home. It is particularly important that more activities and outings are provided for service users who not able to get out and about by themselves. There is considerable scope for improving the dining area to make this a more pleasant place for people to eat their meals. The manager said that the owner has agreed to replace the dining chairs shortly. The current chairs are in poor condition, do not match and are a range of designs. Minster Lodge Residential Care Home DS0000050158.V290392.R01.S.doc Version 5.1 Page 7 The manager has started work auditing the condition of some equipment that was identified for improvement at the last inspection and reported that some equipment has been ordered. There is a requirement for the owners to confirm that they will fund the equipment identified within this report. Overall there are a sufficient number of staff on duty for the current number of people living in the home. However there are occasions when staff have to cover for the cook, which can take as much as three hours from their shift by the time they have cleared up after meals. This is unacceptable and any duties which take staff away from providing direct care to service users must be very brief so as not to compromise the care and attention that people need. Staff are being provided with a suitable range of training, including NVQ training opportunities. Currently staff are expected to attend all training in their own time unpaid. The owners are recommended to provide staff with at least 3 days paid training a year, in keeping with the National Minimum Standards. There is a need to recruit someone to deputise in the absence of the manager the deputy manager has recently left the home to take up another post. This is necessary so that staff have access to proper managerial support at all times to help them in the care of service users and so that care plans and development work in the home is not neglected and is carried out in a timely manner. The manager confirmed that she has not had time to seek the views of service users, relatives and professionals to gather everyone’s views about the home. Two people’s financial records were not available at the home. The manager said this was because the owners are managing these people’s finances until this responsibility is transferred to age concern to act on their behalf. The Registered providers are required to keep the records at the home until the appointee-ship has been transferred so they are available for inspection. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Minster Lodge Residential Care Home DS0000050158.V290392.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Minster Lodge Residential Care Home DS0000050158.V290392.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The judgement for this outcome group is adequate. There is scope for developing areas of the assessment form to ensure that all relevant aspects of new service users’ personal care are identified and planned for by the home. EVIDENCE: No new people have moved into Minster Lodge since the last inspection, 8/3/06. Basic assessment information was seen to be in place on service users files. The last inspection report noted, “records confirmed that assessments of residents take place but it was noted the assessment process does not include a review of all needs as detailed in the care standards. This includes foot care and personal safety and risk”. The manager explained that she is in the process of developing new care planning forms that will include these areas of care. The home’s assessment process will be looked at again at the next key inspection, to see how new service users moving into the home are being assessed. The Home does not provide an intermediate care service so Standard 6 was not assessed. Minster Lodge Residential Care Home DS0000050158.V290392.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 The judgement for this outcome group is poor. The care planning process and monitoring of service users’ general health need to be improved to reduce the possibility of deteriorating health and poor outcomes for service users. EVIDENCE: Service users’ files were seen to contain risk assessments covering a reasonable range of care issues, including skin care and nutrition. However in some instances where the risk assessments indicate a need for care-planned intervention this is not always happening. For example one person’s risk assessment highlighted a risk of falling but no care plan / guidelines were in place to advise staff of the actions to take to reduce this risk. Similarly one persons’ needs had recently changed significantly so that she had been confined to bed for several days and no new care plans were implemented to reflect the change in needs. Another service users skin care risk assessment indicated a potential risk but no preventative care was noted in the person’s care plan to reduce the possibility of skin breakdown occurring. Minster Lodge Residential Care Home DS0000050158.V290392.R01.S.doc Version 5.1 Page 11 Observation charts were seen to be in place, indicating that staff were monitoring this persons well being but the care plan had not been changed to keep staff fully informed of this person’s changing needs. This is necessary to ensure that all staff are clear about the care they are required to provide. There is an outstanding requirement from the last inspection for the manager to devise guidelines to assist staff in their approach to one service user with some aspects of challenging behaviour. Similarly there remains a need to provide service users who venture out alone with identification information and the contact details of the home, so that they can summon help if necessary. The manager said that she is intending to do this shortly. One person indicated that her care needs were met satisfactorily at night but also said that at some time in the past she had been told not to ring the bell as this might wake other people up. The manager demonstrated a satisfactory awareness of this matter and confirmed she had addressed this matter with the person concerned. The manager has previously carried out spot checks at night times to monitor the service provided by night staff. There was evidence of the home enabling service users to access healthcare professionals; this included GP, dentist, optician, chiropodist, district nurse, speech and language therapy and the community psychiatric nurse. During a discussion with the inspector the district nurse commented that staff in the home ‘take on board’ any recommendations made in the care of service users. Records are kept of service user’s weight but this is not always done regularly. It was of concern that records for one service user demonstrated a weight loss of 12lbs in one month and no action was documented to resolve or monitor this. The systems for the management of residents’ medication were examined. Medicines are stored securely in a locked trolley in a small storage room and the staff member in charge holds the keys on their person during their shift. The home uses a monitored dosage system with medication being dispensed every 28 days. It was informed that staff have received training in the safe administration of medicines from their community pharmacist but there are no certificates or records to support this. The manager is currently investigating more formal training using distance learning through a local college. The home has a list of sample staff signatures so that the staff member administering medication can be identified. Prescriptions are returned to the home to be checked before being sent to the pharmacy for dispensing. The inspector observed good practice when a member of the care staff was giving medication to residents and the staff member demonstrated a good knowledge of medicine management during discussion with the inspector. The inspector audited the controlled drugs and medication for two residents. Minster Lodge Residential Care Home DS0000050158.V290392.R01.S.doc Version 5.1 Page 12 The following concerns were raised in relation to medicine safety and discussed with the registered manager during the inspection: The medication policies for the home need to be updated to include a drug error policy. The locked tin and cupboard used to store controlled drugs is not compliant with legislation. A controlled drugs cupboard must be installed which complies with current legislation. There is no evidence of staff training in the safe administration of medicines to ensure that medicines are only administered to residents by staff trained to do so. The inspector recommends that a printed controlled drugs book is ordered and used to record the storage and administration of controlled drugs in the home as a ‘homemade’ loose-leaf book is currently in use. One resident was receiving anticoagulant therapy (warfarin). Although the anticoagulant book was available the dosage required was not ‘cross referenced to the MAR sheet which may increase the risk of a potential error. The number of warfarin tablets stored in the home was not recorded which makes it impossible to audit the number of tablets given. There is no method of auditing the number of tablets held for residents in the home, particularly ‘as required’ medication such as painkillers that are not included in the 28 day dispensing cycle of medication but are ‘carried forward’ to the next month. Records demonstrated that the temperature of the medicine fridge exceeded recommended temperature for the last month. Staff must be aware of the recommended temperature and take action when it exceeds these limits. There is no method of auditing staff practice in the safe administration of medicine to residents. The inspector recommends that staff members writing MAR sheets should sign and date them. Staff were observed to be courteous and kind to residents and assistance was offered and given with discretion. The district nurse for one resident visited during the inspection and she was assisted to her room in order that the consultation was in private. Staff were observed to knock on doors before entering service users’ rooms. Minster Lodge Residential Care Home DS0000050158.V290392.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13, 14 and 15 The judgment for this outcome group is adequate. The service supports more independent service users to make choices and exercise control over their lives but could do more to provide activities to stimulate people with higher support needs. EVIDENCE: Comments made by service users indicate that overall they find the staff to be friendly and helpful. A number of people were seen to chat together in the lounge during the day and one person was seen to return home after venturing out alone to the pub. Another service user said that he had recently been out to the dentist alone, in keeping with his wishes and that he likes to go out on his own, locally, some days. This indicates that service users are encouraged to retain a degree of independence and control over their lives. There is little evidence of planned activities at the home. An activities plan was seen which showed very few planned activities. Comments made by service users confirmed that this to be true. The manager said that she had yet to consult with service users regarding activities and outings, as required at the last inspection, 8/3/06. The manager said that this would be improved very shortly when the activities coordinator returns to work. Minster Lodge Residential Care Home DS0000050158.V290392.R01.S.doc Version 5.1 Page 14 Comments made by service users indicate that their friends and relatives are free to visit the home at most times of the day and that people’s relatives are encouraged to remain involved in their care, (e.g. support to attend appointments). The manager confirmed that visiting times are flexible. A service user’s relative, visiting on the day of the inspection spoke of her gratitude for the service provided by the home. Comments made by service users confirmed that they are offered a choice menu, a copy of which was seen in the kitchen. Comments made by the cook demonstrated a good knowledge of people’s food preferences and dislikes. The manager and cook stated that none of the current service users were on special diets to meet their dietary or cultural needs. Nutrition risk assessments were seen on service users’ files, indicating that the home takes account of service users nutritional needs. Service users were seen to eat their dinner and pudding with very little waste observed. Comments made by service users confirmed that they find the food to be acceptable to them and that they are provided with sufficient drinks throughout the day. Minster Lodge Residential Care Home DS0000050158.V290392.R01.S.doc Version 5.1 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and18 The judgment for this outcome group is adequate. Suitable procedures are in place and staff are being provided with training so that the home can respond appropriately to complaints and ensure people are protected from abuse. EVIDENCE: The complaints procedure has been updated since the last inspection to include the contact details of the Commission for Social Care Inspection. There have been no complaints or concerns raised with the Commission for Social care Inspection since the last inspection. An examination of the home’s complaints log indicates that where complaints are made to the home these are being followed up and investigated. The manager confirmed that she has received no complaints at the home since the last inspection. Comments by service users indicate that they are aware of their rights to make complaints to the home. Comments made by staff confirmed that the home is providing them with distance learning training to equip staff to recognise and respond to suspicions of abuse. A copy of the staff training materials being used were seen to contain good levels of information on this subject. The manager explained that the majority of staff have recently sent their coursework away to be assessed and are awaiting their certificates to be sent to them to confirm they have passed the course. The manager confirmed that there have been no allegations of abuse made at the home since the last inspection. Minster Lodge Residential Care Home DS0000050158.V290392.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 The judgment for this outcome group is poor. Plans for improving the home environment need to be acted upon so that people benefit from a comfortable and homely environment that conveys value on them. EVIDENCE: At the last inspection a long list of maintenance tasks were left with the manager to address. The manager has started work to address a number of the issues and many are still outstanding. The back garden borders are untidy and the gaps between the slabs need weeding. Some of the rear windows are in poor condition and need to be repaired and painted or replaced. The manager has audited the low energy light bulbs with a view to bringing the findings to the owners’ attention for action to increase the light in the home. The manager said that she aims to have the up-lighter lampshades replaced to provide more light in the home. One bathroom was particularly dark. The manager said that she had plans for all the pillows in the home to be audited so that any in poor condition can be replaced and explained that the owner was delivering new face flannels and more spare towels the next day. Minster Lodge Residential Care Home DS0000050158.V290392.R01.S.doc Version 5.1 Page 17 The laundry room was seen to be well ordered and tidy and suitable bags are available at the home for transporting soiled laundry to the laundry room. The laundry room has a machine with pre wash facility and a sluice sink is also available for heavily soiled laundry, which the laundry worker said she uses when necessary. He manager said that a new dryer was being delivered shortly. The laundry room is situated outside the main building and there is no need to carry laundry through food preparation areas, which could otherwise present a risk of infection. The dining area is rather functional and there was little evidence to suggest that efforts have been made to make this area an attractive area, in which to eat. The dining chairs do not match vary in size and design. The manager said that the owner has ordered new replacement chairs. The manager has removed the spindle leg chairs that were identified as a hazard at the last inspection. The lounge was painted recently but this has not been carried out very professionally, as the paper above the rail is peeling in places and the patterned paper shows through the paint in places. This needs a second coat of emulsion or new wallpaper. Overall the carpets in the communal areas were found to clean, although the lounge carpet is looking old and plans need to be made to replace it during the next year. There flooring in the shower room and the bathroom on the first floor would also benefit from replacement. The shower room floor is badly stained and the bathroom floor is discoloured making it look unclean and unpleasant to stand on in bare feet. The wheelie bins were not overflowing as at the last inspection. The manager stated that this had been due to the bin men’s strike action. The paper towel holder has been moved so that it is no longer situated above the cutlery, where it presented a possible hygiene problem. The manager has recently installed a sensor alarm near one door to detect anyone venturing near the external door at night, to avoid the possibility of anyone leaving the home undetected at nighttimes. A corner of the dining area has been set-aside for people to smoke. This is next to a small window, which provides some ventilation but is inadequate to stop the smell of smoke in other parts of the dining room. Seven people’s bedrooms were seen. Overall these areas were seen to be adequate and clean and provided evidence to indicate that people have been supported to personalise their bedrooms to their liking. Old water stains were seen on two bedroom ceilings that need to be painted over. The home was seen to be clean and free from unpleasant odours. Minster Lodge Residential Care Home DS0000050158.V290392.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 The judgment for this outcome group is poor. Staff are provided with training to adequately equip them for their work. The home’s performance under this group of Standards is compromised by occasional shortfalls in the staffing rota and failures in the vetting of new staff. EVIDENCE: At the time of this inspection 19 people were living at the home and there were 8 vacancies. The staff rota includes 3 staff on duty during the waking hours and two staff on duty at nighttime. The home also employs a handyman 16 hours per week, a laundry worker 15 hours a week and a cook 2 days per week and two part time domestic staff. An agency cook is being employed at the home for 4 days. The manager also said that an activity co-ordinator is due to start back at the home shortly. For the majority of the time there are three care staff available to attend to service users needs but there are occasions during the week, when this is reduced to two staff, e.g. when staff are covering for the cook. This can take a person away from providing care for as much as three hours, which is unacceptable. As previously noted there is minimal evidence of planned activities at the home. The manager said that this would improve when the activities co-ordinator returns to the home shortly. Minster Lodge Residential Care Home DS0000050158.V290392.R01.S.doc Version 5.1 Page 19 Comments made by staff confirmed that they are provided with opportunities to undertake training opportunities and information provided by the manager states that 46 of staff hold NVQ qualifications and 5 more staff are being registered to start the NVQ 2 course shortly. A sample examination of staff training information and comments made by staff indicates that people are being provided with access to mandatory courses. The manager reports that 50 of staff have recently undertaken challenging behaviour training with MIND and that the rest of the staff are booked to attend this training shortly. This was verified by staff comments. The manager confirmed that she intends to devise a staff training summary so that staff training needs and achievements can be assessed at a glance. The manager also reports that she has booked alcohol awareness training for staff, as 5 service users have alcohol related needs. There also plans for staff to attend optical awareness training. At the moment staff are expected to attend staff training in their own time, which could have a negative impact on staff willingness to attend training. A sample examination of two staff files highlighted shortfalls in the homes vetting procedures. In both cases the staff started at the home before two satisfactory references had been received by the home. On person had one reference on file and the other person had none. Other recruitment practices, including Criminal Record Bureau checks were satisfactory. Minster Lodge Residential Care Home DS0000050158.V290392.R01.S.doc Version 5.1 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,and 38 The judgment for this outcome group is poor. There is insufficient management time available to enable the home to run effectively. There are shortfalls in Vetting and consultation processes, which are necessary so people are properly protected and have a voice in running the home. EVIDENCE: The present manager has been in post since March 2005 but she has not been registered to-date with the Commission. The manager was advised that her application must be completed and forwarded to the Commission promptly to enable the registration process to commence. The manager said that she would she was waiting for her Criminal Record Bureau Check to be processed so that she has all the information necessary to apply for Registration. Minster Lodge Residential Care Home DS0000050158.V290392.R01.S.doc Version 5.1 Page 21 It was apparent from discussions with the manager and access to documents, such as new care plan forms and audits of equipment and lighting in the home that the manager has been carrying out work to address the outstanding requirements from previous inspections. However progress has been delayed to some extent by the loss of the deputy manager who has recently moved to another post. The manager was unable to confirm that recruitment to this vacancy is taking place as the owners are managing this. Two group leaders are employed at the home to provide on shift leadership but there is nobody with managerial responsibility fro the home in the absence of the manager. Hence the current situation is unacceptable must be addressed so that staff have access to managerial advice in the absence of the manager and in order that administrative tasks, such as writing care plans can be kept up to date. Good work is taking place by the manager to audit a number of areas of practice within the home, on a monthly basis, such as, laundry, kitchen, general environment and medication. If this were supported by an action plan to address any deficits this would provide the basis for a quality assurance programme at the home. The manager said that she has not recently surveyed the views of service users, relatives and other relevant people about the home. This is a necessary part of the quality assurance process to demonstrate that people are being properly consulted and involved in the running of the home. A sample examination of service users’ expenditure records were seen together with receipts, indicating that people’s monies are being accounted for. In most cases service users’ relatives take a lead role in managing their finances and are invoiced for expenditure. Where relatives are not involved, the home refers people to age concern for an advocate to act as appointee. Two people’s financial records were not available at the time of the inspection, as required. The manager explained that the owners were referring the people concerned for support from age concern. In the meantime the owners are retaining their records. A sample examination of fire alarm records indicates that the alarms are being tested each week to ensure they are working properly. A wedge was seen to be in use in one door. The manager explained that she has proposed to the owners that door guards are purchased for some rooms so that people do not resort to wedging doors open. The inspector explained that this must be done only with the agreement of the fire officer to ensure that the correct devices are used for the safety of service users. The manager confirmed that most staff have had fire training this year but a small number of people still need to attend this training. Information provided by the manager, in the pre inspection questionnaire indicates that contractors are in place for maintaining gas and electrical equipment at the home. Minster Lodge Residential Care Home DS0000050158.V290392.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 1 x x x x x x 3 STAFFING Standard No Score 27 2 28 2 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 1 x 2 x x 2 Minster Lodge Residential Care Home DS0000050158.V290392.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3OP7 Regulation 15(2) Requirement Proceed with plans to use the new care plans that have been expanded to include a greater range of care needs, including foot care, personal safety, pressure area care, damaged and ulcerated skin care. Ensure that these needs are reflected in the home’s assessment for new service users moving to the home. The manager must ensure that all care plans are evaluated monthly and that the outcomes are recorded and signed. Previous timescale not met 19/12/05 The manager must ensure that changes in people’s health and care needs are promptly recorded in their care plans, so that staff are kept up to date with the care they are required to provide. Timescale for action 02/06/06 2 OP7 15(1) 15/05/06 Minster Lodge Residential Care Home DS0000050158.V290392.R01.S.doc Version 5.1 Page 24 3 OP7 12(2)(4) (c) The manager must ensure that those residents who go out alone are risk assessed and have their personal details and contact details of the home in their possession when they leave home, to ensure that the risk of harm is minimised and that they can summon help if necessary. The manager must ensure that where risk assessments indicate that a hazard to the service user (e.g. score indicates risk of falls) that guidance is provided in a care plan to enable staff to reduce the risks identified. The registered manager must make arrangements for recording, handling and safe administration of medications received into the care home. The concerns identified in this report on the management and administration of medications must be addressed within a risk management framework. The manager must ensure that there is an activity programme available each week and the residents and/or their families are aware. The manager must ensure that those residents without relatives are given the opportunity to go on outings and have fun. Previous timescale not met – 19/12/05 15/05/06 4 OP8 132)(b) 15/05/06 5 OP9 13 (2) 30/05/06 6 OP12 16(2)(m)( n) 07/06/06 Minster Lodge Residential Care Home DS0000050158.V290392.R01.S.doc Version 5.1 Page 25 7 OP25 13(2)(c) (f) 23(2) (b) & (p) 8 OP25 16(2)(c) The Registered Provider must, in 05/06/06 conjunction with the manager, submit a plan, with timescales, to confirm funding will be made available to address the necessary maintenance and equipment issues identified in this report, including: New dining chairs, lighting, replacement pillows, towels and flannels, replacement flooring in bathroom and shower room, paint bedroom ceilings with water stains, make plans to replace lounge carpet, make plans to repair / replace old wooden exterior windows, maintain garden in good order, exterior rendering at rear of building, air purifier / suitable ventilation in smoking area of the dining room. 30/05/06 The registered provider and manager must ensure that all broken furniture in the bedrooms is replaced; an action plan with timescales must be forwarded to the Commission. Note - some broken furniture has been replaced; work is still ongoing from 19/12/05. 9 OP25 13(4) 23(2)(p) The Registered provider and manager must ensure that the lighting is bright and safe in the residents’ areas. Shades must be available on lighting. Ongoing from previous timescale 19/12/05. Partly achieved. 15/05/06 Minster Lodge Residential Care Home DS0000050158.V290392.R01.S.doc Version 5.1 Page 26 10 OP27 18(1)(a) The registered provider and manager must ensure that there are sufficient staff on duty to carry out all the necessary tasks such as cleaning, laundering and caring for the residents. In particular proper staff cover must be provided when the cook is not available so that service users are not left with only two carers for prolonged periods of time. Ongoing from 19/12/05 The Registered Provider must make arrangements for proper management cover to be available at the home so that the home is managed properly at all times and that care plans and other managerial duties are carried out in a timely fashion. The manager must ensure that the residents, their families and the staff are involved and consulted in changes that are occurring in the Home. Records must be kept of consultations, such as questionnaires and action plans. Previous timescale, 19/12/05 not met. The registered provider and manager must ensure that a complete quality assurance and monitoring system is in place and that results from audits and surveys inform changes in practice and provision. Ongoing from 19/12/05 15/05/06 11 OP31 18 05/06/06 12 OP32 12(2)(3) 30/06/06 13 OP33 24(1) 30/06/06 Minster Lodge Residential Care Home DS0000050158.V290392.R01.S.doc Version 5.1 Page 27 14 OP35 17 (2) Sched 4, 8&9 15 OP38 23(4)(c) (d) The Registered Provider must ensure that all financial records belonging to 2 service users, for whom they are managing finances, are retained at the home until such a time that Age Concern agree to act as appointee for the people concerned. The manager must ensure that the remaining staff attend fire training. Ongoing from 19/12/05 Cease the use of door wedges and consult with the fire officer regarding acceptable alternatives. 15/05/06 01/06/06 Minster Lodge Residential Care Home DS0000050158.V290392.R01.S.doc Version 5.1 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP7 OP19 OP30 Good Practice Recommendations The manager is recommended to monitor service users satisfaction with the care they receive at night. It is recommended that an assessment of garden furniture is conducted and where required new furniture is purchased. The manager is recommended to pay staff for attending training at least three days a year, reward a positive staff attitude towards training and development. Minster Lodge Residential Care Home DS0000050158.V290392.R01.S.doc Version 5.1 Page 29 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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