Inspection on 04/11/08 for Abbeydale Residential Home

This inspection was carried out on 4th November 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Abbeydale Residential Home 08/02/10

Abbeydale Residential Home 05/11/09

Abbeydale Residential Home 13/11/07

Abbeydale Residential Home 05/12/06

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 06/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Abbeydale Residential Home 281 Gloucester Road Cheltenham Glos GL51 7AD     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lynne Bennett     Date: 1 0 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Abbeydale Residential Home 281 Gloucester Road Cheltenham Glos GL51 7AD 01242525107 01242522671 abbeydalerh@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Charlton Care Ltd care home 13 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of sevice users who can be accommodated is 13. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category - (Code OP) Date of last inspection Brief description of the care home Abbeydale is an adapted older property situated in the residential area of St Marks, within easy reach of local shops and the railway station. The Home is also on a bus route to Cheltenham town centre. Charlton Care Ltd purchased the home in 2006. Single accommodation for thirteen older people, who require personal care, is provided on two floors. All the bedrooms are pleasantly decorated comfortably furnished and have en-suite facilities. Communal facilities are provided on the ground floor and consist of a comfortable lounge and a large conservatory, which is used as a dining room. The attractive well maintained garden has easy access and may be enjoyed by the service users during the summer months. A copy of the most recent CSCI report is contained in an information folder located in the main hall of the home. Current fees Care Homes for Older People Page 4 of 33 Over 65 13 0 Brief description of the care home range from 357 pounds to 650 pounds. Prices for hairdressing, chiropody and any personal items are available on request. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection took place in November 2008 by one Inspector and included three visits to the home on 4th, 5th and 10th November. The Registered Manager completed an AQAA (Annual Quality Assurance Assessment) as part of the inspection, providing information about the service and plans for further improvement. It also provided numerical information about the service (DataSet). Time was spent with people living in the home, talking to them about the care provided and observing the care they were receiving. The Registered Manager was in attendance throughout. Five members of staff were spoken with about the care they provide. A selection of documents were examined including care plans, medication records, Care Homes for Older People Page 6 of 33 health and safety systems, quality assurance records and staff files. A walk around the environment was completed and four peoples rooms were visited with their permission. The judgements contained in this report have been made from evidence gathered during the inspection,which included a visit to the service and takes into account the views and experiences of people using the service. What the care home does well: What has improved since the last inspection? 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 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 33 Care Homes for Older People Page 9 of 33 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The assessment of people moving into the home could be more robust, ensuring that their needs can be met by the home. People need to have access to information about the costs of the service they are to receive so that they can make an informed decision about whether they wish to live there. Evidence: Since the last inspection the home had increased the number of rooms to thirteen providing additional accommodation for two people. The admission of two people who had moved into the home during September and October were inspected. Both had been assessed by the home although not all documentation provided as part of this process had been completed. The bed enquiry form, activities of daily living assessment and medical assessment had been completed. Another form providing information about each persons life history had not been completed. Failure to complete the necessary documentation could potentially put people at risk. Care Homes for Older People Page 11 of 33 Evidence: There was no evidence that the Registered Manager had sent a letter to people or the placing authority stating that the home could meet their needs. One person was privately funding themselves. There was no evidence that they had been supplied with a statement of terms and conditions or contract providing details of the fees payable and costs of additional services. The AQAA stated that three people had dementia. Discussions with management and staff confirmed that at present two people were not presenting with behaviour which could not be managed but concerns were being expressed about one person becoming increasingly distressed. They will need to be re-assessed to ascertain whether the home can continue to meet their needs and whether a more appropriate placement should be found. The Registered Manager indicated that this would be done. Standard 6 does not apply, Intermediate Care was not being provided. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans identify peoples needs but they do not provide sufficient information about how these are to be met. Improvements must be made to systems for the administration of medication to make sure that people are safeguarded from possible harm. Evidence: There were significant failings in this outcome group which indicated poor practice. An Improvement Plan will be requested and a Random Inspection may be done to check on compliance with this document. The care being provided for four people was casetracked, which included reading their care plans and other related documentation, examining medication records, observing the care provided to them and talking to them and staff. Care records for other people were also sampled. Since the last inspection new care plans had been produced providing information Care Homes for Older People Page 13 of 33 Evidence: about peoples individual needs. There was evidence that these were being reviewed each month by the deputy manager who had signed these documents. People living in the home had not signed their care plans although there was space for them to do this. Care plans were in place for peoples social, mental and emotional needs, eating and drinking and personal cleanliness. Some of these were vague referring to provide assistance with personal care or give full support to help cope with immediate future. They need to provide the reader with specific information about how this is to be done. For instance, is verbal prompting only needed or does the person require physical help. What kind of toiletries do they like to use. Are there days when they do not require physical help. Do they prefer to be supported by a male carer or a female carer or do they not mind? Staff commented that some people did not wish to have male carers providing their personal care. Daily notes for several people indicated that on some days people completed their personal care independently but on other days needed support. Whether this was due to them refusing personal care offered by male carers or because they felt able to do their own personal care was not indicated. Care plans need to be SMART (Specific, Measurable, Achievable, Realistic and Timely). Daily notes were being kept for people with some of these providing detailed information about how needs had been met and the lifestyles of people living in the home, whilst other entries were very succinct. For instance an entry for one person stated needed help with their personal care needs, ate a good lunch, joined in with a musical activity. Another entry stated needed help with personal care. Happy. The Deputy Manager said that records were being completed once a day usually at mid-day indicating that some afternoon records were being completed in advance of the activity. These records should be completed either twice a day or at the end of the days shift - usually 8.00 pm. Monitoring forms were in place indicating that staff were keeping an eye on peoples weight, diet and healthcare appointments. There were some inconsistencies in record keeping. Good evidence was recorded on a medical form for one person who was having regular input from a district nurse in May and June. However there were no entries for treatment they were receiving in September and October. This information had been noted in the daily records. Copies of appointments with an optician were in place for several people but again there was inconsistent recording on healthcare records of these appointments. On files sampled there was no evidence of dental appointments. Appointments with Doctors appeared to have been made although again recording of these was poor. Staff expressed concerns that occasionally people did not have prompt access to their Care Homes for Older People Page 14 of 33 Evidence: Doctors and that quicker action may have prevented peoples health deteriorating. They felt that the management response to peoples health was reactive and that monitoring of peoples health could be improved. Failure to make prompt appointments could impact on the health and wellbeing of people living in the home. A Doctor was in attendance during one of the visits. People living in the home said they had received support with their mobility from a Physiotherapist and one person was able to show the correct way to get out of their chair and walk with a walking frame. Other people had access to healthcare professionals from local hospitals and were supported to attend outpatient appointments. One person living in the home was now requiring help to care for a Stoma. Staff said they had not received training in this and there did not appear to be any support from a district nurse. Specialist training must be provided for staff and clear protocols put in place about the care needed. This person should also be having regular input from a Stoma care nurse. Systems for the administration of medication were inspected. Staff had completed training in the safe handling of medication. Individual profiles with a photograph of each person were in place. The Deputy Manager stated that she checked medication in and completed an audit of medication stock at that point. She said she also double checked any controlled drugs which were kept in the home. At the time of the visit, the stock tally for controlled drugs did not reflect the stock in the cupboard. This had been checked after the morning medication round and was correct at that time. Two strips of this medication were in use and tablets were not being dispensed consecutively from the strip making it difficult to assess on first sight the stock levels. The Deputy Manager said that she would contact the pharmacy but there did not appear to be a robust procedure in place for reporting of errors with controlled drugs. This was also notifiable to us under Regulation 37 and the Deputy Manager stated this would be done. There were some handwritten entries on the medication administration record (MAR) and there was no evidence that these had been signed or countersigned. On one MAR there were two gaps where medication had been dispensed. There did not appear to be a system in place to monitor this. A regular audit of medication systems would identify these kinds of errors. A signature and initial list of staff administering medication was not with the medication records. The Deputy Manager stated a record did exist for policies and procedures and that a copy could be placed with medication records. Some liquids and creams which were in use did not have the date of opening noted on the container. One liquid, which was not being used, was out of date and Care Homes for Older People Page 15 of 33 Evidence: needed to be returned to the pharmacy. A recent copy of the British National Formula was in place. There was no evidence that the temperature of the medication cabinet was being monitored and recorded. People were observed being treated with respect and sensitivity by staff on duty during the visits. One person required help with their clothing and was taken into their room by a member of staff to sort out the problem. Staff were observed knocking on peoples doors and announcing themselves prior to entering private rooms. Chairs in the lounge had kylie covers (washable covers indicating continence problems). This does not promote dignity for people who may experience incontinence. Other measures need to be put in place. Care Homes for Older People Page 16 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the opportunity to participate in social, cultural and recreational activities that reflect their personal expectations. A healthy and nutritional diet is provided. Greater flexibility is required to ensure personal choice about when and where to eat meals is respected. Evidence: The overall judgement for this outcome group has taken into consideration that the outcomes for Standard 12 was excellent and Standard 15 was adequate. The AQAA indicated there had been increased activities over the past 12 months, including the services of a key board player one day a week. It also stated a menu had been put in place, providing a wide variety of dishes catering for every taste. People were observed enjoying activities with the majority of people joining in with a singalong with a musician who entertained them twice a week. They also took part in a music quiz. Entertainment was being arranged each afternoon, Monday to Friday. People had access to a hairdresser one afternoon who they said visited regularly. An activities co-ordinator had been appointed and discussed the variety of social events being provided either to a group of people or individually. People had recently visited Care Homes for Older People Page 17 of 33 Evidence: Bourton on the Water, gone to the Theatre, went out for afternoon tea and played scrabble or dominoes. She stated that for those who wished to take part in a religious service this was provided each Sunday afternoon by a student missionary. Visitors were observed with relatives and one stated they were made to feel welcome. Some people had telephones in their rooms and others said they could use the homes telephone to keep in touch with relatives. The activity co-ordinator described how she supported one person to keep in touch with friends by writing letters with them. People had personal possessions including fixtures and fittings in their rooms. Inventories were in place. Most people were maintaining control of their personal finances. The Deputy Manager confirmed records were in place for one person who was being supported to manage their finances. These were not seen at this inspection. Since the last inspection a cook had been employed and people said they liked the meals being provided. Some people were joined by us during a meal of cottage pie and fresh vegetables. They all appeared to enjoy the meal which they ate in the dining room. Some people chose to have their meals in their rooms. One person commented that they would have liked to eat her meal in the lounge. People were observed being offered hot drinks and snacks regularly. Fresh fruit was available in the lounge. Alternatives to the main meal were being offered but not recorded in the record of meals when provided. Another person stated that they were being woken up to have their breakfast and staff confirmed this. The Registered Manager said that a meeting had been held with them, their social worker and relative to discuss this. They confirmed that this had been discussed but both thought that this had been resolved. A third visit to the home before 8.00 am indicated that this person was having their breakfast earlier than they wished. Care plans and daily records did not provide any information about the persons wishes or whether alternative times had been tried. Care Homes for Older People Page 18 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place that enable complaints and concerns to be raised by people using the service or on their behalf. The current systems for safeguarding people from possible abuse are not robust enough. Evidence: The home had a complaints system in place and people living in the home said that they would speak to the Registered Manager or staff if they had concerns. A copy of the current complaints procedure was displayed in the entrance hall. The AQAA stated that there is a clear and accessible complaints procedure in place and the DataSet indicated that no complaints had been received. There were no complaints recorded in the homes complaints folder. A relative said that she had contacted social services with some concerns about her relative and that a meeting had been held at the home with the Registered Manager and her relative living in the home with their social worker. She said that she now talks directly to the Registered Manager about any concerns. He confirmed that any issues get dealt with as they occur. It is good practice to record these with evidence of the outcome. Staff had a good understanding of the whistleblowing policy and procedure although they were not confident about using it and having their confidentiality respected. They Care Homes for Older People Page 19 of 33 Evidence: had a comprehensive understanding of abuse and were able to discuss what they should look for and their roles in reporting of suspected abuse. They were aware of the local adult protection team and had completed training in the safeguarding of adults. The Deputy Manager was unable to explain local processes but said she had completed training and that the home had a policy and procedure in place. She and the Registered Manager had completed training in the Mental Capacity Act. Care Homes for Older People Page 20 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home which is safe, warm and comfortable. A regular maintenance programme makes sure that the good standards of decor are maintained. The high standards of accommodation are impacted on by occasional lapses in infection control measures. Evidence: The AQAA identified key changes to the home over the past twelve months including a new lift, two new bedrooms, extensions to existing areas, new carpets and general redecoration throughout the home. At the time of the visits the home was warm, clean and had no odours. There was no cleaner at the time, although the Registered Manager said they had appointed a person. Staff were doing some cleaning as part of their duties and some staff were working additional hours to help out. During the first visit some rooms and a downstairs bathroom were in need of attention but this had been addressed by the end of the visit. On consecutive visits there were no concerns with the cleanliness of the home. Several extractor fans in a shower room and en suites did not appear to work. Lightpulls and call alarms need to be checked and where necessary replaced to ensure access to all. Some were very short and others very dirty. Care Homes for Older People Page 21 of 33 Evidence: Generally the home was pleasantly decorated. Good use was made of personal photographs of people living in the home in the entrance hall as well as a notice board with photographs of staff and regular visitors to the home. Flowers had been provided in the hall, in the lounge and on each dining table. Future plans included replacing flooring in the hallway with new carpets and new fixtures and fittings in the kitchen. A visit by Environmental Health in April had rated the home as poor. The Registered Manager confirmed that they had complied with the requirements issued. Clothes and dirty washing were piled on the floor in the laundry. This is an infection control risk and they should be put into washing baskets. There was soap near to the hand wash basin in the laundry but no paper towels. Personal protective equipment had been provided around the home. Care Homes for Older People Page 22 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are met by a competent staff team, who have access to a satisfactory training programme that provides staff with knowledge about the diverse needs of people living at the home. Improvements in recruitment and selection procedures will ensure that people are being safeguarded from possible harm. Evidence: The home was fully staffed at the time of the inspection. Staff said that ratios of two care staff plus a cook, the Registered Manager and/or Deputy Manager were being maintained. An activities co-ordinator was also employed two afternoons a week in addition to this. A cleaner had just been appointed and they were waiting for the necessary documentation prior to appointment. Waking night staff were employed. Staff spoken with had a good understanding of the needs of the people they support and said they had access to training to acquire the knowledge and skills they need. A training matrix was in place confirming that 85 per cent of the staff have a NVQ in Health and Social Care. This matrix did not include dates when courses/training had been completed. New staff confirmed that they had completed an induction both at the home and externally which was equivalent to the Skills for Care Induction Standards. The Registered Manager stated that the home was involved with the Partnerships for Older People Projects (POPPs) accessing training and support from a range of Care Homes for Older People Page 23 of 33 Evidence: healthcare professionals. Copies of certificates and completed inductions were on staff files. Staff stated that they had completed training in dementia awareness, activities in a care setting, protection of vulnerable adults, safe handling of medication and mandatory training. The cook and the Deputy Manager had completed Level 2 in Food Hygiene but other staff who said they occasionally help prepare food in the kitchen had not completed Food Hygiene awards. Recruitment and selection records were examined for two new members of staff. Application forms and two references were in place prior to appointment. An additional record was being completed to provide a full employment history although this was being completed after appointment. A full employment history and any gaps in employment must be provided prior to staff starting work in the home. Evidence of identity and a photograph were in place. Staff had completed a declaration about their fitness to work. Both had been appointed prior to receipt of their Criminal Records Bureau (CRB) check. A povafirst check had been obtained and their was evidence of this on their file. The registered manager described the process in place until the CRB was received which included the person shadowing staff and not providing personal care. A risk assessment was not in place describing this. Documents on one persons file indicated that their visa had expired. They confirmed that this had been renewed and provided a copy by the second visit to the home. Care Homes for Older People Page 24 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The quality assurance system involves feedback from people living in the home but needs to provide evidence in the form of a report that the home is run in the best interests of people. Health and safety systems are in place which should protect people from possible harm. Evidence: The Registered Manager had the Registered Managers Award and a NVQ Level 4 in Health and Social Care. His continuing professional development included training in the Mental Capacity Act. The day to day management of the home was being shared with the Deputy Manager who was also completing these awards. Work had been completed by the management team to address issues raised at the last inspection. Further work was needed to personalise care plans and make sure that people have timely access to healthcare support. Recruitment and selection of staff could be improved to make sure processes are robust. Care Homes for Older People Page 25 of 33 Evidence: A quality assurance system was being put in place. Regular unannounced visits to the home were being conducted by the Responsible Individual and a report was being produced. These indicated that people living in the home and staff were asked for feedback about the service being provided. Surveys had been completed in November 2007 and copies of these examined. Comments included, the Manager and Deputy Manager very approachable and helpful. A report had not been produced at the time and the Registered Manager was able to talk through improvements which had been actioned (such as people wanting an entertainer in the home). The home did not have a development plan based on the quality assurance system. As mentioned one persons finances were being looked after by the home and the Deputy Manager stated that records were being maintained. These were being kept securely. At the time of the visits, information about people including care plans were kept in a bureau in the hallway. When questioned the Registered Manager said this could be locked but on a return visit this was open. Information about people must be stored securely. Robust systems were in place for the monitoring of health and safety systems within the home. A current fire risk assessment was in place with evidence of regular servicing and testing of fire systems. The Safer Food Better Business Guide was in place and being used. Fridges and freezers were being tested regularly although one indicated being over 8 degrees centrigrade. The cook stated this was because the fridge, which was used for mainly milk storage was constantly open during the day. It was suggested that night staff may be able to record a more realistic temperature. Certificates were in place confirming servicing of Gas, hoists and the lift. Test for Portable Appliances were overdue and the Registered Manager said he was aware of this. Individual risk assessments were in place for people particularly around moving and handling risks and leaving the home without supervision. The front door was being kept locked. The Registered Manager will need to acquaint himself with new legislation being introduced next year about the Deprivation of Liberty. Care Homes for Older People Page 26 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 3 14 (1) The care needs of each resident must be fully assessed and a record made of the processes. (Requirement not met from 31/01/07) 01/02/2008 2 33 24 The registered person must 30/04/2008 establish and maintain a system for reviewing and improving the quality of care provided at the home Care Homes for Older People Page 27 of 33 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 2 5 People living in the home must have a statement of terms and conditions or contract (if privately funding) providing information about the fees payable and any additional costs to them. This is to make sure people are fully aware of the costs of the service and their rights and obligations. 31/12/2008 2 4 14 The needs of the person developing dementia must be reassessed to ascertain whether the home can continue to meet their needs. This is to make sure that the person is receiving the appropriate service and support they require as their needs change. 31/12/2008 Care Homes for Older People Page 28 of 33 3 4 14 The registered person must confirm in writing to people moving into the home that their needs can be met. This is to verify from the assessment of peoples health and welfare that the home can meet their needs. 12/12/2008 4 7 15 Care plans must provide specific detail about how peoples needs are to be met, including their preferences and wishes to how they wish to be supported. This is to make sure that their individual assessed needs are being met, promoting a person centred approach to care. 31/12/2008 5 8 18 Staff must have training in 28/11/2008 specialist techniques. Clear protocols and guidance must be in place for Stoma care. This is to make sure that the health and wellbeing of people needing specialist support is provided safely. 6 9 13 A system must be put in 12/12/2008 place and followed for errors concerning controlled drugs. This is to safeguard people from possible harm. 7 10 12 People living in the home 12/12/2008 must be treated with dignity in respect of how their continence is dealt with and the gender of staff providing their personal care. Care Homes for Older People Page 29 of 33 This is to promote the wishes, privacy and dignity of people living in the home. 8 15 12 Peoples wishes about the service they wish to receive must be respected. This is to make sure that the wishes and wellbeing of people are taken into account. 9 18 13 Staff need to have confidence that when they use the whistleblowing procedure due process is followed, respecting their confidentiality and action taken on their concerns. This is to prevent people being harmed or suffering abuse. 10 29 19 A full employment history must be obtained prior to the appointment of new staff. This is to safeguard people from possible harm. 11 30 13 Any staff who are involved in the preparation of food must complete training in food hygiene. This is to promote infection control and prevent people becoming ill. 12 33 24 A report/development plan must be produced as part of the quality assurance system. 31/12/2008 28/11/2008 28/11/2008 28/11/2008 28/11/2008 Care Homes for Older People Page 30 of 33 This is so that people will know that the home is run in their best interests. 13 37 17 Records and documents relating to people living in the home must be kept securely. This will make sure that confidentiality of information is adhered to. 14 38 13 Portable appliances must be tested regularly. This will make sure people are not at risk when using electrical equipment. 31/12/2008 28/11/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 4 7 Assessments undertaken by the home should be completed in full prior to admission. Daily records should be completed providing a report of what has occurred during the shift and not in advance. People should sign their care plans. 3 8 Arrangements should be made for regular input from relevant healthcare professionals for people requiring support with specialised techniques such as Stoma care. Liquids and creams should be labelled with the date of opening and disposed of following guidelines of the pharmacy. The temperature of the medicine cabinet should be monitored. A regular audit of medication systems should be carried out which would monitor any gaps in the medication administration record and ascertain whether there had been any errors. A signature list with staff initials should be in place. Healthcare records should be completed consistently 4 8 5 8 6 8 Care Homes for Older People Page 31 of 33 providing a full record of appointments including the outcome of any treatment or assessment. 7 8 15 15 When alternatives to the main meal are provided a record should be kept of this indicating who had this meal. Peoples choices should be respected. When they wish to eat their meals in the lounge provision should be made to accommodate this. Where issues or concerns have been raised these should be recorded with a note of the action taken. Extractor fans should be regularly checked, cleaned and working. Lightpulls and call bells should be accessible. Dirty laundry should be placed into washing baskets. Paper towels should be provided near to the hand wash basin in the laundry. A risk assessment should be in place when new staff are starting work without a CRB check in place. This should describe what duties they are unable to perform. The training matrix should include dates of when training was completed so that refresher training can be arranged. Fridge temperatures should be taken at alternative times to ascertain whether there is a problem with the fridge. 9 10 11 16 19 26 12 29 13 14 30 38 Care Homes for Older People Page 32 of 33 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 © (2008) Commission for Social Care Inspection (CSCI). 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