Inspection on 21/08/07 for Abbeymere Care Centre

This inspection was carried out on 21st August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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

Abbeymere Care Centre 11/03/09

Abbeymere Care Centre 21/02/08

Abbeymere Care Centre 20/03/07

Abbeymere Care Centre 04/01/06

Abbeymere Care Centre 22/09/05

Abbeymere Care Centre 24/03/05

Abbeymere Care Centre 18/05/04

Abbeymere Care Centre 08/07/03

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Abbeymere Care Centre 12 Eggington Road Stourbridge West Midlands DY8 4QJ Lead Inspector Jayne Fisher Key Unannounced Inspection 21st August and 5 September 2007 10:00 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 Abbeymere Care Centre DS0000024951.V342884.R01.S.doc Version 5.2 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. Abbeymere Care Centre DS0000024951.V342884.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Abbeymere Care Centre Address 12 Eggington Road Stourbridge West Midlands DY8 4QJ 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) 01384 395195 F/P01384 395195 Karelink Limited Mrs Judith Christine Boden Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (12), Physical disability over 65 years of age (6) of places Abbeymere Care Centre DS0000024951.V342884.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 20th March 2007 Brief Description of the Service: Abbeymere Care Centre is registered for the care of 12 older people and 6 people with physical disabilities over the age of 65. The Home aims to enable people from a multicultural society and diverse community to continue living as independently as possible by receiving care and support consistent with their incapacities and disabilities. Abbeymere is a converted and extended residential property and is located in Wollaston, within a short walking distance of the village, which has a large variety of amenities and facilities. The house is on a main bus route giving access to neighbouring towns. The building comprises of a large communal lounge, dining room and a number of bedrooms (as well as kitchen, laundry, bathroom and toilets) on the ground floor and bedrooms, bathrooms and toilets on the first floor. The home has a shaft lift and some other aids and adaptations consistent with the needs of older people. There is some car parking space to the rear of the building. The staffing in the home consists of a manager who is supported by a deputy and care staff as well as a ancillary member of staff. A director of the company is responsible for line management support to the manager. Information regarding fee levels was provided by the manager on 21 August 2007 which are between £393 - £398 per week. This does not include extra services such chiropody and hairdressing. These are all available at extra cost to the residents. A statement of purpose and service user guide are available to inform residents of their entitlements including how to access a copy of the inspection report. Abbeymere Care Centre DS0000024951.V342884.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over two days. On the first day 2 inspectors visited between 10.00 a.m. and 7.15 p.m. with the home being given no prior notice. We met all of the twelve people who live at the home and interviewed four residents. We spoke with the registered manager, three members of staff and the Managing Director. We also met a visiting relative. A pharmacy inspector visited the home on a separate day when the deputy manager was present. Four questionnaires were received from residents. We looked around the home, examined records and observed care practice. We also looked at all of the information that we have received about this home since it was last inspected. What the service does well: What has improved since the last inspection? The manager has sought advice from an occupational therapist regarding how to support one resident with their mobility problems. Staff are now adhering to home’s policy regarding not wearing jewellery whilst they are working. The Managing Director has told us that he will ensure that any future new staff who are employed will now have the required level of police clearance checks in place. Abbeymere Care Centre DS0000024951.V342884.R01.S.doc Version 5.2 Page 6 What they could do better: Care plans and risk assessments remain poor and do not give staff the sufficient guidance they need in providing support and care to residents. We raised serious concerns regarding the lack of measures in place regarding one resident whose behaviour had resulted in an injury to himself, staff and who posed a risk to other residents. More improvements need to be made so as to ensure that residents’ medication is safely managed. There are unsatisfactory arrangements in place to residents’ respect and promote residents’ dignity. People living in the home should be encouraged and supported to do interesting things, including going out into the local community. More choices could be offered at breakfast and for those residents who require specialist diets. Professional advice needs to be sought in respect of making pureed diets more appealing and to ensure that they meet all nutritional requirements. The bath hoist is broken so that residents who have mobility problems are currently only provided with the choice of a shower. Infection control practice needs improvement in order to minimize risks to residents. Staff are not employed in sufficient numbers to meet all residents’ needs. Further training is needed for staff in order to meet the specialist needs of residents. There are no male staff employed to support male residents. The home needs strong and effective management to ensure that it is run in the best interests of residents. We raised a serious concern regarding unsafe bed rails which posed a risk to residents’ health and safety. There are no systems in place to monitor and analyse the number of accidents and therefore no preventative arrangements in place to minimise risks to residents. There were other health and safety issues which we highlighted during our visit and which need attention. The serious concerns which we raised during our inspection were met with a suitable response by the registered manager and Managing Director who stated that they would take appropriate action. Abbeymere Care Centre DS0000024951.V342884.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Abbeymere Care Centre DS0000024951.V342884.R01.S.doc Version 5.2 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 Abbeymere Care Centre DS0000024951.V342884.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents have the information they need to make an informed choice about whether or not they want to live in the home, although some of the information could be more accurate. Before they are admitted to the home new residents are assessed this is so that they can be assured that the care service can meet their needs and wishes. EVIDENCE: We asked the manager for the current statement of purpose and service user guide as these were not openly available within the home. We read the statement of purpose and saw that it contained a lot of useful information for residents however there are some areas of the document which need either amending or more clarification in order to met the requirements of the Care Homes Regulations 2001. Abbeymere Care Centre DS0000024951.V342884.R01.S.doc Version 5.2 Page 10 For example, there are no details of the relevant qualifications or experience of the registered provider. There is still a statement which says that the registered manager holds a relevant management qualification when this is not the case. There is conflicting information as to the range of needs that the home intends to meet. For example on page 6 it states that the home is registered to provide care for ‘17 residents with one having mental illness or physical disabilities’. On page 5 it states that the home is registered to provide care for ‘18 residents with 6 having physical disabilities’. There are no details of fire precautions and associated emergency procedures. The document states that residents can smoke in a communal area: ‘a little lobby area at the back’. This needs to be reviewed as it does not meet the new smoking legislation. The manager could not locate the service user guide for us to look at. She said that the registered provider does now give a copy to new residents but told us that it had not been produced in a larger print format. We case tracked one resident who had recently been admitted to the home for a short stay. There was a comprehensive assessment which had been completed by the registered provider on the day before the resident was admitted to the home. As the resident is self funding it was not necessary to obtain a copy of a social worker’s assessment and care plan. We saw that a range of needs had been assessed as recommended by the National Minimum Standards (NMS) 3.3. The assessment stated that the resident was ‘inclined to be abusive’ but no further details were recorded regarding the nature of this challenging behaviour. We saw a letter from the registered provider to the person’s relative stating that the care home could meet assessed needs. It also stated that a service user guide, brochure, Dudley advocacy services and a summary of the last inspection report was enclosed. There were details of the fee levels and a contract of residency for signing also enclosed. The tone of the letter was warm, friendly and helpful. At the last inspection visit it was identified that a resident had been admitted to the home with a mental illness and that staff were not trained in this area of support. We saw that staff have not yet received training. Although the manager told us that training is arranged to take place regarding dementia, staff still need to have training in managing challenging behaviour and the specific type of mental illness that the resident suffers from. The last person to be admitted has Parkinson’s disease and staff also require training in this condition (see further comment in standard 30). Abbeymere Care Centre DS0000024951.V342884.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents cannot be sure that their needs will be met as care plans do not provide staff with all of the information require. There are insufficient safeguards in place to ensure that residents are not at risk. Staff do not adequately record or monitor residents’ health care issues in individual plans. Although there is slight improvement, medication systems within the home remain poor and do not always follow good or safe practice guidelines. Practices in the home do not show respect for people living there. EVIDENCE: We looked at a sample of care plans. One person who was admitted seven days ago for a two week respite stay had no care plan in place regarding any element of his care needs. The resident had displayed challenging behaviour and injured a member of staff, and according to his notes, ‘lashed out’ at other residents, and had injured himself requiring hospital treatment. Abbeymere Care Centre DS0000024951.V342884.R01.S.doc Version 5.2 Page 12 We talked to staff and they gave us differing accounts of how they managed this person’s behaviour. We raised serious concerns regarding this resident and other residents’ safety and issued an immediate requirement for the manager to address this issue. It was noted that the resident had fallen previously when living at his own home but there was no falls risk assessment in place. We noted that a number of residents had sustained falls but there were no detailed falls preventions risk assessments in place. The risk assessments that we were shown by the manager were very basic and did not cover all of the hazards to which residents are exposed. For example, there were no risk assessments in place for residents who use wheelchairs. There was a risk assessment in place for one resident’s mobility who requires the use of a hoist. This dated was June 2006 and identified a review date of June 2007. No review had been carried out. The risk assessment did not include all of the moving and handling equipment used by staff. It failed to identify how many staff were needed with transfers, what type of transfers were required, identify any environmental factors, give any details of the resident’s weight, cooperation, continence etc. There were no maintenance or service issues and the type of slings used were not highlighted. We interviewed two care workers. They told us that only read the care plans for the two residents for whom they were key workers. The manager showed us another resident’s care plan which was dated March 2006. We saw that care plans are reviewed using a separate recording sheet but this is not carried out monthly. Original care plans are not being updated when residents’ needs change. For example, one person developed a pressure area according to the review sheet, but a care plan was not generated which was acknowledged by the manager as a shortfall. A resident who is diabetic had a care plan which states that staff are to administer medication, however this ceased in January 2007. The care plan regarding diabetes was very basic in content and failed to identify the frequency of monitoring, aims of care and ideal blood sugar levels, potential complications and side effects and what staff should do in the event hypoglycaemia or hyperglycaemia. There is no evidence to confirm that residents and/or their representatives are involved in the drawing up of their care plans. Care plans had not been reproduced in suitable formats for residents. It was difficult to case track residents’ health care needs due to the lack of detailed care plans and no health care appointment summaries or action plans. We chatted to one resident who told us she has regular visits from her doctor. She said that she was able to call on him when she wanted. She stated that she receives regular chiropody treatment for which she pays privately (but added that the other residents do not receive as regular chiropody treatment Abbeymere Care Centre DS0000024951.V342884.R01.S.doc Version 5.2 Page 13 as herself). We looked at one resident’s ‘report sheet of visiting health professionals’ where the manager told us that details of all health care appointments and their outcomes are recorded. There was no record of regular chiropody treatment apart from a visit in July 2006 despite the resident being diabetic. There were regular visits by the district nurse and the resident had seen the doctor on four occasions during the last seven months. There were no weight checks for this person. The manager said that that it was difficult to weigh people with mobility problems because the home did not have any sit-on weighing scales. We suggested to the manager that she contact the community dieticians to obtain details of how to calculate people’s weight by the mid upper arm circumference (MUAC) measurement. We looked at the nutritional screening tool which stated that the resident was high risk and that fluid charts were required. This had not been reviewed since February 2007. The manager told us that they no longer used fluid charts as the resident had improved; we therefore asked that the nutritional tool be updated accordingly. There were details of the district nurse visiting for treatment of pressure sores which had since healed, and information regarding pressure relieving equipment; although a detailed care plan was not in place. The last resident who was admitted did not have any nutritional screening and had not been weighed on admission. We looked at another resident’s nutritional screening tool this had not been reviewed since March 2006 despite the resident having specialist dietary requirements. The resident has a hearing aid and told us that there was something wrong with it as it keeps whistling. We could find no records of any hearing aid checks or attendance at hearing clinics in her records. All residents’ files that we checked contained details of ophthalmic tests but no there were no dental or mouth checks. We did not see care plans in place for oral hygiene. The continence assessment in place for one resident had not been reviewed since April 2005. Staff are failing to carry out regular blood sugar monitoring for a diabetic resident. The care plan did not identify the frequency of monitoring however a ‘care plan review sheet’ stated that is carried out weekly. According to records given to us by the manager there have been only five recorded checks in the last eight months. The manager told us “we monitor her as and when, when we feel she is looking a bit peaky”. These instructions were not included in any care plan. It is suggested that specialist advice is sought. Medication Storage Medication is stored in the dining area. The majority of medication seen was secured and locked within a medication cupboard, however creams and ointments were stored in an unlocked cupboard, which was not safe or secure. A tub of cream had been opened and partly used; however the name of the resident it belonged to was not on the tub, which increased the risk of the cream being applied to various residents. Abbeymere Care Centre DS0000024951.V342884.R01.S.doc Version 5.2 Page 14 The dining area was very warm. The local supplying pharmacist had previously recommended that the temperature be monitored; however there was no thermometer available to ensure that medication was stored at the correct temperature. Medication requiring cold storage was stored in an unlocked and unsafe plastic container in the kitchen refrigerator. This had been a requirement at the previous inspection in April 2007 and had not been met. The Deputy Manager located a lockable container during the inspection. Controlled drugs, which require special storage arrangements, were not stored correctly. Since the previous inspection a wooden cupboard had been constructed within another cupboard. The lock was a metal hinge with a padlock. This storage did not meet the required arrangements to comply with The Misuse of Drugs (Safe Custody) Requirements 1973. The previous requirement had not been met. Medication was provided in individual monitored dosage cassettes for each service user and also in original boxes or bottles, which were supplied from the pharmacy. Medication was stored neatly in the cupboard and all unwanted medication had been returned to the pharmacy for disposal, which was documented and kept in the residents care files. Medication Procedures There was a medicine policy available dated May 2007. It contained basic guidance for staff on storage, recording, administration and disposal of medication. Medication Records Records for the receipt of medication were available, however the date of receipt was not documented. This was a previous requirement and had not been met. There was a Controlled Drug Register available in order to ensure there were records for this group of medicines, however the register was a spiral bound book and the pages were starting to fall out of the binding. The balances were checked and found to be accurate. One record showed that medication prescribed for pain relief was not always being administered according to the prescribers instructions. The Deputy Manager could not fully explain why the medication was not always given every three days. The resident was spoken to and said ‘I am very happy with the care and the patches are helping with my pain but I had not realised that they should be put on every 3 days’. Abbeymere Care Centre DS0000024951.V342884.R01.S.doc Version 5.2 Page 15 The date of opening on all medication boxes and bottles was not always recorded and balances of medicines did not always match the amount of medication counted in the cupboard. This means that the service could not check service users medication and also a medication audit could not be fully undertaken to ensure safe administration to the service user. All of the medicine record charts were seen, which were mainly pre-printed from the pharmacy. Service users allergy status or ‘none known’ was not always recorded onto the medicine record charts. The majority of the medicine charts seen were documented accurately with a signature for administration or a suitable code with reason why the medication had not been administered. One chart had been incorrectly recorded. The medication directions stated ‘one at night’, however staff had been signing the medicine chart twice a day. The medication was pre-packed by the pharmacy into a cassette as ‘one at night’ and staff were therefore only able to administer one dose at night. The medication record was therefore inaccurate but the resident had received the correct dose. One resident was prescribed medication to help with behaviour management such as agitation or distress. The medication was only to be given to the service user when necessary. There was no documentation available, which detailed under what circumstances the medication should be given to the service user. This means that the health and welfare of the service users were not adequately safeguarded. This had been a previous requirement and had not been met. The pharmacy inspector saw three resident’s care plans. There was limited information regarding resident’s medication. There was no consent to medication available and no information to show if an assessment had been made regarding the resident’s ability to self-administer their own medication. A record of healthcare professional visits was available which documented the reason for the visit and any medication changes were recorded. Staff do not always respect residents’ rights. During our inspection we saw: a resident who was crying that staff were hurting her when she was being hoisted but given no reassurance or comfort by staff a resident who was distressed was asked by a staff member what was the matter, but who then walked away without waiting for a response staff infantilisation of residents such as saying “sit down there’s a good girl” a staff member came into the communal lounge with a wet paper towel and proceeded to wipe a resident’s mouth a resident with her dress tucked into her tights brought back into the lounge by a member of staff residents wearing blue plastic aprons at meal times (usually worn by staff when carrying out personal care tasks) a sign displayed in the communal bathroom ‘all staff must wear white Abbeymere Care Centre DS0000024951.V342884.R01.S.doc Version 5.2 Page 16 aprons when taking clients to the toilet and wash their hands in between clients’. As identified at the last inspection subjective comments are still being used to describe residents’ behaviour, with one person referred to as being ‘nasty’. Abbeymere Care Centre DS0000024951.V342884.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some daily activities are provided, although these could be made more interesting and varied for those residents who require increased stimulation. There are limited opportunities for community involvement. Residents are provided with a range of meals that they like but more effort is needed in promoting choice and independence. EVIDENCE: We saw that residents’ likes and dislikes with regard to social activities are recorded under a section entitled ‘working and play’ in a ‘daily activities’ record sheet. Details were basic, for example one resident was identified as ‘playing, likes to sing and colour books read.’ We did not see any care plans which identified social care as a need or goal. There is a notice board in the lounge which states what activities are going to be provided each day. On the day of our visit the planned activities were ‘DVD/films, jigsaws’, although these did not take place. There is also an activity diary which records what is offered and which residents participated. Abbeymere Care Centre DS0000024951.V342884.R01.S.doc Version 5.2 Page 18 Activities provided mainly consisted of board games. The registered provider told us that monthly entertainers visit the home although these were not always recorded in the diary. We saw that representatives from a local church visit the home. We spoke to one resident who confirmed that he could get up at a time of this own choosing and go to bed when he wished. We looked at residents’ daily reports and saw that these contained varying bed times. Four residents who completed comment cards said that there were ‘usually’ or ‘sometimes’ activities arranged by the home that they could take part in. One resident told us “I’ve never felt so lonely since being in here because there is nothing to do”. When we asked how he spent his day he shrugged his shoulders. On our arrival at 10.00 a.m. four of the seven residents in the lounge area were asleep. Through out our visit a large number of residents spent their time either sleeping or sitting in silence staring at the television. We saw comments from a visiting professional which stated that he saw very few activities taking place, with residents ‘lethargic, uninterested and lack stimulation’. We noted that the layout of the chairs in the lounge does not enable people to communicate very easily. We saw that the activity diary did not contain any community outings. We looked at the minutes from the last two residents’ meetings in 2006 and in March 2007. At both meetings people who lived there had requested to go out for walks and go out around the village. The manager had responded that residents were advised that staffing levels would not allow them to be taken out and that it was the responsibility of family and friends. We chatted to a visiting relative. They told us that they could see their family member in the privacy of her bedroom if they wished. One resident told us that her visitors were always made welcome, although they were not always offered a drink which they used to be. We saw positive and negative practice regarding how residents’ are enabled to exercise choice over their lives. Those residents who were able to articulate their wishes were responded to appropriately by staff. For example one person asked for a drink which he was given directly. However, some residents have difficulty in communication and there were no care plans in place regarding how they are supported to communicate or how staff help them with making choices and decisions. There were limited visual cues such as pictorial menus. We saw one member of staff walk into the lounge and turn the television to another channel without consulting residents. The manager told us that she has been instructed to inform residents that a continental breakfast is provided (upon asking, we were told that this consists of cereal, jam and toast). Abbeymere Care Centre DS0000024951.V342884.R01.S.doc Version 5.2 Page 19 We stated that this did not constitute a choice and were told that alternative would be provided if it was available, and upon request. We asked if the home had any sugar free jam for a diabetic resident. The manager stated ‘no’ and that the resident had not expressed a preference for jam, however she acknowledged that this would be difficult given the resident has very limited communication. We talked to residents about the food provided and were given positive responses. One person said “it’s marvellous, the best and I’ve been in a few care homes” another person said “the food is beautiful, it’s really picked up”. Four residents who completed comment cards stated that they ‘usually’ liked the meals provided at the home. We saw that residents were asked about the menu during their bi-annual meetings. One resident had requested an egg occasionally at breakfast as she feels breakfast can be ‘boring’. A resident had also asked for more meat choices and less pies and fish. A member of staff told us that they ask people every week what they would like to eat for the following week, but there were no records kept of these discussions. There was a menu board in the dining room that displayed the lunch which was tinned salmon or pies. This did not correspond with the written menu plan nor with the weekly menu pinned to a notice board (which we were told related to the previous week). We overhead staff asking residents what they would like to eat for lunch and tea from the two choices available however no records are maintained of what people have chosen. We looked at food records. These are not individualised, occasionally there is a record if someone has had an alternative to the options on the menu. We raised the issue of accuracy with the manager and it is suggested that more detailed records would allow for easier monitoring for residents on specialised diets or who have weight loss. We observed a lunch time meal which consisted of tinned salmon, boiled potatoes, peas and carrots. This was not a congenial or pleasurable experience for some residents. One resident visibly flinched when a plate of food was placed in front of her from behind. She had not seen the carer approaching as she had been left in the hoist sling which covered her head. Residents were shouting at each other and staff did not have the time to sit and calm the situation or ease any distress. Two residents needed assistance with feeding and this meant that the manager and carer were very stretched. The domestic worker stayed after her shift had finished to help assist one resident with feeding. We saw one resident was being fed by a member of staff in a way which did not promote the resident’s dignity. Staff told us the resident required a pureed diet but gave varying reasons as to why this was necessary. Abbeymere Care Centre DS0000024951.V342884.R01.S.doc Version 5.2 Page 20 The manager told us that “we mash it up because it’s easier then feeding it to her bit by bit”. She told us that the resident is encouraged to eat independently at tea time when she is given a sandwich, although this was not reiterated by staff. The care plan was inadequate and gave no details as to why she required a pureed diet. During interviews staff gave us different accounts of how they pureed the diet. No vegetables had been pureed with the resident’s lunch and no piping bags or moulds to make the meal look more appetizing. One resident was served her lunch and was unable to cut up the large potatoes which resulted in her dropping some of her meal into her lap. We saw residents’ food being cut up in front of them and when residents did require support, it was not offered as staff were too busy. We noted that the majority of residents were given spoons to eat their lunch rather than a knife and fork; there was no adapted cutlery. Abbeymere Care Centre DS0000024951.V342884.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a complaints procedure so that people can raise their concerns, although this could be produced in differing formats to aid residents with increased communication needs. Some staff have had training around safeguarding adults but others have not. EVIDENCE: There is a complaints procedure which is displayed. This is not produced in alternative formats. We spoke with a visiting relative who said that they knew how to raise any concerns. All four residents who completed comment cards said that they know how to make a complaint. We asked to see the complaints log and the manager told us that she did not have one as there have been no complaints made. However, later in the day the manager told us that she had changed the care assistant who had been allocated to do the cooking in the absence of a cook, due to complaints from residents about the quality of the food. All complaints and concerns raised must be recorded. Not all staff have received training in vulnerable adult abuse. We checked four carers’ training records and found that only two had received training (in 2004). We interviewed one member of staff who gave good responses to how she would deal with any complaints or potential incidents of abuse. However, when we asked about Whistle Blowing she said “I’ve never heard of it”. Abbeymere Care Centre DS0000024951.V342884.R01.S.doc Version 5.2 Page 22 The policies and procedures folder in the manager’s office contained a Whistle Blowing policy from the previous owner. Staff have not received training in dementia or managing challenging behaviour. As we have already stated, we have raised serious concerns regarding the lack of guidance in how to support one resident’s challenging behaviour which has resulted in an Immediate Requirement being issued. Abbeymere Care Centre DS0000024951.V342884.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Generally the home provides residents with a well furnished and comfortable environment in which to live. However, some areas require improvement due potential risks to safety and limitation of choice. Infection control practice needs improvement in order to offer greater protection to residents from infection. EVIDENCE: We were told by staff that the environment has improved since the new owner took over the running of the home which has been demonstrated at previous inspections. Abbeymere Care Centre DS0000024951.V342884.R01.S.doc Version 5.2 Page 24 We visited all communal areas and three residents’ bedrooms. There is a lounge and separate dining area. These were seen to be decorated and furnished to a good standard although two residents complained that they about the weight of the dining chairs, which were seen to be quite heavy. Another resident added that he could get his fingers easily trapped in the fret work. In addition we saw that the layout of the dining room made it cluttered and staff were observed having difficulty in negotiating their way through when assisting someone in a wheelchair. The communal areas were homely with pictures on the walls, ornaments, linen tablecloths on the dining tables with artificial flowers. There is a shelf containing a range of library books in the corridor leading to the lounge. All areas of the home were brightly lit and smelt fresh. Residents’ bedrooms have privacy locks fitted and contained people’s personal possessions, ornaments and photographs. There are two communal bathrooms and a number of toilets through out the building. Six bedrooms have ensuite toilet facilities. In first floor bathroom there is a bath with an assisted hoist which was broken and the manager told us was not used by residents with mobility problems. We were told that they use the ground floor bathroom which has a level access shower. This does not promote choice for those residents who may like a bath. There was a large tile missing from the first floor bathroom, the bath enamel was worn and has been badly damaged by the hoist. At the last inspection it was identified that risk assessments had not been completed for unguarded radiators as required in the Environmental Health report dated 2005. We did not see any individualised risk assessments for residents with regard to scalding and unprotected radiators. Both bathrooms contained a range of communal items such as combs, nail brushes, nail clippers, a razor, back scrub and tooth brush. There were tubs of Sudocream in the ground floor bathroom; the label had been defaced on one of the tubs so it was not possible to determine to whom it belonged to. All 4 residents who completed comment cards that they felt the home was clean and fresh. The carpet on the main stair way and dining room was slightly stained and we asked the manager if there was a programme of deep cleaning. She said that the domestic carer would occasionally get on her hand and knees to scrub the area or would bring in her own carpet washer. Neither is acceptable. We asked the domestic carer if she had a rota she told us “I do my own thing”, when asked if she had a cleaning schedule she said “yes but it’s not written, it’s in my head”. Abbeymere Care Centre DS0000024951.V342884.R01.S.doc Version 5.2 Page 25 There is a small laundry is situated in a lobby area. There was no laundry procedure displayed nor was there any COSSH information (control of substances hazardous to health). There was a supply of gloves but no aprons The manager told us that the sluice is situated on the first floor but confirmed that staff do not use the sink in the laundry to wash soiled items. It was said that appropriate water soluble bags are used. The laundry was untidy with a supply of brushes, ironing board and a vacuum cleaner. There was a discarded mop head which the manager told us was no longer used. There was a mop and bucket. This mop head was also worn; it was not being dried inverted. The manager agreed that it needed to be disposed of. We asked the manager how mop heads were cleaned and she told us that they are used until they are worn and then thrown away. It is suggested that mop heads are washed on a daily basis at thermal temperatures. Mops and buckets are not colour coded or labelled. There was a supply of COSHH which was unsecured in this area. Abbeymere Care Centre DS0000024951.V342884.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staffing levels do not always meet the needs of the resident group. Although staff are qualified, they require further training to meet the specialist needs of the residents. EVIDENCE: All four residents who completed comment cards said that they ‘always’ or ‘usually’ received the care and support they needed from staff. One person who was interviewed said that she did not have to wait long when for staff when she activated her call alarm. There are however only care two staff on duty per shift. The manager says there are at least five residents who require two staff members to support them with personal care. Through out the day we noted residents sitting in the lounge and there were no staff available in the communal areas to whom they could ask for support. It was also noted that there were insufficient staff to support residents at meal times and during the day with stimulating and therapeutic activities. There are no male staff employed to meet the needs of the two male residents who currently reside at the home. Abbeymere Care Centre DS0000024951.V342884.R01.S.doc Version 5.2 Page 27 The manager told us that nine out of the current ten staff employed hold an NVQ qualification which exceeds the National Minimum Standards and is commendable. This was validated by talking to staff and checking a sample of training records. No new staff have been recruited since the last inspection so we could not evaluate the recruitment process. Concerns were raised at that visit because staff had been employed with a standard rather than a enhanced police check. The owner told us that he did not realise this level of criminal record bureau (CRB) disclosure check was required and that he would ensure that this was carried out for any future new staff. It is suggested that risk assessments are completed regarding those existing staff who do not have the required level of police check. Although there was a training matrix in place the manager acknowledged that this had not been kept up to date. We therefore sampled training certificates to establish what training had been undertaken and spoke with staff and management. The majority of mandatory training has been undertaken (see further comment in standard 38). However there is limited specialist training undertaken. For example, staff have not received training in dementia (although this was said to be booked), managing challenging behaviour, mental illness, diabetes or tissue viability. One member of staff told us that she had undertaken training in continence promotion and it is suggested that all staff receive this training. Abbeymere Care Centre DS0000024951.V342884.R01.S.doc Version 5.2 Page 28 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home lacks strong and effective management, which is needed before the service can go forward and ensure that it is run in the best interests of the residents. Some elements of practice currently have to potential to seriously jeopardise people’s health and safety. EVIDENCE: Mrs. Boden has worked at the home for eleven years and been registered manager for the last five. She has an NVQ 4 in care but has yet to undertake a management qualification. During interviews Mrs. Boden was not familiar with some of the changes in the care homes legislation or good practice Abbeymere Care Centre DS0000024951.V342884.R01.S.doc Version 5.2 Page 29 guidance. For example when we asked about Inspecting for Better Lives, the programme for modernising regulation and inspection she told us that she had heard about it but had not read any literature on it. We asked about Mrs. Boden about the principles of equality and diversity but she told us “I’m not 100 sure what it means”. Mrs. Boden does not have any supernumerary hours. When we asked about how she fulfils her management responsibilities without any dedicated hours she told us “I try and squeeze it in”. The manager told us that she now has a job description and that she would forward it to us. We did not see any job descriptions for senior carers which was recommended following the last inspection. There needs to be more strategies for creating an open, positive and inclusive atmosphere. For example, residents meetings are only held every several months and staff meetings are annual. The frequency of staff supervision is not in line with the National Minimum Standards. For example, one member of staff had only received one supervision session since she commenced employment in October 2006. Two other members of staff had received no formal recorded supervision sessions in 2007. We saw that the home has the Mulberry House Quality assurance system. Questionnaires had been sent to relatives and stakeholders for feedback about the service. The annual development plan only identified three areas for development and there was no evidence that this was based upon a systematic cycle of planning, action and review. For example, outcomes from previous inspection reports, food hygiene inspection and service user comments made in meetings were not included. The homes does keep small amounts of residents’ monies. We checked records and found that they balanced accurately with the amounts held. However, there were a couple of small anomalies identified. Transactions are not always witnessed by two members of staff. Some entries indicated that monies had been spent on hairdressing but did not give the amount or the balance remaining, and had not been signed. The hairdresser signs the personal expenditure sheet for each resident but improved confidentiality would be promoted if she gave individual receipts instead. The manager does not routinely audit the money and records as would be good practice. Record keeping requires improvement. For example, one resident’s episodes of challenging behaviour had not been recorded in his daily notes but in a communal diary. When we asked why, the manager told us “we’ve always been told not to put things like that in daily notes, I don’t know why”. The resident had sustained an injury requiring hospital treatment but the daily report, accident report and entry in the communal diary gave differing accounts and dates of how and when the incident occurred. Abbeymere Care Centre DS0000024951.V342884.R01.S.doc Version 5.2 Page 30 We noted at least two residents had received emergency treatment at hospital after sustaining falls in the last five weeks which had not been reported to the Commission. Whilst it was pleasing to see that the majority of staff had received mandatory training we could find no fire safety training certificates since 2005. The manager told us that staff had received training from the owner in 2006 but certificates had not been produced (although there was a log of who had received this training). The manager said that training had been undertaken in March 2007 but the trainer had not sent training certificates and there was no record of who had received this training. The owner agreed to forward us evidence of which staff had been trained. The manager told us that there were three residents who had bedrails fitted. We asked the manager if there were regular health and safety checks of this equipment. She told us that they were checked by staff but no records were maintained. We were able to view two of these (the third resident was in her room at the time of our inspection). In some instances the bedrails were not high enough to prevent the resident from rolling out of the bed, a pressure relieving mattress had been fitted on top of a divan mattress but bedrails had not been adjusted to accommodate the extra height and this had not been identified in the risk assessment. There were no assessments to ensure that the bedrails fitted were compatible with the beds used. One person’s bedrail was very wobbly and had not been suitably secured. Both residents bedrails posed a risk of entrapment due to the number of gaps. The manager stated that a chair was lodged against one resident’s bedrail to try and stop the resident from becoming agitated and trying to get out of the bottom of the bed. This was not included in the risk assessment. It was not possible to determine from the person’s risk assessment why bedrails were required in the first place given the level of confusion, and no evidence to demonstrate it had been discussed within a multi-disciplinary forum. The manager told us that staff had fitted the bedrails and confirmed that they had received no training and did not have the guidance issued by the Medicines and Healthcare products Regulatory Agency. We issued an immediate requirement for this to be addressed. We looked at the accident report book which does not meet the requirements of the Health and Safety Executive. During the last five months there have been a total of 32 recorded accidents where injuries have been sustained by residents. A number of these related to slips, trips and falls. There was no evidence that the manager was checking the accident book. The manager said that she does not carry out an analysis to determine any patterns or trends in order to establish prevention or control measures. The manager had failed to ensure that the recent injury sustained by a member of staff had been recorded in the accident book. Abbeymere Care Centre DS0000024951.V342884.R01.S.doc Version 5.2 Page 31 Other concerns we identified included: COSHH (disinfectant) unsecured and in the communal bathroom laundry hoists not being serviced on a bi-annual basis staff failing to follow good practice when assisting residents with moving and handling (for example staff were seen lifting residents whilst they were seated in their dining chairs in order to move them closer to the table, telling them to ‘hold on tight’) recorded low water temperatures but no evidence that action has been taken the kitchen door was wedged open with no staff present no recorded health and safety checks for wheelchairs, bedrails or hoists no evidence of annual inspection/servicing of wheelchairs A food safety and hygiene inspection was carried out by Environment Services in June 2007. A number of requirements have been made but as yet not all have been complied with. Whilst it is reasonable that some of the larger items such as replacing or repairing cupboards and work surfaces will take up to the three month timescale given to completed, other requirements should have already have received action. For example, we saw discoloured plastic containers in cupboards, staff were still wearing two overalls and left the kitchen without removing their personal protective clothing and cooked meats foods were being stored above and below raw bacon. Abbeymere Care Centre DS0000024951.V342884.R01.S.doc Version 5.2 Page 32 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 2 2 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 1 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 1 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 2 2 2 1 Abbeymere Care Centre DS0000024951.V342884.R01.S.doc Version 5.2 Page 33 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 OP7 Regulation 15(1) Requirement To continue to develop the care plans so that they identify clear action to ensure that all aspects of the resident’s health, personal and social care needs are being met. These (plans) must be drawn up with the resident or their representative who must sign to acknowledge their agreement. This is a repeated requirement that was to have been met by the 31/03/07 2. OP7 15(1) 22/08/07 To establish a written care plan and risk assessment for ‘X’ which includes behavioural support guidelines within twenty four hours of the inspection (by 5 p.m. 22 August 2007). To forward a copy of the care plan and risk assessment to CSCI by 24 August 2007). Immediate Requirement Timescale for action 01/11/07 Abbeymere Care Centre DS0000024951.V342884.R01.S.doc Version 5.2 Page 34 3. OP7 13(4) b & c The registered persons must ensure all significant areas of risk presented to residents must be assessed, this is to identify and minimise the risks presented to residents. Furthermore staff must be aware of and follow all instructions set out in these assessments so that any management directives are not compromised. Areas of risk may include moving and handling, risk of choking, challenging behaviours and so on. This is a repeated requirement which was to have been met by 30/6/07. 01/11/07 4. OP9 13(2) Controlled drugs stored in the home must meet The Misuse of Drugs (Safe Custody) Requirements 1973 to comply with the safe keeping of service users medication. This is a repeated requirement which was to have been by 31/5/07 01/11/07 5. OP9 13(2) The registered person must ensure that records for the date of receipt of all medication are available to comply with the safekeeping of service users medication This is a repeated requirement which was to have been met by 31/5/07 01/11/07 Abbeymere Care Centre DS0000024951.V342884.R01.S.doc Version 5.2 Page 35 6. OP9 13(2) The registered person must ensure that there is a documented protocol available which describes the care to be given to residents who could become agitated or aggressive. This must include details for the administration of medication prescribed ‘when required’ for behaviour management. This is a repeated requirement which was to have been met by 15/06/07 01/11/07 7. OP9 13(2) The registered person must ensure that all medicine records are documented accurately, to ensure that residents medication records are correct and kept up to date The registered person must ensure that a self administration medication assessment is undertaken with any new admission into the service in order to ensure that residents abilities and wishes regarding their medication is taken into consideration and this is recorded into their care plan. To ensure that practices cease which compromise residents’ dignity. For example: staff using subjective statements as to resident’s behaviour, referred to as being ‘nasty’, by ensuring that staff respond appropriately to residents who are distressed and require assistance, staff to cease the infantilisation of residents, staff to ensure that residents’ are dressed in an appropriate manner. 01/11/07 8. OP9 13(2) 01/11/07 9. YA10 12(4)(a) 01/11/07 Abbeymere Care Centre DS0000024951.V342884.R01.S.doc Version 5.2 Page 36 This is a repeated requirement which was to have been met by 30/06/07. 10. OP12 16(2)(n) To ensure that appropriate recreation/stimulation is provided everyday to meet the assessed needs and preferences of all residents thereby promoting their welfare. To provide opportunities for residents to participate in the local community according to their wishes and preferences thereby providing them with a more stimulating lifestyle. The registered person must complete risk assessments relating to hazards within the home as identified in the last Environmental Health Officers report. If there are difficulties in addressing the above the registered person should contact Environmental Health. This is to include resident’s access to potentially hot surfaces such as radiators. This is a repeated requirement which was to have been met by 30/6/07. 13. OP19 23(2)((j) To provide all residents with access to a range of bathing facilities which include either a bath or shower, thereby promoting their welfare. 01/11/07 01/11/07 11. OP13 16(2)(m) 01/10/07 12. OP19 13(4) a23(1)(2) p & (5) 01/11/07 Abbeymere Care Centre DS0000024951.V342884.R01.S.doc Version 5.2 Page 37 14. OP27 18 (1) a The registered person must review the staffing arrangements in the home so that that there are sufficient staff available at all times to meet the assessed and changing needs of more dependent residents. This is a repeated requirement which was to have been met by 15/6/07. 01/11/07 15. OP27 18(1)(c) The registered person must ensure that staff have the appropriate skills and training to meet the needs of resident’s prior to and following their admission to the home. The review of resident’s needs that fall outside of the homes usual remit must be carried out to decide exactly what is required to allow their needs to be appropriately and fully met. This is a repeated requirement which was to have been met by 30/6/07. 01/11/07 16. OP37 37 All incidents that affect the well being of residents must be reported to the Commission for Social Care Inspection in line with guidance issued. To assess all of the bedrails currently in use and make sure that they are suitable for the beds they are being used upon. Where appropriate bedrails must be replaced in order to reduce the risks to residents including the risk of entrapment – this is to promote the health and safety of residents. Immediate Requirement 01/11/07 17. OP38 13(4)(c) 22/08/07 Abbeymere Care Centre DS0000024951.V342884.R01.S.doc Version 5.2 Page 38 18. OP38 13(4)(c) To ensure that there is a system in place for monitoring and analysising all accidents in order to put strategies in place to reduce the number of accidents to residents such as a falls prevention policy. The accident book must be accurate and contain all injuries sustained by residents and staff. This is to promote residents’ health and safety. 01/11/07 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. Refer to Standard OP1 Good Practice Recommendations To review the statement of purpose to ensure that it accurately reflects the service provided by the care home and complies with the requirements of the Care Homes Regulations 2001. It is recommended that care plans are reviewed at least once a month or sooner if residents’ needs change. It is suggested that care plans are reproduced in formats and styles which are accessible to residents. 3. OP8 To consider establishing health care summary sheets or action plans for the recording of all appointments, treatments and outcomes. To contact the community dietician to obtain details of how to calculate residents’ weight by using alternative measurement calculations (MUAC). To consider purchasing sit-on scales for the weighing of residents. 2. OP7 Abbeymere Care Centre DS0000024951.V342884.R01.S.doc Version 5.2 Page 39 To ensure that nutritional screening is carried out on admission of all new residents and is more regularly reviewed for existing residents (at least annually or sooner if a high risk is identified). To seek and follow advice from the diabetic nurse (or other health care professional) with regard to the frequency of blood sugar monitoring and to record the outcomes in the resident’s individual care plan. 4. OP9 It is recommended that all service users allergy status is documented on their medicine record charts in order to ensure the safety of service users. A record of the room temperature where medication is stored should be recorded to ensure that residents medication are stored at the correct temperature. The date of opening of all medicine containers should be recorded and any balances of medicines carried over onto a new medicine chart in order to undertake a medicine audit. Records for controlled drugs should be kept in a bound book that cannot have pages easily removed to prevent mishandling and to ensure continuous and accurate records. 5. 6. OP12 OP15 To consider providing more stimulating and therapeutic activities for residents with detailed records maintained. To consider providing residents with a more varied choice for their breakfast which should include the option of a cooked breakfast at least on a weekly basis. To keep more detailed and individualised food intake records. To display up to date and accurate menus and ensure that these are in suitable formats for residents. To obtain advice from the community dietician in order to ascertain if a pureed diet is necessary for the identified resident. To take advice as to how to present a pureed diet (if necessary) and to ensure that this contains the required nutrients. Abbeymere Care Centre DS0000024951.V342884.R01.S.doc Version 5.2 Page 40 To ensure that there is a range of sugar free products available for diabetic residents. To consider obtaining adapted cutlery and plate guards for those residents who may need specialised equipment to eat their meals independently and with dignity 7. OP16 To consider producing the complaints procedure in varying formats. To ensure that all complaints and concerns are fully recorded with details of outcomes and actions. 8. OP18 To provide all staff with training in safeguarding and protecting adults. To provide all staff with guidance and training in Whistle Blowing procedures. 9. OP19 To consider replacing the heavy weight dining chairs for more lighter versions thereby reducing the risk to residents. To ensure that bathrooms are kept free of communal items such as combs, brushes, toothpaste and nail clippers. To introduce a written cleaning schedule for the home which should include the regular deep cleaning of carpets. To introduce and display a written laundry procedure and to keep a supply of COSHH information available in this area. To ensure that there is a supply of plastic aprons in the laundry area. To keep the laundry area free of any extraneous items such as vacuum cleaner, brushes, ironing board etc. To ensure that there is a regular programme of washing mop heads at thermal temperatures (which should be included on the cleaning schedule). To consider colour coding mops and buckets and to ensure that these are not stored in the laundry area. 10. OP26 Abbeymere Care Centre DS0000024951.V342884.R01.S.doc Version 5.2 Page 41 11. 12. OP27 OP29 To consider employing male staff to meet the needs of male residents. To carry out written risk assessment with regard to staff who have been employed on a standard CRB check to identify control measures to safeguard and protect residents. It is suggested that staff undertake a range of specialist training which includes dementia, depression, tissue viability, diabetes, mental illness, continence management and person centred planning The manager must commence and attain a qualification in management equivalent to the Registered Manager’s Award (NVQ level 4 in management). Senior staff are to be provided with job descriptions that enable them to fulfil their duties. There should be clear criteria laid down that specify the minimum level of competence for any person that is left in charge of the home in the absence of the manager this to assist with clear lines of accountability and the responsibilities of this position. 13. OP30 14. OP31 15. OP30 Staff should be provided with training to better equip them with the needs of more dependent residents with depression and dementia. To continue developing the homes quality assurance systems so that it becomes an effective management tool and assists in ensuring the service is run in the best interests of the residents. It is suggested that the hairdresser does not sign residents’ personal expenditure sheets but issues separate receipts instead to promote confidentiality. It is recommended that the manager regularly checks and audits residents’ finances with written records maintained. 16. OP33 17. OP35 18. OP38 To ensure that COSHH is held secure at all times. To ensure that hoists are serviced on a bi-annual basis or to demonstrate that the current frequency of servicing is in line with the manufacturer’s specifications. Abbeymere Care Centre DS0000024951.V342884.R01.S.doc Version 5.2 Page 42 To consider fitting a suitable door closer to the kitchen door which is linked to the fire alarm system thereby reducing the risk of staff wedging the door open which poses a fire safety hazard. To continue to take action to comply with all of the requirements and recommendations made at the food safety and hygiene inspection and as detailed in the report dated June 2007. To establish regular recorded health and safety checks for all equipment including wheelchairs, bedrails and hoists. To demonstrate that all wheelchairs have received an annual inspection/service by a competent person. Abbeymere Care Centre DS0000024951.V342884.R01.S.doc Version 5.2 Page 43 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-56 Stephenson Street Birmingham B2 4UZ National Enquiry Line: 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 © 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 Abbeymere Care Centre DS0000024951.V342884.R01.S.doc Version 5.2 Page 44 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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