Inspection on 22/02/07 for Abbotsbury

This inspection was carried out on 22nd February 2007.

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

Abbotsbury 01/11/07

Abbotsbury 17/05/07

Abbotsbury 02/05/06

Abbotsbury 09/11/05

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Carlton The 25 Park Road Southport Merseyside PR9 9JL Lead Inspector Elaine Stoddart Unannounced Inspection 09:30a 22 and 26th February 2007 nd 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 Carlton The DS0000065441.V331860.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. Carlton The DS0000065441.V331860.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Carlton The Address 25 Park Road Southport Merseyside PR9 9JL 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) 01704 537117 0870 762 8881 Ramos Healthcare Limited vacant post Care Home 21 Category(ies) of Old age, not falling within any other category registration, with number (21) of places Carlton The DS0000065441.V331860.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The service must employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 2nd May 2006 Date of last inspection Brief Description of the Service: The Carlton is a care home providing accommodation for up 21 older people who need personal care and support. Ramos Health Care own the home. A new manager is now employed who is yet to be registered with the Commission. The Carlton is situated in a quiet residential area not too far from the centre of Southport and its amenities. It is within easy reach of the local park and public transport. The home is a large detached 3-storey building with 19 single rooms and 1 double. There is a large well-kept garden to the rear and side of the property and parking at the front. The home is well maintained internally and externally with good quality furniture and fittings. There is a passenger lift servicing all floors. The current rate of charges is £360.00 - £370.00 per week. Carlton The DS0000065441.V331860.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over two days. It was an unannounced visit and conducted as part of the regulatory requirement for care homes to be inspected. A pharmacy inspector accompanied the inspector during the first day to inspect medication practices. There have been two random inspection made since the last key inspection. The first took place on the 11th and 12th of January 2007 as a result from a complaint, which raised concerns regarding care practice. The owners were notified of the outcome of the inspection within a random inspection report. The improvements identified to be made by the home were required in set times scales. A further random inspection was made on 25th January 2007 as a result of a further complaint made regarding the heating in the home. The owners were notified of the outcome within a random inspection report and no concerns were required to be addressed on this occasion. This key inspection was conducted. Following a management review of the service, the owners were required to provide an action plan outlining how they are to address the requirements made at the random inspection on 11th and 12th January 2007. A meeting was held with the management and owners of the home on 20th February 2007 to discuss the improvement plan and the progress made. All the key standards were assessed during this key inspection. The pharmacist made an immediate requirement during the inspection as risks in the administration of medication was found. Immediate action was taken to address the issues and confirmed by the manager 28/2/07. A tour of the building was conducted. A selection of care staff and home records were also viewed. The manager, Carole Dacre, a representative of Ramos Health Care, Audrey Tan, deputy manager, Elaine Green, 4 care staff members, 1 cook, 4 of the residents and a relative were spoken with and their views obtained of the home. Satisfaction comment cards were not given to residents and relatives at this inspection as these had been distributed to all residents and relatives at the random inspection 11th and 12th January and comments received were favourable regarding the home and the caring nature of the staff. Carlton The DS0000065441.V331860.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? A new manager has been appointed who is very committed to improving the standards provided in the home has made some progress to meet the requirements made at the last key and random inspections. The new manager is organising the recording of resident’s daily records to provide more concise, detailed information. All care staff are now responsible for keeping daily up to date records of care provided. Care files are securely stored and made available to staff to complete daily. Staff meetings have been arranged to consult with staff on the changes made and their responsibilities. Carlton The DS0000065441.V331860.R01.S.doc Version 5.2 Page 7 Some progress has been made regarding the safe administration, storage and staff training on medication. The manager is assessing the competency of staff to administer medication over the next 3 months. There are still requirements outstanding and these are contained in the section “What they could do better” and highlighted in the requirements of this report for action. Some staff training has taken place in manual handling, first aid and health and safety to provide the staff with the skills to carry out their roles. Improvements have been made in the recording and investigating of complaints. Residents are aware of how to make a complaint. An up to date certificate is in place for the hoist as required at the last inspection. Risk assessments have been completed for the communal areas were radiator covers are not in place. Risk assessments are required in all areas were there are no radiator covers and this is noted in the section. “What they could do better” and a further requirement made in this report. All staff are recruited following the correct procedures and a criminal record bureau check and two written references are obtained prior to employment. Staff have now been issued with contracts of terms and conditions. What they could do better: The manager should make the following improvements to provide a safer and more accountable service to meet the needs of the residents accommodated. Requirements and recommendations made are included within the last section of this report with set times scales for action. The statement of purpose and service user guide should be updated to reflect the new ownership, service provided and distributed to all residents and prospective residents. Residents’ files need to be more organised and proof of resident photo ID to be obtained. Care plans need to be more detailed and involve residents /relatives who should sign their understanding of the care to be provided. Assessments should provide more detailed information on prospective residents to allow the home to meet their needs. Concerns were raised during the inspection regarding the way residents’ medication is managed. An immediate requirement was made on the day of Carlton The DS0000065441.V331860.R01.S.doc Version 5.2 Page 8 the inspection and further requirements and recommendations are contained within this report. Resident’s daily activities should be recorded in their plan of care to demonstrate their involvement. The home is to complete an audit of residents clothing and to continue labelling of residents clothing to avoid losses and ensure laundered clothing is returned to rightful resident. Radiator covers should be fitted throughout. All policies and procedures must be updated to provide safe working practices and staff should sign to acknowledge their understanding of them. The manager should update the abuse policy and procedure in line with Sefton and Liverpool’s “Safeguarding Adults” procedures and make available to staff so that they are aware of the procedures. The staff would benefit from training in abuse and the manager confirmed that this is to be arranged in the near future. The manager should organise and up date staff employment files to provide all details of recruitment. Not all private rooms have locks and the home should record residents’ consent that they don’t wish to have one. Paper towels should be provided in communal areas to avoid cross infection. The manager must provide sufficient staff on duty at weekends to meet the needs of the residents. The manager should monitor hours worked by those staff who work at other homes to ensure that excessive hours are not worked. To equip the staff with the skills to carry out their roles, the manager must continue the training plan for all staff, including NVQ and arrange training in food hygiene and infection control. The manager should introduce a new induction process for all new staff. The manager must make an application to be appointed as registered manager by CSCI. The manager should develop quality-monitoring systems to obtain feedback from residents, visitors and other professionals on the service provided. The manager should arrange resident/relative meetings and provide regular supervision for care staff to keep them involved with the changes and developments. Carlton The DS0000065441.V331860.R01.S.doc Version 5.2 Page 9 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. Carlton The DS0000065441.V331860.R01.S.doc Version 5.2 Page 10 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 Carlton The DS0000065441.V331860.R01.S.doc Version 5.2 Page 11 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): Standards 1,3,6.Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information on the home needs updating to reflect the service provided. Assessments of need are conducted prior to admission. Respite care is provided on a short-term basis when vacancies allow. Intermediate care is not provided. EVIDENCE: Three assessments of need were viewed to show that resident’s needs had been assessed prior to their admission. Records demonstrated that personal profiles had been completed and the information obtained showed residents likes, dislikes, risk assessments and medication needs. One assessment completed on a resident highlighted an allergy issue but the home failed to identify what the allergy was and no details were recorded. This was brought to the attention of the manager who agreed to address this. The manager has only recently been appointed to the home and is very much aware of the Carlton The DS0000065441.V331860.R01.S.doc Version 5.2 Page 12 improvements to be addressed and is to review the assessment process to provide more detailed information when assessing new residents. A recommendation was made to provide more detailed, organised assessments for prospective residents. Residents and a relative spoken were satisfied with care provided and provided positive comments on the staff employed. The statement of purpose and service user guide should be up dated to reflect the new ownership and service provided. On completion these should be distributed to all residents and prospective residents. Carlton The DS0000065441.V331860.R01.S.doc Version 5.2 Page 13 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): Standards 7,8,9,10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Medication practices and procedures fail to be robust to provide a safe system of administration for the residents. Care plans in place should contain more information, demonstrate how care is delivered and involve residents and their relatives. Residents are treated with dignity and respect. EVIDENCE: The new manager has made some progress to meet requirements made at the last inspection. She is an experienced manager and is aware of the improvements to be made to the recording and care planning systems. Three care files were viewed and details were in place of residents needs. One resident daily records viewed failed to demonstrate the day-to-day care provided. Carlton The DS0000065441.V331860.R01.S.doc Version 5.2 Page 14 The manager confirmed that there is a lot of work to do and is to involve the staff in making progress. Staff meetings have been organised to involve all staff in the changes being introduced. Staff, residents and a relative interviewed provided positive comments on the new manager and their confidence that things will improve. “The new manager is nice and should sort things out”. Resident. “The new manager fine. I have learnt so much from her and staff are accepting the changes”. Staff. “Carole has been fine. I feel confident that she will change things”. Staff. The above was discussed with the new manager, who agreed to update care files with all residents/relatives, provide a more structured approach and more detailed information on needs, tasks and outcomes. Care plans are reviewed monthly, however the manager is to change the review format to provide more detailed information to reflect changes in residents needs. Visits by Health care professionals are now recorded on residents care files. Records viewed showed that these visits have been recorded. Care files are securely stored and available to care staff to enable them monitor changing needs. Risk assessments are in place and reviewed regularly. Discussion took place with the three residents who care plans were viewed And positive feedback was received regarding the caring nature of the staff, their access to health care professionals. One relative was spoken with and is very satisfied with the care in place. Staff were observed to treat residents with dignity and respect throughout the two days. To improve the laundry system and ensure all clothing is returned to the rightful owner, residents clothing is in the process of being labelled. One resident commented that clothing is still going missing, has never complained as it is usually returned. Another commented that all his clothes are now labelled. This was brought to the managers’ attention who confirmed that the new system is being implemented but it takes time. The manager confirmed that the laundry system is to be discussed at the next staff meeting to be held 2/3/07 to ensure that staff are aware of maintaining the residents dignity and respect. Pharmacy Inspector. Findings. The new acting manager had begun to look at the handling of medication but concerns about the way residents’ medicines were managed remained. The acting manager knew that the way residents’ medicines were ordered needed to be improved. The existing system was weak and relied on ‘emergency supplies’ because medicines were not always delivered on time. Carlton The DS0000065441.V331860.R01.S.doc Version 5.2 Page 15 The storage was unorganised with evidence of poor stock control but the acting manager had begun to identify unwanted medicines and list them for return to the pharmacy. The acting manager knew that improvement was needed to the handling and recording of controlled drugs and said she had purchased a controlled drugs register to make the recording clearer and simpler. Carers were completing certificated training in the safe handling of medication. The acting manager said she planned to support the training through an inhouse assessment process. The homes medication policies did not provide clear written guidance for carers handling medication. They need to be reviewed, then read and followed by carers to ensure consistency in the handling of residents’ medicines. There were weaknesses in the arrangements for administering residents’ medicines. Medicines were only normally given between 8am (07:30 where they were given before breakfast) in the morning and 9pm in the evening. This leaves little time for flexibility and puts residents at risk of having doses of the same medication too close together. The lack of flexibility and choice was shown in a written entry:’ we are doing the 07:30 medicines at 8am so breakfast will be late for…) Three residents were asleep when the morning medicines were given. Their medicine had been ‘popped out’ of the packet and put into unlabelled medicines pots. The records had been signed to show the medicines had been taken. This poor practice puts residents at risk of being given the wrong medicines. Residents were not given prescribed paracetamol from their own box. This means that dosage instructions cannot be checked and there is a greater risk that medicines will ‘run out’ because the audit trail is lost. Worryingly, several doses of warfarin tablets were prepared in advance and placed into an unlabelled daily cassette. Doses should never be prepared in advance as mistakes in the preparation can easily lead to residents getting the wrong dose. There was no written information about the use of prescribed creams or ‘when required’ medicines so staff were not always sure how they should be used. This puts residents at risk of not having medicines when they need them. Homely remedies were not being safely administered in accordance with a written procedure. Entries were not always made on the medication administration record when they were given, putting residents at risk of accidentally having too many doses. The home has a policy to support the self-administration of medication, but assessment had not been completed for a resident staying for respite care, nor for a resident who was left with each dose of medication to take in his own time. Written assessments are need to help ensure that residents receive any support they may need to manage their own medicines safely. Where Carlton The DS0000065441.V331860.R01.S.doc Version 5.2 Page 16 residents preferred carers to manage their medicines consent was not recorded. The medication administration records were poorly completed. They were not kept up-to-date and listed some medicines that were no longer prescribed. A currently prescribed medicine had been missed off the administration record for a respite care resident. The record for one resident incorrectly showed she had been given two inhalers that staff said she always refused, and were not in stock at the home. There was no evidence that the presciber was aware the inhalers were not being used. It was not always possible to tell why medicines had not been given as the code ‘o –other’ was written onto the administration record without further clarification. The record keeping needs to improve to support the safe administration of medication. Carlton The DS0000065441.V331860.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): Standards 12,13,14,15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The daily life and routine in the home is flexible to suit individual needs. Residents have an appealing balanced diet are able to maintain contact with family and friends. EVIDENCE: Residents were observed to have their meals in the comfortable environment of the dining room or within their own rooms. 4-week menus are in place and the food served is nutritious. The cook confirmed she is informed of all dietary needs of the residents. The cook is responsible for ordering all food supplies and confirmed she is allowed to order what is required and no cut backs are made. The cook provides home cooked foods and home made puddings. The main meal is served at lunchtime and staff were observed to assist were necessary. Residents are able to have their meals in their own rooms should they wish. Drinks and snacks are available throughout the day and staff were Carlton The DS0000065441.V331860.R01.S.doc Version 5.2 Page 18 seen to provide these to residents and visitors. Alternatives are available and residents spoken with confirmed this. The cook normally records fridge and freezer temperatures, however records had not been completed during her recent holiday 17th – 25th February. This was brought to the manager’s attention and action agreed. Positive comments were received from the residents interviewed on the meals provided: “Meals are smashing, they will alter anything I don’t like”. “I have all my meals in the dining room”. “The food is satisfactory” The home provides activities in the form of quizzes and entertainers. Residents interviewed commented they are satisfied with the activities in place and they can join in if they wish. A hairdresser attends weekly. Visitors were observed to come and go at the home and were made welcome by the staff. Residents interviewed confirmed that their visitors are made welcome at all times and often call in daily. Residents were observed to receive visitors in private in their own rooms or in the communal areas. The resident’s handle their own finances were possible and records are kept of all transactions made for personal allowances. Finances for three residents were viewed and they confirmed that these are dealt with by family/representatives. All rooms were viewed, contained personal possessions and were found to be comfortable and clean. The residents spoken with were satisfied with the accommodation. One resident said he had requested a larger room if one became vacant. This was discussed with the owner who is aware of the request. . Carlton The DS0000065441.V331860.R01.S.doc Version 5.2 Page 19 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): Standards 16,18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are aware of how to make a complaint and feel they will be listened to. An abuse policy and procedure is in place and abuse training is being provided to ensure staff are aware of the procedures. EVIDENCE: An abuse policy and procedure is in place, however this needs to be brought up to date in line with Sefton and Liverpool’s “Safeguarding Adults” policy and procedures. This was discussed with the manager who is to make all staff aware of the procedures and will update the policy to reflect this. Staff spoken to confirmed their understanding of what they would do should they witness any abuse. Comments include: “I wouldn’t hesitate to contact the manager”. “I would tell Carole If I had any concerns”. Training records viewed showed some staff have completed abuse training and further training is planned. The manager is to make contact with Sefton adult protection to arrange this. Carlton The DS0000065441.V331860.R01.S.doc Version 5.2 Page 20 The home has a complaints policy and procedures and this is included within the Statement of purpose. The manager was advised to distribute a copy of this to all residents. Residents and a relative spoken to said they wouldn’t hesitate to tell the manager should they have any concerns or complaints and were confident that their views would be listened to and acted upon. The staff recruitment process now includes a satisfactory POVA First (protection of vulnerable adults) check and two written references prior to employment to ensure the residents are in safe hands. Carlton The DS0000065441.V331860.R01.S.doc Version 5.2 Page 21 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): Standards 19,20,21,22,23,24,25,26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents live in a safe, well-maintained, clean and hygienic environment. EVIDENCE: All areas were viewed during this inspection. Rooms were found to be comfortably furnished and clean and contained personal items. A check was made to see if risk assessments had been completed for all radiators without covers as this was identified as completed in the improvement plan. The manager on communal areas had completed risk assessments, however there are a number still outstanding. This was brought of the attention of the Carlton The DS0000065441.V331860.R01.S.doc Version 5.2 Page 22 manager and immediate action taken. Radiator covers have been ordered for some rooms and the paperwork was seen to confirm this. The home employs a maintenance person to deal with day-to-day repairs and was present during one visit fitting self-closing fire doors. The grounds are kept tidy. Access to the premises is via a ramp then two steps at the front door. The owner has requested a visit from an Occupational therapist (OT) to assess the building. The last OT report was made on the premises in 12/11/04 and recommendations made. A fire risk assessment was completed in February 2007. Residents spoken with were satisfied with the accommodation and standards of the home. One resident said he had requested another larger room if one became vacant. This was discussed with the owner who is aware of this. There are sufficient bathrooms and toilet facilities in place for the residents. The laundry is equipped with a sluice facility, washer and tumble dryer. Hand washing facilities and COSHH procedures are in place. A paper towel system in the laundry would be beneficial in all communal areas. Plenty of aprons and gloves are supplied to avoid cross infection. A colour coding system is being organised to avoid laundry going missing. There is a large separate drying room for residents clothing. Equipment is in place for those with difficulty in bathing and toileting in the form of raised toilet seats and assisted bath. The hoist now has a full service certificate. Call systems are in place throughout the home. Not all private rooms have locks and the home should obtain the residents consent that they don’t wish to have one. Bed side bumpers are provided were these are used. The home was found to be warm, ventilated, comfortable and clean. Certificates for all services i.e. gas are up to date. Residents were observed to be comfortable in their surroundings and accessed all areas of the building. Carlton The DS0000065441.V331860.R01.S.doc Version 5.2 Page 23 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): Standards 27,28,29,30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Recruitment and selection procedures have improved to ensure staff are employed using the correct procedures. Sufficient staff fail to be on duty at weekends to meet the residents needs. The staff training programme must continue to ensure staff are trained to meet the needs or the residents. Staff should continue to be encouraged to take National Vocational qualifications. EVIDENCE: At the time of the inspection sufficient staff were on duty to meet the residents needs. These included: the manager, the deputy, a carer and the cook. The owner was also available throughout the visit. The manager is presently covering the weekend shifts to enable her to get to know the weekend staff. A number of staff are employed at the home who also work at other homes within the Ramos Health Care Group. Discussion took place with the manager who should be aware that they are not working excessive hours Carlton The DS0000065441.V331860.R01.S.doc Version 5.2 Page 24 and do not do double shifts. This is to ensure they are capable of fulfilling their duties. Two staff spoken with raised concerns regarding the weekend staffing levels and commented, “Sometimes there are only two carers on duty and a cook”. “We need more staff at weekend, sometimes there is only two carers”. This was brought to the attention of the manager who has now started to do shifts at weekends to get to know the staff and confirmed that staffing levels will be maintained. Only one member of the care staff has an NVQ qualification, however the manager said that progress has been made to secure four places for care staff. Staff spoken with confirmed that they wish to take NVQ qualifications. The home should continue this to meet the National Minimum standard of 50 care staff\qualified with NVQ. The manager confirmed that all new staff are employed using the correct procedures. These include an up to date Criminal Record Bureau check (CRB) and two written references. The manager is recruiting new staff and is updating all staff files to ensure they contain the correct information – application, interview, induction, ID, CRB, references, contracts. Since the last inspection the manager has made progress to meet the requirements made and has been obtaining up to date CRB’s and references for staff who failed to have these. Staff contracts have been issued and were seen. Some have yet to be signed by staff. The new manager confirmed she is to introduce a new induction process and this will be in place for new staff. Some progress has been made to ensure staff are trained in the statutory training. Recent training has taken place on medication 2/2/07, health and safety 8/2/07, first aid 14/2/07 and moving and handling 15/2/07. A list of staff who have completed training and who still requires it is in place. The manager confirmed further training s planned in fire safety on 6/3/07. Food hygiene and infection control is yet to be arranged. Abuse training to be arranged and manager was advised to contact Joan Coupe at Adult protection. The manager said that she is to go through abuse procedures with all staff in house to confirm their understanding. Discussion with staff confirmed their attendance at training – “I have done medication, manual handling and first aid”. “I have completed manual handling, food hygiene and fire safety”. Carlton The DS0000065441.V331860.R01.S.doc Version 5.2 Page 25 Positive comments received from residents and a relative spoken with regarding the staff and management. Carlton The DS0000065441.V331860.R01.S.doc Version 5.2 Page 26 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): Standards 31,33,35,38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are benefiting from the introduction of a new manager who is committed to making progress with the involvement of residents, staff and other interested parties. EVIDENCE: Since the last inspection a new manager has been appointed who is very aware of the problems at the home and the requirements and improvements to be made. She has already made progress in organising training, NVQ for staff, arranging meetings, organising staff files, using the correct recruitment procedures, organising records, care plans and daily records for residents. Carlton The DS0000065441.V331860.R01.S.doc Version 5.2 Page 27 The manager has experience of working as a manager of another care home. An application is yet to be made to Commission for registration of the new manager. The new manager shows clear lines of responsibility and has arranged staff meetings to outline changes and work to be done. Residents, staff and relatives spoken with said they are confident that improvements will be made. “The new manager fine. I have learnt so much from her and staff are accepting the changes”. Staff. “Carole has been fine. I feel confident that she will change things”. Staff. “Carole is very supportive and the home is on the up”. Staff. “I really like working here. The new manager is lovely. The staff are very supportive”. Staff. “The new manager is nice and should sort things out”. Resident. “The home seems to be ok and are caring for my dad”. Relative. The manager is yet to organise a quality assurance survey as she has only been in post for two weeks. Recent surveys completed by residents and relatives as part of the previous random inspections were positive. The manager is yet to organise a residents/relative meeting to introduce herself to the home. Records are made of all transactions made. The home deals with personal allowances only and residents spoken with confirmed that family deals with their finances. Monies are securely stored. The manager is yet to arrange supervision with staff and has been spending time getting to know them and working all shifts both weekday and weekends. A staff meeting is arranged for 2/3/07 and ongoing meetings will take place every three months to keep staff up to date of progress. The manager is to review all policies and procedures in priority order i.e. medication and abuse and these will be distributed to staff and their signatures obtained to acknowledge understanding. The manager making progress in organising staff training and confirmed that this will continue until all staff are up to date. The manager is working on the COSHH register and safe storage has been organised. All certificates for services were viewed and found to be in date. All accidents /injuries are recorded and records viewed. Risk assessments are being up dated for safe working practices. Carlton The DS0000065441.V331860.R01.S.doc Version 5.2 Page 28 Carlton The DS0000065441.V331860.R01.S.doc Version 5.2 Page 29 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 3 Carlton The DS0000065441.V331860.R01.S.doc Version 5.2 Page 30 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 OP31 Regulation 8 Requirement The responsible person must ensure that an experienced and qualified manager approved by CSCI is appointed. (Outstanding from last inspections time scales not met 30/06/06 and 18/02/07). Timescale for action 31/05/07 2. OP9 17(1)(a) 3. OP9 13(2) 4. OP9 13(2) When medication is administered 22/02/07 to people who use the service it must be clearly recorded, to ensure that people receive the correct doses at the right times. (Not met from 18/02/07) There must be robust procedures 18/03/07 for the ordering of residents’ medication to reduce the risk of medicine running out. (Not met from 18/02/07) The self-administration of 18/03/07 medication must be supported within a risk management framework to help ensure residents receive any support they need to do so safely. DS0000065441.V331860.R01.S.doc Version 5.2 Page 31 Carlton The 5. OP9 13(2) 6. OP9 13(2) 7. OP38 18 (Not met from 18/02/07) The arrangements for 22/03/07 administering residents’ medication need to be audited to ensure medicines are safely administered from their own labelled supplies, at the right times. To help ensure consistency in the 22/04/07 handling of medication; the medication policies and procedures need to provide clear guidance to staff administering medication. The registered person must 22/04/07 ensure the staff at the care home receive training in food hygiene and infection control. The manager must ensure sufficient staff are on duty at weekends to meet the needs of the residents. The manager must update the policies and procedures, make these available to staff to ensure the safety of the residents. 18/03/07 8. OP27 18 9. OP33 12 31/08/07 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 2. 3. Refer to Standard OP1 OP3 OP7 Good Practice Recommendations The registered person should provide an up to date statement of purpose and service user guide to all residents and prospective residents. The manager should provide more detailed assessments of need to enable the home to meet those needs. The manager should review all care plans to provide a person centred approach to care plans and involve residents and relatives. Residents should, were possible, sign their acknowledgement of the care they receive. DS0000065441.V331860.R01.S.doc Version 5.2 Page 32 Carlton The 4. OP10 The manager should complete an audit of residents clothing and to continue labelling of residents clothing to avoid losses and ensure laundered clothing is returned to rightful resident. Not all private rooms have locks and the manager should record residents’ consent that they don’t wish to have one. Paper towels should be provided in communal areas to avoid cross infection. The manager should provide the latest ‘Safeguarding Adults’ guide for protection of vulnerable adults and training in abuse awareness for staff. The manager should monitor hours worked by those staff who work at other homes to ensure that excessive hours are not worked. The manager should organise and up date staff employment files to provide all details of recruitment. The manager should develop an induction programme to include all principles of care, safe working practices, work role and particular needs of the service user group. The manager should continue with its programme of NVQ training for staff to ensure they have 50 staff with a qualification in care. The manager should provide regular staff supervision. The manager should arrange resident/relative meetings to keep them involved with the changes and developments. Radiator covers should be fitted throughout the home. The manager should develop quality-monitoring systems to obtain feedback from residents, visitors and other professionals on the service provided. 5. 6. 7. OP24 OP26 OP18 8. OP27 9. 10. 11. OP29 OP30 OP28 12. 13. OP36 OP33 14. 15. OP25 OP33 Carlton The DS0000065441.V331860.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG 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 Carlton The DS0000065441.V331860.R01.S.doc Version 5.2 Page 34 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!