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Inspection on 09/07/07 for Adelaide Nursing And Residential Care Home

Also see our care home review for Adelaide Nursing And Residential Care Home for more information

This inspection was carried out on 9th July 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

A varied and balanced menu was provided. The domestic team worked well to provide a clean environment. Some of the bedrooms seen were personalised with the resident`s own possessions, which made the rooms feel homely and welcoming. The garden was well maintained and provided a pleasant and relaxing area for residents. Health and safety issues were addressed. Safe systems wee in place to manage resident`s personal money. Complaints and concerns were dealt with according to the homes procedures. Appropriate action was taken to protect residents from abuse. Staff had access to training relevant to their work and received supervision.

What has improved since the last inspection?

A number of nursing and care staff had received some training on dementia care. Residents received written confirmation that based on assessment the home can meet their needs. Resident had care plans in place in relation to pressure area care. Medicines were safely stored on units visited. Staff rosters seen showed that minimum staffing levels were maintained and changes had been made to the domestic and laundry staff shifts to improve these areas of the service. Accurate copies of staff rosters were being kept.

What the care home could do better:

Ensure the service has a registered manager. The GP must be informed when a resident repeatedly refuses to take prescribed medicine. Care plans must be reviewed and show changes to resident`s needs or circumstances affecting their wellbeing. The provision of activities and the preparation of individual social care plans for all residents continue to be an issue in this service. The issue with the hot water supply must be addressed. A quality assurance report must be prepared based on the outcome of any quality review and an improvement plan prepared to address issues identified. This report should be made available to residents, relatives, the Commission and others.

CARE HOMES FOR OLDER PEOPLE Adelaide Nursing And Residential Care Home 35 West Street Bexleyheath Kent DA7 4RE Lead Inspector Ms Pauline Lambe Unannounced Inspection 9th July 2007 09:10 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 Adelaide Nursing And Residential Care Home DS0000006752.V339886.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. Adelaide Nursing And Residential Care Home DS0000006752.V339886.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Adelaide Nursing And Residential Care Home Address 35 West Street Bexleyheath Kent DA7 4RE 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) 020 8304 3303 020 8301 0133 adelaide@schealthcare.co.uk www.schealthcare.co.uk Southern Cross Healthcare Services Limited post vacant Care Home 76 Category(ies) of Dementia (42), Dementia - over 65 years of age registration, with number (1), Old age, not falling within any other of places category (34) Adelaide Nursing And Residential Care Home DS0000006752.V339886.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 1 place registered for nursing care for a service user with dementia under 65, as agreed with CSCI. 1 place registered for service user category DE(E) in the general residential unit for named service user only. 15th October 2006 Date of last key inspection Brief Description of the Service: The Adelaide Care Centre is a purpose built nursing and residential care home. It was first registered in July 1997 and was then purchased by Southern Cross Healthcare in September 1998. The home is situated in a side road off Bexleyheath Broadway near the railway station, bus services and the shopping centre. There is car parking space to the front of the property. The home is registered to provide care and accommodation to 76 older people. The home has two floors divided into four separate units providing care for the different categories of service users. On the ground floor, there are 20 general nursing beds and 14 beds for conventional residential care. On the first floor, there are 25 nursing beds and 17 beds for residential care, all for older people with dementia. All of the bedrooms in the home have en-suite facilities. The laundry is sited in a separate building to the side of the home. At the rear of the building there is an enclosed garden. The current fees range from £467.00 - £762.00. Residents pay privately for personal items such as hairdressing, newspapers and chiropody care. Adelaide Nursing And Residential Care Home DS0000006752.V339886.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors from the commission started the site visit for this unannounced inspection on 9th July 2007 and one inspector completed the visit on 13th July 2007. The manager was in charge of the home during both visits and she and staff assisted with the inspection. The service had a key unannounced inspection on 15th October 2006 and a random unannounced inspection on 5th February 2007. This inspection included a review of information held on the service file, a tour of the premises, a review of records, talking to residents, staff, management, visiting professionals and reviewing compliance with previous requirements. Information provided in resident and relative surveys was also reviewed. Time was also taken to review compliance with previous requirements. Since the last key inspection the commission received concerns about the hot water supply. This issue was resolved in December 2006 when a new boiler was fitted. However some problems with hot water supply continue which is being addressed. What the service does well: What has improved since the last inspection? A number of nursing and care staff had received some training on dementia care. Residents received written confirmation that based on assessment the home can meet their needs. Resident had care plans in place in relation to pressure area care. Medicines were safely stored on units visited. Adelaide Nursing And Residential Care Home DS0000006752.V339886.R01.S.doc Version 5.2 Page 6 Staff rosters seen showed that minimum staffing levels were maintained and changes had been made to the domestic and laundry staff shifts to improve these areas of the service. Accurate copies of staff rosters were being kept. What they could do better: 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. Adelaide Nursing And Residential Care Home DS0000006752.V339886.R01.S.doc Version 5.2 Page 7 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 Adelaide Nursing And Residential Care Home DS0000006752.V339886.R01.S.doc Version 5.2 Page 8 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 3 and 4. Standard 6 did not apply to the service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Adequate information was provided about the service. Residents were admitted to the home based on an assessment of care needs. Residents received written confirmation that based on assessment the home was suited to meeting their needs. EVIDENCE: Care plans viewed included pre-admission assessment of care needs and some contained care manager assessments. A senior member of staff from the home completed pre-admission assessments. The current format used on the residential unit was confusing and did not include the date and place of completion. Two member of staff on the residential unit said they found the assessment difficult to follow. The service user guide had recently been updated and plans in place to leave updated copies in resident’s bedrooms. Adelaide Nursing And Residential Care Home DS0000006752.V339886.R01.S.doc Version 5.2 Page 9 Residents received written confirmation to show that following assessment the home was suited to meeting their needs. Recommendation 1. Adelaide Nursing And Residential Care Home DS0000006752.V339886.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7 – 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individual care plans and risk assessments were prepared but not all those seen were up to date. Systems were in place to meet resident’s health care needs. Safe systems were in place to manage medicines. EVIDENCE: Two care plans were viewed on the dementia nursing unit and the residential unit. Care plans were generally up to date, reflected the resident’s needs and included adequate details as to how assessed needs were to be met. Care plans were quite personal and included details such as the provision of hair and nail care and encouraging residents to be independent and make choices. The records also included risk assessments in relation to care such as pressure area care, moving and handling and nutrition. There was evidence to show that residents and relatives were involved with reviewing care plans. Staff must take care when reviewing care plans and assessment to ensure that changes to resident’s needs or circumstances are recorded and care plans amended accordingly. For example on the dementia nursing unit information in one record referred to contacting the residents spouse but had not been Adelaide Nursing And Residential Care Home DS0000006752.V339886.R01.S.doc Version 5.2 Page 11 changed to show that the spouse had died and the falls risk assessment for a resident indicted they ‘wandered’ but had not been changed to reflect that they were now immobile. Requirement 1. All residents were registered with a GP. Residents on the residential units could access the service of the district nurse team as needed. Care plans seen on all units included a record of professional visits. These showed that residents had access to other professionals such as the GP, psycho-geriatrician, district nurse, tissue viability nurse and chiropodist. Residents were supported to access dental and optical services. The district nurse was seen on the residential unit and said that communication was very good between the staff on the residential units and herself with staff using her assistance appropriately and following advice given. Residents were able to see visiting professionals in private in their bedrooms. Medication management was viewed on a residential and the dementia nursing units. The home had a policy and procedure in relation to medicine management. Records were kept for the receipt, administration and disposal of medicines and medicines were safely stored on the units inspected. On the residential unit medicine records were viewed for two residents and no inaccuracies were noted. Each medication record had a clear photograph of the resident and information regarding allergies had been completed. On the dementia nursing unit safe systems were in place to manage medicines. None of the residents currently managed their own medicines. Adequate and appropriate storage was provided for medicines and records seen were up to date. Medicine records checked for two residents. One was correct and one showed that the resident refused some prescribed medicines frequently. It was not clear if the GP had been made aware of this. When staff administered medicines they wore a tabard saying ‘do not to disturb’, which was seen as good practice. It was noted that the medicine round took a long time. For example the morning medicines were still being administered on the residential unit at 10: 30 a.m. and on the nursing unit the afternoon medicines were still being administered at 14.45. Other issues discussed with the manager in relation to medicine management was the need to have a medicine profile for each resident, evidence that the GP has reviewed each residents medicines regularly, when a resident was prescribed ‘as required’ pain relief and was unable to verbalise this need that a protocol was prepared in relation to managing pain relief and besides having sample signatures for staff who administered medicines there should be evidence to show staff had been assessed as competent. Requirement 2 and recommendation 2. Staff were seen knocking on bedroom doors and asking permission to enter bedrooms. Good interaction was seen between staff and residents and assistance was provided in a calm reassuring manner. Adelaide Nursing And Residential Care Home DS0000006752.V339886.R01.S.doc Version 5.2 Page 12 Bathroom and toilet doors had locks fitted, the majority of bedrooms were for single occupancy and all bedrooms had en-suite facilities. The home had a trolley telephone to enable residents to make and receive calls in the privacy of their bedroom. From observation staff respected resident’s privacy and dignity when assisting with care. The residents who completed a survey on behalf of the provider confirmed that their privacy and dignity was respected. Residents on the dementia nursing unit were unable to comment on how this standard was met in relation to them. Some relatives seen raised concerns regarding dignity for example one relative said that residents were left in wheelchairs until after lunch. Another relative said that often when they visit their relative had been given their full meal of soup, main meal and dessert together on a tray. As the resident had dementia the relative felt this made it difficult for them to manage the meal appropriately and they tended to mix the food together. Recommendation 3. Adelaide Nursing And Residential Care Home DS0000006752.V339886.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12 – 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Activities needed improvement. Residents and relatives were satisfied with visiting arrangements and the quality of meals provided. EVIDENCE: The manager said that due to unforeseen circumstances the activities organiser was not in the home for the past three weeks. The manager had asked staff to discuss with individual residents activities they would like to participate in and care staff had been given the additional responsibility of carrying out activities with residents each afternoon. A notice was displayed in each unit listing activities planned for the week and these included reminiscence, arts and crafts, Bingo, card games and coffee break puzzles. Recently a volunteer was recruited who assisted with activities. On the day of the inspection the activity organiser was in the home and a number of residents were seen playing bingo in the ground floor dining room. One care plan viewed on the dementia nursing unit included a social care plan but little evidence to show this had been implemented. The second care plan did not have a social care plan but there was evidence that the resident had attended some activity sessions in the previous month. On the residential unit there was no evidence in residents care plans of their involvement in activities. Both Adelaide Nursing And Residential Care Home DS0000006752.V339886.R01.S.doc Version 5.2 Page 14 residents and relatives spoken with stated that there were not enough activities taking place. The issue had also been raised at a recent resident/relative meeting, had been raised by residents asked to complete internal satisfaction surveys and was raised in previous inspection reports. Some relatives on the dementia nursing unit felt the residents there missed out on activities and mental stimulation. Requirement 3. Arrangements were in place for residents to maintain contact with family and friends. Residents seen said they enjoyed family visits and relatives were encouraged to attend social functions organised in the home. Relatives spoken with stated they are always made feel welcome in the home and found care staff approachable, helpful and informative. Some relatives said they occasionally had difficulty communicating with staff when English was not their first language and were concerned as to how this affected resident communication particularly for residents suffering with dementia. Some residents seen said they could make choices about issues such as meals, what to wear, where to sit and whether to participate in activities. Residents were able to bring in personal effects from home and two residents spoken with on the residential unit said how much they appreciated the fact that relatives had been able to personalise their bedrooms. On the residential unit staff said that it was the responsibility of the night staff to write up the menu on the dry board in the dining room for the following day. Unfortunately the information displayed was incorrect and caused some confusion when staff began serving food. However staff offered a plate of both dishes available to enable the residents to make a choice. A resident spoken with said the food was very good, they enjoyed all the meals and said they told the staff this as it was important to tell people when they got it right. On the dementia nursing unit lunch was more organised that at previous inspection. Tables were laid prior to serving food and serviettes and some condiments were provided. Residents wore ‘bibs’ to protect their clothes. Drinks of squash and water were provided and food was served from a heated trolley. Staff assisted residents appropriately to have their meal. Residents seemed to enjoy their food and those able to comment confirmed this. It was noted that residents on the nursing and dementia nursing units were still having breakfast at 10.30 am. A number of residents on the nursing unit said that breakfast was always late. With lunch being served at 12.30 pm management should ensure that sufficient time is allowed between meals. It was noted that staff continued to maintain food and fluid charts for all residents on the dementia nursing unit. Many of these records were not calculated and therefore were of little benefit to the resident’s, as they did not influence care planning. Staff should be encouraged to use this form of monitoring appropriately and correctly based on resident assessment and need. Adelaide Nursing And Residential Care Home DS0000006752.V339886.R01.S.doc Version 5.2 Page 15 On the second day of the visit the kitchen was viewed. This was clean and well organised and equipped. Records such as food storage, food temperatures and cleaning schedules were up to date. Requests had been made to have the kitchen deep cleaned regularly and emails to head office regarding this were seen. Recommendation 4. Adelaide Nursing And Residential Care Home DS0000006752.V339886.R01.S.doc Version 5.2 Page 16 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 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Satisfactory systems were in place to manage complaints and ensure resident protection. EVIDENCE: A complaints procedure was provided and systems were in place to record complaints made about the service. Since the last inspection three complaints had been made to management. The original letter for one complaint was not seen so it was not possible to assess if all issues raised had been investigated and responded to. Records for the remaining complaints showed these had been appropriately managed. A copy of the complaints procedure was included in the statement of purpose and service user guide. Relatives seen said they knew how to make a complaint. A policy and procedure was in place in relation to safeguarding adults. Staff spoken with had a good understanding of what safeguarding adults meant and how to manage such a situation. Staff understood the ‘whistle blowing’ policy and a copy of this was seen on the wall in the staff room. Since the last inspection social services had investigated two allegations of abuse. One allegation was investigated and was unsubstantiated and one investigation was still in progress. Adelaide Nursing And Residential Care Home DS0000006752.V339886.R01.S.doc Version 5.2 Page 17 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, 24 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and relatives were satisfied with the private and communal space provided. The home was well maintained and kept clean. Systems were in place to prevent the spread of infection. EVIDENCE: A tour of both residential units was undertaken and areas seen were found to be clean and free from unpleasant odour. Residents and relatives said they were satisfied with the standard of cleanliness and comments made on the inhouse survey confirmed this. Rooms were appropriately decorated and furnished. Since the last inspection a wall cupboard had been fitted in the kitchen area to store crockery and the worn and stained dining chairs had been replaced. Areas seen on the nursing and dementia nursing units were also clean, tidy and free of offensive odours. Residents and relatives spoken with were satisfied with the environment. Although at times one domestic staff covered Adelaide Nursing And Residential Care Home DS0000006752.V339886.R01.S.doc Version 5.2 Page 18 two units they managed to maintain a good standard of hygiene. Since the last inspection the shift times for domestic staff had been altered and there was now an evening domestic on duty from 18.00 – 20.00 every day. The housekeeper said this was an improvement and when the domestic team came on duty in the mornings the communal areas had been cleaned. The housekeeper continued to work on a unit every shift and had no time to plan work or provide supervision for the domestic team. There was no system in place to ‘spring clean’ bedrooms for long stay residents. Vacant rooms were cleaned prior to admission of a new resident. Recommendation 5. Since the last key inspection the home has had problems with the hot water supply. In December 2006 areas of the home were without hot water for some time. This meant residents were not being bathed and staff had to carry hot water to the bedrooms. This issue was resolved when the new boiler was fitted. However at this visit residents and staff said that recently there had been further issues with hot water supplies. The manager said that this was to do with the way the fire alarm system worked. When the fire alarm sounded the boilers automatically switched off and had to be relit. Management were seeking to resolve this situation. Requirement 4. Sluice rooms were clean and waste was appropriately stored. Hand washing facilities were provided appropriately and staff had access to protective clothing. The laundry area was clean and tidy and new trolleys had been purchased to transport clothing to the home. However one of these was very large and when filled was too heavy for one person to move. Consideration should be given to allow an overlap of laundry staff between shifts to enable them to safely transfer clothing to the home. Since the last inspection the laundry staff shifts had been changed to ensure the service was covered every day from 07.30 – 17.30. Residents or relatives did not raise any concerns in relation to the laundry service. Recommendation 6. Adelaide Nursing And Residential Care Home DS0000006752.V339886.R01.S.doc Version 5.2 Page 19 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 – 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Adequate staffing levels were maintained. Management were committed to providing NVQ training for care staff. Recruitment procedures were good and complied with regulation. Staff had access to training relevant to the work they did. EVIDENCE: On the units viewed staff rosters seen were an accurate reflection of staff on duty. Rosters seen for a two-week period showed adequate staffing levels were maintained. On one of the residential units the deputy residential Manager was in charge, she had come in to cover a shift and was therefore working her fourth twelve-hour shift consecutively. All staff spoken with thought there should be more staff to enable them to fulfil their roles. Staff said that they felt under constant pressure to complete their work and this had increased with the expectation they would provide additional social activities. Some staff did not take a break during the shift and this was discussed with the manager. On the nursing units staff rosters showed that minimum staffing levels were maintained. The nursing high had a high percentage of highly dependent residents and would benefit from having an additional care assistant on the morning shifts. Management should monitor this situation and make changes to staffing levels appropriately to ensure resident’s needs are met. Adelaide Nursing And Residential Care Home DS0000006752.V339886.R01.S.doc Version 5.2 Page 20 Over 50 of care staff, including bank staff had achieved level 2 NVQ or above. Records were viewed for four recently recruited employees. The sample seen included a volunteer, two nurses and a domestic. All of the files seen complied with regulation and it was evident that staff had been provided with the job descriptions and a contract of employment. Confirmation had been obtained from the Nursing & Midwifery Council to show that the nurses employed were registered with them. A discussion took place with the manager regarding the organisations interview process. The manager was advised to keep a record of interview questions/responses to enable the company to demonstrate it operated an equal opportunities recruitment process and provided feedback for applicants. The manager said that she maintained a training matrix to enable her to record courses staff attended and ensure that statutory training was updated on a regular basis. Copies of qualifications and certificates awarded following training were seen. Staff spoken with said they had received formal induction when their employment commenced and training relevant to their roles including dementia care training. Adelaide Nursing And Residential Care Home DS0000006752.V339886.R01.S.doc Version 5.2 Page 21 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, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home manager was not yet registered with the Commission. Some quality assurance systems were in place however results of surveys were not collated or supported by improvement plans. Staff received regular formal supervision. Safety records were well maintained. EVIDENCE: Since the last inspection the manager had a period of leave from the home and a project manager was responsible for the service. The manager was now back in post and had the qualifications and experience needed to manage the service. The manager said she had her CRB check done and completed her application forms to become the registered manager. The forms were to be sent to the Commission by the provider. Adelaide Nursing And Residential Care Home DS0000006752.V339886.R01.S.doc Version 5.2 Page 22 Copies of relative/resident meetings were seen and showed these were well attended. It was recommended that staff took the opportunity to inform people attending meetings on the action taken to address issues raised at previous meetings so that those attending knew their views were taken seriously. The provider had begun to seek the views of residents and relatives by asking them to complete a quality assurance survey. A total of eight surveys were seen and indicated people were satisfied with the care they received. However a number of people took the opportunity to say they felt there were insufficient activities provided. The provider must collate a report from the surveys to demonstrate to residents, relatives, the Commission and others that an action plan is prepared to address issues raised and that information gathered will be used to improve the service. The provider undertook visits to the home as required by regulation 26. Reports of these visits were sent to the Commission occasionally. Requirement 5. Management provided assistance for residents with personal allowances only. The system in place to manage this was assessed as safe. Receipts were given for money received and obtained for money spent on resident’s behalf. Individual records were kept on the computer for residents and made available to them and their relatives when needed. Personal allowance records were checked for four residents and were found to be correct. Resident’s money, jewellery items found or waiting collection and petty cash for the home were stored in a safe, which was fixed to a solid wall. A list of the safe contents was stored on the computer. Staff spoken with stated they received regular supervision. Supervision notes were seen for three members of staff and the manager said that staff responsible for undertaking supervision had received appropriate training. The deputy manager on the residential unit was expected to undertake supervision and update records but did not have any management time to do this. The manager of this unit did have management hours to fulfil this part of her role. Safety records seen showed attention was given to providing a safe environment for residents and others. Most records seen were up to date and showed that service checks had been done when due. The hoist and bath certificates were provided on the second day of the inspection. Certificates for two hoists were missing and the manager said that one hoist was waiting to be repaired and the other was not available on the day the equipment was serviced. The manager was aware of the need to keep these items out of use until they were serviced. Fire safety records seen showed weekly alarm checks were undertaken. Fire drills were held every two months and included comments on staff reaction and the names of those who attended. Records showed that fire drills were held at times to include night staff. Accident records were viewed and it was noted that a lot of accidents to residents occurred in the communal areas and were not witnessed by staff. Where required residents received medical attention following accidents and Adelaide Nursing And Residential Care Home DS0000006752.V339886.R01.S.doc Version 5.2 Page 23 notifications were sent to the Commission as required by regulation 37. Recommendation 7. Adelaide Nursing And Residential Care Home DS0000006752.V339886.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 X X X 3 X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 3 X 3 Adelaide Nursing And Residential Care Home DS0000006752.V339886.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No 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 Requirement The registered person must care plans are kept up to date and reflect changes to residents needs and circumstances. The registered person must ensure that the GP is informed if a resident frequently refuses to take prescribed medicines. The registered person must ensure individual social care plans are prepared for and with residents or their relatives and ensure these plans are implemented. The registered person must ensure that residents have access to hot water at all times. The Commission must be informed in writing as to the action taken to resolve the problem with the boilers. The registered person must ensure a report is written for quality reviews undertaken and supported by an improvement plan to address issues identified. This report must be made available to residents, relatives and others and a copy sent to DS0000006752.V339886.R01.S.doc Timescale for action 24/08/07 2 OP9 13 24/08/07 3 OP12 16 24/08/07 4 OP19 23 24/08/07 5 OP33 24 31/08/07 Adelaide Nursing And Residential Care Home Version 5.2 Page 26 the Commission. 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 OP3 Good Practice Recommendations The registered person should ensure the pre-admission assessment used is clean and understood by all staff. The form should be fully completed and show where and when the assessment was done. The registered person should ensure a medicine profile is maintained for each resident, there is evidence that the GP has reviewed each residents medicines regularly, when a resident is prescribed ‘as required’ pain relief and cannot verbalise this then a protocol should be prepared in relation to managing pain relief and there should be evidence to show that staff responsible for medicine administration have been assessed as competent. The length of time taken to administer medicines should be monitored to ensure adequate time is provided between doses. The registered person should ensure feedback is sought from relatives in relation to the privacy and dignity of residents and issues raised are addressed and reviewed with them. The registered person should ensure that reasonable time gaps are planned between meals. If residents are not up by breakfast time then consideration should be given to proving them with breakfast in their rooms. The registered person should ensure a system is in place to enable domestic staff to ‘spring clean’ the bedrooms for long stay residents and other areas of the home. The registered person should consider providing an overlap in shifts for the laundry staff to enable them to transport the clothing trolleys to the home. The registered person should ensure staff are allocated to supervise residents in the communal areas. 2 OP9 3 OP10 4 OP15 5 6 7 OP19 OP26 OP38 Adelaide Nursing And Residential Care Home DS0000006752.V339886.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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. 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