Inspection on 25/11/08 for Afton Lodge Care Home

This inspection was carried out on 25th November 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Afton Lodge Care Home 15/05/07

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Afton Lodge Care Home 9-15 St Catherines Road Bootle Merseyside L20 7AL     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Margaret VanSchaick     Date: 2 5 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Afton Lodge Care Home 9-15 St Catherines Road Bootle Merseyside L20 7AL 01519226183 Telephone number: Fax number: Email address: Provider web address: Noemail Name of registered provider(s): Name of registered manager (if applicable) Theresa Rostron Type of registration: Number of places registered: Mr Asif Iqbal Alvi,Muhammad Fayyaz Chauhdry care home 27 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Learning disability - Code LD (maximum number of places: 1) The maximum number of service users who can be accommodated is: 27 Date of last inspection Brief description of the care home Afton Lodge is registered to provide accommodation and care without nursing for up to 27 older people. The home is a large double fronted house in a residential area of Bootle. The local shopping centre is near by as is the local train station . There is also good access to public transport close by. Internally the home offers two lounges, one of which is cuurently used by people who smoke, however due to change in legislation Care Homes for Older People Page 4 of 33 1 0 Over 65 0 27 Brief description of the care home all lounges will be made non smoking in the near future. People who use the service have use of a communal dining room which is large enough to seat everyone in one sitting. People who use the service are able to have a private single bedroom or share facilities with another person if they wish. However most double rooms are currently used for sigle occupancy. To the rear of the home is a large garden area which is well maintained and safe for use, to the front there is limited parking within the walled forecourt. On-street parking is only allowed with a residents permit from the local council. The home does not provide nursing care but has care staff 24 hours a day it also provides the services of a cook, handyman and domestic staff. The current charge for accommodation is #360.50 which includes care support, meals laundry and activities. Charges are made for personal purchases such as hardressing. Contubutions may be asked for towards external trips. Regency healthcare (UK)LLP became registered owners in March 2007. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: A site visit took place as part of the unannounced key inspection. It was conducted over two days by one inspector and lasted 8.75 hours. 17 residents were accommodated at this time. As part of the inspection process most areas of the service were viewed including residents bedrooms. Care records and other documentation were also viewed. Discussion also took place with residents and staff. The inspection was conducted with the deputy manager and two Directors of the company were present during part of the inspection. Discussion also took place with the chef and maintenance person. During the inspection two residents were case tracked (their care files were examined and their views of the service were obtained). All of the key standards for older people Care Homes for Older People Page 6 of 33 were inspected. Previous requirements and recommendations from the last inspection in May 2007 were discussed. Satisfaction forms Have your say about.. were distributed to residents, their relatives, health professionals and staff. A number of comments included in this report are taken from surveys and interviews. An AQAA (Annual Quality Assurance Assessment) has been completed. The AQAA comprises of two self assessment questionnaires that focus on the outcomes for people. The self assessment provides information as to how the manager and staff are meeting the needs of the current residents and a data set that gives basic facts and figures about the service including numbers and training. What the care home does well: What has improved since the last inspection? What they could do better: The statement of purpose and service user guide needs to be updated so that prospective residents and their families are better informed about the service. Pre admission assessments do not contain sufficient information to set up the care plans therefore this needs addressing to ensure needs of prospective residents are not missed. The service need to know that they will be able to meet the needs of the prospective residents and this can only be done by good and effective collating of information prior to admission. The service need to improve the care plans as some needs that have been identified pre admission are not addressed. The care plans need to be discussed with the residents and agreed plan of care needs to be evidenced. Medication is not managed very well at times. There are still problems with missing staff signatures so that it is not known if residents have received their prescribed medication or not. Staff who administer medication need to be assessed to ensure they Care Homes for Older People Page 8 of 33 are competent. Residents need to be consulted with regard to planning activities so that we can be sure it is what they like to do and is suitable for them. One resident interviewed stated, Theres nothing for me to do. Feedback from residents and health professional surveys confirm that the service lack activities. The menus need to be improved so that residents are offered a choice at mealtimes. The service have adult protection procedures that have been set up by the company from last year but they do not have the up to date local procedures. Staff were vague about adult protection procedures therefore the service need to provide the training so that staff are more aware and familiar with the local procedures. The service do not have a complaints log. This needs to be commenced and evidence complaints raised, the investigation and outcomes for the residents. This will then evidence that residents are listened to. The service need to continue with the environmental improvements to ensure residents are comfortable. The service need to ensure that sufficient domestic staff are employed at holiday times or to cover for periods of sickness to ensure a cleaner environment. Pre employment procedures need to be improved to ensure that all checks are carried out prior to employing any staff. This will protect residents. Staff records need to include an up to date training record. This will tell us where staff are up to with regard to induction and training. Mandatory training is not up to date. Induction training needs to be improved to meet the Skills for Care standards. The registered manager left approximately two months ago therefore this needs addressing to ensure the service is run well. Residents need to be consulted through better quality assurance systems with their views published. Gaining residents views will provide the company with an insight into how the service is run. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The pre admission assessment process needs to be improved to ensure that all of the prospective residents needs are indentifed to ensure the service is able to care for their individual needs. Evidence: The dates of assessment and admission are recorded with signatures of the person carrying out the assessment. The first assessment evidences very little information and is not sufficient to set up a care plan to manage their needs. The second assessment viewed had more information recorded but again insufficient to identify all of the prospective residents needs. In some of the assessment areas including communication, sleep pattern, dental care, foot care, medication, daily life, social activities, social contacts/relationships there were blank spaces. None of these areas had any information recorded. Care Homes for Older People Page 11 of 33 Evidence: The whole pre admission assessment process needs to be improved to ensure that prospective residents needs are clearly identified before accepting them into the service. The prospective resident needs to be sure that the service will be able to meet their individual needs and this cannot be confirmed with the little information recorded on the assessment documentation. None of the residents interviewed could remember the pre admission process. One resident interviewed stated, I came from Blackpool for a holiday and I liked it so decided to stay. One resident canvassed for their views responded by recording they had not received enough information prior to moving in. The statement of purpose and service user guide need to be improved to ensure the minimum standards are met. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents health and welfare may be compromised because care plans do not reflect all of the assessed and changing needs of the residents. Medication management and administration needs to be improved to ensure accurate records are kept and residents get the medication they are prescribed. Evidence: The care plan and care documentation of two residents were examined. Care information with regard to two other residents was briefly looked at also. There is documented evidence that residents have had access to health professionals including Gps, District Nurses, Chiropodists and Specialist Nurses. There are records with regards to nutritional assessments, pressure sore assessments and manual handling assessments. Some of these were reviewed with dates and others were undated. Neither of the care plans looked at evidence all of the identified needs prior to Care Homes for Older People Page 13 of 33 Evidence: admission to the service. One of the care plans does not have a plan in place for pain, mobility or falls although both were identified as problems on the assessment documentation. Where a need has been identified, there is no plan in place such as mobility-states not a problem, yet this resident had a fall prior to admission. On one care plan, dietary needs and personal hygiene are recorded on the same page. One or two documents have been left blank and not addressed such as a risk assessment for the bedroom space for the resident. One document set up by the service is in relation to the residents views of their care needs but this has been completed from the staff point of view as evidenced on the staff views document. This means that the service are not reflecting the residents views. There was no evidence to show that residents were involved in the setting up of their care plan and signatures of residents agreement to the care were not seen. One resident has a new medical condition and has been prescribed medication for this yet there is no care plan in place to inform staff how this condition is to be managed. Residents interviewed were complimentary about the support and care provided by staff. Residents interviewed stated, I use my tripod and staff support me to the lift, Im a lot better than I was-Ive been a lot better since I have been here and I think its good here. Health professionals gave mixed feedback in their returned surveys. Health professionals canvassed for their views about how the service is run commented, On occasions, we have asked for clients health care needs to be done on a daily basis, however sometimes this is not always done, some members of staff say we can see a client in the main lounge, we always inform them we need to go to a private room, the service can improve by providing activities for the residents instead of leaving them to watch tv in the lounge all day and My client is happy in the home and they meet all her needs, they seek appropriate advice and support at the appropriate times. Medication is locked securely in the medication trolley. When this is not in use this is secured in a locked medication room. Controlled medication is stored in a separate locked cabinet in the same locked room. Unused medication is returned to the pharmacist with records evidencing this. Controlled medication records evidence that five tablets (prescribed prn i.e. administer when necessary) went missing in August this year. The person in charge during the visit was unsure of the outcome of the investigation carried out by the registered manager. There is no record of this incident and the Commission were not informed. There is no auditing of this medication despite the discrepancy in August therefore the deputy was advised that this needs to be addressed to ensure accurate records are kept. The monthly medication administration records were viewed and showed on occasions missing staff signatures therefore it is Care Homes for Older People Page 14 of 33 Evidence: assumed residents were not given their medication on that day. Some medicines are not carried forward onto the new monthly sheet therefore it would be difficult to audit these medicines. One medicine prescribed daily had no record of what dose was to be given. Medication management was highlighted as a problem at the last inspection therefore this remains an outstanding requirement. Residents were noted to be dressed well and hair groomed. Residents are called by their preferred names as evidenced on care documentation and observed during the visit. Residents were able to have the same gender Person care for them with regard to personal care. The two residents who share a bedroom have a screen in place to ensure privacy for both. Staff were observed to knock on residents bedroom doors prior to entering. Staff were noted to be respectful in their approach with residents. On occasions residents were observed having fun during their interactions with staff. Care Homes for Older People Page 15 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Planned activities need to be put in place following consultation with residents. The residents menu needs to show choices for all meals. Evidence: There was no activity advertised for residents on the day of the inspection. One or two residents were observed to be doing various activities in the day including, jigsaws, knitting and going out with staff. The person in charge told us that activities organised on a regular basis include bingo, jigsaws, discussing news topics, playing music, outside entertainers, Dvds, church visits and crosswords. Some of the residents also visit the local shopping area and cafe independently or with staff. Some groups visit the service on occasions to provide entertainment for the residents. There is no planned activities programme therefore this needs addressing. Some of the residents preferred activities are recorded on care documentation. The service needs to have discussion with the residents so that when staff plan activities, they reflect the needs and abilities of the residents. One resident interviewed stated, Theres nothing for me to do, Im a bit bored, I would like more to do. Residents canvassed for their views commented, There is no Care Homes for Older People Page 16 of 33 Evidence: entertainmentand We need some outings, there is no hobby or activity, we sit from when we get up till we go to bed. A health professional canvassed for their views commented, More activities for residents as currently residents dont do any. One of the residents visits a day centre each week and this gives them additional activities to be involved in. Local Church groups visit the service regularly. Families and friends are encouraged to visit when they wish to. Residents preferred daily routines are recorded in care documentation and residents interviewed confirmed that they can generally do as they wish. One staff interviewed stated, Residents get up when they want to, this is their home. They can go to bed when they wish. Residents are encouraged to personalise their bedrooms as observed during the visit. Residents who are able to, manage their own financial affairs. Where needed family support is provided. External advocacy details are provided for residents who need their assistance. Residents are provided with three meals a day and in between meals drinks and snacks are provided also. Cooked breakfast is available for the residents who wish it. The main meal of the day is served at lunchtime. The menu does not offer alternative meals at lunchtime, only with the evening meal. Residents need to be able to have a choice of main courses and this needs to be organised following consultation with the residents. The menu should then evidence choices for all meals and these choices need to be displayed on the residents notice board in the dining room so they can decide which meal they prefer. Residents usually have their meals served in the dining room, which is a pleasantly domestic environment for residents. Matching crockery is used as observed and tables and chairs suitable for residents use are of good quality. Fresh fruit and vegetables and other foods suitable for residents meals were observed in the kitchen fridges, freezers and stores. Residents interviewed with regard to mealtimes stated, The food is nice, you get a choice and the chef knows what I like. Residents canvassed for their views commented, Food could be better, Sometimes at tea time there is not enough sandwiches and there is no cream on the jellys and If a person does not like a meal, they get a choice of something else. Care Homes for Older People Page 17 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Robust procedures are not in place therefore residents are not protected. Evidence: A complaints procedure is in place and the company guidance and policy with regard to adult protection is in place. There is no complaints log therefore it is difficult to know if residents or their relatives are listened to and their concerns/complaints acted upon. The deputy was advised to start a complaints log and ensure it evidenced all complaints raised, the investigation and outcomes for the complainant. One of the residents canvassed for their views commented, I have no complaint to make, theres no need to be unhappy. The service do not have the up to date Sefton adult protection procedure therefore have been advised to access one. Staff interviewed were vague about adult protection and there was no evidence in staff files that any staff had attended the training. The service was advised to access up to date local adult protection procedures training for staff to ensure residents are protected. This was raised as a requirement at the previous inspection. Residents do not have a lockable facility in their bedrooms. This needs to be addressed promptly so that residents can secure their valuables. Care Homes for Older People Page 18 of 33 Care Homes for Older People Page 19 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service still needs to improve to provide a comfortable and well maintained environment for the residents. Evidence: A tour of the premises took place with the deputy. All areas were viewed including many of the residents bedrooms. The service is decorated in a pleasant domestic style with many of the residents bedrooms containing personal belongings, which makes them look more homely. Following discussion with residents it is apparent that they like their bedrooms but one resident interviewed was not so keen on the location of their bedroom as it meant they had to go up and down a small flight of stairs and stated, I dont like going up and down the stairs, I want to move somewhere else. We asked the deputy if a ground floor room was available but none as yet. It would benefit this resident if they were able to go into a bedroom with easier access. Many of the bedrooms and public areas including lounges, hallways, stairs and landings have new carpets and there has been some redecorating carried out to the same public areas and residents rooms. The dining room has been completely refurbished to include new dining furniture, flooring and decor. New windows have been fitted also. The company have identified areas for refurbishing/improvement and some of these have been carried out by the maintenance person. Where it is too big a Care Homes for Older People Page 20 of 33 Evidence: job the work has been carried out by contractors. There are still items and areas of the service that need work but they have been identified during the audits of the building. The lawn mower and one of the residents electric wheelchairs is stored in the laundry and this could be a fire hazard therefore a more suitable storage area needs to be found. Residents are able to access the garden grounds and a portable ramp is available for the residents who are wheelchair users. The garden grounds are well maintained. The domestic staff was on holiday and this was apparent during a tour of the building with some areas not as hygienic or tidy as they should be. The service need to ensure that domestic cover is provided when staff are on holiday. Care staff also carry out laundry duties as there is no laundry assistant. A resident canvassed for their views commented, The clothes sometimes get mixed up and go missing. Infection control training has been attended by some staff, this needs to include all of the staff employed to ensure a high standard of hygiene. Care Homes for Older People Page 21 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The procedures for recruitment of new staff is not robust enough to protect residents. The training programme needs to be improved to ensure all staff are well trained to meet the needs of the residents. Evidence: The duty rota was viewed and evidenced the staff on duty for the week. The rota was recorded in pencil, this needs to be recorded in ink. Sufficient staff were on duty. Some of the care staff are qualified to NVQ Level 2, 3 and 4. Two staff files including training records were viewed during the visit. Start dates of staff were not recorded. Application forms and medical questionnaires were completed for both staff. Staff files did not evidence the police checks but the company faxed us the information, which confirmed police checks that were carried out evidence that one was confirmed 2 months after they commenced employment. The second employee check was employed for 4 years prior to the police check confirmation. References for one employee were satisfactory. For the second staff file one reference was from a friend, which is fine. The second reference was from a previous employer from some years ago. The most recent employers address was given for a reference but there is no reference from them in the staff file. The service need to ensure that Care Homes for Older People Page 22 of 33 Evidence: one of the references needs to be from the most recent employer. This will give a more accurate account of what their performance as an employee is like to date. The induction for new staff did not evidence that it met the standards set by the National Training Organisation. The induction period for new staff had no set time period and one staff had a brief checklist for their induction carried out on on one day for 2-3 hours as confirmed during interview. There was no evidence of staff contracts on file. The staff files evidenced NVQ qualifications. Not all of the mandatory training has been provided for staff. Training that has includes fire training and that was for this year. The manual handling training certificate for one staff had no date. The staff interviewed confirmed they had done other training including medication training but it is not evidenced in staff files. There was no training matrix to show any planned training for this year. Residents interviewed with regard to the care staff stated, Staff are nice to me and staff are good, they do a good job. Residents canvassed for their views commented, Staff are very helpful, staff are very caring, they always come as quick as they can. Staff interviewed about their working environment stated, I love it, the staff are all brilliant, we always have enough staff on duty and Its a fantastic environment, no pressure/hurry for the residents, we get the job done at a relaxed pace, we talk to the residents, to find out about them, the service is very orientated to clients. Care Homes for Older People Page 23 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality assurance systems need to be improved to show that residents are canvassed for their views on how the service is run. Evidence: The registered manager left the service two months ago and at present the deputy manager is running the service with support from the company until a manager is appointed. One of the residents interviewed was positive in their views with regard to senior management and stated, Ive just had a talk with one of the owners, a good decent bloke, he listened to what I had to say. Staff interviewed with regard to senior staff stated, I feel comfortable speaking to senior staff and I get on well with the deputy manager, she is very understanding. The deputy told us that staff meetings were held and minutes of the one held in February this year were viewed. Staff interviewed confirmed that daily reports were given also at the beginning of the shift. Residents meetings are also held and the Care Homes for Older People Page 24 of 33 Evidence: minutes of the most recent one in June of this year were viewed. Various items were discussed including food, laundry and trips out. Policies and procedures were last reviewed in September 2007. Residents surveys have been produced but none have been sent out this year. The deputy told us that previous surveys have been sent out but the results of these were not available to view. There were no other surveys available to view. Residents need to be canvassed for their views on a regular basis so that their views influence the way the service is run. Records of residents finances were viewed and all financial transactions are recorded. These are audited and receipts of hairdressing, taxis and other items are evidenced. One senior person audits the records in the service as evidenced by their signature. There is no evidence of residents signature on the financial transactions. The head office keep more formal records and these were viewed. All the health and safety checks with regard to services and equipment in the service are up to date as viewed during the visit. Not all of the mandatory training is up to date. Fire training has largely been addressed this year with just four staff identified as needing training in this area. Other mandatory training including basic food hygiene, manual handling, infection control and first aid is not up to date. Therefore this needs addressing to ensure staff are familiar with the health and safety aspects of caring for residents. The staff induction needs to be improved to ensure all staff induction meets the standards set by the National Training Organisation. Care Homes for Older People Page 25 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 9 13(2) Staff must adhere to the policies; procedures and guidance for the safe recording of and administering medicines to ensure medicines are given at the right time to the right person in the right dosage. (Timescale 15/05/07 and 17/09/07 not met) Staff must ensure that all controlled drugs are stored and recorded correctly to ensure residents healthcare needs are met. 31/10/2007 2 9 13(2) 26/10/2007 3 15 16(2)(i) Menus must be provided at 30/11/2007 the home detailing choices of meals available. Residents should be involved in devising these menus in order to promote choice. The manager and all staff must receive training in and be familiar with Local authority adult protection procedures. To ensure that all staff are able to identify and respond to abuse appropriately. (Not examined at this inspection; timescale remains 01/07/07) 26/10/2007 4 18 13(6) 18(1) (c) (i) Care Homes for Older People Page 26 of 33 5 19 19 A detailed plan for upgrading 26/10/2007 of the home including timescales must be provided to ensure that the environment is improved for the benefit of people using the service. (Not examined at this inspection; timescale remains 15/06/07) Staff must receive training 01/01/2008 on infection control to ensure the needs of residents are met. 6 30 18(1)(a) Care Homes for Older People Page 27 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 The registered provider must ensure that pre admission assessments identify all of the prospective service users needs. This will ensure that service users needs will be clear and a decision made to offer a place to the prospective service user will be based on the service knowing they will be able to meet their individual needs. 12/01/2009 2 7 15 The registered person must ensure that the care plans are updated to reflect the changing needs of the residents. This will enable staff to monitor residents closely and inform other staff of any changes in the treatment or management of the resident. 12/01/2009 Care Homes for Older People Page 28 of 33 3 7 15 The registered person must ensure that all service users have a care plan that reflects their assessed needs. This will inform staff how to manage the residents needs effectively. 12/01/2009 4 9 13 The registered person must ensure that the management of medication is improved and includes auditing of medication kept for residents. This is an outstanding requirement. This will ensure that residents are given the prescribed dose at the correct time and regular audits will highlight any problems. 12/01/2009 5 16 22 The registered person must ensure that all complaints are recorded, investigated and outcomes for the complainant are evidenced. This will ensure that residents complaints are being listened to and acted on. 12/02/2009 6 18 13 The registered person must ensure that staff attend Adult Protection training. This is an outstanding requirement. This will ensure that residents are protected. 16/02/2009 Care Homes for Older People Page 29 of 33 7 26 23 The registered person must ensure that the service is kept clean. This will ensure that residents live in a hygienic environment. 12/01/2009 8 29 19 The registered person must ensure that all pre employment records are in place prior to commencing work. This will ensure that residents are protected. 12/01/2009 9 30 18 The registered person must ensure that staff are up to date with mandatory training and that this is evidenced in staff files. This will ensure that staff are skilled and trained to meet the residents needs. 16/03/2009 10 33 24 The registered person must ensure that residents are canvassed for their views about how the service is run and these views are published. This will inform the service how they could improve or change the service so that the needs of the residents are promoted. 02/02/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 It is strongly recommended that the Statement of Purpose Page 30 of 33 Care Homes for Older People and Service User Guide should be updated and reflect the minimum standards. 2 3 4 7 7 7 It is strongly recommended that all residents should sign their care plan as this evidences their agreement. It is strongly recommended that pain, falls and mobility problems should be identified on the care plans. It is strongly recommended that new conditions should be recorded on a new care plan and not recorded on the same page as another problem. It is strongly recommended that all medication should be carried forward to the MAR sheet (Medication Administration Record) when commencing a new record. It is strongly recommended that all prescribed medication should have the exact dose recorded on the MAR (Medication Administration Record). It is strongly recommended that all staff should evidence their signatures on the MAR sheet (Medication Administration Record) immediately following administration of medication. It is strongly recommended that an activities programme should be set up following consultation with the residents and which meets the residents varying needs. It is strongly recommended that following consultation with the residents the menu should be updated to include choices of all meals for residents It is strongly recommended that all residents should have a lockable facility in their bedrooms. It is strongly recommended that the service should access a copy of the Sefton Adult Protection Procedure. It is strongly recommended that as soon as another bedroom with easier access is available then the resident discussed in the report should be offered the room. It is strongly recommended that a more suitable storage area should be found for the electric wheelchair and lawn mower. It is strongly recommended that infection control training should be provided for all staff. It is recommended that care staff should continue to access NVQ training. It is strongly recommended that the start date of employees should be recorded in staff files and include signed staff contracts. 5 9 6 9 7 9 8 12 9 14 10 11 12 18 18 19 13 19 14 15 16 26 28 29 Care Homes for Older People Page 31 of 33 17 30 It is strongly recommended that the service should commence a staff training and development programme which meets the National Training Organisation workforce training targets. It is strongly recommended that the service should appoint a manager. It is strongly recommended that the policies and procedures should be updated this year. It is strongly recommended that the staff induction programme should be improved to meet the standards set by the National Training Organisation 18 19 20 31 33 38 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. 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