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Inspection on 05/12/05 for Alexander House Private Nursing Home

Also see our care home review for Alexander House Private Nursing Home for more information

This inspection was carried out on 5th December 2005.

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

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

Staff at the home were welcoming and helpful with the inspection process. Residents spoken with made positive comments about staff at the home, and also the food provided at the home. Staff were caring and attentive towards residents.

What has improved since the last inspection?

Security keypads have been fitted to areas of the home such as the kitchen and external doors. This helps to keep residents safe. The external fire escape at the home has been repaired and painted. In the event of an emergency a safe means of exit is now provided.

What the care home could do better:

So that residents and their families can make informed choices about moving into care, the home must provide them with comprehensive information about the services that they offer. Although the home meet with prospective residents and assess their needs, they must be sure that they can meet these needs.Care plans need to be completed before, or as soon as possible after a resident has moved into the home, so that staff know how to properly care for them. When changes occur in a resident`s condition, these must be properly recorded and staff kept up to date with the current needs of individual residents. To make sure that residents are kept safe medication must be managed in a way that follows all currently recommended procedures. Residents must have the opportunity to engage in social and individual activities. The home needs to continue to develop a range of suitable activities and opportunities for individual residents. Alexander house is in a poor condition. The home must continue planning for the upgrade of the premises to meet the conditions on the home`s certificate. Plans and a schedule of works must be submitted to and agreed with the CSCI, the Fire Service, and the Health and Safety Executive before works begin. Resident`s welfare must be considered throughout the development. Some areas of the home are very exposed to public view. The home needs to assist resident`s to maintain their privacy. Mealtime routines and timings need to be reviewed to make sure that they are in line with resident`s needs and preferences. Complaints made to the home need to be dealt with in a consistent way so that any concern raised is recorded and dealt with properly. To keep resident`s safe all senior staff at the home should be aware of protection of vulnerable adults procedures, and know how to properly manage any reported incidents. The home should be able to show that staff are recruited safely so that residents are protected. They should also be able to show that staff employed have undertaken all the training necessary to be able to care safely for residents. To do this staffing records must be available at all times. The registered provider must be able to demonstrate that the home is being managed effectively and address the health and safety issues identified in this report.

CARE HOMES FOR OLDER PEOPLE Alexander House Private Nursing Home 25-27 First Avenue Westcliff On Sea Essex SS0 8HS Lead Inspector Vicky Dutton & Carolyn Delaney Unannounced Inspection 5th December 2005 08:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000040206.V267688.R01.S.doc Version 5.0 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. DS0000040206.V267688.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Alexander House Private Nursing Home Address 25-27 First Avenue Westcliff On Sea Essex SS0 8HS 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) 01702 339635 01702 339635 Health and Home Limited Care Home 25 Category(ies) of Dementia - over 65 years of age (12), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (2), Old age, not falling within any other category (25) DS0000040206.V267688.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. To provide care (with nursing) and accommodation for two service users who are under 65 years of age and whose details are known to the Commission. Suitable private accommodation to be provided to all service users in line with the National Minimum Standards for Older People by April 2007. Bathing facilities to be provided for all service users in line with the National Minimum Standards for Older People by April 2007. 10th May 2005 2. 3. Date of last inspection Brief Description of the Service: Alexander House is a two storey private home situated in a quiet residential area of Westcliff on Sea, close to the seafront. The home is close to local bus routes. Alexander House is registered to provide personal care, nursing care and accommodation for 25 Older people. The home has 12 places for service users who have dementia. The home also has a condition on their registration that allows them to accommodate 2 spesific residents who have a mental health condition. Accommodation is provided on three floors in nine single and eight double rooms. Two bedrooms benefit from en suite facilities. Other facilities include two communal lounges and a dining area on the ground floor. A passenger lift provides access to all levels within the home. Visitors parking is available at the front of the property. There is a well maintained garden to the rear for residents to use. DS0000040206.V267688.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over a period of five and a half hours. As two inspectors undertook the inspection, this equated to eleven hours input. The inspection mainly focused on the progress the home had made since the last inspection, although other standards were also considered. The home has an acting manager in place, and registration has been applied for. At this inspection a partial tour of the premises took place. Care, records were selected at random and inspected. Medication processes and some health and safety records were also inspected. A number of residents and staff were spoken with. The acting manager and other staff assisted and took part in the inspection process. What the service does well: What has improved since the last inspection? What they could do better: So that residents and their families can make informed choices about moving into care, the home must provide them with comprehensive information about the services that they offer. Although the home meet with prospective residents and assess their needs, they must be sure that they can meet these needs. DS0000040206.V267688.R01.S.doc Version 5.0 Page 6 Care plans need to be completed before, or as soon as possible after a resident has moved into the home, so that staff know how to properly care for them. When changes occur in a resident’s condition, these must be properly recorded and staff kept up to date with the current needs of individual residents. To make sure that residents are kept safe medication must be managed in a way that follows all currently recommended procedures. Residents must have the opportunity to engage in social and individual activities. The home needs to continue to develop a range of suitable activities and opportunities for individual residents. Alexander house is in a poor condition. The home must continue planning for the upgrade of the premises to meet the conditions on the home’s certificate. Plans and a schedule of works must be submitted to and agreed with the CSCI, the Fire Service, and the Health and Safety Executive before works begin. Resident’s welfare must be considered throughout the development. Some areas of the home are very exposed to public view. The home needs to assist resident’s to maintain their privacy. Mealtime routines and timings need to be reviewed to make sure that they are in line with resident’s needs and preferences. Complaints made to the home need to be dealt with in a consistent way so that any concern raised is recorded and dealt with properly. To keep resident’s safe all senior staff at the home should be aware of protection of vulnerable adults procedures, and know how to properly manage any reported incidents. The home should be able to show that staff are recruited safely so that residents are protected. They should also be able to show that staff employed have undertaken all the training necessary to be able to care safely for residents. To do this staffing records must be available at all times. The registered provider must be able to demonstrate that the home is being managed effectively and address the health and safety issues identified in this report. 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. DS0000040206.V267688.R01.S.doc Version 5.0 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 DS0000040206.V267688.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4, 5 Prospective residents and their families are not given comprehensive information about Alexander House. This does not enable them to make an informed choice about the home before they move in. The home always visits potential residents to assess their needs. However this is not always an effective process in assessing the suitability of residents to move into the home. EVIDENCE: A statement of purpose is available for the home. A service users guide that meets requirements has not yet been seen/provided to CSCI. The acting manager said that she goes to meet and assess prospective residents and tells them verbally about the home. It was stated that following this, the company secretary would send out a service users guide. Given the speed of some admissions to the home this is not likely to be an effective way of making sure that people are fully informed about the service offered by Alexander House. This area therefore needs to be developed. Records showed that resident’s needs are assessed before they move into the home. There is however a feeling among staff that the home must accept DS0000040206.V267688.R01.S.doc Version 5.0 Page 9 residents no matter what issues the assessment highlights, due to pressure from hospitals and social services departments. An example of this was given. One resident who had been admitted had challenging behaviour, and was readmitted to hospital after one week at the home. Another resident was readmitted to hospital on the same day as admission as they had been quite unwell. The acting manager is aware that the home should only admit residents whose needs they can be confident of meeting. Training records could not be accessed at this inspection, but some evidence of induction and training was seen. Staff seemed aware of residents needs. Residents spoken with said that they felt staff at the home looked after them well and met their needs. Intermediate care is not provided at Alexander House. DS0000040206.V267688.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. Care planning at the home is generally comprehensive and provides an adequate basis to ensure that residents’ health and care needs are met. This was not however true in all cases and development is needed to ensure that care plans are put in place in a timely manner, and updated as residents needs change. Medication processes at the home must be monitored to make sure that residents health and safety is maintained. EVIDENCE: Care plans were sampled as part of this inspection. Some viewed were well completed and provided a good basis for care, with clear instructions being available for staff. Others however had significant shortfalls. These related particularly to recently admitted residents, where sufficient care planning information and risk assessments had not been put in place in a timely manner. An established resident’s care needs had changed, and different management strategies had been put in place. These were however not reflected in care planning or risk assessment information. Particular concern was expressed about the care of one resident who had become at risk of falling out of bed. This was not being managed effectively. DS0000040206.V267688.R01.S.doc Version 5.0 Page 11 Generally the home is proactive in meeting resident’s healthcare needs. Good nutrition records are maintained. However sometimes healthcare checks such as blood glucose monitoring were noted to be scheduled, but not subsequently evidenced as being carried out. Appropriate health assessment tools, such as tissue viability, had not always been undertaken. As the home is registered to provide nursing care, registered nurses administer medication at the home. This inspection identified shortfalls for which an immediate requirement/feedback form was issued. Medication records had numerous gaps in administration signatures. One resident had been without their prescribed medication for a week. These issues must be rectified so that residents are cared for safely. During the inspection staff at the home were noted to treat residents with respect, and uphold their dignity. One shared room was noted not to have a dividing curtain in place to ensure that residents can maintain their privacy. At the previous inspection inspectors were informed that this was on order, but it is still not in place. A bedroom and lounge at the front of the house have no blinds or other means in place to ensure resident privacy in these areas. Residents are therefore exposed to passers-by and people parking their cars at the front of the building. The acting manager undertook to address this. It was of concern that the acting manager and staff at the home had not taken appropriate steps to ensure the resident’s privacy and dignity prior to this inspection. DS0000040206.V267688.R01.S.doc Version 5.0 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14, 15 Activities at the home are starting to be developed, but further work is needed to make sure that residents have their social and occupational needs properly assessed and met. Meal times at the home need to be reviewed to make sure that residents are offered food at reasonably spaced intervals and at times that suit their needs. EVIDENCE: During this inspection residents mostly sat passively in chairs in the lounge areas of the home, or wandered around the corridors. The television remained turned on with the volume turned down. An activities book is maintained that showed that some activities are now taking place. Activities include karaoke, ‘physio exercises’ and crosswords. The acting manager said that activities generally happen each afternoon. Musical entertainers regularly visit the home. Residents can access a mobile library. Some residents were noted to receive and enjoy a daily paper. Many residents at the home are very frail, and some remain in bed. The acting manager said that an entertainer now goes round to individual rooms, and that staff are encouraged to spend time with these residents. Development should continue to show how resident’s activity/occupational needs are properly assessed and met. The home seek to meet residents spiritual needs. It was reported that some residents no go out to church on a Sunday. This helps to meet their spiritual needs. DS0000040206.V267688.R01.S.doc Version 5.0 Page 13 Information on advocacy services was noted to be available. Residents are able to bring in personal possessions. Records of this in respect of a resident who had brought in their own furnishings could not be found. It was advised that details of items brought in are fully recorded so that the home are clear about what property and items belong to individual residents. At lunchtime during the inspection food was plentiful and well presented. Appropriate help and encouragement was given to residents to ensure that they had sufficient food and drink. Resident’s generally spoke well of the food offered by the home, and those that were able confirmed that they were offered choice. The home uses a four week menu plan, which is in the process of being reviewed. The home must ensure that the times food and drink is offered is suitable for residents preferences and needs. On the day of inspection resident’s who were up were not offered breakfast until those in bed had been served. Two residents were observed having breakfast at 10.10, and then being given their lunch by staff at 12.30. According to nutrition records tea at the home is served at 16.30/17.00. Tea is frequently recorded as being sandwiches. A member of staff confirmed that only three residents have supper, and that other residents just have a drink. If residents do not have a later supper then the gap between food being offered to residents is too long. Smaller dining tables have now been replaced by one large round table. This does not provide sufficient dining space for the 25 residents that the home is registered to provide care for. It also does not promote resident choice. A number of residents remained in lounge chairs throughout the inspection visit, eating from over bed style tables. The home should evidence that this is in line with resident’s individual choices, as this practice will not help to promote individual health and mobility. DS0000040206.V267688.R01.S.doc Version 5.0 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 17, 18 Complaints need to be dealt with in a consistent manner, in order that residents and others can be confident that any issues raised will be managed effectively. To keep residents safe, urgent development is needed to make sure that all staff have a clear understanding of adult protection issues and procedures. EVIDENCE: The home has a clear complaints process in place. It was noted that the copy on display in the homes lobby was produced in quite small print. This might not be easy to read for some people. Some complaints were recorded and actions evidenced. Other issues were recorded that were more incidents than complaints. An issue on one residents file was a complaint but had not been recorded as such. A consistent approach needs to be developed so that residents and other parties know that their concerns will be properly dealt with. An issue recorded as a complaint contained elements that should have been dealt with under the protection of vulnerable adults guidelines (POVA). This did not happen and the member of staff concerned has now left the home without matters being properly investigated. Staff spoken with were aware of the need to report any concerns about residents care. It was however concerning that the acting manager was unaware of the correct reporting procedures and protocols to be followed should a POVA incident occur. DS0000040206.V267688.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26. The standard of the environment and furnishings is generally poor and does not provide residents with a well maintained, attractive and homely place in which to live. EVIDENCE: Alexander House has a condition on their registration that the premises and facilities must be brought up to current National Minimum standards by 2007. Work to achieve this has not yet begun. Since the previous inspection some remedial works have been undertaken. The external fire escape has been repaired and some security key pads have been fitted to high risk areas such as the kitchen. The current environment is very poor and does not support a valuing people ethos. Specific shortfalls in relation to the premises have been fully itemised in previous inspection reports which can be viewed via the CSCI website on www.csci.org.uk. DS0000040206.V267688.R01.S.doc Version 5.0 Page 16 The home has two lounge areas and a small dining area. Décor and furnishings in communal areas are in poor condition. The home has a pleasant garden that is marred by the storage of some unused items such as a sink unit. One resident said how they enjoyed having a walk in the garden each day. The home currently has insufficient and suitable toilet and bathing facilities to meet the needs of residents. On the ground floor two toilets are used for storage. Only one assisted bath is provided. The home has a condition on their registration that sufficient and suitable toilet and bathing facilities be provided by 2007. Two sluices are provided. Hoists are available to assist residents. Although pressure relieving equipment was noted to be available residents care plans did not indicate what equipment was to be used for individual residents, how this had been assessed or how the equipment was to be used. Corridor areas of the home are very narrow and would be difficult for residents to independently negotiate in a wheelchair. Toilets at the home are out of commission as they are being used for storage. Alexander house is registered to provide care for residents who have dementia. In spite of previous advice on this area, limited appropriate signage is provided to assist these residents with orientation. In common with the communal areas of the home, resident’s bedrooms are generally shabby. Furnishings and décor are in a poor condition. As at the previous two inspections one resident was noted to have the chair in their room pulled away from the wall as there was a hole there with pealing paper and plaster. This has still not been attended to. Rooms are not fitted with locks and lockable storage is not available. It was noted that the registered provider asks residents/their relatives to sign a sheet on admission to say that they do not wish for these facilities to be provided. This is not satisfactory, and residents should have the option of these facilities as indicated by the National Minimum Standards. The home was generally warm and well ventilated. To keep residents safe water temperatures are regularly monitored. When the home is refurbished it should be ensured that the water taps in private and communal accommodation are suitable for residents to use with ease, as the current design is not suitable. On the day of inspection the home was generally odour free. The home has suitable laundry facilities available. A number of infection control issues were identified during the inspection. These issues were pointed out to the acting manager. Paper towels and liquid soap were not available in all relevant areas. The homes two sluices have no hand washing facilities, a number of bins in toilet and other areas had no lids. DS0000040206.V267688.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Many residents at the home have high dependency needs. Therefore staffing levels must be constantly monitored to ensure that their needs are properly met. Proper arrangements need to be made to ensure that staffing records are available at the home. EVIDENCE: On the day of inspection the home was accommodating 17 residents. A further two resident’s were in hospital. The acting manager said that seven residents currently require the assistance of two members of staff for all tasks, including assistance with eating, and that most residents were confused or suffered from dementia. To meet these needs the registered provider is currently providing a registered nurse and three staff to cover each shift. The acting managers hours are supernumerary to this. Staffing levels must be kept under review to make sure that residents needs are fully met. During the inspection a resident with behavioural problems was not properly monitored, and caused disruption in another residents room. Residents in lounges were left without staff attention for extended periods. A cook is provided. The inspector was told that a member of staff was now employed exclusively to undertake domestic tasks from 10 to 14.00 each day. However they were not identified on the rota. The homes rotas showed that many staff are working between 50 and 60 hours each week. This is not good practice and must be monitored. Residents spoken with were positive about the staff at the home and said that they were generally very good and kind. One resident’s perception however was that the home was often short of staff, and that the staff were always very busy. DS0000040206.V267688.R01.S.doc Version 5.0 Page 18 No staff training, recruitment or supervision records were available at this inspection. The inspector was told that the records are held at the other home managed by the registered provider, and that only the company secretary had access to these. As the company secretary was not available the staffing records could not be accessed. This was not an acceptable situation. DS0000040206.V267688.R01.S.doc Version 5.0 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 38. The acting manager has yet to establish a strong leadership presence in the home. Development is needed in establishing effective quality assurance systems. Health and safety issues identified in this report have the potential to place residents at risk and must be addressed. EVIDENCE: Alexander House has been without a registered manager for over two years. An acting manager has now been in post for some months, and an application is being processed by CSCI. The acting manager is a qualified nurse and has undertaken other relevant training. Although not yet registered the acting manager should be to all intents and purposes in charge and control of the home. This will promote a stable and well managed environment for residents. At this inspection the acting manager was unsure as to the scope and range of their authority, particularly in relation to the registered nurses who work at the home. DS0000040206.V267688.R01.S.doc Version 5.0 Page 20 The acting manager reported that resident’s meetings are not held, but that residents are consulted with on a one to one basis. It was reported that staff meetings are held which have an agenda and are minuted. However these were not available. Systems for consultation with relevant parties and quality assurance have not yet been developed by the home. It was reported that questionnaires have been developed and that these will be distributed before Christmas. The registered provider is required (by The Care Homes Regulations) to nominate a person to carry out monthly visits to the home. These visits should include talking to residents and staff to seek their views on the service. Reports of these visits should be sent to CSCI. It was not evidenced that these visits are carried out at least monthly as required. The registered provider is seeking accreditation under the Investors in People Scheme. The acting manager reported that this process is starting soon. It was reported that the home do not hold any valuables or monies for safekeeping, although facilities are available should this be required. Staffing records were not available. The frequency and effectiveness of staff supervision could not therefore be evidenced. During this inspection a number of health and safety issues were identified. The home is registered to provide care for residents with dementia yet disposable gloves and other potentially hazardous materials were left in places freely available to residents. A ‘keep locked’ electrical cupboard was left open and was being used for the storage of pads. The external food storage area of the home was exposed to the elements due to the lack of glass in the door. Staff training in core areas could not be evidenced due to the absence of records. The acting manager however confirmed that staff training in these areas was up to date. Staff spoken with said that they had undertaken relevant training. Although it was possible to see that regular fire checks are carried out, poor records, due to additional sheets being added to a full book hampered this process. Under the section ‘staff fire training’ the last entry was on 20/02/05 with four staff names being recorded. It could not be evidenced that all staff had taken part in regular fire drills. Current servicing/safety certification for systems and equipment at the home could not be found/provided. This must be sent in to CSCI to show that a safe environment is being maintained for resident’s DS0000040206.V267688.R01.S.doc Version 5.0 Page 21 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 1 X 2 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 1 1 1 1 2 1 2 1 STAFFING Standard No Score 27 2 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 1 X 3 2 X 1 DS0000040206.V267688.R01.S.doc Version 5.0 Page 22 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 OP1 Regulation 5 Requirement Timescale for action 14/02/06 2. OP3 14 3. OP4 18 The Service User Guide must incorporate all elements as required by regulation. A copy must be provided to the CSCI and all service users. (Precious requirement dates of 01/02/05 and 01/07/05 not met). 14/01/06 The registered person must not offer accommodation to a service user unless their needs have been fully assessed by a person competent to do so. Confirmation of the assessment and the ability of the home to meet their needs must be given to the service user in writing. This refers to the difficulties experienced with recent admissions. 01/03/06 Staff at the home must receive training appropriate to the work they are to perform. This refers to the need for staff to have specific training and knowledge relevant to residents assessed needs and conditions. This requirement could not be properly assessed at this inspection so it is carried DS0000040206.V267688.R01.S.doc Version 5.0 Page 23 4. OP7OP8 15 5. OP9 13 6. OP10 12 7. OP12 16 8. OP14 17 Sch 4 forward. Previous requirement date of 01/08/05. A detailed service user plan of care must be drawn up in consultation with service users, families and significant multidisciplinary personnel. The care plan must reflect all aspects of service users assessed needs, include risk assessments for appropriate areas. This refers to the shortfals indentified at inspection. Previous requirement date of 01/07/05 not met. The registered person must make arrangements for the safe management and control of medicines in the home. This refers to the issues raised in the body of the report. The registered person must ensure that the home is run in a manner that respects the privacy and dignity of residents. This refers to the need for apropriate screening to be provided for residents in private and communal areas. The registered Person must ensure that the routines of daily living and activities made available are flexible and varied to suit service user’s expectations, preferences and capacities. Activities and stimulation must be provided that meet individual assessed needs. Although some improvements were noted at this inspection further work is needed. (Previous requirement dates of 14/01/05 and 01/08/05 not met.) A record must be kept of furniture brought by a residents into the room occupied by them. DS0000040206.V267688.R01.S.doc 14/01/06 01/01/06 01/01/06 01/02/06 01/01/06 Version 5.0 Page 24 9. OP15 16 10. OP16 22 11. OP18 13 18 12. OP19OP20 OP21OP23 OP25 23 13. OP22 23 14. OP24 23 The registered provider must ensure that residents receive adequate quantities of food and drink at times that are suitable to them. The home need to review mealtime routines and timings as identified in the report. The registered person must establish an effective complaints rocedure. This refers to the need for complaints to be dealt with consistently. Staff should receive training appropriate to the work they are to undertake and residents must be protected from harm. This refers to the need for all staff to undertake training in adult protection, and to be fully aware of procedures to be followed. A planned programme of maintenance and refurbishment must be developed for the home in order that systematic improvement of the environment takes place. Plans must be sent in to the CSCI as to how the home intends to meet their conditions of registration in relation to the home. (Previous requirement date of 01/02/05 and 01/08/05 not met.) The premeses must be suitable to achieve the aims and objectives. The home is registered to provide care for residents with dementia. Adequate orientation and directional signage must be in place to assist these residents. Equipment used for residents must be properly assessed and maintained. Appropriate storage must be provided for equipment. The premeses must be suitable DS0000040206.V267688.R01.S.doc 14/01/06 14/01/06 01/01/06 01/02/06 01/03/06 01/05/06 Page 25 Version 5.0 15. OP26 13 16. OP26 13 17. OP27 18 18. OP28OP29 OP30 17 Sch 4 to achieve the aims and objectives. The home must provide accommodation for each service user, which is furnished and equipped to assure comfort and privacy, and meets the assessed needs of the service user. (Previous requirement dates of 01/05/05 and 01/12/05 not met.) The registered person must make arrangements to prevent the spread of infection at the home. Hand washing facilities with hot water must be available in areas where infected material and or clinical waste are handled. This with particular reference to both the homes sluices and some communal toilet areas. (Previous requirement dates of 01/02/05 and 01/08/05 not met.) The registered person must make arrangements to prevent the spread of infection at the home. This refers to the infection control issues identified in the body of the report. The registered person must ensure that at all times suitably qualified and competent staff are on duty in sufficient numbers as are appropriate to meet the health and welfare needs of service users. Staffing ratios must ensure that the number of staff employed and on shift is sufficient to meet the assessed needs of service users in the home. (This is a repeated requirement.) The registered person must maintain in the care home the records specified in schedule 4. This refers to the need for all DS0000040206.V267688.R01.S.doc 14/02/06 01/01/06 01/01/06 01/01/06 Version 5.0 Page 26 19. OP29 19 20. OP30 18 21. OP32OP33 24 22. OP33 26 23. OP36 18 staffing records to be maintained in the home and available for inspection. The registered person must ensure that robust recruitment processes are maintained. This requirement could not be assessed as staffing records were not available. It is therefore carried forward. (Previous requirements dates of ‘immediate’) The registered person must ensure that there is a robust staff induction, training and development programme, which ensures staff fulfil the aims of the home and meet the changing needs of service users. Suitable systems to record this information should be developed. This requirement could not be assessed as staffing records were not available. It is therefore carried forward. (Previous requirement dates of 01/02/05 and 01/07/05) The registered person must establish and maintain a system of reviewing and improving the quality of care at the home. Reports of findings must be sent in to CSCI. Visits as required by this regulation must be carried out on at least a monthly basis and a written report prepared. The registered person must ensure that staff at the home receive regular formal supervision to support them in the work they carry out and written evidence is available on future Inspection visits. This requirement could not be assessed as staffing records were not available. It is therefore carried forward. DS0000040206.V267688.R01.S.doc 01/01/06 01/01/06 01/03/05 01/01/06 01/01/06 Version 5.0 Page 27 24. OP38 23 25. OP38 12, 23 (Previous requirement dates of 01/02/05 and 01/07/05) Equipment at the home must be appropriatly serviced and maintained. This refers to the fact of appropriate and current safety/servicing certification for systems and equipment being available. This information must be sent in to CSCI within one week. The registered must ensure that the home is run in a way that promotes the health and welfare of residents. This refers to the issues raised in the body of the report and includes the need to adequatly record fire drills and staff training. 14/12/05 14/01/06 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 OP16 Good Practice Recommendations The home should assist residents and other parties in understanding and using the homes complaint procedure, by making sure that it is displayed in a clear manner. DS0000040206.V267688.R01.S.doc Version 5.0 Page 28 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG National Enquiry Line: 0845 015 0120 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 DS0000040206.V267688.R01.S.doc Version 5.0 Page 29 - 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. 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