Inspection on 16/10/07 for Alexian Brothers Care Centre

This inspection was carried out on 16th October 2007.

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.

Other inspections for this house

Alexian Brothers Care Centre 08/04/08

Alexian Brothers Care Centre 16/05/07

Alexian Brothers Care Centre 11/05/06

Similar services:

Thornton Lodge

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

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

CARE HOMES FOR OLDER PEOPLE Alexian Brothers Care Centre 171 St Mary`s Road Moston Manchester M40 0BL Lead Inspector Geraldine Blow Unannounced Inspection 16th October 2007 09:30 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 Alexian Brothers Care Centre DS0000066876.V351244.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Alexian Brothers Care Centre DS0000066876.V351244.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alexian Brothers Care Centre Address 171 St Mary`s Road Moston Manchester M40 0BL 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) 0161 681 1929 0161 947 3609 The Hospital Management Trust Amanda Froggatt Care Home 62 Category(ies) of Old age, not falling within any other category registration, with number (62) of places Alexian Brothers Care Centre DS0000066876.V351244.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The number of service users aged 60 years or over accommodated at any one time shall not exceed 62. A maximum of 46 service users assessed as requiring nursing care, of either sex, aged 60 years or over may be accommodated. 16th May 2007 Date of last inspection Brief Description of the Service: The Alexian Brothers Care Centre is registered to provide accommodation for up to 62 older people. The home is owned by The Alexian Brothers, Province of the Sacred Heart and the Hospital Management Team (HMT) have been registered with the Commission for Social Care Inspection (CSCI) to assume full management responsibility for the Care Centre. The home is located in the residential area of Moston in the North of the city centre of Manchester. Public transport links into Manchester City centre are within easy walking distance. There are ample parking facilities at the front of the building. The home is a three storey purpose-built building set in its own spacious grounds. Accommodation for the residents is provided on three floors and is accessible to residents who use a wheelchair. All bedrooms are single and 48 are fitted with en-suite facilities. A variety of communal areas are available for residents including a chapel with daily services. The home is divided into 3 units. There are 2 nursing units and one unit providing personal care only. The residents have a choice of lounges and dining rooms as the home provides several alternatives. The furnishings and décor throughout the home were found to be of a high standard. The residential unit provides a kitchen for resents and relatives/friends to make drinks or snacks at any time. Each unit provides a smoking room. The home has ample, well-maintained grounds. Alexian Brothers Care Centre DS0000066876.V351244.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit is the second key inspection and was an unannounced visit, which forms part of the overall inspection process. The lead inspector and the pharmacy inspector conducted the visit. The visit took place on Tuesday 16 October 2007. The opportunity was taken to look at all the key standards of the National Minimum Standards (NMS) and the requirements made at the inspection in May 2006. Following the last inspection, an improvement plan was submitted to CSCI detailing how the requirements made in the last inspection report would be met and part of this visit was spent assessing if the action plan had been implemented. Time was also spent with the home’s manager, assessing relevant documents and files, talking to staff, residents and a visitor to the home. A tour of the premises was undertaken. What the service does well: As detailed in the last report Alexian Brothers Care Centre continues to offer a high standard of décor, furnishing and a wide range of facilities and communal areas, which include a hairdressing salon, a consulting room for GP’s visits or other professionals, a physiotherapy gym and a large conservatory to the front of the building. There are large, well maintained gardens that are accessible to residents. A clean and pleasant environment is provided for the residents who live there. A pre admission assessment of needs continues to be carried out before a resident is admitted to the home to make sure that the home can meet their needs. The menus seen at the last inspection visit demonstrated that a wholesome, varied diet was provided and during this visit staff and residents spoken to confirmed that there was always a choice of meals at each mealtime and snacks and drinks were available on request. All the residents spoken to said that they were happy with the food provided. One resident said “the food here is excellent”. As reported in the last report staff confirmed that if residents did not want what was on the menu the chef would prepare any reasonable request. Systems were in place to support residents or visitors to make a complaint and the visitor spoken to said she knew how to make a complaint and issues she has had in the past were dealt with. Alexian Brothers Care Centre DS0000066876.V351244.R01.S.doc Version 5.2 Page 6 There is an open visiting policy, which was confirmed by the staff and visitor spoken to. She said that the staff make her feel very welcome when she visits the home. As reported in the last inspection report the relationships between staff and residents appeared to be very good and the residents spoken to confirmed this. One resident said, “the staff here definitely look after you very well and they are very kind”. Another comment from a resident was “I am very happy here and the I get all the help I need”. The staff and resident spoken to said that residents are encouraged to make choices around their day to day lives and that privacy and dignity of residents is respected. What has improved since the last inspection? What they could do better: At the last two inspection visits it was identified that not all residents were getting their medication as prescribed by the GP and concerns were again identified at this inspection visit. Steps had been taken in an attempt to address the shortfalls identified at the last two visits. However it was a great concern that the same shortfalls were still occurring. For example medication for some residents had run out, and other residents whose medicines were available were not given their medicines properly. If residents do not receive medicines properly their health could be at risk. The records regarding medication were poor and they failed to show exactly what medicines had been given to residents and they also failed to show that all medication could be accounted for. Nurses had not been assessed as competent to administer medicines and this could put residents’ health at significant risk from harm. Alexian Brothers Care Centre DS0000066876.V351244.R01.S.doc Version 5.2 Page 7 At the last visit in May 2007 new care planning paperwork was in the process of being put into place, this was not yet in place for all residents. Also to make sure that all residents’ health care needs are fully met improvements are needed to the care planning process. All care staff must receive regular supervision to ensure that staff are competent to do their job. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Alexian Brothers Care Centre DS0000066876.V351244.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Alexian Brothers Care Centre DS0000066876.V351244.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (Standard 6 intermediate care is not provided at Alexian Brothers Care Centre) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service The home undertakes an assessment of prospective residents’ care needs prior to their admission. EVIDENCE: As reported in the previous report a documented pre admission assessment form is in use to ensure that prospective residents are only admitted on the basis of a full assessment and evidence was seen that for residents who are referred through Care Management arrangements the manager obtains a summary of the Care Management Assessment. The manager said that has not changed and evidence seen in the care files inspected confirmed this. Alexian Brothers Care Centre does not provide an intermediate care service. Alexian Brothers Care Centre DS0000066876.V351244.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service Shortfalls were identified in ensuring that the health care needs of residents were being met. EVIDENCE: It was reported in the last inspection report that the care planning process had been reviewed and new documentation had been developed and was in the early process of being implemented. It had not been fully implemented at the time of this visit. Four residents’ care files were examined. Each resident had an individual plan of care which had been reviewed on a monthly basis. Some areas of the care plans were not person centred and were quite vague and did not clearly set out residents’ personal preferences and the individualised actions which needed to be taken by staff to ensure that Alexian Brothers Care Centre DS0000066876.V351244.R01.S.doc Version 5.2 Page 11 residents’ individual health and personal care needs are fully met. For example some entries include “needs help of 2 cares to wash and dress him” and “wash hair according to personal preferences”” yet there was not details of what help was required to wash and dress or what his personal preferences were to having his hair washed. Some parts of the care plan was found to be contradictory. For example one care plan stated, “turn resident every 2 hours” yet it was also documented in another section of the care plan “turn 3/4 hourly”. It is recommended that that all residents care plans are developed on a person centred approach and contain sufficient detail for staff to meet all residents identified needs. One care plan identified that the resident “gets moody and aggressive sometimes” and this was supported by entries made in the daily information record. It is of concern that the underlying reasons for the behaviour had not been identified through appropriate referral or that there was no plan of care detailing how staff should manage this behaviour. Also another plan of care detailed that the resident “sometimes goes into hypoglycaemia” yet there was no plan detailing how staff should manage this should it occur. These shortfalls have the potential to put residents at risk. To ensure that the health and welfare of residents is fully met a plan of care must be implemented for each identified care need. Appropriate risk assessments were available, which included an updated risk assessment for the use of bed rails. However the updated assessment had not been completed for all residents who had bed rails in situ and it was noted that some residents used the ‘Bucket’ or ‘Cirton’ chair. This chair is considered a form of restraint and as such a risk assessment of its use must be undertaken. Evidence was seen that the care needs had been reviewed on a monthly basis but in some cases the care plan had not then been updated. For example following a Speech and Language therapy review very specific instructions were given but the care plan had not been updated to include these instructions. A monthly review of another care plan identified that the resident required 2 hourly oral care. The care plan had not been updated to include this care need. To ensure all residents’ care needs are met it is recommended that the care plan is updated as soon as a change of care need is identified. It was of concern that a number of recommendations made at the funded nursing reviews had not been implemented. For example one nursing review identified inappropriate language in a care plan and recommended that this be reviewed and amended. Also it had been identified that a repositioning chart did not evidence that the resident had been turned every 2 hours as the care plan stated and a recommendation was made. The recommendations had not been implemented. Alexian Brothers Care Centre DS0000066876.V351244.R01.S.doc Version 5.2 Page 12 The care files were found to be confusing to use and some paperwork was ripped and not secured in the file and therefore was not filed in the appropriate order. In two files there were 3 different feeding regimes for residents, all with different dates and in addition out of date care plans were still in the care file. To avoid confusion and loss of paperwork it is recommended that the care files are reviewed and field in a secure and orderly fashion and all out of date information be removed. From observations of staff interactions and from talking to staff and residents it appears that the privacy and dignity of the residents is promoted, with the exception of the inappropriate language used in one care plan. During the inspection the pharmacist inspector looked at records about medication together with the medicines held by the service to check whether the requirements made at the previous inspection had been met and that residents were receiving their medication safely. At the previous inspection there had been serious concerns regarding the health of residents because they were not being given their medicines properly and because vital medicines for some residents had run out. There were also concerns that the records regarding medicines were inaccurate and could not show the medicines were administered as prescribed by the doctor. The previous report also highlighted that not all medicines could be accounted for by means of an auditable trail and the staff who were administering medicines had been not been assessed as competent to do so. Concerns were also reported that medicines were not being stored at the correct temperatures. At this inspection it was of serious concern to find that no improvements had been made in the way medicines were handled since the last inspection and the five requirements made about medication had not been met. Since the last inspection systems of auditing medication had been introduced. The audit records showed that a number of errors had been made in the administration of medication and in some cases that medication could not be accounted for. The manager could not provide any evidence that the results of the audit had been either considered or acted on to make sure that the errors were not repeated and safer systems could be put in place to make sure residents’ health was not at risk. The records for one resident showed that medication for a heart condition, depression and constipation had run out for between two and five days. An oral antifungal medication, which had been prescribed for another resident, was also noted to have ‘run out’. The lack of continuity of treatment could put residents’ health at serious risk from harm. Alexian Brothers Care Centre DS0000066876.V351244.R01.S.doc Version 5.2 Page 13 It was also found that the records concerning medication were not accurate and the records could not be relied on to show that residents were getting their medicines properly. On a number of occasions it was seen that medication was signed for by the nurses but had not been administered to the residents. Also the nurses had sometimes failed to sign the medication record sheets and it was not possible to tell from the records if people had been given their medicines or not. If nurses do not sign for medicines when they are given the resident could be given another dose of the same medicine, which could put residents’ health at risk. It was also seen that not all the medication in the home could be accounted for. The nurses did not record accurately how much medicine was in the home at the start of the medication cycle and it was not possible to tell if medicines were properly accounted for by means of an audit trail. There were some instances where medication could be tracked by means of an auditable trail and it was seen that some medication could not be accounted for. It is of serious concern if medicines are ‘lost’ or unaccounted for and residents’ health could be at risk There were a number of examples when nurses did not give residents medicines as the doctor prescribed them. One resident was prescribed medicine for excessive mucous and should have been given the prescribed medicine twice a day. For the nine days prior to the inspection it had been administered once daily. There were two occasions where two residents had not been given their medicines at all because according to the records made, the nurses on duty forgot to administer it. The poor administration of these medicines could cause the residents harm to their health. It was also seen that a resident who was prescribed a strong analgesic patch to be applied every 72 hours did not have the patch changed at the right times which left the resident without any pain relief on two occasions for periods ranging between 51 and 140 hours and on another occasion the patch was applied 8 hours late A second resident was also prescribed this same analgesic and it was noted the resident was without pain relief for 3 hours. This could cause distress to the residents and put their health at significant risk from harm. Despite the installation of a mobile air conditioning unit medicines were still being stored in areas of the home that were too hot to store medicines safely. It was noted that during the 16 days prior to the inspection the temperature had been above the manufacturers recommended temperatures on 12 of those days. This may lead to medicines not working properly and the health of residents receiving those medicines may be at risk. Alexian Brothers Care Centre DS0000066876.V351244.R01.S.doc Version 5.2 Page 14 The home had not made proper arrangements for the safe and legal arrangements for the disposal of unwanted medicines. The heath and welfare of residents may be at risk of harm if medicines are not looked after properly. Nurses who were administering medicines had not been assessed as competent to give medicines properly. After the last two inspections there were concerns that residents’ health was at risk because they did not get their medicines safely. A requirement was made that anyone who administered medicines must be assessed as competent to do so. It was of serious concern that this had not been carried out. One nurse was asked why a resident who had been prescribed Loperamide, a medicine to treat diarrhoea, had not been given any capsules. The nurse told the inspector that the GP had been sent for because the resident sometimes got breathless and he is OK at the moment so I have not given him any of the medicine. It is of very serious concern that nurses who had not demonstrated competency continued to administer medicines and place the health of residents at risk. Alexian Brothers Care Centre DS0000066876.V351244.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Activities are provided and residents are able to maintain contact with family and friends. Residents have a choice of varied, well-balanced meals. EVIDENCE: Since the last inspection a full time activity coordinator has been employed and activities were being undertaken and future activities were being planned. In addition to group and organised activities the coordinator does 1:1 activities with residents like going shopping, having lunch out or just having a chat. The activity coordinator keeps an individual record of who attends the activities and the manager said it was her intention to allocate residents a key worker who will have the responsibility of ensuring that person centred activities are undertaken. Staff and a visitor spoken to confirmed that the home facilitated open visiting and visitors could be received in the residents’ own room or any of the communal areas of the home. The visitor said that she is always made to feel very welcome when she visits. It was encouraging that the manager and the Alexian Brothers Care Centre DS0000066876.V351244.R01.S.doc Version 5.2 Page 16 activity coordinator had set up a relative support group and the first meeting had taken place. From speaking to the residents, a visitor and staff it appeared that residents are encouraged to exercise choice and control over their daily lives and from observations residents are encouraged to bring personal possessions into the home. The previous report identified that the menu was on a 4-week rota, which had been reviewed and amended. The new menus were examined on the last visit and demonstrated that a varied diet, which was nutritionally balanced and included adequate supplies of fresh fruit and vegetables was available. All the residents spoken to during this visit were complimentary regarding the quantity of food and staff confirmed that snacks and drinks were available on request. Alexian Brothers Care Centre DS0000066876.V351244.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home encouraged and supported people to raise their concerns and complaints and had the policies, procedures and systems in place to protect residents from abuse. EVIDENCE: As identified in the last inspection report there was a complaint procedure and staff on that visit confirmed the details about how to make a compliant are on the back of resident’s bedroom doors. The manager said that there had been no changes since the last visit. The manager said she operates an open door policy and relatives/visitors, staff and visiting professionals to the home are encouraged to raise any concerns or complaints. The manager had separate files where all complaints are logged and details of the investigation and any action taken. Evidence was seen that staff had attended Protection of Vulnerable Adults (POVA) training, although staff spoken to on this visit had not attended the training. At the previous visit the manager confirmed that the home’s policy relating to the Protection of Vulnerable Adults from Abuse had been reviewed and updated to accurately reflect the Adult Protection Guidance and each unit had a copy although this policy was not viewed on this visit. Since the last inspection visit there has been an allegation of abuse that the manager appropriately referred for investigation. Alexian Brothers Care Centre DS0000066876.V351244.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A clean, comfortable, well maintained environment is provided for residents. EVIDENCE: The accommodation continues to be well furnished, well maintained and is suitable for the residents living there. On the day of this visit as on previous visits the home was odour free and was found to be clean and tidy which created a pleasant environment for the residents and their visitors. The residents spoke to all said that the home is always cleaned to a high standard and all the residents were happy with their room and the communal areas. The visitor confirmed that the standard of hygien was good. As already stated in this report the home offers a variety of communal areas for residents to use and the garden area was well maintained and accessible to residents. Alexian Brothers Care Centre DS0000066876.V351244.R01.S.doc Version 5.2 Page 19 The home provided adequate toilet and bathroom facilities. Toilets were conveniently located in close proximity to bedrooms and communal areas. A variety of bathing facilities were provided to meet a range of needs. Alexian Brothers Care Centre DS0000066876.V351244.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The number and deployment of staff appeared sufficient to meet the residents’ assessed needs and the procedures for recruiting staff were robust and provided adequate safeguards to protect residents. EVIDENCE: At the time of this inspection accommodated 53 residents were accommodated. The numbers and skill mix of the staff appeared to be sufficient to meet the needs of the number of residents accommodated. The home employed 52 care staff, 18 of which had achieved NVQ level 2, 5 members of staff had achieved NVQ level 3 and 4 members of care staff were currently undertaking NVQ Level 2 training and 1 member of care staff was currently undertaking NVQ Level 4. The care staff spoken to confirmed that they were encouraged and supported to undertake NVQ training. The staff files examined contained the appropriate documentation as required by Schedule 2 of The Care Homes Regulations 2001 and the requirement made in the previous inspection report regarding references had been met. Staff files contained photocopied documents, for example passports, utility bills and certificates. However there was no evidence that the original documents had Alexian Brothers Care Centre DS0000066876.V351244.R01.S.doc Version 5.2 Page 21 been seen. It is recommended that that all photocopied documents are signed to indicate that the original had been seen. The manager confirmed that the NMC website is checked monthly by HMT’s clinical Advisor for nurse exclusion or suspension from the register and sends the information directly to her to check against the nurses employed at the home. In addition the reception staff check on a monthly basis for PIN expiries. The manager confirmed that all newly recruited members of staff must attend induction training prior to commencing work. As from August 2007 new staff are to commence on the ‘E-Learning’ induction programmed which the manger confirmed is consistent with Skills For Care. Evidence was seen that as recommended in the previous report that a review of staff training had been undertaken. The administrator confirmed that following the review shortfalls in staff training were identified. However to address the shortfalls a programme of training had been developed. Staff spoken to all said that training was encouraged and staff were supported to attend training. Alexian Brothers Care Centre DS0000066876.V351244.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 36 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Not all areas of the home were managed in the best interest of residents. EVIDENCE: Some areas of the home’s management were weak and did not promote the safety of residents. It was of particular concern that the issues identified in the last 2 reports regarding medication had not been effectively managed and residents were still placed at risk. In addition the shortfalls seen in the care planning process and the failure to implement recommendations made at the funded nurses reviews has the potential to put residents at risk. The manager said that HMT have a quality assurance questionnaire that is sent out on an annual basis to residents, relatives and staff and then the manager Alexian Brothers Care Centre DS0000066876.V351244.R01.S.doc Version 5.2 Page 23 is expected to produce a report based on the findings. The staff had recently received their questionnaire but no results had been fed back to the manager at the time of this visit. The manger said that the HMT Development Manager has recently completed a full catering audit and was due to give feed back to the manager regarding her results. In addition to the formal quality assurance programmes the residents views are obtained during the responsible individual’s monthly Regulation 26 visits and during resident and relatives’ meetings which are held twice a year. Also the manager said she has an open door policy and encourages people to raise concerns or discuss any issues about the service being provided. At the time of this visit staff supervision was not taking place. The manager and the deputy manager had recently attended supervision training and the manager confirmed that it was her intention to implement formal supervision in November 2007. With particular reference to the shortfalls identified with the residents individual plans of care and the medication procedures it is particularly important that all staff receive regular supervision to ensure they are competent to do their job. The home’s administrator has responsibility for residents’ monies. She had computerised records that were password protected. She had a running balance and she said that receipts were kept if anything was bought on behalf of a resident. Copies of invoices were seen at the previous visit. The administrator confirmed that the recommendation made in the previous report regarding interest accrued had been met. Resident’s finances are kept in a pooled account. It is recommended that each resident has an individual interest bearing bank account. As reported in the previous inspection report evidence was provided, in the AQAA, that the home undertook appropriate maintenance of equipment. The manager said that this remains unchanged Alexian Brothers Care Centre DS0000066876.V351244.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 x 3 2 x 3 Alexian Brothers Care Centre DS0000066876.V351244.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 13 (4) (c) 12(1) (a) Requirement 1. To ensure the health and safety of residents, a thorough risk assessments relating to the use of bed rails must be undertaken prior to them being used. 2. The use of the ‘Bucket’ or ‘Cirton’ chair is a form of restraint and as such a risk assessment for its use must be undertaken 3. To ensure that the health and welfare of residents is fully met a detailed plan of care must be implemented for each identified care need. 2. OP9 13(2) 1. Accurate records must be kept 16/10/07 in order to provide evidence that residents receive their medication as prescribed. 2. Medication must be stored at the temperatures specified by the manufacturers in order to ensure that residents receive medication in a good condition. Alexian Brothers Care Centre DS0000066876.V351244.R01.S.doc Version 5.2 Page 26 Timescale for action 30/11/07 3. Medication must be administered in exact accordance with the prescribers’ directions and that there is an adequate stock of medication for each resident, in order to protect residents’ health and safety 4. Medication must be accounted for at all times by means of an audit trail. 5. Only staff who are assessed as competent to administer medication safely must do so, in order to ensure that the health and welfare of the residents are met. (The previous timescales of 15/03/07 and 18/05/07 had not been met and still apply). 3. OP9 13(2) Arrangements must be for the safe disposal of unwanted medicines with a licensed waste management contractor in accordance with the Waste Management regulations 1994. All care staff must receive regular supervision to ensure that staff are competent to do their job. 30/10/07 4. OP36 18 (2) 30/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations 1. It is recommended that all residents care plans are developed on a person centred approach. DS0000066876.V351244.R01.S.doc Version 5.2 Page 27 Alexian Brothers Care Centre 2. To ensure that the health care needs of residents are fully met it is recommended that the individual plans of care contain more detail and specific information as to how care staff are to meet residents identified care needs. 4. To ensure that the health care needs of residents are fully met it is recommended that the care plan is updated as soon as a change of care need is identified. 5. It is recommended that any recommendations made at the funded nursing reviews are immediately implemented. 6. To avoid confusion and loss of paperwork it is recommend that the care files are reviewed and field in a secure and orderly fashion and all out of date information be removed. 7. To ensure that residents care needs are met all charts with particular reference to the positional changes chart should be accurately completed to reflect the care given. To ensure the dignity of residents is protected at all times it is recommended that the care plan containing inappropriate langue is reviewed and updated immediately. It is recommended that all photocopied documents are signed to indicate that the original had been seen. It is recommended that each resident has an individual interest bearing bank account. 2. OP10 3. 4. OP29 OP35 Alexian Brothers Care Centre DS0000066876.V351244.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Alexian Brothers Care Centre DS0000066876.V351244.R01.S.doc Version 5.2 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. 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