Inspection on 15/05/07 for Alton House

This inspection was carried out on 15th May 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

Alton House 09/06/08

Alton House 05/11/07

Alton House 23/11/06

Alton House 09/01/06

Alton House 29/09/05

Alton House 26/01/05

Alton House 15/07/04

Alton House 01/03/04

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

CARE HOMES FOR OLDER PEOPLE Alton House 22 Sunrise Avenue Hornchurch Essex RM12 4YS Lead Inspector Harbinder Ghir Key Unannounced Inspection 15th May 2007 10:00 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 DS0000027828.V339261.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. DS0000027828.V339261.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alton House Address 22 Sunrise Avenue Hornchurch Essex RM12 4YS 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) 01708 451547 Mr Frank Barrs Mrs Patricia Lilian Barrs Mrs Patricia Lilian Barrs Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places DS0000027828.V339261.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Alton House be registered to accommodate 19 older people of either sex, with the registration category of Old Age, not falling within any other category. 23rd November 2006 Date of last inspection Brief Description of the Service: Alton House is a privately owned care home registered to provide care and support to 19 older people. The home is owned by Mr and Mrs Barrs and is currently managed by Mrs Barrs. The home is situated in a quiet residential area of Hornchurch with access to local shops and transport links. The home is traditionally styled and in keeping with other properties in the area. It offers a warm, welcoming environment. DS0000027828.V339261.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection undertaken by Regulation Inspector Harbinder Ghir. The inspection took place on the 15th May 2007 between 9.30am and 4.30pm. The manager and the deputy manager were available throughout the time to aid the inspection process. During the inspection the inspector was able to talk to three service users residing at the home, staff, the manager and the deputy manager. A relative was spoken to while visiting during the inspection. Four relatives were contacted via telephone. As part of the inspection the inspector toured the home, read records of people who use the service and examined documents in relation to the management of the home. At the end of the inspection the inspector was able to provide feedback to the manager and deputy manager of the home. At the beginning of the inspection the service had 20 outstanding requirements from previous inspections. 8 of these were found to be met. 7 previous requirements have been repeated and a further 18 have been issued following this inspection. Unmet requirements impact upon the welfare and safety of service users. Failure to comply by the revised timescale will lead to the Commission for Social Care Inspection considering enforcement action to secure compliance. The inspector would like to thank everyone involved in the inspection process. What the service does well: Trial visits are offered and give residents and relatives the opportunity to visit and assess the suitability of the home. Social activities are organised at the home and staff promote community contact. The meals in the home are nutritious offering variety and catering for special diets The home has a clear complaints procedure, which includes timescales within which a complaint is to be investigated. The home benefits from a staffing ratio of 50 of NVQ qualified staff. DS0000027828.V339261.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Prospective residents must only admitted on the basis of a pre-admission assessment undertaken by people trained to do so, and to which the prospective resident, their representatives and relevant professionals have been party The Statement of Purpose and Service User Guide need to be updated to comply with The Care Homes Regulations 2001. The registered person to conduct a review of all residents’ presenting memory loss and specialist referrals be made to ensure the home can continue to meet their needs. Menus and a list of activities need to be readily available to residents throughout the home. Detailed records need to be maintained of all activities taken place and of all those who participated. Ways to minimise the risks of infection need to be revisited by the manager as a priority. Health and safety risks posed to residents throughout the home need to be reviewed by the manager. A daily log of food intake for each resident needs to be maintained by the home to monitor his or her nutritional intake. This is to be made a priority for residents who are diabetic or who have pressure care areas. DS0000027828.V339261.R01.S.doc Version 5.2 Page 7 Staffing levels at peak times need to be increased to ensure the needs of all residents are met. Staff training to be provided to ensure staff are equipped with the skills to meet the needs of residents, and training in Adult Protection to be prioritised by the home. Staff recruitment practices need to be more robust to ensure the safety and protection of residents. Management of the home currently gives the Commission for Social Care Inspection cause for concern and requirements in this area have been made. 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. DS0000027828.V339261.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 DS0000027828.V339261.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): 1, 2 3, 4, 5 Quality in this outcome area is poor. Residents are provided with detailed information to enable them to decide whether they would like to live at the home. However, this information needs to be provided in formats suitable for the people for whom the service is intended. Prospective residents needs are not assessed before moving into the home. Trial visits are offered and give residents and relatives the opportunity to visit and assess the suitability of the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Statement of Purpose states “it is the responsibility of the manager to carry out the pre-assessment, in her absence the deputy manager. “ To visit the client and carry out an assessment, based on the results of the assessment a decision will be made regarding whether Alton House is able to meet the clients care needs”. DS0000027828.V339261.R01.S.doc Version 5.2 Page 10 During the inspection serious concerns were found around the home not completing pre-admission assessments. Five files of people who use the service were closely examined. No records were found of the home completing a full assessment prior to the prospective resident moving in, ensuring their needs would be met. The home has a pre-admission assessment form but this was given to the family to complete. It is Requirement 1 prospective residents are only admitted on the basis of a full assessment undertaken by people trained to do so, and to which the prospective resident, their representatives and relevant professionals have been party. The Service User Guide is comprehensive and provides prospective residents with detailed information about the service. The document is available in the reception area of the home. However on speaking to three relatives they informed that they were not aware of the document and had not been provided with it. It was a requirement from the last inspection that the Service User Guide be issued to or within 48 hours of admission to residents, relatives or their representatives. This Requirement has not been met and will be restated as Requirement 1a. Both documents were presented in text format, which was unsuitable to the communication needs of people who used the service. It is Requirement 1b that the documents are produced and presented in formats appropriate to the communication needs of residents’. The previous inspection required that a service user contract be issued to each service user or their representative prior to or within 48 hours of admission. The home has now met this requirement. From files examined all service users were issued with a contract. However, one contract was not signed by the home. It is Requirement 2 that all contract of terms and conditions. are signed by the home and resident or their representatives. At the last inspection a recommendation was made that each service user has the opportunity of a trial stay of between one and three months. At this inspection it was evident of the home offering potential residents to visit the home prior to moving in. The relatives of two recently admitted residents were spoken to who stated, “that my mum was given the opportunity to visit the home, but I visited instead”. Another relative stated, “that my aunt couldn’t visit the home as she was in hospital so I visited for her”. DS0000027828.V339261.R01.S.doc Version 5.2 Page 11 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, 11 Quality in this outcome area is adequate. There is a clear and consistent care planning system, however the system needs to be improved in identifying the mental health needs of people who use the service. The systems for medication administration are satisfactory. The wishes of people who use the service at the time of death are not identified. his judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a clear and easy to follow care plan format. All residents have a detailed plan of their daily routine covering personal, physical and emotional and healthcare needs. Care records seen identified that residents’ health is monitored and prompt referrals are made to external healthcare professionals, such as General Practitioners, Chiropodists, and District Nurses when required and all healthcare visits are recorded in detail. There was evidence of the home DS0000027828.V339261.R01.S.doc Version 5.2 Page 12 meeting the needs of a resident who was on the Care Programme Approach and at times could present challenging behaviour. His care plan took account of this by the home completing comprehensive risk assessments and ways to manage challenging behaviour. However, there was lack of evidence of the home identifying specialist care needs of residents who had developed dementia. It was evident by observation and talking to residents that some residents at the home had memory loss. However, on viewing their care plans there was no evidence of specialist referrals being made to Community Psychiatric service.. It is Requirement 3 that the home review all residents presenting memory loss and specialist referrals be made to ensure the home can continue to meet their needs. Daily case recording of residents’ activities and the care, staff were providing during the day was poor and generalised. It is Recommendation 1 that case recording is detailed and individualised to each resident. It was a requirement at the last inspection that all residents care records include a recent photograph; this requirement has been met at this inspection as evidence was seen of recent photographs for five residents’ on their care plan file. It is advised that the home also maintains a record of what each resident has had to eat and what amount of portion he or she has eaten, in order to monitor their nutritional intake. This is to demonstrate that an adequate and balanced diet has been provided, and the home should make dietary monitoring a priority for residents’ with diabetes or pressure care areas. This is Recommendation 2. Care plans examined were reviewed monthly and were amended accordingly. Good risk assessments were completed to assess dependency levels. Medication is administered by the monitored dosage system for most medication. On viewing the medication storage cupboard, unlabelled creams including creams that could be bought over the counter and lotions were found which were out of date and were used communally for residents. No products must be used communally for residents and medications must be returned when no longer required. This is Requirement 4. Medication requiring cold storage was found stored in an unlocked container in the fridge. Any medication requiring cold storage must be stored in a locked safe in a separate kitchen fridge in guidance to The Administration and Control of Medicines in Care Homes and Children’s Services published by The Royal Pharmaceutical Society of Great Britain. This is Requirement 5. Medication Administration Records viewed were completed and signed appropriately. Staff who administer medication had received medication training but required refresher courses, this will be discussed in more detail under standard thirty of the report. The home has an appropriate medication policy and procedure in place. Residents are treated with respect and arrangements for their personal care ensure their right to privacy is upheld by all members of staff. Residents DS0000027828.V339261.R01.S.doc Version 5.2 Page 13 spoken to stated “ the staff are caring”. Relatives highlighted “care staff are very pleasant, they are attentive, and when my mother-in-law asks for help they assist her”. Another relative spoken to informed “I am very pleased with the care carers provide, their attitudes are good and my brother is very well looked after”. Not all residents’ wishes are established and discussed concerning death or the arrangements they would like made after death. Five files were examined and only one resident’s file identified what the resident’s wishes were at the time of death and what type of funeral they would like. It is Requirement 6 that residents wishes concerning death are identified and recorded. DS0000027828.V339261.R01.S.doc Version 5.2 Page 14 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 adequate. Social activities are organised at the home and staff promote community contact. The meals in the home are nutritious offering variety and catering for special diets, however the choice of menu is not always offered to residents. Residents’ needs are promoted and they are encouraged to exercise rights and choices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Social activities such as music, sing a longs, reminiscence sessions, watching films, quizzes and entertainers are part of the entertainment programme at the home. The staff team maintains a log of all activities completed at the home, but a timetable for activities was not displayed around the home. A timetable for activities should be displayed around the home to ensure people who use the service are aware of what is planned for the day. This is Recommendation 3. DS0000027828.V339261.R01.S.doc Version 5.2 Page 15 Community contact is promoted by the home. Two relatives were seen visiting during the inspection. One of the relatives spoken to stated, “staff make me feel very welcome and they are friendly and I can visit any time. “My aunt is looking better now than she did at home, I can sleep now knowing that she is here”. Another relative also informed that “I can visit any time and that the carers are very good, I am very happy with the home”. A resident spoken to stated “ I love going out into the garden, when the weather is good, and my family come and see me any time they want”. Residents spoken informed the routines of daily living were tailored to their individual preference as far as were practicable. A resident spoken to stated “that they don’t force us to go to bed and I have a lie in once in a while.” Another resident stated, “I have no complaints, the home is clean and we are all well fed”. A good choice of hot and cold meals is offered at the home. The daily menu was on display in the dining room in text format, which is unsuitable to the communication needs of residents. It is Recommendation 4 that information displayed around the home for residents is produced and presented in formats appropriate to the communication needs of people who use the service. A choice of two meals is offered on the menu, however on speaking to some members of staff they informed that a choice of two meals is not always communicated to residents. It is Requirement 7 that all residents are offered a choice of meals, in written or other formats or which is given read or explained, ensuring residents are able to exercise choice and control over their lives. Special diets are catered for by the home. Residents said that the food was good with a wide choice of meals to choose from. A resident stated, “the food is good and I like the cups of tea and we have good portions”. Another resident stated, “ I can’t grumble, I have good portions, a good choice and we are all fed”. The kitchen was seen during the tour of the building. It was clean and hygienic and records of all fridge, freezer and food temperatures were recorded daily. However, a thermometer could not be located in the outside freezer and the first aid box did not have blue plasters. It was a repeated requirement at the last inspection that the first aid box needed further supplies of blue plasters. A further requirement was made that the registered person is required to provide new thermometers for the outside freezers. These Requirements have not been met and will be repeated as Requirement 8 and 9. All foods were not stored in airtight containers as packages of food were left open. It is therefore Recommendation 5 that all food is stored in airtight containers to reduce the risk of infection control. Residents had access to their daily records if they wished. DS0000027828.V339261.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 Quality in this outcome area is poor. The home has a clear complaints procedure, which includes timescales within which a complaint is to be investigated. Policies, procedures were provided but up to date staff training has not been provided on adult protection and does not ensure the protection of residents’ from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure was displayed in the main reception area of the home and in each resident’s bedroom. It was also included in the Statement Of Purpose and the Service User Guide. The procedure included timescales and the assurance that complaints will be responded to within 28 days in compliance with the Care Homes Regulations 2001. The complaints logbook was seen which evidenced that complaints were recorded and actioned appropriately. Policies and procedures regarding the abuse of vulnerable adults were viewed which were comprehensive. A repeated requirement with a previous timescale 01/03/06 was set at the last inspection for the registered person to ensure that all staff undertake adult protection training. This requirement has not been met at this inspection, as staff have not received up to date adult protection training. On speaking to staff serious concerns were highlighted on the lack of DS0000027828.V339261.R01.S.doc Version 5.2 Page 17 knowledge staff had in naming the types of abuse. Staff were aware of how to report an incident and would adhere to the homes policies and procedures. It is Requirement 10 that all staff receive up to date Adult Protection training to ensure residents are protected from abuse, as soon as possible and the Commission for Social Care to be informed. DS0000027828.V339261.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, 20, 21, 22, 23, 24, 25, 26 Quality in this outcome area is adequate. The standard of the environment within the home was satisfactory, providing residents with a homely and safe place to live. The home is unable to fully meet the standards until it has ascertained via an occupational assessment what residents needs are in relation to adaptations and the provision of a second assisted bath. This is an ongoing recommendation. Residents were put at risk due to infection control issues. This judgement has been made using available evidence including a visit to this service. EVIDENCE: DS0000027828.V339261.R01.S.doc Version 5.2 Page 19 The home provides a warm and homely environment and in general the home is kept in good decorative order. The communal areas in the home appeared clean and hygienic however some residents’ bedrooms were malodorous. In particular one resident’s room seen by the inspector had an offensive odour of urine that required prompt attention and indicated the need for appropriate management. It is Requirement 11 that the premises are kept clean, hygienic and free from offensive odours. Bedrooms were personalised by residents’ by personal photos and furniture items. However, all rooms did not have window restrictors posing a health and safety risk to residents. It is Requirement 11a that all rooms are fitted with window restrictors to ensure the safety of residents. One bedroom door was found to be propped open by a piece of furniture, which does not comply with fire regulations. It is Requirement 10a that all fire doors are kept closed unless fitted with magnetic closures. During a tour of the building over the bed lighting was not working in some residents’ bedrooms and some maintenance work in one residents bathroom had not been attended too. It is Requirement 12 that all residents are provided with lighting, which is in working order, and live in safe, comfortable surroundings. Communal bathrooms were not provided with hand towels or soap dispensers. Bathrooms stored residents’ personal toiletries and were not labelled in regards to who they belonged too. It is Requirement 13 that communal areas have systems in place to reduce and control the spread of infection; that personal toiletries are not used communally or stored in communal bathrooms. A log of daily-recorded dates of when water tempretures were taken was seen but the log did not indicate what the water temperature was at the time of reading. It is Requirement 14 that staff record water temperature readings. Household hazardous substances were not stored appropriately as powder detergent was stored in an open container left out in the laundry room, which is kept unlocked. This does not ensure the safety of residents and therefore is Requirement 15 that all hazardous substances are appropriately stored to ensure the safety of people who use the service. At the previous inspections the provision of a second assisted bathroom for the home has been recommended. It has also been recommended that an occupational therapy assessment of the home be carried out in order to ensure the appropriate adaptations are provided. This recommendation will be restated as Recommendation 4a. DS0000027828.V339261.R01.S.doc Version 5.2 Page 20 DS0000027828.V339261.R01.S.doc Version 5.2 Page 21 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 poor. Staffing levels during the afternoons are not satisfactory as there was not sufficient care staff on duty to meet the needs of residents. Staff have not received up to date training to ensure that they are equipped with skills necessary to ensure the safety of residents. Recruitment processes have improved but are not robust. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the morning hours there are two care staff and the deputy manager on shift. The afternoon also has two carers on duty and the night has two waking staff. The deputy manager and the manager starts at 9am leave at 3pm. There is a cook on site from 7.30am to 1pm who cooks and provides breakfast and lunch. The two carers on duty in the afternoon have responsibility for preparing the tea. It was observed during the inspection that one carer is left to 15 residents as the other carer prepares the tea. On speaking to one member of staff she stated “ we can sometimes do with more staff in the afternoons, as there is only one carer here, especially when we are cooking a hot tea which can take some time”. The registered person must review its staffing complement during the afternoons and ensures there are adequate DS0000027828.V339261.R01.S.doc Version 5.2 Page 22 staffing numbers to meet the needs of residents. This is Requirement 16. A requirement was set at the last inspection that an accurate record of duties performed by staff is kept. The staffing rota was seen which tailed with the correct numbers of staff on duty and therefore the requirement has been met by the home. A Requirement was set at the last inspection, which has previously been repeated twice that the registered person ensures that all staff attend training in health and safety, first aid, manual handling, dementia awareness, fire training and adult protection. Staff have received no training in the last two years. Prior to this date the staff training record indicated that staff some staff had received training in Health & Safety, First Aid, Moving and Handling, Dementia Awareness and Continence Promotion. It was a requirement at the last inspection dates is added to the training monitoring record to enable a fuller understanding of how often training is provided and updated for staff. On viewing the training record it was identified that no dates were recorded of when staff completed the training or when their training had expired requiring refresher courses. The above requirement has not been met and will be repeated for the third time as Requirement 17. It is Requirement 21 that a detailed staff training monitoring record is maintained to ensure staff receive up to date training on an ongoing basis. A previously repeated requirement was made at the last inspection that the registered person is required to ensure that all staff undertake adult protection training. No adult protection training has been held since the last inspection. On speaking to some members of staff serious concerns were highlighted on their lack of knowledge on Adult Protection. Please see Requirement 8 under standard 17, which requires that all staff must attend Adult Protection training to ensure the safety and protection of residents. Evidence was provided of the service adopting a new induction programme for any new members of staff. The programme is comprehensive ensuring staff are provided with the skills to commence employment. The home has met the previous requirement set in regards to the home providing a full induction to newly recruited employed staff. The home has a permanent staff team and the home has a ratio of 50 of NVQ qualified care staff. The inspector undertook an inspection of a random sample of four files to test the service’s recruitment of staff. One staff file only had one reference and all four files did not include a job description. It is Requirement 18 that all members of staff are properly vetted and that two references are obtained for all members of staff employed by the service. It is Requirement 19 that all staff files include a job description. All four files included a Criminal Bureau DS0000027828.V339261.R01.S.doc Version 5.2 Page 23 Check and a photo of each member of staff, meeting the requirements set out in the last inspection report which stated the registered person is required to ensure that a CRB or POVA first check is in place for every staff prior to commencing employment and that a current photograph is held on file. DS0000027828.V339261.R01.S.doc Version 5.2 Page 24 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, 32, 33, 36, 38 Quality in this outcome area is poor. The home does not benefit from a manager who is committed to undergo training in management. Staff benefit from regular supervision. The systems for Service User consultation are poor with little evidence that Service User views are sought or acted on. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The significant number of recurring requirements from inspection to inspection in addition to new requirements gives the Commission for Social Care Inspection concern as to the effectiveness of the current management arrangements. The current management arrangements are not satisfactory and must be resolved. A requirement was set at the last inspection that the DS0000027828.V339261.R01.S.doc Version 5.2 Page 25 manager of the home Mrs Barrs undertake training in management and inform the Commission for Social Care inspection of the date that she has enrolled to begin or that an application for the registration of a suitably qualified and experienced manager be submitted to the commission by 31st January 2007. The manager of the home has not undertaken training in management and informed that her deputy manager is in the process of completing an application to becoming the registered manager of the home and that she is going to retire as soon as this is done. The Commission for Social Care Inspection has not received an application from the deputy manager. It is Requirement 20 that an application for a suitably qualified manager be submitted to the Commission by 30th June 2007. A supervision programme is now in place. Staff files evidenced that staff members are supervised every two months and are appraised yearly. Staff are also able to express their views in team meetings which are held every 2 months. Minutes seen evidenced that staff issues are taken on board and actioned appropriately. Quality Assurance systems need to be significantly improved within the home. The deputy manager of the home informed that they have sent quality assurance surveys out to family members and relatives a few months ago but have not had a very good response. No evidence was seen of any responses being received by the home. The manager of the home informed that they do not hold any resident meetings due to the request of residents. No evidence was seen in care plans or documentation of any residents declining the opportunity to attend residents meetings. It is Recommendation 4 that the home holds resident meetings to ensure the views of residents are gained in the running of the home and clear documentation is provided of any resident who does not wish to participate. The home must develop effective quality assurance and quality-monitoring systems based on seeking the views of its residents to ensure the home is run in the best interests of people who use the service. This is Requirement 21. The health, safety and welfare of residents and staff is promoted and protected by the service completing regular audits of safe working practices. A wide range of records were looked at including fire safety, accident/ incident records, insurance certificates. These records were found to be up to date, and in good order. DS0000027828.V339261.R01.S.doc Version 5.2 Page 26 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 2 1 1 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 1 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 2 3 3 3 3 3 2 2 STAFFING Standard No Score 27 2 28 3 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 1 X X 3 X 3 DS0000027828.V339261.R01.S.doc Version 5.2 Page 27 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 OP3 Regulation 14 Requirement Prospective residents are only admitted on the basis of a preadmission assessment undertaken by people trained to do so, and to which the prospective resident, their representatives and relevant professionals have been party. The Service User Guide is issued to or within 48 hours of admission to residents. This is a repeated requirement. Previous timescale of 01/01/07 not met. The Statement of Purpose and Service User Guide must be produced and presented in formats appropriate to the communication needs of residents’. The home and resident or their representatives sign the contract of terms and conditions. It is required that the registered DS0000027828.V339261.R01.S.doc Timescale for action 30/06/07 1a OP1 5 31/07/07 1b OP1 4, 5 31/08/07 2 OP2 Schedule 3, 5 30/06/07 3 OP8 13 30/06/07 Page 28 Version 5.2 4 OP9 13 5 OP9 13 6 OP11 12, 15 person conducts a review of all residents’ presenting memory loss and specialist referrals be made to ensure the home can continue to meet their needs. Medical creams must not be used communally for residents and medications must be returned when no longer required. Medication requiring cold storage must be stored in a locked safe, in a separate kitchen fridge in guidance to The Administration and Control of Medicines in Care Homes and Children’s Services published by The Royal Pharmaceutical Society of Great Britain. It is required that residents’ wishes concerning death are identified and recorded. All residents must be offered a choice of meals, in written or other formats or which is given read or explained, ensuring residents are able to exercise choice and control over their lives. The first aid box needed further supplies of blue plasters. This requirement is being repeated for the third time. Previous timescale given 10/02/06. The registered person is required to provide new thermometers for the outside freezers. This is repeated requirement. Previous timescale given 01/01/07. The registered person is required to ensure that all staff undertakes adult protection training and the Commission for DS0000027828.V339261.R01.S.doc 31/07/07 31/07/07 01/08/07 7 OP15 12, 16 01/07/07 8 OP15 23 30/06/07 9 OP15 OP26 13,23 30/06/07 10 OP18 18 31/07/07 Version 5.2 Page 29 Social Care Inspection to be informed when training has been booked. This requirement is being repeated for the third time, previous timescale given 01/03/06 10a OP19 23 All fire doors are kept closed unless fitted with magnetic closures. It is required the premises are kept clean, hygienic and free from offensive odours. All windows where required are fitted with window restrictors. It is requirement all residents are provided with lighting, which is in working order, and live in safe, comfortable surroundings. Communal areas have systems in place to reduce and control the spread of infection; that personal toiletries are not used communally or stored in communal bathrooms. Staff must record water temperature readings daily. All hazardous substances must be appropriately stored to ensure the safety of people who use the service. The registered person must review its staffing complement during the afternoons and ensures there are adequate staffing numbers to meet the needs of residents. The registered person is required to ensure that all staff attend training in health and safety, first aid, manual handling, dementia awareness, fire DS0000027828.V339261.R01.S.doc 30/06/07 11 11a 12 OP26 OP25 OP25 23 13 23 31/08/07 31/08/07 31/07/07 13 OP26 23 31/07/07 14 OP25 23 31/08/07 15 OP19 23 31/08/07 16 OP27 18 31/08/07 17 OP30 18 31/07/07 Version 5.2 Page 30 training and adult protection. This requirement is being repeated for the third time. Previous timescales given 01/03/06. 18 OP29 19 Schedule 2 Schedule 4, 19 It is required that all members of 31/07/07 staff are properly vetted and that two references are obtained for all members of staff employed by the service. All staff files include a job 31/08/07 description, including the position they hold, the work they perform and number of hours they employ. It is required that Mrs Barrs 30/06/07 undertake training in management and inform the commission of the date that she is enrolled to begin or that an application for the registration of a suitably qualified and experienced manager be submitted to the commission. This requirement is repeated for the third time. Previous timescale given 1/03/06. It is required that dates be added to the training monitoring record to enable a fuller understanding of how often training is provided and updated for staff. This is a repeated requirement. Previous timescale given 01/03/07. 31/07/07 19 OP29 20 OP31 9 21 OP30 18 DS0000027828.V339261.R01.S.doc Version 5.2 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP8 Good Practice Recommendations It is recommended that daily case recording is detailed and individualised to each resident. It is advised that the home maintains a record of what each resident has had to eat and what amount of portion he or she has eaten, in order to monitor their nutritional intake. It is recommended a timetable for activities be displayed around the home to ensure people who use the service are aware of activities arranged for the day. It is recommended information displayed around the home for residents is produced and presented in formats appropriate to the communication needs of people who use the service. It is recommended that an occupational therapy assessment of the home be carried out in order to ensure the appropriate adaptations are provided within the home. It is recommended all food is stored in airtight containers to reduce the risk of infection control 3. OP15 4 OP15 4a 5 OP22 OP26 OP15 DS0000027828.V339261.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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 DS0000027828.V339261.R01.S.doc Version 5.2 Page 33 - 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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