Inspection on 12/06/07 for April House

This inspection was carried out on 12th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

April House 10/03/08

April House 07/11/06

April House 15/05/06

April House 31/10/05

April House 24/05/05

April House 26/10/04

April House 07/06/04

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

CARE HOMES FOR OLDER PEOPLE April House 69 Sea Road Westgate on Sea Kent CT8 8QG Lead Inspector Jenny McGookin Key Unannounced Inspection 12th – 14th June 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 April House DS0000044204.V338813.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. April House DS0000044204.V338813.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service April House Address 69 Sea Road Westgate on Sea Kent CT8 8QG 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) 01843 831860 01843 836621 Mrs Kiki Cole Mr Raymond Edwards Ms Jacqueline Newell Care Home 30 Category(ies) of Dementia - over 65 years of age (30) registration, with number of places April House DS0000044204.V338813.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th November 2006 Brief Description of the Service: April House is a detached 4-storey building, comprising a lower ground floor, ground floor, first floor and second floor, with 2 mezzanine floors at first floor level. There is a shaft lift to all floors. Currently the lower ground floor is not in use for residents. The maximum registration number of 30 but the exclusion of bedroom space for 5 residents in the lower ground floor effectively means there is only space to accommodate a maximum number of 25 residents. There are overall five potential double rooms but all the other bedrooms are single occupancy. There are two communal lounge areas and a dining area. April House is registered to provide care for older people with dementia. It is situated on the sea front of Westgate, within easy reach of Westgate shopping centre and several seaside towns, with the community and transport resources that implies. There is some off-street parking available (for 3-4 vehicles) and unrestricted kerb-side parking on Sea Road. And there is an enclosed garden to the rear. The staff team currently includes a manager, senior carers and carers including 2 staff on waking duty at night. Some part-time catering and domestic staff are also employed. The fees range from £377.38 to £500.00 per week and additional charges are made for: clothing, toilet requisites, stationery, dry cleaning, hairdressing, chiropody, physiotherapy, newspapers, special beverages / meals, medical requisites (other than by prescription), spectacles, hearing aids, batteries, incontinence products and items of a luxury or personal nature; any other treatment or care requested by or necessitated by a resident’s worsening state or health not provided by the NHS, as well as certain forms of entertainment and outings. April House DS0000044204.V338813.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report is based on two site visits (the first of which was unannounced, and the other was by prior arrangement) which were used to check progress with matters raised from the last year’s key inspection site visits (November and May 2006), given all the timeframes had run their course; and to review findings on the day-to day running of the home. The inspection process took eighteen and three quarter hours, and involved meetings with six residents (two groups of three over lunch), four visiting relatives, and a range of staff representing the various functions of the home: the proprietors, the manager, a senior carer, a day time carer and a night carer, the cook, the maintenance man and a member of the domestic staff. The inspection also involved an examination of records; the selection of three residents’ case files, to track their care; and an audit of three personnel files against the provisions of the National Minimum Standards. Feedback questionnaires were issued by the Commission but were not submitted in time to be taken into account in this draft; but interactions between the staff and residents were observed. Seventeen bedrooms were inspected for compliance with the National Minimum Standards along with most of the communal facilities. What the service does well: What has improved since the last inspection? There has been a modest investment in specialist dementia care training for some staff, and some aspects of the property causing most concern have been put right. April House DS0000044204.V338813.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can April House DS0000044204.V338813.R01.S.doc Version 5.2 Page 7 be made available in other formats on request. April House DS0000044204.V338813.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 April House DS0000044204.V338813.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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. 1, 2, 3, 4, 5 The home cannot robustly evidence that prospective residents and their representatives have the information needed to choose a home, which will meet their needs. Residents have their needs assessed and each placement is governed by a contract, which clearly tells them about the service they will receive. EVIDENCE: This home has a Statement of Purpose and Service User Guide, each of which describes the facilities, services and principles of care. But work will need to be done to obtain full compliance with all the elements of this standard. These matters have been reported back to the manager separately. Some statements are, on further scrutiny, only aspirational and do not reflect practice. This is likely to be misleading if not disappointing. April House DS0000044204.V338813.R01.S.doc Version 5.2 Page 10 No other languages are currently warranted, but the home should give consideration to making this information available e.g. in large print and / or audiotape – so that residents have all the information they need, in readily accessible formats, to make informed choices. And it should have an admission checklist to evidence the issue of these documents and whether other languages or formats (e.g. large print, tape etc) were required, so that its commitment to equal opportunities can be assessed. The home has a contract, which is generally compliant with the elements of the National Minimum Standard. It does not, however, identify the room allocated to the resident, or list the furniture and fittings to which the resident is entitled. Nor does it give a breakdown on the fees chargeable. The document is written in plain English. No other languages or formats have been warranted, but see comments on public information above in relation to accessibility. Feedback on these site visits confirmed that the decision to apply to this home was generally made by third parties (such as care managers from funding authorities) and influenced more by its locality (i.e. close to where the resident or their friends or relatives lived), than by any public information produced by the home itself for residents or their relatives. The residents spoken to on this occasion were not able to give a view, but relatives were reasonably satisfied with the choice of home made. The admission process is in the first instance led by assessments carried out by care managers, which the manager uses to inform her own. These are usefully underpinned by risk & dependency assessments. There is scope for prospective residents or representatives to visit the home, but the relatives spoken to on this occasion could not recall having done so. The placement contract confirms the manager’s advice that each resident is offered a trial stay of four weeks before their admission is confirmed by contract. See section on “Environment” for a description of equipment and adaptations, and section on “Health and Personal Care” for a description of services provided. Contrary to a statement in the Service User Guide, this home does not have the facilities or expertise to offer Intermediate care. April House DS0000044204.V338813.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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. 7, 8, 9, 10 The health and personal care, which a resident receives, is based on an assessment of their individual needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: The format of the care planning documents used by this home is designed to address a wide range of personal, health and, to a much lesser extent, the social care needs of the residents, and in each case the care plans were usefully underpinned by dependency assessments, risk assessments, daily reports and routine checks. Each care plan is clearly designed to identify a given aspect of the resident’s care and the action required by care staff. However, a number of the instructions in the plans of action would have universal application, and would not single out one resident’s needs from another’s. There was scant evidence April House DS0000044204.V338813.R01.S.doc Version 5.2 Page 12 of specialist dementia care in things like communication or behaviour despite a recent investment in staff training. There was evidence of care needs being reviewed monthly, but the care plans seen often showed little change and there was scant record of attempts to actively pursue the residents’ emotional needs or interests and to establish any unmet needs. These elements will all require attention, to ensure a more holistic approach. When asked, none of the relatives spoken to on this occasion, showed any recognition of the formal care planning process, though they each recalled being asked questions about their care needs either at the outset and/or on a day-to-day basis thereon. Care plans need to better evidence the active participation of interested parties, most notably the residents. Observed interactions were, however, judged appropriately familiar and respectful. The home uses the Royal Pharmaceutical Society Guidance on the administration and storage of medication for reference, and also accesses a copy of the British National Formulary. It has properly secured medication storage arrangements, and an examination of current medication administration records indicated general compliance with required standards for record keeping. There were no apparent gaps of anomalies, but the use of codes to indicate irregularities, could be further detailed on the records sheets, to enable anyone authorised to inspect them to evaluate any emerging problems. This matter has been raised by the Commission before and found to be still outstanding. The manager said that periodic inspections of the home’s medication arrangements had recently been arranged with an independent agency but their first report was not yet available. There was some evidence of staff training in medication, but not comprehensively and there wasn’t evidence of regular updates (see section on staffing). With one exception all the residents are attended by one GP surgery, so residents have had little choice. But records show the home has access to a range of healthcare professionals. This home has five potential double rooms (though one has been decommissioned and the others are all currently being used as a singles). All the other bedrooms in this home are registered for single occupancy, which means personal care and treatments can generally be given in privacy. There has been no overall periodic assessment of the premises by an OT or specialist in dementia care. This is a matter, which is strongly recommended, April House DS0000044204.V338813.R01.S.doc Version 5.2 Page 13 so that the home can maintain its capacity to meet the needs of the residents. See also section on “Environment” for details of equipment and adaptations. April House DS0000044204.V338813.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): Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. 12, 13, 14, 15 There are some activities and residents are supported to keep in contact with family and friends. Residents receive a healthy, requirement and choice. EVIDENCE: The residents were not able (by reason of dementia) to give any examples of any particular interests and hobbies being promoted by the home. But conversations with relatives indicated some had accomplished talents such as oil painting, flower pressing, catering before coming into residential care. Unfortunately, there is currently no dedicated activities co-ordinator to ensure information on the range of community resources and events is kept up to date; to actively motivate individuals; or to ensure records are maintained on individuals’ activities. The manager has been trying to recruit one, so this continues to be strongly recommended. April House DS0000044204.V338813.R01.S.doc Version 5.2 Page 15 varied diet according to their assessed Staff were able to provide some examples of activities; drawing or colouring (“but not a lot do that. We have to be careful they don’t take the colour pens and try to eat them”), listening to music, playing with a ball. Some of them like to look at magazines. Quite a few like old time singing and some like dancing – one member of staff said “we had church people come in to do that. They loved that” but she went on to say they wouldn’t be coming in again until next Christmas! There are also skittles, jigsaw puzzles and board games. Although there is said to be something happening every day, staffing levels would severely restrict the scope for meeting any diversity of activities or for one-to-one attention. The residents go out some times if the weather is nice, and the home has occasional access to a minibus belonging to the group of homes, though this is subject to staffing levels. Reliance is also placed on relatives to provide some quality one-to-one care. Residents can choose when to go to bed or get up, and what to do during the day, but tend in practice to have their own fairly set routines. They were observed being supported to make some choices and decisions during the day of this inspection. The home has open visiting arrangements and this was confirmed by relatives and staff during this site visits. There is a communal payphone at the end of one ground floor corridor. And there is cordless handset in the office for communal use – and no charge is made for its use Records confirmed that dietary needs and preferences are identified as part of the care planning process, and there was anecdotal information on the extent to which individual preferences were being catered for. Since the last inspection, a cook has been recruited after several months of care staff having to cover. Food is bought fresh on a weekly basis from local retailers and prepared on site. Menu planning is done on a 4-weekly basis, and the menus were under review at the time of these visits. Following the recommendations of the last two inspections and a choice is now routinely available. However, there has been no input from a dietician or dementia specialist and there has been no periodic top up training. Both are strongly recommended. No one has a special diet. The residents were joined for lunch on both site visits and the selected lunchtime meal options were judged well prepared and presented. The meals tend to be traditional English fare, and the residents appeared to enjoy them. The pace of the meal was unhurried. Staff were observed attending residents in a respectful way. April House DS0000044204.V338813.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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. 16, 17, 18 These standards were partially assessed on this occasion There is a process for resolving complaints but the home needs to better evidence its application. The home needs to better evidence that residents are protected from abuse and have their legal rights protected. EVIDENCE: This home has a complaints procedure, which is on display in the entrance hall. A copy of the complaints procedure is appended to the home’s Statement of Purpose but the Service User Guide simply directs the reader to the version on display. A summary version would be more accessible. The manager is said to be very approachable. But no complaints had been registered since the last two inspections. This is not judged a realistic reflection of communal living. The manager will need to look for opportunities to demonstrate that residents and their relatives or representatives know how to complain. April House DS0000044204.V338813.R01.S.doc Version 5.2 Page 17 Leaflets are on display on advocacy services and there was evidence of their involvement in a consultation exercise early in 2006, though with limited success. The manager said she would try to enlist their help again. In discussions with the inspector, staff confirmed their commitment to challenge and report any instances of adult abuse, though they each went on to say that this had not been warranted in this home. However, there has been no training in safeguarding procedures. This matter has been raised by the Commission before, and found to be still outstanding. April House DS0000044204.V338813.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): Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. 19, 20, 21, 22, 23, 24, 25, 26 The physical design and layout of the home is complex and does not encourage independence. Residents are put at risk because the property is not entirely safe, or well maintained. EVIDENCE: There is a forecourt immediately in front of the building and a short drive to the side of the property, providing parking for up to four vehicles and there is unrestricted kerb side parking on the road outside. The Westgate shopping centre is just 15 minutes’ walk away, with all the community and transport links that implies. April House DS0000044204.V338813.R01.S.doc Version 5.2 Page 19 All areas of the home inspected were found to be reasonably comfortable and homely and (with the exception of one bedroom) the home was judged adequately lit and maintained at generally comfortable temperatures. The furniture tends to be domestic in style and there were homely touches throughout. All bedrooms have accessible call bells though two bathrooms and one WC did not. The garden at the front has been largely monopolised by a forecourt and is not accessible for people with significant mobility impairment. One feature (a drop between the forecourt and front aspect of the home) was judged particularly hazardous. The garden at the back is large and enclosed and it provides a pleasant enough area to walk or sit in. There is garden furniture there are attractive focal points, including a goldfish pond. The home has a “No Smoking” policy in respect of its communal areas and residents’ bedrooms. Smokers would need to smoke outside and may need to be subject to supervision. There is a shaft passenger lift linking the four main floors, but access to the two mezzanine floors involves using stairs because two stair-lifts are no longer working and there is no prospect of their repair or replacement. There is ramp access to two external doors (on the front and back aspects of the property). But a number of trip and slip hazards means residents cannot enjoy freedom of movement around the site without an escort. And there are not the staffing levels to facilitate this. On both site visits, most residents tended to stay corralled together. There is a very limited range of equipment and adaptation available in this home. Residents have access to wheelchairs, Zimmer frames and other mobility equipment. There are hand / grab rails throughout the property. However, overall periodic audits by specialists such as Occupational Therapist’s, or dementia care specialists are strongly recommended, to ensure the home can demonstrate a capacity to meet the needs of its residents. An outside shed was being converted into a wheelchair store, so that communal areas and thoroughfares in the home do not become unnecessarily cluttered. Residents have a choice of communal areas. This home has two lounge areas, and a separate dining area. Furnishings tend to be domestic in character throughout. Neither lounge has a Loop system for use with hearing aids. This is recommended, subject to specialist advice on this matter. See section on Daily Life and Social Activities for details on telephones and contact with families and friends. April House DS0000044204.V338813.R01.S.doc Version 5.2 Page 20 Five bedrooms are registered as double rooms, though these are currently being used as a single room. All the other residents have assured access to the privacy of single bedrooms. Seventeen bedrooms were selected for assessment against the National Minimum Standards on this occasion. They were found to be not fully compliant with the National Minimum Standards. A number of them did not have a second comfortable chair (unless a guest was prepared to sit on commodes), or tables, bedside lighting, or bedside cabinets. With two exceptions, none had lockable doors or a lockable storage space. The reader is advised that these items should all be standard provision - the home will need to ensure that non-provision is justified in each case by properly documented consultation or risk assessment. With two exceptions, the commodes in use in this home are, however, discreet models, which look more like comfortable chairs, to accord the residents with more dignity. A sluicing facility for the cleaning of commode pans is required. This matter was raised by the Commission before and found to be still outstanding. This home has WC and bathroom facilities on all floors i.e. reasonably accessible to all the bedrooms and communal areas. But one WC and two bathrooms are not in use at all, and one bathroom is only being used for its WC facilities. All these facilities were judged in need of attention and redecorating. Two WCs (including one staff facility) will require the installation of wash hand basins. Most external windows have obscure glass panes, but some should have blinds or curtains to ensure their privacy and provide a homely touch. One cistern handle was found to be difficult to operate. There is only one adapted bath, but it isn’t being used. Two other baths inspected on this occasion have swing-out bath seat, and one other would benefit by the installation of a hoist, to encourage more use. Unfortunately there are currently no shower facilities, either (with the exception of one en-suite bath) integral or separate from bathing facilities. This effectively means that residents do not have choice. This home has a macerator on site, but its laundry facilities (including a commercial washing machine with three sluice cycles) are in an outbuilding, and access to it is not sheltered, which means staff are having to carry laundry in all weather conditions. Although a trolley has been acquired, and the area is inspected every day and kept swept, this is judged potentially hazardous. In other respects, continence does not appear to be managed adequately at this home, for want of an effective carpet cleaner. There were unpleasant odours in most communal areas and two of the bedrooms inspected.. April House DS0000044204.V338813.R01.S.doc Version 5.2 Page 21 The last inspection by an Environmental Health Officer was in May 2007 and required the home to replace the cooker (this was done), to install more impervious flooring beneath the cooker (matter outstanding) and to instigate a full written food safety system (also outstanding). The home should, therefore, follow up these requirements, to ensure practice conforms with recommended standards. Most maintenance checks were in place but the absence of a gas safety certificate was of concern, and was still outstanding at the time of issue of this report despite undertakings to provide this from the proprietors. April House DS0000044204.V338813.R01.S.doc Version 5.2 Page 22 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): Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. 27, 28, 29, 30 Staff in the home are not sufficiently skilled or in sufficient numbers to properly fulfil the aims of the home and meet the changing needs of residents. EVIDENCE: The following staffing arrangements are reported to generally apply: • • From 8am till 8pm – three carers including one senior From 8pm till 8am there are two waking night staff, with the manager on call The cook works from 7.30am till 3.30pm, five days a week. The carers do the cooking on the other days though the manager has been looking for another cook. There are also part time domestic staff to do the cleaning and laundry. The proprietors also run an agency, which the home is required to rely on for relief staff, but this inevitably means existing staff are working extra hours to cover gaps. This can in some cases mean a sixty-hour week. This matter has been raised for attention by the Commission before, as not in the best interests of staff or residents if it becomes normal practice. April House DS0000044204.V338813.R01.S.doc Version 5.2 Page 23 Staffing numbers and deployment complied with this on the day of these site visits. However, they are not judged appropriate to the assessed needs of the service users, given the size, and layout of the home. It is difficult to see just how individual residents could be properly stimulated or supported with the maintenance or development of living skills, or even with freedom of movement around the site. This matter has been raised for attention by the Commission before. In discussions staff confirmed a systematic recruitment process, which was subject in each case to satisfactory references, identification checks and CRB checks. However, an audit of three personnel files, selected at random, showed some gaps (one CRB check, and two induction checklists being the most notable examples), which needed to be addressed. Although it is accepted that work has been done to reorganise the personnel files, this will clearly require further attention as evidence that residents are being protected. The residents at this home are all white British and there are three males and sixteen females. The staff group comprises three males and twelve females, and shows slightly more cultural diversity (Philippine and Lebanese) but is predominantly White British. The full extent of staff training could not be properly assessed on this occasion, for want of available documentation. The proprietors said they keep an overall spreadsheet of information on training investments but this was not on site and was not made available for inspection. The manager reported that since the last inspection five staff were given specialist dementia care training (a 16week course), but there was little evidence of this being translated into the care planning processes. There was anecdotal information that only 3/15 staff had obtained NVQ level 2 or 3 accreditation, which is significantly below targets for the residential care sector. This must be addressed as a priority. Feedback confirms that this manager has an open, accessible management style and that she is supportive to staff. However, see section on “Management and Administration” in respect of staff supervision records. April House DS0000044204.V338813.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): Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect. But there is no evidence of business planning, audited accounts or an effective quality assurance system in operation. EVIDENCE: Mrs Newell has been the registered manager for this home since November 2006 and has worked in the care sector for several years. She has NVQ Level 4 accreditation as well as the Registered Managers’ Award and an NVQ Level 2 in dementia care. April House DS0000044204.V338813.R01.S.doc Version 5.2 Page 25 Mrs Newell has encouraged an open-door ethos. Since her assumption of management responsibility there has been better evidence of formal documented staff supervision meetings, to comply with the elements of this standard. Team working and flexibility appear to be key strengths in this staff group and observed interactions appeared appropriately familiar and kindly. Contrary to a statement in the Service User Guide, and Rossetti Care Group’s ISO accreditation, this home does not have an active Quality Assurance system. The most recent consultation event was in late Spring 2006, which was directed at relatives and other representatives. Although it only obtained ten responses, this was judged promising, and there was evidence that two or three recommendations were taken up. However, a number of recommendations to improve the quality of the environment clearly had not been undertaken and this exercise had not been repeated. The home needs to embrace its complaints procedure as another useful quality assurance tool and as a means to evidence its ability to resolve dissatisfaction effectively. There was no evidence on site of the proprietors’ regulatory duty to carry out their own inspection visits at least monthly. The reader is advised that breach of this duty is an offence and must be addressed as a priority. This matter has been raised by the Commission before. The most recent development plan available for inspection was dated May 2006. And the most recent financial statements of accounts were for the year ended 31 December 2005 - although these were prepared by accountants they were unaudited. Both will require updating. The views of all stakeholders should be central to both processes, to properly measure the home’s success in meeting its aims, objectives and statement of purpose. With one exception (which was supplied subsequently) all the property maintenance records seen were up to date and adequately maintained. There were some risk assessments in place but their scope was not extensive (i.e. in respect of each individual, their activities and their environments), and there needed to be better evidence of their regular review, to ensure the health and safety of residents and residents are being properly safeguarded. April House DS0000044204.V338813.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 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 2 18 1 1 1 1 1 2 1 1 1 STAFFING Standard No Score 27 1 28 1 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 1 1 X 3 X 1 April House DS0000044204.V338813.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? 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 4(1)(c) 5(1) Requirement The home’s Statement of Purpose and Service User Guide will require attention to obtain full compliance with all the elements of this standard The home’s contract will require attention to obtain full compliance with all the elements of this standard Care plans must show how each resident’s needs in respect of health and welfare are to be met. Care plans to be ‘person centred’. Individual procedures for managing behaviours to be more specific. Care plans must be regularly reviewed and updated as changes occur, or new needs are identified. Cross-referencing within the care plans to be improved. (Previous requirement April House DS0000044204.V338813.R01.S.doc Version 5.2 Page 28 Timescale for action 31/07/07 2 OP2 5& Schedule 4 15 31/12/07 3 OP7 31/07/07 4 OP18 13(4)(6) 26/10/2004, 24/5/2005, 31/10/05 & 15/05/06, 18/12/06 partially met and ongoing). Staff must be trained in the management of aggression and dealing with behaviours associated with residents’ dementia that my cause harm to themselves or others. Training on abuse and protection to be provided. (Previous requirement 31/10/05 & 15/05/06, 28 02 07 carried forward). The registered persons must ensure that the home is of sound construction and kept in a good state of repair externally and internally. Programme of routine maintenance and renewal of the fabric and decoration of the premises to be continued. New action plan to be submitted. (Previous requirement 26/10/2004, 24/5/2005, 31/10/05 & 15/05/06, 31/01/07 ongoing and carried forward). There must be sufficient numbers of toilets provided to meet residents’ needs. Toilet facilities to be reviewed and action plan to be submitted. (Previous requirement 26/10/2004, 24/5/2005 & 15/05/06, 31/01/07 carried forward). Suitable furnishings, fixtures and fittings must be provided in bedrooms. 31/07/07 5 OP19 13(4), 16, 23 31/07/07 6 OP21 23(2)(j) 31/07/07 7 OP24 16(2)(c) 31/07/07 April House DS0000044204.V338813.R01.S.doc Version 5.2 Page 29 Bedroom audit to be carried out and action plan submitted showing timescales for replacement/renewal of worn furnishings. (Previous requirement 26/10/2004, 24/5/2005 & 15/05/06, 31/01/07 carried forward). Systems in place to control the spread of infection must be in accordance with relevant legislation and published professional guidance. Provide appropriate foot operated pedal bins. Ensure a safe system of transport between the laundry and the main building. Ensure the premises are kept clean, hygienic and free from offensive odours throughout. (Previous requirement 15/05/06, 18/12/06 partially met and ongoing). At all times there must be 31/07/07 suitably qualified, competent and experienced staff working at the home in such numbers as are appropriate for the health and welfare of the residents. (Previous requirement 26/10/04, 24/05/05, 31/10/05 & 15/05/06. 11/12/06). Evidence to be submitted of action taken. Staff must be provided with training appropriate to the work they are to perform. Structured induction training April House DS0000044204.V338813.R01.S.doc Version 5.2 Page 30 8 OP26 13(3) 16(2) 23(2) 31/07/07 9 OP27 18 10 OP30 18 31/07/07 (Skills for Care certified) to be provided and persons working at the home must be appropriately supervised. During a new workers induction an appropriately qualified experienced staff member must be appointed to supervise the new worker. This process to be documented. (Previous requirement 26/10/2004, 24/5/2005, 31/10/05 & 15/05/06, 31/12/06 carried forward). Arrangements must be made to 31/07/07 provide a safe system for moving and handling residents. (Previous requirement 26/10/2004, 24/5/2005 & 15/05/06, 28/02/07 not met and carried forward). The care home must be conducted in a manner that respects residents’ dignity. Staff must be trained in appropriate communication methods to engage with people who have dementia. (Previous requirement 18/12/06 partially met and carried forward) Sufficient meaningful activities to 31/07/07 be provided suitable for residents with dementia. Programme of activities to be arranged having regard to the needs of residents. (Previous requirement 18/12/06 partially met and carried forward) All staff to complete dementia DS0000044204.V338813.R01.S.doc 11 OP38 13(5) 12 OP10 12 31/07/07 13 OP12 16(2)(n) 14 OP30 18 31/07/07 Page 31 April House Version 5.2 awareness training. Care staff to follow this with a more in-depth training. Senior care staff to complete an advanced dementia-training programme. Action plan be submitted. (Previous requirement 15/05/06, 31/03/07 carried forward). To ensure that the home is run in the best interests of the residents. The registered providers, or an employee not directly concerned with the conduct of the home, must visit the home once a month and write a report on the conduct of the home. The report must be kept available for inspection if requested. (Previous requirement 18/12/06 and carried forward) Suitable arrangements must be made to prevent infection, toxic conditions and the spread of infection at the care home. In relation to the training of staff in infection control. (Previous requirement 26/10/2004, 24/5/2005 & 15/05/06, 30/04/07 and carried forward). Suitable arrangements must be made for the training of staff in first aid. (Previous requirement 24/5/2005 & 15/05/06, April House DS0000044204.V338813.R01.S.doc Version 5.2 Page 32 15 OP33 12, 26 31/07/07 16 OP38 13(3) 31/07/07 17 OP38 13(4) 31/07/07 31/03/07 not met and carried forward). 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 OP1 Good Practice Recommendations The home could usefully include in its admission procedure a checklist to certify the issue of a Statement of Purpose, Service User Guide; and whether other languages or formats were warranted. The home should look for opportunities to introduce periodic assessments of the premises by an OT, so that the home can maintain its capacity to meet the needs of the residents. There should be input from a dietician or dementia specialist in the home’s catering arrangements and periodic top up training. Each lounge should have a loop system for use with hearing aids, subject to specialist advice on this matter That a sluicing facility for the cleaning of commode pans is provided. (Carried forward from 31/10/05 & 15/05/06). To ensure that all appropriate boxes on the medication sheet are completed when administering medicines - When ‘F’ is recorded staff must provide key to show what ‘F’ stands for. 2 OP4 3 4 5 6 OP15 OP4 OP26 OP9 April House DS0000044204.V338813.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Text phone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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