Inspection on 15/05/06 for April House

This inspection was carried out on 15th May 2006.

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

April House 10/03/08

April House 12/06/07

April House 07/11/06

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 Christine Grafton Key Unannounced Inspection 15th May 2006 09:50 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.V291886.R01.S.doc Version 5.1 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.V291886.R01.S.doc Version 5.1 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 Vacant Care Home 30 Category(ies) of Dementia - over 65 years of age (30) registration, with number of places April House DS0000044204.V291886.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st October 2005 Brief Description of the Service: April House is a detached 4-storey building, comprising of 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 includes bedroom space for 5 residents in the lower ground floor, so at this time, as those rooms are not available, there is only space to accommodate a maximum number of 25 residents. The home provides mostly single occupancy bedrooms and there are two communal rooms including lounge areas and a dining area. April House is situated on the sea front of Westgate, within easy reach of all amenities. There is some off-street parking available and an enclosed garden to the rear. The staff team currently consists of an acting manager and team of carers who work shifts including 2 staff on waking duty at night. There are also some ancillary staff and a part-time leisure therapist. Information from the registered providers in May 2006 states that the fees range from £367.82 to £450.00 per week. April House DS0000044204.V291886.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report takes account of information obtained from various sources since the last inspection, including two visits to the home; telephone contacts; written information provided by the new manager and registered providers; surveys completed by, or on behalf of residents; relatives comments; views of one care manager and one doctor. An unannounced site visit was carried out by two inspectors on 15th May 2006 between 09.50 hours and 16.30 hours and a second visit took place on 17th May 2006 between 09.30 hours and 13.00 hours. The visits included talking to the new manager, 4 staff members, 5 relatives; looking round the home, spending time talking with residents, observing their general demeanours, behaviours and interactions with staff and checking some records. The care of 5 residents was case tracked. At the time of the visits there were 18 residents. There has been no registered manager of this home since 29th November 2004. The manager appointed in September 2005 left in January 2006. The new manager has been in post since 13th January 2006. Many of the requirements in this report are ongoing from previous reports. What the service does well: What has improved since the last inspection? Relatives and staff commented that the new manager is providing good leadership and making improvements that are benefiting residents. A change in the dining environment has created a more congenial setting. This combined with the way in which meals are now served, has made meal times more pleasant for residents. The new heated food trolley makes sure that meals are kept hot until served. Two relatives commented that the food is usually good. April House DS0000044204.V291886.R01.S.doc Version 5.1 Page 6 The storage and management of medications has improved and on the whole now provides adequate protection to residents. Quite a few of the building improvements identified at the last inspection have been completed. These include redecoration of some more bedrooms, new dining tables and chairs and the replacement of a section of one of the external fire escape stairs. These have helped to improve residents’ comfort and safety. What they could do better: Further improvements are still needed in a number of areas to ensure residents have a safe, comfortable environment and to promote their good health and welfare. The most important of these is to make sure there are enough staff on duty, with the particular skills needed to work with people with dementia, to ensure they have the best possible quality of life. To do this there must be enough care staff on duty, but also enough staff to do the cleaning and take care of laundry. Staff need specific training in dementia care to equip them to do their jobs, which should then be ongoing for the care staff and more advanced for the more senior staff. Training is also needed on the management of aggression and abuse. Care planning and management of residents’ healthcare still needs some improvement, particularly with the initial assessment process prior to admission, to make sure that any risks are dealt with appropriately. The amount of time available for staff to do activities with residents is limited due to the overall poor staffing levels. The leisure therapist only now works two mornings at the home. Improvements are necessary to make sure that residents are provided with opportunities for stimulation throughout the week. The work on improving the environment must be continued. There are still a number of maintenance and refurbishment things to be completed. There needs to be a system in place to regularly check the building for health and safety and any maintenance needed and to make sure that things identified are addressed. The refurbishment programme needs to include replacement of old, worn furniture. There were some offensive odours in some bedrooms and a corridor area. The laundry was still unhygienic, despite changes made since the last inspection. Practices to maintain hygiene and prevent the spread of infection within the home were poor. These need to be improved to protect residents and staff and to ensure that residents are provided with a pleasant environment. Please contact the provider for advice of actions taken in response to this April House DS0000044204.V291886.R01.S.doc Version 5.1 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. April House DS0000044204.V291886.R01.S.doc Version 5.1 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.V291886.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The statement of purpose and service users’ guide provide the information needed for people to make a decision about moving into the home. Pre-admission assessments are still not sufficiently thorough to ensure that the home can meet the needs of new residents at the time of their admission. The home does not provide intensive rehabilitation, or admit people for intermediate care, so standard 6 is judged as not applicable. EVIDENCE: Updated copies of the Statement of Purpose and Service Users’ Guide were provided at end of second site visit. These have been revised and amended to contain all the necessary information. There is now one less toilet available for residents’ use, which needs to be reflected in the documents, but apart from this, both are well written and provide a good indication of what to expect upon moving into the home. April House DS0000044204.V291886.R01.S.doc Version 5.1 Page 10 The pre-admission assessment documentation was seen for two new residents. The new manager carries out her own assessment visits prior to admission and obtains copies of the care management assessments wherever possible. However, the home’s pre-admission assessments lacked important information about the person and were still not sufficiently detailed. For example, information about a person’s communication difficulties had not been recorded and the risk of falls had not been picked up in the risk assessment. The home’s assessments and care plans, drawn up following admission, had not been adequately completed and contained significant gaps. Information in the care management assessment had not been used to inform the care plan. Discussion with the new manager indicated that she clearly understood the new residents needs but had not had time to record everything. One of the new residents had been unsettled at first, but had become more content since being given a key to their bedroom door. April House DS0000044204.V291886.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care planning system provides the basic information necessary to plan each individual resident’s care, but improvements are needed to ensure that care plans are ‘person centred’ and specific. Medication storage and procedures have improved, but further attention is needed in the record keeping to ensure safe practice. Residents are treated with respect for their dignity. EVIDENCE: The care of five residents was case tracked. The care plan format used covers the components specified in the standards and contains some good information, but due to the layout, there is repetition and some things are not appropriately cross-referenced. An audit of a resident’s daily records, to follow up a significant incident, was difficult because of this and the records failed to show whether it had been appropriately followed up as part of a care plan review. Some information about the event, provided in conversation with the resident’s husband, also had not been included in the care plan. April House DS0000044204.V291886.R01.S.doc Version 5.1 Page 12 Another resident’s dependency assessment was judged as low, but this person’s behaviour included verbal and physical aggression. Entries in the care plan indicated that reviews had taken place, but no details were recorded. The behaviour sections of the care plans on the whole, were not detailed or specific enough. Care plans are not sufficiently ‘person centred’. This was particularly evident in one case where the care plan did not identify how to ensure equality for a person with dementia and the added disability of deafness, which can exacerbate any communication problems associated with the dementia. Although an example of good communication was observed, the lack of recording means that vital information could be lost if carers forget to transfer it verbally. A new medication trolley has been obtained since the last inspection and has been suitably secured. The medication administration (MAR) sheets were on the whole well recorded. A discrepancy was identified in that a resident’s tablets left did not match with the records in the MAR sheet. The new manager was asked to check this, but the overall management of the medications indicated an improvement. The home now has an appropriate refrigerator for medications that have to be kept cool. On the whole, staff were observed treating residents with respect for their dignity. A situation was observed that indicated staff did not have sufficient time to spend with a resident to allay their agitation, which then continued throughout an afternoon period. Staff were clearly doing their best, but did not understand the importance of recognising the person’s individual reality, or how to make more measured responses to try to reach the person’s own world. In order to do this, staff need training in dementia care beyond the basic. There needs to be enough staff on duty so that staff do not feel under pressure to complete tasks, or feel rushed when they need to spend time really listening to what the residents are trying to communicate. (See also staffing section – standard 27). April House DS0000044204.V291886.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although some meaningful activities are provided, there are not enough staff on duty to make sure that residents with dementia have the appropriate stimulation throughout the whole week. Contacts with relatives and visitors are positively encouraged. The change in the dining arrangements is having a beneficial effect and residents’ meals are being served in a more appealing way. EVIDENCE: The staff rota indicated that the leisure therapist has reduced her hours from three to two mornings a week since the last inspection. The leisure therapist was observed working with residents on one morning of the site visits. Residents’ responses to the activities indicated their well-being. Activities included floor games, soft ball, use of sensory objects, music, story telling, or spending time with residents individually. Regular outings in the home’s minibus are arranged. Whilst all this is good on two half days a week, care staff are expected to do activities with residents the rest of the week. As evidence was gathered that there are not enough staff on duty at all times to meet the needs of residents, there is a shortfall in completely meeting standard 12. (See staffing section). April House DS0000044204.V291886.R01.S.doc Version 5.1 Page 14 Two visiting relatives said they are encouraged to visit and always made to feel welcome. A relative commented that his wife is happier sitting in the new lounge area created since the changeover in the dining area. He feels that she is now more stimulated and fulfilled. The lunchtime meal was observed. The new dining room has been furnished with round tables and chairs and provides a pleasant environment for eating. A heated trolley is now in use to keep the food hot when it is brought up from the kitchen. Meals were attractively served and portion sizes varied according to taste. An alternative meal was given to a resident who did not like the main choice. Two relatives regularly visit at lunch times and help feed their spouses. Both commented that the food is usually good. Whilst some good interaction between staff and residents was observed during the mealtime, observations were made of some practices that did not show respect for dignity. In one instance, the new manager acted immediately to address it. A recommendation was made at the last inspection to review the menus to provide two cooked options rather than the main meal and a salad, or omelette, as the alternative choice. The manager had not had time to do this, but the cook was now keeping better records of the food provided. The manager agreed that the menus could be more varied. April House DS0000044204.V291886.R01.S.doc Version 5.1 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service, but determined due to the ongoing staff training needs not having been met at this and from previous inspections. The home has a satisfactory complaints procedure. However, the lack of sufficient staff training in dementia care, communication and the management of behaviour does not ensure that physical and verbal aggression by residents is understood and consistently dealt with appropriately. EVIDENCE: Relatives’ comments in their surveys and those spoken to at the two site visits confirmed that they know who to speak to if they have a concern or complaint. Two relatives commented that the home has improved under the new manager’s leadership and they felt confident that she would deal with any complaints in a competent way. The manager said there had been no complaints since the last inspection, but confirmed that any complaints received would be taken seriously and investigated. Staff spoken to indicated their understanding of the home’s complaints procedure and the importance of passing information on if abuse were suspected. Information provided by the new manager indicates that only three staff have received training on the management of aggression and only two of the current staff group have done training on abuse. Physical and verbal aggression between residents and staff management of such situations was raised at the last inspection and again at this inspection, as April House DS0000044204.V291886.R01.S.doc Version 5.1 Page 16 an area where staff actions are based upon good intent, rather than from a sound knowledge base. The lack of sufficient staff training in dementia care and the management of behaviour, plus the need for further training in communication, impacts upon the way incidents are dealt with. All this, combined with the lack of specific detail in the care plans on how to manage behaviour and the absence of clear audit trails following any significant incidents, poses a risk of harm to residents if these things are not dealt with appropriately. April House DS0000044204.V291886.R01.S.doc Version 5.1 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Some recent improvements to the environment have made a difference to residents’ safety and comfort. However, further improvements are still necessary to provide residents with a safe, well-maintained environment. Measures to maintain hygiene and prevent the spread of infection in the home are still unsatisfactory and place residents and staff at risk of harm. EVIDENCE: The tour of the building identified that some improvements have been made since the last inspection, including: redecoration of a further six bedrooms; two new washbasins in a top floor double bedroom; new dining room tables; provision of a heated trolley for food transportation between the kitchen and dining room; a new macerator for disposal of soiled incontinence pads; new vinyl flooring and new washable work top in the laundry; radiator guard in ground floor bathroom; first floor toilet in working order; part of external fire escape stairs replaced and moss removed from fire escapes. April House DS0000044204.V291886.R01.S.doc Version 5.1 Page 18 However, there are still a significant number of environmental issues requiring attention. Changes to the laundry completed since the last inspection have not resolved the risk of cross contamination. The creation of a hand made unit with flip top lid to separate soiled clothing and bedding has not been properly thought through. Changes made under the direction of the previous manager, whilst well-intentioned, still pose significant contamination risks that were discussed with the new manager. The laundry was again not being kept clean, soiled washing was being collected in black plastic bags with no segregation of clean and dirty areas in the laundry. The piles of soiled laundry waiting to be washed and the general untidiness of the laundry indicated a lack of staff time. This was agreed in discussion with the new manager (see staffing section). Staff practices being followed indicate inadequate infection control procedures. There is still a lack of sufficient foot operated pedal bins in areas where clinical waste is handled. In some places, where pedal bins have been provided, they are far too small and were seen to be full. A wheelie bin in the ladies toilet is used for soiled articles and was extremely odorous. There were strong odours in a number of areas, including the ground floor bedroom corridor and four bedrooms. A toilet near the lounge areas has been taken out of use for the residents, as it now holds the macerator. This was previously the male toilet; so male residents now have to use the toilet in the bathroom at the end of the ground floor bedroom corridor, which is kept locked. They need staff assistance to open it and would not have access if the bath were being used. This bathroom had no liquid soap and no toilet paper. There was no liquid soap in the room where the macerator has been fitted. The majority of bedrooms have been personalised with the residents’ own possessions. The manager stated that disabled access to the home has been reviewed since the last inspection and the doorway from the lounge to the front ramp has been re-installed, but the railings need attention. The kitchen extractor fan was not working and the kitchen was extremely hot, so an immediate requirement was made. The new manager subsequently confirmed that this was rectified on 19th May 2006. April House DS0000044204.V291886.R01.S.doc Version 5.1 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The current staffing levels are insufficient to meet the diverse needs of the people with dementia being cared for in the home. The home’s recruitment procedures are generally satisfactory but induction training needs to be improved. Staff need further training in dementia care to improve their competence. EVIDENCE: The duty rota provided for the week of inspection indicated three carers on duty during the day and two at night. The manager stated there were a total of 554 care hours, but an analysis of the rota for the week of the site visits indicated a total of 420 care hours plus 6 activity hours and the 40 hours worked by the manager. The calculation of care hours provided by the home indicates 5 high, 3 medium and 10 low dependency residents for which the Department of Health guidance indicates that a total of 495 duty hours per week should be provided. However, the staffing tool should be used as a guide to the minimum number of care hours required. The calculation did not take into account the effect on the provision of care of the general environment and layout of the building, or of any special assistance needed to deal with behaviours that challenge. This has been an ongoing issue. Some of the dependency assessment scores did not accurately reflect the residents’ needs. The new manager stated that her assessments of some of April House DS0000044204.V291886.R01.S.doc Version 5.1 Page 20 the residents’ dependencies were higher and did not match the dependency scores identified in the assessments completed by staff. Observations made during the inspection indicated that there were not enough care staff on duty to meet the complex needs of residents with dementia, do activities and deal with the laundry. For example, staff discussion indicated that three residents need two staff to assist them with toileting. Therefore, when two care staff are needed to deal with the personal care needs of one of those residents, either in the bathroom, or in their bedroom, only one carer is left to supervise residents in the lounge areas. If that carer then has to assist a resident to the toilet, there is nobody left to supervise residents in the lounges. At weekends, when the manager and cleaner are off duty and the cook finishes in the afternoon, care staff have to do any necessary cleaning, as well as deal with the evening meal. The state of the laundry and large amount of soiled items waiting to be laundered indicated that there had been insufficient time to deal with this. The manager has identified that an extra person is needed to do the laundry and cover the cleaning on the cleaner’s three days off and said she is hoping to recruit someone for this role. The staff-training matrix indicates that two staff have completed their National Vocational Qualification (NVQ) in care level 2, but only one is currently on the rota. The manager stated that three staff are currently working towards their NVQ level 3 and one is currently doing their NVQ level 2. Only four of the eleven care staff on the rota have done a basic dementia care course. A new staff member confirmed they had gone through an induction process. Staff recruitment is generally satisfactory although there were no photographs on two files for new staff employed. There was no induction record for a new staff member who had been employed at the home for six weeks and another new staff member’s induction record had not had all the relevant parts completed even though she had been in post for two months. This was particularly important in relation to the moving and handling section, which had not been completed. April House DS0000044204.V291886.R01.S.doc Version 5.1 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 36 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The appointment of the new manager is having a positive effect on the home and provides the leadership and skills needed to bring about the necessary changes. The manager has a good understanding of what needs to improve in the home, but the support and cooperation of the registered providers is essential to bring about and sustain the necessary improvements. Health and safety practices still need to be improved to safeguard residents, staff and visitors to the home. EVIDENCE: There has been no registered manager in post since December 2004, following which there was a period where staff lacked the necessary leadership and direction until another manager was appointed in September 2005, but she left on 13th January 2006. April House DS0000044204.V291886.R01.S.doc Version 5.1 Page 22 The new manager started on 16th January 2006, has the necessary qualifications and previous management experience with the client group and is currently undertaking an NVQ Assessors Course. An application for registration as manager has not yet been submitted to the Commission. Comments from relatives and staff spoken to indicated that they felt the new manager was making improvements in the home for the benefit of residents. The management have continued to create an open culture. Copies of minutes of recent staff and residents’/relatives meetings and the home’s updated development plan indicate consultation with relatives and staff about practices in the home. Efforts have been made to address some of the last inspection requirements but there are still a number of outstanding requirements that have not been met. Some of the safety risks identified at the last inspection have been addressed, including replacement of part of the external fire escape stairs that had been identified as posing a safety hazard. However, some environmental risks were still apparent, such as the height of the kick board at the fire escape door on the top floor, posing a trip hazard, but the manager had not had time to update the environmental risk assessments. The fire safety logbook had been satisfactorily completed except for the previous two weeks. The staff-training matrix indicates that five care staff require moving and handling training, plus a new staff member who had not done any recent moving and handling training. April House DS0000044204.V291886.R01.S.doc Version 5.1 Page 23 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 3 x 2 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 1 1 2 1 2 3 2 2 1 STAFFING Standard No Score 27 1 28 1 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X X 2 X 2 April House DS0000044204.V291886.R01.S.doc Version 5.1 Page 24 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 Pre-admission assessments must be sufficiently detailed to enable care staff to meet the persons needs upon admission. Assessments must include a risk assessment, be kept under review and having regard to any change of circumstances be revised as necessary. (Previous requirement 31/10/05 not met). Timescale for action 31/07/06 2. OP7 15 31/07/06 Care plans must be sufficiently detailed. Individual procedures for managing behaviours that might cause harm to self or others must be more specific and regularly reviewed. Care plans must be updated as changes occur and new needs are identified. (Previous requirement 27/10/2005, 24/5/2005 & 31/10/05 partially met and ongoing). The registered persons must promote and make proper provision for the health and safety of residents. Records of actions taken 31/07/06 3. OP8 12 &13 April House DS0000044204.V291886.R01.S.doc Version 5.1 Page 25 following significant incidents to be improved. Care plans to be ‘person centred’. 4. OP9 13(2) The registered persons must make appropriate arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. Medications must be recorded and administered safely and accurately. (Previous requirement 27/10/04 & 24/5/05 almost met). 5. OP12 16 Residents must be provided with opportunities for stimulation throughout the week. There must be enough staff on duty and specific time allocated for this purpose. Staff organising activities must have the necessary skills to tailor activities for people with dementia. The registered persons must ensure that physical and verbal aggression by a vulnerable adult to other vulnerable adults is dealt with appropriately to protect them from harm. The registered persons must ensure that sufficient staff are trained in the management of aggression and dealing with behaviours associated with residents’ dementia that my cause harm to themselves or others. (Previous requirement 31/10/05 not met and carried forward). 31/08/06 17/05/06 6. OP18 13(4)(6) 30/09/06 April House DS0000044204.V291886.R01.S.doc Version 5.1 Page 26 Training on abuse and protection to be provided. 7. OP19 13(4), 16, 23 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. (Previous requirement 27/10/2004, 24/5/2005 and 31/10/05 partially met and carried forward). New action plan to be submitted. 8. OP21 23(j) There must be sufficient numbers of toilets provided to meet residents’ needs. Toilet facilities to be reviewed. Identified deficit near lounge and dining areas to be addressed. (Rooms previously specified at 27/10/2004 inspection, no toilet in use nearby bedrooms nos. 16, 17, 18, 19 & 23 on the first floor still not addressed). (Previous requirement 27/10/2004, 24/5/2005 and 31/10/05 carried forward). Action plan to be submitted. 9. OP24 16(2)(c) Suitable furnishings, fixtures and 31/08/06 fittings must be provided in bedrooms. Bedroom audit to be carried out and Action Plan submitted showing timescales for replacement/renewal of worn furnishings. (Previous DS0000044204.V291886.R01.S.doc Version 5.1 Page 27 31/08/06 31/08/06 April House requirement 27/10/2004, 24/5/2005 and 31/10/05 carried forward). 10. OP26 13,16,23 The Registered Persons must ensure suitable arrangements to prevent infection and the spread of infection in the home, including arrangements for the handling of soiled continence aids and soiled laundry, protective equipment, clinical waste and hand washing facilities in all areas where staff have to deal with body fluids, spillages and clinical waste. The laundry must be clean, hygienic and suitable for its purpose. Fouled linen must be transported and laundered safely. Requirements previously made on 8/10/2003, 7/6/2004, 27/10/2004, 24/5/2005 and 31/10/05. 11. OP27 18 The registered persons must provide sufficient numbers of suitably qualified and experienced staff on duty in numbers that are appropriate for the health and welfare of residents. (Previous requirement 27/10/2004, 24/5/2005 and 31/10/05). Evidence to be submitted of action taken. 12. OP28 18 Staff must be trained and suitably qualified to do their jobs. A minimum of 50 of trained members of staff (NVQ level 2 or equivalent) to be DS0000044204.V291886.R01.S.doc 30/06/06 30/06/06 31/12/06 April House Version 5.1 Page 28 achieved. 13. OP30 12, 13, 18 Staff must be provided with training appropriate to the work they are to perform, including structured induction training (Skills for Care certified) 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 must be documented. (Previous requirement 26/10/2004, 24/5/2005 and 31/10/05 carried forward). 14 OP30 12, 13, 18 All staff must complete dementia awareness training. All staff to complete a basic dementia awareness course. 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. 15. OP38 13(3)(4) (5) & 23 The registered persons must ensure that environmental risks are identified and strategies to reduce risk put in place. Environmental risk assessments must be sufficiently detailed and regularly reviewed. Regular building health and safety checks must be carried out and any necessary action taken to ensure safety. April House DS0000044204.V291886.R01.S.doc Version 5.1 Page 29 31/07/06 30/09/06 31/08/06 Care staff must be provided with moving and handling training, infection control training, first aid and fire safety training at the appropriate intervals. (Previous requirements 26/10/2004, 24/5/2005 and 31/10/05 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 OP15 Good Practice Recommendations That the menus are reviewed to ensure that residents are provided with positive choices, to include two hot options at lunchtime. (Carried forward from 31/10/05). That a sluicing facility for the cleaning of commode pans is provided. (Carried forward from 31/10/05). That the new manager updates her knowledge of best practice in dementia care. 2. 3. OP26 OP31 April House DS0000044204.V291886.R01.S.doc Version 5.1 Page 30 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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