Inspection on 24/05/05 for April House

This inspection was carried out on 24th May 2005.

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 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 15/05/06

April House 31/10/05

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 Unannounced 24 May 2005 09:35 th 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 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 H56-H05 S44204 April House V224980 240505 Stage 4.doc Version 1.30 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 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 836700 april@rossetticare.co.uk Mrs Kiki Cole P C Care Home 30 Category(ies) of Dementia - Over 65 registration, with number of places April House H56-H05 S44204 April House V224980 240505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26/10/2004 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. The home provides care for older people with dementia. April House is situated on the sea front of Westgate, within easy reach of all amenities. There is some off-street parking available and there is an enclosed garden to the rear. The staff team currently consists of an acting manager, senior carers and carers who work shifts including 2 staff on waking duty at night. There are also two cooks, a part-time cleaner and a part-time leisure therapist. The registered providers live nearby and can be easily contacted at all times day or night. April House H56-H05 S44204 April House V224980 240505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out by two inspectors over one day, which lasted 7 hours 40 minutes. Additional time was spent in preparation and report writing. The main focus of the inspection was to check progress made on the 21 requirements and 3 recommendations made at the 26th/27th October 2004 inspection. Time spent in the home comprised of: looking round the communal areas of the home, the kitchen, laundry and sampling some bedrooms; talking to 9 residents, 8 visitors, 6 staff and the 2 registered providers; observing the lunch-time meal being prepared and served, a medication round and reading some records. The registered manager left on 29th November 2004. An acting manager is currently working with the registered providers in managing the home. The Commission for Social Care Inspection received an anonymous complaint in January 2005, following which an additional inspection visit was made on 20th January 2005, when it was found that some elements of the complaint were substantiated. Kent County Council Social Services carried out an adult protection investigation, which has been concluded. What the service does well: What has improved since the last inspection? Relatives said that the acting manager has introduced some new ideas such as: doing gardening with some of the residents. They also felt that the home is cleaner. Some action has been taken to address previous requirements to improve menus, care plans and to meet residents’ health care needs. A new care plan format has been introduced that is easier for staff to follow and the April House H56-H05 S44204 April House V224980 240505 Stage 4.doc Version 1.30 Page 6 dependency assessments being completed by staff give a better picture of the residents and their needs, helping to provide more consistent care for residents. Changes have been made to the menus, which include home cooked meals that are more nutritious. The registered providers have engaged an independent consultant to carry out visits to the home to assess the quality of the care, environment and service provided for residents. This has resulted in an additional element of supervision and support for the acting manager. 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. April House H56-H05 S44204 April House V224980 240505 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection April House H56-H05 S44204 April House V224980 240505 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 & 5 The home’s statement of purpose and service users’ guide do not provide prospective residents and their relatives with accurate information about the home. People cannot make an informed choice when deciding about the home’s suitability. Prospective residents and their relatives are encouraged to visit the home before moving in. EVIDENCE: The statement of purpose and service users’ guide have not been updated since 2003 and both contain some out of date information, for example: it should be made clear that the lower ground floor rooms are not in use for residents. Other inaccuracies include: numbers of baths and toilets; numbers and qualifications of staff employed; the residents’ age range and numbers and sizes of rooms in the home. A relative said he had visited April House for an introductory visit before his wife moved in and liked the home because it was roomy and homely. He confirmed that additional trial visits were offered. The acting manager offered to send someone to collect a prospective resident and relative for a visit to the home. April House H56-H05 S44204 April House V224980 240505 Stage 4.doc Version 1.30 Page 9 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 standard(s) 7, 8, 9 & 10 The individual care plans have improved, but still do not contain enough detail to make sure that residents’ health care needs are met properly. Relatives feel that the home provides good care, but residents are at risk because care plans are not being regularly reviewed and new health care needs are not followed up. The systems for the storage and administration of medications are poor and potentially place residents at risk. Residents are treated with respect. EVIDENCE: The care of five residents was case tracked by observing and speaking to the residents, talking to their relatives and care staff about their care and reading the care plans. The care plans are now well ordered, easier to follow and provide a better picture of the residents and their needs. However, they are still too generalised and do not contain enough information for staff on actions needed to meet the identified needs. Some evident needs were not recorded, such as skin integrity risks. Care plans include a nutritional risk assessment, with weight records and a body mass index score. These were being appropriately completed, but the information was not then used to inform the care plan. Food intake was not consistently recorded in the daily records and actions to address a malnutrition risk had not been followed up. Personal care records could be improved, for April House H56-H05 S44204 April House V224980 240505 Stage 4.doc Version 1.30 Page 10 example it was unclear how often some residents are bathed. Further work is needed to complete the residents’ life story section of the care plans. Monthly reviews were not being recorded. A new dependency assessment tool has been introduced. Those assessed were found to give a more accurate dependency score than previously. It was identified that communication needs have not been acknowledged or recorded. Four relatives said that they feel the care being provided is good. Two relatives spoke of being informed promptly of any health care changes and that staff contact the doctor, or call an ambulance, if necessary. The home has regular contact with the mental health team. The storage facility for controlled drugs (CD) was a box fitted inside the medicine cupboard and not a proper CD cupboard. The medication cupboard was dirty and was not fixed to the wall. The cool box used for drugs that have to be kept cold is not appropriate and this has previously been identified. There were some gaps and discrepancies in the medication administration (MAR) sheets. The lunch time medication administration was observed. The medication cupboard was left unlocked and unattended while the drugs were being taken from the office to give to residents in the lounges and dining area. A safe system to transport medications to residents is needed. All of the relatives praised the way the staff treat residents with respect for their dignity. Residents were at ease with staff and most were dressed in clean clothing. Attention had been paid to grooming, but some males were unshaven. A relative felt it was preferable for the resident to be left unshaven if anxious. A carer took a resident for a shave later in the morning when he agreed for the task to be performed. April House H56-H05 S44204 April House V224980 240505 Stage 4.doc Version 1.30 Page 11 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 standard(s) 12, 13 & 15 The flexible routines in the home can accommodate individual preferences. Contacts with relatives and visitors are positively encouraged. Relatives are happy with the home and care given. There has been improvement in the menus so that meals provided are now more nutritious. EVIDENCE: Relatives commented about the flexible routines in the home. Several were appreciative that residents are not made to go to bed in the evenings if they do not wish to, saying that the evenings are very relaxed and a nice time to visit. A leisure therapist works two mornings and one afternoon each week. She has built up a good relationship with the residents and provides various stimulating activities for them. During this inspection, the leisure therapist was doing the cooking, so there were no activities. A relative spoke of her father’s interest in gardening and of how the acting manager had recently involved him in doing some planting in the garden, which he had enjoyed. Three relatives said they would like residents to be taken out more. Eight visitors were seen during the course of the day and each said that they visit at varying times and are always welcomed. Two residents said that the food is lovely and they enjoy it. Three relatives said that they have observed the meals and “they have lovely meals”. Two relatives came in at lunch-time to help with feeding. Menus have been April House H56-H05 S44204 April House V224980 240505 Stage 4.doc Version 1.30 Page 12 reviewed since the last inspection and now show a more nutritious diet. Home cooked meals are provided, such as braised steak, shepherds pie, home made steak and kidney pie and chicken casserole. A home made apple pie had been made for dessert and the evening meal planned was a pasta bake and fresh trifle. The actual records of food provided for each resident did not contain details of alternatives to the menu, although the menus indicate this. The lunch-time meal was observed. Meals are brought up in the lift to the dining room from the kitchen in the lower ground floor. The cook serves the meals onto plates (with covers) in the kitchen. There is no ‘hot trolley’ but the food temperature is checked in the kitchen at the time of serving. There is a microwave in a kitchenette area adjacent to the dining room, which can be used if necessary. There were no tablecloths on the dining tables and residents were not provided with serviettes or tabards to protect their clothing, consequently some had food stains on their clothes in the afternoon. There were twelve residents sitting at dining tables, relatives were feeding two residents in the music lounge and one resident was eating dinner in an armchair in the main lounge. A carer sat beside a resident when assisting with feeding. The carer did not take any notice when a resident did not eat. There was only one carer in the dining room during the meal time. The meals on the plates were attractively served. April House H56-H05 S44204 April House V224980 240505 Stage 4.doc Version 1.30 Page 13 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 standard(s) 15 The home has a satisfactory complaints procedure but relatives are unsure how to contact the registered providers. EVIDENCE: The home has a formal complaints procedure, which is displayed in the entrance hall. This includes outdated details for the Commission and does not include the address for contacting the registered providers, although a small Rossetti Care card had been added to the bottom. Three relatives stated that they have no complaints, saying, “staff are so kind to” (the resident) “and we know s/he is not mistreated.” They said they would talk to the acting manager if they had a complaint. Two other relatives spoken to were not aware of the formal complaints procedure, but stated they were happy with the care and had no complaints. Relatives said they felt confident that if they had any concerns, the acting manager, or senior care staff, would deal with them. However, they were unsure how to contact the registered providers without having to ask staff. A complaints book was not being used properly by staff, who were using it as a communication book. April House H56-H05 S44204 April House V224980 240505 Stage 4.doc Version 1.30 Page 14 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 standard(s) 19, 20, 25 & 26 The building is in a poor state of repair and the quality of the furnishings and fittings is poor. This does not provide a safe, pleasant environment for residents to live in. The maintenance and fabric renewal programme is ineffective. There have been no improvements in the home’s infection control procedures and practices, which are unsafe and place residents and staff at risk of harm. EVIDENCE: The music lounge ceiling has been repaired and redecorated since the last inspection, but no further progress has been made to improve the maintenance, decoration and refurbishment of the building. External fire escape stairs are still rusty and covered in moss. The outside paintwork is flaking and the wooden balustrade on the first floor balcony is rotten. A bedroom identified at the 26th/27th October 2004 inspection, as having stained flooring, was still the same. There were signs of a water leak by the pay phone and the coving was missing above the phone and above the radiator in the ground floor corridor opposite the pay phone. Relatives commented that they would like to see the building “done up a bit”. April House H56-H05 S44204 April House V224980 240505 Stage 4.doc Version 1.30 Page 15 The lower ground floor has four rooms specified as bedrooms, which are not habitable as such. One has been changed into a hairdressing/chiropody room, one is used as an office and the other two are in an unfit state. The bathroom on this floor has been stripped of its sanitary ware. The registered providers were asked to submit an action plan for the refurbishment and/or use of these lower ground floor rooms on 27th October 2004, but this was not provided. A maintenance book was seen to have ten pages of work to be completed, but there were no dates of when repairs needed had been first identified or of the planned completion dates. One high risk identified, where a wardrobe needed fixing to a wall, had not been completed. The programme to guard radiators is progressing and further guards have been purchased. The maintenance person was working on these. Communal areas of the home were clean. Eight bedrooms were seen. A strong urine odour was noted in two bedrooms and one other bedroom had a slight odour. Work identified at the October 2004 inspection as necessary to ensure safety in the laundry, has not been completed. Unsafe practices for dealing with soiled articles were evident. Staff were not being provided with appropriate protective equipment. There were no alginate bags for fouled laundry. The clinical waste bin in the ladies toilet is wooden with a hinged lid. There are no hand washing facilities in the residents’ toilets. The general assistant who does the laundry was due to attend an infection control course. April House H56-H05 S44204 April House V224980 240505 Stage 4.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 & 30 Only limited progress has been made to address staffing shortfalls previously identified. The number of care staff on duty in the evenings is not sufficient to provide residents with adequate protection or ensure that their needs are properly met. The recruitment and induction processes for new staff were unsatisfactory. EVIDENCE: The cook was off sick and the arranged agency carer had failed to arrive on duty at 08.00 hours. One of the two carers on duty was initially doing the cooking, but the leisure therapist took over so the carer could accompany a resident to hospital. An agency carer, who had worked at the home previously and knew the residents, arrived at approximately 10.15 hours. The staff adapted to the situation and maintained a calm atmosphere. Changes have been made to the staff rota to provide a third carer on duty between 07.00 hours and 08.00 hours as this had been identified as a peak time. However, evening staffing levels have been reduced to two carers between 17.00 hours and 20.00 hours, when there had previously been three. Evidence from the care plans and discussion with relatives and staff indicates that three (and sometimes four) residents require two staff to move them and attend to their care, leaving no one in the lounge to supervise residents. A relative said, “staff can be a bit sparse in the evenings”. Another relative felt the care is good, but stated “staffing is the biggest problem”, “the staff are pressured” and “staffing levels could be improved”. April House H56-H05 S44204 April House V224980 240505 Stage 4.doc Version 1.30 Page 17 Residents’ dependency assessments are being completed monthly by the care staff and provide a reasonably accurate reflection of their needs. The list of residents’ dependency scores being used by the registered providers to calculate staffing numbers was inaccurate. At least three rated as low dependency were actually high, according to the dependency scores in their care plans. Three staff files were seen and these still do not contain all the required information. A carer had started work following recruitment checks including a POVA First check, but before the CRB check had been received. The induction training check list was blank and there was no evidence to show that she had been properly supervised whilst on shift, as the regulations require. The staff training matrix did not show the dates courses were completed. The staff files did not show whether individual training needs had been identified and there were no individual training programmes. There was evidence of regular formal supervision. April House H56-H05 S44204 April House V224980 240505 Stage 4.doc Version 1.30 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33 & 38 The current arrangements for the management of this home lack the leadership and guidance necessary to ensure a consistent quality care. The quality monitoring process has not brought about the necessary changes to improve the residents’ environment and safety. Insufficient attention to health and safety issues poses a risk of harm to residents, staff and visitors to the home. EVIDENCE: The acting manager works on shift with the carers and does not have sufficient supernumerary management time to adequately fulfil the necessary management tasks. Health and safety shortfalls identified at the October 2004 inspection have not been addressed. Relatives commented that they like the new acting manager, saying that she had made improvements and introduced new ideas, such as changing the dining room layout and taking the residents into the garden. However health and safety procedures were not being adhered to, particularly in relation to building maintenance, environmental April House H56-H05 S44204 April House V224980 240505 Stage 4.doc Version 1.30 Page 19 risks, kitchen cleanliness, laundry procedures and the safe management of clinical waste. The registered providers have appointed a person to carry out regulation 26 visits to the home to inspect the premises and report on the standard of care provided. Issues raised in the March 2005 visit report identify similar things to those raised at the October 2004 inspection, which have not been addressed. A relative asked why a lounge fire exit door could not be opened. A door in the bay window in the lounge leads onto a ramped exit walkway to the front garden, but the door has been sealed. A fire plan on the residents’ notice board shows this as an exit route. The acting manager said the relative had discussed this with her, but she was unsure whether the registered providers would be following this up. A copy of the home’s electrical certificate still could not be found and had been asked for at the October 2004 inspection. The staff training matrix shows two staff with ‘stars’ against their names for infection control training and only four staff with ‘stars’ for manual handling training. Both these were identified as requiring action at the October 2004 inspection. There was no indication as to whether the ‘stars’ represent completed training or planned training. The matrix indicates that the new carer had not completed any fire training. April House H56-H05 S44204 April House V224980 240505 Stage 4.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x x x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 2 COMPLAINTS AND PROTECTION 1 2 x x x x 2 1 STAFFING Standard No Score 27 1 28 x 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x x 1 x 2 x x x x 1 April House H56-H05 S44204 April House V224980 240505 Stage 4.doc Version 1.30 Page 21 yes 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, 5 & 6 Requirement Timescale for action 31/8/2005 2. OP7 15 3. OP8 13 4. OP9 13 The statement of purpose and service users guide must contain accurate information and be kept under review. They must be revised to take account of any changes to the environment, services and staffing. Revised copies to be forwarded to the Commission. (Previous requirement made 27/10/2004 timescale of 31/1/2005 not met). Care plans must be sufficiently 30/9/2005 detailed. Needs identified in the various parts of the assessment process must be included. Care plans must be kept under review and updated as changes occur and new needs are identified. (Requirement partially met from 27/10/2004 carried forward) Skin integrity risks associated 30/9/2005 with incontinence and/or other factors must be followed through in the care plans. The registered persons must 30/9/2005 ensure that medication is recorded and administered safely and accurately. Appropriate drug storage facilities and refrigerated facilities to be Version 1.30 Page 22 April House H56-H05 S44204 April House V224980 240505 Stage 4.doc 5. OP16 22 6. OP19 13, 16, 23(1)(2) 7. OP20 16(c) 23(2)(i) 8. OP21 23(j) provided with reference to the Royal Pharmaceutiacal Societys guidance. Procedures for the safe transportation of medication around the home to be reviewed and revised as discussed. (Previous requirement27/10/2004 not met) The complaints procedure must contain details of how to contact the registered providers and the correct details for the Commission (CSCI). The registered persons to ensure that residents or their representatives are provided with the updated copy. The registered persons must ensure that the home is of sound construction and kept in a good state of repair externally and internally. (1) Action Plan to be submitted showing a maintenance programme that provides short and long-term plans and identifies target dates for completion of urgent work. (Previous requirement27/10/04 not met). (2) Proposals for the refurbishment and use of the lower ground floor to be submitted. (Previously required 8/12/03 and 27/10/04) There must be sufficient armchairs provided in lounges for residents use and sufficient numbers of additional chairs for visitors use. This is a previously made requirement 27/10/2004 carried forward There must be sufficient numbers of toilets provided to meet residents needs. Toilet facilities to be reviewed and evidence submitted showing actions to be taken - (rooms specified at 27/10/2004 31/8/2005 (1)31/8/05 (2)30/6/05 30/9/2005 30/9/2005 April House H56-H05 S44204 April House V224980 240505 Stage 4.doc Version 1.30 Page 23 9. OP22 23(n)(o) 10. OP24 16(2)(c) 11. OP25 13(4) 12. OP26 13(3) 16(2)(k) 23(2(k) 13. OP27 18 inspection) This is a previously made requirement carried forward. Access to the home for disabled persons must be safe and appropriate. Action plan to be submitted. This is a previously made requirement carried forward. Suitable furnishings, fixtures and fittings must be provided in bedrooms. Bedroom audit to be carried out and Action Plan submitted showing timescales for replacement/renewal of worn furnishings. This is a previously made requirement carried forward. Record of hot water temperature tests to be kept. (Previous requirement of 27/10/04 carried forward) 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 storage and hand washing facilities in all areas where staff have to deal with body fluids, spillages and clinical waste. Laundry floor finish to be impermeable and wall finishes to be readily cleanable. Requirements previously made on 8/10/2003, 7/6/2004 and 27/10/2004 The registered persons must provide suffient numbers of suitably qualified and experienced staff on duty in numbers that are appropriate for the health and welfare of residents. To conduct a complete review of staffing levels 30/9/2005 31/8/2005 30/6/2005 15/6/2005 15/6/2005 April House H56-H05 S44204 April House V224980 240505 Stage 4.doc Version 1.30 Page 24 14. OP29 19 15. OP30 12, 13, 18(1)(c) 16. OP31 8, 9, 10 17. OP38 13(3)(4)( 5) & 23(2)(b) (4)(5) taking account of accurate dependency scores and to review shift patterns. Action plan and evidence to be submitted. Staff files must contain the information specified in Schedule 2 and new staff must not start work before return of their CRB check unless regulation 19(11) (Miscellaneous Amendments) Regulations 2004 is complied with. 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 approprtiately qualified experienced staff member must be appointed to supervise the new worker. This process must be documented. Evidence of individual staff training programmes and an active staff training matrix with dates/expiry dates to be provided. The registered persons must ensure that the manager appointed has the necessary experience and qualifications to run the home. The manager must be given sufficient supernumerary time. There must be clear lines of accountability setting out the responsibilities of the manager and those of the registered providers. The registered persons must ensure that environmental risks are identified, strategies to reduce risk put in place and regularly reviewed. Environmental risk assessments 30/9/2005 30/9/2005 30/9/2005 30/6/2005 April House H56-H05 S44204 April House V224980 240505 Stage 4.doc Version 1.30 Page 25 18. OP38 23(4) must be sufficiently detailed. Regular building health and safety checks to be carried out, recorded and actioned. Care staff must be provided with moving and handling training,infection control training, first aid and fire safety training at the appropriate intervals. Copy of the homes current electrical certificate to be provided (previous requirement 27/10/2004). Evidence to be submitted to confirm that the lounge fire exit door in the bay window is being maintained as a safe fire exit. 15/6/2005 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 records of food provided are more detailed and show the individual choices. That a heated trolley is provided for the transport of food from the kitchen on the lower ground floor to the dining room on the ground floor. April House H56-H05 S44204 April House V224980 240505 Stage 4.doc Version 1.30 Page 26 Commission for Social Care Inspection 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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