Inspection on 31/10/05 for April House

This inspection was carried out on 31st October 2005.

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 15/05/06

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 Announced Inspection 31st October 2005 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.V251376.R01.S.doc Version 5.0 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.V251376.R01.S.doc Version 5.0 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 836700 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.V251376.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th May 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. 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 consists of a manager, senior carers and carers who work shifts including 2 staff on waking duty at night. There are also a part-time cook, 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 DS0000044204.V251376.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was carried out by two inspectors and took place over two days. The total time spent at the home was 12 hours 25 minutes. Additional time was spent in preparation and report writing. The inspection consisted of speaking with the new manager, 3 staff members and 4 relatives/visitors to the home. The inspectors spoke briefly to several residents, but due to the level of their dementia, feedback was obtained using a variety of other methods. These included: case tracking, discussions with staff and relatives, plus observations of the residents’ appearance, demeanours and behaviours. Observations of staff practices and their interactions with residents throughout the two days were also used to inform conclusions reached. Records were seen and an accompanied tour of the building was made. The inspection focussed on the requirements from the last inspection and key standards. As part of the pre-inspection process, a pre-inspection questionnaire was completed and has been used in the preparation of this report. Feedback was sought from relatives, care managers and health care professionals. A total of 13 responses were received. Three relatives, one resident, eight care managers and one general practitioner returned their comments cards that were sent out prior to the inspection. These provided useful feedback about the home and services provided. Issues raised were explored during the inspection. The last registered manager left on 29th November 2004. Since then, an acting manager was promoted and put in charge of the home, overseen by the registered providers. Following two adult protection alerts raised on 10th June and 6th July 2005, the registered providers employed a consultant to manage the home in September, until an appropriately qualified manager could be recruited. The new manager took up her post on 26th September 2005 and worked with the consultant for two weeks before taking over the sole responsibility for the management of the home, three weeks prior to this inspection. Some of the requirements in this report have been made at previous inspections and the non-compliance with these is solely down to the registered providers. At the time of this inspection there were 17 residents at the home. The care of 5 residents was case tracked. April House DS0000044204.V251376.R01.S.doc Version 5.0 Page 6 What the service does well: What has improved since the last inspection? What they could do better: There are still a great many things that need to be done to make sure that the health and safety of the residents is fully protected. Most of the things identified at this inspection where improvement is necessary have been pointed out at previous inspections. As can be seen in the above section, some improvements have been made, but there is still much work to be done. It is important that the new manager and registered providers work together in April House DS0000044204.V251376.R01.S.doc Version 5.0 Page 7 a planned way to bring about the things necessary to make sure that the residents are provided with a good, consistent quality of care and that they have a pleasant, safe environment in which to live. There are sixteen things identified in the full report that the management must work on, most of which have been set out in the last and previous reports. Five things have also been recommended for further consideration. The most important things that must be done include the following: • Urgent improvements are needed to ensure safe hygiene practices and good infection control in the home, particularly in the laundry and practices for the handling of soiled linen, clothing and incontinence aids. The laundry was unclean with a huge amount of dirty laundry piled up, waiting to be washed. There were health and safety risks in the way that soiled laundry was being transferred from the main building to the laundry (in the garden) that need addressing. There must be safe and proper hand washing facilities available for the protection of residents and staff and clinical waste must be stored and disposed of properly (this has previously been pointed out). A short timescale for improvement was given and the manager and registered providers indicated that work would start as soon as possible on the laundry improvements. Feedback in five of the relatives’, health care professionals’ and care managers’ comment cards indicated their views that there is not always sufficient staff on duty. The outcome of this inspection supports those views. Care staff have to attend to the laundry, cleaning tasks when the part-time cleaner is off duty and at the moment, they are covering the cooking for part of the week. Some improvements have been made in the number of staff on duty since the last inspection, but in view of some of the behaviours associated with dementia that have occurred within the last five months, there is a need for the management to review the home’s staffing requirements to make sure that the residents are properly supervised and not left at risk. This has been an ongoing issue that has not yet been properly met. The work started on improving the environment for residents must be continued. This needs to be done in a planned way as part of an overall maintenance and refurbishment programme for the home. Some environmental risks were identified, such as an unsafe external fire escape and two more fire escapes where the moss presents a hazard. These need to be addressed to ensure the safety of residents, staff and visitors to the home. There has been some improvement in medication practices since the last inspection, but there were some discrepancies that needed attention. A new medication system was due to be introduced and the manager is confident that this will meet the required standard. Improvements are still needed in care planning, pre-admission assessments, residents’ risk DS0000044204.V251376.R01.S.doc Version 5.0 Page 8 • • • April House assessments, particularly with the management of behaviours and in the recording of incidents, to make sure that residents’ care needs are met in a consistent way and to ensure their safety. The reader is advised to refer to the full report for details of the other aspects identified at this inspection where there is a need for improvement. 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 DS0000044204.V251376.R01.S.doc Version 5.0 Page 9 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.V251376.R01.S.doc Version 5.0 Page 10 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 The Statement of Purpose and Service Users’ Guide provide most of the information needed for people to make a decision about moving into the home, but some of the contents are still inaccurate and misleading. Pre-admission assessments are not sufficiently detailed and do not ensure that the needs of prospective residents can be met when they move into the home. The home does not provide intensive rehabilitation, or admit people for intermediate care, so standard 6 was judged as not applicable. EVIDENCE: Revised copies of the home’s Statement of Purpose and Service Users’ Guide are readily available for any interested party to view. The requirement made at the last inspection, regarding standard 1, to update these documents has almost been met. Following discussion with the registered providers, it was agreed that some further amendments would be made to both documents to ensure accuracy and that they contain all the details specified in the regulations and schedules, for example, regarding the numbers of baths and toilets provided. April House DS0000044204.V251376.R01.S.doc Version 5.0 Page 11 The new manager had carried out a pre-admission assessment for a new resident recently admitted. This had entailed visiting the person in their previous home and making a brief record of the assessment. This was seen to provide only rudimentary information. From the discussion with the manager it was apparent that certain risks were evident when the person was assessed prior to moving into the home, but these had not been fully documented. Therefore the home could not demonstrate how it intends to manage those risks and whether it has the capacity to meet the person’s needs. April House DS0000044204.V251376.R01.S.doc Version 5.0 Page 12 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 The care planning system provides some of the information needed to make sure that residents’ health care needs are met, but gaps in the records and inconsistencies have a potential to place residents at risk. This is particularly important regarding risk management strategies. Medication storage and procedures do not fully meet the required standards, placing residents at risk of harm. Residents are treated with respect. EVIDENCE: Improvements have been made in the care plans since the last inspection, as a result of the consultant’s input. Five care plans were viewed in detail. These now cover most aspects of the residents’ health, personal and social care needs, but work is needed to make them more individual and ‘person centred’. Nutritional needs and the risk of malnourishment are being dealt with in a better way. Regular weight checks are recorded and food intake monitored where there is a high risk of malnutrition. The care plans had been reviewed and updated in September and October by the consultant before she handed over to the new manager. These contained action plans for staff to follow, but the advice was general, with similar patterns evident and some individual needs had been missed. For example, on-going problems with a resident’s April House DS0000044204.V251376.R01.S.doc Version 5.0 Page 13 incontinence management and behaviour were discussed with the manager that had not been reflected in the care plan. Behaviour sections of the care plans were too vague and not specific to the individual. Action plans emphasised using a calm approach, reassurance and diversionary tactics, but lacked explicit details. Communication is not covered in the care plans as a particular need, but this is important for people with dementia. Two separate incidents that had recently occurred were discussed concerning two of the residents’ case tracked. These had not been recorded in either of the residents’ daily entries in their case records and the care plans lacked detail regarding behaviour management. Medication procedures and storage were checked and evidence was found of gaps in the administration records and some evidence indicating the possible sharing of drugs. Other records and medication raised concerns that staff were signing for administering medicines but not giving them, predominately liquid medicines. Another discrepancy was found in the records for a controlled drug, the balance of tablets left did not correspond with the records of those received into the home and that administered. The manager said that arrangements have been made for the introduction of a new medication system that will include improved storage and some training. Two relatives spoken to praised the way staff care for the residents and both said that staff treat the residents with respect. The inspectors observed staff interacting with residents and noted that their manner was calm, courteous and friendly. A carer said that relationships with residents are good and spoke about taking a pride in her job, saying, “I try to dress residents in something nice in the morning. What they look like is how you’ve done your job.” April House DS0000044204.V251376.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Activities organised on the three half-days when the leisure therapist is on duty provide stimulation for residents, which is clearly beneficial for their wellbeing. Contacts with relatives and visitors are positively encouraged. Staff work in a way that promotes residents’ choice. Residents’ dietary needs are being considered, but they would benefit if more positive choices were offered at meal times. EVIDENCE: The leisure therapist was observed working with residents on one morning of inspection. She has built a good relationship with the residents who were responsive and participating in several different activities. A variety of methods are used to promote motor skills and sensory appreciation. Activities include: art and craft work, floor games, soft ball, puzzles, use of sensory objects, music, singing, reminiscence, story telling and one to one engagement. There is currently only one part-time cook employed who covers four mornings a week. The cooking is being done by care staff on the other three days. A four-week menu plan is followed that indicates variety. Although this shows two alternatives for the lunchtime and teatime meals, these mainly consist of one hot option, with alternatives such as a salad or omelette at lunchtime and sandwiches as the teatime alternative. One week’s Monday menu consists of April House DS0000044204.V251376.R01.S.doc Version 5.0 Page 15 cold meat, grilled tomatoes and croquette potatoes, or cold ham and vegetables. The lunchtime meal served on the first day of inspection consisted of chicken burger or sausages, mashed potatoes and baked beans, or omelette, whereas the menu indicated liver and bacon, or corned beef or tuna salad. The cook explained the menu had to be altered as no-one got the meat out of the freezer. Choice lists had not been completed for two weeks. The home is currently trying to recruit a second cook. The manager agreed that some changes to the menus could be made to ensure residents are provided with more positive choices, such as two hot options at lunch times. Two relatives visit at lunch times to help with feeding. Both said that the food is good. They said that they are always made to feel welcome in the home whenever they visit. A carer said that the quality of food is good and that there is always fresh fruit. Two carers described how they work with residents and make sure that their choices are respected, for example they know who likes to have a lie-in bed in the mornings and make sure that those residents are not disturbed and have a late breakfast. April House DS0000044204.V251376.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 The home has a satisfactory complaints procedure. Relatives are confident that their views will be listened to and acted on. Policies and procedures are in place for the protection of residents from abuse, but the management needs to develop the way it responds to incidents of abuse of vulnerable adults by other vulnerable adults. EVIDENCE: Relatives spoken to said they had no complaints and felt comfortable in speaking with the new manager if they had any concerns about the home or care provided. The complaints procedure has been updated and is prominently displayed in the entrance hall by the visitors’ book. The manager said there had been no recent complaints. A staff member confirmed awareness of the complaints procedure and the ‘whistle blowing’ procedure and said she would speak to the manager if she were concerned about anything that might indicate abuse. There have been two adult protection alerts raised under the social services procedures. These occurred during the period when there was no manager in post, in June and July 2005. Both these incidents involved injuries to residents. Investigations were carried out under the social services adult protection procedures, as a result of which, the registered providers have reviewed the home’s practices and taken action to improve procedures. During discussions with staff and from the case tracking, some incidents of abuse of vulnerable adults by other vulnerable adults (between residents) were identified. (See Health & Personal Care section above). A carer spoken to was April House DS0000044204.V251376.R01.S.doc Version 5.0 Page 17 aware of the home’s adult protection procedures and explained how staff deal with residents’ behaviours. The carer gave an example of the sort of behaviour that staff have to deal with whereby a resident sometimes hits other residents. Where behaviours have been identified as risky in the care plans, there is insufficient information recorded about the management of aggressive incidents, or of the follow up action. Care plans contain statements such as: staff to “be vigilant”, “to be aware of (the resident’s) whereabouts”, “to monitor” (certain behaviours). The manager agreed that those care plans are too generalised and need reviewing to provide staff with more guidance. Staffing numbers on duty also need to be reviewed to make sure these are sufficient taking account of residents’ behaviours. Whilst some staff have attended short courses on mental health awareness, and dementia, according to the staff-training matrix, only one staff member has attended a course on how to deal with aggression. April House DS0000044204.V251376.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24, 25 & 26 Some recent improvements to the building have enhanced safety. Limited improvements to the décor and fabric have been made. The outstanding matters still do not provide the people living in the home with a safe, pleasant environment in which to live. There has been a failure to ensure that safe infection control measures are in place and adhered to, which places residents and staff at risk of harm. EVIDENCE: Since the last inspection the home has carried out some maintenance, redecoration and renewal of the fabric of the building. This has included replacement of the wooden balustrade on the first floor balcony; work has been carried out to the home’s electrical installation, including the rewiring of the basement; the programme to guard radiators has been completed in bedrooms and communal areas, but an unguarded radiator in a bathroom poses a risk of burns. New carpets had been fitted in four bedrooms, one bedroom has new non-slip flooring, a worn bath has been replaced and several bedrooms have been redecorated. Those rooms provide pleasant surroundings for the occupants. A relative commented on the improvements, saying that April House DS0000044204.V251376.R01.S.doc Version 5.0 Page 19 s/he always felt that the care is good, but the poor state of the building had let the home down. Now the home has been “done up a bit” s/he feels “things are moving on”. A number of other areas require attention, in particular: three bedrooms were seen to have water stains on the ceilings; a bath on the first floor was stained with worn enamel and tiles were missing behind the toilet cistern; four empty bedrooms have cracked ceilings and there were signs of damp. There was thick green moss on the external fire escapes and one fire escape from the first floor had a sign “Danger do not use this fire escape.” Most areas of the home were clean and odour free, but there were offensive odours in four bedrooms where there are particular continence issues. There have been no changes to ensure safe infection control since the last inspection. This has been an on-going requirement from four previous inspections, which has not been met, the latest of which were carried out on 26th October 2004 and 24th May 2005. The laundry was dirty and unhygienic. Unsafe practices for dealing with soiled articles were again evident. There were five sacks of dirty laundry, plus a large pile of dirty articles stacked in front of the washing machine, which was on and working through a wash cycle. The wooden floor was covered with grime and dust, the top of the washing machine was covered in white powder and cobwebs were hanging from the ceiling. There was an open bin, nearly full, with no lid, the paper towel dispenser was empty and a container of bleach was left out on a shelf. There were inadequate procedures to ensure the safe transportation of soiled laundry between the main building and the laundry situated in the garden. A requirement has again been made with a short timescale to ensure safe infection control practices. April House DS0000044204.V251376.R01.S.doc Version 5.0 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Some improvements have been made to address the staffing shortfalls identified at the last inspection. However, the deployment and number of staff available throughout the day is still not sufficient to properly meet the needs of residents, provide them with adequate protection and maintain safety in the home. Staff morale has improved and staff are beginning to form positive relationships with residents. Recruitment procedures are satisfactory but the induction process for new staff needs to be developed to ensure residents are protected. EVIDENCE: Evidence was seen confirming some improvements in staffing levels since the last inspection, for example there are now three carers on duty throughout the day from 08.00 hours to 20.00 hours, plus the new manager works supernumerary hours Monday to Friday between 08.00 hours and 16.00 hours. Although this is better than what was found at the last inspection, this still does not provide sufficient time for staff to attend to all their duties and provide the one to one time that some residents need. Risk assessments for the management of behaviour in two cases indicate that a high level of supervision is required. As there is no separate person employed to do the laundry, care staff have to leave the building to attend to the laundry, which is situated in the garden. Care staff also have to attend to any cleaning tasks on the cleaner’s days off, three days a week. Therefore when staff are away from the residents attending to these tasks, it is doubtful April House DS0000044204.V251376.R01.S.doc Version 5.0 Page 21 that there is sufficient staff to monitor the behaviours of those residents where risks have been identified. Currently care staff are doing the cooking on three days a week. The manager indicated that the home is trying to recruit another part time cook and consideration is being given to the recruitment of a laundry assistant. Care staff told the inspectors that the build up of dirty washing in the laundry on the first day of inspection, which was a Monday, had occurred over the weekend. There are only three care staff on duty throughout the day at weekends, plus someone to do the cooking in the mornings. Six staff files were audited and seen to contain most of the relevant paperwork required by legislation, for example: application forms, references, letter of appointment, job description, statement of the terms and conditions of employment and a documentary evidence sheet, indicating the CRB reference number, date and POVA first checks. An induction record for a carer who had been in post eight weeks, had been completed in two days. The manager showed the inspectors some Skills for Care Induction Programme Workbooks that have recently been obtained and indicated that she would be using these for all new staff, including the above carer. Currently there are two staff with an NVQ level 2 in care qualification, which is the equivalent to 20 . The staff-training matrix indicates that two more staff are currently undertaking their NVQ level 2 and the manager stated that two staff have been enrolled for their NVQ level 3. April House DS0000044204.V251376.R01.S.doc Version 5.0 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 & 38 Recent changes in the arrangements for the management of the home have provided staff with the leadership and guidance that has been lacking this year. 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 to ensure residents are provided with a pleasant, safe environment and a consistent quality of care. Health and safety practices need to be improved to safeguard residents, staff and visitors to the home. EVIDENCE: There has been no registered manager since December 2004. At the last inspection in May 2005, it was identified that the acting manager did not have sufficient supernumerary time to fulfil the management tasks required of her. The staff team lacked leadership and direction, which resulted in practices that did not promote and safeguard the health, safety and welfare of the residents. April House DS0000044204.V251376.R01.S.doc Version 5.0 Page 23 A new manager has been in post since 26th September 2005. She has an NVQ level 4 in management and care and is experienced in the management of residential care settings for older people and people with mental health problems, but has not done any recent training in dementia care. Staff and visiting relatives spoken to, made positive comments about the new leadership and the atmosphere in the home. A staff member said they now work more as a team and relationships with residents are good. Relatives and staff commented on the homely atmosphere and the manager’s open approach. Procedures for dealing with residents’ personal spending monies were checked and seen to be appropriate. Some record keeping practices did not show respect for the residents by the terminology used. The inspectors saw that general communication books were being used to record personal details about individual residents, which does not maintain confidentiality. Examples of safety risks identified have been referred to throughout this report, but those not mentioned include: poor kitchen cleanliness; the volunteer seen walking through the kitchen on her way back from the laundry; risks in the event of a fire evacuation, with the first floor fire exit out of use and the unsafe conditions of the other two fire escapes, due to moss and rust, which had not been addressed in the fire risk assessment. Other safety hazards were noted on the route from the building to the laundry. It was raining and there were wet leaves on the ground by the laundry presenting a slip hazard. The gate was open leading to the basement steps to the kitchen, posing a risk of falls, as staff have to carry the laundry sacks along the path adjacent to this. April House DS0000044204.V251376.R01.S.doc Version 5.0 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 x 2 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 1 2 2 2 x 2 2 1 STAFFING Standard No Score 27 1 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 x 3 2 2 2 April House DS0000044204.V251376.R01.S.doc Version 5.0 Page 25 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4, 5 & 6 Requirement Timescale for action 31/01/06 2 OP3 14 3 OP7 15 The statement of purpose and service users’ guide must contain accurate information. Amendments needed re: building as discussed and to make sure they contain all the information specified in schedule 1. Revised copies to be forwarded to the Commission. (Previous requirements made 27/10/2004 and 24/5/2005 partially met and carried forward). Pre-admission assessments must 20/12/05 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. Care plans must be sufficiently 20/12/05 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 DS0000044204.V251376.R01.S.doc Version 5.0 April House Page 26 4 OP8 12 &13 5 OP9 13(2) requirement 27/10/2005 and 24/5/2005 partially met The registered persons must promote and make proper provision for the health and safety of residents. They must ensure that care staff accurately record details of any incidents in residents’ individual daily records. The registered persons must ensure that there is a clear audit trail that can be monitored when an incident has occurred. 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. Appropriate drug storage facilities and refrigerated facilities to be provided with reference to the Royal Poharmaceutical Society’s guidance. Procedures for the safe transportation of medication around the home to be reviewed and revised as discussed. (Previous requirement 27/10/04 & 24/5/05 not met and carried forward). Manager to audit medication practices and notify the Commission of the date of installation of the new medication/storage system. Manager to carry out regualr medication audits. The registered persons must ensure that physical and verbal aggression by a vulnerable adult to other vulnerable adults is dealt with appropriately to DS0000044204.V251376.R01.S.doc 20/12/05 30/11/05 6 OP18 13(4)(6) 31/01/06 April House Version 5.0 Page 27 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. The registered persons must ensure that the home is of sound construction and kept in a good state of repair externally and internally. Action Plan to be submitted showing a maintenance and refurbishment programme that provides short and long-term plans and identifies target dates for completion of works. (Previous requirement 27/10/2004 and 24/5/2005 carried forward). There must be sufficient suitable armchairs provided in lounges for residents’ use and sufficient numbers of additional chairs available for visitors use. (Previous requirement 27/10/2004 and 24/5/2005 carried forward). There must be sufficient numbers of toilets provided to meet residents’ needs. Toilet facilities to be reviewed and evidence submitted showing actions taken (rooms previously specified at 27/10/2004 inspection, no toilet in use nearby bedrooms nos. 16, 17, 18, 19 & 23 on the first floor). (Previous requirement 27/10/2004 and 24/5/2005 carried forward). Action plan to be submitted by Access to the home for disabled DS0000044204.V251376.R01.S.doc 7 OP19 13(4), 16, 23 30/11/05 8 OP20 16(c) 23(2)(i) 31/01/06 9 OP21 23(j) 31/01/06 10 OP22 23(n)(o) 31/01/06 Page 28 April House Version 5.0 11 OP24 16(2)(c) 12 OP25 13(4) 13 OP26 13(3) 16(2) 23(2) persons must be safe and appropriate. Action plan to be submitted. (Previous requirement 27/10/2004 and 24/5/2005 carried forward) Suitable furnishings, fixtures and 30/11/05 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 requirement 27/10/2004 and 24/5/2005 carried forward). The registered persons must 31/01/06 ensure that unnecessary risks to the health and safety of residents are eliminated as far as possible – action to be taken to address the risk of burns from the unguarded radiator in the ground floor bathroom. The Registered Persons must 30/11/05 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, 27/10/2004 and 24/5/2005. Action required to ensure the laundry is clean hygienic, suitable for its purpose, facilties are provided for protection/handwashing. Foulded linen must be April House DS0000044204.V251376.R01.S.doc Version 5.0 Page 29 14 OP27 18 transported and laundered safely. 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 and 24/5/2005 – some action taken but still not sufficent). 20/12/05 15 OP30 16 OP38 Evidence to be submitted of action taken, to include cover for laundry tasks, cooking, cleaning and care duties as discussed. 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 and 24/5/2005 carried forward). 13(3)(4) The registered persons must (5) & 23 ensure that environmental risks are identified, strategies to reduce risk put in place and regularly reviewed. Environmental risk assessments must be sufficiently detailed. Regular building health and safety checks must be carried out, recorded and actioned. Action must be taken to remove moss on external fire escapes, 20/12/05 20/12/05 April House DS0000044204.V251376.R01.S.doc Version 5.0 Page 30 which must be maintained in safe condition. Fire risk assessment must be reviewed and updated to take account of the unsafe first floor fire escape that is out of use. 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 and 24/5/2005 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. Records of food to include details of 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. That a sluicing facility for the cleaning of commode pans is provided. That staff files are audited to ensure they contain all the information specified in regulation 19 Schedule 2 That the new manager updates her knowledge of best practice in dementia care. That the new manager reviews record keeping procedures to ensure confidentiality and that staff are instructed about showing respect for dignity when writing reports. 2 3 4 5 OP26 OP27 OP31 OP37 April House DS0000044204.V251376.R01.S.doc Version 5.0 Page 31 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. Extracts may not be used or reproduced without the express permission of CSCI April House DS0000044204.V251376.R01.S.doc Version 5.0 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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