Inspection on 07/11/06 for April House

This inspection was carried out on 7th November 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 15/05/06

April House 31/10/05

April House 24/05/05

April House 26/10/04

April House 07/06/04

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

CARE HOMES FOR OLDER PEOPLE April House 69 Sea Road Westgate on Sea Kent CT8 8QG Lead Inspector Christine Grafton Unannounced Inspection 10:10 07 November 2006 th 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.V306110.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. April House DS0000044204.V306110.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service April House Address 69 Sea Road Westgate on Sea Kent CT8 8QG Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01843 831860 01843 836621 Mrs Kiki Cole Mr Raymond Edwards Post Vacant Care Home 30 Category(ies) of Dementia - over 65 years of age (30) registration, with number of places April House DS0000044204.V306110.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th May 2006 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 includes a manager, senior carers and carers who work shifts including 2 staff on waking duty at night. Some part-time catering and domestic staff are also employed. Information provided in the pre-inspection questionnaire in October 2006 indicates that the fees range from £367.00 to £450.00 per week and additional charges are made for hairdressing, chiropody, special toiletries and newspapers. April House DS0000044204.V306110.R01.S.doc Version 5.2 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. Two inspectors carried out an unannounced visit on 7th November 2006 between 10.10 hours and 15.00 hours and an announced visit on 9th November 2006 between 09.0 hours and 13.00 hours. The visits included talking to the manager, staff, residents, visiting relatives and observing the interactions between residents and staff. Time was spent observing how residents were spending their time in the lounges and some areas of the home were seen, including a sample of bedrooms. Various records were checked and the care of two residents was case tracked. At the time of the visits there were 21 residents. The inspection followed up on the things identified as needing improvement and the requirements made at the last inspection of 15th May 2006. As this was the second inspection this year and relatives, care managers and doctors were consulted at the last inspection, further surveys were not sent out on this occasion. The registered providers were away at the time of both visits and therefore not available for discussion. Verbal feedback was given throughout the visits to the manager, who made notes and said she would discuss the findings with the providers on their return. What the service does well: The manager is experienced in caring for people with dementia and has a good understanding of residents’ needs. She leads by example, encouraging and coaching staff on the principles of good practice for the benefit of residents. Visitors are welcomed and relatives’ involvement is positively encouraged. Regular meetings are held with relatives, providing the opportunity for them to make suggestions to influence residents’ care. Relatives and staff spoken to appreciated the manger’s open approach and ready availability to listen to any concerns they may have. April House DS0000044204.V306110.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: There are a number of improvements that are still necessary to ensure that residents’ welfare is promoted and they are provided with a safe, comfortable environment. Although each resident has an individual plan of care, inconsistencies and poor cross-referencing, particularly following any accidents or incidents, pose the risk that residents’ needs might not be met. Some staff practices observed did not promote residents’ dignity, for example, the methods they use for communicating with residents and ways of assisting residents at mealtimes. Staff need to broaden their understanding of working with people who have dementia. This area for improvement was identified at the last inspection. Some action has been taken to arrange specific dementia care training for five staff, due to commence towards the end of November. This needs to be continued so that all staff receive this training to at least a basic level. The training should then be ongoing for the care staff to make sure that they have the appropriate skills to provide residents with good care. The numbers and skill mix of staff on duty are still insufficient to meet the diverse needs of people with dementia being cared for in this home. This was identified at the last inspection as an area for improvement. Although there has been no change in the outcomes for residents in this respect, the manager has been actively trying to recruit more staff. Three new staff had recently been appointed but failed to take up or continue with their appointments. Agency staff are being used to cover on a regular basis. The poor staffing situation has impinged upon other aspects of the service provided, for example, the activities provided do not give sufficient stimulation April House DS0000044204.V306110.R01.S.doc Version 5.2 Page 7 to residents. This is because the care staff are trying to fit activities in between their caring tasks. The manager is currently completing a number of care-associated tasks because there is no one at a senior level with the competence to do them. This affects the time available for the manager to spend training staff and attend to some of her other management duties. Recommendations were made at the last inspection to review menus to provide a more positive choice of alternative meal at lunchtime. At these two visits, the residents were not being provided with an appealing, varied and balanced diet. This was discussed and agreed with the manager who made a commitment to work with the cook to bring about the necessary changes. There are still a number of outstanding maintenance and refurbishment things to be completed to improve the environment for residents, including the replacement of old, worn bedroom furniture. The manager said that the providers have an improvement plan, but was unable to indicate proposed timescales. These environmental issues have been ongoing now for some time. A scheduled improvement plan for the building has been requested. The providers need to make sure that sufficient resources are made available to bring about the necessary improvements. They need to work together with the manager in addressing all of these things in a timely fashion to make sure that residents’ best interests are protected. 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.V306110.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection April House DS0000044204.V306110.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3&4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can move into the home knowing that their needs have been assessed and the home endeavours to meet their needs. The home does not provide intensive rehabilitation, or admit people for intermediate care, so standard 6 is judged as not applicable. EVIDENCE: The admission process for two new residents was discussed with the manager and the assessment documentation seen. The manager stated that she obtains a copy of the care management assessment beforehand and visits the person herself to complete an initial assessment of needs, including a risk assessment element. The documentation contained some useful information and gave some indication of needs, but it was clear that the pre-admission assessment forms had been completed hurriedly and neither had been dated or signed. One of the care management assessments was undated and the April House DS0000044204.V306110.R01.S.doc Version 5.2 Page 10 initial care plan documentation for that person contained gaps in the history section and was not detailed enough. The home’s assessments and care plans completed following admission, showed some improvement since the last inspection and it was clear that the care management assessments had been used to inform the care plans. Behaviours associated with a resident’s dementia had been recorded in the care plan with some management instructions but it was discussed that these need to be more specific. The manager clearly understands the new residents’ needs but agreed that there were some gaps in their initial needs assessment records. The manager said she has had to compile all the care plans herself, as there is currently no one else in the staff team with the skills to undertake the assessments. April House DS0000044204.V306110.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected 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. Inconsistencies in the care planning system place residents at risk of their health and welfare needs not being properly met. Medications are on the whole well managed and promote good health. Staff practices do not always promote residents’ dignity. EVIDENCE: Two residents care was case tracked. The two care plans were seen to cover all the components specified in the standards and efforts to improve the documentation have continued. Some of the actions that staff should take to ensure that all aspects of residents’ health, personal and social care needs are met had not been recorded in enough detail, for example, in relation to communication and behaviour, but the plans provide a reasonable basis for the care to be delivered. April House DS0000044204.V306110.R01.S.doc Version 5.2 Page 12 Weight records are included in the care plans and for one resident where a weight loss had been recorded, there was evidence to show that this had been followed up with the doctor and the home was monitoring the situation. It was seen in relation to health care matters regarding one resident that reviews had not been carried out monthly, even though the person’s needs had clearly changed over a two-month period. Two records of accidents were seen in the daily records for this person, but the poor ongoing records made it difficult to follow through the actions taken. There was conflicting information about the injuries, with an injury to one leg recorded at one time and then reference to pain in the other leg on another occasion. A number of entries did not denote which leg was causing the problem. Another daily record entry indicated a fall, but there was no accident record for this and the care plan had not been appropriately updated following the incident. All of this was discussed at length with the manager, who agreed that the records were insufficient and muddled and this was an area of the health care management that needs improvement. It was difficult to check back on this person’s medication administration record (MAR) sheets as the ones seen did not indicate the month and the relevant one took a long time to find because it had been stored away (See Management and Administration section). However, when the last month’s MAR sheet was found, it was seen that pain relief had been given regularly as prescribed. The medication records were examined and overall indicated that they were appropriately recorded and up to date. It was discussed to specify the reason when a prescribed medication is not given. Some observations were raised with the manager, for example: at times there were no staff in the lounge to oversee the residents sitting there; a staff member was seen standing behind a resident giving instructions to turn left when escorting them to the toilet. The instructions were repeated twice, but as the resident could not see the carer, they could not pick up clues from facial expression and body language to help with the communication. A resident was seen sitting on the lap of another resident. A carer came into the lounge and walked past them to another resident. It was only when an inspector asked this carer about this that the carer then proceeded to encourage the resident to change chairs. The carers’ approach was discussed with the manager who said that due to the staffing problems, staff on duty sometimes feel pressured to complete tasks and do not have the time to spend with the residents that they want. She also recognises the need for more training in dementia care and arrangements have been made for some staff to commence a dementia course shortly. (See also staffing section – standard 27). It was observed that the manager spends time on the floor with the residents and encourages and directs staff in good practice. April House DS0000044204.V306110.R01.S.doc Version 5.2 Page 13 A visiting relative asked to speak with the inspectors and indicated that their mother is well looked after and nicely dressed. April House DS0000044204.V306110.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected 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 poor. This judgement has been made using available evidence including a visit to this service. The limited activities provided do not give sufficient stimulation to meet the diverse needs of people with dementia being cared for in this home. Residents benefit from the home’s open visiting policy, which encourages contacts from relatives and visitors to the home and their participation in home events. Residents are not always being provided with an appealing, varied and balanced diet. EVIDENCE: A new part-time activities person was appointed in October, but only worked two days and did not return. Consequently care staff have to do activities as well as attend to their care duties. As there are only three carers on shift during the day, the time they spend on activities has to be fitted in with their care work. The manager is actively trying to recruit another carer for activities. At one time during the first visit, there were eleven residents in the lounge with one carer. The television was on, but also music was being April House DS0000044204.V306110.R01.S.doc Version 5.2 Page 15 played. Some jigsaw puzzles were seen and a carer was seen playing dominoes with one resident. The manager said that a ‘pat dog’ visits the home twice a week and an outside entertainer comes once a month. An autumn fayre had been held at the home in September and a group of residents were taken to a harvest festival celebration at a local church where they had cream teas. An invitation has been extended for six residents to go to the church coffee morning every Wednesday, but the manager stated she needs a member of staff to take them. A resident’s care plan specified the need to be taken out for walks along the seafront, but there was no evidence of this being done and the manager stated that staff had not had time. Residents were seen freely moving about between the lounges and bedroom areas. Two visiting relatives confirmed that they are encouraged to visit and always made to feel welcome. The lunchtime meal at the first visit consisted of shepherds pie or spaghetti bolognaise. The meal was served without any accompanying vegetables. The cook said that there were peas, broad beans and sweet corn in the shepherds pie but when this was discussed with the manager, she agreed that this did not constitute a well-balanced meal. Some observations were made during the mealtime of practices that did not show respect for dignity. The meals are served from a heated trolley, but the cook was observed serving the shepherds pie and spaghetti bolognaise meals from two large saucepans on top of the trolley. This contrasted with the inspection of 15th May 2006, when the meals had been plated in the kitchen and attractively served. At the second visit, the roast lamb portions were extremely small and the dessert did not look very appetising. A resident was given their dinner and left to eat it from a small table in front of their chair in the lounge. No assistance was offered and the resident pushed the meal away. A carer returned and stuck a fork upright in the dinner and walked away. The resident again pushed the meal away. When another carer eventually came to assist the resident, they stood over them while assisting with feeding. The manager said this resident often eats their dinner when it is cold but agreed that staff actions could have been construed as insensitive. 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. Menus provided with the pre-inspection questionnaire indicate no change. The new cook said he would be reviewing the menus to provide more variety. The other part-time cook was off sick. April House DS0000044204.V306110.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be 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 and the staff practices observed. The home has a satisfactory complaints system. Residents, or their representatives, can be confident that the manager will listen to them and act upon their views and is committed to protecting residents from abuse. Staff have not been provided with the necessary training to ensure residents are adequately protected from abuse. EVIDENCE: The home’s complaints procedure is prominently displayed in the entrance hall. The pre-inspection questionnaire indicated there had been no complaints since the last inspection. The manager said there had been one verbal complaint from a resident’s guardian about an odour in their bedroom. A new mattress had been purchased for the bed and new washable flooring provided. It was discussed that this should have been documented and would have provided positive evidence of a complaint appropriately responded to. April House DS0000044204.V306110.R01.S.doc Version 5.2 Page 17 A visiting relative and staff member both commented that the manager is very approachable and they would go to her with any concerns. The staff member was aware of the home’s ‘whistle blowing’ policy and indicated they felt confident to follow it if necessary. The manager described a situation that she had investigated. The records did not indicate all the action taken to resolve the matter, but from the discussion it was clear that the manager had followed it up and was still monitoring the outcome. At the last inspection, it was identified that some staff did not clearly understand how to manage verbal and physical aggression and behaviours associated with residents’ dementia. A need for staff training on abuse and adult protection was also identified. The staff-training matrix provided at this inspection indicates that there is still only two staff that have undergone adult protection training. No further training has been arranged to address this. The manager said that she had been working with staff to guide them on how to manage behaviours and there had been no recent incidents of physical aggression between residents. The manager made an undertaking to arrange staff training on adult protection by the end of February 2007 and stated that in the meantime she would instruct them herself and document it. April House DS0000044204.V306110.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected 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. Improvements in laundry procedures and measures to prevent the spread of infection have benefited residents and staff by reducing the risk of harm. Further improvements are still necessary in the maintenance of the building and the quality of furnishings and fittings to ensure residents have a comfortable, safe environment. EVIDENCE: Since the last inspection, the outside walls have been painted, the hand rail from the front lounge exit has been repaired and painted, the hall has been painted and vinyl has been laid in some bedrooms due to incontinence. The pathway leading to the laundry in the garden had been swept clear of leaves and the laundry was much cleaner and tidier than at the last inspection. An effort has been made to separate soiled and clean laundry and the wheelie April House DS0000044204.V306110.R01.S.doc Version 5.2 Page 19 bin used to transport soiled washing from the main building to the laundry is now being cleaned with disinfectant at the end of each shift. Water-soluble bags are being used for soiled items and there was a supply of gloves, liquid soap and paper towels. However, an unsuitable rusty trolley is still being used to transport the individual plastic containers of clean laundry back to the main building. The health and safety risks were discussed with the manager who agreed that the trolley should be changed. It was also discussed that the laundry procedure should be displayed. Infection control procedures have improved, but the only toilet now available near the lounge areas had a strong odour, there was no pedal bin and staff were still using the hand made chipboard bin in the corner for used gloves, aprons and paper towels. Soiled pads are taken to the macerator room next door, which did not have a suitable pedal bin. The manager said she had identified the need for a large stainless steel foot operated pedal bin in the toilet and indicated that this would be ordered. She also agreed to write a procedure for the transfer of the soiled pads between the two rooms. Most areas of the home seen were clean, but some odours were noted in one bedroom and in part of the lounge areas. The manager stated that the new maintenance person is working through a programme of routine maintenance. The maintenance and renewal action plan requested at the last inspection has not been provided, but the manager said she would discuss this with the providers and hoped to forward it soon. It was discussed that the bedroom furnishings in rooms seen were of poor quality and there is still a need for the replacement and renewal of worn furnishings. A room in the lower ground floor was being used for storage and was full of boxes. This was identified as a possible safety risk. April House DS0000044204.V306110.R01.S.doc Version 5.2 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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of staff on duty are not sufficient to meet the diverse needs of people with dementia being cared for in this home. The plans to provide some staff with specific dementia care training should result in better outcomes for residents. Recruitment procedures need to be strengthened to fully protect residents. EVIDENCE: Rotas provided at this inspection indicated no improvement in the numbers of staff on duty to meet residents’ needs. The manager had been actively trying to recruit more staff but there had been a number of recent staff shortages caused by sickness, other unexplained absences and annual leave. Agency staff have been used to cover these gaps in the rota, which totalled 54 hours for the week of inspection. Rotas indicate that three carers are provided during the daytime shifts, plus one person for cooking and one person for the cleaning and laundry. The manager said she tries to ensure that there is only one agency person out of the three carers on duty during the day in order to give residents some consistency. April House DS0000044204.V306110.R01.S.doc Version 5.2 Page 21 When considering the assistance that is required during the day, the support needed to provide a good quality of life and the stimulation that residents with dementia need to develop or maintain skills, the manager agreed that that staffing levels are not adequate and indicated that she is trying to recruit an extra carer to provide an additional person on duty for activities and to help with the laundry. The rota indicates that the majority of staff regularly work twelve-hours shifts, with some working sixty or more hours a week. In relation to good practice, it was discussed that it is not advisable for staff to work long shifts on a regular basis. The manager stated that two staff have completed their National Vocational Qualification (NVQ) Level 2 in care and a further three staff are currently undertaking their NVQ. Observations made in relation to staff practices and discussed with the manager do not support this NVQ training. The manager agreed that staff need to develop their skills and arrangements have been made for five staff to start a 16-week dementia course on 24th November 2006. The manager had recruited three new staff that had been due to start work during October, but two did not start and one only worked for two days. Two staff files were checked and it was seen that for one new staff member a full employment history had not been obtained, there was no photograph on file, no evidence of identity and no evidence of the criminal records bureau (CRB) check, although the manager confirmed that a protection of vulnerable adults register (POVA) first check had been obtained. April House DS0000044204.V306110.R01.S.doc Version 5.2 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service, but determined mainly due to the manager’s performance, without which the overall outcome for this group of standards would have been judged as poor. The leadership provided by the manager is having a positive effect on the way the home is being run for the benefit of the residents. Whilst the manager has a good understanding of what needs to improve in the home, the support and cooperation of the registered providers is essential to bring about and sustain the improvements needed to protect residents’ best interests. Residents’ health and safety could be compromised because there are not enough staff trained in first aid and moving and handling. April House DS0000044204.V306110.R01.S.doc Version 5.2 Page 23 EVIDENCE: The manager has the necessary qualifications and experience with the client group to run this home and has made an application for registration. She has continued to make changes to try to enhance the quality of care and overall service provided. Staff and relatives spoken to felt that the manager is improving the way the home is run and appreciated her open management style. One staff member said, “She gets things done”. The manager holds regular residents’/relatives’ meetings and staff meetings and provides formal supervision for all staff. However, the manager stated that the providers do not regularly visit the home and they have not carried out any monthly Regulation 26 visits to check on the conduct of the home, nor have they delegated this task to another responsible person. There are a number of ongoing requirements specified in previous inspection reports, which are the responsibility of the providers that have not been progressed in a timely fashion. The manager spoke of the need for a competent deputy manager, or head of care, to assist her to bring about the necessary changes, as she does not have sufficient time to do everything herself without some support. (See also staffing section). The manager stated that the home does not handle residents’ monies, but invoices families or representatives for any additional charges such as hairdressing and chiropody. An appropriately recorded print out of these charges was seen. A lack of sufficient storage space for records was identified in relation to the storage of the completed medication administration (MAR) sheets. The manager’s office is rather small and she stated she does not have access to the administrator’s office in the basement where there is some additional secure storage space. It was discussed that there must be sufficient secure storage space for confidential records. The Fire Log Book was seen to contain up to date records of weekly fire bell tests, monthly emergency lighting tests, extinguisher checks and good records of staff fire instruction. The manager had started a fire risk assessment and had recently updated the environmental risk assessments. Action has been taken to add ramps to fire escape exits identified at the last inspection as posing safety hazards. The staff-training matrix provided indicated courses completed but had no dates. The manager said that the majority of staff need their first aid training updated. Moving and handling training is still outstanding. The manager April House DS0000044204.V306110.R01.S.doc Version 5.2 Page 24 made an undertaking to try and arrange staff moving and handling training by the end of February 2007 and first aid training by the end of March 2007. April House DS0000044204.V306110.R01.S.doc Version 5.2 Page 25 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 x x 2 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 3 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 1 2 1 2 3 2 2 2 STAFFING Standard No Score 27 1 28 1 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 3 2 1 April House DS0000044204.V306110.R01.S.doc Version 5.2 Page 26 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 OP7 Regulation 15 Requirement Care plans must show how each resident’s needs in respect of health and welfare are to be met. Care plans to be ‘person centred’. Individual procedures for managing behaviours to be more specific. Care plans must be regularly reviewed and updated as changes occur, or new needs are identified. Cross-referencing within the care plans to be improved. (Previous requirement 26/10/2004, 24/5/2005, 31/10/05 & 15/05/06 partially met and ongoing). 2 OP8 12 &13 To promote and make proper provision for the health and welfare of residents. Records of incidents in residents’ April House DS0000044204.V306110.R01.S.doc Version 5.2 Page 27 Timescale for action 18/12/06 18/12/06 individual daily records must be accurate and there must be a clear audit trail that can be monitored when an incident has occurred. 3 OP10 12 The care home must be conducted in a manner that respects residents’ dignity. Staff must be trained in appropriate communication methods to engage with people who have dementia. 4 OP12 16(2)(n) Sufficient meaningful activities to 18/12/06 be provided suitable for residents with dementia. Programme of activities to be arranged having regard to the needs of residents. 5 OP15 16(2)(i) To provide, in adequate quantities, suitable, wholesome and nutritious food, which is varied and properly prepared to suit residents’ individual needs. Staff must be trained in the management of aggression and dealing with behaviours associated with residents’ dementia that my cause harm to themselves or others. Training on abuse and protection to be provided. (Previous requirement 31/10/05 & 15/05/06 carried forward). 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. DS0000044204.V306110.R01.S.doc 18/12/06 18/12/06 6 OP18 13(4)(6) 28/02/07 31/01/07 April House Version 5.2 Page 28 Programme of routine maintenance and renewal of the fabric and decoration of the premises to be continued. New action plan to be submitted. (Previous requirement 26/10/2004, 24/5/2005, 31/10/05 & 15/05/06 ongoing and carried forward). 8 OP21 23(2)(j) There must be sufficient numbers of toilets provided to meet residents’ needs. Toilet facilities to be reviewed and action plan to be submitted. (Previous requirement 26/10/2004, 24/5/2005 & 15/05/06 carried forward). 9 OP24 16(2)(c) 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. (Previous requirement 26/10/2004, 24/5/2005 & 15/05/06 carried forward). 10 OP26 13(3) 16(2) 23(2) Systems in place to control the 18/12/06 spread of infection must be in accordance with relevant legislation and published professional guidance. Provide appropriate operated pedal bins. foot 31/01/07 31/01/07 Ensure a safe system of transport between the laundry April House DS0000044204.V306110.R01.S.doc Version 5.2 Page 29 and the main building. Ensure the premises are kept clean, hygienic and free from offensive odours throughout. (Previous requirement 15/05/06 partially met and ongoing). 11 OP27 18 At all times there must be 11/12/06 suitably qualified, competent and experienced staff working at the home in such numbers as are appropriate for the health and welfare of the residents. (Previous requirement 26/10/04, 24/05/05, 31/10/05 & 15/05/06). Evidence to be submitted of action taken. 12 OP30 18 Staff must be provided with training appropriate to the work they are to perform. Structured induction training (Skills for Care certified) to be provided and persons working at the home must be appropriately supervised. During a new workers induction an appropriately qualified experienced staff member must be appointed to supervise the new worker. This process to be documented. (Previous requirement 26/10/2004, 24/5/2005, 31/10/05 & 15/05/06 carried forward). 13 OP30 18 All staff to complete dementia awareness training. 31/03/07 31/12/06 April House DS0000044204.V306110.R01.S.doc Version 5.2 Page 30 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. (Previous requirement 15/05/06 carried forward). 14 OP33 12, 26 To ensure that the home is run in the best interests of the residents. The registered providers, or an employee not directly concerned with the conduct of the home, must visit the home once a month and write a report on the conduct of the home. The report must be kept available for inspection if requested. 15 OP37 17 Secure storage must be provided for all confidential records that are required to be kept in the home. 18/12/06 18/12/06 16 OP38 13(5) Arrangements must be made to 28/02/07 provide a safe system for moving and handling residents. (Previous requirement 26/10/2004, 24/5/2005 & 15/05/06 not met and carried forward). 17 OP38 13(3) Suitable arrangements must be made to prevent infection, toxic conditions and the spread of infection at the care home. DS0000044204.V306110.R01.S.doc 30/04/07 April House Version 5.2 Page 31 In relation to the training of staff in infection control. (Previous requirement 26/10/2004, 24/5/2005 & 15/05/06 carried forward). 18 OP38 13(4) Suitable arrangements must be made for the training of staff in first aid. (Previous requirement 24/5/2005 & 15/05/06 not met and carried forward). 31/03/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP3 OP9 Good Practice Recommendations To make sure that pre-admission assessments contain sufficient information and are properly signed and dated. To ensure that all appropriate boxes on the medication sheet are completed when administering medicines – When ‘F’ is recorded staff must provide key to show what ‘F’ stands for. That a sluicing facility for the cleaning of commode pans is provided. (Carried forward from 31/10/05 & 15/05/06). 3 OP26 April House DS0000044204.V306110.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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.V306110.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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