Inspection on 15/10/08 for Ashwood Rest Home

This inspection was carried out on 15th October 2008.

CSCI found this care home to be providing an Poor service.

The inspector found no outstanding requirements from the previous inspection report, but made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ashwood Rest Home 14/03/07

Ashwood Rest Home 05/01/06

Ashwood Rest Home 29/06/05

Ashwood Rest Home 19/10/04

Ashwood Rest Home 29/04/04

Ashwood Rest Home 03/11/03

Ashwood Rest Home 21/10/02

Extracts from inspection reports are licensed from CQC, this page was updated on 06/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Ashwood Rest Home 10/12 Shirley Avenue Shirley Southampton Hampshire SO15 5NG     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Anita Tengnah     Date: 1 5 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Ashwood Rest Home 10/12 Shirley Avenue Shirley Southampton Hampshire SO15 5NG 02380780232 Telephone number: Fax number: Email address: Provider web address: gill@ashwoodcare.co.uk Name of registered provider(s): Name of registered manager (if applicable) Mrs Gill Miller Type of registration: Number of places registered: Mrs Gill Miller care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: No more than 4 service users in the categories PD(E) May be accommodated at ony one time. Date of last inspection Brief description of the care home Ashwood is a registered care home providing personal care and accommodation for twenty older people over the age of 65 years. The home is owned and managed by Mrs Gill Miller, and provides a service to people with frailty of old age, mental health disorders, dementia and physical disability. The location of the home, in a residential Care Homes for Older People Page 4 of 34 Over 65 20 20 20 4 0 0 0 0 Brief description of the care home area close to Shirley (a suburb of Southampton), means it is close to the local shops and amenities. The house is a large two storey residential property that has been extended at the back to provide further accommodation. There is a car parking available at the rear of the premises. The home has eight single and six double rooms and en-suite facilities are available in two of the double rooms only. There is a passenger lift for access to the upper floor. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: An unannounced visit was undertaken on the 15th of October 2008 as part of our inspection process. We sent out the Annual Quality Assurance Assessment (AQAA) to the registered person at the service. This is one of the means of collecting data from the service. We also sent out service users surveys to people living at the home. We spoke to a number of the service users and a relative at the time of the visit. We looked at the service users and the staff records as maintained at the home and observed practices. We have also used information as supplied by the home in the AQAA and other information that we have received from external agencies who have dealings with the home. Care Homes for Older People Page 6 of 34 Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: The preadmission assessment, care planning and risk assessments would benefit from development to ensure that care needs are assessed and action plans put in place to meet them. The service users privacy and dignity was not always respected. The management of the service users medication does not fully protect them. The activity programme should be tailored according to the client group accommodated. The involvement of the friends and family in providing life histories would assist to enhance the type of activity provided. The reporting of incidents that affect the welfare of people living at the service must be further developed including recording all safeguarding alerts and outcomes. The environmental hazards and infection control procedures were inadequate to protect the vulnerable people using the service. The recruitment of staff was inadequate and put the service users at risk of harm. Training records and a matrix would be beneficial in monitoring any gaps in knowledge and ensuring that staff have the skills required to deliver care safely. The overall management of the service lacked clear lines of accountability. The lack of effective monitoring of practices placed the service users at risk of needs not being met and harm to their safety. Care Homes for Older People Page 8 of 34 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 34 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is an inadequate pre -admission assessment available in order for staff to adequately and safely meet the service users needs. The service does not provide intermediate care. Evidence: We looked at the pre admission assessment process and checked the care records of three service users as part of case tracking. We found that one person had an assessment record but we could not ascertain who had assessed this person and when this was carried out. The record contained minimal information about the care needs of this person to inform practice and for the service to be certain that they would be able to meet their needs. We looked at two other records and staff reported that the pre- assessment records Care Homes for Older People Page 11 of 34 Evidence: were not available. This included a new service user who had been admitted for respite care. Information from the AQAA showed that the home was planning to review their preadmission process to take into account the changing clients needs and to produce a new brochure and service users guide. The staff reported that the service did not provide intermediate care. Care Homes for Older People Page 12 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans, assessments and records of care given do not adequately protect the service users. The medication management is not good as the service users are put at risk of harm. The service users access to healthcare was good. The privacy and dignity of people using the service are compromised through poor practices. Evidence: We looked at the plans and assessments for three service users as part of this visit. The manager stated that the home had introduced a new system of care planning and assessments. We were informed that the service users records were all kept on the homes computer and all the staff were able to access the service users records. Care Homes for Older People Page 13 of 34 Evidence: We looked at the records for three service users. We found that although some assessments had been completed there was inadequate care plans in place to show how the home planned to meet the care needs of the service users. The care plans on the computer system was generic and these had not been developed in order to take into account the individual needs of the people accommodated. One of the service users care plan showed that they used a zimmer frame to aid their mobility, also they required full assistance with their personal care and required an assisted bath. There were no risk assessments such as moving and handling assessment. There was no care plan in place to reflect what type of assistance was required with personal care and bathing in order to effectively meet that persons needs. Another service user had been admitted for respite care and no pre admission assessment was available at the time of the visit. Again there was a lack of care plans to show what action the carers needed to take to meet her needs. The care record for another service user showed that they had senile dementia. Their care plan again contained minimal information such as for personal care it said needs some help. For bathing it was recorded that they required one staff and no further information was available. No moving and handling assessment was available in any of the care records we looked at. These are serious concerns, as the staff reported that a high proportion of the service users accommodated have some form of dementia and would not be able to participate in the care planning. There was no evidence in the records seen of involvement of the service users relatives and advocates in the formulation of their plans of care to reflect their choices about how they would like to be cared for. It was unclear how the service users and or relatives would access their care plans once this was developed with adequate information about the service users assessed care needs. The manager stated that this would be printed when they had a review. This did not address the issue about the access to their care plans. There was no evidence that the care plans were reviewed at regular intervals in order to take into account any changes in the peoples needs. The staff reported that all the service users are registered with the local surgery and they are well supported by the local Primary Care Trust. The GP visited on request and advice from district nurses and regular visits from the community psychiatric nurses was available. Care Homes for Older People Page 14 of 34 Evidence: We looked at the medication management that the home undertook on behalf of the service users. The home was using the monitored dosage system that ran over a twenty- eight days cycle. Staff maintained records of medication administered , however these were not always accurate and there was a lack of records that related to medication that was not given / missed. We found that one of the service users was having Insulin twice a day. The record on her MAR sheet showed that this was to be given as directed. There was no clear prescription available to show how much Insulin this person was prescribed and should be having. There was a lack of evidence to ensure that the service users needs were being adequately met. A record of the amount of Insulin administered was kept separately. There was also confusing information regarding who was responsible for the Insulin administration. The staff said that they prepared the pen fill cartridge and took it to the service user to administer herself. However the service user told us that the nurses gave her Insulin, as she had stopped taking her own Insulin since admission. The record of medication received at the service was also inadequate as these were not always recorded as required. We found that some prescribed medication had not been administered such as iron tablets and aperients. We found that one of the service users had not received their prescribed pain killer for a week, and staff reported that this had not been received from the pharmacy. We observed that staff had signed on the MAR sheet record for one of the service users that showed that they had received a larger dosage of analgesia than prescribed. We checked the analgesia that had been received from the pharmacy and found that the correct dosage had been dispensed from pharmacy. The staff reported and MAR record showed that one of the service users was administering their own medication. There was no procedure in place for selfadministering medication and no risk assessment had been completed for those taking their own medicine to ensure that these are carried out safely and they receive their prescribed medication. We found that in a number of bedrooms creams and ointments were found that did not belong to the current service users. In the laundry room we found two lots of ointments that belonged to someone who was no longer at the service. The management of prescribed medication was inadequate to safeguard the welfare of Care Homes for Older People Page 15 of 34 Evidence: people living at the home. Prescribed medication including ointments must only be used for the person that this has been prescribed as using other people creams and ointments pose high infection control risks. A procedure for homely remedies was not available and we found that one of the service users was using cough medicine that had been bought over the counter. There was no record of this in the care record for that person. The manager must ensure that clear guidance for homely remedies is developed and this is managed appropriately to ensure that any homely medication that the service users use are taking is recorded and consent gained to prevent any adverse reaction with their current medication. We noted that the controlled medication facility at the service did not meet with the current Regulation. This was brought to the attention of the staff and manager and must be addressed. During the visit the manager reported that to us that she understood that the carers are not able to dispense medication in individual containers when they are admitted from hospital. The staff would put these medication in a Dosset box. As discussed this is not good practice as secondary dispensing has a high risk of medicine error. Medicines must only be dispensed from the original container and strictly in accordance with the prescribers instructions. Further information about the safe management of medication can be obtained from the Royal Pharmaceutical Guidelines. The three service users we spoke to said that the staff treated them well and their comments included that the staff were nice and helpful. Interaction we observed at the time of the visit showed that the staff spoke to the service users in a courteous manner. When we visited the shared rooms we found that the service users did not have any screens in place in order to promote and protect their privacy and dignity. This was brought to the attention of the manager who reported that the home had received their consents and they had signed refusing to have screens. We could not find any evidence of these as they were not available. Also some service users may not be able to give consent but may have the capacity to recognise when their privacy was compromised. We also observed on two occasions when the privacy and dignity of the service users were compromised and an immediate requirement was raised at the time of the visit. Both of these involved service users using the toilet/ commode and being fully Care Homes for Older People Page 16 of 34 Evidence: exposed. One of these incidents was also witnessed by the manager at the time of the visit. Discussion about measures to promote the privacy and dignity of the service users and action that the home needed to take was undertaken with the manager. Care Homes for Older People Page 17 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is an activity programme in place, however this should be further developed to ensure it meets the social and cultural needs of the people accommodated. The service users are supported to maintain links with their friends and family. The meals at the home was well managed and offer the service users choice and variety that meets with their satisfaction. Evidence: The record we looked at showed that there is an activity programme in place for the service users. The list of activities included trips to the New Forest and lunch in May, cinema trip in August 08. Planned activities for the Christmas season includes cooked breakfast and presents wrapping 7th December 08, shopping and coffee at West Quay shopping centre, Christmas party 13th December 08. Three of the service users who were able to participate said that they chose when they got up and also they preferred to stay in their rooms and this was not a problem. Care Homes for Older People Page 18 of 34 Evidence: Another service user said that she preferred to remain in her room and kept herself occupied with her puzzles book. A visitor we spoke to was happy with the care that her mother was receiving. We found that the home maintained a record of visitors to the service and two people said that they could receive their visitors at any time. One service user said that the staff came to get them up and it was usually very early and guessed that it was six in the morning. The registered person has stated that this was at their request. There was no record to show how choices were offered in relation to activities of daily living for those who were unable to express their choice. The care records we looked at did not contain details of activities and should be developed to demonstrate how the home was meeting the social and recreational needs of people accommodated. We noted that through out the day of our visit there was no activity except for the television in the main lounge and people were left unsupervised. When asked about activities staff reported that people watched television and most were in bed by seven thirty in the evening. The home maintained a record of the visitors to the service, evidence from the visitors book and people we spoke to indicated that there was no restriction on visiting. One person said that she came in regularly and other family members visited at different times and this was fine. We looked at the meals at the service and found that this was well managed. The home has a menu that was rotated on a three weekly basis. The chef discussed that they were in the process of introducing the winter menu. Information from the AQAA indicated that the menu had been reviewed to accommodate the service users preferences. The chef discussed introduction of old fashioned meals that the service users enjoy. We found that the chef had developed and put in place detailed nutritional assessments since she recently took over the job and records of these were available. These included monthly weight records and the chef discussed that she would be monitoring any weight loss as part of these assessments and action plans would be put in place. Records of meals taken were maintained and any variation from the main menu was recorded. A daily menu was displayed and and a service user spoken with said that Care Homes for Older People Page 19 of 34 Evidence: they could go and ask for something different from the planned menu and this was not a problem. None of the service users we spoke to knew what the menu was for lunch, two of them said that it would be a roast dinner as it was Wednesday and they had two roast dinners per week. All of the service users and a relative we spoke to said that the meals were very good and choices were available. The lunchtime meal was observed and this looked well balanced, and nicely presented. Staff were available to support the service users with their meals. Care Homes for Older People Page 20 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a satisfactory process in place for raising and investigating any concerns raised at the service. There is a lack of processes in place to ensure that people are safeguarded from risk of harm. Evidence: We looked at the system that the home had in place to deal with any concerns raised. There was a complaint log that the manager reported had been put in place following the last visit. There was one complaint recorded that the manager had investigated and this had been resolved. People we spoke to said that they would talk to the staff if they were not happy. The commission received two reports of concerns that were investigated under safeguarding procedures. One of these had been resolved following an occupational therapist assessment and equipment for the safe moving of this person was put in place. The manager reported that the other concern had been sorted, as the person had been moved to hospital. The manager has stated that this was not investigated as safeguarding. Care Homes for Older People Page 21 of 34 Evidence: There was no record of these two incidents at the time of our visit that the registered person must maintain. We were unable to assess staff training in safeguarding as this record was not available. The regsitered person must ensure that the home accesses the updated safeguarding procedures and staff are updated on its contents. The registered person failed to ensure that all appropriate checks are completed prior to staff being employed. Care Homes for Older People Page 22 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is adequate communal areas to meet the needs of the service users. Further development of the accommodation is needed to ensure that people are provided with a clean and safe environment. The infection control practices are poor and put the service users at risk of harm. Evidence: We walked around the home as part of this visit and found that the home had two lounges and a communal dining room. The kitchen on the ground floor was clean and in good state of repair. Information from the AQAA showed that as part of the home refurbishment, a new shower facility has been put in place and the two communal bathrooms have been refurbished. The home has a passenger lift that allowed the service users access to all parts of the building. The environment was homely with some areas in a satisfactory state of repair and other areas were in need of refurbishment. We found that the communal bathrooms contained substances that are hazardous to health and also a number of communal toiletries. Both of these pose serious risk to the service users. These were brought to Care Homes for Older People Page 23 of 34 Evidence: the attention of the manager and the hazardous substances were removed at the time. The manager is aware of issues regarding communal toiletries and stated that this had been an ongoing problem that staff needed to address. We found that some of the rooms were personalized and people were supported to bring in items of personal choice when they were admitted. Other bedrooms were impersonal and bleak. We found that several areas of the home had offensive odours. The mattress cover in one bedroom was heavily stained and the room smelt of urine. In another bedroom the mattress cover was hard and crinkled up that poses risk of pressure sores. Another bedroom had a damp patch on the ceiling and had an offensive odour. As stated in other sections of this report, there were a number of creams and ointments that were not safely managed in peoples bedrooms and posed infection control risk. Also prescribed ointments were left in the laundry. We noticed that a couple of the bedrooms locks that we randomly tested were not working. One of the toilets did not have disposable soap container and towels in place. We brought this to the attention of the manager and these were addressed at the time. The home has a small laundry on the ground floor that was equipped with washing machines with a sluice facility and dryer. These were appropriate to the needs of the people accommodated. The laundry room was poorly maintained with the sink heavily stained and items of clothing left on the floor. We noted that equipment for the control of infection such as gloves and disposable aprons were available. Staff practices observed did not always ensure that infection control procedures were followed. We observed soiled linen left on the floor in a service users bedroom. During the visit we saw staff walking in the corridor carrying soiled laundry in their arms. Care Homes for Older People Page 24 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is adequate staff on the day shifts to meet the current service users needs, however the night staff numbers should be reviewed according to the service users needs. The staff recruitment is poor and puts the service users at risk of harm and abuse. There was no training record including induction record available to make an informed judgement as to whether the staff are skilled to meet peoples needs. Evidence: We looked at the number of staff employed and this indicated for the sixteen service users accommodated there are three carers on weekdays until four pm. During the weekend there are three carers until half past one in the afternoon and two carers in the evening. Night duty has one awake and one sleeping carer. The service users said that usually they did not have long to wait for assistance. However consideration should be given to the night time cover to ensure that there are adequate staff as per the assessed needs of the service users. Recruitment records for three carers were looked at as part of this visit. We found that Care Homes for Older People Page 25 of 34 Evidence: two of the carers completed an application form. References were sought however these were not always from the last employer. One carer did not have any current reference or application form for her present job. All the three carers records we looked at showed that they were employed without any evidence of a Prevention Of Vulnerable Adult (POVA) checks and prior to their full Criminal Record Bureau (CRB) clearance had been received. We spoke to the staff who stated that there is a training programme at the service and they had to complete the medication training before they are allowed to manage the service users medication. We were unable to access any training record as the manager reported that she did not have access to these at the time. The registered person must ensure that arrangements are in place to ensure records as required are available for inspection. There was therefore no evidence that the staff have the skills and received training they needed to carry out their role. Care Homes for Older People Page 26 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management at the service is inadequate to fully protect people accomodated at the service. There is a lack of records to show that the service users are protected. The health and safety of the service users were not always protected. Evidence: The service has a registered manager who is also the provider. The manager has a number of years experience in caring for older people. Mrs Miller is a registered nurse and also has a qualification in social care. She maintains good relationships with the service users and people we spoke to said that they would approach her with any problems. An immediate requirement was issued following the visit for the registered person to Care Homes for Older People Page 27 of 34 Evidence: ensure hazardous substances are maintained safely at all times. During this visit we identified three areas of concerns that needed immediate action and immediate requirements notices were sent to the manager in order to ensure the safety of people using the service. We also needed a response from the manager within a set timescale to advise us of the action that has been taken. We found that the home did not have an internal audit system in place to monitor the staff practices and ensure that the environment was safe. The manager took action to remove the hazardous substances and fitting a hand washing facility in the toilet as identified and reviewing the locks when we brought those to her attention. However the lack of a clear audit in the home does not promote the safety of people. The medication management and the lack of care plans and assessments are the responsibilities of the manager and these were not in place to safeguard people living at the home. The lack of a robust recruitment process puts the service users at risk of harm. Accurate records of all allegations of abuse and its outcome were not maintained. There was a lack of record to show that the staff had the appropriate skills through training and in particular mandatory training to ensure that people are not subjected to risk of harm through poor practices. We were unable to assess the section regarding how the home managed the personal allowances for some of the service users, as the manager stated that she did not have access to them on the day. We have received some notifications from the service relating to incidents that affect the welfare and well being of people living at the home. On the day of the visit we learnt that part of the service had been without hot water or heating for five days. The manager failed to inform the commission of this incident as required. We noted that the engineer arrived in the afternoon of our visit to deal with this problem. This placed vulnerable people in a position where they did not have adequate facilities. During the visit we noticed that the insurance liability certificate displayed at the service had expired and this was brought to the attention of the manager. The current insurance certificate was found and replaced at the time of the visit. Care Homes for Older People Page 28 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 18 12 The registered person must ensure that the home is conducted in a manner that promote and make proper provision for the health and safety of the service users. Records as required by Regulations are maintained. So that the service users are not put at risk of poor care and abuse. 30/11/2008 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 The registered person must 15/12/2008 ensure that a thorough pre admission assessment of the service users needs have been completed prior to admission and them receiving care. So that you can ensure that the assessed needs of the person can be met and people are not put at risk of their needs not being met. 2 7 15 The registered person must ensure that individual care plans are developed for the service users to show how 30/11/2008 Care Homes for Older People Page 30 of 34 their needs in respect of health and personal care are to be met by the home. So that you can ensure that they receive appropriate care at all times to meet their assessed needs. 3 8 12 The registered person must ensure that the home is conducted to make proper provision for the health and welfare of people using the service. This must include risk assessments for pressure ulcers and skin integrity, continence and moving and handling. So that you can ensure the service users are not put at risk of harm. 4 9 17 The registered person must ensure that arrangements are in place for the safe handling, recording, safe administration and disposal of medicines in the care home. So that the service users are not put at risk of harm. 5 10 12 The registered person must 30/11/2008 make suitable arrangements to make sure that the service users privacy and dignity are promoted and preserved at all times. 30/11/2008 30/11/2008 Care Homes for Older People Page 31 of 34 So that people receive care in a respectful manner and are not harmed. 6 19 13 A programme of refurbishment must be in place to ensure that the service users are provided with a well maintained, clean and safe environment. So that the home is in good state of repair and meet their needs. 7 26 13 The registered person must 30/11/2008 ensure that suitable arrangements are in place to prevent the spread of infection at the care home So that people using the service are protected. 8 29 19 The registered person must ensure that all necessary staff checks are completed prior to employment. So that the service users are not put at unnecessary risk of poor practice and abuse. 9 30 18 The registered person must ensure that staff employed receive training appropriate to their work. Records of these must be available. So that people living at the home receive appropriate care for their health and welfare. 10 31 12 The registered person must ensure that the home is conducted at all times in a 30/11/2008 30/11/2008 30/11/2008 30/11/2008 Care Homes for Older People Page 32 of 34 manner that safeguards the health and welfare of the service users. So that you can ensure that people receive the care they deserve. 11 35 17 The registered person must 30/11/2008 ensure that records of all transaction undertaken on behalf of the service users are available at the home for inspection So that the financial interests are safeguarded. 12 37 17 The registered person must ensure that reports as required by regulations are sent to the commission So that you can ensure that the rights and interests of the service users are best safeguarded. 13 38 13 The registered person must ensure that the home is conducted in a manner that prevents unnecessary risks to the health and welfare of people using the service. So that you can ensure that care is provided in a safe environment with staff who have been trained and are skilled. 30/11/2008 30/11/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 33 of 34 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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