Inspection on 12/09/06 for Attwoods Residential Care Home

This inspection was carried out on 12th September 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

Attwoods Residential Care Home 25/11/09

Attwoods Residential Care Home 09/02/09

Attwoods Residential Care Home 19/08/08

Attwoods Residential Care Home 18/04/08

Attwoods Residential Care Home 19/11/07

Attwoods Residential Care Home 26/02/07

Attwoods Residential Care Home 14/11/05

Similar services:

Abbey The

Snydale Care Home

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Attwoods Residential Care Home 46 Northgate Cottingham East Yorkshire HU16 4EZ Lead Inspector Pam Dimishky Key Unannounced Inspection 12th September 2006 09:30 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 DS0000064183.V312119.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. DS0000064183.V312119.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Attwoods Residential Care Home Address 46 Northgate Cottingham East Yorkshire HU16 4EZ 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) 01482 841133 Mr Ateeq Rehman *** Post Vacant *** Care Home 19 Category(ies) of Dementia - over 65 years of age (19), Old age, registration, with number not falling within any other category (19) of places DS0000064183.V312119.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th November 2005 Brief Description of the Service: Attwoods is a care home providing personal care and accommodation. It is registered for older people and also for older people with dementia. The home is situated in Cottingham within easy reach of the village centre and local amenities; a bus stop is outside the door and the railway station is nearby. The home is a large detached house arranged on two floors. Three bedrooms are on the ground floor and other bedrooms can be accessed by the stairs or stair lift. There are six double and seven single bedrooms, however, some of the double rooms are used as singles. There are two lounges and a dining room on the ground floor; one of the lounges is used by residents who smoke. The kitchen is located directly off the dining room. A paved courtyard and flower-beds are situated to the rear of the building which has full access for wheelchair users and all other residents. There is also limited car parking in this area. The current scale of charges for the home is £286.80. DS0000064183.V312119.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection visit took place over eight hours. The inspector looked around all areas of the home and a number of records were inspected. Six residents, one relative, two members of staff and the manager were spoken to; other residents and staff practice were observed both directly and indirectly. A random inspection was conducted on 5th June 2006 specifically to check progress in meeting requirements from the previous inspection; fourteen requirements were found to be outstanding and a further two identified. At this key inspection (12.9.06) only four of these requirements remain outstanding. However, a number of additional requirements were made at this inspection. Details of the random inspection on 5th June 2006 are also incorporated into this report. What the service does well: What has improved since the last inspection? The majority of requirements made at previous inspections have been completed, including all radiators being covered, the call alarm system being extended to both lounges and the dining room, new care plans introduced and evidence of continuing the programme for redecoration. Since taking over ownership of the home a year ago, the provider has made a significant investment in improving environmental standards and is making some headway in meeting health and safety requirements. DS0000064183.V312119.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. DS0000064183.V312119.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000064183.V312119.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 Quality in this outcome area was adequate. This judgement has been made using available evidence including two visits to the service. The information provided in the statement of purpose and service user guide is not sufficiently detailed to enable prospective residents to make an informed choice about living in the home. The assessment procedure for prospective residents is now good having improved since the inspection of 5.6.06; a decision can now be made as to whether individual needs can be met by the home. EVIDENCE: Random Inspection 5.6.06 The home has a statement of purpose and service user guide which are given to residents and prospective residents, but these do not include all the areas required by regulation. A statement of terms and conditions has been issued to all residents but has not been signed by the resident or provider. One resident had been admitted without the home making its own assessment of needs prior to admission. Residents had not been given written confirmation DS0000064183.V312119.R01.S.doc Version 5.2 Page 9 the home can meet their assessed needs. The home is not registered for intermediate care. Key Inspection 12.9.06 A service user guide was seen in residents’ rooms, but the statement of purpose has not yet been issued and on examination still does not include all the areas required by regulation. As this has been a long standing requirement, a list of the missing subjects needing to be covered were handwritten by the inspector and left with the manager at the time of the inspection. To ensure the home can meet care needs, the manager is now undertaking pre-admission assessments of prospective residents prior to them coming into the home. A copy of the letter confirming the residents needs can be met by the home was seen to have been issued and signed by the provider. The home is not registered for intermediate care. DS0000064183.V312119.R01.S.doc Version 5.2 Page 10 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 and 10 Quality in this outcome area was poor. This judgement has been made using available evidence including two visits to the service. Limited progress has been made on improving the care plans to ensure that the health care needs of service users are identified and met. However, the remaining shortfalls have a potential to place residents at risk. There is evidence of multi-disciplinary working taking place in the home which will ensure health needs involving health service professionals are met. The systems for the administration of medication are poor and potentially place residents at risk. EVIDENCE: Random Inspection 5.6.06 Residents care plans do not have evidence they are being seen by the manager or that they have been agreed with the resident or their representative. Resident’s admission records, kept on a small card in a photograph album, do not include a photograph, the resident’s address, marital status, address of next of kin, or the name of the placing authority. One resident’s care notes had been taken home by a care assistant to be written up; this is in breach of regulations and residents confidentiality. The care assistant was not scheduled DS0000064183.V312119.R01.S.doc Version 5.2 Page 11 to be on duty until two days later, but the records had been returned when the inspector visited the following day. Key Inspection 12.6.06 New care plans have been introduced which are very comprehensive and the deputy manager is in the process of completing these for all residents. Seven residents records were examined including two who are receiving respite care. No care plans were in place for the two respite residents despite one being admitted 19.7.06 and the second 21.8.06. Full assessments were in evidence covering mental health, physical health, moving and handling, behaviour, pressure assessment, nutrition screening, and falls risk but these assessments are not reflected in the plan for delivering care and the home cannot, therefore, be sure all the residents individual care needs are being met. The spouse of one resident telephoned the inspector following the day of inspection to say she is happy with the home and the care given and the staff are very caring, however, staff had not been aware a particular diet had to be followed and had been close to giving inappropriate food which could have had dire consequences. Arrangements are in place for accessing health service professionals, including general practitioner and district nurse. The district nurse is attending to three residents, who the staff stated, acquired pressure sores whilst in hospital. Arrangements are in place for an optician to visit the home on 16.10.06 and the chiropodist attends every six weeks. Dental appointments are arranged as needed either through the home or by relatives. All staff who administer medications received drugs awareness training four years ago, provided through Hull College. Omissions were found in the seven residents medications checked. One resident prescribed two puffs Combivent three times a day had missed the morning dose as the inhaler was missing (the manager stated she had ordered another one); the entry recording Loperamide as being given to one resident was not dated; one resident’s Diazepam was one tablet short and the days entry had not been signed as being given although the member of staff assured the inspector this had been given and was witnessed by the acting manager. (The manager stated two days following the inspection she was still unable to explain why the tablet was missing). Controlled drugs are being witnessed by a second member of staff and entered on the medication administration record; the home does not have a controlled drugs register. There is evidence the deputy manager is auditing medications weekly. Two staff questionnaires stated medication is not always ordered on time and one stated sometimes there is a two to three week delay. However, there was no evidence of this happening in the medication records and staff interviewed stated they had never known residents to be without their medication and if there is some doubt it will not be delivered on time, then arrangements are made for the home to collect the prescription from the pharmacist. During the course of the inspection, the medication cabinet was left unlocked and the acting manager was reminded the cabinet must be kept locked at all times. One relative informed the inspector she was concerned about some aspects of care. Her relative has lost two hearing aids and has been without for two DS0000064183.V312119.R01.S.doc Version 5.2 Page 12 months. Concern was also expressed about eye drops which were discontinued as the resident is still having problems with her eyes. However, the manager stated a further prescription has been requested and delivery was expected. The home has a policy for maintaining residents privacy, dignity, choice and independence, and one resident said staff always maintain her dignity when giving personal care; staff were observed knocking on residents doors before entering. A number of residents enjoy the privacy of staying in their own room and their choice to do this is assisted by the home’s arrangements. DS0000064183.V312119.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area was adequate. This judgement has been made using available evidence including two visits to the service. Residents are given the opportunity to participate in some basic activities within the home but these are not always stimulating or interesting to the people living there. The lives of residents are enriched by family and friends being able to visit the home at all reasonable times. Residents are able to make choices and are supported in making decisions about the way they live. The meals in this home are good and cater for special dietary needs EVIDENCE: Random Inspection 5.6.06 During the course of this inspection one lady was observed to be absorbed in colouring pictures in a book. The provider has introduced painting, card making and sculpture kits for those residents interested in art and crafts and also books for those who enjoy reading. Key Inspection 12.9.06 A record is now being kept of activities taking place in the home and of those residents who participate. Small prizes have been purchased to be awarded to those residents winning games, eg bingo, noughts and crosses. Recent entries in the activities book include colouring, arts and crafts, reading novels, games DS0000064183.V312119.R01.S.doc Version 5.2 Page 14 afternoon, cards, jigsaw. Out of the seven comment cards returned from residents, two said usually there are activities they can take part in, two said sometimes and one said never, although this was by choice; a further two were unable to participate. A coffee morning has been arranged for 23.9.06 in the church hall and a poster advertising the event was displayed in the hallway for the benefit of residents and visitors. The acting manager said the home is now starting to think about Christmas activities including a party, to which relatives and friends are also invited. Visitors to the home are welcome at any reasonable time and were observed during the course of the inspection. Residents are able to make choices about their daily life in the home and some prefer the privacy of their own room, occasionally joining other residents in the dining room. Four relatives completed a questionnaire and all stated they could visit their relative/friend in private and that they were kept informed of important matters affecting them. Residents, relatives and staff expressed their satisfaction with the food provided and there were no adverse comments in the completed questionnaires from residents. A menu board in the hallway displays the menus for the day and lunch on the day of inspection was diced beef casserole, potatoes, cauliflower, carrots, turnip, peas and gravy followed by coconut sponge and custard. Lunch was observed to be plentiful, nicely presented and enjoyed by the residents. Tea was teacakes and/or sandwiches, assorted buns, cakes and pastries; the acting manager said a hot choice is always available on request. The manager stated one resident had made a request to have fish pie but she was unsure whether this had yet to be provided. Meat, fish and vegetables are all purchased locally, however on the day of inspection a recent delivery of leeks, carrots and cabbage were not in good condition and the acting manager was also aware of some lettuce which had been received at another time from the same supplier which was not fresh. During a conversation with the provider, he was disturbed to hear this is happening and said he would look into the matter. DS0000064183.V312119.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area was adequate. This judgement has been made using available evidence including two visits to the service. The home has a satisfactory complaints procedure available to residents and their relatives. Staff are aware of the procedures for protecting vulnerable adults from abuse which protects residents from the risk. Weaknesses in recruitment practice could affect the safety of residents. EVIDENCE: Random Inspection 5.6.06 The acting manager confirmed residents now have a copy of the complaints procedure although residents spoken to did not appear to have one but did say they would speak to the acting manager if they had concerns. The provider’s action plan also confirms the procedure has been given to residents and is now included in the welcome pack (service user guide). The revision of the procedure for “whistle blowing” remains outstanding and the actual procedure was missing from the policies and procedures file. A member of staff appointed during January 2006 has not had a Criminal Records Bureau (CRB) check and there is no Schedule 2 (Care Homes Regulations) information apart from a reference provided by the mother of the member of staff. The acting manager stated the CRB application had been posted three weeks previously. An immediate requirement form was left with the acting manager regarding the appointment of staff without obtaining information as required by regulations. DS0000064183.V312119.R01.S.doc Version 5.2 Page 16 Key Inspection 12.9.06 No complaints have been recorded since the last key inspection, although a relative informed the inspector that although she has not made an official complaint, she does “spend a lot of time complaining” but her concerns are “resolved eventually”. The welcome pack (service user guide) includes the complaints procedure and has been given to all residents and was seen in some rooms. The procedure for “whistle blowing” was examined and seen to have been amended in line with the Department of Health document “No Secrets”. No new members of staff have been appointed since the last inspection in June so staff records were not examined at this inspection. The CRB check, outstanding at the last inspection, remains outstanding despite the acting manager checking with the umbrella body responsible for processing the application. A POVA first check was received 15.6.06 and the acting manager stated the member of staff continues to work under supervision. The inspector advised it is not usual for CRB checks to take four months and should therefore be chased-up more rigorously with the umbrella company. The home has a policy and procedure for the protection of vulnerable adults and staff completing the questionnaire demonstrated their knowledge of protecting vulnerable adults from abuse. DS0000064183.V312119.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area was adequate. This judgement has been made using available evidence including two visits to the service. The new owner has commenced a programme of redecoration and refurbishment of the home, but until this is complete the home does not present as a homely and comfortable environment for residents throughout. Until the home is cleaned thoroughly it is not conducive to being a clean and hygienic place for residents to live. EVIDENCE: Random Inspection 5.6.06 Since the last inspection three bedrooms and the small lounge have been redecorated. The provider has an ongoing programme for replacing furniture and there is evidence of items being introduced into the home. Some chairs have been replaced and cabinets in the hallway and dining room have been introduced. Quotes have been obtained for extending the call alarm to the dining room and both lounges and the manager expects this to be in place in the very near future. The provider is fitting radiator guards as redecoration is DS0000064183.V312119.R01.S.doc Version 5.2 Page 18 completed and the timescale for completing the redecoration has therefore been extended to 31.12.06. The provider has reconfirmed his intention to fit thermostatically controlled valves to all hot water outlets used by residents. Key inspection 12.9.06 The location and layout of the home is suitable for its stated purpose and once the redecoration and refurbishment programme is completed, will present as comfortable and homely. A suggestion that one tall resident needs a longer bed has been resolved by making sure the resident sleeps higher up in the bed. However, the bed was not in good condition and the acting manager said a new bed is available in the home and this will be in place the next day the handyman is in the home. One bedroom had two pieces of extra carpet which could present as a trip hazard, and the acting manager said she would attend to this. An old toilet situated under the stairs on the ground floor is now being used as a store room for zimmer frames, pictures, pads etc. and until this is sorted out and the toilet removed, the home cannot be certain it is a hygienic area for pads to be stored. A second cupboard, adjacent to room 1 also needs sorting and old duvets discarding. Since the last inspection, there is evidence of a further three bedrooms being prepared for redecoration. The call alarm has been extended to include both lounges and dining room which helps residents maximise their independence. The programme for fitting radiator covers is now complete making the home a safer place to live. Thermostatically controlled valves are in the process of being fitted to all hot water outlets accessible to residents. The home has three bathrooms, one is not used and only one has a bath hoist. The assisted bath is on the first floor and is not accessible to residents who are not mobile due to being on a lower level reached by steps. Attention is needed to the water supply in this bathroom as the hot water to the bath does not run until the taps in the hand basin are also turned on. The second bathroom on the first floor is not used and the taps cannot be turned on. An immediate requirement form was left for the hot water temperature in both bathrooms in use to be regulated to a temperature not exceeding 43 degrees C. A new fire door has been fitted to bedroom 4 but this does not automatically close into the rebate and does not have an intumescent seal. A similar problem was identified with the door to room 2 and the door to the small lounge. Some doors had been propped open with a door wedge which compromises fire safety. The environmental health officer has inspected the kitchen recently and as a result of his requirements, the kitchen has been redecorated. At the time of this inspection a dirty dishcloth used for cleaning surfaces was removed immediately; records for refrigerator temperatures were not available and according to staff have not been completed for some time although a daily record is being kept of freezer temperatures. Food safety management records are not being completed and as a result of these concerns the inspector advised the environmental health officer of her findings. A recent DS0000064183.V312119.R01.S.doc Version 5.2 Page 19 delivery of vegetables did not appear fresh, particularly leeks, cabbage and carrots. DS0000064183.V312119.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 and 30 Quality in this outcome area was poor. This judgement has been made using available evidence including two visits to the service. Sufficient staff are deployed on each shift, however, work schedules may need to be reviewed to ensure the needs of residents are being met. The home cannot be sure residents are in safe hands at all time until training is complete and the home’s recruitment practices improve. EVIDENCE: Random Inspection 5.6.06 The number of residents in the home has reduced from fourteen at the last inspection to eleven at this inspection, therefore the current staffing level is sufficient. Only one new member of staff has commenced working in the home since the last inspection and the appointment was made without first obtaining a Criminal Records Bureau or POVA check, only one reference was evident and this was from the employee’s mother dated 25.9.99. (this person had previously been employed in the home). None of the information required to be obtained by legislation was available. Key Inspection 12.9.06 Twelve residents are currently living in the home and two staff are on duty on each shift. The acting manager is on duty on the early and late shifts apart from weekends, a cook is employed 21 hours a week and a domestic 20 hours. Eight staff questionnaires were returned to the Commission and only two said they felt enough staff are on duty to meet residents needs on all shifts; seven DS0000064183.V312119.R01.S.doc Version 5.2 Page 21 said they do not have sufficient time to spend with residents. Although the acting manager is in the process of appointing a new cleaner, the perceived lack of time on the part of care staff may be due to having had to cover cleaning duties. However, the provider should review the deployment of staff to ensure residents’ needs are being met on all shifts. Staff are receiving regular supervision and records of supervision were examined for five members of staff covering areas of care practice, but training needs was not included and staff confirmed this is not discussed. Despite concerns at a previous inspection that a member of staff has been employed in the home without a Criminal Records Bureau check, there has been little progress in obtaining this (see also under the section of this report for Complaints and Protection). No new staff have been appointed since the last inspection, therefore staff records were not inspected on this occasion. According to the acting manager seven staff (including herself) have NVQ level II and a further three have enrolled to take the qualification. There is very little evidence of training taking place during the last twelve months and a course on nutrition, which the acting manager stated during the November 2005 inspection was being planned for the near future, is still on the agenda along with a course on diabetes. Staff generally need update training for mandatory subjects ie moving and handling, health and safety, first aid, food hygiene. Four staff questionnaires stated they did not get time off or funding (or both) for training. DS0000064183.V312119.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): 31,33,35 and 38 Quality in this outcome area was poor. This judgement has been made using available evidence including two visits to the service. The home is not being managed properly and there is little leadership, guidance and direction to staff to ensure residents receive consistent care. This results in some practices that do not promote and safeguard the health, safety and welfare of the people using the service. The home is not involved with residents’ financial arrangements. However, the arrangements for keeping small amounts of money on residents behalf ensures their interests are safeguarded. EVIDENCE: Random Inspection 5.6.06 The acting manager is awaiting the results of her CRB check before making application to the Commission for registration as the manager. The provider is making regular visits to the home as required by regulation and has forwarded DS0000064183.V312119.R01.S.doc Version 5.2 Page 23 copies of his reports to the Commission. (A sample format for making Regulation 26 visits was left with the manager for the provider’s information). The stairlift and bath hoist were serviced on 2.6.06 but the thorough examination (LOLER) is outstanding. The acting manager stated she has arranged for the examination to take place on 6.6.06 and will fax a copy of the certificates to the Commission. A fax was received on 7.6.07 but this included a copy of the service report undertaken on 2.6.06. A telephone call to the provider on 13.6.06 confirmed the thorough examination had taken place and copies would be forwarded to the Commission. The provider was advised to speak to the health and safety officer regarding these examinations and any other health and safety issues the home may not be sure of. According to the acting manager, fire training is taking place for all staff twice a year. A member of staff has been given responsibility for showing a video but there is no evidence this has taken place and staff interviewed were not sure they were receiving twice yearly training. The fire door (room 4) identified at the last inspection as not closing into the rebate, had not been adjusted and the handyman said he would attend to it today (5.6.06). However, the work still had not been done when the home was visited on 6.6.06. The acting manager telephoned on 7.6.06 to confirm a carpenter was booked for 10.00 am to adjust the door. Key Inspection 12.9.06 The home has been under new ownership for a year and the acting manager has been in post since April 2005; application has been made to the Commission for the manager to be registered and an interview has been arranged to take place this month. The acting manager stated she has commenced NVQ IV in management and has qualified to NVQ level II in care. The provider makes approximately six weekly visits to the home but has not made a report in recent months as required by regulations. Team meetings are held monthly and staff are invited to submit items for the agenda but not everyone attends. Resident meetings are also held monthly and for those who prefer to stay in their rooms, the activities co-ordinator visits their room. All residents receive their full personal allowance which is held by the family. Some money is provided by the resident’s family for toiletries etc and the home is keeping records of incoming and outgoing money, with receipts. All those residents (5) records, for whom the home is keeping monies on their behalf, were checked and found to be in order. Some headway has been made in meeting health and safety requirements ie the home has a current gas safety certificate dated 22.5.06, a thorough examination has been undertaken of all people lifting equipment dated 21.7.06, fire extinguishers were checked during August, 2006 but fire alarm tests and emergency lighting checks had not been recorded since 16.7.06 and 29.5.06 respectively. The stair lift was still in use despite the examining contractor stating it had not to be used until the seat belt had been replaced. An electrical wiring certificate was not available for examination. Two staff questionnaires alluded to residents having a number of falls, however, the DS0000064183.V312119.R01.S.doc Version 5.2 Page 24 accident book was full with the last entry being 23.7.06. The acting manager and staff on duty could not recall any recent accidents, but this was not consistent with the number of entries up to 23.7.06. Of those recorded entries the Commission has not received Regulation 37 notices for four accidents occurring in the home where an emergency care practitioner or ambulance has been called. As a result of the concerns over outstanding health and safety issues, the inspector has spoken to the health and safety officer who will visit the home to advise. DS0000064183.V312119.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 2 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 1 x x x x x x 1 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 x x 1 DS0000064183.V312119.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 OP1 Regulation 4,5,6 Requirement Make available to residents and/or their representatives an up-to-date statement of purpose which includes all the requirements listed in Schedule l of the Care Homes Regulations (Outstanding requirement) The registered person must prepare a service user plan as to how the resident’s needs are to be met, provide evidence this has been written in consultation with the resident or their representative and keep the plan under review, the resident being notified of any such revision. The registered person must make arrangements for the recording, handling, safe keeping, safe administration and disposal of medicines received into the care home. The registered person must consult residents about the programme of activities and interests and make arrangements to enable them to engage in local social and community activities and provide DS0000064183.V312119.R01.S.doc Timescale for action 31/10/06 2. OP7 15 31/10/06 3. OP9 13 31/10/06 4. OP12 16 30/11/06 Version 5.2 Page 27 5. 6. OP15 OP18 16 13,19 7. OP19 23 8. OP19 23 9. OP19 16 10. OP22 23 11. OP22 23 12. OP25 13,23 facilities for recreation. Ensure vegetables delivered to the home are fresh and nutritious A Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) check must be applied for before staff commence working in the home. The progress made so far with the internal decoration must continue (Outstanding requirement with extended timescale) The registered person must consult with the fire authority and take adequate precautions against the risk of fire. Fire doors must close into the rebate and be fitted with intumescent seals. (Immediate requirement left). The acting manager informed the inspector 20.9.06 this work had been completed. After consultation with the environmental health officer, make satisfactory arrangements for maintaining satisfactory standards of hygiene in the kitchen Ensure suitable provision is made for storage and equipment in the home and that clinical items are kept in hygienic conditions If the toilet on the ground floor is to be used for storage, then proper provision must be made and the toilet removed and drains adequately sealed The progress made so far in ensuring hot water outlets in areas used by residents are controlled to maintain a temperature not exceeding 43 degrees C continues (Immediate requirement left DS0000064183.V312119.R01.S.doc 12/09/06 12/09/06 31/12/06 12/09/06 12/09/06 12/09/06 31/12/06 31/12/06 Version 5.2 Page 28 13. OP27 18 14. OP27 18 15. OP33 26 16. OP38 23 17. OP38 37 for the water temperatures in two bathrooms be regulated to 43 degrees C). The acting manager informed the inspector 20.9.06 the plumber is completing this work by the end of the week. The registered person must ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of residents The registered person must ensure that persons employed in the care home receive training appropriate to the work they are to perform and suitable assistance, including time off, for the purpose of obtaining further qualifications appropriate to the work The registered person must visit the home at least once a month, inspect the premises, its records of event and records of complaint and prepare a written report on the conduct of the care home with a copy to the manager The seat belt on the stair-lift must be replaced as required following the thorough examination (Immediate Requirement left for this to be actionned). The acting manager informed the inspector 20.9.06 the part required has been ordered and will be fitted immediately on receipt. The registered person must give notice to the Commission without delay of death, illness and other events occurring in the home including any serious injury to a resident. A record DS0000064183.V312119.R01.S.doc 12/09/06 12/09/06 12/09/06 15/09/06 12/09/06 Version 5.2 Page 29 18 19 OP38 OP38 23 23 must also be kept of these events including accidents. Therefore the home must inform the Commission of the four accidents, and any others, involving the emergency care practitioner and/or ambulance service Fire alarm tests and emergency lighting checks must be made and recorded weekly Provide the Commission with evidence the home has a current electrical wiring certificate 12/09/06 31/10/06 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 OP28 Good Practice Recommendations A minimum ratio of 50 trained members of care staff at NVQ level II or equivalent should be achieved. (Outstanding recommendation) The registered manager should have a qualification at level IV NVQ in management and care or equivalent. (Outstanding recommendation) The manager should provide a written statement of the policy, organisation and arrangements for maintaining safe working practices. (Outstanding recommendation) 2. OP31 3. OP38 DS0000064183.V312119.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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