Inspection on 17/03/08 for Autumn Care

This inspection was carried out on 17th March 2008.

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

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

Autumn Care 18/03/09

Autumn Care 26/11/07

Autumn Care 24/08/06

Autumn Care 13/10/05

Autumn Care 30/06/05

Autumn Care 16/12/04

Autumn Care 30/06/04

Autumn Care 18/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Autumn Care 41 Dudsbury Road Ferndown Dorset BH22 8RB Lead Inspector Debra Jones Key Unannounced Inspection 17th March 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Autumn Care DS0000026795.V360905.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. Autumn Care DS0000026795.V360905.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Autumn Care Address 41 Dudsbury Road Ferndown Dorset BH22 8RB 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) 01202 573746 F/P01202 573746 Mr John Henry Hughes Mrs Susan Linda Hughes Mrs Debra Eve Barbara Dacey Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (14) of places Autumn Care DS0000026795.V360905.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th November 2007 Brief Description of the Service: Autumn Care is registered with the Commission for Social Care Inspection to accommodate a maximum of 14 older people. Mr & Mrs Hughes own the home and Ms Dacey is the registered manager. The premises are located in a residential area a short drive from the centre of Ferndown. Local amenities including shops and a pub are within walking distance. A bus service is available nearby. The home is a converted and extended family home. The bedrooms are located on the ground and first floors. There are 10 single rooms, 8 of which have en-suites, and two shared rooms. Both shared and two of the singles are on the ground floor. A stairlift provides access between floors. A communal dining room and lounge is on the ground floor. The gardens are well maintained and there is outside seating to the rear of the home. The fees for the home as provided to CSCI at the time of inspection range from £395 to £550. Additional charges include hairdressing, chiropody and newspapers. See the following website for further guidance on fees and contracts. http:/www.csci.org.uk/about_csci/press_releases/better_advice_for_people_c hoos.aspx Autumn Care DS0000026795.V360905.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced inspection took place on 17 March 2008. Debra Dacey, the Registered Manager, was present and assisted with the inspection. This was a ‘key’ inspection where the home’s performance against the key National Minimum Standards was assessed. Nineteen requirements and 3 recommendations were made in the last inspection report and the home was rated as poor. This inspection focussed on how the home had addressed these and what progress they had made in meeting them. Significant progress has been made and only 4 requirements and 2 recommendations remain. It was really encouraging to see that most of these had been partly met or where they hadn’t plans were in place to meet them. The home completed an improvement plan and sent it to the Commission for Social Care Inspection after the last inspection visit in November 2007. During the visit relevant records were reviewed and parts of the premises were visited. What the service does well: What has improved since the last inspection? Autumn Care DS0000026795.V360905.R01.S.doc Version 5.2 Page 6 Detailed care plans and appropriate risk assessments, including falls and nutrition, have been put in place that focus on the individual needs of the residents. Residents care plans now contain sufficient detail to provide clear guidance to staff on the actions to be taken to meet their care needs. Evidence is in place to show that residents are consulted regarding care outcomes, care planning and decision making about care routines. (Once the home has obtained their ‘sit on scales’ they will be able to complete their moving and handling, and nutritional assessments to determine whether any actions need to be taken.) The home has improved the storage, administration and recording of medication and provided training for staff in medication administration further safeguarding people living at the home. (see below for some aspects that still need to be addressed.) Residents have been consulted about their social interests and plans are in hand for more things to go on at the home. To ensure the safety of the residents, and as part of the fire safety procedure, all visitors to the care home are being encouraged to sign the visitors book. Sufficient food to enable the home to provide a balanced diet is available. All staff have received training in the prevention of abuse and the policy relating to this has been updated to relate to the practice of the home. The laundry floor finish is now impermeable and readily cleanable thereby helping prevent the spread of infection. Staffing levels have been reviewed to ensure that at all times they are appropriate to meet the needs of residents and steps have been taken to ensure that they do. The staff rota accurately reflects the number of staff on duty. Staff have received training appropriate to the work they are to perform including recently the care of residents with dementia and moving and handling. Time has been set aside for the more effective management of the care home. Comprehensive records are being maintained of accidents affecting residents. What they could do better: Four requirements and two good practice recommendations have been made as a result of this inspection. The home have since submitted some supporting evidence, received on 21 May 2008, to demonstrate that they are making good progress towards meeting these shortfalls. This will be checked at the next inspection. Autumn Care DS0000026795.V360905.R01.S.doc Version 5.2 Page 7 To ensure that residents are getting their medication safely it must be stored properly, the home must confirm that it is administered by signing the medication administration record (MAR) when it is taken by the resident and MAR sheets need to include any known allergies. In addition the medicines policy needs updating and the maximum and minimum temperature achieved by the refrigerator where medicines are stored needs to be recorded daily to ensure that the medication remains effective. Also a lockable plastic box should be used to store medicines in the refrigerator rather than a metal box. In order to meet the social and psychological needs of residents there needs to be more suitable leisure and recreational activities on offer to make life more enjoyable. In order to meet their legal obligations the registered persons must ensure that the staff rota includes the full names of all staff on duty. To ensure that residents are only cared for by appropriate people the home needs to obtain proof that all their staff are eligible to work in the UK and that they do not work more hours than they are allowed to according to their visas. For residents to be well cared for staff need to be well trained. The home has been providing training for staff and more is planned. So far the home does not have the evidence to prove that staff have all the training they need to do their jobs well. In addition to the requirements and recommendations made above the following are suggested to improve the service. • Where fluids are being monitored it would be helpful to note the amount of water drunk. • • It would be good if the home reviewed, along with the district nursing service, the frequency of the nightly repositioning of one resident. Documentation could be clearer about the use and storage of inhalers. 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. The summary of this inspection report can be made available in other formats on request. Autumn Care DS0000026795.V360905.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 Autumn Care DS0000026795.V360905.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admissions only take place when the home is confident that they are able to meet the assessed needs of the prospective resident. EVIDENCE: This standard was not assessed at this site visit. At the last visit in November 2007 the standard was assessed and the outcome for residents considered to be good. At that time three resident care files were examined, one for a recent admission to the home. It was evident that each person’s care needs had been assessed prior to him or her moving to the home. The registered manager or senior staff member visit prospective residents prior to admission to carry out pre admission assessments. They identify, with the help of the resident and their representative, what the persons needs are and whether Autumn Care has sufficient resources to meet them. Where a person Autumn Care DS0000026795.V360905.R01.S.doc Version 5.2 Page 10 has local authority support with their funding arrangements, the local authority also undertake an assessment to assess the resident’s needs and the suitability of the home in meeting them. Assessments examined detailed each person’s personal care needs, physical needs including continence, mobility, diet and skin care and psychological and emotional needs including communication and mental state. Assessments are signed by either the resident or their representative to indicate they agree with the identified care outcomes. Autumn Care does not provide intermediate care therefore standard 6 is not applicable. Autumn Care DS0000026795.V360905.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements have been made to the completion of care plans, risk assessment documentation and medication administration to ensure that the health and personal care provided is safe and meets residents’ individual needs. EVIDENCE: During the course of the visit a number of care plans were referred to to evidence the changes the home have made to their record keeping. The manager has been carrying out extensive reviews of the assessments that underpin the care plans and the care plans themselves. She showed a real understanding of the relationship between assessments and plans and care plans cross referenced with pertinent assessments. Information was clear, person centred, and where any risks were identified the plans gave direction as to how risk was to be minimised. Plans also demonstrated the involvement of residents or, where more appropriate, their supporters. Autumn Care DS0000026795.V360905.R01.S.doc Version 5.2 Page 12 Moving and handling and nutrition assessments and plans are being developed. Once the home has obtained ‘sit on scales’ they will be able to fully complete these with the residents’ weights. Where residents have been identified as needing assessment and equipment from the Occupational Therapy service the home have initiated referrals. Falls diaries have been introduced. The manager talked of how she was working with staff to improve recording e.g. of the night chart for a resident who is being repositioned every two hours. The frequency of the repositioning was also discussed, as the person has a pressure relieving mattress in place and the home was amenable to take advice from the district nursing service regarding potentially repositioning less often. The manager also talked of how she was intending to introduce wound charts for use where appropriate. One resident was having their fluid intake monitored. This showed the amount of liquids they drank each day but did not include water, which is significant if there are any hydration concerns. The success of the changes will be better measured at the next inspection visit when it can be assessed how well plans reflect changing needs and are being updated. The manager confirmed that all but one member of staff had now had training in medication administration. The staff member who has not been trained does not administer medication without supervision. The training certificates for the recent training had not yet arrived at the home. Medication administration record sheets (MARs) are provided by the pharmacy. A number were reviewed and were clearly completed, included information about how many tablets were given when there was a choice of dose and used the correct codes. One sheet showed that the resident had not had any medication that day, the actual medication showed that they had, demonstrating an error in recording. The home records medicine allergies for people or “none known”, if appropriate, to protect them from receiving medicines they are allergic to. This same information should be on the MARs provided by the pharmacy, and was in all but one case. This resident had not been prescribed penicillin. Good practice was observed in respect of photographs of residents being kept with the MAR sheets and the home has a sample signature sheet for staff administering medicines. Risk assessments were on file for residents self medicating. Clear information about creams was available e.g. how and when they are to be used. Where medicines were not in tablet form estimates were made as to when they needed to be re ordered e.g. inhalers. Two residents use inhalers and need to keep them about their person. Documentation as to the agreement for this and their storage was not clear. Autumn Care DS0000026795.V360905.R01.S.doc Version 5.2 Page 13 The home has a fairly comprehensive medicines policy but it needs updating with procedures for self-medication, storing and recording controlled drugs and the relevance of the Mental Capacity Act to giving medicines covertly. The home now has a cupboard for storing medicines that require special storage arrangements and a separate book for recording them appropriately. Both are in use. The medicines trolley was secured to the wall and sufficient lockable storage was available for the medicines in the home on the day of the visit. Some medicine was in use that has to be kept refrigerated. This was being kept in a locked metal box. A thermometer was in place that records the maximum and minimum thermometer to monitor the temperature that they were stored at. This showed that the temperature had dipped to one degree, a degree under the temperature advised. Temperatures are not recorded daily. Unopened eye drops for one resident that should be refrigerated were properly stored. The dates that medicines are now being recorded on bottles so it is easy to see when they are brought into use and when they should be taken out of use. At the last visit the residents that were able to express an opinion all confirmed they are treated respectfully by a caring staff group who are able to meet their needs in the manner to which they expect. Residents confirmed that their privacy is respected in their rooms and when receiving assistance with personal care routines. In addition a relative commented ‘they always treat the resident as an individual and with respect and their needs are always met immediately’. Autumn Care DS0000026795.V360905.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Changes are being made to try to improve the daily life of residents through offering more activities and social opportunities. The home encourages residents to make choices and have control over their lives as far as possible within the service provided. EVIDENCE: As at previous inspection visits it was again evident that residents are able to form and maintain friendships within the home and during the lunch period, a group of residents sat together engaged in lively conversation. Care records viewed included information relating to the social history of residents, which assist staff in planning for their current and future care. The home has identified through quality assurance surveys that residents are interested in more being provided in respect of activities and general things to do to make life more interesting for them. It is recognised that the residents Autumn Care DS0000026795.V360905.R01.S.doc Version 5.2 Page 15 enjoy different things and so group and individual activities need to be provided to their needs. The home are looking to develop an activities programme with something organised taking place each day. In addition an activities record sheet has been devised so that what individual residents take part in can be logged. Activities now include a motivational therapist visiting the home weekly, who does exercises with interested residents, and a church service once a month. Plans are afoot to book singers, pianists, start art and craft sessions and to introduce pamper afternoons. The manager talked of how residents loved using the garden in the summer. Some residents benefit from staff spending time with them individually and it is planned that this be responded to in a more structure way. Residents receive visitors whenever they wish. A record is maintained of all visitors to the home. A sign has been put up near the visitors book encouraging all visitors to sign in and out. Friends and relatives are encouraged to keep in contact. Residents are able to go out on their own, if able, or with a member of staff, relative or friend. Visitors spoken with at the last visit confirmed that they are always made welcome by the staff. At the last inspection residents talked about how comfortable they were in the home and how they were happy with the daily routines. Since then the home have improved the way that they evidence in the care records how residents are involved in making personal choices and decisions about their life in the home through getting them to sign care plans and reviews. On the day of the visit lunch was homemade shepherds pie. Residents who did not want this were having jacket potatoes or bacon and eggs. The meals are always prepared by one of the care staff on duty. There was plenty of food available in the home, fresh, frozen and long life. The home is now routinely carrying out nutrition assessments, using a recognised tool to do this. In order to properly assess the ongoing needs of residents the home will have to monitor their weight. Autumn Care has ordered ‘sit on scales’ to make this easier. Where the home have already identified concerns they have sought medical advice and are keeping food records. In addition, the manager talked of how she was actively seeking information about nutrition for the elderly to ensure that the home was doing everything they could to provide appropriate diets for people in their care. Autumn Care DS0000026795.V360905.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The systems in place provide residents with the confidence that their complaints will be listened to and acted upon. Safeguarding adults procedures and staff training provide protection to residents from abuse. EVIDENCE: The Service User Guide contains the home’s complaints procedure and is available to all residents and their representatives. At the last inspection visit it was noted that the home had received and investigated two complaints in the last twelve months, both had been well documented with clear outcomes. One resident commented ‘Debbie always listens to my problems and acts on any problems I’ve had (not been many)’ The residents that responded to the survey all agreed that they knew how to make a complaint and who to speak to if they were unhappy. The Adult Protection procedure has been updated and appropriately refers to the Dorset multi agency ‘No Secrets’ guidelines. The manager confirmed that all staff had now had training in this area. Certificates have not yet arrived from the training provider. Autumn Care DS0000026795.V360905.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Autumn Care home provides residents with a home that is generally clean, safe and well maintained. EVIDENCE: In the past twelve months a new carpet has been fitted in the lounge and further new carpets are planned for the hallways and staircase. The home is generally well maintained. Autumn Care has very limited space with one communal room; easy chairs line the two walls and tables and chairs are placed against the back wall. This room also contains cabinets and the paperwork required for the running of the home as there is no office. No other room is available for carrying out staff supervision or any discussions with staff, relatives and health professionals. This makes maintaining confidentiality very difficult. Autumn Care DS0000026795.V360905.R01.S.doc Version 5.2 Page 18 The manager advised that the proprietors are planning to extend the home in order to improve the available facilities. The cleaning and laundry are undertaken as part of the general duties of care staff. All areas of the home that were seen during the visit were in a clean condition and there were no unpleasant odours. Laundry procedures have been reviewed and improved. Some residents’ personal clothing and bed linen were seen and touched and had clearly been appropriately laundered, with garments having been fully rinsed and not retaining soap powder, as had been the case at the last visit. The laundry floor has been covered with flooring that is impermeable and easy to clean. Autumn Care DS0000026795.V360905.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff recruitment practices generally ensure resident’s safety with appropriate checks being carried out prior to offering employment. However the lack of some essential training leaves residents at risk of their individual needs not being fully met. EVIDENCE: A staff rota was available that showed who was on duty, the hours they worked and the job that they did. The full names of staff were not included. At the last visit residents commented ‘excellent rapport and relationship with staff. Always have time for me’ and ‘always answers bell quickly’. A relative in the survey commented ‘staff always bright and cheery. Kind to the confused patients and always ready for a chat with clients’. It is still the case that there are three staff on duty in the morning and two in the afternoon. In addition to providing personal care for residents staff on duty are required to prepare and cook the meals, undertake domestic tasks and do the laundry. The manager has a ‘hands on’ approach to her job and is very much involved in the direct care of the residents. After the last visit the home were asked to review their staffing levels to check that there were sufficient carers on duty as it was identified that there were Autumn Care DS0000026795.V360905.R01.S.doc Version 5.2 Page 20 some residents who at times need the assistance of two carers and other residents who need to be accompanied when moving around. When this happens at busy times of the day there is a risk that the other residents are not able to get the attention they need. Whilst the staffing levels remain the same the residents with the highest needs have been reassessed and one is due to move to a home providing nursing care, lessening the demands on staff. The manager confirmed that when she is not on duty she is mostly available to support staff if they need her and the emergency call system extends into her private accommodation. At night there is a waking member of staff on duty and one asleep/ on call, for back up if needed. Previous inspectors have recommended that a record is held detailing each time the night sleep in/on call carer is called to assist the waking member of staff. The manager advised that this had not happened since the last inspection visit in November 2007. At the last visit concern was expressed that one member of staff was regularly working exceptionally long hours. This has been addressed and staff are now working shifts of an acceptable length. The home continues to exceed the Department of Health target of 50 of care staff having a qualification at NVQ level 2 or equivalent. Three staff are set to achieve NVQ level 3 in the near future. The recruitment procedure was reviewed at the last inspection visit using the file of a member of staff that that had recently started work. The file demonstrated that all satisfactory information had been received and appropriate checks completed prior to their working at the home. Not all files viewed provided evidence of care workers being eligible to work in the UK, or the hours they were allowed to work. Certificates to evidence recent training in medication administration, client handling, dementia awareness and prevention of abuse were not available. The manager said that they had not yet received them from the training provider. The manager showed me the planned dates for training. By the end of July 2008, should the planned training go ahead, all staff will have had training in first aid, infection control, fire safety, health and safety and food hygiene. Autumn Care DS0000026795.V360905.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Significant improvements have been made in how Autumn Care is being managed resulting in a safer service for the residents living there. EVIDENCE: Autumn Care was rated as being a poor home after the last site visit. This was in part due to the lack of leadership and organisation, with the manager working as a carer, domestic and cook with no time allocated to the running of the home. The manager and proprietors have taken this criticism seriously and the roster has now been changed to allow the manager dedicated time to carry out their management tasks. The improvement to the running of the home from the Commissions view is significant and a real commitment to Autumn Care DS0000026795.V360905.R01.S.doc Version 5.2 Page 22 addressing the requirements and recommendations made in the last inspection report was apparent during the course of this visit. The manager has completed her Registered Managers Award and is awaiting the result. All residents are assisted by family, friends or professional advisors to manage their financial affairs. Small amounts of money are held for a few residents and receipts maintained. At the last visit all were checked and found to be correct. Records viewed at the last visit in November 2007 evidenced that all gas installations, central heating, and appliances and equipment used to meet service user needs had been checked. At this visit accident records were reviewed. They were consistently well completed with the essential details needed e.g. time of accident, nature of accident and any action taken. Few accidents occur at the home, averaging about one a month. All staff have completed moving and handling training in the last 4 months and when carers were transferring residents no poor practice was observed. Concern was raised at the last visit about the stability of a wardrobe in a resident’s bedroom. Since then wardrobes have been bracketed to the wall making them far more safe and secure. A fire risk assessment was in place when the home was last visited and records of testing and maintenance of alarms systems, fire fighting equipment and emergency lighting demonstrated that these were being undertaken at the required intervals. A service contract is in place demonstrating the required level of maintenance of the fire warning system, fire-fighting equipment, and emergency lighting. At the last inspection visit concern was raised about the storage of cleaning fluids e.g. bleach, disinfectant etc in the laundry area. Bleach was also found in a cupboard under the sink. Now bleach is now out of reach in the laundry room or stored under the kitchen sink in a locked cupboard. The registered manager agreed to remove from reach the cleaning products still stored in the laundry that may cause skin irritation. Autumn Care DS0000026795.V360905.R01.S.doc Version 5.2 Page 23 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 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 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 4 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Autumn Care DS0000026795.V360905.R01.S.doc Version 5.2 Page 24 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 OP9 Regulation 13(2) Requirement The Registered Person must make arrangements for the safe storage, administration and recording of medicines received in the care home including: Ensuring that medicines are administered and signed as given. MAR sheets must include any known allergies. Medicines must be stored at the correct temperature to maintain their effectiveness and the maximum and minimum temperatures of the refrigerator used to store medicines must be monitored to keep the temperature in the correct range (2-8(C). Timescale of 31/01/08 not met. 2. OP27 18 The registered persons must ensure that the staff rota includes the full names of all staff on duty. 01/04/08 Timescale for action 01/04/08 Autumn Care DS0000026795.V360905.R01.S.doc Version 5.2 Page 25 3. OP29 19 The registered persons must hold documented evidence of any and all employees’ eligibility to work in the UK. Workers must not exceed the hours they are allowed to work according to their visas. Timescale of 31/10/06 not met 01/04/08 4. OP30 18(1) Evidence must be available to demonstrate that all staff have received training appropriate to the work they are to perform. Timescale of 31/10/06 not met 31/03/08 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 OP9 Good Practice Recommendations The medicines policy should be updated. The maximum and minimum temperature achieved by the refrigerator where medicines are stored should be recorded daily. A lockable plastic box should be used to store the medicines in the refrigerator. There should be suitable leisure and recreational activities on offer that meet the needs, preferences and capacities of the residents. 2. OP12 Autumn Care DS0000026795.V360905.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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