Inspection on 26/11/07 for Autumn Care

This inspection was carried out on 26th November 2007.

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

Autumn Care 18/03/09

Autumn Care 17/03/08

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 Chris Gould Key Unannounced Inspection 26th November 2007 07:30 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 Autumn Care DS0000026795.V355156.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.V355156.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.V355156.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th August 2006 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 available 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 of the home 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.V355156.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was undertaken by two inspectors over twelve hours on 26th November 2007. The CSCI Pharmacy Inspector had visited the home on 23rd November 2007 and the findings of that inspection are included within this report. Debra Dacey, Registered Manager was present and assisted with the inspection. The inspectors spoke with the twelve residents, two relatives and the staff on duty, examined relevant records and took a tour of the premises. This was a ‘key’ inspection where the home’s performance against the key National Minimum Standards was assessed along with progress in meeting requirements of the last inspection. Completed surveys were received from residents, care managers, health professionals, relatives, carers and advocates prior to the inspection. At the time of writing the report, five surveys had been received from residents, four from health professionals, six from staff and six from relatives; their comments are included as relevant throughout this report. The Annual Quality Assurance Assessment had been completed and returned to the Commission for Social Care Inspection prior to the inspection. What the service does well: Autumn Care provides a clean, well maintained home where residents and relatives comments have included ‘excellent rapport and relationship with staff. Always have time for me’, ‘they always treat the resident as an individual and with respect and their needs are always met immediately’, ‘they allow access to my mother at any time. They understand my mother as a person and seem to care for her in a compassionate way’. The registered manager or senior staff member will visit the resident prior to admission to undertake an assessment to ensure that the home is able to meet the prospective resident’s needs. The home has a complaints procedure that is available to all residents and their representatives. 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. Autumn Care DS0000026795.V355156.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Nineteen requirements have been made following this inspection including four repeated from the last inspection. Residents care plans must contain sufficient detail to provide clear guidance to staff on the actions to be taken to meet their care needs. Detailed care plans and appropriate risk assessments including falls and nutrition must be put in place and updated to ensure they relate to the actual care being provided and are focused on the individual needs of the resident. The home needs to improve medication training for staff and the storage, administration and recording of medication to safeguard people. An immediate requirement was made to ensure that medicines are given, and signed for on the MAR chart, one person at a time. An urgent requirement was made about improving the storage of medicines. Residents must be consulted about their social interests and facilities and resources provided to meet there needs. To ensure the safety of the residents and as part of the fire safety procedure a record of all visitors to the care home, including the names of visitors must be maintained. Residents must be consulted with regard to care outcomes identified through assessment and care planning and must be party to decision making about care routines. Adequate quantities of a variety of food must be available at such time as may be reasonably required by the residents. All staff must receive training in the prevention of abuse and the available policy must relate to the practice of the home. The laundry floor finish must be impermeable and readily cleanable to prevent the spread of infection. Autumn Care DS0000026795.V355156.R01.S.doc Version 5.2 Page 7 The staffing at the home must be reviewed to ensure that at all times the number and skill mix are appropriate to meet the needs of residents. The staff rota must accurately reflect the number of staff on duty. All staff must receive training appropriate to the work they are to perform. This should include the care of residents with dementia, moving and handling, infection control and food hygiene. The care home must be managed with sufficient care, competence and skill and communicate a clear sense of direction and leadership. A record must be maintained of any accident affecting the resident including the nature, date and time of the accident and whether medical treatment was required. A safe system for moving and handling residents must be used at all times. 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.V355156.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.V355156.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: 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 will visit the resident prior to admission for the purpose of this assessment and will 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 has local authority support with their funding arrangements, the local authority will also Autumn Care DS0000026795.V355156.R01.S.doc Version 5.2 Page 10 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.V355156.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 poor. This judgement has been made using available evidence including a visit to this service. Shortfalls in the completion of care plans, risk assessment documentation and practices in the home does not ensure that the health and personal care provided is safe and meets the resident’s individual needs, potentially placing them at risk. Residents are at risk from some of the home’s practices for storing, administering and recording medication. EVIDENCE: Two residents care records were viewed prior to visiting and talking to the residents. The care plans were found to be variable in their content, lacking in sufficient detail and not consistently related to the actual care provided. The personal care needs for one resident states two carers to assist with washing, needs total help with all areas. There is no further information Autumn Care DS0000026795.V355156.R01.S.doc Version 5.2 Page 12 available on how this task is to be carried out. Dentures are to be cleaned twice a day. The resident does have dentures but is unable to wear them. Two residents are assessed as having a history of falls. Risks assessments have not been undertaken and there is no plan in place to inform care staff of the action that should be taken should the resident fall. The care plans state that the residents use a walking frame and must have a carer with them while they are mobile. The residents were observed walking with their walking frames unaccompanied by a carer at periods during the day. One care plan records that a resident requires one carer to assist with washing and dressing. On the day of the inspection the resident washed and dressed herself unassisted. The night chart for one resident recorded that two hourly checks had been undertaken and they were asleep at the time of each visit. The night report records that the resident was up and about from 10:30pm until morning. Further checks identified that on other nights the night chart did not cross reference with the night report. One resident has had recent weight loss and the care plan states that a high protein, high calorie diet is required. A nutritional assessment had not been undertaken and there was no system in place for monitoring the resident’s actual food or fluid intake. During the inspection the resident was observed as receiving a very limited fluid intake as they required assistance. Drinks were placed in front of the resident but were removed untouched when cold. The diet provided during the day was not supplemented in any way to ensure that it was high in protein and high in calories as identified in the care plan. The three main meals were provided with no additional snacks in between. Health professionals commented ‘can be difficult communicating with care staff and making instructions understood,’ ‘care could be better co-ordinated’ and ‘? needs better records for individuals or if they already have records to refer to them more often as I have not seen them’. One resident commented ‘Doctors and District Nurses contacted when needed’ When we arrived the manager said that all the breakfast time medication had been given. Medicines due at 8am on the day and 10pm the previous night were not signed as given on people’s Medicine Administration Record (MAR) charts but the tablets were missing from monitored dosage blister packs. The manager said she was interrupted when giving medicines last night and a carer said she was not confident about signing on the MAR charts medicines she had given that morning. An immediate requirement was made to ensure that medicines are given, and signed for on the MAR chart, one person at a time to safeguard residents. At lunchtime 2 carers used a lockable trolley to take medicines to people but they seemed to lack confidence and one resident said, “what is that?” when the trolley was wheeled into the dining room / lounge. We saw certificates for 3 staff who had completed medication training but others had not done an accredited course, and there were no records to show that staff who give medicines have been assessed as competent to do this. Autumn Care DS0000026795.V355156.R01.S.doc Version 5.2 Page 13 We checked 4 people’s records with the medicines in stock to see if they were given as prescribed, recorded and stored correctly. MAR charts are printed by the pharmacy and the manager had created separate charts for clearly recording medicines with a choice of dose. For some medicines in packets the quantity in stock did not agree with the records indicating that some medicines were not given as prescribed and / or errors in recording. The home did not record medicine allergies for people or “none known”, if appropriate, to protect them from receiving medicines they are allergic to. The manager said there were none but in one person’s care plan there was a statement that they were allergic to Penicillin. The manager agreed to check this with the GP and relatives. There were details of 2 inhalers on one person’s MAR chart but no records of giving them. The manager said they self-medicated them but there was no mention of this on the MAR chart, or risk assessment in their care plan. There was some information in one person’s care plan about giving medicines with sufficient liquid and watching them carefully because of difficulty taking them. We saw staff do this. Another’s care plan mentioned giving their pain relief regularly but there was nothing to guide staff in the use of the different analgesics they were taking, or about a sedative medicine prescribed, “when required”. For other people there was very little in care plans about medication, including application of creams, or to indicate whether they could or wanted to self-medicate. 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 did not have a cupboard and record book for recording medicines requiring special storage and recording but during the visit the manager made arrangement to obtain these. The medicines trolley was not secured to the wall and there was insufficient lockable storage for when monthly repeat medicines arrive. Refrigerated medicines were not stored securely and there was no maximum and minimum thermometer to monitor that they were stored at the correct temperature. An urgent requirement was made to store all medicines securely to safeguard people. Unopened eye drops for one resident that should be refrigerated were stored at room temperature. Staff were still using one liquid medicine, supplied in July, which only keeps for 3 months after opening. The date of opening was not recorded on the bottle so that it could be replaced when expired. 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 Autumn Care DS0000026795.V355156.R01.S.doc Version 5.2 Page 14 respected in their rooms and when receiving assistance with personal care routines. One relative commented ‘they always treat the resident as an individual and with respect and their needs are always met immediately’. Autumn Care DS0000026795.V355156.R01.S.doc Version 5.2 Page 15 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 poor. This judgement has been made using available evidence including a visit to this service. The home tries to be flexible and offer choices however there are times due to restrictions on the service when not all the residents are provided with the opportunity to retain control over their lives or to have their social needs met. EVIDENCE: It was evident that residents are able to form and maintain friendships within the home and during the lunch period, a group of four residents sat together engaged in lively conversation. The manager identified when completing the Annual Quality Assurance Assessment that the home needs ‘to focus a lot more attention on activities for all residents’. This was confirmed by residents and relatives who responded to the survey with comments including ‘I would like more activities’, ‘activities arranged maybe once a month. Not often enough!’, ‘can improve by having more activities’ and ‘it would be nice to see a few more activities or entertainment for the residents and social events’, Autumn Care DS0000026795.V355156.R01.S.doc Version 5.2 Page 16 One member of staff commented ‘we are trying our best with activities for the residents, but can be difficult as not all residents enjoy the same thing or want to take part’. The manager identified lack of space, staff time and cost as issues that need to be addressed to provide social activities in a group and individually to meet resident’s needs. The records viewed were limited in the information they included relating to the social history of the resident. Further work is still required in this area as a full picture of the person’s past family, work and social history will assist with planning for their future care. Residents receive visitors whenever they wish. A record is maintained of all visitors to the home. On the day of the inspection a number of visitors entered the home but did not sign the book. 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 confirmed that they are always made welcome by the staff. Comments received from relatives include ‘they allow access to my mother at any time. They understand my mother as a person and seem to care for her in a compassionate way’,’ we can phone our relative anytime don’t know if she ever asks to speak to us’ and ‘we are not called at time of incident but would like to be’. Residents confirmed that they are comfortable in the home and are happy with the daily routines although there was limited evidence in the care records reviewed that the resident had been supported in making personal choices and decisions about their life in the home through consultation with the assessment and care planning process. One resident’s assessment states that they like to get up at 8 o’clock but on the morning of the inspection they had been washed, dressed and provided with breakfast by 7:30 am. Residents, relatives and health professionals comments relating to the food provided included ‘lovely home cooking. Have put on weight since being here which is good’, ‘very good food’, ‘nutrition needs met well – excellent home cooking’ and could improve with ‘more fresh fruit and vegetables. More choice of food’. The home does not provide a menu but asks the residents each day what they would like based on what is available. On the day of inspection the residents chose from faggot, burger or an individual chicken pie with cabbage, peas and mashed or jacket potato followed by rice pudding. The home do not make their own cakes, puddings and pies partly due to time restraints as the meals are provided by one of the care staff on duty. There was very little fresh food available with no cheese, eggs, bread or fruit as the manager was waiting for a delivery that she thought was ordered for that day but didn’t arrive. Autumn Care DS0000026795.V355156.R01.S.doc Version 5.2 Page 17 Jars of food that need to be stored in a cool dry place were being kept in a cupboard that gets very warm and a piece of corned beef that had been removed from a tin and wrapped in a film covering was undated in the refrigerator. Autumn Care DS0000026795.V355156.R01.S.doc Version 5.2 Page 18 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. Training for all staff and a review of the procedure will ensure that all residents are protected from abuse. EVIDENCE: The Service User Guide contains the home’s complaints procedure that is available to all residents and their representatives. The home has 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. An Adult Protection procedure with reference to the Dorset multi agency ‘No Secrets’ guidelines is in place and training records available evidenced that most staff have received training. The manager was clear about the procedure that would be followed in the event of an alleged abuse being reported. Autumn Care DS0000026795.V355156.R01.S.doc Version 5.2 Page 19 The home’s procedure was part of a package of policies and procedures that have been purchased. The procedure needs reviewing to ensure that it provides the detail to reflect the practice of Autumn Care. Autumn Care DS0000026795.V355156.R01.S.doc Version 5.2 Page 20 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 well maintained and clean. However the management of the laundry does not provide residents with clothes, bed linen and towels that are laundered to a satisfactory standard. EVIDENCE: In the past twelve months a new carpet has been fitted in the lounge and the home has been generally well maintained. When visiting a resident’s room it was noted that a chest of drawers had come apart. The home has very limited space with one communal room providing easy chairs along two walls and tables and chairs against the back wall. This room is also used as an office and contains cabinets and paperwork required for the running of the home. There Autumn Care DS0000026795.V355156.R01.S.doc Version 5.2 Page 21 is no other room available for undertaking staff supervision, discussion with staff, relatives and health professionals. This was observed during the inspection where it was very difficult to maintain confidentiality. 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 care staffs general duties. One resident commented ‘staff are always cleaning’. All areas of the home that were seen during the tour of the home were generally in a clean condition and free from unpleasant odours, residents and visitors confirmed that this is always the case. The residents’ personal clothing and bed linen appeared when touched to have been poorly laundered. It felt as if the garments had not been fully rinsed and had retained some of the soap powder. The manager agreed and suggested that it was the soap powder used as the washing machine is less than twelve months old. The laundry floor does not have a floor that is impermeable and easy to clean. One relative commented when asked as part of the survey what could improve ‘a bit more care with staff appearance’. Two members of staff were observed putting on stained creased tabards when starting their period of duty. Autumn Care DS0000026795.V355156.R01.S.doc Version 5.2 Page 22 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 screening prior to offering employment. However the training and number and skill mix of staff available at times during the day are not sufficient to ensure that the individual needs of the residents are fully met. EVIDENCE: A staff rota is available but this did not reflect the actual staff that were on duty or had worked on previous days as recorded in a diary. 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’. There are three staff on duty in the morning, two in the afternoon and one awake at night with a sleeping member of staff available if required. The last inspection 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 only happens on very rare occasions. A member of staff who is under eighteen so unable to provide personal care is employed as Autumn Care DS0000026795.V355156.R01.S.doc Version 5.2 Page 23 an activities co-ordinator on some afternoons. Although on the rota for the afternoon of the inspection they were not available. The staff on duty are required to prepare and cook the meals, undertake domestic tasks and the laundry. According to their care plans there are two residents requiring two hourly toileting that need the assistance of two carers and other residents who are at risk of falling if unaccompanied when mobilising. The manager is included as one of the carers as well as managing the day to day running of the home. On the day of the inspection it was the manager’s day off but she was observed throughout the day as very much involved in the care of the residents. The diary recorded one member of staff as working exceptionally long hours once a week from 2pm on one day until 8am the following morning. The carer is the only member of staff on duty at night and required to be awake. Twelve care staff are employed, seven of whom have attained NVQ level 2 or above in care and five are working towards the award. An assessor from the college visits the home to support staff through their training and assess their work. An assessor visited on the day of the inspection to meet with one of the carers. The recruitment file of a member of staff that that has started work recently was viewed and demonstrated that all satisfactory information had been received and checks completed prior to their commencement at the home. A second file viewed did not provided evidence of the care workers eligibility to work in the UK. Certificates of training were seen in staff files but it was not possible from the available information to evidence that all staff have received up to date training required to meet the needs of the residents including moving and handling, infection control, care of residents with dementia and the prevention of abuse. Autumn Care DS0000026795.V355156.R01.S.doc Version 5.2 Page 24 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 poor. This judgement has been made using available evidence including a visit to this service. Management responsibilities are not being fully discharged; this means Autumn Care is not operating a safe service. Working practices do not always ensure that the health, safety and welfare of residents and staff are promoted and protected. EVIDENCE: In discussion with the manager and observation during the inspection it was identified that the home lacks leadership and organisation. The manager works as one of the rostered staff while on duty working as a carer, domestic Autumn Care DS0000026795.V355156.R01.S.doc Version 5.2 Page 25 and cook with no time allocated to the running of the home. The manager is undertaking the Managers Award and during the day of the inspection she had a meeting at the home with her assessor. The meeting took place inside the porch at the entrance to the home. A health professional commented ‘when I visit there does not seem to be one person who is in charge and well informed regarding all individuals in their care’. Relatives and residents commented ‘excellent rapport and relationship with staff. Always have time for me’ and ‘they create a homely relaxed atmosphere, always available to answer questions’. The registered manager returned the completed Annual Quality Assurance Questionnaire to CSCI prior to the inspection. This will now form part of the home’s quality assurance programme. All residents are assisted by family, friends or professional advisors to manage their financial affairs. Pocket money is held for five residents and receipts maintained. All were checked and found to be correct. Records viewed evidenced that all gas installations, central heating, and appliances and equipment used to meet service user needs has been checked. The manager advised that the electrical wiring check has been completed and they are waiting for a certificate to be issued. The manager agreed to provide CSCI with a copy when it arrived. Accident reporting was inconsistent in the information provided. In the daily report for one service user it identified two falls that had not been recorded on an accident form and one fall for another resident had been recorded on the accident form but not in the resident’s care records although a skin flat is referred to on the following day. Accident records did not always record the time of the accident. During the inspection inappropriate moving and handling practice by carers when transferring residents was observed. This was discussed with the manager. When visiting one resident’s bedroom the wardrobe appeared unstable with the potential of falling forward when pulling the door open. This was discussed with the manager. A fire risk assessment has been carried out dated November 2006 and due for review in November 2007. The manager is aware that the review is due to be carried out. Examination of records of testing and maintenance of alarms systems, fire fighting equipment and emergency lighting demonstrated that these are being undertaken at the required intervals. A service contract is in Autumn Care DS0000026795.V355156.R01.S.doc Version 5.2 Page 26 place demonstrating the required level of maintenance of the fire warning system, fire-fighting equipment, and emergency lighting is in place. The laundry room door has a sign saying keep locked although it was found to be unlocked. The room is used to store cleaning fluids, bleach, washing up liquid, disinfectant etc. Bleach was also found in a cupboard under the sink. The registered manager removed the bleach and locked the laundry room. Autumn Care DS0000026795.V355156.R01.S.doc Version 5.2 Page 27 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 1 8 1 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 1 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 3 X X 1 Autumn Care DS0000026795.V355156.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement The registered person shall ensure that residents care plans contain sufficient detail to provide clear guidance to staff on the actions to be taken to meet their care needs. The care plans must be reviewed and updated to ensure they relate to the actual care being provided and are focused on the individual needs of the resident. 2. OP7 13 The registered person must ensure that a falls risk assessment is undertaken and where necessary appropriate action taken. The registered person must ensure that a nutritional assessment is undertaken and where necessary, detailed records are kept in respect of nutrition and appropriate action taken. 29/02/08 Timescale for action 31/03/08 3. OP8 14 17(1)(a) Schedule 3 (m) 29/02/08 Autumn Care DS0000026795.V355156.R01.S.doc Version 5.2 Page 29 4. OP9 13(2) 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, or the reason for nonadministration recorded, on the MAR chart for one resident at a time to reduce the risk of medication errors. The manager advised us in writing on 3rd December of the action she was taking to address this requirement. Medicines must be stored securely to safeguard people. 26/11/07 5. 6. OP9 OP9 13(2) 13(2)(4) 30/11/07 31/01/08 Staff who give medicines must be trained and assessed as competent to safeguard people. There must be an effective system to ensure that people’s medicines, including creams are administered, as prescribed, and recorded, to meet their healthcare needs. You must record whether people have any allergies to medicines, or not, to protect them from receiving medicines they are allergic to. You must record the date of opening eye drops and medicines with a short shelf life so that they can be replaced when expired to protect people. Medicines must be stored in accordance with legal requirements. Medicines must be stored at the correct temperature to maintain their effectiveness and the maximum and minimum temperatures of DS0000026795.V355156.R01.S.doc Version 5.2 Page 30 Autumn Care the refrigerator used to store medicines must be monitored to keep the temperature in the correct range (2-8°C). There must be a risk assessment for residents who self-medicate to ensure that they and other residents in the home are protected. 7. OP12 16(2)(n) The registered person must consult residents about their social interests and provide facilities and resources to meet their needs. The registered manager must ensure that a record of all visitors to the care home, including the names of visitors is maintained. 31/03/08 8. OP13 17(2) Sch 4(17 29/02/08 9. OP14 15 The registered persons shall 31/03/08 demonstrate by means of written documentation that residents have been consulted with regard to how their needs in respect of their health and welfare are to be met. Timescale of 31/10/06 not met 10. OP15 16(2)(i) The registered manager must ensure that adequate quantities of a variety of food are available at such time as may be reasonably required by service users. 31/01/08 11. OP18 13(6) The registered person shall make 31/03/08 arrangements for all staff to receive training in the prevention of abuse and to ensure the available policy relates to the practice of the home. Autumn Care DS0000026795.V355156.R01.S.doc Version 5.2 Page 31 12. OP26 13(3) 13. OP27 18 The registered person must ensure that the laundry floor finish is impermeable and readily cleanable to prevent the spread of infection. The registered persons must ensure that the staff rota accurately reflects the number of staff on duty in the home and that there are sufficient numbers of staff to meet residents’ needs. Timescale of 31/10/07 not met The registered person must review the staffing at the home to ensure that at all times the number and skill mix are appropriate to meet the needs of residents. 31/03/08 31/01/08 14. OP29 19 Using their recruitment procedure, the registered persons must hold documented evidence of the employee’s eligibility to work in the UK. Timescale of 31/10/06 not met 31/01/08 15. OP30 18(1) All staff must receive training in moving and handling, infection control and food hygiene. Timescale of 31/10/06 not met The registered person must ensure that all staff receive training appropriate to the work they are to perform. This should include the care of residents with dementia. 31/03/08 Autumn Care DS0000026795.V355156.R01.S.doc Version 5.2 Page 32 16. OP31 10 17. OP38 17(1a) Sch 3 The registered persons must manage the care home with sufficient care, competence and skill and communicate a clear sense of direction and leadership. The registered person must maintain a record of any accident affecting the resident including the nature, date and time of the accident and whether medical treatment was required. The registered person must ensure that all parts of the home which service users have access are safe. Wardrobes must be stable and not have the potential for falling forward onto the resident. Suitable arrangements must be made for the storage of cleaning equipment. 31/03/08 31/01/08 18. OP38 13(4) 31/01/08 19. OP38 13(5) The registered person shall make 31/01/08 suitable arrangements to provide a safe system for moving and handling residents. Autumn Care DS0000026795.V355156.R01.S.doc Version 5.2 Page 33 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 Receipt, administration and disposal of Controlled drugs should be recorded in a bound record book with numbered pages. Care plans should include information about medication to help staff meet people’s healthcare needs. The medicines policy should be updated. It is 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. Quality assurance process need to be developed to ensure an improvement plan for the service is available. 2. OP27 3. OP33 Autumn Care DS0000026795.V355156.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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. Extracts may not be used or reproduced without the express permission of CSCI Autumn Care DS0000026795.V355156.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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