Inspection on 25/07/06 for Avenue House Nursing and Residential Home

This inspection was carried out on 25th July 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Avenue House Nursing and... 31/10/08

Avenue House Nursing and... 01/05/08

Avenue House Nursing and... 10/05/07

Avenue House Nursing and... 23/02/07

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Avenue House Nursing and Residential Home 173 - 175 Avenue Road Rushden Northants NN10 0SN Lead Inspector Mrs Kathy Jones Unannounced Inspection 25th July 2006 10:30 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 DS0000067495.V305300.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. DS0000067495.V305300.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Avenue House Nursing and Residential Home Address 173 - 175 Avenue Road Rushden Northants NN10 0SN 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) 01933 358455 01933 317671 Jasmine Healthcare Limited Mrs Jayne Melanie Lack Care Home 43 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (43), of places Physical disability (1), Terminally ill (8) DS0000067495.V305300.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. That the home is permitted to accommodate one named service user in the category of PD No one falling within the category of OP may be admitted into the home where there are 43 Service Users who fall within the category of OP already accommodated within the home No one falling within the category of DE (E) may be admitted into the home where there are 10 Service Users who fall within the category of DE (E) already accommodated within the home No one falling within the category of TI may be admitted into the home where there are 8 Service Users who fall within the category of TI already accommodated within the home Not applicable Date of last inspection Brief Description of the Service: Avenue House is a 43 bedded home located on the outskirts of Rushden, owned by Jasmine Healthcare Limited. The home provides for elderly people requiring personal care or nursing care. There are up to 10 places for people with dementia and 8 places for people who are terminally ill. The home was formerly two domestic dwellings, which have been connected and extended. Residents’ bedrooms are located on the ground and first floors with a small passenger lift providing access to the first floor. Some of the bedrooms on the ground floor have doors leading out onto the garden. Five of the bedrooms are shared and the remainder are single rooms. Communal areas consist of four lounges, a dining room split in two areas plus one small dining room with one table. The following fees were provided by the registered manager as being current at the time of the inspection on 25 July 2006. Fees range between £400 and £700 per week dependent on the assessment of care needs and room provided. The fees include personal care and where applicable nursing care, meals and accommodation. Chiropody, hairdressing services, transport and newspapers can be arranged and are charged separately. Other costs would include clothing and toiletries. DS0000067495.V305300.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. All standards identified as ‘key’ standards and highlighted through the report were inspected. The key standards are those considered by the Commission to have a particular impact on outcomes for residents. Inspection of the standards was achieved through review of existing evidence, pre-inspection planning, an unannounced inspection visit to the home and drawing together all of the evidence gathered. The pre-inspection planning was carried out over the period of two and a half hours and involved reviewing the service history, which details all contact with the home including notifications of events reported by the home, telephone calls and any complaints received. A pre-inspection questionnaire submitted by the registered manager, nine comment cards from residents and relatives and three comment cards from health professionals. This was the first inspection carried out since the registration of the current owners, therefore there were no previous inspection reports relevant to the service. The information gathered assisted with planning the particular areas to be inspected during the visit. Information received from a further three relatives following the inspection and prior to issuing the draft report has also been incorporated into the inspection findings. The unannounced inspection visit covered the late morning and afternoon of a weekday. The inspection was carried out by ‘case tracking’ which involves selecting residents’ and tracking their care and experiences through review of their records, discussion with them, the care staff and observation of care practices. The inspector also spoke with other residents’ who were not part of the case tracking process. The management of residents’ medication was reviewed. A sample of staff files were reviewed to check the adequacy of the recruitment procedures Communal areas and a sample of residents’ bedrooms were viewed and observations were made of residents’ general well being, daily routines and interactions between staff and residents. Feedback on the inspection findings was given to the registered manager during the inspection. What the service does well: Comments received from health professionals were positive about the care provided and a relative confirmed that medical support is always accessed and prompt action taken for a resident who was taken ill. DS0000067495.V305300.R01.S.doc Version 5.2 Page 6 Comments received in questionnaires confirmed that suitable activities are provided and one relative said that their mother particularly enjoys the entertainer/singer on Mondays. The majority of relatives confirm that the home is always fresh and clean and that there are no unpleasant odours. The home was comfortable and the new owners are planning to re-decorate. What has improved since the last inspection? What they could do better: The care plans, which are tools to guide staff in the actions that they need to meet the care and nursing needs of residents’ need to be kept up to date and detail residents individual needs. For example the pressure area care plans did not give details of the type of dressing to be used or the current condition of the pressure ulcer, which leaves residents’ at risk of having inappropriate or inconsistent treatment. Closer monitoring and improvements to the recording of medication is required to ensure that quantities can be easily checked with any discrepancies of shortages quickly identified. Arrangements need to be made for all medication to be securely stored to reduce any risk to residents’. Elasticated pants for use with incontinence aids should be laundered separately for each resident rather than using a communal supply, which is not very dignified. Staff availability to assist residents’ to the toilet was identified as an area which requires review and monitoring. Residents’ routines appear to be based around the routines of the home rather than their needs and preferences. Rather than assistance being given to those residents’ who are awake first or wish to be assisted early, it would appear that some are being woken early and others are waiting for assistance until late morning. This issue should also be considered in relation to staffing levels and staff deployment. Three comments from relatives were raised about the adequacy of fluids given to residents with three of them concerned about the lack of assistance given with food and fluids. The concerns indicate a need to monitor the arrangements for food and fluids. Storage of equipment is a problem due to the lack of storage space, however a review of the equipment and storage needs should be carried out as this has an impact on space and gives a cluttered appearance. DS0000067495.V305300.R01.S.doc Version 5.2 Page 7 Comments received from relatives and residents raise concerns about the care practices and standards of care in the home and indicate the need for good, quality assurance processes to be introduced as a priority to review and improve standards of care. 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. DS0000067495.V305300.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 DS0000067495.V305300.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, standard 6 is not applicable as intermediate care is not provided. Quality in this outcome area is good. This judgement has been made using all the available evidence including a visit to the service. The admission process provides assurances that the needs of residents’ entering the home can be met. EVIDENCE: Information received in questionnaires from relatives confirmed that sufficient information was provided before admission for the prospective resident and their family to make a decision about moving into the home. Responses in the questionnaires about having a contract, produced varying responses, some said they had, others that they didn’t while one said they had but it was with the previous owners of the home. The registered manager has advised that copies of contracts/terms and conditions have been sent out from the new owners however a number have not yet been signed and returned. The registered manager confirmed that she would check and ensure that each resident and or their representative have a copy. DS0000067495.V305300.R01.S.doc Version 5.2 Page 10 A sample check of residents’ care files identified that assessments of their care and nursing needs are carried out prior to admission to the home. Additional information is then gathered on admission to the home. Information gathered was sufficiently detailed to make a judgement about whether the needs of a prospective resident could be met within the home. DS0000067495.V305300.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. This judgement has been made using all the available evidence including a visit to the service. Shortfalls in planning of care and management of medication have the potential to put residents’ at risk of their needs not being met. EVIDENCE: Comments received from relatives and residents’ in questionnaires and during the inspection identify that the majority feel that they are getting the care and support they need. However this is not the experience of all residents, other comments include “ Carers have failed to notice visible ailments”, “there no longer seems to be a regular review of resident’s progress and care”. Care plans are in place to guide staff in the care and support required to meet residents’ needs. However review of a sample of the care plans identified that in many cases a core care plan is used which identifies the areas to be taken into consideration when providing care rather than the actions required to meet their individual needs. One resident had been admitted to the home with a number of pressure ulcers. Records were kept of the treatment given, however it was difficult to ascertain from the records without an up to date DS0000067495.V305300.R01.S.doc Version 5.2 Page 12 care plan the current condition of the pressure ulcers and the treatment to be given to maintain appropriate and consistent care i.e. type of dressing to be used. Some of the records were also quite difficult to read. Records showed that health care services are accessed on behalf of residents and care plans for one resident identified that a physiotherapist had provided some staff training on how to move a particular resident safely as there was concern about pain on movement. The care plan did not contain any detail of the advice given to remind staff and guide any new or agency staff. In some cases care plans were recorded, as being reviewed monthly, however in one case they had not been reviewed for two months. A relative confirmed that medical support is always accessed and that staff responded very promptly when a resident was taken ill. During the inspection staff reacted promptly and appropriately when told a resident had fallen. Comment cards received from three health professionals’ including one who hadn’t been personally involved for a few months contained positive comments about the care provided including pressure area care. Information received in resident and relative questionnaires contained a comment that medication has occasionally been ‘lost’ and a resident has had to query/request medication. The registered manager was not able to recall such an incident however did say that there had been an incident where there was a national shortage of a particular drug and she had to collect it from a Northampton pharmacy, as none was available locally. A sample check of residents’ medication identified that there is a system in place for recording medication received and medication administered. Appropriate records were kept for controlled drugs and no discrepancies were identified in a sample check of these. The majority of medication is received in a monitored dose system however other medication was difficult to audit and advice was given to record all medication carried forward to the next month to help identify any discrepancies. A check of one medication for a resident identified that there was not sufficient stock to last until the next medication cycle and there was no evidence of additional supplies being ordered. The majority of medication was securely stored however laxatives were stored on an open shelf of the drugs trolley in an open office at the time of the inspection. Staff were treating residents with dignity during the inspection and personal care was provided in the privacy of their rooms. However comments received from relatives include concerns about residents’ being left without assistance to go to the toilet and incidences of resident’s wearing other people’s clothes. DS0000067495.V305300.R01.S.doc Version 5.2 Page 13 It was identified during the inspection that there is a communal supply of elasticated pants for incontinence aids, which is not considered to be dignified. The registered manager advised that individual laundry bags had been provided to enable these to be washed and kept separate for each resident and that she would re-instate this practice. DS0000067495.V305300.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate. This judgement has been made using all the available evidence including a visit to the service. Visitors are welcomed into the home and residents’ were on the whole satisfied with the food provided, however the daily routines are not based on the needs and preferences of residents’. EVIDENCE: The registered manager advised that some recent changes to residents’ morning routines have been made to ensure that they all receive breakfast at a reasonable time. Discussion with staff and residents identified that more work is required to ensure that the routines of the home and staffing arrangements are always based around residents’ individual preferences and choices. The routines for assisting residents’ with personal care do not appear to be based on who is awake. It was highlighted that some residents are sometimes being woken in the morning to be assisted with washing and dressing and others are not assisted until late morning. Advice was given to incorporate preferences in relation to routines in the care planning. The majority of comments received in questionnaires said that suitable activities are provided and one relative said that their mother particularly enjoys the entertainer/singer on Mondays. However there would appear to be DS0000067495.V305300.R01.S.doc Version 5.2 Page 15 a lack of attention to individual needs as one relative was concerned that a resident was left in their room and staff don’t have the time to sit with her so she can have a cup of tea or put the television or music on for her. Information gathered at the time of admission identifies any religious or cultural needs. The inspector was informed that the Christian group who visit for songs and prayers some Sunday’s are well received. The majority of comments received confirmed that residents’ are happy with the meals provided. One comment suggested that although the food was good, individual needs should be given more consideration, for example a resident who has been sick. The cook advised that where necessary special diets are catered for and that there is always a vegetarian option which residents’ who are not vegetarian often also choose. At the time of the inspection there were no residents’ requiring diets specifically to meet religious or cultural needs. Where residents’ require liquidised meals the ingredients are liquidised separately to retain a better appearance and flavour. On the day of inspection staff were observed to give any necessary assistance to residents with their meals. Two residents spoken to confirmed that they were being given sufficient fluids during the hot weather. Four comments from relatives raised questions about the adequacy of fluids being given, with two of them concerned that food and fluids are put in front of residents without assistance being given to those who can’t manage independently. Fluid charts were in place for those residents considered to be at risk, staff confirmed all were getting regular fluids however review of a sample of the records identified that at 4-20pm no entries had been made on one residents record and others indicated minimal fluid had been given. Senior staff were confident that the problem was of staff not recording rather than residents’ not having fluid however confirmed that they would follow this up with staff. Visiting arrangements are flexible and during the inspection staff were greeting visitors in a friendly manner. A staff member talked to a visitor who hadn’t visited for some time and sensitively prepared them for the changes in their relatives’ condition since the last visit. DS0000067495.V305300.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is adequate. This judgement has been made using all the available evidence including a visit to the service. Failure to record and use information gathered through complaints/concerns/grumbles to identify and address recurrent issues puts residents’ at risk of continuing poor care. EVIDENCE: The Commission for Social Care Inspection had received no complaints about The Avenue at the time of the inspection however following the inspection an anonymous complaint was received. The complaint raised concerns about staffing levels, supervision of residents, staff training and handling of any concerns raised. This complaint has been referred to the responsible individual for Jasmine Healthcare for investigation and action. At the time of the inspection the registered manager advised that no complaints had been received by the home, however she had dealt with a “grumble” from a relative about laundry during the inspection. The inspector advised that a record of all complaints/concerns/grumbles with details of any action taken should be kept which can then be used as a management tool for identifying recurring issues. Comments received from the majority of residents and relatives’ confirm that they know who to talk to if they have a concern. Two relatives were not aware of the complaint procedure. It was difficult to ascertain the adequacy of the DS0000067495.V305300.R01.S.doc Version 5.2 Page 17 action taken to address complaints as one relative stated that “any problem is always addressed”, while information from another indicated that concerns/complaints had been made about standards of care and no action/improvements made. No concerns were identified about the treatment of residents through discussion with staff and residents. Comments from three relatives identify that some staff are very caring but others are described as being uncaring. The registered manager was unable to identify an incident or incidents that these comments related to. Staff spoken to were clear about their responsibilities for the protection of residents’ in their care. Clarification was given to the registered manager about the process for referring any allegations through adult protection procedures. DS0000067495.V305300.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is good. This judgement has been made using all the available evidence including a visit to the service. Residents’ have a clean and comfortable place to live with a re-decoration programme in place. EVIDENCE: Comments from relatives prior to the inspection confirmed that the home is always fresh and clean and that there are no unpleasant odours. Information received from a relative following the inspection identified that this is not always the case and more assistance is required for incontinent residents. Some of the bedrooms on the ground floor have glass doors leading into the garden, providing a pleasant view and easy access to the garden. One resident who is being cared for in bed was positioned so as to have a pleasant outlook onto the garden and the area outside the door contained additional plants and several gnomes brought in by visitors. DS0000067495.V305300.R01.S.doc Version 5.2 Page 19 Communal areas of the home and a sample of residents’ bedrooms were seen during the inspection. The home was reasonably decorated and furnished; some areas of the home were beginning to look in need of re-decoration, however the registered manager advised that the new owners were planning to re-decorate and refurbish the home. Some alterations to the garden were also being made at the time of the inspection. The home caters for people with a wide range of needs including people who need wheelchairs and hoists for assistance with movement and handling. It was noted that at present there are no storage facilities for this type of equipment and it is stored in bathrooms and lounges. Five wheelchairs and three walking frames were stored in the corner of one lounge and the shower area of one bathroom seen was full of equipment. The inspector would advise that a review is carried out of storage arrangements and review of the equipment is carried out to ensure that it is all necessary. DS0000067495.V305300.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using all the available evidence including a visit to the service. Recruitment procedures are in place, which protect residents’ however staffing arrangements need to be reviewed to ensure that residents’ needs are fully met. EVIDENCE: Of the twelve comment cards received from residents’ and relatives about the staffing arrangements, nine expressed concerns or doubts about the adequacy of staffing. Comments about staff include “friendly and competent and always available”, “Many carers are helpful, cheerful and caring but some are not”, “Staff can be busy, or not available to cater for individual needs”, “Carers can be very stretched”. Two comments were received about organisation of staff, for example the difficulties in getting assistance when staff all have their break together. Discussion with staff indicated that staff have recently started staggering their break times however the register manager should monitor this as one comment related to it being a particular problem at weekends when there was no management. DS0000067495.V305300.R01.S.doc Version 5.2 Page 21 No observations were made during the inspection of staff being uncaring or of physical care needs not being met. Of the four staff spoken to during the inspection they all presented as caring about the residents’ and their welfare. Nine out of twenty six care staff have achieved a National Vocational Qualification (NVQ) at level 2, which provides staff with a basic understanding of the care needs of Older People. This is slightly below the National Minimum Standards target of 50 staff being trained to NVQ level 2 however the registered manager confirmed that six other staff are currently working towards the qualification which will enable this target to be met. Discussion with two members of staff confirmed that new staff receive induction training based on the national training organisation specifications and initially work alongside an experienced member of staff. Additional training is being provided appropriate to meeting the needs of residents with dementia care being specifically highlighted as a training need by the registered manager. Observations during the inspection would support the need to look at staff training and staffing levels in relation to the specific needs of residents’ with dementia. Records for a recently recruited staff member were reviewed to check the adequacy of the recruitment process in protecting residents’ and found to be satisfactory. DS0000067495.V305300.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, 36, 38 Quality in this outcome area is adequate. This judgement has been made using all the available evidence including a visit to the service. The lack of good, quality assurance systems puts residents’ at risk of any shortfalls in care not being identified and their needs not being adequately met. EVIDENCE: The registered manager is a registered nurse and is currently working towards a registered managers award. The registered manager is not aware of any specific quality assurance systems in place however advised that the new owners are reviewing current practices in the home and working to update policies and procedures. The registered manager advised that the directors of the company are always contactable for advice and visit the home regularly including a recent night time visit. DS0000067495.V305300.R01.S.doc Version 5.2 Page 23 Currently the registered manager does not receive a report of the findings of the directors’ visits, which is something they may wish to consider. The concerns and comments received from relatives and residents highlight the urgency of implementing good quality assurance processes to improve and maintain standards of care. A sample check of the management of residents’ monies confirmed that there is a clear system for recording any money held on their behalf and evidence that the money is stored securely. Discussion with staff identified that staff meetings are held however they do not receive any minutes of the meetings or information about how or if issues raised are going to be addressed. Staff have not been receiving supervision sessions which are considered to be good practice in identifying any training and support needs they have in relation to providing good care to residents’. No health and safety hazards were identified during the inspection. The preinspection questionnaire submitted by the registered manager confirms that regular servicing and maintenance takes place on equipment, which includes hoists, the lift, and central heating system and fire safety equipment. Staff training includes fire safety, movement and handling and staff training in first aid has been arranged. DS0000067495.V305300.R01.S.doc Version 5.2 Page 24 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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X 3 2 X 3 DS0000067495.V305300.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? N/A 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 12 (1) (a &b) Requirement Care plans and particularly pressure area plans must be reflective of residents’ current needs and sufficiently detailed to guide staff in providing consistent care. Staffing levels and deployment of staff must be reviewed to ensure that they meet the needs and preferences of residents’. A quality assurance system, which reviews and monitors the care provided, must be implemented. Timescale for action 30/08/06 2. OP27 18 (1) (a) 30/08/06 3. OP33 24 (1) (a, b) 30/09/06 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 2 Refer to Standard OP9 OP9 Good Practice Recommendations Systems should be in place that enable an easy audit system for medication and highlight at an early stage any shortfalls or discrepancies. Medication storage systems should be reviewed to ensure DS0000067495.V305300.R01.S.doc Version 5.2 Page 26 3 OP12 OP14 4 5 OP15 OP16 safe storage at all times for all medication. The routines of the home and care practices should be reviewed to ensure that they are based on the needs and preferences of residents’, for example times for getting up and going to bed. Systems should be in place to ensure residents have an adequate food and fluid intake with any necessary assistance provided. Records should be kept of all complaints/concerns/grumbles, the action taken to address and used to improve standards of care. DS0000067495.V305300.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000067495.V305300.R01.S.doc Version 5.2 Page 28 - 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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