CARE HOMES FOR OLDER PEOPLE
Barkat 254 Alcester Road Moseley Birmingham West Midlands B13 8EY Lead Inspector
Jill Brown Unannounced Inspection 3rd May 2007 09.20 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 Barkat DS0000016738.V335774.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. Barkat DS0000016738.V335774.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Barkat Address 254 Alcester Road Moseley Birmingham West Midlands B13 8EY 0121 449 0584 0121 449 2726 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) Ms Seemia Butt Ms Shahnaz Butt Ms Seemia Butt Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27) of places Barkat DS0000016738.V335774.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. That the home can accommodate up to three people under 65 years of age for reasons of mental disorder. 22nd September 2006 Date of last inspection Brief Description of the Service: Barkat House is a large detached property situated on the main Alcester Road in Moseley. It is within easy walking distance of the main shopping area of Moseley where shops, restaurants, public houses and churches can be found and a larger shopping area can be reached by walking to Kings Heath. The home enjoys easy access to public transport routes leading to the city centre and beyond. Barkat House offers accommodation to currently 27 older people in single rooms on the ground and first floor and a number of these rooms have en suite facilities. There is a passenger lift between the ground and first floor. Communal areas are located on the ground floor. There is a large lounge to the front of the house, a smaller lounge to the rear. Residents that smoke use the small lounge. The home has a separate dining room. There are communal toilets and either assisted bathing or a shower facility based on both floors. The ground floor also houses the kitchen, office, laundry and large storage area. The home has a dedicated garden for the use of service users. The home has a small amount of parking at the front of the building. The home currently charges £332.00 per week for the rooms en suite rooms are likely to be charged for more when the contract is agreed with Social Care and Health. Barkat DS0000016738.V335774.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place on a day in May the inspector was at the home for almost 10 hours. The inspection was a key inspection, which means that the majority of the standards were looked at. A member of the Commission’s staff joined the inspector to act as an interpreter for two residents. During the inspection the inspector case tracked three residents. Records, information and views on those residents care were looked at. During the inspection seven residents were spoken to. Care records, medication administration, staff records and maintenance and inspection of the building records were looked at. A tour of the building was completed. What the service does well:
The home keeps a copy of the agreement with Social Services on resident’s care files and this is part of the contract with the home and this protects residents’ rights. The home updates residents’ assessment as new information is given to them. The home has a number of residents from the black and ethnic minority cultures and responds well to their needs. The home has a mixture of staff from different cultures that speak the languages of the current residents. Asian food is brought into the home and a resident said ‘it tasted just like it was made in India.’ Care plans remained improved; these were reviewed and updated when needed. This is important as this describes the care residents’ need and helps to ensure consistent care is given. Residents’ personal hygiene needs were met with residents having baths and showers as much as they would allow. A district nurse thought the home had improved in this area of care. The home had good risk assessments for people that smoke but now needed to check that changes in the home’s environment didn’t impact on these. The administration of medication was good, with good storage and systems to make sure residents were given medication appropriately. Barkat DS0000016738.V335774.R01.S.doc Version 5.2 Page 6 Residents spoken to said that they were happy in the home, one saying ‘No complaints couldn’t be happier.’ A district nurse said that the residents appeared more happy than on the last inspection.’ The home ensures that residents can follow their religion if they wish. A Christian service is held in the home and one resident said that they attended a Gurdwara occasionally. A relative thought there was good communication between the home and relatives saying that they let you know if your relative is not well or if they need anything. Residents feel safe in the home and there have been no incidents of an adult protection nature at the home since the last inspection. The home keeps good records of residents’ finances and look at ways to ensure that the financial arrangements meet the needs of the resident. The home had certificates of fire safety, gas and electrical safety required. What has improved since the last inspection?
The home had introduced a key worker system to ensure that each resident had oversight from a particular carer. This had ensured that each resident had time spent with them every week and improved the understanding of the needs of residents. This system increased the amount of meaningful activities for residents such as ‘spent time looking at a photograph album,’ ‘ playing cards’ and led to more information about residents such as ‘likes music especially Tom Jones.’ The home was keeping a record of what residents eat at meal times this ensures that staff can monitor along with their weight any health issues. The home ensured the privacy of a number of residents by placing a frosted screen to certain windows. The home has purchased a piano. The home had surveyed individual residents and had started addressing some of the points that they had raised to make the home better. There have been several improvements to the home’s environment including new windows, new floor coverings, redecoration, a number of replacement beds and storage. Staff were having regular supervision. This is a way that the manager can ensure consistent care for residents and that staff have a place to voice any concerns about care practice.
Barkat DS0000016738.V335774.R01.S.doc Version 5.2 Page 7 Nine residents had been spoken to about what they think about the home and the home had started to act on areas that the residents felt could be improved. What they could do better:
The homes Statement of Purpose did not reflect the service the home is now offering and the service user’s guide similarly needed updating. The home did not have these available in appropriate forms for residents to understand. The home did not keep a record of when the Service User Guide had been given to the resident. This means it is difficult for residents or their representatives to decide whether this home can meet their needs. The home did not always insist on getting the social worker’s assessment before the resident was admitted and this is important as it helps the home decide whether the home can meet the resident’s needs. The home was not confirming in writing that the home could meet individual residents needs before admission. The home has predominantly male residents and the home did not have any male care staff at the time of the inspection. Although care plans were improved further work was needed to ensure that residents and health colleagues were consulted and able to add to them to ensure the best care for the resident. Risk assessments for moving and handling and nutrition were not clear in stating what help the resident needs and how the home intends to give it. For example a moving and handling risk assessment stated that the resident needs help from two carers but didn’t describe the help needed. This could lead to residents being transferred from place to place in a poor way. Residents that receive ‘as required medication’ did not have a written protocol to ensure that medication was given in a consistent way. The home needs to ensure that it responds to residents’ dissatisfaction with the food and keep a record of how they have resolved this. The home needed to show more clearly how residents’ food met their health needs. Although there have been improvements in the homes environment some areas of work needed to be completed and the decorators were still on site. A number of the items such as window restrictors and infection and odour control affect the comfort and well being of residents. The home did not have robust plans for the recruitment and training of staff and there were shortfalls in required checks and foundation training. These lacks could put residents at risk and we may take legal action if this does not improve.
Barkat DS0000016738.V335774.R01.S.doc Version 5.2 Page 8 Whilst the management of the home has been improving in a number of areas there has been a lack of consistency. The registered manager is now on maternity leave and arrangements had not been made to fill the position in her absence. The home needs to continue to improve and not lose some of the improvements it has made. 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. Barkat DS0000016738.V335774.R01.S.doc Version 5.2 Page 9 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 Barkat DS0000016738.V335774.R01.S.doc Version 5.2 Page 10 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): 1,2,3,4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents do not receive all the information required to enable them to make an informed choice about whether the home is suitable for them. Residents’ needs are not fully assessed prior to admission, this could result in some care needs not being met. The home tries to ensure that all residents’ needs and wishes are met and this makes residents satisfied with the care in the home. EVIDENCE: The inspector asked for the statement of purpose, the one given had not been reviewed. It contained information about staff that were no longer working at the home and did not reflect the homes registration in number of residents and the service it offers. The home had developed a service user guide these
Barkat DS0000016738.V335774.R01.S.doc Version 5.2 Page 11 were said to be in the rooms of the residents but none of these were seen on the visit. The new resident’s care file did not record that a service user guide had been given. These were not available in the languages the residents speak. The home was unable to show how residents were assisted to decide that the home could meet their needs. The residents of the home had copies of their three way agreements with social services and the home on their file. This in all cases acts as the contract for the residents in the home. The home stated that they had an additional contract but this was not available to inspect. This was provided later and needed to update the complaints area in the terms and conditions. The home collects some good information about individual residents and was trying to put this into a standardised order. The home did not ensure where social services were involved that they received a copy of the single assessment information prior to admission, and the care plans supplied by social workers did not always give the level of information needed to plan good care. Care files did not show whether the resident had had an introductory visit to the home. Information collected on an individual resident’s admission did not contain enough detail to determine whether the home could care for the individual although this was added to subsequently. The home did not write to residents formally to say that they could meet the needs of residents that were admitted. The home has a number of residents from the black and ethnic minority cultures (Punjabi, Sikh, Yemeni, African Caribbean and Irish) and tries to ensure that these residents’ needs are met. The home has staff that speak a number of languages, which cover all of the languages that the residents speak. The home has an arrangement with a day centre to provide Asian food daily. The home is predominantly for men with only two female residents. The majority of the residents have had unsettled lifestyles, which can lead to challenging behaviour. The manager and some staff have had training in challenging behaviour. Barkat DS0000016738.V335774.R01.S.doc Version 5.2 Page 12 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 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care planning in this home had improved but consultation with residents and health professionals would improve these further and ensure that residents’ needs are met in an appropriate way. Whilst the home was meeting the health needs of residents further work was needed on risk assessments to ensure that residents health was maintained. The medication administration in this home was good and this helps to keep residents healthy. EVIDENCE: Care plans remained improved since the last inspection with some good detail in parts but poor in others. Care plans showed the help residents needed with their care for example; ‘Likes to get up between 8 and 8.30 with the help of two carers that will need to wash the residents face and body and change the residents incontinence pad and help to dress.’ ‘This man is a Sikh he needs to grow his beard and maintain it…… staff to refrain from touching it.’ ‘can speak
Barkat DS0000016738.V335774.R01.S.doc Version 5.2 Page 13 English, use very simple English words insulted by complex sentences.’ However this was not consistent. A resident with a pressure ulcer did not have instructions on their plan about bathing and showering and what to do if the dressing fell off. District nurse notes showed that this had been an issue several times for a resident. Incontinence pad sizes were neither recorded on the care plan, nor were there any systems in the storage places to ensure that residents were given the right size pad for them. There was no evidence to show that care plans had been shared with the resident concerned. Residents’ care plans were reviewed and care plans were changed when resident’s needs changed. The home had started a key worker system which means that staff were allocated particular residents and in some cases this worked well with staff getting further information about the resident such as ‘likes to listen to Tom Jones’ and ‘came in with 1x trousers and 1 x shirt new clothes bought and changes into them.’ In others there was little information or evidence of a building relationship. The home’s records showed that residents were bathed or showered as much as they wished or would allow. Records showed that residents were not always getting their hygiene needs met in the way the care plan stated. Two residents were having showers but their care plan stating their preference was for baths. However the care plans have good information on how to individually assist residents that refuse showers and baths and the home improved the number of times they managed to get residents to agree as they got to know them. The home ensured that residents had the call of health professionals and district nurses attended several residents of the home. A district nurse said that the home had improved since the last inspection. The home tries to do what the district nurses ask and the environment has improved. The inspector found one accident recorded in the daily notes where an accident form had failed to be filled in for an accident on a night, and there was no notification to us. The district nurses were told that he hadn’t had a fall even though the resident said they had there was no reference to the daily records before talking to the district nurse. The home had undertaken risk assessments for moving and handling and nutrition but these needed to be completed more fully. Moving and handling assessments did not result in a description of how the resident was to be moved only the number of people it takes and this could result in residents being moved inappropriately. Similarly nutritional assessments did not always result in clear instructions for the amount of food or supplements residents needed. Residents were weighed
Barkat DS0000016738.V335774.R01.S.doc Version 5.2 Page 14 where possible and generally maintained a good weight, one resident had concerns about their weight and this was being monitored. The home had started keeping records of food that residents have eaten at meal times records of snacks would improve these records. The home had better risk assessments for residents that smoke of which there are a number in the home. The ordering, checking of medication, storage, administration and returns of unwanted medication is good. Systems were in place to ensure that the prescriptions were seen and checked against Medication Administration Record, residents’ photographs were next to these records and this ensures that medication is given to the appropriate resident. Medication was signed for with only three gaps being noted. Medication in the monitored dosage system, boxed medication and liquid medications were checked and found to be correct. The deputy manager was knowledgeable about certain medications. A number of residents were on as required medication. These medications were not supported by a protocol of how and when they are to be used and details of the time between administering and the maximum dose within 24 hours. These protocols ensure that such medication is given consistently and in a safe way. Although the home has an appropriate gender and intimate care policy the home has no male carers apart from the deputy manager who is not involved in giving personal care. This lack can mean that residents’ needs are not met in the way they would wish. Residents that express a wish about their personal care did have this attended to, a resident that expressed a wish to have their hair dyed had this was done. All residents spoken to said that they were happy in the home including two residents who were spoken to in their first languages. One resident said ‘No complaints, couldn’t be happier’. The home had ensured that bedrooms that backed on to private gardens had some privacy frosting on the windows. Barkat DS0000016738.V335774.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 &15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are given activities that are meaningful to them and are able to receive visitors and this enhances their lives. Meals in this home do not always reflect residents’ views and do not always respond to nutritional need. EVIDENCE: The home tries to engage residents in activities. Two residents go out to day centres or sheltered workshops. The home purchased a pool table, which is used by the men, and recently a piano has been purchased as one of the resident plays. The home has two large screen televisions for residents to watch. The home has planned activities for residents throughout the week. The home has introduced a key working system and the residents were assured of some individual time with a member of staff. Records of this showed ‘looked at photo album,’ ‘likes it here never had a bath,’ ‘listens to music likes Tom Jones.’ The home is getting better at recording residents’ activities so activities enjoyed can be repeated. A person comes once a fortnight to do music and mobility.
Barkat DS0000016738.V335774.R01.S.doc Version 5.2 Page 16 A deputy manager occasionally takes residents down to the pub if they wish to go. A staff meeting discussed taking a number of residents out for an afternoon in response to their requests. The home has a visiting church service for those residents that wish to attend. One resident said he attended a Gurdwara occasionally. Many of the residents do not have visitors. A visitor spoken to though said that they had no concerns about the home, they said they were made to feel welcome. They feel their relative has improved over the 5 years that they have been here. There is good communication between relatives and staff saying that they let you know if your relative is not well or if they need anything. Residents go out if they are safe to do so others need assistance. Residents were able to go to their rooms at any point during the day. A number of residents were in bed during the tour of the building. The home has a set meal and a set Asian meal at lunchtime. Menus provided did not show the Asian meals. Breakfasts consist of cereal and toast and tea times of soup sandwiches pies and so on. The home has started to record what residents eat and this is good practice. These records showed a variety of food given to residents over the three meal times. Where residents had refused food other alternatives were shown on the record of food eaten. The home surveyed 9 residents in April and comments were made about how the teatime meals were a bit the same and that more high protein foods like sardines and kippers should be put on the menu. The home was not showing how they were responding to comments on food. The home was not showing how food responded to individual resident’s nutritional need. The food was due in on the day of the inspection and food stocks were running low. On the day of the inspection residents spoken to thought the food was good this included the Asian food brought on to the site. One resident said of the Asian food ‘it tasted just like it was made in India.’ Barkat DS0000016738.V335774.R01.S.doc Version 5.2 Page 17 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 &18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good systems for hearing residents’ views and this promotes residents’ confidence that their concerns will be listened to. The residents in this home are protected by staff practices and good procedures. EVIDENCE: The home has had no complaints and we have received none. The home has an appropriate complaints procedure and this was reviewed in April. Residents spoken to thought they could talk to the management in the home. One resident thought the manager and the deputy manager were very kind and that the home had improved a lot this year. The home had started individual discussions with residents to get their views and this had worked well. The home hadn’t informed the residents what they are going to do with the issues raised in some cases. There have been no referrals of an adult protection nature since the last inspection. Residents in this home can have challenging behaviour. Senior staff have undertaken training on adult protection and aggression and this training must be made available to all care staff. The home kept an inventory of resident’s belongings. Residents’ freedoms are not taken away without a risk assessment being undertaken and risk assessments looked at trying to enable residents to undertake an activity. A relative spoken to stated that they had Barkat DS0000016738.V335774.R01.S.doc Version 5.2 Page 18 seen residents be difficult, like their relative could be, but the staff have a way of remaining calm. They said their relative feels safe at the home. Barkat DS0000016738.V335774.R01.S.doc Version 5.2 Page 19 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): 19,25 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment in this home is improving, further improvements were needed to ensure that infection control and risks to residents were managed. EVIDENCE: There has been a lot of building and decoration work undertaken on this home since the last inspection. All the corridors have been painted and a number of the rooms have been decorated. The corridors in the home have been decorated in different colours to help people orientate themselves around the home. The home has replaced the windows in a large portion of the home. The home had redecorated the toilet by the smokers lounge. A number of floors had been recovered using flooring that was more durable. The home had bought some new beds and was in the process of exchanging these with ones in residents’ bedrooms. Good progress has been made on
Barkat DS0000016738.V335774.R01.S.doc Version 5.2 Page 20 previous requirements. This work was making the home a more pleasant place for residents to live. The home had improved on its storage facilities for continence supplies and put a lock on the commode pot washer room and this ensures that the safety of residents. The home has a number of smokers and the UPVC windows were particularly susceptible to marks from cigarettes and an additional surface may be needed to ensure that these remain in a good state. The home had yet to ensure that window restraints were operating on all windows after their fitting, this needs to be done to ensure the safety of residents. Radiator covers still need to be painted and some covers were not secured properly. The maintenance and decorators were still on site at the time of the inspection and a number of these items were to be addressed after the inspection. The home was clean and fresh in most areas and improved to previous inspections. However a number of bedrooms could be improved with replacement pillows and duvets especially where continence was an issue. The home was undertaking routine infection control audits of the home and records of monthly checks were seen. However the home’s process for managing infected laundry needed to be improved to ensure that infected laundry was well contained before transporting it to the laundry. The process did not show that gloves and aprons must be removed before leaving a room where personal care had been given. The commode disinfector was not working. The district nurses commented that taps needed to be cleaned. These areas do not promote good infection control and this could potentially be a risk to residents of the home. The kitchen area was clean and ordered however it was noted that the system of checks was starting to decline because of a lack of appropriate recording documents. Barkat DS0000016738.V335774.R01.S.doc Version 5.2 Page 21 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 &30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The level of care staffing is good but more domestic staff would ensure that individual resident’s rooms received more attention. The recruitment process of staff is not robust enough to ensure the continued safety of residents. Training of staff is not enough to ensure that residents have the benefit of trained and competent staff at all times. EVIDENCE: The inspector received two weeks rosters that showed that there are 3 care staff on a morning and afternoon and two staff on duty throughout the night. In addition there is management available from Monday through Friday. On the weekend there is an additional member of care staff in the morning. The home has a cook every day and a cleaner five days a week. Whilst this staffing level is good the demands of these residents would be better met with an increase in domestic provision. The home had 31 of the staff trained to National Vocational Qualification (NVQ) Level 2 in care. Two further staff were expected to finish this course later this month, which would mean the home almost meeting their target of 50 .
Barkat DS0000016738.V335774.R01.S.doc Version 5.2 Page 22 Staff records were not in a level of detail to show that a robust recruitment of staff was taking place. A number of the staff in the home were supplied by an employment agency that brings in potential staff from other countries. These agencies supply references and police checks from their country of origin. These checks were not supplemented by timely checks in the UK. Not all application forms, references, Criminal Record Bureau checks were in place before staff started to work at the home. The starting dates of staff were not clearly recorded, and there were no job descriptions or contracts on the staff file. This lack puts residents at risk. The agency that supplied staff undertakes two orientation days with potential staff; the areas covered were so numerous as to not be effective. The home had started ensuring staff were equipped with basic skills but could not show how this related to the new Skills for Care organisations common skill for care training. The home showed that there was ongoing training as moving and handling was planned for this month, however could not supply an up to date staff training matrix. . Barkat DS0000016738.V335774.R01.S.doc Version 5.2 Page 23 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): 31,33,35,36,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management of this home are making improvements in most areas to improve the service for the residents. However there are gaps in management and planning that impact on the residents’ safety and satisfaction of the service. EVIDENCE: The manager and part owner of the home was not at the inspection having left the home to go on maternity leave rather earlier than expected. The two deputy managers are in charge of the home however one deputy is not involved in the personal care of residents and this leaves the home short on managers of care. A deputy manager has an NVQ3 in care and no
Barkat DS0000016738.V335774.R01.S.doc Version 5.2 Page 24 management qualification. The home had yet to put in place temporary management arrangements. The home has not devised a formal quality assurance system however the home has undertaken routine and regular audits of medication administration, infection control and has started consulting residents in a way that assists residents to give honest feedback. The home had a staff meeting in February and a range of issues was discussed and these were relevant to ensuring good consistent care is given to residents. The residents that were case tracked have no money held by the home so the inspector looked at the money records of two other residents. Residents have access to their money as they wish or as is appropriate. A number of residents sign for their weekly personal allowance and manage this themselves. Others ask for money as and when they need. A number of residents need help budgeting their money and cigarettes and this is managed by the home. The home had accurate records of the money held and receipts for any spending. A deputy manager stated that individual resident’s belongings are insured for any losses. These measures ensured that resident’s money was handled appropriately. Staff files showed that staff received supervision on a routine basis and this was an improvement from previous inspections. The format of these supervisions could be improved but this is likely to happen, as the new key worker system becomes established practice. Regular supervision of staff allows for consistent care practice to be maintained and ensures that staff have the opportunity to report poor practice and this benefits residents. The home had good records of the maintenance and inspection of the building such as gas and electrical safety certificates. They had appropriate employers liability insurance. The home undertook all fire safety checks and the fire equipment had been serviced. The home undertakes a fire drill on a monthly basis to ensure that all the staff are aware of their responsibilities. The service of the lifting equipment including the passenger lift was found however a thorough inspection of the passenger lift was not found on this occasion. The home has a fire risk assessment this needs to be reviewed in light of the changes to fire safety regulations. The home needed to ensure that window restrictors were in place. Barkat DS0000016738.V335774.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 1 2 2 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X 2 2 STAFFING Standard No Score 27 3 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 3 X 2 Barkat DS0000016738.V335774.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP8 Regulation 13(4)(c) Timescale for action Risk assessments for moving and 30/06/07 handling where residents need assistance must result in a description of how transfer manoeuvres must be carried out to ensure the consistent safety of the resident. Administration of ‘as required medication’ must be supported by a written protocol to ensure that residents are only given this medication appropriately . Food must be available to ensure that residents have a nutritious diet and where needed are enabled to lose or gain weight to maintain their health. (Outstanding since 30/06/06 31/10/06 and 31/10/06) Staff must have the relevant training in adult protection and aggression awareness to ensure the continued safety of residents. (This requirement remains outstanding since 30/04/05
DS0000016738.V335774.R01.S.doc Requirement 2 OP9 13(2) 30/06/07 3 OP15 12(1)(a), (3) 30/06/07 4 OP18 13(6) 31/08/07 Barkat Version 5.2 Page 27 5 OP26 13(3) 31/05/06 30/08/06 and 31/12/06) . Measures must be taken to improve the infection control in the home including: Replacing stained duvets and pillows. Ensuring an effective process for containing and handling infected linen is written and adhered to. Repair of the commode disinfector. A process to ensure the cleansing of water outlets routinely. 31/07/07 6 OP27 18(1)(a) 7 OP29 19(1)(a) Further cleaning hours must be added to ensure good infection control and to make the home comfortable for residents. (Outstanding since 30/11/06 ) Employment procedures must be devised and implemented to ensure that: Recruitment processes are robust and follow the form of application, references, interviews and checks before recruitment to ensure that staff are fit to work in a care home and to maintain the safety of the residents. New staff must have induction training to ensure they are competent to give care to residents. 31/07/07 30/06/07 8 OP30 18(1)(c) 30/06/07 9 OP31 38 Details of the absence of the 31/05/07 registered manager must be sent to the Commission as outlined in Regulation 38 so as to ensure proper management of care arrangements.
DS0000016738.V335774.R01.S.doc Version 5.2 Page 28 Barkat 10 OP38 23(2)(c) The lifting equipment must be inspected to ensure its worthiness and to protect the safety of residents. Window restraints must be fitted to ensure that residents are protected from people gaining access to the building and to ensure that these are not used as a means of leaving the building . 30/06/07 11 OP38 13(4)(c) 30/06/07 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 OP1 Good Practice Recommendations The home should review its statement of purpose and its service user guide to ensure that residents and their representatives have appropriate information in an appropriate format to determine whether the home can meet their needs. A copy of the revised documents should be sent to the Commission. It is recommended that the home gain copies of the social worker’s assessment prior to the resident being admitted into the home. It is recommended that the home confirm in writing to new residents or their representative that the home is able to meet the resident’s needs a copy of this letter should be retained. All residents following admission must have a care plan that is written with the resident and signed by the resident wherever possible and dated. It is recommended where health professionals are involved in the care of the resident their input is gained to the home’s care plan It is recommended that the home purchase seated scales.
DS0000016738.V335774.R01.S.doc Version 5.2 Page 29 2 3 OP3 OP4 4 5 6.
Barkat OP7 OP8 OP8 7 8 9 10 OP25 OP28 OP31 OP33 It is recommended that radiator covers are checked and where necessary fixed to the wall and their surfaces sealed. The home should have a plan to achieve 50 qualified NVQ2 staff. The registered manager should undertake the NVQ4 in care and the Registered Managers Award. A system should be implemented to take the views of those people using the service into account. This will contribute to person centred care. Barkat DS0000016738.V335774.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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
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