Inspection on 13/11/07 for Baroda Residential Care Home

This inspection was carried out on 13th 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

Baroda Residential Care Home 30/08/06

Similar services:

21 High Street

Vale House

Chestnut Walk

The Old Vicarage

Cherwood House Care Centre

Ashley House

Ascot Nursing Home

Fountain View

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

CARE HOMES FOR OLDER PEOPLE Baroda Care Home for the Elderly 34 Merdon Avenue Chandlers Ford Eastleigh Hampshire SO53 1EP Lead Inspector Beverley Rand Key Unannounced Inspection 13th November 2007 10:35 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 Baroda Care Home for the Elderly DS0000067235.V349691.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. Baroda Care Home for the Elderly DS0000067235.V349691.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Baroda Care Home for the Elderly Address 34 Merdon Avenue Chandlers Ford Eastleigh Hampshire SO53 1EP 02380 261764 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) Branksome Care Limited Mrs Joan Josephine Vijayanathan Mrs Joan Josephine Vijayanathan Care Home 12 Category(ies) of Old age, not falling within any other category registration, with number (12) of places Baroda Care Home for the Elderly DS0000067235.V349691.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th August 2006 Brief Description of the Service: Baroda is located in a residential area of Chandlers Ford, Eastleigh. The home is set in a spacious landscaped garden and provides accommodation for twelve older persons. The accommodation is in single rooms, ten of which have ensuite facilities, over two floors, though most resident’s rooms are on the ground floor. There are two lounges, one with doors leading out into the garden and a smaller room mainly used for activities such as puzzles and board games. A dining room leads from the main lounge. A chair lift is available for residents who have rooms on the first floor. Residents have varying needs with aspects of daily living. Mr and Mrs Vijayanathan took over the ownership of the home in July 2006. Mrs Vijayanathan is also the manager of the home. Mrs Vijayanathan stated, during the inspection visit, that the fees for the home were £476 to £520 a week. Baroda Care Home for the Elderly DS0000067235.V349691.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection. Prior to the inspection we looked at the last inspection report and the Annual Quality Assurance Assessment which had been completed by the manager. We also received six surveys from residents and four from relatives. During the inspection the inspection spoke with four residents, one relative, three staff and the manager, and looked at records and care plans. What the service does well: What has improved since the last inspection? What they could do better: Staff must be better trained in areas such as medication administration and moving and handling to ensure residents are not put at risk. There must be risk assessments in place regarding uncovered radiators and a plan of action put in place, dependent on the risks. Hot water temperatures must be monitored and recorded: this issue was raised at the last inspection but was Baroda Care Home for the Elderly DS0000067235.V349691.R01.S.doc Version 5.2 Page 6 not addressed. The manager does not have a management qualification and has not enrolled on a course. Due to the areas of concern highlighted in this report, the manager must enrol on a suitable course. 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. Baroda Care Home for the Elderly DS0000067235.V349691.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Baroda Care Home for the Elderly DS0000067235.V349691.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 does not apply. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager ensures that no-one moves into the home without their needs being assessed. EVIDENCE: The manager described the assessment process she follows after she receives a referral. She takes as many details as possible, verbally and then arranges to visit the potential resident wherever they are at the time. She then discusses their needs with them and any other parties who are involved such as family members or health and social care professionals. The manager describes the home and offers people an opportunity to visit the home before deciding to move in. The inspector looked at two assessments and found they contained all the necessary information. One of the residents said when they visited to look around, they had been impressed with the home and that the home looked clean. Baroda Care Home for the Elderly DS0000067235.V349691.R01.S.doc Version 5.2 Page 9 Baroda Care Home for the Elderly DS0000067235.V349691.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. All residents have a care plan in place which provides information about individual preferences. The home accesses healthcare professionals to ensure healthcare needs are met. There is an appropriate medication procedure in place but the lack of medication training or assessment may put residents at risk. Residents are happy that the staff respect their privacy and dignity. EVIDENCE: Care plans contained information about when doctors, nurses and the chiropodist visited, listed medication and showed individual needs and preferences. The plans were reviewed monthly. There was also evidence that residents’ weight is monitored and medical care is sought when needed. Plans showed that ‘some help was needed’ or ‘assistance’ was needed, for example, when bathing. The inspector discussed the need for more detail, for example what help was needed. However, the inspector discussed with residents about how staff supported them with personal care, and all were happy. There is also Baroda Care Home for the Elderly DS0000067235.V349691.R01.S.doc Version 5.2 Page 11 a key worker system in place which means residents are generally bathed by the same person. The manager accepted that more information could be beneficial. As stated above, there was evidence that the home accesses health care professionals when necessary. However, one person might be entitled to a free healthcare service and whilst the manager had asked about this, she had not chased it up. During the inspection she raised the issue with the doctor who will look into it again. Since the last inspection the manager has introduced a book for recording the use of controlled drugs and this was seen to be completed and signed by two staff. Controlled drugs were stored appropriately. The home has placed a photograph of each resident next to his or her medication administration record sheet, which is seen as good practice. The record sheets were generally completed but there were some gaps with regard to creams and eardrops for which there was no explanation. Staff described the procedure they followed which included signing the records after the medication has been taken. When residents die the home usually returns prescribed medicines to the pharmacy but there was a stock of Gaviscon still being held. The manager thought it might be useful to give to another resident. The inspector advised that prescribed medicines must not be given to another resident under any circumstances. Staff told the inspector that they had not received training in medication and that the manager had shown them how to administer medication. One was asked how they knew what medications were for, what side effects to look for and so on. They said unsure but said they could look at patient information leaflets, but there was less of these with the system used by the home, or there was a book which listed medication. Training was discussed with the manager who agreed there had not been any formal training but that the local pharmacy had said they would send someone to discuss the dispensing system used. The manager has not assessed the staff with regard to their competence and has not recorded the detail of any in-house training she has provided. Therefore, the manager was unable to evidence the suitability of the training and to ensure staff were competent. Residents spoke highly of staff and the way they worked. Comments included, ‘the attitude of the staff is excellent, never known a nicer set of girls. They make everyone feel they are important, they look after you so well’, and, ‘they are lovely, good girls who work hard.’ Residents were happy with the way care staff worked with them and said it was usually the same staff member who assisted them with bathing. Staff gave examples showing how they respected residents’ privacy and dignity when entering their bedrooms, attending to their personal care and so on. Baroda Care Home for the Elderly DS0000067235.V349691.R01.S.doc Version 5.2 Page 12 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 good. This judgement has been made using available evidence including a visit to this service. Residents are happy with the daily routines and the meals provided. Visitors are welcomed and residents can personalise their rooms. EVIDENCE: Residents told the inspector that they enjoyed the activities within the home. Weekly activities include art and craft sessions and armchair aerobics. A person comes in each month to play music and communion is also held monthly. There is a games room in the home with a range of board games and artwork is displayed there. Residents also told the inspector they were happy with the daily routines, such as when they got up and went to bed. Residents have a cup of tea, followed by breakfast in bed. A resident said the home was, ‘very good with visitors, they always bring them a drink’ and said that their family had recently had lunch with them, in their room. A visitor was seen to be having a cup of tea with their relative. Residents are able to personalise their rooms with their own furniture and ornaments. All rooms were seen to be personalised in these ways. Baroda Care Home for the Elderly DS0000067235.V349691.R01.S.doc Version 5.2 Page 13 Residents said that the food was, ‘tip top, a properly balanced diet’, ‘good, excellent I would say’ and, ‘very good on the whole’. Residents also confirmed that staff knew their likes and dislikes and that if they did not want the main dish something else would be prepared. The cook makes homemade food and on the day of the inspection was making lasagne and apricot tart. The inspector was told by staff that they had consulted with residents about the menu and encouraged them to suggest menu ideas. The cook completes a menu board which is placed in the dining room. Out of the six surveys received from residents, three said they liked the food, ‘always’; two, ‘usually’ and one did not answer. Baroda Care Home for the Elderly DS0000067235.V349691.R01.S.doc Version 5.2 Page 14 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 good. This judgement has been made using available evidence including a visit to this service. Residents feel able to complain. Procedures are in place to protect residents from abuse. EVIDENCE: The home has a complaints procedure in place. In response to the question, ‘do you know who to speak to if you are not happy?’ in the residents’ surveys received by the Commission, one did not answer, one said, ‘usually’ and four said, ‘always’. Five agreed they did know how to make a complaint and one did not answer. The home has not had any formal complaints, as issues such as cold vegetables or ironing not being done properly are dealt with straight away. There is a Safeguarding Adults procedure in place although this did need a slight amendment, which the manager agreed to do. The manager appropriately described what she would do if there were an allegation of abuse. Staff have not had any formal training in safeguarding adults but the manager said she had gone through the policies with staff and discussed the issue at supervision. Staff and residents may benefit from staff having formal training in safeguarding adults. Baroda Care Home for the Elderly DS0000067235.V349691.R01.S.doc Version 5.2 Page 15 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. The home is clean. However, residents would benefit from better systems to prioritise safety issues and maintenance. EVIDENCE: The communal space is comprised of a dining room, a lounge and an activities room. Bedrooms are generally larger than the standard suggests and are single occupancy. All but two of the bedrooms have en-suite toilet facilities and many have baths. The home has ongoing maintenance and re-decoration. Since the last inspection the outside of the home has been painted and a new toilet has been installed in the hall. However, at the last inspection the manager said she was planning to get radiator covers for the sitting room, dining room and corridors but this has not been done. The manager said she was seeking the right person to do the work. The home does not have risk assessments in place to determine areas which need to be addressed first. The Baroda Care Home for the Elderly DS0000067235.V349691.R01.S.doc Version 5.2 Page 16 manager said all baths had thermostatically controlled valves on them to limit the temperature of the hot water. However, the home has not maintained the valves and does not test the water with a thermometer. The manager said the staff test the bath water with their hands. The inspector felt the temperature of the hot water in two baths and found one to be very hot. It was not possible to ascertain the exact temperature of the water. This issue was raised at the last inspection and a requirement made to monitor and record the temperature. This has not been done and the manager was unable to give an explanation as to why. Upstairs there are four bedrooms and these are served by a fire escape route which is accessed by going through the office. The manager had put a bolt on the outside of the door at the top, in response to a resident walking into the office and nearly falling down the step which leads into the office. This meant that the fire escape could not be easily accessed by anyone who could not reach the lock, or by someone who was confused in the event of a fire. The manager agreed to unlock the door at once and arranged for the lock to be removed later that day. The home has large gardens and vegetables and fruit are provided for the kitchen. A gardener is employed but residents have been involved in growing pot vegetables. Four surveys received from residents agreed that the home was always clean, one said usually clean and one did not answer. The home has installed a new washing machine with a sluice wash and a tumble drier. Baroda Care Home for the Elderly DS0000067235.V349691.R01.S.doc Version 5.2 Page 17 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 adequate. This judgement has been made using available evidence including a visit to this service. Adequate staff are available but they would benefit by having better training and being qualified. More attention should be given to the recruitment records to evidence that the procedures are robust. EVIDENCE: The rota generally includes three care staff in the morning, then two for the rest of the day and night. The manager will work on the floor when needed and takes residents to appointments or out to church and so on. The home also employs a chef and a gardener. All six surveys from residents said the staff were always available when they needed them. A resident who was asked said that staff always came quickly when she pressed the buzzer on the call system. The manager’s recruitment procedure includes face-to-face interviews and obtaining two written references, a Protection of Vulnerable Adults check and a Criminal Records Bureau check. The inspector looked at the recruitment files for three new staff and found two files to be complete. One did not have the second reference. The manager recalled receiving the second one, but did not know why it was not on the file. Baroda Care Home for the Elderly DS0000067235.V349691.R01.S.doc Version 5.2 Page 18 A number of staff do not have English as their first language and this was raised as an issue on one of the comment cards from residents, and one from relatives. The matter was discussed with the manager who said she discusses this with all staff, and in particular tells staff not to talk in their own language when with residents. Some staff are taking English lessons. One resident who was asked confirmed that staff spoke in English when in their room, but that they did hear staff talking in their own language in the corridor. The manager was made aware of this feedback and said she would address the issue again. General feedback from residents was positive, as detailed in standard 10. The home does not have a robust training plan or system in place. Training has included food hygiene, health and safety, fire safety, first aid and risk assessment but between one and three staff have attended each course (other than fire training). Moving and handling training has not been provided and the manager said this was due to there being a problem in getting somebody to do the training. Medication training is also lacking as referred to in standard 9. Out of eleven care staff, only one has achieved a National Vocational Qualification, (NVQ) in care. The manager said that the remaining staff have not been motivated to study for NVQs but that opportunity is there. Baroda Care Home for the Elderly DS0000067235.V349691.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are happy at the home but the manager has not got a qualification in management and does not have adequate systems in place to ensure the health and safety of residents. Residents expressed their satisfaction with the home but would benefit from a more formal quality assurance programme. Resident’s financial interests are safeguarded. EVIDENCE: The manager is a registered general nurse and has certificates in Teaching and Assessing Clinical Practice, Care of the Elderly and Counselling. The manager works with residents, both with regard to moving and handling and cooking meals three days a week. However, she has not had any training in moving and handling or food hygiene. The manager has not got a qualification in Baroda Care Home for the Elderly DS0000067235.V349691.R01.S.doc Version 5.2 Page 20 management and has no plans to do so in the near future. She explained that this was due to the time pressures in buying the business and moving house to be near the home. However, due to the areas of concern highlighted within this report, the manager must arrange to enrol on a suitable course. One of the care staff who spoke with the inspector said they found the manager, ‘so nice, we can speak with her’. The home receives ‘thank you’ cards from relatives but has not yet put a quality assurance system in place. The manager has written a survey to give to relatives but this has not yet been sent out. The manager did not have a firm plan as to when it would be sent out but thought maybe before Christmas. The manager said she sought views from residents through talking with them, one to one, or sitting with them after a meal and observing daily life. The home looks after personal money on behalf of one resident. Records are kept and records tallied with the amount of money held. Records are kept regarding the regular testing of fire alarm systems. Fire safety training has been provided twice since March this year, but not all staff have attended both. The fire escape route had been locked, as detailed in the environment standards . Portable appliance testing had been carried out on electrical equipment in August, which includes the bath lifts. The manager did not know whether the bath lifts needed to be tested as a moving and handling piece of equipment and therefore she should refer to the manufacturers information and act accordingly. Maintenance certificates were available for equipment such as the boiler and stair lift. Baroda Care Home for the Elderly DS0000067235.V349691.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Baroda Care Home for the Elderly DS0000067235.V349691.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13 (2) Requirement All staff must have suitable training to ensure their competence with regard to administering medication. Risk assessments must be completed with regard to the uncovered radiators and action taken as prioritised to ensure residents are not scalded. The registered person must ensure that the temperature of the hot water from bath taps is monitored and recorded. This requirement was made at the last inspection. All staff must have suitable core training such as moving and handling to ensure residents are not at risk. The manager must enrol on a suitable management course to improve the outcomes for residents. Timescale for action 29/02/08 2 OP19 13 (4)(c) 31/12/07 3 OP25 13 (4)(c) 31/12/07 4 OP30 18 (1) (c) 29/02/08 5 OP31 10 (2) 29/02/08 Baroda Care Home for the Elderly DS0000067235.V349691.R01.S.doc Version 5.2 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Baroda Care Home for the Elderly DS0000067235.V349691.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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