Inspection on 23/01/07 for Broadwaters

This inspection was carried out on 23rd January 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

Broadwaters 14/05/07

Broadwaters 22/02/06

Broadwaters 02/08/05

Broadwaters 28/02/05

Broadwaters 09/06/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Broadwaters 55 Wick Lane Tuckton Bournemouth Dorset BH6 4LA Lead Inspector Sally Wernick Key Unannounced Inspection 23rd January 2007 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 DS0000032041.V328153.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. DS0000032041.V328153.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Broadwaters Address 55 Wick Lane Tuckton Bournemouth Dorset BH6 4LA 01202 423709 01202 429923 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) Bournemouth Borough Council Michael Twigg Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27) of places DS0000032041.V328153.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The registered persons must comply with any requirements of the building control officer concerning works undertaken to the premises. 16 of the 27 beds are for intermediate care and 11 are for respite care. 22nd February 2006 Date of last inspection Brief Description of the Service: Bournemouth Borough Council Social Services Directorate manages Broadwaters. Situated in the Tuckton area, local shops, cafe and a library are within half-mile level walking distance of the home. There are pleasant riverside walks with a ferry into Christchurch. The home provides respite/short stay, assessment and intermediate care/rehabilitation for 27 older people who live in the Borough of Bournemouth. The service enables individuals to remain living in the community for as long as possible by providing respite for carers and helping service users to regain or learn skills, and improve their health so they can return home after a hospital stay or alternatively prevent admission to long term care. The home is purpose built with a passenger lift to all three floors. Separate facilities are provided for the 16 service users receiving intermediate care on the first and second floors and the 10 respite care service users and one permanent service user accommodated on the ground floor. All bedrooms are for single occupancy and do not have en-suite facilities, but there are sufficient bathrooms and toilets available on each floor. Extensive grounds that are easily accessible surround the home and garden furniture is available. The staff group for the intermediate care service includes health care professionals either employed or contracted to work in the home and the establishment works closely with the local Primary Health Care Trust and the Community Assessment and Rehabilitation Team. Fee Range: - Full fee:- £431.00 per week, basic fee:- £89.45 per week, temporary fee-£94.45. See the following website for further guidance on fees and contracts. http:/www.csci.org.uk/about_csci/press_releases/better_advice_for_people_ choos.aspx DS0000032041.V328153.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit was unannounced and began at 10.30am on Tuesday 23 January 07. This was a ‘key inspection’ where the homes performance against the key National Minimum Standards was assessed alongside progress in meeting requirements and recommendations made at the previous inspection and the pharmacy inspection in September of last year. Duty Managers and the service manager assisted the inspector, as did other members of care staff. Methodology used included a tour of the premises, review of records and discussions with service users and staff. The inspector also reviewed the contact sheet for Broadwaters. Prior to the inspection comment cards were sent out by the home on behalf of the commission. Of those returned twenty were from current and previous residents, two from G.P’s, four from care managers, two from social care professionals and four from relatives and friends. Most comment cards returned were very positive about the staff and service provided at the home. “The staff at Broadwaters are always friendly and approachable kind and caring. Thank-you for helping my relative to regain her mobility and build her confidence”. “I have visited many times and have always found the staff most helpful” “I am impressed with the very pleasant and helpful staff my friend is very happy at Broadwaters and says how kind the staff are”. “The rehab programme attends to both the physical and psychological needs of the patients and are carried out by all staff”. “Broadwaters has always offered a good service from my perspective”. “High level of care provided dignity and respect shown to service users. Always get informed information when relevant. Some recording by care staff could be improved on by using more client centred terminology”. DS0000032041.V328153.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Broadwaters offers a very good short-term facility for service users who require a period of rehabilitation and the standard of care is high. This standard has been maintained through a period of transition, which has involved a number of staff changes. In contrast the ground floor at Broadwaters has generally offered accommodation for short periods of respite. Service users were traditionally returning to their own homes and dependency needs were not generally high. A change in emphasis and the introduction of assessment and emergency care beds has however in some cases led the need to provide high dependency care which has not always been matched by an increase in resources. In addition whilst pre-assessment documentation is in place for those receiving respite care the absence of a plan of care whilst at the home means that the home cannot be sure that needs are correctly identified or that they are being met. Risk assessments are in place but lack detail referring only to the condition not the nature of the risk or how it could best be managed. Both care plans and risk assessments need to be implemented and improved. DS0000032041.V328153.R01.S.doc Version 5.2 Page 7 To improve the quality of life for those receiving respite it is recommended that social care plans be formulated that identify following assessment, how personal and social care needs can be met during short stays at the home. Medication systems at the home have seen some improvements but audit trails were still incomplete. Greater care must be taken to ensure the requirements and recommendations from inspections are met. The registered person should offer service users the opportunity to have the key to their bedroom door to further safeguard privacy and dignity. The front door to the premises should also be properly secured. During the transition period a number of staff members have not updated their mandatory training. In order to safeguard the health, safety and welfare of the residents all must now undertake relevant training, which also includes fire prevention, evacuation and drills. In addition to ensure a proper response to any suspicion or allegation of abuse all staff would benefit from undertaking up-to-date adult protection training. The home must also be able to demonstrate that all health and safety measures are in place and that regular equipment checks are up-to-date. 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. DS0000032041.V328153.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 DS0000032041.V328153.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information provided about Broadwaters and the admissions procedure allows some prospective residents to make informed decisions about admission to the home and ensures that only those who would benefit from the service are offered places there. Those admitted solely for intermediate care (rehabilitation) are helped to maximise their independence before returning home. EVIDENCE: Broadwaters has a range of printed information about the services provided for intermediate (rehabilitation) care and short-term care (respite), which includes large print and audio versions. The home’s service user Guide (information pack) gives an indication of what a service user can expect from the home and is available in each room. Some areas of the pack however do now require updating. (See also standards 15,16.) DS0000032041.V328153.R01.S.doc Version 5.2 Page 10 Broadwaters has a written admissions policy and the home’s routines and facilities are explained to new residents on arrival. All residents are admitted to the home through local authority care management arrangements and all receive community care assessments. Two records examined evidenced that; prior to moving to the home care needs had been fully assessed by social services care managers. Accommodation on the first and second floors at Broadwaters is dedicated specifically to an intermediate care service, providing rehabilitation to help people live independently in their own homes. The unit is self-contained and includes rehabilitation kitchens where service users may relearn, adapt and or/ acquire skills needed for daily living. The kitchens are fitted with domestic appliances of the sort to be found in service users own homes. Service users are admitted for rehabilitation from hospital or the community and staff at Broadwaters are supported by members of the Community Assessment Rehabilitation Team (CART). This means that service users have access to physiotherapists and Occupational Therapists who are responsible for devising rehabilitation programmes. Access to medical advice is also available and a visiting G.P calls twice a week. Wherever possible, service users are encouraged to take responsibility for their own medication. Arrangements can be made for service users to visit their own homes with a care manager and occupational therapist prior to discharge to ensure that any equipment required is in place. The inspector spoke to six residents in the rehabilitation unit all expressed a high level of satisfaction with the care that they had received. Residents confirmed that the each had a plan of care that focussed on rehabilitation and a return to independence. One resident commented that the “care couldn’t be faulted”. The ground floor at Broadwaters provides approximately 9 short-term beds for a combination of respite, assessment and emergency care. One service user resides permanently at the home. Residents have a combination of low to high dependency needs and many are unable to return to live independently as a result of their increased dependency. The move towards assessment and emergency presents a change within the home for staff, as many service users now require greater levels of care than those who previously attended for respite. Where service users have been admitted on an emergency placement the written admissions procedure is explained and an information pack provided. DS0000032041.V328153.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. A care planning system is in place, which allows some staff to have the information they need to meet the needs of some service users. The health needs of residents are generally well met with evidence of support from a range of community health professionals. The home continues to make progress towards managing medication more effectively in order to promote and evidence the good health and well being of residents but shortfalls in practice have the potential to place residents at risk. Service users are generally treated with respect and their privacy and dignity are promoted. DS0000032041.V328153.R01.S.doc Version 5.2 Page 12 EVIDENCE: Broadwaters is in a unique position in that local authority care managers carry out the pre-admission assessments. In addition staff informed the inspector that for those who are admitted for rehabilitation the multi-disciplinary team in that unit carries out a further assessment and devises a detailed day and night care plan with the service user which is reviewed weekly. Twenty written survey forms from residents were received by the commission the majority of which were returned by those who had benefited from a period of rehabilitation at the home. The majority of those forms indicated that staff were always available and the standard of medical care was good. Additional comments included: “The staff at Broadwaters have been very kind and helpful. I consider myself very fortunate to have been here”. “The nursing staff is excellent” “Staff always respond in a kind way to my needs” Although one written survey stated that: “Two helpers are not nice” The duty manager confirmed that a chiropodist regularly visits the home and service users have access to a flying dentist and visiting optician service when necessary. Residents on respite are temporarily registered with a local G.P and when required district nurses attend from the local surgeries. One written survey card received from a local G.P commented: “An excellent establishment to work with – staff communication and organisation very well considered”. For those receiving respite care or who have been admitted to the home on an emergency basis senior staff draws up a brief synopsis based on the original assessment. A written admissions procedure is used to elicit additional information such as preferred times of rising and going to bed. A plan of care is not drawn up with the service user and there was no evidence of consultation with the individual on the two files examined. A daily log is kept and after two weeks formal reviews are planned. These may not take place if a resident is unwell; care managers are not always able to attend. The inspector was not able to identify where staff were establishing or updating plans to reflect the changing needs of residents the home had no clear objectives and was not able to demonstrate how they were helping to meet the needs of those in their DS0000032041.V328153.R01.S.doc Version 5.2 Page 13 care. It was uncertain how the home is contributing to the assessment process. This is in strong contrast to the rehabilitation unit. Risk assessments were in place but contained limited written information and hazards were identified by number. Neither the duty manager or inspector were able to confidently interpret the level of risk and in the current form it is not possible to see how this information could be used to properly safeguard residents. The inspector spent some time observing and spoke to a number of residents receiving respite throughout the morning. Staffing levels did not appear to match the needs of residents and the absence of care plans meant that the care delivered appeared to evolve not from the needs of residents but on what the home was able to provide on that day. One resident commented: “I don’t think they care for you very well” “Its alright if they like you but sometimes they don’t” The commission pharmacy inspector visited the home on 29th September 06 this was an announced inspection, which reviewed the requirements and recommendations made at the previous inspection. One requirement and recommendation were made at the review, which have almost been met. An audit trail of prescribed drugs however indicated that there were still some shortfalls particularly when recording quantities on MAR sheets. This means that not all medicines can confidently be accounted for. Some improvements have been implemented however the home still has some way to go. On the day of inspection staff was observed to be polite and caring and residents confirmed that those on duty were kind and supportive when meeting their needs. Visitors are welcome and are able to call at times that are suited to the resident. Exit questionnaires indicated that residents at Broadwaters are not generally offered keys to their rooms. It would be helpful to safeguard the privacy and dignity for those living at the home if this service was improved. DS0000032041.V328153.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The quality of daily life in the rehabilitation unit is good with residents assisted to maintain as much independence as possible. For those in respite however the home does not provide suitable or sufficient opportunities for stimulation through leisure and recreational activities. Residents are assisted to maintain as much independence as possible and are encouraged to maintain contact with friends and relatives. Residents are provided with a varied menu offering choices of meals that generally meet dietary needs. EVIDENCE: The majority of service users are only in the home for a short time and for those on respite limited information is recorded on how they would prefer to spend their day. For those in the rehabilitation unit games and exercises to music are arranged and some service users like to participate in quizzes all of which are open to all residents. Service users have access to televisions, music, a selection of books, board games, cards, dominoes, jigsaw puzzles etc. DS0000032041.V328153.R01.S.doc Version 5.2 Page 15 The hairdresser attends weekly and staff do arrange occasional beauty/nail sessions. On the day of the inspection activities had been identified for service users on the ground floor lack of staff time however meant that these did not take place, which members of care staff confirmed was often the case. At the current time the home does not employ specific staff for the organisation and provision of activities but relies upon heavily stretched care staff. One resident in the rehabilitation unit told the inspector that during the Christmas period residents had enjoyed a party and jazz night. Staff confirmed that this is often the case and occasions such as Easter, bonfire night and Halloween are marked with a party or celebration. Family and friends are always welcomed by staff and are free to visit at times which are flexible. The majority of residents at Broadwaters are independent and the rehabilitation process is designed to maximise service users capacity to exercise personal autonomy and choice. Residents spoken to confirmed that meals provided by the home are good and plentiful. The inspector observed home baking and a tour of the food area revealed fresh produce. Written responses from service users indicated that the food was good or excellent with a regular change of a well-balanced menu. One written response indicated that an increased range of fresh vegetables would enhance the menu further this view was also expressed by a resident at the home. DS0000032041.V328153.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. A system is in place to deal with any complaints that might be made about the home to ensure that concerns will be listened to and acted upon. There is a policy and procedure in place for the protection of vulnerable adults. Not all staff has received training in this area. EVIDENCE: The home has a comprehensive complaints procedure, which is contained in the service user guide however this needs to be updated to include details of the commission for social care who the complaint should be directed to and the timescale by which complaints will be dealt with. The home has up-to-date policies and procedures in place to protect residents from possible harm or abuse, however the home cannot demonstrate that staff has undertaken training in the Protection of Vulnerable Adults. This was a requirement from the previous inspection and still remains to be met. As a result enforcement action may now be taken. DS0000032041.V328153.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The premises are maintained in a safe and clean condition, providing a pleasant environment for service users. The home is clean, pleasant and hygienic promoting the comfort and wellbeing of service users. EVIDENCE: The service manager who was present at the home on the day of inspection confirmed to the inspector that council staff undertakes regular maintenance and it is hoped that there will be a programme of renewal within the coming year. Communal areas within the home are pleasant and well maintained although some re-decoration of bedrooms would be beneficial. The duty manager confirmed that the home had recently had a visit from the local fire DS0000032041.V328153.R01.S.doc Version 5.2 Page 18 service. The council also undertakes its own environmental health inspection of borough homes. On the day of inspection it was evident that the front door was not always secure. Care must be taken to ensure the safety and well being of residents is not compromised by this. Similarly hoists and other equipment, which is not in use, should not be stored in communal lounges. Residents spoken to at the home stated that the facilities were very good many enjoyed the excellent views to the river. Two written responses indicated that there had been a problem with uncomfortable mattresses however this had been brought to the attention of the Registered manager who quickly resolved this. A previous recommendation identified the need to provide a method to allow service users to control the level of heating in their bedrooms. The service manager explained that this had been explored but given the design of the current system this was not possible. The home was clean and hygienic throughout and there were no unpleasant odours. Laundry facilities are suitably sited and well maintained. DS0000032041.V328153.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of staff are sufficient to meet the needs of service users in the rehabilitation unit for those receiving respite care however staff were unable to demonstrate that they could meet the needs of residents. This resulted in the creation of an unnecessary risk factor. Over 50 of the current staff team are trained to NVQ level 2 and above. A robust recruitment procedure is operated by Bournemouth borough council to protect residents from the risk of unsuitable staff working at the home. Staff are equipped with some of the necessary training to meet the assessed needs of residents. EVIDENCE: A tour of the premises and discussion with those on duty evidenced that staff are employed both in sufficient numbers and with a range of skills to meet the assessed needs of residents within the rehabilitation unit. Residents spoken to confirm that staff was almost always available and health care needs were well met. DS0000032041.V328153.R01.S.doc Version 5.2 Page 20 On the ground floor staff on duty were not sufficient in numbers to provide care to service users and to carry out all necessary catering and domestic duties. The assessed needs of residents are constantly changing along with the service user group and on the day of inspection staff were stretched to capacity. When deciding the ratio of care staff to service users the home are reminded that this must be determined according to the assessed needs of residents. The duty manager confirmed that over 50 of the care staff are qualified at NVQ level 2 and above although the documentation was not examined on this occasion and will be reviewed at the next inspection. Staff recruitment files are held at the home although CRB and POVA first checks are carried out by the Borough Council and retained on the Human Resources file at head office. The inspector saw copies of CRB checks and the service manager confirmed that all POVA first checks and employment histories are sought before staff are able to take up their post. Copies of these documents do need to be available for inspection on the next occasion. All staff appointed within council care homes are required to undertake induction, which includes a range of health and safety topics as well as mandatory subjects such as moving and handling. On the day of the inspection the registered manager was not available so was not able to confirm that induction is in line with skills for care. This will be explored at the next inspection and the relevant information for all staff must be held on file at the home. For information on induction and skills for care staff are directed to the following website: www.skillsforcare.org.uk. Whilst there was nothing to indicate during the inspection that staff had not been appropriately trained to do their jobs, the duty manager confirmed that not all staff had received their mandatory updates. The staff training matrix indicated that the majority of staff where awaiting training in moving and handling and adult protection amongst others. DS0000032041.V328153.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The manager is currently absent on sick leave this standard therefore was not inspected on this occasion. The lack of a quality assurance system means that the home is not in a position to demonstrate that there is an on-going review of aims and outcomes for service users. Residents can have confidence in the manner in which their money is being handled at the home. Insufficient records were available to confirm the health and safety of all in the home. DS0000032041.V328153.R01.S.doc Version 5.2 Page 22 EVIDENCE: The home has experienced a number of changes during the last 12 months the registered manager retired during the early part of last year and was replaced by an interim manager until the appointment of the current manager who joined the team in August 2006. The transitional period has resulted in a number of changes and a range of tasks is delegated to the duty managers across the two units. The deputy manager is currently absent on a training course the registered manager is absent on sick leave. Managers from across the borough have provided temporary cover and the service manager is available at other times. The absence of sustained leadership coupled with a change in emphasis in the respite unit has undermined the home’s ability to meet the needs of all service users and to safeguard their welfare. Requirements identified at the previous inspection have yet to be met and the home is now facing possible enforcement action. The home is still some way off from developing a quality assurance system. Exit questionnaires are provided to service users, which are reviewed by the registered manager. These are not currently collated/aggregated however and the results are not made known. It is not clear how they influence quality of the care delivered or whether changes are made as a result. There was no evidence that staff, families, community professionals or other stakeholders are consulted during this process. The home holds a small amount of cash for residents who wish them to. The duty manager confirmed that balances are kept and transactions are recorded although the accounts were not seen on this occasion. On the day of the inspection fire training was found to be not up to date however a letter from the executive director of adult and community services confirmed to the inspector that fire training had been undertaken as was recorded in Regulation 26 reports. The duty manager stated that the water temperatures to reduce the risk of Legionella are regularly monitored and the inspector noted that there was safe storage for all hazardous substances with appropriate data information sheets. DS0000032041.V328153.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 3 X X X X X X 3 STAFFING Standard No Score 27 1 28 3 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 X X 1 DS0000032041.V328153.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Information gained at preadmission assessment must be used to formulate an effective plan of care and a care plan must be recorded for each resident. Service users must be consulted with regard to the decision-making processes of assessment and care planning. Risk assessments must identify specific risks and detail what action needs to be taken to minimise harm. The registered person must make arrangements for the recording, handling, safekeeping and safe administration of medicines including: Following up discrepancies found when monitoring MAR charts with the audit trails so that all medicines can be accounted for. The home must develop and implement an activities programme suitable for the individual needs of the DS0000032041.V328153.R01.S.doc Timescale for action 23/02/07 2. OP7 13 23/02/07 3. OP9 13(2) 23/02/07 4. OP12 16 23/03/07 Version 5.2 Page 25 accommodated service users and develop individual social care plans indicating how social and recreational needs can be met. 5. OP18 13 The registered person shall make 23/03/07 arrangements, by training staff or by other measures, to prevent residents being harmed or suffering abuse or being placed at risk of harm or abuse. Timescale for action was 01/04/06. Enforcement action may now be taken. 6. OP27 12 The registered provider must ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. The registered person must ensure that staff receive training appropriate to the work they are to perform, including structured induction training. This requirement is repeated. The initial timescale for action was 01/04/06. Enforcement action may now be taken. 8. OP38 13 The registered person must ensure that staff receives appropriate training in moving and handling, infection control and all mandatory health and safety practices. This is to ensure safe practice for service users. 23/02/07 23/02/07 7. OP30 18 (1) 23/03/07 DS0000032041.V328153.R01.S.doc Version 5.2 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations The home should follow guidance from the Royal Pharmaceutical society in The Administration of medicines in Care Homes and Children’s Services: When staff handwrite the details of prescribed medicines on to the medicine chart a second competent person should countersign to confirm that all the details are correct. The home should have a clear audit trail for medicines not in MDS blister packs e.g. by recording when a new container is started or entering a carry forward balance on the MAR chart. This recommendation has again been repeated, as improvement has been slow. All service users should be offered a key to their bedroom door unless risk assessment determines otherwise. In the event that a service user declines the key, a note to that effect should be made in the care record. The registered persons must ensure that access to the property is properly secured and the safety of the residents is prioritised. Policies and procedures should be updated / reviewed annually. Where needed, new policies / procedures should be developed. Not inspected on this occasion and carried forward. 2. OP10 3. OP19 4. OP30 DS0000032041.V328153.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000032041.V328153.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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!