Inspection on 23/04/07 for Casa Mia

This inspection was carried out on 23rd April 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

Casa Mia 23/02/09

Casa Mia 13/06/06

Casa Mia 29/03/06

Casa Mia 08/09/05

Casa Mia 23/03/05

Casa Mia 27/07/04

Casa Mia 03/03/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOMES FOR OLDER PEOPLE Casa Mia Cleobury Road Far Forest Near Kidderminster Worcestershire DY14 9EH Lead Inspector Nic Andrews Unannounced Inspection 23 and 25 April 2007 09:10 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 Casa Mia DS0000018499.V335081.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. Casa Mia DS0000018499.V335081.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Casa Mia Address Cleobury Road Far Forest Near Kidderminster Worcestershire DY14 9EH 01299 266317 01299 266406 martin@casa-mia.org.uk www.casa-mia.org.uk Mr Martin James Winfield Mrs Michelle Dawn Winfield Mr Martin James Winfield Care Home 15 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) Category(ies) of Old age, not falling within any other category registration, with number (15), Physical disability over 65 years of age of places (15) Casa Mia DS0000018499.V335081.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The home may also accommodate a maximum of 5 people over 55 with a mental disorder, subject to discussion and agreement with the Commission prior to each admission. The home may also accommodate a maximum of 3 people over 55 with a learning disability, subject to discussion and agreement with the Commission prior to each admission. The home may also accommodate a maximum of 3 people over 65 years of age with dementia illness. The home may also accommodate one named person under the age of 65 years, who has a physical disability. 13th June 2006 Date of last inspection Brief Description of the Service: Casa Mia is a detached building situated in a rural area of Far Forest. The home has been extended and adapted in order to provide accommodation for a maximum of 15 people who may also have a physical disability. The home may also accommodate up to five people over 55 with a mental disorder, three people over 55 with a learning disability, three people over 65 with a dementia illness and one named person under the age of 65 years with a physical disability. The home is set back from the road and provides car parking at the front of the premises and a patio and an attractive garden at the rear. Thirteen of the service users are accommodated on the ground floor and two service users are accommodated on the first floor. Two of the bedrooms on the ground floor are double rooms. A portable ramp provides access at the front entrance for people in wheelchairs and a ramp provides access to the rear garden. There is no mechanical means of access to the two bedrooms on the first floor. The fees ranged from £350.00 to £600.00 per week. Additional charges were made for hairdressing, holidays, transport, toiletries, newspapers, magazines, reflexology and massage. Casa Mia DS0000018499.V335081.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 that took place over the course of two days. The home was inspected against the key National Minimum Standards with the help of the registered manager (on the second day) and the lead senior care. The home’s response to the requirements and recommendations that were made as a result of previous inspections was also assessed. Various records and a number of different policies and procedures that the home is required to maintain were inspected. A tour of the premises was also carried out. Individual discussions were held with two service users and three members of staff. As part of the inspection Comment Cards were also issued to the relatives of the service users and to visiting professionals. Two Comment Cards were completed and returned, one from a visiting professional and one from a service user’s relative. The majority of the responses to the questions that were asked in the Comment cards were mainly positive. Any additional comments provided are reflected in this report. What the service does well: What has improved since the last inspection? The registered manager and lead senior care felt that improvements had been made regarding the care plans, service users’ guide, staff training and the procedures for the administration of medication. The home had embarked on the ‘Safer Food Better Business’ initiative. Casa Mia DS0000018499.V335081.R01.S.doc Version 5.2 Page 6 What they could do better: 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. Casa Mia DS0000018499.V335081.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 Casa Mia DS0000018499.V335081.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): 1, 2, 3 and 5. The quality outcome in this area was adequate. This judgement has been made using available evidence including a visit to this service. Prospective service users were provided with information to enable them to make a choice about the home. Their needs were assessed and they were given a contract that clearly told them about the service they would receive. However, some aspects of the information provided and assessment form needed to be written in more detail. EVIDENCE: A copy of the home’s statement of purpose was made available for inspection. The statement of purpose contained relevant information and included a reference to all of the issues required by Regulation 4 and Schedule 1. It was also pleasing to note the emphasis that had been placed on the service users’ rights. However, the statement of purpose needed to include, under the section headed ‘fire precautions’, details of the arrangements made for the care and accommodation of the service users in the event of a temporary closure of the home in the event of a fire (Schedule 1.11 ‘associated emergency procedures’). The statement of purpose also needed to set out in Casa Mia DS0000018499.V335081.R01.S.doc Version 5.2 Page 9 greater detail how the home intended to provide appropriate care for people with widely differing needs as specified in the categories of registration. A requirement was made as a result of the previous inspection that the service users’ guide must be amended and copies given to all current and any prospective service users. The lead senior care confirmed that the requirement had been implemented. The service users with whom discussions were held also confirmed that they had been given a copy of the service users’ guide. A copy of the service users’ guide was made available for inspection. It contained relevant information. However, it was noted that the details of the staffing needed to be updated and the address and telephone number of the local social services and healthcare authorities needed to be included. It was also noted that some information had been repeated and that the service users’ guide contained a number of grammatical and typographical errors. The service users’ guide needed to be amended accordingly. It was confirmed that all of the service users had been issued with a statement of their terms and conditions of residence (contract). Copies of the contracts were held on the service users’ files. The contracts in respect of three service users were inspected. The contents of the contracts were satisfactory and included a reference to a four-week trial period. All three contracts had been signed and dated. However, it was noted that one of the contracts did not specify the room to be occupied. Another contract did not include the service user’s name. It was confirmed that all of the service users had been assessed prior to admission. The registered manager and lead senior care carried out the assessments and visited the prospective service users at their homes or in hospital. It was pleasing to note that the assessment form covered all of the aspects of care referred to in Standard 3.3. However, the assessment in respect of one service user had not been fully completed. For example, no information had been recorded in regard to diet/allergies, personal safety and risk or weight. All sections of the assessment form must be completed in as much detail as possible in order to enable staff to prepare a full and accurate care plan. The lead senior care stated that all prospective service users were given the opportunity to visit the home prior to admission. During the pre-admission visits prospective service users were provided with a meal and would view the vacant room and meet the other service users and staff. Prospective service users were also informed about the range of activities provided by the home. Emergency admissions were not accepted. Casa Mia DS0000018499.V335081.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. The quality outcome in this area was adequate. This judgement has been made using available evidence including a visit to this service. The service users’ health and personal care was based on their individual needs and their right to privacy was maintained. However, more attention needed to be given to care planning and to aspects of care relating to the administration of medication. EVIDENCE: It was confirmed that all of the service users had a care plan. The care plans that were inspected had been reviewed monthly. The care plans included nutritional screening and a risk assessment on smoking. However, the care plans did not include details of all aspects of the service users’ care referred to in Standard 3.3. For example, one care plan did not include a reference to the service user’s diet/allergies, religious needs or personal safety and risk and there was no risk assessment on falls or, in one case, epileptic seizures. The daily record in respect of one service user included references to aggressive behaviour on 27 and 28 March 2007. However, there was no reference to this behaviour in the service user’s care plan and no instructions to the staff about the way in which they should respond when situations of this kind arose. The care plans of the more able service users included very little evidence to show Casa Mia DS0000018499.V335081.R01.S.doc Version 5.2 Page 11 that they were being enabled to retain or develop their independence and selfhelp skills. The files must also include a photograph of the service user. It was confirmed that all of the service users were registered with the GPs at the local Medical Centre. The GPs visited the home regularly every six weeks to monitor the medical care of the service users. The district nurse was visiting the home every week to attend to one service user. None of the service users had pressure sores. The lead senior care stated that the majority of the staff would recognise the signs of any pressure sores developing. The district nurse provided any pressure relieving equipment as required. One service user had a pro-pad cushion. The continence adviser visited the home annually to carry out assessments and would also visit when requested in response to any concerns. Two service users received visits from the community psychiatric nurse. The home also received visits from a person every month who encouraged the service users to participate in activities including ‘gentle exercises’. It was also stated that a professional masseur visited each month and provided reflexology and head and body massage. The service users received a chiropody service. Dental care was provided when necessary. Annual eyesight tests were carried out on all service users and more frequently if required. The optician had visited on 18 April 2007. The lead senior care confirmed that risk assessments had been carried out on all of the service users that smoked. A requirement was made as a result of the previous inspection that all of the service users must have a detailed pressure area assessment and nutritional assessment. It was confirmed that the requirement had been implemented. The Comment Card from one visiting professional stated, ‘Senior staff seem to cope with the patients (service users) very well and on the whole we have no problems with communication and advice, any problems we have encountered have been reflected back to staff’. The home used the Boots Monitored Dosage System (MDS) for the administration of medication. The medication was kept in a lockable drugs trolley that was secured to the wall when not in use. Access to the medication was restricted. The senior member of staff on duty was responsible for the key to the medication trolley. The home also had a controlled drugs cupboard and a controlled drugs register. The cupboard and the register were not being used as none of the current service users were in receipt of controlled drugs. Some medication stock was also being kept in the lead senior care’s office. A requirement was made as a result of the previous inspection. The requirement was that the general medication stock must not be stored in the controlled drugs cupboard and internal preparations should be stored separately from external preparations and, therefore, the amount of suitable storage space must be increased. The requirement had been implemented. The lead senior care was advised not to use the controlled drugs cupboard to store any other items. The date of opening of medication was recorded on the outside of the packet. A record of medication received and returned was being maintained. The prescriptions were being photocopied before they were sent to the pharmacist. The Medication Administration Record (MAR) charts were Casa Mia DS0000018499.V335081.R01.S.doc Version 5.2 Page 12 inspected. It was noted that a second member of staff had not witnessed the medication written on to the MAR charts by hand in respect of one service user. Anti-biotic medication and an insulin pen were being stored in a separate compartment in the fridge. Medication that requires cold storage must be kept in a dedicated fridge. A record of the fridge temperatures was being maintained. The list of ‘key abbreviations’ for the staff involved in the administration of medication needed to be updated. The staff had received training in the Boots MDS system but not accredited training in the administration of medication. The home’s policy and procedure on the administration of medication was not seen. The home had a homely remedies policy and a copy of ‘The Administration and Control of Medicines in Care Homes and Children’s Services’ produced by the Royal Pharmaceutical Society of Great Britain’ published in June 2003. The staff with whom discussions were held understood the importance of upholding the service users privacy. The service users with whom discussions were held also confirmed that they were treated with respect and that the staff respected their privacy. It was confirmed that the staff always knocked the door before entering the bedrooms and that medical examinations and other meetings of a confidential nature always took place in private. A mobile handset was provided to enable the service users to make and receive calls in private. The service users always wore their own clothes and these were appropriately labelled. The staff induction included instructions on how to treat service users with respect. Some of the service users preferred the staff to refer to them using shortened or abbreviated names. However, the use of a ‘pet’ name for one service user could not be justified in this way. Although no hurt or discourtesy was intended, the lead senior care accepted that it was not appropriate for the staff to use the term and it would be discontinued. Two of the bedrooms were double rooms and screening was provided. Casa Mia DS0000018499.V335081.R01.S.doc Version 5.2 Page 13 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. The quality outcome in this area was good. This judgement has been made using available evidence including a visit to this service. The home promoted the service users’ quality of life by offering choice, providing wholesome food, and by encouraging them to retain contact with their relatives and to take part in social activities. EVIDENCE: The home provided various leisure and social activities including television, Bingo, quizzes, cards, and needlework. A singer/guitarist and other entertainers, including a ‘Black Country’ singing group, visited the home throughout the year. Birthdays and special occasions were celebrated. A person visited the home every two weeks to hold a craft session. A mobile library service with large print books visited the home. Two service users attended a day centre two days per week. Outings were arranged to restaurants and to a local nursery and forestry centre. Several service users were taken to an Indian restaurant for an evening meal during the inspection. The service users with whom discussions were held said that they were able to get up and go to bed when they wished. They also confirmed that they could eat meals in their own rooms if the wished to do so. Members of the local Anglican Church visited once a month to hold a Communion service. Special ‘get together’ events were held usually twice a year to which the service users’ relatives were invited. It was proposed to purchase a seven-seat people Casa Mia DS0000018499.V335081.R01.S.doc Version 5.2 Page 14 carrier to enable the service users to be transported more easily and to enhance the level of excursions from the home. The relative of one service user stated in the Comment Card that the atmosphere within the home was ‘caring and lively’. There were no unreasonable restrictions in regard to the home’s visiting arrangements. The lead senior care stated that visitors were welcome at any time. The service users with whom discussions were held confirmed that their visitors were made welcome and were always offered a drink. They also confirmed that they were able to meet with their visitors in private. It was stated that all the service users were encouraged to handle their own finances where possible. However, in most cases, the service users’ relatives were involved and helped the service users with this aspect of their care. Arrangements were in hand for the relative of one service user to have Power of Attorney. Information about the local advocacy service was available in the home and details were placed in the service users’ files. There was evidence in the bedrooms to show that service users were entitled to bring personal possessions with them when they were admitted to the home. It was also confirmed that the service users had access to the records held about them by the home. The service users’ guide should include a statement that service users are entitled to bring personal possessions with them when they are admitted. The service users’ guide should also state that, under the Data Protection Act 1998, the service users have the right of access to the individual records held about them by the home and how this will be facilitated for them. The meals were served at appropriate times. Mid morning and mid-afternoon drinks were also served and drinks and snacks were available throughout the day. Supper was provided from 8.00 pm onwards. The service users were asked each day what they would like for their lunch and the teatime meals. There was always a choice of at least two main meals. One service user who was also a vegetarian required her food to be liquefied. The portions of food were not kept separate. The cook confirmed that this was the service user’s choice. The home catered for the dietary needs of two other service users who were diabetic. A record of the food provided was maintained. The food that was observed being served during the inspection was wholesome and nutritious. The teatime meal was often sandwiches with alternatives such as crumpets, toasted teacakes, pancakes etc being offered. The cook was advised to continue to offer a wide variety of teatime meals. The Environmental Health Officer had visited on 7 March 2007. A letter dated 8 March 2007 had been received by the home confirming that the Environmental Health Officer was satisfied with the standard of hygiene. The home had embarked on the Council’s ‘Safer Food-Better Business’ initiative. None of the service users required staff help with eating or needed to use special cutlery. A record of fridge and freezer temperatures was maintained. The kitchen had a cleaning schedule, a food probe and all of the necessary equipment. The dining area provided a congenial setting in which to eat although the amount Casa Mia DS0000018499.V335081.R01.S.doc Version 5.2 Page 15 of space was restricted because part of the room had been taken up as an office. Wherever possible, the meals should be presented in serving dishes in order to encourage the service users to retain their independence. The service users with whom discussions were held commented positively on the standard of food. One service user said, ‘The food is very good, it’s what I call home cooking’. The relative of another service user stated in the Comment Card that her relative had said that the food was ‘excellent’. Casa Mia DS0000018499.V335081.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 and 18. The quality outcome in this area was adequate. This judgement has been made using available evidence including a visit to this service. The home had policies and procedures in place to ensure that the service users were protected from abuse. The service users felt that any complaints would be taken seriously and responded to appropriately. However, attention needed to be given to some aspects of the policies and practice relating to this area. EVIDENCE: A requirement and recommendation were made in regard to Standard 16 as a result of the previous inspection. The requirement was that facilities must be available to enable a record to be maintained of all complaints that are received that includes details of the investigation and any action taken. The requirement had been implemented. The home had a ‘Record of Complaints Folder’ in which details of any complaints investigation could be recorded. However, no complaints had been recorded since the previous inspection. The recommendation was that when the service users’ guide has been updated and the service users have been supplied with new copies it is suggested that the service users and all principle relatives are informed and their notice drawn to the complaints procedure. The registered manager confirmed that the recommendation had been implemented. The home had a clear complaints procedure. However, the complaints procedure needed to be amended i.e. the telephone number of the CSCI was incorrect and the reference to the County Inspectorate was out of date and should be deleted and replaced with a reference to the registration authority. The complaints procedure also needed to be signed and dated by the registered manager. These amendments were made during the period of the inspection. The home also had a ‘Complaints Casa Mia DS0000018499.V335081.R01.S.doc Version 5.2 Page 17 Policy Statement’ that had been reviewed on 5 August 2006. The blank spaces in the policy statement needed to be completed appropriately and the policy signed and dated by the registered manager. The address of the Commission for Social Care Inspection in the home’s ‘letter of acknowledgment of a complaint’ was also incorrect and needed to be amended. The service users with whom discussions were held confirmed that they felt confident about making a complaint, if necessary. They also felt that any complaint made would be dealt with quickly and appropriately. However, the relative of one service user stated in the Comment Card that she did not know how to make a complaint if she needed to. The registered manager should ensure that the service users’ relatives are made more aware of the home’s complaints procedure. The home had a policy on the protection of vulnerable adults from abuse, a ‘whistle blowing’ policy and a policy on dealing with aggression towards staff. The home also had a copy of the Department of Health guidance ‘No Secrets’. The home’s policy and procedure on the protection of vulnerable adults from abuse must be amended as follows, • The reference to ‘patient’ should be deleted and replaced by the word ‘resident’ or ‘service user’. • The word ‘should’ in the sentence beginning ‘Where a member of staff is the alleged abuser they should be suspended…’ must be deleted and replaced with the word ‘must’. • The references to obtaining the service users’ consent and ‘absence of consent’ prior to reporting an alleged or suspected incident of abuse must be deleted. The policy and procedure must state clearly that all alleged or suspected incidents of abuse will be reported to the Adult Protection Coordinator and the CSCI and/or the Police immediately. • The policy and procedure must state clearly that all incidents of alleged or suspected abuse must be reported to the CSCI without delay in accordance with Regulation 37 and include the address and telephone number of the CSCI. The whistle blowing policy had not been reviewed since June 2003 and included an incorrect reference to the National Care Standards Commission. The home’s policy on aggression towards staff had not been reviewed since June 2003. It was confirmed that all the staff had undertaken formal training in the protection of vulnerable adults from abuse on 16 November 2006. It was confirmed that no incidents of alleged or suspected abuse had occurred within the home or had been reported since the previous inspection. It was also confirmed that there had been no reason to refer any member or former member of staff for consideration for inclusion on the POVA register. However, the registered manager should ensure that the lead senior care is fully aware of the action to be taken in the event of any allegations of abuse being made during his absence from the home. Casa Mia DS0000018499.V335081.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. The quality outcome in this area was poor. This judgement has been made using available evidence including a visit to this service. The home was clean comfortable and homely. However, various aspects of the environment were not well maintained and did not ensure the safety and wellbeing of the service users. EVIDENCE: The premises were clean, homely and comfortable. A portable ramp was available near the front entrance to enable access for people who used wheelchairs. The home had a designated smoking room for the service users that smoked. The majority of service users were accommodated on the ground floor. However, two service users were accommodated on the first floor. The home did not provide a passenger lift or a stair lift. A risk assessment must be carried out, recorded and kept under review in respect of the service users that are accommodated on the first floor regarding their ability to access their bedrooms safely using the stairs. The home had two double bedrooms. It was proposed to extend and convert one of the double bedrooms at the front of the premises into two single bedrooms with en suite Casa Mia DS0000018499.V335081.R01.S.doc Version 5.2 Page 19 facilities. This adaptation would enhance significantly the privacy and dignity of the two service users accommodated in this part of the home. In the meantime, the portable screening in the double bedroom should be removed and replaced with fixed curtain screening for the safety of the service users. The space in the dining room was restricted because part of the area was being used as an office. The registered manager said that he intended to provide an appropriate office facility in the future. The garden at the rear of the premises was attractive and accessible. However, there was dog excrement on the decking that formed the rear patio area and the surface of the decking posed a potential safety hazard when wet. The wet surface had already been the cause of an accident involving one member of staff who had fallen as a result. The registered manager was aware of the hazard and had placed appropriate notices warning the service users of the danger. The registered manager confirmed that work would be undertaken in the near future to cover the decking with a non-slip surface. This work was seen as a priority. It was noted that the kitchen became very warm and was without any form of ventilation. It was confirmed by the staff that the kitchen was a very uncomfortable environment in which to work. An appropriate mechanical means of ventilation must be installed in the kitchen for the comfort and safety of the staff. A requirement was made as a result of the previous inspection that the registered provider must ensure that all areas of the home, including bathrooms and toilets are well maintained and in good and sound order. The requirement had not been implemented and still stands. It was noted with concern that the work to refurbish the bathroom on the ground floor had not been completed. The registered manager stated that the work to refurbish the bathroom would be completed within two weeks. It was also noted that, • The toilet seat in the ground floor shower room was loose. • There were no paper towels and no liquid soap dispenser in the ground floor shower room. • A grab rail needed to be fitted near to the toilet in the ground floor shower room. • Several tiles on the steps leading to the front door and two of the slabs near to the front door were loose and presented a possible trip hazard. • The front door and surrounding woodwork needed to be painted. • The plastic unit housing the doorbell in the main corridor needed to be repaired/replaced. • The cupboards in the main corridor housing the central heating boiler and the surrounding area needed to be painted/redecorated. • The staff alarm call in bedroom 5 was not working and needed to be repaired and overhead lighting needed to be provided. • The wardrobes in bedrooms 3, 6, 9, 10 and 13 needed to be secured to the wall. • The packs of incontinence pads should be removed from the top of the wardrobe in bedroom 7 and stored in a more appropriate place. • A shade needed to be fitted to the lamp in bedroom 9. • A mechanical means of ventilation (extractor fan) needed to be installed in the room designated as a smoking room. Casa Mia DS0000018499.V335081.R01.S.doc Version 5.2 Page 20 • The extractor fan in the shower room needed to be repaired/replaced. All of the issues highlighted above must be addressed as part of the implementation of the above requirement for the safety, benefit and wellbeing of the service users. The lead senior care kept a written note of the items that required replacement or repair. However, the home did not have a clear, written programme of routine maintenance and renewal of the fabric and decoration of the premises. The home had a small laundry. The laundry contained two washing machines, one of which had a wash facility of 90 degrees. The home did not have a sluicing facility. Consideration should be given to the provision of a washing machine that has a sluicing facility. There was no wash hand basin in the laundry. The floor finishes were impermeable and the floor and walls were readily cleanable. The level of incontinence within the home was small. Similarly, the level of use of commodes was also small. Currently, the staff cleaned manually the commode pots that are used. The home did not have appropriate facilities to carry out this task and manual cleaning is not the recommended method of decontamination. Disposable commode pots should be used. The home had an infection control policy. However, there was no indication that the policy had been reviewed since January 2003. A requirement was made as a result of the previous inspection that the home must be well maintained. Specifically the laundry must be kept clean and tidy. Personal toiletries must not be left in a communal bathroom. A light shade must be hung in the bedroom identified. All bedroom and en suite locks must be repaired or replaced. The lead senior care stated that some of the specific aspects of the requirement, for example the repair or replacement of bedroom and en suite locks, had been implemented. It was also noted that the laundry was clean and tidy. Therefore, the requirement was regarded as having been implemented. However, it was also noted that other aspects regarding the maintenance of the environment needed attention. These are referred to in Standard 19 above and included in the requirements at the end of this report. The service users with whom discussions were held confirmed that they were satisfied with the standard of cleanliness within their bedrooms. They also expressed their satisfaction with the laundering of their clothes. Casa Mia DS0000018499.V335081.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 and 30. The quality outcome in this area was adequate. This judgement has been made using available evidence including a visit to this service. The staff received induction training and further training. However, the staff recruitment procedures needed to be adhered to more rigorously in order to fully protect the service users. EVIDENCE: The home had a four-week staff rota, a copy of which was made available for inspection. The staff rota needed to include the name of and the hours worked by the registered manager as well as the designated roles of all the staff. The staff rota showed that there were periods throughout the day when only two members of staff were on duty i.e. between 10.00 and 11.00 am, 2.00 and 4.00 pm and 4.00 and 6.00 pm. In addition to the registered manager, the home employed two full time senior care assistants and a further nine members of staff who were involved in the provision of personal care for a total of 222 hours per week (days). At night, one member of staff was on waking duty and another member of staff was on sleeping in duty and on call. One member of staff was employed to carry out cleaning duties for 18 hours per week. One of the senior care assistants deputised for the registered manager in his absence and took a lead role in managing the home. The service users’ guide referred to a ‘deputy manager’. However, a deputy manager had not been appointed. The relative of one service user stated in the Comment Card that, from observation, the staff were ‘competent and caring’. Casa Mia DS0000018499.V335081.R01.S.doc Version 5.2 Page 22 A total of eleven staff, excluding the registered manager, were employed to provide personal care. It was pleasing to note that six members of staff had achieved NVQ level 2 or equivalent. Therefore, the home had exceeded the target of 50 trained members of care staff set by the National Minimum Standards. The files of two members of staff were inspected. The files contained application forms. There was also evidence to show that POVAfirst and CRB checks had been carried out. The registered manager confirmed that all the staff had been issued with a contract and had undergone a CRB check. However, one file did not contain a photograph or proof of identity. The other file contained only one written reference and the application form was not signed or dated. The home had a medical questionnaire for prospective staff to complete. However, there was no evidence to show that it had been used as part of the staff recruitment procedure. It was stated that the two most recently appointed staff had not been issued with a copy of the code of conduct and practice set by the General Social Care Council. A member of staff confirmed that she had undergone a CRB check and that she had received a copy of a contract. The home had an appropriate induction programme that had recently been obtained from a training organisation. It was stated that the induction programme met Skills for Care standards and was used to help prepare new staff for NVQ level 2 training. The lead senior care said that successful completion of the induction programme would go towards meeting some of the NVQ units. The lead senior care stated that the induction programme would be used for all new staff even though they may already have relevant experience in order to enable them to adapt to the particular circumstances and procedures of the home. It was confirmed that all the staff received three paid days training per year and had individual training and development assessments and profiles. Therefore, the recommendation that was made as a result of the previous inspection that individual training profiles should be maintained for all the staff had been implemented. Casa Mia DS0000018499.V335081.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 and 38. The quality outcome in this area was adequate. This judgement has been made using available evidence including a visit to this service. The manager was appropriately qualified and experienced and an open management approach had been adopted. However, there was a need to develop systems and training that would monitor and maintain the quality of care and ensure that the safety and welfare of the service users and staff were promoted and protected. EVIDENCE: The registered manager had been in post since 1998. He had completed the NVQ level 4 training in June 2006 and hoped to complete the Registered Managers’ Award (RMA) training in June 2007. He had maintained his awareness of social care issues by attending various conferences. He had undertaken training in the protection of vulnerable adults from abuse in November 2006 and had updated his first aid training in February 2007. The lead senior care had completed the NVQ level 4 training and was also Casa Mia DS0000018499.V335081.R01.S.doc Version 5.2 Page 24 undertaking the RMA training. The second senior care had also undertaken NVQ level 3 training. The home had recently introduced a commercially produced quality assurance system. The system was not yet fully operational and needed to be developed in order to meet the requirements of Regulation 24 and Standard 33. It was confirmed that meetings with the service users were held usually held once a month and minutes of the meetings were maintained. Questionnaires had been issued to service users, their relatives and to stakeholders in March 2006. However, the results had not been analysed or published. The use of questionnaires should become a regular part of the home’s quality assurance system. The home should be able to demonstrate how feedback from the service users and the results of questionnaires are used to improve the quality of the service. The lead senior care acted as the agent in respect of one service user. She provided assistance with writing cheques and dealing with the service user’s pension. The registered manager also provided help to two service users in drawing money from their bank accounts. Wherever possible, this practice should cease and the responsibility for dealing with the service users money passed to a relative or a suitable representative who is unconnected with the running of the home. The home held money for safekeeping on behalf of three service users. The money was held separately and individual accounts were maintained. The money that was held for one service user was kept in a cash tin in an unlocked cabinet. All the money that is held in safekeeping on behalf of service users must be kept in a lockable storage. The money and accounts held for the same service user was checked. It was noted that the amount held on behalf of the service user was 95 pence less than the record in the accounts. Although this was only a small discrepancy such errors can be avoided by regular audits preferably by a person that is independent of the home. The home also held in safekeeping the bank accounts and building society books and cheque books for four service users. It was stated that no other valuables were kept. Standard 36 was not fully inspected on this occasion. However, it was noted that the registered manager and lead senior care had shared responsibility for staff supervision. It was stated that individual supervision meetings were being held with all the staff at the required frequency i.e. six times per year. This Standard will be assessed fully at the next planned inspection. Standard 37 was not fully inspected on this occasion. However, the home’s response to the requirement that was made in regard to Standard 37 as a result of the previous inspection was assessed. The requirement was that notifications must be made to the Commission for Social Care Inspection (CSCI) in accordance with the requirements of Regulation 37. The accident record was checked and it was noted that the CSCI had not been informed of potentially serious accidents that had occurred since the previous inspection. Casa Mia DS0000018499.V335081.R01.S.doc Version 5.2 Page 25 Therefore, the requirement had had not been fully implemented and still stands. It was pleasing to note that training in the protection of vulnerable adults from abuse had been carried out in November 2006. Different members of staff had also undertaken First Aid at Work training during December 2006 and February and April 2007. Eight members of staff now had the full first aid certificate and three members of staff were intending to complete the training in the near future. Food hygiene training had been undertaken in January 2007 and fire safety training had been undertaken in February 2007. Some training had been undertaken in the past but needed to be up dated for all the staff. For example, moving and handling training had not been undertaken since 2005. Other relevant training had not been undertaken by some or all of the staff, for example infection control, dementia care, person centred planning and working with people with learning disabilities (LDAF) and with mental health needs. The fire fighting equipment was serviced on 05/09/06. An annual check on the emergency lighting and fire alarm system was carried out on 03/01/07. There was a fire risk assessment dated 22/01/07. Apart from fire safety, risk assessments had not been carried out for all of the safe working practice topics covered in Standards 38.2 and 38.3. The gas boilers and central heating system was serviced on 16/01/07. The bath hoist was not in use because the refurbishment of the bathroom had not been completed. The home had a health and safety policy and a commercially produced ‘health and safety guidance system’. PAT testing had been carried out in May 2006 and was due to be repeated on 18/05/07. Two requirements were made in regard to Standard 38 as a result of the previous inspection. The first requirement was that the free standing radiator must be taken out of use until it is fitted with a cover and that chemicals must be stored securely. It was confirmed that the requirement had been implemented. The second requirement was that the upstairs windows must be fitted with restrictors and free standing wardrobes must be secured to the walls. It was confirmed that opening restrictors had been fitted to the windows on the first floor. However, the second part of the requirement regarding the security of the wardrobes had not been implemented and still stands. It was noted that the wardrobes in bedrooms 3, 6, 9, 10 and 13 had not been made secure. (See Standard 19 above). Casa Mia DS0000018499.V335081.R01.S.doc Version 5.2 Page 26 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 2 3 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 1 X X X X X X 2 STAFFING Standard No Score 27 2 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 X X 1 Casa Mia DS0000018499.V335081.R01.S.doc Version 5.2 Page 27 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 OP3 Regulation 14 Requirement All prospective service users must be fully assessed prior to admission to the home in accordance with the requirements of Regulation 14 and Standard 3.3. The service users’ care plans must cover all aspects of care as set out in Standards 7.2 and 3.3. The care plans must set out in detail the action which needs to be taken by the staff to ensure that all aspects of the service users’ needs, including aggressive behaviour, are met. The care plans of the more able service users must include details of the action to be taken to enable the service users to develop and maintain their social, personal and independent self-help skills. The records kept in the home must include a photograph of each service user to help ensure the correct identification, especially in the event of an emergency. A dedicated fridge must be DS0000018499.V335081.R01.S.doc Timescale for action 31/05/07 2 3 OP7 OP7 15 15 30/06/07 30/06/07 4 OP7 15 30/06/07 5 OP7 17 30/06/07 6 Casa Mia OP9 13 30/06/07 Page 28 Version 5.2 7 OP9 13 8 OP18 12,13 9 OP19 12 10 OP19 12,13 11 OP19 12,13 12 OP19 23 13 Casa Mia OP29 19 provided for medication that requires cold storage. All staff involved in the administration of medication must receive accredited training that includes basic knowledge of how medicines are used and how to recognise and deal with problems in use and the principles behind all aspects of the home’s policy on medicines handling and records. The home’s policy and procedure for the protection of vulnerable adults from abuse must be amended in accordance with the guidance given in this report. A risk assessment must be carried out, recorded and kept under review in respect of the service users who are accommodated on the first floor regarding their ability to access their bedrooms safely using the stairs. A risk assessment must be carried out and appropriate control measures put in place regarding the decking on the rear patio in order to ensure the safety of both the service users and staff. An appropriate mechanical means of ventilation must be installed in the kitchen for the comfort and safety of the staff. The registered provider must ensure that all areas of the home, including the bathrooms and toilets are well maintained and in good working. All of the issues referred to in Standard 19 above must also be addressed as a matter of urgency. (Previous timescales 31/08/05, 31/12/05 and 30/08/06 not met). Proof of the person’s identity including a recent photograph DS0000018499.V335081.R01.S.doc 30/06/07 31/05/07 30/06/07 31/05/07 30/06/07 31/05/07 31/05/07 Page 29 Version 5.2 14 OP29 19 15 OP29 18 16 OP33 24 17 OP35 16 18 OP37 17 19 OP38 12,18 20 OP38 12,18 21 OP38 13 22 OP38 12,13 must be obtained in respect of all staff employed at the home. Two written references and a medical questionnaire must be obtained before appointing any prospective member of staff. A copy of the code of conduct and practice set by the General Social Care Council must be issued to all members of staff as part of their employment at the home. The quality assurance system, including the use of questionnaires, must be developed in accordance with the requirements of Regulation 24 and Standard 33. The money and accounts that are held on behalf of the service users must be kept in a secure, lockable facility and accurately maintained at all times. Notifications must be made to the Commission for Social Care Inspection in accordance with the requirements of Regulation 37. (Previous timescale 13/06/06 not met). All members of staff must receive training in all of the core areas including moving and handling and infection control. All of the care staff must receive training in dementia care, person centred planning and in work with people with learning disabilities and mental health needs. Risk assessments must be carried out and recorded for all the safe working practice topics covered in Standards 38.2 and 38.3. The free standing wardrobes in all of the bedrooms must be secured to the walls. (Previous timescale 31/07/06 not met). DS0000018499.V335081.R01.S.doc 31/05/07 31/05/07 31/07/07 31/05/07 31/05/07 30/06/07 31/07/07 30/06/07 31/05/07 Casa Mia Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 Refer to Standard OP1 OP9 OP9 OP10 OP14 Good Practice Recommendations The statement of purpose and service users’ guide should be amended in accordance with the guidance given in this report. A second member of staff should check and sign that the medication is correct when medication is written on to the MAR charts by hand. The home’s list of ‘key abbreviations’ for the staff involved in the administration of medication should be updated. All the staff should use the term of address preferred by the service users. The service users’ guide should include a statement that service users are entitled to bring personal possessions with them when they are admitted and that they have the right of access to the records held about them by the home. Meals should be presented in serving dishes to encourage the service users to retain their independence. Action should be taken to ensure that the relatives of the service users are made more aware of the home’s complaints procedure. The home’s complaints policy statement and letter of acknowledgement of a complaint should be amended in accordance with the guidance given in this report. The home’s ‘whistle blowing’ policy and policy on dealing with aggression towards staff should be reviewed, amended where necessary, signed and dated. The registered manager should ensure that the lead senior care is fully aware of the action to be taken in the event of any allegations of abuse being made during his absence from the home. Any future development of the home should include the conversion of the double bedroom at the front of the premises into two single bedrooms and the provision of a suitable, separate office in order that the dining room can be used as a facility solely for the service users. The portable screening in the front double bedroom should DS0000018499.V335081.R01.S.doc Version 5.2 Page 31 6 7 8 9 10 OP15 OP16 OP16 OP18 OP18 11 OP19 12 Casa Mia OP19 13 14 15 16 17 18 19 20 21 22 23 OP19 OP26 OP26 OP26 OP26 OP27 OP27 OP27 OP29 OP35 OP35 be removed and replaced with fixed curtain screening. A programme of routine maintenance and renewal of the fabric and decoration of the premises should be produced and implemented. Consideration should be given to the provision of a washing machine that has a sluicing facility. Hand washing facilities should be prominently sited in the laundry and liquid soap and paper towel dispensers provided. Disposable commode pots should be used. The home’s infection control policy should be reviewed at least annually, dated and signed by the registered manager. The staff duty rota should be amended to include the names and designated positions of all the staff and the hours that they work during the day and night. Additional staff should be on duty at peak times of activity during the day. Consideration should be given to the formal appointment of a deputy manager. The registered manager should ensure that prospective staff always complete their job application forms in full. Wherever possible, no one connected with the running of the home should act as an agent on behalf of any of the service users. The money and accounts that are held on behalf of the service users should be independently audited at least every three months. Casa Mia DS0000018499.V335081.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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 Casa Mia DS0000018499.V335081.R01.S.doc Version 5.2 Page 33 - 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. 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