Inspection on 15/06/05 for Cecil Court

This inspection was carried out on 15th June 2005.

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

Cecil Court 23/05/07

Cecil Court 22/11/06

Cecil Court 07/06/06

Cecil Court 29/11/05

Cecil Court 16/12/04

Cecil Court 01/07/04

Cecil Court 19/02/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Cecil Court 2-4 Priory Road Kew Richmond Surrey TW9 3DG Lead Inspector Sandy Patrick Unnanounced 15 June 2005 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 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. Cecil Court v233338 g54-g04 s17354 cecil court v233338 150605 stage 411.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Cecil Court Address 2-4 Priory Road Kew Richmond Surrey TW9 3DG 020 8940 5242 020 8332 1044 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Central & Cecil Housing Trust Ms Rhona Bourke Care Home 45 Category(ies) of Old age (OP) registration, with number Physical disability over 65 yrs of age (PD(E)) of places Cecil Court v233338 g54-g04 s17354 cecil court v233338 150605 stage 411.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: none Date of last inspection 16th December 2005 Brief Description of the Service: Cecil Court is a residential care home providing accommodation and personal care for up to forty-five service users. The home is managed by Central & Cecil Housing Trust. The Trust is a non-profit making organisation providing accommodation and support to vulnerable adults throughout London and the Home Counties. The house is situated in pleasant grounds in Kew, close to local shops, public transport links and local facilities. The home is also close to Kew Gardens and the River Thames. Accommodation is provided on three floors, all accessed by a passenger lift. The home is divided into four units, accommodating between 6 – 19 people. Each unit is equipped with its own facilities and communal space. All bedrooms have en suite facilities. The Registered Persons have produced a Service User Guide, which includes information on the aims and objectives of the service. Cecil Court v233338 g54-g04 s17354 cecil court v233338 150605 stage 411.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on the 15th June 2005, and was unannounced. The Inspection Team included a Pharmacy Inspector. The report of his findings is detailed within Section 2 (Standard 9) of this report. The Inspection Team met with service users and staff on duty and were made welcome by all. The Lead Inspector joined one group of service users for their midday meal. This was a pleasant social occasion. The Inspection Team observed positive interactions throughout the day and service users pursuing a range of activities. The Lead Inspector was invited to join a group of service users for part of their afternoon activities. The Registered Manager was seconded to another home within the organisation in February 2005. She has since decided not to return to Cecil Court. The post of Manager has been advertised. The Deputy Manager has been managing the home since February and will continue to do so until the Manager’s post is recruited to. The Deputy Manager was not on duty at the time of the inspection, however the Inspectors met with all of the Team Leaders who are in charge of the day-to-day organisation and running of the home. These senior staff demonstrated a good knowledge of the home and the service users. Forty service users were living at the home at the time of the inspection. Service users and their representatives were invited to complete written comment cards on the service as part of the inspection process. Nine comment cards were completed, seven from service users and two from visitors to the home on the day of the inspection. Six of the service users who completed comment cards reported that they liked living at the home, that they were well cared for and they liked the food. One service user stated that they sometimes liked living at the home, were sometimes well cared for and sometimes liked the food. All seven service users reported that their privacy was respected, that the home provided suitable activities, that they felt safe at the home and that they knew who to speak with if they were unhappy about any aspect of their care. Both visitors reported that they were made welcome at the home, that they were able to meet service users in private and that they were well informed and appropriately consulted. One visitor wrote that vegetables served at mealtimes were often cold and that staff washing up during mealtimes was noisy. The other visitor wrote that their relative had lived at the home for many years and was very happy and received excellent care. Comments from service users and their visitors are reflected in the main body of the report. Cecil Court v233338 g54-g04 s17354 cecil court v233338 150605 stage 411.doc Version 1.30 Page 6 In general the comments received from service users who spoke with the Inspectors were positive. Specific staff were mentioned by name as particularly good, kind and caring. Service users spoke enthusiastically about activity provision at the home. Two service users spoke about the freedom they had to do things that they wanted. One service user reported that the house was always very clean and tidy. Comments about food were mixed. The majority of those who spoke with the Inspectors reported that they liked the food at the home, although others had some concerns about specific aspects of food or mealtimes. One service user spoke about the positive support they had received when moving to the home earlier in the year. One service user said, ‘we get everything we need here’. What the service does well: What has improved since the last inspection? New equipment for activities and to meet the social needs of service users have been purchased. The Manager has left since the last inspection and senior staff and the Deputy Manager have worked hard and consistently to ensure service users’ needs are met. Improvements to care planning have started and the home is starting to use a new computerised system. Activities continue to run well and service users commented positively about new activities, such as a movie club. New furniture has been purchased for one lounge and the garden. Cecil Court v233338 g54-g04 s17354 cecil court v233338 150605 stage 411.doc Version 1.30 Page 7 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. Cecil Court v233338 g54-g04 s17354 cecil court v233338 150605 stage 411.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Cecil Court v233338 g54-g04 s17354 cecil court v233338 150605 stage 411.doc Version 1.30 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2 & 5 There is a range of information for service users about the home. Copies of the Statement of Purpose and Service User Guide are issued to potential service users and copies are available at the home, allowing service users to make informed choices regarding admission to the home. Procedures allow for service users to visit the home prior to admission and there is a period of trial stay. This gives service users the opportunity to assess the quality, facilities and suitability of the home. Individual license agreements are issued to all service users, detailing the terms and conditions for residency. EVIDENCE: The Registered Person has produced a comprehensive Statement of Purpose and Service User Guide for the home. These cover the required areas, including information on admission criteria, the complaints procedure and review of service user plans. There have been no changes to these documents since the last inspection. These documents should be updated to reflect changes in staffing and management of the home. Individual licence agreements were seen to be in place in all service user files examined. These contained copies of the terms and conditions of residency and obligations of the provider. Licence agreements were signed by the Cecil Court v233338 g54-g04 s17354 cecil court v233338 150605 stage 411.doc Version 1.30 Page 10 service user or their representatives. Licence agreements stated the number of the room to be occupied and initial fees. Team Leaders reported that all service users had been given copies of the agreement. All potential service users are invited to spend a day at the home, sharing activities and meals with other service users. All service users are admitted on a six week trail stay. At the end of this period a review meeting is held, where the service user, their representatives, the placing authority and representatives of the home make a decision about whether the service can continue to meet that person’s needs. One service user spoke about the experiences when moving to the home. They said that they felt well informed and supported with the move and that they were able to make decisions about their care. The home does not provide intermediate care. Cecil Court v233338 g54-g04 s17354 cecil court v233338 150605 stage 411.doc Version 1.30 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 Individual service user plans are in place, although these need some improvements to ensure that records are accurate and include information on meeting a wide range of needs. There was limited evidence of consultation in some service user plans and therefore the agreement of the service user or their representative could not be assessed. Some service user plans and risk assessments had not been completed or there was no evidence of review. Some of the terminology within service users plans was inappropriate and the majority of daily notes gave inadequate information on whether needs had been met. Service users have access to a range of health care services. In some cases there was limited evidence of health care monitoring. The home has arrangements for the ordering, storage, administration, recording and auditing of medication and has access to a pharmacist for advice. Errors and omissions in recording and unsafe arrangements regarding storage of medication in service users’ rooms might put the health and welfare of service users at risk. Personal care needs are recorded and service users reported that these are met. Bathing records indicated that service users are not offered regular baths and that temperatures of the bath are lower than would normally be comfortable. Cecil Court v233338 g54-g04 s17354 cecil court v233338 150605 stage 411.doc Version 1.30 Page 12 EVIDENCE: Individual service user plans are in place for all service users. The Inspector examined six of these from three different units. Service user plans varied in quality. A new system of care planning has been introduced to provide consistency throughout the organisation. This has been implemented to some extent in Cecil Court. Some service user plans are on the new format. Team Leaders reported that all service user plans were due to be transferred to the new system. In some cases, information was only half complete and there was limited detail on some areas of need, such as social and emotional needs. Some service user plans required photographs. The Inspector was told that staff were in the process of taking photographs of all service users. The Team Leaders reported that they developed service user plans in conjunction with the service user and their representative. They said that they then discussed this with the keyworker. Not all service user plans had been signed by the service user or their representative. It is important that plans are signed as a record of the service users’ agreement and understanding. Daily care notes are made by staff. These were generally vague and the majority were single statements such as, ‘slept well’, ‘no problems’, ‘good day’, ‘bed changed’ and ‘same as usual’. These statements are insufficient and do not adequate reflect the events of the day for the service user. Some comments made limited sense and should be avoided, for example, ‘confused’ and ‘sitting in the lounge at the moment’. The Inspector saw one comment which stated that the service user was ‘very nasty this evening’. This kind of statement is unacceptable and actual behaviour should be described rather than staff making broad judgements and using negative terminology. The format for risk assessments includes space for the views of the service users and their representative. This had not been completed in a number of assessments and service users had not signed these assessments. In one case, the service user plan would indicate that the service user was able to make informed choices and had a good understanding of risk, however their opinion was not recorded within their assessments of risk. In some cases assessments of risk were incomplete. Some risk assessments had not been dated and there had been no recorded review. All information must be appropriately dated and these assessments must be subject to regular recorded review. Service users, their representatives and any relevant Cecil Court v233338 g54-g04 s17354 cecil court v233338 150605 stage 411.doc Version 1.30 Page 13 professionals must be consulted as part of the risk assessment process and this must be recorded. Two service users were known to have had serious falls shortly before the inspection. Both falls were recorded on incident reports and briefly within daily notes. However, there was no record to indicate that either the service user plan or the risk assessment had been reviewed. One service user plan recorded that a period of ill health was attributed to a urinary tract infection following medical consultation. However charts to monitor fluid intake during this period were incomplete. It is important that staff ensure that appropriate monitoring takes place in order to be able to assess and meet health care needs. All service users are registered with local GPs and staff reported that other health care professionals are consulted as required. One service user spoke about visits from the chiropodist, dentist and optician. All medications administered by staff along with the policies and procedures, records relating to receipt, storage, administration and disposal of medication were examined. The person in charge of each unit was interviewed, all medication not supplied in the monitored dosage system was counted and compared with the record of receipt and administration, four service users’ rooms were checked and the audit records for the previous month seen. From these observations and discussions external medication and denture cleaning material that could be harmful were found on the sink in the en suite bathrooms. No risk assessment had been done covering these arrangements. Two of the items in one room had expired. The receipt of medication supplied in the monitored dosage system had not been recorded fully for two service users. The allergy section on the medication records had not been completed for ten service users. The actual quantity of medication given had not been recorded for four service users prescribed medication with a variable dose. One service user had been recorded as receiving their medication when other records and medication remaining in the monitored dosage system indicated the person had been in hospital at the time. In one instance large amounts of medication had been returned. It was not clear from the records why such large amounts had been returned. Temazepam was not stored in the controlled drugs cupboard. All other records had been completed accurately and provided evidence that all medication had been administered correctly, service users are able to self-medicate after an assessment and all other medication was stored and administered safely. Only appropriately trained and designated staff administer medication Cecil Court v233338 g54-g04 s17354 cecil court v233338 150605 stage 411.doc Version 1.30 Page 14 Service users who spoke with the Inspector reported that they can rise, retire and eat at times of their choosing. Service users reported that they purchased their own toiletries or made arrangements for this. Personal care needs are recorded within individual service user plans. A record of baths and showers is held within each service user plan. In one case a service user had received no recorded bath for twenty-three days. There was two records of baths refused within this time. No other record indicated that baths had been offered. In another service user plan there had been two periods of ten days, one period of nineteen days and another of twenty-nine days between baths. There was no record of baths being offered and refused. Bathing temperatures are recorded. With the exception of one recorded bath at 36°C, all recorded bathing temperatures seen were 34°C. These temperatures are low and could be uncomfortable. The temperature of hot water delivery at the home should be limited to 43°C at outlets used by service users in order to reduce the risk of scalding, however these recorded temperatures are significantly lower than this. In general interactions observed at the home were positive and service users presented as happy and comfortable. The majority of staff demonstrated a positive rapport with service users. One service user mentioned a staff by name saying they ‘really liked’ her. Service users in one unit praised their unit manager and several other service users mentioned staff they liked by name. The Inspector observed one incident where a staff member entered a communal lounge where three service users were sitting. The staff member did not speak with or acknowledge service users, but sat with them reading a newspaper to themselves for a period of approximately twenty minutes. This behaviour is inappropriate and was discussed with the Managers on duty. One service user told the Inspector that the hairdresser visited weekly and that they were good and value for money. Another service user said that staff at the home helped them with nail care and that this support was appreciated. Cecil Court v233338 g54-g04 s17354 cecil court v233338 150605 stage 411.doc Version 1.30 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 & 15 There is a range of planned activities which service users are able to participate in. Service users reported that activities were generally well organised and fun. Service users are able to maintain independence both at the home and within the community according to wishes and risk assessment. There is a range of information on services available within the home, although some of this is out of date and is confusing. There is a varied menu offering choice. Service users have mixed feelings about food, but were generally positive. However there was a lack of information about menu choices in one unit and inaccurate information in another, making it difficult for service users to make informed choices. EVIDENCE: Cecil Court v233338 g54-g04 s17354 cecil court v233338 150605 stage 411.doc Version 1.30 Page 16 There is a planned programme of activities offering a wide range of craft, games and entertainment for small groups and individuals. There is an activities room on the ground floor, which is used for large group activities. Service users reported that they participated in small group and individual activities within the units. Since the last inspection, new equipment for activities has been purchased. Service users spoke enthusiastically about this. The service users and staff have all contributed to a ceramics project, which depicts the four seasons at Kew Gardens. The work is near to completion and is due to be displayed in the main entrance. One service user told the Inspector that themed celebrations had been organised within their unit, where service users celebrated different cultures and sampled different foods. Service users told the Inspector that the home sometimes had visiting entertainers, organised some trips to places of interest and had regular activities, such as bingo and film afternoons. One service user told the Inspector that they had enjoyed a barbeques party at the home. A group of service users meets every Wednesday to participate in shared art work, discussions, massage and exercise. This group is facilitated by a visiting Activities Coordinator. The Inspector was invited to join the group for a short period and service users demonstrated a range of activities they normally pursued. There was an excellent rapport and community spirit within the group. Service users reported they enjoyed the group and spoke fondly of the Activities Coordinator and each other. One service user said, ‘we are a very happy group’ and this was apparent. Other service users told the Inspector spoke positively about the support they received from individual staff to read newspapers, helping with knitting and just spending time chatting. A number of service users reported that they were well supported to pursue creative activities, such as art work, poster making, needle work and ceramics. The home has two pet cats and these were the topic of conversation with many service users and are clearly much loved additions to the home. Throughout the home, the Inspector met service users who were enjoying different activities. Service users in one unit were listening to a selection of CDs of their choice. One incident referred to in the last section of this report highlighted that a staff member spent time reading their own newspaper instead of speaking with service users in the same room. These service users were not pursuing any activities and spend some time dosing. In this instance the Inspector felt that the staff member should have been more proactive in offering support to service users to meet their social and emotional needs. Improvements to information in service user plans about individual social Cecil Court v233338 g54-g04 s17354 cecil court v233338 150605 stage 411.doc Version 1.30 Page 17 needs would help staff to have a better understanding of how to support service users. Service users are able to access the community according to risk assessment. Assessments of risk relating to this were seen within the service user plans examined. One service user reported that they felt free to go to local shops and the post office. They also reported that there was no pressure to use the visiting hairdresser and that they could use independent hairdressers, and arrange their own services as they wished. Staff on duty reported that the majority of service users had regular visitors. Service users who spoke with the Inspector confirmed that their visitors were made welcome and that they were able to meet them in private. The Team Leaders reported that relative and service user meetings were well attended. Visitors who completed questionnaires on the service reported that they were made welcome and were appropriately informed. Service users are able to bring personal belongings and furniture to decorate their own rooms. Service users reported that they are supported to maintain independence where they wish to, for example with personal care and keeping their own rooms clean and tidy. Service users are offered a key for their room. Notice boards around the home give information on menu choices, activities and key procedures. However the information on these was, in some cases, old and no longer relevant. The menu for the week ahead was only on display in one unit. The menu for the day was not on display within one unit. Information on activities on one notice board was several years out of date. The menu at the home offers a wide range of wholesome food, with a choice at each meal time. Food is prepared by a trained chef and transported to the units in heated trolleys. Service users opinions on food were mixed, both in their conversations with the Inspector and in a recent quality audit regarding food at the home. The organisation organised for all service users to be interviewed about the quality of food at the home and prepared a report on their findings. The Chef also attends service user meetings to gain feedback and ideas. The Inspector was invited to join the service users on one unit for their midday meal. This was well prepared and tasty. One service user who shared a meal with the Inspector commented that although roast potatoes were on the menu, mashed potatoes had been served. They then requested roast potatoes, a small amount of which had been brought to the unit, although these had not been offered by staff until this point. Service users also commented that vegetables were brought to the table in uncovered serving dishes for diners to Cecil Court v233338 g54-g04 s17354 cecil court v233338 150605 stage 411.doc Version 1.30 Page 18 help themselves. This practice allows service users to make choices, however, service users complained that by the time they ate their meals the vegetables were cold. Consideration should be given to how vegetables can be kept warm whilst still ensuring individual choice about the amount and variety of vegetables. The food served at lunch was nicely presented and staff offered choices about the main course, sauce and desserts to service users. One service user reported that staff washing up whilst they ate was noisy. Staff should not undertake unnecessary or noisy tasks that have a detrimental impact on service users and should give consideration to the service users overall enjoyment of the mealtime experience. Service users reported that cooked breakfasts were available and were made by trained staff. The Inspector observed a member of staff serving food using a spoon and their thumb. This is unacceptable and staff should not use their hands to serve food. Service users reported that they were able to eat in their rooms if they wished. Cecil Court v233338 g54-g04 s17354 cecil court v233338 150605 stage 411.doc Version 1.30 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 There is an appropriate complaints procedure which is available to service users. There are appropriate procedures designed to protect service users from harm and abuse. EVIDENCE: There is an appropriate complaints procedure, which includes timescales and reference to the Commission for Social Care Inspection. Senior staff reported that there had been no complaints since the last inspection. The home has adopted the London Borough of Richmond Protection of Vulnerable Adults Procedure and the organisation has their own procedures on abuse and whistle blowing. Cecil Court v233338 g54-g04 s17354 cecil court v233338 150605 stage 411.doc Version 1.30 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 25 & 26 The environment is generally safe, well maintained and comfortable. Service users have unrestricted access to communal areas and report that they are happy with the environment. There is insufficient seating in two, and insufficient space in one communal area and service users’ needs are not being met. EVIDENCE: The building is situated in pleasant and well-kept grounds, with level access areas and raised beds. The home is generally well decorated and maintained. Pictures, plants and ornaments were seen throughout communal areas. Since the last inspection some new furniture has been purchased to replace badly worn chairs in one unit. New garden furniture had also been purchased. Service users spoke positively about the environment and the home’s garden. One service user told the Inspector that they liked their room. All bedrooms have en suite facilities and have TV aerial points. Service users can organise Cecil Court v233338 g54-g04 s17354 cecil court v233338 150605 stage 411.doc Version 1.30 Page 21 for their own telephone line if they wish. service users within each unit. Trolley telephones are available for Each of the units at the home has a lounge and dining area. There is also a large activities room on the ground floor. The lounge area in the first floor unit provides limited space for service users. There are only five arm chairs for a unit accommodating eleven service users. There is limited room for equipment and the small floor area can be difficult for some service users to negotiate. Additional equipment such as electric fans in the summer occupy further space in this area. The staff on duty within this unit reported that a number of falls have resulted from the poor layout of this area. The room has potential for extension into an unused area of corridor. At previous inspections the Manager has reported that the organisation plan to undertake work to extend the area. However, no definite plans were in place at the time of this inspection and staff within the unit expressed frustration at this. The Inspector is concerned that service users may be put at risk because of the layout and lack of space. In addition there must be enough chairs to accommodate all service users within the unit to be able to sit within the lounge. In one unit, accommodating seventeen service users, there are only twelve dining chairs within the dining room. The remaining five service users dine in the unit’s lounge away from other service users. The staff on duty within this unit stated that this was not their choice. In addition staff reported that service users preferred dining chairs with arms because this allowed them to stand more easily. Some service users need this kind of chair. There are not enough of these chairs for all service users within this unit. The existing chairs and tables within this unit are old and some are worn and need replacement. Consideration must be given to replacing these chairs with the type preferred by service users. All service users should be offered the opportunity to eat in the dining room with fellow diners and consideration should be given to the arrangement of the dining area to allow for this. The premises are suitably equipped with adaptations and equipment throughout. A passenger lift accesses all floors accommodating service users. All rooms are equipped with call alarm systems. There is a programme of decoration and refurbishment and a number of rooms had been decorated since the last inspection. The carpet on the second floor is stained and consideration should be given to the replacement of this. The home was clean throughout and there are appropriate procedures for the laundering of clothes, Control of Substances Hazardous to Health, disposal of clinical waste and infection control. Cecil Court v233338 g54-g04 s17354 cecil court v233338 150605 stage 411.doc Version 1.30 Page 22 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 The home employs sufficient staff to meet the needs of service users. EVIDENCE: Staff, including senior staff, are allocated to each unit. Rotas indicate that sufficient staff are employed to meet the needs of service users in each unit. Senior staff demonstrated that the organised staffing on their units appropriately. Waking staff are employed at night. Volunteers offer additional support with certain activities, but do not support service users with personal care and must not do so. There is an extensive range of information for all staff on their roles and responsibilities. The senior staff on duty reported that there was only one care staff and the Manager’s position vacant. The Inspector spoke with a number of staff members with varying lengths of service and experience. Staff spoke fondly of service users and were knowledgeable about their role and the needs of the service users who they worked with. One staff member reported that training they attended was useful. There are regular staff and senior team meetings and a system of individual supervision. The Inspector did not examine training or recruitment records at this inspection visit and these will be examined at the next inspection. Cecil Court v233338 g54-g04 s17354 cecil court v233338 150605 stage 411.doc Version 1.30 Page 23 Cecil Court v233338 g54-g04 s17354 cecil court v233338 150605 stage 411.doc Version 1.30 Page 24 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 35, 37, 38 There is currently no registered Manager at the home. Staff on duty reported that the Deputy Manager is managing the home well and is supportive. There are systems for quality monitoring, however the reports of the monthly inspections of the home by the Registered Person are not being forwarded to the Commission for Social Care Inspection. There are appropriate procedures to safeguard service users’ money. Procedures to check health and safety and equipment are in place. Unrestricted windows could pose as a risk to service users. EVIDENCE: The Manager was seconded to another home earlier in the year. She has since left. The Deputy Manager is managing the home until the Manager’s post is recruited to. Once a permanent Manager is in post, this person must apply for registration with the Commission for Social Care Inspection. Cecil Court v233338 g54-g04 s17354 cecil court v233338 150605 stage 411.doc Version 1.30 Page 25 Staff at the home spoke positively about the Deputy Manager and the work she had undertaken whilst managing the home. Staff and service users at the home who spoke with the Inspector indicated that they are able to contribute their ideas and opinions and that they are listened to. The senior staff team appear to work together well and reported that the Deputy Manager was doing a good job. The organisation is required to organise for the home to have monthly unannounced visits by the Registered Person or their representative. Staff on duty reported that these did take place. However the reports from these visits must be sent to the Commission for Social Care Inspection. NO reports have been received since November 2004. A quality audit of different services is conducted on a quarterly basis. The most recent of these was regarding food at the home. The report indicated that all service users were asked about their experiences and enjoyment of food. A large number of fall, hospital admissions and deaths had not been reported to the Commission for Social Care Inspection in accordance with Regulation and should have been. In addition the Commission for Social Care Inspection was not notified of the resignation of the Registered Manager, and the Inspector was told by staff on duty on arrival at the home. Service user make private arrangements for the management of their finances. Small amounts of cash are held by the home so that service users can make small purchases and pay for additional services, such as hairdressing. The Inspector examined records relating to money held on behalf of three service users. There was a clear audit trail and balances were seen to be correct. Records required by Regulation were seen to be in place. The Inspector saw evidence of regular checks on fire equipment, water temperatures, food storage areas, electricity and gas safety and water temperatures. Not all windows had been equipped with restricting devices and must be. The Inspector saw a number of windows opened wide and left unattended by staff throughout the day of the inspection. The Inspector was told that one service user living at the home had a history of climbing out of windows. The requirement was made at the last two inspection and the Inspector is concerned that no action has been taken to minimise this serious risk to service users. Cecil Court v233338 g54-g04 s17354 cecil court v233338 150605 stage 411.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 x x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION 3 2 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 2 3 2 x 3 x 3 2 Cecil Court v233338 g54-g04 s17354 cecil court v233338 150605 stage 411.doc Version 1.30 Page 27 YES Are there any outstanding requirements from the last inspection? 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 7 Regulation 12(1-3) 13(4),15 Requirement The Registered Person must: 1. Ensure that service user plans are completed and included detailed information on social and emotional needs. 2. Daily care notes are sufficiently detailed and do not make negative judgements based on the opinions of staff. 3. Service users and their representatives are consulted and agree to service user plans and their agreement is evidenced. 4. All service user plans must include a photograph of service. 2. 7 12(1-3) 13(4),15 31/07/05 The Registered Person must ensure that risk assessments are dated, complete, are subject to regular review and consultation with the service user and other relevant parties is recorded. All risk assessments should be reassessed following a fall. The Registered Person must Timescale for action 30/09/05 3. 8 12(1) 31/07/05 Page 28 Cecil Court v233338 g54-g04 s17354 cecil court v233338 150605 stage 411.doc Version 1.30 ensure that health care needs are appropriately monitored. 4. 9 13(2) The Registered Person must: 1. Ensure that the receipt of all medication is recorded accurately. 2. Ensure that the administration and non-administration of all medication is recorded accurately. (Previous requirement made December 2004) 3. Ensure that the allergy section on the administration record is completed for all service users. 4. Ensure that all medication and denture cleaning material in service users’ rooms are stored appropriately in accordance with a risk assessment and checked regularly for expired items and items no longer needed. The Registered Person must: 1. Ensure that service users are offered regular baths or showers and that this is recorded. 2. Ensure that bath temperatures are not uncomfortbaly low. 6. 15 12,13(4& 6)16(2j) The Registered Person must ensure that: 1. Staff do not serve food with their hands. 2. The menus are on display so that service users are able to make informed choices. Cecil Court v233338 g54-g04 s17354 cecil court v233338 150605 stage 411.doc Version 1.30 Page 29 15/07/05 5. 10 12(1-3)& 4 31/07/05 31/07/05 3. Service users are offered the food choices detailed on the menu and are informed of any substitutions in advance. 7. 20 23(2e&g) The Registered Person must ensure that: 1. There is sufficient and suitable seating for all service users of the ground floor unit to eat in the dining room if they wish to. 2. There is sufficient space and seating for all service users of the unit to safely and comfortably use the lounge on the first floor. 8. 31 8, 9 The Registered Person must ensure that a Manager is recruited and that this person makes an application to be registered with the CSCI. The Registered Person must ensure that unanounced monthly inspections of the home take place and reports of these visits are forwarded to the CSCI. The Registered Person must notify the CSCI of any significant event in accordance with this Regulation. The Registered Person must ensure that all windows are equipped with restricting devices. Requirement made August and December 2004 31/08/05 31/12/05 9. 33 26 31/07/05 10. 31 37 31/07/05 11. 38 13(4&6) 31/08/05 Cecil Court v233338 g54-g04 s17354 cecil court v233338 150605 stage 411.doc Version 1.30 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. Refer to Standard 9 Good Practice Recommendations 1. It is recommended that the reason for disposal be recorded when large amounts of medication are returned. 2. It is recommended that Temazepam be stored in the controlled drug cupboard. 2. 14 The Registered Person should give consideration to updating infromation on service users notice boards around the home. Cecil Court v233338 g54-g04 s17354 cecil court v233338 150605 stage 411.doc Version 1.30 Page 31 Commission for Social Care Inspection Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cecil Court v233338 g54-g04 s17354 cecil court v233338 150605 stage 411.doc Version 1.30 Page 32 - 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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