CARE HOME ADULTS 18-65
Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA Cedar House 47 Smethurst Street Middleton Manchester M24 2BA Lead Inspector
Tracey Devine Unannounced Inspection 14th September 2005 11:15
Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V249829.R01.S.doc Version 5.0 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 Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V249829.R01.S.doc Version 5.0 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 Adults 18-65. 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. Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V249829.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA Cedar House 47 Smethurst Street Middleton Manchester M24 2BA 0161 6553553 Address 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) Mrs Ann Merabi Care Home 16 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (16), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (3) Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V249829.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is registered for a maximum number of 16 service users to include 16 service users in the category of MD (Mental disorder) and up to 3 service users in the category of MD(E) (Mental disorder excluding learning disability or dementia over 65 years of age) within the total number of 16. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 24th May 2005 2. Date of last inspection Brief Description of the Service: Cedar House is a care home providing personal care for 16 residents who have been diagnosed with a mental disorder. The home provides 16 single bedrooms, a lounge, conservatory, dining room and communal toileting and bathing facilities. Cedar House is located at the end of a residential street, approximately 2 miles from the town centre of Middleton. A number of small local shops, post office, and pubs are near by. The home has a car park for residents and visitors. Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V249829.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 14th September 2005 by 2 Inspectors. The inspection started at 11.15am and finished at 4.30pm – a period of 5.25 hours. Time was spent time talking with residents to see what they thought of the home. Time was also spent talking with the Manager and staff about the home and what they do for residents, and looking at how some records are kept. The particular areas looked at on this inspection were: how the medication is handled, residents monies, the environment, if sufficient staff are employed at the home, and what training they receive in order to do their job better. What the service does well: What has improved since the last inspection? What they could do better:
The home needs to do a lot of things better. When a resident develops needs which the staff and the manager are struggling to deal with, they must seek help from Social Services to discuss if the resident is best placed to stay at the home. Records of medicines given to residents were poor, they showed that some residents are not always given their medicines correctly; sometimes this was because the medicine had ‘run out’. This can make residents feel very poorly, and may cause their mental illness to become more pronounced. The provider must ensure that staff give out medications as detailed by the doctor, and
Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V249829.R01.S.doc Version 5.0 Page 6 better systems need to be in place to make sure that medicine does not run out. The bedrooms, toilets and bathrooms are dirty and need to be cleaned better and more often. Soap and towels must be provided to bathroom and toilet areas to ensure that residents can wash their hands after using the toilet and so maintain proper hygiene standards in the home. The provider must employ a domestic who can keep all parts of the home clean. The provider has not done what the Environmental Health officer has asked her to do, which means that parts of the kitchen are not hygienically maintained. The provider must do what the Environmental Health officer has asked her to do. In most cases, the bedrooms are poorly decorated, carpets are stained and need to be replaced, the furnishings have broken, duvets and pillows need to be replaced, and generally with the exception of a few, all the bedrooms provide poor accommodation. The provider must provide new furnishings, and provision of bedding etc which is of a good quality. A redecoration programme must be put into place for all bedrooms. The staff group is small and keeping staff has been difficult. Staff have had to work long hours to cover shifts, and the provider has had to employ agency staff to cover night shifts in particular. On some shifts there has not been enough staff to ensure that the residents receive the care they need. The provider must ensure that each shift is adequately staffed by staff who are experienced in caring for residents with mental health needs. Training must be provided to all staff in mental health awareness. The record keeping undertaken by the staff and manager is poor, misleading and in some instances has stopped. The rota was not accurate and showed staff to be working when in fact they were not working. The manager must ensure that the rota is an accurate record of who is working at the home and when. No up to date records on the monies held by the manager for the residents was in place, and those looked at were incomplete and showed gaps relating to weeks when money was not given as it should have been. The manager had no reason for this, and it is not possible to determine if residents have had their money appropriately. A full audit of residents’ monies must be undertaken, by a professionally qualified person and the findings must be related to the Commission For Social Care Inspection, residents and care managers. The manager of the home is not suitably qualified or experienced to run this home and the shortfalls identified during this inspection demonstrate her lack of management of the home. The Provider must recruit to this position someone who has experience of managing a mental health home and can demonstrate their management abilities.
Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V249829.R01.S.doc Version 5.0 Page 7 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. Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V249829.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V249829.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): An assessment of need is made before the resident moves into the home to ensure that the home can provide the care needed by the individual. The home lacks a formal system for ensuring that all information is shared with staff resulting in some residents needs remaining unknown and therefore unmet. EVIDENCE: Standard 2 and standard 4 were assessed on the last inspection. For full comments please refer to the inspection report of 24th May 2005. The requirement relating to the manager improving the systems within the home for sharing information with all staff has not been implemented. The judgment made by the inspector at the last inspection remains and is made again above, and the registered person is required to comply with this requirement. Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V249829.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 10 Care plans have improved in their format which makes it easier for staff to reference and follow in knowing the needs of residents. However, the changing needs of residents are not always documented nor is action to be taken made known to all staff thereby leaving some residents with complex needs not met. Residents have confidence in staff that information known to them is respected and treated in confidence. EVIDENCE: Care plans have improved in their layout since the last inspection and they are now easier to read and information can be found more quickly owing to dividers being in use. However, of several care plans looked at, one care plan selected did not demonstrate that the complex changing needs of the person had been addressed fully. The action to be taken by staff to ensure that this person’s
Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V249829.R01.S.doc Version 5.0 Page 11 needs were being met was not consistently being followed by all staff. For instance, concerns about this resident’s weight had started to be monitored through the use of a fluid and food intake chart. However, not all staff knew about this chart and on looking at the chart the intake was not consistently monitored. The chart had not been completed for some weeks (although the concerns remained as prevalent) and it would seem that the food intake is no longer being monitored by staff. The “acting” manager was unaware that staff had ceased monitoring. Further action by the manager to ensure that this resident’s health and personal care (bathing and general hygiene) needs were being met was limited, and neither inspector felt the action taken was sufficient to ensure this resident’s well being was being maintained. Several residents were spoken to and all felt the staff treated them well, and respected information held in the office. All said that staff spoke to social workers and one resident said he had given staff “permission to open my post, because I might read something upsetting”. Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V249829.R01.S.doc Version 5.0 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: All the above standards were assessed at the last inspection. Please refer to the report of 24th May 2005 for full comments. The requirement made at the last inspection relating to the menu needing to be more varied has been implemented, and residents spoken too said they enjoyed the food more, and that the variety had increased. Comments such as “we have lovely meals” and “I can have whatever I like” were made to the inspector. Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V249829.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 The more complex physical and mental health needs of residents are not being met leaving them vulnerable in terms of physical and mental health. Changes to resident’s medication are poorly managed putting residents at risk of not receiving their medicines correctly. EVIDENCE: The basic physical and emotional health needs of residents are in the main met. However, the more complex needs presented by at least 1 resident were not being met. It was evident through talking with staff that this person has increased physical and mental health needs which have changed significantly and his needs are now beyond the experience of the staff group. However, whilst well intentioned, their actions to care for this person were insufficient leaving this resident in a very vulnerable position health wise. The manager had not sought additional help in the form of contact with the Social Services Department. References to GP visits and their outcome were not detailed on the resident’s file. Part of the inspection focused on concerns raised by a professional visitor to the home about staff not supporting and accompanying a resident to an appointment (with his consultant) resulting in him not attending. On looking
Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V249829.R01.S.doc Version 5.0 Page 14 through the diary, it was identified that an appointment was detailed in the diary for this particular resident to attend a review with his consultant. No reference to this appointment having been attended could be found on the resident’s file, nor could the manager confirm that the resident had attended. The manager said that the home has suffered from being short staffed in recent months, and it is possible that this resident did not attend for this appointment. The manager could not confirm that this situation would not reoccur, as she felt that the low staffing of the home at times did not allow her sufficient capacity to send a support worker with a resident. The purpose of the medication inspection was to follow-up on action taken to address concerns previously raised (7th September 2005). One of the medication records examined revealed that medication was still not being given as prescribed following a hospital review on 11th August 2005. Four of the reviewed medicines and one regular medicine had ‘run out’. Another medicine appeared to be given other than in accordance with the prescriber’s instructions. Previous advice was repeated, and the manager was again requested to contact the surgery to confirm current medication and obtain further supplies. Confirmation of contact with the surgery was only received following a ‘phone call made directly to the provider on Friday 15th September. Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V249829.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 The system in place for accounting for the safe keeping of residents monies has ceased to be operated, leaving residents in a wholly unacceptable position, and placing them at risk of financial abuse. EVIDENCE: In response to concerns raised by a CPN prior to this inspection, the inspector focused on the transactions undertaken by staff in ensuring that residents monies are held safely and clearly accounted for. The system of accounting monies for 5 residents were looked at. Of these, the incomings and outgoings were not consistently completed, the balance was not always entered (in some cases for weeks), the sheets used did not always run concurrently in date order, monies for 1 resident had been stopped then recommenced but there was no written evidence they had been recommenced. In essence, residents money could not be accounted for. The manager had no explanation for these accounts not being accountable or up to date. The inspector had also been made aware that on occasion residents did not have access to their monies as none of the staff on duty had a key to the safe. The manager confirmed that this did happen, and indeed on the day of this inspection, the manager had not brought her safe key to the home. Therefore there was no ready access to the safe during this inspection for the inspector nor to residents should they have wanted some money. Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V249829.R01.S.doc Version 5.0 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29, 30 With the exception of the lounge and the conservatory, all other parts of the home are not well maintained, not reasonably decorated, not clean, and do not provide residents with an acceptable environment in which to live. EVIDENCE: The communal areas, bedrooms, and toilets and bathrooms were inspected. The lounge is reasonably decorated and furnished although a number of the light bulbs in the ceiling lights were once again not working and had not been replaced. This has been continually raised during a previous inspection and monitoring visits. The conservatory is bright and provides a quiet area for residents to sit in. The conservatory would present better if the freezer was removed or if it was better disguised by a cloth which fully covered it. The dining area is looking shabby with a worn and stained carpet on the floor. The tables and chairs whilst adequate are not made to look attractive in any way. The bin (for use by residents when making a drink) is heavily stained with tea/coffee.
Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V249829.R01.S.doc Version 5.0 Page 17 All toilets, bathrooms and shower rooms were inspected. The bathroom on the 1st floor is shabby with peeling paint around the toilet, the area around the toilet pedestal is badly marked and needs sealing, and the bath panel is in a poor condition. The towel provided was shabby, dirty, there was no soap for hand washing purposes, and there was no plug for the sink. Throughout the home this type of poor condition was replicated in the bathrooms, shower rooms and toilets – no soap dispensers, tatty towels, no toilet roll holders, and the mechanical ventilation not working in some toilets/shower rooms. Bedrooms were also poorly maintained. The majority of bedrooms were gloomy, the walls are scuffed and dirty, in two bedrooms the ceiling lights did not work, plastering around a door (which had been done some 12 months ago) had not been painted over, carpets were badly stained and dirty, pillows were worn and lacked filling, duvets were thin and lacked filling, doors were missing off some vanity units, and the lock to the bedroom door for 13 could be deadlocked which presents staff with a room they could not access quickly in the event of an emergency. The bedrooms were in most cases dirty, with walls, skirting boards and in particular areas around the sinks needing a thorough clean. Some bedrooms looked bare and institutional whilst other bedrooms had been well personalised. A number of residents have acquired a lot of possessions, which usually do not present any problem. However, one resident with many possessions would benefit from additional storage space and staff assistance in determining the best use of such storage. The recent inspection undertaken by the Environmental Health Officer on 6th July 2005, has not been fully complied with. Matters not addressed by the include drawer fronts being replaced in the kitchen, the kitchen work surface has not been replaced, the hot water tap in the kitchen remains defective, temperature recordings of food are still not being done, food cooked in the microwave was to probed – however the microwave is broke and has not been replaced, and generally the Environmental Health Officer commented on the poor state of repairs in the kitchen, and recommended that the kitchen be refurbished to a commercial standard. Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V249829.R01.S.doc Version 5.0 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 36 The home has experienced severe staffing shortages which has impacted on the efficient running of the home and the delivery of care which has left residents in vulnerable situations with either insufficient staff on duty or staff they do not know. Staff have not received any formal training in mental health, and as such are limited in their delivery of caring for residents with a mental health problem. EVIDENCE: As commented upon in the report of the 24th May 2005, the home has experienced staffing difficulties in terms of recruitment and retention. These difficulties have continued, and the manager has had to make considerable use of agency staff to cover shifts within the home. The core staff who remain at the home provide residents with a stable staff group. Relations between staff and residents are very good, with genuine affection between staff and residents. The rota looked on during this inspection was not accurate in that the manager had been “off sick” and this had not been identified on the rota, so in essence it looked like the home was sufficiently staffed when in fact it was not. The shifts for some of the nights were not detailed on the rota, so if taken at face
Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V249829.R01.S.doc Version 5.0 Page 19 value, those shifts looked not to be covered. The manager said they were covered by agency staff, but this information was not on the rota. No domestic was employed, the previous one having retired and no replacement recruited. The impact of this position being left vacant, is that the standards of cleanliness in the home have deteriorated. At the time of this inspection (prior to the manager arriving at 11.30am when she was due on at 8.00am), there were just two staff on duty. These two staff were undertaking all duties – giving out medication, cooking, some cleaning, attending to residents needs, answering the phone, etc. Staff said it was not uncommon for them to have just two staff on duty during the day and they recognised all the areas they needed to improve upon, but felt unable to do so owing to being insufficiently staffed, or having to work long hours resulting in them being very tired. The impact of the long hours staff were expected to work was addressed at the last inspection, and whilst this has been addressed in part by the use of agency staff, the more experienced members of staff feel they are still expected to work for long periods within the home. Staff receive training in fire drills, and medication. The manager said no other training was generally provided, and this was evidenced through looking through personnel files. The manager does not have a training budget, nor is there a training programme in place. A training needs analysis is not in place for any of the staff group. None of the staff have received any training in mental health. There are no formal systems in place for the monitoring and supervision and development of staff. Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V249829.R01.S.doc Version 5.0 Page 20 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 42, 43 EVIDENCE: The home has been without a registered manager since March 2005 when the Registered Manager resigned her position with immediate effect. An “acting” manager has been managing the home since that time. Following the inspection of Cedar House in May 2005, as a result of concerns the Commission For Social Care Inspection (CSCI) had in respect of the home, the home has been subject to 4 additional monitoring visits. The monitoring visits made and the results of this inspection, have demonstrated to the CSCI that the manager does not have the skills or experience to manage the home effectively in a way which meets residents needs, and in keeping with the Care Homes Regulations 2001. Record keeping in all aspects is poor with many records not maintained, staff receive no formal supervision and training is very limited, staff shortages continue, the welfare of the residents is satisfactory unless more complex needs develop,
Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V249829.R01.S.doc Version 5.0 Page 21 monies of residents are not handled in any way which is adequate, infection control systems within the home are poor, the medication system is poorly managed and general running repairs and maintenance of the home and its furnishings is poor. Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V249829.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 1 x x x Standard No 22 23 Score x 1 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 1 x x x 3 Standard No 24 25 26 27 28 29 30
STAFFING Score 1 1 3 3 3 3 1 LIFESTYLES Standard No Score 11 x 12 x 13 x 14 x 15 x 16 x 17 Standard No 31 32 33 34 35 36 Score x 1 1 x x 1 CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 1 1 x Standard No 37 38 39 40 41 42 43 Score 1 1 3 1 1 1 1 Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V249829.R01.S.doc Version 5.0 Page 23 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 YA2 Regulation 14(1) Requirement Specific action on assessed needs as identified by the care plan must be put into place and maintained. (Previous timescale of 24th May 2005 not met) Resident’s who develop needs outside of the scope of the staff at the home must be referred to their care manager for a review of the placement. Residents are supported in attending appointments as agreed through the Service Delivery Agreement with funding local authorities. The accounting of monies held on behalf of residents must be fully audited for the last 12 months and maintained on a weekly basis, or when ever there is a transaction. The broken bulbs in the ceiling lights in the lounge must be replaced. Suitable towels and soap is provided to each toilet and bathroom and this provision maintained. All parts of the home including the bedrooms, and the
DS0000041209.V249829.R01.S.doc Timescale for action 14/10/05 2 YA6 14(1) 14/10/05 3 YA18 13 14/10/05 4 YA23 17 14/10/05 5 6 YA24 YA30 23 13 14/10/05 14/10/05 7 YA30 13 14/10/05
Page 24 Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA Version 5.0 8 YA24 23 9 10 11 YA24 YA24 YA24 23 23 23 12 YA25 16 13 14 15 YA24 YA24 YA25 16 23 12 16 17 18 19 20 21 YA33 YA33 YA41 YA35 YA37 YA20 18 18 17 18 8(1) 18(c)(i) 13(2) bathrooms and toilets are cleaned to an acceptable standard, and this is maintained. The bath panel, the crack in the wall, and the area around the toilet in the bathroom on the 1st floor are made good, and this room kept presentable. The carpets in bedrooms 8, 11, 13, 14, 15 are cleaned to an acceptable standard or replaced. Bedrooms 6, 11, 15, 16, 14, need redecorating. The minor repair work to cupboard doors, wardrobe doors in bedrooms is undertaken, or replacement furniture provided. New pillows and duvets covers must be purchased and provided to residents in bedrooms 8, 13, and 15. The dining room carpet must be replaced. The mechanical ventilation in the toilets and shower rooms must be in working order. The lock fitted to the door of bedroom 13 must be adapted to ensure that staff can enter in the event of an emergency. Sufficient care staff are employed at all times within the home. A domestic is employed. The rota is accurate at all times. A training programme is provided which identifies training in mental health for all staff. A manager who is suitably qualified and experienced must be recruited. The provider must ensure that medication is handled according to policies and procedures describing safe medication handling (not met from previous inspections)
DS0000041209.V249829.R01.S.doc 14/10/05 28/10/05 28/10/05 28/10/05 14/10/05 28/10/05 28/10/05 14/10/05 14/10/05 28/10/05 14/10/05 28/10/05 30/11/05 10/10/05 Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA Version 5.0 Page 25 22 YA20 23 YA20 17(1)(a)(i) The provider must ensure that all medication records are clear, 13(2) complete, accurate and up-todate (not met from previous inspections. 13(2) The provider must ensure that ordering and stock control is such that medication is normally available for administration. Prompt action must be taken should medication ‘run out’ 14/09/05 14/09/05 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 6 7 8 9 Refer to Standard YA23 YA24 YA24 YA36 YA24 YA20 YA20 YA20 YA20 Good Practice Recommendations Arrangements must be put into place for residents monies to be available and accessible at all times. The dining room should be made to look more attractive. The microwave should be replaced/repaired. Staff receive formal supervision, which is planned, and recorded. Additional storage, and assistance with such storage should be provided to residents. The assessment of safe self-administration should be expanded and reviewed in accordance with written policies. Handwritten MAR entries should be signed, independently checked and countersigned. Verbal changes should always be clearly referenced to the prescriber making the change. A list of carers authorised to administer medication should be maintained including their usual initials and training date. The provider should discuss the potential for advisory visits with the supplying pharmacist. Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V249829.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG 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 Cedar House, 47 Smethurst Street, Middleton, M/cr M24 2BA DS0000041209.V249829.R01.S.doc Version 5.0 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
