Inspection on 03/10/07 for Cheneys

This inspection was carried out on 3rd October 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

Cheneys 19/08/08

Cheneys 26/10/06

Cheneys 19/12/05

Cheneys 24/05/05

Cheneys 26/10/04

Cheneys 24/05/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Cheneys Links Road Seaford East Sussex BN25 4HY Lead Inspector Melanie Freeman Key Unannounced Inspection 3rd October 2007 09:40 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 Cheneys DS0000028541.V346952.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. Cheneys DS0000028541.V346952.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cheneys Address Links Road Seaford East Sussex BN25 4HY 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) 01323 893373 01323 491480 cheneys@btconnect.com www.sxhousing.org.uk Sussex Housing and Care Mrs Angela Ruth Preston Care Home 51 Category(ies) of Old age, not falling within any other category registration, with number (51) of places Cheneys DS0000028541.V346952.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users to be accommodated is fiftyone (51). Service users must be older people aged sixty-five (65) years or over on admission. Up to a maximum of thirty-three (33) service users may be in receipt of nursing care. 26th October 2006 Date of last inspection Brief Description of the Service: Cheneys is situated in a quiet residential area of Seaford a short walk from the seafront and approximately half a mile from the town centre with its access to bus and rail routes. The home is registered to accommodate up to 54 older people, 33 of whom may be in receipt of nursing care. The registered owners are Sussex Housing and Care. The home is part purpose built and part converted with accommodation over two floors. The home comprises of 48 single bedrooms (26 of which have ensuite facilities) and 3 double bedrooms (all 3 of which have en-suite facilities). There are additional toilet and bathroom facilities throughout the home. Rooms are located over two floors, accessible by two passenger shaft lifts. The home has a number of specialist equipment in use such as mobility aids, specialist nursing beds and bath and moving/handling hoists. There are extensive attractive gardens to the rear of the property that are accessible to residents. There are car-parking facilities to the front of the premises. Potential new service users can obtain information relating to the home via the internet, CSCI Inspection Reports, Care Managers, Placing Authorities, by word of mouth and by contacting the home direct. The range of fees charged (at the time of this report) are £345 - £660 per week, with additional charges made for newspapers, hairdressing, toiletries and chiropody. Cheneys DS0000028541.V346952.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term ‘service user’ to describe those living in care home settings. For the purpose of this report those living at Cheneys Care Home will be referred to as ‘residents’. This was a key inspection that included an unannounced visit to the home and follow up contact with resident’s representatives and visiting health care professionals. The allocated inspector spent approximately eight hours in the home and was able to meet briefly with the regional manager. The acting manager was available throughout the inspection visit and received the feedback at the conclusion of the visit. During the assessment visits the inspector was able to spend most of her time meeting with the staff, residents and their visitors and observing practice in the home. Six staff members were seen in private and able to express their view on the homes management. A brief tour of the premises was undertaken and a range of documentation was reviewed including the homes statement of purpose and service users guide, care plans, duty rotas, medication records, and recruitment files. The care documentation pertaining to four residents were reviewed in depth. The inspector was able to eat a midday meal in the main residents dining room. Although an Annual Quality Assurance Assessment (AQAA) was completed before the inspection visit and used to plan the inspection. The registered manager completed this jointly with the deputy manager both of which are on sick leave and have not worked in the home for the last month. Therefore the contents and planned improvements have not been progressed as recorded. Since the absence of the registered manager and the deputy manager the regional manager took on the day-to-day management of the home until three weeks ago when an acting manager was appointed. What the service does well: The health needs of residents are being met with evidence of good multi disciplinary working taking place. During the inspection staff were seen to be interacting with residents engaging them in conversation and activity. Mealtimes are unhurried and all meals are home cooked with an alternative option being available for each mealtime. Residents complimented the food. Cheneys DS0000028541.V346952.R01.S.doc Version 5.2 Page 6 The staff and management of the home are welcoming to all visitors and visiting is unrestricted The location and layout of the home are suitable for its stated purpose. All areas of the home are accessible to residents. Staff recruitment was found to be robust and thorough. What has improved since the last inspection? What they could do better: The management of the home needs to ensure that all prospective residents are suitably assessed and that the home confirms in writing to the prospective resident or their representative that with regard to the needs assessment completed the home can meet the needs of the prospective resident. This ensures that decisions around admission to the home are informed and evidenced. Further attention needs to be paid to ensuring all residents care needs are fully documented and responded to in consultation with either the resident or their representative. All possible risks need to be assessed with appropriate documentation that records the interventions made to minimise these risks. Practice relating to medicine administration needs to be improved to ensure residents receive all their prescribed medicines safely. All complaints received must be recorded along with the action taken in response. Staff need to have a clear procedure to follow in the event of abuse being alleged or suspected to ensure residents safety. The home needs to ensure a suitable call bell system is functioning in the home to ensure residents can call for assistance when they want to and that staff can hear this and respond in a prompt manner. Cheneys DS0000028541.V346952.R01.S.doc Version 5.2 Page 7 Staffing numbers must be monitored and altered according to the level of need of all service users in order to ensure that all residents needs are being met. The management arrangements need to be improved to promote strong and effective management for the home. 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. Cheneys DS0000028541.V346952.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cheneys DS0000028541.V346952.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 and 6 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides prospective residents and relatives, with some information about the home; further information about the services and costs needs to be made readily available. The admission procedures followed mostly ensures prospective residents are suitably assessed prior to their admission by a competent person. Practice ensures that the home admits only those residents whose needs can be met by the home. Intermediate care is not provided at Cheneys. EVIDENCE: Cheneys DS0000028541.V346952.R01.S.doc Version 5.2 Page 10 On arrival at the home it was noted that a copy of the service users guide and statement of purpose is displayed in the front entrance area. A copy of the service users guide is also given to each resident and copies were seen in some resident’s rooms. It was however noted that a copy of the homes terms and conditions of residency is not included in the service users guide and the last inspection report was not readily available in the home. A review of the admission process included the review of the last three admissions to the home. The documentation relating to these indicated that in most cases a full and thorough assessment is completed before an admission to the home is considered. One admission however seems to have been processed without the usual assessment process being completed. Although the acting manager confirmed that all prospective residents or their representatives are advised verbally that following the assessment the home is able to meet their needs. It does not appear that this is also confirmed in writing in accordance with the required documentation. One relative was complimentary about the admission practice and expressed how satisfied she was with the way the home responded to the individual preferences of her husband. Intermediate care is not offered by this home. Cheneys DS0000028541.V346952.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Although care records do not sufficiently evidence this, residents’ health needs are generally met. Medicine management is still not robust enough to fully minimise potential risks to residents. Residents are treated with respect and on the whole and have their privacy and dignity maintained. EVIDENCE: The care documentation pertaining to four residents were reviewed as part of the inspection process and each of these residents were met with, during the inspection visit to the home. The care documentation seen demonstrated that full assessments are completed and care plans are developed that take into account variable risk assessments. The assessment process also includes resident’s histories and references to individual choices which evidenced a more person centred approach to care. Unfortunately it was noted that one resident did not have Cheneys DS0000028541.V346952.R01.S.doc Version 5.2 Page 12 any care plans and that some of the plans of care in place did not reflect the up to date care needed. Some of the plans of care associated with individual risk assessments are rather generalised and did not provide specific instruction. Daily records are maintained however the standard of these were rather mixed in content and recording as who and when was not always clear. It was noted that in some cases the care of residents is discussed with the residents and their representatives and one relative said that she was involved in monthly reviews. Some fluid balance charts were also viewed and it was evidenced that these documents are not well maintained or residents hydration needs are not being well attended to, with two indicating that residents had only had 160 mls of fluid all day. This issue was raised with the acting manager who said that she would address these matters. It was also noted that one resident did not have her drink within reach. The records indicated that the home has regular contact with General Practitioners and other community health care specialists. Two health care specialists spoken to said that the home responded to the advice they give in a positive way ensuring residents have the appropriate equipment and care. All contact with residents, relatives and visiting professionals indicated that the standard of care and nursing care was provided at a good standard, although the attention to detail could be improved. Comments received included ‘the care is very good my mother spends a great deal of time in bed and she is not sore and she always looks clean and well cared for’ ‘the care on the whole is good and I get looked after well’ ‘I am very happy with the care in the home’. During the visit it was confirmed that the registered nurses on duty always administers the medicines to those residents not wishing or unable to administer their own, and that a trolley is used to transport medicines to the residents. Concerns however were raised throughout the inspection process from various sources that medicines are not administered at the time that they are prescribed. Registered nurses confirmed that in the morning particularly the early morning round although started at 7.30 is not concluded until 11.00. This clearly causes distress to residents and the pharmacist working for the Commission for Social Care Inspection has visited the home since this inspection and given advise to the home on how to address this problem. The homes management recognised that there were problems with the medicine administration practice in the home a month ago and engaged an independent pharmacist to provide a report. Shortfalls identified in this report have been acknowledged by the home and systems are being developed to address them. However this inspection identified that problems remain, these are compounded by the over reliance on Agency registered nurses who are not familiar with the home, its procedures and the residents in the home. The home must establish a team of competent staff with the necessary skills to meet the health and welfare care needs of all residents. Agency staff used must be appropriately trained and supported by the homes management to Cheneys DS0000028541.V346952.R01.S.doc Version 5.2 Page 13 ensure resident safety and ensure all registered nurses working in the home adhere to the Nursing and Midwifery Council’s code of conduct. During this inspection a review of the medicine administration sheets indicated that creams and lotions are still not being signed for and that there are a number of unexplained gaps in the records in addition the records relating to the administration of Wafarin were not accurate. The acting manager confirmed that she would address these issues and investigate the administration inaccuracies around the wafarin. Some residents are on medicines on an ‘as required’ basis and the need to provide individual guidance to staff on when to give this medication was discussed with the acting manager along with the need to have a record of each staff members signature who administers medicines for auditing purposes. The regional manager confirmed that record of staff’s signatures was to be updated. The medicine storage room was viewed and was found to be maintained in a clean and orderly manner. The controlled drug register was viewed and this was found to be maintained in an appropriate manner and systems were in place to monitor the medicines coming in and out of the home. Staff were observed providing personal support to service users in such a way that promoted and protected residents privacy and dignity. Staff have a good relationship with residents and feedback remarked on how ‘friendly and kind’ staff are. Resident’s individual rooms were personalised with many of them having their own possessions around them. Cheneys DS0000028541.V346952.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides good social, cultural and recreational facilities, including a specialist diets to residents, with resident’s choice and wishes being respected. EVIDENCE: The variety of activities offered by the home are planned in advance and after consultation residents confirmed that they enjoyed the entertainment and activities provided. Residents spoken to said that they were able to do what they wanted and a couple of residents said that they liked to be independent and were able to get out of the home and did so as much as possible. The care documentation included life histories and individual preferences in respect of activity and entertainment. It was however noted that the regular activities coordinators have left and have not been replaced yet. So although group activities are being maintained as far as possible individual time for residents has been reduced. During this visit the home provided activity that included a game of Bingo in the communal dining area. Cheneys DS0000028541.V346952.R01.S.doc Version 5.2 Page 15 Visiting is well promoted and encouraged with no restrictions. During the inspection visit, visitors were noted to be coming and going from the home freely many of them taking residents out for either a walk or a car trip. Resident’s religious wishes are observed and arrangements are in place for residents to receive Holy Communion (Baptist, Roman Catholic and non denominational) if they wish. The home’s menus are devised on a four-week rolling programme. All meals are home cooked with an alternative option available for each mealtime. Apparently residents choose what they wish to eat a week in advance, and this may be difficult for some residents and needs to be borne in mind. Mealtimes can however be varied upon request and resident’s guests are also welcome to have meals at the home. Medical, therapeutic or religious diets are provided as needed. Homemade cakes are served with afternoon tea. The meal eaten with residents was served in the large dining room; some more dependent residents eat in a separate dining room where they can be assisted in a personalised unobtrusive way. The meal was found to be attractive and well enjoyed by residents. The meal included roast chicken, roast potatoes, and fresh vegetables. The dining room provides a good environment that allows for social interaction. Each table is provided with individual condiments and drinks. All comments received from relatives and residents about the food were positive. Cheneys DS0000028541.V346952.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 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Although the home has a suitable procedure for dealing with complaints made to it records did not demonstrate that complaints were being documented and responded to effectively. The home does not have suitable Safeguarding Vulnerable Adults procedures to ensure that the correct alerting procedures are followed once an allegation or suspicion of abuse is highlighted. EVIDENCE: The home has a suitable complaints procedure in place, which is available within the homes service users guide. The records in the home relating to complaints were not well documented or maintained. A number of relatives confirmed that they had raised issues with the homes management and although one relative was happy with the outcome one resident had felt that the complaint had not been dealt with. Other complaints raised by people had not been recorded. These shortfalls indicated a poor management of concerns and complaints raised. The one complaint documented indicated that it had been responded to and resolved and the AQAA received confirmed that the adult protection alert referred to in the last inspection report, as a result of the multi agency investigation, was found to be an unsubstantiated complaint. Cheneys DS0000028541.V346952.R01.S.doc Version 5.2 Page 17 The acting manager confirmed that since her appointment she had received two complaints. These have been recorded and the police have been contacted with regard to missing item. When the inspector asked to see the adult protection procedure (Safeguarding Vulnerable Adults) this was not available and the acting manager was unaware that there had been new local policies and procedures issued in June 07. She was advised on where these can be located. This lack of clear guidance for staff needs to be addressed to ensure any allegation or suspicion of abuse is dealt with appropriately. Records indicated that staff had received training on adult protection issues. Staff recruitment files recorded that Criminal Record Bureau (CRB) checks have been carried out on all existing staff and both CRB and Protection of Vulnerable Adult (POVA) checks are carried out on all new staff. Cheneys DS0000028541.V346952.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, 22 and 26 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable, clean and safe environment for those living in the home and visiting. Residents are enabled and encouraged to personalise their room, and rooms are homely and reflect the resident’s preferences. EVIDENCE: The location and layout of the home are suitable for its stated purpose. The home is well maintained apart from some areas that have been damaged with equipment used in the home. All areas of the home, including the garden, are accessible to residents. The home has an ongoing plan of refurbishment in place. Residents spoken with said that they liked their bedrooms and that the communal areas of the home were comfortable and decorated nicely. Cheneys DS0000028541.V346952.R01.S.doc Version 5.2 Page 19 During the inspection staff said that the bells system did not indicate where the bell was ringing and on most occasions they needed to confirm where the bell was ringing at a central consul before answering and this took time. Residents and relatives indicated that the bells were not responded to quickly and that some bells did not always work. The acting manager said that the delay in the responding to bells had been raised with the management and they were working on ensuring staff respond promptly, however the system also needs to be reviewed. During the visit it was noted that staff were wearing suitable protective clothing and carried individual alcohol hand gel to promote hand cleanliness. Residents were seen to have clean and well-laundered clothing and relatives commented on how well presented residents were. A separate domestic team are employed in the home who ensures the home is clean and suitable laundering procedures are in place. Cheneys DS0000028541.V346952.R01.S.doc Version 5.2 Page 20 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 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staffing arrangements do not ensure that there are suitably qualified staff in such numbers to ensure the needs of residents are met. Recruitment practice is satisfactory and staff are receiving a planned programme of training. EVIDENCE: At the time of this inspection visit 52 residents were living at Cheneys. Although the care staff team is fairly stable the trained nursing team working in the home are not stable and the home is having to rely greatly on Agency registered nurses to provide a minimal cover of two registered nurses over the waking day. This reliance on Agency nurses causes problems in continuity of care and clearly nurses who are not familiar with the home, residents and the homes procedures will take more time to complete care and tasks in the home an example of this is the medicines round. Although the carers are stable during the inspection they did verbalise that they were not happy with the staffing arrangements and the lack of regular registered nurses and lack of stable management had resulted in them feeling Cheneys DS0000028541.V346952.R01.S.doc Version 5.2 Page 21 pressurised and not supported. They did however say that they felt residents were still being well cared for at this time. A health care professional visiting the home said that she often could not find a registered nurse to liaise with. Other feedback from relatives and residents although recognising that the home still appeared to be short staffed evidenced by the time taken to respond to residents needs. They had noted that there had been an increase in the number of registered nurses working in the home. Clearly the staffing arrangements need to be reviewed and sufficient staff need to be deployed in the home to ensure the needs of residents are fully met at all times. The acting manager confirmed that she wanted to increase the staffing levels and the regional manager advised the inspector that recruitment for registered nurses was being progressed. The AQAA received indicated that increased staffing at high activity times was being discussed with the homes Accountant and the board of Sussex Housing and Care. Comments received about the staff working in the home were very positive with everyone saying staff were ‘friendly’ and ‘kind’. Some people did however identify that understanding what staff were saying was difficult in respect of some overseas staff. One relative summed up the staff by saying ‘all the staff are full of laughter and cheerfulness’. Staff training has in the past been well organised with many of the carers completing their National Vocational Qualification in care. Staff training is being maintained and this is evidenced on a training matrix. The recruitment practice in respect of three staff members were reviewed and found to be full and robust, and the records checked included an application form, two references and the necessary Protection Of Vulnerable Adults and Criminal Records Bureau checks had also been obtained. Cheneys DS0000028541.V346952.R01.S.doc Version 5.2 Page 22 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 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The current management arrangements are not providing an appropriate management structure. Systems are in place to monitor the quality of care provided. Resident’s financial interests are safeguarded. The health, safety and welfare of residents and staff are generally promoted and protected. EVIDENCE: The registered manager and the deputy manager were at the time of this inspection visit on sick leave and had not been worked in the home since the end of August 2007. The regional manager initially took on the day-to-day management of the home but has recognised that she was not able to fulfil the Cheneys DS0000028541.V346952.R01.S.doc Version 5.2 Page 23 role of home manager with her additional responsibilities and without a senior nurse working in the home. She has therefore recruited an acting manager through a London Agency who has now been working in the home for three weeks. She is a registered nurse and explained that she was working in a supporting role to the regional manager. The regional manager confirmed that during her quality monitoring of the home she had identified some problems with the staffing arrangements, the management of resident’s pressure sores and the arrangements for medicine administration. In response to these issues she has increased the number of registered nurses working on the floor, arranged for the community tissue viability nurse to visit the home to provide advice and training on pressure sore care, and has arranged for a community pharmacist to provide a report on the practice in the home. Discussion with staff clearly reflected that they were not happy with the current management arrangements and missed the structure and leadership provided by a registered manager and deputy manager. Residents and relatives spoken to also expressed concern over the lack of management in the home. One relative said that she did not know that the registered manager was on sick leave and a further relative said ‘. There is no leadership or direction in the home. The lack of management has put a huge strain on the regional manager’. There are systems in place to monitor the quality in the home and include the use of questionnaires, an annual development plan, monthly unannounced (Regulation 26) visit, staff and residents meetings are also held with minutes being documented. The quality systems need to be maintained through this difficult time with the responses to staff and residents views being documented. The administrator confirmed that she deals with some resident’s personal allowances and records seen demonstrated that good book keeping arrangements are in place. These accounts are audited on an annual basis. During the inspection it was noted that all substances in the home were being stored in accordance with Control Of Substances Hazardous to Health. (C.O.S.H.H) The acting manager said that she was completing the necessary environmental risk assessments to ensure the health and safety of residents and staff is maintained. Cheneys DS0000028541.V346952.R01.S.doc Version 5.2 Page 24 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 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 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 3 X X 2 X X X 3 STAFFING Standard No Score 27 1 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 3 X X 3 Cheneys DS0000028541.V346952.R01.S.doc Version 5.2 Page 25 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 OP1 Regulation 5 (1) (2) Requirement That the Service User Guide is further developed to include the terms and conditions of residency, the last inspection report and the views of residents. That a full needs assessment is completed by a competent person for each perspective resident and following this if an admission is thought to be appropriate the home confirms in writing that having regard to the assessment made that the home can meet those needs. That a plan of care is generated for each resident in the home. That all documentation in respect of residents health needs are kept up to date, reviewed regularly and reflect the current needs of residents. In particular fluid charts need to be accurate and suitably maintained and their use reflected in the plan of care. That care plans are drawn up in Cheneys DS0000028541.V346952.R01.S.doc Version 5.2 Page 26 Timescale for action 01/12/07 2. OP3 14(1) 01/11/07 3. OP7 15(1)(2) (c) 01/11/07 4. OP8 12 (1)(a) 5. OP9 13 (2) 6. OP9 13 (2) consultation with residents or their representatives as appropriate and that where this is not practical, care plans reflect this. (outstanding from the last inspection report with a completion date of 02/01/07) That individual risk assessments 01/11/07 that cover all residents risk are recorded and responded to on an individual basis. These should include the risks associated with the use of bed rails. The medication administration 01/11/07 record chart must be a true and accurate record of the medication administered to the resident. That all medications 01/11/07 administered, which are creams/lotions/ointments, must be signed for. (outstanding from the last inspection with a completion date of 02/11/06. That all medicines are administered at appropriate times to ensure the medicines effectiveness and the safety of residents. To provide clear criteria guidelines for medicine prescribed on a ‘when require’ basis. That the registered person ensures that all complaints are recorded and dealt with effectively. With appropriate records maintained to demonstrate a thorough and robust investigation with enough information for auditing purposes. That the home updates its safeguarding vulnerable adults (adult protection) policy and procedure and ensures it is DS0000028541.V346952.R01.S.doc 7. OP9 13 (2) 01/11/07 8. OP9 13 (2) 01/02/08 9. OP16 22 01/11/07 10. OP18 13 (3) (6) (7) (8) 01/01/08 Cheneys Version 5.2 Page 27 11. OP22 13(4) 12 (1)(a) 18 (1) (a) 12. OP27 available for reference purposes. That a suitable call bell system is provided to ensure bells can be heard and responded to promptly. That staffing numbers are monitored and are altered according to the level of need of all service users. (outstanding from the last inspection with a compliment date of 30/11/06) That the management arrangements ensure the home is run in an effective manner and ensures the aims and objectives of the home are met. 01/11/07 01/11/07 13. OP31 10 01/11/07 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 OP7 Good Practice Recommendations That entries onto residents daily care records are reflective of the residents care plan. (This is outstanding from the previous inspection). That staff who make entries onto residents daily care records, record the date, time and their job designation on each entry made, in accordance with the NMC guidance on Documentation and Record Keeping. (This is outstanding from the previous inspection). It is strongly recommended that pain management tools be included in care plans, when appropriate. That 50 of staff are trained to NVQ level 2 by the end of 2005. (This is outstanding from the two previous inspections). 2. OP7 3. 4. OP8 OP28 Cheneys DS0000028541.V346952.R01.S.doc Version 5.2 Page 28 Cheneys DS0000028541.V346952.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Cheneys DS0000028541.V346952.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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