Inspection on 23/10/07 for Cherry Acre

This inspection was carried out on 23rd 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

Cherry Acre 27/02/09

Cherry Acre 11/04/08

Cherry Acre 27/04/07

Cherry Acre 06/10/06

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

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 Cherry Acre 21 Berengrave Lane Rainham Gillingham Kent ME8 7LS Lead Inspector Marion Weller Key Unannounced Inspection 23rd 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 Cherry Acre DS0000066219.V352251.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. Cherry Acre DS0000066219.V352251.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cherry Acre Address 21 Berengrave Lane Rainham Gillingham Kent ME8 7LS 01634 388876 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) cherryacre5@aol.com Uday Kumar Kiranjit Juttla-Kumar Uday Kumar Care Home 17 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (1), Old age, of places not falling within any other category (16) Cherry Acre DS0000066219.V352251.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th April 2007 Brief Description of the Service: Cherry Acre Residential Home provides personal care and accommodation for up to 17 older people and is owned and managed by Mr Uday Kumar. The home does not offer nursing or intermediate care. The home occupies detached premises and is located in a residential area, close to local shops and on a bus route. The premises are large with ample parking and established mature gardens to the front and to the rear of the property, which are easily accessible. Residents’ accommodation is arranged over two floors. There is no passenger shaft or stair lift to the second floor. A call bell is installed within each of the 17 single bedrooms to alert staff; all bedrooms have television aerial points. Telephone points can be installed if required at the individual’s cost. No bedrooms have en-suite facilities. All bedrooms include a wash hand basin. The home employs care staff working a roster, which gives 24-hour cover. Ancillary staff for catering and domestic duties are also employed. Current fees range from £323 to £500 per week according to assessed personal need. Please contact the manager for further information. Cherry Acre DS0000066219.V352251.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection was conducted by Marion Weller and Sue Mc Grath, Regulatory Inspectors, who were in Cherry Acre on Tuesday 23rd October 2007 from 09:40 a.m. until 1:40 pm and again on Wednesday 24th October 2007 from 1:15 pm until 4:40 pm. During that time the Inspectors spoke with the owner manager, a community nurse, some residents and their relatives and some staff. Some judgements about the quality of life within the home were taken from observations and conversations. Some records and documents were looked at. In addition, a tour of the building was undertaken and the grounds were viewed. The home has an Improvement Plan in place, which has been agreed with the CSCI. Areas of the service in need of improvement and covered by the Improvement Plan were inspected on this visit to establish the home’s full compliance with or progress made in relation to the Improvement Plan. The Care Homes Regulations 2001 and the National Minimum Standards for Care Home’s for Older People refer to people who use the service as “service users”. People living at Cherry Acre prefer to be referred to as “residents”. Accordingly this shall be done in the text of this report. In addition, Mr Uday Kumar, the owner manager will be referred to throughout the report as the manager. Statements made during the inspection included: “Food excellent and staff fantastic” “They always give you a choice of food” “We are happy with the care, but the home really does need updating” “Staff always busy, haven’t got time to have a chat and that is so important to me” “Would like to go into the gardens but can’t, staff never offer to take me out, too busy” And “ Cleaning doesn’t get done like it used to” The manager and the staff gave their full cooperation throughout the visit Cherry Acre DS0000066219.V352251.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Prospective and existing residents would benefit from information documents that fully meet the demands of Regulation and are made available in other formats to suit all levels of capacity. There are opportunities to further develop the home’s pre admission process and documentation to ensure more detailed assessment information is recorded and shared with staff. This will ensure people’s needs are fully met. Cherry Acre DS0000066219.V352251.R01.S.doc Version 5.2 Page 7 An admission checklist is recommended in residents’ files to evidence the issue of a Statement of Purpose, Service User Guide, contract and other key public information to individuals admitted. Although the home’s contract generally complies with most elements of good practice it does not state the room number allocated and neither does it describe the room’s provisions. This is recommended to ensure people are clear about what they are being offered and what they are paying for. Care planning and daily record keeping still need to be further developed to better promote residents’ health and welfare and evidence good practice. Despite some improvements in this area, some medication administration shortfalls require the home to review current arrangements in light of good practice advice to fully secure residents safety and protection. Residents would benefit from a greater involvement in the programme of activities arranged both inside and outside the home and sufficient staff to support their choices. Residents would benefit if the complaints procedure was revised to meet the required standard and made available in formats to meet all residents’ capacities. Residents would be better protected if all staff had received training in safeguarding adults. Although further improvements have been made in the access staff have to mandatory training, not all staff can evidence the skills and knowledge required to ensure that a consistent high standard of care is being delivered. Residents would benefit from a further review of staffing levels to ensure the numbers of staff employed are meeting the holistic needs of the people who live in the home. Despite some improvements, the quality of life and safety of some residents continues to be adversely affected by issues concerning the home’s environment and the lack of facilities designed to secure their welfare. There remain important areas in the home for further improvement and development. The operation of the home does not yet fully safeguard residents. Cherry Acre DS0000066219.V352251.R01.S.doc Version 5.2 Page 8 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. Cherry Acre DS0000066219.V352251.R01.S.doc Version 5.2 Page 9 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 Cherry Acre DS0000066219.V352251.R01.S.doc Version 5.2 Page 10 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): 123456 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People using this service have most of the information about the home they need to make an informed decision about whether the service is right for them. Residents would benefit further from service information that fully meets the required standard and the demands of Regulation and is made available in other formats to suit all levels of capacity. The personalised needs assessment means that people’s diverse needs are identified and planned before they move to the home. There are opportunities to further develop this process to ensure more detailed information is recorded and shared with staff to ensure peoples needs will be met. The home continues to make arrangements to train their staff to ensure they all have the skills, knowledge and experience to deliver the services and care the home offers to provide. Cherry Acre DS0000066219.V352251.R01.S.doc Version 5.2 Page 11 EVIDENCE: The home’s Statement of Purpose and Service User Guide are produced as two separate documents. They are generally designed to provide a range of information about the home, its principles of care, facilities and services. At the last key inspection content did not fully comply with the demands of Regulation. Although the manager stated they had been further revised documents provided on this inspection still evidenced minor shortfalls. Although the document is more comprehensive, improvements have not been made in line with previous guidance. It will remain a requirement in this report for the manager to further revise both documents in line with Regulation and good practice to ensure prospective residents and their representatives are provided with up to date information on which to base decisions about the suitability of the home. Information documents are available to residents in standard format. The home should consider providing other formats to suit all prospective resident capacities and to make them accessible to residents when they are in residence as an aid memoir. An admission checklist is recommended in resident files to evidence the issue of a Statement of Purpose, Service User Guide, contract and other key public information to individuals admitted. Residents spoken with were not able to accurately recall the preadmission process in any detail. However, records confirm that an assessment of needs is carried out before each admission, either by the funding authority (and supplemented by the home’s own) or home (if the placement is self funded). The home’s own pre admission documentation could be improved upon and further developed to ensure it provides more detail on which to base the individuals plans of care once admitted. There are opportunities for residents or their representatives to visit the home before admission to assess suitability. There is also a four-week trial stay. Each admission is properly confirmed by a contract. The contract generally complies with most elements of good practice however it does not state the room number allocated and neither does it describe the room’s provisions. This is recommended to ensure people are clear about what they are being offered and what they are paying for. In line with the home’s Improvement Plan agreed with the CSCI, the manager could evidence having taken some action to address current shortfalls identified in staff training needs since the last inspection. This home does not provide intermediate care. Cherry Acre DS0000066219.V352251.R01.S.doc Version 5.2 Page 12 Cherry Acre DS0000066219.V352251.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Despite recent improvements in care planning and daily record keeping, these processes still need to be further developed to better promote residents’ health and welfare and evidence good practice. People who live in the home are largely protected by the home’s policies and procedures regarding medication. Shortfalls evidenced require the home to review arrangements in light of good practice advice to fully secure residents safety and protection. Residents are treated with respect. EVIDENCE: Each resident has a plan of care. The more recent ones evidence pre admission documentaion. Three care plans were looked at in detail and evidenced some improvements in the care planning process. Cherry Acre DS0000066219.V352251.R01.S.doc Version 5.2 Page 14 Care plans are now maintained seperatly for each resident and kept in a locakable cupboard which is accessible to staff. Care plans contained most of the required elements. Risk assessments were seen in some files but these are not in a consistent format and require further development to fully protect residents and adequately guide and direct staff. It remains unclear how much residents or their representatives are involved in the formulation of the original care plan upon admission. The plan needs to be signed to show the individuals agreement to it and evidence they or their representative’s full involvement in the drawing up of the document. Records need to better evidence this. Care plans had been reviewed regularly and a series of review dates were hand written on the front sheet. However, there was no clear documentation to show what elements had been reviewed. One resident’s care plan evidenced a health concern that had caused a loss of weight and prompted the GP to organise a hospital consultation and diagnostic tests. In conversation with the resident it was clearly evidenced that both the process and the uncertainty as to the results had impacted on their behaviour, eating and sleeping patterns. Their written plan of care however had been recently reviewed and the results recorded, ‘no change’. This clearly shows a lack of attention to detail and room for further improvement. There was clear evidence to demonstrate that the healthcare needs of service users are generally being met. Records are now simplistically maintained for all healthcare professionals input, including that for district nurses, GPs and complimentary healthcare professionals who visit the home regularly. There was evidence that a request from a healthcare professional had not been complied with regarding the cleaning of spilled body fluids and faecal smears on a resident’s bedroom carpet. The manager stated his firm intention to address this via cleaning schedules and the purchase of a ‘spillage kit’ for future use. Nutritional assessment should be undertaken on admission and subsequently on a periodic basis. This was still not being undertaken. The home is reminded that a record must be maintained of nutrition, including weight gain or loss and any appropriate action taken to address this. Although some residents had specialist equipment in place to prevent and treat pressure areas the assessment process was still not recorded and no skin integrity assessments were seen in care plans. The standard of daily record keeping is generally informative but does not always reflect the demands of the individual’s plan of care. There were occasions when poor terminology had been used when completing records. The manager is aware of current shortfalls and has plans to further develop the care planning system in the home. He stated his intention of contracting with Cherry Acre DS0000066219.V352251.R01.S.doc Version 5.2 Page 15 an agency that provides help and support to care home managers who need to develop services in line with Regulation and best practice. No specific date however for this to be undertaken by the agency was provided to the CSCI. Medication administration processes and medication administration records were inspected. The lunchtime medication round was also observed by one of the inspectors on the first day of the site visit. Some topical medicines were seen left in bedrooms and in an unlocked cupboard in the laundry area. When questioned staff said that some residents apply topical medicines, such as creams and ointments themselves or administer other types of medication such as that to ease breathing problems on occasions. There is currently no policy or procedure for residents who may elect to self-administer medicines, neither is there a risk assessment to establish an individuals capacity to do so. This needs to be addressed. Some bedrooms do not evidence a lockable storage facility, as standards require enabling safe storage of medicines left in the care of residents. Some wardrobes are lockable but these are inappropriate for medication storage as they are accessed regularly to return clean washing etc. The home has access to a lockable medicines trolley, which contains medication currently being administered. They use a monitored dosage system (MDS) provided by a local pharmacy. Medication records showed no obvious gaps in records of administration. Most staff that administers medication has received one day training. There are plans to provide more comprehensive medication training for some staff. This should be arranged without delay. Staff should also have their ongoing competency regularly tested, with records maintained as evidence in their staff files. A further requirement will be issued in the respect of medication administration in the home. It is however acknowledged that some improvements were evidenced in regard to medication administration on this visit. For instance, the security of keys to medication storage areas now meets best practice and is retained by the senior carer and handed over formally between shifts. Residents’ privacy and dignity are respected. All bedrooms are used as single occupancy, which means health and personal care can be given in private. Staff were seen to knock on doors before entering and called residents by their preferred name. Interactions between staff and residents were observed as friendly and relaxed but respectful. Where gaps in information were seen in written care plans, staff were able to give a verbal updates as to residents needs and how they met them. Cherry Acre DS0000066219.V352251.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents find the lifestyle experienced in the home largely matches their expectations and preferences and family and friends are made welcome when they visit. Opportunities for residents to participate in social activities within the home have improved however they would benefit from a greater involvement in the programme of activities arranged both inside and outside the home and the availability of staff to support their choices. EVIDENCE: There is no dedicated activities co-ordinator at Cherry Acre. Staff provide activities as part of their daily care routine. A local student was in the home during the inspection and was said to visit regularly. The individual offers support to residents who like to take part in tabletop games and may need a partner. Activities on site were said to include bingo, card games, tabletop games, weekly sing-along, mobile library services, monthly motivation classes Cherry Acre DS0000066219.V352251.R01.S.doc Version 5.2 Page 17 and movie matinees. The manager has recently updated some of the tabletop games available to residents. Residents commented that they felt able to choose how to spend their time during the day and staff respected their choices and preferences. Some residents spoken with were critical that no activities were arranged for them outside the home. One resident stated that they would like to access the garden more often but recognised that staff do not have always have time to do this. There was a general consensus of opinion between residents that it is difficult to please everybody in relation to recreational activities. Regular church services are arranged in the home for residents if they wish to attend. The Salvation Army regularly visits at Christmas and traditional days such as St George’s day are celebrated. Residents have previously expressed a wish to attend residents’ meetings and be able to express views jointly with staff and their relatives. The manager was not able to evidence formal residents meetings having been arranged since the last inspection. It is recommended that this matter be reconsidered. It will provide a safe forum for residents and their representatives to raise the matter of activities and other areas of daily life at Cherry Acre they may wish to discuss with the manager. Minutes of meetings should be kept to evidence good practice. Residents are able to have visitors at any reasonable time. There is no separate visitors room in the home but residents can use their bedrooms to entertain friends and family in private if they wish. Residents can arrange to have phones installed in their rooms at their own expense. Unless other arrangements have been agreed, the manager stated that residents receive their mail unopened. Residents are given a choice of menu at lunchtime; staff also confirmed that the meal offered at teatime was flexible in relation to the food offered. Residents spoken with were largely complimentary about menus and the quality of the food offered to them. It was however noted that practice in relation to residents who require a liquidised diet could be improved upon in relation to ‘best practice’. Staff assisted where they could during meal times. Cherry Acre DS0000066219.V352251.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Systems are in place to enable those living and those visiting the home to raise concerns or complaints. Residents would benefit further if the complaints procedure was revised to meet the required standard and made available in formats to meet all residents’ capacities. Residents would be better protected if all staff had received formal training in safeguarding adults. EVIDENCE: The home has a complaints procedure. The procedure included in the current service users guide fails to fully explain the timescales for resolution of complaints raised with the home. The text also has the potential to confuse the reader in reference to when they may refer a complaint to the CSCI. Good practice also suggests that contact details should be included for the local Social Services Department. It is recommended that the complaints procedure is reviewed to ensure it meets the required standard and the revised format made widely available to people who live in the home. As there are some residents with sensory loss, the written procedure would benefit from being produced in other formats suitable to meet the needs of all capacities of resident accommodated. Cherry Acre DS0000066219.V352251.R01.S.doc Version 5.2 Page 19 Resident spoken with largely said they felt safe in the home. Examples were given by residents of personal concerns, which had been raised with the manager and apparently speedily addressed. One residents said, “The manager does everything he can to please you and put things right” The manager said there had been no formal complaints received since the last inspection in April 2007. The home does not record minor concerns such as those raised by the residents spoken with. It is a recommendation that they do this in future to evidence good practice. The home has adopted the Kent and Medway’s Adult Protection Policy. It was clearly evidenced that a further two staff have received Adult Safeguarding training since the last inspection. Some staff still needs to attend this training. Adult Protection is included in the induction of new staff although this largely consists of an ‘in-house’ brief given by the manager. There have been no referrals under the POVA scheme. Cherry Acre DS0000066219.V352251.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 20 21 22 24 25 26 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Despite some improvements, the quality of life and safety of some residents continues to be adversely affected by issues concerning the home’s environment and the lack of facilities designed to secure their welfare. EVIDENCE: Cherry Acre is a detached building with residents’ accommodation arranged over two floors. Changes in residential and social care mean that people referred to care homes have increased frailties and care needs than previously. Whilst Cherry Acre is able to offer people a “homely” environment, from observation and discussion, it could be very difficult for staff to meet residents’ continuing care needs safely if for instance individuals become immobile or bedfast and unable to negotiate stairs. The home does not have a passenger or chair lift and relies on people maintaining their mobility to access the second Cherry Acre DS0000066219.V352251.R01.S.doc Version 5.2 Page 21 floor. Transporting lifting hoists to the second floor of the home could be problematic if not impossible and the absence of such equipment may potentially place residents and staff at risk. The manager must make an informed decision as to whether the current environment fully safeguards residents’ long-term welfare without further adaptations being made to the premises, such as the provision of a passenger lift. The home’s Improvement Plan demands that the manager provide a full assessment of the premises and the facilities currently provided. This should be undertaken by someone qualified to do so and has specialist knowledge of the client group accommodated. This is to ensure that residents are provided with the specialist equipment they need to maximise their independence and to address their changing needs, including end of life needs. To date this assessment has not been provided to the CSCI. The manager states that a consultant has been appointed to undertake this with a completion date of November 2007 It is strongly recommended that no new residents with mobility problems be admitted to first floor rooms. All bedrooms at Cherry Acre offer single accommodation, eight of the bedrooms are below 10sq.m (National Minimum Standard recommendation) but residents occupying these rooms are said to be happy with and accepting of size limitations. Residents spoken with said they had been given the opportunity to bring personal items into the home upon moving in and rooms appeared to reflect the personal tastes and interests of the occupant. Not all bedrooms provide lockable storage space for residents’ use, as standards require. The reason for not doing so is not explained in care plans. There had been some areas of improvement in relation to environmental health and safety since the last inspection. All portable electric appliances had been tested and a certificate issued. Lifting equipment in the home had been serviced. The home’s water system had been tested for Legionnela and found to be clear. A digital thermometer had been provided to ensure residents’ bath water was prepared at the correct temperature for safe bathing. Some new commodes and other items of sanitary equipment, such as raised toilet seats had been provided. A tour of the building continued to evidence areas of continuing concern. The home’s general environment, fixtures and fittings require updating and refurbishment. Some furniture, particularly in residents’ bedrooms requires replacement. Beds and headboards are in a very poor condition with exposed wooden frames showing through bed bases and the material on headboards so thin that it appears almost transparent. Items in this condition can no longer be kept clean and therefore the situation compromises resident’s’ health and safety and the home’s infection control measures. Several areas of carpeting throughout the home were badly worn, dirty and/ or stained. In some cases staining was caused by spilled body fluids. A health professional had complained of spilled body fluids and faecal smearing on a Cherry Acre DS0000066219.V352251.R01.S.doc Version 5.2 Page 22 resident’s bedroom carpet, which had not been attended to. The manager stated he was unaware of this concern having been raised. Some carpet in residents’ rooms was raised up and ridged and had the potential to cause a trip hazard. The manager stated at the last inspection that he had plans to re carpet the home by September 2007. It is understood that he has now extended the timescale to the end of December 2007. During discussions the manager evidenced he had applied for and secured Local Authority funding for the purchase of new carpets and some armchairs in the home. Several of the toilets appeared stained and dirty. The owner said this was due to the enamel finish wearing off the surface making it difficult to keep them clean. Likewise some sinks evidenced surface wear and one was cracked. This situation was included in the last report. The toilet and shower room on the first floor was very small; the toilet was dirty and odorous. The shower was not used and the showerhead not cleaned. The manager stated he had plans to move the room around and make it fit for purpose. No timescale was given for completion of this work. As mentioned in the previous report, some work had been completed in the laundry room following advice from a specialist nurse from the Infection Control Unit. There was a new hand-washing sink and some new shelves. New worktops have been fitted and some cupboards moved. It was noted that where items had been moved around, an exposed area of bare floor remained which was clearly difficult to keep clean. The situation compromises good infection control. It will be a requirement that the laundry floor is recovered on this report. Commodes are still being washed in this room by hand which is not best practice. It is strongly recommended that a sluicing machine be installed. The laundry room was not entirely clean, with dirt and debris clearly evident behind the washing machine and surfaces that would benefit from deep cleaning. Several residents’ bedroom sinks evidenced hot water temperatures that exceeded the safe limit and have the potential to scald the unwary. The home does not have thermostatic mixers valves installed to hand wash basins in residents’ rooms and there were no records of water temperatures being regularly recorded or action taken to resolve the issue. Radiators remain unguarded and a satisfactory risk assessment had not been completed. The manager stated that a consultant had been appointed to undertake risk assessment. Radiator covers are included in the home’s improvement plan with a completion date of November 2007. First floor windows evidence no window restrainers in place. A satisfactory risk assessment had not been completed. The manager stated that a consultant has been appointed to undertake risk assessments in the home. Cherry Acre DS0000066219.V352251.R01.S.doc Version 5.2 Page 23 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 18 29 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although further improvements have been made in the access staff have to suitable training, not all staff can evidence the skills and knowledge required to ensure that a consistent high standard of care is being delivered. Residents would benefit from a review of staffing levels to ensure the numbers of staff employed are meeting the holistic needs of the people who live in the home. EVIDENCE: The home’s staffing roster deploys two care staff throughout the 24-hour period to meet the needs of up to 17 residents. This means that residents’ basic needs are largely being met but there are times when staffing levels are not sufficient to respond to residents’ needs as they would like in the home. Comments received during the inspection, which clearly illustrated this included: “Staff always busy, haven’t got time to have a chat and that is so important” “Would like to go into the gardens but can’t, staff never offer to take me out, too busy” Cherry Acre DS0000066219.V352251.R01.S.doc Version 5.2 Page 24 “Staff have much to do, they are fantastic but too busy to spend much time with me” It was a requirement that a risk assessment was undertaken by the manager in relation to individual residents care needs, The maintenance of their choices and preferences in every day living, versus the numbers and competencies of staff on duty. The manager has recently completed the Department of Health’s Residential staffing formula. The completed document illustrates the inspectors’ initial point. There are sufficient staff employed to meet residents’ basic needs but no provision is made in the calculation for social, recreational and cultural activities. Observation on the day of the site visits indicated that staff try their hardest to work efficiently and effectively to meet residents’ needs. However, expectations and demands placed upon them are heavy. The home’s cleaner was absent on the day of the site visit. The two care staff were busy trying to fit in as many of the basic cleaning tasks as they could manage. This was in addition to meeting the demands of their own role. The home’s care staff are also expected to undertake residents’ personal laundry as part of their normal daily routine and to ensure the residents’ teatime meal is provided. The home has two cooks who are both part time and prepare the main mid day meal only. The home has a total of 24 staffing hours dedicated to cleaning every week. This equates to four hours daily over 6 days on the rosters. The cleaner has been regularly used to fill vacancies on the care roster and therefore comments that, ‘cleaning was not as good as it was’ were evidenced from people who live in the home. Cherry Acre is geographically quite large and requires considerable investment to maintain it in a clean and hygienic condition. There were areas and items seen on this inspection and discussed at the time with the manager that were not clean and required improvement. It is acknowledged that some areas of the home are now difficult to keep clean as they are need of replacement or redecoration. However, it remains the inspector’s opinion that the home has insufficient domestic hours and relief staff to ensure it is kept clean and hygienic. Some staff files were looked at. There were some shortfalls noted in content and discussed with the manager. It will be required for the manager to check all staff files to ensure they meet the demands of Regulation. The manager stated that he is arranging some external support to improve personnel practice in the home. Most of the new staff has not been issued with contracts of employment. CRB and POVA checks had been made for all staff. Cherry Acre DS0000066219.V352251.R01.S.doc Version 5.2 Page 25 The home does have a basic induction course in place. Some recent staff records evidenced the whole induction programme, elements 1 –28 had all been completed and signed off by both parties over a period of 2 days for a new starter. This is too short a period to ensure all areas are covered in sufficient depth and detail. It is recommended that staff employed by the home are given copies of the code of conduct and practice set by the GSCC as part of the induction process. The manager has a simplistic training matrix for staff. It was clearly evident that access to staff training had improved and more training was being planned. It was previously recommended that more in-depth training be sought for those who undertake medication administration in the home. The manager stated that 3 care staff would be undertaking a more comprehensive course in November 07 arranged via Bexley College. Some areas of staff training still require improvement, including ‘safeguarding adults’ and elements of mandatory training to ensure residents basic needs are met. Although the home is currently not able to evidence the 50 required standard of trained staff, some further staff are commencing their NVQ qualifications in November 2007. Progress and compliance with the standard will be checked at the next inspection of the home. Cherry Acre DS0000066219.V352251.R01.S.doc Version 5.2 Page 26 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 36 37 38 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The operation of this home does not fully safeguard residents. EVIDENCE: Mr Uday Kumar has owned and managed Cherry Acre for the last 18 months. Although well aware of the inherent problems, progress to address the home’s environmental issues and other shortfalls in the service have been slow. His plans and good intentions must now be put firmly into practice. The home is establishing a history of non-compliance with the Regulator and a continuing lack of awareness with the demands of regulation, national minimum standards and good practice. Mr Kumar has been advised on previous inspections to seek more external support and possibly employ an experienced operational manager to assist him with the day-to-day operation of the home. It was Cherry Acre DS0000066219.V352251.R01.S.doc Version 5.2 Page 27 therefore disappointing that he explained plans to recruit a senior member of staff who has no operational experience of residential care and only retail experience in management. As mentioned elsewhere there have been some improvements noted throughout the report but there remain important areas in relation to the premises and the service that require further improvement , investment and development. There are some concerns regarding the promotion and protection of resdients health, safety and welfare apart from those mentioned elswhere in the report. A Legionella check was completed and a certificate of testing was issued. The home still needs to produce a comprehensive risk based approach to Legionella as detailed in the national Minimum Standards (NMS), the same applies for the necessary installation of Thermostatic Mixer Valves (TMV’s) which when fitted prevent water being discharged at more than 44’c in hand wash basins and are designed to protect vulnerable residents from harm. Mr Kumar has informed the CSCI of his plans to have TMV’s fitted in November 2007. There are no window restrictors. Window restrictors should be fitted as standard to upper floor windows in care home’s, unless a risk assessment, based around the occupant of a room indicates how windows are otherwise safe. This should be documented on individual care plans. Progress and compliance with these issues will be checked and recorded at the next Inspection. The home has had recent training from the Environmental Health Department and is using new food hygiene documentation. The home’s main kitchen evidenced the edge of the sink top being badly broken which could potentially compromise adequate cleaning measures and therefore food hygiene standards. The door remains broken on the second freezer and the kitchen floor remains badly pitted and marked, and therefore difficult for staff to clean. These issues need to be added to the home’s Improvement plan scheduling all environmental work to be undertaken. The service has to meet fire safety obligations. It was discussed again on this visit that records evidenced insufficient fire drills. One had been undertaken in October 2006 and another in 7th June 2007. Best practice indicates that fire drills should be more frequent. Some staff have not received any training in fire safety although Mr Kumar stated this is planned. Mr Kumar is investigating the purchase of automatic fire door closures. Currently doors are being wedged open, which is in contravention of fire safety regulations for residential home’s. The evacuation needs of individuals are not currently included in residents care documentation. The home has one bath hoist and one general hoist. Both had been serviced on this inspection. Regulations state they should be serviced every six months. Some gaps remain for staff training in safe moving and handling procedures. Cherry Acre DS0000066219.V352251.R01.S.doc Version 5.2 Page 28 There have been no further Quality Assurance exercises completed since December 2006. The manger spoke of his intention to further develop quality assurance processes in the home, which could involve an annual survey of residents, staff and relatives regarding their views about the service. To evidence that the home is run in the best interests of residents the manager must have effective quality assurance and quality monitoring systems in place. The results of such surveys should be published in report form with a relevant action plan and be made available to current and prospective residents; their representative and other interested parties, including CSCI Mr Kumar has reviewed most of the home’s Policies and Procedures. The file was looked at briefly. Policies and Procedures are the responsibility of the Provider and as such Mr Kumar would be well advised to check content fully meets with the demands of current legislation and good practice. Some staff appears to be having supervision, although it is not always on a regular basis. Care staff must receive formal supervision at least six times a year. Records must be clearly maintained and available in staff files for inspection. The home encourages residents’ relatives/ representatives to give assistance with the management of their finances. There was a system for holding and recording residents cash for those that the home takes some responsibility for. Some aspects of best practice were discussed with Mr Kumar as he was often left in arrears waiting for money to be deposited to individual’s accounts. This is not in the best interests of either party and some organisational impeovewemtbs could be made to ensure full compliance with the standard and regulation. Cherry Acre DS0000066219.V352251.R01.S.doc Version 5.2 Page 29 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 2 2 2 3 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 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 1 x 2 1 x 2 2 1 STAFFING Standard No Score 27 1 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 x 2 2 2 1 Cherry Acre DS0000066219.V352251.R01.S.doc Version 5.2 Page 30 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 Home’s Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 6(a) Requirement The home’s Statement of Purpose and Service User Guide must be revised to ensure current and prospective residents & their representatives have all the information they need about the service. The content of the home’s information documents must be clear and easy to read, comply fully with regulation (Schedule1.) and be up to date. It should include a revised complaints procedure. An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale stated. Previous timescale of 29/06/07 not met. This requirement has now been carried over from the two previous reports. In relation to Care Plans: 1. Residents care plans must DS0000066219.V352251.R01.S.doc Version 5.2 Page 31 Timescale for action 07/01/08 2. OP7 15 (1) (2) 13 (4) (b) (c) 07/01/08 Cherry Acre 2. 3. 4. 5. be further developed and be in a format that easily provides clear detail, direction and guidance for staff. All Care Plans must be reviewed at least once a month and the main plan revised where necessary. There must be written documentation of the review undertaken to evidence good practice. Care Plans must be signed by the resident to evidence their involvement in its compilation and their agreement to the plan of care. The care plan must include risk assessment (s) where necessary and must always pay particular attention to the prevention of falls. Daily records must clearly evidence that the demands of the care plan are being met. An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale stated. Previous timescale of 29/06/07 not met. This requirement has now been carried over from the two previous reports. Nutritional screening must be undertaken on admission and subsequently on a periodic basis, a record must be maintained of nutrition, including weight gain and loss, and appropriate action taken. 3. OP8 14 (1) (2) 17 Schedule 3 (o) 07/01/08 Cherry Acre DS0000066219.V352251.R01.S.doc Version 5.2 Page 32 An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale stated. 4. OP9 13(2) 18 1(a) In relation to the home’s arrangements for the recording, handling, safekeeping, safe administration and safe disposal of medicines” 1. The home’s medication policy and procedures document must be reviewed by the manager to ensure that medicines are handled according to the requirements of The Medicines Act 1968 and Guidelines from the Royal Pharmaceutical Society, ‘The Handling of Medicines in Social Care. • This review must include the home’s policy and arrangements for residents that elect to self medicate and include a risk assessment to establish their capacity to do so. 2. Training in the safe handling of medication if staff administer or may be needed to administer medicines must be given and should remain ongoing until all medication administrators are suitably trained. 3. ‘When Required’ (PRN) Medication – Reasons for administering should be better recorded to provide Cherry Acre DS0000066219.V352251.R01.S.doc Version 5.2 Page 33 07/01/08 audit/ review of care plan information. 4. Staff must be regularly assessed for competency with regard to the administration of medication and records maintained in staff files to evidence good practice. 5. The home must store medicines received into the home in secure areas. An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale stated. Some elements of this requirement remain unmet from 29/06/07 and have been carried over from the previous two reports. 5. OP18 13 (6) The registered person shall make 07/01/08 arrangements for all staff to receive training in Adult Protection. An improvement plan detailing how the service will address this must be forwarded to the Commission. There is clear evidence this is being addressed through the records assessed, but there are still gaps. This has been carried over from the previous two reports. Cherry Acre DS0000066219.V352251.R01.S.doc Version 5.2 Page 34 6. OP19 23(2), 16(2) You must submit a detailed action plan scheduling all environmental work to be undertaken within the home providing realistic timescales. This is form part of the home’s Improvement plan Provide replacement carpet in residents’ bedrooms and to communal areas where it is considered necessary to secure Residents health and safety. This is to be undertaken by the timescale given if not sooner. 07/01/08 7 OP19 16(2)(c) 23 1 (a) (2) (b)(d) 31/12/07 8. OP22 16(1) 23(2) (n) A full assessment of the premises and the facilities must be made by a suitably qualified person(s), including an occupational therapist, with specialist knowledge of the client groups catered for and a subsequent written report obtained. You must evidence the recommended disability equipment, including passenger lifts, have been secured or provided and environmental adaptations made, to meet the needs of service users accommodated. An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale indicated. 07/01/08 9 OP24 23 (2) (m) Bedrooms - The furniture and fittings in each bedroom should be checked for compliance with all the provisions of the National Minimum Standards (NMS24). Of particular concern is the lack of lockable storage facilities for DS0000066219.V352251.R01.S.doc 07/01/08 Cherry Acre Version 5.2 Page 35 10. OP25 13 (4) (a) (c) residents. Non-provision of items listed in the standard needs to be supported by fully documented consultation and/or risk assessment in the individuals care plan. An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale indicated. Radiators in residents bedrooms and in communal areas of the home are not guarded and not of a guaranteed low temperature surface type. A risk assessment must be undertaken to identify where the surface temperature does present a risk to residents and these radiators must be replaced or guarded. Non-provision of items to residents needs to be supported by fully documented consultation and/or risk assessment in the individuals care plan. An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale indicated. This requirement has been carried over from the previous two reports. Hygiene and Infection Control: • A new floor finish is required in the laundry which is impermeable and this and wall finishes are readily cleanable. The enamel finish is compromised on some toilets and sinks and must be replaced to ensure they 07/01/08 11. OP26 13 (3)(4) (c) 23 (1) (a) 07/01/08 • Cherry Acre DS0000066219.V352251.R01.S.doc Version 5.2 Page 36 are readily cleanable. An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale indicated. 12. OP27 18 1 (a) There must be a realistic and accurate review of domestic hours provided to ensure that the home is being maintained in a clean and hygienic state, kept free from dirt and unpleasant odours and meets the needs of the people who live there. An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale indicated This requirement has been carried over from the previous two reports. 07/01/08 13 OP29 OP37 19 (1) No person shall be employed at 07/01/08 the home unless a minimum of two satisfactory written references are obtained, their employment history including their reason for leaving the last employer, gaps in employment are adequately explored and answers recorded. Previous training is validated. A recent picture is provided in staff files. • Staff files must be reviewed to ensure they contain all the requirements of regulation, adhere to good personnel practice and evidences the DS0000066219.V352251.R01.S.doc Version 5.2 Page 37 Cherry Acre home exercises robust recruitment practices to secure the welfare and safety of residents. An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale indicated Staff are to receive training in all aspects of care and safe practice and this is to include: Fire Training First Aid Moving and Handling Care Planning Health & Safety & COSHH Risk assessment Infection Control Food hygiene. With refresher training and assessment of competency within good practice guidelines An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale indicated There is evidence that this is being addressed but there are still some gaps for core training. Training Certificates must all be available as evidence of compliance on staff files. This has been carried over from two previous reports 15. OP33 24 The registered person shall establish and maintain a system for evaluating the quality of the services provided at the care home. 07/01/08 14. OP30 18 1(a) 07/01/08 Cherry Acre DS0000066219.V352251.R01.S.doc Version 5.2 Page 38 16 OP36 17. OP38 There needs to be compliance with the National Minimum Standard in respect of formal staff supervision sessions. An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale indicated. Schedule The registered provider must four ensure safe working practises 23(4)(c)(d including regular fire drills and )(e) fire safety training for staff. An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale indicated. This is carried over from the previous inspection 18(2) 31/12/07 07/01/08 18. OP38 13 (3) (4) (a) (b) (c) In relation to the provision of water temperature and design solutions to control Legionella: • Hot water to be stored at a temperature of at least 60 C and distributed at 50 C. – This is to aid infection control measures in the home. Water temperature records to be maintained and actions taken. Shower heads to be cleaned and checked regularly and stored appropriately. To prevent risks from scalding to residents installation of pre-set valves of a type unaffected by changes in water pressure and which have failsafe devices should be o o 07/01/08 • • • Cherry Acre DS0000066219.V352251.R01.S.doc Version 5.2 Page 39 fitted to provide water close to 44 C at the point of delivery. (TMV’s) o An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale indicated. This is carried over from the previous inspection. 19. OP38 13 (4) (a) (b) (c) There must be the provision of and maintenance of window restrictors on rooms above the ground floor based on an assessment of vulnerability. Non-provision needs to be supported by fully documented consultation and/or risk assessment in the individuals care plan. 07/01/08 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 OP1 Good Practice Recommendations An admission checklist is recommended to evidence the issue of a Statement of Purpose, Service User Guide, contract and other key public information to residents. It is recommended that the Service User Guide be produced in formats that meet all resident capacity. The home’s contract should identify the facilities and provisions of allocated rooms. The home’s own pre admission documentation should be improved upon and further developed to ensure it provides more detail on which to base a new residents plan of care. 2. 3. 4. OP1 OP2 OP3 Cherry Acre DS0000066219.V352251.R01.S.doc Version 5.2 Page 40 5. OP12 It is recommended that consultation take place with residents and staff in regards to developing the home’s activities programme inside and outside the home. This could be managed through regular residents/relatives meetings. Special consideration should be given to meeting the needs of all capacities of residents and those with specific impairments. Service users individual interests are to be recorded in their plan of care. This recommendation has been carried over from the last report. It is recommended that liquefied meals be presented in a manner, which is attractive and appealing in terms of texture, flavour, and appearance in order to maintain appetite and nutrition. It is strongly recommended that the complaints procedure is revised and re-distributed to existing residents. It must be appropriate to the needs of the individual. It should be clear in the procedure that obtaining advocacy to support a resident with a complaint or referring a complaint to the CSCI can be made at any stage of a complaint. The local Social Services Dept contact details should also be included. Comprehensive records of complaints and concerns must be maintained by the home to evidence good practice. It is strongly recommended that the home continue in its efforts to achieve a minimum ratio of 50 of staff trained to NVQ level 2. This recommendation has been carried over from the last 2 reports. It is recommended that recruitment / induction records / staff files should evidence that staff employed by the home are given copies of the code of conduct and practice set by the GSCC. It is strongly recommended that the manager complete their stated intention to further develop the home’s training matrix, which provides a ready and clear overview of staff training needs. 6. OP15 7. OP16 8. OP28 9. OP29 10. OP30 Cherry Acre DS0000066219.V352251.R01.S.doc Version 5.2 Page 41 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 Cherry Acre DS0000066219.V352251.R01.S.doc Version 5.2 Page 42 - 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. 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