Inspection on 27/04/07 for Cherry Acre

This inspection was carried out on 27th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 23/10/07

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 Sue McGrath Key Unannounced Inspection 27th April 2007 09:30 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.V336231.R02.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.V336231.R02.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) 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.V336231.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th October 2006 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 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 well-maintained established 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 or stair lift to the second floor. A call bell is installed within each of the 17 single bedrooms; all bedrooms have television aerial points. Telephone points can be installed if required at the individuals’ own cost. No bedrooms have ensuite 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. Cherry Acre DS0000066219.V336231.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is a key unannounced inspection that took place on 27th and 30th June 2007 and was conducted by Sue McGrath, Regulation Inspector for the Commission for Social Care Inspection. The key inspections for care home services are part of the new methodology for The Commission For Social Care Inspection, whereby the home provides information through a questionnaire process and further feedback is gained through surveys sent to service users and relatives and information provided from professionals associated with the home, wherever possible. The actual date of the site visit is unannounced. At the site visit, service users and staff were spoken to, records were viewed and a tour of the environment was undertaken. Some judgements have been made through observation only. Some comment cards were completed during and after the inspection. Responses received from residents, relatives and health professionals indicated they were mostly satisfied with the standard of care. Some raised concerns about staffing levels, activities available to residents and the need for the home to be refurbished as at the last inspection. Statements on comment cards and discussions with visitors included: ‘There are not a lot of activities and I do get bored’ ‘The staff are very nice and I feel safe here’ ‘The home really does not need to be re decorated both inside and out’ ‘The promise of a lift has not materialised’ ‘I like looking out over the back garden and watching the birds’ The requirements made at the last inspection have not been fully complied with. The owners have managed the home for the past year and are aware they have to improve the service offered. Cherry Acre DS0000066219.V336231.R02.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The administration of medication remains poor with staff not being offered appropriate training. The owners are strongly advised to review the method of administration and ensure that appropriate training is sourced. Several areas of health and safety were poor including a lack portable electric testing (PAT) certificate, poor maintenance of the lifting equipment, lack of thermostatic mixers valve and no recording of water temperatures. Radiators remain unguarded and a satisfactory risk assessment has not been completed. Care planning continues to need to be developed to ensure residents’ needs are fully met. Staff training, especially medication training, needs to improve to ensure staff have adequate skills and knowledge to care for the residents. The owners require a lot of support with the service and are advised to consider employing experienced senior staff, possibly a manager. The quality of life would be improved for those residents with rooms on the first floor if a lift were to be installed. The plans for this are still being drawn up Cherry Acre DS0000066219.V336231.R02.S.doc Version 5.2 Page 7 and have taken a long time to be completed. The home is advised not to admit any more residents with mobility problems until it is installed. Access to the building needs to be improved with ramps and handrails fitted. Staff supervision must be more structured and carried out on a regular basis by competent and trained staff. An environmental risk assessment carried out by competent people with relevant qualifications and experience would assist the owners in identifying areas of risk to residents. Consideration must be given to installing thermostatic mixers valves to the sinks to regulate water temperatures. With the high number of residents who have visual impairment it is not sufficient to place a small warning notice above the sinks. Consideration must also be given to fitting radiator covers or undertaking a comprehensive risk assessment for each service user to ensure they remain safe and reduce any risk. It is strongly recommended that radiator guards be fitted. It is also recommended that the use of baby alarms at night be reviewed as this could be seen as an infringement of privacy. The owners must comply with all the requirements made at this inspection as many have been carried forward from the last inspection. 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.V336231.R02.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 Cherry Acre DS0000066219.V336231.R02.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, 2, 3, 4, 5 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents are not provided with accurate written information they need to make an informed choice about moving into the home. Prospective residents would benefit from a more in depth assessment prior to admission. Residents cannot be confident that their needs can be fully met at all times. Not all staff evidence they have the skills, knowledge and experience to deliver the services and care the home offers to provide. Cherry Acre DS0000066219.V336231.R02.S.doc Version 5.2 Page 10 EVIDENCE: The home’s statement of purpose has been updated by Mr Kumar but still does not reflect the requirements of Schedule 1 of the Care Home Regulations 2001. The owners will be required to produce a document, which meets Schedule 1, and to make it available to existing and prospective residents. Conversation with the family of a recently admitted resident confirms they were not supplied with this information prior to admittance. The home’s service users guide was made available to residents during the inspection, however the owners were advised to ensure it fully complies with the guidance available on the CSCI website. Mr Kumar states that all residents have written contracts that meet the guidelines from the Office of Fair Trading Guidelines for contacts in care homes, good practice advice and current legislation. The document was not inspected in detail on this occasion. Not all residents are aware they have a contract with the home. Evidence was seen that all prospective resident are assessed prior to admission. Relatives and a Care Manager from Medway Social Services confirmed this. However the assessments seen did not always contain a lot of information and would benefit from being more in depth. Families confirmed they visited the home prior to their relative’s admission and one resident confirmed that trial periods are part of the admission process. The manager is focussing on the necessity for all staff to be appropriately trained and continues to identify staff training needs. The manager is aware that the home cannot evidence that all staff individually and collectively have the skills and experience to deliver the services and care the home offers to provide. The training needs have now been identified and training must be put in place. Cherry Acre does not offer Intermediate Care services Cherry Acre DS0000066219.V336231.R02.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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents are put at some risk by inadequacies in the systems for care planning and medication. Residents are treated with respect. EVIDENCE: Mr Kumar has developed new care plans and these are now held separately for each resident, as required from the last inspection. Work needs to continue in developing these documents as the information in some is conflicting and does not give clear guidance to staff. The plans do not appear to have been drawn up with each resident and or their families. The care plan needs to set out in detail all of the aspects of health, personal and social care needs of the resident. None of the care plans had any information on social preferences or needs. Further work is required on Cherry Acre DS0000066219.V336231.R02.S.doc Version 5.2 Page 12 establishing safe systems of work to inform and guide staffs work with individuals. The care plans do not contain any nutritional risk assessments, adequate moving and handling assessments or skin integrity assessments. The plans must meet relevant clinical guidelines that are produced by the professional bodies concerned with older people and include risk assessments, with particular attention to the prevention of falls. Training is required in care planning and the involvement of resident, families and staff would improve the information gathered. Staff write in the daily logs but some inappropriate comments were seen in some plans. There is some evidence that advice and requests from other professional was not always acted upon or followed through at appropriate times. No outcomes are recorded following G.P. visits. Residents are registered with a local G.P. and the District Nurse visits regularly. Chiropody and opticians visits are arranged at cost to the resident. Although some residents had specialist equipment in place to prevent and treat pressure areas the assessment process was not recorded. If the home is unsure how to assess skin integrity it should consult with other professionals for advise. Nutritional assessment should be undertaken on admission and subsequently on a periodic basis. A record must be maintained of nutrition, including weight gain or loss and any appropriate action taken. Any resident with diabetes should have a risk assessment that gives clear guidance to staff on how to care for them. The reviews of care plans could be recorded better. Currently review dates are written on the front cover. It is advised that a separate sheet for reviews is added to the plan and any outcome recorded. Arrangements must be made to ensure all staff are aware of any changes to the care plans. Medication remains an area of concern. Staff practises seen on the day could put residents at risk from misadministration. None of the staff have attended an accredited training course and this is reflected in their knowledge and poor practise. Some staff have received a one-day training course but others have not. The owners must ensure that all staff that administers medication receive the appropriate training. Staff are not currently assessed as to their competency to administer medication. Cherry Acre DS0000066219.V336231.R02.S.doc Version 5.2 Page 13 Errors were found on the MAR sheets with some residents having been given more tablets that were dispensed for them i.e. paracetamol. On advise from the inspector more supplies were sourced. The home does have a new medication trolley. The keys for the new trolley were seen in an unlocked cupboard in the laundry room. The owner must ensure that these keys are secure at all times. Residents spoken with confirmed that the staff are pleasant and look after them well. Staff were seen to be friendly and supportive to residents and to use their preferred terms of address. Cherry Acre DS0000066219.V336231.R02.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): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents would benefit still further from a greater involvement in the programme of activities arranged and sufficient staff resources to support and encourage their participation in stimulating and motivating activities that are designed to suit all capacities inside and outside the home. Residents are supported to maintain contact with family and friends, which ensures they continue to receive stimulation and emotional support. EVIDENCE: A number of residents were in the lounge reading books; newspapers and others were watching television on the day of the visit. All spoken with felt the home tries to offer some activities, but some residents and their families indicate that insufficient appropriate activities are available. Cherry Acre DS0000066219.V336231.R02.S.doc Version 5.2 Page 15 Some residents kept to their rooms by choice. Residents commented that they felt able to choose how to spend their time during the day and staff respected their choices and preferences The owner gave a timetable of activities including weekly sing-alongs, mobile library services, monthly motivation classes, movie matinees and bingo. It was also stated that karaoke and birthday parties are arranged. The owner states that pub visits and shopping trips are arranged but the residents could not confirm this. The owner is strongly advised to record all activities and to consider having dedicated staffing hours for activities. Most of the residents spoken with said they would like trips out. The owner has a list of planned activities, which he now needs to activate. The owner confirmed that last Christmas the Salvation Army came to entertain the residents and recently some students came to talk to them. Traditional days such as St George’s day are celebrated. Written records could confirm these activities. Regular church services are available for residents if they wish to attend. Trips arranged by families for individual holiday should not be counted as activities arranged by the home. The home is advised to hold regular residents meetings to find out what sort of activities would be enjoyed by the residents. It appears that residents have previously expressed a wish to have the opportunity to attend residents meetings and be able to express views jointly with staff. It is advised that minutes from these meetings are maintained. Residents confirm they are able to have visitors at any reasonable time and can use their own rooms if they need to be private. The menus were viewed and residents mainly said the food was good, however a choice is not regularly given for the main meal of the day. Staff did confirm that the meal offered at teatime was flexible. It is recommended that a choice is given for the main meal and that this is recorded. During the breakfast meal some residents did not receive appropriate help because both the members of staff were administering medication. One resident was seen to leave her meal because she could not see the lip of the cup or her meal. This was remedied when highlighted to staff. Another resident was seen having difficulty in standing unaided. Cherry Acre DS0000066219.V336231.R02.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 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are protected by the home’s written complaints procedure. They would further benefit if it were made more freely available to them and their representatives and were available in other formats to meet all residents’ capacities. A staff group who are insufficiently aware of adult protection procedures does not have the potential to fully protect residents from the potential for abuse. EVIDENCE: The home has a complaints procedure, which is included in the service users guide. The procedure is clearly written and easy to understand. It could be improved by ensuring that it is widely distributed and has a high profile in the service. Several survey respondents stated they were unaware of the home’s complaints procedure. It could be further improved by ensuring it is available in formats to suit all individual capacities resident in the home. Residents spoken with had a good understanding of how to make a complaint and who to speak to should it be necessary. Most residents said they felt safe and their concerns were listened to. Cherry Acre DS0000066219.V336231.R02.S.doc Version 5.2 Page 17 The manager confirmed two complaints have been made since the last inspection and these had been dealt with appropriately. It is advised that all records of complaints are kept separate to ensure client confidentiality. The home has adopted the Kent and Medway’s Adult Protection Policy and staff need to be made aware of this. Some training has occurred since the last inspection but all the remaining staff require formal training. Adult Protection is included in the induction of new staff although this consists of an ‘in-house’ brief from the manager. Cherry Acre DS0000066219.V336231.R02.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, 20, 21, 22,24, 25 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home needs to be refurbished for the benefit of residents. Residents have access to comfortable indoor and outdoor communal areas. They would further benefit from improvements to the home’s health and safety systems, equipment and procedures including those for infection control and the safeguarding of all hot surfaces and water temperatures. EVIDENCE: Residents spoken with are largely happy with the home and enjoy the homely environment it offers them. They like their bedrooms and find the communal areas comfortable. All bedrooms at Cherry Acre offer single accommodation, Cherry Acre DS0000066219.V336231.R02.S.doc Version 5.2 Page 19 eight of the bedrooms are below 10sq.m (National Minimum Standards recommendation) but residents occupying these rooms are said to be happy with and accepting of the limitations. Residents spoken to say they had been given the opportunity to bring personal items into the home upon moving in and rooms appeared very personalised with pictures, family photos and ornaments. A tour of the building highlighted several areas of concern and the overall impression is that the home is in need of a general overhaul and redecoration. One room visited had problems with the sink; it was not draining properly and had a large crack that was leaking into the cupboards below. Although this was highlighted on the Friday remedial work had not been completed by the Monday afternoon when the inspection closed. Several of the toilets appeared stained and dirty. The owner said this was due to the enamel wearing off the surface making it difficult to keep them clean. It will be a requirement that damaged toilets be replaced. One visiting relative highlighted the lack of cleanliness in his relative’s room. The armchair was found to be dirty, the cushion looked as if it had never been moved. This family had decided to decorate the room themselves because they felt it ‘was not fit for purpose’ they also purchased new furniture. The owner denied this and said they choose to redecorate the room. Some of the bedroom furniture was in a poor condition. Several areas of carpeting were badly worn and or stained. The owner says he has plans to re carpet the home by September 2007. A programme of renewal of the fabric and decoration of the premises has been produced and now needs to be implemented with records kept. Some work had been completed in the laundry room following the last visit from the Infection Control Nurse. A new hand-washing sink has been fitted and some new shelves installed. New worktops have been fitted and some cupboards moved. This means that the floor covering now needs to be replaced, as there are areas of bare floor. Commodes are still being washed in this room and the home is recommended to consider installing a sluicing machine as required in the National Minimum Standards (26.6). A safe procedure for washing commode pots by hand was not evidenced. The home does have a nurse call system however the call point for the lounge was behind a chair and difficult to access. Staff confirmed this was the only call point available. It was also noted that the home uses two ‘Baby Alarms’ in two of the bedrooms. When queried staff said they used them for two residents who were downstairs so they could hear them through the night and enable them to be taken to the toilet. This appears to be an intrusion of their privacy Cherry Acre DS0000066219.V336231.R02.S.doc Version 5.2 Page 20 as they could be listened to at all times. The home must review the use if these items and reassess their management of safety of residents at night. There was no evidence that the said residents agreed to the use of this apparatus in their care plans. At the last inspection it was noted that none of the radiators had covers and the first floor windows did not have restrictors fitted. The manager stated at the last inspection that measures were to be put in place to reduce risks to residents wherever possible in the transitional period before improvements to the home began. It was agreed that the manager would complete a full environmental risk assessment for the home to identify current hazards and record actions taken to minimise risks and protect residents from harm. This risk assessment had not been completed and the risks remain. It will be a requirement that radiators that present a risk are covered and that window restrictors are fitted to all first floor windows. The risk assessments must take into account that several residents have a visual impairment. The manager will be required to have a full environmental assessment of the premises and facilities is made by a suitably qualified person, including a qualified occupational therapist with specialist knowledge of the client group catered for and provide evidence that the recommended disability equipment and environmental adaptations are made to meet the needs of the needs of the service users (NMS 22). Several residents, their families and care management raised the issue of the home not having a lift. The owner stated that plans are underway and that work was due to start soon. At this date the permission required from Medway’s Council Building Regulation Department has not been applied for. Mr Kumar was unclear if funding had been agreed with his bank or Medway Social Services. Medway Social Services confirmed they do not fund such alterations in private homes. It is strongly recommended that the problem with the lift is made a priority and a solution found. It is also recommended that no new residents with mobility problem be admitted to the first floor rooms. Cherry Acre DS0000066219.V336231.R02.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Due to current work practises there are not enough staff at peak times. There is a lack of qualified supervisory staff. The staffing structure and staffing levels in the home must be accurately reviewed to reflect residents personal and social care needs versus numbers and competencies of staff on duty. Although some recent improvements in access to staff training have been made, not all staff have the skills and knowledge required to ensure that a consistent high standard of care is being delivered. EVIDENCE: The home’s roster deploys two care staff on duty throughout any 24-hour period to meet the needs of up to 17 residents. This means that although residents basic needs are largely being met, there are times when this is not sufficient to respond to their individual needs as they would like or need. It will be a requirement that a risk assessment is undertaken in relation to individual residents care needs, maintenance of their choices and preferences Cherry Acre DS0000066219.V336231.R02.S.doc Version 5.2 Page 22 in daily living versus numbers and competencies of staff on duty. Some staff practises are taking staff off the floor i.e. two staff administering medication. If the home wished to continue with two staff it must provide extra staff to meet the needs of the service users at these times. During observation on the day of the site visit there was every indication that staff tried their hardest to meet service users needs efficiently and effectively. However, comments such as those made by residents and relatives are entirely understandable with the heavy demands placed upon staff at certain times. The owner has promoted one member of staff to a senior care post but she is only contracted for 25/30 hours per week. The manager is contactable out of hours by telephone. The manager must organise rosters to ensure that suitably qualified, competent and experienced staff are working at the care home to ensure residents are in safe hands at all times. The home has a total of 24 domestic hours for cleaning Monday to Friday. In the cleaner’s absence at weekends care staff take on additional cleaning tasks where necessary. 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’s two cooks are part time and only prepare the main mid day meal. From observation it was clear that ancillary staff are doing their best to maintain standards in the home, which is geographically quite large. However, there are areas that require improvement. This was reflected in comments received on surveys and in talking to residents and families and included: ‘Cleanliness not bad, but could do with a real ‘spring clean’’. It is the inspector’s opinion that the home has insufficient domestic hours. The home’s written recruitment procedure was found to be robust. Applicants are asked to complete an application form, with written references requested and a CRB/POVA check is undertaken before staff are offered employment. However the last two applicants CRB checked had not been returned. One had not been applied for as the owner was using one from a previous employer. This is not permitted and the owner is required to evidence that all staff have current CRB checks and supply the commission with that information. Most of the newer staff have not been issued with contracts of employment and the owners are strongly advised to take legal advise on this matter. The owner did say he was considering outsourcing employment responsibilities to ensure full compliance with employment law. The home does have a basic induction course in place but neither of the last two employees had entirely completed the course. It is recommended that the course be developed to ensure if fully complies with the Skills for Care from the Skills for Care website. These have been in place since October 2005. Cherry Acre DS0000066219.V336231.R02.S.doc Version 5.2 Page 23 The manager has a simplistic training matrix for staff, which could be further developed to give a clear overview of staff training needs. Most of the training recently undertaken was of the one-day ‘awareness’ type. There needs to be more in-depth training for some members of staff. For example, those individuals who undertake medication administration in the home require more in depth understanding. Some areas of staff training still require improvement, including ‘safeguarding adults’ and mandatory training to ensure residents basic needs are met. Moving and handling, health and safety and fire training are a priority. The owner did say most courses had been booked but not yet undertaken. The owner also said all staff who did not hold an NVQ in care were booked onto a course and were due to start soon and he hoped to be 100 in compliance by December 2007. Cherry Acre DS0000066219.V336231.R02.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33,35,36 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although enthusiastic poor management skills could put residents at risk. Current arrangements were not sufficient to fully protect the health, safety and welfare of residents and staff. EVIDENCE: The owner/manager has been in post for a year now and is aware of the problems in the home. Throughout the inspection he clearly had the residents welfare at heart and demonstrated openness and enthusiasm. However progress is slow and his good intentions need to be put into practise and work Cherry Acre DS0000066219.V336231.R02.S.doc Version 5.2 Page 25 completed. He remains highly motivated to achieve the necessary standard for Cherry Acre but does need to evidence his progress. 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. A survey of residents and their families was undertaken last December but nothing was done with the results. To evidence that the home is run in the best interests of the residents the owner must have effective quality assurance and quality monitoring systems in place that are based on seeking the views of residents, families and of stakeholders in the community i.e. GP’S, Chiropodists, and Care Managers. The results of such surveys should be published and made available to current and prospective residents; their representative and other interested parties, including CSCI (NMS 33). Only some staff appear 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 (NMS 36). The manager is advised to ensure appropriate records are clearly maintained in staff files. 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 individuals for whom the home took some responsibility. However when these were audited several did not balance. The inspector was not concerned there were any financial irregularities, but felt it was more indicative of poor management control. The manager would be well advised to seek more support and possibly employ a dedicated manager to help with the day-to-day running of the home. This was discussed with the owner but he felt there all of his staff were managers and he did not need to employ another named manager. Some health and safety concerns were highlighted during the visit, not least that all staff must receive appropriate guidance and training in safe practices and this must include the safe administration of medication, First Aid, Food Hygiene, Risk Assessments, Moving and Handling, and Fire safety. The home must be able to provide evidence that training has been undertaken. Poor management of health and safety is putting residents at risk. Staff have not received any training in fire safety although again the manager said this is planned. No evidence could be found of regular fire drills and this needs to be urgently addressed. The manager did say that he had arranged a fire drill last May (2006) but staff had not reacted the first time. This makes regular fire drills even more important. The fire system and emergency lighting was last service on the 28/04/06 and are now due to be serviced. Portable Appliance testing (PAT) is seven months overdue. Cherry Acre DS0000066219.V336231.R02.S.doc Version 5.2 Page 26 None of the sinks have thermostatic mixers valves fitted and when the water was run for several minutes it was scaldingly hot. It is not sufficient to place a notice saying the water is hot. Several residents would be unable to read this due to sight problems. If thermostaiv valves are not fitted, a comprehensive risk assessment must be in place to identify that each resident is individually capable of controlling risk and that other residents are unlikely to come into contact with excessively hot water. It is strongly recommended that water temperatures be recoded weekly. No evidence could be found that the home has a comprehensive risk assessment based approach to Legionella. This approach should consist of a legionella risk assessment, a scheme for prevention, evidence of managing control measures and an appointed, competent, person to be responsible. The home has one bath hoist and one general hoist. The last service date for the Oxford mini hoist was 16/05/06. Regulations state they should be serviced every six months. The owner did sent a copy of a worksheet following a breakdown but not a full service. The bath hoist was also overdue. No letter was received confirming any work being done on the bath hoist. Cherry Acre DS0000066219.V336231.R02.S.doc Version 5.2 Page 27 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 1 2 2 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 2 2 1 X 2 2 2 STAFFING Standard No Score 27 1 28 1 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 1 X 2 1 X 1 Cherry Acre DS0000066219.V336231.R02.S.doc Version 5.2 Page 28 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 Registered person shall keep under review and where appropriate revise the home’s statement of purpose and the service user guide. In that: 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 new service. The contents must be clear, comply fully with regulation, be kept up to date and include a revised complaints procedure. A copy to be provided to the CSCI. An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale stated. This requirement has been carried over from the last report. Timescale for action 29/06/07 Cherry Acre DS0000066219.V336231.R02.S.doc Version 5.2 Page 29 2. OP7 14 (2) (b) 15 (1) (2) (a)-(d) 17 Schedule 3Schedule 4 The Registered Person shall maintain records as specified in Schedules 3 and 4. The registered person shall keep the service user’s plan under review In that: Individual plans of care and records must be kept, be up to date and reviewed at least once a month. The contents must be consistent and specific in detail of information. The plans must be signed by the individual or their representative to evidence their involvement in its formulation and agreement to the plan. It must be kept securely in the home. An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale stated. This requirement has been carried over from the last report. 29/06/07 3. OP9 13(2) 18 1(a) The Registered Person shall make arrangements for the recording, handling, safe administration and disposal of medicines received in the care home. In that: The home’s medication policy and procedures must be revised and updated to ensure that medicines in the custody of the home are handled according to the requirements of The Medicines Act 1968, guidelines from the Royal Pharmaceutical Society, ‘Administration and Control of Medicines in Care 29/06/07 Cherry Acre DS0000066219.V336231.R02.S.doc Version 5.2 Page 30 home’s’, The Misuse of Drugs Act 1971. Staff must adhere to the home’s policy and procedures for the safe administration of medicines. Staff must be suitably trained to administer medication. Staff must be regularly assessed for ongoing competency with regard to the administration of medication and records maintained. Keys relating to medication storage areas/ trolleys to be kept secure and a policy and procedure for handing over the responsibility for keys are established. The home must store medication trolleys/ medicines received into the home in secure areas. Written temperature records for the correct storage of medicines in the home must be maintained. This requirement has been carried over from the last report. 4. OP16 22 (1) (2) (5) (6) (7) (8) The registered person shall establish a complaints procedure for considering complaints made to the provider by a resident or their representative. The complaints procedure shall be appropriate to the needs of the service user. In that: the complaints procedure must be reviewed, revised and re-distributed to all DS0000066219.V336231.R02.S.doc 29/06/07 Cherry Acre Version 5.2 Page 31 interested parties. It should be available in other formats to suit all individual capacities resident in the home. 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. Records of complaints must be maintained by the home. An improvement plan detailing how the service will address this must be forwarded to the Commission This requirement has been carried over from the last report. 5. OP18 13 (6) The registered person shall make 29/06/07 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. This requirement has been carried over from the last report. 6. OP25 13 (4) (a) (c) The Registered Person shall ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety and any activities in which service users participate are so far as reasonably practicable free from avoidable risks. Unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. DS0000066219.V336231.R02.S.doc 29/06/07 Cherry Acre Version 5.2 Page 32 In that: Radiators in residents bedrooms and in some other areas 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. Any service user whose sensory capacity to recognise danger from heat should have this risk detailed in their care documentation. 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 last report. 7. OP27 18 1 (a) The Registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. In that: A risk assessment must be undertaken in relation to residents care needs versus numbers and competencies of staff on duty. The risk assessment, the methodology used and the outcome are to be forwarded to the Commission. An improvement plan detailing Cherry Acre DS0000066219.V336231.R02.S.doc Version 5.2 Page 33 29/06/07 how the service will address this must be forwarded to the Commission within the timescale indicated This requirement has been carried over from the last report. 8. OP27 18 1 (a) The Registered person shall, 29/06/07 having regard to the size of the care home, the statement of purpose and the number and needs of service users ensure domestic staff are employed in sufficient numbers to ensure that the home is maintained in a clean and hygienic state, free from dirt and unpleasant odours. In that: There must be a realistic and accurate review of domestic hours to demonstrate that the home’s arrangements can fulfil its obligations within the regulations and standards with reference to the size of the home to be cleaned and the needs of service users resident there. The methodology used and the outcomes are to be forwarded to the Commission and included in the improvement 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 last report. 9. OP30 18 1(a) The registered person shall make 29/06/07 arrangements for staff to receive DS0000066219.V336231.R02.S.doc Version 5.2 Page 34 Cherry Acre training in all aspects of care and safe practice and is to include: First Aid Moving and Handling Care Planning Health & Safety Risk assessment Infection Control Fire Training Food hygiene. 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 last report. 10. OP33 12 1(a) The registered Person shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users. In that: The home’s policies and procedures must be reviewed and revised to ensure they comply with current legislation and good practice guidelines and kept under review thereafter. 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 last report. 11 OP22 16(1) 23(2) The registered person shall 29/06/07 having regard to the number and DS0000066219.V336231.R02.S.doc Version 5.2 Page 35 29/06/07 Cherry Acre needs of the service users ensure that the physical design and layout of the premises meets the needs of the service users. In that an assessment of the premises and facilities have been made by a suitably qualified person, including an occupational therapist, with specialist knowledge of the client group catered for and provides evidence that the recommended disability equipment has been provided and environmental adaptations made to the needs of the service users. An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale indicated. 12 OP33 24 The registered person shall establish and maintain a system for evaluating the quality of the services provided at the care home. The registered provider must ensure safe working practises including regular fire drills and 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. 14 OP38 13(5) The registered provider must ensure the health and safety of service users and staff by having safe working practises in place for moving and handling of people and objects that avoids injury to service users and staff. 29/06/07 29/06/07 13 OP38 Schedule four 23(4)(c) (d)(e) 29/06/07 Cherry Acre DS0000066219.V336231.R02.S.doc Version 5.2 Page 36 An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale indicated. 15. OP38 16(2)(g) The registered person must ensure the health and safety of service users and staff by being able to demonstrate that equipment used to move, lift or transfer service users is fully maintained. Written evidence of this must be supplied to the Commission by the end of June 2007. The registered provider must ensure the health and safety of service users and staff by including regulation of water temperature and design solutions to control risk of legionella and risks from hot water. 29/06/07 16. OP38 16(2)(g) 29/06/07 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 OP8 Good Practice Recommendations It is recommended that nutritional screening be undertaken for residents on admission and subsequently on a periodic basis, a record maintained of nutrition including weight gain or loss. Records to show appropriate action taken. This recommendation has been carried over from the last report. It is strongly recommended that residents moving and handling risk assessments are improved to give clearer guidance to staff. DS0000066219.V336231.R02.S.doc Version 5.2 Page 37 2. OP10 Cherry Acre This recommendation has been carried over from the last report. 3. OP10 Induction and training for all staff is to include the issues surrounding Privacy, Dignity and Respect. This recommendation has been carried over from the last report. 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. 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 strongly recommended that the home’s routines and working schedules are reviewed to ensure residents rights and choices are promoted. This recommendation has been carried over from the last report. It is recommended that residents’ menus are displayed illustrating a choice of meals and that availability of ‘choice’ is explained and facilitated for residents. This recommendation has been carried over from the last report. It is strongly recommended that now the home produce a written programme of routine maintenance and renewal of the fabric and decoration of the premises it is acted upon. Copy should be sent to CSCI upon completion and included in the home’s improvement plan. This recommendation has been carried over from the last report. 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 report. 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. DS0000066219.V336231.R02.S.doc Version 5.2 Page 38 4. OP12 5. OP14 6. OP15 9. OP19 10. OP28 11. OP30 Cherry Acre This recommendation has been carried over from the last report. 12. OP24 Lockable storage should be provided for all residents This recommendation has been carried over from the last report. It is recommended that the stained and damaged toilets be replaced. It is recommended that the use of a baby alarm at night is reviewed and the safety of service users at night is also reassessed. 13. 14. OP26 OP19 Cherry Acre DS0000066219.V336231.R02.S.doc Version 5.2 Page 39 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. 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