Inspection on 06/10/06 for Cherry Acre

This inspection was carried out on 6th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 27/04/07

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 6th October 2006 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.V315580.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.V315580.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) 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.V315580.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13 /10 /2005 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 £400 per week according to assessed personal need. Cherry Acre DS0000066219.V315580.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, Regulatory Inspector between 9:30 a.m. and 3:45 p.m. During that time the inspector spoke to some residents, staff and visitors to the home. Mr Uday Kumar and Mrs Kiranjit Juttla Kumar are the registered providers of the home and assisted with the inspection throughout the day. Mr Kumar also operationally manages the service. Some judgements about the quality of life within the home were taken from observations and conversation. Some records and documents were looked at. In addition a tour of the building was undertaken. Some comment cards were received prior to the inspection. Responses received from residents, relatives and health professionals indicated they were mostly satisfied with the standard of care. Some individuals raised concerns about staffing levels, activities available to residents and the need for the home to be refurbished. Statements on comment cards included: “Overall pleased with the home, but feel it should be updated a bit - care seems very good” “Staff help me all they can, they are good” “I feel there should be more for my relative to do” “Concerned about staffing - 3 staff needed at times, especially at night” “Cleanliness not bad, but could do with a real ‘spring clean’ This is the first inspection of the home undertaken since registration of the new owners was approved on the 22nd May 2006. The new owner/manager is therefore in the process of work to update the service. The home is currently in a transitional stage, in the process of development and with plans for the future. This has been taken into consideration within the inspection process. The manager and staff gave their full cooperation throughout the visit. Cherry Acre DS0000066219.V315580.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 the availability of information about the home being up to date. The home’s policies, procedures and codes of practice require extensive review to ensure they meet the demands of current legislation and good practice. Residents would benefit from a greater involvement in the programme of activities arranged and sufficient staff resources to support and encourage participation in activities designed to suit all capacities inside and outside the home. Residents’ health, personal and social care needs would be better promoted by the further development of the home’s current care planning system to ensure that all staff know exactly how to care for individuals living in the home. Care plans must be regularly reviewed. Residents’ individual care plans and daily-monitoring records must be maintained separately in accordance with regulation. Systems and procedures must be established to protect residents’ personal information and maintain confidentiality. The home’s systems of work, staff knowledge and lack of facilities for the safe storage of medicines put residents at potential risk of harm. Residents would benefit from improvements to the home’s health and safety systems, equipment and procedures including those for infection control. Cherry Acre DS0000066219.V315580.R01.S.doc Version 5.2 Page 7 Although recent improvements in access to staff training have been made, not all staff can evidence the skills and knowledge required to ensure that a consistent high standard of care is being delivered. 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. The home must start to develop quality assurance systems. 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.V315580.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cherry Acre DS0000066219.V315580.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1.2. 3. 4. 5. 6. Quality in this outcome is adequate. This judgement has been made using available evidence including a site 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 the availability of information about the home that is brought up to date for them to base their decisions upon. The personalised needs assessment means that people’s diverse needs are identified and planned before they move to the home. Residents cannot be confidant 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.V315580.R01.S.doc Version 5.2 Page 10 EVIDENCE: Upon the registration of the new owners on the 22nd May 2006, the manager had summarily updated the home’s original Statement of Purpose and Service User Guide to reflect the new ownership details. The original home’s brochure was still being used. Some further review and amendment would provide prospective and current residents and their representatives with more detailed and up to date information about the new service at Cherry Acre and would ensure the documents meet the requirements of regulation. It was advised that the manager show a clear formulation and review date and sign all of the home’s information, codes of practice and policy and procedure documents. The home’s complaints procedure is included in the service user guide. The manager demonstrated a clear understanding regarding the category and needs of residents that the home could meet. The manager visited prospective residents prior to admission to make a decision whether the home could meet the person’s needs. Information was obtained from other interested parties, including relevant health care professionals, to assist in the assessment process. Residents or their representatives were able to visit the home before moving in and some residents said that staff had been very helpful in assisting them to settle in. Each resident or their representative had been provided with a contract between the home and themselves. The manager stated that the contract clearly stated the responsibilities of the owners and the individual rights of the resident. The manger also spoke of his intention to check the contract to ensure that it met with the Office of Fair Trading Guidelines for contacts in care home’s, good practice advice and current legislation. The document was not inspected in detail on this occasion. The home 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. Cherry Acre does not offer Intermediate Care services Cherry Acre DS0000066219.V315580.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7. 8. 9. 10. 11. Quality in this outcome is poor. This judgement has been made using available evidence including a site visit to this service. Residents’ health, personal and social care needs would be better promoted by the further development of the home’s current care planning system to ensure that all staff know exactly how to care for individuals living in the home. Systems and procedures must be established to protect residents’ personal information held by the home. The home’s systems of work, staff knowledge and lack of facilities for the safe storage of medicines put residents at potential risk of harm. EVIDENCE: All residents had a care plan. Although it was clear efforts were being made to improve care planning systems and some staff had received a one day care practice training course, they were not adequate in regard to comprehensive detail and consistency of information in some parts. Those seen had not been Cherry Acre DS0000066219.V315580.R01.S.doc Version 5.2 Page 12 formally reviewed on a monthly basis and had not all been signed by the resident or their representative to show their involvement in and agreement to the plan. The manager demonstrated a sound knowledge and understanding of residents needs and was able to fill in gaps in information when questioned. Some advice received from health professionals had not been written down. A survey card from a health professional received prior to the inspection also included the comment that specialist advice is not always incorporated into residents individual plans of care and that not all staff demonstrate a clear understanding of residents needs in the home. Residents’ daily monitoring records were being maintained. Evidence was seen of an entry that recorded ‘all care given’ which is not helpful or adequate. Daily records when well written, help senior staff to audit the care provided and ensure that staff are following guidelines given in the care plan. It is in the home’s interests to be able to show what they have done for a resident and provides evidence on which to base reviews and to record they are following the assessment of a residents needs. The amount of detail in entries is inconsistent and dependent on the staff member completing the record. Records did not always stipulate the time the report was completed and the time events took place or care was provided. Resident’s individual care plans and daily monitoring records are not maintained separately in accordance with regulation. They need to be accessible to the person to whom they relate and in a form that enables that. Personal information relating to each individual resident should not be fragmented around the home and must always be kept securely. A staff communication book, in the form of a lined exercise book evidenced numerous entries regarding residents’ personal details in relation to their health and welfare with no regard to the protection of this personal information. The staff information file in relation to residents care needs and the staff communication book were left in a communal area of the home where it could potentially have been accessed by anyone. Risk assessments were completed for each resident where necessary. Assessments completed recorded outcomes and identified levels of risk. Some showed what actions were to be taken by staff to eliminate or reduce the risk. Further work is required on establishing safe systems of work to inform and guide staffs work with individuals. Risk assessments although available to staff were attached to residents bedroom furniture, which did not protect their privacy and dignity. This should be addressed. Documentation seen confirmed that all residents had access to a GP and visits from other health professionals were arranged and enabled. No residents currently had pressure areas. The manager said that risk assessments and treatment plans would be maintained for the individual if this were the case. Cherry Acre DS0000066219.V315580.R01.S.doc Version 5.2 Page 13 Not all care plans evidenced weight monitoring records for residents. The manager stated the home had access to stand on scales, which should accommodate the needs of all residents. Some files require audit. Information that has been superseded or changed needs to be removed to eliminate confusion and to ensure that files remain current at all times. The home has a Monitored Dosage System to assist with the administration of residents’ medication. The metal trolley to store the home’s medicines was kept in the residents’ dining room and was aged. It had a padlock fitted to the front storage cupboard. The draws above were not lockable and when inspected were found to contain residents eye drops, ointments and tablets. The monitoring of and records required in relation to medication storage temperatures was not being maintained. The medication trolley was constantly stored in a communal area of the home. The keys to the medication trolley were laying on another trolley nearby and had not been securely locked away or kept with the person responsible for the administration of medication in the home. Medication administration records were largely in good order with no obvious gaps in recording. Some staff had received one-day medication administration courses in the past and more are planned. It was advised that more in-depth training is required to ensure medication and health care practice offered by the home is safe for residents. Only staff with proven skills and whose ongoing competency is regularly assessed should be given responsibility for medication. The home’s admission process does not encourage residents to keep and administer their own medication in line with current good practice guidelines and the home has no formal process for establishing their capacity to do so. The manager is aware that improvements must be made to the home’s systems of work and procedures and was open to the suggestion that a referral be made to the CSCI Pharmacy Inspector for further professional assessment and guidance. The manager stated his intention of replacing the medication trolley as soon as a new one could be obtained and accessing guidance documents on ‘The Administration and Control of Medicines in Care home’s’ Death and dying in the home were handled appropriately. Not all residents’ wishes were recorded but the manager was able to give verbal accounts of the arrangements required for individuals. Cherry Acre DS0000066219.V315580.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Quality in this outcome is adequate. This judgement has been made using available evidence including a site visit to this service. Residents find the lifestyle experienced in the home largely matches their expectations and preferences. The home’s routines of daily living would benefit from review to ensure residents’ rights and choices are promoted. Opportunities for residents to participate in social activities within the home have improved. 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. EVIDENCE: The manager said activities available to residents in the home had improved. There is now a movie matinee every Monday, a library service open every Tuesday morning and a musical entertainment every Wednesday. The home also offers sessions entitled exercise, mind and body every six weeks. An external provider provides this activity. Residents spoken with also mentioned Cherry Acre DS0000066219.V315580.R01.S.doc Version 5.2 Page 15 Bingo sessions. No community-based activities were mentioned either in the home’s pre inspection information supplied or by residents. The majority of surveys received from residents indicated that activities are available ‘sometimes’ in the home and they would generally like more activities and outings to be arranged. 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 tried to offer activities, but acknowledged that it was difficult to please everyone and staff was kept very busy with other tasks. 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. It appears that residents had previously expressed a wish to have the opportunity to attend residents meetings and be able to express views jointly with staff. The new owners held a relatives and residents meeting to introduce themselves on purchasing the home, which was well received. It was observed that there were only two staff on duty on each shift to meet residents individual needs and to undertake residents laundry which leaves them little time to support and encourage residents participation individually or collectively in stimulating, motivating and meaningful activities that are designed to suit all capacities. The home has several residents who spoke of their sensory impairments and whose needs for stimulation through leisure and recreational activities are not noted specifically in their plans of care. The home should consider whether residents have been expected to be overly compliant with the home’s routines rather than the home providing sufficient resources to ensure they meet residents’ individual choices and wishes in their home. As plans for improvement by the new owner are being formulated, this is an area where residents could be involved in decision making about future daily routines and activities. Family and friends felt welcome and knew they could visit the home at any reasonable time. The design of the home provided small seating areas within the communal living area of the home where residents could entertain their visitors in addition to the privacy of their own room. The home employs two part time cooks. The particular likes and dislikes of residents are known to the cooks. The cook spoken with confirmed that a second choice to the daily menu is available if they know someone doesn’t like or can’t eat something. It was advised that the home’s printed menu displayed in the residents’ dining room show the alternative choices of meal available to them. Most residents said meals were good and tasty. Cherry Acre DS0000066219.V315580.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 18 Quality in this outcome is adequate. This judgement has been made using available evidence including a site 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.V315580.R01.S.doc Version 5.2 Page 17 It should be clear in the complaints procedure that obtaining advocacy to support a resident with a complaint or referring a complaint to the CSCI can be made at any stage and not only when the complaint process in the home fails. The manager stated that no complaints or concerns have been raised with the home since the last inspection and therefore no records are currently maintained. Some staff have now received one day adult protection training. It is vital that all staff receive this training for the protection of residents in their care. Adult Protection is included in the induction of new staff although this consists of an ‘in-house’ brief from the manager. Some of the home’s policies in relation to adult protection would benefit from review and updating in line with new legislation and current good practice guidance. Cherry Acre DS0000066219.V315580.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 20 21 23 24 25 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit to this service. Residents benefit from living in a homely and comfortable environment where they are able to access all 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. EVIDENCE: Residents spoken with were largely happy with the home and enjoyed the homely environment it offered them. They liked their bedrooms and found the communal areas comfortable. All bedrooms at Cherry Acre offer single accommodation, eight of the bedrooms are below 10sq.m (National Minimum Standards recommendation) but residents occupying these rooms were said to Cherry Acre DS0000066219.V315580.R01.S.doc Version 5.2 Page 19 be happy with and accepting of the limitations. Residents spoken to said 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. While touring the building some infection control issues were discovered and discussed with the manager. There was liquid soap available but no paper towels in communal toilets accessed by residents and visitors. Ordinary domestic hand towels are used by the home. This practice has the potential to compromise the home’s infection control policy and places individuals at risk. The home’s laundry is housed in a small room equipped with an industrial washing machine and tumble dryer. There is one sink in the room, which is used for laundry purposes and also for washing out commode pots. Suitable personal protective equipment for staff was in evidence for this task with the exception of facial and eye protection to avoid contamination from splashing with body fluids and cleaning chemicals. A safe procedure for washing commode pots by hand was not evidenced. There is no designated hand washing facility available to staff in the room. Staff commented how difficult it was to ensure all continence aids are dried sufficiently well in the available space during inclement weather. The room was cramped and storage areas would benefit from reorganisation. The home has an infection control policy and this element of good care practice is mentioned on staff induction. The home’s policy requires review and revision to ensure it complies with current good practice guidelines and legislation. It was agreed with the manager that the home would benefit from a full infection control audit and guidance from the Kent Health Protection Team. The home is looking tired and is now in need of refurbishment. A programme of renewal of the fabric and decoration of the premises should be produced and implemented with records kept. One bedroom was found to smell strongly of urine, as did the wooden commode in the room. The manager was advised to replace this item. The manager was aware of the unpleasant odour and had recovered the floor with a washable non-slip surface. The decision to use a floor covering that was not carpet and therefore different from the facilities offered to other residents in the home was not appropriately recorded and therefore no agreement with the individual occupying the room or their representative could be evidenced. The manager said this action had been taken because the resident’s needs indicated this to be necessary. Vinyl flooring and linoleum are not normally an acceptable equivalent to carpeting. Once the room is vacated, it is the expectation that carpeting be provided to any new resident. Cherry Acre DS0000066219.V315580.R01.S.doc Version 5.2 Page 20 The kitchen was clean and the home had received a visit from the Environmental Health Officer on the 26th September 2006. Temperature records were being maintained for cold food storage. The dry food store was not located in the main kitchen. It was discussed with the manager that the floor covering in this small room was in the inspector’s opinion, not clean. The home’s dishwasher in the main kitchen was said to be functioning poorly and would benefit from replacement. The manager is aware that not all radiators and pipe work in resident accessible areas are protected, neither are there window restrictors on resident’s bedroom windows on the first floor of the home. The manager stated that measures are in place to reduce risks to residents wherever possible in this transitional period before improvements to the home begin. 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. A copy must be sent to the CSCI. It was taken into consideration during the inspection that the current owner/manager had inherited the situation found in the home and is keen to have issues identified and to receive clear guidance as to how to address them. Cherry Acre DS0000066219.V315580.R01.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 30 Quality in this outcome is poor. This judgement has been made using available evidence including a site visit to this service. There are not enough staff at peak times and 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 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: Residents and their relatives spoke well of the staff saying that they were friendly and helpful. It was not evident however that staffing levels in the home were adequate at all times. This view was echoed in statements included in comment cards received prior to the inspection which included: “Concerned about staffing - three staff needed at times, especially at night” and “Staffing should be reviewed, inadequate” Cherry Acre DS0000066219.V315580.R01.S.doc Version 5.2 Page 22 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 in daily living versus numbers and competencies of staff on duty. The completed assessment must be forwarded to the Commission. Residents Survey forms received prior to the inspection indicated that there are occasions when staff are ‘sometimes’ not available to meet residents needs. One comment indicated that staff do not always listen and act upon requests for assistance. 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 are entirely understandable with the heavy demands placed upon staff at certain times. There is currently no supervisory or senior staff to take responsibility when the manager is not in the home. 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. This is particularly important as experienced staff have left the home since the last inspection and new staff have been appointed. The home has a total of 25 Domestic hours rostered for cleaning Monday 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. 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 prior to the inspection and included: ““Cleanliness not bad, but could do with a real ‘spring clean’ “ The home’s 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. A selection of staff files were viewed which evidenced this practice. Staff files contained most of the elements required by regulation. Staff are issued with a contract of employment and a job description and are subject to an initial probationary period during which time they follow an induction-training programme. This programme was seen and would enable staff to understand what is expected of them and give them a good overview of how to care for residents. Induction is undertaken ‘in house’. To date no new staff are Cherry Acre DS0000066219.V315580.R01.S.doc Version 5.2 Page 23 undertaking the formal induction and foundation training which is required for all new care staff within the first six months of employment. It was noted that there had been some recent improvement to staffs access to training courses. 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. Some areas of staff training still require improvement, including ‘safeguarding adults’ and mandatory training to ensure residents basic needs are met, such as moving and handling, health and safety and fire training. Data provided by the manager showed that 4 of the home’s carers have a NVQ qualification in care. This does not meet the minimum standard of 50 of the staff group. Cherry Acre DS0000066219.V315580.R01.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 34 35 36 37 38 Quality in this outcome is adequate. This judgement has been made using available evidence including a site visit to this service. New management arrangements are now in place. Residents benefit from a qualified and caring manager who has robust plans for improvement which should result in better outcomes for people using the service. Residents would further benefit from the manager providing clear evidence of a staffing review and rotas that take into account good practice requirements, the supervisory needs of staff and periods of high and low activity in the home. The home’s policy and procedure documents require review and revision to ensure residents’ rights; welfare and best interests are safeguard. Cherry Acre DS0000066219.V315580.R01.S.doc Version 5.2 Page 25 EVIDENCE: The new owner/manager has completed the NVQ level 4 Registered Managers Award. Throughout the inspection he clearly had the residents welfare at heart and demonstrated openness and honesty. Staff and residents appeared to feel comfortable in his presence and said he was approachable and supportive. He is aware that the home requires updating both environmentally and in terms of policy and procedure, codes of practice and systems of work. He also knows this will take some time to achieve but states that he has firm plans for improvement and remains highly motivated to achieve the necessary standard for Cherry Acre. He evidenced that he was keen to gain as much guidance and advice as possible to assist in his plans and was therefore keen to receive a visit from the CSCI Pharmacy Inspector and an officer from The Health Protection Team. The home has been referred to both individuals. The manager had received no complaints and had no record of any concerns raised by stakeholders in the service. 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. Staff records mainly complied with regulation. Formal supervision has now been implemented for most staff. The content of supervision notes viewed was constructive, well-recorded and identified staff training needs. Residents would benefit from the manager providing clear evidence of a staffing review to address staffing issues mentioned elsewhere in the report. The home’s rotas must in future take into account good practice requirements, the supervisory needs of staff and periods of high and low activity in the home. The home encouraged residents’ relatives/ representatives to give assistance with the management of their finances. There was a sound system for holding and recording residents cash for those individuals for whom the home took some responsibility, which facilitated ease of monitoring. Resident’s individual care plans and daily monitoring records are not maintained separately in accordance with regulation. They need to be accessible to the person to whom they relate and in a form that enables that. Personal information relating to each individual resident should not be fragmented around the home and must always be kept securely. The manager stated his intention to reorganise the home’s records to ensure they preserve individual confidentiality. 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 for the home’s Cherry Acre DS0000066219.V315580.R01.S.doc Version 5.2 Page 26 medication administrators, First Aid, Food Hygiene, Risk Assessment, Moving and Handling training, and Fire safety. Diligence also needs to be paid to infection control procedures. It is noted that the home has made some progress with booking training for staff. Due to the current level of staff competency evidenced and the ongoing recruitment of new staff, there is a need for this to remain a firm focus for the home. Cherry Acre DS0000066219.V315580.R01.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 2 3 3 2 3 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 3 3 X 3 2 2 2 STAFFING Standard No Score 27 1 28 1 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 3 3 3 2 1 Cherry Acre DS0000066219.V315580.R01.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. Timescale for action 14/12/06 2 OP7 OP37 14 (2) (b) 15 (1) (2) (a)-(d) “The Registered Person shall maintain records as specified in Schedules 3 and 4. The DS0000066219.V315580.R01.S.doc 14/12/06 Cherry Acre Version 5.2 Page 29 17 Schedule 3 Schedule 4 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. 3 OP9 OP30 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 home’s’, The Misuse of Drugs Act 1971. 14/12/06 Cherry Acre DS0000066219.V315580.R01.S.doc Version 5.2 Page 30 • 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. Service users are able to take responsibity for their own medication if they wish within a risk assessment framework and the home must have a formal process for establishing service users capacity to do so. 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. A specialist in this field Version 5.2 Page 31 • • • • • • • Cherry Acre DS0000066219.V315580.R01.S.doc must check medication administration and procedures. i.e. the CSCI Pharmacy Inspector. An improvement plan detailing how the service will address this must be forwarded to the Commission 14/12/06 “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 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 The registered person shall make 14/12/06 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. “The Registered Person shall ensure that all parts of the home DS0000066219.V315580.R01.S.doc 4 OP16 22 (1) (2) (5) (6) (7) (8) 5 OP18 13 (6) 6 OP25 13 (4) (a) (c) 14/12/06 Cherry Acre Version 5.2 Page 32 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. 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. 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 DS0000066219.V315580.R01.S.doc 14/12/06 Cherry Acre Version 5.2 Page 33 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 how the service will address this must be forwarded to the Commission within the timescale indicated 8 OP27 18 1 (a) 14/12/06 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 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 9 OP30 OP38 Cherry Acre 18 1(a) The registered person shall make 14/12/06 arrangements for staff to receive training in all aspects of care and DS0000066219.V315580.R01.S.doc Version 5.2 Page 34 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 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. 14/12/06 Cherry Acre DS0000066219.V315580.R01.S.doc Version 5.2 Page 35 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. It is strongly recommended that residents moving and handling risk assessments are removed from their bedroom furniture to ensure privacy and dignity is protected and respected at all times. Induction and training for all staff is to include the issues surrounding Privacy, Dignity and Respect. 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. It is recommended that access to personal records, in accordance with the Data Protection Act 1998 be facilitated for residents as well as opportunities to help maintain their personal records. It is strongly recommended that the home’s routines and working schedules are reviewed to ensure residents rights and choices are promoted. It is recommended that residents’ menus are displayed illustrating a choice of meals and that availability of ‘choice’ is explained and facilitated for residents. It is strongly recommended that the home produce a written programme of routine maintenance and renewal of the fabric and decoration of the premises. Copy should be sent to CSCI upon completion and included in the home’s improvement plan. It is strongly recommended that the needs of the individual occupying the uncarpeted bedroom be discussed within a multi disciplinary setting with them or their representative’s full involvement and presence. The outcome to address specific needs must be accurately recorded in a plan of care. The room should be equipped and furnished to assure as much comfort as possible and be kept clean, hygienic and free from offensive odour. DS0000066219.V315580.R01.S.doc Version 5.2 Page 36 2 OP10 3 4 OP10 OP12 5 OP14 OP37 6 7 8 OP14 OP15 OP19 9 OP24 OP7 OP8 Cherry Acre 10 OP26 OP38 11 12 13 OP28 OP30 OP33 It is very strongly recommended that the manager complete their stated intention to implement any recommendations made by the Health Protection Team following the assessment of equipment and the environment in the home. 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. 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. It is recommended that effective quality assurance and monitoring systems based on a systematic cycle of planning-action-review are introduced Cherry Acre DS0000066219.V315580.R01.S.doc Version 5.2 Page 37 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.V315580.R01.S.doc Version 5.2 Page 38 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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