Inspection on 10/04/06 for Clarence House

This inspection was carried out on 10th April 2006.

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

Clarence House 08/03/10

Clarence House 10/11/09

Clarence House 15/10/08

Clarence House 14/02/08

Clarence House 16/04/07

Clarence House 29/08/06

Clarence House 03/11/05

Clarence House 28/04/05

Clarence House 11/01/05

Clarence House 20/10/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Clarence House Clarence House 42 Warwick New Road Leamington Spa CV32 6AA Lead Inspector Jean Thomas Key Unannounced Inspection 10th April 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 Clarence House DS0000040534.V288530.R01.S.doc Version 5.1 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. Clarence House DS0000040534.V288530.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Clarence House Address Clarence House 42 Warwick New Road Leamington Spa CV32 6AA 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) 01926 832826 01926 882677 Dr Jeyaratha Sivasoruban Mr Kanagasabai Sivasoruban Mr Kanagasabai Sivasoruban Care Home 21 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (16) of places Clarence House DS0000040534.V288530.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. RECOMMENDED CONDITIONS OF REGISTRATION That the Registered Manager enrols for appropriate training to obtain a qualification in the management of a care home at NVQ Level 4 and that he obtains this qualification by 1 April 2005. That until the Registered Manager has obtained a qualification as a care home manager at NVQ Level 4 the Registered Providers will employ a person as Deputy Manager who is suitably experienced/qualified in the supervision of staff who are providing personal care to elderly people. That the Registered Providers will notify the Care Standards Commission of the name and qualifications of the Deputy Manager. That on any change of Deputy Manager the Registered Providers will notify the Care Standards Commission of the name and qualifications of the new Deputy Manager. Date of last inspection 3rd November 2005 Brief Description of the Service: Clarence House is a large Victorian property that was converted from a hotel to a care home in 1984. The home has parking to the front and garden at the rear. There is a ramped access to the front door. The home is situated ¾ of a mile from the town centre with all major facilities readily accessible. The home provides residential care for 21 older people (including 5 people with dementia care needs) with a wide range of needs, e.g. physical disability, sensory loss, general frailty and other conditions often associated with old age. The accommodation is arranged on three floors, there is a shaft-lift and a chair lift to ensure accessibility. On the ground floor there are two communal lounges with a dining room situated between them. Also on the ground floor there are four single bedrooms and one double bedroom. On the first floor and mezzanine floors there are seven single and one double bedroom. On the top floor there are a further three bedrooms, one of which is a double room with an ensuite which is currently being refurbished. The fees for the rooms currently payable are in the range £338.00 - £465.00 per week and payable in advance by either cheque or standing order. Clarence House DS0000040534.V288530.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for service users and their views of the service provided. This process considers the care home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. This unannounced inspection took place over two days and commenced at 10.15am on Monday April 10, 2006 and finishing at 4.30pm and again at 10.30am on Tuesday April 11 2006 and finishing at 3.45. The visits involved two inspectors. A separate visit made by the pharmacy inspector to look at the management of medication, took place on Wednesday April 5 2006. The inspection involved: • • Discussions with the Registered Manager, Care Manager, seven care workers, a kitchen assistant and the cook. Three residents were identified for close examination by reading their, care plans, risk assessments, daily records and other relevant information. This is part of a process known as ‘case tracking’ where evidence is matched to outcomes for residents. An inspection of a proportion of the environment was undertaken, and records were sampled, including staff training, health and safety, rotas, complaints and fire records. The inspectors’ spoke with eight residents and four visitors. Interactions between residents and staff were observed. Of the twenty-one surveys sent to residents, two were completed and returned. Seven of the twenty-one surveys sent to relatives and visitors, were completed and responses analysed. • • • Finally, feedback took place with the Registered Manager and Care Manager about the inspection findings. What the service does well: The home is generally clean and comfortable. The decoration and furnishings are satisfactory and suitable for purpose. There is a warm and welcoming atmosphere in the home. Information recorded on the one comment card received from a resident indicates general satisfaction with the service provided by the home. Of the nine relatives who returned comment cards all stated that they were satisfied with the overall care that was provided. Clarence House DS0000040534.V288530.R01.S.doc Version 5.1 Page 6 One relative commented, “My mother has the utmost care and attention. We could not wish for better staff caring for her”. Another relative said, “It’s a very welcoming atmosphere”. When asked what the best thing about the home one resident said, “the girls are lovely, I’m well looked after”. There is an open visiting policy, to encourage contact with family and friends. What has improved since the last inspection? What they could do better: The home is not well managed consequently information related to the residents and the maintenance of equipment in the home is disorganised and not easy to find. The management must make sure that these are organised to assist the staff in their daily work. There is inadequate contingency to manage unplanned staff absence, which often results in insufficient numbers of staff on duty to meet the needs of residents in the home. In order to ensure senior staff at the home are appropriately qualified to manage the care home the Registered Manager must be able to demonstrate how he will achieve the Registered Manager Award or equivalent qualification. So that we can be sure the home is able to meet the needs of residents a pre admission assessment of health and social care needs must be undertaken and a plan of care based on the initial assessment be devised and agreed. Care plans are not sufficiently detailed and further information and guidance is needed to make sure that the staff have direction in the care to be given. The care prescribed must be properly evaluated each month with any changes to care needs clearly identified, and where appropriate changes to the written care plans carried out. Greater effort is required to make sure residents have access to a full range of community health care professionals and resources, including, dental, sight and hearing checks. Clarence House DS0000040534.V288530.R01.S.doc Version 5.1 Page 7 Advice on how to provide appropriate care for residents with complex care needs should be sought from appropriate health care professionals including a Community Psychiatric Nurse, Speech Therapist, Dietician, Occupational Therapist, Psychologist etc. Residents should have access to menus and the food provided should be as recorded on the kitchen menu. Residents are not offered alternatives and any specialist dietary needs identified are not taken into account when planning menus. Therefore we cannot be sure residents needs are being met. Although a new bath and shower have been installed, the home has only one assisted bath; this is below the acceptable standard of bathing facilities. The management must assess this situation and produce a plan on how this can be appropriately dealt with. Work to change the use of an en suite in a double room to a communal bathroom must cease until approval for changes to the environment have been agreed with the Commission and those residents effected by any proposed changes. The environment should take into account and reflect the individual needs of residents and display signage and picture images so as to promote independence and assist with orientation. The Registered Manager must ensure that induction and health and safety training is provided and regular updates available to the staff to ensure that the work force is suitably trained for their individual roles. The medicine management within the home must improve to ensure the safety of the residents within. There is an absence of social and therapeutic stimulation therefore residents are not engaged and do not have opportunity to pursue hobbies or to develop and participate in any new interests. A number of areas of concern identified during previous inspection visits to the home remain outstanding. This impacts on the management of the staff and care given. Improvements in these areas are required with urgency: • • • • Thorough and rigorous pre employment checks. Fire safety training. Risk assessments for the environment and for individual activities that may place residents at risk. Accredited staff training for managing complex and challenging behaviours. An annual quality audit seeking the views and opinions of residents, their relatives and other stakeholders must be carried out. An internal audit and a copy of the findings must also be distributed and displayed in the home. Clarence House DS0000040534.V288530.R01.S.doc Version 5.1 Page 8 The Registered Manager must ensure the insurance certificate for the home displayed is current and a copy of this is sent to the Commission. 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. Clarence House DS0000040534.V288530.R01.S.doc Version 5.1 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Clarence House DS0000040534.V288530.R01.S.doc Version 5.1 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,6 Quality in this outcome is poor. This judgement has been made using available evidence including a visit to this service. Information given to prospective residents does not fully reflect the service provided and not all residents have their care needs assessed prior to admission. Therefore we cannot be sure individual care needs can be met. The home does not provide intermediate care. EVIDENCE: Residents and prospective residents have a copy of the Service User Guide. The document is informative and includes guidance on health and safety and on the roles and responsibilities of residents and the Registered Provider. Residents sign and date the Service Users Guide, which also serves as a contract. Some of the information in the document does not accurately reflect current practices for example the document states: • ‘Clarence house does require a Doctors report, with the full medical history of the resident up to the time of admission’. DS0000040534.V288530.R01.S.doc Version 5.1 Page 11 Clarence House Examination of a selection of residents’ care files found that a Doctors report had not been submitted prior to prospective residents moving into the home. Prior to moving into the care home residents have their care needs assessed by either Social Services or by the Care Manager. Discussion with the Registered Manager and Care Manager found that an exception had been made in one instance when the health and social care needs of one resident had not been assessed prior to admission. In order to make appropriate care provision for a resident whose first language is not English, the registered Manager has employed a dedicated carer with the same ethnic background. Clarence House DS0000040534.V288530.R01.S.doc Version 5.1 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome is poor. This judgement has been made using available evidence including a visit to this service. Care plans do not clearly define health and personal social care needs, therefore there may be an oversight in care causing risk of harm. Residents have limited access to community health care services. The standard of medicine management within the home is poor and must improve to ensure the safety of the service users who live in the home. EVIDENCE: Examination of a selection of residents’ care files found the information held was insufficient and did not accurately reflect the complexity of the care to be provided. For instance one resident with a habit of storing food in her mouth was assessed as requiring both soft and liquidised diets. Also on the ‘daily care plan’ it was recorded that the resident ‘likes two toast for breakfast’. Other information recorded included a risk of choking. Observations at lunchtime evidenced care staff serving the resident beef burgers and vegetables. Discussion with the Care Manager confirmed that intervention, advice or guidance had not been sought from a Speech Therapist or Dietician. Clarence House DS0000040534.V288530.R01.S.doc Version 5.1 Page 13 Information held about the resident’s needs did not include a risk assessment to determine what actions should be taken by staff to minimise any risk of choking. The care plans of two residents being treated by the District Nurse for pressure sores did not identify the actions to be taken by staff to promote pressure area care. A hospital type bed, fitted with a pressure-relieving mattress had been provided for one of these residents. The care plans of three residents assessed, as being incontinent did not include details of the actions to be taken by staff to manage or promote continence. Records of fluid input and output were not held for a resident being cared for in bed. Neither were nutritional needs monitored. The absence of effective monitoring and recording is unsafe and place residents at risk. Care plans should be as specific as possible and should include the techniques to be used for any moving and handling activity so that staff are able to promote safe working practices and are able to monitor and evaluate the care delivered effectively. No aspects of care were linked to a risk management strategy and information held did not provide staff with the information necessary to minimise any potential risks. Three staff spoken with were not fully aware of the information held in the care plans or of any risk assessments, therefore we cannot be sure practices are safe. Discussion with staff and observations during the visit found that a number of residents have dementia or other cognitive impairment. Advice and guidance as to how to meet specialist dementia care needs is not routinely sought from the Community Psychiatric Nurse or Clinical Psychologist. Records indicate not all residents have their weight monitored or have access to regular dental, sight or hearing checks. Information held in the Service Users Guide includes the arrangements for dealing with reviews of the care plans, and includes consultation with ‘the named carer, the service user, next of kin or other third parties’. The Care Manager carries out the residents care reviews. Records do not evidence consultation with the resident or their relative and like the care plans documentation is not always dated and signed. Changes in care needs are not always reflected in the care plans. For instance one resident was assessed as needing prompting to go to the bathroom. The need for prompting or the frequency of when this should be done was not included in the care plan. Clarence House DS0000040534.V288530.R01.S.doc Version 5.1 Page 14 Three residents spoken with were unaware of the information held in their care plans and said they had not been involved in devising the plan. The Care Manager demonstrated commitment to the development and introduction of a new care planning tool to reflect current needs and to ensuring detailed records are held and maintained. Daily records tend to be repetitive and fail to detail how individual needs have been met. Further work is also required to improve the frequency and recording of the personal hygiene of residents. One resident spoken with said she didn’t have a bath or shower and didn’t know why. A number of residents with dementia were unable to express their views and opinions, but those who could say the staff treat them well and are both kind and patient. Comments on surveys completed by relatives include: • • ‘My Mother is happy and well looked after’. ‘I am more than happy with the care my Father is receiving. I find the staff very friendly and very approachable’. Privacy screens were available in double rooms and staff were observed closing doors to toilets and residents’ bedrooms when they were undertaking personal care tasks. All bedrooms were unlocked and freely accessible to anyone in the home. A resident spoken with said they had spoken to staff about wishing to have a key to their room to be sure that their possessions were safe but had not been given one. The Manager said that keys are available for residents and this is also documented in the Service User Guide. The records recording the receipt and administration of medicines did not accurately reflect what had occurred in the home. Medicines have been signed as administered when they had not been. One medicines had been administered but not at the prescribed dosage resulting in the service user receiving a sub-therapeutic level of antibiotic. Inadequate procedures had been installed to check the prescriptions and the dispensed medicines received into the home. Medicines had been recorded on the Medicine Administration Record (MAR) chart but were not available for administration resulting in the service user not receiving their prescribed medication, as a further supply had not been requested in time. One medicine had been crossed off the MAR chart as the dose had been changed but it was still available to administer and had not been returned to the pharmacy for destruction. Clarence House DS0000040534.V288530.R01.S.doc Version 5.1 Page 15 Staff did not review the medicines they required in the home resulting in two medicines being routinely ordered but never administered for a period of four months. Loose tablets were found in the cabinet and it could not be demonstrated who they belonged to. They were not in a box or labelled. Medicines were found for one service user who had died in 2005. This had not been returned after seven days post death, to the pharmacist for destruction. Medicines were unaccounted for at the time of the inspection. Medicines had been recorded as received but in one instance none had been recorded as administered but 54 tablets were unaccounted for. Staff indicated that these had been administered to other service users as a homely remedy. Staff undertaking the medicine round place the medicines in a pot, which is then taken to the service user. This is considered a high risk, as they cannot be safely secured quickly in the event of an emergency despite assurances they would be returned to the cabinet. Homely remedies had been purchased but they had not been administered against a homely remedy policy. Poorly written MAR charts were seen recording two months administrations on one MAR chart. A new MAR chart had not been written for the subsequent 28 days. This resulted in the medicine being recorded as administered twice each day and not daily. Dates had not been recorded to reflect administration. Medicines had been prescribed to be administered “when required” but there were no written protocols reflecting their clinical use. The pharmacist had been in to undertake some training but none had received accredited training in the safe handling of medicine. Clarence House DS0000040534.V288530.R01.S.doc Version 5.1 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome is poor. This judgement has been made using available evidence including a visit to this service. The individual dietary needs of residents are not given priority and are therefore not being met in an appropriate or timely manner. Residents are not supported to make informed choices about daily living activities. Consequently their right to independence and autonomy is sometimes restricted. EVIDENCE: The home operates a flexible visiting policy that takes into account the expressed wishes of residents. Three residents spoken with said they could have visitors when they chose. One visitor spoken with said she visits the home regularly and is always made to feel welcome by the staff. Two relative said they could visit their family member at anytime, which they did, and found their mother’s care to be “always good”. Comments held on relatives’ surveys include: • ‘It’s a very welcoming atmosphere’. • ‘Staff are very friendly and very approachable’. Clarence House DS0000040534.V288530.R01.S.doc Version 5.1 Page 17 Visitors use communal areas and resident’s own rooms as they wished. One relative expressed satisfaction with the overall service, but felt “there is a lack of an in house activity programme for people”. An activities coordinator is employed at the home on a part-time basis for the development of, and provision of, therapeutic activities during the daytime. On both days of the inspection visits there were no planned activities for residents, although some residents were having a hand massage or opportunity for some individual discussion with the activities coordinator on the first visit. Staff spoke kindly to residents and were respectful when doing so and at times there was good communication between staff and residents however, this has generally at mealtimes or when staff were supporting residents or passing through the lounge area. The television was on constantly in the resident’s lounge during both visits and the choices of residents for the programs on the television were not observed to be sought. A number of residents would not have been able to view the television screen comfortably if they had wished to watch a programme however due to the seating arrangements in the room. The television in one resident’s bedroom was on throughout the day. The resident, who was not well and in bed, had a remote control at hand but did not appear to know, when asked, how to use this and therefore was relying on staff to adjust the volume, select programmes or turn the television off. During the visit residents were seen to be able to access daily newspapers however there were no activities on view, for example jigsaws, playing cards, dominoes or reading material, for residents to easily access for themselves. Residents able to move around the home independently were doing so freely. A number of residents attend a church service that is held in the home each month. The home holds a wide range of provisions and this includes fresh fruit. Two residents spoken with said the quality of the food varied and sometimes the potatoes were hard. At the time of the visit potatoes were cooked and ready for lunch by 10.30am. The explanation for this was ‘its always been done this way’. Other vegetables were also being cooked at this time. The Cook then keeps the vegetables warm in the oven until lunch is served at 12.30pm. When serving lunch staff wore protective aprons and some interacted with residents. One care worker remained standing while assisting a resident to eat her food. Clarence House DS0000040534.V288530.R01.S.doc Version 5.1 Page 18 Due to their frailty a number of residents required assistance to eat their food. A visitor assisted two residents to eat their lunch; one of the residents being assisted by the visitor was a relative. The other was a resident assessed as being at risk of choking. Some residents sit at the dining tables for meals while others remain in their armchairs. A care worker assisted two residents to eat their food while other residents had to wait for the assistance they needed until two care workers had finished washing the dishes in the kitchen. Washing dishes is a secondary task and as such should not take place until the needs of the residents have been met. When asked about the range of food available, three residents said they never knew what was for lunch and were not offered choices. This was evidenced during the visit when lunch was served, residents were not made aware of choices and food was not visually displayed to those residents with dementia so that they could also make informed choices. Residents spoken with said they usually have cereals and toast for breakfast, sandwiches at teatime, and a hot drink and biscuits before they go to bed. One resident whose first language is not English said he was generally satisfied with the food and had over the years made changes to his diet and was therefore familiar with and enjoyed the food. Accurate records of food offered or consumed by residents are not held. Therefore we cannot be sure nutritional needs are being met. At the time of the visit residents were served beef burgers potatoes and vegetables for lunch, followed by a slice of an iced sponge birthday cake (also served the day before) served with custard. Residents were offered hot and cold drinks throughout the day. Residents did not have access to a menu. The only menu seen was held in the kitchen and used by staff. Discussion with the cook evidenced that no special dietary needs were being catered for even though one care plan identified the need for a soft diet. Records are held of fridge, freezer and high risk cooked foods, but are not regularly maintained, as gaps in recording were evident. Clarence House DS0000040534.V288530.R01.S.doc Version 5.1 Page 19 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome is poor. This judgement has been made using available evidence including a visit to this service. The absence of clear procedures combined with unsafe staff practices place residents at risk of harm or injury. EVIDENCE: The home has a complaints procedure but some of the information included in the document requires revising to make clear complaints can be referred to the Commission at any stage of the process. The complaints procedure should also include the timescale for responding to complaints so that we can be sure any concerns are responded to in a timely manner. In discussion the Care Manager said they had not received any complaints. A copy of the complaints form is included in the Service Users Guide. One resident spoken with said she wasn’t aware of the complaints procedure but would complain if she was dissatisfied with any aspect of the service. Examination of the accident and incident record in the home showed that in November 2005 physical intervention was used by staff as part of managing an incident with a resident and an injury to the resident was sustained. Clarence House DS0000040534.V288530.R01.S.doc Version 5.1 Page 20 This incident was not reported to the Vulnerable Adults Team for consideration of investigation through the Protection of Vulnerable Adults policy and procedure or Commission for Social Care Inspection. It is of concern that physical restraint was used in the home by untrained staff and not in accordance with Department of Health guidance and this is putting people living at the home at serious risk of harm. The need to review and revise the home’s adult protection policy and procedure taking into account the Local Authority arrangements for the protection of vulnerable adults, and the Department of Health guidance, “No Secrets” remains outstanding from the last inspection visit. Two staff spoken with were not aware of the ‘Whistle Blowing policy, but said they would raise any issues with the Manager or Care Manager should they have cause for concern. Clarence House DS0000040534.V288530.R01.S.doc Version 5.1 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21,23, 24 25 and 26 Quality in this outcome is poor. This judgement has been made using available evidence including a visit to this service. The overall quality of the furnishings and fittings is adequate however the management are failing to demonstrate that the environment is safe and well maintained, thus placing residents’ health and well being at risk. EVIDENCE: The home is warm and welcoming and the people living there said that they are happy to do so. Recent improvements since the last inspection has included decoration to the lounge/dining area, refurbishment of the kitchen and replacing the seating in the lounge. There is no record of any further planned refurbishment or maintenance of the environment although the managers discussed plans to re-site the Managers office. Clarence House DS0000040534.V288530.R01.S.doc Version 5.1 Page 22 A shower ensuite facility in a double room has been in the process of refurbishment over the past nine month period with a view to changing usage to that of a shared shower facility for all residents with bedrooms on that floor. During this time the two residents who previously used this ensuite have not had access to washing facilities in their bedroom and use a commode at night time if not wanting to access the toilet facility away from their bedroom. To meet their personal care needs they have either accessed the shower facility on the first floor of the home or staff have brought a bowl of hot water to their bedroom. There was no evidence of discussion or agreement with the residents regarding the loss of their ensuite facility. Withdrawal of the ensuite facility without prior consultation with the residents, their relatives or the Commission for Social Care Inspection is not acceptable and has impinged on the resident’s rights and contractual agreements. The doorway from the shared bedroom to the ensuite was not locked and residents could easily access this area, which posed a risk to their safety due to the refurbishment work that was taking place and equipment being stored there. Individual seating arrangements in the lounge since the last inspection have been reviewed and three large leather settees have replaced a number of armchairs. Whilst some residents appeared to be comfortable when using the settees two residents were observed to have difficulty as the seating was not providing adequate support to promote their well-being. For instance, as they had fallen asleep one resident had fallen to their side and was lying face down into the leather cushioning and another resident had fallen forward with their head falling onto their lap. Falling into these positions had the potential to cause harm as these positions could cause some restriction to airways. There are two lounges in the home for residents to use although residents appeared to prefer to use the lounge/dining room area with only two residents seen to use the front lounge during the two visits to the home. Access to the second lounge is either through the dining area or from the hallway at the front entrance. The high number of residents preferring to use the lounge/dining room, including those using mobility equipment such as walking frames and wheelchairs, causes some restriction on easy movement around the room. The accident record for the home shows that there have been a high number of falls, 17 since January 2006, and seven of these occurring in the lounge/dining area. The entrance to this lounge is via a small hallway and this is also used by residents accessing ground floor bedrooms, by kitchen and domestic staff accessing the kitchen and laundry facilities and is also used as a workstation by staff, with some records being stored there. The volume of traffic in this area has the potential for accidents for example, falls and injury from bumping into people including people carrying trays of hot food/drinks. Clarence House DS0000040534.V288530.R01.S.doc Version 5.1 Page 23 A resident with bruising to the forehead and arm said that she had fallen in the corridor coming from her bedroom. The visitor with her when the accident happened confirmed the accident took place in a corridor. Access to the second lounge area and dining room from the front hallway was not seen to be used regularly; the dining room door off the hallway was blocked by a dining table restricting access this way. A smoke room facility is available in a conservatory area off the lounge/dining room, which can only be accessed through an outside door. There is a raised door tread at the doorway and the accident record shows a resident has tripped over the raise tread and sustained an injury as a result. There is no recorded evidence of an assessment of the premises having taken place by a suitably qualified person to ensure that residents had appropriate aids and adaptations to maximise independence and promote safety throughout the home. Toilet and washing facilities are provided in most bedrooms, with the toilet facility being a commode, screens are used for privacy. Toilet facilities are accessible on all floors and were clean and fresh with some aids and adaptations in place to promote independence. Soap dispensers were found to be empty in all facilities other than the ground floor. There is only one shower facility available and one bathroom facility on the lower ground floor however the inspectors were informed that residents do not use the bathroom facility. The shower facility is in poor condition, the shower seat was not clean and the armchair for residents to sit on whilst being dried or washed was not of a washable material to promote infection control and good hygiene. There were no cleansing wipes in the room to also support infection control. The flooring of the shower base was sealed with tape. The Manager said that water damage from the upstairs bathroom had caused this disrepair which would be made good as part of the building work in the bathroom above. There is a mobile hoist in the home although this was not seen being used during the inspection. As mentioned previously stair lifts are available and there is a record of these being regularly maintained All resident’s bedrooms were seen and found to be comfortable and in general safe and adequately furnished. Residents spoken with said they were satisfied with their facilities. One resident said that their bed was comfortable. Linen and fabrics in all bedrooms were fresh and clean. Residents have a call alarm system in their bedroom however one resident said that staff did not always respond when they rang for assistance. Further examination showed that the buzzer in their bedroom was found to be unconnected to the system. The curtain rail to the window was broken. Door closures in bedrooms eight and seven were broken away from the door hinges. Clarence House DS0000040534.V288530.R01.S.doc Version 5.1 Page 24 The premises were in general clean and pleasant. Two cleaners were working in the home on both occasions. There was evidence of offensive odours noted in two resident’s bedrooms. Laundry facilities are in the basement of the building and were found to be in an acceptable order. Hand washing facilities are available in the kitchen, laundry, toilets and bathrooms. The floor covering in both toilets situated off the lounge area is in poor condition and does not promote effective cleaning as part of infection control measures. Gloves and aprons were in sufficient supply for staff and seen to be used appropriately in bathroom/toilet areas. Clarence House DS0000040534.V288530.R01.S.doc Version 5.1 Page 25 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome is poor. This judgement has been made using available evidence including a visit to this service. The recruitment policy and procedure for the home is not robust enough to ensure that residents are supported and protected from harm by the people caring for them. Staff do not have opportunity for the continuing development of skills necessary to meet the assessed and changing needs of people living in the home or to promote safe working practice. The practice of allowing staff to work long hours is unsafe and may impact on the standard and consistency of care offered. EVIDENCE: The staffing rotas for the four week period prior to the inspection visit were examined and identified that some staff continued to work excessive hours, or a day shift followed by a nightshift, for instance; • • • Five staff members worked in excess of 37 hours each week over the four week period, with shifts of between 9 and 13 hours duration. Split shifts followed by a nightshift are regularly recorded and this can be, in a 24 hour period, a total of 18 hours. One staff member worked 71 hours over a six-day period during one week. DS0000040534.V288530.R01.S.doc Version 5.1 Page 26 Clarence House The practice of staff working long hours is unsafe and may have a detrimental impact on the standard and consistency of care offered. Staff spoken with said that they felt not enough staff were on duty some mornings. The staffing rota for one week in March 2006 showed that the number of staff working at 8 a.m. is either 3 or 4, this excludes the care manager. There was no evidence in the home to suggest that an audit of staffing levels against residents needs is reviewed regularly to ensure that staffing levels are sufficient to meet identified and changing needs. The registered manager is not recording the hours he is spending in the care home although staff said he attends daily. Training records are not being maintained up to date or in good order and therefore do not demonstrate that the staff team have the necessary skills to meet the assessed and recorded needs of residents at all times. The training record for the year 2004 showed that some staff accessed training in manual handling, first aid and dementia care. Recorded information regarding training accessed in 2005 show that three staff had some dementia care training and two staff accessed training in the Protection of Vulnerable Adults, (POVA). The Care Manager has an NVQ Assessors Award at Level 2, one carer has achieved an NVQ Level 2 in Care and two carers are working towards achieving the award. This falls below the expectation that a minimum of 50 trained care staff at NVQ level 2 is achieved by 2005, excluding the Manager or Care Manager. Staff spoken with said that a training appraisal is currently taking place with the staff team. There is no record of training and development programme for the staff team for 2006/07 however there is some evidence to suggest that managers are planning training with the Warwickshire Quality Partnership Board and this will include Food Hygiene and NVQ assessment. Staff files evidenced that rigorous staff recruitment checks necessary to ensure the protection of residents had been not carried out before staff were confirmed in post. A requirement that the Registered Manager obtain Criminal Record Bureau (CRB) checks in respect of six staff employed before the outcome of a CRB was known remains outstanding from the last inspection visit. Clarence House DS0000040534.V288530.R01.S.doc Version 5.1 Page 27 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35,36,37,38 Quality in this outcome is poor. This judgement has been made using available evidence including a visit to this service. Leadership, guidance and direction to staff to ensure service users receive consistent quality care have been poor. Health and safety management in the home is not satisfactory. Care practices therefore fail to promote and safeguard the health, safety and welfare of the people living in the home. EVIDENCE: In discussion the Registered Manager confirmed that he has not yet made a commitment to undertake the Registered Manager Award or NVQ Level 4 in care. Successful completion of the Award is one of the conditions placed on the home’s registration. Clarence House DS0000040534.V288530.R01.S.doc Version 5.1 Page 28 A further condition placed on registration also requires that the Care Manager be suitably qualified. Although the Care Manager has a NVQ Level 2 Assessor’s Award in care this qualification is not deemed to be suitable for a senior supervisory role. The Care Manger should therefore be qualified to NVQ Level 3 or the equivalent. There was no evidence available to suggest that effective quality assurance and quality monitoring systems, based on seeking the views of residents, are in place to measure success in meeting the aims, objectives and statement of purpose of the home. The Manager spoke of the intention for further refurbishment of the home however, this is not documented. Team meetings are not taking place, which would give opportunities to the staff team to discuss service development planning and review. Staff spoken with were aware of what should be done better in the home and comments included; action needs to take place when poor practice is reported, regular team meetings and supervision must happen, “refurbishment needs a kick, routine maintenance needs attending to promptly and we need training in risk assessment. Residents spoken with said they can talk to staff and they are listened to however, there is no evidence to suggest their views are acted upon. Residents are not meeting with the Manager, or staff, to discuss home issues such as menu planning, provision of equipment or for planning social activities. There was sufficient staff on duty at the time of the visits to meet personal and social care needs however it was evident that the deployment of staff is not being supervised or managed effectively, for instance, on two separate occasions staff were observed to be sitting with residents in the lounge and offering no activity or conversation. One domestic staff member appeared to be minding residents in the absence of care staff and on another occasion a carer was observed sitting in the lounge with residents reading a magazine for approximately a one-hour period offering no activity or conversation to the residents who were also sitting in the lounge. Staff said they do not have individual supervision on a formal basis with a Manager and management confirmed this. The home does not have a written policy or procedure for safe guarding resident’s finances. Records are maintained of all monies held on behalf of the residents, but receipts are not issued when money is deposited for safekeeping. Individual receipts confirming expenditure on chiropody, hairdressing and other personal items purchased on behalf of residents are not held. Discussion with the Care Manager evidence that independent professional advocacy services support three residents with managing their finances. Clarence House DS0000040534.V288530.R01.S.doc Version 5.1 Page 29 This inspection evidence that the record keeping practices and policies is inadequate and not safeguarding the best interests and rights of residents, for example, • Resident’s GP at appointment entries are maintained in the home diary which is kept in the kitchen. • Care plans and home records were left in communal areas, (the workstation), or on shelves outside the laundry room. • Fire safety records were not up to date, or easily available for examination, the managers had to search for these. • The Manager and Care Manager were not able to find relevant records essential to the management of the home, i.e. health and safety records, staff training records, risk assessment and staff recruitment records. Through discussion with Managers’, examination of records available, observation of care practices and talking with staff, it was identified that the staff team do not receive regular training, or proper induction in safe working practices. This includes, moving and handling, fire safety, first aid, food hygiene and infection control. Staff were observed on two occasions to be moving residents unsafely putting the residents and themselves at risk. Staff with responsibility for food preparation have not received training in food safety practice. Records relating to the management of health and safety were in poor order. The Manager and Care Manager could not easily find health and safety records requested during the inspection for examination and this suggests that the system is poorly managed. C.O.S.H.H. Risk Assessments have not been reviewed for some time or audited against cleaning products currently being used in the home. Documents show that a water risk assessment took place in November 2004 however, the manager could not find any record for examination to show that identified action following the risk assessment had taken place and risks monitored regularly, including monitoring that hot water temperatures are maintained close to 43°C. A resident’s bedroom window on the ground floor was wide open, there were no restrictors in place and the room could be easily accessed from outside. Staff practices in the home were found to be unsafe for instance, the door to the cellar was not secure and a bottle of liquid cleaning chemicals (Hydrochloric acid) had been left unattended on a chair outside a resident’s bedroom. There was some evidence to suggest that electrical equipment had been tested for safety in January 2006 however, a report of the outcome of the tests was not available. Records evidence the lift in the home was serviced in November 2005. An Environmental Health Food Safety inspection took place in October 2005. Clarence House DS0000040534.V288530.R01.S.doc Version 5.1 Page 30 Three actions were required to take place and these have been met although the action taken has not been be forwarded to the Commission for Social Care Inspection as required since the last inspection. Staff working in the kitchen were observed not wearing protective clothing as part of food safety hygiene and practice. The kitchen area is also being used by care staff when answering the telephone or recording information in the home diary. Staff are not wearing protective clothing when entering this area to complete these tasks. There is no recorded evidence in the home to suggest that risks in working practice and activities are being reviewed regularly which is essential in health and safety management nor following any accident or incident in the home. Records of incidents and accidents are being recorded on home records but are not being forwarded, as required under Regulation 37 of the Care Home Regulations, to the Commission for Social Care Inspection. Fire safety records show that fire alarms had not been tested since December 2005. Staff spoken with said that these do take place weekly. The Manager, when requested to, tested the alarms on the first day of the inspection. Fire safety records were not up-to-date or easily available, with the manager having to search for current records. The staff team, including night staff, have not had a fire drill since January 2004 and this posed a serious risk to the health, well-being and safety of the people living and working in the home. The Registered Manager and Care Manager demonstrated some understanding through discussion, of their responsibility in health and safety management, including risk management, however, neither have accessed training in the management of health and safety. Attendance at accredited training in health and safety management would be beneficial in supporting and promoting a safe environment for the people living and working in the home. Staff working in the home each have a copy of a Health and Safety Employees Handbook however, there is no evidence of a Health and Safety Policy or Infection Control Procedure relating to the specific requirements of the home. The insurance certificate displayed for the home was not current. The registered manager said this was being reviewed and all paperwork was with the insurers. Clarence House DS0000040534.V288530.R01.S.doc Version 5.1 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 1 2 1 X 1 2 2 2 STAFFING Standard No Score 27 2 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 1 2 2 1 Clarence House DS0000040534.V288530.R01.S.doc Version 5.1 Page 32 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 (1) Timescale for action The Registered Manager shall not 21/04/06 provide accommodation to a service user at the care home unless; the needs of the service user have been assessed. After consultation with the service user, or a representative of his, prepare a written care plan as to how the service user’s needs in respect of his health and welfare are to be met. The Registered Manager must 21/05/06 ensure that care plans are current and set out in detail each service users health, personal and social care needs. Care plans should be reviewed monthly. (Timescale of 31/01/04 part met). Service users must have access to appropriate community health care professionals and facilities. Risk assessments needs to be developed on an individual basis for the service users. (Timescale of 31/01/06 not met). Requirement 2 OP7 15,12 (1) (a) 3 OP7 13,14,17 21/05/06 Clarence House DS0000040534.V288530.R01.S.doc Version 5.1 Page 33 4 OP8 13(1)(b) 5 OP9 13(2) 6 OP9 13(2) 7 OP9 13(2) 8 OP9 13(2) 9 OP9 13(2) The Registered Manager shall make arrangements for service users to receive where necessary, treatment, advice and other services from any health care professional. The Registered Manager must review the home’s policy and procedure for the receipt, recording, storage, handling, administration and disposal of medicines in the home. (Timescale of 31/01/06 not met). A system must be installed to check the prescription prior to dispensing and the dispensed medicines and MAR chart received into the home The MAR chart must be referred to before all administrations of medicines to ensure that all medicine are administered as prescribed at the correct dose, the correct time to the correct service user. Records must accurately reflect all transactions. The quantities of all medicine received or balances carried over from previous cycles must be recorded to enable audits to take place to demonstrate that the medicine are administered as prescribed A trolley must be purchased to safely transport the medicines to the service users that can be locked in the case of an emergency within the home. The practice of dispensing into pots to take to the service user must cease. 31/05/06 06/05/06 06/05/06 06/05/06 12/04/06 06/05/06 Clarence House DS0000040534.V288530.R01.S.doc Version 5.1 Page 34 10 OP9 13(2) 11 12 OP9 OP9 13 (2) 13 (2) 13 14 OP9 OP9 13 (2) 13 (2) 15 OP9 13 (2) 15 OP9 13 (2) 16 OP9 13 (2) 17 OP9 13 (2) Care staff must order medicine that the service users require in time to ensure that there is enough medicine to administer as prescribed. Regular reviews must take place with the doctor if the service user no longer takes prescribed medicines. All medicines that are no longer required must be returned to the doctor for destruction. All medicines must be administered to the service user they are prescribed to. The practice of administering one service users to another must cease. All medicines must be administered from a pharmacist labelled box. Any homely remedy that is administered to a service user must be purchased and administered against a homely remedy policy. The practice of administering prescribed medicines to other service users cease. A new MAR chart must be written for each 28 day cycle. The practice of using one MAR chart for more than one 28 day cycle must cease Any “when required” medicine must be supported by a “prn” protocol written with the support of a clinician All care staff that handle medicines must undertake an accredited course in the safe handling of medicines The purchase of a Controlled Drug register is required and all CD transactions must be recorded in this 12/04/06 12/04/06 06/04/06 12/04/06 12/04/06 12/04/06 06/05/06 06/07/06 06/05/06 Clarence House DS0000040534.V288530.R01.S.doc Version 5.1 Page 35 18 OP9 13 (2) 19 OP9 13 (2) 20 OP12 12.3 21 OP15 14 (1) 22 OP15 16 (2) (i) 23 OP15 18 The medicine refrigerators maximum, minimum and current temperatures must be read daily and must lie between 2°C and 8°C at all times to ensure the stability of medicine requiring refrigeration within in accordance with their product licences. Appropriate action must be taken if the temperatures fall outside these limits The Registered Manager must undertake staff drug audits before and after a drug round to confirm staff competence in medicine management. Appropriate action must be taken if these audits indicate that staff are not administering the medicines as prescribed and accurately recording the transaction. The Registered Manager must ensure service users have opportunity to exercise their choice in relation to leisure and social activities. The Registered Manager shall ensure that the specialist dietary needs of service users are assessed by suitably qualified or trained persons. The Registered Manager shall ensure that the home is conducted so as to provide suitable, wholesome and nutritious and properly prepared food. The Registered Person shall, having regard to the size of the care home ensure that at all times competent and experienced persons support service users’ with their food. 12/04/06 12/04/06 31/05/06 30/06/06 14/06/06 21/05/06 Clarence House DS0000040534.V288530.R01.S.doc Version 5.1 Page 36 24 OP18 13. (7) 25 OP18 12 (1) 26 OP18 13,18 The Registered Manager must ensure that physical and/or verbal aggression by residents is understood and dealt with appropriately, and that physical intervention is used only as a last resort and in accordance with Department of Health guidance. The Registered Manager must review the Adult Protection Procedure taking into account the Local Authority procedure and the Department of Health guidance, No Secrets. (Timescale of 11/01/05 31/07/05, 31/01/06 not met). The Registered Manager must make arrangements by training staff to prevent residents being harmed, or suffering abuse as part of a risk management strategy. Staff must receive training on Adult Protection and the Management of Challenging Behaviours and Restraint. (Timescale of 11/01/05,31/07/05, 31/01/06 not met). The Registered Manager should produce a programme of routine maintenance and evidence of renewal of the fabric and decoration of the premises. The programme should include costing and implementation. (Timescale of 11/01/05 not met.) The Registered Manager must ensure that the bathroom area undergoing refurbishment is secure and not accessible to residents. 21/05/06 31/05/06 11/04/06 27 OP19 23(2) 31/07/06 28 OP19 13(4) 21/04/06 Clarence House DS0000040534.V288530.R01.S.doc Version 5.1 Page 37 29 OP19 39(h) 30 OP20 14(1) 31 OP21 23(2)(j) 32 OP22 12(1) 33 OP24 23(2)(b) 34 OP24 12 The Registered Provider shall give notice in writing of any proposed alterations, and obtain approval before any significant changes to the environment are made. The Registered Manager must ensure that seating in the home, including the lounge area, is designed to meet the collective and individual assessed needs of the people living in the home. The Registered Manager must ensure that the people living in the home have toilet, washing and bathing facilities sufficient and suitable to meet their identified needs. The Registered Manager must ensure that call systems in place in resident’s bedrooms are in good order and easily accessible. The Registered Manager must make arrangements for the repair of the following; • The broken door closures in bedrooms 7 & 8. • The broken curtain rail in the downstairs front bedroom. The Registered Manager must ensure service users are provided with a key to their room unless their risk assessment suggests otherwise. 31/05/06 30/06/06 31/08/06 21/05/06 31/05/06 31/05/06 Clarence House DS0000040534.V288530.R01.S.doc Version 5.1 Page 38 35 OP26 16(2)(j) 36 OP27 18 Schedule 4(17) The Registered Manager must 21/05/06 ensure that systems are in place to control the spread of infection. This includes: • A policy and procedure for the prevention and control of infection. • Ensuring hand washing facilities, (soap dispensers), are available. • The laundry floor finishes must be impermeable. • Equipment used in bathroom and toilet facilities is washable and also in good order. The staffing levels and skill mix 31/05/06 must be maintained within agreed levels and based on assessed level of dependency and service users’ care need. The Registered Manager must inform the Commission of any shifts which fall below agreed levels. (Timescale of 31/01/06 not met). The Registered Manager must include details on the staff rota of the time spent in the care home. The Registered Manager must ensure that staff do not work excessive hours or a day shift followed by a night shift. (Timescale of 03/11/06 not met). The outstanding CRB checks for the six members of staff must be obtained. (Timescale of 31/11/04, 11/01/05, 20/05/05 and 31/01/06 not met). 37 OP27 18(1)(a) 31/05/06 38 OP29 19 11/04/06 Clarence House DS0000040534.V288530.R01.S.doc Version 5.1 Page 39 39 OP30 18 40 OP30 12 41 OP31 9 42 OP33 24 43 OP34 25(2)(c) 44 OP35 20(1) The Registered Manager must provide a written staff training and development programme for 2005/6. A completed staff training matrix must be forwarded to the Commission. This should include induction, NVQ and mandatory training. (Timescale of 11/01/05, 31/07/05 and 28/02/06 not met). The Registered Manager must complete an audit of staff training attended. (Timescale of 31/07/05 and 28/02/06 part met). The Registered Manager must be able to demonstrate how he will achieve the Registered Managers Award or equivalent qualification. The Registered Manager must establish and maintain a system for reviewing and improving the quality of care provided at Clarence House and shall supply the CSCI a report in respect of any review. (Timescale of 31/08/05, 28/02/06 not met). The Registered Manager must ensure that a current certificate of insurance is displayed in the home and that a copy of the insurance certificate for the 2006/07 period is forwarded to the Commission. The Registered Manager must ensure receipts are held of all financial transactions undertaken on behalf of the service users’. 31/07/06 14/06/06 31/05/06 31/07/06 21/05/06 31/05/06 Clarence House DS0000040534.V288530.R01.S.doc Version 5.1 Page 40 45 OP36 18 46 OP37 17 47 OP37 17 48 OP38 13(4) 49 OP38 23 50 OP38 37 51 OP38 23 A formal staff supervision programme must be implemented on a regular basis for each staff member and records of the supervision be held. (Timescale of 11/01/05, 31/08/05 and 31/01/06 not met). All policies and procedures must be reviewed and be in line with current good practice. (Timescale of 31/01/06 not met). The Registered Manager shall ensure that all records, in respect of the service provision, are kept secure, up-to-date and in good order and readily available at all times for inspection in the care home by any person authorised by the Commission. The Registered Manager must provide window restrictors based on assessment of vulnerability of and risk to individual residents. The Registered Manager must ensure a fire drill is undertaken for night staff. (Timescale of 11/01/05, 31/08/05 and 31/01/06 not met). The Registered Manager must inform the CSCI of any accidents or incidents effecting the health or welfare of service users (Timescale of 05/05/05, 03/11/05 not met). The Registered Manager must ensure safe working practices through the induction process and refresher training for all staff in moving and handling, fire safety, first aid, food hygiene and infection control. 30/06/06 30/06/06 30/06/06 31/05/06 21/05/06 21/05/06 31/05/06 Clarence House DS0000040534.V288530.R01.S.doc Version 5.1 Page 41 52 OP38 23(5) 53 OP38 13(4) 54 OP38 13(4) 55 OP38 13(4)(c) The Registered Manager must ensure that all persons accessing, or working in the kitchen area wear protective clothing, (aprons and hats), at all times. A copy of the most recent electrical portable appliance testing report must be forwarded to the Commission. (Timescale of 31/01/06 not met). The Registered Manager must ensure that regulation of hot water temperature and risk of Legionella in the home is monitored and a record maintained of all monitoring practices. The Registered Manager must ensure that all areas in the home which residents have access to are so far as reasonably practicable free from hazards to their safety. The door to the cellar is to be kept secure and cleaning chemicals must held safely and securely. The Registered Manager must activate a fire drill in the home and shall document the event to include, the date and time, issues discussed and the names of the staff in attendance. The Registered Manager must undertake accredited training in the Management of Health and Safety in the Workplace. 31/05/06 31/05/06 31/05/06 11/04/06 56 OP38 23(4) 11/04/06 57 OP38 10(3) 30/06/06 Clarence House DS0000040534.V288530.R01.S.doc Version 5.1 Page 42 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. 1. OP19 2 3 4 OP27 OP36 OP38 It is recommended that an assessment of the environment in carried out by a suitably trained and competent person to ensure service users have appropriate aids and adaptations to maximise independence and promote safety throughout the home. The Care Manager should complete a NVQ Level 3 in care or equivalent. Regular team meetings should be introduced so as to encourage cross fertilisation of ideas. The Registered Manager should make arrangements to attend training in the management of health and safety so as to provide a safe environment for the people living and working in the home. Clarence House DS0000040534.V288530.R01.S.doc Version 5.1 Page 43 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Clarence House DS0000040534.V288530.R01.S.doc Version 5.1 Page 44 - 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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