Inspection on 01/08/06 for Cloyda

This inspection was carried out on 1st August 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

Cloyda 27/11/07

Cloyda 10/05/07

Cloyda 13/04/06

Cloyda 15/09/05

Cloyda 26/04/05

Cloyda 01/11/04

Cloyda 12/05/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Cloyda 227 Malden Road New Malden Surrey KT3 6AG Lead Inspector Diane Thackrah Key Unannounced Inspection 1st and 2nd August 2006 10:00a 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 Cloyda DS0000013381.V305233.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. Cloyda DS0000013381.V305233.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cloyda Address 227 Malden Road New Malden Surrey KT3 6AG 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) 020 8949 1839 020 8949 1839 Mr Vallabhbhai Morarbhai Patel Mrs Dahiben Vallabhbhai Patel Mrs Avril Smith Care Home 35 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (25) of places Cloyda DS0000013381.V305233.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th April 2006 Brief Description of the Service: Cloyda is a residential care home registered with the Commission for Social Care Inspection to provide care for up to thirty five people over the age of sixty five, ten of which may have a diagnosis of dementia. The home is a large detached property, located on a main road close to the centre of New Malden. There is easy access to the A3 and to public transport. Accommodation is provided over three floors, all of which can be accessed by passenger lift. There is a large garden to the rear of the property. Copies of the home’s Statement of Purpose and Service User Guide can be obtained from the Registered Providers on request, as can a copy of the Commission for Social Care Inspection’s most recent inspection report. Fees at the time of writing range between £406 - £510 and there are no additional charges. Cloyda DS0000013381.V305233.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place on 1st and 2nd August 2006 between 10.00 and 10.40 and 10.00 and 15.45. The inspection on 1st August 2006 was abandoned due to a failure by the Registered Providers to cooperate appropriately with the inspection process. The inspection on 2nd August 2006 was carried out by two Regulation inspectors. Alison Ford, Regulation Inspector accompanied Lead Inspector, Diane Thackrah in the inspection between 10.00 and 13.35. A partial tour of the premises took place on each day of the inspection and care records were examined. The Registered Providers, their son, the Registered Manager and three staff members were spoken with, as were five service users. A number of service users do not have the mental capacity to share their views about the care that they receive. Observations of care practices and interactions with staff members occurred in order to gain an insight into the experiences of these service users. The views of four relatives have been received via comment cards. The views of these people will be reflected in this report. What the service does well: What has improved since the last inspection? Some of the Requirements set at the last inspection of the home have been met. There has been improved record keeping, and daily observation records Cloyda DS0000013381.V305233.R01.S.doc Version 5.2 Page 6 are now more detailed. Fire exists are no longer obstructed. New arm chairs have been purchased for the lounge and the lounge and some bedrooms have been repainted. The garden has been tidied up, with potentially dangerous objects being removed, and the service user’s lounge is no longer used for staff training. Some areas of the home have been cleaned, including the food storage area, door handles, and the oven. What they could do better: 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. Cloyda DS0000013381.V305233.R01.S.doc Version 5.2 Page 7 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 Cloyda DS0000013381.V305233.R01.S.doc Version 5.2 Page 8 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): 3 and 6. There are poor arrangements for planning for the care of service users prior to them moving into the home, it is therefore unclear whether service users have their needs fully met. The home does not provide intermediate care. Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: There was no comprehensive assessment of needs in place in relation to the most recent service user to move into the home. There was a brief summary of needs that had been obtained from the hospital were the service user had been admitted from, and there was documentation detailing the service user’s medication that had been obtained from the service user’s General Practitioner. The Registered Manager said that someone from the home usually goes to see the service user to carry out an assessment of their needs before they move into the home. She was unable to give an explanation about why this service user had not had their needs assessed. There was Cloyda DS0000013381.V305233.R01.S.doc Version 5.2 Page 9 however, a brief care plan that had been prepared by the service user’s placing authority. This provided some information about the service user’s personal care and health needs. It did not provide comprehensive information about the service user’s needs, and, it had not been obtained prior to the service user moving into the home. There was limited information in a second service user’s personal file regarding their needs assessment. The Registered Manager said that this person had been admitted by the home’s Deputy Manager, and she did not know where the needs assessment information would be. The Registered Provider and Registered Manager were unable to provide a needs assessment template to demonstrate how they would carry out an assessment of a prospective service user’s needs. These issues raise concerns about practices for carrying out needs assessments, record keeping and the effectiveness of the management structure in the home. No service user should move into the home without having their needs assessed and been assured that these needs will be met. Written assessments of need must be carried out by a trained representative from the home, in conjunction with the service user, and/or their representative for privately funded service users. For individuals referred through Care Management arrangements, the Registered Providers must obtain the Care Management assessment of needs. A Requirement and recommendation has been made regarding this issue. Cloyda DS0000013381.V305233.R01.S.doc Version 5.2 Page 10 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 and 10. There have been some improvements in this area, and, in general, there are suitable arrangements for ensuring that service users have their health, personal and social care needs met. However, there remain some poor practice issues that put into question the quality of care provision in the home. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The Registered Manager said that all service users have a care plan that is reviewed at least monthly. Two care plans were examined and these provided information about how staff members should address the service user’s personal, health and social care needs. There were records detailing that care plans had been reviewed monthly. However, there was information in one service user’s care plan detailing that they were at risk of falls. There was no information about how staff members should manage this in order to reduce the risks. Risk assessment must be in place where a significant risk to a service user has been identified. A Requirement has been made regarding this issue. Whilst care plans appeared to be comprehensive, it is unclear whether Cloyda DS0000013381.V305233.R01.S.doc Version 5.2 Page 11 they fully detail the needs of service users as the home has failed to obtain needs assessments for some service users (Refer to Standard 3 of this report) There was positive feedback about the care provided in the home from the relatives of four service users. All said that they were satisfied with the care that their relative received and one said that their relative was “well looked after” The majority of service users seen appeared to have their personal care needs met. The Registered Providers purchase toiletries on behalf of a number of service users who are unable to obtain them. A Requirement made a the last inspection of the home regarding the need for improved record keeping in relation to care notes is now considered meet. Care notes seen detailed that service users had been seen in the home by their relatives, and a number of health care professionals. There were records detailing that service users have their weight monitored on a regular basis. A dirty set of false teeth were noted to be on a shelf in one service user’s bedroom. There was a storage box for these nearby, but no cleaning solution. The owner of these teeth had a care plan that said that they should be reminded to wear the teeth at all times. The Registered Manager said that the carer responsible for ensuing this person’s care had forgotten about teeth. Whilst this is disappointing, it was further disappointing to observe that a carer failed to clean the teeth properly before giving them to the service user. There is a need for improved care practices and staff training. Requirements are made regarding this issue. The Registered Provider said that there have been no changes in relation to medication since the last inspection of the home, when medication was found to have been handled safely. Medication Administration Records for ten service users were examined and these were in good order. A number of staff members have attended training in the safe handling of medication, run by the Royal Borough of Kingston, Social Services, since the last inspection of the home. Certificates confirming attendance at this training were viewed. Some positive interactions between service users and staff members were observed during this inspection. Staff members were noted to treat service users with respect, knock on bedroom doors before entering and seek to views of service users. Cloyda DS0000013381.V305233.R01.S.doc Version 5.2 Page 12 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 and 15. There are arrangements in place for ensuring that service users have access to social and leisure activities and for keeping in touch with their friends and family members. Meals are healthy and varied. Service users are therefore able to enjoy a lifestyle in accordance with their wishes. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: There was information in two care plans viewed about the service user’s leisure interests. During this inspection the majority of service users sat in one of the three lounges watching television. One service users was spending a day out with their family members. A care worker said that staff members usually facilitate an activity involving music or exercise with service users each day. One bedroom viewed had a television; however, this did not have a plug. One service user was noted to have a private telephone line in their bedroom. There was a selection of large print books and some games available in the home. The Registered Manager said that visitors are welcome to the home and that some service users go out with their family members. The home supports some service users to practice their religion. One service user visits to local temple with their family members on regular basis. Cloyda DS0000013381.V305233.R01.S.doc Version 5.2 Page 13 There was a menu board displayed in the dining room at the time of this inspection. This did not indicate that there was a choice of meal; however, one staff member said that service users are always spoken with individually about what they want to eat, and if they do not wish to eat what is on the menu, they are provided with and alternative. A main meal of roast beef, vegetables and Yorkshire pudding was served for lunch during this inspection. Meals were presented attractively and appeared nutritious. Some service users said that the food was good. Other service users appeared to be enjoying the meal. Staff members were available throughout the meal and offered appropriate support. A table cloth was placed on the dining table in the small lounge in line with a recommendation made at the last inspection of the home. Service users are provided with hot and cold drinks throughout the day. It was concerning to note that on the first day of this inspection, one staff member had prepared hot drinks for service users in cups that had not been cleaned properly and had tea stains both in the inside and out. This issue was also identified as a problem at the last inspection of the home. Service users must not be provided with dirty cups from which to drink from. Service users must also be offered a crockery, as opposed to a plastic cup. During this, and the last inspection of the home, there were poor hygiene standards in the kitchen. These issues are discussed in detail under Standard 19 and 26 of this report. Cloyda DS0000013381.V305233.R01.S.doc Version 5.2 Page 14 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 and 18. There is a system in place for the effective handling of complaints and service users and their relatives are encouraged to raise any concerns they have. Service users therefore know that their concerns will be acted upon. Arrangements are in place for handling allegations and instances of abuse. This ensures that service users will be protected from harm. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: There are policies and procedures in place for dealing with complaints. Information is made available in the Service User Guide about how a compliant, concern or suggestion should be made, and how this will be handled. This information also includes details about how a concern may be raised with the Commission for Social Care Inspection. Feedback from four relatives indicated that they had been made aware of the home’s complaints policies and procedures. The Registered Manager said that no complaints have been made about the home since the last inspection The home has a copy of the Royal Borough of Kingston Council’s vulnerable adult protection procedures. Records were available detailing that staff members have undergone training in the Protection of vulnerable adults Cloyda DS0000013381.V305233.R01.S.doc Version 5.2 Page 15 Cloyda DS0000013381.V305233.R01.S.doc Version 5.2 Page 16 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, 24, 25 and 26. There have been some improvements to the environment. However, there remain a number of serious matters that are ongoing and which place service users at risk of harm, and do not provide safe, homely and comfortable surroundings in which to live. There continue to be very poor hygiene standards throughout the home which do not promote the wellbeing of service users. Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: A high number of Requirements were made at the last inspection of the home regarding poor maintenance of the building, poor hygiene standards and the failure to provide a homely and comfortable atmosphere. Some of these Requirements have been addressed; however there remain serious concerns about the environment, and about the Registered Providers’ and Registered Cloyda DS0000013381.V305233.R01.S.doc Version 5.2 Page 17 Managers’ ability to acknowledge the severity of these issues. Enforcement action will be taken by the Commission for Social Care Inspection regarding some of these serious issues of concern. Immediate Requirements were issued at the last inspection of the home as a result of the immediate risk faced by service users and staff members due to poor fire safety arrangements. These issues were addressed by the home within agreed timescales; however, further poor fire safety practices were noted during this inspection: 1. The door from the small lounge to the corridor was propped open with a chair. 2. The fire alarm was activated and three automatic door closure devises failed to work. 3. There were no records detailing that the fire alarm had been tested between the end of March 2006 and the end of July 2006. The home appears scruffy and poorly maintained. There were cobwebs in some areas, stained walls and carpets, chipped and mismatched furniture, carpets and wallpaper. There were windows without blinds and light fittings without bulbs or lampshades. The home does not appear homely, domestic in character, or comfortable in many areas. A number of service user’s bedrooms had very few personal items. Some did not have any pictures. The home is registered to provide care to up to ten service users who have dementia. It is therefore disappointing to not that there are no environmental adaptations that would promote the independence of these service users. Bedroom, bathroom and toilet doors are not marked, and therefore not easily identifiable to anybody living in the home. A Requirement has been made regarding this issue. At the last inspection of the home it was noted that there were not enough comfortable armchairs for service users to sit in, and some service users were sat in hard back dining chairs in the lounge. The Registered Providers have purchased ten new chairs since the last inspection. However, the communal areas of the home still do not contain enough comfortable chairs to seat all service users, if the home is fully occupied. This Requirement is repeated. Each of the issues listed under Requirement four during the last inspection of the home have been addressed. However, a very high number or additional concerns with the environment have been raised as a result of this inspection. These are detailed below and Requirements have been made regarding these issues: 1. There are pigeons living on the roof at the front of the home and this has resulted in there being large amounts of pigeon droppings on the Cloyda DS0000013381.V305233.R01.S.doc Version 5.2 Page 18 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. front on the building, including windows, which were open at the time of this inspection. Some parts of the lino, and wall tiles in the kitchen were very dirty. One side of the fence in the garden had been removed, with only a ladder separating the garden from the next door garden which has open access to the main road, and contained large amounts of rubble and garden waste. The Registered Provider said that a new fence would be erected within a week, however, there was no risk assessment in place regarding this. There were stains on the wall paper in the small lounge and wallpaper was peeling of in some places. There were torn Christmas decorations hanging from the ceiling, and the room, in general, did not appear homely. There was a strip light in the large lounge, which was not conducive to a homely atmosphere. The carpets in the hallway, on both floors of the home were poorly fitted in some parts, were a trip hazard, and looked scruffy. The entrance hall carpet was worn and dirty. A number of bedrooms were viewed. Many of these were not homely in appearance, nor did they contain soft furnishing or personal touches. A number of bed bases in bedrooms were viewed. All of these were stained with faeces and urine in a number of areas. The side of the sink in bedroom seven was very dirty with ingrained dirt. The radiator in the en suite facilities in bedroom seven did not have a cover, and was rusty. The pole used to provide screening in bedroom twenty three was not attached securely to the wall and was propped on top of a wardrobe, posing a risk of hitting someone if knocked. There was a smell of stale urine in most corridors, and some bedrooms. There was worn and chipped furniture in a number of rooms throughout the home. The temperature of the hot water in bedrooms twenty and twenty three was 47.9 degrees, posing a risk of scalding to the service users in these bedrooms. The carpets in bedrooms twenty three and five were worn and stained in a number of areas. The service user in bedroom twenty six had not been given a top sheet after informing staff members that they were too warm with a continental quilt. This service user had been provided with only a bedspread. The new lino in bedroom two was poorly fitted and uneven. Cellotape had been used to fit the lino. The radiator cover in bedroom five was broken. The showroom on the ground floor was institutional in appearance. There was a dirty blind at the window, no lampshade, chipped tiling Cloyda DS0000013381.V305233.R01.S.doc Version 5.2 Page 19 20. 21. 22. 23. around the shower, poorly fitted lino, and no hot water from the shower. There was a badly stained carpet and dirty walls in bedroom fifteen. Seals on the fridges and freezer in the kitchen were dirty. There is a very large garden to the front and rear of the home. Some areas of the garden have been tended to and provide a pleasant area to sit, however, in general, the garden is scruffy and unmanaged. Requirements were made at the last inspection of the home regarding the need to remove items that posed a risk to service users from the garden. This Requirement as now been met, however, it remains that there is a risk to service users should they use the garden. (Refer to point 2/Requirment 12) The driveway is uneven and potholed and has not been made safe despite a Requirement being made regarding this issue at the last two inspections of the home. The Registered Manager said that the small communal lounge is no longer used as a training room for staff members, and this was seen to be the case at the time of this inspection. In light of the poor hygiene standards in the home a Requirement is made regarding the need to increase the current cleaning staff hours, which currently, at one staff member, for five hours each day, are not sufficient. Since the last inspection, there has been monitoring of the water temperatures throughout the home. Whilst this is an improvement to health and safety, it is strongly recommended that water temperatures are tested at least weekly, with records kept. Cloyda DS0000013381.V305233.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. There is a need to increase staffing levels in order to ensure that the welling being of service users is fully promoted and protected. There are adequate arrangements for the vetting of staff members with offer protection to service users. In general, there are suitable arrangements in place for ensuring that staff members receive the training necessary for dong their jobs. However, further staff training is necessary in order to ensure that the health and personal care needs of service users are fully met. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The number of care staff members in the home at the time of this inspection, and detailed in staffing rotas appears to be adequate, and in line with the needs of the current service user group. Staff meeting minutes detailed that there have been discussions about improving and maintaining good care practices. There was feedback from a relative detailing that the staff members were welcoming and friendly. Four relatives surveyed said that they believed that there are sufficient staff members on duty. However, a Requirement has been Cloyda DS0000013381.V305233.R01.S.doc Version 5.2 Page 21 made regarding the need for increase cleaning staff levels. This is as a result of poor hygiene standards in the home (Refer to Standard 26) A number of the staff team are currently undertaking NVQ Level 2 Care qualifications. There were records detailing that there has been ongoing training for some staff members since the last inspection. There were certificates detailing that staff members had completed training in ‘Foundation Food Hygiene’ and ‘Care and Control of Medication’ Two Requirements have been made regarding the need for improved staff training (Refer to standard 8 of this report) The Registered Manager said that there has been no new staff members employed since the last inspection of the home. Staffing files were therefore not examined as part of this inspection. Cloyda DS0000013381.V305233.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 and 38 There remain poor practices in the home that continue to put into question the effectiveness of the Registered Manager and Registered Providers in meeting the aims and objectives of the home. There are poor arrangements for health and safety and for quality assurance. The home is therefore not run in the best interests of service users. Quality in this outcome is poor. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: There was feedback from two visitors about their satisfaction with the service provided by the Registered Manager. One visitor said that she was very helpful. The Registered Manager was noted to share a respectful and positive relationship with service users and staff members during this inspection. Cloyda DS0000013381.V305233.R01.S.doc Version 5.2 Page 23 However, despite a number of Requirements set at the last inspection of the home being met, it remains of great concern that the home is failing to meet Nation Minimum Standards. There is confusion in the home about who is responsible for addressing Requirements which puts into question to relationship between the Registered Manager and Registered Providers, and therefore their ability to meet the aims and objectives of the home. No action has been taken to meet Requirements regarding quality assurance in the home. The Registered Manager said that some questionnaires have been sent to some family members, but there has, as yet, been no response. There remains a need to formalise the system for surveying service users and their representatives (including visitors to the home, such as Care Managers, Health Care Workers and General Practitioners) on an annual basis. The results of these surveys must be published and made available to current and prospective service users (where there is no response, published results should include information about how many people were surveyed and did not respond) No action has been taken by the Registered Providers to develop and carry out Regulation 26 visits to the home for the purpose of quality monitoring. This is of concern. No action has been taken by the Registered Providers to produce an annual development plan for the home. An action plan must be produced, based on a system of planning, action and review, reflecting aims and outcomes for service users. The action plan must detail how the Registered Provider intends to address the Requirements set out in this report. The Registered Provider said that family members, in general, retain control over service user’s finances. Small amounts of money are kept in the homes safe for some service users for purchases such as toiletries and hairdressing. There were records detailing the money held by the home on behalf of service users. Some family members had signed to say that they had handed over money and others had not. The Registered Provider buys toiletries for some service users, but there were no receipts in place for these. The Registered Provider said that this was due to toiletries being bought in bulk. It is strongly recommended that any deposited money in the home by service users, or their representative is signed for, and a receipt is provided for any purchases made on behalf of service users. A Requirement made regarding the need for the home’s old call bell system to be safety tested has not been met. The Registered Provider said that they believed this had occurred, but was unable to produce documentation detailing that the testing had occurred. This Requirement is repeated. The home was visited by the Environmental Health Officer in April 2006 and there remain outstanding Requirements following these visits. Further serious concerns about hygiene standards in the home have been raised during this inspection. Cloyda DS0000013381.V305233.R01.S.doc Version 5.2 Page 24 Concerns about the arrangements for fire safety in the home have also been raised during this inspection. The London Fire and Emergency Planning Authority will be alerted to these concerns. (Refer to Standard 19 of this report) Cloyda DS0000013381.V305233.R01.S.doc Version 5.2 Page 25 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 X X 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 1 1 X X 2 2 1 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 1 X 2 X X 1 Cloyda DS0000013381.V305233.R01.S.doc Version 5.2 Page 26 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) (a)(b) (c)(d) Requirement The Registered Providers must not admit a service user to the home, unless they have carried out, or obtained, a full assessment of the service user’s needs. A written copy of the needs assessment must be maintained in the home and available for inspection. The Registered Providers must ensure that information about any significant risks to service users, and how staff members should manage these risks, are documented in care plans. The Registered Providers must ensure that service users receive personal care that is in line with their care plan, including being reminded to wear their false teeth and having their false teeth clean properly. The Registered Providers must ensure that the staff members responsible for leaving dirty false teeth on a bedroom shelf, and for giving a service user dirty false teeth to wear, receive refresher training in providing DS0000013381.V305233.R01.S.doc Timescale for action 01/09/06 2. OP7 13 (4)(c) 15 (1) 01/09/06 3. OP8 12 (1)(a)(b) 01/09/06 4. OP8 18 (1)(a) 01/09/06 Cloyda Version 5.2 Page 27 5. OP15 12 (1)(a) 16 (2)(g) 23 (2)(g)(h) 6. OP19 7. OP19 12 (1)(a) 23 (4)(a) 12 (1)(a) 23 (4)(a) 8. OP19 9. OP19 12 (1)(a) 23 (4)(a) 10. OP19 23 (2)(d)(o) 11. OP19 23 (2)(d) 12. OP19 13 (4)(c) personal care, hygiene and dignity and respect. The Registered Providers must ensure that service users are not provided with dirty cups in which to drink from. The Registered Provider must ensure that there is at least one comfortable armchair provided in the communal lounges for each service user. Repeat Requirement. Timescale of 01/06/06 unmet. The Registered Providers must ensure that all automatic door closure devises in the home are in good working order. The Registered Providers must ensure that doors in the home are not propped open with anything other than a functioning, London Fire and Emergency Planning Authority approved, automatic closing devise. Repeat Requirement. Timescale of 20/04/06 unmet. The Registered Providers must ensure that records are available detailing that there has been a weekly safety check of the home’s fire alarm The Registered Providers must ensure that action is taken to remove pigeon droppings from the front walls and windows of the home, and to prevent future occurrences of this. The Registered Providers must ensure that the kitchen floor and kitchen tiles are kept in a clean and hygienic state. The Registered Providers must ensure that there is a risk assessment in place regarding the missing section of the garden DS0000013381.V305233.R01.S.doc 01/09/06 01/09/06 01/09/06 01/09/06 01/09/06 01/09/06 01/09/06 03/08/06 Cloyda Version 5.2 Page 28 13. OP19 23 (2)(d) 14. OP19 23 (2)(d) 15. OP19 23 (1)(a) & (2)(b) 13 (4)(a) 16. OP19 17. OP19 13 (4)(a) 18. 19. OP19 OP19 23 (2)(c) 16 (2)(c) 23 (2)(c) 23 (2)(d) 20. OP19 21. OP19 23 (2)(d) 22. OP19 23 (2)(d) 23. OP19 23 (2)(d) 24. Cloyda OP19 23 fence. The Registered Providers must ensure that the wallpaper in the lounge is not peeling and dirty. Repeat Requirement. Timescale of 01/05/06 unmet. The Registered Providers must ensure that the torn Christmas decorated in the small lounge are removed. The Registered Providers must ensure that the carpets in the corridors of the home are well fitted, and are not a trip hazard. The Registered Providers must ensure that radiator in the en suite bathroom (bedroom 7) is suitably guarded. The Registered Providers must ensure that the screening in bedroom twenty three is made secure. The Registered Providers must ensure that the radiator cover in bedroom five is repaired. The Registered Providers must ensure that furniture provided in the home is not chipped and worn. The Registered Providers must ensure that the flooring in bedroom two is not bumpy and held together with cellotape. The Registered Providers must ensure that the ground floor shower room is not dirty and contain chipped tiles. The Registered Providers must ensure that the carpets in bedrooms twenty three, fifteen and five are replaced. The Registered Providers must ensure that there are not dirty and stained walls in bedroom fifteen. The Registered Providers must DS0000013381.V305233.R01.S.doc 01/09/06 01/09/06 01/09/06 01/09/06 01/09/06 01/09/06 01/09/06 01/09/06 01/09/06 01/09/06 01/06/09 01/09/06 Page 29 Version 5.2 (2)(b)(o) ensure that the driveway is not uneven and have potholes. Repeat Requirement, timescales of 01/12/05, 01/06/09 unmet. 25. OP19 23 (1)(a) 26. OP20 23 (1)(a) & (2)(p) 27. OP20 16 (2)(c) 28. OP25 13 (4)(a)(c) 29. OP26 16 (2)(k) 23 (1)(a) 23 (2)(d) 30. 31. OP26 OP26 23 (2)(d 16 (2)(c) The Registered Provider must ensure that there are suitable arrangements in place for ensuring that bedrooms, bathrooms and toilets are easily identifiable to service users. The Registered Providers must ensure that there is suitable lighting that is domestic in nature (i.e. not a strip light) in the large communal lounge. The Registered Providers must ensure that service users are provided with suitable bed linen at all times. The Registered Providers must ensure that water that does not exceed 43 degrees is available from all hot water outlets in the home. Repeat Requirement, timescale of 01/05/06 unmet. The Registered Providers must ensure that there is not an unpleasant odour in corridors and bedrooms in the home. Repeat Requirement. Timescale of 01/05/06 unmet. The Registered Providers must ensure that the side of the sink in bedroom 7 is cleaned. The Registered Providers must ensure that all stained bed bases in bedrooms are replaced. The Registered Providers must ensure that the seals on fridge and freezer doors are clean and hygienic at all times. DS0000013381.V305233.R01.S.doc 01/09/06 01/09/06 01/09/06 01/09/06 01/09/06 01/09/06 01/09/06 32. OP26 23 (2)(d) 29/08/06 Cloyda Version 5.2 Page 30 33. OP26 23 (2)(d) 34. OP26 18 (1)(a) 35. OP33 24 (1)(a)(b) 36. OP33 26 The Registered Providers must ensure that there are no cobwebs around ceilings and doorways. Repeat Requirement. Timescale of 01/05/06 unmet. The Registered Providers must ensure that cleaning staff members are employed in sufficient numbers in the home, by increasing the current staffing levels. The Registered Providers must publish the results of satisfaction surveys and make these available to service users and their family members. Repeat Requirement, timescales of 01/12/05 and 01/07/06 unmet. The Registered Providers must: 1. Ensure that a written report is compiled, at least monthly. This report must focus on the maintenance of the premises, health and safety issues, any incidents, accidents and complaints, consultation with service users and visitors about care provided and record keeping. 2. Ensure that these reports are not complied by the Registered Manager. 3. Supply copies of these reports to the Commission for Social Care Inspection. Repeat Requirement, timescales of 01/08/05, 01/11/05 and 01/06/06 unmet. The Registered Providers must produce an annual development DS0000013381.V305233.R01.S.doc 01/09/06 01/09/06 01/10/06 01/11/06 37. OP33 24 (1)(a)(b) 01/09/06 Cloyda Version 5.2 Page 31 38. OP38 23 (2)(c) plan and make this available for inspection. Repeat Requirement, timescales of 01/08/05, 01/11/05 and 01/07/06 unmet. The Registered Provider must ensure that the call bell system is safety tested by a person trained to do so. Records of this safety testing must be available for inspection. Repeat Requirement, timescales of 01/08/06 unmet. 01/09/06 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 OP3 Good Practice Recommendations It is strongly recommended that the arrangements for carrying out needs assessments are reviewed in order to ensure that there are clear lines of responsibility in the home. It is strongly recommended that where a service user, their friend/family member/Care Manager has not personalised a bedroom and added homely touches, the Registered Providers provide some homely touches. The Registered Providers should ensure that risk assessments are in place were service users do not have a bedroom door key. It is strongly recommended that there is monitoring of hot water temperatures throughout the home, on at least a weekly basis, with records kept. It is strongly recommended that any money deposited in the home by service users, or their representative is signed for, and a receipt is provided for any purchases made on behalf of service users. 2. OP19 3. 4. 5. OP24 OP25 OP35 Cloyda DS0000013381.V305233.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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. 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