Inspection on 04/09/06 for Collyhurst

This inspection was carried out on 4th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Collyhurst 05/12/08

Collyhurst 04/06/07

Collyhurst 16/01/06

Collyhurst 14/09/05

Collyhurst 14/10/04

Collyhurst 08/04/04

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 Collyhurst 31-33 Nuneaton Road Collycroft Bedworth Warwickshire CV12 8AN Lead Inspector Jean Thomas Key Unannounced Inspection 4th September 2006 08:30 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 Collyhurst DS0000004206.V309497.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. Collyhurst DS0000004206.V309497.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Collyhurst Address 31-33 Nuneaton Road Collycroft Bedworth Warwickshire CV12 8AN 02476 319092 02476 319092 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) Mr K Taylor Mrs Elizabeth Taylor Mr Charles George Taylor Care Home 22 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (1), Old age, not falling within any of places other category (21) Collyhurst DS0000004206.V309497.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Any admission of a person under the age of 65 shall be agreed with the Commission for Social Care Inspection in advance. 16th January 2006 Date of last inspection Brief Description of the Service: Collyhurst Home is a family owned and run care home, which is situated in the Collycroft area of Bedworth. The home is registered to provide care for the older person and one younger adult with specialist needs. Collyhurst is located on the main road, which links to the two towns of Nuneaton and Bedworth and is very convenient for local services, hairdressers and shops, and a community centre, which is within close walking distance. Accommodation is provided both in the main building and a small bungalow, which is situated to the rear of the property. Service user accommodation is comprised of 18 single rooms and 2 shared rooms. The bedrooms in the main house are accessible via a passenger lift or stairs. The bungalow has it’s own small kitchen and lounge facility and accommodates up to four service users. There are pleasant garden areas at the rear of the home, which are accessible to all current service users. At the time of the inspection visit the fees charged are in the range £300.00 £345.00 per week and payable usually in advance by either cheque, direct debit or standing order. The fees do not include newspapers, toiletries, chiropody or hairdressing. Collyhurst DS0000004206.V309497.R01.S.doc Version 5.2 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. The inspection visit was unannounced and took place on Monday September 4 2006 commencing at 08.30am and concluding at 4.45pm. A separate visit made by a pharmacist inspector to look at the management of medication, took place on Thursday June 22nd 2006. • • • • The inspection involved: Discussions with The Registered Provider, senior carer, three care workers, kitchen assistant and cook. Observations at a mealtime. Two service users 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 service users. An inspection of the environment was undertaken, and records were sampled, including staff training, health and safety, staff rotas, complaints and fire records. The inspector spoke with one visitor and one health care professional about their experiences of the home. • • The inspector had the opportunity to meet most of the service users and talked to three of them about their experience of the home. The service users were able to express their opinion of the service they received to the inspector. General conversation was held with other service users along with observation of working practices and staff interaction with service users. A number of service users experience some cognitive impairment or dementia and were unable to express their views or experiences of the service provided, therefore placing greater emphasis on observation and interaction. 10 questionnaire surveys were sent to service users and relatives. At the time of writing the report five service users had responded. An audit of service user’s surveys evidence: general satisfaction with the service provided, activities are usually arranged, the staff listen and act on what service users say and the staff are “usually” available when they need them. Comments noted include: I wish there were places like this when my mother was alive. I enjoy taking part in the craft club and making things. I am happy here - the staff are always helpful and I have my friends here. Collyhurst DS0000004206.V309497.R01.S.doc Version 5.2 Page 6 I enjoy the entertainers when they come in. Since the last inspection on January 16 2006, there have not been any complaints, incidents or reports of alleged abuse made to the home or the Commission for Social Care Inspection. A number of requirements and recommendations made against the regulations or minimum standards were outstanding from the last inspection report. All service users had received a pre admission assessment and were invited to visit the home before making a decision to move there. The trial period following admission enabled the individual to decide if the home was the right place for them. Service users confirmed they were treated with dignity and respect and were happy living in the home. The home was not well maintained and some areas were unhygienic and required cleaning. There were adequate toilet and washing facilities within the home. Each bedroom was individually personalised with the service users possessions and were generally comfortable and homely. An absence of sufficient storage space has resulted in the communal areas of the home looking untidy and cluttered. Staff present as kind and caring. The Inspector would like to thank staff and service users’ for their cooperation. What the service does well: What has improved since the last inspection? Risk assessments were carried out on unguarded electric storage heaters and safety guards fitted so as to protect service users from any risk of getting burnt. Shortfalls identified during a visit from the Environmental Health Officer have been addressed. Collyhurst DS0000004206.V309497.R01.S.doc Version 5.2 Page 7 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. Collyhurst DS0000004206.V309497.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Collyhurst DS0000004206.V309497.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome is adequate. This judgment has been made using available evidence including a visit to the home. Service users and family members are encouraged to visit the home prior to admission. A basic care needs assessment is undertaken but information recorded is limited and may not be sufficiently detailed to determine whether the home is able to meet the individuals needs. EVIDENCE: In discussion the manager said all prospective service users have their needs assessed and are encouraged to visit the home prior to admission. There is an agreed trial period and a review date set as soon as the service user moves into the home. Prior to admission the manager visits prospective service users in their own home to assess their care needs and to provide information about the home. A record of the initial care needs assessment was held and used to determine whether the service user’s care needs can be met. Collyhurst DS0000004206.V309497.R01.S.doc Version 5.2 Page 10 Two service users spoken with said they had been given the opportunity to visit the home prior to admission but had not been able to do so as they moved directly to the home from hospital. One service user said family members had visited on their behalf and had shared their views and opinions of the service. One service user said “ I was made to feel very welcome when I moved into the home”. Two initial care needs assessments examined held some information about the service user’s: background; personal circumstances and care needs, but the details were limited and failed to include key information about the service user’s abilities and limitations: what aspects of personal care they could manage themselves and what if any practical assistance was needed. The home’s admissions procedure should be revised to include: visits to the home; pre admission assessment; trial period and review. Collyhurst DS0000004206.V309497.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome is poor. This judgment has been made using available evidence including a visit to the home. There is a lack of procedures or guidance to promote good health care and ongoing monitoring of health is poor. Service users are treated respectfully and their right to privacy promoted and maintained. EVIDENCE: Each service user has a care plan that is based on the initial care needs assessments. Examination of the care plans; daily records and other documentation held in respect of two service users evidence: service users have regular access to GPs; community nurses; optician; chiropodist and dentist. Advice on continence management was sought from the continence advisory service that also provides service users with any necessary incontinence pads. Service users have access to a range of equipment and adaptations that encourage and promote independence, for example: grab rails; raised toilet seats; bath hoist and a mechanical hoist used to assist with transferring. Collyhurst DS0000004206.V309497.R01.S.doc Version 5.2 Page 12 Nutritional screening is carried out at the point of admission and the outcome of regular weight checks recorded. Examination of one service user’s care records evidence the service user was assessed as being ‘ high risk’ had sustained a significant weight loss of nearly a stone during the past seven months. The action plan requires staff to encourage small amounts often there was no documentary evidence that advice had been sought from health care professionals such as: GP; dietician; or speech therapist, although a food supplement ‘Calogen’ had been prescribed and was being used. Once opened ‘Calogen’ has a lifespan of 14 days therefore the date of opening must be recorded so that the staff can be sure the product is used in accordance with the manufacturer’s instruction. Daily recording failed to evidence effective monitoring of dietary input therefore we couldn’t be sure the service users nutritional needs were being met. One service user’s care plan identifies the need for regular eye checks to be carried out by the optician. Documentation evidence eyesight checks were carried out and two pairs of spectacles prescribed, one pair for reading and one to be worn for daily use. Observations evidence the service user wearing the spectacles. The care plans did not always provide staff with the information necessary to meet the service user’s needs for example: the care plan states needs assistance with personal care but fails to identify what level of assistance is required. Care plans are not always revised to reflect changes, for instance the care plan of a service user with dementia failed to include: • Dental treatment - two teeth extracted. • The need for a soft diet. • The need to monitor the wound site for any bleeding. • Pain management. • Oral mouthwash using salt water to be carried out two or three times daily to aid healing. Daily records examined failed to evidence any of these activities occurring, therefore we cannot be sure the service user’s needs were being met safely and appropriately. A second care plan examined requires night staff to sit her on commode during the night but is not clear whether she is to be woken up or why this is necessary. Documentation failed to evidence whether the service user used the commode each night or whether she was incontinent. Risk assessments for the prevention of pressure sores and moving and handling were in place, but a risk assessment for the prevention of falls had not been undertaken for a service user assessed as being prone to falls. Collyhurst DS0000004206.V309497.R01.S.doc Version 5.2 Page 13 A number of service users have some level of cognitive impairment or have been diagnosed with dementia and were not able to express their views of the service to the inspector. Three service users spoken with were able to express their views and said the staff were always kind and considerate. Observations of staff practices evidence service users had their personal care needs attended to in private and discussion with one service user confirmed any consultations with health care professionals or treatments are also carried out in the privacy of the service user’s own room. Observations evidence service users were appropriately dressed and their clothes clean and well cared for. A visiting health care professional spoken with said the staff are polite and most are friendly. The staff follow any instructions left by the nurses and seek advice should they have cause for concern. If assessed as necessary pressure relieving cushions and mattresses are provided by the community nurses. An inspection of the management of medication evidence the records did not always support practice because the quantities of medicines received or balances carried over had not been recorded making audits difficult to undertake to demonstrate that all the medicines had been administered as prescribed. Where audits could be undertaken they did demonstrate that the majority had been administered as prescribed. Staff photocopy prescriptions but do not use them to check the medicines and Medicine Administration Record (MAR) chart for accuracy upon receipt. New service users medication is not checked with the doctor to confirm the current drug regime. “As directed” doses had not been confirmed with the doctor. One warfarin dose had not been recorded on the MAR chart. Consequently a sub therapeutic dose of warfarin had been given. All staff had successfully undertaken accredited training in the safe handling of medicines and staff interviewed had a good understanding what the medicines do. The manager demonstrated a willingness to improve practice. Collyhurst DS0000004206.V309497.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome is poor. This judgment has been made using available evidence including a visit to the home. Service users can choose how and where to spend their time but the absence of stimulation and recreation may result in unmet needs. The absence of freshly prepared cooked food may result in nutritional needs not being met. EVIDENCE: In response to shortfalls identified during the last inspection details of any planned activities were held in the office diary but were not yet displayed in the home. The service users have not been involved in planning the activities and consideration was not always given to their individual needs and preferences. Activities available include dominoes, craft club, occasional bingo and entertainment provided by visiting musicians. One service user spoken with said she enjoyed the company and was keen to participate in activities and especially enjoyed making things and doing quizzes. Daily records examined held very little information about how service users spend their time. On the day of the visit one service user played dominoes with a care worker and another spent time reading. Collyhurst DS0000004206.V309497.R01.S.doc Version 5.2 Page 15 Three service users spoken with said they didnt have meetings and had not been asked about activities. The main lounge/dining area has a loop system installed that enables service users with a hearing aid to listen to the television without interference from any background noise. On the day of the visit most service users spent the day in the lounge/dining area talking to each other, watching television or sleeping. Two service users have communion in the home each week and one service user visits the local church on Sundays. A visit to the kitchen found a cleaning schedule in place and used to ensure all areas of the kitchen are regularly cleaned. Food preparation areas were clean and tidy. The storerooms, fridges and freezers held only a small amount of stock. The manager explained that the weekly delivery of provisions was due the following day and that was why stock was low. Menus were held in the kitchen and were planned only a few days in advance and did not include fresh meat or fresh vegetables. The majority of meals provided were frozen economy processed foods and include meat pies, cottage pies and quiche, rhubarb crumble, cheesecake and gateaux. Menus were repetitive for instance; sandwiches always served at teatime and for 12 out of the past 13 weeks a roast chicken lunch served each Sunday and no alternative. On the one occasion when chicken wasnt on the menu service users were given processed pork purchased at a local supermarket. The home employs two cooks both of which were on duty on the day of the inspection. Both cooks were spoken to and confirmed they were qualified to NVQ level 3 in catering and each held a basic food hygiene certificate. The inspector was advised that the cooks were not involved in menu planning and the manager devised the menus. Four service users spoken with said they had not been consulted about menus and confirmed that staff advised them each day what is on offer and record their preferences. Three service users spoken with said they “get fed up with sandwiches every day” at teatime but were generally satisfied with the rest of the food provided. Fresh fruit was available in the lounge/dining areas and was offered as an alternative at mealtimes. Desserts for service users requiring a diabetic diet were often limited to either ice cream or yoghurt. Improvements are necessary so as to enhance the quality and range of food provided and to ensure a suitable alternative is available. Detailed records of the food provided must be held so that we can fully assess the nutritional value of the food offered to service users. Observations at lunchtime evidence staff sitting with the service users while having their own lunch. The staff were aware of the needs of service users and were available to provide assistance when necessary. Collyhurst DS0000004206.V309497.R01.S.doc Version 5.2 Page 16 Hot food was plated up in the kitchen and transported to the dining room in a heated trolley. Service users were offered meat and potato pie or quiche served with mashed potatoes and broccoli. It was noted that both dishes were served with gravy. Cold food (gateaux) was transported from the kitchen to the dining room uncovered and in an open trolley thus increasing the risk of cross contamination. Drinks were readily available throughout the day and service users and visitors had access to a cold-water dispenser in the lounge/dining area. From talking to service users it was evident that the lifestyle in the home generally reflects their expectations, but that is not to say there is no room for improvements, as sometimes service users may have low expectations based on preconceived ideas about what residential care has to offer them. Three service users spoken with said they were able to exercise choice and could choose how and where to spend their time. One service user spoken with said I cant always get a bath when I want one, but I do have regular baths. Collyhurst DS0000004206.V309497.R01.S.doc Version 5.2 Page 17 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 Quality in this outcome is adequate. This judgment has been made using available evidence including a visit to the home. The policies and procedures regarding protection of service users are adequate, but the absence of appropriate staff training in the area of protection may place service users at risk. EVIDENCE: We have not received any complaints, concerns or allegations of abuse about the service since the last inspection. No complaints have been made at the home since the last inspection. The home has a complaints procedure, which is displayed in the hallway and is included in the Service User Guide. The information held in the complaints procedure requires revising to include complaints can be referred to the commission at any stage of the process. Three service users spoken with said they werent aware of the complaints procedure that would speak to the manager if they were dissatisfied with any aspect of the service. One service user spoken with said, I sometimes have a moan about something and its dealt with straightaway I couldnt complain they look after me very well”. One care worker spoken with said she would report any complaints to the senior carer. The home has a procedure for responding to allegations of abuse that provides clear guidance for staff. The manager is aware of the local arrangements for dealing with allegations of abuse and would refer any issues of concern about the safety of service users to Social Services. Collyhurst DS0000004206.V309497.R01.S.doc Version 5.2 Page 18 Two staff spoken with were not aware of the adult protection policy and procedure but said they would report any issues of concern to the senior carer. One care worker spoken with had only limited knowledge of how to identify any potential abuse and was unable to describe the different types of abuse that may occur. The care worker had not undertaken training in understanding adult protection or the prevention of abuse and was also unaware of the ‘whistle blowing’ policy and procedure. The manager must ensure that staff attend appropriate training in abuse awareness and how to respond to suspicions of abuse in order to ensure the protection of service users. Collyhurst DS0000004206.V309497.R01.S.doc Version 5.2 Page 19 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,and 26 Quality in this outcome is poor. This judgment has been made using available evidence including a visit to the home. Service users do not benefit from living in a comfortable environment that is free of offensive odours. EVIDENCE: A tour of the premises evidence the environment was in need of refurbishment and redecoration. It was disappointing to note that shortfalls identified during the last inspection remained outstanding as all areas of the home were not kept clean for instance, carpets in corridors and in some service user’s private rooms required either cleaning or replacing and offensive odours were evident in some service user’s rooms and in communal areas of the home. Collyhurst DS0000004206.V309497.R01.S.doc Version 5.2 Page 20 The absence of soap and disposable hand towels in toilets and bathrooms is unsafe and place service users at risk of infection. The furnishings and fittings looked old, tired and shabby and required replacing. Tablecloths in the dining room were creased and the kitchenette adjacent to the lounge/dining area needed cleaning and the shelves in the storage cupboards replacing. Service users private rooms were personalised and homely. Three electric razors were left in one bathroom and a lack of storage space has resulted in various items being left around the home, for instance a bucket and stepladder in one bathroom, a sweeping brush and a vacuum cleaner left in a corridor. Two service users spoken with said they were satisfied with their rooms and confirmed they had been able to personalise their rooms and had brought some items of furniture in with them including a bed. One service user said she would like more space and had been offered an alternative room, but as the room offered was upstairs she had decided to stay where she was. Picture images were displayed on toilet doors and a double room was being used as a single and occupied by one service user. In response to shortfalls identified during the last inspection risk assessments had been carried out and a number of safety guards fitted to storage heaters so that service users are not at risk of injury should they come into direct contact with the heaters. One of the two showers had a cracked shower tray and was not being used. In order to access the shower cubicle service users have to negotiate a step. Discussion with the manager evidence risk assessments had not been carried out therefore service users may be at risk of harm or injury. One care worker spoken with evidence commodes were cleaned in the sluice and yellow bags used for the safe disposal of incontinence pads. Clinical dressings are disposed of separately in a clinical box. Observations in the home evidence disposable gloves were readily available and two carers spoken with confirmed gloves were used when assisting service users with personal care tasks. There were no disposable gloves or aprons available in the laundry room and in discussion the manager said that staff always used disposable gloves when handling soiled linen. One care worker spoken with confirmed this occurred. Collyhurst DS0000004206.V309497.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected 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 good. This judgment has been made using available evidence including a visit to the home. Service users benefit from having their care needs met by a qualified and experienced staff team. EVIDENCE: Staff spoke positively of the training they had received and of the programme for achieving a National Vocational Qualification (NVQ). A number certificates were displayed in the home and training records evidence the manager has a coordinated programme to ensure that staff had the necessary skills for the work they were doing. Of the 11 care staff employed nine have completed an NVQ level 2 in care. The home therefore meets the expectation that 50 of staff will have achieved this by 2005. There was a staff induction programme linked to TOPPS competencies and training records demonstrate that staff have accessed training in first aid, continence promotion and food safety. Four staff have been trained in mental health including the manager and a number in dementia care but there had been no update in dementia care training for two years. It is therefore recommended that dementia care training is included in this year’s staff training programme. Collyhurst DS0000004206.V309497.R01.S.doc Version 5.2 Page 22 A staff rota was maintained but did not include the time spent in the home by The Registered Provider or the role of the worker as required, and in accordance with the Care Homes Regulations. The rota showed three care staff on duty in the mornings, two or three in the afternoons/evenings and two working a waking night duty. Staff at the home cover any staff absence. Three service users, one visitor and one health care professional spoken with were all of the opinion that the number of staff available were sufficient to meet the needs of service users. One service user said, they work hard, nothing is too much trouble. Observations of staff practices and interactions with service users evidence sufficient numbers of qualified and experienced care staff necessary to meet the needs of service users were available. The home employed a domestic assistant for four hours each day and six days a week. The manager must review the number of staff hours spent on cleaning the home and take appropriate action to ensure the home is clean and maintained to a satisfactory standard. The personnel files of four recently employed staff were examined and these contained the necessary pre-employment checks such as references, Criminal Record Bureau (CRB) disclosures and checks made against the Protection of Vulnerable Adults register (POVA). One application form examined failed to include full details of the applicant’s employment history and these gaps had not been identified or explored. The manager demonstrated a commitment to ensuring that all the information necessary to determine fitness was sought before prospective employees were confirmed in post. Collyhurst DS0000004206.V309497.R01.S.doc Version 5.2 Page 23 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 and 38 Quality in this outcome is adequate. This judgment has been made using available evidence including a visit to the home. The manager is experienced, qualified and competent and staff are regularly supervised, but quality assurance monitoring is not regarded or implemented as a core management tool. EVIDENCE: The manager has a number of years experience and has completed The Registered Providers Award (RMA) and National Vocational Qualification level 4 in social care. A formal quality assurance system has not yet been introduced to monitor and to make sure that all services and procedures in the home operate in the service users’ best interests. Collyhurst DS0000004206.V309497.R01.S.doc Version 5.2 Page 24 In response to shortfalls identified during the last inspection formal staff supervision had been introduced but failed to include staff practices or identify staff training and development needs. The manager said he monitors staff practices and gave feedback but could not provide documentary evidence to support this. Two staff spoken with were not aware their practices were monitored and had not received feedback on their performance. Information on how to access professional advocacy services is displayed in the home. Of the 19 service users three maintain their own benefit book and handle their own financial affairs, three are subject to Power of Attorney, one subject to Guardianship, one supported by a solicitor and one supported by a professional advocate (advocacy alliance). Family members support the remaining service users. One family member spoken with said they managed their relative’s money and brought small amounts into the home to be held for safekeeping until required by the service user. The home has a policy and procedure for safeguarding service user’s finances. Monies held for safekeeping was stored safely and securely. Records of all financial transactions were held and receipts for items or services purchased on behalf of the service user were obtained apart from receipts for money paid to the chiropodist for foot care. In response the manager agreed to raise this issue with the chiropodist and would make sure individual receipts were sought and held on the service user’s personal record file. Service users had a lockable space in their room in which to keep medication or private papers. The manager ensures that tests for Legionella are carried out and regular checks carried out on: portable electrical appliances; electrical and gas systems; passenger lift and fire alarms. In response to shortfalls identified during the last inspection staff training in the use of fire fighting equipment took place in January 2006 and a fire drill in April 2006. During the inspection a number of unsafe practices were identified: A visit to the laundry room evidenced the fire door leading into the laundry was wedged open and a tumble dryer waiting to be collected for repair had been placed in front of a fire extinguisher. The manager responded immediately and closed the fire door and moved the machine away from the fire extinguisher. The manager demonstrated a commitment to ensuring staff adhered to the homes health and safety policies and procedures. A tour of the premises found footrests had been removed from the wheel chairs were not fitted when the chairs were used to transfer service users. This practice is unsafe and place service users at risk. The manager was required to address this issue immediately. Collyhurst DS0000004206.V309497.R01.S.doc Version 5.2 Page 25 Staff training on moving in handling is provided by the manager and a senior carer neither of which have been appropriately trained to provide instruction to staff therefore practices are unsafe. Staff responsible for carrying out risk assessments must also receive appropriate training. Collyhurst DS0000004206.V309497.R01.S.doc Version 5.2 Page 26 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 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 X X X X X X 2 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 3 X 1 X 2 3 X 2 Collyhurst DS0000004206.V309497.R01.S.doc Version 5.2 Page 27 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 Provider/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 Schedule 3(1)(d) Requirement Timescale for action 30/09/06 2 OP7 15, 17 3 OP7 13,14,17 The Registered Provider must ensure that a full pre-admission assessment is carried out on all prospective service users to ensure that their needs can be met. The Registered Provider must 30/09/06 ensure that care plans are written to describe in detail the actions required to meet all the current needs of service users in respect of their health and welfare and the plans must be kept under review (Outstanding from January 2006) The Registered Provider must 30/09/06 ensure risk assessments are developed on an individual basis and include any activity that may pose a risk. Where a risk is determined a care plan must be devised describing the action to be taken to minimise the risk. Accurate and effective monitoring records must be held and clearly identify how service user’s care needs are being met. DS0000004206.V309497.R01.S.doc Version 5.2 Collyhurst Page 28 4 OP8 12(1) 5 OP9 13(2) 6 OP9 13(2) The Registered Provider must ensure advice and where necessary treatment is sought when service user’s nutritional needs are giving cause for concern. The Registered Provider must ensure that the date any food supplements are opened is recorded. The Registered Provider must install a system to check all the medicines into the home. This includes the regular medicines ordered in addition to medication bought in by new service users who come to live in the home. This standard was not assessed during this inspection and the timescale for completion is 22/07/06. The Registered Provider must ensure that quantities of all medicines received or balances carried over are recorded to enable audits to take place to demonstrate that medicines are administered as prescribed and records reflect practice. Regular staff drug audits must be undertaken to demonstrate staff competence in medicine management. This standard was not assessed during this inspection and the timescale for completion is 22/07/06. The Registered Provider must ensure all “as directed” doses must be clarified with the doctor. “When required” protocols must be written and the actual warfarin doses recorded on the MAR chart. 21/09/06 21/09/06 30/09/06 7 OP9 13(2) 30/09/06 8 OP9 13(2) 30/09/06 Collyhurst DS0000004206.V309497.R01.S.doc Version 5.2 Page 29 9 OP12 16 10 OP15 16(2)(i) 13(4)(c) 11 OP18 18(1)(c) 12 OP19 23 13 OP26 16, 23 14 OP27 17(2) Schedule 4(7) This standard was not assessed during this inspection and the timescale for completion is 22/07/06. The Registered Provider must ensure that there are organised activities that reflect the service users’ social, cultural and interest needs. (Outstanding from January 2006) The Registered Provider must provide, in adequate quantities, suitable, wholesome and nutritious food, which is varied and properly prepared and available at such time as may reasonably be required by the service users. The Registered Provider must ensure that food transported around the home is covered. The Registered Provider must ensure that all staff attend up to date training in adult protection to include ‘Whistle blowing’. The Registered Provider must produce a programme of routine maintenance and evidence of renewal of the fabric and decoration of the premises. The programme must include the timescale for implementation. The Registered Provider must ensure that all areas of the home are kept clean and hygienic. (Outstanding from January 2006) The Registered Provider must ensure that the duty roster includes details of all staff working in the care home, to include full name and the capacity in which the staff are working. 14/10/06 30/09/06 14/10/06 14/10/06 21/09/06 21/09/06 Collyhurst DS0000004206.V309497.R01.S.doc Version 5.2 Page 30 15 OP33 24 16 OP38 23 17 OP38 13(4)(c) The Registered Provider must introduce systems that will effectively monitor and audit working and care practice in the home. These procedures must be ongoing. (Outstanding from January 2006) The Registered Provider must ensure that fire doors are not wedged open and access to fire fighting equipment not obstructed. (Original timescale of 04/09/06) The Registered Provider must ensure training on moving handling and risk assessing is only undertaken by those deemed to be suitably qualified and competent to do so. Wheelchairs must be fitted with footrests when being used to transfer service users. (Timescale of 04/09/06). 31/10/06 21/09/06 21/09/06 Collyhurst DS0000004206.V309497.R01.S.doc Version 5.2 Page 31 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 OP9 Good Practice Recommendations The inspector recommends that the policies for the management and administration of medication are reviewed and that a copy of The Administration and Control of Medicines in Care Homes and Children’s Services is obtained. (Royal Pharmaceutical Society of Great Britain June 2003) It is recommended that gravy is not routinely served with quiche and service users should be asked and their preferences respected. A menu should be displayed in the home so that service users can see what alternatives are available. It is recommended that designated storage space be identified and used to hold equipment. It is recommended that dementia care training is included in this year’s staff training programme. Individual staff supervision should include observation of staff practices and provide constructive feed back to the worker. 2 OP15 3 4 5 OP19 OP27 OP36 Collyhurst DS0000004206.V309497.R01.S.doc Version 5.2 Page 32 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 Collyhurst DS0000004206.V309497.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!