Inspection on 18/01/06 for Coombe End Court

This inspection was carried out on 18th January 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Coombe End Court 05/06/07

Coombe End Court 12/06/06

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Coombe End Court Coombe End Court London Road Marlborough SN8 2AP Lead Inspector Ms Sally Walker Announced Inspection 18th January 2006 09:25 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 Coombe End Court DS0000065400.V267385.R01.S.doc Version 5.0 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. Coombe End Court DS0000065400.V267385.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Coombe End Court Address Coombe End Court London Road Marlborough SN8 2AP 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) 01672 512075 The Orders of St John Care Trust Care Home 60 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (40) of places Coombe End Court DS0000065400.V267385.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person will ensure that staffing levels meet the needs of residents at all times and do not fall below that stipulated in the Residenti al Forum `Care Staffing in Homes for Older People` Model The home may from time to time to admit residents between the ages of 60 and 65 First announced inspection since registration. Additional visit made by Pharmacist Inspector on 11th November 2005 2. Date of last inspection Brief Description of the Service: The home was recently registered on 20th September 2005 to The Orders of St John Care Trust. The home is registered for a total of 60 beds for older people, including a separate unit for residents with a diagnosis of dementia. There are 10 beds in the main home registered for dementia. The building was purpose built in 2005 and comprises three named areas: Emerald, Ruby and Pearl. A day service is also attached to the building. Residents’ accommodation is all single bedrooms with ensuite toilet and shower. Mrs Carol Rickman is the registered manager. On registration it was agreed that staffing levels have been calculated to meet the Residential Forum “Care Staffing in Homes for Older People” model – 1120 care hours per week for 60 residents. Coombe End Court DS0000065400.V267385.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first announced inspection since the home was registered in September 2005. The home had 51 residents. It was reported that the 10 beds allocated to dementia care in the main home were for those residents with ‘mild’ dementia. The main focus of the inspection was to consider the care records, medication, staffing and training, following 4 medication errors since October 2005. Mrs Diane Bowden, county director, had given assurances to the Commission that strategies are in place to address issues identified by her own investigations and that she will be monitoring progress. Inspectors spoke with 9 residents and 4 staff. The inspection took place from 9.25am to 5.10pm. Mrs Rickman was present throughout the inspection as was Debra Yeates, care services manager, Jill Mitchener, care development manager and Diane Bowden, county director for The Orders of St John Care Trust for the feedback. One relative’s comment card was received comments were “No problems with my mothers care. Staff at Coombe End always cheerful. Cares for all my mothers needs. I am aware they are short of staff at times.” What the service does well: What has improved since the last inspection? What they could do better: Coombe End Court DS0000065400.V267385.R01.S.doc Version 5.0 Page 6 The current recording format for assessments does not support the home in carrying out a full and detailed assessment with potential residents before they are admitted to the home, in particular, with those residents who may have a diagnosis of dementia. Care plans need to direct the care with full details of current needs, guidance to staff on how to meet those needs and how to monitor progress. Clear guidance needs to be incorporated into the care plans with regard to presentation of behaviours and how to manage them. Care plans need regularly monthly review and revision as well as when needs change. Residents risk of developing pressure sores needs to be assessed particularly those residents who may have a diagnosis of dementia. Other potential risks of daily living need to be assessed, for example, going out in the gardens or unsupervised activities. Staff need to be trained in tissue viability and to be made aware of the preventative measures in reducing the risk of pressure sores developing. Those residents who may have a diagnosis of dementia will need to have bowel management strategies in place. The Health Protection Agency guidance to care homes on infection control needs to be implemented when infections are identified and all staff need to be aware of any management strategies in place. Whilst it is recognised that actions have been taken or are being taken to make sure the organisation’s policies and procedures are implemented with regard to the administration and control of medication, other areas need consideration; the rota must ensure that competent staff are on duty to administer the medication when needed, care plans must identify specific prescribing details. Records must show that new staff have been properly inducted. Staffing levels must not be reduced at the weekends. 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. Coombe End Court DS0000065400.V267385.R01.S.doc Version 5.0 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 Coombe End Court DS0000065400.V267385.R01.S.doc Version 5.0 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 Pre-admission assessments of need were variable and depended on the amount of information gathered. The organisation’s current format for assessing need does not support staff to fully assess those potential residents who may have a diagnosis of dementia. The home’s own assessments were variable in the detail gathered. EVIDENCE: Mrs Mitchener said that the home requests a letter of original diagnosis for those residents who may have a diagnosis of dementia before they are admitted to the home as part of the assessment process. Care managers were also required to provide up to date assessments if residents were funded by a local authority. If residents paid their own fees, the home carried out its own assessment. The home was using a form entitled needs assessment and long term care plan for pre-admission assessments and these were variable in their detail. The inspectors were under the impression that the organisation was to provide its homes with an assessment document developed by Mrs Mitchener and other managers which provided more detail on assessment, particularly for those people who may have dementia. The current document was not effective to ensure that all care needs were fully assessed. Service users guides were seen in residents bedrooms. Coombe End Court DS0000065400.V267385.R01.S.doc Version 5.0 Page 9 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 Poor recording could not evidence that residents healthcare needs were being fully met, although staff did refer to healthcare professionals when concerned. Those residents with a diagnosis of dementia had good access to mental health specialists. When needs were identified there was no effective planning for meeting those needs and no guidance to staff for managing complex care needs in terms of dementia, behaviours, pressure sores and specific infections. Four medication errors meant that residents had not been protected by the organisation’s policy on administration of medication or by ensuring staff were following that policy. EVIDENCE: All residents had a care plan. Not all of the care plans had been regularly reviewed each month or as care needs changed. Staff were recording directives in the daily report when incidents occurred but this did not prompt a review or revision of the residents care plan. There was however good evidence in the daily reports that residents were promptly referred to healthcare professionals when concerns were noted. Care plans did not state how the often complex care needs of those residents who had a diagnosis of dementia were being met in relation to their dementia. It was evident from the records that mental healthcare specialists were involved with residents, however there were not always clear guidelines to staff for dealing with Coombe End Court DS0000065400.V267385.R01.S.doc Version 5.0 Page 10 behaviours or how they may present. The inspectors examined the files of three residents who were identified by staff as having pressure damage. There was no written evidence of assessment of risk of these residents developing pressure sores. No evidence could be found in the care plans whether these residents had pressure sores or if they did, how they were being treated. One residents pressure sore risk assessment only identified the areas as “in tact” others identified in great detail what staff should do if red marks appear, which is clearly too late for preventative measures. The evidence suggested that staff did not have an understanding of pressure sore prevention and staff confirmed that they had not been trained in tissue viability. The inspectors had been assured by the organisation that a format would be introduced into the homes. The inspectors advised the use of body maps for all wounds and unusual marks. Body maps were in evidence for falls. One resident who was sitting in a wheelchair during the morning was still sitting in it at lunchtime and was taken to the seating area in the wheelchair for the afternoon. Mrs Rickman said the person normally had a self propelling wheelchair which had not accompanied them to the home and this was being followed up. The inspectors were of the view that this resident should have been encouraged to sit in the dining room chair or the comfortable chair to reduce any risk of pressure damage from a wheelchair that was not designed for long term use. Some residents files identified that they had a notifiable infection yet the care plans made no reference to this, the site of the infection was not known and there was no guidance on caring for these residents in terms of infection control measures. A member of staff who carried out cleaning duties was not aware of the status of these residents or of any special precautions they should be taking. A number of eye infections were recorded both in the unit and in the main home. A copy of The Health Protection Agency guidance to care homes on infection control was found in one of the management offices and this should be made more available to staff. Mrs Rickman had identified that staff needed training in infection control in her training matrix. The inspectors were concerned that this had not had a higher profile as part of the initial induction of staff into the home. Two food and fluid intake charts had been set up for some residents. They had not been kept up to date or gave full details of the amount of fluids taken, for example, ‘a cup of tea’ taken rather than the amount of fluid in order to assess adequate fluid intake. However there was a good example in one daily report of a member of staff noting that a resident had missed a meal as they were sleeping and had later been given something to eat when they awoke. Food supplements were also given. The forms were a good document but inspectors advised that the two different charts may be confusing and proper recording may be achieved if only one was used. Nutritional risk assessments were not in place to support the dietary needs of residents with dementia. Residents had been weighed on admission and monthly thereafter. Coombe End Court DS0000065400.V267385.R01.S.doc Version 5.0 Page 11 Recording of assessment of risk was intermittent. There was some good evidence of assessment of risk regarding falls but not all residents had had full risk assessments. Some files did not have photographs of residents. The Pharmacist Inspector visited on 11th November 2005 to inspect the medication arrangements following registration. The requirement that ‘as required’ medication must be clearly documented in the care plan and use of medication as part of a behaviour management plan evidenced in the records had not been actioned. The medication administration record and the daily report showed inconsistencies with administration of medication prescribed for bowel management and pain relief. Evidence suggested that staff may not have an understanding of the medication’s actions to prevent bowel impaction. The medication was not given continuously and the daily records did not show clear instruction or that monitoring was in place. The inspectors advised that a bowel management system must be implemented for those residents who may have a dementia. One resident had not had pain relief for 11 days and it could not be established from their care plan the prescriber’s instructions or whether staff would know when they were in pain. There were also inconsistencies with administering medication which was prescribed to be taken when required. When this medication was not given some staff wrote the reason’s on the back of the sheet and others made no record. The requirement that medication, including ‘as required’ and variable doses, must only be administered in accordance with the prescriber’s instructions and evidenced in the records had not been actioned. One medication that was prescribed to be taken each week had be signed for the following day. A check on the remainder showed that it had not been given, but the prescribing details on the label were not clear as to the time of day it should be given. The head of care said they would immediately request clarification from the prescriber. The recommendation that training of staff who administer medication should be expanded beyond local policies and competency, had been addressed in part in that the supplying pharmacy had given some training, but following the maladministrations the organisation’s training manager had gone through the material supplied by the pharmacist again with staff. The head of care explained the arrangements for the control and administration of medication. It was clear from discussions that the head of care was very familiar with the complexities of residents prescribed medication and was open to the advice given by the nurse inspector. Each record had a photograph of the resident. The organisation’s new medication policy although available to staff on each floor, should be kept in the medication administration record. Mrs Rickman had attached a précis of the salient points to the front of the record. Handwritten entries following changes in medication should be witnessed, signed and dated by 2 staff. Duplicate separate sheets handwritten Coombe End Court DS0000065400.V267385.R01.S.doc Version 5.0 Page 12 by the pharmacist should be removed from the files to avoid confusion. Mrs Rickman said that she was meeting with the supplying pharmacist later that week to resolve some of the issues encountered with not always having the medication administration record in printed form. Reasons for taking anticoagulants, and foods or alcohol which should be avoided were not recorded nor could it be confirmed that the chef was aware of this. Controlled drug records should start with a balance to avoid confusion in monitoring storage. Care plans did not identify administration of medication which was to be taken when needed, for example, a spray for angina; the care plans did not record how staff would establish that medication was needed specially when a resident’s dementia may not allow them to express themselves verbally. The amount of medication prescribed which the home was having difficulties in storing should be discussed with the prescriber. Some of this medication should be stored in the metal drug cabinet rather than under the sink, although secured, it could not be protected from leakage. The head of care said a further metal cupboard was ordered. As a matter of good practice it could be established that antibiotics were being given to residents as soon as they were collected from the pharmacy. There was evidence that staff were checking with new residents GP regarding their currently prescribed medication. A container was on order to safely store unused and unwanted medication to be returned to the pharmacy. Four medication errors had occurred since October 2005; three where residents had been given other residents medication and one where a resident was without medication as it had not been ordered when they were admitted. Following the first two incidents the home confirmed that staff had been made aware again of the organisation’s medication and admission policies. Following the third error, Mrs Rickman’s investigation report supplied to the Commission, identified that the home’s disciplinary procedure had been activated and further training in medication was taking place. Following the fourth maladministration Mrs Bowden became involved and has given assurances to the Commission that further investigations were underway. Mrs Bowden also confirmed that those residents had not been harmed by the incidents, that she had met with senior staff to discuss the seriousness of the situation, that disciplinary action was being taken, that further training was underway and that the newly published medication policy was being implemented with consideration of the carrying out of the procedure to discover any hindrances to proper administration of medication, for example, interruptions. The inspectors were concerned to find that the care staffing rota had not allowed for staff deemed competent to be on duty when medication was needing to be administered. Earlier that morning a designated senior staff had not been available to administer medication which was prescribed to be taken before food so, on their own admission to the inspectors, another member of staff had given medication to five residents. Also a member of staff was seen Coombe End Court DS0000065400.V267385.R01.S.doc Version 5.0 Page 13 to be carrying around the home medication for 2 residents who were attending the day service. It was clear that staff were ensuring that residents were well groomed, with clean matching clothing, clean teeth, hair and fingernails. Two agency staff in the dementia unit showed good support of the residents in the communal sitting room, they engaged with residents who appeared contented. Those residents who were walking around the unit did not have the agitation often associated with people with dementia who may be trying to make sense of their environment. Again an agency staff was supporting these residents with engagement and purpose. Mrs Rickman said that the psychiatrist visited once a month to review those residents with dementia and provide advice. A specialist nurse was visiting each week to provide guidance and strategies for managing behaviours, in particular, for those residents who were trying to make sense of their new surroundings and displaying agitation. This nurse was due to train staff in managing behaviours. One resident who had recently fractured their hip, as a matter of good practice, had in their care plan that although they walked with a frame, they were to be offered a wheelchair so they did not have to walk long distances. Coombe End Court DS0000065400.V267385.R01.S.doc Version 5.0 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): None of these standards were inspected. EVIDENCE: In the main entrance there was a small shop and bar with facilities for visitors to make hot refreshments. A hairdressing salon was also being used opposite. There was a sensory room with some equipment installed. It was reported that it was not used much. The inspectors were of the view that the current staffing levels would not necessarily support continued use of the room. One residents said they enjoyed the food. Coombe End Court DS0000065400.V267385.R01.S.doc Version 5.0 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 A complaints procedure was in place and training was being given by the organisation to its managers. The local Vulnerable Adults procedure had been discussed at induction and all staff had their own copy. EVIDENCE: Mrs Rickman kept a log of any complaints. The home was using 2 forms one of which identified verbal complaints as not serious and showed no action plan. Mrs Rickman said she was due to train in managing complaints later that week. She said she had only received one concern which the person did not want to take further; this was documented. It was reported that all staff had been given a copy of the local vulnerable adults procedure booklet entitled “No Secrets in Swindon and Wiltshire”. It was reported that the policy had been discussed at the initial induction. Coombe End Court DS0000065400.V267385.R01.S.doc Version 5.0 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 & 26 The home was newly built and all residents benefited from their own ensuite washbasin, shower and toilet. Residents had personalised their bedrooms and appeared satisfied with the accommodation. The home was cleaned to a high standard by a housekeeping staff team that were employed throughout the day. No unpleasant odours were detected. Infection control guidance was not in place to protect residents and staff from certain infections. EVIDENCE: The front door was temporarily locked on the day of the inspection and all visitors were redirected to the rear entrance. A receptionist is employed from 9.00am to 2.00pm, Monday to Friday, to support visitors with enquiries. The site was still being developed to provide the entrance drive and car parking. Eventually some houses for older people will be built to the front of the building but they will not be part of the registration. The inspectors made a tour of the building with Mrs Rickman and Mrs Yeates. Residents accommodation is all single bedrooms with ensuite toilet, wash basin and shower. Most of the rooms have a good view either of the central courtyard or the surrounding area. Residents’ rooms were light, bright and airy and most residents had been able to bring small items of furniture and other items to Coombe End Court DS0000065400.V267385.R01.S.doc Version 5.0 Page 17 make the rooms more homely. One of the residents showed the inspector their bedroom and they appeared to be very satisfied with it. Each of the areas and the dementia unit had its own dining room with kitchen/serving area. Risk assessments were in place for the use of the folding counter top to access the kitchen area to protect those residents with dementia from accessing the kitchen and using some of the equipment. There was also a large sitting area opposite the entrance hall which was used for functions and some activities. The garden area to the rear of the building had been enclosed so that those residents who may have dementia can go out of the building without getting lost. The inspectors advised not to identify the doors of residents with special care need by coloured squares put by their name plates. Any special measures must be identified in care plans not in a public place. A member of staff was asked what the colours meant and they said they did not know. Infection control guidance needs to be in place. See Standard 8. The home was cleaned to a good standard and no unpleasant odours were detected at any time during the inspection. Mrs Rickman reported that there were cleaning staff employed throughout the day. On registration the organisation agreed to provide a minimum of 195 hours housekeeping and laundry. Coombe End Court DS0000065400.V267385.R01.S.doc Version 5.0 Page 18 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 & 30 Staffing levels were not consistent throughout the week reducing at the weekends to below what was agreed on registration. Induction of new and existing staff was not consistent as evidenced in the records and by 4 medication errors since October 2005. Staff were seen to be friendly and engaged with residents. It was clear that they put much effort into ensuring residents were well groomed. A training programme was in place which included dementia care. EVIDENCE: A large number of the staff transferred from the Wiltshire County Council home that was taken over by the organisation. More staff had been recruited to fill the posts required for a larger home. Some agency staff were used to cover whilst posts were filled. It was reported that all staff had been inducted into their roles before the transfer, however evidence was not found for all staff. Staff personnel files showed that induction was not consistent for all staff; one staff had no record that they had been inducted and another had not completed all of the competencies, for example, moving and handling. Mrs Bowden said that a full programme of induction had been carried out before the staff had moved to the new building. One agency worker said they had had a good induction into the home. Staff personnel files showed that the home gathered all the information and documents required by schedule 2 and that no staff had commenced work without a Criminal Records Bureau certificate being sought and POVAfirst confirmation that they could commence duties. However 2 staff were identified as being moving and handling and first aid trainers but there was no evidence of certification of this training and the Coombe End Court DS0000065400.V267385.R01.S.doc Version 5.0 Page 19 inspectors advised that they should not carry out this training until the home was satisfied of their competency. Mrs Rickman had produced a training matrix showing which staff needed to train in different subjects. There was an accompanying training availability list of the different courses run by the organisation. A list was provided of those staff having to undertake individual training with regard to the safe administration of medication. Mrs Mitchener was due to provide staff with training in dementia care using a training pack jointly produced by the organisation and the Alzheimers Society. Staff were required to complete a workbook and an exam. It was reported that the agency staff were not in charge of shifts and did not give medication. The care staffing structure was 2 heads of care with care leaders to lead the shifts, care staff and waking night staff. Mrs Yeates said that staff now allocated duties at the beginning of each shift and that there were plans to provide note books for staff to help them organise their duties. The staffing for the dementia unit for that day was: the head of care, a care leader, a permanent member of staff and 2 agency staff. There were 4 staff and a care leader in the main home and a care leader described as ‘floating’ between the main home and the unit. A staff member who worked in the day service had come to the home during lunchtime to assist the care staff with meals. The rota showed that the care staffing levels were reduced at the weekends. The previous Sunday identified that there would have only been three care staff and a care leader working in the main home, which was disputed by management. The following Sunday showed 4 care staff and a care leader. The inspectors advised that the rota should show a true record of the number of care staff on duty. The rota showed 4 waking night staff, 2 working upstairs and 2 downstairs. One resident said that the staff were very kind and another said they liked the staff. Coombe End Court DS0000065400.V267385.R01.S.doc Version 5.0 Page 20 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 & 38 Managers and senior manager from the organisation have assured the Commission that an action plan is being implemented to reduce the residents’ risk from further medication errors. EVIDENCE: Mrs Rickman has had much experience of working in and managing care homes both with the local authority and the organisation. She was registered as manager on 20th September 2005. Mrs Bowden, Mrs Yeates and Mrs Mitchener have given assurances to the Commission that they will support Mrs Rickman to ensure that improvement strategies are fully implemented for the protection of residents. Mrs Yeates reported that she will be spending more time in the home as care services manager. Mrs Bowden has given written assurances that her action plan will be implemented in order that staff understand the organisation’s policies and procedures. She has assured the Commission that she will continue to monitor the progress. Coombe End Court DS0000065400.V267385.R01.S.doc Version 5.0 Page 21 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 2 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X X 2 Coombe End Court DS0000065400.V267385.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? 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 OP9 Regulation 13(2), 12(1)(b) Requirement Criteria for the use of ‘as required’ medication must be clearly documented in the care plan, use of medication as part of a behaviour management plan must be evidenced in the records. (Not addressed at 18th January 2006). Medication must only be administered in accordance with the prescriber’s instructions. These instructions must be evidenced in the records. This includes all ‘as required’ and variable doses. (Not addressed at 18th January 2006) Timescale for action 18/01/06 2. OP9 13(2) 18/01/06 3 OP3 14 4 OP7 15 The person registered must 18/01/06 ensure that suitable formats are in place so that pre-admission assessments cover all aspects of residents care needs in order that a full care plan can be produced. The person registered must 18/01/06 ensure that care plans identify residents current care needs with full detail of how those needs are DS0000065400.V267385.R01.S.doc Version 5.0 Page 23 Coombe End Court 5 OP7 15 6 OP8 18(1)(i) 7 OP8 13(4)(c) 8 OP38OP8 16(2)(j) 9 OP7 13(4) 10 OP7 13(2) 11 OP30 18 (1)(c)(i) & 18(2) 18(1)(a) 12 OP27 to be met. This must include, if relevant: dementia care, pressure area care or prevention, managing behaviours, managing infection, medication, bowel management, nutrition and other conditions as they are presented. The person registered must ensure that care plans are reviewed and revised at least once a month and as needs change. The person registered must ensure that care staff receive training in tissue viability in order that they can assess residents potential risk of developing pressure sores. The person registered must ensure that residents are assessed as to their risk of developing pressure sores. Strategies must be in place to prevent further risk and recorded in the care plans. The person registered must ensure that all staff are aware of infection control policy particularly when infections occur. The person registered must ensure that all risks of daily living are assessed for each resident. The person registered must ensure that the organisation’s own procedures are followed if there are questions over staffs competence in administering medication. Competent staff must be available to administer medication when needed. The person registered must ensure that all new staff are inducted into the work with records kept. The person registered must DS0000065400.V267385.R01.S.doc 18/01/06 31/03/06 01/04/06 18/01/06 18/01/06 18/01/06 18/01/06 18/01/06 Page 24 Coombe End Court Version 5.0 ensure that care staffing levels are maintained throughout the week in all areas of the home and not reduced at the weekend. 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 training of staff who administer medication should be expanded beyond local policies and competency. (Addressed in part at 18th January 2006). The use of body maps would support accurate recording of wounds and marks. Identifying residents’ bedrooms with coloured markers should be discouraged. Any special care should be recorded in care plans and relevant staff notified. Nutritional monitoring charts for food and fluid intake could be amalgamated to ensure that they are fully documented. Precise amounts of fluids should be recorded to assess how much is actually taken in a day. The organisation’s new medication policy and procedure should accompany the medication administration record for easy access. Handwritten entries in the medication administration record when medication is changed or newly prescribed should be witnessed, signed and dated by 2 staff. Separate medication administration records handwritten by the supplying pharmacist should be removed from the file if not used to avoid confusion. Controlled medication records should start with a received balance to avoid confusion in monitoring storage. Large prescription orders should be discussed with the prescriber if difficulties in storage are encountered. Certificates of training must be evidenced if staff are to train others in certain procedures, for example, moving and handling and first aid. 2 3 4 OP8 OP8 OP8 5 6 7 8 9 10 OP9 OP9 OP9 OP9 OP9 OP30 Coombe End Court DS0000065400.V267385.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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 Coombe End Court DS0000065400.V267385.R01.S.doc Version 5.0 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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