Inspection on 26/09/08 for Culwood House

This inspection was carried out on 26th September 2008.

CSCI found this care home to be providing an Adequate service.

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

Culwood House 09/04/08

Culwood House 20/04/07

Culwood House 28/07/06

Culwood House 07/02/06

Culwood House 24/05/05

Culwood House 10/01/05

Culwood House 17/08/04

Culwood House 28/03/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

CARE HOMES FOR OLDER PEOPLE Culwood House 130 Lye Green Road Chesham Bucks HP5 3NH Lead Inspector Jane Handscombe Unannounced Inspection 26th September 2008 12:40 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 Culwood House DS0000022968.V372669.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. Culwood House DS0000022968.V372669.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Culwood House Address 130 Lye Green Road Chesham Bucks HP5 3NH 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) 01494 771012 01494 783051 webbecj4572@aol.com www.culwoodhouse.co.uk Mrs Anita Larkin Mr Larkin Mr Chris Webb Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (14) of places Culwood House DS0000022968.V372669.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The number of persons for whom residential accommodation with both board and care is provided at any one time shall not exceed 14 (fourteen) The Home is registered to accommodate older people 12th June 2008 Date of last inspection Brief Description of the Service: Culwood House is a privately run care home providing personal care and accommodation for 14 older people. The home is in an Edwardian building, located on the outskirts of Chesham about one mile from the town centre. There is dropping off space and parking at the front of the building. There is a mature garden with shady seating areas for residents. A part of the home is the private residence of the manager. The home is not purpose built and does not have a lift. All bedrooms are single and have en-suite facilities (WC and sink). The fees range from £460 to £625 pounds per week. Additional costs include hairdressing, chiropody, papers and personal effects. Information about the home can be obtained directly from the home. Culwood House DS0000022968.V372669.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced inspection which took place on 26th September2008, from 12.40am until 9.00 pm and undertaken by one inspector. Results of this inspection report are derived from feedback gained from the service users, discussions with staff during the visit, responses to questionnaires sent out prior to this visit, viewing client’s records held within the service, viewing policies and procedures, staff personnel files, general observation throughout the day, along with information provided to us within the AQAA and any other information that CSCI has received about the service in order to gain an understanding of how the service meet the service users’ needs, and impact upon their lives. We looked at how well the home was meeting the key standards set by the government and have in this report made judgments about the standard of the service. During the course of the inspection the requirements and recommendations from the previous inspection were discussed and some evidence was found to ensure that these shortfalls had been met. Some of the bedrooms and communal areas were seen during a tour of the building. Three care plans were studied and the care of these residents tracked. Medication Administration Record (MAR) sheets were also studied. Staff practice was observed and staff were spoken to during the inspection. Time was spent in discussions with the administrator and proprietor and the inspector spoke with people using the service during the course of the visit. Feedback on the findings was provided at the end of the inspection. We would like to thank all those who gave their time during the inspection process. Culwood House DS0000022968.V372669.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Much work has been undertaken on the current service users care plans, to ensure that they are up to date, contain accurate detailed information about their health social and personal care needs to ensure that staff are able to address all their needs fully. Care plans viewed during this visit contained evidence that health care needs are fully documented, a medical history is now included and where separate documents are held in the files, detailing specific needs and regimes, reference is made to them within the care plans in order that staff are aware that they are in place to enable them to meet the service users needs fully. Documentation within the residents’ files is dated to show when it was produced and evidences that service users and/or their representatives have been involved in the care planning process. Culwood House DS0000022968.V372669.R01.S.doc Version 5.2 Page 7 A system is now in place to ensure that care plans and assessments for service users are kept under review and updated when necessary to reflect the current and changing needs of all people using the service. A Controlled Drugs cupboard complying with the Misuse of Drugs (Safe Custody) Regulations 1973 has been purchased for the storage of such medications. Medications with a short shelf life are now dated on opening to ensure the health, safety and welfare of those using the service A new call bell system has been installed and cords replaced to ensure that people using the service have access to fully working call bells in which they can get assistance when needed. Flooring has been replaced in some bedrooms to allow for comfortable surroundings, which is free from offensive odours. Service users are provided with keys to their rooms where required, within a risk management process. People who are able to self medicate within a risk management process are provided with lockable storage facilities in which to store them. Hazardous substances are now stored securely at all times to ensure the health, safety and welfare of those using the service. Current and past service user records are being stored securely in the care home. Three staff members have attended training to ensure assessments are undertaken by a suitably qualified person. What they could do better: There are some poor practices highlighted within this report, which potentially place those using the service at risk. The service needs to ensure they work in the best interests of those using the service and improve on a number of areas to ensure their health, safety and welfare at all times; requirements and recommendations have been made to ensure that outcomes for those using the service are improved, these include: Undertaking an audit of all staff personnel files to ensure all information and documentation listed in Schedule 2 of the Care Homes Regulations 2001 are contained within their personnel files and provide confirmation to the Commission of any deficits found and what actions have been taken. Culwood House DS0000022968.V372669.R01.S.doc Version 5.2 Page 8 Ensure that arrangements are in place and procedures adhered to at all times for the safe storage, administration and recording of medications, at all times. Ensure that people who use the service receive their medication as prescribed. Ensure that appropriate risk assessments are undertaken for people who wish to self medicate and appropriate storage facilities be provided. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Culwood House DS0000022968.V372669.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Culwood House DS0000022968.V372669.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. Appropriate systems are now in place to ensure that all prospective users of the service have their needs thoroughly assessed to ensure that the home can meet these needs appropriately before a place is offered. The home does not provide for intermediate care and therefore standard 6 does not apply. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection undertaken in April 2008, the registered manager and two further members of staff have undertaken training, to ensure that they are Culwood House DS0000022968.V372669.R01.S.doc Version 5.2 Page 11 equipped with the appropriate skills and knowledge to provide people with a fully comprehensive assessment of needs. Likewise, the home has worked to ensure that appropriate procedures are in place to allow for a fully documented assessment of needs upon which a plan of care can be based, prior to them moving to the home. During this visit, it was ascertained that there are no newly admitted service users since our last visit in April 2008; we discussed the admission procedure and viewed relevant documentation and are confident that appropriate systems are now in place to ensure that prospective residents are provided with a full needs assessment before any decisions are taken to admit a person. This ensures that only the people whose care needs can be fully met are admitted. The assessments are undertaken either in the person’s own home, or in hospital, if that is where they are at the time, by a person suitably qualified to undertake such a task. We visited the service in June 2008 and viewed a newly admitted persons file, who was admitted to the home for 2 weeks respite, and found that it contained a comprehensive assessment of their health, personal and social care needs, which evidenced that they had been assessed prior to them being offered a place at Culwood House. This persons needs had been fully documented in a plan of care detailing how their needs were to be met and evidenced that they had been involved in the assessment and care planning process. During this visit we looked at three service users file and found they contained a good range of relevant and appropriate information on which their care plans had been based. Culwood House DS0000022968.V372669.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. The care planning system provides staff with the information they need to meet residents’ needs. Personal support is offered in such a way that promotes and protects residents’ privacy, dignity and independence. Medication systems do not always follow good practice or safe practice guidelines and has needed action to ensure the health, safety and welfare of those using the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans of three service users were looked at in detail and they each contained clear information about each person’s care needs, as well as giving information to staff about what they had to do to provide the care the person Culwood House DS0000022968.V372669.R01.S.doc Version 5.2 Page 13 required. Care plans are regularly reviewed to ensure people’s changing needs are taken account of in a timely way. Since the last inspection undertaken in April 2008, it is acknowledged that a great deal of work has been undertaken to ensure that those using the service have an up to date, comprehensive care plan, detailing all their personal health and social care needs. The service users’ files viewed were found to be individualised, comprehensive and up to date. Equality and diversity was addressed throughout the care plans. All those viewed gave a good ‘all round view’ of their needs and how these were being addressed. Feedback from one healthcare professional informs us that the staff always respect individuals privacy and dignity and that the home seeks advice and acts upon it to manage and improve individuals health care needs. Those using the service tell us that they receive the care and support that they need including medical support when required. Monthly reviews of the care plans were documented within the plans and where issues arise, separate documentation was seen to be held within the files with entries detailing the interventions being undertaken to address the issue. All three plans viewed contained nutritional assessments along with evidence of regular monthly weights being undertaken. Pressure area care assessments were also evident within the files. Any accidents or incidents that occur and which may affect the health, safety or welfare of service users are contained within the relevant users’ files, the appropriate accidents/incidents forms are completed and the relevant authorities are notified as is required. Details of health professional’s visits and interventions were clearly noted in each file, as were eye tests and any visits to the hospital or referrals. The files seen on this visit generally contained appropriate risk assessments and any risks were supported by a support plan which was cross referenced throughout the care plan to alert staff and ensure all aspects of their personal, social and health care needs are appropriately met. However, the home needs to ensure that people are made aware that homely remedies could interact with prescribed medications and procedures put in place to risk assess any such situations to ensure the health, safety and welfare of those using the service. There is evidence in the files to show that the service user and/or their representative has been consulted with and understands and agrees to the contents of their care plan. The service endeavours to work in the best interests of all those using the service and where service users have no family involvement and little or no capacity the home will seek the services of an Culwood House DS0000022968.V372669.R01.S.doc Version 5.2 Page 14 independent advocate to work alongside that particular service user to ensure their best interests. In June 2008 we undertook a visit to follow up on requirements made during our last key inspection undertaken in April 2008, which included requirements around medication procedures and practices. At this visit, in June, we found most of the issues identified with medication at the previous inspection had been addressed. The requirement that products with a short shelf-life after opening, be dated when they are opened had been met and all medication was found to be stored in locked cupboards, medication records were well filled in showing that medication appears to be given to residents as their doctor prescribes for them. There were some packs of medication that had been supplied from the pharmacy that were not fully labelled, which makes it impossible to identify the contents, and to ensure that the correct medicines are being given and told the provider that this needed to be discussed with the supplying pharmacy. A requirement was made for the home to make sure that all medicines are given from fully labelled packs, to ensure that residents are receiving the correct medication at the correct dose. We also found that the home had started recording administration of temazepam in a notebook, but without a running total balance. This makes it hard to check that levels are correct and we therefore recommended the service purchase a proper controlled drugs register to record temazepam, as it would be needed to record any schedule 2 CD that may be used in the home in the future and this would help to audit levels of temazepam in the home and to provide further evidence that residents are receiving the medication as prescribed. The service has recognised that medications are the property of those using the service and where they are able to self administer, within a risk management procedure, they have provided each user with lockable facilities within their personal bedrooms in which to store them. However during a tour of the home, with a member of staff, it was noted that some homely remedies were being stored in three service users rooms with no lockable facilities having been provided in which to store them. Upon further enquiry it was acknowledged that the service was unaware of the homely remedies being stored and therefore appropriate risk assessments had not been undertaken. The service acted promptly to remove the medications and store them safely until appropriate risk assessments be undertaken to ensure both the services users and other users of the services health, safety and welfare. A previous requirement was made, during our visit in April 2008, to ensure that controlled drugs (CD) be stored in a controlled drugs cabinet to comply with the Misuse of Drugs Regulations 1973. During this visit it was noted that the home has since purchased an appropriate CD cabinet for the storage of such medications and an appropriate Controlled Drugs Register is now in use. The service inform us that discussions have taken place with the supplying pharmacy to request that medication packs be fully labelled in such a way that Culwood House DS0000022968.V372669.R01.S.doc Version 5.2 Page 15 enables staff to identify the contents and ensure the correct medication is being given; however this has proved problematic and thus the service have made the decision to change over to a monitored dosage system and tell us that they are in the process of putting this into place through a local pharmacy who provide this service. During our visit we chose to view the medication administration records (MAR); one service users MAR sheet contained gaps where staff had not signed to evidence that the prescribed medication had been administered and the coding system had not been used to detail the reason why the medication had not been administered. A further service users MAR sheet was viewed and highlighted discrepancies. This particular service user had been prescribed Temazepam and to take one tablet each evening at bedtime, however the MAR sheet highlighted that this particular medication was not being administered as prescribed; on the 2/7/08 28 tablets had been received into the home and the MAR clearly highlighted that one tablet had been administered on 20/7/08 and one tablet administered on 24/7/08 and the running balance of this medication, logged in the Controlled Drugs register confirmed that the medication had not been administered. Where medication has not been administered the coding system should be used to explain the reasons why it has not been administered, as prescribed by their GP. Any returns are stored securely and appropriately. At the time of writing this report, we have been informed via the registered manager, that actions were taken, following our visit, in view of the findings around medication. Discussions were undertaken with staff members around the findings of poor recording and administration of medication and training has been booked to update their knowledge and skills to ensure such errors are not repeated. In the meantime, medication administration is under supervision until such time as those concerned have undertaken the refresher training and their competencies have been assessed. Users of the service experience care and support in a manner, which respects their dignity and respect. People using the service tell us that they receive the medical support that they need and that staff always listen and act on what they say. Culwood House DS0000022968.V372669.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. People using the service find the lifestyle experienced in the home meets their needs and expectations appropriately The home recognises the importance of visitors to the home and are welcome to visit the home at any reasonable time and be involved as little or as much as is required. A varied menu is provided and special dietary needs are catered for those who require. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a varied programme of activities provided for those who wish to partake which includes flower arranging, board and card games, art and crafts, cake decorating, music afternoons, hand massages and manicures. Culwood House DS0000022968.V372669.R01.S.doc Version 5.2 Page 17 Users of the service have the opportunity to take Communion once a month, which is undertaken by a local Reverend who comes into the home to provide this service. Those who wish to attend church on a regular basis are enabled to do so and the local church provides a car service for those who require. Visitors from the local Catholic Church visit the home regularly with some children from the church to provide them with entertainment in the evening, mainly that of singing. People who use the service are provided with good quality food, which is freshly cooked on the premises and are offered a choice. Special diets are available to meet residents’ health and cultural needs. The chef endeavours to take individual tastes into account. People using the service can choose to take their meals in the dining room or their own bedroom, whichever they prefer. Beverages and snacks are available throughout the day and tea and coffee making facilities are available within the home. Discussions with service users inform us that people using the service are happy with the meals and choice of meals provided. Comments included ‘the food is very good, they cook it fresh’, ‘they bring my breakfast to me in my bedroom’. Visitors are welcomed into the home at any reasonable time and are made to feel welcome. Users of the service can choose to see their visitors in their own rooms or in the communal areas of the home, whichever is to their liking. . Culwood House DS0000022968.V372669.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. People using the service know how to make a complaint if the need should arise and are confident that any concerns they may have will be dealt with appropriately. Staff working at the home have received training to ensure that they are able to protect those living at the home from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints policy and procedure in place to enable people to make a complaint if the need should arise, which can be made available in various formats to meet the needs of individual service users. All four service users who responded to questionnaires sent out prior to this visit tell us that they know who to speak to if they are not happy and know how to make a complaint if the need should arise. Likewise those spoken to during this inspection tell us that they feel confident that any concern they may have would be dealt with appropriately. Since the last key inspection, undertaken in April 2008, we are informed that the service have received no complaints made direct to them. Likewise, the commission have received no complaints. Culwood House DS0000022968.V372669.R01.S.doc Version 5.2 Page 19 There is a copy of the Buckinghamshire local interagency policy and procedure for safeguarding adults within the home and all staff are provided with safeguarding adults training, to enable them to recognise and respond to any incidences or allegations of abuse. We were informed that all staff members attended safeguarding training in April this year, and the three staff personnel files viewed during this visit, provided evidence to substantiate this. The service itself has not had any safeguarding referrals or investigations during the last 12 months, and we at the Commission have not been alerted to any such referrals or investigations. The home will signpost people to advocacy services or similar, where the need may arise Culwood House DS0000022968.V372669.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26 Quality in this outcome area is good. The home presents as clean, pleasant and hygienic with no odours apparent. The service have maintained the environment to ensure the safety of the people living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During our visit in April of this year, a number of requirements were made to ensure that users of the service were provided with a safe, well-maintained environment in which to live. A number of call bells were not working and some rooms failed to have pull cords to enable people to call for assistance when required. Since our last inspection, the service have replaced the cords Culwood House DS0000022968.V372669.R01.S.doc Version 5.2 Page 21 in those rooms that were without, have installed a new call bell system and undertake regular monthly checks to ensure that they are working and that people have the facility to call for assistance when required. Likewise, the home has been addressing requirements made around providing radiator guards to radiators without such covers; they have been replacing any broken/loose radiator guards. Three radiators were positioned in such a way that they had to be moved to enable a guard to fit around them, of these three, two still remain to be covered. The maintenance person was in the service during part of the inspection working on a service users bedroom that has suffered some damage due to a leak in the roof. The proprietor assured us that the remaining radiator covers would be addressed the week following this visit. At the time of writing this report, we are informed that all radiators are now covered as required. Through discussion it was ascertained that monthly room checks are undertaken and any maintenance areas that need addressing are documented along with actions that are to be taken. During this visit, the home presented as clean and tidy throughout, with no odours apparent. Carpets that presented as odorous during the last inspection have been replaced with vinyl covering to ensure the service users dignity is maintained and to provide them with pleasant surroundings in which to live. The registered manager discussed the options of vinyl flooring or that of carpeting with the said service users and/or their representatives who were in agreement to the choice of vinyl flooring and have signed documentation to evidence their agreement. People using the service are encouraged to personalise their bedrooms and this was apparent whilst touring the home. Since our last visit, users of the service have been offered the option of having a key to their own room, unless a person centred risk assessment indicates otherwise. People have access to large well-maintained gardens; new garden benches have been provided for service users and their visitors to enjoy and a new summerhouse has been purchased which we are informed is arriving the day after this visit. Culwood House DS0000022968.V372669.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor. The service has a poor recruitment procedure with shortfalls in recording and processes being evident. They do not ensure that only suitable persons are employed to work with people using the service and potentially places people at risk of harm. Staff are provided with appropriate training to ensure they have the skills and knowledge to undertake their roles competently. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We chose to look at three staff personnel files at random to ensure that robust recruitment procedures are in place and to ensure that staff are provided with appropriate training to ensure that those using the service are protected by the homes recruitment procedures and that staff have the skills and knowledge to undertake their roles competently. There were serious failings in the recruitment procedure, found during our last inspection undertaken in April 2008, for which an immediate requirement was Culwood House DS0000022968.V372669.R01.S.doc Version 5.2 Page 23 made to ensure that people living at the home were protected from any harm. Since that visit, the service addressed the failings that we found and provided us with relevant evidence that they had sought, to ensure that the relevant members of staffs personnel files contained everything that is required under the Care Homes Regulations 2001. The service also provided us with an improvement plan detailing how improvements were to be made to ensure that a robust recruitment procedure be in place by the end of September 2008. Actions included obtaining a recent photograph of each staff member, a full employment history with any gaps explained and working under supervision whilst awaiting their full CRB disclosure. However, of the three files viewed, during this inspection, there were still some failings; none of the three files viewed contained an up to date photograph of the staff members, one failed to contain a full employment history and one file failed to contain any written references, whilst another contained two personal character references as opposed to one of the references either being from a previous employer, or where this not possible, from a professional. After speaking with one further member of staff, whose file not was viewed amongst the three we viewed, we asked to look at his/her personnel file; it was apparent that there was no file held within the home. The said member of staff informed us that he/she was up to date with his/her training as he/she works for another care service besides that of Culwood House and has an up to date CRB disclosure however, there was no evidence within the home to substantiate this. At the time of writing this report, we are informed that action was taken immediately to address these issues and recent photographs are now in place in each staff members file, appropriate references have been sought retrospectively for the members of staff whose files that we viewed failed to contain appropriate references. We are also informed that a POVA first check (protection of Vulnerable Adults) has been obtained for the member of staff whose file was not present within the home with supervision in place whilst awaiting the full CRB disclosure. A requirement has been made within this report to undertake an audit of all staff personnel files to ensure all information and documentation listed in Schedule 2 of the Care Homes Regulations 2001 are contained within their personnel files and provide confirmation to the Commission of any deficits found and what actions have been taken. The staff files viewed generally evidenced that the service provides them with appropriate training to undertake their roles competently and safely, providing them with the necessary skills to ensure that people’s needs are met appropriately. Recent training has included, safeguarding of vulnerable adults, fire safety, medication training, infection control, first aid, food hygiene, bereavement and loss and health and safety. Further training is planned the week following this visit, to provide staff with an update to their manual handling training. Culwood House DS0000022968.V372669.R01.S.doc Version 5.2 Page 24 Whilst no new staff members have been employed since our last visit, we are informed that they will be provided with a staff induction programme followed by the appropriate mandatory training. We are also informed that those whose files viewed at our last visit, which failed to evidence that they had been provided with an appropriate induction, are being provided with an induction retrospectively, which is seen as good practice. Culwood House DS0000022968.V372669.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is adequate. There continues to be some weaknesses in areas relating to health and safety issues which do not act in the service users best interests. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service have recognised that there has been a history of non-compliance within the service and have worked hard to address these shortcomings to improve outcomes for those using the service. Since our last inspection undertaken in April 2008 the registered manager has undertaken some training to update his skills and knowledge to ensure that he Culwood House DS0000022968.V372669.R01.S.doc Version 5.2 Page 26 is equipped with the appropriate skills and knowledge to provide people with a fully comprehensive assessment of needs. Furthermore, we are informed that he has now registered to undertake the Registered Managers Award, to add to his skills in the overall management of the home, which will begin at the end of the month. Whilst it was apparent that staff were not receiving formal supervisions during our last key inspection, the registered manager and one further member of staff have undertaken supervision and appraisal training to enable them to undertake such supervisions competently. Supervision of staff has begun and evidence was provided to show us that dates have been booked to provide the remaining staff with supervision. The home does not handle the financial affairs of those using the service; it is an expectation that family members, solicitors or other representative will undertake this role. During this visit, we have seen improvements in the care planning and review process; those using the service now have an up to date, comprehensive care plan, detailing all their personal health and social care needs. The service has worked to ensure that they are individualised, comprehensive and up to date. Likewise the service have addressed the requirements made around the physical environment to ensure that people using the service are provided with a safe environment in which to live. Whilst improvements have been made and actions taken to address most of the requirements made during our last key inspection earlier this year, there still remains some shortcomings that do not act in the service users best interests. The registered manager continues to fail to ensure the health safety and welfare of those using the service, in that some staff files continue to evidence that they are employed to work at the care home without having ensured their fitness and undertaking essential checks to ensure their suitability to work with vulnerable adults. (See section headed staffing). Likewise, there still continues to be poor procedures taking place around the storage, recording and administration of medications, which do not act in the service users best interests to ensure their health, safety and welfare. Providing the service address the shortcomings within this report and sustain a track record of delivering good performance and managing improvement we would expect to see the overall rating change from that of adequate. Culwood House DS0000022968.V372669.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 2 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Culwood House DS0000022968.V372669.R01.S.doc Version 5.2 Page 28 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 OP29 Regulation 19 Schedule 2 Requirement Undertake an audit of all staff personnel files to ensure all information and documentation listed in Schedule 2 of the Care Homes Regulations 2001 are contained within their personnel files and provide confirmation to the Commission of any deficits found and what actions have been taken. Ensure that arrangements are in place and procedures adhered to at all times for the safe storage, administration and recording of medications, at all times. Ensure that people who use the service receive their medication as prescribed. 3 OP38 13 Ensure that appropriate risk assessments are undertaken for people who wish to self medicate and appropriate storage facilities be provided. 30/11/08 Timescale for action 30/11/08 2. OP9 13(2) 30/11/08 Culwood House DS0000022968.V372669.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Culwood House DS0000022968.V372669.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Culwood House DS0000022968.V372669.R01.S.doc Version 5.2 Page 31 - 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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