Inspection on 18/06/07 for Derham House

This inspection was carried out on 18th June 2007.

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

Derham House 02/06/08

Derham House 29/11/07

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

CARE HOMES FOR OLDER PEOPLE Derham House Harwood Hall Lane Upminster Essex RM14 2YP Lead Inspector Mrs Sandra Parnell-Hopkinson Unannounced Inspection 10:00 18th June & 25th June 2007 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 Derham House DS0000069403.V340103.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. Derham House DS0000069403.V340103.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Derham House Address Harwood Hall Lane Upminster Essex RM14 2YP 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) 01708 641 441 01808 641 743 catherine.mcaweaney@barchester.com Barchester Healthcare Homes Ltd vacant post Care Home 64 Category(ies) of Dementia - over 65 years of age (32), Old age, registration, with number not falling within any other category (32) of places Derham House DS0000069403.V340103.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th January, 2007 Brief Description of the Service: Derham House is a single storey purpose built home providing care with nursing for sixty-four older people, some of whom have dementia. Opened in 1996, there are two separate 32 place units, Foxhall for those service users with dementia, and Bridge for those service users with a nursing need. Both units have a lounge and a dining room. All bedrooms are single and have ensuite toilet and washbasin. The building is fully accessible to wheelchair users. It is situated in a quiet rural area of Upminster within the London Borough of Havering, behind Harwood Hall Equestrian Stables, with a long drive leading to the main entrance of the home. The grounds are well maintained with two enclosed courtyard gardens. Upminster Station (District Line) is approximately two miles away, and other public transport is limited. A copy of the statement of purpose and last inspection report was available in the reception area of the home, and a copy of the statement of purpose can be obtained on request to the manager of the home. At the time of this inspection fee levels ranged from £675. to £900. per week. Derham House DS0000069403.V340103.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection undertaken by two inspections, namely the lead inspector Mrs. Sandra Parnell-Hopkinson and Mrs. Julie Legg. The site visit took place on the 18th June, 2007 between the hours of 09.30 hours and 18.45 hours. The inspection process was finalised on the 26th June, 2007 upon receipt of the Annual Quality Assurance Assessment (AQAA). The deputy manager was available throughout the time of the site visit, and the Regional Operations Director arrived during the site visit and both were available to take feedback at the end of the site visit. During the visit the inspectors were able to speak to many residents, visiting relatives and staff members. A sample of residents’ files were viewed and case tracked, together with the viewing of medication administration records (MAR), staff rotas, training schedules, activity programmes, maintenance records, accident records, fire safety records, menus, complaints records, staff recruitment processes and files. The inspectors were also able to talk to the deputy manager regarding equality and diversity issues, and she was able to demonstrate a good understanding of the many issues relevant to these areas. People using the service were asked how they wished to be referred to in this report, and the majority said residents. In view of this the term resident/s is used in this report. What the service does well: Meals on both units were well presented and a good variety was offered to residents. Dining tables are laid so that they look welcoming to make dining a positive experience. In discussions with the assistant chef, the inspectors were satisfied that she was aware of any special health related dietary needs, together with likes and dislikes of the residents. Comprehensive pre-admission assessments are undertaken by people who are qualified to do so. Also prospective residents and family members are invited to visit prior to making a decision. One family member stated, “I visited three other homes and chose this one, because the staff made me welcome and I could see my wife settling here”. Another family member stated “I felt that my wife would be happy here, people were chatting and the atmosphere was nice and I am happy with my decision”. Derham House DS0000069403.V340103.R01.S.doc Version 5.2 Page 6 Again the maintenance records were found to be in very good order and up to date. The service employs a physiotherapist for 4 hours each week. Monthly Regulation 26 visits as required under the Care Homes Regulations are undertaken by the organisation, and a copy of these reports are retained in the care home. The home is well maintained and provides a pleasant environment for residents accommodated on both units. What has improved since the last inspection? What they could do better: Although the AQAA indicates that staffing ratios are high compared to other care homes, this was not evidenced on the day of the inspection nor from viewing staff rotas for several days. Members of staff, residents and relatives commented on staff shortages during the inspection, and also in an anonymous letter which has been received by the Commission. Staffing levels must always be appropriate to meet the assessed needs of the residents, and there should be no specific ratio as staff numbers may fluctuate depending upon needs. Currently many of the residents at Derham House require a high level of staff input, for example at meal times many residents require assistance with feeding. In discussions with the assistant chef she informed the inspector that currently 27 of the residents are on a pureed diet, this in itself indicates a high level of need even if only supervision. On the day of the inspection there was only one person undertaking the cleaning for the whole home, and this apparently has not been the only time. The smooth running of a care home is dependent upon all members of staff, and the employment of an appropriate number of ancillary staff is very important. The lack of staff numbers on various occasions is having an impact on staff morale, some of whom indicated that they feel undervalued. There was a requirement made at the previous inspection that staff numbers be reviewed as a matter of urgency. This was not done and, therefore, this requirement will be repeated in this report. Many of the residents and relatives raised concerns with the inspectors around the fact that the bedroom doors have to be closed at all times, in line with the Derham House DS0000069403.V340103.R01.S.doc Version 5.2 Page 7 fire policy of Barchester Healthcare. If the bedroom doors were fitted with closures which could be activated by the fire alarm, this would obviate the need for the doors to be kept shut. Again this matter was raised with the manager at the two previous inspections, and at the last inspection the inspectors were told that there was going to be a rolling programme of fitting such closures to the bedroom doors, and that this was due to begin in March, 2007. However, at this inspection it was apparent that no such work had begun, and in discussions with the Regional Operations Director it was clear that because of financial restraints Barchester Healthcare would not be doing this work. The closure of the bedroom doors is of prime concern to many of the residents and relatives, and some indicated that it is having an adverse effect on their health and well being. One relative told the inspector “Mum feels so lonely in her room sometimes because she can’t even see people passing by.” Many said that they felt isolated and those that were bed-bound found it difficult to call for assistance as they often could not use the emergency bell due to a physical/mental impairment. During the inspection one relative felt so strongly that he had instigated a petition to be signed by residents and visitors. Care plans focus on health care needs, with little attention to the social and daily living activities for residents. Again there was little indication that the social needs of residents are being met. On Foxhall Unit, which accommodates people living with dementia, there was no evidence that the Memory Lane resources are being used for the benefit of the residents. On Bridge Unit there was little evidence of activities or staff interaction with residents. According to many of the relatives and residents, staff are too busy undertaking the basic care needs for residents and have little time for other things. Although the deputy manager and staff were aware of the importance of equality and diversity issues, it was not always apparent that these were consistently being implemented within the service. The permanent recruitment of a General Manager and other staff is of a major concern to the Commission, and every effort must be made by the organisation to address these issues. The organisation is aware of this as indicated in the AQAA. 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. Derham House DS0000069403.V340103.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 Derham House DS0000069403.V340103.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 5 (Standard 6 does not apply to this service) People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to the service. Prospective service users and/or their relatives are given information needed to enable them to decide if they want to live at Derham House, and a full assessment of their needs is undertaken prior to them making a decision to move in. The statement of purpose and service user guide is made available for all prospective service users and their relatives, and all are invited to visit the home before making a decision. EVIDENCE: Files of fairly new residents were examined, and it was evident that comprehensive pre-admission assessments had been undertaken by a person qualified and experienced to do so. Information had been obtained from the prospective resident, family and health professionals, as well as being in receipt of an assessment that had been carried out by a local authority where necessary. From the assessment and other relevant information, a care plan had been drawn up, which identified the residents’ needs and how these should be met. Derham House DS0000069403.V340103.R01.S.doc Version 5.2 Page 10 Residents and relatives are able to visit the home prior to a resident moving in. The inspectors spoke to a number of families, some of whom stated that their relatives were unable to visit the home prior to their admission due to their frailty. However, all of the families had visited this and other homes before making their choice. One family member stated, “I visited three other homes and chose this one, because the staff made me welcome and I could see my wife settling here.” Another family member stated “I felt that my wife would be happy here, people were chatting and the atmosphere was nice and I am happy with my decision.” The statement of purpose and service user guide were available in the reception area of the home, and some relatives told the inspectors that they had been given a copy of these documents. In discussions with the Regional Operations Director, the inspectors were told that all residents would have a contract if they are self-funding, or a statement of terms and conditions if being supported by a local authority. This is also supported by information contained within the AQAA. The contracts used by Barchester Healthcare are agreed with the Office of Fair Trading. According to the information provided by the organisation in the AQAA, it will be developing an improved information pack to be sent to prospective residents. It will be important for the organisation to ensure that such information is also provided in different formats more suited to residents who may have dementia or a sight impairment or other disability which may affect a person’s reading ability. Derham House DS0000069403.V340103.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 People who use the service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to the service. The health and personal care needs for residents on both units are set out in individual care plans which generally are reviewed on a monthly basis. The involvement of residents and/or relatives remains variable. Although medication administration records have improved, further improvements are necessary to ensure resident safety. The health and well being of some residents may be affected by the current fire policy, which means that bedrooms doors must remain closed due to the absence of closures which can be activated by the fire alarm. Residents can be sure that they will be treated with respect and the arrangements for their personal will ensure that their right to privacy is upheld. Derham House DS0000069403.V340103.R01.S.doc Version 5.2 Page 12 EVIDENCE: FOXHALL UNIT Some staff were observed to be ‘leading’ residents by the hand without any interaction at all and some residents experienced this lack of interaction during lunch. The inspector was satisfied that each resident has their own care plan; four of these care plans were case tracked and related documentation inspected. Resident’s health, personal and social care needs are set out in individual plans but not all of the care plans accurately reflect their current needs. There was limited information on meeting the dementia care needs of residents and the care plans did not include end of life matters. Although there was a lack of detailed information in the care plans, the inspector was satisfied that during discussions with staff they were able to demonstrate a knowledge of residents’ individual needs. The deputy manager stated that currently the care plans are being replaced with a new format, and in the process will be updated. Ten care plans are still to be updated for residents on this unit. The care plans demonstrated little sense of the person, and therefore, they need to be more person-centred. Of the four files that were examined only one contained evidence of the resident’s life history. The gathering of this information for all residents could then be used in a more meaningful way in planning individual social activities, and as a basis for staff to gain more insight and knowledge of the resident. Care plans that were examined showed that they are being evaluated on a monthly basis, but because of the limited information in the care plans it was not possible to determine if they accurately reflected the current needs of the residents. As part of the case tracking the documentation/health records relating to the management of diabetes was looked at. Four of the residents have diabetes and all are controlled by medication. Evidence showed that the monitoring of blood sugars was being undertaken weekly, and that sugar levels were stable. All residents are weighed on admission and thereafter monthly. Four of the residents are currently being weighed every two weeks because of concern over their weight loss. The nursing staff have contacted the dietician who has given appropriate advise to the home. Nutritional food record charts were examined and it was evident that these are not always completed appropriately. One resident’s chart for the 16th and 17th June had only been completed for breakfast and supper, but there were no recordings for lunch or snacks. The term ‘pureed’ is sometimes being recorded but not what type of food had been pureed. One resident is having their food pureed, though the Derham House DS0000069403.V340103.R01.S.doc Version 5.2 Page 13 nurse stated that the resident could eat a soft diet. Nursing staff must be clear as to the dietary needs of residents, and also how foods are to be prepared for residents, that is a normal diet, soft diet or pureed diet. Fluid charts were also examined and again it was evident that these are not always being completed appropriately. Not all drinks are being recorded, and one resident’s chart did not have any drinks recorded from lunch until 10 o’clock that night. Some residents are receiving Ensull (which is a food supplement), and this is sometimes being recorded on their food chart and at other times on their fluid chart. The inspector did observe that fluids are being freely offered to residents at regular times throughout the day. Nurses must be aware that monitoring charts are clinical records and must be treated as such. The residents on Foxhall all have a diagnosis of dementia and, therefore, it is vitally important that where it is indicated, food and drink intake is recorded accurately to ensure their health and well being are not being put at risk. Residents’ files have written evidence that there is involvement from other health professionals including dietician, dentist, optician and chiropodist, as well as GP and hospital outpatient appointments. This was confirmed in discussions with relatives, who were visiting at the time of the inspection. Risk assessments are routinely undertaken on admission for all residents around nutrition, moving and handling, falls and pressure sore prevention. Three care plans recorded that bed rails were indicated for use, and written consent had been sought from the residents’ relatives and there were associated risk assessments in place. However, there was evidence that not all of the risk assessments are being reviewed on a regular basis. Most of the staff talked about residents, and were observed to treat residents, in a respectful and sensitive manner. They understood the need to promote dignity through practices such as in the way they addressed residents and when entering bedrooms, bathrooms and toilets. Most staff were observed to be gentle when undertaking moving and handling tasks and offered explanation and reassurance throughout the activity. However, one member of staff was seen to be ‘leading’ residents by the hand without any interaction at all. Relatives that were spoken to had varying opinions on the level of care at the home. One relative stated, “The standard of care varies dramatically, depending on who is on duty”, other relatives were complimentary stating, “the staff look after her really well, I am really happy with the care my wife receives.” There are some areas of good practice and this was evidenced through the care of a resident who is currently receiving 1:1 care because of physical and health problems. There has been a very marked improvement in the health Derham House DS0000069403.V340103.R01.S.doc Version 5.2 Page 14 and well being of this resident who is now able to walk outside of the home, with the assistance of a member of staff. BRIDGE UNIT The files of five residents were inspected and case tracked, and all had a comprehensive pre-admission assessment on file. There was a noticeable improvement in the care plans, although these are still very health orientated with little emphasis on social needs. A new format for care plans has been introduced by Barchester Healthcare, and although four of the files inspected had been transferred to the new format, the nurse confirmed that there are still the majority of the files to be changed. Care plans were being reviewed on a monthly basis or more frequently where necessary. It was evident from the files that risk assessments for bed rails, where used, were in place. The plan for one resident indicated that hourly checks needed to be undertaken and on visiting the resident in her bedroom, it was evident that such checks are being undertaken and the necessary record being maintained. Some residents were on monitoring charts for fluids and food, and whilst these were being maintained appropriately by the day staff, it was evident that night staff are not always completing these records. On those viewed there was no evidence that residents were being given fluids before 08.30 hours in the morning, and generally not after 21.00 hours in the evening. Where necessary risk assessments were in place around nutrition, manual handling, continence, risk of falls and pressure sore prevention. Care plans for wound management were good, and advice and input had been sought from the tissue viability nurse. One relative who spoke to the inspector said “some staff are really nice, but some are lazy and I have had some problems with the quality of care. Sometimes residents are wet, and sometimes the buzzer is out of reach, and often staffing levels are low.” On the day of the inspection there were no offensive odours, and staff were observed reminding residents to go to the toilet, and giving assistance where indicated. The issue of the accessibility of emergency alarms for some residents was discussed with the Regional Operations Director and the deputy manager during the inspection, and the inspectors were told that the use of alternative forms of alarms such as mats, infrared beams and those that can be put under a mattress were considered an intrusion on the privacy of residents. It is essential that when residents are alone in their bedrooms, that they have the appropriate resources at their disposal to call for help when required. This will be a requirement that the organisation ensures that all residents are able to summon assistance when they are alone in their bedrooms. Derham House DS0000069403.V340103.R01.S.doc Version 5.2 Page 15 The weights of all residents are recorded monthly, or more frequently where need indicates, and where concerns are highlighted due to weight loss/or continuous weight increase, the necessary referrals are made for specialist input and advice. One care plan indicated that the resident was to be offered a bath once a week, but the information contained in the statement of purpose and service user guide indicates that residents can have a bath/shower as they request. This was discussed with the Regional Operations Director and the deputy manager who both agreed that residents could request a bath/shower as they wished, and that they would look at this issue to ensure that such records in the care plans were amended. GENERAL There was evidence that all residents have access to health professionals such as the GP, chiropodist, dentist and optician and that referrals are made to other health professionals as necessary. However, there are sometimes quite long delays in accessing speech therapists and other specialist services through the local Primary Care Trust. Also the withdrawal of some community specialist services such as hospital transport for outpatients appointments, and the availability of obtaining appropriate specialist equipment such as wheel chairs is causing major problems. This is referred to by the organisation in the AQAA. In order to endeavour to address these issues the organisation is working with relatives in order to provide other means of hospital transport, and also discussing funding with the supporting local authorities. Medication administration records (MAR) were inspected on both units and those on Bridge Unit were found to be in good order. However, there were some discrepancies found in the records on Foxhall Unit. These were addressed during the inspection with the senior nurse, and also with the Regional Operations Director and the deputy manager. These issues were: The medication for one resident indicated that it should be given at specific times, 8a.m. and 6p.m. but it was actually being given morning and teatime. The morning medication round was usually anytime between 08.30-09.30 hours and the teatime round after 17.00 hours. Another prescription stated lactulose three 5mls. Twice a day, but the medication was actually being given PRN. The nurse said that the change had been made by the GP, and that she is constantly requesting the surgery to change the prescription, without success. There was a gap in the lunchtime medication for a resident on the 10th June with no record as to why. Clarification was required with regard to the administration of hemineverin syrup as the prescription said 2.5 mls by syringe a.m. and tea, and 5mls. Lunch and night by spoon. The nurse was unable to Derham House DS0000069403.V340103.R01.S.doc Version 5.2 Page 16 clarify why this was, and as the nurse responsible for administering medication she should be aware of the reasons. Clarification was required re the administration of lorezepam for one resident, as the prescription said half a tablet x 3 times when required. The nurse was not clear as to what this instruction meant. Did it mean half a tablet 3 times as day when required, or half a tablet up to 3 times a day when required. It is essential that nurses are clear as to the administration of medication, and where prescriptions can be interpreted in several ways, then clarification must be sought so that all nurses are administering medication according to the instructions of the GP. In discussions with some members of staff it was evident that they do not always look at the care plans because of shortage of time. It is essential that the care plans are available to all staff, and especially to new staff, before they commence the shift so that the care required by residents is delivered by the staff. Again this is the responsibility of the nurses in charge. Although previously some nurses were in the process of receiving palliative care training as the home had introduced the Gold Standard Framework for end of life care in both units, there was no evidence of appropriate end of life care plans on the files inspected. However, in discussions with staff members it was apparent that they were committed to giving care and comfort to residents who are dying, and that their death would be handled with dignity and propriety with their spiritual needs, rites and functions being observed. This was also evidenced from letters which had been received by the home. It was also evident from discussions with residents and relatives that the fact of having to have the bedroom doors closed, in line with the Barchester Healthcare fire policy, is having an impact on the wellbeing of some of the residents. They are feeling isolated when in their bedrooms, and one resident told the inspector “I hate having my door closed all the time, it really makes me feel quite depressed at times.” This is a matter which is of prime importance to many of the residents at Derham House, and must be addressed by the management as a matter of urgency so that the wellbeing of residents is improved. Derham House DS0000069403.V340103.R01.S.doc Version 5.2 Page 17 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 People who use this service experience poor outcomes in this area. We have made this judgement using available evidence including a visit to the service. Currently many residents do not find that the lifestyle experienced in the home matches their expectations and preferences. There was little evidence of meaningful activities being undertaken by residents, although all residents are encouraged to maintain contact with family and friends. Frequent staff shortages impact on the ability of residents to exercise choice and control over their lives. However, a wholesome and appealing balanced diet is provided in pleasing surroundings. EVIDENCE: FOXHALL UNIT Records kept on the unit show a limited activities programme. There was little social interaction going on between residents and staff, and other than music playing, residents were sitting in the armchairs sleeping, which meant overall there was a general lack of stimulation. Limited activities are available; monthly entertainment, a monthly church service and the hairdresser visiting weekly. Relatives that were spoken to also felt that more activities should be available. A more person centred activities programme needs to be developed Derham House DS0000069403.V340103.R01.S.doc Version 5.2 Page 18 and consideration given to the specialist needs of people living with dementia. For instance more individual activities, including the use of life histories and small group activities focusing on the individual’s needs and cognitive functioning. All staff must recognise the important part that they can play in the encouragement and motivation of residents living with dementia. The home has created a ‘Memory Lane’ in the corridors but these resources are not being utilised by staff for the benefit of the residents. During the inspection not one resident, with staff assistance, was observed to be walking along the corridors to enable them to be involved in reminiscence and handling objects of ‘yesterday’. Indeed it was evident that this resource was not used on a regular basis; handles were either missing or came off in the inspector’s hand when attempting to open the drawers on a chest. Many of the drawers were empty and in one of the drawers there was an incontinence pad. Relatives told the inspector “the ‘Memory Lane’‘ was used infrequently and felt that the material pictures on the wall were nothing more than dust collectors.” It is important for residents to be able to access the garden areas of the home and even though on the day of the inspection the weather was warm and sunny, none of the residents were sitting in the garden. One resident was observed being taken for a walk during the later part of the afternoon. This resident was receiving 1:1 care which is not the norm for residents on this unit. Residents are encouraged to bring into the home some of their own possessions and this was evident when visiting residents’ bedrooms. Personal radios, televisions, photographs, pictures, ornaments and small pieces of furniture, including armchairs and cabinets, were in situ. The lack of appropriate signage on this unit restricts the ability of residents to locate their own bedroom, toilets or other rooms thus restricting choice of freedom of movement around the building and could lead to residents entering the rooms of others, by mistake. There is a choice of meals and because of the resident’s cognitive impairment, two different meals are plated up at lunchtime and teatime, to enable residents to choose which meal they would like. It could be beneficial to some of the residents if the menu was also in pictorial form. Many of the residents require either supervision or assistance with eating and the inspector observed staff undertaking this task. Most of the care staff undertook this task with sensitivity, not rushing the resident, having eye contact and talking to them. However one member of staff was observed sitting by the side of the resident and not engaging in any conversation. Lunch for this resident could not be seen as a social and congenial activity. Meals are mostly served in the dining room, although one resident prefers to have her meals in her bedroom. The majority of the residents eat in the dining room, which is set with tablecloths and place mats, and a few residents eat from small tables in the lounge. One Derham House DS0000069403.V340103.R01.S.doc Version 5.2 Page 19 of the relatives sated “the food is good, the chef is very obliging; he gives me the menus for four weeks and I choose my wife’s meals”. Some of the residents receive visitors at this time of day and at least three of the visitors were assisting their relative with eating their lunch. Two relatives stated that this was their choice, though one relative stated “I used to come in every day but it got too much for me, I now come in every other day but I know this puts more pressure on the staff”. The management must ensure that it is a relative’s choice to come in and assist their loved ones with eating and not feel that they have to. BRIDGE UNIT Residents are encouraged to personalise their bedrooms, and many of the residents and their families have chosen to do this. One resident has had sky television installed in his bedroom and his own telephone, and he told the inspector “I like my room and I have it just as I want.” Many residents on this unit remain in their bedrooms either through choice or infirmity. Those residents who were in the lounge were not observed to be engaged in any meaningful activities, other than for some who had a relative/friend visiting. Occasionally a member of staff would talk to a resident in passing, or when serving a drink. There was a large flat screen television on the wall but this could not be seen by all of the residents who were sat nearby. For example two residents were sat in chairs immediately alongside the wall where the television was sited. They could not see the television, but obviously could hear it but had no means of changing their position either to move completely away, or to be in a position to see the screen, because there were no other seats available nor staff members concerned enough to give assistance. Again the issue of the closed bedroom doors was raised by both residents and visiting relatives. Again due to staff shortages staff were seen to be engaged in delivering the basic care tasks, but not engaging residents in social activities. This was certainly not happening in the lounge, and when the inspector asked several residents in their bedrooms if staff come in to sit and chat one told her “generally they only come in to give me a drink or food or to change me” , another told the inspector “the staff always seem to be rushed and sometimes I don’t see anybody for hours especially now that I have to have my door closed, I don’t even see anybody passing by.” Several residents and relatives told the inspector that there was often not enough staff on duty. One resident told the inspector “things have changed, I have seen 4 managers out, but the biggest difference is in the attitudes of care staff. There has been some bad feeling between care staff and nurses and between care staff. This does really affect us. Derham House DS0000069403.V340103.R01.S.doc Version 5.2 Page 20 Things started to improve with Cathy, but now she has gone.” This resident went on to say “Many of the residents are not happy, there is nothing happening at the moment with activities, and I would like my door left open. I am lucky because I have friends and family to visit and this has made the difference.” One relative told the inspector “Mum has improved since she has lived here.” However, she did go on to say that “we bring flowers in for her but unless we change the water or throw the dead flowers away, this doesn’t seem to get done so I don’t know whose job it is.” The serving of the lunchtime meals was observed and it provided residents with a varied, appealing and nutritious meal. The dining room tables were laid with tablecloths, napkins, cutlery and cruet and looked very attractive. Pureed meals were served in an attractive manner, and generally residents who required assistance were not hurried. However, the inspector did observe a member of staff assisting a resident who was sat in the lounge. The resident was sat in a lounge chair with the member of staff sat on the arm by his side, and was pushing food into his mouth with a spoon, not talking to the resident or even really looking at him. This is totally unacceptable practice, and raises the issues of both staff training and appropriate supervision. Relatives of some residents visit daily and assist with feeding. GENERAL The home has a vacancy for an activities co-ordinator and interviews were taking place on the day of the inspection. It would be beneficial to the residents if this post could be appointed to, but all staff must be aware that the provision of activities for residents is everyone’s responsibility. Activities include interacting with residents in a meaningful way, sitting and talking is very important, enabling residents to watch a television programme from a suitable position, enabling residents to go for a walk or to visit the garden, and to take part in activities of daily living can make a very positive contribution to the quality of life experienced by vulnerable people who require assistance. Visiting times are very flexible and visitors confirmed that they could visit at any time. Residents have the choice as to where they see their relatives and friends, either in the lounge, garden or their own bedroom and there is also a larger ‘blue lounge’ which is situated between the two units. The signing-in book indicated that there is a steady stream of visitors to the home. All of the relatives spoken to stated that they were made to feel welcome. One relative stated, “I visit every day and I always feel welcome”. The inspectors did observe that plated seasonal fruits and biscuits were delivered to the units during the morning, and these were being enjoyed by the residents. Derham House DS0000069403.V340103.R01.S.doc Version 5.2 Page 21 The inspectors were concerned that many relatives visit at lunchtime in order to assist with feeding, and some did indicate that at times they feel they need to visit to assist staff who often seem to be short on numbers. Whilst relatives are to be encouraged, and who want to be involved in the care of a resident, the organisation must ensure that there is always sufficient staff on duty at such times, especially in the event that a relative does not visit. During a visit to the kitchen the inspector was talking to the assistant chef and was informed that currently there are 27 residents on a pureed diet. This is a high level of dependency and therefore staffing levels must be reflective of this or mealtimes staggered. The inspectors are not satisfied that equality and diversity issues at the home are being appropriately addressed. There is a resident of Chinese origin who is still not consistently being offered a culturally appropriate diet or social activities, and there is another resident of Polish origin who, whilst sometimes may choose to have a British diet, should be offered culturally appropriate food when requested. Residents and relatives (on behalf of the residents) need to be more involved in decision making within the home, such as menu planning, activities and other social events. This will help to ensure that residents have more choice and control over their lives. The service does present as being run by the staff and for the organisation, with insufficient consideration given to the wishes and choices of the residents. It is apparent from the AQAA that the organisation is aware of many of the problems since they state that the improvement and accessibility of activities is included in its’ improvement plan, and to introduce a newsletter for the home. However, the AQAA does state that there has been improved access to a newly developed sensory garden. This was not evident during the inspection as the access remains as before, and the garden is not yet completed. Derham House DS0000069403.V340103.R01.S.doc Version 5.2 Page 22 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 People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to the service. The home’s complaints policy and procedure provides residents and their relatives with the appropriate information to ensure that formal complaints are dealt with promptly. However, verbal complaints are not always recorded nor are they always dealt with appropriately. Although many staff have received training in dealing with complaints and safeguarding adults, this is not always put into practice. EVIDENCE: The majority of the residents have family who are in regular contact with them and the home. Most of the relatives that were spoken to said that they would speak to the deputy manager at the moment if they had any concerns or complaints. The also said that they felt confident that they would be listened to and that complaints would sometimes be acted upon. One relative stated, “ I did mention about an item of food and this is no longer being provided”. However another relative stated, “ I don’t know about now but the previous manager didn’t take any notice and just made excuses”. A resident told the inspector “I don’t want my bedroom door to be closed, but when I ask for it to be left open I am told it is company policy which doesn’t help me.” The issue of the closed bedroom doors was raised Derham House DS0000069403.V340103.R01.S.doc Version 5.2 Page 23 many times with the inspectors at this, and previous inspections, and currently nothing seems to have been addressed in an appropriate manner by the organisation. Staff that were spoken to during the inspection were aware of the action to be taken if they had any concerns about the welfare and safety of residents, however not all staff have received training in Safeguarding Adults. During the training it is essential that all staff are made aware that the abuse of vulnerable people is not just about physical abuse. Some poor care practices, as observed during this inspection, are also an abuse of the individual. For instance the practices of some staff in pushing food into a person’s mouth without any other interaction, staff walking past a person without any acknowledgement, and staff leaving residents in situations where they are unable to interact in a meaningful way with the world around them. It was also evident in talking to some nurses that they do not feel able to deal with relatives who may consistently complain, or who they may feel are being difficult. Often because of the inability of the nurse in charge to deal effectively with difficult situations, concerns become major complaints. The organisation is aware of this area of concern, and has highlighted the need to improve communication with relatives, and hopefully residents, in the AQAA as an area for improvement. The complaints procedure is displayed in the home and many residents and relatives were aware of this. However, the complaints procedure should also be produced in different formats to meet the needs of all of the residents accommodated at the home. Derham House DS0000069403.V340103.R01.S.doc Version 5.2 Page 24 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, 22, 23 and 26 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to the service. People can be sure that they will be able to live in safe, comfortable surroundings with their own possessions around them in their bedrooms, and that the home will be well maintained and kept clean and hygienic. EVIDENCE: A tour of the whole premises was undertaken and this included an inspection of the kitchen and laundry. Both of these areas were clean and tidy. Food was being appropriately stored and labelled, and the laundry equipment was in good working order with the exception of one item which was being replaced during the inspection. The standard of the décor, furnishings and fittings are being maintained to a good standard. However, there is currently one bathroom out of use because of the need to replace the bath, and this is being used for the storage of equipment. This is not acceptable and the organisation must make Derham House DS0000069403.V340103.R01.S.doc Version 5.2 Page 25 arrangements for the replacement of the bath, and for adequate storage facilities. Residents should have access to the appropriate number of baths/showers in order to meet their needs. The home was found to be clean and free from offensive odours throughout, and staff were observed to be operating infection control methods. During the tour of the home all bedroom doors were observed to be closed in accordance with the organisation’s current fire policy, but obviously contrary to residents’ choice. At the previous inspection the inspectors were informed that an order had been placed for bedroom door closures, to be activated by the fire alarm, to be fitted on 10 bedroom doors and that all bedroom doors would be fitted with these closures on a rolling programme. However, at this inspection the inspectors could not evidence this, and were told that it would not happen because of the financial implications for the organisation. The AQAA has indicated that the organisation needs to continue to reaffirm that bedroom doors are not propped/wedged open in an attempt to improve fire safety, but there is no mention of the need to meet choices, improve the wellbeing and social needs of residents. Call alarms were available in all bedrooms and these were observed to be in reach of residents, but not always able to be used by the individual resident due to cognitive or other disabilities. One of the courtyard gardens was well maintained but the other was not accessible to residents as it was still in the process of being turned into a sensory garden. The general grounds of the home are well maintained and were colourful with hanging baskets and flowerbeds. Derham House DS0000069403.V340103.R01.S.doc Version 5.2 Page 26 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 People who use this service experience poor outcomes in this area. We have made this judgement using available evidence including a visit to the service. People who use this service cannot be sure that their needs will be met by adequate numbers and skill mix of staff, who are trained and competent to do their jobs. However, they will be protected by the home’s recruitment policy and practices. EVIDENCE: At the beginning of the inspection the inspectors were quite clearly told by the deputy manager and a training and development manager for Barchester Healthcare that the programmed training would not have an impact on the staffing levels on the floor. However, this was not the case because 1 nurse from Bridge Unit was off the floor attending training, and 1 care worker from Foxhall Unit was off the floor attending training. The inspectors were told that staffing levels on Foxhall unit should be: 2 registered nurses and 5 care staff plus 1:1 for a resident a.m. 1 registered nurse and 4 care staff plus 1:1 for a resident p.m. At night 1 registered nurse and 2 waking care staff. Staffing levels on Bridge unit should be: 2 registered nurses and 4 care staff a.m. Derham House DS0000069403.V340103.R01.S.doc Version 5.2 Page 27 1 registered nurse and 4 care staff p.m. At night 1 registered nurse and 2 waking care staff. The inspectors were also told that the deputy manager, when working on the floor, is supernumerary. However, in discussions with various staff members this would not always seem to be the case, and this was evidence in viewing some rotas. Staff rotas were examined and during the morning of the inspection the number of staff on duty did not correlate with the rota. There were four care staff identified on the rota but one of the care staff was attending training from 10 o’clock. This meant that three care staff and not five were staffing the unit. Other rotas were inspected and there were a number of days when the units was short staffed. This is not acceptable and the organisation must ensure that there are sufficient staff on duty at all times to ensure that residents’ needs are met. Also the staffing levels are significantly lower in the afternoon than in the morning, residents’ needs do not diminish in the afternoon and staffing levels need to be appropriate to their needs. One relative stated, “Staffing levels have gone down since Barchester has taken over, they are only interested in their image”. Again on the day of the inspection there should have been 2 domestic staff on duty, but there was only one to clean the entire home, with no extra hours. Again rotas, staff, residents and relatives confirmed that this has happened on previous occasions. When discussed with the Regional Operations Director she appeared not be aware of this fact, and said to the deputy manager that there were systems in place for her to have authorised additional staff. Either the deputy manager was not aware of these systems, or such systems do not work in practice. A requirement at the previous inspection was that staffing levels must be reviewed in the light of the high dependencies of many of the current residents. This quite clearly has not been done. Staffing levels must be based on the needs of the residents, and not on a ratio of numbers of staff to residents. It was evident during the inspection that the daily life and activities for residents was not in accordance with their needs, in part due to the shortage of staff. Some staff that were spoken to stated that they enjoyed working at the home, but felt at times that they would benefit from having more staff particularly in the afternoon. On Bridge unit two care workers, who were both car drivers, had worked at the home one day and never returned. The member of staff who told the inspector this felt that it was because many of the staff feel that the work is too hard and that there is often insufficient staff on duty. Derham House DS0000069403.V340103.R01.S.doc Version 5.2 Page 28 Another member of staff told the inspector “the induction training should be better, some people have only done 1 day induction and then are expected to work on the floor.” It was also apparent on the day of the inspection that not all staff had a good command of the English language. If staff are caring for vulnerable people who may have hearing problems, or a cognitive impairment due to a stroke or dementia, or speech problems then it is essential that they have a good command of English to enable them to provide the necessary care, and meet the needs of the residents. There does seem to be a high turnover of staff, with little use of agency staff (as directed by the organisation) and this is obviously impacting on the delivery of care at the home. Staff’s training records were examined and during the past year training has taken place in administration of medication, customer care, palliative care, safe handling of medication, tissue viability, dementia awareness, syringe driver training, memory lane and effective communication. However, there are gaps in training and a large number of staff still need to complete Moving & Handling, Food & Hygiene, Infection Control and Safeguarding Adults training. However good the training is, it will be ineffective if it is not being implemented in daily work practices. A random sample of personnel files of the four most recently appointed staff were examined and found to be in good order with the necessary references, Criminal Records Bureau (CRB) disclosures and application forms duly completed. Gaps in employment history are addressed at interview. The inspectors must record that residents and relatives did speak highly of many of the staff, one resident said “many of the staff are really nice and kind, and nothing seems to be too much trouble for them.” Derham House DS0000069403.V340103.R01.S.doc Version 5.2 Page 29 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, 32, 33, 35, 36 and 38 People who use this service experience poor outcomes in this area. We have made this judgement using available evidence including a visit to the service. Due to a high turnover of General Managers, residents cannot be sure that they live in a home which is run and managed well. It is not always apparent that the home is being run in the best interests of the residents. However, residents can be sure that their financial interests are safeguarded and that their health, safety and welfare will generally be promoted and protected. EVIDENCE: The manager’s post is currently vacant. There is a deputy manager who was appointed in April 2007, so does not currently know the home or the residents and staff very well. She was being supported at the time of the inspection through visits from the Regional Operations Director and the Clinical Development Nurse. This obviously has not been sufficient to maintain all of the standards. Because of the high turnover of General Managers in the past Derham House DS0000069403.V340103.R01.S.doc Version 5.2 Page 30 few years, and the relatively high turnover of other staff (40 as indicated in the AQAA) in the past 12 months it is having a detrimental effect on the operation of the service, and therefore, on the residents and staff. It is evident from the AQAA and from discussions with the Regional Operations Manager that the organisation acknowledges that improvements are necessary in the following areas: The general management of the home The quality of training, appraisal and supervision of staff Improve the quality of care and medication records through training and supervision of the registered nurses A higher level of involvement from service users in shaping the services. The above is in addition to other areas for improvement that have been highlighted through this inspection process. The inspectors were told that plans are now in place for an acting general manager to be appointed on a full time basis until an appropriate permanent general manager is employed. It is to be hoped that this will enable the organisation to substantially improve the quality of the service currently being provided to residents at Derham House. During the inspection some staff mentioned that management does not always display appropriate acknowledgement of the value of staff, and some felt undervalued. This was also evidenced in an anonymous letter sent to the Commission. It is essential that the organisation endeavours to put into place appropriate systems to enable staff retention so that residents can begin to feel a consistency in their care. To provide effective care to vulnerable people, staff must feel valued, well trained and skilled. Equality and diversity issues must be addressed for both residents and staff, and this may mean additional intensive training for those staff members who have English as a second language, and who may not be au fait with the cultural needs of the residents at Derham House. It was evident from discussions with staff, the head of care and the deputy manager, and checking staff files that regular 1:1 supervisions, yearly appraisals and staff meetings are not taking place. The home has carried out all health and safety checks. All gas and electrical checks have been undertaken within the past 12 months and the fire alarm has been serviced this year, and a new fire panel and detector heads have been installed. Fire drills and alarm testing are regularly undertaken as are water, freezer and refrigerator temperatures. The maintenance person carries out daily checks on the safety system, lighting, heating and plumbing. Weekly Derham House DS0000069403.V340103.R01.S.doc Version 5.2 Page 31 checks are carried out on doors, windows, nurse call system, décor, fire doors, gardens and catering equipment. Monthly checks are undertaken on wheelchairs, electrical beds and emergency lighting system. Six monthly checks are undertaken on hoists & slings, ladders and yearly checks on the general environment. The inspectors were satisfied that the financial interests of residents are safeguarded, and that their best interests are protected by the administration record keeping. Although generally policies and procedures protected the best interests of the residents, this was not apparent through the current fire safety policy as it is affecting the general wellbeing of some of the residents. During the inspection discussions were had with the Regional Operations Director and the deputy manager around the training needs for staff with the forthcoming implementation of the Mental Capacity Act 2005 on the 1st October, 2007. The deputy manager said that she had already received some training, and it is essential that training in the important area is made available to all other members of staff. From the AQAA it would indicate that over 50 of the staff have achieved NVQ level 2, but with the high turnover of staff this figure is probably very fluid. Monthly Regulation 26 visits are being undertaken and reports are being produced in accordance with the Care Home Regulations 2001. Also Regulation 37 notifications as required under the Care Home Regulations 2001 are also being sent to the Commission. Barchester Healthcare does have a comprehensive quality assurance system, but this does not appear to be effective with regard to Derham House in view of the many areas for improvement identified in this report. Derham House DS0000069403.V340103.R01.S.doc Version 5.2 Page 32 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 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X 3 3 X X 3 STAFFING Standard No Score 27 1 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 2 X 3 2 X 2 Derham House DS0000069403.V340103.R01.S.doc Version 5.2 Page 33 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(2)(b) Requirement Timescale for action 31/08/07 2 OP9 13(2) The registered persons must ensure that each resident’s care plan is comprehensive and covers social needs, and that this plan including other associated records such as risk assessments, fluid, nutritional and other such charts, are regularly reviewed, maintained in an up to date manner with the involvement of the resident and/or his/her relative or representative. This is to ensure that the needs of the individual resident are being met and monitored with their involvement. (This is a repeated requirement where the timescale of the 31/03/07 has not been met) The registered persons must 13/07/07 ensure that all medication administration records are maintained up to date, and that nurses administering medication are fully aware of the needs of the prescription. This will ensure that residents receive the correct medication, at the correct time and in accordance with the DS0000069403.V340103.R01.S.doc Version 5.2 Derham House Page 34 3 OP10 4(a) 4 OP12 OP14 12(1)(a) 16 (1)(2)(m) (n) 5 OP16 22 instructions of the GP. (This is a partially repeated requirement where the timescale of the 06/02/07 has not been met) The registered persons must 13/07/07 ensure that the care delivered is in such a manner that it respects the privacy and dignity of service users. This is in particular to the frequency of baths/showers, and to the methods used by some staff when assisting residents with food. The registered persons must 31/08/07 ensure that proper provision is made to promote the health and welfare of residents especially with those who have feelings of isolation, and whose wellbeing is affected by the closure of bedroom doors when they are in the room. Residents must also be consulted on their social interests and a programme of activities in relation to recreation. This will benefit residents and add to their sense of wellbeing and quality of life being experienced at the home. (This is generally an unmet requirement from previous inspections where the timescale of 31/03/07) have not been met) The registered persons must 31/08/07 ensure that all complaints, whether written or verbal are recorded and dealt with effectively. Also the complaints procedure must be in formats accessible to all residents. This is to enable residents and relative to feel confident that they can complain, and such complaints will be dealt with effectively. (This is an unmet requirement where the DS0000069403.V340103.R01.S.doc Version 5.2 Page 35 Derham House 6 OP27 7 OP28 OP30 OP18 8 OP31 OP33 9 OP4 OP32 timescale of 31/03.07 has not been met) 18(1)(a)( The registered persons must b) review the numbers and skill mix of staff to ensure that at all times these are sufficient and appropriate to meet the needs of all of the residents accommodated at the home. (This is an unmet requirement where the timescale of the 28/02/07 has not been met) 12(1)(a) The registered persons ensure 13(6) that all staff working at the care 18(1)(a)(c home receive appropriate )(i) induction training, and undertake 19(5)(b) regular and ongoing training appropriate to the tasks to be performed. This does include all staff being training in safeguarding adults and in the implications of the Mental Capacity Act 2005. All staff must have the appropriate language skills to positively interact with, and meet the needs of the residents. This is to ensure the protection and wellbeing of residents. 8(1)(a)(b) The registered persons must (i) appoint a person to manage the home because there is currently no registered manager and the registered provider is an organisation. This will ensure that quality assurance systems are more effective, that residents live in a home with is run in their best interests, and managed by a person fit to do so, and that they should benefit from the ethos, leadership and management approach of the home. 10(1) The registered persons must ensure that the ethos, leadership and management approach of DS0000069403.V340103.R01.S.doc 31/07/07 30/09/07 18/09/07 31/07/07 Derham House Version 5.2 Page 36 10 OP36 OP38 18(2)(a) 12(1)(a) the home ensures that the social, cultural, religious, sexual, language and other diverse needs of residents are met and respected, and that this also is applied to staff working at the home. The registered persons must ensure that all staff working at the home are appropriately supervised to ensure that the health, safety and welfare of service users are promoted and protected. (This is a repeated requirement where timescales of 31/03/07 were not met) 31/07/07 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 Derham House DS0000069403.V340103.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU 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. 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