Inspection on 19/07/06 for Drake Court

This inspection was carried out on 19th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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

Drake Court 20/04/09

Drake Court 23/10/08

Drake Court 29/04/08

Drake Court 22/11/07

Drake Court 18/05/07

Drake Court 27/11/06

Drake Court 28/01/06

Drake Court 16/06/05

Drake Court 10/01/05

Drake Court 13/08/04

Drake Court 10/03/04

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

CARE HOMES FOR OLDER PEOPLE Drake Court Drake Close Bloxwich Walsall West Midlands WS3 3LW Lead Inspector Chris Fuller Key Unannounced Inspection 19th July 2006 08:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Drake Court DS0000020809.V304589.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. Drake Court DS0000020809.V304589.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Drake Court Address Drake Close Bloxwich Walsall West Midlands WS3 3LW 01922 476060 01922 407555 Telephone number Fax number Email address Provider Web address Name of Responsible Individual(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Drake Court Health Care Limited Miss Gillian Rosemary Bates Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29) of places Drake Court DS0000020809.V304589.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28/01/06 Brief Description of the Service: Drake Court is a two-storey purpose built home which provides accommodation for twenty-nine elderly service users. The home is situated close to Bloxwich town centre and local amenities. The home is maintained to a high standard with adequate parking to the front and side of the property. There are twentyseven single rooms and one double room, all with a toilet and washbasin. The current scale of charges is £327.15 to £341.36 per week. Drake Court DS0000020809.V304589.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This year the Commission for Social Care Inspection is making a key inspection of a selected number of the National Minimum Standards. The focus remains on assessing the quality of care provided through the experience and outcomes for service users, to review progress on meeting statutory requirements from last years inspections and focusing on aspects of service provision that require further development, or pose the most significant risk to service users. A short unannounced inspection was carried out on a Saturday afternoon in January 2006. The inspector at that time commented “it was disappointing to note that, although some progress had been made towards meeting requirements, many have not been addressed. These are beyond the control of the care staff and need to be addressed by the manager and provider. Staff informed the inspector that the manager had been away from the home for five weeks at the time of this visit. It was evident that staff had been working hard to maintain the standards and to make improvements in recording systems.” The current unannounced key inspection took place on Thursday and Friday the 20th and 21st July 2006. The registered manager was on a day off on the first day and was available with the newly designated Responsible Individual Mr. Mike Wardle on the second day to assist with the inspection and receive feedback. The inspector spoke with staff on shift and with residents. A sample of residents files and staff records were seen. Mealtimes and administration of medication were observed and a tour of the premises was made. As previously there has been little progress with meeting statutory requirements from the previous years inspection visits. The Responsible Individual has consistently failed to establish regular monitoring visits and reporting and effective quality assurance systems and management of the home. To compound this the registered manager has been unable to establish regular supervision of staff and implement effective monitoring systems of the care practice in the home. There have been long periods of the year where there has been very limited management support to staff due to the prolonged absence of the manager and business commitments of the Responsible Individual. The staff group have shown commitment in maintaining a service with insufficient numbers of staff to cover the care and ancillary duties and meet the needs of service users. The residents express appreciation of the friendly and helpful attitude of most members of staff. Drake Court DS0000020809.V304589.R01.S.doc Version 5.2 Page 6 Two serious complaints were made to the Commission of Social Care Inspection during the past inspection year. The inspector was most concerned to find that not all of the issues raised in the complaints had been addressed or the evidence of action taken provided. The newly designated Responsible Individual gave assurances these matters would be addressed. Both complaints related to the level of care provided to residents once there was a change in their health and wellbeing. There is evidence in the admissions and discharge records of the home of a history of inappropriate admissions outside the category of people the home is registered to care for. This has been brought to the attention of the registered manager on previous inspection visits. What the service does well: What has improved since the last inspection? Since the last inspection a few of the statutory requirements made in the last report have been met. The medication fridge has been wall mounted and is in use. There are thermometers to check the temperature of the fridge and the medication store room however there is no monitoring or written record of the temperatures. The registered manager confirmed that senior staff designated to provide supervision sessions to staff have completed training in supervision skills. The registered manager intends to implement a programme of supervision with all staff. The registered manager confirmed that all staff have received training in Dementia Care. The ventilation shaft above the cooker has been deep cleansed by a competent contractor. Drake Court DS0000020809.V304589.R01.S.doc Version 5.2 Page 7 What they could do better: The home is establishing a history of non-compliance and failure to meet National Minimum Standards of Care and failure to meet statutory requirements within agreed timescales. Past inspection reports evidence recurring issues and concerns regarding the lack of action taken by the Responsible Individual and the manager of the home to address issues highlighted in reports and discussed and agreed at inspections. Several requirements made at the last visit have not been addressed and these are listed in the relevant section of this report. It was also found some of the matters to be addressed following the findings of two complaints investigated by the CSCI remain outstanding. In addition to this a number of statutory requirements were made from the findings of the current inspection once again highlighting recurring issues. The Responsible Individual and the registered manager are required to submit an action plan to state how these requirements will be met and the timescales for completion. The matters to be addressed include the following: the home must provide the statement of purpose and a guide to the home to prospective residents and their families so they can make an informed choice about living at the home. A written contract must be given to each resident which is signed and dated by all parties prior to admission to the home. Most importantly the registered manager must not admit anyone to the home unless a full assessment of need has been made and she is satisfied and can demonstrate that the home can meet those needs. Upon admission a care plan showing how personal and health care needs will be met must be written with the involvement of the resident and their relatives; this can be reviewed within one month of living at the home. The aforementioned matters are all basic to good care practice and ensuring an appropriate placement for prospective residents. This matter has been raised with the manager before. During a tour of the building the Inspector noted that the carpets in communal areas were looking worn and stained which make the home look unclean. The home made one notification of infectious disease during the last inspection period. Appropriate action was taken at the time however the management must ensure there are sufficient staff to cover hygiene and cleaning tasks seven days a week. A kitchen assistant must be provided to support the cook’s role in the kitchen and release care staff from moving between caring tasks and kitchen tasks without change of uniform, washing hands, head gear etc. Medication needs to be stored at an appropriate temperature to make sure it is still effective. This shortfall could pose a danger to residents and also needs to be addressed immediately. Drake Court DS0000020809.V304589.R01.S.doc Version 5.2 Page 8 The home has begun to reorganise staff files and there is some improvement with recruitment process this needs to be consolidated with regular supervision sessions and staff appraisals. Staff need to undertake training in Adult Protection, Infection Control, manual handling and Complaints. The home needs a quality assurance system and a business and financial plan. The provider needs to ensure that the monthly unannounced visits are made to the home and that the required reports are produced. As with staff files the resident’s files are to be restructured to ensure all recording formats are implemented and completed. The existing files were incomplete and difficult to find relevant information. The newly designated Responsible Individual has given a commitment to support the registered manager to address the above issues in a timely manner. 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. Drake Court DS0000020809.V304589.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 Drake Court DS0000020809.V304589.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 and 6 The overall outcome for this set of standards is judged as adequate. The admission procedure is not implemented by the registered manager and staff at the home. There must be a proper assessment made by the home prior to people moving into the service. Without this there is no assurance that care needs will be met. EVIDENCE: The Statement of Purpose for the home had been revised by the Responsible Individual however this still did not fully address the issues relating to moving and lifting of residents or arrangements at the time of deteriorating health and changes in the level of care needs. There was no evidence that the Service Users’ Guide is available and issued to the service users and their representatives. The residents’ files seen did not hold copies of contracts and those that were available to be inspected were not signed and dated by all of the relevant parties. Drake Court DS0000020809.V304589.R01.S.doc Version 5.2 Page 11 A sample of files of residents most recently admitted to the home were seen. It was found there had been inappropriate admissions with service users being placed who had been diagnosed with Dementia Care needs and no evidence that the home are able to meet their needs. The registered manager had made an admission to the home based on verbal information from health and social care services without completing a written assessment for the home or checking out the status of the information provided. The home does have a standard letter to be adapted to reflect individual residents request for admission to the home however this does not appear to have been implemented. There was no evidence on the files that the letter is issued to confirm in writing to the prospective resident and demonstrate the home’s capacity to meet their needs prior to their admission. The home offer residents and their relatives a chance to visit the home to determine its suitability. The manager and or senior staff will visit in service users own home’s, hospital or current place of residence should they prefer this arrangement. The home will take emergency admissions and must ensure an assessment of need is made prior to admission and information of services to be provided made available. The registered manager states the home does not provide intermediate care and does not provide intensive rehabilitation to enable residents to return home. It was noted that there had been a number of short-term placements, it was stated these were for respite and residents generally planned these in advance. Drake Court DS0000020809.V304589.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8 and9, The overall outcome for this set of standards is judged as adequate. There is limited progress in the improvement of arrangements to ensure the health care needs of residents are identified and met. Care practice is inconsistent and without monitoring through regular care plan reviews shortfalls arise that have a potential to place residents at risk. EVIDENCE: The sample of files seen did not hold the required care plan. The registered manager stated that this is not developed until the resident has been living at the home for a month or so and the manager and staff have got to know them. This practice is unsatisfactory as it provides no guidance to staff of how the residents’ needs are to be met during this period. This is particularly pertinent where admissions are made without any written information of full assessment of need and care plan from professional agencies is produced for the resident upon admission to the home. Drake Court DS0000020809.V304589.R01.S.doc Version 5.2 Page 13 The same problem arises in respect of addressing the health care needs of residents and how these will be met. Residents files did not hold a comprehensive health care plan. This matter has been raised with the registered manager on previous inspection visits especially in instances where residents are admitted from hospital or are from another local authority. Talking with residents it was evident that some health care needs were not being addressed proactively such as chiropody. The registered manager and care staff stated the chiropody services had been contacted and were stating there was a backlog and appointments were delayed. However there was limited evidence on files that this matter was being pursued and addressed. It was causing problems for several residents with discomfort in walking etc and was a health issue for those with diabetes. Staff and later management did take action to address this matter during the period of the inspection. Another aspect of health care was audio care, relatives stated “they were impressed with staff perseverance in sorting out and obtaining a hearing aid for their mother.” The inspector had the opportunity to observe the administration of medication. It was noted that staff do not always observe residents take their medication. This is poor practice and can pose a risk to the resident and others. A good standard of practice needs to be developed and monitored by the registered manager to ensure the safe administration of medication. The home does have a separate secure room for the storage of medication. There has been some progress with the medication cabinet being wall mounted. Thermometers have been provided for room temperatures and fridge temperatures, however there is no written record kept to monitor these. The staff confirm the room can be overly warm; the registered manager must ensure drugs are stored at appropriate temperature levels. The home has made progress with some staff completing the accredited safe handling and administration of medication training. However there was no central record available of the names of staff and completion dates of those that have completed accredited medication training. This is important for shift planning and handover meetings to ensure staff are designated duties appropriately. The complaints received by the Commission for Social Care Inspection raised issues about the timely and appropriate contact with relatives of residents (if that is what the resident wants) with all aspects of a residents care planning and in particular at times of changes to the care plan, health care needs and any incidents. There was some evidence of involvement of and contact with relatives and feedback from one set of relatives was very positive. However this was in direct contrast with the experience of others which indicated practice in the home by the registered manager and staff was inconsistent and unsatisfactory. Drake Court DS0000020809.V304589.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 15 The overall outcome for this set of standards is judged as adequate. The residents continue to enjoy the range and quality of meals provided in the home. There is room for improvement in the provision of the social activities both in the home and the community to reflect and meet the individual interests and preferences of the residents. EVIDENCE: The sample of files seen held limited information on individual residents choice of activities and how these will be met. Where there was information this appeared to be taken from the original assessment and had not been updated to reflect changes. Case records did not reflect daily routines or activities a sample seen covering a two month period all reports said “Resident has been fine spent a pleasant day within the home, diet and food intake good.” The comments varied on only three occasions. For activities it was recorded that the person enjoyed the keep fit sessions, otherwise it recorded none. Residents spoken with stated that occasionally they played bingo or had chair exercise sessions but felt they would like more variety and the option of some trips out or entertainment in the home. There was a notice of a weekly visit from an activities organiser. Drake Court DS0000020809.V304589.R01.S.doc Version 5.2 Page 15 Feedback from staff indicated that staffing levels did not allow for development of a leisure and activity programme of events. Staff also felt that there was little interest from residents. There did appear to be a good rapport between staff and residents with conversation and humour between them. Staff stated some residents do go out alone and others with their families. The TV is generally on in one area of the lounge for those that watch it in the morning and music from old records in the afternoon. All residents spoken with stated they enjoyed the meals provided and felt they had sufficient to eat and were frequently offered more should they wish to have it. The meal of the day was steak pie and jacket potatoes and for tea a poached egg and a sandwich. Other dishes on the weekly menu included gammon, poached fish, lamb chops, pork chops and pasties all with a choice of potatoes and vegetables. The cook has a weekly budget for food and feels this is adequate. Residents knew the cook and felt they could talk with the cook about their likes and dislikes and that the staff knew their preferences. The cook is supported by the care staff in fulfilling the kitchen duties particularly at mealtimes with serving up etc. The Kitchen records are maintained current and up to date and the cook stated the utensils and equipment were in working order. Progress had been made with the cleaning of the ventilation shaft. The dining room was in need of improvement to the carpets, fabric and furnishing all looking worn and soiled. This is addressed in the environment section. Drake Court DS0000020809.V304589.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 The overall outcome for this set of standards is judged as adequate. Complaints are not always recorded. Relatives and residents are not confident that their concerns will be listened to, taken seriously and acted upon. To develop a positive proactive ethos the registered manager must encourage feedback and act upon suggestions from residents and relatives for the constructive development of the service and to ensure the well being of the residents. EVIDENCE: The home has a book for the recording of complaints however there were no records of complaints received during the past inspection year. The Commission for Social Care Inspection had received two written complaints and these had been notified in writing to the Responsible Individual and the registered manager of the home. The registered manager had also received concerns from a relative of another resident however this was not recorded as a complaint. The Commission for Social Care Inspection investigated the two complaints which respectively held a range of issues relating to the care provided. In both instances a number of the issues were found to be upheld and some upheld in part whilst others it was not possible to substantiate. The complaints raised gave serious cause for concern regarding the policy and procedures and practice in the home relating to admissions, moving and handling of residents and sharing of information and involvement of relatives. Drake Court DS0000020809.V304589.R01.S.doc Version 5.2 Page 17 Other matters of serious concern were the judgements made by the registered manager and lack of action taken to address a residents needs. As a result of the CSCI complaint investigation a number of statutory requirements were made and the Responsible Individual and registered manager submitted an action plan to meet the requirements. Progress of these matters has been monitored and will continue to be monitored through the inspection process. Drake Court DS0000020809.V304589.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26 The overall outcome for this set of standards is judged as adequate. The fabric, furnishings and decoration in communal areas of the home is showing signs of wear and tear. The home must be assessed for suitable aids, adaptations and equipment to provide a pleasant, comfortable and safe environment for residents to live in. EVIDENCE: The home is conveniently placed near Bloxwich High Street. The majority of staff are local people familiar with the local culture and background of residents. Family and friends are encouraged to visit the home and the more able resident will venture out to the shops and local facilities. The home was generally clean and tidy on the day of inspection though some areas were in need of a deep cleanse and or decoration. Maintenance and repairs are done regularly. Drake Court DS0000020809.V304589.R01.S.doc Version 5.2 Page 19 The inspector made a tour of the communal rooms, a sample of individual bedrooms and the outdoor area of the home. There were no unpleasant odours at the time of inspection. It was very hot weather during the inspection period and front doors were open with some garden furniture (table and chairs) outside with umbrella’s to provide shade and allow the residents to sit comfortably. On entering the home the carpet in hallways, the lounge and the dining room were worn and soiled and with potential trip hazards in part. In the dining room unfortunately this combined with worn and faded fabric on dining room furnishing made the area look dull and in need of refurbishment. The worn carpet by room 3 was shown to the registered manager; it is a trip hazard and danger to the health and safety of residents, visitors and staff. The Responsible Individual and the registered manager have reviewed the moving and handling policy for the home. This indicates staff will use appropriate aids and adaptations to assist and meet the needs of the residents. There is limited equipment in the home for moving and handling, or aids and adaptations. Given the changing needs of residents the Responsible Individual and registered manager should obtain advice and assessment of the premises by an occupational therapist in respect of providing aids and adaptations that reflect and meet the needs of the residents. The registered manager and cook confirmed the ventilation shaft in the kitchen had been cleaned in May 2006. The pre inspection information included details of the annual checks and certificates for Fire, Gas, Central heating, Electrical wiring, Emergency Call systems as being completed and current within the last twelve months. The Fire Officer last visited in May 2002. Environmental Health Officer and the Health and Safety Officer visited in 2005. Drake Court DS0000020809.V304589.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 The overall outcome for this set of standards is judged as poor. Management implementation of recruitment, training and support systems for staff is not thorough or consistent and do not provide the safeguards to offer protection to people living in the home. EVIDENCE: On the day of the inspection the registered manager was on a day off. Staffing rotas were seen and the registered manager is on the shift rota as a member of care staff covering a mix of 9.00am – 5.00pm and 2.00pm - 9.00pm shifts. The Responsible Individual must ensure the registered manager remains supernumerary at all times. There are numerous national minimum standards that are management responsibilities that remain unmet, such as supervision, staff appraisals, providing an adequate complement of staff, staff training programmes and staff records and recruitment process. At the time of the inspection there were 21 residents with seven vacancies in the home. Whilst there were sufficient care staff on duty during the inspection, staff rotas indicate there are shifts with only two members of staff on duty when the manager is supernumerary. The Responsible Individual and the registered manager must ensure staffing numbers, abilities and skill mix of qualified /unqualified staff are appropriate to the assessed needs of the residents at all times. Drake Court DS0000020809.V304589.R01.S.doc Version 5.2 Page 21 There has been progress made with the provision of a designated person to cover the laundry duties. The laundry was clean and tidy. At the present time there is only one domestic who has been asked to pick up additional hours covering a six-day week. However this is a temporary situation and it is expected the vacant post will be advertised to cover the duties over a sevenday period. A sample of staff files seen show that there are significant records missing. The newly designated Responsible Individual gave assurance that staff contracts had been revised and issued for staff to sign with copies provided and held on file. The registered manager is making an audit to ensure that all staff receive a contract with terms and conditions and a job description. The revised documents are to include guidance in respect of lifting and handling tasks. A copy of both are to be kept on the staff file. There was limited evidence of staff training and no central staff training and development plan. The following topics: Adult Protection, Infection Control, manual handling and Complaints were identified as significant training shortfalls and should be given priority. Drake Court DS0000020809.V304589.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,34,36,37 and 38 The overall outcome for this set of standards is judged as poor. There is a poor working relationship between management and staff at the home. There is a lack of consistent leadership, guidance and direction to staff. This results in some practices that do not promote and safeguard the health and well being of residents. EVIDENCE: There is evidence in the home of inappropriate admissions being made, questionable instructions and guidance to staff regarding care practice and insufficient or inappropriate deployment of staff on shift rotas. Examples were noted where residents were admitted to the home without full assessments or written information regarding the home’s assessment of their needs and the registered manager had made a judgement their needs could be met. However it subsequently was found the home were unable to provide for their needs. Drake Court DS0000020809.V304589.R01.S.doc Version 5.2 Page 23 Residents files and feedback from residents and staff indicate the manager gave instructions relating to health care needs or lifting and handling of residents that left staff with confused and or conflicting dilemmas in respect of providing adequate care to residents whilst fulfilling the home’s policy and procedures. Staff rotas demonstrate there are insufficient care and ancillary staff to cover all duties over the period of the week. This is particularly notable during holiday periods and any sickness or staff vacancies placing other staff under stress to cover shift shortfalls. Feedback from staff and relatives indicate a range of conflicting opinions and experiences of the management ethos in the home. There is limited information through supervision records, staff team meeting minutes and residents meetings or feedback questionnaires to demonstrate effective communication systems that would reflect an open, positive and inclusive management style. The finance manager for the company was designated as the Responsible Individual to make the monthly unannounced visit to the home and provide a comprehensive written report to the registered manager of the home and the Commission for Social Care Inspection. There was no evidence held in the home of the reports or visits being made. The registered manager did locate two reports and it was agreed copies of the twelve months reports would be forwarded to the Commission for Social Care Inspection. The finance manager has now been appointed as the Responsible Individual for the company and gave assurances these visits would be made and reported. There was no evidence of residents meetings or feedback from residents and their families. The inspector has on previous inspections discussed the importance of developing feedback questionnaires and discussion with residents and their families, that is formally recorded, to provide the opportunity to express their views and make suggestions about services and facilities provided. The Inspector had provided feedback questionnaires to be issued to residents and their families and returned to the Commission for Social Care Inspection for the purpose of the inspection but these were not distributed by the registered manager. Some feedback was received during the inspection process however this was conflicting with some relatives stating “ They gave us our mum back”, and “We find it a pleasure to visit, like coming into a family home”. “The manager and staff are very approachable and helpful.” and “There had been one stomach bug in the home and staff informed relatives straight away”. Other relatives had expressed real concern that “the management had been insensitive to the needs of their relative and had made bad judgements when instructing staff in their duties.” Drake Court DS0000020809.V304589.R01.S.doc Version 5.2 Page 24 The home still does not produce an annual Quality Assurance development plan for the home, based on a systematic cycle of planning, action, review, aims and objectives and outcomes for service users. Planning and development of the service appears to be dealt with as issues arise rather than in a proactive manner. Similarly the Responsible Individual has not produced a business and financial plan for the home that is available and open to inspection and reviewed annually. The purpose of and content for this has been discussed and explained to the Responsible Individual and manager at previous inspections. A number of the statutory requirements remain on the report from previous inspection, as the agreed action has not been progressed within agreed timescales. The home is developing a history of non-compliance. The changes in delegation of duties of the Responsible Individual has been made with the objective of improving the strategic and operational management of the service. The inspector noted that the senior staff in charge of a shift receive fees from relatives but do not have access to a secure place to store the monies. This is resident’s money, staff members are vulnerable and the practice and procedures in respect of resident’s money needs to be reviewed to ensure that it is safe and secure for all parties concerned. The staff files and feedback from the registered manager confirmed that staff do not receive regular supervision (at least every two months). There has been some progress made with the registered manager and senior staff completing training in supervision skills. However as yet a supervision programme and regular individual sessions have not been established. This is most important for developing good standards of care practice and good working relationships between management and staff. The Accident Record book was seen with 50 accidents recorded for the period of 20.08.05 –19.07.06. The inspector noted there was one accident record book missing for the period of 13.10.04 –20.08.05. Notifications of accidents and incidents had been made with 26 being made for the period of 28.08.05 – 11.07.06. The records were completed with relevant information, signed and dated. The Inspector saw a sample of resident’s records. The files seen were incomplete with required information not available. This indicates that decisions are being made and care being provided without the necessary information for management and staff to make informed judgements and to provide effective care planning. The registered manager stated that resident’s files were due to be restructured with an index and dividers to make records more accessible and make sure that all recording formats were being used by Drake Court DS0000020809.V304589.R01.S.doc Version 5.2 Page 25 staff and relevant information recorded. The inspector noted that on a number of records the resident and or their representative had not signed and or dated the information recorded indicating they had not been involved or consulted when the information was recorded. The Responsible Individual and registered manager had been asked to review and revise policy procedures and practice in the home in respect moving and handling. Any changes made would also need to be reflected in the statement of purpose, staff job descriptions and contracts and in the equipment provided by the home to ensure safe working practice was implemented and to provide safe care of residents. Drake Court DS0000020809.V304589.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 2 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 X 3 X X X X 2 X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 2 X 1 1 2 Drake Court DS0000020809.V304589.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the Responsible Individual/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Responsible Individual(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4&5 Requirement The Responsible Individual must ensure that the Statement of Purpose for the home and the Service Users’ Guide are issued to the service users and their representatives. (original date for compliance 31/07/05) Not met The registered manager must ensure that each resident has a contract which is signed and dated by the relevant parties. The registered manager must ensure new residents are admitted only on the basis of a full assessment and where the home can demonstrate it is able to meet those needs. 3.1 The home must confirm in writing to the prospective resident and demonstrate the home’s capacity to meet their needs prior to their admission. 4.1 Timescale for action 31/08/06 2. OP2 5 31/08/06 3. OP3 14 23/07/06 4. OP4 12 23/07/06 Drake Court DS0000020809.V304589.R01.S.doc Version 5.2 Page 28 5. OP7 15 6. OP8 12 7. OP8 12,13 8. OP9 17 9. OP9 13 10 OP9 13 11. OP11 15,12 The registered manager must ensure that a care plan is produced for the resident upon admission to the home. 7.1 The registered manager must ensure the health care needs of residents and how these will be met are detailed within the care plan. 8.1 The registered manager and care staff must enable residents to have access to specialist services e g chiropody. 8.11 The registered manager must monitor the administration of medication to ensure staff observe residents taking their medication. 9.3 The registered manager must maintain a written record of the medication fridge temperature and that in the medication room to ensure drugs are stored at appropriate temperature levels. 9.4 The registered manager must maintain a central record (with the medication administration sheets), of the names of staff and completion dates of those that have completed accredited medication training. 9.7 The Responsible Individual and the registered manager must review practice and procedures to ensure the service user’s family and friends are involved (if that is what the resident wants) with planning for and dealing with increasing infirmity, terminal illness and death. 11.4 The registered manager must ensure care plans record residents choice of activities and how these will be met. 12.3 DS0000020809.V304589.R01.S.doc 23/07/06 23/07/06 23/07/06 30/07/06 31/08/06 31/08/06 31.07.06 12. OP12 16 31/08/06 Drake Court Version 5.2 Page 29 13. OP16 17 The Responsible Individual and the registered manager must ensure a record is kept of all complaints. 16.3 The Responsible Individual and the registered manager must ensure the worn carpet by room 3 producing a trip hazard is made safe. 19.1 The Responsible Individual and the registered manager must replace the dining room chairs and tables. 19.2 The Responsible Individual and the registered manager must replace carpets in the dining room, lounge and downstairs hallways. 19.2 The Responsible Individual must ensure the registered manager must provide aids, hoists and assisted toilets and baths which are capable of meeting the assessed needs of the residents. 22.4 The Responsible Individual must ensure the registered manager remains supernumerary at all times. 27.7 31/08/06 14. OP19 13 23/07/06 15. OP19 23 30/09/06 16. OP19 23 30/09/06 17. OP22 14 30/09/06 18. OP27 18 31/07/06 19. OP27 18 The Responsible Individual and 31/08/06 the registered manager must ensure staffing numbers, abilities and skill mix of qualified /unqualified staff are appropriate to the assessed needs of the residents at all times. 27.7 Drake Court DS0000020809.V304589.R01.S.doc Version 5.2 Page 30 20. OP27 18 The Responsible Individual and 31/08/06 the registered manager must ensure there are a sufficient number of ancillary staff employed to cover the duties over a seven-day period. Employ another domestic staff. Employ a kitchen assistant. 27.7 The Responsible Individual and the registered manager must ensure that all staff receive a contract with terms and conditions and a job description. The revised documents are to include lifting and handling tasks. A copy of both to be kept on the staff file. 29 The registered manager must ensure all staff receive training in the following topics: Adult Protection, Infection Control, manual handling and Complaints. 30.3 The registered manager must demonstrate competency through providing evidence of making judgements that ensure the health and wellbeing of residents. such as appropriate admissions, instructions to staff and deployment of staff on shift rotas. 31.1 The Responsible Individual must ensure that at least once a month an unannounced visit is made to the home and a comprehensive written report is provided to the registered manager of the home and the Commission for Social Care Inspection. (original date for compliance 30/07/05) DS0000020809.V304589.R01.S.doc 21. OP29 19 31/07/06 22. OP30 12 30/09/06 23. OP31 9 31/07/06 24. OP33 24 31/08/06 Drake Court Version 5.2 Page 31 25. OP33 24 The registered manager must ensure residents are given the opportunity and consulted about services provided through anonymous questionnaires, residents meetings etc 33.1 The Registered Manager must produce an annual Quality Assurance development plan for the home, based on a systematic cycle of planning, action, review, aims and objectives and outcomes for service users. (original date for compliance 30/07/05) The Responsible Individual must ensure that there is a business and financial plan for the home, open to inspection and reviewed annually. (original date for compliance 30/07/05) The Responsible Individual and the registered manager must ensure that action is progressed within agreed timescales to implement requirements identified in the Commission for Social Care inspection reports. 33.10 The Responsible Individual and the registered manager must make suitable arrangements to receive and store resident’s fees and monies in a safe and secure manner (in the safe) providing receipts with copies held in the home. 35.5 The registered manager must ensure all staff receive regular supervision (at least every two months). 36.2 DS0000020809.V304589.R01.S.doc 30/09/06 26. OP33 24 30/09/06 27. OP34 25 30/09/06 28. OP33 24 30/09/06 29. OP35 12 23/07/06 30. OP36 18 31/08/06 Drake Court Version 5.2 Page 32 31. OP32 10,12 The registered manager must ensure that the management approach of the home creates an open, positive and inclusive atmosphere. 32.1 The registered manager must ensure that residents have access to their personal records and are encouraged to help contribute to and maintain them. 37.1 Revise the moving and handling policy, procedures and practice in the home. 30/09/06 32 OP37 17 30/09/06 33 OP38 12,13 31/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Responsible Individual/s to consider carrying out. No. 1 Refer to Standard OP22 Good Practice Recommendations The Responsible Individual and registered manager should obtain advice and assessment of the premises by an occupational therapist in respect of providing aids and adaptations that reflect and meet the needs of the residents. Replace the faulty washing machine. 2 OP26 Drake Court DS0000020809.V304589.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Drake Court DS0000020809.V304589.R01.S.doc Version 5.2 Page 34 - 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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