Inspection on 29/04/08 for Drake Court

This inspection was carried out on 29th April 2008.

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

Drake Court 20/04/09

Drake Court 23/10/08

Drake Court 22/11/07

Drake Court 18/05/07

Drake Court 27/11/06

Drake Court 19/07/06

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 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Drake Court Drake Close Bloxwich Walsall West Midlands WS3 3LW Lead Inspector Mandy Beck Key Unannounced Inspection 09:00 29 and 30th April 2008 th 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.V363417.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.V363417.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 registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Drake Court Health Care Limited Manager post vacant Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29) of places Drake Court DS0000020809.V363417.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd November 2007 Brief Description of the Service: Drake Court is a two-storey, purpose built, home situated close to Bloxwich Town Centre and the local amenities it offers. Accommodation is provided for the 29 Residents in 27 single rooms, and 1 double room, all with en-suite toilet facilities. There is small garden with a patio area to the rear, and car parking to the front and side aspect of the building. The range of fees payable is not available in information for prospective residents. Readers of this report may wish to contact the service directly for this information. Drake Court DS0000020809.V363417.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 visit to the service and took place over two days. We looked at all the information that we have received, or asked for, since the last key inspection. This included: • The annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. • Surveys returned to us by people using the service and from other people with an interest in the service. • Information we have about how the service has managed any complaints. • What the service has told us about things that have happened in the service, these are called ‘notifications’ and are a legal requirement. • The previous key inspection and the results of any other visits that we have made to the service in the last 12 months. • Relevant information from other organisations. • We also spent time talking to the people who use the service and to the staff who support them. • We looked at the care of three people who use this service in depth. This is part of our case tracking process and helps us makes judgements about the home’s abilities to meet people’s needs. The quality rating for this service is 0 star. This means that people who use this service experience poor quality outcomes. What the service does well: We spoke to the people who live here. They told us “this is the best place to be”, “I wouldn’t want to live anywhere else, they really take care of us”. The home does try to support people in leading active lives and maintaining family contacts. People said “they do have a lot of entertainment for us, there’s a man comes in sings to us”. “I like the crafts mornings the best”. People told us that the home makes sure that they have a balanced and varied diet. “The food is very nice and there is always fresh fruit”. Drake Court DS0000020809.V363417.R01.S.doc Version 5.2 Page 6 The staff were given a lot of praise by the people who use this service. “the carers are so nice and patient”, “I don’t think they get enough praise for the very good work they do in helping us”. What has improved since the last inspection? What they could do better: The home must improve it assessment and care planning systems. They need to do this to make sure people’s needs are clearly recorded and planned for. A person centred approach to assessment and care planning would mean a more individual service for each of the people living in the home. care planning has previously been highlighted as a problem at the home’s last key inspection in November 2007. The medication systems within the home must be improved in order to safeguard the people the people who live here. Staff should have an understanding of the Mental Capacity Act 2005 and the code of practice. This will help them to understand their roles and responsibilities in supporting people who may not be able to make choices about their care. Staff must have training in safeguarding/adult protection. This is because staff do not have the knowledge to act appropriately should an allegation of abuse be disclosed to them. This means that people living in this home may not be protected from harm and this should be addressed. There have been some improvements to the environment but more are needed. The home feels drab and is in need of redecoration throughout. Staffing levels in this home are not always sufficient. There are times when there is too few staff on duty to meet the needs of the people living there. The manager must develop better ways of managing the staff to make sure that people who live here are not placed at risk because of poor attendance by staff. This was also raised as an issue at the homes last inspection. Staff told us “things are no better”, “there is a little improvement but not much”. Staff training needs to happen more frequently so that all staff can have required training within a twelve month period. The manager must develop the Quality assurance system within the home. This must include regular audits of care practice; care plans, medication, the Drake Court DS0000020809.V363417.R01.S.doc Version 5.2 Page 7 physical environment and accidents. This will mean that the manager is aware of shortfalls in practice and can plan effectively to improve the service. It is again recommended that the Manager/Responsible Individual review and revise the current arrangement for storage of and access to people’s money. The manager told us that this system has not changed since the last inspection. This means that people can still have difficulty accessing their money when they need it. 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. Drake Court DS0000020809.V363417.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 Drake Court DS0000020809.V363417.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): 1,2,3,6 Quality in this outcome area is adequate. People who may use this service will have some information about it to make a choice about living there. People’s needs will be assessed prior to their admission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home does provide information to prospective service users. The information is generally up to date and since the last inspection the manager has included the range of fees that people are expected to pay for residency. The manager did tell us the fees in the current service user guide are now out of date. It is recommended that readers of this report contact the home directly for up to date information about the fees they will be charged. We looked at the needs assessments for three people who use this service. We saw that the information in the home’s own assessments did not reflect the information in the Care manager’s assessment in all cases. This meant that Drake Court DS0000020809.V363417.R01.S.doc Version 5.2 Page 10 some people’s needs had not been identified by the home and had not been planned for. The information in the homes “activity of daily living assessment” was limited and not person centred in its approach. For example the eating and drinking section of one person’s assessment said “fine, shandy”. This limited information gives no details of the individuals’ likes or dislikes or of their needs in this area. There is no evidence that people have been involved in their assessment of needs this must be improved. We did not find a contract or terms of residency in any of the people’s documents we looked at as part of our case tracking process. The manager told us “they haven’t been sent to us yet”. It is recommended that people have their contracts and terms and conditions of residency when they move into the home. This will help them to understand their rights and responsibilities as service users. It will also give them an understanding of the rights and responsibilities of the home as service providers. This home does not provide intermediate care facilities for people. This standard was not assessed. Drake Court DS0000020809.V363417.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. Quality in this outcome area is poor. People who live in this home cannot be assured that all their needs will be met. Care planning systems are not structured enough to provide guidance for staff in meeting peoples needs. People cannot be sure that all of their needs will be detailed in a care plan. There must be an improvement in medication practices to make sure the people are safeguarded. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each of the people’s care plans we looked at as part of our case tracking process, contained information about some of their needs. We found that improvements could be made to this process that would mean people’s needs are met and planned for. We made requirements about this practice during our key inspection last November. When we visited the home again in March 2008 we felt that improvements had been made to care plans and the requirement was removed. However during this key inspection it is evident that care planning must improve if the home is to be able to satisfy itself it is meeting the needs of the people who live there. Drake Court DS0000020809.V363417.R01.S.doc Version 5.2 Page 12 The home stores the people’s care plans separately from their assessments. This means that important information may not always be transferred to the care plans as a result. For example, one person’s assessment clearly indicated that they had a broken arm but there was no care plan to demonstrate how the home was going to help meet this persons needs in this area. Another person was admitted with a pressure sore, the information was in the social workers assessment but again there was no care plan. The manager did tell us that this pressure had healed and was now only reddened but a care plan should still be in place to show how the home is going to prevent further deterioration or promote healing of this person’s skin condition. It was also concerning that the pressure sore risk assessment had identified that this person was still considered to be at high risk of developing pressure sores. There was no pressure relieving equipment in use. The manager told us that the District Nurses had been out to assess this person and the home was waiting for a pressure-relieving cushion to be delivered. A further assessment showed a person required warfarin therapy but there was no care plan to show how the home was going to manage this need either. In addition to this, records for this person showed that they had missed a hospital appointment to check their warfarin levels. The manager did explain to us that the person was waiting to be registered with the home doctor and his warfarin levels would be checked at this visit. This was due to happen the following day after our visit. The home uses a nutritional screening tool to identify those people considered to be at risk of malnutrition. We found one person was assessed as being at risk, their assessment had showed us that they had experienced recent weight loss, although it was now stable. The home had failed to record and monitor this person’s weight since their admission. The nutritional screening tool scores 8 which means “take appropriate action such as supplements, high calorie drinks, full fat milky drinks, increase choice of favourite food”. There was no evidence to show that any of these things had been done. There was evidence to show us that people are in contact with other health professionals as and when they need them. The doctor visits the home on a regular basis and people told us that they are supported to attend out patients appointments at the local hospital. Chiropodists, dentist and optical services all visit the home to make sure people’s needs are addressed. However two of the people’s care plans we looked at showed that they were still waiting for Chiropodist visits following their admission. There are generally safe systems in place for administration of medicines in this home but improvements could be made. Only the Manager and senior staff administer medicines and all have received training. At the last inspection it was recommended that the Manager should undertake a periodic assessment of the staff to ensure their continuing competency in administering Drake Court DS0000020809.V363417.R01.S.doc Version 5.2 Page 13 medication correctly. The manager told us that she does this but does not record this competency assessment anywhere, such as the workers personnel file. It is recommended that this happen so that she can clearly show how she has determined that a member of staff is competent to administer medication. We also found that there were some discrepancies with the administration and recording of administration on the Medication Administration Record (MAR). We saw that staff do not always record the amount of medication that is received from the pharmacy onto the MAR sheet. This lack of recording makes auditing medication very difficult. We also found that some people’s medication did not balance, as it should of. For example when we checked one persons medication we found that there was more of it than there should be. This means that the person has not been receiving their medication as it has been prescribed. This was an area for improvement from the last inspection that has not been addressed in sufficient detail and must be improved. There are at present no staff who are trained to administer medication on a night shift. This means that if people needed medication during the night the staff have to contact the “on call” manager who will visit the home and dispense medication. This situation is not ideal and consideration must be given to appropriate training for night staff to avoid any unnecessary delays in treatment for the people who live there. The storage of medication is satisfactory but the ongoing issue of temperature recording has yet to be resolved. The manager said the home has been unable to purchase a suitable thermometer. It was strongly recommended that she contact the supplying pharmacist who may be able to assist. Throughout this inspection staff were observed being polite and generally getting on very well with the people who live there. People we spoke to said, “they (staff) are wonderful, they never rush me”, “I am always clean and tidy you can’t ask for more than that can you”. “I don’t think the staff get enough praise for the very hard work they do for us”. We asked people if they felt that they were treated with respect and dignity they said “most definitely couldn’t be any better”. “I never have a problem”. We also spoke to staff and asked them how they knew what care to give people here. They told us “the seniors tell us”. We asked them if they had opportunities to read care plans and assessments for people. They told us “no”, “sometimes we can use them for reference they are good for training”. This was bought to the managers attention, she must develop systems for the home that allow staff to read care plans so that they are sure they are providing the care that people want. Drake Court DS0000020809.V363417.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is adequate. The home does offer activites for people to take part in to keep them active. Meals in the home are well planned around people’s tastes. The staff need more of an understanding in their role of supporting people who may not be able to make decisions for themselves. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home continues to provide activities for people to take part in. They told us “I like the crafts best of all but there is lots more to do”. “we have a nice man that comes in and sings to us, he’s very good”. “I think there is someone here who does the organising but I’m not too sure”. The manager recently published a report on the quality of the service the home provides. The outcomes were good for most of the report. However, for the second time activities were the area that people wanted to see improvements in. “We are planning to go out when the warmer weather comes on day trips” one member of staff told us. They also said “it would be nice to be able to take them out more, we have a minibus now so it’s a shame not to use it”. Drake Court DS0000020809.V363417.R01.S.doc Version 5.2 Page 15 There was a steady flow of visitors throughout both days of this inspection. One person said “my son always comes to see me rain or shine, its nice because I know I couldn’t cope at home and he knows I’m safe here”. Relatives have expressed their concern to the Commission recently about the poor staffing levels. They told us they felt that people were not always able to have the care they needed because there were only two members of staff on duty sometimes. This was discussed with the manager at the time of the inspection. Our recommendations are discussed in the staffing section of this report. The home must also consider training for staff around the Mental Capacity Act 2005. This should be done so that staff will be aware of their roles and responsibilities in supporting those people who do not have the capacity to make decisions about their own care. We asked staff if they had any knowledge of the Mental Capacity Act 2005 they told us “no, never heard of it”. We also asked the manager is she was aware of her role and responsibility to the people who use the service. She said “no”. it was recommended that the home obtain a code of practice and guidance about the Mental Capacity Act 2005. Meal times and meals are a relaxed occasion. We saw breakfast and lunch on both days. People told us “the food is very good, there is always a choice”, “if you don’t like something they make something else for you”. We asked if they were consulted about menus and planning. “Oh yes, they put what you like on”. The home works on a four-week pre planned menu that is displayed in the dining room and also on a notice board next to it. Tables are set and people appeared to enjoy their meals. Fresh fruit and snacks are on offer throughout the day for people to enjoy. The home could further improve on menu planning by keeping up to date records of individual’s likes and dislikes in their files. This was seen in one person’s care plan, it stated “give him meals he likes and record this”. There was no record in the care plan or the assessment that this had been done. Drake Court DS0000020809.V363417.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is adequate. The interests of the people using the service are protected through ready access to information relating to advocacy services and the Home’s Complaints Procedure, although not all staff are adequately trained to carry out their role in safe guarding them from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People using the service told us that they had nothing to complain about, but if they did were confident the Manager and staff would take the necessary action to resolve any issues raised. “I would never have any to moan about here its lovely”. We asked staff how they would deal with a complaint should one be made to them. One person said “take it to the office we are not allowed to discuss things like that on the floor”. Whilst no complaints had been logged in the Home’s Complaints Record since the previous inspection we, the commission have received anonymous concerns about staffing levels and the home not meeting people’s needs. We found that on occasions this has been the case and have made recommendations and requirements to address this. We were also concerned that none of the staff have had any training in Safeguarding/adult protection. When we spoke to staff we asked them about any adult protection training they may have had. They told us “none”, we Drake Court DS0000020809.V363417.R01.S.doc Version 5.2 Page 17 asked if they were aware of different types of abuse, they said “not really but we have to keep people safe”. What this means for the people who live here is that staff are not trained to recognise and deal with any allegations of abuse or misconduct. The manager told us that she was not aware of the Protection of Vulnerable Adults (PoVA) list and its function. It was recommended that she obtain a copy of this guidance and familiarise herself with it in order to protect people. It is also recommended that staff familiarise themselves with the homes policies and procedures so that people will be safeguarded. The home does not have an up to date copy of the local authority guidance and one must be obtained to make sure that should the need arise the manager will be acting in accordance with it. Drake Court DS0000020809.V363417.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,25,26 Quality in this outcome area is adequate. The home needs to be redecorated and refurbished in order to give people comfort and pleasant surroundings. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been little changes in the home since the last inspection. Some of the bedrooms have been decorated but the home is in need of money being spent on it to replenish the furniture that is worn, dirty and looks unsightly. Carpets are soiled and stained in places. The home feels drab and gloomy and needs to be updated. We also noticed that some of the people living here did not have a sufficient hot water supply to their rooms. It was also evident in the bathroom on the ground floor. The hand basin had hot water but the bath failed to reach a Drake Court DS0000020809.V363417.R01.S.doc Version 5.2 Page 19 satisfactory temperature. This was bought to the manager’s attention for her prompt action. The home is taking some steps to reduce the risk of cross infection to the people who live there. There is anti bacterial hand scrub in the reception area for visitors to use. Each toilet and bathroom has its own supply of liquid soap and paper towels. Gloves and aprons are also available for staff use to prevent the spread on infection. Staff do need training in current infection control practices, the manager told us that this has been arranged for some staff over the next year. Drake Court DS0000020809.V363417.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. At times there are insufficient staff on duty to meet the needs of the people who live here. The staff group is stable and people said that they felt comfortable and cared for by them. More training would ensure that staff have the knowledge and skills to meet peoples needs more effectively. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We, the commission have received anonymous concerns about the staffing levels in this home. We have looked at the staffing rotas for the last four weeks and found that on occasions staffing levels are not enough to meet the needs of the people who live here. Staff are expected to do other duties alongside their caring role. For instance, we noted that during an afternoon shift there were only two staff on duty to meet the needs of twenty nine service users, in addition to this one of the members of staff was expected to prepare and cook the tea for service users. This is unacceptable and was discussed with the manager. She told us that “things are getting a bit better now but staff do let us down at the last minute when they ring in sick and then we can’t get agency cover”. Additionally during the inspection we noted that staff had telephoned in sick, the rota appeared to show that only one member of staff had been on duty during the night shift. The manager said that agency cover had been obtained Drake Court DS0000020809.V363417.R01.S.doc Version 5.2 Page 21 but she could not provide the timesheet for the agency worker as proof this had happened. It was recommended that an immediate review of staffing levels and staff roles be undertaken. It was also recommended that the staff rota be kept up to date to reflect all changes in workers. At the last inspection it was noted that there is a lot of staff unrest and this was having a detrimental effect on the people who live at the home. We asked both staff and the manager what had been done to address this. The manager told us “we have had a meeting with the staff and told them to ring in at decent time if they are going to be off work, it is not acceptable”. Staff told us “I suppose some things are better but nothing much has changed”. “It depends who is on duty as to what gets done”. Clearly there are still issues here that the manager must take action on in the service users best interests. The manager told us that there have been no new workers employed at the home since the last inspection. We were unable to check recruitment for new workers as a result. This also meant that we were unable to assess how the home supports new workers through their induction. There were no current members of staff currently doing this. Staff training has been arranged; this means that the outstanding requirement from the last inspection should be addressed. We did however notice that the amount of training arranged would not cover all of the staff that work at the home. This was bought to the manager’s attention for her action. Drake Court DS0000020809.V363417.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is poor. The management systems do not fully protect the people using the service, although appropriate priority is given to Health and Safety. Improvements need to be made before the home can confidently say it is run in the best interests of the people who live there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is currently no registered manager for this service. The manager in place was working at another of the company’s homes prior to moving to Drake Court. There are a number of issues raised throughout this report that the manager must take action on if the service is to improve. This is the third time this Drake Court DS0000020809.V363417.R01.S.doc Version 5.2 Page 23 service has been judged as being a poor service with poor outcomes for the people who live here. This is not acceptable and improvements must be made. The home did provide us with an Annual Quality Assurance Assessment (AQAA) but the information in it was basic and did not give us a reliable picture of the service. The home’s own quality assurance systems need to be improved upon. At present the manager does not completed regular audits for any aspect of service delivery. She has produced a report based upon her findings from the service users surveys. This small report has been published and is on display on the notice board in the lounge for people to read. The manager should be completing regular audits of for example; medication systems and care planning documentation. If effective audits were being done the shortfalls identified in this report would have been identified and the manager would be taking action to address them. It is also concerning that the manager and staff did not show a sufficient understanding and knowledge of the safeguarding systems that should be in place within the home to protect the people who live there. There is limited staff training in this area that the manager should have addressed to make sure that people are protected. There has been some improvement from the responsible individual for the company. It was noted that the required Regulation 26 visits are now being conducted on a monthly basis. Records of this visit are kept in the home for inspection. Staff are not aware of the homes policies and procedures or the Statement of Purpose for the home. We asked staff if they knew what was in the Statement of Purpose they said, “never heard of it” “hasn’t got a clue”. We also asked staff about specific policies that safeguard the people who live there. They said “not sure, I think I have heard of it but not what it is”. The arrangements for safe storage and handling of people’s money have not been changed since the last inspection. There fore the recommendation that the system be reviewed will remain. The manager must take action to address this in order to give people confidence there money will be held safely at all times and that they can have access to their money at all times. There has been an outstanding requirement for mandatory staff training to be arranged for all staff. The manager has arranged this with a local training company. However as mentioned previously there are not enough dates and places for all staff to attend this year. The manager will need to take action to make sure that this happens for staff. This will ensure that they have up to date knowledge of current best practice and people who use this service will benefit from this. Drake Court DS0000020809.V363417.R01.S.doc Version 5.2 Page 24 We spot checked safety certificates for gas and electricity they were found to be in order. Fire safety records were up to date, although there were gaps in the fire safety training and drills for some of the staff which the manager will have to deal with. Drake Court DS0000020809.V363417.R01.S.doc Version 5.2 Page 25 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 3 2 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 1 X X X X X 2 2 STAFFING Standard No Score 27 2 28 2 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 2 X X 2 Drake Court DS0000020809.V363417.R01.S.doc Version 5.2 Page 26 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 OP3 Regulation 14 Requirement The manager must make sure that people’s needs are identified and recorded during their assessment. Peoples assessed needs must be reflected in their plan of care. When people are identified as being at risk of developing pressure sores they must have the pressure relieving equipment they need promptly. The manager must make sure that people’s weight’s are recorded and monitored, appropriate action must be taken to address any issues arising. There must be a clear audit trail of medication brought into, administered, and leaving the Home. This will ensure that all times staff know exactly what medication the people using the service are supposed to receive and how much is held on their behalf. (previous timescale of 10/01/08 and 30/04/08 not met) Timescale for action 30/06/08 2 3 OP7 OP8 15 (1) 13 (4) (c) 30/06/08 30/06/08 4 OP8 13 (4) (c) 10/05/08 5 OP9 13. (2) 30/04/08 Drake Court DS0000020809.V363417.R01.S.doc Version 5.2 Page 27 6 OP9 13. (2) 7 OP9 13. (2) 8 OP18 13 (6) 9 OP27 18 (1) (a) 10 OP30 18. (1)(c)(i)(ii ) 11 OP33 24. - Clear instruction must be obtained as to the exact circumstances for the administration of ‘As Required’ medication. This will ensure that the people using the service always get this medication in the correct circumstances. (previous timescale of 31/01/08 and 30/04/08 not met) Methods of medicines administration must match the prescribing clinician’s instructions and be recorded in detail, so that the staff can ensure a consistent approach for the people using the service. (previous timescale of 31/01/08 and 30/04/08 not met) The manager must arrange training for all staff in safeguarding/adult protection in order to protect the people living in the home. The number of staff on duty must be sufficient to meet the needs of the people who live there. This must be kept under regular review. Staff must receive mandatory training at the required frequencies to ensure that the people using the service are supported at all times by a trained workforce. (previous timescale of 31/01/08 not met) A system for evaluating the quality of services provided at the care home must be established and maintained, based on a systematic cycle of planning, action and review, to enhance the outcomes for the people using the service. (previous timescale of DS0000020809.V363417.R01.S.doc 30/04/08 30/04/08 30/06/08 30/04/08 31/05/08 31/05/08 Drake Court Version 5.2 Page 28 31/01/08 not met) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations It is recommended that the Statement of Purpose document be dated as evidence of its currency so that the people using the service can be confident that they have up to date information. It is recommended that the manager consider developing the Home’s documentation in alternative formats, for example bold print or pictorial, to enable more people access to vital information about the service promised. It is recommended that each person is given a contract and terms and conditions of residency at the point of admission to the home. It is recommended that staff and the manager have training in person centred care and this knowledge be put into practice for people’s benefit. It is recommended that people’s dietary likes and dislikes are recorded in their care plans, to reflect the actions detailed in the home’s nutritional screening tool. It is recommended that internal temperatures for the medicines fridge are monitored/recorded daily and that all staff involved in this activity are competent in undertaking the task, so that the people using the service can receive this medication safely. It is recommended the competency of staff to administer medication should be assessed on a regular basis to ensure they continue to do so in a manner which safe guards the people using the service. It is recommended that following compliance with the medication issues identified during this inspection, the Home’s medication policy and procedures should be reviewed to ensure that they follow legislation and good practice. It is recommended that all staff receive training in Mental Capacity Act 2005 and that the home obtains a copy of the Code of Practice for this Act. It is strongly recommended that the manager obtain DS0000020809.V363417.R01.S.doc Version 5.2 Page 29 2 OP1 3 4 5 6 OP2 OP7 OP8 OP9 7 OP9 8 OP9 9 10 OP14 OP18 Drake Court 11 12 OP18 OP19 13 OP33 14 OP35 15 OP37 guidance from the local authority in Safeguarding/adult protection It is recommended that all staff read the home safeguarding policies and familiarise themselves with them It is recommended that carpet replacement in some areas (e.g. entrance hall and main lounge where the carpets are particularly worn and grimy) should receive priority to ensure that the people using the service live in a pleasant environment. It is recommended that relatives, visiting clinical and social care professionals and staff are given the opportunity to complete satisfaction questionnaires - anonymously if preferred. It is again recommended that the arrangements for the overnight storage of the personal monies belonging to the people using the service (e.g. received from relatives), be reviewed, to allow them access to their money at all times. Records should be individualised. This includes storage, which should comply with the Data Protection Act 1998. This will ensure confidentiality for the people using the service. Drake Court DS0000020809.V363417.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection West Midlands Office West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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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