Inspection on 20/07/06 for Elders (The)

This inspection was carried out on 20th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Elders (The) 25/09/08

Elders (The) 26/07/07

Elders (The) 21/11/06

Elders (The) 15/12/05

Elders (The) 18/08/05

Elders (The) 31/08/04

Elders (The) 29/04/04

Similar services:

Springfield House

The Shelley

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Elders (The) The Elders Epsom Road Ewell Surrey KT17 1JT Lead Inspector Sandra Holland Unannounced Inspection 20th July 2006 10:30 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 Elders (The) DS0000013633.V302214.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. Elders (The) DS0000013633.V302214.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elders (The) Address The Elders Epsom Road Ewell Surrey KT17 1JT 020 8393 9757 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) Golden Hours Fellowship Limited Mr R Taylor Care Home 21 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (21) of places Elders (The) DS0000013633.V302214.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Of the 21 residents accommodated up to 3 service users may be within the category DE(E), Older People with Dementia The age/age range of the persons to be accommodated will be: OVER 65 YEARS OF AGE 15th December 2005 Date of last inspection Brief Description of the Service: The Elders is a care home providing personal care and accommodation for up to 21 older people, of whom a maximum of 3 may suffer from dementia. The home is a large detached and extended property, close to the village of Ewell and Epsom town centre. Good transport links are nearby. The home is operated by a charity, the Golden Hours Fellowship and benefits from a well-established management structure. The registered manager has worked at the home for many years and lives very close by. He is actively involved in the day-to-day running of the home. There has been considerable improvement to the premises in recent years, in order to comply with the National Minimum Standards for Older People. Bedroom accommodation is currently provided at ground and first floor level, with some rooms having en suite facilities. All rooms are single. The home has a lift and a stair lift for use by service users. The fees at this service range from£400.00 to £500.00 Elders (The) DS0000013633.V302214.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced “key” inspection was the first to be carried out in the Commission for Social Care Inspection year, April 2006 to June 2007, and was carried out under the CSCI’s Inspecting for Better Lives programme. Mrs Sandra Holland, Lead Inspector carried out the inspection over nine hours. Mr Ron Taylor, Registered Manager was present representing the service. Mrs Elizabeth Smith, Support Manager was present for the first half of the inspection. An Inspecting for Better Lives presentation was given to Mr Taylor and Mrs Smith before the inspection was carried out. A full tour of the premises was carried out and a number of records and documents were examined. These included care plans, medication administration record (MAR) charts, staff files and some, but not all, of the records relating to health and safety in the home. Five residents, one visitor and four members of staff were spoken with. A pre-inspection questionnaire was supplied to the home and this was completed and returned to CSCI within the requested timescale. Some of the information provided in the questionnaire will be referred to in this report. The people living at the home prefer to be known as residents and that is the term that will be used throughout the report. The inspector wishes to thank the residents, management and staff for their hospitality, time and assistance. What the service does well: A range of appetising and well-balanced meals are served and enjoyed by the residents. The home is well-maintained and is clean and freshly-aired. A new conservatory has been added and is nearing completion. Staff are sensitive and observant and provide prompt assistance to residents. The home has a very stable staff team, most of whom have worked at the home for many years. The preferences and choices of residents are catered and provided for. Elders (The) DS0000013633.V302214.R01.S.doc Version 5.2 Page 6 The management team have successfully overseen the running of the home during a difficult period of instability and change, minimising the impact on the daily lives of residents. What has improved since the last inspection? What they could do better: Assessments of the needs of prospective residents must be carried out before they are admitted to the home, and a written record of this must be kept. All medication received into the home must be recorded, to enable staff to check that the correct quantities are present and to enable an audit trail to be followed. Staff must ensure that the administration of medication is supervised to ensure that residents have received the medication and that an accurate record is maintained. The complaints procedure must include the timescales in which a response or action will be taken and must be made available to all who may wish to use it. An updated copy of the Surrey Multi-Agency Procedure for the Protection of Vulnerable Adults should be obtained and kept in the home. Liquid soap must be provided to prevent the spread of infection. People must not be employed to work in the care home unless all the required recruitment records and documents have been obtained. Staff must receive training to enable them to carry out their role. Specifically, training in safeguarding adults must be updated. Residents’ monies held for safekeeping, must not be held in the home’s bank account. Elders (The) DS0000013633.V302214.R01.S.doc Version 5.2 Page 7 Records of transactions of residents’ monies should be signed and dated by both parties involved in the transaction. Products hazardous to health must be stored in a locked provision. Windows must be fitted with restrictors to prevent them opening fully to safeguard anyone from falling out of them. 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. Elders (The) DS0000013633.V302214.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 Elders (The) DS0000013633.V302214.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Records of the pre-admission assessments of the needs of prospective residents are not maintained in the home. EVIDENCE: The home’s statement of purpose and service user guides which are held on file by CSCI were seen to date from 2004. Updated copies of these were requested during the inspection and the manager advised that these will be sent. The manager advised that currently he and the support manager carry out pre-admission assessments of the needs of prospective residents and that this is done verbally. The required information is obtained from a resident or their representatives but a written record of the assessment is not made. The manager stated that he makes entries into a draft care plan, which is later completed fully to be used as the working plan of care. Of the care plans seen, none had been signed or dated by the person carrying out the Elders (The) DS0000013633.V302214.R01.S.doc Version 5.2 Page 10 assessment, to indicate which area was the pre-admission assessment, when the assessment was carried out or by whom. The manager stated that the person carrying out the assessment would visit the prospective resident, either at their home or in hospital if that was the case, but this was not recorded. The manager stated that intermediate care is not provided at the home. An immediate requirement has been made regarding Standard 3. Elders (The) DS0000013633.V302214.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A care plan is maintained for residents to guide staff to the care and support each resident needs and these include an assessment of risks to residents. Residents’ healthcare needs are well met, but the standard of medication administration must be improved to safeguard residents. Residents are treated with dignity and their privacy is respected. EVIDENCE: Staff advised that a detailed care plan is drawn up for each resident to provide guidance to the care and support needs of the residents. These were seen to include residents’ needs with regard to personal care, mobility, diet, communication, sleep, social interaction, emotional well-being and memory and religion and culture. The review of the care plans had been carried out on a monthly basis and this was recorded, along with any changes in needs. It was pleasing to see that where they were able, residents have signed their care plans to show their involvement. Elders (The) DS0000013633.V302214.R01.S.doc Version 5.2 Page 12 Assessments of risks to resident have been carried out, including the risks associated with falls and mobility, burns and scalds, access to poisons, going out alone, choking and self-medicating. From the records seen and speaking to residents, it is clear that residents’ healthcare needs are well met. A new patient assessment form is completed and supplied to the resident’s general practitioner (GP), when a resident moves into the home, if they are not retaining their existing GP. This provides the GP with a background history and basic information regarding the resident. Any referrals that need to be made to specialists such as a dietician, are made through the GP, the manager advised. A chiropodist and a domiciliary optician service visit the home on a regular basis or on request. The deputy manager stated that medication is supplied by a local pharmacy in filled “dossett” boxes, which are divided boxes with sections for differing times of day in which the pharmacist places the appropriate medications. These are supplied to the home on a weekly basis. The home uses a medication administration record (MAR) sheet, which has been designed by staff at the home and this records one month’s administration. The MAR chart was originally handwritten and has been photocopied for repeated use. Any additional medications that are prescribed have been handwritten onto the MAR chart. It was noted that for one resident, a medication appeared to be missing from the dossett box, although staff had signed the MAR chart that morning to indicate that the medication had been administered. The medication was checked and for one resident, three boxes and a bottle all containing the same medication in varying quantities, were held. As the receipt of medication into the home is not currently recorded, it is not possible to know how much medication should be present or to follow an audit trail. Medication which is managed as a controlled drug (CD), to be administered and recorded by two staff was also held in stock for another resident, but this was no longer being administered. A number of other medications were stored in the CD cupboard and the deputy manager stated that these were no longer in use and would be returned to the pharmacy. A record book of medication returned to the pharmacy is maintained and the receipt of the returned items is signed by the pharmacist. Whilst the inspector was talking to a resident in her bedroom, a member of staff was observed to deliver a meal tray to the resident, which also contained a pot with medication. The staff member spoke to the resident, left the tray and medication and then left the room. The staff member did not supervise the administration of the medication and would not have known if the resident had taken it or not. The manager also observed this and immediately spoke to the staff member concerned to advise against this poor practice. Elders (The) DS0000013633.V302214.R01.S.doc Version 5.2 Page 13 The deputy manager stated that she had become aware of weaknesses in the system of medication in use in the home, and that the home was looking into other, improved systems of medication administration, in order to more effectively safeguard residents. Staff were observed to interact with residents in an informal, but appropriate way, which respected their dignity. Support with personal care was provided discreetly and promoted the privacy of residents. Staff were very observant and responded promptly to any resident requiring assistance. One resident speaks Italian and enjoys conversation with a member of staff who can also speak this language. There is cultural and racial diversity amongst the staff group, but this is not reflected within the resident group. An immediate requirement has been made regarding Standard 9. Elders (The) DS0000013633.V302214.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, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A range of social and recreational activities are available and a varied and well balanced menu is offered. Residents are encouraged and supported to make their own choices and to maintain contact with their families and friends. EVIDENCE: Staff advised that they are allocated to carry out activities on a daily basis and the activity carried out is recorded, to include the names of residents who took part. The record showed that a puppet show, indoor bowls, dancing and manicures had been carried out recently and that a number of residents had been involved. On three days each week, an activities organiser visits the home for a short and varied activity session, the manager stated. This person visited on the day of inspection and was seen to engage residents in a music quiz and gentle exercises. It was good to see that the quiz was tailored to the needs and age group of the residents, with popular music from their younger days being played. Elders (The) DS0000013633.V302214.R01.S.doc Version 5.2 Page 15 The manager advised that the public library visits the home and leaves a supply of books and that a Pentecostal church service is held each Sunday. A holy communion service is also held each month and is carried out by the vicar from the local parish church. Some residents said that they prefer to spend their time in their rooms, and their choice is accommodated. A number of residents were spoken with in their rooms, and meals were seen being delivered to them. It was pleasing that residents had brought items from their previous home, to personalise their rooms, including smaller items of furniture, pictures, photos and ornaments. Residents stated that their visitors were made welcome in the home and were offered refreshments. Staff advised that visitors were able to visit at any time, but that many came to the home at weekends. Details of a local advocacy service were made available in the entrance hall, to support residents who made need it. A two week menu was supplied with the pre-inspection questionnaire and this was seen to include well-balanced and wholesome meals. Staff advised that the main meal of the day is served at lunchtime, with a lighter high tea served in the early evening. Residents spoken to said they enjoyed their meals and the tea being served was attractively presented and looked appetising. The staff member preparing the tea said the menu had been changed to salad because of the hot weather. The dining room is a large, spacious room, with a number of tables accommodating different numbers of residents. The tables were well laid with white table cloths, placemats and silk flowers. Elders (The) DS0000013633.V302214.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 and 18. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. A complaints procedure is available, but needs to be more detailed and the complaints record book needs to be made available to all who may wish to use it. Staff are aware of their responsibilities in the protection of residents. EVIDENCE: The home’s complaints procedure and record book are currently stored in a file in the office and anyone wishing to make a complaint would have to ask staff for access to these. This prevents anyone making an anonymous complaint, should they wish to do so. It is recommended that these are made openly available in the home, so that they are accessible to residents, visitors or staff. It was pleasing that few complaints had been recorded, the last one being three months ago. This had been signed by the support manager and recorded the action taken in response to the complaint. It was noted that the complaints procedure was very brief and did not provide any timescales for a response to be made or actions to be taken. It is required that any complainant must be informed within 28 days (or a shorter period if that is reasonable in the circumstances of the complaint), of the action to be taken. The procedure must also advise any complainant of the name and address of CSCI. This needs to be amended on the home’s complaints procedure as it refers to NCSC, which is no longer applicable. Elders (The) DS0000013633.V302214.R01.S.doc Version 5.2 Page 17 Residents stated that although they were not aware of the home’s complaint procedure, they would inform the manager or deputy manager if they were unhappy in any way. From the records seen, the majority of the staff and the manager have received training in the Protection of Vulnerable Adults (now known as Safeguarding Adults). It was noted that the most recent of these training courses, was attended in 2004 and it is required that this training is updated. Staff spoken to stated that they would inform the manager or person in charge, if they had any concerns about the abuse or possible abuse of residents. A “Whistle-Blowing” leaflet is provided on the staff notice board and staff were aware that they could contact CSCI, in the event of concerns that they felt were not being addressed. The manager stated that in the event of abuse or suspected abuse, the home follows the Surrey Multi-Agency Procedure for the protection of vulnerable adults. A copy of the procedure is held in the home and this was seen to be the outdated version. It is recommended that the new version dating from February 2005 is obtained, to ensure the correct procedure is followed if required. The manager advised that monies are held for safekeeping for a small number of residents. It is of concern that the management of these do not fully safeguard residents. Please see Standard 35 for full details. Requirements and recommendations have been made regarding Standards 16 and 18. Elders (The) DS0000013633.V302214.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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home presents as a comfortable place in which to live and was clean, tidy and fresh. EVIDENCE: A tour of the premises was carried out and it was seen to be clean, spacious, airy and well maintained. A new conservatory that links with the lounge, has recently been built and is nearing completion. Staff advised that this will enable residents to spend time away from each other and will create an additional sitting room which overlooks the garden. The manager stated that the number of registered bedrooms has been reduced and the rooms have been used to create en-suite bathroom or toilet facilities for next door bedrooms. A further bedroom has been converted into a large shower room, to enable residents to have the choice of a bath or shower. Elders (The) DS0000013633.V302214.R01.S.doc Version 5.2 Page 19 Residents were spoken with in their bedrooms and all stated how happy they were with the care and facilities provided. Two residents told of bringing their own furniture and belongings into the home to personalise their rooms. The manager stated that although he does not maintain a written record, he maintains a mental record of when rooms have been decorated or improvements have been made to the home. It is recommended that a written programme of routine maintenance and decoration of the premises is produced and records kept, and to ensure that appropriate staff in the home are aware of these, in the event of the absence of the manager. All areas of the home were freshly aired and odour control in the home was good, except in one bedroom. The manager advised that the carpet in this bedroom is regularly cleaned. It would be good practice to record this in the maintenance programme to ensure that it is carried out to the required frequency. Staff were seen to use gloves and aprons appropriately to prevent the spread of infection and a number have undertaken training in the control of infection. Hand-washing facilities were provided in all appropriate places and in most bathrooms and toilets, paper towels and fabric towels were available. It was noted that bars of soap were in use, which are not hygienic. It is required that liquid, anti-bacterial soap is provided to prevent the spread of infection. The manager stated that the home does not have a contract for the collection of clinical waste, as this is currently disposed of in the general, household waste. This is poor practice and the home must make arrangements for the appropriate disposal of clinical waste. Two shortfalls that present a hazard to residents’ health and safety were noted during the tour of the premises and these are referred to at Standard 38. Requirements and a recommendation have been made regarding Standards 19 and 26. Elders (The) DS0000013633.V302214.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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A stable and effective team of staff are employed to meet the needs of residents. The recruitment practices need to be more robust to fully protect residents. EVIDENCE: From the information provided in the pre-inspection questionnaire, it was clear that a very stable and long-standing team of staff are employed to meet the needs of the residents. Most of the staff have been employed at the home for at least two years and some for very much longer. Staff advised that the team is made up of care staff in the main and they carry out housekeeping and laundry tasks, as well as providing personal care. A cook is employed to provide meals on five days each week and another member of staff who is employed as a weekend cook also works as a carer on other days. The management team carry out administrative tasks. A number of staff have achieved or are currently undertaking National Vocational Qualifications (NVQ’s) at Level 2 or 3 in Care. The support manager advised that she is an NVQ assessor and has overseen this and other training at the home. Staff files were seen and it was clear that the standard of recruitment practices in the home needs to be more robust to fully safeguard residents. Although Elders (The) DS0000013633.V302214.R01.S.doc Version 5.2 Page 21 staff are required to complete an application form, two of these were very basic and a full employment history had not been obtained for either of these staff. For one member of staff only one reference had been obtained and for another, no references had been obtained. The home does not currently require prospective staff to complete a health questionnaire, so it has no way of assessing whether the applicant is physically or mentally fit to work in the home. The home’s application form does ask if applicants are in good health and provides a choice of a yes or no answer, but no specific details regarding health conditions are obtained. A training record is maintained and indicates that staff have undertaken training required by law, such as fire safety, first aid and food hygiene and other training to develop their knowledge and skills, such as infection control and continence care. It was noted (and referred to at Standard 18) that although staff have undertaken training in the past for the protection of vulnerable adults, this needs to be updated. An immediate requirement has been made regarding Standard 29. Elders (The) DS0000013633.V302214.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, 35 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has been effectively managed during a period of instability and change and a survey has been carried out to assess residents’ views. The management of residents’ monies held for safekeeping and of health and safety matters must be more robust to fully protect residents. EVIDENCE: At the time of the last inspection, the manager had just been taken seriously ill and was subsequently away from the home for nearly four months. As the manager was the treasurer for the Golden Hours Fellowship, the charitable organisation that runs The Elders, and had been the key person in many areas of the homes’ operation, this created a number of difficulties in the day-to-day management of the home. Elders (The) DS0000013633.V302214.R01.S.doc Version 5.2 Page 23 It is to the credit of the management support team who stepped in to oversee the home, that the home has been able to continue to operate successfully, with minimal disruption to the daily lives of the residents. The manager has now returned to work full-time, following a period of gradually increasing hours. A team leader has been promoted to deputy manager to provide support to the manager and the support manager has retained the task of preparing invoices for the payment of residents’ fees. As mentioned at Standard 30, the support manager is also an NVQ assessor and is involved in the support of staff undertaking NVQ’s and carries out or arranges other training courses for staff. The manager stated that the low level of funding received from social services for some of the residents living at the home, has a significant impact on the home’s finances. The support manager advised that a residents’ questionnaire was supplied to residents in April this year to ask their views on the quality of the service provided. Of eighteen questionnaires supplied, eleven responses were received and a summary of these was provided at the inspection. All respondents said that the food was well cooked and was hot when served, that staff were polite and that the bathrooms were warm enough when having a bath. A more mixed response was given to questions about the activities on offer, staff knocking on residents bedroom doors, privacy at bath-times and being involved in care planning. The support manager stated that the last few questionnaires were awaited and the outcomes of the survey had still to be collated. The manager advised that monies are held for safekeeping for a small number of residents. It is of concern that the monies held for two residents were not present in the home, but are held in the home’s bank account, the manager stated. This is not good practice, as the residents do not have access to their money, residents are not safeguarded from financial abuse and pooling of residents’ monies must not occur. For another resident, monies held were present, the amount held matched the record held, and receipts were retained for any expenditure. It was noted that the records regarding residents monies held for safe keeping, were very informal. Transactions such as deposits were listed but were not signed or dated. It is strongly recommended that for each transaction, the signature of the person depositing or withdrawing money and the signature of the person handling the transaction, are both recorded. This will ensure that residents and staff are safeguarded. A safe is available for the short-term storage of monies or valuables. During the tour of the premises, two hazards to the health and safety of residents were noted. In one resident’s bedroom there were two sash Elders (The) DS0000013633.V302214.R01.S.doc Version 5.2 Page 24 windows. One of these had not been fitted with a restricting device and could be opened fully with no safeguards to prevent a person falling out. The other window had a handwritten note attached to it saying “do not open”, so this was not tested. The manager stated that he was not aware who had placed the note on the window or why. A bucket containing products hazardous to health was stored in an unlocked cupboard on the main landing leading to resident’s bedrooms. The manager stated that staff removed the hazardous products to a locked provision immediately. An immediate requirement has been made regarding Standard 38 and another requirement has been made regarding Standard 35. Elders (The) DS0000013633.V302214.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 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X 3 X 2 STAFFING Standard No Score 27 3 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 1 Elders (The) DS0000013633.V302214.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO 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 Residents must not be admitted to the home unless an assessment of their needs has been carried out by a suitably trained or suitably qualified person, and a copy of the assessment has been obtained and retained in the home. Arrangements must be made for the recording, handling, safekeeping, safe administration and disposal of medications received into the care home. Where staff administer medication to a resident, this must be fully supervised to enable an accurate record of the administration to be maintained. A record must be maintained of all medication received into the home, to enable an audit trail to be followed. The home’s complaints policy and procedure must specify the timescales in which a response or action will be taken. The complaints procedure and record must be made available to all who may wish to use it. DS0000013633.V302214.R01.S.doc Timescale for action 20/07/06 2 OP9 13 (2) 20/07/06 3 OP16 22 25/08/06 Elders (The) Version 5.2 Page 27 4 OP26 13 (3) 5 OP29 19 & Sch. 2 6 OP30 18 (1)(c)(i) 7 OP35 20 8 OP38 13 (4) (a) Arrangements must be made to prevent infection and the spread of infection at the care home. Liquid soap must be made available and used in the care home. Persons must not be employed to work at the care home unless the person is fit to work at the care home, and the information and documents specified in Schedule 2 have been obtained in respect of that person. Staff must receive training appropriate to the work they are to perform. Staff must receive updated training in the safeguarding of adults (formerly the protection of vulnerable adults). Money belonging to a resident must not be paid into a bank account unless (a) the account is in the name of the resident, or any of the residents, to whom the money belongs or (b) the account is not used by the registered person in connection with the carrying on or management of the care home. Al parts of the home to which residents have access must be free from hazards to their safety. Products which are hazardous to health must be stored in a locked provision and windows must be fitted with restrictors to safeguard against anyone falling from them. 25/08/06 20/07/06 20/10/06 25/08/06 20/07/06 Elders (The) DS0000013633.V302214.R01.S.doc Version 5.2 Page 28 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 2 3 Refer to Standard OP18 OP19 OP35 Good Practice Recommendations It is recommended that an updated copy of the Surrey Multi-Agency Procedure for the protection of vulnerable adults is obtained and kept in the home. A written programme of routine maintenance and decoration should be developed, implemented and records kept. It is good practice and recommended that records of transactions of residents’ monies should be signed and dated by both parties involved in the transaction. Elders (The) DS0000013633.V302214.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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. 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