Inspection on 01/05/07 for Fessey House

This inspection was carried out on 1st May 2007.

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

Fessey House 06/11/07

Fessey House 13/11/06

Fessey House 06/12/05

Fessey House 05/09/05

Fessey House 14/12/04

Fessey House 28/04/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Fessey House Brookdene Haydon Wick Swindon Wiltshire SN25 1RY Lead Inspector Bernard McDonald Unannounced Inspection 1st May 2007 09:00 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 DS0000035422.V333678.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. DS0000035422.V333678.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fessey House Address Brookdene Haydon Wick Swindon Wiltshire SN25 1RY 01793 725844 01793 706104 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) Swindon Borough Council Vacant Care Home 43 Category(ies) of Old age, not falling within any other category registration, with number (43) of places DS0000035422.V333678.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may also admit not more than 2 adults at anyone time who are aged over 55 years but under 65 years so long as these people are accommodated in the short term care unit and their period of stay does not exceed 8 consecutive weeks in any one care episode. 13th November 2006 Date of last inspection Brief Description of the Service: Fessey House is a large care home owned and managed by Swindon Borough Council. It is located in a quiet cul de sac in the Haydon Wick area of Swindon the local shops and a community centre are nearby. The home is on 2 floors and is sub divided in to 4 living areas. Three of these living areas provide long term social care and accommodation. The other area provides respite and crisis care on a short term basis. Each living area has its own separate lounge and dining room with a kitchenette where drinks and snacks can be prepared. The main meals (typically lunch and tea) are cooked in a central kitchen. Other meals are prepared in the living units. All bedrooms are single rooms and can be decorated to the occupants choice. Service users are encouraged to personalise their rooms and may furnish them with their own furniture. Typically there are 7 or 8 care staff on duty plus a shift leader or manager. At night 3 care staff work in the home. Additionally the home deploys a housekeeper in the mornings at busy times in each living area as well as providing cleaning staff. Designated staff are employed to carry out administrative and cooking duties. If the home is short of permanent staff it relies on staff working extra hours or agency staff. On the same site there is a local day centre that is run by Age Concern. Some service users can attend the day centre if there is a vacancy and they meet the criteria. The Commission does not inspect the day centre, as it has no powers to do so. The fees charged for the service are £94 to £376 per week. DS0000035422.V333678.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit took place over three days for a total of twentythree and a half hours. A tour of the building was made and all areas of the home including a sample of people’s bedrooms and communal living areas were seen. We met with the majority of people who use the service and had opportunity to speak to a number of people in private to obtain their views on the service they receive. In addition ten members of staff and seven visitors to the home were spoken to in private. The manager was also available to assist throughout the site visit. As part of our inspection, comment cards were sent to people living at the home, their representative’s, health care professionals and placing authorities. Five care plans were examined in detail. In addition medication records, staff recruitment files, training records, health and safety documents and a sample of risk assessments were also examined. A number of requirements remain outstanding from the last inspection. Feedback on the preliminary findings was given to the manager at the end of our site visit. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: The admission of people to the home is generally well managed. People using the service receive copies of the service user guide and have opportunity to visit before deciding to move in. People are informed of the terms and conditions of their stay. People using the service were complimentary about the standard and quality of meals being provided. Visitors to the home confirmed they are able to visit at anytime and are made to feel welcome by the staff. The home has formed a resident’s committee to look at ways of improving the variety and frequency of activities. DS0000035422.V333678.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: All the requirements made in our last inspection report have not been met. We have serious concerns regarding the health and welfare of people living at the home. Care plans are vague and do not direct care. People with diabetes do not have care plans specifying how their needs can be met and what action staff should take should they become ill. The lack of direction in care plans puts people at unnecessary risk. Medication practices at the home are poor. Two immediate requirements were made at our site visit to ensure peoples safety. People who self medicate had no storage facilities to keep their medication secure. Medication found in people’s rooms was out of date. Two people were taking medication they were not prescribed for. One person had medication in a bottle with no pharmacy label or direction on how it should be administered. There are limited opportunities for people to engage in meaningful activities. The home is still in need of refurbishment and parts of the home are continuing to show signs of excessive wear and tear. Not all parts of the home were clean and concerns regarding the cleanliness of the building were identified in comment cards we received from Staff are failing to put into practice their knowledge, skills and training to ensure people using the service receive the care and support they need. The current level of staff vacancies is having an impact on the service being provided to people living at the home. Formal supervision of staff is not happening as frequently as it should. The Commission is now seeking legal advice regarding enforcement action being taken to ensure the health safety and wellbeing of people living at the home. DS0000035422.V333678.R01.S.doc Version 5.2 Page 7 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. DS0000035422.V333678.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 DS0000035422.V333678.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, 5, 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service are provided with information about the home and are informed about the terms and conditions of their stay. Opportunities are provided to enable people to visit the home before making a decision to move. People’s individual needs are assessed prior to moving to the home but care plans do not fully reflect their needs. EVIDENCE: The records of people who have recently moved to the home were examined in detail. The records examined demonstrated people using the service are advised in writing of the terms and conditions of their stay including their financial contribution. People using the service had been provided with a guide to inform them of the service provided at the home. One person had used the guide to inform their decision about moving to the home. Discussion with one person confirmed they had been able to visit the home prior to moving. They DS0000035422.V333678.R01.S.doc Version 5.2 Page 10 said, “ I liked the home and the staff” when asked about choosing to come to Fessey House. The records demonstrated that the needs of the people using the service had been assessed prior to them moving to ensure the home could meet their needs. In addition the home completes a pre admission assessment, which forms the basis of the initial care plan. However the care plans did not provide sufficient detail to inform the support worker on how their needs should be met. Deficits identified in plans are evidenced in more detail in the health and personal care outcome group. In discussion with people about their experiences at the home they stated, “ I think it is wonderful”. Discussion with the manager confirmed that people are encouraged to visit the home prior to moving in. Where this is not possible their representative would normally visit to see the room and facilities on offer. The manager confirmed that as part of the pre admission procedure people are provided with a guide. The home does not provide intermediate care. DS0000035422.V333678.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. This judgement has been made using available evidence including a visit to this service. People who use the service are put at risk from poor medication practices. Care plans do not set out individual care needs and peoples specific health care needs are not being safely met. People feel they are treated respectfully by the care team however, the practice of wedging open bedroom doors compromises peoples dignity. EVIDENCE: A total of five care records were examined in detail. The format used for recording people’s care needs had been updated since our last inspection. Care plans were being routinely reviewed each month. However the care plans that were examined did not fully reflect the needs of people using the service and deficits identified at the site visits need to be urgently improved upon to ensure their health, safety and wellbeing is protected. The care plan of one person with a specific medical condition made no mention of the condition or the impact it may have on the person. The only mention of DS0000035422.V333678.R01.S.doc Version 5.2 Page 12 the condition was a piece of paper stuck to the front of the file dated October 2005. In discussion with staff and management it was unclear whether the person had the condition. By the third day of our site visit the manager had received confirmation from the GP about the person’s medical condition. The manager stated they would update the persons care plan to reflect the information they had received. There was opportunity to meet the relatives of the person and they expressed concerns over the care of their relative. They had also made a complaint, which was being investigated by the home. There is a lack of consistency in the care plans and support plans. For example one care plan stated that the person required the supplement Ensure. The care plan stated it was to be kept in their room and the support plan provided no direction on the frequency of the supplement. The relatives stated the person requires assistance with the supplement. The manager reported this is now on the medication administration sheet to ensure it is regularly administered. However in the medication needs section of the care plan it states; the person administers their ensure drink when they require them. This clearly contradicts the action agreed by the manager. The care plan of one person who is an insulin dependent diabetic states, they self-administer insulin at 8.00am and 4.00pm. The support plan states the insulin is administered at 7.30am and 5.00pm. The person using the service described their care as “fair”. The person stated they did not always get their insulin at the right time and can wait for up to an hour for a meal after receiving their injection. This practice puts the persons health at serious risk and was brought to the attention of the manager during the site visit. Discussion with one member of staff indicated that the person is normally first to receive medication. However discussion with person receiving the service and other staff at the home confirmed that it depends on which staff are on duty as to when they receive breakfast and evening meal. There was no reference to mealtimes in the persons care plan. This is unacceptable and urgently needs to be addressed to ensure the safety of people using the service. Examination of the care plan highlighted indicators for staff to be aware of such as, sweet breath, sweating, clammy and tiredness. However there was no information about what action they should take if these symptoms are found. It was evident from discussion with staff that they were not fully aware of the action to take. It was a requirement at the last inspection that the needs and risks associated with diabetes must be clearly recorded and known by staff. This requirement had not been met. The manager reported they had contacted the district nurse to provide training for staff in the management of diabetes but a date for the training has still to be arranged. All care plans examined contained statements such as, ‘needs assistance’, ‘needs support’, ‘staff to assist’ or ‘staff to monitor’. There were no clear directions to inform staff how to provide the assistance or support that the care plan stipulates. Discussion with staff did demonstrate an understanding of DS0000035422.V333678.R01.S.doc Version 5.2 Page 13 the needs of people in relation to providing personal care. However where the needs of the people were more specialised the action and understanding of staff was not as comprehensive. At our last site visit a requirement was made that the home must ensure as far as possible that all unnecessary risks to people are or controlled within acceptable limits. The manager reported that they had not completed risk assessments on the open staircase on the first floor. The failure to consider all risks to people living at the home continue to put them at unnecessary risk and action must be taken to ensure safety. One person who required pressure support had the appropriate pressure relief mattress and cushions for their chairs. People are registered with the local health care practice although some have continued to use the GP they were registered with prior to admission to the home. People using the service spoke positively about staff at the home. Care staff were observed speaking to people in a respectful manner and taking time to explain tasks they were about to perform. Comment cards received from people using the service and their relatives raised concerns about the numbers of staff on duty and that they were always busy. The practice of wedging open bedrooms doors continues to compromise people’s dignity. Throughout the three days of the site visit people were seen sleeping in their beds, adjusting their clothing and using their commodes. Although staff were not always aware of some of these practices, more attention should be given to ensure that where ever possible bedrooms are closed especially when people are asleep or attending to their personal care needs. Serious errors were found in the way medication is managed at the home. Such were the concerns that two immediate requirements were left with the manager to ensure people’s safety. In addition a report has to be provided to the Commission regarding medication that has gone missing and cannot be accounted for. People who self-administer their medication had nowhere secure to keep their medication safe. Errors in the administration of medication to people using the service were found on a significant number of medication administration records (MAR). It was difficult to evidence whether people using the service had received their medication as prescribed. For example one person who self-administers their medication had a MAR sheet, which identified that the person should not be taking any other paracetamol product while taking co-codomol. However the person was taking paracetamol and stated they did not have any co-codomol. When brought to the attention of the manager and the staff responsible for administering medication, they were not aware the person had paracetamol in their room and reported they had been giving the person co-codomol although none could be found. In addition we found a number of creams in a persons room that were unopened, and medication that was out of date was also found in rooms. One member of staff reported that at our last key inspection they had been to every person’s room DS0000035422.V333678.R01.S.doc Version 5.2 Page 14 to remove out of date medication. It is evident that this practice had not been undertaken since. One person who self-administered their medication informed us they could not put a prescribed cream on their legs and feet because they could not reach. The person reported that this procedure was recorded on the board in the care office. The person stated they had not had cream on their legs for a number of weeks. Discussion with staff demonstrated they were not aware they should be doing this. One member of the care team however did know about this procedure and yet the cream had not been applied. One person who self-administers their medication had an eye cream that was dated November 2006. The cream was opened though the person using the service was not sure when they received it. This was brought to the attention of the manager who then provided the person with a new tube. The box was dated to ensure this would be replaced after a month as requested by the pharmacy. Examination of medication records showed no record was made of medication given to people who self-administer their medication. In addition no safety check or monitoring system was in place to ensure those people who selfadminister medication remain safe to do so. The risk assessment for people who self-administer medication is confusing as it states staff will hold their medication and monitor service users when taking medication. This practice was not happening. The home was failing to keep a record of medication received at the home. One member of staff reported that these records are destroyed when they receive the medication. DS0000035422.V333678.R01.S.doc Version 5.2 Page 15 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. This judgement has been made using available evidence including a visit to this service. Opportunities for people to engage in social and recreational activites are limited, though the development of a ‘peoples committee’ should improve outcomes for those using the service. Visitors are made welcome and can visit at anytime. Mealtimes are relaxed and unhurried but not everybody’s dietary needs are being met in the home. EVIDENCE: Discussion with the manager confirmed two members of staff are responsible for providing activities at the home. This is in addition to their normal duties and no set hours are allocated to this task. Records examined showed a minimal amount of structured daytime activities is being provided at the home. There was however some evidence of some people’s artwork on display at the entrance to the home. The activities book showed that approximately one activity a month is being provided. One person using the service commented “ I normally pop down to the bits and bobs they have downstairs, its alright” when asked about activities. Another person commented, “there is not much to DS0000035422.V333678.R01.S.doc Version 5.2 Page 16 do”. However at a recent home meeting a committee made up of people using the service has been formed to specifically look at activities in the home. One member of the committee said, “for me there is not enough to do so we are going to look at what else we can do”. There was opportunity to meet with a number of people who were visiting the home during the site visit. Discussion with visitors to the home confirmed they could visit at anytime. Comment cards received from people’s relatives also confirmed they are made to feel welcome when they visit. One person using the service had a private telephone installed in their room to enable them to maintain contact with people that are important to them. People’s religious needs are recorded in their care plan. One record examined showed the person needed support from staff to attend the monthly church service at Fessey House. People using the service commented favourably about the meals provided at the home. The menu offers people a choice at each meal. Since the last inspection the cook confirmed each person now has a diet sheet, which records peoples likes, dislikes, allergies and dietary requirements. The cook stated this is now incorporated into the persons care plan and is completed for each person on admission. However the dietary needs of one person from an ethnic minority group are still not being fully addressed at the home. There continues to be a heavy reliance on the person’s relatives to provide cooked meals for the person to eat. However by the last day of the site visit the cook confirmed they had arranged to meet with the person’s relatives to look at ways of providing the person with a menu suited to their needs. DS0000035422.V333678.R01.S.doc Version 5.2 Page 17 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. This judgement has been made using available evidence including a visit to this service. The home is making every effort to ensure people who use the service are protected from abuse, though medication practices being followed at the home put people at risk. EVIDENCE: The home has received two complaints since our last inspection. One complaint had been received by CSCI and passed to Swindon Borough Council to investigate. The outcome of the complaint investigation has not been determined. Information on how to make a complaint is on display throughout the home. In addition the home has received a number of compliments about the service they provide. Discussion with people who use the service confirmed they felt safe living at the home and were spoken to in an appropriate manner by staff. Policies for the safeguarding of vulnerable people were available in the home. At the previous key inspection in November 2006 it was found that the majority of staff working in the home had completed abuse awareness training. Discussion with staff demonstrated an awareness of what action they would take to report any concerns affecting the welfare of people living at the home. However the concerns identified earlier in the report regarding the medication practices at the home could put people at serious risk. DS0000035422.V333678.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, 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Not all parts of the home were clean and the failure to commence the refurbishment plan means people are living in a home that is showing considerable signs of wear and tear. EVIDENCE: Over the three days of the site visit several tours of the building were made including visits to peoples rooms. On the first day of our site visit we found a persons chair had faeces on it and several bedrooms and communal living areas were in need of a good clean. On the second day of the site visit the manager had implemented a deep clean programme to improve the standard of cleanliness at the home. Comment cards received from the relatives of people living in the home highlighted the DS0000035422.V333678.R01.S.doc Version 5.2 Page 19 overall lack of cleanliness in the building, which the manager attributed to the lack of housekeepers. No progress has been made on the planned refurbishment of the home and overall the general fabric of the building is showing increasing signs of wear and tear. The manager reported that it is hoped that the landscaping of the garden area will commence in the next month though no date has been given to commence the internal renovations. The laundry is sited well away from food preparation areas. Discussion with the laundry assistant confirmed there is normally one person on laundry duty each day. On the first day of our site visit there was a substantial amount of clothing and linen waiting to be washed. This was due to one washing machine being broken although parts had been ordered. The laundry room had two washing machines and dryers. A member of staff commented that the washing machines were inadequate for the amount of washing at the home and felt a commercial washer would be more appropriate to the needs of the home. No adverse comments were received from people living at the home about the laundry service. Discussion with the laundry assistant and examination of training records confirmed they had received infection control training. DS0000035422.V333678.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 poor. This judgement has been made using available evidence including a visit to this service. Staff are failing to put into practice their knowledge, skills and training to ensure people using the service receive the care and support they need. The current level of staff vacancies is having an impact on the service being provided to people living at the home. Safe recruitment practices are being followed. EVIDENCE: Comments received from people living at the home and from their representatives clearly indicate that at times there is insufficient staff on duty. The relative of one person commented that “we are very happy with the care provided but at times the home is short staffed” another person commented, “I feel they do well within the resources they have”. People living at the home commented, “staff are very kind”. Another person commented, “staff are always busy” while another person commented that their call bell is not always answered promptly. This was also evidenced during the site visits when call bells were left ringing without staff attending. The manager reported that there are still a number of housekeeping posts that are vacant. Discussion with staff also confirmed low staffing levels especially at weekends. This has resulted in kitchen staff having to help serve breakfast. One member of the housekeeping staff stated, “there is normally only two on DS0000035422.V333678.R01.S.doc Version 5.2 Page 21 duty at the weekends and it is impossible to keep on top of things”. A member of the care team commented that they, “loved working at the home but there is not always enough staff which can lead to people getting up later”. The manager reported there are currently over 200 hours a week in vacancies. This shortfall is due to staff leaving and not being replaced. Although the existing staff team and agency staff are covering a number of these hours it is clearly evident the shortfalls is having an impact on the care and services being provided to people living at the home. Samples of the staff rota from 1st April 2007 were examined. The manager reported that there are normally three members of staff on night duty. However one night the rota showed only two staff on duty, which is insufficient for the safety of people using the service. Discussion with staff and examination of training records evidenced over 90 of the care team have achieved a National Vocational Qualification (NVQ) in care. In addition records showed staff had received training in abuse awareness, first aid, equality, infection control, care programming, dementia care and professional boundaries. In 1.1 discussions with staff it was apparent that staff had an understanding of their roles and responsibilities but collectively were failing to put into practice the knowledge and skills that they have. For example issues found in medication practices and deficits in care planning cannot be attributed to a lack training. Staff were aware that one person with diabetes needed to have their meal after receiving their insulin injection yet this was not routinely happening. The answering of emergency call bells has already been highlighted in the report. One member of staff was aware one person using the service needed to have cream rubbed on their legs two times a day and yet this was not being done. There appears to be a lack of team unity or clear guidelines outlining staff responsibility. This was brought to the attention of the manager and now needs to be urgently addressed to improve the health and welfare of people using the service. Discussion with the manager confirmed that all new staff complete the principles of care training course as part of their induction. Once this training has been completed new staff are given an induction booklet to work through. The induction system involves a more senior member of staff providing support to the new staff and assistance to work through the induction standards. However there was no evidence to show this was happening in practice. One member of staff recently appointed confirmed they shadowed a senior member of staff for a couple of days. They confirmed they had completed abuse awareness training, first aid and manual handling but had not received an induction booklet. A sample of recruitment records were examined and showed staff had received a satisfactory Criminal Records Bureau (CRB) check and Protection of Vulnerable Adults (POVA) check before commencing work. DS0000035422.V333678.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): 31,33,35,36,38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The manager needs to ensure that staff are appropriately supervised in their role. Quality assurance systems are not sufficient to improve and maintain the health and wellbeing of people living at the home. EVIDENCE: The manager has been in post since February 2007. The manager confirmed they are working towards their Registered Managers Award, which they anticipate should be completed by July 2007. The manager has yet to apply to the Commission to be the registered manager. This is an outstanding requirement from the last inspection. DS0000035422.V333678.R01.S.doc Version 5.2 Page 23 During the site visit the home was receiving a financial audit inspection. The home was holding money on behalf of people using the service however in view of the recent audit the money being held was not examined on this occasion. Since our last inspection questionnaires have been sent out to the families of people living in the home. To progress the quality assurance process the home needs to seek the views of stakeholders on the quality of service being provided. Following the last key inspection the home was required to provide us with an action plan on how the service would be improved. Although at the random inspection in February 2007 some improvements were noted, many of the concerns identified at the key inspection have once again been identified. In view of the continued failure to meet a number of statutory requirements we are taking legal advice on the need to take enforcement action to improve outcomes for people living at the home. The manager has implemented a rota for staff supervision. Discussion with staff confirmed they do receive supervision though the frequency of these meeting has dropped in the last few months. The manager should ensure supervision meeting are held at regular intervals. The manager should ensure the meetings cover all aspects of care practice and philosophy of care to ensure they are fully aware of their roles and responsibilities in meeting the needs of people living in the home. Staff receive health and safety training and hot water is now regulated close to 43c to ensure the safety of people in the home. The passenger lift was recently serviced and a clinical waste contract is in place. A ‘handy person’ is employed to ensure minor repairs are quickly responded to. Portable appliance testing needs to be completed. Fire risk assessment is in place and fire safety practices are being held on a regular basis, DS0000035422.V333678.R01.S.doc Version 5.2 Page 24 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 3 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 1 28 3 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 1 X 2 DS0000035422.V333678.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement The registered person must ensure people have an individual plan that clearly specifies how their needs must be met. This was a requirement at the last two inspections. The timescale given was 01/01/07 & 30/04/07 The registered person must ensure that the risks associated with any person who is diabetic is clearly recorded and known by all care staff. This was a requirement at the last inspection. The timescale given was 30/04/07 The registered person must ensure all unnecessary risks to people using the service are as far as possible eliminated and ensure risk assessments are completed on the safe administration of medication where service users may be at risk. This was a requirement at the last inspection. The DS0000035422.V333678.R01.S.doc Timescale for action 01/07/07 2. OP7 12(1)(a)( b) 01/07/07 3. OP9 13(4)(c) 01/07/07 Version 5.2 Page 26 timescale given was 30/04/07 4. OP7 13(4)(c) The registered person must ensure all unnecessary risks to people are as far as possible eliminated and ensure risk assessments are completed on the open middle staircase on the first floor. If a risk is identified then action must be taken to reduce the risk to people using the service. This was a requirement at the last inspection. The timescale given was 30/04/07 The registered person must make arrangements for the recording and safe administration of medicines and must ensure all administration records are completed at the time of administration. This was a requirement at the last two inspections. The timescale given was 22/12/06 & 01/03/07 01/07/07 5. OP9 13(2) 01/07/07 6. OP9 13(2) 7 OP9 13(2) 8. OP9 13(2) The registered person must 24/05/07 ensure that people who self medicate are provided with safe and secure facilities to store their medication. An immediate requirement was issued at the time of the inspection. The registered person must 24/05/07 ensure that all medication is administered as prescribed and that an accurate record is kept of all medication that is administered in the home. An immediate requirement was issued at the time of the inspection. The registered person must 18/06/07 undertake an investigation into DS0000035422.V333678.R01.S.doc Version 5.2 Page 27 9. OP9 13(2) 10. 11. OP9 OP9 13(2) 13(2) 12. OP10 12(4)(a) 13. OP15 16(2)(i) 14. 15. OP19 OP27 23(2)(d) 23(2)(d) 18(1)(a) 16 OP27 18(1)(a) 17. 18. OP30 OP31 18(1)(c) (i) 8, 9. the missing Co-codamol and provide a report of the outcome of your investigation. An immediate requirement was issued at the time of the inspection.. The registered person must review the medication risk assessment for people who self medicate to ensure it safeguards peoples health and welfare. The registered person must ensure all eye drops are dated when they are opened. The registered person must ensure any medication that is out of date is returned to the pharmacy. The registered person must ensure that people’s privacy and dignity is respected at all times and ensure bedrooms doors are closed when people are sleeping or when personal care is being provided. The registered person must ensure that the dietary needs of people using the service from ethnic minority groups are met at the home. The registered person must ensure all parts of the home are kept clean at all times. The registered person must ensure staff are employed in sufficient numbers to ensure all parts of the home are kept clean at all times. The registered person must ensure there are competent and experienced staff on duty in sufficient numbers to meet the needs of people using the service. The registered person must ensure all new staff receive structured induction training. The manager must apply to the DS0000035422.V333678.R01.S.doc 01/07/07 01/07/07 01/07/07 01/07/07 01/07/07 01/07/07 01/07/07 01/07/07 01/07/07 01/07/07 Page 28 Version 5.2 Commission to be registered. 19. OP33 24(1) The registered person must ensure quality assurance systems seek the views of relevant stakeholders and the methods by which the registered person intends to improve the services provided at the home. The registered person must ensure staff receive formal supervision on a regular basis. The meeting must cover all aspects of care practice and the philosophy of care at the home. 01/08/07 20. OP36 18(2)(a) 01/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP12 Good Practice Recommendations The registered person should ensure terminology such as needs assistance or needs help is full explained in the persons care plan. The registered person should consider allocating specific hours to the role of activites co-ordinator to improve the variety and frequency of activities being provided to people living at the home. The registered person should inform the Commission of the start date for the refurbishment of the home. The registered person should consider purchasing a commercial washing machine. The registered person should ensure the training staff receive is put into practice to ensure the changing needs of people who use the service are safely met. The registered person should ensure portable appliance testing is completed. 3. 4. 5. 6 OP19 OP26 OP30 OP38 DS0000035422.V333678.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000035422.V333678.R01.S.doc Version 5.2 Page 30 - 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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