Inspection on 07/12/06 for Four Acres

This inspection was carried out on 7th December 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Four Acres 29/01/08

Four Acres 11/01/06

Four Acres 26/07/05

Four Acres 07/02/05

Four Acres 05/08/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Four Acres Archer Close Studley Warwickshire B80 7HX Lead Inspector Patricia Flanaghan Key Unannounced Inspection 7 & 14 December 2006 10:45 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 Four Acres DS0000036343.V323468.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. Four Acres DS0000036343.V323468.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Four Acres Address Archer Close Studley Warwickshire B80 7HX 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) 01527 853766 01527 853766 Warwickshire County Council, Social Services Department Care Home 35 Category(ies) of Dementia - over 65 years of age (11), Old age, registration, with number not falling within any other category (35) of places Four Acres DS0000036343.V323468.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2 3 The total number of residents accommodated will be 35 to include up to 11 service users assessed as requiring dementia care. Services users assessed as requiring dementia care to be admitted only to the dedicated unit identified as `Warwick`. The garden to be used for the service users admitted to the dementia unit should be made safely accessible and stimulating for service users with dementia (July 31st 2006.) Four Acres may also care for a resident named in the care plan attached to the variation application dated 19th October 2005 11th January 2006 4 Date of last inspection Brief Description of the Service: Four Acres is a Local Authority home for elderly people, with thirty-five beds. It provides permanent care, short stays and day care. The home is situated in the village of Studley, which has a variety of shops, churches, public houses, social clubs, a library and community centre. There is a regular bus service to Redditch town centre. The home provides accommodation on two floors. There are four units, one of which provides short stay or respite care, and one of which provides care specifically for people with dementia. Each unit has a lounge/diner with kitchenette, and there are additional communal areas, including two conservatories, on the ground floor. The home has a hairdressing salon. On each floor there are bathrooms and lavatories suitable for people with physical disabilities. The kitchen, laundry and staff offices are situated on the ground floor. There is a shaft lift to the first floor. At the time of the inspection the fees charged were in the range £94.45 £380.24 per week. The fees do not include newspapers, toiletries, chiropody or hairdressing. Four Acres DS0000036343.V323468.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for residents and their views of the service provided. This process considers the care home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. This unannounced inspection visit took place over two days on Thursday 7th December between 10.45am and 4.00pm and Thursday 14th December between 11.00am and 4.30pm. The Pharmacist Inspector for the commission carried out an inspection on the 11th November to assess medicine administration practices in the home and her findings are included in this report. As part of this unannounced inspection the quality of information given to people about the care home was looked at. People who use services were also spoken to, to see if they could understand this information and how it helped them to make choices. The information included the service user’s guide (sometimes called a brochure or prospectus), statement of terms and conditions (also known as contracts of care) and the complaints procedure. These findings will be used as part of a wider study that CSCI are carrying out about the information that people get about care homes for older people. This report will be published in May 2007. Further information on this can be found on our website www.csci.org.uk. Three residents were ‘case tracked’. This involves establishing an individual’s experience of living in the care home by meeting or observing them, discussing their care with staff, looking at their care files, and focusing on outcomes. Records including staff files, policies and procedures, health and safety and risk assessments were also examined. Before the inspection, a random selection of residents and relatives were sent questionnaires to seek their independent views about the home. Five responses were received from residents and six responses from relatives/visitors. An audit of the residents’ surveys showed, in the main, satisfaction with the service provided, the residents knew who to speak to if they were unhappy, the home was usually fresh and clean, the staff listen and act on what residents say and are available when residents need them. A comment noted on one questionnaire stated, “Carers are very kind and considerate, always on hand to help and comfort when needed.” Another resident commented on their form, “the home is cleaned well, but it is in need of decoration in all areas.” Four Acres DS0000036343.V323468.R01.S.doc Version 5.2 Page 6 The manager of the home completed and returned a questionnaire containing further information about the home as part of the inspection process. Some of the information contained within this document has also been used in assessing actions taken by the home to meet care standards. The inspector had the opportunity to meet a number of the residents in each unit and talked to five of them about their experience of the home. The residents were able to express their opinion of the service they received. General conversation was held with other residents along with observation of working practices and staff interaction with residents. The inspector also spoke with two visitors about their experience of the home. The inspector would like to thank residents and staff for their cooperation and hospitality. What the service does well: Four Acres has good systems in place for assessing the needs of prospective residents to the home so the staff were able to decide if they could meet any identified needs. All residents spoken with were positive about the staff and the care they receive at the home. One resident said, “all the girls are good to us.” There did not appear to be any rigid rules or routines in the home and residents could spend their time as they chose. Residents had been involved in some activities both inside and outside of the home and more were planned. All residents spoken with were satisfied with the meals they were served and the menus evidenced a varied and nutritious diet with choices available for the residents. One resident spoke highly of the food saying, “we get plenty of good food to eat.” Suitable procedures are in place for dealing with complaints. Regular meetings provide an opportunity for the manager to check that residents are happy and to respond to any concerns. The home is well managed and the views of the residents are routinely sought about everyday matters that affect their lives. For example, following a recent request for more activities to be provided, the home had employed an activities co-ordinator for one day a week and two staff members had undertaken ‘therapeutic activities’ training. Throughout the inspection staff were observed to be caring and supportive to residents who reacted positively towards the staff. Staff communicate well with residents and relatives. One visitor commented, “the staff are absolutely wonderful.” Four Acres DS0000036343.V323468.R01.S.doc Version 5.2 Page 7 Health and safety systems are in place at the home, fire equipment has been checked and is regularly serviced. What has improved since the last inspection? What they could do better: 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. Four Acres DS0000036343.V323468.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 Four Acres DS0000036343.V323468.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 and 3 Quality in this outcome area is good. Documentation available to inform prospective residents about the services provided is available, and residents’ needs are assessed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 1, 2 and 3 were assessed as part of the ‘themed’ inspection. These focus on the information available for residents about the care home and the pre admission needs assessment that the home is required to undertake, to demonstrate that it can meet the needs of those residents admitted to the home. Three residents and in one relative were spoken with during the inspection. The three residents said that they had not received a copy of the home’s ‘Users Guide’, however, the visitor confirmed that they had received a copy from the care manager arranging the placement, at the time they viewed the home. Four Acres DS0000036343.V323468.R01.S.doc Version 5.2 Page 10 Five completed questionnaires were received from residents. All five stated that they had received information about the home before they moved in so they could decide if it was where they wanted to live. The deputy manager said the home does have a ‘Service Users Guide’ but it is currently out of date and that the local authority are in the process of updating the information it contains. One of the residents spoken with confirmed that they had received a contract between themselves and the home which describes the terms and conditions. The visiting relative also confirmed that she had received a contract after her mother moved into the home. Copies of signed contracts were seen on the three residents’ files examined. One of the residents confirmed that they had been assessed by someone from the home before admission. The visiting relative also confirmed that the manager had visited her mother at home to undertake an assessment of her needs. Records read show that residents are assessed prior to admission and that the assessment process meets the required standards and allows the home to make an informed judgement about whether or not it can meet the needs of prospective residents. Four Acres DS0000036343.V323468.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): Quality in this outcome area is adequate. Residents are provided with the support they require to meet their personal and healthcare needs in a manner that respects their privacy and dignity. Evidence of updating information and changing actions does not always appear on care plans or daily records. The service must make sure that the control and handling of medication is further developed in order to maintain the safety and welfare of the service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plan files for three residents were examined. The files contain detailed, helpful information explaining people’s needs. The care plans cover a comprehensive range of personal care need and health care needs although more could be done within the care plan to show that residents are being cared for in a way that suits their individual needs and preferences. The use of life histories would also demonstrate that staff have a good understanding of the resident and their individuality. Each area of care is risk assessed, for Four Acres DS0000036343.V323468.R01.S.doc Version 5.2 Page 12 example, risk of falling, skin care and where risks are identified clear directions and guidance are in place for staff to follow. Health care needs are generally well attended to. The home has a visiting GP who comes to the home for a weekly surgery. During the inspection it was noted that residents were being supported to attend out patient appointments, and that there was good communication between staff and relatives. One resident with diabetes did not have regular checks with the chiropodist and her feet were very swollen. The resident was due to be seen by the doctor the following day but the daily records and care plans did not support any reason why this appointment was to take place. Regular checks at the diabetic foot clinic or chiropodist did not take place. The ‘oral health’ care plan of another resident identified “he has problems with his teeth and needs to have them removed.” This plan had been reviewed and this instruction carried forward for at least 18 months. The deputy manager said that the home would follow up the delay in receiving an appointment from the dental hospital. The arrangement for the management and administration of medicines were assessed on two units within the home. Audits were undertaken for a selection of residents and two residents were spoken with and one member of staff. Feedback to the manager was hurried due to her having to attend another meeting but it was well received. Care staff were keen to improve practice further. All staff have undertaken accredited training the safe handling of medicines and one care assistant spoken with during the inspection had a good understanding of the what medicines were for. Staff were observed administering medicines to residents. They were treated with respect and were asked whether they needed pain relief if prescribed on a “when required” basis. Two senior care assistants are responsible for ordering and checking in the medicines received into the home from the pharmacy. Neither were present for the inspection. There was no evidence that the dispensed medicines were checked against the prescriptions written by the doctor indicating that the checking procedures were not robust. Each unit has its own medication room. Individual resident’s medicines were transported to them either in their room or the dining room. Concern was raised that medicines could not be locked away in the event of an emergency and may be accessible for other residents who may inadvertently take them. Four Acres DS0000036343.V323468.R01.S.doc Version 5.2 Page 13 Medicines bought in by new residents to the home were recorded on the medicine chart and these had been checked with the doctor for accuracy. However as many as three boxes of the same medicines were open at the same time and this may lead to potentially giving more than the prescribed dose at any one time. The total quantities had not always been recorded accurately so it was difficult to demonstrate whether these had been administered correctly. Medicine charts were well written and doses clearly recorded including doses changed mid cycle. Variable doses were recorded so it was clear exactly what had been given. From audits all the medicines dispensed in a monitored dosage system were correctly recorded and administered. Audits showed that medicines dispensed in traditional boxes were not always administered correctly. This was due to a failure to record the exact quantity of medicines received or recording medicines as administered when they had not been. The latter resulted in the residents not receiving all their medicines as prescribed at all times. Care plans did not support why some medicines were prescribed and care plans seen were not reviewed frequently enough to enable staff to meet the resident’s needs in all cases. One resident was self administering her creams and she had not been risk assessed as able to do this safely. One cream purchased by her and used daily was out of date and a bottle of medicine also purchased and taken occasionally was out of date. The home had no homely remedy policy for occasionally use medicines. New residents are automatically administered medicines by care staff and are not offered the opportunity to self-administer their own medicines. All Controlled Drug balances were correct but these balances did not always match those recorded on the medicine chart, because staff failed to record all quantities of all medicines received. Residents spoken with said that they found all the staff to be kind and courteous. One resident commented “all the girls are good to us” and another resident stated “some staff are better than others.” During the inspection residents were observed to be treated with courtesy and their privacy respected. Doors were knocked before entering, and appropriate terms of address used. Four Acres DS0000036343.V323468.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 and 15 Quality in this outcome area is good. Residents are able to choose their lifestyle, social activity and maintain contact with family and friends. Residents receive a healthy, varied diet according to their assessed needs and choice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a planned programme of activities and entertainment in the home. The home employs a dedicated activities co-ordinator for one day a week. Staff also undertake regular activities with residents. Two members of staff have recently undertaken a ‘therapeutic activities’ training course. Activities listed on the programme displayed in the home include bingo sessions, reminiscence, life history, card making, film shows, painting, board games and manicures. Trips out to local places of interest such as garden centres are arranged. Some residents also enjoy meals out in local pubs. One resident said she particularly enjoyed reminiscence and film shows. Staff keep a record of activities undertaken by residents. Four Acres DS0000036343.V323468.R01.S.doc Version 5.2 Page 15 Entertainers also visit the home and church services are held there. One resident spoken with said she has Communion once a month. Residents said that they could choose how they spend their day and could take part in the social activities if they wished to. Residents meetings are held regularly. The minutes demonstrated that residents have a say in the running of the home with several suggestions on activities they would like to see delivered. The deputy manager said this was being actioned. The staff were also assisting residents to complete a ‘memory book’ which will enable the home provide leisure activities based on their preferences. A question on the questionnaire from the commission asked ‘ Are there activities arranged by the home that you can take part in?’ Five responses were received with four of the residents stated ‘usually’ and one resident commented ‘never’. The deputy manager undertook to discuss leisure interests at the next residents meeting and ascertain preferences for future social and leisure activities. Observations made during the inspection showed that staff allowed service users time to carry out their daily living routines. Most residents have good contact with their relatives and some residents go out with their family on a regular basis. Family and friends are welcomed at the home and are invited to attend parties and other celebrations. Meals are served by care staff in the dining area within each separate unit presenting a homely environment which encourages socialising between residents. Meals can also be served in residents’ own rooms if preferred. Choices are available at mealtimes. Each unit has a kitchenette with a fridge, freezer, microwave and dishwasher. Meals were seen to be nutritious and well presented and the residents were seen to eat heartily and really enjoy their meals. On the day of the visit, for the main meal, residents were offered lamb hotpot with vegetables or cheese and onion pie followed by a choice of trifle or cheese and biscuits. Residents said they enjoyed their meal and one resident said, “we get plenty to eat.” The cook is familiar with individual residents likes and dislikes and any special meals required. The kitchen has been refurbished since the last inspection. A brief inspection of the kitchen found it to be clean and in good order. Records are held of all food provided so the home can be sure residents nutritional needs are being met. Four Acres DS0000036343.V323468.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 and 18 Quality in this outcome area is good. The home has appropriate policies and procedures for the protection of residents and complaints are listened to and taken seriously. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standard 16 was inspected as part of the ‘themed’ inspection process to review if residents in the home have enough information to help them make a complaint if they wish to do so. Warwickshire County Council Social Services Department has a corporate complaints procedure. A copy of the home’s complaints procedure was displayed in a number of prominent positions in the home including the reception area. The deputy manager talked about the complaints procedure and said the home had not received any complaints since the last inspection. An examination of the complaints log demonstrates that there are proper systems in place for investigating and recording complaints. Residents said they were very satisfied with the service and had no cause to complain. An audit of the residents and relative’s questionnaire surveys received by the commission showed that none of those surveyed had complained about the service. Since the last inspection there have not been any complaints made directly to the commission. Four Acres DS0000036343.V323468.R01.S.doc Version 5.2 Page 17 None of the residents spoken with said that they had seen a copy of the complaints procedure, but all said that if they wished to make a complaint that they would speak to one of the staff or management team. A visitor said that the deputy manager is “always ready to listen, no matter how busy he is.” The home has a policy and procedure for the Protection of Vulnerable Adults (PoVA). Two staff members spoken with said they would refer any issues of concern about the safety of residents to the senior staff or the manager. All had knowledge of how to identify any potential abuse and were able to describe the different types of abuse that may occur. From the training records examined it was not clear if all staff have attended recent training in the Protection of Vulnerable Adults so that they are aware of the different ways vulnerable people are at risk of abuse, and would know how to respond. The manager is currently investigating a incident under PoVA the outcome of which is not yet known. The incident relates to an injury sustained by a resident. Four Acres DS0000036343.V323468.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, 24 and 26 Quality in this outcome area is adequate. Residents live in a home, which is fairly well maintained and has had some recent refurbishment. Some improvements could be made to ensure that residents benefit from an environment which contributes to a better quality of life. The management of infection control is in need of improvement to ensure poor practice does not impact on residents’ health. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the home was undertaken. The home is on two levels and a passenger lift is provided to assist residents’ to access to their rooms. Each floor has two units comprising a communal lounge and a kitchenette with a dining area. The dementia care unit is on the ground floor and is secured by a Four Acres DS0000036343.V323468.R01.S.doc Version 5.2 Page 19 coded keypad lock. Suitable accessible communal bathrooms and toilets are situated close to lounge and dining areas. Refurbishment of the Warwick unit was ongoing at the time of the inspection. As a result, the paintwork on the corridor was badly scuffed and the carpet was grubby and sticky underfoot. The small lounge at the end of the corridor was being used to store building work materials such as work tools, wiring, tiles and electric sockets. The room was very crowded and untidy as furniture was still being stored here. Chemical sprays was also seen in the room. All chemical substances that may be hazardous to health should be secured in a locked cupboard when not in use. The door to the room was open and residents from the dementia unit could access this room and potentially have an accident. The care officer was asked to secure the room immediately. She was unsure if a risk assessment had been undertaken regarding the building work, but undertook to complete one if necessary. Confirmation was later received that this had been done. Some of the individual bedrooms visited were pleasantly decorated and others required some attention. For example, one room was showing evidence of water damage following an incident earlier in the year. Residents are encouraged to bring personal items in with them and can furnish and redecorate their private room to their own taste if they wish. Personal possessions were noted in the bedrooms viewed during the inspection visit. En suite facilities are sufficiently spacious to meet resident’s needs. Two residents spoken with said they were very comfortable in their rooms. One resident commented “the home is cleaned well, but is in need of decoration in all areas.” A visitor said, “the décor lets the home down.” She stated that the family had decorated their mother’s room themselves, as “it looked shabby.” Staff wear disposable gloves when carrying out personal care tasks or when handling soiled linen, and protective clothing when handling or serving food. Liquid soap and paper hand towels is available in the toilets and the laundry room. Incontinence pads and clinical waste is held and disposed of safely and appropriately. The laundry has been relocated and is now situated next to the kitchen. The sluice and linen cupboard remains in the Warwick unit, which means both dirty and clean laundry has to be transported around the ground floor, through public areas such as the reception. The new laundry has an identifiable dirty to clean flow, but the hand-washing sink has been sited in the clean area and staff have to move clean clothes to reach the sink, as there is very little space in this area. There are no work surfaces on which to fold clean clothing/bed linen as they are removed from the dryers, or shelving to store clean clothes, such as residents underwear, which would minimise the risk of cross infection. During the tour of the Warwick unit, clean under and outer wear was seen on the grab rails outside residents bedrooms. This practice compromises residents’ dignity, is a potential source of cross infection and a potential trip Four Acres DS0000036343.V323468.R01.S.doc Version 5.2 Page 20 hazard to a partially sighted or confused resident. The care officer said that the clothing should have been taken into the bedrooms and put away by staff. Four Acres DS0000036343.V323468.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. Qualified staff are available in sufficient numbers to provide care for residents. Recruitment practices are robust. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of the inspection there were 31 residents living in the home. The manager was not available during the inspections and the inspection was therefore carried out with the assistance of the deputy manager and care officers. There is a care officer and five care staff on duty in the mornings and a care officer and four care staff on in the afternoon. Two extra care staff also provide additional cover during the busy evening shift between 5pm to 9pm. The manager works supernumerary hours to those of the care staff. At night there are three waking night staff and an emergency on call system in place. In addition to this the home employs domestic, kitchen and laundry staff. One relative and all residents spoken with all said there were sufficient numbers of staff available to meet the needs of residents. Six questionnaires were returned from relatives/visitors with three commenting that they felt there are not always sufficient numbers staff on duty. An additional comment made by a visitor was that “Staff are very good and do a wonderful job, Four Acres DS0000036343.V323468.R01.S.doc Version 5.2 Page 22 however, sometimes there is not enough staff to give the individual care people need when they need it.” The recruitment files of three staff were examined. All files contained information to confirm that the home operate an equal opportunities interview process and staff are properly vetted before starting work. This includes taking up references and a Criminal Record Bureau check to ensure that staff are safe to work at the home. Information provided by the deputy manager during the inspection visit indicated that 22 of the 36 care staff employed at the home have an National Vocational Qualification (NVQ) level 2, or Level 3 in care. A further nine staff have been registered to undertaken this qualification. New staff have an induction relevant to their role and responsibilities that includes shadowing an experienced worker and training in health and safety, safe moving and handling techniques and the principles of care. The training manual new staff complete is called ‘Working in Care Settings; Induction and Foundation Standards.’ Staff are supervised until they have satisfactorily completed the training course. Staff training records were not up to date, therefore we cannot be sure that staffs have received regular updates in health and safety issues and moving and handling. Information supplied by the deputy manager, records seen and discussion with staff confirmed that some training linked to resident care had been undertaken by some staff such as Parkinson’s disease awareness, stroke workshops and dementia care. Further training has been arranged on topics such as equality and diversity for all staff. Four Acres DS0000036343.V323468.R01.S.doc Version 5.2 Page 23 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): 33, 35 and 38 Quality in this outcome area is good. Systems are in place to allow residents to comment on how the home is managed so that they feel valued and supported but there are some issues relating to health and safety that need to be addressed to ensure the residents are fully safeguarded. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager of the home was appointed to the home in July 2006 and is in the process of being registered with the commission. She was not available during the inspection process so Standard 31 was not assessed on this occasion. Four Acres DS0000036343.V323468.R01.S.doc Version 5.2 Page 24 A quality survey was carried out in November 2005 by Age Concern whose representatives visited the home and talked to residents about the service they received. Individual questionnaires were completed during the consultation process and the outcome of an audit of responses sent to the home. The findings of the previous quality audit were reported back to residents at one of their meetings. The 2006 survey had yet to be completed and the deputy manager was unsure when this would be undertaken. The home keep a file of thank you cards and comments received, and there were a significant number of positive responses seen. Residents’ personal money is securely held for safekeeping in the home if the resident or their relative requests this. Individual receipts are available for all transactions and accurate records are kept of income and expenditure. Financial records of three residents were audited and found to be in order. A review of health and safety was undertaken. The home confirmed in a preinspection questionnaire forwarded to the commission that health and safety checks had been completed. Records examined include maintenance, contracts and servicing documentation for electrical equipment. Fire records and electrical tests are up to date. Hot water ‘hand’ tested in the home on the day of inspection was within safe levels to prevent any risks of scalding to the residents. Examination of documentation confirmed the absence of accurate training records confirming that staff received regular mandatory training. These issues must be addressed by the Registered Provider so that we can be sure staff receive appropriate health and safety training and any updates necessary to carry out their duties safely and responsibly. As indicated previously in this report a number of health and safety hazards were seen during the inspection visit. • • • Cleaning items were not being stored safely in accordance with COSHH regulations (Control of Substances Hazardous to Health). Infection control procedures in the laundry process were not robust. The unlocked room in the Warwick unit used for storage of building materials was a potential hazard to the residents. Four Acres DS0000036343.V323468.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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 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 3 17 X 18 2 2 X X X X X x 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X 2 Four Acres DS0000036343.V323468.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 OP7 Regulation 15 Requirement The Registered Person must ensure care plans set out in detail changes in service users’ needs with documentation of action taken to meet and address any change in circumstances. The Registered Person must arrange for service users to receive where necessary treatment, advice and other services from any health care professional. Timescale for action 28/02/07 2 OP8 13(1) 31/01/07 3 OP9 13(2) The registered person must 31/01/07 arrange for the safe handling, storage and recording of medication in accordance with the home’s policy and procedure. (Previous timescale of 14/02/06 not met.) 4 OP9 13(2) The registered person must ensure that all prescriptions are seen before dispensing and a system installed to check the dispensed medicines and MAR DS0000036343.V323468.R01.S.doc 31/01/07 Four Acres Version 5.2 Page 27 chart received into the home. Staff must document that they have checked all new service users medicines brought into the home to confirm they are their current drug regime. The quantities of all medicines must be clearly recorded on each new Medicine Administration Record (MAR) chart to enable audits to take place to demonstrate that all medicines are administered as prescribed. 5 OP9 13(2) The registered person must 31/01/07 ensure that all staff refer to the Medicines Administration Record (MAR) chart before the administration of medicines and directly sign following the transaction or record the reasons for non-administration. The MAR chart must accurately reflect what has been administered within the home. All medicines must be administered as prescribed in all instances and records reflect practice. The registered person must ensure that staff drug audits are undertaken before and after a drug round to confirm staff competence in medicine management. Appropriate action must be taken when discrepancies are found. The registered person must ensure that a system is implemented to check the expiry of all medicines used in the home including those purchased by the resident. Any medicines purchased by a resident must be checked for any interactions with DS0000036343.V323468.R01.S.doc 6 OP9 13(2) 31/01/07 7 OP9 13(2) 31/01/07 Four Acres Version 5.2 Page 28 their prescribed medication with the pharmacist or doctor. 8 OP9 13(2) The registered person must ensure that any service user wishing to self administer their own medication must be risk assessed as able and compliance checks undertaken on a regular basis to confirm they do safely take them. A robust selfadministration risk assessment policy must be written and residents offered the opportunity to handle their own medicines. The registered person must arrange, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. The registered person must ensure that the home is kept in good decorative repair. (Previous timescale of 31/10/05 and 31/03/06 part met.) 11 OP26 13(3) The registered person must ensure that robust procedures for infection control are used throughout the home. The Registered Person must ensure accurate training records are maintained and demonstrate that staff receive regular mandatory training. The registered provider must ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. Unnecessary risks must be identified and so far as DS0000036343.V323468.R01.S.doc 31/01/07 9 OP18 13(6) 28/02/07 10 OP19 23 28/02/07 31/01/07 12 OP30 18(1) 28/02/07 13 OP38 13 (4) 31/01/07 Four Acres Version 5.2 Page 29 possible eliminated. 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 OP9 Good Practice Recommendations The purchase of a trolley for each unit is advised to safely transport the medicines around the home and to be able to securely lock them away in the event of an emergency. Only one opened box is available for use at any one time to reduce the risk of administering more than one duplicated medicine. 2 OP9 Four Acres DS0000036343.V323468.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB 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 Four Acres DS0000036343.V323468.R01.S.doc Version 5.2 Page 31 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!