Inspection on 22/02/07 for Galtres Care Home

This inspection was carried out on 22nd February 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Galtres Care Home 17/07/07

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

CARE HOMES FOR OLDER PEOPLE Galtres Care Home Ox Carr Lane Strensall York YO32 5TD Lead Inspector Jo Bell Unannounced Inspection 09:30 22 February 2007 nd 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 Galtres Care Home DS0000068222.V325265.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. Galtres Care Home DS0000068222.V325265.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Galtres Care Home Address Ox Carr Lane Strensall York YO32 5TD 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) 01904 491300 01904 491300 galtresch@yahoo.co.uk Mrs Gillian Mary Conroy Mr John Anthony Conroy *** Post Vacant *** Care Home 20 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (20) of places Galtres Care Home DS0000068222.V325265.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include up to 20 (OP) and up to 20(DE(E) up to a maximum of 20 service users. N/A Date of last inspection Brief Description of the Service: Galtres care home has recently been bought by Mrs. G. Conroy, this is a home offering personal care for up to twenty older people who may have dementia. The home is situated in the village of Strensall and has two gardened area and an area for visitors and staff to park. Service users have access to local shops and amenities within walking distance. Galtres Care Home DS0000068222.V325265.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A key inspection of this service took place on Thursday 22nd February 2007. This is viewed as a new service as it has recently been bought by Mrs. G. Conroy. Prior to the visit a pre-inspection questionnaire was completed and nineteen relatives surveys were returned. One inspector spent eight hours at the home speaking with service users, staff, relatives and a healthcare professional. Documentation relating to care planning, medication, activities and health and safety was examined, and issues relating to staff were discussed with the manager and provider. Aspects of the environment were inspected and all the key standards were covered at this visit. Generally service users were happy with the care they received and the meals provided. However, there were many areas including staffing levels, the environment, documentation, aspects of storage of medication and evidence of mandatory training that need addressing. These issues impacted on service users and need to be addressed to ensure the safety of all those living and working in the home. What the service does well: What has improved since the last inspection? This is a new service and this is the first key inspection. Galtres Care Home DS0000068222.V325265.R01.S.doc Version 5.2 Page 6 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. Galtres Care Home DS0000068222.V325265.R01.S.doc Version 5.2 Page 7 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 Galtres Care Home DS0000068222.V325265.R01.S.doc Version 5.2 Page 8 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): 3 (Standard 6 is not applicable) Quality in this outcome area is good. Service users have their needs assessed, though this is not always clearly documented. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One pre-admission assessment was examined. The manager confirmed that every service user who enters the home whether care managed or self funding has an initial assessment. The manager is aware that work needs to be done to complete some previous assessments, and how future assessments need to be filled in. The documentation was completed correctly, although this did not cover sleeping routines. This information is then used to inform the plans of care. Galtres Care Home DS0000068222.V325265.R01.S.doc Version 5.2 Page 9 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 adequate. Whilst staff work hard to offer a good standard of care, the lack of appropriate documentation, issues with the medication system and lack of nutritional information compromise the level of care being provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The basic care that staff provide is good, however this is not sufficient to meet all the needs of each individual in the home. Service users looked happy in the home, they looked clean and tidy with groomed hair, trimmed nails and well ironed clothes. One man said ‘the care is really good’ and the staff are great. This was confirmed in many relatives surveys. Staff had a good rapport with the service users and were observed treating them in a kind and gentle manner. Throughout the inspection privacy and dignity was maintained, although it would have been beneficial having toilet signs on doors, and vacant and engaged signs on bathroom doors. Consideration should also be given to having pictorial signs at eye level for those service users with dementia. Four care plans were examined, some information was completed including healthcare professional visits i.e. GP or district nurse, activities participated in, Galtres Care Home DS0000068222.V325265.R01.S.doc Version 5.2 Page 10 moving and handling assessments and the prevention of pressure sore assessment. Four assessments were examined, one checked had very little information regarding daily routines, therefore it was difficult to assess what specific care would be needed to meet the needs of this person with mental health needs. The other three assessments had some information but this was not enough to build up a complete picture of the person. For example regarding sleeping and waking routines one comment was ‘sleeps well’ from this it was unclear if the person get up early or went to bed late, this was also evident with eating and drinking and orientation needs. No specific information was recorded. This is especially important with service users with mental health needs. Two assessments did not mention mental health needs in the initial assessment though staff said the service users definitely had mental health problems. Service users spoken with confirmed that assessments had taken place either at home or in hospital. Overall the care plans were poor, no nutritional assessments were completed (though the form was in the plan) only a few weights had been recorded and it was unclear which service users were at risk nutritionally as the plans of care were either blank or not specific enough. This puts service users at risk and must be dealt with. Care plans had not been reviewed or evaluated though the manager is currently trying to work through them. Currently there is no key worker system in place, though this is being reviewed. one senior carer confirmed she could not read English which meant she was unable to write in the care plans, carry out medication rounds, correspond with healthcare professionals or write details in the accident or complaints book. However, part of this role is undertaken by the administrator. This impacts on service users as at the site visit the manager was away from the home and this senior carer was left in-charge with one other carer (see Standard 27-Staffing). Evidence of visits from the district nurse, GP, chiropodist and optician were evident. One district nurse said the care is good at the home and she had no concerns. The staff in the home felt they had a good relationship with all of the healthcare professionals. The home is aware of how to complete accident forms and these are routinely forwarded to CSCI under Regulation 37. The medication system was checked. A policy is in place and staff are aware of how to administer and dispose of medication. A blister pack system is used and service users confirmed that staff give them their medication on a regular basis. Staff can only administer medication if they have attended training, a member of night staff had to administer the morning medication as the senior carer and carer on the day shift were not trained to do so. The home have a medication cupboard, four charts were checked and these were completed correctly without omissions, currently no monthly stock balance takes place, Galtres Care Home DS0000068222.V325265.R01.S.doc Version 5.2 Page 11 this would be beneficial to ensure there is a clear audit trail of all medication. The home have a controlled drugs book which on one occasion only one signature had been obtained instead of two. The drugs trolley had a secure lock, however this could not be secured to the wall when not in use. The controlled drugs cupboard was unlocked with the key in the door. All these areas must be addressed. A letter of serious concern was issued. Galtres Care Home DS0000068222.V325265.R01.S.doc Version 5.2 Page 12 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. Service users can participate in some activities, with visitors been welcomed and autonomy encouraged. The standard of food and drink provided is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care staff provide some activities for service users. Dominoes, television, newspapers and entertainers take place and these are sometimes documented in individual care plans. One man said staff go out for a newspaper with him, and another confirmed staff go on a trip to the bakers with a few service users. A more planned approach to activities is needed, although this can only take place if there are sufficient staff. On an afternoon staff who have time are involved with activities but this is on an adhoc basis. Surveys confirmed that visits to the church can take place and links with the community in Strensall are encouraged (there are local amenities within walking distance). If the initial assessments are completed more comprehensively staff should have a greater understanding of the likes and dislikes regarding activities and hobbies for service users, this would help plan to ensure the activities match service users needs. Galtres Care Home DS0000068222.V325265.R01.S.doc Version 5.2 Page 13 Staff have a good rapport with visitors and the signing in book confirmed visitors can come at any time. One service user goes to his own home on a weekend to visit his wife and the staff are keen to develop independence and autonomy with all service users. Service users were observed enjoying a cooked meal at lunchtime, homecooked food if offered with fresh vegetables and hot pudding and a choice of drinks. Appropriate napkins, crockery and dining furniture are available (though some is quite worn in the conservatory). Currently there are a range of lounge/dining areas to eat in and service users are generally given a choice. However, it was observed in one of the lounge dining areas that the six service users who needed assistance at mealtimes remained in the chairs they were sitting in from breakfast, to lunchtime without a change of position. This needs to be reviewed to improve the quality of life for these individuals. Meals are offered at a range of times and mid morning and afternoon drinks were observed being offered and enjoyed. At breakfast time cereals, porridge, toast and fruit juices are offered. One man said he would like a cooked breakfast but thought this was not an option. However, it was confirmed by the kitchen staff that a cooked breakfast is always available. The provider did confirm that this was going to be introduced. The kitchen area was examined and a new cook had recently been employed. Staff from the home were attending a seminar regarding the safe food standard agency, this information will be cascaded to the rest of the staff. The kitchen area was clean and tidy and the cook was aware of how to puree food individually and cater for diabetics or those who are overweight. Issues regarding the kitchen space are discussed in the environmental standards. Galtres Care Home DS0000068222.V325265.R01.S.doc Version 5.2 Page 14 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 good. Service users are confident that their concerns will be listened to and acted upon and they feel protected in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users spoken with confirmed they could discuss their concerns with any member of staff including the manager. Surveys returned from relatives confirmed this to be the case and recently a residents meeting has taken place where views and opinions were aired. The home have a complaints procedure in place and the manager is aware of how to act upon any concerns or complaints. The CSCI has not received any complaints regarding this service. Staff are aware of adult protection procedures and how to identify different types of abuse. This was evident when speaking with four different staff. Service users spoken with all said they felt safe and protected in the home. Relatives comments stated staff treat them with dignity and respect. The manager discussed the adult protection procedure and how to whistle blow. She was knowledgeable in the referral system and the action to take regarding employment law when an allegation of abuse is made. The provider has obtained leaflets on abuse and is aware of ongoing training in this area which staff will be attending. Galtres Care Home DS0000068222.V325265.R01.S.doc Version 5.2 Page 15 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 poor. Service users live generally in an unsuitable environment for people with dementia. There is an increased risk of falls, and cross contamination, and a reduced quality of life for some service users because of the inappropriate layout and internal décor of the building. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has recently been taken over by a different provider, a discussion has taken place regarding the improvements needed to ensure the environment is suitable for this client group. Currently the environment is poor, the location of the kitchen, laundry and food store means that staff have to walk through the laundry (where dirty linen is situated) from the food store to get to the kitchen. There is a risk of cross contamination and service users have access to all these areas. There are small steps in different areas of the Galtres Care Home DS0000068222.V325265.R01.S.doc Version 5.2 Page 16 home which pose a trip/fall hazard and the décor is worn and in a poor state of repair. Two rooms have been refurbished to a good standard and the provider is aware that environmental design issues need to be considered for service users with dementia. For example the colour scheme, pictures, signs, defining areas of the home with different colours of paint and promoting independence by using carpet and wall colours effectively. The communal areas are currently used as lounge/dining areas this needs to be reviewed as currently the conservatory area is underused, and the dining experience needs to be enhanced. The environment currently makes it difficult for staff to use a hoist, only one bathroom is easily accessible, the corridors are narrow and there is no lift for service users (though a stair lift is available). Areas of the home smell of urine, and in one service users room there is a constant tapping noise due to the plumbing system. There is also a lack of storage space for equipment. Staff said they have attended infection control training, though no evidence was available to confirm this. Hand washing techniques were observed and handrub was evident throughout the home. In the laundry room there is one washing machine and one tumble drier, both clean and dirty laundry has to go in and out of the laundry room using the same door. There is a housekeeper, though there are times when care staff have to carry out laundry duties (especially overnight). Service users clothes looked washed and ironed and in discussions with service users it was evident that people are happy with this service. Galtres Care Home DS0000068222.V325265.R01.S.doc Version 5.2 Page 17 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. Service users are cared for by experienced staff, though this is compromised due to insufficient numbers of staff who are not recruited in a robust manner. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Due to the poor staffing levels on purchase the Home does at times struggle to provide sufficient staff. At the inspection one senior carer and one care staff were working in the home with a cook, domestic and administrator during the morning. There were nineteen service users with varying degrees of dementia. The manager was on a course and the senior carer was incharge. In discussions with staff it was evident that the night staff usually get up approximately ten service users prior to the day staff starting their shift at 8am, some of these individuals would be already awake, however there was no evidence in the care plans that all these service users requested to be up at this time. During the evening shift there are usually three care staff to help getting people ready for bed, though in the morning this varies form two to three. Overnight there are two care staff which is sufficient. On arrival at the home a carer was administering the morning medication, on further enquiries it was evident that this person had worked the night shift Galtres Care Home DS0000068222.V325265.R01.S.doc Version 5.2 Page 18 then had to come in to administer the medication at 9.30am as the senior carer (in charge) and carer were not trained in doing this. This must be reviewed. The two care staff had to care for nineteen service users, approximately six of which needed two care staff to transfer them, and four of them it was felt had more challenging behaviour. Therefore when the senior carer was busy only one other staff member was available to meet the needs of the other service users. This poses a risk to the service users and members of staff. A letter of serious concern was issued requiring the home to obtain more staff within forty eight hours. The provider was fully aware of the staffing issues and was actively recruiting to resolve this. Some staff have undertaken dementia training and sixty one percent of care staff have achieved an NVQ Level 2 in care. This was confirmed in verbal discussions and in the pre-inspection questionnaire. Surveys returned all commented that staff knew how to care for this client group and no concerns were raised regarding this. Recruitment procedures were discussed with the manager and provider. Staff spoken with confirmed they have received some induction training, though this is not completed yet, and when they were recruited a police check, protection of vulnerable adults check and two written references were obtained. Induction files were available and these were completed, although one member of staff did say that no induction training had been given, evidence suggested this had taken place. Three staff files were checked, on one occasion only one reference was available, though police and POVA checks had been obtained. A discussion took place regarding the hairdresser, the manager felt she had not had a police check, and whilst she is not employed by the home she has regular contact with older people and sometimes she is in a room on her own with them. The manager needs to ascertain what checks the hairdresser herself has undertaken. The hairdresser at lunchtime was observed handling service users and helping them to their chairs to and from the hairdressing room. The manager must be clear about accountability with regards to moving and handling and the risk if a service user had a fall when the hairdresser was assisting them. Galtres Care Home DS0000068222.V325265.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 & 38 Quality in this outcome area is poor. Although service users like living at the home and they are able to air their views, their health and safety needs are compromised due to the manager not been able to carry out her management responsibilities effectively. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has completed her Managers award and NVQ Level 4, she has worked at the home for a number of years and clearly knows the home and the service users very well. She has a pleasant disposition and is keen to progress the service forward. Galtres Care Home DS0000068222.V325265.R01.S.doc Version 5.2 Page 20 The new owners of Galtres are aiming to have the manager supernumerary. Currently she is having to work on the floor when the home is short staffed which then means that her management responsibilities are being neglected. A concerted effort needs to take place to get the documentation up to a reasonable standard and put the systems in place to ensure the smooth running of the home. This cannot happen if the manager continues to have to work as a carer. The manager must be fully aware of both her role and the administrator’s role. The manager is in the process of applying to be the registered manager of Galtres with the CSCI. Service users are able to air their views and opinions through verbal discussions with staff, a residents meeting has recently taken place with the new owners who are fully aware of the improvements that are needed. Surveys completed all confirmed service users and their relatives feel confident in talking to staff about any care issues they may have. Currently there is no formal quality assurance system in place, no auditing of the care plans, medication, accident book, or other documentation systems takes place. This needs to be addressed. Service users finances were discussed, those spoken with said they have pocket money for hairdressing, chiropody or activities where there is a minimum charge. The administrator confirmed this was the case. The home encourages service users or their families to deal with their own financial affairs. One issue regarding service users money has been highlighted by the provider which is currently been investigated by social services. Health and safety in the home was discussed, a range of water temperatures were tested, some of these were too high. Bathroom 2, and service users rooms 1 & 2 were over fifty degrees centigrade. These must be adjusted. Some health and safety certificates were available and these were referred to in the pre-inspection questionnaire. Staff said they had received fire training, moving and handling, and infection control, along with first aid. However, the training records were not available in the home as the trainer for the company was in the process of examining these. However, the provider did feel that some training will have lapsed. Evidence of this needs to be submitted to the CSCI. A fire test currently takes place weekly and a previous visit from the fire officer identified that the fire escape needs to be changed. The home need to carry out their own fire risk assessment of the home, which they are aware of. The emergency lighting was checked in February 2007, along with the central heating system. Galtres Care Home DS0000068222.V325265.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x 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 3 1 x x x x x x 1 STAFFING Standard No Score 27 1 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 1 x 3 x x 1 Galtres Care Home DS0000068222.V325265.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? N/A 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 Service users plans must detail each need with a specific plan of care i.e. mental health needs. Care plans must be reviewed and evaluated on a monthly basis. An audit of the care plans must take place, and any omissions must be corrected. Care plans must be signed and dated with the involvement of the service user or their family. 2. OP8 17 Service users must have their nutritional needs assessed, which includes weight, likes and dislikes and a specific plan of care when a need has been identified. .. 22/03/07 Timescale for action 22/03/07 3. OP9 13 24/02/07 The drugs trolley must be secured to the wall of the medication room when not in use (immediate requirement issued) The controlled drugs cupboard must be kept locked when not in Galtres Care Home DS0000068222.V325265.R01.S.doc Version 5.2 Page 23 use. Temazepam must be signed for in line with the medication policy (two signatures). 4. OP19 OP26 23 A plan of refurbishment for the home must be forwarded to the CSCI. The details below must be included: Specific reference to how the environment will be made suitable for service users with dementia. Details of how cross contamination will be prevented and a good standard of hygiene will be maintained in the kitchen/laundry/food store area. How the communal areas will be improved and risks to safety will be managed. (This can be completed when the improvement plan is requested) 5. OP27 18 Sufficient care staff must be provided on all morning shifts. Two care staff is insufficient for twenty service users. (immediate requirement issued) The manager must ensure the person in charge of each shift is able to fulfil their role appropriately. Evidence of two written references must be available in each staff file. The manager must ensure the hairdresser has had appropriate checks to work with this client group. Galtres Care Home DS0000068222.V325265.R01.S.doc Version 5.2 Page 24 22/05/07 24/02/07 6. OP29 19 01/03/07 7. OP33 24 The provider must implement a quality assurance system which includes seeking the views and opinions of service users and their relatives, and regular auditing of documentation used. The provider must supply evidence to the CSCI of mandatory training that has taken place in the past 12 months for all staff. The provider must carry out a fire risk assessment of the home. 22/04/07 8. OP38 13,23 22/03/07 9. OP38 13 All water temperatures in bathrooms and service users rooms must be rechecked to ensure they are not above 43 degrees centigrade. 01/03/07 Galtres Care Home DS0000068222.V325265.R01.S.doc Version 5.2 Page 25 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 A monthly stock balance of medication should take place. The fridge in the medication room should be kept secure when not in use. 2. OP10 Consideration should be given to having more appropriate signs on toilets and bathrooms, with engaged and vacant or pictorial information on. This needs to be suitable for those service users with dementia. A review of the activities provided is needed (this should be acted on once sufficient staff are in place). A review of the use of the communal areas for mealtimes should take place to ensure service users are not sat in one seat from breakfast, over lunchtime and during the afternoon and evening. A review of the role of the administrator should be made. 3. 4. OP12 OP15 5. OP31 Galtres Care Home DS0000068222.V325265.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ 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 Galtres Care Home DS0000068222.V325265.R01.S.doc Version 5.2 Page 27 - 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!