Inspection on 05/09/06 for Ganarew House

This inspection was carried out on 5th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

Ganarew House 18/12/08

Ganarew House 05/12/07

Ganarew House 23/01/07

Ganarew House 08/02/06

Ganarew House 25/10/05

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

CARE HOMES FOR OLDER PEOPLE Ganarew House Ganarew Near Monmouth Monmouthshire NP25 3SS Lead Inspector Denise Reynolds Unannounced Inspection 5th September 2006 08.20 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 Ganarew House DS0000065335.V307070.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. Ganarew House DS0000065335.V307070.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ganarew House Address Ganarew Near Monmouth Monmouthshire NP25 3SS 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) 01600 890273 Milkwood Care Limited Care Home 17 Category(ies) of Dementia - over 65 years of age (17), Old age, registration, with number not falling within any other category (17) of places Ganarew House DS0000065335.V307070.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Until a manager is appointed by Milkwood Care Ltd and registered by CSCI, Janet Lloyd-Leech (Responsible Individual) and Marion Flett (Group Manager) will between them spend a minimum of 30 hours a week at Ganarew House. 30/05/2006 Date of last inspection Brief Description of the Service: Ganarew House is a converted country house in a rural hamlet between the towns of Ross on Wye and Monmouth. The setting is very attractive with views over open countryside and large gardens. The Provider, Milkwood Care Ltd took over the Home on 4th October 2005 from the previous owners who had run the Home for over 15 years. The Provider is registered in respect of the Home to provide care for up to 17 people with care needs relating to the ageing process or the effects of having a dementia illness. The new Providers are currently having an extension to the premises built. When finished, this will increase the number of people that can be accommodated. Information provided in the pre inspection questionnaire states that the current range of fees for Ganarew House is from £350 to £500 per week. Additional charges are made for hairdressing, chiropody and newspapers. Ganarew House DS0000065335.V307070.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the report on a key inspection. This involved one visit to the Home starting at 8.20am and ending at 6.55pm. Before the visit we sent the acting manager a pre inspection questionnaire and consultation leaflets for people living in the Home. We also sent comment cards to relatives of people living at the Home. We received one reply from a resident and thirteen from relatives. Eight relatives were spoken to on the phone because of the length of time between receiving the comments cards and the actual inspection. No information was received from health or social care professionals. During the visit two staff were interviewed and three residents spoken to privately. One person had visitors and they were also spoken to privately. There were discussions with the acting manager about the way the Home is operating. What the service does well: The residents feel well looked after and relatives are satisfied with the quality of the care. Residents feel safe and they and their relatives are confident that they can raise concerns if they have any. Some of the residents spoken to said they miss the staff who left recently but like the new staff too. All the residents spoken to liked the acting manager and the owners of the Home, one said, “they are for the people you’ll find” and described the acting manager as “marvellous” and the staff as “very willing”. A range of activities is provided and residents enjoy taking part in these. One person said how much she enjoys the local weekly tea dance and going out in the minibus for trips like a recent one to a garden centre. Visitors are welcomed in the Home at any time and they appreciate the relaxed and welcoming atmosphere. Although catering is disrupted by the lack of a proper kitchen while a new one is installed, the residents all say that they enjoy the food provided by an outside caterer while this is being done. The general view was that the food is hot and appetising. Ganarew House DS0000065335.V307070.R01.S.doc Version 5.2 Page 6 A number of matters of concern needing urgent attention were drawn to the attention of the providers. They responded promptly and indicated that they had dealt with these issues within the timescales set down. What has improved since the last inspection? What they could do better: It would be beneficial for the pre admission assessment information obtained by the Home to contain more detail about the care the person will need. This is to make sure that the Home can offer the person the right care. It is also important for staff to have an understanding of the circumstances that have led to a person needing to come to the Home so that they are prepared to provide support and care as soon as they arrive. The information in the care plans needs to be more detailed to make sure they describe the care needed and reflect each persons’ views and wishes. Certain aspects of care need to be managed more effectively, for example weight loss and pressure area care. The home has specialist registration to accommodate people who have dementia illnesses. They need to continue to develop staff training and care planning to make sure that people with this type of care need receive the individualise support they need. Ganarew House DS0000065335.V307070.R01.S.doc Version 5.2 Page 7 Day to day life for people living at the Home could be enhanced by providing more individual activity based on individual preferences interests and abilities. The management of medication needs to be improved to ensure that it is safe. An official letter was left at the home to require them to keep keys for medication cupboards safe. There are accepted difficulties in keeping a building clean when building work is taking place nearby; however, the lack of cleanliness found during this inspection could not all be put down to this as a cause. For example, two beds were checked and it was found that the bedding was not clean and clothing waiting to be washed had been left in piles on the laundry floor. Similarly, the temporary kitchen and surrounding areas were not clean and hygienic. An official letter was left at the home requiring them to make sure that the kitchenette and the laundry were cleaned promptly. The Home’s arrangements for the training and deployment of staff do not ensure that there are always enough suitably trained and competent staff on duty to meet the needs of the residents. An official letter was left at the home requiring them to provide induction training in fire safety for all staff working in the home overnight with effect from the night of the inspection. Recruitment practice needs to be improved to ensure that the possibility of employing unsuitable staff is minimised. The acting manager is not aware of the full range of responsibilities required by legislation and has not been well supported by the organisation. The lack of strong management has resulted in shortcomings in the service that could put residents at risk. In view of the involvement of the responsible individual and group manager for 30 hours a week as agreed with the Commission, it is of serious concern that the matters identified by inspectors have developed. 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. Ganarew House DS0000065335.V307070.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 Ganarew House DS0000065335.V307070.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (Standard 6 does not apply to Ganarew House). Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home gathers information about prospective service users before offering them a place at the home. This means that there is information for the Home to make a decision about whether it can meet the care needs of service users before offering them a place. EVIDENCE: The file for the most recently admitted resident was examined. This contained a pre admission assessment. This needed to contain further information to provide guidance for the initial care plan. Although health and social care professionals are involved in the person’s care, there was no evidence of discussion between them and the Home to make sure all the person’s care needs were recognised and included in the care plan. The acting manager said she had tried to get more information without success. There was no record to show how or when she had done this. Ganarew House DS0000065335.V307070.R01.S.doc Version 5.2 Page 10 There were pre admission assessments on other files that were examined. These also needed further detail. Ganarew House DS0000065335.V307070.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, and 10. Quality in this area is poor. This judgement has been made using available evidence including a visit to this service. The residents feel well looked after and relatives are satisfied with the quality of the care. The care plans need to be developed to provide more detail about each persons care needs making sure they cover all aspects of residents’ health, safety and welfare and reflect their views and wishes. The management of medication needs to be improved to ensure that it is safe. EVIDENCE: The residents and relatives were positive about the care at Ganarew House. One relative commented that she thought that recent changes had been for the better and that she is very happy with things, another that the care is very good and that her relative is always clean and nice. A further person said, “The staff have always been kind, helpful and considerate to my mother and myself.” One resident said, “Very friendly, homely place. Caring and supportive.” Ganarew House DS0000065335.V307070.R01.S.doc Version 5.2 Page 12 Residents have a plan of care in their individual file. On each file examined a representative of the service user had signed a form to indicate that they did not wish to be involved in the care planning process. Each care plan contains a list of dates showing the plans are reviewed monthly or more frequently if required. The information in the care plans provides staff with a basic framework to work consistently with the residents. This needs more depth so that care staff are provided with guidance about the nature of the care they need to provide. A number of examples were seen where there was no explanation about why certain help was needed, when it was needed, how often or who by. A simple example of this was the phrase “needs assistance with personal care” which does not guide staff as to specific actions to be taken. There was no information about oral care in any of the files examined. The lack of detail in the care plans is of particular concern for residents with very complex care needs. One person had lost weight over recent months but there was no nutritional assessment or indication in the file that this weight loss had been taken into account in the provision of care. Another person has a health care need that calls for specific dietary guidance and precise instructions about personal care, neither of which were available. Further examples that were identified included lack of attention to pressure area care, visual impairment needs and certain health related care needs. A number of service users have dementia illnesses. There was no information in the care plans to specifically provide staff with guidance about how to manage the issues arising from each individual’s dementia illness. There was a sheet in each resident’s file for contacts with health care professionals. These had not been completed after each contact and it was difficult to find out when and why residents had been referred for attention. There was no skin care assessment on the file for a resident with pressure area care needs and it was not possible to find out from the plan of care or daily record what action had been taken. The daily record did not show that staff were attending to this daily or monitoring progress or deterioration. The last entry was on the 29th August, a week before the inspection and this indicated that the area was very sore. The manager said she had checked the sore area herself on the Friday before the inspection (1st September) but there was no record of this. Staff said this sore area is an ongoing problem and the cream used agreed with district nurses some time ago. Staff did not feel that a district nurse needed to be asked to give guidance. The inspector’s opinion based on the description written in the daily record was that a nurse should be asked to visit and this was drawn to the acting manager’s attention. The daily recording in the file of a resident who has been unwell showed good observation by staff and communication with the GP. Ganarew House DS0000065335.V307070.R01.S.doc Version 5.2 Page 13 The specialist pharmacist inspector carried out an inspection at Ganarew House in June 2006. A number of requirements and recommendations were made and these had been attended to. There were aspects of the practice with regard to the management of medication that remained unsafe. There were prescribed medications kept on top of the medication cupboard and accessible to all in the Home, the record of administration was signed before residents had been given their medication, the key to the Controlled Drugs cupboard was kept in an unlocked drawer and accessible to all in the Home and recording in the Controlled Drugs Register was unclear. A chiropodist visits the home. One relative commented that they were concerned about the use of the dining room for chiropody with regard to hygiene issues. On the day of the inspection a dentist visited one resident in her bedroom, where she was able to have her treatment in private, and she was there and prepared well in advance of the visit. There is no lock on one of the ground floor bathrooms. This means that residents and visitors are unable to be sure of privacy whilst in the toilet. Staff members were observed opening toilet doors whilst residents were in there without taking sufficient care that they were not exposed to anyone passing by. Privacy screens have not been provided in the shared rooms. Ganarew House DS0000065335.V307070.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this area is adequate. This judgement has been made using available evidence including a visit to this service. A range of activities is provided and residents enjoy taking part in these. This would be improved by the consideration of individual interests and abilities. Visitors are welcomed in the Home at any time and they appreciate the relaxed and welcoming atmosphere. The catering is disrupted by a kitchen upgrade but the residents all say that they enjoy the food that is provided in the Home. EVIDENCE: The pre-inspection questionnaire submitted by the Home lists as activities provided – • Music and movement • Video afternoons • Bingo • Knitting • Manicures • Singalongs • Jigsaws • Flower arranging • Outings Ganarew House DS0000065335.V307070.R01.S.doc Version 5.2 Page 15 There was a poster in the hall saying what is on this month. One resident said that she had recently been out for a drive in a minibus and the acting manager reported that the Home is scheduled to have a half share in a minibus within the next few weeks. One person mentioned the accordion player and there were references in records to residents attending local tea dances. There were no references in care plans to residents preferred activities, bearing in mind their individual abilities or impairments and no evidence that consideration was given to ways of providing these. A file is kept in the hall in which residents, and other people could write any suggestions that they had for improvements in the Home. There were lots of ideas written down and it was positive to see that residents felt able to make good use of it. The kitchen had been gutted and work had started on installing a new kitchen. The acting manager said it was expected that this work would take three weeks. A temporary kitchen area provided a base for washing up and limited storage (see the accommodation section of this report). Breakfast and tea were being provided from the dining room with the main meal of the day brought in by outside caterers during this period. Breakfast was cereals and toast with a roast chicken dinner at lunchtime. The residents all said that the meals were good and they were enjoying the food provided for them. Ganarew House DS0000065335.V307070.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this area is adequate. This judgement has been made using available evidence including a visit to this service. Residents feel safe and they and their relatives are confident that they can raise concerns. This needs to be supported by an effective complaints management process and adult protection training for all staff. EVIDENCE: There was a poster displayed in the hall informing people how to make a complaint. At the inspection the acting manager said that there had been no complaints. There was a complaints log in the Home in which to record receipt of complaints and write about any action taken to investigate what had happened. In the pre inspection questionnaire the Responsible Individual who filled in the form reported that there had been one complaint. The Commission is aware of one further complaint received by the Home since that time. Although none of the 13 relatives who returned comment cards had needed to make complaints, only 4 said they were aware of the Home’s complaints procedure. They had been provided with this information in the homes statement of terms and conditions. The residents spoken to said they feel safe at the Home and would happily speak to the acting manager or owners if they had concerns A recent high turnover of staff means that only a small proportion of the staff team have received training about the protection of vulnerable adults and the correct procedures to follow if abuse or neglect is suspected. Ganarew House DS0000065335.V307070.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this area is poor. This judgement has been made using available evidence including a visit to this service. Areas of the house are not clean and this causes a health and safety risk for the residents. The premises are being upgraded and a new extension is being built which should improve the current facilities in the Home. EVIDENCE: An extension is in the process of being built at Ganarew House and this is causing some disruption to the daily functioning of the Home. Workmen were seen in some areas of the Home and at one point the electricity supply was severed, although power was restored very quickly. The inspectors looked round the building as part of the inspection. There were parts of the home that were not clean or hygienic. Ganarew House DS0000065335.V307070.R01.S.doc Version 5.2 Page 18 • • • • • • • • • • The kitchen had been removed and a temporary area was being used for dishwashing and some limited storage. This area had been an access point for the workmen and had not been cleaned before being brought into use for the residents. It was dirty. The bin in the temporary kitchen was full before lunch and the lid was soiled. The home has three cats and their litter tray was kept close to the temporary kitchen area. This was attracting flies not only into the kitchen but also into other rooms. The laundry was also in this area. The cat’s food bowls were kept in there and food had spilled onto the floor. Residents’ dirty washing was seen on the floor by these bowls. The floor in this room was also dirty. The sink in the laundry was dirty. There were toilets that were unclean. There were two beds where the bed linen was unclean. There were a large number of swallows’ nests in the eaves of the house. The windows below these were badly soiled with droppings. There were two rooms that smelled offensive. In the view of the inspectors the odour was caused by urine. An unused bath in an ensuite bathroom had been covered with sheets of wood. These had holes cut in them – possibly to use as handle to remove the wood. An inspector lifted one of these and found a faeces soiled tissue in the bath. One bathroom on the ground floor does not have a lock. This affected the privacy and dignity of residents and visitors to the Home. There are two residents’ rooms where the residents do not have access to a call bell. This provision has been attached to a pressure mat outside their bedroom so that staff are alerted in the event of them leaving their room. This means that the residents have no means of calling for staff assistance from inside their rooms. The lounge and dining room on the ground floor, where most of the residents spend the waking day, are comfortable and homely rooms. Earlier in the summer the second floor rooms had to be taken out of use due to a prohibition order by the Fire Service. This came about due to concerns about safety at night following the removal of both external fire escapes to make way for the extension. This was resolved by upgrading other fire precautions in the building and by having 3 staff on the premises every night. Ambulant residents were able to return to their second floor rooms but one person with very poor mobility was unable to on the advice of the Fire Service. Ganarew House DS0000065335.V307070.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this area is poor. This judgement has been made using available evidence including a visit to this service. Whilst resident and relatives were complimentary about staff, there are times when the number of staff on duty is not sufficient to meet the care needs of the residents. The Home’s arrangements for the training and deployment of staff do not ensure that there are always enough suitably trained and competent staff on duty to meet the needs of the residents. Poor recruitment practice means that residents are not protected from the possibility of unsuitable staff working in the Home. EVIDENCE: There were rotas available to show the staffing arrangements for that week and the proposed arrangements for the next three weeks. The manager reported that the rotas for previous weeks had been thrown away. The acting manager was informed that they were a statutory record that should be kept for three years; she explained that she had not known this. Examination of the rotas that were available showed that there are times when there are two staff on duty in the home with no ancillary support. This is not sufficient to provide care and support for seventeen residents some of whom have high dependency needs. At the time of the inspection the cook was on holiday because the outside caterers were cooking the main meal of the day. This meant that the cook was not available to help care staff serve lunch. The Ganarew House DS0000065335.V307070.R01.S.doc Version 5.2 Page 20 evidence in the home of lack of cleanliness indicates that there are not sufficient domestic hours. Discussion with the residents and their relatives indicated that they were aware of the recent number of staff who had left Ganarew House. The general view was that this had not caused much disruption and that they liked the new staff. Milkwood Care Limited is improving the overall level of training the staff have received. There was evidence that staff have attended a number of appropriate training courses. There remain gaps in the training that staff are expected to have received, for example one senior carer has not taken training in moving and handling since 2002 and this should be updated each year, nor had she done food hygiene training since 1984. None of the staff have completed a First Aid at Work course to qualify them to take a lead role in first aid, although eleven staff have taken appointed persons first aid training. No staff have done fire safety training aimed at managers of care services covering fire safety risk assessment and equipping them to provide staff with in house fire training. Staff have been rostered on duty at night without having had fire safety induction training. Limited training has taken place in other care related topics such as continence management, mental health, challenging behaviour and pressure area care although there are residents living in the home with these type of care needs. Training had been arranged in stoma care to inform the staff of how to provide care for residents with these needs. The home is registered to accommodate people who have dementia illnesses. The evidence about staff training indicated that few of them had completed any training in this area. A number of staff have achieved an NVQ qualification and further staff are enrolled to start NVQ training in September. Staff files were examined. The information in these showed that the recruitment and selection processes in the Home are not carried out to a satisfactory standard. Application forms had not been fully completed and staff had started work without a minimum of a POVAfirst and two written references. A full employment history had not been obtained and there was no satisfactory written explanation of any gaps in employment as required. In one case a reference had been accepted from a person’s colleague. This should have been obtained from the personnel department of the official organisation for which the person had worked. In one file examined there was no evidence that a new member of staff, who had not previously worked in the care sector, had received induction training. An induction checklist and monitoring of practice form was seen on another staff file. This did not amount to genuine induction in line with the standards set down by Skills for Care the lead body for training in social care. Ganarew House DS0000065335.V307070.R01.S.doc Version 5.2 Page 21 The information in some files was incomplete. For example they did not all contain the expected proof of identity including a recent photograph, full training information or dates on which that person started to work in the home or the position they held and the number of hours worked. There is evidence that the home does not have a reliable process for scrutinising the results of pre-employment checks on prospective staff. There was at least one night when two young and inexperienced staff were rostered together on duty overnight. This is poor management practice. They had not carried out their duties appropriately, which had led to disciplinary proceedings being taken. One member of staff had brought their child into the Home for the duration of their shift at work. This is not appropriate practice and should not happen when staff are working because they may not be able to carry out their duties fully and would have a difficult choice to make between the residents and the child if there was an emergency. Ganarew House DS0000065335.V307070.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 and 38 Quality in this area is poor. This judgement has been made using available evidence including a visit to this service. The acting manager is not aware of the full range of responsibilities required by legislation and has not been well supported by the organisation. The lack of strong management has resulted in shortcomings in the service that could put residents at risk. EVIDENCE: The acting manager is working towards obtaining the registered manager’s award. She has been in post since the provider bought the Home in October 2005. A condition of registration that the Responsible Individual and Group Manager spend 30 hours a week at the Home whilst there is no registered manager could not be fully reviewed because they are not shown on the rota and there was no record of their visits. In view of the 30 hours per week Ganarew House DS0000065335.V307070.R01.S.doc Version 5.2 Page 23 involvement of the Responsible Individual and the Group Manager of it is of serious concern that the matters identified by inspectors have developed. Residents and relatives spoke about the acting manager very positively, finding her friendly and approachable. Throughout the inspection she was helpful and constructive and showed a willingness to learn from the concerns drawn to her attention. There were several areas identified during the inspection that indicated the acting manager’s lack of knowledge and understanding about the role of manager of a care service. These included not knowing what is required by law e.g. she had thrown staff rotas away because she didn’t know they were a statutory record that must be kept for 3 years and had not informed CSCI about notifiable events because she was unaware of the types of things that should be notified. Other issues described in this report, such as the concerns about care planning, cleanliness, medication and staff recruitment show both a lack of knowledge and of effective management skills. Serious shortcomings were found in how a resident’s money is being dealt with. Staff had taken the person to the bank on two occasions. There was no record of how much had been withdrawn or of how this money had been spent. There was no evidence to show the current balance of the service user’s personal money or where this is being held. Staff said it had been put in the controlled drug cupboard; this was checked but no money was found there. It was only when the inspectors pointed out this information that the acting manager was aware that money had been withdrawn from the bank twice and appreciated the potential seriousness of the situation. She said the only thing she could think of was that the Group Manager might have taken the money to the organisation’s head office. No structured staff supervision has been established. The acting manager said she takes part in management meetings but does not have individual support/supervision meetings focused on her professional development. She confirmed that she has not had training relating to structured staff supervision. The manager was not able to find the reports of the statutory monthly visits carried out by the provider after April 2006. Ganarew House DS0000065335.V307070.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 X X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 1 X X X X X X 1 STAFFING Standard No Score 27 1 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 1 1 X 1 Ganarew House DS0000065335.V307070.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 & 17(1) Requirement The information recorded in the service user plans must be more comprehensive in order to provide staff with a clear picture of service users ongoing care needs and how these are to be met. Service users must receive where necessary, treatment, advice and other services from any health care professional for example, from a community nurse in respect of pressure area damage. Arrangements must be made to ensure that keys to the medication storage are available only to designated staff and cannot be accessed by service users or members of the public. The registered person must make arrangements for the safe keeping of medication. The registered person must make arrangements for the recording of medication. In particular – • The CD register must make clear the location of DS0000065335.V307070.R01.S.doc Timescale for action 31/10/06 2 OP8 13(1) 08/09/06 3 OP9 13(2) 05/09/06 4 5 OP9 OP9 13(2) 13(2) 07/09/06 07/09/06 Ganarew House Version 5.2 Page 26 6 OP26 13(3) & 23(2)(d) 16 7 OP22 8 OP27 18 & 23 9 OP27 17(2), Schedule 4 10 OP29 19 11 OP29 19 12 OP29 19 13 OP30 18 storage of any medications detailed. • Staff must sign the record of administration as each service user has taken their medication not before. The temporary kitchenette and the laundry must be cleaned and then kept clean. Dirty laundry must not be left/put on the floor. The registered person must ensure that call bells with an accessible alarm facility are provided in every room. The registered person must review the numbers of domestic staff employed to ensure that they are sufficient to keep the home clean and hygienic. The registered person must ensure that the staff rota includes details of all staff on duty and in what capacity. The rota must show the actual hours worked. Staff recruitment procedures must be improved to make sure that staff are appointed in accordance with the requirements of regulation. (Previous timescale of 30/06/06 not met) The registered person must obtain all the information and fully completed documents required by regulation for all staff already employed at the Home. The registered person must ensure that any staff for whom a full CRB certificate has not yet been obtained is supervised as required by regulation. The registered person must put in place a training and development plan for the Home to ensure that staff receive all DS0000065335.V307070.R01.S.doc 06/09/06 20/09/06 30/09/06 07/09/06 07/09/06 30/09/06 07/09/06 31/10/06 Ganarew House Version 5.2 Page 27 14 OP31 8 15 OP35 17(2) Schedule 4 16 OP37 37 17 18 19 OP38 OP38 OP38 13(3) & 23(2)(d) 23(2) 13(4) 20 OP30 OP38 23(4) the training they need to carry out their particular role knowledgably and safely. This must include suitable induction, core health and safety, and care related training. The registered person must ensure that an application is submitted to the Commission, from a suitably qualified, competent and experienced person, for registration as the manager of the Home. The registered person must keep a record of all money or other valuables held for safekeeping on a resident’s behalf. A written record of all transactions must be maintained. The registered person must ensure that notifications are made to the Commission in line with the requirements of Regulation 37. Arrangements must be made to prevent the risk of infection from the cat litter. The registered person must make sure that all parts of the Home are kept clean. The registered person must ensure the health and safety of service users by ensuring the safe storage of hazardous substances. Care staff must not be left on duty in the home overnight unless they have attended fire safety induction. 15/10/06 07/09/06 20/09/06 06/09/06 13/09/06 07/09/06 05/09/06 Ganarew House DS0000065335.V307070.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard DO9 Good Practice Recommendations Medication records would be strengthened if the following practices were introduced: All allergy boxes completed A sample list of staff initials used on administration records Initials of the two staff who check transcribed instructions to be shown on the relevant administration record Re-write, rather than alter existing instructions on administration records. (This recommendation was made at a previous visit and was not reviewed on this occasion) The registered person should review the deployment of staff to ensure that there are sufficient care and ancillary staff on duty throughout the waking day to meet the needs of the service users and to ensure that the ancillary tasks are undertaken. The registered person must ensure that staff do not take their child/ren to work when they are on duty. 2. DO27 3. DO27 Ganarew House DS0000065335.V307070.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ganarew House DS0000065335.V307070.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. 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. 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