Inspection on 25/11/08 for Garsewednack Residential Home

This inspection was carried out on 25th November 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Garsewednack Residential Home 30/05/08

Garsewednack Residential Home 20/08/07

Garsewednack Residential Home 20/06/06

Garsewednack Residential Home 15/11/05

Garsewednack Residential Home 16/05/05

Garsewednack Residential Home 25/02/05

Garsewednack Residential Home 13/12/04

Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Garsewednack Residential Home 132 Albany Road Redruth Cornwall TR15 2HZ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Ian Wright     Date: 2 5 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Garsewednack Residential Home 132 Albany Road Redruth Cornwall TR15 2HZ 01209215798 01209215798 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Nicola Carla Brazier,Mr Neil Edward Brazier,Mrs Anne Brazier Type of registration: Number of places registered: care home 21 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: Service users to include up to 21 adults of old age (OP) Service users to include up to 4 adults over 65 years with Dementia (DE) [E] Service users to include up to 4 adults over 65 years with a mental disorder (MD) [E] Total number of service users not to exceed a maximum of 21 Date of last inspection Brief description of the care home Garsewednack provides personal care for twenty-one older people. Four people living in the home may have dementia, and four other people who use the service may have other mental health needs. The home also provides day care for some people. The Care Homes for Older People Page 4 of 33 Over 65 4 4 21 0 0 0 Brief description of the care home registered providers are Mrs Anne Brazier, and Mr Neil and Mrs Nicola Brazier. The providers purchased the home in August 2003. Mr N and Mrs N Brazier also own another residential care home in Newquay. The manager Ms Alison Smith supervises care and the staff team on a day-to-day basis, although she is not registered with the Commission as the manager. The accommodation is on two floors. There is a staircase and stair lift, which allows access to the first floor. There are 19 single bedrooms and 2 shared bedrooms. A minority of bedrooms have en suite facilities. There are sufficient shared toilet and bathroom facilities. There are two lounges, a dining room and garden area accessible to people living in the home. A copy of the inspection report is available in the hallway. It is suggested a copy is requested from management if required. Alternatively a copy is available free of charge from the CSCI website, or via our customer services team, details of which are on the back page of this report. The range of fees at the time of the inspection is £360 to £450 per week. There are additional charges e.g. for hairdressing, chiropody, and newspapers etc. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Two inspectors completed this unannounced inspection in one day. The methodology used for this inspection was: *To case track people who use the service. This included, where possible, meeting and discussing with the people concerned their experiences and inspecting their records. *Discussing with staff members their experiences working in the home. *Discussion with other people who use the service and their representatives. *Observing care practices. *Discussing care practices with management. *Inspecting records and the care environment. Other evidence gathered since the previous inspection such as notifications received from the home (e.g. regarding any incidents which occurred) were used to help form the judgments made in the report. Care Homes for Older People Page 6 of 33 Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 33 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information provided to people who use the service (e.g. regarding services offered) is satisfactory. For example all people who use the service receive a statement of terms and conditions of residency or contract when they move in. This ensures people are aware of their rights and responsibilities. Pre assessment procedures are satisfactory , although notes of contacts prior to admission need to be maintained. Overall assessment procedures ensure the registered provider checks they can meet the persons needs before admission is arranged. Evidence: The registered provider outlined a satisfactory assessment procedure. For example we were told a senior member of staff will visit the persons home/ the hospital, to meet them. People are able to visit the home before moving in. We inspected files for two people who had moved to the home since the last Care Homes for Older People Page 10 of 33 Evidence: inspection. Records showed an assessment was completed by a senior member of staff regarding these people. Notes from the actual visit, and contacts prior to admission, should be maintained on file. We were able to inspect contracts / statements of terms and conditions of residency for two people using the service, and information seems satisfactory. Care Homes for Older People Page 11 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Health and personal care needs of people living in the home appear to be satisfactorily promoted and met. However it is essential each person has a moving and handling assessment, and there is information regarding when a person last saw medical professionals so regular checks can be maintained. The management of medication is only adequate. This requires further improvement so medication is managed safely. Care staff are viewed positively, and we were told by people using the service that staff treat them with respect and dignity. However, a matter regarding whether some people should have a single bedroom still needs to be resolved. Improvement regarding these matters will ensure peoples personal care and health needs are met to a higher standard. Evidence: A care plan was contained in the files for the people we casetracked. These are basic, but contain satisfactory information. There is evidence care plans are reviewed. Care plans are accessible to staff. It is essential each person has a moving and handling assessment. The requirement issued at the last inspection is therefore renotified. A Care Homes for Older People Page 12 of 33 Evidence: risk assessment has been completed regarding the use of cot sides on beds. This was required at the last inspection. People who use the service, who we spoke to, were positive about the care they received. However they did not appear to be aware of their care plan or any involvement in the process. People who use the service said they were satisfied with the health care support they receive. This includes visits from GPs, district nurses, chiropodists, dentists and opticians. However medical interventions still need to be more clearly recorded within care records e.g. when somebody last saw a dentist, chiropodist or optician etc. The previous requirement regarding this is renotified. The manager confirmed people using the service are now accompanied to hospital appointments, as necessary, which was required following concerns raised prior to the previous inspection. The policy regarding medication needs to be more comprehensive. For example it must include (1) information regarding the storage and use of oxygen (2) use of insulin (3)guidelines regarding when to administer as required or PRN medication. A copy of the current Royal Pharmaceutical Guidelines should be obtained (as outlined in the previous inspection report dated 30th May 2008), and referred to in the redrafting of the homes policy. We inspected the medication system. Some improvement regarding the operation of the system is required: * Records of medication added to pre printed medication charts should be countersigned by a second member of staff. * It should be possible to ascertain how many tablets (etc.) are held in stock. For example stock totals should be brought forward and carried forward from/to each administration period on the medication sheet. *The packaging of creams held should be dated when opened. * Disposal records need to be available for inspection. * A suitable system needs to be in place if controlled drugs are stored and administered. For example there needs to be a controlled drugs cabinet (in accordance with Royal Pharmaceutical Society Guidelines), and a controlled drugs book. *There must be appropriate signage where oxygen is stored. *There needs to be clear protocols for the administration of as required / PRN medication. Storage and records of general prescribed medication has improved since the last inspection. However we did note instructions regarding the dosage of one persons medication was incorrectly recorded by staff on the medication sheet. We also noted two tablets were loose in the cupboard and it was not clear what the tablets were or who they were prescribed for. In regard to one persons medication it was recorded the person had received the medication, although this was still in the container. Staff appear to have received training regarding handling medication. It is essential Care Homes for Older People Page 13 of 33 Evidence: the registered provider checks the CSCI guidance (as referenced in the inspection report dated 30th May 2008) to ascertain the training delivered meets the required standard. It is important that senior staff involved in this training receive full training to deliver this. For example, if they have not received an update in formal external training in the last three years, they should receive a refresher preferably from a pharmacist. We spoke to several people who use the service who were complimentary about the care they received. People said they felt their privacy and dignity was respected by staff. People said they were always referred to by their preferred name. The previous requirement to fit foot plates to wheelchairs has been complied with. However, we are concerned that a matter regarding whether it is appropriate for two people to share a bedroom has still not been resolved. This situation is outlined in our inspection report dated 30th May 2008. The manager of the home said both people had said to her they did not want their own bedrooms and were happy to share. We spoke to both people again at this inspection. One person was very clear they would like their own bedroom. The registered provider said she would ask the Department of Adult Social Care to visit the women to ascertain if they would like their own rooms. We have also discussed the matter with the Care Manager concerned. The registered provider therefore needs to make contact with DASC to arrange for social services to visit.It is clear in the national minimum standards that people sharing bedrooms should be offered their own room when one becomes available. Care Homes for Older People Page 14 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Routines, food and opportunities meet the needs of the people living in the home Evidence: People using the service, who the inspector spoke to, said they could get up and go to bed when they wished, and said routines in the home are relaxed. People, who we spoke to, said they could spend their time in their bedroom or in one of the lounges according to their wishes. Some activities are available to people living in the home. For example there are several organised sessions planned over the next month from different musical entertainers. Staff also organise other activities and these are displayed on a notice board. Some people are happy to organise their own time either reading, watching TV or listening to music. Some people said they were fed up with the TV being on all the time in the lounge. Management acknowledged this, but we all concluded it is difficult to please everyone in the lounges as some people want the TV on. Some people receive regular visitors, and some people go out with relatives. People are positive about the food provided. This appears to be to a good standard. Care Homes for Older People Page 15 of 33 Evidence: There is not a choice of main meal but people said it is always nice. There is a choice of evening tea, and people appear to have hot and cold drinks / snacks available to them. Suitable records of food eaten are kept. Care Homes for Older People Page 16 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered provider has satisfactory complaints and adult safeguarding procedures. These should help ensure any complaints, concerns and allegations are investigated appropriately should they occur. Evidence: A copy of the complaints procedure was inspected and this appeared to be satisfactory. The registered provider said they have not received any complaints during this inspection period. The Commission has not received any concerns or complaints. We advised the registered provider to include information regarding access to the social services complaints procedure within their procedure and the service user guide. People who are funded by local authorities have a right to use this procedure if they are funded by social services. The registered provider has a satisfactory Adult Safeguarding procedure. There have been no adult safeguarding issues recorded. Some staff have received training regarding adult safeguarding, and other staff will be trained as opportunities become available either internally or from Cornwall County Council. Care Homes for Older People Page 17 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Garsewednack provides a pleasant environment for the people living there. However locks on bathroom and toilet doors need to work,and we recommend locks are fitted to all bedroom doors. These measures will improve peoples privacy and security. Evidence: The building was inspected. There is suitable shared space, for example, two lounges and a dining room. Communal rooms seem pleasant and homely. Toilet and bathroom facilities are suitable in size and facilities provided. Soap and paper towels were available in bathrooms and toilets. These facilities were clean on the day of the inspection. Following the last report the registered provider fitted locks to all toilet and bathroom doors. However some of these have broken again and need to be repaired. The previous requirement is therefore renotified. We advised there were too many memos and notes on the bathroom walls. It is unlikely these will be effective after a while, and certainly detract from providing a homely and welcoming atmosphere in these facilities. If such memos are necessary they could be within a folder in the office which staff are required to read and sign. Bedrooms are generally decorated and furnished according to individual tastes. People who use the service said they were able to bring their own furnishings and belongings with them when they moved in. Call bells appear to be accessible to people who use Care Homes for Older People Page 18 of 33 Evidence: the service. The majority of bedrooms do not have a working lock on the door. Some have a plastic lock, but the majority of these are not working. The registered provider said people are asked if they want a lock on their bedroom door when they move in and this is recorded on the persons file. We did also see a risk assessment on some peoples files stating it was not suitable for these people to have a lock. It should be the default position of the home that there is a lock on each bedroom door, and people are issued a key if appropriate. This measure is recommended to the registered provider and should be given serious consideration. Parts of the home inspected seemed clean, were warm and light enough on the day of the inspection. The kitchen also was clean. Laundry facilities seem satisfactory. Gloves and aprons are provided to staff to assist with cleaning and personal care. Alcohol gel still needs to be made available to staff, visitors and people who use the service. The outside of the building and the gardens are well maintained. Care Homes for Older People Page 19 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels appear satisfactory to meet the needs of people currently accommodated at the home. Recruitment checks have significantly improved. However it is essential some improvements are made to the staff application form (regarding employment history and medical fitness), and evidence is maintained of the employees identity. Training has improved, although there is some further training that needs to be delivered. For example it is essential suitable levels of first aid cover are maintained at all times. These measures will ensure people who use the service are supported by suitably knowledgeable and skilled staff. Evidence: On the day of the inspection there were five care staff on duty from 0800 to 13:30, three staff on duty in the afternoon until 1800, two staff on duty in the evening, and two waking night staff on duty from 2200-0800. Additional ancillary staff such as cooks and cleaners are employed. This seems satisfactory, although staffing in the evening needs to be kept under review with reference to the changing needs of people living and/ or being admitted to the home. Personnel records were inspected for twelve staff (i.e.staff on duty during the 24 hour period on the day of the inspection). Information obtained, and its quality has improved, for new staff employed, since the last inspection in May 2008. Staff Care Homes for Older People Page 20 of 33 Evidence: employed since the last inspection had two references, a Protection of Vulnerable Adults First check (POVA First) , a Criminal Records Bureau check (CRB) and a completed application form. One person did not have a POVA First check but the registered provider assured us the person did not start work until their full CRB was returned. However, evidence of identification was not maintained on file (as required by the regulations). The declaration staff are medically fit to work in a care setting is very basic and should be expanded. A full employment history needs to be obtained for new staff as outlined in the regulations. Currently only a limited employment history is obtained. Training has improved at the home, and a considerable amount of training has been delivered since the last inspection. By law staff require the following training: * Regular fire training in accordance with the requirements of the fire authority. * There must always be at least one first aider on duty (at appointed person level). *All staff must have manual handling training and regular updates of this (e.g. annually) * All staff must have basic training in infection control. * Staff who handle food receive food hygiene training. * All staff must have an induction and there needs to be a record of this. * At this home people should have training regarding dementia awareness * Staff need to have training regarding people with mental health needs. Induction training appears satisfactory. All people who have commenced employment since the last inspection have a record of induction. We spoke to some new members of staff who confirmed they had received this. Despite considerable development of training provided, some improvements are still required: * Everyone must have fire training at least annually; two of the staff in the sample need refresher training. * Five staff needed to have food handling training. Some staff did not have a certificate on file only a copy of a test sheet. The cooks have only received internal food handling training. It is advisable they receive external training (at least at basic level). The environmental health officer can provide advice regarding this. * Three people need infection control training. * Four people did not have manual handling training. * Four care staff needed training regarding dementia. * There is no record that any staff have received training regarding people with mental health needs. *On the night of 2526/11 there was no person with appointed person first aid training on duty (one of the staff had received in-house training, but this is unlikely to be satisfactory in an emergency situation). It is essential that there is satisfactory first aid cover at all times otherwise people using the service could be placed at significant risk. This training therefore must be received as a priority. There has been several staff recruited since the last inspection (i.e. seven in this sample). However four people in the sample had been employed for at least a year and should have received all mandatory training. We do note the improvement, but Care Homes for Older People Page 21 of 33 Evidence: the registered provider needs to complete the current training programme, and then ensure staff training is kept updated. It is important a certificate is issued, from the training provider, on completion of training. Training packages used should be available for inspection, and where possible training should be externally assessed. There appears to be satisfactory access to obtain a National Vocational Qualification in Care. A record of training for the staff group is maintained which also indicates when they need an update. Care Homes for Older People Page 22 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered providers have made improvements to the service since the last inspection in May 2008. The current standards need to be maintained, and where necessary improved. Improvement is still required to quality assurance and health and safety standards. These measures will assist in ensuring there is a satisfactory system of continuous improvement. They will also ensure people are protected from any necessary risks to their health and safety. Evidence: The registered providers have owned the home since 2003. They have submitted an application for the current manager to be registered with the Commission for Social Care Inspection. This should be processed shortly. Since the last inspection in May 2008, the registered provider has submitted an improvement plan regarding the requirements issued at that inspection. This has generally been implemented although some issues are renotified in this report. Overall Care Homes for Older People Page 23 of 33 Evidence: good progress has been made and the overall star rating of the home has improved. We were not presented with a quality management policy. We gave advice regarding what needed to be included within this. The registered providers approach to quality has improved. For example the registered provider is completing monthly checks regarding aspects of the service. This needs some fine tuning regarding the methodology used, baring in mind some of the repeated requirements issued at this inspection. The registered providers have ensured some resident meetings and staff meetings have occurred. These are good fora for ascertaining peoples views, ensuring people feel supported and involving them in the process of bringing about continuous improvement. A survey has been completed. There only appears, to date, a limited response. Surveys can be useful as long as an action plan is developed and implemented from the work completed. The registered providers look after some monies on behalf of people who use the service. We advised receipts obtained to be pinned together and numbered to make audit easier. No valuables are currently held on behalf of people who use the service. The registered provider has a health and safety policy. Testing of fire extinguishers, call points, emergency lighting appears satisfactory. We have stated an improvement in fire safety training is required, as outlined in the staffing section of this report. Health and safety risk assessments are completed. Portable electrical appliances have been tested by the registered provider. This is satisfactory as long as the registered provider uses suitable equipment for this task, and the equipment is tested regularly to ensure it is effective. The Environmental Health Department at Kerrier District Council can provide advice regarding this matter. The electrical hardwire circuit has been tested. The documentation states the circuit unsatisfactory i.e. on page 2 of the certificate it states Due to the conditions of the distribution boards it (the electrical circuit) is in a poor condition. Subsequently appropriate action needs to be completed, and the circuit retested. A certificate stating the hardwire circuit is satisfactory must then be obtained and a copy forwarded to the Commission. There appears to be a suitable system regarding the prevention of legionella. Manual handling equipment appears to be tested appropriately. The stairlift has been serviced and now has a safety strap. However we observed this equipment being used by a person using the service without a safety strap. If the person fell off the stairlift this could result in at least a serious injury. The registered provider said she would discuss this with the staff member concerned. Suitable records are maintained regarding the Care Homes for Older People Page 24 of 33 Evidence: testing of the temperature of bathwater. It however is advisable that thermostatic valves are fitted to hot water outlets to prevent scalding. The gas certificate expired in July 2007, and therefore gas appliances need retesting and a new certificate issued. A copy of this needs to be sent to CSCI. We have stated there needs to be some improvement regarding training in regard to health and safety issues-as outlined in the staffing section of this report. An up to date certificate of insurance is displayed. Care Homes for Older People Page 25 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 8 12, 13, 15 Each person who uses the 01/10/2008 service must: Have an up to date care plan. Care plans must include an accurate moving and handling risk assessment. Records must be maintained when people receive external health care support. Suitable care plans will help ensure people who use the service receive appropriate care and support from the registered provider. Timescale of 01/10/07 not met. Second Notification. 2 9 13 The management, 01/08/2008 administration and storage of medication needs to be improved, with reference Royal Pharmaceutical Society Guidelines and Care Homes Regulations 2001. Issues outlined in the report need to be addressed. People who use the service can then be more assured their drugs are appropriately stored and managed to an appropriate standard. The registered providers 01/08/2008 must ensure: People using the service who do not wish to share a Page 26 of 33 3 10 7, 12 Care Homes for Older People bedroom need to be offered a single bedroom at the earliest opportunity, when one becomes available. This will help ensure people who use the service have suitable private space, and also can make a choice how and where they spend their time. 4 21 12(4)(a)23(j) Locks must be fitted to all 01/10/2008 bathroom and toilet doors. (An over riding facility and 180 degree hinge needs to be fitted to these doors if this is necessary) Previous timescale of 01/10/07 not met. 4th Notification These measures will ensure people who use the service can have a bath or go to the toilet in private. 12, 13(4), 18, The registered provider must 01/08/2008 19 ensure staff receive appropriate levels of first aid training, and there is always sufficient first aiders on duty at all times: A risk assessment - in line with CSCI guidance- must be submitted to the Commission within the timescale (with an action plan as appropriate). Confirmation of satisfactory levels of first aid cover, at all times, must be provided to CSCI. These measures will help to ensure people who use the service receive appropriate first aid support in an emergency situation, and help to minimise any risk to their health and safety. 5 30 Care Homes for Older People Page 27 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Each person must have a suitable care plan: (1) Care plans must contain a full moving and handling assessment to inform and direct staff to assist people with these needs. This should assist manoeuvre being carried out appropriately, and also aim to minimise accidents (e.g. falls) (2) Care plans need to include a record of all medical, dental, chiropody and optician etc. appointments particularly so on going treatment can be maintained and future checks arranged. (Requirement from report dated 30/5/08 only met in part.Deadline of 01/10/08 not met. Third Notification) 01/03/2009 Care Homes for Older People Page 28 of 33 Detailed care plans assist care staff to provide appropriate levels of care for people who use the service. 2 9 13 The management and storage of medication needs to be improved, with reference to the Royal Pharmaceutical Society Guidelines and Care Homes Regulations 2001. The issues outlined in the body of the report need to be addressed. (Previous timescale of 01/08/08 not met Second Notification) People who use the service can then be more assured their medication is appropriately stored and managed in a secure manner. 3 10 12 The registered providers must ensure people using the service who do not wish to share a bedroom need to be offered a single bedroom at the earliest opportunity, when one becomes available. (Previous timescale of 01/08/08 not met Second Notification) This will help ensure people who use the service have suitable private space and also can make a choice how 01/02/2009 01/02/2009 Care Homes for Older People Page 29 of 33 and where they spend their time. 4 21 12 Locks must be fitted to all bathroom and toilet doors. (An over riding facility and 180 degree hinge needs to be fitted to these doors if this necessary). (Requirement from report dated 30/5/08 only met in part .Deadline of 01/10/08 not met. Fifth Notification) This measure will improve peoples privacy and security. 5 29 19 The registered provider 31/01/2009 must ensure suitable information is maintained regarding all new staff working in the home, as outlined in the regulations (for example an employment history, evidence of identity and a self declaration of medical fitness). (Requirement from report dated 30/5/08 only met in part .Deadline of 03/06/08 not met. Third Notification) Rigorous recruitment checks help to ensure people who use the service are protected from people who are unsuitable to work with the vulnerable. 6 30 18 The registered provider 01/03/2009 must complete training planned for all staff. For example staff need to receive training regarding manual handling, fire safety, 31/01/2009 Care Homes for Older People Page 30 of 33 infection control, food hygiene, first aid, dementia awareness, and people with mental health needs. This will help to ensure people who use the service are supported by suitably trained and skilled staff. 7 30 18 The registered provider 01/02/2009 must ensure staff receive appropriate levels of first aid training, and there is always sufficient first aiders on duty at all times. CSCI guidance regarding this matter should be consulted. (Requirement from report dated 30/5/08 only met in part .Deadline of 01/08/08 not met. Second Notification) This will help to ensure people who use the service are supported by suitably trained first aiders in an emergency. 8 33 24 The registered provider must have a quality assurance policy. This will help improve service quality 9 38 13 A certificate regarding the testing of gas appliance must be obtained deeming them safe and not a risk to people working and living in the home. A copy of the certificate is required. 01/02/2009 01/02/2009 Care Homes for Older People Page 31 of 33 This will ensure gas appliances in the home is safe, and there is less health and safety risk to staff and people who use the service. 10 38 13 A certificate regarding the testing of the electrical hardwire circuit must be obtained deeming the electrical wiring in the home as safe and not a risk to people working and living in the home. A copy of the certificate is required by CSCI. We require written confirmation when satisfactory work to make the system safe has been completed. This will ensure the electrical circuit in the home is safe, and there is less health and safety risk to staff and people who use the service. 01/02/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 3 16 Retain all dated and signed notes regarding pre admission assessment contacts. Ensure there is reference to the Social Services Complaints procedure, in the homes complaints procedure, as people funded by local authorities have a right to use this if they have a concern or a complaint. A lock should be fitted to each bedroom door. People should be offered a key if they are able to use one. This measure will improve peoples privacy and security. 3 24 Care Homes for Older People Page 32 of 33 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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