Inspection on 30/05/08 for Garsewednack Residential Home

This inspection was carried out on 30th May 2008.

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

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

Garsewednack Residential Home 25/11/08

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 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Garsewednack Residential Home 132 Albany Road Redruth Cornwall TR15 2HZ Lead Inspector Ian Wright Unannounced Inspection 08:15 30th May & 3rd June 2008 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 Garsewednack Residential Home DS0000054567.V365454.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. Garsewednack Residential Home DS0000054567.V365454.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Garsewednack Residential Home Address 132 Albany Road Redruth Cornwall TR15 2HZ 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) 01209 215798 01209 215798 Mrs Anne Brazier Mr Neil Edward Brazier, Mrs Nicola Carla Brazier Manager post vacant Care Home 21 Category(ies) of Dementia - over 65 years of age (4), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (4), Old age, not falling within any other category (21) Garsewednack Residential Home DS0000054567.V365454.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 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 20th August 2007 Brief Description of the Service: 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 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. No rooms have en suite facilities but 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 £350-£365 per week. There are additional charges e.g. for hairdressing, chiropody, and newspapers etc. Garsewednack Residential Home DS0000054567.V365454.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This unannounced key inspection took place in fifteen and a half hours over two days. All key national minimum standards were inspected. We also investigated two complaints which were received before the inspection. The methodology used for this inspection was: • To case track five people who use the service. This included, where possible, meeting and discussing with the people who use the service their experiences, and inspecting their records. • Discussing with three staff 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), was used to help form the judgements made in the report. What the service does well: What has improved since the last inspection? The roof has been replaced. There continues to be an ongoing maintenance plan to upgrade facilities, fixtures and fittings. Garsewednack Residential Home DS0000054567.V365454.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. Garsewednack Residential Home DS0000054567.V365454.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 Garsewednack Residential Home DS0000054567.V365454.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): 2, 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information provided to people who use the service (e.g. the issuing of terms and conditions of residency /contracts) need improvement so people are aware of their rights and responsibilities. Pre assessment procedures need improvement so people who use the service, and their representatives, can be assured the needs of service users are assessed appropriately. EVIDENCE: Several files of people who use the service were inspected. Most had a copy of a contract of care on file. However, this was absent for one person who was admitted in January 2008. The manager said the registered providers were awaiting confirmation that this person would be admitted on a permanent basis. However, it is advisable that all people are given a contract- even if it is a temporary one so they are aware of their rights and responsibilities. One person who was admitted in 1997 and had no contract. It is important this person is issued with a contract as soon as possible. Garsewednack Residential Home DS0000054567.V365454.R01.S.doc Version 5.2 Page 9 The inspector spoke to several people who use the service regarding their experiences of moving to the home. People who have moved in since the last inspection, said they could not recall anyone completing an assessment before they arrived. Some said they visited, some said they did not. When the inspector spoke to the manager she said a senior member of staff would go out and assess a potential resident where possible. She said subsequently each person is on a month’s trial during which time a fuller assessment is completed. Assessments inspected were dated on the day of their admission or after that date. We would expect that a pre admission assessment is always completed for any person admitted to the service. In extraordinary circumstances where there is an emergency admission, or somebody is moving from a location a long way from the home, it is essential a health or social services assessment is obtained. Contemporaneous notes of the assessment need to be kept, and these should be signed and dated accordingly. National Minimum Standard 3.3. clearly details what information should be obtained at the time of the assessment. It may be helpful for the registered provider to develop an assessment form containing this information. Such information gathering is vital if the registered persons can be relatively sure they can meet the individual’s needs. It is also important, if possible, that the person concerned gets the opportunity to visit the home so they can make an informed choice whether the home will be appropriate for them. Some copies of assessments completed by either social services and/or the National Health Service were inspected on several people’s files. Garsewednack Residential Home DS0000054567.V365454.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who use the service and their representatives, who the inspector could speak to, said they were generally happy with the care provided. However, improvement is required to care planning, so care plans accurately reflect people’s needs, and it is clear what support individuals require. It is unclear whether there is appropriate access to health care professionals. We have some concerns about some people’s care who use this service, whether some people’s wishes are respected, and their care is suitably individualised. Medication also needs to be managed to a higher standard. Improvement in these areas will help to ensure people who use the service receive appropriate care according to their wishes and needs. EVIDENCE: There was a copy of a care plan on all five people’s files case tracked. Some of the care plans were originally written some time ago, and the needs of the people concerned had changed dramatically. Although care plans are reviewed, and people’s changing needs were recorded within the reviews, it is quite Garsewednack Residential Home DS0000054567.V365454.R01.S.doc Version 5.2 Page 11 difficult to ascertain what people’s current needs are. Care plans were subsequently quite confusing in some cases, and this could result in staff error, if the reader was unfamiliar with the person concerned. It is therefore essential that care plans are completely re written when and where appropriate. Some people did not have an up to date moving and handling assessment. A moving and handling risk assessment was absent in some cases. Moving and handling assessments did not present clear information for example regarding how many staff are required to assist an individual with specific manoeuvres. There was differing understanding of what help people needed with moving and handling between what some staff said, and what was written in the assessment. This could result in significant risk to people who use the service, and to staff involved in the manoeuvres. Apart from ‘environmental’ risks, there is no system of risk assessment in place. Some people had cot sides on their beds, and no risk assessment regarding these were in place e.g. to prevent these being used as unauthorised restraint, or regarding the misfitting of these which could cause fatal injury. At least one person is diagnosed as having MRSA, but the person did not appear to have a risk assessment stating how the risk of cross infection could be avoided / minimised. There did not seem an alcoholic gel available, or what procedures are in place to prevent cross infection. The Health Protection Agency can assist the home in developing such procedures, and give advice. Care plans are accessible to staff. Although most people who use the service, who the inspector spoke to, did not seem aware they had a care plan, most people said care is delivered to a good standard, and staff did their best to meet their needs. All people looked as if they were dressed nicely and according to their personalities, their hair and nails well cared for, they all appeared clean and personal care did not look neglected. Regulatory issues relating to two complaints received by CSCI were investigated as part of this inspection. Complainants alleged: 1. A doctor was sometimes not called promptly, and staff were required to have management authorisation before a doctor could be called. 2. People who are incontinent are not changed appropriately by night staff. 3. People who wish to stay in their bedrooms during the day are prevented from doing so, and have to spend their time in the communal lounges. 4. One person now has to stay in bed due to having her leg in a cast, when she was spending time, according to her wishes, with other people who use the service. 5. People do not receive appropriate support with moving and handling. For example some manoeuvres are being performed incorrectly and sometimes without equipment. Medical support. There are some records that people do receive visits from GP’s and district nurses. There are some records that some people have seen a Garsewednack Residential Home DS0000054567.V365454.R01.S.doc Version 5.2 Page 12 stroke nurse, a diabetic nurse, a speech therapist and a dentist. However there should be clear records kept when people last saw their GP, Community Psychiatric Nurse / Psychiatrist, District Nurse, Optician, Dentist, Chiropodist (etc. as applicable). This will enable staff to monitor when people who use the service last saw relevant health care professionals, and ensure there is regular input from these professionals as appropriate. The inspector was able to talk to some people who use the service who all said they were satisfied with the healthcare support they received. Some relatives of people who use the service were contacted and they generally did not express concern about health care support. However the relative of one person who used to use the service stated that they did not feel satisfied that a GP was called promptly regarding health concerns. Their relative was later admitted to hospital, and the relative believed this could have been done sooner. The manager stated staff do not need to seek permission when calling a GP or an ambulance. However the complainant alleged this was the case. The person’s relative also was told staff would require management authorisation for a GP to be called. When the inspector was told this, the relative did not know we had received an allegation this occurred. It is essential that staff are empowered to call medical professionals as appropriate. It is also essential that people who use the service can see a medical professional if they wish. A complainant made allegations that another person, who no longer uses the service, also did not receive prompt medical treatment for a urine infection in 2007. The manager said the person’s records could not be found so we were unable to make an assessment regarding this matter. Such records must always be readily available for inspection. Management of incontinence. The inspector was able to talk to the two people who use the service, whom the complainant alleged were not being changed. One person said they were always changed as appropriate. The second person said at times they were not changed promptly and could be left for periods of time soiled. The manager said it was not appropriate to regularly wake people during the night if they were soiled or wet. This may be acceptable as long as pads used are suitable, and people have not been faecally incontinent. However, management do need to monitor pads are appropriately changed, there are appropriate toileting routines worked in place and these are adhered to. These issues should be clearly recorded in care plans. People’s right to spend time in their bedrooms. The inspector spoke to the two people referred to by complainants. Both said they preferred to spend their time in their bedrooms. They felt aggrieved that they were regularly told they had to go downstairs to the communal lounges by some staff. Both people had to share a room, and said to the inspector they would prefer to have separate bedrooms. It is of concern the registered providers had not Garsewednack Residential Home DS0000054567.V365454.R01.S.doc Version 5.2 Page 13 considered this previously, particularly as the two people have different interests how they wish to spend their time. The manager said she had received no complaints regarding the two people sharing or them having to go downstairs. She stated one person’s health had improved, and the relatives of both people were happy with their care. It is however essential that all people living in the home have a right to decide where and how they spend their time. If people are at risk, and need to be in a communal area for their own safety, the matter should be risk assessed, in line with the principles of the Mental Capacity Act 2005. Where people share a room, they should always be offered a single room when one comes available. National Minimum Standard 23 of Care Homes for Older People sets out clear principles for practice regarding this matter. The commission has requested for these people’s living arrangements to be reviewed. Care of person who is in bed Care notes give conflicting reports of what support this person requires following the person having a leg fracture and becoming very dependent. The person’s care plan needs significant revision, as information in it is unclear and conflicting. One member of staff had written that the person was not to be got out of bed until staff were trained to use the hoist. Before this note the person did appear to regularly go downstairs, and subsequently the person appears to have spent increasing amounts of time in bed. The person does not have access to a call bell, as the cable is too short. The person is therefore totally dependent on staff visiting for any assistance. The complainant also raised concerns that when the person had to attend hospital appointments, they went in an ambulance without any staff from the home, as the person’s relative could not go with the person. The person’s notes state she had dementia, and on one occasion was abusive to hospital staff and hit one of them. This matter was discussed with the manager of the home. She said the person was due to go to the hospital shortly, and this may result in the person being able to have the plaster removed. The manager said the person had developed pressure sores at the top of the leg plaster. She said the district nurses said not to put the person in a wheel chair, as this aggravated the wounds. Subsequently following the district nurse’s advice the person should remain in bed. The manager said the person is hoisted out of bed to use the commode. She said the home had not received any concerns or complaints from hospital staff regarding the person attending hospital without staff. The manager said they would ensure the call bell was extended. The manager said staff regularly check the person, although there are no records of checks completed. The manager said the person no longer had any pressure sores. The manager said she was not aware of two incidents in the care notes where the person had crawled out of the bottom of the bed. Significant harm could have resulted if further injury had occurred. Staff should have reported these Garsewednack Residential Home DS0000054567.V365454.R01.S.doc Version 5.2 Page 14 incidents. Cot sides are fitted to the person’s bed. However, there is no risk assessment for their use. The inspector was able to speak to the person’s next of kin who said they were happy with the care provided. The inspector also spoke to the District Nurse Team Leader regarding the person’s care. The team leader said the district nurses did not have any concerns about the person’s care. She said they had advised the person should stay in bed as ‘the lesser of two evils’. This practice therefore appears acceptable, but the reasons should have been clearly recorded in the care plan. The nurse team leader also said the person’s pressure sore had healed. The inspector has also contacted the person’s GP surgery and asked for the GP to contact CSCI if they have concerns about the person’s care. We however have not had any further contact from the GP. The District Nurse Team Leader said her team did not have any concerns about other people’s care in the home. Appropriate Moving and Handling The inspector discussed what assistance is required for moving and handling for two of the people case tracked. Support stated in the care plan differed from what the manager said. For example the manager said in regard to some manoeuvres staff support was lower than what was written in the care plan. The manager said that in these cases, care plans were incorrect, for example people’s abilities had improved over the course of time. The manager confirmed that moving and handling equipment is always used when necessary. However, moving and handling training needs to be improved as outlined later in the report. The manager, who said to the inspector that she is a qualified moving and handling trainer, delivers this training internally. It is essential that appropriate risk assessments are completed regarding moving and handling, satisfactory training is delivered to all care staff, and appropriate equipment is always used. The inspector noted that some wheel chairs were not fitted with foot rests. Two people using the service were seen being wheeled around in these chairs. This could present a significant risk of injury, if the occupant’s foot got trapped or caught. There was nothing in either person’s care plans or moving and handling risk assessments, which stated why footrests were not fitted. It is essential from a health and safety perspective, that unless there is a very good reason, that wheel chairs are always fitted with footrests. The medication system of the home was inspected. The registered provider has a medication policy. Medication is administered via the monitored dosage system. However it’s operation does not meet the required standard. For example: • There was a minority of dosages, which appeared to be given but were not signed for. Garsewednack Residential Home DS0000054567.V365454.R01.S.doc Version 5.2 Page 15 • • • • There was a minority of dosages, which were signed for but appeared not to be given. If Lorazepam is to continue to be treated as a controlled drug, dosages should be recorded in a controlled drugs book, which is bound and tamper proof. If any controlled drugs are kept in the home they also need to be recorded appropriately. Books for this purpose are available from a pharmacist. Medication trolleys need to be fastened to the wall when not in use. This should help improve security. There should be a photograph of the individual person using the service within each section of the medication file. This helps ensure medication is given to the right person, if the person administrating medication is not very familiar with the people living in the home. The management of medication needs to comply with Royal Pharmaceutical Society Guidelines. A copy of these guidelines can be found on the internet at: http:/www.rpsgb.org/pdfs/handlingmedsocialcare.pdf Three of the staff (out of the ten staff files assessed) had a record of receiving some training regarding the handling of medication. Nobody on the night shift appeared to have received training regarding the handling of medication, although some medication appears to be administered on this shift. The training received appears to be from a training package, which does not appear to be externally assessed when individuals complete the course. The registered provider should check that current training provided is satisfactory, and ensure when it is completed the training provider externally assesses individual’s course work. The commission has published useful guidance regarding required standards of medication training. These can be found on our website at: http:/www.csci.org.uk/professional/default.aspx?page=7328&key People who use the service, who the inspector spoke to, were generally happy with the care provided, and said staff worked with them in a manner, which respected their privacy and dignity. However, as outlined above some concerns have been expressed in regard to some people, and these matters need to be resolved to improve these people’s lives. The concerns expressed may indicate that some people’s individuality is not being satisfactorily respected, and their privacy is not being promoted. Otherwise, other people the inspector spoke to on the inspection were positive about their care. People using the service, who the inspector spoke to, on the days of the inspection, said they thought the staff were very good and caring. Staff were also observed working with people, in a positive manner, were friendly appeared caring and kind. There are currently no people who use the service from ethnic minorities, although it is understood the registered provider would be happy to Garsewednack Residential Home DS0000054567.V365454.R01.S.doc Version 5.2 Page 16 accommodate people who use the service from other cultures. The local population is predominantly Cornish, and from ‘White-UK’ background. Issues regarding sexuality and gender appear to be suitably addressed. Garsewednack Residential Home DS0000054567.V365454.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some activities are available, and food provided is to a good standard. However, it is not clear whether people are enabled to choose about how they spend their time and improvement is required in this area. EVIDENCE: The inspector arrived at 08:15 on the first day of the inspection. Staff were in the process of assisting people to get up. Most people came down to the lounge between the time the inspection commenced and about 10 am. Some people remained in their room- these tend to be the more able people using the service. The morning routine appeared unrushed, and individualised. Lunch time was at 12:30, and most people either had this in the dining room or in the lounge. The meal was to a high standard, and people are able to have some variation if they do not like what is on the menu. For example the main meal was fish and chips, followed by sponge pudding. Some people had potatoes instead of chips, eggs instead of fish. All people who the inspector spoke to said they were happy with the meals provided. People were offered ‘seconds’ if they wished. Water, tea and coffee were served with or after the Garsewednack Residential Home DS0000054567.V365454.R01.S.doc Version 5.2 Page 18 meal. The inspector shared a meal with people using the service. The meal time was a generally positive event, and staff helped most people using the service where this was necessary. One person could have had more support cutting her food, as it was clear she had limited strength. The inspector suggested to her she used a spoon to eat her peas. The need for increased support for this person was pointed out to staff. The person’s daughter however said she felt the lady did manage to eat well. Some people did say they were frustrated at times about having to come to the dining room and having to wait for the meal to be served. There was a wait of 5-10 minutes for the meal at the meal time the inspector participated in. Others were however were more sanguine about the wait. All however enjoyed the meal when it arrived. One of the complainants said the home did not provide enough specialist food for diabetic cater appropriately for diabetics. However when this matter was discussed with the manager, she said diabetics were catered for and catering staff had appropriate awareness of individual diabetic needs. The inspector was able to speak to the specialist diabetic nurse who works with the home. The nurse said she had limited experience of the home, but she did not have any concerns about the people she had been referred to work with. This specialist service can provide advice and staff training regarding current best practice, and the registered provider should seek advice and training regarding diabetes as necessary (e.g. for catering staff, senior carers etc.) In the afternoon people spent their time either in their rooms, the lounge or the garden. The garden is very pleasant and people the inspector spoke to said they enjoyed it. There are sun shades, sun hats and sun cream if needed and wanted. There is an activities session in the latter part of the afternoon. An activities book is maintained. There is a range of activities provided such as group games, DVD’s, quizzes and a group exercise sessions. A musician comes in and provides music and sing a longs. One person said there was not enough to do. The person was at the more able end of the spectrum of people accommodated in the home. Where necessary the home needs to consider how such a person’s educational, social and recreational needs can be met. For example can the person go out on their own? Could the person have a befriender to take them out? Can they help with general house tasks such as laying the table, cake baking, gardening etc.? Are there any social clubs / groups which people can attend? Individual needs should be considered as part of the care planning process and recorded within the care plan. Keyworkers can then assist individuals to provide appropriate individualised opportunities and activities. Other people who the inspector spoke to did say they were generally happy how they spent their time. Garsewednack Residential Home DS0000054567.V365454.R01.S.doc Version 5.2 Page 19 The manager said representatives from the church attend on a monthly basis. There did not appear to be any people from other religious groups living at the home. One person enjoyed reading. The inspector suggested to the manager that staff should explore whether the Cornwall County Council library service could regularly visit the person, to enable them to have a wider choice of literature. Others may benefit from this service. People using the service can have a newspaper delivered if they wish. Tea time is in the late afternoon / early evening. Staff assist the people who live in the home to have a wide choice in what to eat. For example, they can have a hot snack or various types of sandwiches. Home made cakes are provided. People said they watch the TV in the evening. People said they could go to bed when they wished. The previous section of the report expressed concerns that some people may be given limited choice how to spend their time. For example there had been no attempt to offer single bedroom to two people who would benefit from this. These people also said they were not given a choice by some staff about remaining in their bedroom during the day. These people are at the more dependent spectrum of the people cared for at the home, and it is concerning that decision-making may be taken away from these people. If this is the case, this is particularly of concern, as some of the senior staff have attended training regarding the Mental Capacity Act 2005. This legislation enshrines in law for example that staff should presume people have capacity to make decisions, and subsequently help them to make decisions. There did not appear to be any evidence that the two people would be at risk left in their bedroom, or any risk assessment to state they were at risk. Both of these people seemed happy not have to go to the lounge. Garsewednack Residential Home DS0000054567.V365454.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A suitable complaints procedure is in place. The adult protection policy and recruitment checks, e.g. in relation to Protection of Vulnerable Adults ‘First’ checks need improvement. Improvement in these areas should give people who use the service more confidence about protection from bad practice and abuse. EVIDENCE: There appears to be a satisfactory complaints procedure. The Commission for Social Care Inspection received two complaints regarding this service before the inspection, and regulatory issues raised by the complainants have been investigated as part of this inspection. Issues raised are discussed in the relevant sections of this report. The registered persons said they had not received any complaints regarding the service. A complaints book is maintained. Most people who use the service, who the inspector spoke to during the inspection, generally said they had no concerns, complaints and allegations about the service. They said if they did have concerns or allegations staff would resolve these appropriately. Where issues have been raised either prior to the inspection, or at the inspection these are outlined elsewhere in the report. Garsewednack Residential Home DS0000054567.V365454.R01.S.doc Version 5.2 Page 21 The registered provider has an adult safeguarding (protection) policy. There is also a poster on the office wall stating any allegations should be reported to the manager. There is also information regarding the government’s ‘No Secrets’ guidance, which should form the bedrock of any adult safeguarding policy and procedure. The provider’s policy states it was reviewed in April 2008. The policy does need some development to make it more robust. The policy also needs to be clearer regarding what people living and working in the home should do if there is an allegation: 1. Firstly, any accusations must be reported to Cornwall County Council’s Department of Adult Social Care. The registered provider has a duty to ensure such matters are always reported- even if the alleged victim of abuse wishes confidentiality to be maintained. The current policy states this may not happen if the person concerned does not wish it to be reported. The person subsequently needs to be informed of the registered provider’s duty if an allegation is made. If the person does wish the matter not to be raised, the social services department should be informed of the person’s wishes. This will ensure if there is a need for an investigation this can be carried out sensitively. 2. The Department of Adult Social Care are the coordinating agency for any investigation. The manager, registered provider or other persons should not investigate any allegations, beyond basic information gathering, unless delegated by social services to do so. 3. The policy should state how people using the service, and their representatives, will be informed of what to do if they have any allegations of abuse or poor practice. 4. The policy should state what pre employment checks and training staff will receive. This should detail how staff will be informed (e.g. on induction) of correct protocols they should follow if there is an allegation. 5. Contact addresses and phone numbers should be in the policy and readily available to staff, people who use the service and their representatives. Two staff, the inspector spoke to, showed some awareness what to do if there was an allegation. For example people said they would either report any allegation to management, CSCI or social services. Nine staff personnel files were assessed in regard to training regarding awareness of abuse. There was no evidence e.g. training certificate, competency assessment etc. to show people had received formal training in this area. However the manager said all staff watch a video regarding abuse awareness, and work through a training folder to develop awareness. This needs to be evidenced e.g. as part of a staff induction / foundation training checklist. People should preferably also receive the opportunity to attend the free Cornwall County Council courses regarding prevention of abuse. The manager said there had been no allegations of abuse, and the provider’s had not had to refer any ex members of staff for inclusion on to the Protection Garsewednack Residential Home DS0000054567.V365454.R01.S.doc Version 5.2 Page 22 of Vulnerable Adults Register. The inspector was concerned regarding recruitment checks completed on new staff, for example in relation to Protection of Vulnerable Adults ‘First’ checks (POVA First) being completed. This is detailed in the ‘Staffing’ section of this report. Garsewednack Residential Home DS0000054567.V365454.R01.S.doc Version 5.2 Page 23 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, 21, 23, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Garsewednack provides a generally satisfactory environment for the people living there, although a previous requirement regarding having locks on bathroom / toilet doors are still outstanding. There is no safety strap on part of the chair lift which presents a potentially serious health and safety risk. Some improvement is required to infection control procedures. Improvements in these areas will help ensure people who use the service can enjoy living in a comfortable, hygienic and safe environment. EVIDENCE: The building was inspected. The building was light, warm and clean on the day of the inspection. Decorations, fixtures and fittings are all to a good standard, and the building appears to be generally well maintained. There are two lounges so people have a choice where they can spend their time if they wish to be in the communal areas. There is a pleasant separate dining room. People living in the home can also sit in this area, during and outside mealtimes, Garsewednack Residential Home DS0000054567.V365454.R01.S.doc Version 5.2 Page 24 although staff at times also use this as a meeting space. A new roof has just been fitted. The gardens are very pleasant, and people who use the service can sit outside if they wish. Satisfactory kitchen and laundry facilities are available. There is a chair lift to help people get up and down stairs. However one section of this does not have a lap strap and this could be potentially dangerous. Bathrooms and toilets are generally satisfactory. For example there is a chair lift on baths to assist people with disabilities. However the registered provider has now been notified on four separate occasions regarding fitting a lock on each bath room and toilet door. Although some doors have these, others have not or are broken. One toilet door does not even have a handle. ‘Engaged’/‘vacant’ signs are fitted on some toilet and bathroom doors, but these clearly are not effective. For example the inspector went to the toilet marked ‘vacant’ although when the door was opened there was someone in there which was embarrassing. We asked the registered providers to attend to this matter, at the last inspection, and write to us when the appropriate work had been completed. However we have no record that the registered provider did this. Lack of locks means that people using the service do not have appropriate levels of privacy from staff, visitors and other residents. If the registered provider has concerns about any person getting locked in the bathroom or toilet, a lock with an over riding facility should be fitted. A 180 degree hinge can also be fitted to each door in case people fall against the door when inside the room, and staff need to get in to assist the person. We are repeating the requirement, and we will consider taking enforcement action if the requirement is not complied with. All bedrooms are of a satisfactory size; all are decorated and furnished to a good standard. Most of the bedroom doors do not have locks. There is a ‘break bolt’ system on bedroom doors, but some of these are broken. There should be a lock (with an overriding facility if necessary) on each door. People who use the service should be issued with a key if they can manage this (e.g. in terms of cognitive ability). It should be the default position of any home that a lock is fitted to each bedroom door and people should be given a key. If people lack the cognitive skills to hold a key, the matter should be risk assessed, and the decision recorded. Everyone should have a lockable space in their bedrooms to put money / valuables. The laundry area is suitable. The home also appeared clean and hygienic. However one of the complainants raised a concern that staff do not wear aprons when giving personal care. It was also stated that there is no alcohol gel for staff, visitors and people who use the service to use. The inspector did see staff using aprons appropriately. There were also satisfactory supplies of disposable gloves. However there was no evidence of alcohol gel being supplied to people living in the home, visitors or staff. The manager said she did not know this was required. There was also no soap in Garsewednack Residential Home DS0000054567.V365454.R01.S.doc Version 5.2 Page 25 some bathrooms / toilets. The registered provider must ensure there are satisfactory precautions for staff, people who use the service and visitors to prevent infection, for example if people accommodated are diagnosed with for example MRSA. The Environmental Health Department, Health and Safety Executive as well as the Health Protection Agency can provide suitable guidance regarding these matters. The registered provider should review / develop a policy regarding this matter, and ensure it is implemented accordingly. Garsewednack Residential Home DS0000054567.V365454.R01.S.doc Version 5.2 Page 26 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. 27, 28, 29, 30 Staffing levels appear satisfactory to meet current people’s needs. However these need to be adjusted as appropriate if people’s needs change, or if people with a higher level of need are accommodated. Improvements are required to staff recruitment checks e.g. obtaining references and Protection of Vulnerable Adult checks / Criminal Records Bureau checks (CRB/POVA) for new staff. Improvement is required to staff training so it meets the needs of people who are living in the home and regulatory standards. These measures will ensure people who use the service are better protected from staff deemed unsuitable to work with vulnerable people, and they are supported from staff who are appropriately trained to meet their needs. EVIDENCE: On the days of the inspection the following staffing was provided: • One member of care staff from 0800-1300 • Two care staff from 0800-1500 • Two members of care staff from 1500-2200 • Two waking night staff from 2200 to 0800 • Cooking and cleaning staff were also provided. The manager was on duty. One of the registered providers was also on duty during the day on the first day of the inspection. Garsewednack Residential Home DS0000054567.V365454.R01.S.doc Version 5.2 Page 27 One of the complainants stated that doing the afternoon / evening shift can be very difficult as there are only two staff to care for up to twenty one residents. Staff and people who use the service, who the inspector spoke to during the inspection, did not express any concerns regarding staffing levels. People who use the service said they could go to bed when they wished. However, we do recognise it must be difficult for two staff to complete their duties, with appropriate consideration for individual resident’s wishes and needs. This is particularly the case, as some people’s needs have changed, and can only be manoeuvred using a hoist. Subsequently the registered provider needs to keep staffing levels under review, according to the individual and collective needs of the people accommodated in the home. The registered provider has a suitable approach to providing National Vocational Qualifications for care staff. The manager has stated 57 of staff have an NVQ 2 or 3. However there was no copies of certificates on people’s files to validate this. The previous requirement is therefore renotified. Personnel records were inspected. However checks and records completed on staff need improvement. Current staff have completed an application form. However this should be improved, as required by the regulations, for staff employed in future: 1. There needs to be an employment history- Currently prospective employees only need to provide two references. An employment history will give the provider a record of where applicants have worked before they worked at the home. Subsequently, the registered provider will have the opportunity to investigate any gaps in people’s employment history, and why previous employers have not been given as referees. 2. A statement by the person applying for the job as to their mental /physical health. The current information is too brief and does not enable the provider to ascertain whether applicants are deemed suitable to work in a care home. The records of ten staff employed were assessed in detail. Seven of this sample had two references. However two staff only had one reference, and one person had no references on file. All these staff started in 2008. An application forms for one of these people was only partly completed. Of the ten staff there was only evidence on file that one person had received a Protection of Vulnerable Adults ‘First’ check. This was dated after the person had commenced employment, rather than before as it should be. This check is required by law to check the person is not on a list of people who are considered unfit to work with vulnerable people. Seven of the sample had an enhanced Criminal Record Bureau / Protection of Vulnerable Adults (CRB/POVA) check on file. However the completed check for Garsewednack Residential Home DS0000054567.V365454.R01.S.doc Version 5.2 Page 28 a further person was produced the following day after the inspection. We have requested copies of the two outstanding CRB /POVA checks. An immediate requirement was issued on 3rd June 2008 to the registered providers stating that employment checks according the regulations must always be completed for all new staff. For example: 1. A POVA First check before the person commences employment 2. An enhanced CRB/ POVA check before the person works unsupervised. 3. Two written references 4. A full employment history 5. Other documentation as outlined in the regulations. Written confirmation of compliance is required within one week of the issuing of the notice. The Commission for Social Care Inspection has written to the registered provider on 9th June 2008,regarding concerns and requesting clarification regarding the employment of some staff recently employed at the home. Staff training records were inspected for a sample of ten staff. Staff training has developed since the last key inspection, but the results of this are mixed. By law all staff must have: • All new staff must have an induction and there should be a record of this. • 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. • All staff must have basic training in infection control. • If staff handle food they must receive training regarding food hygiene. The inspector spoke to staff regarding staff induction arrangements. One person said they were working ‘supernumary’ when they commenced employment, were shadowing and learning how to carry out the job from more experienced staff. Of the ten staff files assessed there was an induction checklist competed by the employee / supervisor for seven staff. The checklist could be expanded as it is brief, and it is essential it covers all areas necessary for a member of care staff new to such a setting. ‘Skills for Care’ publish detailed standards regarding what staff induction in a care setting should cover. For example see: http:/www.topssengland.net/view.asp?id=58 In regard to: 1. Fire awareness one of the registered providers has trained with Cornwall County Council’s fire department as a fire warden. Training is subsequently completed internally. In regard to the ten staff files inspected eight staff appeared to have received training in this area. Garsewednack Residential Home DS0000054567.V365454.R01.S.doc Version 5.2 Page 29 2. 3. 4. 5. However, it needs to be clear what the training consists of, and a summary of the training should be kept for example in the fire file or training file. Food hygiene Four staff had received training regarding this, but a certificate does not appear to have been issued in some cases to state people have passed the course and have been trained to the appropriate standard. Manual handling The manager has received training as a manual handling trainer, and training of care staff is completed internally. Staff also appear to have to read training manuals provided by an external training provider. Our understanding is that this company usually requires candidates to complete a test, this test is sent to them for marking and they issue a certificate if the person passes. In regard to the ten staff files inspected five staff appeared to have received training in this area. However, it needs to be clear what the training consists of, and a summary of the training should be kept for example in the training file, along with external verification of the trainer’s qualifications. Also if the external training package is being used, candidates should submit their work to the training provider for marking so a certificate can be issued. It is also essential that the internal trainer keeps their knowledge and skills up to date if the training is to meet legal requirements. Infection control. Five people in the sample have completed training in this area. However certificates have not been issued in some cases to state people have passed the course and have been trained to the appropriate standard. We have raised concerns about infection control standards elsewhere, so it is important the registered providers assess the current training is satisfactory. First aid. Five people in the sample have completed training in this area. However certificates have not been issued in some cases to state people have passed the course and have been trained to the appropriate standard. On the night shift one person had completed a basic internal course which did not appear to be to the approved person level, and the other person had no training in this area. We have also required in the past for the registered providers to ensure staff have training regarding dementia and mental health needs due to the needs of the people accommodated in the home. Six of the ten staff had completed training regarding dementia, but there is no record that any training has been completed regarding basic mental health awareness. We have also stated earlier in the report that improvement is required regarding evidencing people have received training regarding abuse awareness. In the last report dated 20th August 2007, the timescale for ensuring staff received the appropriate training was 01/03/08, and from the evidence we have obtained this statutory requirement was not complied with. We are subsequently renotifying this requirement. Garsewednack Residential Home DS0000054567.V365454.R01.S.doc Version 5.2 Page 30 CSCI is also concerned about the following issues regarding staff training: 1. Most of the training is delivered internally. The content, particularly in relation to questionnaires used to test individuals, did not appear particularly rigorous to ascertain people had attained appropriate levels of skills and knowledge. From what was seen it is not clear whether training being provided takes into account current legal requirements and best practice. 2. If senior staff are to provide appropriate levels of mentoring and tuition, it is essential they receive regular updates to develop their skills and knowledge. This is particularly the case regarding staff acting as manual handling trainers and fire wardens, as well as those who mark the questionnaires for example regarding ‘dementia awareness’, ‘food hygiene’ etc. 3. Training needs to be externally validated. For example certificates for the training are obtained from the training provider to state people have met the required standard from the provider’s courses. 4. In regard to infection control and food hygiene training it is important these training packages comply, for example, with Health Protection Agency, and Food Standards Agency Guidance. (These agencies or the Environmental Health Officer may provide advice regarding these matters). CSCI are particularly concerned regarding First Aid training delivered by the registered provider. For example it is not clear whether the training provided ensures staff have the appropriate skills to be an ‘appointed person’, and to have the right skills to assist people using the service in an emergency. If it does not, people using the service could be put at significant risk. It is essential that CSCI guidance regarding First Aid training is followed. Full details of this are available on the CSCI Professional website. A copy of the registered provider’s risk assessment regarding this matter must be submitted to the commission (with an action plan as appropriate) within the timescale set. Appropriate levels of First Aid cover, must be provided by the registered provider, at all times, as a matter of urgency. Confirmation from the registered provider is required regarding this. Garsewednack Residential Home DS0000054567.V365454.R01.S.doc Version 5.2 Page 31 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. This judgement has been made using available evidence including a visit to this service. Action is required particularly to improve ‘health and personal care’, ‘staffing’ and ‘management’ standards. There are also shortfalls in other areas as outlined in the report. These areas of practice result in the commission having concerns about how the home is currently managed. The registered providers must urgently focus on bringing improvement in these areas otherwise enforcement action may occur. Suitable action will ensure people using the service can be assured they live in a safer service, and they receive suitable levels of support from competently recruited and trained staff. EVIDENCE: The Commission for Social Care Inspection issued a statutory requirement at the last key inspection on 20th August 2007 for the registered providers to Garsewednack Residential Home DS0000054567.V365454.R01.S.doc Version 5.2 Page 32 have a registered manager at the home. We have not received an application. Our concerns are in regard to the need for the providers to have a manager because they own two homes and are a partnership of three people. Regulation 8 of the Care Homes Regulations 2001 states the appointment of a registered manager is required in such an instance. As a result of this inspection we have concluded that although the home offers a generally pleasant environment, people mostly seem happy, appear clean and in most cases well cared for; there are significant shortfalls in several areas. We are also concerned that some statutory requirements have been renotified on several occasions. There are concerns regarding some practices about enabling choice for some people living at the home, and in regard to staff recruitment and training. Despite some strengths of the service, the shortfalls in key areas mean we must rate this service as poor, and include it as part of our regional improvement strategy. This means we will increase our focus in ensuring the registered provider’s comply with the statutory requirements issued, and if there is not compliance, we may take enforcement action. The registered providers have a quality assurance policy, although this was not available for inspection. Records show there are occasional residents’ meetings which is a very good idea to obtain the views of people using the service, and give them some ownership in how the home is run. The registered providers also seem to have completed a formal survey to ascertain people’s views of the service, although there are only a handful of responses on file. A plan to bring improvements to the fabric of the building, and upgrade decorations is also on file. Physical standards of the building are generally pleasant. Further monitoring needs to take place by the registered providers to ensure some of the regulatory issues highlighted in the report are checked, and either maintained or improved. We are concerned this report has resulted in substantially more statutory requirements than when we last inspected. Management subsequently need to consider significantly improving their systems to ensure there is compliance with the regulations. The Commission will be requesting a CSCI Improvement Plan as a consequence of this inspection regarding the requirements issued. Some monies are looked after on behalf of people who use the service, and records are kept regarding this. Money kept for individuals corresponded with totals in records. However, it was not possible for the inspector to audit expenditure, as receipts were not available in many cases. Subsequently the registered provider needs to ensure receipts are obtained, or if this is not possible in some cases, at least a petty cash voucher completed and signed by the registered provider. Garsewednack Residential Home DS0000054567.V365454.R01.S.doc Version 5.2 Page 33 Other monies of people using the service are either maintained via individual solicitors or people’s relatives via Power of Attorney arrangements. Otherwise people who use the service or their representatives are responsible for their finances, and fees are paid via bank transfer. Suitable insurance for the building and people using it appears to be in place. The registered persons have a health and safety policy. Records of testing by staff of the fire alarm, the effectiveness of fire doors and emergency lighting seem satisfactory. Health and safety risk assessments have been completed. A risk assessment regarding legionella has also been completed. However there are no records regarding checks completed to minimise this risk. We have made a recommendation for the registered provider to seek further advice about this matter from the Environmental Health Officer. The Health and Safety Executive publish a useful leaflet regarding this matter which is available on their website at www.hse.gov.uk The stair lift was serviced in February 2008. However we are concerned that part of the stair lift does not have a safety strap. There is a risk of significant injury if somebody fell off this. Subsequently a safety strap must be fitted with minimal delay. Each bath has a bath hoist. One of these has only just been purchased in April 2008, and another was serviced in September 2007. However one had a note on it stating it is unsafe, and if repair has not been arranged, it must be completed as soon as possible. The home has a valid gas certificate dated July 2007. The electrical circuit was tested in July 2006, and an electrical hardwire certificate has been obtained to state this was satisfactory. No record of portable electrical appliance testing was presented. Testing of this equipment should be completed annually. Records are kept regarding the monitoring of the temperature of hot water (e.g. to prevent scalding) in one bathroom, but there was no record in the downstairs bathroom. If and when this bathroom is used, bath temperatures records need to be maintained. If not fitted, the registered provider needs to consider the fitting of thermostatic valves to at least taps on baths. Some concerns have been expressed regarding the effectiveness of infection control procedures elsewhere in the report. The environmental health officer has visited the home in regard to food standards and health and safety standards. Concerns have been raised in the ‘staffing’ section of the report regarding some aspects of health and safety training provided to care staff. Garsewednack Residential Home DS0000054567.V365454.R01.S.doc Version 5.2 Page 34 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 2 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 1 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X 1 2 2 X X 2 STAFFING Standard No Score 27 2 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 2 X X 1 Garsewednack Residential Home DS0000054567.V365454.R01.S.doc Version 5.2 Page 35 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 OP2 Regulation 5 Requirement Timescale for action 01/08/08 2. OP3 OP8 OP27 3. OP7 OP8 All people admitted to the service must be issued with a statement of terms and conditions of residency or contract (depending on the source of funding). This will help to ensure people who use the service are aware of their rights and responsibilities. 7,12, 13, A suitable assessment regarding 14, 18 the needs of people using the service must be completed before they are admitted to the service. There should be appropriate reassessment of people’s needs if, for example, the person’s needs significantly change. Suitable staffing levels need to be provided to meet these needs. This will help ensure people using the service have their needs met to a satisfactory standard. 12, 13, 15 Each person who uses the service must: 1. Have an up to date care plan. 2. Care plans must include an accurate moving and handling risk assessment. DS0000054567.V365454.R01.S.doc 01/08/08 01/10/08 Garsewednack Residential Home Version 5.2 Page 36 3. Care plans need to include a risk assessment where appropriate. 4. Where cot sides are used (or any other restrictive practice) these matters must be risk assessed, and any restrictions agreed either with the person’s next of kin / other key professionals involved in the person’s care. 5. Care plans must be reviewed on a regular basis. 6. Records must be maintained when people receive external health care support. 7. Matters of concern regarding care plans in the report must be satisfactorily resolved. Suitable care plans will help ensure people who use the service receive appropriate care and support from the registered provider. Timescale, regarding items 1,2,5, of 01/10/07 not met. Second Notification Wheel chairs must always be 01/08/08 fitted with foot rests. This will minimise the risk of injury when people using wheelchairs are transferred in the home, or within the wider community. People using the service must 01/08/08 have appropriate access to health professionals without delay. Where appropriate, people who use the service must receive suitable staff support to attend medical appointments e.g. if a person using the service has difficulty communicating their wishes and needs. All medical DS0000054567.V365454.R01.S.doc Version 5.2 Page 37 4. OP8 OP38 12, 13 5. OP8 12, 13 Garsewednack Residential Home 6. OP10 OP23 OP14 7. 8. OP10 OP22 OP9 9. OP9 interventions must be appropriately recorded. This will help ensure people who use the service receive satisfactory health care support. 7, 12 The registered providers must ensure: 1. People using the service can spend their time in the part of the care home they choose (e.g. their bedroom or the lounge etc.). If such a choice creates an unsatisfactory risk, the matter should be risk assessed in line with the principles of the Mental Capacity Act 2005. 2. 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. 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. 12, 16, 23 People who use the service must have satisfactory access to the call bell system. 13 The management, 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. 13, 18 All staff who administer medication must receive DS0000054567.V365454.R01.S.doc 01/08/08 01/08/08 01/08/08 01/10/08 Garsewednack Residential Home Version 5.2 Page 38 10. OP18 10, 12, 13, 19 appropriate training. This will help to ensure the medication of people who use the service is managed appropriately and in line with current best practice guidelines. The registered provider must have a suitable adult safeguarding policy. Matters outlined in the report must be addressed. Having an appropriate policy will help to give people who use the service, and other stakeholders, more assurance that agreed multi disciplinary procedures will be followed when necessary. 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 is necessary) All bathroom and toilet doors also must have a handle. Previous timescale of 01/10/07 not met. 4th Notification The registered provider must confirm in writing what action has been taken regarding this statutory requirement within the timescale set. ) Previous timescale of 01/10/07 not met. 2nd Notification These measures will ensure people who use the service can have a bath or go to the toilet in private 01/10/08 11. OP21 12(4)(a)2 3(j) 01/10/08 12. OP26 OP38 13, 16, 23 The registered provider must develop / review and implement DS0000054567.V365454.R01.S.doc 01/10/08 Garsewednack Residential Home Version 5.2 Page 39 13. OP29 7, 17, 18,19 a suitable infection control policy and procedure. Suitable cleaning materials and protective clothing must be provided. These measures will ensure staff, visitors and people who use the service are more protected against cross contamination and infection. The health protection agency, environmental health officer, and health and safety executive may provide guidance regarding this matter. The registered provider must complete satisfactory pre employment / employment checks, before/when staff commence employment. Records, according to the regulations, must be maintained on file and be available for inspection. For example: 1. A POVA First check (before commencement of employment) must be completed. 2. A CRB/POVA check, at enhanced level, before the person works unsupervised (i.e. in line with CSCI /CRB guidance) 3. Two written references (one should be from the previous employer) 4. A full employment history 5. Other documentation as outlined in the regulations The registered provider is required to confirm compliance to CSCI within one week of this notice. These measures will ensure appropriate checks are completed on new staff before they are employed, and assist in ensuring that people who are unsuitable to work in a care 03/06/08 Garsewednack Residential Home DS0000054567.V365454.R01.S.doc Version 5.2 Page 40 setting are not employed. Immediate Requirement (Previous deadline of 01/10/07 not met. Second Notification.) There must be satisfactory evidence that all staff receive a comprehensive induction. This will provide reassurance, for people who use the service, that all new staff are provided with appropriate knowledge and skills to perform their job Staff must receive training required by law. (For example: (a)This must include training required by regulation such as infection control, food hygiene, Fire training, manual handling training and first aid. (b) Training regarding people with dementia and mental health needs.) Timescale of 01/03/08 not met. Fourth Notification. Staff should receive this training within six months of commencement of employment. (c)Suitable records of training e.g. NVQ and other training certificates need to be maintained and available for inspection. (d)The registered provider must provide the Commission with an update regarding what training staff have received by no later than 01/10/08. Timescale of 01/03/08 not met. Second Notification. 14. OP30 18, 19 01/10/08 15. OP30 OP38 10(3),12, 13(5)(6) 16(2)(j) 18, 23(4)(5) 01/12/08 Garsewednack Residential Home DS0000054567.V365454.R01.S.doc Version 5.2 Page 41 Matters of concern outlined in the ‘staffing’ section of the report regarding staff training must be addressed and resolved satisfactorily in respect of the law and the national minimum standards. This will help ensure people who use the service receive appropriate care and support from staff, who have suitable knowledge and skills. It will also help ensure risks to people’s health and safety are minimised. The registered provider must 01/08/08 ensure staff receive appropriate levels of first aid training, and there is always sufficient first aiders on duty at all times: 1. A risk assessment- in line with CSCI guidance- must be submitted to the Commission within the timescale (with an action plan as appropriate). 2. 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. 01/10/08 An application for a registered manager must be submitted, within the timescale. This will ensure suitable arrangements for the management of the home are in place according to the Care Homes Regulations 2001. (Previous deadline of 01/11/07 not met. Second Notification.) 16. OP30 OP38 12, 13(4), 18, 19 17. OP31 7, 8, 9, Garsewednack Residential Home DS0000054567.V365454.R01.S.doc Version 5.2 Page 42 18. OP31 OP33 7, 9, 12, 13, 24 19. OP35 20. OP38 OP22 21. OP38 Further develop the quality assurance system to monitor regulatory standards in the home. Measures taken should be included in the quality assurance policy. This will help improve service quality and help minimise risks to staff and people who use the service. (Previous deadline of 01/12/07 not met. Second Notification.) 13(6), 20 Receipts must be provided for expenditure carried out on behalf of people using the service. This will help to ensure there is suitable evidence that any expenditure on behalf of people who use the service is legitimate, and any risk of financial abuse of people’s monies is minimised. (Previous deadline of 01/09/07 not met. Second Notification.) 13, 16, 23 The upper part of the stair lift must have a safety strap. This will ensure that the risk of people falling off the chair lift is minimised. 12, 13(4) The registered providers must 23(2)(c) ensure health and safety standards are improved and maintained (For example: • Portable electrical appliances must be tested annually. • Maintain a record of the temperature of hot water (for baths and shower facilities). (Previous deadline of 01/12/07 not met. Second Notification.) 01/10/08 01/08/08 01/08/08 01/08/08 Garsewednack Residential Home DS0000054567.V365454.R01.S.doc Version 5.2 Page 43 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 OP8 Good Practice Recommendations The registered providers should ensure that incontinence pads are regularly changed, where necessary there are appropriate individual toileting routines, and routines regarding these matters are adhered to. Any routines should be agreed with individual people using the service, and recorded in their care plan. Explore further options for social, recreational and educational opportunities for people using the service. Ascertain and arrange for a library service to visit the home for some people who use the service Existing people who use the service should be offered a suitable lock and key for their bedroom door. People subsequently admitted to the service should also be offered this facility. This will ensure people who use the service can lock their bedroom door if they wish to improve security and privacy. Staffing levels, particularly on the afternoon / evening shift need to be kept under review, and adjusted accordingly according to the needs of the people accommodated in the service. The registered provider is advised to send a copy of the Legionella risk assessment to the Environmental Health Department (Health and safety) for advice whether any regular checks need to be completed by the provider or a qualified contractor. Fit thermostatic valves to control the temperature of hot water on baths and also wash hand basins. 2. 3. 4. OP12 OP13 OP12 OP13 OP10 OP24 5. OP27 6. OP38 7. OP38 Garsewednack Residential Home DS0000054567.V365454.R01.S.doc Version 5.2 Page 44 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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. 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