Inspection on 11/04/05 for George Leonard Rest Home

This inspection was carried out on 11th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

George Leonard Rest Home 16/03/10

George Leonard Rest Home 05/03/09

George Leonard Rest Home 02/08/06

George Leonard Rest Home 28/11/05

George Leonard Rest Home 04/10/04

George Leonard Rest Home 27/04/04

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

CARE HOMES FOR OLDER PEOPLE George Leonard Rest Home 237-239 Oldbury Road Rowley Regis West Midlands. B65 OPP Lead Inspector Cathy Moore . Unannounced 11.04.05 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 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. George Leonard Rest Home Version 1.10 Page 3 SERVICE INFORMATION Name of service George Leonard Address 237-239 Oldbury Road Rowley Regis West Midlands. B65 OPP 0121 561 4984 0121 561 1783 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr. S. B. Odedra Mr. R. S. Odedra Mrs Christine Price Care Home 23 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (23) of places George Leonard Rest Home Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 04.10.04 Brief Description of the Service: George Leonard Care Home is located on a main road between Blackheath and Whiteheath . A number of local shops and other facilities are available within easy reach of the home. The home is accessible to main bus routes. The home orginally comprised of two semi-detached police houses that have been linked together, converted and extended to provide the 23 bedded care home, as it now consists. The home has a small garden and a car parking space for approximatley five cars to the front of the property and a garden to the rear. The home comprises of two storeys . The ground floor houses the office , lounge , dining room , conservatory, kitchen, one of the assisted bathrooms and toilets . The first floor houses bedrooms, toilets and the second assisted bathroom. The home provides nineteen single and two double bedrooms . Ten single and both double bedrooms are provided with en-suite facilities. George Leonard is registered with the Commission for Social Care Inspection to provide care to a maximum of 23 residents who have needs that fall within the cayegorey of old age, 3 of these places at any one time can be allocated to older people who have a diagnosis of dementia. George Leonard Rest Home Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place during the period of 07.50-16.40 hours, involved two inspectors and was carried out as a routine unannounced inspection and follow up to an anonymous complaint received by the Commission for Social Care inspection in February 2005. A partial tour of the premises took place which included the kitchen and laundry, three staff and three residents files were scrutinised. Two residents were spoken with in some detail and three of the four staff on duty. Six other residents, one relative and one visiting healthcare professional were also spoken with but in less detail. Records relating to the environment, health and safety, care planning, care delivery and medication were sampled. The main meal time of the day was observed. Only samples of evidence identified during this inspection were incorporated into this report. For more detail of improvement instruction given the reader should access the requirement section at the end of the full report. What the service does well: Positive comments were received from residents as well as the home’s comments book about the manager, staff and care provided, samples of which are as follows: “I am happy with everything, I’d tell them if I wasn’t”. “My family can visit any time they want”. “I am happy with the manager”. We are happy with Mum’s care, she has been here for four years without any major problems”. “Very happy with the care Mum has received. Her mobility has improved significantly since she has had the physiotherapy that was arranged for her”. The manager and staff during the course of the inspection appeared to be kind and caring towards the residents. George Leonard Rest Home Version 1.10 Page 6 The home encourages prospective residents to visit and spend time at the home to aid the decision making process on whether they want to move into the home or not. The home actively encourages relatives to maintain contact with residents. Visiting times are open and flexible. What has improved since the last inspection? What they could do better: The home has a number of outstanding requirements from previous inspections. A large number of requirements have been made following this inspection. There has been a lack of pro-activity for a number of years which has caused the home’s overall compliance / standards of care to fluctuate. The home must improve in key areas, examples being care planning, record keeping, resident choice and participation, staff recruitment, selection, screening and retention, health and safety, infection control, risk assessment and general auditing, planning and financial investment to enhance the premises and environment. George Leonard Rest Home Version 1.10 Page 7 An overall quality assurance / quality monitoring system is needed to ensure that the manager has a framework to monitor and evidence strengths and weaknesses of the home. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. George Leonard Rest Home Version 1.10 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection George Leonard Rest Home Version 1.10 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2,3,4,5 It is clear that the home generally issues terms and conditions, gives prospective residents and their families the opportunity to visit the home prior to deciding on admission and conducts a limited assessment of need. However, greater diligence is needed to complete necessary records and documents. Particularly important is attention to be given to a full assessment of need. EVIDENCE: Four residents files were viewed. It was identified that three residents had been issued with a terms and conditions document, the fourth, a new resident had not. One of the terms and conditions seen had not been signed or dated. The terms and conditions document seen has not been reviewed since 2003. An assessment of need format was seen to be in operation, however, the information on completed assessment of need documentation was limited and had not been signed by the assessor or the resident. There was no evidence available to demonstrate that the registered persons provide residents on admission with a written acknowledgement of how they intend to meet needs identified. George Leonard Rest Home Version 1.10 Page 10 The newest resident admitted to the home, the week before the inspection, confirmed that he visited the home prior to his admission this giving him the opportunity to assess the quality and facilities of the home and to assess whether the home could meet his needs. He said, “ I came to the home the day before I was admitted, they said I could take time to make a decision. I told them I didn’t need any time as I wanted to come and live in the home”. Brief records of this introductory visit were made by the home. George Leonard Rest Home Version 1.10 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9 Although efforts appear to have been made to produce care plans for residents they are basic, incomplete and residents generally do not contribute to their content. Risk assessment processes are particularly poor. Residents’ healthcare needs seem not to be consistently addressed. There is some evidence to suggest basic care needs are met. The medication systems are particularly poor and this creates a potential risk to residents. EVIDENCE: Three residents care plans were scrutinised, these did not detail any resident signatures to indicate that they had been consulted about these. Two residents confirmed that they were not aware of their care plan. The care plan for the newest resident to be admitted, who has complex needs, had not been completed. Care plans seen did not always reflect individual needs of the residents, for example, one resident had been assessed as ‘ being at risk’ in terms of tissue viability, yet there was no record of this on her care plan. Another resident had two falls last autumn yet this was not reflected in her care plan. It was not clear on all care plans seen when they were last reviewed and no evidence to indicate that residents are being involved in the review of their care plans. The manager agreed that there are still a number of shortfalls in respect to the care planning process. It was noted that individual George Leonard Rest Home Version 1.10 Page 12 residents files have been transferred to a document holder, which, is an improvement on the previous storage method. Care staff are responsible for providing direct personal care to residents who require this help or are unable to attend to their personal care independently. A resident commented that the staff had helped her have a shower the day before. She further commented “ last week I had sickness, they put me to bed and looked after me “. Although there were no concerns raised by residents about their direct care delivery, there was little evidence to demonstrate on a daily basis what care is being provided, examples being bathing, showering, continence management, foot and mouth care. Good practice was evidenced in that residents had been asked in writing if they would prefer not have a male carer attending to their personal care. One residents file examined had recorded that a doctor and psychiatrist had assessed his mental health / behavioural needs. The continence team had carried out a continence assessment and that he had been seen recently by an optician. A second residents file examined revealed that her blood pressure had been checked by a nurse, she had received the flu vaccine, had been assessed by the continence nurse and been seen by the optician all within the last eight months. There was no evidence to suggest that these two residents had been assessed by a dentist or chiropodist recently. A nurse visited the home during the inspection to renew one resident’s leg dressing. There was no evidence to demonstrate that residents are receiving a full annual medical review from their doctor, this confirmed by the manager. There was no evidence that a nutritional or tissue viability assessment had been carried out in respect of the newest resident or that he had been weighed. There was no evidence to demonstrate that specific risk assessments in terms of falls risk assessment are being carried out or measures are taken to ensure fall prevention. There had been no falls risk assessment carried out for a resident who had been admitted the previous week who had a history of falls. A moving and handling assessment had not been carried out for the newly admitted resident and another moving and handling assessment seen had not been signed or dated by the person carrying out the assessment. The morning medication administration, undertaken by the manager was observed. The process was seen to be lengthy, partly due to there being one staff member short, the manager having to halt the process to attend to residents needs. The medication policy was dated 2005. A contract between the home and their pharmacy provider was seen dated 9/04. The last medication audit carried out by the pharmacist was also dated 9/04, it is recommended that these audits are carried out on a 3 monthly basis. Only one staff member to date has received accredited medication training. Accredited medication training has been booked, however, to commence in April 2005. It appeared from records George Leonard Rest Home Version 1.10 Page 13 that processes are not being followed correctly in terms of the receipt, storage, administration or disposal of medication. Examples being, the lack of recording of medication received by the home, a discrepancy between the social workers list of medications for one resident to what was detailed on his medication administration record, refusal of medication by residents not being recorded, 47 staff initial gaps on the residents medication administration records in a 4 week period, a lack of risk assessments in respect of one resident who self medicates his prescribed inhalers, variable doses not being recorded precisely when being prescribed as one or two tablets to be taken, a lack of recorded opening dates on short life medication. The medication needs of the residents, including medications being prescribed ‘ as needed’, are not included in their care plans. There was no evidence to suggest that individual residents are being reviewed by their doctors in respect of their medication. There was evidence to suggest good practice in respect of medication processes in that a medication key handover system is in operation between each shift, the home has a suitable medication trolley which is secured when not in use and a lockable facility was seen to be provided in all bedrooms viewed. One resident was self administering his inhalers commented “ I like to look after my inhalers myself, I would rather the staff look after my tablets though”. George Leonard Rest Home Version 1.10 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,15 There is some effort made at the home to engage residents in social and other activities, though attempts to establish individual preferences are limited. The home endeavours to enable residents to maintain contact with their family and friends. The absence of a cook is currently having a detrimental effect on the provision of food and menu information should be further developed to enhance greater choice at mealtimes. EVIDENCE: There was little evidence available to demonstrate that the preferences of each resident on admission are being explored in terms of daily routines, rising and retiring and meal times, preferred form of address and hobbies or interests. A resident commented “I have only been here a couple of days but it seems I can get up and go to bed when I want to“. In house activities are provided by the staff. Evidence of activity session recording was available these records did not however, detail the individual residents names who participated in these activities. There was evidence available demonstrating that external activities providers are secured at times. One resident commented positively“ The music man comes here and we all have a sing song”. George Leonard Rest Home Version 1.10 Page 15 It was confirmed during the inspection that the vicar was coming to the home to provide a service during the coming week. There was lack of evidence to demonstrate that resident meetings are held. This lack of meetings was confirmed by the manager. However, on a periodic basis meetings are held for relatives to attend. Visiting times are open and flexible. A number of relatives visited the home during the inspection. One commented, “ we can visit whenever we want to. We are always made to feel welcome”. Observations indicated that management and staff have developed a good rapport with relatives. Two residents went out with their relatives during the inspection, one to a local supermarket another back to his daughter’s house for a meal. It was evident from the manager that the home very much encourages residents to maintain contact with their family and friends. The home at the present time does not have a cook. Catering duties are being undertaken by care, senior care staff or the manager. This lack of a cook is having a negative impact on meals and meal times. The situation was exacerbated on the inspection day by the home being one care staff member short. One resident commented whilst waiting for her breakfast” I am hungry”. Meals for the main meal of the day were standing in the kitchen for some time resulting in residents having to wait and the meal not being as hot as it would if it had been served straight away. It was apparent however, from observation that the staff member cooking for that day did try hard to ensure that the quality and the presentation of the food was of a good standard. Good practice was also observed in that a care staff was overheard asking a resident what he would like for his breakfast and giving him a choice. One resident commented” I had cheese pie and baked beans, it was all right. Occasionally you get something that you don’t fancy, but I don’t bother I just eat it”. Initially there was no menu on display. The menu when eventually displayed only detailed the main meal of the day not breakfast, evening meal or supper. One resident commented,” we don’t have supper”; the manager however suggested otherwise and said that supper was always provided. Good practice was noted in that the main meal consumed by each resident is recorded on a daily basis. However, there were no records of the food consumed by each resident at breakfast, evening meal time or supper. There is no choice of milk offered, the only milk provided is the sterilised type. George Leonard Rest Home Version 1.10 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 Though policies were present to protect vulnerable adults they need updating and augmenting with Sandwell Council’s Adult Protection Procedures. Record keeping in this area is inadequate. Some progress has been made regarding training to support adult protection polices, but this area needs further and continued attention. EVIDENCE: Since the last inspection one allegation of abusive practice has been made resulting in the staff member concerned being dismissed and referred to the Protection Of Vulnerable Adults list. A further concern is being dealt with in accordance with Sandwell Council’s adult protection procedures. Records relating to this incident, subsequent investigations and the referral to the list described were not available. A number of policies relating to the protection of vulnerable adults were available, however a number of these require updating. Sandwell council’s adult protection guidance was not available. Records were available detailing that 6 staff attended abuse awareness, challenging behaviour and communication skills training in March 2005. However, two staff who were detailed on the list commented that they had not received abuse awareness training. George Leonard Rest Home Version 1.10 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,24,25,26 Although there is evidence to suggest some attention to the maintenance to the environment has taken place, significant work remains to be done to render the environment safe, comfortable, hygienic and pleasant. EVIDENCE: It was noted that paintwork in particular requires renewing in many places. The manager was not able to give a date when the last mass redecoration had been carried out. One visiting professional commented,” the home appears dark and dreary”. There was no evidence to demonstrate that a recent redecoration or renewal of fabric audit had been carried out. There was no written proposed maintenance programme available. There was evidence in the form of an invoice demonstrating that 23 easy chairs have been ordered. Two residents commented that they were content with the décor of and furnishings in the home. George Leonard Rest Home Version 1.10 Page 18 The bedrooms of three residents were viewed. One of the three residents to whom these rooms belonged was in hospital. Of the two residents available to comment on their rooms, one was satisfied, the other commented, “ I really like my room, but it could do with being bigger”. There was no evidence to demonstrate that an audit has been carried out in respect of each bedroom which has been a requirement following past inspections. It was identified that not all residents have been given a key to their bedroom door. One resident, new to the home, commented when asked “No I have not been given a key to my door. No one has spoken to me about this”. Bedroom door locks do not comply with West Midland Fire Service specifications. It was noted that windows on the first floor are opening wider than 6 inches and that a number of the call system points in the bedrooms are not working. The home has guarded radiators throughout linked to the central heating supply. Copper piping in the en-suite of bedroom 7 was very hot to touch. The water pressure from the tap in this room, when run for two minutes was insufficient, as it was too low. There were no records available for the last two months to demonstrate that the hot water temperatures had been checked. The light source in the dining room is generated by florescent tube lighting which is not ‘homely’ in appearance. It was observed some bathrooms and toilet lights are not provided with light shades. The laundry is equipped with contracted washing machines capable of reaching sluice wash temperatures. Only one sink is provided in the laundry, not allowing for any sluicing to be carried out. The manager stated, “All soiled washing is put into the washing machine on a sluice wash. No soluble bags were available to improve this process, the manager confirmed that these bags are not used in the home. The home does not have any dedicated laundry staff. Concise laundry procedures to prevent infection contamination were not available. There was no evidence of paper towels or liquid soap in the laundry. The laundry was seen to house a number of extraneous items, examples being storage boxes and staff outdoor clothing. A staff member commented that the commode pots are cleaned in the bathroom. This was confirmed by the manager. There was no evidence to suggest that the manager had contacted the Infection Control Nurse for infection control guidance in respect of the home in general, the commode pots being cleaned in the bathroom or to determine if a sluicing disinfector is required. George Leonard Rest Home Version 1.10 Page 19 Mops in the home were not seen to be colour coded, this was confirmed by the manager. There was no evidence that mop heads were being suitably laundered daily. It was identified that a number of staff have not yet received infection control training. An anonymous complaint made in February 2005 alleged that residents were not being changed frequently enough and that they were left to sit in urine, and that the mattresses were not protected. No odour was identified in the lounge or other areas except for bedroom 21. Three beds assessed were seen to have relatively new mattresses complete with mattress protectors. Skirting boards and furniture in the home were seen to be dusty. This was highlighted by demonstration to the manager. There was no evidence to suggest that a cleaning schedule is in operation in the home, this confirmed by the manager. George Leonard Rest Home Version 1.10 Page 20 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29,30 Staff shortage at the home is having a detrimental effect on the level of care provision. Recruitment practices are not conducted with appropriate diligence to protect and support residents. Prescribed training requirements are not effectively in place. EVIDENCE: During the morning of the inspection it was identified that the home was short of one care staff member. A care staff member who could have covered this deficit had been sent to another home owned by the registered owners, to cover the previous night shift. The home at the present time does not have a cook. The home is experiencing a shortage of senior staff .One senior carer has been recently appointed and is being left in charge of the home who has no previous experience, has not received the prescribed induction and foundation training, medication training, and does not hold a National Vocational Qualification in care or first aid certificate. One resident commented that “the staff are always busy, they are kind and helpful”. Three staff members’ personal files were scrutinised. It was identified that two staff had been allowed to commence employment before the registered persons had received an up to date enhanced Criminal Records Bureau disclosure / Protection Of Vulnerable Adults list check. Two references had been obtained for each staff member, although the full name and position of the referee was not detailed. There were two sources of photocopied identity George Leonard Rest Home Version 1.10 Page 21 on file for each staff member, there was no evidence available to demonstrate that the manager had seen the original documents. There was no written evidence to demonstrate that staff have been issued with a job description or contract of employment. There was no written evidence to demonstrate that new staff have received induction or foundation training to the required specifications, this confirmed by both the staff and the manager. George Leonard Rest Home Version 1.10 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33,36,38 Although the manager appears committed to providing a good service, it was identified that she lacks the resources and support to fulfil her role effectively. The home needs to further develop quality assurance and quality monitoring processes to ensure the home is run in the best interests of service users. Staff supervision processes need considerable development. Significant attention to health and safety and food hygiene issues and general resident welfare is required. EVIDENCE: The manager has been employed at this home in excess of ten years. The manager confirmed that although she has completed her N.V.Q (National Vocational Qualification) level 4 in management, “It has not been signed off”. She has not completed the additional N.V.Q units in order for her to achieve the Registered Managers Award. The manager intimated that she did not want to pursue this training any further. George Leonard Rest Home Version 1.10 Page 23 The manager on this day was part of the ‘hands on’ complement of care staff. The manager confirmed that this is not unusual and that on some days she has to attend to the catering. The manager also confirmed that she is not able to have supernumerary hours to attend to managerial duties very frequently. She provided evidence of the wages process which she has to carry out, these she indicated can take a whole day to complete. It was apparent from observations and speaking to the manager that she is committed to providing a good quality of care to the residents and confirmed “paper work and policy comes second to resident care” and that she had limited time to address the administration tasks. One resident commented, “ I am happy with the manager, she’s very good, it’s like talking to your mum” The manager provided documentation to demonstrate to what degree the home has developed quality assurance and quality monitoring. This documentation did not demonstrate full compliance to the required standards. There was no evidence of continuous self monitoring, or an annual development plan for the home. The results from questionnaires and comments processes had not been published or fed back into any self assessment/ monitoring processes. There were no written reports available to demonstrate that the registered providers are complying with the required monthly Regulation 26 visits. There was documentary evidence demonstrating that a number of staff are receiving one to one supervision sessions. However, the content of these sessions lacked any mention of individual development. Staff, this year have only received on average two supervision sessions each. There was no evidence to demonstrate that the manager is receiving formal, structured, regular supervision. The health and safety poster displayed in the home was obscured by the fridge making it difficult to read. A wooden wedge was holding open the kitchen door and at least one bedroom door. The environmental risk assessment seen must be expanded and be more specific. Overall, the records pertaining to servicing of fire fighting and other equipment was seen to be satisfactory with the exception of the service record for the Sunrise Merlin hoist. There was no evidence to suggest that an analysis of accidents is carried out or of any follow up in individual cases where accidents have occurred. For example, one resident commented, “My hand hurts and tingles”. On observation the hand appeared to be swollen in comparison with the other one. When asked the resident said, “I fell over the other day”. It was seen that this accident had been recorded in the accident book, however, there was no evidence to suggest that the resident had been subsequently assessed in terms of injury. George Leonard Rest Home Version 1.10 Page 24 There were a number of gaps in mandatory training. One senior staff member worked in the home for one month before receiving food hygiene training and is not due to receive fire training until the end of April 2005. The training matrix seen requires an up date as it details fire training last received 2003, other dates were not clear. There was no evidence to suggest that fire evacuation procedures have been produced, this confirmed by the manager. The staff toilet door was open allowing access to an unguarded radiator. A bottle of cleaning solution was seen in the kitchen. The manager confirmed that she has not received any risk assessment training. Kitchen surfaces and cupboards looked poor in some places where they were damaged or sealant was worn. There is no dishwasher provided at the home. Processes and systems were lacking in the home examples being, food hazard identification, food and fridge / freezer temperature monitoring and the labelling of jams, sauces and cold meats once opened. There was no documentation to demonstrate that risk assessments were being carried out in respect of kitchen equipment. The microwave held a notice stating that it was out of order. This had not been attended to as the registered providers were out of the country and the manager does not have budgetary control for such. George Leonard Rest Home Version 1.10 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 2 2 1 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 2 COMPLAINTS AND PROTECTION 2 x x x x 2 2 1 STAFFING Standard No Score 27 1 28 x 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 1 2 x 1 x x 2 x 1 George Leonard Rest Home Version 1.10 Page 26 Yes Are there any outstanding requirements from the last inspection? 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 OP1 Regulation 5(1)(b)17 (2) Requirement The registered providers and manager must ensure that each resident is provided with an agreed terms and conditions at the point of moving into the home. The registered providers and manager must ensure that the residents terms and conditions document is reviewed. It would be advisable to consult with the contract manager of funding local authorities involved. The registered providers and manager must ensure that all residents inital assement of need documentation is signed and dated by the person compiling this information and wherever possible the resident or their representative.l The registered provider , registered manager must ensure that Regulation 14(d) is fully confrmed with .(Timescale of 30.10.04 not met) The registered providers and manager must record a more detailed account of any prospective residents preadmission visit to the home. Version 1.10 Timescale for action 11.04.05 2. OP2 5(1)(b) 11.06.05 3. OP3 14(1)(c) 11.04.05 4. OP4 14(1)(d) 11.04.05 5. OP5 17(1) 11.04.05 George Leonard Rest Home Page 27 6. OP7 15(1) 7. OP7 15(2)(a)( b)(c) The registered providers and manager must prepare a written care plan for each resident on admission. The registered providers and manager must : Make the care plan available to the individual resident . where appropriate and, unless it is impracticable to do so consult with the resident about their care plan. Must ensure (where they choose to) that the resident and or their chosen representative are fully involved in their care planning process. 11.04.05 01.05.05 8. OP7 15(2) 9. OP7 15(1) 10. OP7 15(2)(d) 11. OP8 12(1)(b) the registered providers and manager must ask the residents to sign and date their individual care plan to demonstrate that they are satisfied with its content. (Timescale of 30.10.04 not met). The registered providers and manager must revise/expand upon the care plan format/content . Clear instructions must be detailed against each need of what is required of the staff in order for these needs to be met. (Timescale of 04.10.04 not met). The registered providers and manager must ensure that residents care plans are reviewed at least monthly , or earlier if changes occur and that the resident is involved in this process or notified of any revision. The registered providers and manager must ensure that a Version 1.10 01.05.05 01.05.05 01.05.05 01.05.05 Page 28 George Leonard Rest Home 12. OP8 12(1)(a) 13. OP8 12(1) 14. OP8 12(1) 15. OP8 13(2) 16. OP8 13(2) 17. OP9 13(2) 18. OP9 13(2) record is made on a daily basis of all care delivered to each service user (Timescale of 04.10.04 not met). The registered providers and manager must ensure that all residents recieve services in accordance with the National Service Framework for Older people . The registered providers and manager must ensure that a nutritional and tissue viability assessment is carried out for each resident on admission. The registered providers and manager must ensure that all residents are weighed on admission and monthly thereafter. The registered providers and manager must ensure that a falls risk assessment is carried out in respect of all residents on admission and monthly thereafter. The registered providers and manager must ensure that all risk assessments are signed and dated by the risk assessor.(Timescale of 04.10.04 not met ) The registered providers and manager must ensure that satisfactory processes are in place and are adhered to ensure the safehandling , safekeeping , safe administration and disposal of medicines received. The registered providers and manager must ensure that the pharmacy provider carried out an audit of medications / medication systems within the home on a three monthly basis and produces a written report of his findings. Version 1.10 01.05.05 11.04.05 11.04.05 11.04.05 01.05.05 10.05.05 10.05.05 George Leonard Rest Home Page 29 19. OP9 13(2) The registered providers and manager must ensure that : A risk assessment is carried out in respect of any resident who self medicates. That medication administration records are initalled by the staff member administrating the medication immediatley after it has been taken by the resident. That all short term medications examples being, optical preperations are dated on the first day of opening. That a suitable lockable facility is made available in the fridge to store the one residents medication . If more than one resident requires their medication to be refridgerated then a proper medication fridge must be purchased. That the doctor is requested to review all resdents medication on at least an annual basis where they are being prescribed four or more medications. That (E.A) doctor is asked to review her Olanzapine. That an approved pharmacutical guide no older than one year is available at all times. That all staff who have responsibilty for medication training as per the proposed date. Where medications are prescribed as one or two to be taken then the precise number given each time must be recorded. 11.05.05 George Leonard Rest Home Version 1.10 Page 30 An up to date list of medications currently being prescribed and administation or any other special instructions ( for example medications prescribed on an as needed basis and sedatives ) must be included in the individual residents care plan. This to include medication being prescribed on a short term basis an example being antibiotics. That the staff list must be updated to also include each staff members full signature. Homely remedies intending to be given to any resident must be ratified by their doctor. prescribed oral and external medication must be stored seperatley. No items than medication must be stored in the medication cupboard. Where medication is refused for more than 48 hours (earlier depending on the type of medication) this must be reported to the residents doctor. The registered providers and 01.05.05 manager must ensure that the preferred daily routines, form of address , hobbies and activities are explored in respect of each resident on admission and regularly thereafter. The outcomes of this must be recorded on the individual residents files. The registered providers and 11.04.04 manager must expand on the activity recording system to detail the names of each resident who participates in the individual activities provided. Version 1.10 Page 31 20. OP12 12(3),16( 2)(m)(n) 21. OP12 16(m) George Leonard Rest Home 22. OP12 12(3) 23. OP15 17(2) 24. OP15 (17(2)) 25. OP15 16(2) 26. OP18 13(6) 27. OP18 13(6,7,8) The registered providers and manager must devise a schedule of meetings for the service users (all service users as a group) . These meetings must be recorded. Issues for discussion must include complaints, meals, menus and activities. (Timescale of 30.10.04 not met). The registered providers and manager must ensure that a menu in a format understandable to all residents is on display at all times. This menu must detail all meals for the day including breakfast, lunch evening meal and supper There must be a choice of milk provided to the residents. The registered providers and manager must ensure that all food consumed on a daily basis by each resident is recorded. This to include breakfast, lunch, evening meal and supper. The registered providers and manager must ensure that there are sufficent staff on duty each day to ensure that the meals are served on time . The registered providers and manager must obtain the new Sandwell Council guidelines relating to the management of abuse and make these available in the home for the staff to read and reference.( Timescale of 10.11.04 not met ). The registered providers and manager must ensure the following: That the homes abuse policy is updated to include recent new guidance and legislation, bedrail usage and medication. That the physical intervention policy is updated to include 01.06.05 01.05.05 30.04.05 11.04.05 01.05.05 01.06.05 George Leonard Rest Home Version 1.10 Page 32 specific processes examples being permissions in relation to any limitations and training. That the violence and aggression policy is updated to include the need to ensure clear records are made in respect of any incidents of violence and aggression. That the whistle blowing policy is expanded to ensure that staff are aware that if they report any incidents and are not happy with the managers response that they can approach the registered owners, Social Services, the Commission for Social Care Inspection, the police, or Public Concern at Work . The regsieterd providers must 01.05.05 provide the lead inspector with a list of all staff who have recieved abuse awareness training, the name of the training provider and a copy of the content of the course. All staff must abuse awareness training. The registered providers and manager must ensure that all records relating to incidents or allegations of abuse , subsequent investigations and referral to the POVA list remain within the home. The registered providers and manager must carry out an audit of the homes redecoration and replacement of furniture,fixtures and fittings throughout the home, all work identified must be incorporated in an order of priority into the routine maintenance programme. (Timescale of 30.11.04 not met}. Version 1.10 28. OP18 13(6) 29. OP18 13(6) 11.04.05. 30. OP19 16(2)c, 23(2) 15.11.05 George Leonard Rest Home Page 33 31. OP19 16(2)23(2 ) 32. OP24 16(1)c 33. OP24 16(1)c 34. OP24 13(4)(a) 35. OP24 16(1) 36. OP25 13(4)(a) The registered providers and manager must produce a proposed maintenance programme to incorporate work required from the audit above. This must include timescales. a copy of the maintainence programme must be forwarded to the lead inspector. The registered providers and manager must ensure that all items of furniture listed in standard 24 are provided in each bedroom (including the two double electrical sockets). Where any service user refuses any item or where following a risk assessment it has been determined that a risk may present by providing all of these items then this must be documented in the service users care plan. Service users who refuse any item must be asked to sign a document to this effect. (Timescale of 10.11.04 not met. The registered providers and manager must consult with West Midlands Fire Service about the suitability of the present bedroom door locks. The registered providers and manager must consult with the local authority Environmental Health department about the window restrictors. The registered providers and manager must ensure that call systems throughout the home, to include all bedrooms are in good working order at all times.The ones presently not working must be mended. The registered providers and manager must ensure that all exposed hot pipework is guarded. In the interim period risk assessments must be carried Version 1.10 01.06.05 01.06.05 11.05.05 11.05.05 01.05.05 01.05.05 George Leonard Rest Home Page 34 37. OP25 23(2) 38. OP25 16(1)c 39. OP26 13(3) out to eliminate any incidence of burning. The registered providers and 01.05.05 manager must ensure that water pressures throughout the home are satisfactory. The registered providers and 01.05.05 manager must ensure that all lights in toilets and bathrooms are provided with a light shade. (Timescale of 20.11.05 not met). The registered providers and 01.06.05 manager must : Purchase soluable bags for dealing with soiled laundry. Produce policies and procedures to prevent any contamination in the laundry. Ensure that all non-laundry items are removed from the laundry. Ensure that all mop heads are cleaned daily and that records are made when this is done. Ensure that all buckets and mops are colour co-ordinated. Ask for advice on infection control processes and procedures from the Infection Control Nurse. Manage and eliminate the odour in room 21. 40. OP26 23(2)(d) The registered providers and manager must ensure that the home is adequatley clean throughout at all times. Dedicated domestic hours must be increased on a daily basis and must cover seven days. 01.05.05 George Leonard Rest Home Version 1.10 Page 35 41. OP26 13(3) 42. OP27 18(1)(a) The registered providers and manager must produce a cleaning schedule and be able to evidence at all times that this is being adhered to. The registered providers and manager must ensure that all staff infection control training . Commencement dates for this training must be provided to the CSCI.(Timescale of 15.11.04 not met). The registered providers and manager must ensure that all all times suitably qualified , competent and experienced persons are working at the home in such numbers as are appropriate for the health and welfare of the residents. An immediate requirement was issued by the inspector during the inspection for the regisrered providers and manager to provide an action plan detailing how this will be met. The registered providers and manager must not loan staff to other homes unless they can demonstrate that they have excess staffing hours. If staff are loaned to any other homes then the CSCI must be informed in , this must detail the staff name and be accompanied by a the staff rota corresponding to that week. The registered providers and manager must ensure that a suitably qualified and experienced cook is recruited An action plan detailing how this will be addresssed must be forwarded to the CSCI office. The registered providers and manager must ensure that no further senior carers are Version 1.10 01.05.05 13.04.05 43. OP27 18(1)(a) 11.04.05 44. OP27 18(1)(a) 11.05.05 45. OP27 18(1)(a) 11.04.05 George Leonard Rest Home Page 36 46. OP27 18(1)(a) 47. OP29 19(2) 48. OP29 19(5) 49. OP29 19(5) 50. OP29 18(1)(a) 51. OP30 18(1)(a) employed unless they are suitably experienced, qualified and competent. A job description and role specification for seniors must be forwarded to the CSCI office. The registered providers and manager must ensure that the senior who has no experience or qualifications is enrolled/ commences onto the required induction and foundation and N.V.Q training. Evidence that this has been addressed must be provided to the CSCI office. The registered providers and manager must ensure that no staff are allowed to commence employment without firstly recieving a valid CRB/POVA list check. If an extreme case of staffing shortage occurs the manager must contact the CSCI office. The registered providers and manager must ensure that all staff original documents as per schedule 4 are seen. All photocopies taken from these orginals must be signed and dated by the manager. The registered providers and manager must ensure that the reference form in operation is updated this must make provision for the referee to sign their full name and enter there position. The registered providers and manager must ensure that each staff member is issued with an appropriate job description and contract. Evidence of this must be available for inspection at all times (Timescale of 15.11.04 not met). The registered providers and manager must ensure that all Version 1.10 11.05.05 11.04.05 11.04.05 01.05.05 01.05.05 01.05.05 Page 37 George Leonard Rest Home 52. OP31 9(1)18(1) (a) new staff the prescribed TOPSS induction and foundation training.Evidence of this must be available for inspection at all times. The registered providers and manager must ensure that the manager is allocated sufficient supernumeary hours to: Enable her to attend to all managerial tasks required relating to staffing , residents records and care, general record keeping and audits of the premises , systems and quality monitoring. Address requirements under her control in the requirements section of this report The supernumeray hours must be clearly denoted on the staff rota. The registered providers and manager must fully implement within the home a quality assurance / quality monitoring system as descirbed in standard 33. (Timescale of 30.11.04 not met). The registered providers must visit the home at least on a monthly basis and compile a written report as required of Regulation 26. A copy of this report must be forwarded to the link inspector on a monthly basis. (Timesacle of 30.10.04 not met). The registered providers and manager must ensure that the staff supervision template is expanded upon to include : All aspects of practice. Philosophy of care in the home. Career development needs. Version 1.10 01.05.05 53. OP33 24 01.06.06 54. OP33 26 01.05.05 55. OP36 18(1) 01.05.05 George Leonard Rest Home Page 38 56. OP38 23(4) 57. OP38 13(4), 16(2)23(2 ) All staff must receive 6 formal, documented one to one supervision sessions in any 12 month period. This to include the manager the registered providers and 01.05.05 manager must ensure that no doors are propped open. Automatic door closures, linked to the homes fire alarm system must be purchased and installed. For advice contact West Midlands Fire Service. The registered providers and 01.05.05 manager must ensure : That food, fridge and frezeer temperatures are taken and recorded as required. That food analysis and hazard identification methods are established and implemented. That all jams, sauces cooked meats and other short life products are dated when opened and stored as per manufacturers guidelines. That risk assessments are carried out and recorded in respect of all kitchen equipment. That foods are stored appropriately in the fridges and freezers. That separate bins are used for storing wet and dry waste. That a sink is used for hand washing purposes. The allocated sink must be clearly identifiable. For full advice contact the local environmental food safety George Leonard Rest Home Version 1.10 Page 39 department. 58. OP38 23(5) The registered providers and manager must contact the local Environmental Health department for advice on risk assessments and ensure that : Risk assessments are carried out for each resident in respect of falls, moving and handling, behaviour or any other concerning areas. That the environmental risk assessmentmust be expanded upon to include measures to minimise or erradicate any risks and timescales for action. That the health and safety poster is accessible to read at all times. The registered providers and manager must ensure that the manager is allocated and has access to sufficient budget to ensure that vital kitchen items (and other items) can be mended or replaced at any time. the registered providers and manage must employ an effective accident analysis process. Any accidents , falls or other incidents to residents must be fully monitored with records made. the registered providers and manager must forward to the lead inspector documentary evidence to demonstrate that the required work has been carried out on the Sunrise Mermaid hoist. The registered providers and manager must ensure that ALL Version 1.10 01.05.05 59. OP38 16(2)(g) 20.04.05 60. OP38 13(2)c 11.04.05 61. OP38 23(2) 01.05.05 62. OP38 23(2) 01.06.05 Page 40 George Leonard Rest Home STAFF have or recieve the following : Food hygiene, first aid, moving and handling/ hoist training, fire training and drills twice in any 12 month period, infection control and health and safety. (Timescale of 12.12.04 not met). The registered providers and manager must ensure that the staff training matrix is accurate and up to date at all times. The registered providers and manager must produce documented fire evacuation procedures , this information must be disseminated and made available to all staff. (Timescale of 20.11.04 not met). The registered providers and manager must ensure that a documented weekly check is carried out in relation to all hoisting equipment , an additional visual check of this equipment must be made daily. (Timescale of 25.10.04 not met). The registered providers and manager must ensure that a suitable bolt is fitted to the staff toilet door. (As the radiator is not guarded). (Timescale of 11.10.04 not met). The registered providers and managers must ensure that all substances that have a potential to be hazardous to health (COSHH) are stored in a locked cupboard. The manufacturers data applicable to these substances must be available in all areas where these substances are stored. (Timescale of 04.10.04 not met). The registered providers and manager must ensure that at least the manager recieves Version 1.10 63. OP38 23(2) 01.05.05 64. OP38 23(2) 01.05.05 65. OP38 13(4) 01.05.05 66. OP38 13(4) 20.04.05 67. OP38 23 01.06.05 68. OP38 13(3) 01.06.05 George Leonard Rest Home Page 41 approved risk assessment training. 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. 2. 3. 4. 5. 6. Refer to Standard OP25 OP26 OP26 OP31 OP31 OP38 Good Practice Recommendations the registered providers and manager should consider replacing the lighting in the dining room. The registered providers and manager should consider purchsing a slucing disinfector. The registered providers and manager should consider employing dedicated laundry staff. The regsietered providers should ensure that the manager completes N.V.Q level 4 in management and care. The registered providers and manager should consider employing additional administration staff to attend to the wages process. The registered providers and manager should consider refurbishing the kitchen and installing a dishwasher. George Leonard Rest Home Version 1.10 Page 42 Commission for Social Care Inspection West Point Mucklow Office Park Mucklow Hill Halesowen. B62 8DA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI George Leonard Rest Home Version 1.10 Page 43 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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