Inspection on 15/12/06 for Gold Hill Residential Home

This inspection was carried out on 15th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Gold Hill Residential Home 27/02/09

Gold Hill Residential Home 24/09/08

Gold Hill Residential Home 30/04/07

Gold Hill Residential Home 21/04/06

Gold Hill Residential Home 29/11/05

Gold Hill Residential Home 29/07/05

Gold Hill Residential Home 14/03/05

Gold Hill Residential Home 18/08/04

Gold Hill Residential Home 26/03/04

Gold Hill Residential Home 15/12/03

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

CARE HOMES FOR OLDER PEOPLE Gold Hill Residential Home 5 Avenue Road Malvern Worcestershire WR14 3AL Lead Inspector Nic Andrews Unannounced Inspection 09:30 15 & 20 December 2006 and 18 January th th 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 Gold Hill Residential Home DS0000018654.V323775.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. Gold Hill Residential Home DS0000018654.V323775.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gold Hill Residential Home Address 5 Avenue Road Malvern Worcestershire WR14 3AL 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) 01684 574000 Manor Care Limited Mrs Susan Carol Powell Care Home 40 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (40), of places Physical disability over 65 years of age (40) Gold Hill Residential Home DS0000018654.V323775.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The Home may also accommodate a maximum of two people, under the age of 65, with both a mental disorder and physical disorder. The Home may also accommodate one named person with mental health needs who is below the age of 65 years. The admission criteria for people with dementia care needs are those specified in the Statement of Purpose dated March 2006. 21 April 2006 Date of last inspection Brief Description of the Service: Gold Hill is a large building occupying a corner position within close proximity to the centre of Malvern which has all of the amenities usually associated with a small town. There are car-parking facilities at the front of the premises and a garden is located at the side of the building. The home is registered to provide personal care for a maximum of 40 older people. The service users are accommodated in 24 single bedrooms and 8 double bedrooms on four levels i.e. lower ground, ground, first and second floor. Sixteen of the single bedrooms and 7 of the double bedrooms have an en suite facility. Several of the bedrooms enjoy attractive views of the Malvern Hills and the surrounding area. The home has a small, two-person passenger lift. The home also has two lounges on the ground floor and a dining room on the lower ground floor. The dining room has an adjoining conservatory that is used as a designated smoking area. The homes stated aim is to offer the best of care whilst preserving the right of each resident to be regarded as an individual and to assist each resident to achieve maximum independence. At the time of the inspection there were thirty-eight service users in residence and two vacancies. The fees ranged from £1344.00 to £1640.00 per month. Gold Hill Residential Home DS0000018654.V323775.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection that took place over the course of two days. The inspection also included a separate visit by the Pharmacist Inspector who examined the home’s policy and procedures on the administration of medication. The home was inspected against the key National Minimum Standards and time was spent with the deputy manager and the company’s Area Manager assessing the home’s response to the requirements and recommendations that were made as a result of the previous inspection. Various records and a number of policies and procedures that the home is required to maintain were inspected. A tour of the premises was also made. Individual discussions were held with three service users, three members of staff and the relative of one service user. As part of the inspection ‘Comment Cards’ were issued to the relatives/visitors of the service users and to visiting professionals. Two Comment Cards from visiting professionals were completed and returned. The responses to the questions that were asked were positive. What the service does well: What has improved since the last inspection? What they could do better: The home needed to improve the care plans, risk assessments, social activities, quality assurance monitoring, induction and other aspects of staff training in order to enhance the quality of care and to ensure the safety of the service users. The procedures for ordering, checking, storing, administering and recording medication all needed to be improved in order to ensure the safety and wellbeing of the service users. The deputy manager stated that the Gold Hill Residential Home DS0000018654.V323775.R01.S.doc Version 5.2 Page 6 work of refurbishing the premises needed to be completed including the coordination of the fabric and furnishings in the service users’ bedrooms. 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. Gold Hill Residential Home DS0000018654.V323775.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 Gold Hill Residential Home DS0000018654.V323775.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): 1, 2, 3 and 5. The quality outcome in this area was adequate. This judgement has been made using available evidence including a visit to this service. The statement of purpose did not include all of the required information to enable prospective service users to make a fully informed choice about the home. A new contract needed to be issued to all of the service users. EVIDENCE: A copy of the home’s statement of purpose was made available for inspection. The statement of purpose contained most of the required information listed in Schedule 1 of the Regulations. However, the statement of purpose must be amended as follows, • The information in section 9 on staffing must include details of the relevant experience of the staff. • The reference in section 12 to past or present dependence on alcohol or drugs and sensory impairment should be deleted. The range of needs that the home is intended to meet should be limited to the categories for which the home is registered i.e. referred to in the Certificate of Registration, and those that are more generally associated with old age. • Section 14 should include a reference to the home’s policy and procedure (if any) for emergency admissions. Gold Hill Residential Home DS0000018654.V323775.R01.S.doc Version 5.2 Page 9 Section 17 should include a reference to the home’s associated emergency procedures i.e. the arrangements for the care and accommodation of the service users in the event of a temporary closure of the home in the event of an emergency e.g. a fire. • The information in section 20 regarding the arrangements made for dealing with complaints should be much more specific. • The information in section 21 regarding the arrangements made for dealing with the reviews of the service user’s care plan should be much more specific. • The information in section 22 regarding the physical environment was incomplete and should include details of all the room sizes. • The information in section 23 should only include details of the specific therapeutic techniques used in the home. The references to therapeutic techniques that are not provided e.g. hypnotism and yoga etc should be deleted. • Section 24 should include details of all the arrangements made for respecting the privacy and dignity of service users without having to refer to other documentation provided by the home. The statement of purpose should be checked for typographical errors. A copy of the home’s service users’ guide was made available for inspection. The service users’ guide contained all of the required information except for the details of the physical environment referred to in Standard 1.1 of the National Minimum Standards. Evidence should be retained on the service users’ individual files to show that a copy of the service users’ guide has been issued to all of the service users and/or their representatives. A requirement was made as a result of the previous inspection that the home must provide one clear, accurate and comprehensive statement of terms and conditions of residence (contract) that includes all of the information detailed in Standard 2.2. A copy of the home’s statement of terms and conditions of residence or contract, referred to by the home as ‘Service Users Agreement’, was made available for inspection. The contract did not include a reference to any specific room to be occupied. However, the contract stated, ‘The moving of service users between rooms and single and double rooms will only take place with consultation with service users, relatives and representing authorities’. Therefore, the requirement was regarded as having been implemented. It was confirmed that the home had commenced the process of issuing all of the new service users with a copy of the new contract. Seven new service users had been given a new contract. It was confirmed that this process would continue and that it would also include all of the current service users. Two of the four service users’ files that were inspected, including one service user admitted in September 2006, did not contain a copy of the service users’ contract. It was confirmed that the care needs of all of the service users had been assessed by the home. In addition, a community care assessment had been Gold Hill Residential Home DS0000018654.V323775.R01.S.doc Version 5.2 Page 10 • provided by the placing authorities in respect of the majority of service users. A copy of an assessment form that was used by another home owned by the same company was made available for inspection. It was intended that the same form would be used for assessing prospective service users. The form needed to be amended as follows, • The assessment form should include the name of the home. • The references to ‘patient’, and ‘nursing’ should be deleted. • The form should include specific references to history of falls; personal safety and risk; social interests, hobbies, religious and cultural needs; food preferences and carer and family involvement and other social contacts. The requirement that was made as a result of the previous inspection that the home’s assessment form must be amended to include all of the issues referred to in Standard 3.3 had not been implemented and still stands. The Area Manager stated that she was currently undertaking assessments of prospective service users in the absence of the registered manager. Standard 4 was not fully assessed during this inspection. However, the home’s response to the requirement that was made as a result of the previous inspection was assessed. The requirement was that the home must be able to demonstrate that the care provided for service users with a dementia illness is based on current good practice and reflects specialist guidance. There was little evidence available either in the discussions with staff or in the service users’ care plans to show that the requirement had been implemented. The requirement, therefore, still stands. It was confirmed that prospective service users were given the opportunity to visit the home prior to admission but did not always do so in practice. It was stated that social workers did not always have the time to escort prospective service users on pre-admission visits. Two of the three service users with whom discussions were held stated that they did not make a pre-admission visit. Appropriate action should be taken to ensure that the home’s policy on pre-admission visits is upheld. Prospective service users who are unable to visit the home prior to admission should only be admitted in exceptional circumstances. The home had a trial period following admission of four weeks. The trial period was referred to in the service users’ guide and in the service users’ contract. One service user had recently been admitted in an emergency. The home was still in the process of implementing the procedures referred to in Standard 5.3. Gold Hill Residential Home DS0000018654.V323775.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. The quality outcome in this area was poor. This judgement has been made using available evidence including a visit to this service. The information set out in the care plans and other related records was not in sufficient or accurate detail to ensure that all of the service users’ needs were met. The service users did not always receive their medicines as the doctor prescribed them. There was an increased risk of over-dose or under-dose of medicines because records were not always signed when medicines were given to service users. Consequently, the health and wellbeing of the service users was at risk. There was evidence to show that the service users’ privacy and dignity was not always respected. EVIDENCE: The files of four service users were made available for inspection. There was no evidence on the files to show that the service users had been issued with a service users’ guide or a contract. None of the files contained a photograph of the service user. The format of the care plans was discussed and it was stated that in the future the care plans would include sections that indicate clearly ‘needs’, ‘goals’ and ‘action’. The care plans should be reviewed monthly. However, one care plan had not been reviewed since 8 November 2006. It was acknowledged that the home was ‘behind with the reviews of the care plans’. The contents of the care plans were largely descriptive of the service Gold Hill Residential Home DS0000018654.V323775.R01.S.doc Version 5.2 Page 12 users’ needs rather than providing clear instructions to the staff regarding the action to be taken to meet the needs identified. One of the care plans did not include a reference to the visits that the service user received from the district nurse. Another care plan stated that the service user ‘cannot read or write’ but did not include any guidance to the staff of any action to be taken to help meet these needs. The monitoring forms in regard to the behaviour of one service user were missing from his file. The ‘untoward incident report’ forms were not always dated or completed. The ‘dependency profiles’ were not up to date. Two requirements were made in regard to Standard 7 as a result of the previous inspection. The first requirement was that the care plans in respect of each service user must include all of the aspects of care referred to in Standard 3.3, be reviewed every month and any changes recorded, signed and dated. The date of the reviews must be recorded in full. The requirement had not been implemented and still stands. The second requirement was that recordings made on a daily basis must contain adequate information about all aspects of the service users, including emotional care and social interaction. The requirement had not been implemented and still stands. The deputy manager and Area Manager acknowledged the current deficiencies in the home’s care planning arrangements. It was stated that it was intended to introduce the company’s care planning forms in January 2007 and that these would include all of the necessary risk assessments etc. It was confirmed that all of the service users were registered with local GP surgeries. The district nurse visited the home daily to administer insulin to service users who had diabetes. None of the service users had pressure sores. Three service users were provided with high dependency cushions and mattresses that were supplied by the district nurse. It was confirmed that a risk assessment had been carried out and recorded in respect of one service user who had been provided with bed rails. The support of the continence adviser was obtained when necessary. Nutritional screening was undertaken on admission. It was stated that none of the service users were in need of the help of a psychologist or physiotherapist at the present time. An optician visited the home twice a year to carry out eye tests and some service users had their own opticians. Dental and hearing checks were carried out when required. The service users’ weight was monitored. The service users felt that their healthcare needs were being met. However, there was evidence to show that correct procedures for the administration of medication were not being followed and that the service users’ safety was being seriously compromised. The medicine stock control and storage was very poor with over stocked medication. A dedicated, lockable cupboard was used for storing the service users’ medication on the first floor. A passenger lift was installed that could be used to transport the medicine trolley between floors. A senior care assistant held the keys for the medication storage. The conditions in the store cupboard for medication were small and cramped with heating pipes running through the cupboard. The Nomad Monitored Dosage System (MDS) cassettes, which contained the service users’ medication for the week, were stacked on shelves Gold Hill Residential Home DS0000018654.V323775.R01.S.doc Version 5.2 Page 13 around the store cupboard. A dedicated refrigerator for the storage of medication was also inside the cupboard, which greatly reduced storage space and increased the heat inside the cupboard. The refrigerator door could not be fully opened due to the presence of the medicine trolley stored inside the medication cupboard. The only way to access the refrigerator easily was to move the medicine trolley into the corridor but that blocked the access for the service users’ and staff. A wooden cupboard inside the medication cupboard was used to store service users’ medication but this was very difficult to access. Another smaller wooden cupboard at floor level was also used to store more medication. A metal medicine cabinet was used to store controlled drugs. Due to the large amount of excess medication stored in the medicine trolley and the various shelves and cupboards within the medication cupboard it was very difficult to easily locate the service users’ medication. For example, • One service user had four boxes of zopiclone (a night sedative) 3.75 mg containing 28 tablets dated June 2006, September 2006, November 2006 and December 2006. This demonstrated a lack of control in ordering medication. This meant that the service user’s health and welfare were not safeguarded to ensure safe storage of medication. The medicine trolley was too small and not suitable for the storage or safe transportation of service users’ medication around the home. This was of particular concern as the Nomad MDS was used for the administration of medicine and the cassettes would not all fit safely into the trolley together with any bottles or other boxes of medication. In the event of the lift not working there was no provision for the safe transportation of medication around the home in a lockable container. The service users’ medication was transported in open baskets with no safe or secure lockable carry case. This issue had been highlighted during the previous inspection on 11 September 2006 when the lift was not in operation and a requirement was made. The lift had not been operational on the morning of this inspection and no safe transportation system was used. Medication for individual service users was not easy to locate in the trolley due to a haphazard system of storage. This meant that the health and welfare of service users was not safeguarded. Medication requiring refrigeration was stored in a separate, dedicated refrigerator. However, there was no documented temperature record of the refrigerator to show the maximum or minimum and daily temperature checks. Medication requiring refrigeration must be stored between 2 and 8 degrees C. The temperature of the medication cupboard was not being checked or recorded. A record of the temperature of the medication cupboard should be maintained because of the presence of the heating pipes in the same small space as the refrigerator. Medication should not be stored in temperatures above 25 degrees C. Gold Hill Residential Home DS0000018654.V323775.R01.S.doc Version 5.2 Page 14 Controlled drug medicine was not stored in a metal cabinet that met the Misuse of Drugs (Safe Custody) Regulations 1973. A medication audit could not be undertaken to ensure that medication had been administered to the service users as directed by a medical practitioner. There were poor records of the receipt of medication into the home. Boxes and bottles of medication were not always dated when opened and no balances were carried forward on to the new medicine charts. A laminated notice was clearly displayed in the medication cupboard informing staff of the importance of this procedure but the procedure was not being implemented. A full and complete medication audit could not be completed and serious concern was raised about the poor management and control of the service users’ medication requirements. This issue had also been the subject of a requirement at the inspection on 11 September 2006. Medicines were recorded on the medicine chart as having been administered when they had not been administered. For example, • The medicine chart for one service user recorded clarithromycin (an antibiotic) 500mg twice a day. However, no record of the receipt of the clarithromycin had been documented. The medicine chart had been signed on 8 occasions in the mornings for the administration of the clarithromycin. There was no record of the second administration at teatime. The tablets were not available at the time of the inspection to enable an audit to be undertaken. Following this inspection, the community pharmacist visited the home on 19 January 2007 and noted that the clarithromycin had been signed for administration that morning. There was no clarithromycin available in the home to administer and the member of staff admitted that there were two further signatures for the administration when the tablet had not been administered. The service users’ medicines were not being safely controlled or managed and there was an increased risk of medication errors. For example, • One medication error was highlighted during the inspection by the pharmacist inspector. The pre–printed medicine chart for one service user stated ‘omeprazole 20mg one every day’. The medication available in the medicine trolley for the service user was labelled and stated ‘omeprazole 40mg one each day’. The medication had been dispensed by the pharmacist on 29/11/06. Excess named supplies of the medicine for the service user were located inside a box (labelled Calcichew) in a cupboard above the medicine trolley. The box contained several boxes of omeprazole for the service user. Some of the boxes had been labelled omeprazole 40mg by the pharmacist on 29/11/06 and there were also boxes of omeprazole 20mg labelled by the pharmacist on 7/12/06. It was not clear which was the correct dose to be administered. However, concern was expressed that staff had not noticed this discrepancy. It DS0000018654.V323775.R01.S.doc Version 5.2 Page 15 Gold Hill Residential Home also appeared that the medical practitioner had reduced the dose from 40mg to 20mg on 7/12/06 but due to the poor control and management of medication the staff had continued to administer the higher strength of medicine. Medicines had not been recorded or administered to service users as required by a medical practitioner. There were many gaps on the medicine records. For example, • Medication for the treatment of Parkinson’s Disease was not administered to one service user in accordance with a medical practitioner’s prescribing. There was no record indicating any reason why it had not been administered. Sinemet Plus one to be taken four times a day and also Half Sinemet CR one to be taken four times a day had not been recorded for administration or a code for refusal documented at bedtime on 10/1/07, 12/1/07, 14/1/07 and 17/1/07. The Nomad cassette containing medication for the week beginning 15 January 2007 was checked and the tablets for bedtime on 17/1/07 were still in the cassette. Medicines had been recorded on the MAR chart as not being administered using an unrecognised code, ‘X’. For example, • An unrecognised code ‘x’ was used on the medicine chart for two prescribed medicines for one service user i.e. Donepezil 10mg at bedtime (Alzheimer’s treatment) and simvastatin 40mg at bedtime (treats high cholesterol). The medicine chart commenced on 8 January 2007. There were no signatures for the administration of these two medicines from 8 January to 18 January 2007, except for one signature on 16 January 2007. Both medicines were available in the medicine trolley. This meant that the service user had not received the prescribed medication as required by a medical practitioner and that the home had failed to safeguard the health and welfare of the service user. The Controlled Drug Register (CDR) records were very poor and inaccurate. There were no running stock balances kept to ensure the accuracy of the controlled drugs. Two staff had signed for the administration of the controlled drugs but no one had ensured that the balances were kept accurate. There were no records for the receipt of the controlled drugs and this made it very difficult to complete a full audit. The community pharmacist visited the home on 19 January 2007 and also found discrepancies with the CDR. The discrepancies meant that the service users’ medication was not being safely controlled or managed and the risk of medication errors was increased. A recommendation was made in regard to Standard 10 as a result of the previous inspection that all items of clothing belonging to the service users Gold Hill Residential Home DS0000018654.V323775.R01.S.doc Version 5.2 Page 16 should be appropriately marked or labelled with the name of the individual service user. It was stated that the process of marking the service users’ clothing had not been completed and that the home was ‘still catching up’. Therefore, the recommendation still stands. The staff with whom discussions were held acknowledged the importance of maintaining the service users’ privacy and dignity. However, there was no reference to privacy and dignity on the sheets that were used for staff induction training. One of the service users with whom discussions were held said that the staff knocked his bedroom door before entering ‘most of the time’. It was stated that service users that received visits from the district nurse and other professionals were always seen in private. However, it was also stated that the service users did not always wear their own clothes and that items of clothing belonging to other service users sometimes had to be ‘borrowed’. A clothing store was kept that contained items of new clothing and clothes that had been left by former service users. New underwear and nightdresses were provided by the home for use ‘in emergencies’. It was stated that one service user was referred to using a term that had been coined by the staff. The term was inappropriate and the practice should be discontinued. The instruction given to staff on how to treat service users with respect at all times should be reinforced. It was stated that two service users had their own phones. It was also confirmed that the home provided a cordless phone to enable service users to make and receive telephone calls in private. Gold Hill Residential Home DS0000018654.V323775.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 and 15. The quality outcome in this area was adequate. This judgement has been made using available evidence including a visit to this service. The service users were able to maintain contact with their relatives and friends and visitors were made welcome. However, further work was needed to enable the service users to participate in a wider range of social activities. The record of the food provided needed to be written in greater detail and accurately maintained in order to ensure that a satisfactory diet was provided. EVIDENCE: The home had recently used the Community Action Bus to transport service users to a local garden centre. It was intended to make regular weekly use of the vehicle in 2007. Arrangements had been made to take eight service users to a pantomime on 28 December 2006. One service user was taken by taxi to a day centre five days per week. Another service user also attended a day centre once a week. An organist visited the home once a week. During the inspection a group of children visited the home to sing to the service users. It was stated that the staff organised activities including Bingo, exercises with beanbags and quizzes. No specific member of staff was responsible for organising social and recreational activities. One member of staff said, ‘There’s not a great deal that the residents do’. The deputy manager acknowledged that the level and range of internal and external activities provided could be improved. In order to address this issue the home was taking active steps to recruit a part time activities coordinator for 12 hours per Gold Hill Residential Home DS0000018654.V323775.R01.S.doc Version 5.2 Page 18 week. A record of the social and leisure activities was not maintained. A hairdresser visited the home once a fortnight. The local Anglican minister visited the home once a month to hold a Communion service. One of the service users with whom discussions were held stated that he was able to get up and go to bed when he wished. Another service user said that the staff asked him to go to bed at 9:30 pm but he preferred to go to bed a bit later because he slept better. The deputy manager felt that the home provided a good standard of care and a choice in daily routines, meals, activities and hairdressing. The home did not have any unnecessary restrictions on visiting. It was confirmed that service users were able to receive their visitors in private and that visitors were made welcome and offered a drink. An appropriate reference regarding visiting and to the home’s policy on maintaining relatives and friends’ involvement with service users was included in the service users’ guide. The relative of one of the service users said that he was always made to feel welcome when he visited. The service users that were able to do so handled their own financial affairs. However, in practice, the majority of the service users had their finances handled for them by their relatives. The recommendation that was made as a result of the previous inspection regarding the inclusion of information in the service users’ guide about advocacy, personal possessions and access to personal records had not been implemented. It was stated that the home had information available regarding the local advocacy service. The address and telephone number of the local advocacy service should be included in the service users’ guide. The service users’ guide should also include a statement confirming the service users’ right of access to the records held about them by the home. The bedrooms that were inspected contained evidence to show that the service users were entitled to bring personal possessions with them when they were admitted. The service user contract stated, ‘At the discretion of the proprietors items of furniture may be brought in by the service user subject to inspection as to condition and defects liable to render the article unsafe or unfit’. It was stated that some of the service users were served breakfast in their bedrooms. The majority of the service users ate their lunch and teatime meal in the dining room. A small number of service users preferred to eat all their meals in their bedrooms. Meals were evenly spaced throughout the day. Drinks were served mid-morning and mid-afternoon. Supper, consisting of drinks and snacks, was served at 7.00 and 9.00 pm. One service user who attended a day centre during the week was provided with a packed lunch each day. Three service users who were diabetic were provided with sugar-free desserts. A choice of two main meals was provided at lunchtime. It was confirmed that none of the service users had difficulty in swallowing although one service user had her food cut into small pieces. None of the service users required special diets, liquefied meals or the use of special cutlery or eating Gold Hill Residential Home DS0000018654.V323775.R01.S.doc Version 5.2 Page 19 aids. Details of the main mid-day meal were written on a notice board. The service users were consulted each day about their choice of food. The food that was observed being served during the inspection was appetising and wholesome. However, there were large gaps in the record of the food provided for November and December 2006. The record of the food provided that was available was not in sufficient detail to enable an accurate assessment of the nutritional content to be made. One of the service users with whom discussions were held described the food as ‘pretty good’. Another service user said, ‘The food is quite good. I’ve no complaints about the food’. A third service user said, ‘Sometimes the food isn’t very nice’. One of the members of staff said that ‘sandwiches were on the menu a lot’. The relative of one service user said that his wife ate her breakfast and tea in her bedroom and was ‘satisfied with the food’. Two new freezers and one new fridge had been provided as well as new china. The kitchen contained a cleaning schedule, a record of fridge and freezer temperatures, a fire blanket and fire extinguisher and a first aid box. Gold Hill Residential Home DS0000018654.V323775.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 and 18 The quality outcome in this area was adequate. This judgement has been made using available evidence including a visit to this service. The home had a satisfactory complaints procedure and the service users felt confident about making a complaint. However, the policy and procedures on the protection of vulnerable adults needed to be brought together into one clear, comprehensive document in order to ensure that the service users are fully protected. EVIDENCE: The home had a satisfactory complaints procedure that was referred to in the service users’ guide. A copy of the complaints procedure was displayed near the main reception area in the ground floor corridor. A requirement was made as a result of the previous inspection that a record of all the complaints made against the home and the action taken in response to any complaint must be maintained. The record of the complaints made against the home since the previous inspection was not immediately available but was subsequently made available for inspection. The record of complaints must be maintained at the home and readily available for inspection at all times. The home had received three complaints from service users since the previous inspection on 10 July, 20 July and 18 August 2006 respectively. The complaints had been dealt with satisfactorily. The requirement, therefore, was regarded as having been implemented. The three service users and one relative with whom discussions were held felt confident about making a complaint, if necessary. A further six complaints about the home had also been made since the previous inspection. Five of the complaints had come direct to the CSCI and one complaint was made to the Malvern Older Persons Team. The complaints have alleged poor care practice, the passenger lift being out of working order for a long period, issues concerning the administration of medication, lack of choice for service Gold Hill Residential Home DS0000018654.V323775.R01.S.doc Version 5.2 Page 21 users and shortage of staff etc. Four of the complaints were referred in full or in part to the registered provider for investigation using the home’s own complaints procedure. The two most recent complaints were mainly concerned with the administration of medication. The home’s compliance with the Regulations relating to the administration of medication was considered as part of this inspection. During the period of the inspection the CSCI received information about a concern relating to the employment at the home of a child of compulsory school age. This matter was referred to the registered provider for investigation. The responses to the complaints from the registered provider have indicated that some of the allegations are not always well founded. However, the number and frequency of the complaints made against the home is a cause of concern and reflects adversely on the effectiveness of the management of the service. The home had a policy on abuse i.e. the protection of vulnerable adults from abuse, whistle blowing and restraint. At the time of the inspection the home were experiencing difficulties in accessing the home’s computer on which copies of the policies were stored. The Area Manager stated that all of the policies would be ‘streamlined’ i.e. brought together into one comprehensive policy in line with the company’s policies. It was confirmed that no incidents of suspected or alleged abuse had been reported or otherwise come to the attention of the deputy manager or Area Manager since the previous inspection. It was also confirmed that no member of staff had had to have their name referred for possible inclusion on the POVA register. Gold Hill Residential Home DS0000018654.V323775.R01.S.doc Version 5.2 Page 22 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 and 26. The quality outcome in this area was adequate. This judgement has been made using available evidence including a visit to this service. Appropriate action was being taken to significantly improve the environment. However, further work was needed to complete the refurbishment of the premises and to ensure that the service users lived in safe, comfortable and hygienic surroundings. EVIDENCE: Three requirements and two recommendations were made in regard to Standard 19 as a result of the previous inspection. The first requirement concerned the introduction of a programme of routine maintenance and renewal of the fabric and decoration of the premises. There was no programme available for inspection and, therefore, the requirement still stands. However, it was pleasing to note that work was in progress to upgrade the home both internally and externally. It was stated that the registered provider intended to make significant improvements in order to bring the home up to a satisfactory standard. The second requirement was that the vertical passenger lift must be repaired and returned to full and proper working order for the safety and benefit of the service users. The requirement had been Gold Hill Residential Home DS0000018654.V323775.R01.S.doc Version 5.2 Page 23 implemented. However, it was noted during the inspection that the home was still experiencing occasional problems with the lift. For example, the lift was not working properly on 18 January 2007 when the Pharmacist Inspector visited the home. The third requirement was that a secure, lockable gate must be provided at the entrance to the garden at the front of the premises in order to ensure the safety of the service users. It was confirmed that the requirement had been implemented. The two recommendations concerned the provision of a ramp at the front of the premises and a new cooker. Neither of the recommendations had been implemented and both still stand. Since the previous inspection a new staff room had been created on the lower ground floor. It was also pleasing to note that the dining room had been refurbished and extended. New flooring and new dining room tables and chairs had been provided. It was also noted that work was in progress to upgrade the home’s central heating system. It was stated that the work would be completed by the end of February 2007. However, as a consequence of this work, various parts of the home needed to be re-decorated and re-carpeted and exposed pipe work needed to be guarded. It was confirmed that the use of portable heaters that had been provided during the period to upgrade the central heating system would be discontinued as soon as the central heating system was fully operational. The kitchen had been upgraded. However, part of the wall area in the kitchen where food was being stored was damaged and in need of repair. It was confirmed that the work to upgrade the outside of the premises would be completed by the end of February 2006. It was also stated that, during an inspection in November 2006, the Environmental Health Officer had highlighted potential risks to service users and other people created by the uneven surface of the car park at the front of the premises. It was also stated that the tree stump in the car park would be removed. A recommendation was made in regard to Standard 22 as a result of the previous inspection that the advice of a qualified occupational therapist should be sought to ensure that the home provides all of the recommended disability equipment and environmental adaptations to meet the needs of the service users. The recommendation had not been implemented and still stands. A requirement was made in regard to Standard 24 as a result of the previous inspection that all of the items of furniture specified in Standard 24 must be provided in rooms occupied by service users. The requirement had not been implemented and still stands. It was stated that the requirement would be implemented after all of the work to upgrade the premises had been completed. A recommendation was made in regard to Standard 25 as a result of the previous inspection that the service users should be able to control the heating in their own bedrooms. It was stated that the recommendation would be implemented when the work of securing the radiators in the service users’ Gold Hill Residential Home DS0000018654.V323775.R01.S.doc Version 5.2 Page 24 bedrooms to the walls had been completed. In the meantime, the recommendation still stands. Two requirements were made in regard to Standard 26 as a result of the previous inspection. The first requirement was that the home must be kept free from offensive odours. During the inspection the home was free from unpleasant odours. Therefore, the requirement was regarded as having been implemented. The second requirement was that all parts of the premises including bed linen and wash hand basins must be kept clean for the benefit of service users and in order to avoid the spread of infection. At the time of the inspection the process of upgrading the home was underway and various parts of the premises were still below a satisfactory standard. Apart from this, the standard of cleanliness within the home was satisfactory. Therefore, the requirement was regarded as having been implemented. It was pleasing to note that, since the last key inspection, three new washing machines had been installed in the laundry. The laundry had also been painted. However, the laundry floor needed to be covered with a washable surface. The Nurse Consultant-Health Protection carried out an infection control audit at the home on 28 June 2006. It was a matter of concern that neither the deputy manager nor the Area Manager had seen a copy of the report arising from the audit. Consequently, they had not had the opportunity to consider the contents of the report and, therefore, none of the recommendations contained in the report had been addressed. Gold Hill Residential Home DS0000018654.V323775.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. The quality outcome in this area was poor. This judgement has been made using available evidence including a visit to this service. The home provided an adequate number of staff to meet the needs of the service users. However, the staff recruitment practices and induction training did not fully protect the service users. EVIDENCE: Two requirements were made in regard to Standard 27 as a result of the previous inspection. The first requirement was that the staff rota must show the designated position of all the staff on duty. A copy of the staff duty rota for the week commencing 11/12/06 and a list of all the staff and their contracted hours of employment dated 29/11/06 were made available for inspection. The names of two members of staff that were on the list of contracted hours were not included on the staff duty rota. Therefore, the requirement had not been implemented. The second requirement was that the record of all the persons employed at the care home i.e. the staff register, and the records of the training provided for or to be undertaken by staff as detailed in the individual training and development assessments and profiles must be accurately maintained at all times in accordance with Schedule 4. There were no individual training and development assessments and profiles. Therefore, the requirement had not been implemented and still stands. The home employed an adequate number of staff during the working day. Three members of staff, one senior and two care assistants, were employed on waking duty at night. The home also employed adequate numbers of catering and domestic staff. Interviews were being held at the time of the inspection in order to recruit a full-time maintenance person. The service users and the one Gold Hill Residential Home DS0000018654.V323775.R01.S.doc Version 5.2 Page 26 relative with whom discussions were held spoke positively about the staff. The staff were described as ‘excellent’ and ‘helpful’. Another service user felt that he was being looked after well and expressed his satisfaction with the care he received. The three service users and the relative of another service user felt that there were always sufficient staff on duty. However, two members of staff felt that more time could be spent providing individual care, particularly for the service users with a dementia illness, if there were more staff. The home employed twenty-three members of care staff. Ten members of staff had completed the NVQ level 2 training. Therefore, the home did not meet the minimum ratio of 50 trained members of care staff (NVQ level2 or equivalent) as laid down in the National Minimum Standards. However, it was pleasing to note that eight members of staff were currently undertaking the NVQ level 2 training. Since the previous inspection the Area Manager had discovered that seven members of staff did not have a personnel file and that there were nine members of staff for whom an enhanced disclosure check had not been obtained from the Criminal Records Bureau (CRB). The Area Manager stated that this deficiency had been addressed and that all of the staff employed by the home now had an enhanced disclosure from the CRB. The files of three new members of staff who had commenced working at the home since the previous inspection were inspected. It was noted that one of the staff files did not contain a CRB disclosure. It was stated that an application for an enhanced CRB check had been made but had not yet been received. This practice is unacceptable. An enhanced disclosure check from the CRB must be obtained for all prospective staff prior to the commencement of their employment at the home. There was no evidence on any of the three files to show that the staff had been issued with a contract or a copy of the code of conduct and practice set by the General Social Care Council. It was stated that a contract had been issued to each of the new members of staff but had not yet been returned. However, one member of staff stated that she had not been given a contract or a job description. The reference request forms in the files referred to the post of ‘home manager for learning disabilities’ and were, therefore, inappropriate for staff employed as care assistants in a home for older people. Parts of the application form in respect of one member of staff had not been completed i.e. the declaration of health and reasons for applying for the post, and the form was not dated. There was no evidence on two of the files to show that the staff had received any induction training. The Area Manager stated that all the staff were being issued with new contracts. Two requirements were made in regard to Standard 29 as a result of the previous inspection. The first requirement concerned the information that must be kept on staff files. The requirement had not been implemented and still stands. The second requirement was that all declared convictions for offences must be discussed with prospective staff prior to a decision being made about their appointment and a written record of the discussion and the reasons for the decision maintained. The deputy manager and Area Manager acknowledged Gold Hill Residential Home DS0000018654.V323775.R01.S.doc Version 5.2 Page 27 the importance of following the practice outlined in the requirement in the future. It was stated that, since the previous inspection, it had not been necessary to implement the requirement. The requirement has, therefore, been deleted. A recommendation was made in regard to Standard 30 as a result of the previous inspection that formal training on key working should be provided for all the staff. The recommendation had not been implemented and still stands. It was confirmed that the home had its own staff induction programme. There was no reference on the current induction sheets to privacy and dignity. The home did not provide induction training that met the standards set by Skills for Care. However, the Area Manager stated that arrangements were in hand to introduce the skills for life training that would be used for the induction of all new staff. It was intended that the deputy manager would become responsible for the induction training. Although the training was not yet operating, the deputy manager and Area Manager intended to prepare for the introduction of the induction programme by attending a training day in January 2007. It was stated that the induction training would be used for all new staff initially but would also be used eventually as ‘refresher‘ training for all the staff. The majority of the staff received a minimum of three paid days training per year and a record of training is maintained. The Area Manager stated that the training certificates in respect of some members of staff were missing from their files and that staff training records needed to be brought up to date. It was stated that most of the staff training would be renewed during 2007. Gold Hill Residential Home DS0000018654.V323775.R01.S.doc Version 5.2 Page 28 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 and 38. The quality outcome in this area was poor. This judgement has been made using available evidence including a visit to this service. The absence of a permanent registered manager, an effective quality assurance system, regular and consistent staff supervision and risk assessments and other records did not fully ensure the safety of the service users or the quality of the service. EVIDENCE: The registered manager had been on long-term absence through ill health for almost three months. There was no indication of her date of return. A requirement was made in regard to Standard 31 as a result of the previous inspection that ongoing, formal, professional supervision and support must be provided for the registered manager. The absence of the registered manager meant that the requirement could not be implemented. However, it was evident that the deputy manager who was managing the home on a temporary basis was receiving support from the Area Manager. The requirement was, therefore, regarded as having been implemented. The deputy manager had relevant experience in caring for older people and had worked at the home for Gold Hill Residential Home DS0000018654.V323775.R01.S.doc Version 5.2 Page 29 several years. However, the deputy manager did not have the qualification required for registered managers. A recommendation was made as a result of the previous inspection that the deputy manager should give serious consideration to undertaking NVQ training. It was pleasing to note that the deputy manager had recently commenced NVQ level 3 training. The recommendation had, therefore, been implemented. However, it was noted that the deputy manager had not undertaken any training in the protection of vulnerable adults from abuse. The serious concerns raised in regard to the administration of medication referred to earlier in this report indicated the need for a permanent and effective management presence. Two requirements and two recommendations were made in regard to Standard 33 as a result of the previous inspection. The first requirement was that the home’s quality assurance system must become fully operational and effective. The requirement had not been implemented and still stands. The Area Manager stated that the home did not have a formal quality assurance system but one would be introduced during 2007. It was also stated that the home would ‘import’ all of the company’s policies and procedures. The second requirement was that an annual development plan for the home, based on a systematic cycle of planning, action, review, reflecting aims and outcomes for service users, must be introduced. The requirement had not been implemented. However, the requirement has been deleted from this report as it is superseded by a requirement for the home to provide an improvement plan. The first recommendation was that the results of service user surveys should be published and made available to current and prospective service users, their representatives and other interested parties, including the CSCI. The recommendation had not been implemented and still stands. It was stated that questionnaires would be issued to all of the service users’ relatives and to all the members of staff during the early part of 2007. The second recommendation was that the home should be able to demonstrate a commitment to lifelong learning and development for each service user, linked to implementation of their individual care plans. The recommendation had not been implemented and still stands. It was noted that a general meeting of all the staff had been held on 11 October 2006 and that a meeting of the senior staff had been held on 6 November 2006. The minutes of earlier staff meetings were not available for inspection. Staff meetings should continue to be held on a regular and frequent basis. Standard 34 was not fully assessed during this inspection. However, the home’s response to a recommendation that was made as a result of the previous inspection that a business and financial plan for the establishment should be drawn up, made open to inspection and reviewed annually was assessed. The recommendation had not been implemented and still stands. The home holds money that is handed over for safekeeping by relatives and friends on behalf of twelve service users. The home receives Giros in respect of twelve service users. The service users sign the Giros and then the Giros Gold Hill Residential Home DS0000018654.V323775.R01.S.doc Version 5.2 Page 30 are cashed and the fees for the care and accommodation are paid to the company. The service users receive their Personal Allowances each week. The home employs an administrative officer for 30 hours per week who is responsible for handling the service users’ money and maintaining the accounts. The administrative officer also acts as the appointee on behalf of one service user. It was stated that this responsibility would shortly pass to the service user’s relative. No person who is employed by or connected with the running of the home should act as an appointee on behalf of any of the service users, if at all possible. The service users’ money was stored securely. It was stated that it was very difficult to open bank or savings accounts on behalf of the service users and that the local authority was not able to provide a system that would ensure that the service users’ money accrued interest and was safe and accessible. It was stated that the Area Manager or the company’s chief accountant audited the service users’ finances every six to eight weeks. However, the last audit was undertaken in July 2006. It was confirmed that the money that was held on site was stored securely with restricted access and that it was appropriately insured. The service users’ money was kept in individual wallets and separate accounts were maintained. The accounts and amounts of money held for service users were checked at random and were found to be correct. Standard 36 was not fully assessed during this inspection. However, the home’s response to the two requirements that were made as a result of the previous inspection was assessed. The first requirement was that care staff, including the deputy manager, must receive formal supervision at least six times a year that includes all aspects of practice, philosophy of care in the home and career development needs. It was stated that action had been taken to commence the implementation of the requirement with about 50 of the staff but that the requirement had not been fully implemented. The second requirement was that the registered manager, deputy manager and any other senior member of staff responsible for undertaking formal supervision must receive appropriate supervision training. The requirement had not been implemented and still stands. Standard 37 was not fully assessed during this inspection. However, the home’s response to the requirement that was made as a result of the previous inspection was assessed. The requirement was that a visit to the home by the registered provider must take place at least once a month and a written report on the conduct of the home supplied to the registered manager and made available for inspection at all times. The Area Manager stated that she had been in constant attendance at the home since September 2006 when the registered manager had gone on sick leave. The reports on the visits made in accordance with Regulation 26 would be re-introduced after she had resumed her normal role and when the position regarding the registered manager had been resolved. The last Regulation 26 report was dated 2 March 2006. The requirement had not been implemented and still stands. Gold Hill Residential Home DS0000018654.V323775.R01.S.doc Version 5.2 Page 31 Four requirements were made in regard to Standard 38 as a result of the previous inspection. The first requirement was that risk assessments must be carried out and recorded for all the safe working practice topics covered in Standards 38.2 and 38.3. No risk assessments were available for inspection in regard to infection control, the regular servicing of boilers or the provision and maintenance of window restrictors. The requirement had not been fully implemented and still stands. It was also noted that the fire risk assessment that was dated 20 June 2005 had not been reviewed. The fire risk assessment must be reviewed and updated periodically by a competent person to reflect any changes to fire risk, signed and dated. This should be done at least annually and more frequently, if necessary. The second requirement was that a valid electrical safety certificate for the home provided by a qualified electrician must be obtained and made available for inspection. It was confirmed that the electrical rewiring had been completed. However, the home had not yet been issued with an electrical safety certificate. Therefore, the requirement had not been fully implemented and still stands. The third requirement was that the accident forms must be completed in full and checked by a senior member of staff at the time of the accident. The requirement had been implemented. The fourth requirement was that the boilers and central heating system must be serviced at least annually and copies of the servicing certificate retained at the home and made available for inspection. It was confirmed that a gas safety inspection was carried out on 7 November 2006. Therefore, the requirement was regarded as having been implemented. However, a certificate must be obtained and kept at the home available for inspection following the completion of the work to upgrade the central heating system. It was stated that no PAT tests had been carried out since 2003. The records relating to fire safety were not available for inspection. The fire safety records must be kept in the home and made available for inspection at all times. It was confirmed that the hoists were serviced on 25 October 2006 and that new washing machines were installed on 16 November 2006. It was confirmed that infection control training and health and safety training had been carried out in June 2006. It was also stated that arrangements had been made for first aid training and fire safety training to be provided in January 2007. However, moving and handling training needed to be updated. Gold Hill Residential Home DS0000018654.V323775.R01.S.doc Version 5.2 Page 32 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 2 2 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 1 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 X X 1 Gold Hill Residential Home DS0000018654.V323775.R01.S.doc Version 5.2 Page 33 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 OP1 Regulation 4 Requirement The statement of purpose must be amended so that it includes all the information detailed in Regulation 4 and Schedule 1 as outlined in the guidance given in this report. The service users’ guide must be amended in accordance with the guidance given in this report and copies given to all prospective service users. A copy of the home’s statement of terms and conditions of residence (contract) that includes all of the information detailed in Standard 2.2 must be issued to all current, and any prospective service users and a copy retained on the service users’ individual files. The homes assessment form must be amended to include all of the issues referred to in Standard 3.3, in accordance with the guidance given in this report. (Previous timescale 30/06/06 not met). The home must be able to demonstrate that the care DS0000018654.V323775.R01.S.doc Timescale for action 28/02/07 2 OP1 5 28/02/07 3 OP2 5 28/02/07 4 OP3 14 28/02/07 5 OP4 12 31/03/07 Gold Hill Residential Home Version 5.2 Page 34 6 OP7 15 7 OP7 15 8 OP7 15 9 OP9 13 10 OP9 13 provided for service users with a dementia illness is based on current good practice and reflects specialist guidance. (Previous timescale 30/09/06 not met). The care plans in respect of each service user must include all of the aspects of care referred to in Standard 3.3 reviewed every month and any changes recorded, signed and dated. The date of the reviews must be recorded in full. The care plans must set out in detail the action to be taken by the staff to ensure that all aspects of the service users’ needs are met. (Previous timescale 30/06/06 not met). Recordings made on a daily basis must contain adequate information about all aspects of the service users, including emotional care and social interaction. (Previous timescale 30/06/06 not met). The service users’ files must contain a photograph of the service user and records that are kept regarding their safety and welfare e.g. untoward incident reports, dependency profiles and behaviour monitoring forms, must be kept up to date and accurately and securely maintained. The date of opening of all medicine containers must be recorded and any balances of medicines carried over on to a new medicine chart in order to ensure that a medicine audit can be undertaken. (Previous timescale 01/10/06 not met) Records and documentation for the administration of medicine must be up to date and accurate. DS0000018654.V323775.R01.S.doc 28/02/07 28/02/07 28/02/07 07/02/07 07/02/07 Gold Hill Residential Home Version 5.2 Page 35 11 OP9 13 12 OP9 13 13 OP9 13 14 OP9 13 15 OP9 13 16 OP9 13 17 OP9 13 Directions on the medicine charts must be clear and include the same information recorded on the pharmacy label. (Previous timescale 01/10/06 not met). A protocol must be available outlining the action to take when a verbal message relating to medication is received. (Previous timescale 01/10/06 not met). Serious errors relating to the administration of medication must be documented and the Commission for Social Care Inspection informed as a Regulation 37 notification. (Previous timescale 01/10/06 not met). Storage for medication must be safe and secure at all times, including the safe transportation of medicines around the home to protect the service users from harm. (Previous timescale 01/10/06 not met). The correct dosage of medication must be administered to the correct service user at the correct time as prescribed by the clinician in order to prevent any medication errors. The Medication Administration Record (MAR) charts must show clearly what medicine has been prescribed and administered, at all times. The MAR charts for each service user must be referred to before and signed immediately after the administration of medication and the reasons for any nonadministration accurately recorded and signed for on the MAR chart using the codes identified on the MAR chart. Checks must be made of the DS0000018654.V323775.R01.S.doc 07/02/07 07/02/07 07/02/07 07/02/07 07/02/07 07/02/07 07/02/07 Page 36 Gold Hill Residential Home Version 5.2 18 OP9 13 19 OP9 13 20 OP9 13 21 OP9 13 22 OP9 13 dispensed medication and MAR charts when the medication is received into the home against the details on the original prescription and all quantities of medicines received and balances carried over from previous MAR charts accurately recorded. Drug audits must be undertaken before and after medicine rounds to ensure that all the staff who administer medicine do so correctly and that the administration of medicines is accurately recorded in accordance with the doctor’s instructions. The medication policy and procedures must be reviewed, updated and signed to ensure that they reflect good practice and the safe control and handling of medication. All the staff involved in administration of medication must be asked to confirm in writing that they have read them and agree to adhere to them. Appropriate facilities must be provided to ensure that the medication is stored safely and securely at all times, including the provision of a suitable, lockable medicine trolley that is able to accommodate current medication supplies. The record for the administration of controlled drugs must be accurately maintained, including a running stock balance so that a full audit can be carried out at all times. Medicine must be available for service users as prescribed by a GP and all medication no longer required must be returned to the supplying pharmacy and an accurate record of the returns DS0000018654.V323775.R01.S.doc 07/02/07 07/02/07 07/02/07 07/02/07 07/02/07 Gold Hill Residential Home Version 5.2 Page 37 23 OP9 13 24 OP10 12 25 OP12 16 26 OP15 17 27 OP18 12,13 28 OP19 23 29 OP19 13,23 30 OP24 16 maintained. Medicines that require refrigeration must be stored within the correct temperature range of between 2 and 8 degrees C. Action must be taken to ensure that all the staff address the service users appropriately and in a manner which respects their dignity at all times. A comprehensive range of social and leisure activities must be provided in accordance with the service users’ individual and collective needs, preferences and capacities and a record of all such activities maintained. The record of food provided for service users must be fully and accurately maintained in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory. All of the home’s policies and procedures on the protection of vulnerable adults from abuse must be brought together into one clear, comprehensive and accessible document. A programme of routine maintenance and renewal of the fabric and decoration of the premises must be produced and implemented with particular attention to the coordination of the furnishings and the décor/colour. (Previous timescale 30/06/06 not met). The car parking area at the front of the premises must be made safe in accordance with the recommendations of the Environmental Health Officer. All of the items of furniture specified in Standard 24, as outlined in this report, must be DS0000018654.V323775.R01.S.doc 07/02/07 28/02/07 28/02/07 28/02/07 28/02/07 28/02/07 28/02/07 31/03/07 Gold Hill Residential Home Version 5.2 Page 38 31 OP26 13,23 32 OP27 17 33 OP27 17 34 OP29 19 35 OP29 17,19 provided in rooms occupied by service users. If the provision of any item poses an unacceptable risk to the service user or they decline the provision, details of the discussions and decision about this should be recorded in the assessment of the service users needs. (Previous timescale 30/06/06 not met). The recommendations for improving the standards on infection control as outlined in the Infection Control Audit dated 28 June 2006 must be implemented. The staff duty rota must show the names, designated position and hours worked of all the staff employed to work at the home. (Previous timescale 31/05/06 not met). The records of the training provided for or to be undertaken by staff as detailed in the individual training and development assessments and profiles must be accurately maintained at all times in accordance with Schedule 4. (Previous timescale 31/05/06 not met). Disclosure checks from the Criminal Records Bureau must be obtained for all new staff prior to the commencement of their employment. Staff files must contain a full employment history, a declaration about health etc (as normally included in an application form), an up to date list of training, including induction training, two relevant, written references and proof that an enhanced disclosure check has been obtained from the CRB prior to the commencement of DS0000018654.V323775.R01.S.doc 28/02/07 28/02/07 28/02/07 31/01/07 28/02/07 Gold Hill Residential Home Version 5.2 Page 39 36 OP31 18 37 OP33 24 38 OP36 18 39 OP36 18 40 OP37 26 41 OP38 13 42 OP38 13 employment at the home. (Previous timescale 25/05/06 not met). The deputy manager must undertake training in the protection of vulnerable adults from abuse at an appropriate level for managers. The home’s quality assurance system must become fully operational and effective. (Previous timescale 30/06/06 not met). Care staff, including the deputy manager, must receive formal supervision at least six times a year that includes all aspects of practice, philosophy of care in the home and career development needs. (Previous timescale 30/06/06 not met). The registered manager, deputy manager and any other senior member of staff responsible for undertaking formal supervision must receive appropriate supervision training. (Previous timescale 31/07/07 not met). A visit to the home by the registered provider must take place at least once a month and a written report on the conduct of the home supplied to the registered manager and made available for inspection at all times in accordance with the requirements of Regulation 26. (Previous timescale 31/05/06 not met). Risk assessments must be carried out and recorded for all the safe working practice topics covered in Standards 38.2 and 38.3 including infection control, servicing of boilers and window restrictors. (Previous timescale 23/05/06 not met). The home’s fire safety risk DS0000018654.V323775.R01.S.doc 31/03/07 31/03/07 31/03/07 31/03/07 31/01/07 28/02/07 28/02/07 Page 40 Gold Hill Residential Home Version 5.2 43 OP38 13 44 OP38 13,23 45 OP38 18 assessment must be updated periodically by a competent person to reflect any changes to fire risk, signed and dated. A valid electrical safety certificate for the home provided by a qualified electrician must be obtained and made available for inspection. (Previous timescale 30/06/06 not met). The records that are maintained in regard to fire safety must be kept in the home and made available for inspection at all times. Updated moving and handling training must be provided for all the staff. 28/02/07 31/01/07 28/02/07 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 OP1 Good Practice Recommendations A written record should be maintained on each of the service users’ files as evidence to show that they and/or their representatives have been issued with a copy of the service users’ guide and a copy of the contract. Prospective service users who are not able to make a preadmission visit should only be admitted in exceptional circumstances. The storage arrangements for controlled drugs should meet the Misuse of Drugs (Safe Custody) Regulations 1973. A thermometer should be provided to enable the temperature of the medication store cupboard to be checked and recorded in order to ensure that the temperature does not exceed 25 degrees C. All items of clothing belonging to the service users should be appropriately marked or labelled with the name of the individual service user. DS0000018654.V323775.R01.S.doc Version 5.2 Page 41 2 3 4 OP5 OP9 OP9 5 OP10 Gold Hill Residential Home 6 7 OP10 OP14 8 9 10 OP19 OP19 OP22 11 12 OP25 OP29 13 14 15 OP30 OP30 OP33 16 17 18 19 20 OP33 OP33 OP34 OP35 OP38 Appropriate action should be taken to ensure that all the service users wear their own clothes at all times. The service users’ guide should include details of the local advocacy service, a reference to the service users entitlement to bring personal possessions with them when they are admitted to the home and their right of access to the records held about them by the home. An appropriate means of access i.e. a permanent ramp, should be provided at the front of the home for people who use wheelchairs and people with mobility problems. A new cooker should be provided in the main kitchen. The advice of a qualified occupational therapist should be sought in order to ensure that the home provides all of the recommended disability equipment and environmental adaptations to meet the needs of the service users. The service users should be able to control the heating in their own bedrooms. The staff files should contain a copy of the contract of employment and evidence to show that staff have been issued with a copy of the code of conduct and practice set by the GSCC. Formal training on key working should be provided for all the staff. The process of introducing an effective staff induction programme that meets the Skills for Care specified standards should continue. The results of service user surveys should be published and made available to current and prospective service users, their representatives and other interested parties, including the CSCI. The home should be able to demonstrate a commitment to lifelong learning and development for each service user, linked to implementation of their individual care plans. Staff meetings should continue to be held on a regular and frequent basis with minutes kept. A business and financial plan for the establishment should be drawn up, made open to inspection and reviewed annually. The financial accounts maintained on behalf of the service users should be regularly and independently audited at least every two months. All portable electrical appliances should be PAT tested. Gold Hill Residential Home DS0000018654.V323775.R01.S.doc Version 5.2 Page 42 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Gold Hill Residential Home DS0000018654.V323775.R01.S.doc Version 5.2 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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