Inspection on 21/04/06 for Gold Hill Residential Home

This inspection was carried out on 21st April 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 15/12/06

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 N Andrews Unannounced Inspection 09:05 21 & 24 April and 16th May 2006 st 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.V290476.R01.S.doc Version 5.1 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.V290476.R01.S.doc Version 5.1 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 Old age, not falling within any other category registration, with number (40), Physical disability over 65 years of age of places (40) Gold Hill Residential Home DS0000018654.V290476.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 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 Home may also accommodate any service user who has a dementia illness who was resident in the Home on 16 November 2005. The Home will not admit any prospective service user who has a diagnosed dementia illness. 29th November 2005 Date of last inspection Brief Description of the Service: Gold Hill is a large building occupying a corner position on a hill 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 a residential i.e. personal, care service 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 countryside. The home has a small, twoperson 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 smoking area by the service users that smoke. 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 the fees ranged from £1176.00 to £1640.00 per month. The registered manager intended to make information about the service available to prospective service users by providing copies of the statement of purpose, service users’ guide and CSCI inspection reports in the home’s foyer. Gold Hill Residential Home DS0000018654.V290476.R01.S.doc Version 5.1 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 three days. In addition a visit was made to the home by the Pharmacist Inspector to inspect the home’s policy and procedures on medication. The inspection included a tour of the premises and an inspection of various records that the home is required to maintain and several of the home’s policies and procedures. Time was also spent with both the registered manager and the deputy manager assessing the progress made by the home in implementing the requirements and recommendations arising from the previous inspection. Individual discussions were held with six service users and four members of staff. ‘Case tracking was carried out in respect of a number of service users. What the service does well: What has improved since the last inspection? What they could do better: The form used for assessing prospective service users must be improved in order to ensure that all of the service users’ needs are fully assessed prior to admission. The statement of terms and conditions of residence (contract) must be amended and completed and used consistently in order to ensure that the service users understand clearly the terms of their residency at the home. Gold Hill Residential Home DS0000018654.V290476.R01.S.doc Version 5.1 Page 6 The care plans must be fully and accurately maintained in order to ensure that all of the service users needs are appropriately met. The procedure for checking that medicine has been given to service users could be improved to ensure that medicines are given as prescribed by the GP. The medication stored in a refrigerator must be kept secure. The range of social and recreational activities should be extended so that the service users are able to pursue their individual interests. The key worker system should be developed so that the care provided helps to promote the service users’ individual needs. The home’s record keeping in relation to complaints, staff supervision and accidents must be improved. Improvements must also be made to the standard of decoration, maintenance and cleanliness in order to provide a safer and more homely and hygienic environment. Correct staff recruitment practices must be followed in order to ensure the safety and protection of the service users. The systems for monitoring the quality of the service must be more thorough and effective. Staff training must be carried out to enable the staff to develop the service and to meet the service users’ individual needs. 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. Gold Hill Residential Home DS0000018654.V290476.R01.S.doc Version 5.1 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.V290476.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The quality outcome in this area was adequate. The needs of prospective service users were assessed prior to admission. However, the form used for carrying out the assessments needed to be amended in order to ensure that all potential needs are identified. Further work was also needed to ensure that all of the service users are provided with a complete and accurate statement of the terms and conditions of residence. EVIDENCE: Two requirements and one recommendation were made in regard to Standard 1 as a result of the previous inspection. The first requirement was that the statement of purpose must be amended to include all of the information required by Regulation 4 and Schedule 1, as outlined in this (i.e. the previous) report. The requirement had been implemented. The second requirement was that the service users’ guide must be amended to include all of the information referred to in Regulation 5 and Standard 1.2 as outlined in this (i.e. the previous) report and copies given to all current and prospective service users. The service users’ guide had been amended. However, some of the service users with whom discussions were held said that they had not received a copy of the service users’ guide. The deputy manager confirmed that the service users and/or their relatives had been given a copy. Copies of the service Gold Hill Residential Home DS0000018654.V290476.R01.S.doc Version 5.1 Page 9 users’ guide were evident in some of the bedrooms. The requirement was regarded as having been implemented. The recommendation was that information about how to contact local social services and health care authorities should be included in the service users’ guide. The recommendation had been implemented. A requirement was made in regard to Standard 2 as a result of the previous inspection that the home must provide one clear, accurate and comprehensive statement of terms and conditions of residence that includes all of the information detailed in Standard 2.2. A copy of the statement of terms and conditions of residence (contract) was made available for inspection. The contract did not include detailed information regarding the terms and conditions of occupancy e.g. the circumstances under which the service users’ period of occupancy may be terminated. In addition, it was noted that the file in respect of a service user that had recently been admitted to the home contained an outdated contract. The service user had signed the contract. However, the contract did not include the weekly fee or the correct title of the Commission for Social Care Inspection. Therefore, the requirement had not been implemented and still stands. Two requirements were made in regard to Standard 3 as a result of the previous inspection. The first requirement was that the home’s assessment form must be amended to include all of the issues referred to in Standard 3.3, including mental state and cognition, and individuals who are self-funding and without a care management assessment must be assessed using one comprehensive and appropriately worded form in accordance with Regulation 14. Since the previous inspection the home had introduced a new assessment form. The assessment form was used to assess the needs of prospective service users prior to admission. The assessment form did not include any reference to dietary preferences, history of falls or personal safety and risk. Therefore, the requirement had not been implemented and still stands. The second requirement was that a clear, comprehensive and detailed assessment, that identifies all of the needs of the service users, must be undertaken and recorded. The deputy manager confirmed that since the previous inspection, a new ‘Care Assessment Table’ had been introduced. The ‘Care Assessment Table’ included a section on ‘Nutrition Screening’. The deputy manager confirmed that the ‘Care Assessment Table’ had been completed in respect of the one new service user admitted to the home since the previous inspection and a small number of other service users. The deputy manager anticipated that the process of assessing all of the service users using the ‘Care Assessment Table’ would be completed by the end of May 2006. Therefore, the requirement had not been fully implemented and still stands. The two outstanding requirements that cover very similar issues will be combined into one requirement in this report. It was confirmed that all of the service users had a care plan based on the home’s assessment of their needs. Gold Hill Residential Home DS0000018654.V290476.R01.S.doc Version 5.1 Page 10 A requirement was made in regard to Standard 4 as a result of the previous inspection 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. The process of assessing the needs of the service users using the new ‘Care Assessment Table’ had not been completed. Consequently, the staff had not had the opportunity to update the majority of the service users’ care plans using any additional information arising from the assessments. In addition, the key worker system had only recently been introduced and was not fully operational. The requirement, therefore, still stands. A recommendation was made in regard to Standard 5 as a result of the previous inspection that the home’s policy and procedure on pre-admission visits and the four-week trial period following admission should be clearly stated in the service users’ guide. The recommendation had been implemented. Gold Hill Residential Home DS0000018654.V290476.R01.S.doc Version 5.1 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 The quality outcome in this area was adequate. All of the service users had a care plan. However, the format of the care plans and the standard of recording needed to be improved. 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’ health, personal and social care needs are met. The staff must ensure that it is possible to carry out a complete medicine audit trail in order to ensure the health and welfare of the service users. The service users felt that they were treated with respect and that their right to privacy was upheld. EVIDENCE: Four 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 reviewed every month and any changes recorded, signed and dated. The deputy manager confirmed that, since the previous inspection, a new ‘Monthly Review of Care Plans’ form had been introduced. The form recorded the details of the aspects of care that had been reviewed and the changes that had been made as a result of the reviews. The forms also recorded the month and year. The care plan in respect of a service user who had recently been admitted to the home was examined. The care plan showed that some of the information in the forms used by the home was being Gold Hill Residential Home DS0000018654.V290476.R01.S.doc Version 5.1 Page 12 repeated unnecessarily. Two sets of forms were being used. One set of forms was headed ‘Care Plan’ and the other set of forms was headed ‘Care Plan Assessment’. The deputy manager agreed that the forms needed to be amended in order to avoid unnecessary duplication and possible confusion. A way of achieving this was discussed. The service user had not signed his care plan. One of the service users with whom a discussion was held stated that he slept in his chair at night and not in his bed. The care plan did not include any reference to this matter. The deputy manager was advised to instruct the night staff to observe the service user and to record their observations. The care plan must include appropriate details of the action to be taken by the staff to meet the service user’s needs in regard to this issue. The requirement had not been fully 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. It was pleasing to note that the daily handover sheets contained references to the support offered by the deputy manager to one of the service users following the death of his wife. However, it was also noted that there was no reference to this matter in the service users’ care plan. One service user had had three falls in quick succession. The home had responded appropriately by reporting the incidents to the G P and remedial action was being taken. The falls had occurred during the early mornings. The deputy manager was advised to instruct the night staff to increase their supervision of the service user during the early morning and to record her instruction in the care plan. The ‘Physical Health Assessment’ form in respect of one service user dated January 2006 highlighted various needs that had not been recorded in the care plan. There was scope for developing this aspect of recording further, particularly in regard to the service users with a dementia illness. The requirement had not been fully implemented and still stands. The third requirement was that risk assessments must be put in place for nutrition and falls. Service users who are significantly overweight should be referred to a dietician. As indicated earlier in this report, since the previous inspection, the home had introduced a ‘Care Assessment Table’ that included a section on ‘Nutrition Screening’. The deputy manager also confirmed that risk assessments on falls had been carried out on all of the service users. The needs of two service users were discussed. One service user had been referred to the district nurse and subsequently to the dietician. However, the dietician had not visited the home because the service user had declined to cooperate with any weight loss programme. Another service user had expressed his willingness to follow a diet designed to help him lose weight. Information about this matter had been recorded in the handover book and in the daily report book. However, there was no specific mention of this issue in the service user’s care plan. The deputy manager was asked to seek the advice of the dietician regarding both service users and to record in their respective care plans details of the action to be taken by the staff to ensure that their healthcare needs were met. The requirement was regarded as having been implemented. The fourth requirement was that the risk assessments on smoking must be reviewed in order to ensure that they include Gold Hill Residential Home DS0000018654.V290476.R01.S.doc Version 5.1 Page 13 all of the relevant control measures in accordance with the guidance outlined in this (i.e. the previous) report. The risk assessments in respect of the four service users that smoked were inspected and, following amendments by the deputy manager, were regarded as satisfactory. The requirement had been implemented. Since the previous inspection the home had introduced a ‘Residents Smoking Policy’. The deputy manager said that she would amend the policy in order to include a reference to the home’s practice of retaining the service users’ cigarettes in the office. The registered manager confirmed that the home enjoyed a positive relationship with outside agencies that provided support for the benefit of service users. All of the service users were registered with GPs in a total of six local surgeries. The NHS chiropodist visited the home every four weeks. Three service users that were diabetic were visited more frequently. A private chiropodist also visited every month. Support was available from the continence adviser and physiotherapist both of whom were based at the local Malvern County Hospital. One service user was currently receiving physiotherapy. The district nurse is asked to assess any service user that may be at risk of developing pressure sores. None of the current service users had a pressure sore. Pressure relieving mattresses and chair cushions were supplied, when necessary, following an assessment of the service users. A consultant psychiatrist was involved in monitoring the care of two service users. None of the service users were involved in any formal therapeutic exercise programme. However, the home had recently engaged the services of an Activities Coordinator who was in the process of introducing different activities that would be of benefit to the service users including ‘movement to music’. The registered manager confirmed that a local dentist and an optician visited the home and provided treatment as necessary. The two requirements that were made in regard to Standard 9 as a result of the previous inspection had been implemented. Only senior care workers who have completed training on the safe handling of medication are able to give medicines to service users. Medicines received into the home are checked and recorded by trained senior care workers. A mistake from the pharmacy was discovered by a senior care worker and immediately dealt with, which ensured the safe welfare of the service user. The medicine charts and information relating to medicine in service users’ care files were clearly recorded by senior care staff. Any medicine refused by a service user with the reason for the refusal was clearly documented. The review of medication was discussed with the service user’s GP and recorded. The receipt of medication was not always recorded and the date of opening on the original container (box or bottle) was not recorded, which meant a full medicine audit could not be done to ensure that medication had been given to service users as prescribed by the GP. The medicine trolley could not be used on the ground floor because the lift was not working. This meant that an open basket was used to carry medicine down the stairs. Medicine was not secure or safe in the open basket. Medication stored in the refrigerator was not locked or secure. The registered manager Gold Hill Residential Home DS0000018654.V290476.R01.S.doc Version 5.1 Page 14 agreed to put a lock on the refrigerator immediately and subsequently confirmed during the inspection that this action had been taken. The service users with whom discussions were held stated that the staff respected their privacy and dignity. The service users also confirmed that the staff were kind and helpful. Five of the six service users confirmed that the staff always knocked the door before entering their bedrooms. The members of staff with whom discussions were held gave a clear indication that they would take appropriate action to ensure the service users’ dignity when carrying out personal care tasks. The registered manager confirmed that four service users had a telephone in their bedrooms. A mobile handset was also available for service users to enable them to make and receive calls in private. The registered manager confirmed that the service users wore their own clothes at all times. However, several items of the service users’ clothing in the laundry were not marked. Consequently, the staff had no way of ensuring that all of the items of clothing were delivered to the correct service user. All of the service users’ clothing should be appropriately marked or labelled with the name of the individual service user in order to ensure that each service user wears their own clothes. A recommendation was made in regard to Standard 10 as a result of the previous inspection that fixed screening should be provided in all of the double bedrooms except where the service users e.g. a married couple, have chosen not to have them. In these cases, the decision of both service users should be recorded in their individual care plans. The recommendation had been implemented. Two recommendations were made in regard to Standard 11 as a result of the previous inspection. The first recommendation was that the home’s policy and procedure on ‘Dealing with a Dying Resident’ should include the correct telephone number of the CSCI. The recommendation had been implemented. The second recommendation was that the service users’ wishes concerning terminal care and arrangements after death, should be discussed, recorded in their individual care plans and carried out. The recommendation had been implemented in respect of the majority of service users. Gold Hill Residential Home DS0000018654.V290476.R01.S.doc Version 5.1 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 The quality outcome in this area was good. Further work was needed to ensure that the service users’ lifestyle in the home met their individual social and recreational needs. However, the visiting arrangements ensured that the service users were able to maintain contact with their relatives and friends. The service users were helped to exercise choice over their own lives and they received a wholesome and balanced diet. EVIDENCE: The home provided opportunities for the service users to exercise their choice in relation to a limited range of social and recreational activities. However, it was pleasing to note that the home had recently engaged the services of an Activities Coordinator in order to improve this aspect of the service. The Activities Coordinator had commenced a process of talking individually to all of the service users and recording details of their particular interests. This process was still in the early stages and the information collected so far had not yet been written into the service users’ care plans in order to improve practice. The registered manager confirmed that when sufficient information had been collected a wider range of social and recreational activities would be introduced. A recommendation was made as a result of a recent complaint that an accurate and up to date record of the social and recreational activities provided for the service users, including the names of the service users who participate in the activities, should be maintained. The recommendation had been implemented. The home maintained a record of daily activities including Gold Hill Residential Home DS0000018654.V290476.R01.S.doc Version 5.1 Page 16 the names of the service users that participated. The routines of the home followed a similar daily pattern. However, there was scope for changing the routines in order to accommodate individual needs and requirements. The service users with whom discussions were held stated that they were able to get up and go to bed when they wished. They also confirmed that they were offered a choice of food. (See Standard 15 below). The activities that take place on a regular basis include a visiting musician twice a week, Bingo every Monday morning and a visiting hairdresser on a Sunday. In warmer weather the staff may escort the service users to the park or play garden games. The local Anglican minister and the Roman Catholic priest visited the home every two weeks to offer Communion to the service users. Information about activities was placed on a notice board in the corridor near to the main entrance to the home. Two of the service users with whom discussions were held said that they would like to visit the shops and the water gardens and one of them stated that she would like to ‘join in some activities if the staff came for her’. The service users were able to have visitors at any reasonable time. The service users with whom discussions were held stated that their visitors were always welcomed. The registered manager stated that any visitors that had to travel a long distance to get to the home were always offered a meal. The registered manager also confirmed that the service users’ right to choose whom they wished to see was respected. The service users’ guide stated that ‘Service users’ family, relatives and friends are encouraged to visit regularly and maintain contact by letter or telephone when visiting is not possible’. The registered manager expressed the hope that the key worker system would help to ensure that the service users’ contact with their relatives and the local community was developed and enhanced. There were no volunteers working in the home. However, members of the local Priory Church visited the home once a month to hold a service. In addition, students from the nearby Malvern Girls College visited the home on an occasional basis and spent time talking to the service users or playing their musical instruments for them. The registered manager stated that the service users were encouraged to take responsibility for their own affairs wherever possible. If any of the service users were unable to manage their own finances their relatives usually accepted this responsibility. The finances of two service users were handled by Social Services. Information leaflets about the local advocacy service were available in the home’s foyer and a notice was displayed in the main corridor that also contained details of the local advocacy service. A review of the care of one service user held on 17 November 2005 had recommended a referral to the advocacy service to see whether the service user could ‘be supported with finding outside interests’. An advocate had subsequently visited the home and had spoken to the service user. However, the service user had declined any further help. It was noted that the service user’s care plan did not include any details about the reasons for the referral or the desired outcome. The care plan contained the brief note ‘Visited by advocacy’. Two of the four members Gold Hill Residential Home DS0000018654.V290476.R01.S.doc Version 5.1 Page 17 of staff with whom discussions were held did not have a clear understanding of the purpose of the advocacy service. Some of the bedrooms contained personal items belonging to the service users. 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. The home followed a four-week menu. Any changes to the menu were recorded. The record of the food provided indicated a nutritious and balanced diet. The deputy manager stated that each day after lunch the service users were asked what they would like for their teatime meal and for their lunch the following day and their preferences were recorded. The mid-day meal that was observed during the inspection was wholesome and nutritious. The six service users with whom discussions were held expressed their satisfaction with the food provided. The service users confirmed that they were given a choice of food and asked each day about the food that was to be provided. One service user preferred to buy some of his food from the local shops. Some of the service users preferred to eat their meals in their own rooms. Two service users ate all their meals in their own rooms by choice. Drinks were available throughout the day. One service user had a kettle in his bedroom so that he could make his own drinks. The deputy manager said that a risk assessment had been carried out in regard to this matter. None of the service users were in receipt of liquidised food or any special diets because of medical, religious or cultural reasons. However, three service users who were diabetic were provided with sugar-free food. The deputy manager said that a healthy diet was promoted. It was confirmed that none of the service users were underweight. The registered manager stated that none of the service users required feeding and none of them had any difficulties swallowing. However, it was stated that members of staff were always present in the dining room at meal times in order to supervise the service users. It was confirmed that the staff had also been instructed to make regular checks on the service users who ate their meals in their own rooms. All the staff that were involved in the catering had undergone food hygiene training. Gold Hill Residential Home DS0000018654.V290476.R01.S.doc Version 5.1 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The quality outcome in this area was adequate. The home had a satisfactory complaints procedure. However, the record of complaints was not being fully maintained. The home had policies and procedures in place to help ensure the protection of service users from abuse. EVIDENCE: The home had a complaints procedure. The complaints procedure was referred to in the statement of purpose and in the service users’ guide. The home also provided a leaflet that explained the complaints procedure. Copies of the leaflet were available in the home’s foyer. The service users with whom discussions were held were not aware of the home’s complaints procedure. However, they all stated that they felt confident about making a complaint, if necessary. Since the previous inspection the home had received one complaint from a service user. The complaint was recorded in the complaints folder and had been responded to appropriately. In addition, the home had been the subject of two further anonymous complaints both of which had been forwarded direct to the CSCI. One complaint was investigated by the CSCI. The other complaint was referred to the registered provider for investigation using the home’s complaints procedure and was investigated by the registered manager. These two complaints contained a total of 14 elements that related primarily to care practice, food and standards of hygiene. Three elements of the complaints were upheld and six elements of the complaint were unresolved. However, details of these two complaints had not been recorded in the complaints folder. The registered manager was reminded that all complaints against the home must be recorded. Gold Hill Residential Home DS0000018654.V290476.R01.S.doc Version 5.1 Page 19 The registered manager confirmed that no incidents of suspected or alleged abuse had been reported to her or otherwise come to her attention since the previous inspection. The registered manager also confirmed that she had not had any reason to refer any member of staff who may be unsuitable to work with vulnerable adults for consideration for inclusion on the POVA register. The registered manager also confirmed that she had had no reason to invoke the home’s staff disciplinary procedures. Three requirements and two recommendations were made in regard to Standard 18 as a result of the previous inspection. The first requirement was that the home’s policy and procedure on ‘The Protection of Vulnerable Residents’ must include the full address and telephone number of the Adult Protection Coordinator and the CSCI to whom all cases of suspected or alleged abuse must be reported. It was noted that the name, address and telephone number of the Adult Protection Coordinator was not included in the policy and procedure. However, the address and telephone number of the local social services office was included in the policy and procedure and it was subsequently confirmed that this information was sufficient. The second requirement was that the home’s ‘Whistle Blowing’ policy must be amended in line with the Public Interest Disclosure Act 1998 to make it clear that any concerns may be referred to the CSCI without the home’s internal investigation mechanisms having to be exhausted first. The requirement had been implemented. The third requirement was that training in the protection of vulnerable adults from abuse must be provided for all the staff including the deputy manager. The registered manager confirmed that training in ‘Adult Abuse and Protection’ led by Affordable Training had been undertaken by all the staff including the deputy manager on 9 February 2006. The requirement was regarded as having been implemented. However, the staff with whom discussions were held showed limited awareness of the principles underlying the protection of vulnerable adults from abuse. The first recommendation was that a copy of ‘No Secrets’ should be obtained and kept in the home. The recommendation had been implemented. The second recommendation was that the home’s policy and procedure regarding service users’ money and financial affairs should be amended in order to include a reference to all of the issues referred to in Standard 18.6 and the guidance contained in this (i.e. the previous) report. A copy of the policy and procedure was made available for inspection. It was noted that it contained an appropriate reference to all of the relevant issues except personal insurance. However, there was a reference to personal insurance in the home’s statement of terms and conditions of residence (contract). The recommendation was regarded as having been implemented. Gold Hill Residential Home DS0000018654.V290476.R01.S.doc Version 5.1 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26 The quality outcome in this area was poor. Although recent improvements have been made to the general maintenance of the premises a considerable amount of work is still needed to ensure that the home meets an acceptable standard. A number of the service users’ bedrooms did not have all of the items listed in Standard 24. A more robust approach needed to be taken towards maintaining a satisfactory standard of cleanliness and hygiene. EVIDENCE: The home is located near to the town centre and to local shops and all of the other facilities associated with a small town. A number of the service users’ bedrooms enjoy splendid views of the Malvern Hills and the surrounding countryside. Two requirements and one recommendation were made in regard to Standard 19 as a result of the previous inspection. The first requirement was that the rotten window frames must be replaced and others must be repainted, where necessary. The window frames on the inside of the premises had been painted. The window frames had not been painted on the outside. The outside walls of the building and down pipes were also in need of painting. Consequently, the outside appearance of the premises was below an acceptable standard. The requirement had not been implemented. However, Gold Hill Residential Home DS0000018654.V290476.R01.S.doc Version 5.1 Page 21 this work should form part of the home’s programme of routine maintenance that is referred to below and covered by the relevant requirement. The second requirement was that an appropriate means of access at the entrance of the home i.e. a permanent ramp, must be provided for people who use wheelchairs. Service users with mobility problems may also find it difficult to negotiate the steps at the front of the building and gain easy access to the premises. The requirement had not been implemented. The registered provider indicated his unwillingness to implement the requirement because the home already provided access for wheelchair users at the side of the premises via the rear, ground floor lounge. Therefore, the requirement has been removed. However, the provision of a permanent ramp at the front entrance of the home is recommended in order to provide equality of access for people with disabilities. The recommendation was that a programme of routine maintenance and renewal of the fabric and decoration of the premises should be produced and implemented. The registered manager stated that she carried out a monthly audit of items that required repair and/or renewal. However, that action was not sufficient to ensure that all of the environmental issues that need attention are satisfactorily addressed. A more pro-active approach with a recorded long-term rolling programme of refurbishment is required. The recommendation had not been implemented and has, therefore, become a requirement. The absence of any systematic programme of maintenance and renewal and a failure by the previous proprietor to invest sufficiently in the upkeep of the premises has resulted in the home’s worn internal appearance. Some improvements have recently been made. However, there is still a significant amount of colour-coordinated refurbishment needed in order to improve the appearance of both the service users’ bedrooms and the communal areas. The registered manager also recognised the need for further refurbishment of the premises. At the time of the inspection the passenger lift was not in working order. Two service users that shared a double room on the first floor had been moved temporarily to a double room on the ground floor to enable them to have easier access to the lounge. The deputy manager stated that all of the other service users were able to walk up and down the stairs with the help of the staff. An electrical survey was also being undertaken to assess the work that needed to be carried out in order to ensure that the electrical system was brought up to a satisfactory standard. During the inspection of the premises it was noted that the gas cooker in the kitchen was old and consideration needed to be given to its replacement. It was also noted that the gate leading from the pavement at the front of the premises providing access to the garden at the side of the building was insecure and without a lock. A secure, lockable gate must be provided in order to enable the service users to make use of the garden in safety. A requirement was made in regard to Standard 20 as a result of the previous inspection that all the chairs and sofas in the communal areas that are too low or worn and no longer suitable for use by service users that are frail or that have mobility problems must be replaced with more appropriate seating. It Gold Hill Residential Home DS0000018654.V290476.R01.S.doc Version 5.1 Page 22 was noted that six new armchairs had been provided in both the rear lounge and in the lounge at the front of the premises. A sofa had been retained in both lounges. The requirement was regarded as having been implemented. One requirement and one recommendation were made in regard to Standard 22 as a result of the previous inspection. The requirement was that a grab rail must be provided in the communal toilet on the second floor. The requirement had been implemented. The recommendation was that 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 recommendation had not been implemented and still stands. The registered manager was given advice to enable her to implement this recommendation. Two requirements were made in regard to Standard 24 as a result of the previous inspection. The first requirement was that all of the items of furniture specified in Standard 24, as outlined in this (i.e. the previous) report, must be provided in rooms occupied by service users. The service users’ bedrooms were inspected and it was noted that in bedroom 4 there was no carpet, only one comfortable chair, only one double electric socket and there was a hole in the bedspread which was worn and in need of replacement. In bedrooms 5, 6, 9 and 26 there was only one double electric socket. In bedroom 16 a thermostatically controlled mixer valve had not been fitted to the wash hand basin in the en suite facility. In bedroom 18 a handle was missing from the bedside cupboard. In bedroom 19 the wall tiles that were missing from beneath the wash hand basin in the en suite facility were replaced during the inspection. In bedroom 25 the grouting around the wash hand basin in the en suite facility needed to be upgraded. In bedroom 31 the en suite bathroom needed to be redecorated. In bedrooms 28 and 29 there was no carpet. In bedroom 29 there was no table to sit at and the drawers needed to be replaced. The registered manager gave an assurance that the floor coverings in the bedrooms that did not have a carpet were non-slip. Nevertheless, the floor coverings gave the bedrooms a cold and institutional appearance. It was also noted that some of the bedrooms e.g. bedrooms 2, 3, 6 and 32 did not have space for a bedside table. The bedrooms lacked coordination both in the furnishings and in the décor/colour. The carpet in bedroom 30 was stained and in need of replacement. The requirement had not been implemented and still stands. The second requirement was that all stained baths and wash hand basins must be resurfaced or replaced with new baths and wash hand basins as indicated in this (i.e. the previous) report. The requirement had been implemented. One requirement and one recommendation were made in regard to Standard 25 as a result of the previous inspection. The requirement was that pipe work in areas used by service users must be guarded. The requirement had been implemented. The recommendation was that the service users should be able to control the heating in their own bedrooms. The recommendation had not Gold Hill Residential Home DS0000018654.V290476.R01.S.doc Version 5.1 Page 23 been implemented and still stands. However, the registered manager stated that the home was in the process of replacing all of the radiators. One requirement and one recommendation were made in regard to Standard 26 as a result of the previous inspection. The requirement was that the home’s infection control policies and procedures must be amended in order to include dealing with spillages and other relevant information. The requirement had been implemented. The recommendation was that the home should obtain a copy of the ‘Guidelines for Infection Control in Care Homes (2003) produced by Herefordshire and Worcestershire Local Health Protection Unit. The recommendation had been implemented. The premises were inspected and it was noted that in bedroom 12 the wash hand basin in the en suite facility was dirty and in need of cleaning. A requirement was made in regard to Standard 26 as a result of the findings of an investigation into a recent complaint. The requirement was that appropriate action must be taken to keep the home free from offensive odours. It was noted that in bedrooms 5, 19, 23 and 32 there was still an unacceptable odour. The requirement had not been fully implemented and still stands. The issue of odour control and continence management was discussed. It was agreed that the Infection Control Nurse would be asked to visit the home and to offer advice on these matters. It was noted that in bedroom 23 the bedcover was stained with faeces. The deputy manager subsequently confirmed that the bedcover had been replaced with a clean bedspread. The laundry walls showed signs of dampness. Internal access to the laundry could only be obtained via the dining room. However, a risk assessment had been carried out and recorded and procedures were in place to ensure that the risk of cross infection caused by soiled linen being taken through the dining room was kept to a minimum. Gold Hill Residential Home DS0000018654.V290476.R01.S.doc Version 5.1 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 The quality outcome in this area was poor. The home employed adequate numbers of staff and the level of NVQ 2 training exceeded the National Minimum Standard. However, the service users were not fully protected by the home’s recruitment practices. Further updated training was required in a number of core areas. EVIDENCE: A copy of the staff rota and also a copy of the staff register were made available for inspection. The staff rota indicated that the home had an adequate number of staff. The service users with whom discussions were held also stated that there were adequate numbers of staff on duty. However, the staff rota did not show the position of the deputy manager, two head seniors and senior care assistants. There were also discrepancies between the names of the staff listed on the staff rota and the names of the staff shown on the staff register. There were three names on the staff register that did not appear on the staff rota and eight names on the staff rota that did not appear on the staff register. In addition, the registered manager stated that the home employed three members of staff whose names did not appear on the staff register. The records maintained by the home in respect of the staff must be kept up to date. (See Standard 30 below). Two members of staff were on maternity leave and one member of staff was on long-term sick leave. The registered manager stated that, normally, there were two senior care assistants and four care assistants on duty during the mornings and afternoons in addition to the registered manager, deputy manager and ancillary staff. During the evenings, one senior care assistant and four care assistants were on duty. One senior care assistant and two care assistants were on waking Gold Hill Residential Home DS0000018654.V290476.R01.S.doc Version 5.1 Page 25 duty at night. A cook was employed for 30 hours per week i.e. from 8:00 am to 2:00 pm Monday to Friday. Catering staff were also employed during the afternoon/early evening period and at weekends. Three members of staff were employed for a total of 95 hours per week to undertake the domestic work. The registered manager said that there had been relatively little change recently within the staff group. It was confirmed that only one new member of staff had been appointed to work at the home since the previous inspection. It was noted that several members of staff including the registered manager and deputy manager had relatives who worked at the home. This practice is not always conducive to good working relationships. It was pleasing to note that over 50 of the care staff employed at the home, including the two members of staff who were on maternity leave and the one member of staff who was on long-term sick leave, had completed the NVQ level 2 training. Four of the care staff that had completed NVQ level 2 training had also completed the NVQ level 3 training. Three requirements were made in regard to Standard 29 as a result of the previous inspection. The first requirement was that staff files must contain all the information and documents listed in Schedule 2. The file in respect of a member of staff appointed to work in the home since the previous inspection was examined. The contents were satisfactory. However, it was also noted that another part time member of staff had been appointed to work in the home without any of the normal recruitment procedures being followed. Therefore, the requirement had not been implemented and still stands. It is essential that recruitment checks, and an appropriate record of these, are made in respect of all staff including those who are self-employed or employed via an agency. Despite being given additional time, the registered manager was unable to make an up to date list of all the training undertaken by the staff available for inspection. The second requirement was that two relevant, written references must be obtained in respect of all prospective staff prior to the commencement of their employment at the home and any gaps in employment records must be explored. It was noted that the files of recently appointed staff, apart from one for whom there was no relevant information available, contained two written references. The requirement had not been implemented and still stands. The third requirement was that an enhanced disclosure check must be obtained from the Criminal Records Bureau (CRB) in respect of all prospective staff prior to the commencement of their employment at the home. It was noted that an enhanced disclosure check had been obtained from the CRB in respect of all recently appointed staff except for one. The registered manager stated that the person for whom a CRB disclosure check had not been sought was self employed and had provided her own CRB and POVA check. The registered manager stated that she had spoken to the Job Centre who had given her a verbal reference. However, the home had not sought any written references in respect of the person’s employment at the home. The registered manager was reminded again that CRB disclosures were not ‘portable’ and that a disclosure check from the CRB Gold Hill Residential Home DS0000018654.V290476.R01.S.doc Version 5.1 Page 26 must be obtained for all people who worked in the home who had substantial access to the service users. The requirement had not been implemented and still stands. The three requirements referred to above have been combined into one requirement in this report. In addition, the registered manager was advised that all declared convictions for offences must not only be discussed with prospective staff prior to a decision being made about their appointment but that a written record of the discussion and of the reasons for the decision made must also be maintained. The registered manager stated that all the staff apart from one part time member of staff had been issued with a copy of the code of conduct and practice set by the GSCC and a copy of their terms and conditions of employment. It was confirmed that the home provided ‘Skills for Care’ induction training. None of the staff were undertaking the induction training at present. However, the registered manager stated that it was intended that one recently appointed member of staff would commence the training in the near future. A requirement was made in regard to Standard 30 as a result of the previous inspection that 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 kept up to date. The requirement had not been implemented and still stands. This requirement has been combined with an earlier requirement made in connection with maintaining accurate and up to date staff records. (See Standard 27 above). The staff required updated training in several core areas. However, the registered manager confirmed that arrangements had been made for training to be undertaken in the near future including fire safety (19/05/06), moving and handling (25/05/06), infection control (05/06/06), food hygiene (19/06/06), medication (20/06/06), challenging behaviour (28/06/06), first aid (14/07/06), health and safety (19/07/06) and infection control (25/07/06). It was noted that the home had recently introduced a key worker system. However, none of the staff had undertaken any formal training in key working. Gold Hill Residential Home DS0000018654.V290476.R01.S.doc Version 5.1 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, and 38 The quality outcome in this area is poor. The registered manager was experienced and had undergone relevant NVQ training. However, further training needed to be undertaken by the senior staff. The systems for monitoring the quality of the service, record keeping and for carrying out and recording individual staff supervision must be improved. EVIDENCE: The registered manager had considerable relevant experience in the management of the care home. In addition, she had completed the NVQ level 4 training in July 2004. She had also completed her NVQ Assessors award training and had undertaken other relevant training in order to enhance her knowledge and skills. The home had recently introduced the key worker system. However, the registered manager, deputy manager and none of the other staff had undertaken any relevant training in key working. Appropriate training in the key worker system is essential in order to develop the key worker role and to enable the home to care appropriately for service users with a dementia illness. The registered manager confirmed that she had Gold Hill Residential Home DS0000018654.V290476.R01.S.doc Version 5.1 Page 28 undertaken training in ‘Person Centred Planning’ organised by Abacus Care in March 2006. None of the other senior staff had undertaken training in Person Centred Planning. However, it was subsequently confirmed that training in person centred planning had been arranged for all senior staff. The four members of staff with whom discussions were held stated that they had no or very little involvement in care planning. Formal, professional supervision and support will also be necessary in order to help the registered manager implement the proposed changes in care practice resulting from the introduction of key working and a greater emphasis on meeting the needs of people with a dementia illness. The deputy manager had not undertaken any NVQ training. Having regard to her position and her responsibilities within the home, the deputy manager should give serious consideration to NVQ training. A requirement was made in regard to Standard 31 as a result of the previous inspection that a new disclosure application must be made to the Criminal Records Bureau by the registered manager. The requirement had been implemented. Two recommendations were made in regard to Standard 32 as a result of the previous inspection. The first recommendation was that a key worker system should be introduced for the benefit of the service users. The recommendation had been implemented. The registered manager confirmed that a key worker system had been introduced at the beginning of April 2006. However, it was noted that limited information had been provided for the staff and very little discussion had taken place so far to explain the principles of key working or the way in which the system would operate in the home. Some of the staff had been issued with a copy of the ‘Key Worker Policy’. The members of staff with whom discussions were held showed varying levels of understanding about the key worker system or person centred planning and confirmed that they would welcome training on both of these issues. The key worker role should be underpinned by formal training and reinforced through discussions at staff meetings and in discussion with the service users. The second recommendation was that the home should introduce management planning and practice that will encourage innovation, creativity and development. The registered manager stated that the home had appointed an ‘Activities Coordinator’ who had been coming to the home since the beginning of April for between 1 and 2 hours per afternoon three times a week. The job of the Activities Coordinator was to help the home develop a range of appropriate social and recreational activities for the service users. The recommendation was regarded as having been implemented. 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 quality assurance system involved the registered manager signing and dating a commercially produced manual to confirm that the home had all of the necessary policies and procedures in place. None of the service users or members of staff were directly involved in this process. The quality assurance Gold Hill Residential Home DS0000018654.V290476.R01.S.doc Version 5.1 Page 29 system was still ineffective in ensuring a satisfactory standard in a number of areas as the requirements and recommendations in this report show. The requirement, therefore, still stands. 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 in accordance with the requirements of Regulation 24 and Standard 33. The registered manager stated that the company probably had a development plan but there was no copy of a plan in the home available for inspection. Therefore, the requirement was regarded as not having been implemented and still stands. 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 registered manager stated that the home had issued 40 questionnaires in October 2005 and that 12 had been completed and returned. In February 2006, 34 questionnaires had been issued and to date 3 had been returned. The registered manager stated that she had not yet analysed or published the results. The recommendation still stands. 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 in relation to one service user was discussed with the deputy manager. The home’s assessment had identified the service user’s interest in gardening. However, the care plan did not show how the service user’s interest could be maintained or developed e.g. by the provision of gardening magazines, visits to garden centres, involvement in household plants and/or raised garden beds at the home etc. The recommendation had not been implemented. A recommendation was made in regard to Standard 34 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. The recommendation had not been implemented and still stands. The registered manager stated that the home handled the personal allowances on behalf of approximately ten service users. The monies were kept in individual packets, together with their separate records of account, in a safe. The system was checked in respect of one service user chosen at random and the amount of money and the record of accounts agreed. The home employed an administrator who was responsible for dealing with the service users’ personal allowances and finances. The administrator acted as the appointee on behalf of two service users. The two service users were aware of the arrangements made for the administrator to collect their money. The home retained records and receipts for all of the transactions. A requirement was made in regard to Standard 36 as a result of the previous inspection 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. The registered Gold Hill Residential Home DS0000018654.V290476.R01.S.doc Version 5.1 Page 30 manager stated that she, the deputy manager and, on occasions, a senior member of staff were responsible for carrying out the staff supervision meetings. It was noted that, since the previous inspection, there had not been a noticeable increase in the frequency of the supervision meetings as recorded in the files that were inspected. One senior member of staff had not received any formal, individual supervision since the previous inspection. Another senior member of staff had only had one formal, individual supervision meeting since the last inspection. It was also noted that the majority of the supervision forms that were seen did not include all of the relevant issues as outlined in Standard 36.3. In addition, the information that was recorded on the supervision forms was brief and unspecific. The requirement had not been implemented and still stands. The different forms that were being used for supervision needed to be combined into one comprehensive form so that all of the relevant issues are covered. All of the senior staff that are responsible for formal supervision must be provided with appropriate training in supervision. The staff with whom discussions were held were unsure about the purpose or frequency of supervision. Three requirements were made in regard to Standard 37 as a result of the previous inspection. The first requirement was that fire safety checks must be carried out and recorded in respect of all fire safety equipment, including fire alarms and fire extinguishers. The requirement had been implemented. The second 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 CSCI and the registered manager in accordance with the requirements of Regulation 26. Since the previous inspection the home and the CSCI had been supplied with copies of only one report made in accordance with Regulation 26. That report was dated 2 March 2006. No reports had been supplied for the months of January or February 2006. The requirement had not been fully implemented. The registered manager must be provided with copies of Regulation 26 reports each month as part of the quality monitoring of the home and to ensure that she has a record of any issues that need to be addressed. It would also be helpful if copies of the reports could be supplied to the CSCI to assist the monitoring of progress at the home. The third requirement was that the statements of the procedure to be followed in the event of accidents and in the event of a service user becoming missing must be amended in accordance with the guidance given in this (i.e. the previous) report. The requirement had been implemented. 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 safe working practice topics covered in Standards 38.2 and 38.3. The folder containing copies of the home’s risk assessments was inspected. The folder did not contain risk assessments on all of the safe working practice topics. For example, there was no risk assessment available on first aid, food hygiene or the security of the premises. The requirement, therefore, had not been fully implemented and still stands. A Gold Hill Residential Home DS0000018654.V290476.R01.S.doc Version 5.1 Page 31 Notice of Immediate Requirement was issued at the conclusion of the inspection in regard to this matter. The second requirement was that arrangements must be made to ensure that all the staff receive suitable training in infection control and health and safety in accordance with Regulations 13 and 18 and Standard 38.2. It was confirmed that some of the staff had undertaken training on infection control organised by Affordable Training on 13 April 2006 and that arrangements had been made for other members of staff to undertake the same training in the near future. (See Standard 30 above). It was also confirmed that all of the staff had undertaken training on health and safety organised by First Response on 3 and 28 March 2006. The registered manager said that she and some other staff were also undertaking a distance-learning course on health and safety. It was also stated that all the staff had been issued with a training supplement booklet on infection control that included information on MRSA. The requirement was regarded as having been implemented. The third requirement was that a valid electrical safety certificate for the home provided by a qualified electrician must be obtained and made available for inspection. An electrical survey of the home was being carried out at the time of the inspection. The electrician stated that there was no immediate danger to any of the service users. However, the home fell below present electrical standards and work needed to be carried out to ensure that the home was brought up to an acceptable level of safety. The requirement had not been implemented. The fourth requirement was that opening restrictors must be fitted to the windows in bedrooms 7 and 22. It was confirmed that the requirement had been implemented. The record of accidents involving service users was inspected. It was noted that, since 23 February 2006, seven of the accident forms had not been fully completed. The accident forms must be completed in full and checked by a senior member of staff at the time of the accident. A Notice of Immediate Requirement was issued at the conclusion of the inspection in regard to this matter. In addition, the home had failed to notify the CSCI of the accidents in accordance with Regulation 37. A Notice of Immediate Requirement was issued at the conclusion of the inspection in regard to this matter. However, the registered provider subsequently stated that the accidents referred to minor skin tears. Therefore, a requirement in respect of this issue has not been included in this report. The registered manager stated that the boilers and central heating system had been recently serviced. However, despite being given additional time to provide evidence that the boilers and central heating system had been recently serviced, the registered manager was unable to make the servicing certificate available for inspection. Gold Hill Residential Home DS0000018654.V290476.R01.S.doc Version 5.1 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 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 1 X X X X 1 X 1 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 1 Gold Hill Residential Home DS0000018654.V290476.R01.S.doc Version 5.1 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 OP2 Regulation 5 Requirement The home must provide one clear, accurate and comprehensive statement of terms and conditions of residence that includes all of the information detailed in Standard 2.2. (Previous timescale 31/01/06 not met). The homes assessment form must be amended to include all of the issues referred to in Standard 3.3, including dietary preferences, history of falls and personal safety and risk, and a detailed assessment of all the service users undertaken and recorded in accordance with Regulation 14. (Previous timescale 31/01/06 not met). 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. (Previous timescale 31/03/06 not met). The care plans in respect of each service user must include all of DS0000018654.V290476.R01.S.doc Timescale for action 30/06/06 2 OP3 14 30/06/06 3 OP4 12 30/09/06 4 OP7 15 30/06/06 Gold Hill Residential Home Version 5.1 Page 34 5 OP7 15 6 OP9 13 7 OP9 13 8 OP16 17 9 OP19 23 10 OP19 23 11 OP19 13,23 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. (Previous timescale 31/01/06 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 31/01/06 not met). The registered manager must ensure that a medicine audit can be completed. The date of opening of all medicine containers must be recorded and any balances of medicines carried over on to a new medicine chart. The medication must be transported safely and securely around the home whilst the lift is out of order. A record of all the complaints made against the home and the action taken in response to any complaint must be maintained. 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. The vertical passenger lift must be repaired and returned to full and proper working order for the safety and benefit of the service users. 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. DS0000018654.V290476.R01.S.doc 30/06/06 01/06/06 09/05/06 23/05/06 30/06/06 06/06/06 31/05/06 Gold Hill Residential Home Version 5.1 Page 35 12 OP24 16 13 14 OP26 OP26 16 13,23 15 16 OP27 OP27 17 17 17 OP29 17,19 All of the items of furniture specified in Standard 24, as outlined in this report, must be 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 31/01/06 not met). The home must be kept free from offensive odours. (Previous timescale 25/01/06 not met). 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. The staff rota must show the designated position of all the staff on duty. 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. (Previous timescale 31/01/06 not met). Staff files must contain all the information and documents listed in Schedule 2, including an up to date list of training, two relevant, written references and proof of an enhanced disclosure check from the CRB obtained in respect of all staff prior to the commencement of their employment at the home. (Previous timescales 31/01/06 DS0000018654.V290476.R01.S.doc 30/06/06 31/05/06 31/05/06 31/05/06 31/05/06 25/05/06 Gold Hill Residential Home Version 5.1 Page 36 18 OP29 17,19 19 OP31 18 20 OP33 24 21 OP33 24 22 OP36 18 23 OP36 18 24 OP37 26 and 02/12/05 not met). 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. Ongoing, formal, professional supervision and support must be provided for the registered manager. The home’s quality assurance system must become fully operational and effective. (Previous timescale 31/01/06 not met). 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 in accordance with the requirements of Regulation 24 and Standard 33. (Previous timescale 31/01/06 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 31/03/06 not met). The registered manager, deputy manager and any other senior member of staff responsible for undertaking formal supervision must receive appropriate supervision training. 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 DS0000018654.V290476.R01.S.doc 31/05/06 30/06/06 30/06/06 31/05/06 30/06/06 31/07/06 31/05/06 Gold Hill Residential Home Version 5.1 Page 37 25 OP38 13 26 OP38 13 27 OP38 12,13,17 28 OP38 23 times in accordance with the requirements of Regulation 26. (Previous timescale 31/01/06 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. (Previous timescale 09/01/06 not met). A valid electrical safety certificate for the home provided by a qualified electrician must be obtained and made available for inspection. (Previous timescale 31/03/06 not met). The accident forms must be completed in full and checked by a senior member of staff at the time of the accident. 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. 23/05/06 30/06/06 16/05/06 30/06/06 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 Refer to Standard OP10 OP14 Good Practice Recommendations All items of clothing belonging to the service users should be appropriately marked or labelled with the name of the individual service user. 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, DS0000018654.V290476.R01.S.doc Version 5.1 Page 38 3 OP19 Gold Hill Residential Home 4 5 OP19 OP22 6 7 8 9 OP25 OP30 OP31 OP33 10 11 OP33 OP34 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. Formal training on key working should be provided for all the staff. The deputy manager should give serious consideration to undertaking NVQ training. 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. A business and financial plan for the establishment should be drawn up, made open to inspection and reviewed annually. Gold Hill Residential Home DS0000018654.V290476.R01.S.doc Version 5.1 Page 39 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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