Inspection on 19/02/07 for Great Wheatley

This inspection was carried out on 19th February 2007.

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

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

Other inspections for this house

Great Wheatley 25/09/07

Great Wheatley 10/08/06

Great Wheatley 16/12/05

Great Wheatley 19/05/05

Great Wheatley 09/12/04

Great Wheatley 15/07/04

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

CARE HOMES FOR OLDER PEOPLE Great Wheatley 3a Great Wheatley Road Rayleigh Essex SS6 7AL Lead Inspector Carolyn Delaney Unannounced Inspection 19th February 2007 09:00 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 Great Wheatley DS0000048207.V329479.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. Great Wheatley DS0000048207.V329479.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Great Wheatley Address 3a Great Wheatley Road Rayleigh Essex SS6 7AL 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) 01268 777281 maritafarr24@fsnet.co.uk Mr Raju Ramasamy Mr Inayet Mohmed Patel Manager post vacant Care Home 21 Category(ies) of Dementia - over 65 years of age (21), Old age, registration, with number not falling within any other category (21) of places Great Wheatley DS0000048207.V329479.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Personal or nursing care to be provided to no more than 21 people. Over the age of 65 years (OP). Personal or nursing care to be provided to no more than 21 people. Over the age of 65 years with dementia (DE). Number of service users to whom personal and nursing care is to be provided shall not exceed (21) twenty-one. The kitchen must be refurbished as highlighted in the home’s recent EHO visit on the 10th April 2003. This to be undertaken within six months from the date of registration. The steep slope on the patio and steps to the rear of the property present a safety hazard. A gate with access is to be fitted across both the slope area and the steps. This to be undertaken within three months from the date of registration. The front gate and the signage for the home at the entrance to the driveway require replacement. This to be undertaken within one month from the date of registration. Storage facilities for equipment must be made available. This to be undertaken within three months from the date of registration. Pipework, which is presently temporarily lagged, must be priority risk assessed and boxed in. This to be undertaken within one month from the date of registration. Individual lockable facilities within a risk-assessed strategy should be made available for service users to use in their rooms. This to be undertaken within two months from the date of registration. A plan of renewal and routine maintenance for the home should be collated and forwarded to the National Care Standards Commission. This to be undertaken within two months from the date of registration. 10th August 2006 5. 6. 7. 8. 9. 10. Date of last inspection Brief Description of the Service: Great Wheatley is a care home, which provides services for older people in need of nursing care. Whilst most service users have long term care requirements, the home also offers short-term respite care provision when needed. The home is situated in a residential area of Rayleigh, close to all amenities and within a quarter of a mile from the A127 London/Southend. Service provision includes nine single rooms and six double bedrooms five of Great Wheatley DS0000048207.V329479.R01.S.doc Version 5.2 Page 5 which have ensuite facilities. Assisted bathrooms and WCs are provided on both floors. There are four communal areas for service users and a small terraced garden with seating. Car parking for up to four cars is provided at the front of the property. Both trained nurses and carers make up the staff team. The range of fees for accommodation and nursing care at the home is between £531.00 for a shared room and £577.00 for a single room. Other services such as hairdressing, chiropody and aromatherapy are available at an additional charge. Great Wheatley DS0000048207.V329479.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine unannounced Key Inspection carried on 19th February 2007. Records including assessments, care plans, daily care notes and risk assessment documents in respect of three people living at the home were examined. The relatives of ten residents living at the home were contacted by post so as to offer them the opportunity to make comments about the services provided by the home. Five responded. In addition two contacted the Commission by telephone so as to express their views about the home. Three residents and a number of relatives who visited the home on the day of the inspection were spoken with. A number of staff were spoken with and a number of records including duty rota’s and staff recruitment files were examined. A tour of the premises was carried out and the serving of lunch was observed. Each of the Key Standards as identified in the intended outcomes sections of this report have been inspected during this Key Inspection. Other standards, which have not been assessed at this time, may be assessed at the next inspection visit. Where other standards have not been inspected on this occasion they will have been inspected at the previous inspections. Reports in respect of previous inspections may be accessed via the Commissions website www.csci.org.uk Below is a brief overview of the findings of the inspection, which are covered more fully throughout the main body of the report. What the service does well: The majority of people who commented about the home said that the staff who work there were kind, caring and compassionate and that they ‘do a good job’. People commented that staff work very hard and that resident’s personal hygiene needs are well managed. Great Wheatley DS0000048207.V329479.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: There has been no manager employed at the home for some time and this has had an adverse impact on the way in which the home is run. There have been a number of serious concerns raised during this inspection in respect of the way in which the systems for detecting and warning of fires at the home have been maintained and as a result Statutory Requirement Notices have been issued which require the homes owners to take action or face possible prosecution. A number of people have commented that there are not enough staff working at the home so as to meet the needs of the people who live there. As a result staff do not have time to spend with residents offering support for example at mealtimes, and some have to wait unacceptably long periods of time for staff to assist them to the toilet etc. There is very little for residents to do during the day as there are few activities provided and relatives have commented that residents ‘are left to their own devices …’ The way in which information about the needs of people living at the home is recorded could be improved and reviewed when the persons care or treatment changes so as to ensure that all staff are aware of the residents needs and that care and treatment is delivered in an effective and consistent way. Risks to person health and safety are not well managed and where there are specific risks identified such as the risk of developing pressure sores or risks of sustaining injuries through the use of bedrails or from falls there was little evidence that staff act so as to minimise the risks to residents. Staff are not recruited in a consistent manner and all of the checks such as references etc are not always undertaken before employing a person to work at the home. The provision of training for staff has been very poor and some staff have not received even basic training such as fire safety and training for the safe moving and handling of people. Great Wheatley DS0000048207.V329479.R01.S.doc Version 5.2 Page 8 Complaints and concerns are not dealt with effectively and people who have made complaints or raised concerns in the past have had a poor or no response from the homes owners. One relative said that when they raised issues of concern that they ‘were fobbed off…’ another relative said that when complaints are made that ‘nothing changes…’ Relative feel that the homes owners do not communicate with them. For example there is refurbishment work planned for the home and relatives have said that they have not been informed as to the extent of the work and any impact this will have upon the people living at the home. On the day of the inspection there were problems with the supply of hot water and heating in the home. There have been similar problems and it was not evident that the homes owners took prompt action so as to deal with these issues. Overall there are great a number of issues which must be addressed so as to improve the quality of life for the people who live at the home. 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. Great Wheatley DS0000048207.V329479.R01.S.doc Version 5.2 Page 9 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 Great Wheatley DS0000048207.V329479.R01.S.doc Version 5.2 Page 10 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, 3 & 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The information, which is made available about the home and the services offered, is not indicative of the actual services provided. Assessment of a persons needs are not detailed so as to determine that taking into account the needs of the people living at the home and the resources available that the home will be able to meet the persons needs. EVIDENCE: There is a detailed statement of purpose, which describes the services provided by the home. However the actual experiences for the people who use the service falls far short of descriptions in the information provided in the statement of purpose. For example this document states that there is continuous programme for staff training, that new staff receive induction, there are regular fire drill exercises for staff working at the home and that complaints will be investigated fully in accordance with the homes complaints policy. There was no evidence during this inspection that the registered Great Wheatley DS0000048207.V329479.R01.S.doc Version 5.2 Page 11 providers ensure that the home is run and managed in a manner as described in the statement of purpose. Two of the five residents relatives who completed ‘ Have Your Say About…’ surveys said that they had received enough information about the home to help them make a decision. The pre-admission assessment document for the person who had most recently moved into the home was examined. The assessment was not detailed and there was no evidence that there had been any consultation with the person’s relatives as the resident was unable to express their needs fully at the time of the assessment. Great Wheatley does not provide intermediate or rehabilitative care. Great Wheatley DS0000048207.V329479.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Risks to the health, welfare and safety of people living at the home are not well managed and people do not receive the care and treatment they need. EVIDENCE: One of the five residents relatives who completed surveys said that they feel that the care home always meets the need of residents; three said that the home usually did and one said that the home sometimes did. One of the five said that the home helps residents keep in touch with relatives. One of the five relatives said that they were always kept up to date with important issues affecting residents; two said that they usually did; one said that they sometimes did and one said that they never did. A number of residents said that due to the shortages of staff and the needs of the people living at the home who have dementia, that the needs of other Great Wheatley DS0000048207.V329479.R01.S.doc Version 5.2 Page 13 residents are not being met. Two of the five said that staff attended to residents personal care needs well. The care plans for six people living at the home were examined. The care plans did not always included details of the care and treatment to be provided to residents. For example for one person who has dysphasia there was no information recorded as to how this was to be managed. For one person living at the home who is known to be verbally and physically aggressive and who wanders there was no information recorded in the plan of care as to how this persons needs were to be met by staff. On the day of the inspection the local tissue viability nurse specialist was visiting the home to give advice about the management and treatment of one residents pressure sores and ulcers which had deteriorated significantly. (The care plan, which had been developed by staff working at the home, indicated that this person’s position should be changed every three hours. There was no evidence that this care had been provided). The tissue viability nurse specialist advised that the pressure-relieving mattress, which the home uses, was not appropriate and had no scientific data in respect of their effectiveness at minimising the risk of pressure area damage. It was noted that where people were identified as being at risk of developing pressure sores due to immobility and poor overall health that there was no consistency in the measures taken by staff so as to minimise these risks such as assisting the person to change position while in bed so as to relive pressure from areas of the body at particular risk of skin damage. Staff working at the home have not received training for the effective management of pressure area damage. The risks to residents of sustaining injuries from falls are not well managed. Assessments in respect of risks do not identify how the risks are to be managed. There were a number of records in respect of where people have had falls. There was no evidence that the assessment of risk had been reviewed in light of this and there was little evidence that following a fall that staff monitored the persons condition periodically to determine if there was any serious injury. The use of bedrails for some residents appeared to be as a form of restraint rather then to prevent people from falling out of bed. The risks associated with the use of bedrails were not assessed. There was evidence that at least one resident had sustained an injury through entrapment of their limbs in the bedrails. Records in respect of the administration of medicines to people living at the home were assessed and were noted to be generally well maintained. It was Great Wheatley DS0000048207.V329479.R01.S.doc Version 5.2 Page 14 noted that the arrangements for the storage of controlled medicines were not suitable. One resident’s relative stated that they were concerned at the use of medication to ‘calm down’ residents, which resulted in residents being permanently drowsy. These issues had been referred to the local Primary Care Trust (PCT) for investigation. Great Wheatley DS0000048207.V329479.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at Great Wheatley are not supported in making decisions about how they spend their time and there are very few opportunities for socialising or participating in activities. EVIDENCE: Three of the resident’s relatives who completed ‘Have Your Say About…’ surveys commented that there could be more activities and stimulation for residents. Two relatives who spoke with the inspector commented that staff working at the home did not have time to spend with residents and two residents who were spoken with during the inspection indicated that they had very little to do other than watch television all day. It was noted that during the inspection two residents were left for most of the day in one of the communal areas with no support from staff and no form of stimulation. One resident was displaying both verbal and physical aggression towards the other resident. Great Wheatley DS0000048207.V329479.R01.S.doc Version 5.2 Page 16 Relatives have informed the Commission that it is they and not the homes owners who purchased a television and provided a range of videos for residents. There was no evidence during the inspection that there are any planned activities for residents living at the home. Records maintained by staff in respect of activities provided by the home were poorly maintained and entries which where made generally referred to visits made by residents relatives, hairdressing and very little for other activities or opportunities for stimulation. One of the six people who made comment said that the home support residents to live the life they choose. On the day of the inspection the lunchtime meal was served to residents where they sat in the lounge areas or in their bedrooms. No residents were offered the opportunity to sit at dining room tables. Some residents had difficulty in feeding themselves but staff were not available to assist. The meal portions were noted to be small and residents were not offered extra portions. Residents were not offered the choice of gravy and no condiments were offered. Residents who were spoken during the inspection said that the food was generally good. Some resident’s relatives who have recently contacted the Commission have said that the quality of food has deteriorated in the past few weeks. One resident’s relative who completed a survey commented that there is no fresh fruit available for residents and that the portions served were smaller. Great Wheatley DS0000048207.V329479.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Complaints and concerns are not received and dealt with in a manner, which inspires confidence in the complainant that issues are taken seriously or that people living at the home will be protected. EVIDENCE: The records, which were available in respect of complaints made about the home, were poorly maintained and it was not possible to establish what if any action had been taken so as to resolve the issues and concerns raised. Some relatives have informed the Commission of complaints they have made, yet there were no records in respect of these complaints on file. The relatives of four people who live at the home who have had cause to make complaints to the homes owners indicated that they were not happy with how complaints were received and dealt with. One person said that that they had to write five letters of complaint before they received a response. Of the five residents relatives who completed surveys, four said that they knew how to make a complaint about the home. Three indicated that complaints were not dealt with properly. One relative said that despite making complaints that often ‘there is no change..’ None of the five people who completed surveys or the two people who contacted the Commission directly feel that the Great Wheatley DS0000048207.V329479.R01.S.doc Version 5.2 Page 18 there is an appropriate response when they have raised concerns about the care provided by the home. Of the twenty-five people working at the home only six have received training pertaining to the protection of people from abuse, harm or neglect. None of the staff working at the home have received training in respect of managing aggressive behaviour. The home provides care for people who have dementia and at least one of the resident’s displays physical aggressive behaviour towards both staff and other residents. During this inspection a resident was seen to be physically aggressive and threatening towards another resident who had been left unsupervised in the same room. There was recorded evidence that this resident had previously ‘hurt and shocked’ a resident during an altercation. One resident’s relative who completed a survey said that on occasions they had noticed bruising to the residents skin for which staff had no explanation or knowledge and had not reported this to the relative. Great Wheatley DS0000048207.V329479.R01.S.doc Version 5.2 Page 19 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 20, 21 & 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Great Wheatley is poorly maintained and when issues in respect of heating and hot water are identified they are not dealt with promptly. EVIDENCE: A number of resident’s relatives who completed ‘Have Your Say About…’ surveys commented that the home is in need of redecoration. One relative commented that ‘the fees are high enough to justify this…’ One resident’s relative commented that a resident’s relative and not the homes owner had provided the television in the lounge area. There are plans in place for the refurbishment of some areas of the home. However it is disappointing to note that a number of residents relatives have Great Wheatley DS0000048207.V329479.R01.S.doc Version 5.2 Page 20 commented that they have not been informed by the homes owners the nature of the planned changes to the home and any disruption likely to impact upon residents during the period when the work is carried out. On the day of the inspection visit the inspectors were informed by staff that due to a problem with heating in one area of the home that a resident who usually spends her days in one of the lounge areas was appending the day in their bedroom. On speaking with this resident it was found that the problem with the heating had been ongoing for a number of days. There was no evidence that any action had been taken so as to deal with the problem. During the inspection a number of residents bedrooms were noted to be very cold and residents hands and face were also cold. This was brought to the attention of the most senior member of staff on duty at the time (the acting manager from one of the registered providers other care homes). After some time it was reported that the boiler had been set on a timer and that this was why the rooms had been cold. The supply of hot water to bathrooms in the home was noted to be very poor. The water pressure was poor and the temperature was not constant and fluctuated between being hot and cold. There was no hand washing soap available for staff and residents to wash their hands in some of the bathrooms and toilets. There were no odours detected in the home and resident’s relatives commented that the home is generally clean and fresh. Great Wheatley DS0000048207.V329479.R01.S.doc Version 5.2 Page 21 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 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff are not recruited robustly, trained or employed in sufficient numbers so as to meet the needs of the people who live there. EVIDENCE: On the day of the inspection visit the inspectors were informed that the staffing levels at the home had been reduced as the home had vacancies. There was no evidence that the dependencies of the people living at the home had been assessed and considered when making this decision. Resident’s relatives who commented said that the staff working at the home were kind, caring and compassionate and that they worked very hard under difficult circumstances. One of the five residents relatives who completed surveys said that staff at the home have the right skills and experience to look after people properly; of the remaining four two said staff sometimes did. The others did not complete this section of the survey. During the day of the inspection residents were left for periods of up to an hour without any staff intervention. One resident who has dementia and who Great Wheatley DS0000048207.V329479.R01.S.doc Version 5.2 Page 22 can become verbally and physically aggressive was left unattended for long periods during which they exhibited aggressive behaviour towards another resident in the room. One resident was incontinent of urine and left for over one hour before staff noticed and acted to assist the resident. Two residents relatives who contacted the Commission since the date of the inspection to express concerns about the home said that they had been informed that staffing levels at the home had been reduced yet again and that so that there were only two members of care staff on duty in the afternoon and one nurse who ‘spends most of the time in the office..’ Another residents relative said that the resident waited for over a half an hour on more than one occasion when they used their call bell to call for staff to assist them to use the toilet. Both relatives commented that staff never had any time to spend with residents. The staff file for the person who had most recently recruited to work at the home was assessed. There were no references on file from the place where this person last worked. This person had been recruited by an agency on behalf of the home and there was no evidence that any interview had been carried out so as to determine the person’s suitability to work at the home. There was no evidence that this person had received any training or induction before commencing work at the home. The files for three other members of staff were examined. There was very little evidence of training provided for these members of staff. It was noted that for one staff member that their ‘Leave to Remain’ status had expired in July 2006 and that there was no evidence that the person was legally entitled to live and work in the United Kingdom. There was little evidence that staff working at the home have received training in respect of the roles they are to perform and the needs of the people who live there. The staff training matrix was requested and from this it was noted that of the twenty-five people who work at the home five have not received moving and handling training. Of the remaining twenty people one had not received moving and handling training since 2003, two have not received training since 2004 and two have not received training since 2005. Six have not received fire safety training, of the remaining nineteen, six have not received training since 2005, two have not received training since 2004, three have not received training since 2003 and one member has not received training since 2002. There was very little evidence that staff working at the home had undertaken any specialist training. For example only one member of staff had received training with respect to the management of wounds and only one member of staff had received training for the management of diabetes. From the information provided it was noted that two of the fifteen care staff had undertaken National Vocational Qualification (NVQ) in care. Great Wheatley DS0000048207.V329479.R01.S.doc Version 5.2 Page 23 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, 36, & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Great Wheatley is not managed in the interests of the people who live there and the health, safety and welfare of residents are not promoted or protected. EVIDENCE: There has been no registered manager at the home for the past two years. The homes acting manager left in November 2006 and the acting manager from one of the registered providers other care homes has been overseeing the management of both homes. A number of resident’s relatives have commented that there is little or no communication between the owners of the home and relatives. One relative commented that ‘the only time I hear from them is Great Wheatley DS0000048207.V329479.R01.S.doc Version 5.2 Page 24 when I get the bill each month…’ One resident’s relative said that there ‘could be more communication between the owners and relatives…’ When issues are identified and brought to the attention of the registered providers they become very defensive and uncooperative. Following this inspection a letter identifying the serious concerns was sent to the registered providers requiring them to take action to address the issues. However they chose to reply only to argue with the findings of the inspection. A number of resident’s relatives who have had cause to complain or to raise issues of concern have indicated that they have received similar responses. There was evidence that staff working at the home had received supervision although this was not always carried out on a regular basis. The records for three people who have monies held by the home on their behalf. Records were not well maintained so as to minimise the risk of mishandling of residents monies. On the day of the inspection cleaning materials were noted to be left within easy access of residents who wander around the home and who may be at risk of harm. There were a number of issues identified in respect of the arrangements for fire safety at the home. Records did not evidence sufficiently that the systems and equipment for detecting and containing fire at the home is properly maintained. For example there were records indicating problems with the door closure systems, which should close door in the event that the fire alarms are triggered. There was no evidence that the issues had been dealt with. Similar issues had been identified at the previous key inspection. There was no assessment in respect of the risk of outbreak of fire at the home. A letter identifying the seriousness of these issues was sent to the registered provider. The response was not satisfactory and a Statutory Requirement Notice was issued in respect of the registered providers failure to ensure the safety of the people who live and work in the home. Great Wheatley DS0000048207.V329479.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. 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 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 3 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 1 17 X 18 1 2 2 2 X X X X 3 STAFFING Standard No Score 27 1 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 2 2 X 1 Great Wheatley DS0000048207.V329479.R01.S.doc Version 5.2 Page 26 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&6 Requirement The homes statement of purpose must be an accurate reflection of the services provided by the home, be kept up to date and made available to residents and others in accordance with Regulation. This is a repeat requirement. The previous timescale of 30/06/06 has not been met. 2. OP3 14(1) (c) So far as it is practicable the service user or their relative must be consulted when carrying out an assessment of the persons needs. The plan of care for each individual must be kept under review and revised at any time where there is a change to the care and treatment to be provided Risks to the health, safety and welfare of people living at the home must be assessed and managed. This is a repeat requirement. Great Wheatley DS0000048207.V329479.R01.S.doc Version 5.2 Page 27 Timescale for action 30/08/07 30/05/07 3. OP7 15 (1) & (2) 30/06/07 4. OP8 13(4) (c)12(1) (a) 30/07/07 The previous timescales of 09/06/06 & 30/09/07 have not been met. 5. OP9 13(2) The arrangements for the storage of controlled drugs must be in accordance with current regulation for the safe storage of medicines. So far as it is practicable the people who live at the home must be consulted about their social interests and the programme of activities provided must reflect the wishes of residents. Resident’s wishes must be taken into consideration and so far as it is practicable care and facilities must be provided which promotes choice and independence. This is a repeat requirement. The previous timescale of 10/06/06 has not been met. 8. OP16 22(3) (4) Complaints must be received and 30/06/07 dealt with in accordance with the homes policy and procedure and the provisions of regulation 22 of the Care Homes Regulations 2001. This is a repeat requirement. The previous timescale of 30/09/06 has not been met. 9. OP18 13(5) (6) People living at the home must be protected from abuse, harm and neglect. The home must be well maintained and reasonably decorated in a manner, which provides a homely environment DS0000048207.V329479.R01.S.doc 30/07/07 6. OP12 16(m) & (n) 30/05/07 7. OP14 12(2) & (3) 30/07/07 30/06/07 10. OP19 16 & 23 (2) (d) 31/10/07 Great Wheatley Version 5.2 Page 28 for the people who live there. This is a repeat requirement. The previous timescale of 30/10/06 has not been met. 11. OP20 23(2) (p) The systems for providing heating to the home must be maintained in good working order and any issues dealt with in a prompt manner. The facilities for washing and providing personal care to residents must be maintained in good working order. This is a repeat requirement. The previous timescale of 30/09/06 has not been met. 13. OP27 18(1) (a) Staffing levels must be reviewed in accordance with the changing needs of the people living at the home and the numbers of staff employed must be sufficient to meet the needs of residents. This is a repeat requirement. The previous timescale of 30/09/06 has not been met. 14. OP29 19 People must only be employed to 30/05/07 work at the home once all of the checks as required by regulation have been carried out and are satisfactory. This is a repeat requirement. The previous timescales of 30/09/06 has not been met. 15. OP30 12(1) (a) 18(1) (c) Staff working at the home must staff receive training appropriate to the work they are to carry out. DS0000048207.V329479.R01.S.doc 30/04/07 12. OP21 23(2) (j) 30/08/07 30/04/07 30/07/07 Great Wheatley Version 5.2 Page 29 This is a repeat requirement. The previous timescales of 26/06/06 & 30/10/06 have not been met. A Statutory Requirement Notice has been issued in respect of the registered providers failure to ensure that staff working at the home are provided with training appropriate for the work they are to perform. A suitably qualified person must be employed to manage the home. The registered provider must carry out unannounced visits to the home in accordance with regulation 26 of the Care Homes Regulations 2001 and the reports made in respect of these visits must be supplied to the Commission. The registered persons must ensure that the home has robust systems in place for detecting and safely dealing with an outbreak of fire and that the home complies with the requirements and recommendations as made by the local fire authority. An Immediate Requirement notice was issued in respect of this on the day of the previous key inspection visit. This is a repeat requirement. The previous timescale of 10/08/06has not been met. A Statutory Requirement Notice has been issued in Great Wheatley DS0000048207.V329479.R01.S.doc Version 5.2 Page 30 16. OP31 8(1) 30/08/07 17. OP33 26 30/04/07 18. OP38 23(4) 30/04/07 respect of the registered providers failure to ensure the systems for detecting and giving warnings of fire are maintained in good working order and that staff have received suitable training in fire safety. 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 OP15 Good Practice Recommendations More could be done so as to ensure that residents receive their meals in a congenial setting and that they are provided with a choice of condiments to accompany meals. A minimum of 50 of care staff should have undertaken NVQ training in care. Records in respect of the monies held on behalf of residents should be audited regularly and maintained in good order so as to aid inspection and minimise the risk of mishandling or errors. Staff should receive regular supervision. 2. 3. OP28 OP35 4. OP36 Great Wheatley DS0000048207.V329479.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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 Great Wheatley DS0000048207.V329479.R01.S.doc Version 5.2 Page 32 - 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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