Inspection on 18/06/08 for Greenford Care Home

This inspection was carried out on 18th June 2008.

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

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

Other inspections for this house

Greenford Care Home 07/10/08

Greenford Care Home 30/11/07

Greenford Care Home 26/07/07

Greenford Care Home 20/06/06

Greenford Care Home 07/03/06

Greenford Care Home 07/07/05

Greenford Care Home 29/12/04

Greenford Care Home 12/07/04

Greenford Care Home 22/12/03

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Greenford Care Home 260-262 Nelson Road Gillingham Kent ME7 4NA Lead Inspector Sue McGrath Unannounced Inspection 18th June 2008 08:30 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 Greenford Care Home DS0000029057.V367224.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. Greenford Care Home DS0000029057.V367224.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greenford Care Home Address 260-262 Nelson Road Gillingham Kent ME7 4NA 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) 01634 580711 Purelake (Greenford) Ltd Vacant Care Home 18 Category(ies) of Dementia (0) registration, with number of places Greenford Care Home DS0000029057.V367224.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Dementia (DE). The maximum number of service users to be accommodated is 18. Date of last inspection 30th November 2007 Brief Description of the Service: Greenford is home to 18 service users with dementia. The home itself is situated in Gillingham adjacent to Gillingham Park, which can be accessed via the back courtyard. The home has mainly single rooms, two having en-suite facilities, day areas have a homely feel even though it is open plan in design. The main town of Gillingham offers High Street shopping and a mainline railway station. The home itself is on a bus route. There is limited parking to the rear of the home. The cost of the service ranges from £495.00p to £520:00p per week. Greenford Care Home DS0000029057.V367224.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This was a Key Unannounced inspection that took place in accordance with the Inspecting for Better Lives (IBL) process. Key inspections are aimed at making sure that the individual services are meeting the standards and that the outcomes are promoting the best interests of the people living in the home. The IBL process for a Key inspection involves a pre-inspection assessment of service information obtained from a variety of sources including an annual selfassessment and surveys. It is now a legal requirement for services to complete and return an Annual Quality Assurance Assessment (AQAA). This assessment is aimed at looking at how services are performing and achieving outcomes for people. Judgements have been made with regards to each outcome area in this report, based on records viewed, observations and verbal responses given by those people who were spoken with. These judgements have been made using the Key Lines of Regulatory Assessment (KLORA), which are guidelines that enable The Commission for Social Care Inspection (CSCI) to be able to make an informed decision about each outcome area. Further information can be found on the CSCI website with regards to the IBL process including information on KLORA’s and AQAA’s. The actual site visit to the service was carried out over one day by one inspector, who was in the home from approximately 08.30 until 18.00. The main focus of the visit was to review any improvements made since the last visit and the well-being of the service users. Time was spent touring the building, talking to people living in the home, talking to staff and reviewing a selection of assessments, service user plans, medication records, menus, staff files and other relevant documents. This inspection had been brought forward due to the outstanding Safe Guarding Adults alert. There is no registered manager at this service at this time but the Provider had employed a person to be in charge of the day to day running of the service who will be referred to in this report as the Manager although they are not registered with CSCI. Greenford Care Home DS0000029057.V367224.R01.S.doc Version 5.2 Page 6 One immediate requirement, eight requirements and two statutory notices have been made following this inspection. What the service does well: What has improved since the last inspection? What they could do better: The staff training is poor and this had resulted in staff not having the full range of skills to meet the needs of some of the residents. The new owners have started to book some training and are aware of the requirements made. The staff do not always follow the homes procedures and recent history has evidenced that the Responsible Individual did not carry out the required Regulation 26 visits. This meant that staff were not correctly monitored. The Greenford Care Home DS0000029057.V367224.R01.S.doc Version 5.2 Page 7 new provider is also aware of these issues and now regulation 26 visits are being carried out and staffs currently are better monitored. Staff supervision was not being completed but has now been started by the new manager. The home does not provide any outdoor space for the residents and should therefore be more proactive in arranging outside visits and outings. The home must provide adequate moving and handling equipment and ensure it is fully maintained. Fire drills must be completed to ensure staff are fully aware of and competent in the procedure. The provider must ensure the safety of residents and staff by ensuring the electric wiring is safe. The homes statement of purpose and service user guide need to be updated and made available to existing and prospective residents. Several of the carpets will need to be extensively cleaned or replaced. The home should include in its long-term maintenance plan the refurbishment of the kitchen. 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. Greenford Care Home DS0000029057.V367224.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Greenford Care Home DS0000029057.V367224.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents and their families are not currently provided with the information they need to make an informed choice about moving into the home. Residents’ benefit from a comprehensive assessment of their needs prior to moving into the home to ensure their assessed needs can be met. Residents and families also benefit from the opportunity to visit the home prior to admission to assess the quality, facilities and suitability of the service. EVIDENCE: The current statement of purpose does not reflect what the service offers the people who live in the home. Families of relatives who were visiting the home confirmed they had not received a copy of either document. Both documents Greenford Care Home DS0000029057.V367224.R01.S.doc Version 5.2 Page 10 were stored in the manager’s office and clearly these were not working documents. The new manager was aware of this issue and was preparing an updated version of both documents. This was expected to be ready in the very near future and the manager confirmed that once the provider had approved these, both would be made more accessible to all existing and prospective residents. A copy should be sent to the Commission. Samples were seen of both of the contracts issued to the people who live in the home. The people who live in the home and were funded by Social Services did not have the details of specific rooms or fees included in their contracts. The people who live in the home and who pay privately for their care have these details written into their contract. The manager was unable to explain why the difference had been made. The care plans that were viewed confirmed that prospective service users were assessed by the home prior to admission. These assessments were detailed in some areas but could be improved upon. There was very little information on resident’s personal wishes or past life. The manager explained that it was their intention to move to a new assessment process for all future service users. Examples of the proposed paperwork was seen and appeared to contain the relevant areas. Examples were also seen of Care Management assessments, where applicable, and Care Management reviews. The current low level of completed mandatory training means that people who use the service cannot be confident all their needs would be met. This was discussed with the manager who evidenced that a high level of training had been booked and she was confident the home would be complaint with mandatory training within four months. Several visitors were spoken with and all confirmed the home had open visiting hours and they were made welcomed at any time. Some stated they tried to avoid meal times, as they were aware it was a busy time for the staff. All said they were made very welcomed by the staff and were normally offered refreshments on arrival. One visitor confirmed a trial period was offered initially. The home does not have a quiet area for residents to meet with visitors, so most visits are in the main lounge. Visitors can access resident’s rooms if they so wish. The manager confirmed the home does not offer Intermediate Care. Greenford Care Home DS0000029057.V367224.R01.S.doc Version 5.2 Page 11 Greenford Care Home DS0000029057.V367224.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 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents are put at risk by inadequacies in the systems for care planning. Residents are protected by the home’s policies and procedures for dealing with medicines. Residents are treated with respect. EVIDENCE: The judgment for this outcome group has taken into account the quality of life for all the residents. The judgement also includes assessment of the level of knowledge and understanding displayed by staff when providing both personal and health care. Greenford Care Home DS0000029057.V367224.R01.S.doc Version 5.2 Page 13 Four care plans were reviewed and all appeared to be comprehensive and regularly reviewed. However, on closer examination it was found that all were very similar with stock phrases such as ‘she like to have her hands and face washed’ and ‘she like to sit near her friends at mealtimes’ were noted. It was also noted that the reviews dates were all the same and that no changes had been recorded for approximately sixteen months. With the ever-increasing frailty of the residents this would appear unlikely. One specific care plan failed to be changed after the resident had been diagnosed by her GP as having suffered a CVA. This also would appear unlikely and the daily care notes that were written by care staff indicated that her needs had indeed changed fairly dramatically. This would indicate that the reviews were not actually undertaken but merely signed off as being completed. Medical assessments such as Bartell and Waterlow were being undertaken and it was not possible to ascertain whether the manager had undertaken appropriate training to undertake these. It was noted that the outcome for some of these assessments were not followed, for example one assessment indicated that a service user required an air pressure mattress but staff could not remember if one had been supplied or not. Nutritional assessments had been undertaken and service users were weighed regularly but again the outcomes were not acted upon. All of the four care plans indicated that in the past year all four residents had lost a minimum of over one stone, with some losing more. No action had been taken to address this loss or to seek further input from other professionals. Records for District Nurse and G.P. visits were in place, but again there was little evidence of any follow through or recorded outcomes. One resident had been referred to her G.P. because of a lump being found, but there was no record of any outcomes. One member of staff recalled the event but not the outcome. There was evidence in the care plans that residents had access to opticians, chiropodists and audiologist. However dental checks had not appeared to have taken place for some time Staff confirmed that the previous manager wrote and reviewed the care plans without any input from residents, staff or the resident’s families. Visiting family members confirmed this, some of whom were totally unaware of the care plans. These issues were raised with the new manager who confirmed the care plans would be re written with the involvement of staff, service users where appropriate family members. The manager and senior carers were responsible for medication. The manager and some of the senior carers had undertaken a one-day medication training. There was a designated medical room and a mobile drug trolley. The standard of storage and cleanliness in the medical room was good. All of the Medication Record Administration Record (MAR) sheets inspected were completed appropriately. Medicines were seen to be given in accordance with good practice guidelines on the day of the inspection. There was an issue regarding Greenford Care Home DS0000029057.V367224.R01.S.doc Version 5.2 Page 14 the administration of medication where the resident was unwilling or unable to take the dose in that current form. This was discussed with the manager who assured the inspector she would confirm with all staff exactly what the written procedure was. Evidence in one care plan indicated that a resident who held her tablets in her mouth had not been reviewed. It would have been expected that discussion would have taken place with her G.P to ensure the correct medication was given in appropriate dosages and form. Written advise from a G.P. must be followed. During the inspection staff were seen to be kind and considerate to the residents and both the residents and the visitors confirmed this. Some very good examples of positive interactions was seen between staff and residents and choices were seen to be given. Greenford Care Home DS0000029057.V367224.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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents social and recreational interest and needs are provided for with a range of activities organised. Residents are supported to maintain contact with family and friends, which ensures they continue to receive stimulation and emotional support. Residents receive a wholesome appealing and balanced diet. EVIDENCE: On the day of the inspection the residents appeared relaxed and at ease. The home does not have a dedicated activities co-ordinator at the present time, but the staff in the afternoons arrange activities and these vary from cooking, sing a longs, puzzles, games and artwork. The home’s sister home has a minibus and it was hoped to arrange some outings in the near future. The resident do Greenford Care Home DS0000029057.V367224.R01.S.doc Version 5.2 Page 16 not have access to any garden space as the limited garden to the rear is mainly used as a staff smoking area and remains untidy. Staff stated they had planned to take some of the residents to the park next door last week but rain had prevented this from happening. Staff did confirm that the residents had enjoyed two or three trips to a fish and chip shop recently. Residents are encouraged to maintain contact with their friends and relatives and several still go out with their relatives. With the levels of dementia within the home it was not always easy to ensure full choices were given at all times, however staff were seen to offer choices where possible and where not possible, gave full support and consideration. From observation during the inspection it was apparent that residents were encouraged to personalise their rooms where possible. The cook had only been at the home for about four weeks but all residents said the food was nice and that there was plenty of it. On the day of the inspection the meal choice was a roast chicken dinner or pasty with vegetables. Mealtimes were relaxed; staff were patient and helpful and allowed residents the time they needed to finish their meal comfortably. The menus viewed indicated that a range of foods was offered and a choice was always available. Snacks and drinks were offered throughout the day. The cook was aware of who was on a diabetic diet and could offer other specialist diets if needed. The kitchen was compact and would need a refurbishment in the near future. This was discussed with the manager who hoped that the long-term maintenance plan would include the refurbishment, as this had already been recognised by the new owners. Greenford Care Home DS0000029057.V367224.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 and 17 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents are protected by a complaints system and residents and relatives feel their views are listened to and acted upon. The homes adult protection procedures and understanding do not protect residents. EVIDENCE: The complaints procedure was displayed in the home and reflected the new owners contact name and address. Families spoken with said they would first approach the manager if they had any complaints. There had been no complaint made to the home or to the Commission since the last inspection. The home is currently under going a formal Safe Guarding Vulnerable Adults investigation into an incident where resident received a serious burn that went untreated by staff. Staff had not sought medical advise or attention and this resulted in the resident finally being admitted to hospital where she received treatment via a specialist burns unit. The hospital, not the home had raised this issue. Greenford Care Home DS0000029057.V367224.R01.S.doc Version 5.2 Page 18 Staff training in Adult Protection had been undertaken by only ten of the twenty staff earlier this year but the remainder had not been trained. First Aid training was also poor. Greenford Care Home DS0000029057.V367224.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, 22, 23, 25 and 26 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Not all of the areas are well maintained and some re-decoration and replacement of equipment and furniture is necessary. Residents do not benefit from having any outside space. EVIDENCE: The current SVA alert had highlighted the home had not covered all hot pipe work as is required by the National Minimum Standard 25.5 and Regulation 13(4)(a) and (c) of the Care Home Regulations 2001. The Commission is currently undertaking enforcement action against the home. All of the pipe work has now been covered. Greenford Care Home DS0000029057.V367224.R01.S.doc Version 5.2 Page 20 Radiators had been covered and this work was being undertaken during the last inspection. All of the rooms had new vanity units fitted and the registered provider confirmed in their AQAA that the problems with the hot water pressure had been addressed. On the day of the inspection the water did not appear to be excessively hot and the water ran at an adequate pressure in most rooms. The homes handyman recorded water temperatures on a weekly basis. The lounge and hallway were in the process of being decorated with the work being undertaken during the night to reduce the inconvenience to the residents. Of the eight wall lights in the lounge only four were working. This made the room appear dim. Apart from the lighting the lounge and dining room were pleasant and according to the residents very comfortable. The carpets were in need of cleaning or replacement, as they were badly stained in some areas. The hallway carpet was also heavily stained. The manager stated that carpet cleaning was planned for the following weekend and the bathroom flooring was to be replaced. An order had been made and they were just awaiting the fitting. Several of the bedrooms had been decorated recently and the home is hoping to continue with this procedure. The remainder were adequately decorated. Environmental risk assessments had been undertaken for each room and the staff had written these. The new manager had re written all the assessments since her arrival in the home. The home had not undergone a professional environmental risk assessment by a qualified person. The manager confirmed the home has one Oxford Mini hoist for use upstairs and downstairs. This hoist has to be taken upstairs in the lift when needed, including in an emergency. A recent incident when a resident should have been lifted with the use of a hoist confirmed that staff do not, in practise, take the hoist upstairs. The manager also confirmed that it is the policy of the home that if a hoist cannot be used to lift a resident from the floor, staff should call for an ambulance. This also was not the practise on the day of the incident. The home must ensure they have policies and procedures in place and that staff follow these policies and procedures at all times. If it is not practicable for the hoist to be taken upstairs in the lift then the home must ensure other procedures or other suitable equipment are in place. Greenford Care Home DS0000029057.V367224.R01.S.doc Version 5.2 Page 21 The laundry is situated in the cellar and was extremely hot and felt damp on the day of the inspection. The door at the top of the stairs had a child gate fitted but this meant staff had difficulty in closing the door properly. An immediate requirement was made to ensure the door was safely secure. The home complied with the requirement within twenty-four hours and fitted a digi lock. The edges of the steps had protectors fitted but some of these were loose and had stated to lift from the steps making them a trip hazard. The registered provider is strongly advised to look at the sighting of the laundry. The floor was not impermeable and the walls were not easily cleanable as required in NMS 26.4. Clothes were seen hanging on coat hangers from the water pipes. The home has one washing machine and one tumble dryer. The home does not have any sluicing facilities and is advised to consult the infection control nurse for advise on the emptying and cleaning of commodes. The remainder of the home was clean and fresh on the day of the inspection. Greenford Care Home DS0000029057.V367224.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents do not benefit from staff that are well trained and competent to do their jobs. EVIDENCE: The home employs seventeen care staff and five domestic staff. Staff and rotas confirmed that three staff are on duty in the mornings and afternoon with two at night. Staff commented that sometimes these figures are not maintained. Other staff commented that sometimes during busy times residents are on their own in the dining room. All staff attend the handover period and this means that no one is on the floor during this time in the mornings and early afternoons. The manager will be required to look at the shift patterns to ensure residents are safe at all times. Due to the lack of mandatory training in the home residents cannot be confident they are currently in safe hands at all times. The new providers have booked a high number of courses and must ensure that skills learnt are reflected in the workplace. Priority must be given to First Aid training. Further enforcement action is being taken. Greenford Care Home DS0000029057.V367224.R01.S.doc Version 5.2 Page 23 Several staff files were viewed and some were found to be lacking in detail. And did not meet Schedule 2 of the Care Homes Regulations 2001. The providers had also undertaken assessment of staff files and identified the shortfalls. The manager indicated that it was her priority to ensure all staff file held the necessary information as required under legislation. Greenford Care Home DS0000029057.V367224.R01.S.doc Version 5.2 Page 24 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, 36, 37 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Lack of support and intervention by the provider has meant that the residents have been put at risk. Residents do not benefit from having staff who receive regular supervision. EVIDENCE: The manager had only been in post for ten days at this inspection and was concerned at what she was finding in the home. This rating is not a reflection of her skills as a manager. Greenford Care Home DS0000029057.V367224.R01.S.doc Version 5.2 Page 25 The previous manager had not been completing the manager’s monthly reports, the last one being dated 26/06/07. However the registered individual had not identified this. The last regulation 26 visit was made on 11/01/08. It was also difficult to assess whether the previous manager had received any supervision. The new manager confirmed she intended to apply to the Commission to become the registered manager. The new providers stated it was their intentions to fully her support her in this role. Regulation 26 visits are now happening. The new providers have recently sent out questionnaires to all families and this was confirmed by some of the visitors. They are waiting for all questionnaires to be returned and intend to compile a report of the outcomes. A copy of the report must be sent to the Commission as required under NMS 33. There was little evidence in the staff files that any structured supervision of staff had been undertaken. Staff confirmed they had not received supervision. The new manager was in the process of starting structured supervision for all staff and hoped to have the initial session completed for all staff in the very near future. She has undertaken the appropriate training. The recent incident where an event took place regarding a serious injury to a service user was not report to the Commission under Regulation 37. This is a breach of regulation and further enforcement action will be taken. The new providers are in the process of updating and reviewing all policies and procedures and again this should be completed in the very near future. Procedures. Systems were not in place to ensure the risks to the safety service users were identified and eliminated and that staff were trained to respond appropriately to accidents. The Commission is taking further enforcement action. The home had a current fire risk assessment that was completed by a senior manager who had undergone appropriate training. The fire system was regularly tested and serviced but fire drills had not been undertaken since 11/02/07. A requirement will be made to ensure all staff undertake the necessary training and practise. Greenford Care Home DS0000029057.V367224.R01.S.doc Version 5.2 Page 26 The provider could not evidence that a competent person had checked the hard wiring and again a requirement will be made. The home did hold a Landlords Gas Safety certificate. The lift was serviced on a regular basis. The bath hoists were regularly serviced but one hoist in the home was not. The last service date was February 2004. The manager confirmed this was no longer used. However, as it is on the premises it must be serviced in case of an emergency where it may have to be used. This was stored in one residents bedroom, the resident did not use the hoist. Efforts must be made to store the hoist elsewhere. Greenford Care Home DS0000029057.V367224.R01.S.doc Version 5.2 Page 27 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 1 2 3 1 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 2 X 2 2 X 2 2 STAFFING Standard No Score 27 2 28 1 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X X 1 2 2 Greenford Care Home DS0000029057.V367224.R01.S.doc Version 5.2 Page 28 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 OP7 Regulation 15 Schedule 3 (1)(b) 18(1)(a) Requirement The registered person must ensure that service users health, personal and social needs are set out in an individual plan of care. The registered person must ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. The registered person must ensure there are sufficient and suitable lifting aids in place, which are capable of meeting the assessed needs of the service users. The registered person must ensure that staff files contain all of the information required under Schedule 2 of the Care Standards Act 2001 The registered person must ensure that persons working at the care home are appropriately supervised. The registered person must ensure staff have an DS0000029057.V367224.R01.S.doc Timescale for action 31/08/08 2 OP27 31/07/08 3 OP22 23(2)(n) 31/07/08 4 OP29 19 and Schedule 2 18(2)(a) 31/07/08 5 OP36 31/07/08 6 OP38 Schedule 4 31/07/08 Greenford Care Home Version 5.2 Page 29 7 OP38 13 (4) 8 OP26 13(3) understanding and can implement appropriate fire procedures. Records must be kept of all fire drills. The registered person must ensure the safety of all service users and staff by providing evidence that the electrical wiring is safe. The registered person must ensure the arrangements to prevent infection, toxic conditions and the spread of infection at the care home are suitable. In that the laundry meets NMS 26 31/07/08 30/09/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Greenford Care Home DS0000029057.V367224.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Greenford Care Home DS0000029057.V367224.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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