Inspection on 26/07/07 for Greenford Care Home

This inspection was carried out on 26th July 2007.

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

Greenford Care Home 07/10/08

Greenford Care Home 18/06/08

Greenford Care Home 30/11/07

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Greenford 260-262 Nelson Road Gillingham Kent ME7 4NA Lead Inspector June Davies Key Unannounced Inspection 31st July 2007 10:00 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 Greenford DS0000029057.V345816.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 DS0000029057.V345816.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greenford 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 Mr Cemal Osman Donna Horn Care Home 18 Category(ies) of Dementia - over 65 years of age (18) registration, with number of places Greenford DS0000029057.V345816.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th June 2006 Brief Description of the Service: Greenford is home to 17 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 £394.75p to £500:00p per week. Greenford DS0000029057.V345816.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was carried out over a period of eight hours. The inspector spoke with the manager, head of care, staff and two residents. The inspector also telephone two relatives to gain their views on the home. The home is registered for dementia care and many of the residents were not able to hold a meaningful conversation regarding their views of the home. Care plans were case tracked, and other documentation was inspected that was relevant to the standards inspected. A tour of the building and small back garden took place. What the service does well: What has improved since the last inspection? What they could do better: While pre-admission assessments are generally good some further attention needs to be included regarding whether residents have their own glasses, wear denture or have their own teeth, and if they have a hearing aid. Greenford DS0000029057.V345816.R01.S.doc Version 5.2 Page 6 Daily reports should reflect what aspects of personal care have been given or have been supervised by the care staff. Full-recorded details must be kept of all complaints, the investigation and outcomes. The home must be kept in a good state of decoration and maintenance issues must be addressed. Especially where there is a high risk to the residents in the home. The issue regarding the bath hoist on the first floor must be addressed and the delivery of hot water in the bathroom on the ground floor must also be investigated and put right. Staff recruitment and training needs to improve to ensure that residents are receiving care from staff who have been appropriately vetted, and trained. All radiators must be covered, and hot water temperatures addressed so that residents are not placed at risk from burning or scalding. 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 DS0000029057.V345816.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Greenford DS0000029057.V345816.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 and 6 Quality in this outcome area is good. Residents come into the home knowing that their needs have been assessed and can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: From the three pre-admission assessments viewed on the day of this key inspection all contained comprehensive information relating to the prospective residents’ care needs, which included interests, likes and dislikes, physical assessment, mental assessment and personal hygiene needs. There was also evidence that the manager had obtained pre-admission assessments from care managers, consultant psychiatrist and Health Community Services. The Greenford DS0000029057.V345816.R01.S.doc Version 5.2 Page 9 inspector did note that there was no information on the pre-admission assessments, regarding oral care or hearing aids. This home does not offer intermediate care. Greenford DS0000029057.V345816.R01.S.doc Version 5.2 Page 10 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): Standards 7, 8, 9 and 10 Quality in this outcome area is good. The residents know their personal care needs and goals are reflected in their individual plans and that potential risks are managed. The health needs of the residents are well met with evidence of good multi disciplinary working taking place on a regular basis. The systems for medication administration are good with clear and comprehensive arrangements being in place to ensure residents medication needs are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All three care plans were based on the pre-admission assessments and were fully completed and gave good information relating to the care that staff would be expected to give for each resident. Risk assessments were in place and Greenford DS0000029057.V345816.R01.S.doc Version 5.2 Page 11 gave clear guidelines to staff as to what actions needed to be taken to reduce any risk to the residents. There was evidence within the care plans that they are reviewed on a monthly basis. Evidence within the daily report regarding visits from health care professionals also case tracked to the professional visits sheet in the Care plan. The care plans had been signed by the residents’ relatives and or their representative. The care plans were not specific as to what personal hygiene care had been given to the residents e.g. Oral Care, checking of tissue viability, bathing and nail care. None of the residents in the home have pressure areas. The manager said that should these arise they would be reported immediately to the district nurse team. Care plans stated where a resident had continence problems and evidence was available that a district nurse would assess the level of continence aids to be provided. There was evidence that residents are given an opportunity for some armchair exercise. The inspector witnessed that on the day of the visit a Motivation Instructor was visiting the home and she was offering residents a variety of exercises. Each care plan showed that residents are weighed on a regular basis, and any concerns are reported directly to the G.P. G.P. visits were clearly recorded within the care plan, both on the daily report sheets and on the professional visits sheet. There was also evidence that when needed residents have contact with Community Psychiatric Nurse, Dentist, Chiropodist, Optician and Diabetic Nurse, and a variety of specialist consultants at the local hospital. The home has up to date policies and procedures on the receipt, administration, storage and disposal of medication. The home uses Boots the Chemist monitored dosage system. The inspector carried out an audit of the medication and found that there were no errors on the MAR sheets, all properly initialled when medication administered. Written medication brought in mid month had been properly recorded onto the MAR sheet, and where handwritten had been checked by two members of staff who had initialled the MAR sheet. The homes uses Boot The Chemist monitored dosage system for it medication. At the present time the home does not use Controlled Drugs. The medication trolley was properly fixed to the wall when not in use. The returned medication Greenford DS0000029057.V345816.R01.S.doc Version 5.2 Page 12 book showed that unused medications are returned to the pharmacy each month. Eye drops and liquid medications were dated on the day of opening. All personal care is given either in the privacy of the resident’s own bedroom or in a communal bathroom. Staff make sure that toilet doors are closed when in use. Staff said that residents have a choice as to whether they entertain their visitors in the privacy of their own bedroom or in the communal lounge. Residents see their G.P, or other professional visitors in the privacy of their own bedrooms. The inspector noted on two occasions that staff knocked on bedroom doors prior to entering the room. Residents have access to a mobile phone in the home if they wish to make telephone calls and can make these calls in the privacy of their own bedrooms. On the day of this key inspection all residents were individually dressed according to their own preferences. The manager said that the home ensures that all clothing is labelled with the resident’s name. Care plans clearly stated how the residents’ preferred to be addressed – Mrs/Mr, first name or nickname. At the present time the home has one shared bedroom, and appropriate privacy curtains are fitted around the beds, but not around the shared sink area. Greenford DS0000029057.V345816.R01.S.doc Version 5.2 Page 13 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): Standards 12, 13, 14 and 15 Quality in this outcome area is good. The residents have a variety of activities on offer in the home, but more provision could be made to provide activities suitable for dementia care. Visitors are welcome in the home at all times. Residents are encouraged to make choices to maintain the autonomy but this is not always possible due to the level of dementia. The meals in this home are good offering both choice and variety and catering for special diets. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents are able to make choices regarding how they spend their days; some residents prefer to spend time on their own in their bedrooms while others prefer to use the communal lounge. Greenford DS0000029057.V345816.R01.S.doc Version 5.2 Page 14 From the three care plans seen by the inspector there was evidence that residents’ past personal interests are recorded. The home offers a variety of activities, but these could be expanded upon to meet the needs of dementia care. The home backs on to a park and when the weather is nice the staff take the residents around the park for a walk. There are no restrictions on visiting the home and visitors are free to come and go. As previously stated residents are able to entertain their visitors in their own bedrooms if they wish to. Apart from visiting entertainers and the hairdresser, there was no evidence to show that residents have any other community contact. Families take their residents out from time to time and one resident goes to stay with her family occasionally. Due to their levels of dementia none of the residents are able to manage their own financial affairs. With the exception of one resident who has a solicitor who acts on her behalf financially, all the other residents have nominated families to look after their finances. There was no information available in the home relating to advocacy services. During a tour of the building the inspector noted that each bedroom reflected the residents own personal interests and choices, and there was evidence that the residents’ are able to bring personal items into the home when they move in – televisions, radios, pictures, photographs, ornaments, cuddly toys, bed linen, small items of furniture. The menus in the home showed that residents are offered a variety of fresh, wholesome and nutritious food. Evidence was also available on each individual care plan to show that residents are given a wide range of choices both at lunch and tea-time, and that their likes and dislikes are recorded. The home offers residents three meals a day, breakfast, lunch and tea. Drinks are offered with each meal and at other times throughout the day. All food eaten is recorded within the daily report of each individual care plan. Some of the residents have a diabetic diet, and the home can cater for other diets if necessary. Some residents prefer to have soft food, and this is appropriately presented, none of the residents are on liquidised diets at the present time. Two residents stated that the food was very nice. Greenford DS0000029057.V345816.R01.S.doc Version 5.2 Page 15 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): Standards 16 and 18 Quality in this outcome area is adequate. The complaints system in the home needs to ensure that all complaints are dealt with appropriately. Staff have some knowledge and understanding of Adult protection issues, but require more training to ensure that residents are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has an up to date complaints policy and procedure, which is displayed in the main entrance of the home. One complaint has been made since the last inspection. The manager acknowledged the complaint in writing the day after it was made and after investigation a reply was made within the 28 days. The inspector did note that no recorded evidence was available relating to the investigation and is making a requirement that all investigations should be recorded in writing. The home has policies and procedures in place relating to the safeguarding of vulnerable adults, and whistle blowing. There have been no Adult Protections incidences since the last inspection. Greenford DS0000029057.V345816.R01.S.doc Version 5.2 Page 16 Staff are made aware through induction the policy and procedure on accepting gifts from residents and that it is not company policy for staff to accept gifts. Only 35 of the staff have received training on the protection of vulnerable adults and reference to this is made further on in this report. Greenford DS0000029057.V345816.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20, 21, 22, 24, 25 and 26 Quality in this outcome area is poor. The standard of the environment is poor, there has been no change in the décor, furnishing and maintenance in the last 12 months, and there is a risk to the service users. The standard of cleanliness in the home is good and protects residents from cross infection. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The location of the home is suitable for the service users, it backs on to a public park, and has a small safe and secure back garden, which is paved and has seating and tables where residents are able to sit and look out over the park. Greenford DS0000029057.V345816.R01.S.doc Version 5.2 Page 18 There is still a problem with the boiler/hot water tank that delivers hot water over the whole home. When washing machines are being used, there is a lot of noise in some of the first floor bedrooms. In all bedrooms on the first floor hot water is limited, due to the uptake of water from the washing machines. The washing machine is in operation for most of the day, and this means that when residents are getting up and going to bed, hot water for washing is very limited. Due to this diminishing pressure after a few seconds, hot water is none existent in first floor bedrooms. None of the wash basins are fitted with water temperature control valves and the inspector found that the delivery of hot water was over 50ºC which poses a risk to the residents a requirement will be made under Health and Safety within this report. While there has been a recent fire officer inspection the inspector noted that one of the bedroom fire doors still had not been attended to and had a large gap where a hinge was missing. Communal lounge was pleasantly decorated, although the manager pointed out that no decoration to this area had been carried out for the past five years. Carpets and furniture were in good condition. Dining area has had tables replaced, and again was in good decorative order. The carpet in the front entrance and hallway, looked grubby and worn. The manager said that staff are always cleaning the hall carpet, but it never looks any better. In the first floor bathroom the window frame needs decorating. The bath hoist is not suitable for the residents, while the hoist could be lowered into the bath, it could not be swung round and lowered out of the bath, to enable a resident to sit on it, therefore the resident would need to sit on it from above bath height. The bathroom was very small, and would not allow access for a wheelchair as well as staff. A tile missing from sink support, and had just plastered over. The call bell was inaccessible. The communal toilet had no hot water running into the hand basin due to the use of the washing machine. In the bathroom on the ground floor the hot tap to the bath only trickles hot water. Hot water temperature was 40ºC and manager said that a control valve was fitted to the bath hot water. Most of the residents are having strip washes because the bath takes so long to fill up, and most residents cannot manage the first floor bathroom hoist. Communal toilets all clean and tidy, hot water temperatures are over 50ºC. Liquid soap, paper hand towels in situ and there are covered waste bins. In one bedroom the call bell is inaccessible. The shaft lift is in good order, but it was pointed out by the manager that the mobile hoist does not fit into the lift. In two bedrooms the vanity unit needed replacing because they are in a bad state of repair. One of the bedrooms had a chest of drawers where the drawers were jammed and this item of furniture needs replacing. Greenford DS0000029057.V345816.R01.S.doc Version 5.2 Page 19 The inspector noted that none of the radiators had been covered in the bedrooms. A requirement will be made under Health and Safety within this report. Door to basement was left open, and a real risk to a resident should they try to access the basement, as the stairs are very steep and not covered. Laundry was situated in the basement, and there was an industrial washing machine with a sluice facility and an industrial tumble drier. The laundry room was reasonable tidy bearing in mind the number of residents it caters for. There was no ventilation system in the laundry and the laundress explained that is why she keeps the door open, despite two fans being used in this area, it was still very hot and stuffy. Bathroom Ground Floor – The hot tap to the bath only trickles hot water. Hot water temperature was 40ºC and manager said that a control valve was fitted to the bath hot water. Most of the residents are having strip washes because the bath takes so long to fill up, and most residents cannot manage the first floor bathroom hoist. Communal toilets are all clean and tidy, hot water temperature are over 50ºC and liquid soap, paper hand towels are in situ as well as covered waste bins. Greenford DS0000029057.V345816.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 Quality in this outcome area is adequate. Staffing levels need to be reviewed to ensure there are sufficient staff on duty at all times of the day to meet the assessed needs of the residents. At least 50 of staff should have a recognised qualification to ensure they can meet the assessed needs of the residents. Recruitment policies have not been consistently followed resulting in Service Users receiving care from staff that have not been appropriately vetted. Staff training needs to improve so the residents receive care from staff who have a good understanding of their needs and health and safety issues. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Whilst talking to members of staff they stated that afternoon shifts were very rushed. One member of staff had to go into the kitchen to cook tea for the residents. There is laundry to put away, as well as tending to the needs of the residents. They never have time to sit and talk with the residents. Teatime is exceptionally busy, because there is one member of staff dishing up teas another member of staff serving teas and another member of staff doing Greenford DS0000029057.V345816.R01.S.doc Version 5.2 Page 21 medication. If one or more residents need assistance, this holds up the whole routine, and often residents’ have to wait for their tea or medication. The inspector spoke with two relatives on the telephone who said that they noticed the need for staff in the afternoons, and both visitors said that this should be a time to sit and talk with residents who do not have visitors. Both commented how rushed the care staff were at tea time, and if anything goes wrong, residents get fed up with waiting and move away from the tables without having their tea. These relatives also said they were satisfied with the care their residents received and that the staff were always welcoming and polite. There is certainly a need for a kitchen assistant in the afternoon to enable staff to spend time with the residents and have sufficient time to meet the residents’ needs without this having a detrimental effect on other residents. At the time of this key inspection 35 of staff have an NVQ qualification. Four members of staff are waiting to sign up for their NVQ course and when they have completed 55 of staff will have this qualification. The inspector viewed four staff files; two application forms did not have a full employment history. While two files do have two written references, another file had only one written reference and another had no references. There was evidence that CRB checks had been received with the exception on one file for a new employee, but there was a POVA first check. The manager said that a CRB had been applied for and they were awaiting its return. All new staff receive the General Social Care Council code of practice. All files had at least three forms of identification. All files had a medical health questionnaire. The training matrix and staff files showed that not all staff had completed or updated their mandatory training. One member of staff confirmed that some of her training was out of date. Less than half the care staff have dementia care training and only a quarter of the care staff have received protection of vulnerable adults training. While staff had completed initial induction introducing them to the home and health and safety procedures, they had not completed the Skills for Care, Common Induction Procedures. The manager showed the inspector an induction programme, which relates to these Skills for Care, Common Induction Procedures, but was not sure how to use them herself and it was evident that the manager should have received training in staff induction. Greenford DS0000029057.V345816.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 and 38 Quality in this outcome area is poor. The manager has a good understanding of what needs to improve in the home, but needs the support of management as to how the improvements will be resourced and managed. The systems for resident consultation are good, but further improvements need to be made, to ensure that residents are receiving a high quality of care. Health and safety issues need to be addressed as at the present time residents are at risk. This judgement has been made using available evidence including a visit to this service. Greenford DS0000029057.V345816.R01.S.doc Version 5.2 Page 23 EVIDENCE: The registered manager has worked in the home for two years. She is about to embark on her NVQ level 4 in December 2007 and completed her RMA in 2008. The manager is well supported by the head of care, and has worked hard in raising standards in the home. She has some concerns about how she is supported by senior management, regarding some of the maintenance issues in the home and with staff training. The manager is fully aware that there are staff who need to complete or update their mandatory training. The manager also stated that she does not receive any form of formal supervision. Staff and relatives spoke highly of the manager, saying that she works hard, and has an open and positive approach to management. One relative stated that she had always found the manager to be available for discussion and that she is very kind to the residents in the home. Head office sends out residents/relative questionnaires, but no surveys are carried out on stakeholders or staff. The company does publish results from relative/relative questionnaires each year, and the inspector was able to view this publication for 2006. Regular recorded monitoring checks are carried out on Care Plans, Medication, Clients personal allowance monies, complaints, staff files. Fire risk assessments and environmental risk assessments have been carried out this year. This environmental assessment also highlights areas in the home that need maintenance issues addressed i.e. radiator repairs, decoration, taps etc., but there was no timescale or action plan as to when completion would take place. The manager also keeps a record of resident falls that occur in the home, but these are not always written onto the daily record. All the residents in the home have stated that they wish the manager to look after their personal finances. All residents have their own finance sheets, and monies in and out are recorded on this sheet. Where expenditures are made on the residents’ behalf receipts are kept in their own personal finance file. All resident’s monies are kept separately in a secure place within the home. The manager or head of care only have access to the resident’s personal allowances, and monthly monitoring checks are carried out and signed by the manager and head of care. As mentioned previously in this report (staffing) not all staff have their mandatory training in health and safety issues, either they have not received it or their training is out of date. While the home does have a COSHH cupboard, COSHH leaflets and a policy and procedure for COSHH, the inspector noted that the COSHH cupboard had been left unlocked on the day of this key inspection. The inspector viewed certificates relating to the maintenance of equipment used in the home and found them all to be in date. Greenford DS0000029057.V345816.R01.S.doc Version 5.2 Page 24 While there is a record of fire point tests these were not always carried out weekly. Emergency lights are tested monthly and these were last done on. Last fire drill was 24/07/07 The inspector found that the majority of bedroom radiators had not been covered and therefore left residents at risk of burning if they fell. Water temperatures from hot water taps, with exception of the two communal bathrooms were very high well over 43ºC and in most cases over 50ºC. In the kitchen the wash hand basin hot water taps cannot be used. The plumbing in the home is in need of urgent attention, when the washing machine is in use, hot water on the first floor is almost non-existent, and there is a pipe noise in some of the first floor bedrooms. The plumber has confirmed that there are plumbing issues that need to be addressed. The laundry room does not have any ventilation, and therefore is unbearably hot, even with two electric fans being used. The laundress tends to leave the door to the cellar from the main hallway wedged open, this poses a great risk to any resident who might attempt to go down steep concrete steps into the cellar, and this also poses a fire risk. All outside doors have number locks fitted and residents are secure within the home. All resident falls are recorded in a HSE accident book, but not always recorded in the daily report. The home has policies and procedures that relate to health and safety issues in the home. Greenford DS0000029057.V345816.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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 1 2 1 2 X 2 1 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 1 Greenford DS0000029057.V345816.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 OP7 Regulation 12(1) Requirement Timescale for action 30/09/07 2. OP16 17 (2) Schedule 4 (11) 23(1)(a) 23(2)(b) (d) 23(5) 3. OP19 The registered manager must ensure that daily records reflect in detail the personal hygiene care given. To use the term ‘All care given’ is not helpful or adequate. Daily records when well written, help to ensure a consistent approach and good quality of care for the residents. The registered manager must 30/09/07 ensure that a record is kept of all complaints made and includes details of investigation and any action taken. That the Registered person shall 01/11/07 having regard to the number and needs of the Service Users ensure that: the premises are suitable for the purpose of achieving the aims and objectives set out in the Statement of Purpose; and that all parts of the care home are kept clean and reasonably decorated. Issues to be addressed are: 1)The effect on the kitchen and bedroom water outlets when the washing machine is filling; Greenford DS0000029057.V345816.R01.S.doc Version 5.2 Page 27 2) Some bedrooms and the communal area need redecorating; 3) Some bedroom furniture needs to be replaced or repaired. 4) Tiles need fixing and grouting in the kitchen. 5) Sufficient bathrooms should be usable and have the appropriate aids to ensure that residents are able to bathe in safety. Requirement made at previous inspection on 20/06/06 and not met 4. OP27 18(1)(a) The registered person must provide sufficient ancillary staff to ensure that care staff can carry out their duties and meet the residents’ needs. 24/09/07 5. OP29 19 (1)(ac)(2)(7) The registered person must ensure that a full employment history is sought, any gaps in employment are explored and recorded, and that two references are sought for each new employee. The registered person must ensure that staff receive mandatory training within the first six months of their appointment, and that this is updated at regular period during their employment. The registered person must ensure that all new staff complete a set induction as laid 24/09/07 6. OP30 12(1)(a) (b) 18(1)(a) (c) 03/12/07 Greenford DS0000029057.V345816.R01.S.doc Version 5.2 Page 28 7. OP38 13 (3)(4)(6) 16(2)(g) out by Skills for Care, Common Induction Procedures. The Registered person shall ensure that - all parts of the home to which Service Users have access are so far as reasonably practical free from hazards to their safety; and unnecessary risks to health or safety of Service Users are identified and so far as possible eliminated. 1) 2) All bedroom radiators must be covered. The hot water system must be service and maintained in good working order. All hot water taps must deliver water at 43ºC. The washbasin in the kitchen must have the hot tap repaired. The hall door to the cellar must be closed at all times, and proper ventilation provided in the laundry room. The COSHH cupboard must be kept locked at all times. 15/10/07 3) 4) 5) 6) 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 OP3 Good Practice Recommendations Information must be obtained on the pre-admission assessments to identify if the residents has dentures, glasses and a hearing aid. DS0000029057.V345816.R01.S.doc Version 5.2 Page 29 Greenford 2. OP33 The quality assurance publication should also give the views of stakeholders and report on other quality assurance issues like the monitoring systems, fire and health and safety checks. Greenford DS0000029057.V345816.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone Local 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. 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