Inspection on 01/02/06 for Grove House

This inspection was carried out on 1st February 2006.

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

Grove House 20/12/06

Grove House 22/05/06

Grove House 16/06/05

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

CARE HOMES FOR OLDER PEOPLE Emmanuel Christian Care Home Grove House 1 Palm Grove Claughton Prenton Wirral CH43 1TE Lead Inspector Jeanette Fielding Unannounced Inspection 1st February 2006 11:30 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 Emmanuel Christian Care Home DS0000063096.V280295.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Emmanuel Christian Care Home DS0000063096.V280295.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Emmanuel Christian Care Home Address Grove House 1 Palm Grove Claughton Prenton Wirral CH43 1TE 0151 652 1021 0151 652 2629 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) Gladman Care Homes (Emmanual Christian Care Home) Ltd Mrs Siobhan Dean Care Home 63 Category(ies) of Dementia (23), Old age, not falling within any registration, with number other category (23) of places Emmanuel Christian Care Home DS0000063096.V280295.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home may from time to time admit persons from the ages sixty years to sixty five years of age. 17 Intermediate Care beds aged 50 years and over Date of last inspection 16th June 2005 Brief Description of the Service: Grove House is part of the Emmanuel Care Centre located in a residential area in Birkenhead, Wirral. The home is owned by Gladman Care Homes Ltd which is a wholly owned subsidiary of Four Seasons Health Care Limited. The home is registered to provide transitional care for up to 46 persons and intermediate care for up to 17 persons. All service users are accommodated in single bedrooms, each having en-suite facilities. A number of lounges and seating areas are provided to enable service users to choose where they spend their day. Service users accommodated for intermediate care have a greater input from Occupational and Physiotherapists to provide them with the skills to enable them to return home following hospitalisation and are accommodated at the home for a period of up to six weeks. The ground floor provides for 17 persons requiring Intermediate Care. The first floor provides for 23 persons who have dementia and are awaiting a place in a care home of their choosing, and the second floor provides for 23 elderly persons who are awaiting a place in a care home of their choosing. Service users accommodated for transitional care are usually accommodated for up to eight weeks. Emmanuel Christian Care Home DS0000063096.V280295.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was conducted by Jeanette Fielding and Natalie Charnley. The inspection was conducted in one day, over a period of seven hours. The focus of this inspection was the care given to service users and the evidence provided by the home. The main focus was the pre-admission assessments and the identified care needs of the service users, the care plans to inform staff of the service users specific care needs and the records relating to the actual care given. The assessments seen did not clearly identify the service users specific needs, resulting in three service users being accommodated in an unsuitable area of the home. The staff available to care for these service users were not sufficiently trained, nor did they have the skills or experience to meet their needs. The care plans did not inform staff of the care necessary or of the expected goals and outcomes for those service users accommodated for intermediate care. The reports completed by some staff were good, but were poor for others, with a lack of information being recorded by staff following changes made by doctors or other healthcare professionals. It was evident from the inspection that the care provision for some service users has deteriorated since the last inspection. The inspectors were extremely concerned regarding the procedures in effect in relation to the ordering, storage, administration and recording of medications. Discussion regarding this took place with the manager who gave assurances that this would be addressed immediately. A further visit will be made to ensure that the staff follow the requirements of their professional code of conduct. The building is purpose built and provides all service users with single, en-suite accommodation. A range of lounges and seating areas are provided, although some armchairs in lounges did not have seat cushions. The home was found to be clean but there was an offensive odour in those bathrooms used for storing linen bags prior to them being sent to the laundry. What the service does well: What has improved since the last inspection? No improvements have been noted since the last inspection. Emmanuel Christian Care Home DS0000063096.V280295.R01.S.doc Version 5.1 Page 6 What they could do better: 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. Emmanuel Christian Care Home DS0000063096.V280295.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Emmanuel Christian Care Home DS0000063096.V280295.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 6 No accurate statement of purpose or service user guide has yet been produced to provide full information for prospective service users to enable them to choose their care provider. Pre-admission assessments are poor and do not include sufficient information to enable a plan of care to be produced resulting in the potential for an inadequate level of care to be provided. EVIDENCE: Since the last inspection, the owner of the home, Gladman Care Homes (Emmanuel Christian Care Home) Ltd has become a wholly owned subsidiary of Four Seasons Healthcare. A new statement of purpose and service user guide require to be prepared to give full information regarding the service provider to prospective and current service users. Copies of the new documents are to be submitted to CSCI. The home provides both intermediate and transitional care. Emmanuel Christian Care Home DS0000063096.V280295.R01.S.doc Version 5.1 Page 9 The inspectors were advised that full assessments are undertaken on all prospective service users prior to their admission to the home. These assessments are made by the Social Workers, the Long Term Care team and one of the senior members of staff from the home. The inspection began on the second floor of the home where service users are accommodated for nursing care whilst a permanent nursing home place is found. Some of the assessments were not in place and for some service users, the assessment form had not been fully completed to provide evidence that the home was able to meet the service users needs. The assessments for three service users identify that there primary need for care was in respect of their dementia, with one service user not needing any form of nursing intervention. The documentation currently in use for the assessments is a mix of those provided by Gladman Care Homes and those provided by Four Seasons Health Care. The two systems are in use in the majority of care files inspected, few of which have any system which has been adequately completed. The pre-admission assessments for service users accommodated due to their dementia do not identify with the specific detail of how the dementia is displayed. No information is recorded with regard to wandering, aggression or any risk to themselves, other service users or staff. One service user is blind but the assessment form is incomplete and therefore denying the opportunity to prepare an appropriate plan of care to meet the service users’ needs. The pre-admission assessments for those service users accommodated for intermediate care were again incomplete and lacking in information. There is a lack of specific care needs recorded on the files. These service users are accommodated for rehabilitation to enable them to return home but there is little information regarding their specific rehabilitation, physiotherapy or occupational therapy needs. No goals or expected outcomes are recorded and no discharge plan prepared. Emmanuel Christian Care Home DS0000063096.V280295.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 The lack of information within the home has the potential for placing service users at risk through inappropriate or inadequate care provision. Service users are not protected by the safe practices of medication procedures. EVIDENCE: Service users are accommodated in single bedrooms, each having en-suite facilities to promote their privacy and dignity. Personal care is given to service users in their bedroom or the bathroom as appropriate. The inspectors evaluated the care files for six service users on each floor of the home. On the second floor, service users are accommodated for general nursing transitional care. A number of service users have a diagnosis of dementia and no evidence of general nursing care requirements could be found. These service users are inappropriately placed. The care files were found to contain documentation produced for Gladman Emmanuel Christian Care Home DS0000063096.V280295.R01.S.doc Version 5.1 Page 11 Care homes and Four Seasons Health Care. The information within the files proved difficult to find due to duplication and incomplete documentation. None of the care plans inspected showed evidence of service user involvement in the preparation, and no signatures were in place to provide evidence of agreement to the plan. On the second floor, the care plans were extremely vague. One care plan included the comment ‘Ensure sufficient pillows’ but there was no information as to how many pillows constituted ‘sufficient’ or the service users preference. One care plan in respect of meals stated ‘ensure meals are of a consistency he can tolerate’, but no information was recorded as to the appropriate consistency of the food. The risk assessment for one service user stated that hip protectors are to be used, but this information is not detailed in the plan of care and no reference to the use of these is recorded in the daily report completed by the nurses. One service users’ care plan indicates that bed rails and bumpers are to be used but there is no documentation to indicate that the use of these has been assessed, any risks identified or any agreement to the use. The same service user has a history of falls, but no falls risk assessment had been made or risk management plan put in place. Many of the forms held on service users care files were blank or incomplete. Some of the documentation is conflicting with one service user being assessed as being at risk from falls but another assessment indicating that the risk is low. The daily report written by some of the staff were detailed and informative but some were vague and contained very little information regarding the care afforded to the service users. The service users on the first floor of the home are accommodated for care due to their dementia whilst waiting to be accommodated in a home for long term care. Again, the care plans were poor with conflicting information being recorded and duplication of two types of documentation. One service user had suffered a high number of falls and was assessed as being at a high risk of subsequent falls. No evidence was seen of any action plan to remove or reduce the risk of falls. Minimal information is recorded regarding those service users who may become aggressive. No information is recorded as to the triggers to the Emmanuel Christian Care Home DS0000063096.V280295.R01.S.doc Version 5.1 Page 12 aggression or of the specific action to be taken regarding the protection of the service user, other service users or staff. One daily report states ‘Safety maintained at all times. Was found on the floor at 22.00 hrs’. This clearly indicates that the staff do not have the knowledge or understanding of adult protection and safety issues. There is insufficient information recorded to inform staff of how the individual service users dementia is displayed. Some service users were seen to wander up and down the corridor, one service user was shouting and demanding staff attention and some service users sat in the lounge. Service users on the ground floor of the home are accommodated for intermediate care. The information given to CSCI at the time of registration states that service users will be accommodated for a period of up to eight weeks for rehabilitation. On inspection of the records held in the home, it was found that six service users had exceeded this expected time frame by a time of between 12 and 129 days. No information was recorded in their care plans for the reason for this or of a reassessment and an agreed programme to further develop their abilities. Little information is recorded in the care files of the rehabilitation programme for each service user. The records held by the physiotherapists and occupational therapists are held separately from the care files and so information is not available for staff to continue with the programme. On this floor, care plans were again found to be incomplete and often undated. No goals or expected outcomes are recorded. The moving and handling risk assessment for one service user identified that the service user was heavy, but no information regarding the type of hoist or sling to be used was recorded. Records are held of visits by GP’s, who make their own records within the care files. It was not possible for the inspectors to read the information recorded by the GP’s due to the poor handwriting. Few details had been recorded by the staff following these visits. The inspectors were extremely concerned regarding the management of medications within the home. The medication policy which is held in each of the medication rooms is dated March 2003 and had not been revised to reflect the Emmanuel Christian Care Home current procedures. Specifically the policy failed to give guidance on disposal of waste medication and procurement of medications. Emmanuel Christian Care Home DS0000063096.V280295.R01.S.doc Version 5.1 Page 13 Handwritten entries are not witnessed by a second person to confirm that the correct medication, at the correct dose is to be given to the correct service user at the correct time. Some handwritten entries do not include the amount of medication entered into the home. An audit trail of medications could not be carried out to account for all medications. The MAR sheet for one service user indicates that three Trazadone capsules are to be administered as a single dose. Two of the blisters contained only two capsules. The medications had been checked into the home and the initials of one member of staff had been signed to indicate that the contents of the blister pack were accurate. It is evident that the qualified nurses had failed to check the medications entering the home adequately. The blister pack was half used but there was no evidence that the staff had made contact with Boots pharmacy to inform them of the discrepancy or had requested that additional capsules had been provided to cover the shortfall. Lorazepam, half a tablet had been prescribed for one service user. These were held in a bottle that was appropriately labelled. A check on the number of signatures on the MAR sheets indicates that 13.5 tablets had been administered but when counting the medication, 14.5 tablets had been removed. This is a shortfall of one tablet. On the first floor (EMI), the MAR sheet for one service user indicates that Hypromellose eye drops were dispensed on 21.1.06. The MAR sheet had been marked by staff with the letter ‘M’ indicating that this medication was to be made available. The explanation at the bottom of the MAR sheet is ‘Make Available’. This would indicate that the eye drops had not been administered. The container of Hypromellose was found with the seal broken in the refrigerator, undated as to the date the container was opened. One service user was prescribed Timolol Maleate eye drops. The container was found to have been opened on 21.1.06 as this information was handwritten on the container. The MAR sheet is marked with a letter ‘M’ between the 22.1.06 and 29.2.06 indicating that the eye drops had not been administered. The Lactulose prescribed for one service user had run out on 19.1.06 and no further supplies were available. The qualified nurse in charge was asked about this and said that he had ordered more. He was asked to provide evidence of this and showed the inspectors the book where all medications ordered were recorded. There was no record of this medication being ordered. The nurse said that he must have forgotten to order it. Both Lorazepam and Paracetamol are prescribed for one service user on an ‘as needed’ basis (PRN). No information was recorded in the plan of care or with the medication records to indicate when these medications should be given. Emmanuel Christian Care Home DS0000063096.V280295.R01.S.doc Version 5.1 Page 14 The Lorazepam did not indicate the minimum period between doses or the maximum dose within a 24 hour period. The MAR sheet for one service user indicated that the medication be given ‘prn’, as needed. This had been changed by staff to ‘bd’ (twice daily). The qualified nurse stated that Boots, the dispensing pharmacy had made an error in the instructions. There was no evidence that the nurse had contacted the GP to ascertain the actual instructions for the medication. Loarazepam 1mg, half a tablet had been prescribed ‘prn’ for one service user. There was no information for staff to indicate when this medication should be given, the minimum period between doses or the maximum dose within a 24 hour period. The medications refrigerator temperature had not been recorded on a daily basis. Clinistix (urine testing sticks) had expired in May 2005. On the second floor, nineteen blood collection bottles had expired in May 2005. On the second floor, thirty four blood collection bottles had expired between August 2005 and January 2006. On the second floor, fifty blood collection bottles had expired in December 2005. Morphine Sulphate 10mgs in 5mls was signed as destroyed on 21.12.05 but had only been signed for by one person. Four Fentanyl patches 25mcs had been signed for as destroyed by only one person. Two blank lines were noted in the controlled drug book for one named service user. On the first floor, 100mls of Oramorph 10mgs in 5mls had been recorded in the controlled drug book but the name of the service user had not been recorded. Temazepam had been administered but only one person had signed the controlled drugs book. This is in respect of two service users. 92.5 mls of Oramorph had been ‘returned to the pharmacy’ but only one person had signed the controlled drugs book. Emmanuel Christian Care Home DS0000063096.V280295.R01.S.doc Version 5.1 Page 15 On the first floor, a large bag of blood collection bottles were held, many of which were out of date. No policy has yet been prepared for the disposal of medications. At present, the manager is taking responsibility for disposal on a daily basis. The process involves all unwanted medications being taken to a storage container on the ground floor from the ground, first and second floors of the home. It is essential that an updated medication policy is prepared and issued to all nurses and that the competency of nurses is ensured through training and supervision. Discussion took place with the manager of the home following the inspection and the serious concerns regarding the medications were expressed. The manager gave assurances that these issues would be addressed as a priority. A further visit to the home will be made to monitor any improvements and to ensure the safety of the service users. Emmanuel Christian Care Home DS0000063096.V280295.R01.S.doc Version 5.1 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 The meals in this home are good offering both choice and variety and catering for special dietary needs. EVIDENCE: The inspectors were advised that routines within the home are flexible to suit the service users preferences. Those service users accommodated for rehabilitation have a more structured day to work around the routines of the occupational and physiotherapy professionals. Visiting is available at any time and relatives and friends are encouraged to visit. The inspectors were given conflicting information during the inspection. They were advised that two activities co-ordinators work between the two homes on the site, for a total of 174 service users by one member of staff, whilst another said that no activities co-ordinator was employed as the last one left before Christmas. No evidence of activities was seen to be taking place at the time of the inspection. The inspectors were advised that ministers of religion visit the home on a regular basis and provide services for those service users who request this. Emmanuel Christian Care Home DS0000063096.V280295.R01.S.doc Version 5.1 Page 17 The care plans inspected did not provide evidence that individual preferences had been identified. The home offers a four-week rotating menu that offers a selection of meals at each mealtime. The menus were displayed but could not be seen clearly as the type was extremely small and access to the menus was blocked by a dining table. It is recommended that the menus be clearly displayed in an accessible area. Service users are encouraged to take their meal in the attractive dining rooms to promote social interaction, but can be served their meal in the privacy of their bedroom if they wish. The menus provide evidence that a varied and balanced diet is offered to all service users. Special diets can be provided on the advice or recommendation of the GP or dietician. The meal served on the day of the inspection looked and smelled appetising. Meals are prepared in the main kitchen and are served individually from heated trolleys. Emmanuel Christian Care Home DS0000063096.V280295.R01.S.doc Version 5.1 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16. 18 Arrangements for ensuring that complaints are dealt with adequately are not in place and has the potential for placing service users at risk. EVIDENCE: The complaints procedure is displayed in the home but does not give full information regarding the persons to whom complaints can be made. The statement of purpose and service user guide have not been completed since Gladman Care Homes became a wholly owned subsidiary of Four Seasons Health Care. Therefore, no information is available of the named representative of the company to contact. The contact telephone number of CSCI is to be included on the complaints procedure. Four complaints have been received by CSCI within the last year and requirements set where shortfalls have been identified. Information gathered from two of the complainants identified that their concerns were raised with the home but were not adequately addressed. It is therefore evident that the home’s complaints procedure is unsatisfactory. The home has an Adult Protection procedure, including a whistle blowing policy. Some training has been given to staff on adult protection issues during the induction training, but it is recommended that a more comprehensive training opportunity is made available to staff on the different types of abuse and the action to be taken in the event of it being suspected. It is evident from comments written in reports that some staff do not have a clear understanding of adult protection issues. Emmanuel Christian Care Home DS0000063096.V280295.R01.S.doc Version 5.1 Page 19 In view of the serious concerns relating to the documentation within the home and the practices relating to medications, service users are not protected. Emmanuel Christian Care Home DS0000063096.V280295.R01.S.doc Version 5.1 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 The quality of the building and facilities within the home are good creating a comfortable environment for the service users. EVIDENCE: Grove House is a purpose built care home located within the Emmanuel Care Home Centre. It is located close to shops, parks and is accessible by public transport. Car parking areas are provided. The home is on three floors with all areas being accessible by a passenger lift. All service users are provided with a single bedroom, each having en-suite facilities. Bedrooms are decorated and furnished to a high standard. A selection of communal areas is provided although the inspectors observed that a number of armchairs did not have cushions on the seats. All en-suite facilities are provided with a shower. Additional toilets and baths are provided together with additional shower and bath rooms. The inspectors Emmanuel Christian Care Home DS0000063096.V280295.R01.S.doc Version 5.1 Page 21 observed a number of full laundry bags within bathrooms. Staff spoken to said that there was nowhere else to store the bags as they were waiting for them to be taken to the laundry area in the adjacent home. They further explained that these bathrooms were used for storage as the rooms were not suited to the service users and so were not used. These bathrooms smelled offensive but are not currently used by service users. It is evident that appropriate arrangements are not in place for dealing with linens and service users personal clothing that require laundering. Sluices are to be locked when not in use as a number of cleaning products are held in these areas. The occupational therapists have been involved in the assessment of the premises to ensure that it provides the appropriate facilities to meet the needs of service users. The home is central heated and all rooms have windows that can be opened to provide natural light and ventilation. Thermostatic valves have been fitted to all hot water outlets to ensure that the service users are not put at risk of scalding. Emmanuel Christian Care Home DS0000063096.V280295.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29,30 The programme of training for staff has not been effective to ensure the protection of service users. EVIDENCE: The home provides qualified nurses, supported by care staff to provide for the service users care needs. Agency staff are used to cover for holidays and sickness where necessary and regular staff also work additional hours at this time. A sample of staff files were inspected. One file was found not to contain evidence of Protection of Vulnerable Adults, Criminal Record Bureau checks or evidence of induction training although the manager stated that these had been undertaken but not filed appropriately. Evidence was seen on files of training undertaken. All staff files will be fully inspected at the next inspection. Other staff files inspected were found to contain full information as required. Evidence was seen of checks made on qualified nurses to ensure that they are registered with the Nursing and Midwifery Council and these were found to be up to date. Training has been given to staff regarding accountability and record keeping but from inspection of the care files, it is evident that the training has not been effective. Emmanuel Christian Care Home DS0000063096.V280295.R01.S.doc Version 5.1 Page 23 A programme of training has been planned for all staff and evidence was seen of training opportunities that have been made available. Care staff were spoken to during the inspection. They said that the changes in ownership of the home had not had any great impact on them or the work that they undertook. They confirmed that they had completed induction training and that NVQ training was ongoing. The actual number of care staff with NVQ qualifications was not assessed at this inspection. Two members of staff said that the home often operated with a shortage of one or two staff when agency or bank staff could not be obtained resulting in them having to do additional work. Domestic staff said that they now had all the cleaning products and equipment necessary for them to do their job and it was evident that they worked hard to maintain the level of cleanliness within the home. The home also employs catering staff and a handyman. Emmanuel Christian Care Home DS0000063096.V280295.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 The systems for service user consultation are poor with little evidence that service users views are sought or acted upon. EVIDENCE: The manager is a qualified nurse and an experienced manager. She has achieved an NVQ level 4 in management and could evidence details of ongoing training. She has an open door policy and is available to service users and families each day. Staff meetings are held on a regular basis and minutes of these meetings are held. No quality monitoring system is yet in place. Meetings have been held between the new owners of the home, the service users and family members to give information regarding the recent changes. It is expected that Emmanuel Christian Care Home DS0000063096.V280295.R01.S.doc Version 5.1 Page 25 questionnaires will be sent out to gain the views of service users, relatives and health care professionals later this year. The Registered Person in respect of the home has changed and a new person will be registered in accordance with legislation and CSCI requirements. The home does not deal with any of the service users finances. These are dealt with by the service users, their families or advocate as appropriate. The inspectors were informed that a Four Seasons contractor checked all safety issues two weeks prior to the inspection and that the certificates had not yet been provided. Some safety certificates were in place, however, a further visit will be made to the home to inspect all safety certificates. Emmanuel Christian Care Home DS0000063096.V280295.R01.S.doc Version 5.1 Page 26 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 X 1 X X 2 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X N/A X X 1 Emmanuel Christian Care Home DS0000063096.V280295.R01.S.doc Version 5.1 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4 Requirement Timescale for action 31/03/06 2. OP1 5 3. OP3 14 4. OP7 15 The registered person must produce and make available to service users an up to date statement of purpose setting out the aims, objectives, philosophy of care, services and facilities, and terms and conditions of the home; The statement of purpose clearly sets out the physical environmental standards met by a home in relation to standards 20.1, 20.4, 21.3, 21.4, 22.2, 22.5, 23.3 and 23.10: The registered person must 31/03/06 provide a service users’ guide to the home for current and prospective residents which should also include a summary of the statement of purpose. 10/03/06 The Registered Person must ensure that the pre-admission assessments contain all necessary information to ensure that the specific needs of the service users can be met. This remains outstanding from the last inspection. The registered person must 10/03/06 ensure a plan of care generated DS0000063096.V280295.R01.S.doc Version 5.1 Emmanuel Christian Care Home Page 28 5. OP7 13(4)(c) 6. OP8 17(1)(a) Schedule 3 13(2) 7. OP9 8. OP12 12(1)(b) 9. OP14 12(2) 10. OP16 22 11 OP19 13(4) from a comprehensive assessment (see Standard 3) is drawn up with each service user and provides the basis for the care to be delivered. The registered person must ensure that all risks to the health and safety of service users are identified and so far as possible eliminated. The registered person promotes and maintains service users’ health and ensures access to health care services to meet assessed needs. The registered person ensures that there is a policy and staff adhere to the procedures for the receipt, recording, storage, handling administration and disposal of medicines, and service users are able to take responsibility for their own medication if they wish, within a risk management framework. The registered person must ensure the routines of daily living and activities made available are flexible and varied to suit service users’ expectations, preferences and capacities. The registered person conducts the home so as to maximise service users’ capacity to exercise personal autonomy and choice. The registered person must ensure that there is a simple, clear and accessible complaints procedure which includes the stages and time-scales for the process, and that complaints are dealt with promptly and effectively. The registered person must ensure the safety of service users through appropriate DS0000063096.V280295.R01.S.doc 01/02/06 01/02/06 01/02/06 24/02/06 24/02/06 24/02/06 01/02/06 Emmanuel Christian Care Home Version 5.1 Page 29 12. 13. 14. OP19 OP26 OP26 16(2)(c) 16(2)(j) 16(2)(e) 15. OP27 18(1)(a) 16. OP30 19(5)(b) 13(6) 17. OP33 24 18. OP38 13 storage. Sluices must therefore be locked. The registered person must ensure that all armchairs are fitted with seat cushions. The registered person must ensure that all offensive odours are eradicated. The registered person must ensure arrangements are in place for the regular laundering of linen and clothing. The registered person must ensure that sufficient staff are employed to meet the needs of the service users. The registered person must ensure that effective training is given with regard to adult protection, abuse and medications. The registered person must ensure effective quality assurance and quality monitoring systems, based on seeking the views of service users, are in place to measure success in meeting the aims, objectives and the statement of purpose of the home. The registered manager ensures so far as is reasonably practicable the health, safety and welfare of service users and staff. Evidence of this is required through the provision of safety certification. 24/02/06 24/02/06 24/02/06 01/02/06 24/02/06 31/03/06 10/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000063096.V280295.R01.S.doc Version 5.1 Page 30 Emmanuel Christian Care Home 1. Standard OP6 Where service users are accommodated for intermediate care, arrangements should be put in place for long term care where rehabilitation arrangements are not effective. Emmanuel Christian Care Home DS0000063096.V280295.R01.S.doc Version 5.1 Page 31 Commission for Social Care Inspection Liverpool Local Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Emmanuel Christian Care Home DS0000063096.V280295.R01.S.doc Version 5.1 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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