Inspection on 22/12/08 for Hawthorns, The

This inspection was carried out on 22nd December 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hawthorns, The 12/01/07

Hawthorns, The 16/10/05

Hawthorns, The 22/06/05

Hawthorns, The 05/10/04

Hawthorns, The 23/04/04

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Heathlands

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Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Hawthorns, The 29 Rotton Park Road Edgbaston Birmingham West Midlands B16 9JH     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jill Brown     Date: 2 2 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Hawthorns, The 29 Rotton Park Road Edgbaston Birmingham West Midlands B16 9JH 01214559024 01214545375 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr John Holcroft Jnr care home 22 Number of places (if applicable): Under 65 Over 65 22 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 The Hawthorns is a care home providing personal care and accommodation for up to 22 older people. It is privately owned by Mr John Holcroft and is situated in a residential area of Birmingham close to a variety of community resources. The property is a large three storey detached building. There is a stair lift in place covering all the stairs. There are bedrooms on all three floors. The lounge space is arranged to give two connecting sitting rooms. Smoking is allowed in the conservatory that overlooks the rear garden. There is a dining room off the kitchen and the homes laundry is located off the dining room. There are a number of baths and showers throughout the home. Some aids and adaptations are available in the home. There is a mature and pleasant garden to the rear of the property with a fishpond that is fenced off for reasons of safety. The garden is accessed via steps, and a steep ramp. The home currently charges the Birmingham social services rate £326-69 per week Care Homes for Older People Page 4 of 31 Brief description of the care home without a top up for people placed by them private rates may be more. These rates are likely to change in April 2009. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We visited the home without notice on a day in December 2008 and undertook a key inspection where we looked at the majority of the National Minimum Standards. There was an Annual Service Review undertaken last year we last visited the home in January 2007. The home gave us information in an Annual Quality Assurance Assessment (AQAA) before the key inspection. The AQAA shows how the home rates their performance in the areas set out in this report. During the inspection we case tracked the care of 2 peoplewho lived in the home, this involves looking at all the records about this person and how the home manages their Care Homes for Older People Page 6 of 31 care and we looked at another persons care records. We looked at a number of peoples medication records. We spoke to 3 of the people whilst we were there. We looked around parts of the building and viewed the health and safety checks that had been undertaken. We looked at staff records and spoke to staff. We sent 35 comment cards to the home for relatives, health and social services professionals and staff. We received 4 comments cards back from people that live in the home, 6 from family members, 7 from health and social care professionals and 5 from staff. The majority of the comments received about the home was good. We received a complaint about the home before we inspected. Information about all of the above is contained in this report. What the care home does well: What has improved since the last inspection? What they could do better: The home did not collect enough information about peoples needs before admission to ensure they can meet all of their needs, They did not find out how people manage when they visited the hom so the care could more individual to the person. Care plans were not written for every need so risks identified to ensure that people get the care that makes them safe and well. Although medication was usually administered satisfactorily staff were not always using the right codes and this made it dificult to match the number of tablets with the medication administration records. The audits of medication were not being done regularly enough to spot these mistakes. Relatives have voiced concerns to the management about people not being dressed in their own clothes, clothes going missing (despite being marked with their name) or are being ruined by the laundry. We also saw that people were not dressed well on the day of the inspection. Despite concerns being raised with the management these have not been logged as complaints or been addressed in a way that will resolve this situation. This means that peoples dignity is not being promoted or respected. Care Homes for Older People Page 8 of 31 Concerns raised in peoples daily records, in residents meetings are not being logged, looked at or reported back on which can mean issues keep on happening. There were insufficient records to show that people had activities on a regular basis and we received a number of comments about the lack of activities and access to the garden. This means that people may not have enough activities to retain their interest and wellbeing. We found that the carpets, toilets and commodes in the home were dirty and we had received comments about this. A GP commented that carpets in the home needed to be cleaned more regularly. We received a complaint about the cleaniliness and the infection control in the home including not enough attention to hygiene when moving from the kitchen and giving personal care. When we visited we found that staff did not always maintain good infection control. Peoples health could be at risk because of this. We found that staff, at times, were working long shifts on occasions and one member of staff worked over 48 hours in a week. Staff were not recruited well, in that required Protection of Vulnerable Adult list checks and Criminal Record Bureau checks were not timely enough. Offences disclosed on two of these checks were not risk assessed before people were employed. Evidence of staffs ability to work in the country were not sufficiently checked. Staff records did not show that staff had regular recorded supervision. These failures could mean that people are at risk of harm and abuse. Although there are good things about the home, practices around recruitment, staffing, complaints and maintenance of dignity are significant enough to give cause for concern. We have asked the home to act in some areas urgently and we have asked them to provide an improvement plan. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is not collected in a way to ensure that all peoples needs are identified and this could mean that needs are not met. Evidence: We looked at the assessments of two people that had recently been admitted into the home. We found that information was collected about people before they are admitted. Some information was received from social workers that had undertaken assessments and the home also undertook their own assessment. The homes assessment was an answer sheet that prompted yes, or no answers. In some cases this was not sufficient to plan care appropriately. For example for one person it was said that assistance was required with hygiene and personal care but did not say in what way. One person had a prosthesis and there was no mention of this until the care plan. For another person the social worker provided detailed information about why the person needed to be admitted into residential care and this had not been transferred on to the homes Care Homes for Older People Page 11 of 31 Evidence: assessment form. This means the care or monitoring needed may not be given. People had a chance to visit the home before admission and another yes, no questionnaire was completed. Sometimes the information was not accurate for example both peoples information looked at said they have only top dentures when this was not the case. Sometimes information was not altered if circumstances change, for example a persons assessment showed they were taking certain medication and on discharge from hospital they were no longer on the medication and the assessment information was not changed. There was little information about how the person managed on their visit or whether the home could meet their needs. People are asked about their ethnic origin and their religion and this should assist the home to ensure a persons cultural and religious needs are met. The home asks yes no questions about sexuality and these questions need some revision to be more sensitive. From the Annual Quality Assurance Assessment (AQAA) there are slightly more female than male people being cared for however all the staff are female. This means that male residents do not have the opportunity of receiving care from a member of staff of the same gender in preference to respect their dignity or have social conversations with. The ethnic origin of staff was poorly completed in the AQAA. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning and risk assessments are not individual enough to ensure that people always get the care in the way that they wish. People can be assured that health problems will be referred appropriately to health professionals and this helps them to maintain their well-being. People cannot be assured that their rights to privacy and dignity will always be maintained. Evidence: People have care plans and risk assessments but these are not always individual enough to respond to peoples needs and tend to repeat the information found in the assessment. People have the same plan to monitor their condition if they are diabetic which gives the same range of blood sugar levels for each person. This does not allow for the Care Homes for Older People Page 13 of 31 Evidence: individual nature of the condition. A person was assessed to be at no nutritional risk despite having to restart medication to manage diabetes and it being recorded that they were eating inappropriate food. Peoples weights were not recorded monthly or unplanned changes acted upon and for one person this was a weight loss of 9 kilograms over 9 months. There were two people who were of low weight with no detail of what measures were being taken to monitor or improve this in the care plan. One persons assessment showed that they smoked and drank alcohol. Later in the plan as additional information it states sociable person who enjoys a chat can have two cans of lager per day. There is no information about who has determined that this is an appropriate level and this may restrict the persons rights. The person has had difficulty managing alcohol in the past and the risk assessment sets out what the home will tolerate with a review date a year in the future. There was little assessment about the persons risks in smoking and this could lead to dangers for the person and other residents. There was no plan of care for a prosthesis despite the person having a diagnosis of dementia. Although the person was said to be able to do this themselves there was no assessment of this and no monitoring plan. We discussed this with staff who had little knowledge about the care of the prosthesis including how and when cleaning should take place. This could lead to a person getting an infection. A person signed to say that they understood how to use the call bell however the assessment from the social worker clearly showed that when the person needed to use one previously in the community they had not done so. This is a known risk and a plan to overcome this should be developed. There was little planning to ensure that a person that walks continuously has other forms of stimulation and that risks to them are minimised. We found that people were referred to health services when needed, and that the home had good relationships with health and other professionals. The home checked when people had last contact with dentists, opticians and hospital appointments and when necessary rearranged these. The comment cards from these professionals said the home was well managed, people received individual care, it was a family run home rather than an institution, staff were helpful and had good clinical judgement. We looked at the administration of medication and found for the most part this was safe. Medication brought into the home was recorded and checked against the prescription, and stored appropriately. Generally medication given was recorded on the medication administration record with few gaps. However on occasions the wrong code Care Homes for Older People Page 14 of 31 Evidence: was used and this made it difficult to audit some medications. A number of medications had been signed for and not given. The manager said that they had not done the medication audit recently to check staff competence. A number of people on the day the inspection were not dressed well. One person had a dress that did not fit properly, another had a hem down on her dress and some cardigans were creased. Comments we have received have said that: (My relative) has been inadequately dressed not in appropriate underwear and without socks. I buy (my relative) beautiful clothes I put her name in them and they go missing. She gets cardigans but they are the homes (cardigans) they put her name in them. She is being given underwear and other clothes that do not belong to her. On admission to the home people going into shared rooms sign a form to say they do not want screening to maintain their privacy. This does not promote privacy and dignity and is completed at a time when people are at their most vulnerable. A person said when staff were assisting their room mate to get ready they get out of the room and vice versa. A staff member said that they do use screening and think it important. We were told that people have health consultations in their own rooms and this does promote peoples privacy. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People do not always get the activities they need to maintain their interest and wellbeing. Although people enjoy the food prepared it did not always meet peoples needs. Evidence: We looked at the activities record for December 08 and found that people had visits from the hairdresser, there was an aromatherapy visit, a Christmas party and two birthday parties recorded. Peoples care records did not show what activities people enjoyed in the past and how they planned to maintain these. For example a person enjoyed sketching but there was no activity plan to promote this. A number of comment cards said that people wanted or needed more activities to be available. Some comment cards said that people needed better access to the garden. The homes Annual Quality Assurance Assessment (AQAA) said that the home should improve on outings for people. Relatives spoken to at the inspection and comment cards received said that they were Care Homes for Older People Page 16 of 31 Evidence: happy with the service that the home provides. They said that they were made to feel welcome, and that staff, the manager and the owners were approachable and family feel of the home. When we arrived at the home at 8:30am we found that 11 people were in the lounge, all had had their breakfast, and the majority of them were dozing in chairs. Records showed that it was normal practice for a large number of people to be assisted to get up by the night staff. There are 2 night staff on duty and they are also preparing breakfast. People were not unduly restricted and could move about freely in the home. There is a menu board in the dining area displaying the meal available for the day. There is a board that displays the choices that people have breakfast. The list includes cereal, toast, jam, marmalade porridge and eggs and that there is a cooked breakfast available on Saturdays. Breakfast is between 6.30 and 09.30 am. There is a set lunch and snacks are available such as jacket potatoes, soup and sandwiches if the person does not want this. The teatime meal is based on the same alternative lunch menu and further food was available for supper. The menu seemed a little repetitive and the snacks between meals appeared to be biscuits. We found that two people were supplying some items themselves, ribena, cheese and crackers and these choices should be able to be accommodated by the home. Generally people thought the food was good. At a residents meeting people thought the time between tea and breakfast was too long. The response that people that dont go to bed early can have something off the snack menu suggests that some people are going too long without eating. Care Homes for Older People Page 17 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Concerns raised by people and or by their representatives are not always investigated and action taken and this means peoples concerns are not listened to or acted upon and these issues arise again. The home could not demonstrate that the safety of the people was paramount and therefore people could be at risk. Evidence: On the Annual Quality Assurance Assessment the home stated that they have not had any complaints in the last 12 months. There are no complaints logged from July 2007 in the homes complaint record. We received a complaint prior to this inspection. We are aware from comment cards that people have spoken to the management about the poor laundry service and these have not been recorded, investigated or resolved see standard 10 and 26. We also noted that in a persons care records that they had complained that staff were not taking them to the toilet. This was not logged or details of any investigation undertaken. We were advised in an anonymous complaint that a person had been told to use their pad when they asked to be taken to the toilet. This represents a clear lack of care and respect for this person The home has routine meetings for people at the home. Concerns raised in residents Care Homes for Older People Page 18 of 31 Evidence: meetings were not logged and looked at as a way the home could improve the service. Although we have received many good comments about the home we have also received comments that staff have not on all occasions been kind but neither person felt confident enough to let us know details of this. Staff were not recruited in a safe way, risk assessments were not completed where needed and management of employment issues was poor. (Please see standards 27 to 30) Care Homes for Older People Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst the home was improving on the fabric of the building, cleanliness and infection control needed to be improved to ensure a more pleasant and safe environment for the people to live there. Evidence: People living in the home, their relatives and people visiting the home all thought the environment was homely. The homes Annual Quality Assurance Assessment (AQAA) said in the last 12 months the laundry has been refitted including a new tumble drier, two new stair lifts, a patio door and a new central heating boiler have been installed. A new roof is being fitted and various rooms have been redecorated and refurbished. The kitchen had been updated since the last key inspection in January 2007. Requirements made at the previous inspection about the environment have been acted upon. We received a complaint about the odour and infection control in the home. We found that the carpets in the dining area and corridors were very dirty. A similar comment was made by a GP about the carpets. We were told that these carpets were for Care Homes for Older People Page 20 of 31 Evidence: replacement and that the home was having work done however, we expect them to be at a reasonable state of cleanliness at all times. Concern was expressed about staff cooking in the kitchen and delivering personal care and not attending to good infection control. We observed staff walking still wearing plastic aprons and gloves on coming from the laundry to the dining area and back again. We found that the cleanliness of commodes and toilets needed improvement. An urgent requirement was made about these issues and we will be monitoring the homes performance on this. The environmental health food safety team had visited the home recently and found that the kitchen was serviceable and gave them a 4 star rating. Care Homes for Older People Page 21 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The recruitment of staff is not robust enough to ensure that people in the home remain safe. The number and training of staff need to be improved to ensure that peoples needs and choices can be met. Evidence: We received comments from three sources that staffing was not sufficient at times. The number of people who were dressed and had breakfast by 8:30 am would support this. We were supplied with a rota for the week of the inspection and it showed that there were two care staff available in the morning and another who was acting as a cook plus a domestic. Three care staff were available in the afternoons one of which was responsible for the teas. The rota was confirmed by the manager. The manager works Monday to Friday 9-3pm. She stated that she was on call at all times when not at the home. The rota did not say who was in charge of the home when the manager was absent. On this rota it showed that staff were working long hours, on one weeks rota 2 staff had worked a 17 hour shift and one member of staff had worked over 48 hours. We received comments saying that at times more staff were needed, one said after 3pm Care Homes for Older People Page 22 of 31 Evidence: another said on evenings and at weekends. People appear to be assisted to rise and given breakfast by the night staff in a large number of cases and a number of people have need a lot of assistance to ensure their care. The homes Annual Quality Assurance Assessment (AQAA) stated the 62 per cent of staff had achieved a National Vocational Qualification level 2 in care this meets the standard. This means that staff have been trained to understand the needs of people they care for. We looked at recruitment records for four staff and at the record of another member of staff and found the following. Staff had started at the home before the results of their checks had been known. One person had been started before the Protection of Vulnerable Adults (PoVA) check, another persons PoVA could not be checked as there was no start date on file. There was no risk assessment about the duties the person could undertake until the Criminal Records Bureau (CRB) checks arrived. When the CRBs arrived there was an offence listed on two of the CRBs, one person had not declared this on their application form. There was no record of their interview for the job, there was no record of a discussion about the offences and no risk assessment. One person did not have evidence of a CRB for this home. This lack of robustness in checking does not protect people living in the home. A number of staff have limited leave to remain in the country, these dates have passed and the home does not have sufficient documentary evidence that they can continue to work in the UK. We have made urgent requirements about these issues. Staff were receiving refresher training on mandatory issues such as moving and handling, fire and so on. However with discussions with staff, staff files and comments received there are gaps in training. An up to date training matrix was not available. Staff records did not show that staff had routine recorded supervision. A number of people living in the home have the onset of dementia and have mental health issues and training in these areas would be beneficial. Care Homes for Older People Page 23 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although the management is looking to meet the immediate needs of people it is not ensuring that wider matters that affect well being of people are fully considered and acted upon such as recruitment. The home manages peoples money and the health and safety of the building well and in these areas the home is well run. Evidence: The manager has worked at the home for a large number of years, she has completed a Registered Managers Award the recognised qualification for people managing a care home. There are a number of areas outlined in this report where the home need to make substantial improvements to maintain the safety and well being of people in the home. The manager and the owners are said to be friendly and approachable and the service is run on a family basis. Care Homes for Older People Page 24 of 31 Evidence: Although there are resident meetings and audits of some parts of the service this is not being pulled together to ensure that people can influence the service they receive. The home keeps some money on behalf of each person living in the home. Some people have money managed by the Court of Protection and were left money for their day-to-day expenses; others have money left by social services or relatives. We looked at three peoples records. All but one had money that matched the record there was a small shortfall in one account. We advised that that the home should undertake and audit of money on at least weekly basis so they can determine whether there have been any errors and if so where the mistake has been made. Receipts were available for expenditure, but it is recommended that there be 2 staff signatures for any money transaction. We looked at a number of health and safety records for the building for example for electrical, fire and gas safety and found that these had been undertaken. Care Homes for Older People Page 25 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 29 19 Sch 2 The home must ensure that they receive a new, clear, Protection of Vulnerable Adults list check before employing staff. 15/02/2007 Care Homes for Older People Page 26 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 26 13 (2)You must ensure that 28/01/2009 there is an appropriate infection control system in place and monitoring of this is recorded and remedial action put in place. You must advise us of what measures you are putting in place by the 16th of January 2009. This is to ensure that people are not at increased risk of infection 2 29 19 Your recruitment and 28/01/2009 selection process must have the required checks, be recorded and thorough enough to ensure that people living in the home are not at risk of harm and abuse. You must advise us of what measures you are putting in place by the 16th of January 2009. This is to ensure that all future recruitment of staff is undertaken in a safe way to protect people living int he home Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 31 1 3 14 More detail is must be collected on peoples needs. to ensure that care plans can be individual to the person and meet their needs. 28/02/2009 2 7 15 (1)(13(4)(c)Care plans and risk assessments must be written for each need and risk identified . This is to ensure that people receive the care that they need and to help them remain safe. 28/02/2009 3 16 22 (3)All complaints and concerns must be logged, investigated and reasonable measures put in place to prevent recurrence. This is to ensure that people living in the home have the confidence that their concerns are listened to and acted upon. 15/02/2009 4 29 19 You must ensure that the person that does not have a CRB check for the home has one undertaken. This is to ensure that this person has no issues that should prevent them working with vulnerable people 15/03/2009 5 29 19 No new person must be 15/02/2009 taken on before appropriate checks and where necessary risk assessments are undertaken. Care Homes for Older People Page 28 of 31 This is to ensure that contact between people and the new member of staff is limited until all checks are received 6 29 19 You must ensure that staff 28/02/2009 whose leave to remain in the country has expired have documentary evidence that they can continue to work and have systems to monitor this. This is to ensure that people working for you have the right to remain. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 5 Records of the visit before admission should include what the person has done and how they have managed within the home and the decision whether persons needs can be met. People should be weighed at least monthly and where there are unexpected losses or gains plans put in place. Codes must be accurately recorded on the Medication administration record to ensure that medication can be audited. Audits of staff competence in administration of medication should be done on a routine basis. You should ensure that people are given the expectation that their dignity will be respected from admission. Regular activities should be available to people and these should have regard to their previous interests and lifestyle. No person should have longer than 12 hours without food. Rotas should show who is in charge of the home when the manager is not present. Page 29 of 31 2 3 8 9 4 5 6 7 8 9 10 12 15 27 Care Homes for Older People 9 10 11 27 30 33 You should review your staffing levels to ensure that people choices and lifestyle can be maintained. You should ensure that specialised training is given to assist staff to meet peoples specific needs. A quality assurance system should be in place that brings together peoples views of the service, the homes audits of the service, compliments concerns and complaints to determine an action plan for the following year. The money held for people against the record weekly to ensure that mistakes can be found sooner. Two signatures should be against each transaction to improve the security of peoples money. 12 35 Care Homes for Older People Page 30 of 31 Helpline: 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 We want people to be able to access this information. 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