Inspection on 29/07/08 for Hickling House

This inspection was carried out on 29th July 2008.

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

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

Other inspections for this house

Hickling House 19/08/09

Hickling House 17/03/09

Hickling House 22/05/07

Hickling House 26/09/06

Hickling House 24/02/06

Hickling House 25/10/05

Hickling House 29/11/04

Hickling House 16/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 23/11/2008.

CARE HOMES FOR OLDER PEOPLE Hickling House Town Street Hickling Norwich Norfolk NR12 0AY Lead Inspector Kim Patience Unannounced Inspection 29th July 2008 11:45 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 Hickling House DS0000027434.V369333.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. Hickling House DS0000027434.V369333.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hickling House Address Town Street Hickling Norwich Norfolk NR12 0AY 01692 598372 P/F01692 598372 info@hicklinghouse.fsnet.co.uk info@glendonhouse.fsnet.co.uk Mr Rhoderick Smart Mrs Frances Smart Angela Marlow Care Home 29 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) Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (28) of places Hickling House DS0000027434.V369333.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Up to twenty-eight (28) service users, over 65 years of age with dementia may be accommodated. One (1) adult with dementia may be accommodated The total number not to exceed twenty-nine (29). Date of last inspection 22/05/07 Brief Description of the Service: Hickling House is a care home providing personal care and accommodation for 29 older people with dementia. The home is situated on the outskirts of the village of Hickling, close to Hickling Broad and less than 5 miles from the Norfolk Coast. Originally a Victorian Inn, the premises has been extended and modernised to provide residential accommodation on two floors. There is a choice of communal areas to suit the various needs of people living in the home. There are 25 single rooms, 24 of which have en suite facilities, and 2 double rooms, both with en suite facilities. A shaft lift and separate stair lift provide access to the upper floor and there are two outside fire escapes. The weekly fees for care and accommodation are between £404 and £500 a week. Day care is provided to a small group of people and they are accommodated during the day in the general communal areas. Hickling House DS0000027434.V369333.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This site visit was unannounced and took approximately 6.5 hours to complete. The site visit forms part of the overall inspection of the service, which also includes information gathered by surveying residents, relatives and staff working in the home. During the site visit we looked at the way in which the home meets people’s health and care needs, which included examination of records relating to people living and working in the home. We took at tour of the premises and looked at people’s private accommodation. We also spoke to residents, visitors and staff. The majority of people living in the home have dementia and whilst we gave people the opportunity to express their views about the service they receive, many were unable to do this. Therefore, observations of people engaged in their daily life were made and included in this report. What the service does well: What has improved since the last inspection? Since the last inspection the providers have appointed a consultant to give advice and guidance to all the three homes they own. There have been improvements to care plans and these provide much more information about Hickling House DS0000027434.V369333.R01.S.doc Version 5.2 Page 6 the individual and their needs to enable staff to provide person centred care. There has also been some good work on life stories, as mentioned previously. This work is still in progress and there are still improvements to be made in the area of care planning and associated records. The home has introduced a new medication system so that they can improve their medication management practices, but again improvements are still needed in this area. More training has been provided and staff said they were pleased with the opportunity to enhance their knowledge and skills. What they could do better: The home must improve its management and monitoring systems to ensure that the service is running in accordance with its own policies and procedures and meets the standard they aim to achieve. Care plans and risk assessments must be completed in full and reviewed on a regular basis so that staff have up to date information about people’s needs. This is particularly important when providing care for people with dementia who may not be able to communicate their needs as effectively as they wish. Medication management must be improved in order to safeguard the health and welfare of people living in the home. The current system has recently been introduced and whilst it is taking some time for staff to adjust to it there are issues about the way they administer medication, which shows poor practice. The home could make further improvements to the mealtime experience by presenting food in manner that suits individual needs and by making the experience of supported dining much more pleasurable. Attention should also be paid to ensuring that people’s choice and dignity is promoted at all times. The home must carryout risk assessments in relation to products in people’s rooms that are potentially hazardous if used incorrectly. Staffing levels need to be reviewed to ensure they are adequate. Whilst we did not receive information that suggested staffing levels were low, observations throughout the day may indicate that people would benefit from an increase in staffing or better deployment of staff at peak times of the day. People would also benefit from staff having their competence assessed to identify if further training is needed in some areas of their work. Hickling House DS0000027434.V369333.R01.S.doc Version 5.2 Page 7 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. Hickling House DS0000027434.V369333.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hickling House DS0000027434.V369333.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. People moving into the home do so with the knowledge that the service is suitable and their needs have been assessed and can be met. However, they cannot always be assured that care plans setting out their needs in more detail will be written promptly. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a policy and procedure in relation to new people admitted to the home. The manager said that she always completes a pre admission assessment prior to anyone moving in so that they can be sure their needs can be met. Each prospective resident is provided with an opportunity to view the accommodation and is given a brochure containing information about the service they can expect to receive. We looked at the records relating to two people recently admitted to the home and found that pre admission assessments were written prior to people moving in. The care plans relating to one person had been written within 24 hours of Hickling House DS0000027434.V369333.R01.S.doc Version 5.2 Page 10 them moving in but with the other, care plans were not written until 5 days following admission. There was very little information about the person’s needs and how they should be met in the first week. Hickling House DS0000027434.V369333.R01.S.doc Version 5.2 Page 11 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): Quality in this outcome area is poor. People living in the home can be assured their needs will be assessed and met. However, risk assessments may not be completed for all risks associated with their health and care needs. People cannot be assured that their medication will be managed in a way that safeguards their health and well being. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at care plans relating to 4 people who live in the home. We found that care plans had recently been updated and now offered some detailed person centred information about how people’s needs should be met. For instance, there was information about when people prefer to get up and go to bed and what they like to eat. However, there did not appear to be a system in place for ensuring that care plans are reviewed on a monthly basis so they contain up to date information about people’s changing needs. Some risk assessments were present in people’s care records but for some people they did not cover all risks associated with daily living. For instance, one resident was said to be at risk of having ‘fits’ yet there was no risk Hickling House DS0000027434.V369333.R01.S.doc Version 5.2 Page 12 assessment setting out what steps staff should take in the event of the person having a ‘fit’. For another person a ‘personal risk assessment’ was written but did not contain any meaningful information and had not been reviewed for over 12 months. As with care plans there does not appear to be a system of review and up date in place. There were other risk assessments such as pressure care, manual handling, fall’s and nutritional needs assessments. However, where some assessments identified there was a high risk, there was no care plan setting out what action should be taken in response to the risk. For instance, a nutritional needs assessment stated that the person was at risk due to poor appetite but did not link to a care plan saying what steps should be taken to increase the person’s nutritional intake. The home has not completed capacity assessments for all residents in accordance with the Mental Capacity Act (2005). However, we were informed by the home’s consultant that documentation to facilitate this is now in place. Three surveys were returned by residents who completed them with support of relatives. Two of the surveys indicated that people always have their needs met and one indicated ‘usually’. All three indicated that they ‘always’ have their medical needs met. Of the three relative surveys returned, one stated their relative or friend ‘always’ has their needs met, one indicated ‘usually’ and one said “my mother is in better physical health than when living alone” During the inspection we looked at the way medicines are managed for people living at the home. The home has a locked treatment room for the storage of medicines. Senior carers hold the keys to keep medicines secure. There is a refrigerator for the storage of medicines requiring refrigeration and temperatures are monitored and recorded. The home has obtained a cabinet for the storage of controlled drugs but they are still being stored in a safe, which does not meet the Misuse of Drugs Regulations. We found that there are medicines prescribed for external application (creams, ointments) stored non-securely in people’s rooms. These could be accessed by vulnerable people who might come to harm. There were no risk assessments in this respect. We observed the senior care assistant administering medicines during the lunchtime medicine round in the dining room. They took medicines to people who were scheduled to have them administered, but for some, they left the vessels containing tablets on the dining tables and returned to complete medication chart records without checking that people had taken their medicines and swallowed them. Other people at the table were at risk of taking the tablets, as they were not being supervised by staff. Hickling House DS0000027434.V369333.R01.S.doc Version 5.2 Page 13 For some other people given medicines, the senior care was seen placing medicines into people’s mouths when it appeared with time and support they would have been able to take them independently. The medicine round was completed rapidly without due consideration for people’s dignity and own pace. The senior carer did not ensure that medicines were properly ingested by encouraging people to take a drink. The manager said the home has a new system for medicine administration but she said carers do not fully understand how to use it yet. The system has 28day medication charts synchronised with medicine containers for many medicines which enables these medicines to be monitored. The medication charts are separated by divider cards showing identifying photographs for each person, their personal details and known allergies. This is helpful when staff select people’s medicines to administer them. There is also a sample signature list of care staff who are authorised to handle and administer medicines. When asked, the manager confirmed there is one person living at the home who would regularly refuse their medicines and has them mixed in foodstuffs to conceal them. She also confirmed staff do not ensure all the food is eaten. The GP and a relative of the person have signed an agreement to say this method of administering the medicines is acceptable as it is in the person’s best interest but there has been no assessment of the person’s mental capacity which may indicate that this practice is acceptable and there is no care plan or risk assessment relating to this method of giving medicines in this way. There has been no contact with a pharmacist to check the medicines can be mixed with food. The records also indicated that one of the medicines (prescribed to manage behavioural disturbance and potentially sedating) is given to this person regularly knowing that it has no positive effect. There has been no recent prescriber review of this medicine. We found there to be no written guidance or care planning in place for medicines prescribed for administration at the discretion of care staff (PRN administration). Most of the medicines prescribed in this way are painkillers. There was also no pain assessment recorded for these people. During the inspection, we looked at current (and some previous) medication charts. We found gaps in records for the administration of medicines where it could not be determined if they had been given to residents as scheduled. There were also some medicines received on behalf of people at the home where there was no record of their receipt. There were records for the disposal of medicines. Where we could attempt to account for medicines we frequently found discrepancies indicating that medicines have not been given to people in line with their prescribed instructions. The home is conducting its own internal auditing of medicines and is also finding numerous omissions in records and quantity discrepancies. Hickling House DS0000027434.V369333.R01.S.doc Version 5.2 Page 14 We looked to see if the home were recording controlled drugs in a register. The senior carer had no knowledge of a register being in use at the home. The manager eventually found the register but it had recently not been used. Some care staff authorised to handle and administer medicines have received medication training but the manager confirmed staff do not fully understand the home’s new medication systems (see above). Night care staff who also sometimes administer medicines have not received training. The manager said she can respond when medicines need to be given outside of normal hours but there is no formal arrangement in place. However, we were later informed by the home’s consultant that there are formal arrangements in place and the home has an on call system. Hickling House DS0000027434.V369333.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. People can be assured the home is striving to meet their expectations in respect of social and emotional needs. People enjoy the mealtime experience, however choice and dignity could be better and food could be presented in a way that better meets their individual needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has made some progress in ensuring that people live their lives in a way that is consistent with their previous life experiences. For instance, care plans contain information about people’s preferences and choices, some information about their life history and their interests and hobbies. However, there is still improvement to be made here, so that the information is used to provide meaningful plans of activity that meet individual needs and expectations. The home employs an activities organiser and other staff with a special interest in this area are getting involved with activities. The activities organiser has been doing some excellent work on life story books for which she is to be commended. Relatives expressed how pleased they were about the effort that Hickling House DS0000027434.V369333.R01.S.doc Version 5.2 Page 16 had been made in this area and said that their relatives really enjoyed looking through the books at the pictures and other memorabilia. The books also help to provide staff with an insight into the lives of people living in the home. Three surveys were returned by residents who completed them with support of relatives. When asked if there were activities arranged by the home that you can take part in, one indicated ‘always’, one indicated ‘usually’ and one indicated ‘sometimes’. One relative stated the home could provide more outings. Staff spoken with said that they had been out with residents picking strawberries and had plans to take some to the shops. A relative visiting the home on the day of the inspection said she now visits for one afternoon a week and spends time with the residents doing some activities such as the window boxes. She said she “likes it here, its lovely” and her mother is well cared for. During the inspection we observed the mealtime experience. Staff said that most people prefer to eat in the dining room but there are a small number that prefer to eat in quieter parts of the home. Dining tables were nicely set and people were happily seated waiting for lunch. The atmosphere was calm and there was music playing in the background that people were singing along to. There was only one member of staff in the dining room for the first part of the meal and this member of staff was providing people with plastic aprons to protect their clothing. Some people were offered a choice of having an apron and some were not. There was a choice of two meals, sweet and sour chicken or pizza and salad. Both meals looked appetising and residents appeared to enjoy the food. A care assistant served the meal and food was provided on various sized plates, some with plate guards. It was noted that some people found the Pizza difficult to manage with cutlery and one person was trying to pick up the food with their fingers. A care assistant began cutting up a person’s food without asking if they needed help. One other care assistant started supporting a person with their meal then moved on to help another. Once the meal was served some care assistants sat with residents to eat a meal with them. This is good practice and is intended to provide some modelling and enhance the social experience. However, staff were also assisting people to dine at the same time and the experience was not as relaxed as intended. Of the three surveys returned by residents, two indicated they ‘always’ enjoyed the meals and one indicated ‘usually’. Hickling House DS0000027434.V369333.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. People living in the home can be assured that the service will take all complaints and safeguarding matters seriously and deal with them appropriately. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has policies and procedures in place for handling complaints. The procedure is on display in the entrance hall and there are suggesting/comments leaflets for people to take away and complete if they wish. The home has not received any complaints or adult protection concerns since the last inspection. Four staff surveys were completed and returned to the Commission. All four indicated that staff knew how to raise concerns if they had any and how to support residents in making complaints. All staff have received training in safeguarding vulnerable people. Hickling House DS0000027434.V369333.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is adequate. People living in the home have a comfortable clean environment in which to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the premises was carried out. The home has a good range of communal space, which provides people with a choice of where they want to spend their time. The communal rooms offer space for a variety of activities and on the day of inspection, people were sitting watching TV in the lounge, having their nails and hair done in another lounge and sitting engaged in conversation with visitors in the dining room. Some people’s private accommodation was entered and found to be homely and comfortable with lots of personal items on display. The home has introduced some signage to aid recognition of rooms and facilities but this Hickling House DS0000027434.V369333.R01.S.doc Version 5.2 Page 19 could still be improved by designing an environment that enables people to orientate independently around the home. Some rooms contained products that may be hazardous to their safety if used incorrectly. For instance, denture cleaning tablets and razors. There were no risk assessments in place to ensure that the risk has been assessed and minimised. Some odours could be detected when entering the home and when sitting in the dining room and carpets in some parts of the building were stained and faded. Otherwise the home was clean and tidy. The home employs domestic staff who cover 7 days a week. Care assistants are responsible for dealing with laundry and those spoken to said that it is manageable along with their other work. The laundry room is currently accessed through a communal bathroom, which is not ideal, as the bathroom cannot be used for the majority of the time. However, the providers have plans to change the layout in this area and provide access to the laundry via another route. The laundry room is in need of some refurbishment as the floor is cracked and uneven. Hickling House DS0000027434.V369333.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): Quality in this outcome area is adequate. People living in the home can be assured their needs will be met by a team of staff with the necessary skills. However, the numbers of staff may not always be adequate to meet the individual needs of all people. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at the number of staff working in the home to assess if they were available in sufficient numbers to meet people’s needs and that they have sufficient training. The manager stated that the homes target staffing levels are 5 care assistants during the waking day and 2 at night. On examination of the staff rota’s for one week in July 2008, on two of the seven morning shifts there were only 4 care assistants on duty and for six of the afternoon shifts there were only four on duty, falling to three on one afternoon. However, on the day of inspection staff and visitors were spoken with and no one expressed any concern about people’s needs not being met or that the home was understaffed. We looked at the files relating to new employees and found that these were in good order. Staff do not commence employment without the necessary pre employment checks and an induction into the home. Staff are provided with mandatory training, including dementia care awareness, and the home has a training plan for the year. The home employs 22 care staff and 9 have Hickling House DS0000027434.V369333.R01.S.doc Version 5.2 Page 21 completed a NVQ2 and 2 are in the process of completing one. The range and quality of the training was not assessed in detail on this occasion. However, there was a concern about the competence of staff administering medication and this indicates that staff may need to have their refresher training and their competency assessed at regular intervals. Staff spoken with said they were adequately trained and offered good supervision and support. The home’s annual quality assurance assessment indicates that they plan to increase the number of staff with an NVQ qualification and provide more advanced training in Dementia care and the Mental Capacity Act. Hickling House DS0000027434.V369333.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): Quality in this outcome area is adequate. People can be assured that the home is adequately managed by an experienced manager. However, management systems could be improved to ensure that aspects of the service provided are continuously monitored and improved. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a registered manager who has just completed a registered managers award. The home has systems in place for monitoring the quality of the service, which includes consultation with people who live in the home and their representatives. Residents and relatives meetings are held and people are Hickling House DS0000027434.V369333.R01.S.doc Version 5.2 Page 23 given an opportunity to express their views about the service and any improvements that could be made. The providers have appointed a consultant who has carried out an audit of the service and written an action plan to address any areas of improvement. The consultant has also been completing regulation 26 visits. However, there are areas that still require improvement, such as care planning, risk assessment, reviews and monitoring of staff competence. The home does not look after any money for residents. We looked at health and safety and found that the home completes health and safety checks on the premises. However, there were issues with products in people’s rooms that may be hazardous if used incorrectly that had not been risk assessed. Systems are in place for addressing any issues that arise with maintenance, such as recording any needs in the maintenance book and dealt with by the maintenance man. Hoists and other equipment are checked by companies that are contracted to complete the checks at regular intervals. We looked at fire safety and found that all staff are trained in fire safety. A risk assessment has been carried out and checks of fire safety equipment are carried out. However, it was noted that checks on the fire alarms were not being carried out on a weekly basis as required. Hickling House DS0000027434.V369333.R01.S.doc Version 5.2 Page 24 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 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 X 2 3 X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Hickling House DS0000027434.V369333.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15.1 Requirement People living in the home must have their needs in respect of health and welfare fully assessed with a plan as to how they should be met. People living in the home must have their health and care needs reviewed at regular intervals. People living in the home must have all risks associated with daily living assessed with a plan as to what steps should be taken to minimise the risk. Medicines including those prescribed for external application must be stored securely at all times. Controlled drugs must be stored in a cabinet compliant with the Misuse Of Drugs (Safe Custody) Regulations. Staff must follow safe procedures for the administration of medicines ensuring they are not left unattended, they are given with dignity to people and staff ensure they are properly swallowed. DS0000027434.V369333.R01.S.doc Timescale for action 29/09/08 2. 3. OP7 OP8 15.2(b) 13.4 29/09/08 29/09/08 4. OP9 13.2 29/08/08 5. OP9 13.2 29/08/08 Hickling House Version 5.2 Page 26 6. OP9 13.2 Medicines must only be administered covertly when residents are deemed, by assessment, to be without capacity to consent to their medicines being administered (Mental Capacity Act 2005) Full and accurate records for the receipt and administration of medicines must be completed at all times. Medicines must be administered to people in line with prescribed instructions. This must be demonstrated by record-keeping practices. Staff handling and administering medicines must receive training and be deemed competent to undertake medication related tasks. All staff should be offered formal supervision on a regular basis. This will ensure that the staff received the support, guidance and training to fulfil their role and their competence is formally monitored. People living in the home must have their privacy and dignity promoted at all times. People must be provided with an environment that is odour free. 29/08/08 7. OP9 13.2 29/08/08 8. OP9 13.2 29/08/08 9. OP9 18.2 29/08/08 10. OP36 18.2 29/09/08 11. 12. OP10 OP26 12.4(a) 16.2(k) 29/09/08 29/09/08 Hickling House DS0000027434.V369333.R01.S.doc Version 5.2 Page 27 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. 2. 3. 4. Refer to Standard OP19 OP9 OP9 OP9 Good Practice Recommendations The manager should continue to develop the environment to ensure it meets the needs of people with dementia. Professional advice should be taken and documented in relation to the mixing of medicines with food or drink. Arrangements should be made so that people prescribed medicines that appear to have no or adverse affects receive a professional review of their medication People prescribed painkillers for administration at the discretion of care staff should have pain assessments undertaken and recorded. Action should be taken to undertake more frequent auditing of medication and associated records so that issues identified are more promptly identified and resolved. 5. OP9 Hickling House DS0000027434.V369333.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hickling House DS0000027434.V369333.R01.S.doc Version 5.2 Page 29 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!