Inspection on 16/10/06 for High Dene Residential Home

This inspection was carried out on 16th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

High Dene Residential Home 29/07/09

High Dene Residential Home 17/04/08

High Dene Residential Home 17/12/07

High Dene Residential Home 19/04/07

High Dene Residential Home 04/05/06

High Dene Residential Home 23/02/05

Similar services:

Claremont House

Oak Ridge

Coopers Mill Ltd

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Paradise Lodge

Bilney Hall

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE High Dene Residential Home 105 Park Road Lowestoft Suffolk NR32 4HU Lead Inspector Mary Jeffries Key Unannounced Inspection 16th October 2006 10:45m 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 DS0000066149.V319691.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. DS0000066149.V319691.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service High Dene Residential Home Address 105 Park Road Lowestoft Suffolk NR32 4HU 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) 01502 515907 01502 515909 Mr Subhir Sen Lochun Post Vacant Care Home 15 Category(ies) of Dementia - over 65 years of age (15), Old age, registration, with number not falling within any other category (15) of places DS0000066149.V319691.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th July 2006 Brief Description of the Service: Highdene is registered to provide personal care to up to fifteen older persons, all of who may have dementia. The home is in an adapted Victorian house with an extension to the rear of the building situated in a residential area of Lowestoft and on a local bus route. It is near to shops and other community facilities and within walking distance of the sea. Accommodation consists of eleven single and two shared bedrooms, all with wash hand basins and approximately half of them with en suite toilets. Residents’ accommodation is on the ground and first floors, with shaft lift access. There is one bathroom on the first floor that is suitable for residents. On the ground floor there is a main lounge, a lounge/dining room and seating in the entrance hall. The second floor consists of office and staff rooms. There is a secure garden at the back of the property available for residents’ use. All new residents are charged £430:00 per week. Hairdressing, chiropody, personal toiletries and newspapers are provided at extra cost. DS0000066149.V319691.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection was carried out by two inspectors during one day in October 2006 and took six and a quarter hours. The home had provided a pre inspection questionnaire. Five residents including the two recent admissions were tracked. One resident and one relative were spoken with in some depth, other residents were observed at different times and activities through out the day. The acting manager facilitated the inspection, care staff and domestic staff participated. What the service does well: What has improved since the last inspection? What they could do better: A large number of requirements have been made around medication practices highlighting what must improve. The environment and staff interventions need to be developed to offer stimulation to residents with dementia who might otherwise sleep or wander. Staff training and supervision need to improve. Care plan reviewing and recording needs to improve. Quality assurance systems need to improve. DS0000066149.V319691.R01.S.doc Version 5.2 Page 6 In addition to a number of repeat requirements from previous inspections there are a large number of requirements made from this inspection across all areas within the home, with few standards being fully met. A number of these requirements relate to hazards or small works within the environment that require attention. 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. DS0000066149.V319691.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000066149.V319691.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents entering the home can expect to receive a pre admission assessment. However, they cannot be assured that they will receive full and correct information to enable them to make a choice. EVIDENCE: The Statement of Purpose had been updated, to show the current manager’s detail, however, the copy provided stated that Mr Harding was the Registered Manager. This must be corrected to identify that the post of registered manager is vacant. A completed application for registration of the manager had not yet been received by the CSCI. The Service User’s Guide was not very user friendly and the acting manager advised it was not given to individual residents. DS0000066149.V319691.R01.S.doc Version 5.2 Page 9 All residents tracked had care plans on file. The two most recently admitted residents’ files were inspected and found to contain pre admission assessments. Files also contained contracts. The acting manager advised that a policy had not been drawn up for emergency admissions, as in practice this will not happen. The Statement Of Purpose does not clearly state this; rather it states, “ emergency admissions are not normally accepted.” The statement of purpose needs to be amended to reflect the practice. Staff and the acting manager confirmed that one resident had a learning difficultly. The home is not registered for this. This resident had been admitted prior to the current owner taking on the home. The acting manager confirmed that the home does not provide intermediate care. DS0000066149.V319691.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is poor. The health and welfare of residents is at risk because of the home’s medication management practices. This judgement has been made based on evidence gathered during the unannounced pharmacy inspection conducted on 12th October 2006. EVIDENCE: An unannounced pharmacy inspection was undertaken by the CSCI pharmacy inspector on 12th October 2006. During that inspection, the arrangements in place for the storage, administration and record-keeping for medicines were examined. Records for the receipt, administration and disposal of medicines and evidence of staff training were requested. Mr G Harding (acting manager) was on duty and assisted during the inspection. Matters arising were discussed with Mr Harding throughout the inspection. The large number of requirements and recommendations made are incorporated into this report. DS0000066149.V319691.R01.S.doc Version 5.2 Page 11 While medication administration was not inspected on this occasion, the medication round was observed. It was noted that privacy and dignity were compromised by the medication administration records (MAR) sheets being left out on top of medication cabinets unattended where inquisitive visitors could access them. Care plans sampled were generally good and included risk assessments and evidence of review. One plan had a good social history, but others had very little information to build on for development of life story work. Reviews were minimal. Care plans had been updated to show if a resident has a diagnosis of dementia. All but two did according to the staff and the acting manager who were asked, however, the care plan for one resident who the manager confirmed does not have dementia, stated that they did. This resident and a relative were spoken to. Subsequent to the loss of a friend this person had decided that they now wished to move to another home as they lacked the quality of conversation this person could offer them. All residents appeared reasonably well groomed and clean. Healthcare plans, District Nurse and General Practitioner visits were documented in care plans, however these records need to be consistently comprehensive; one of the residents tracked was noted from the accident records to have had a fall in July, following which the doctor was called. The home’s diary also states that the doctor was called and that a urine infection was diagnosed. The resident’s care plan included detail that the resident had a urine infection, but not that the doctor had attended. The manager advised that the doctor had not attended, but had been spoken to on the telephone and that the district nurse had seen the resident. The records supported this and showed a swab had been taken by the nurse. This resident also has suffered from various pains for some considerable time and known to be related to a degenerative bone condition, however, the resident advised that they suffer from stomach pains as well as back pains, and a relative spoken with queried the need for a person to remain in discomfort. This was discussed with the acting manager who confirmed that the resident had not had a full health check/ medication review. One of the residents tracked had been appropriately referred to the psychiatrist when they had displayed obsess ional behaviour. While the care record indicted that the results of the consultation were awaited there was no note of the appointment on the residents file. All staff were observed to address residents by their preferred names. DS0000066149.V319691.R01.S.doc Version 5.2 Page 12 A resident spoken with said they thought staff’s manner was all right and confirmed that staff did always knock before entering their room, and say hello when they pass. DS0000066149.V319691.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. While there is undoubtedly scope to enhance the quality of life for some residents, they can expect to enjoy good food and considerable freedom within the home. Residents can also expect that staff will have the skills to communicate well with them. EVIDENCE: None of the residents displayed any distress at any time during the day, and a number were seen enjoying lively fun. One resident was in bed during the morning of the inspection. Staff advised that they had stayed up until 3 am, and then liked to have a lie in which the resident confirmed was their choice. While the physical decoration had improved in the home, little had been done to make the environment stimulating for residents with dementia. At 10:45 a.m. four residents were sitting in the lounge sleeping, including a recently admitted resident. Two residents were wandering around. At 11:30 am, three of these residents were still asleep. The recently admitted resident was also seen sleeping at 3:30 pm in the sitting room. At one stage the TV was out of focus. DS0000066149.V319691.R01.S.doc Version 5.2 Page 14 Sleeping throughout the day had been identified as an issue for this resident during their pre admission information. The acting manager advised that they had very few interests, but had asked the resident’s relatives to bring in photographs of old Lowestoft. There were no displays of this nature in the home. One resident by 11:30 am, had woken and was in an elevated mood and pointed out Halloween decorations. The carer was asked what this resident had done in their working life but they did not know. Two other residents were enjoying a lively interchange in the other sitting room/dining room which is also used by residents during the day. Residents were able to move around freely, but their wandering was not picked up by staff engaging with them or attempting to divert them. There were no signs or symbols on doors to help residents orientate themselves and know where their own rooms were. One of these residents asked the inspector to accompany them around the garden later in the day. A relative who visits on a daily basis was spoken with. They reported that they felt the atmosphere in the home had changed for the better and that the meals had improved greatly. This resident had regained some weight they had recently lost. One of the residents showed photographs of their spouse and dog, who they advised came to visit. Staff confirmed this. Two residents who choose to spend much of their time in their rooms were visited and one was spoken to in some depth. This resident had a daily visitor, and staff confirmed that the other resident did join the others in the communal areas at times. A weekly programme of activities during the afternoons was provided. The acting manager advised that he had been working with staff to promote choice, for example in choosing clothing, and that their were now more activities, for example the hairdresser was now attending regularly and also an aroma therapist visited. One of the residents had advised that they were booked is the following week for a hand massage, and understood there would be a cost for this. During the afternoon old time music was played. Some of the residents were encouraged to get up and dance, which they clearly enjoyed. A member of staff confirmed that they had been drawing with one of the residents. One of the residents spoken with advised, “ We haven’t had an outing.” The acting manager confirmed that they did not have a programme of outings and events in place, but that the next coffee morning, as advertised on the front door of the home had been planned. DS0000066149.V319691.R01.S.doc Version 5.2 Page 15 The refrigerators were inspected and food was appropriately covered and labelled. Full records of food provided to residents were maintained. The home had put food safety management system based on the principals of HACCP in place. The menu was inspected. The home offered nutritious food, with meals planned on a fortnightly rota. The home provided a choice of 2 meals for the main meal of the day. The cook was spoken with, they were not aware of any special or ethnic needs regarding diet, apart from one diabetic diet. Care plans were inspected in respect of this; they did refer to diabetic needs but otherwise did not refer to preferences. DS0000066149.V319691.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst there is undoubtedly scope to enhance the quality of life for some residents, they can expect to enjoy good food and considerable freedom within the home. Residents can also expect that staff will have the skills to communicate well with them. Although residents can be confident that any such concerns regarding abuse or neglect will be responded to promptly, they cannot be assured that the management have the current knowledge of local agreements to fully protect them from abuse. EVIDENCE: The complaints procedure was prominently displayed. The Pre Inspection Questionnaire indicated that no complaints had been received by the home in the last twelve months, and this was confirmed in the complaints log. One complaint regarding food had been dealt with by the CSCI in the last twelve months. Records were seen that showed staff had received training in the protection of vulnerable adults. However the acting manager and senior carer had missed this training. The acting manager was not familiar with the local procedures. They advised of a recent incident, which was initially considered to be a POVA issue by ambulance staff who attended the home, but which hospital staff who saw the resident did not consider it appropriate to refer. DS0000066149.V319691.R01.S.doc Version 5.2 Page 17 The acting manager commenced their own investigation immediately, on the basis of the views expressed by ambulance staff without establishing whether this was to go through Protection of Vulnerable Adults channels. A requirement had been made at the last two inspections that Enhanced Criminal Records Bureau checks must be applied for any all existing staff who only have standard level CRBs but require enhanced. The acting manager wrote to the CSCI prior to this inspection to confirm that these had been applied for through an umbrella organisation, and there was evidence on file that all had been sent for. DS0000066149.V319691.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): 19,20,22,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can expect the home to be clean and homely, although possibly a bit tatty around the edges. They can expect to feel that they are unrestricted in the home and in its grounds, but would benefit from range of adaptations and displays that would engage them on a sensory basis, and assist them in orientation. EVIDENCE: The front garden gate did not close properly as there was no latch. An outline programme for renewal of the decoration of the premises, including timescales had been provided to the CSCI. However the acting manager advised that they had not been provided with this. Upon approaching the premises it was notable that the trees in the front garden had been lopped. Inside the home the environment was much brighter as this allowed sunlight to access the dining room. DS0000066149.V319691.R01.S.doc Version 5.2 Page 19 The dining room had been decorated and table settings provided. There was a new carpet and the acting manager advised that they intended to obtain the other new carpet for the communal areas the following month. The dining room, had only 8 dining chairs however it was not feasible for all 15 residents to be seated together for their meals should they wish. The curtain pole in this room was broken and the curtain hanging down from the pole. There is a large staircase leading from the ground floor hall to the first floor, and residents are free to negotiate these stairs. Two residents were seen wandering on a number of occasions during the day. At one point they indicated to one of the inspectors that they were not able to find their rooms, and were wandering into other rooms looking for them. One of the doors opened was the door on the first floor to the emergency fire exit, which opened directly onto a steep flight of stairs. One of the residents seen wandering and opening various doors on the first floor said that they thought this was a door to a larder. The accident records were checked to establish whether there had been any recent falls or trips on the staircase. One of the residents seen wandering up and down the stairs on this occasion had incurred a mark on their knuckle where they had fallen against the stairs. The acting manager advised that a specialist mobility firm had been called in to service all wheelchairs, and to show the maintenance person the required checks. Wheelchairs in the home had stickers on from this company, but no checklist had been drawn up for the maintenance person to ensure they serviced the chairs as shown. The manager advised that one wheelchair had come back into commission as a result of this. Several residents were waiting to be assessed for their own chairs for outdoor use. A requirement was made at the last inspection for a risk assessment and appropriate remedial action be undertaken to minimise the risk posed by the very hot water in the utility room next to the kitchen, if residents are to continue to have access to this area. This area was found to be inaccessible to residents. Water temperatures were tested at several different outlets accessible to residents, and was found to be at 43 degrees Celsius. An understair cupboard, housing a toilet was found to give access to an open cupboard containing electrical equipment. A panel in the stained glass window on the stairs, within reach, was badly cracked and represented a hazard. In the back garden, an electrical meter cupboard in garden was accessible with small bolt and had a pile of cigarette stubs in it, and a resident brought a pile of leaves on a path to the attention of one of the inspectors. DS0000066149.V319691.R01.S.doc Version 5.2 Page 20 One resident asked an inspector to see a pile of dirt in the garden; in a secondary garden there was a pile of leaves and tufts of grass between slabs that need clearing, as the area is accessible to residents. Damaged work surfaces in the kitchen had been replaced. The environmental health department had visited the home in August 2006 and sent a copy letter of their findings to CSCI, which were positive. The cleaning standards throughout the home, including high cleaning, were acceptable. Cleaning schedules, and temperatures for fridge and freezers were in evidence in kitchen area. A contract for clinical waste was seen to be in place. DS0000066149.V319691.R01.S.doc Version 5.2 Page 21 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): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can expect to be looked after by a well meaning and caring group of staff who have some good intrapersonal skills, however the level of individuals qualified for their roles within the home is very low, and the level of staffing is not sufficient. Residents can expect, however, that the level of care available will be supplemented by the manager. EVIDENCE: The staff rota was inspected. On the day of the inspection the rota was not consistent with staff on duty. And on 6 and 8 October (2 random dates chosen for checking), the home was down one carer on duty on a shift. This means that there have been times when there are only two staff on duty to care for 15 residents, 13 of whom have dementia. On these occasion the manager advised that they had been covering for care staff. They had in fact asked that the inspection to be announced in case it fell on a day when they needed to be on the floor. Some use although not extensive of agency staff had been made. There were now however, designated staff for certain roles, which had not previously been the case, i.e. cook and cleaner. This meant that care staff more able to concentrate on care duties. A senior carer who had not been qualified had lost that role as a consequence of disciplinary action. No replacement had been made for the administrator. DS0000066149.V319691.R01.S.doc Version 5.2 Page 22 The pre inspection questionnaire indicates that only 3 of 19 carers hold an NVQ 2. Younger staff, who can access free training thro local college are being put in for this but older, experienced staff had not signed up to any NVQ work at the time of the inspection. The acting manager advised that they were awaiting funding for senior team to undertake NVQ 3, although not all seniors have NVQ 2. Seven files were seen, all had appropriate recruitment information on file. Three staff on duty during the day were spoken with about their training. The senior advised that they had recently received manual handling training and first aid; another had undertaken a dementia training course at Otley College. The senior and the acting manager had both missed the recent Protection of Vulnerable Adults training that other staff attended. When staff were relating to residents, they showed a good level of skill and sensitivity, getting to their level, achieving eye contact and responding to the resident’s mood. Some staff had a limited knowledge of residents’ backgrounds; this reflected the lack of documentation on life histories on file. DS0000066149.V319691.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents can expect morale in the home to be reasonable, but cannot be assured that their care is being monitored by good supervision or that the service is being quality controlled. The implication of this is that there are a large number of shortfalls across the home, with few standards fully met. EVIDENCE: No application had been received for a Registered Manager. The home has been without a Registered Manager since 16th December 2005 when it was purchased by the current owner. The acting manager advised that they had level 3 NVQ, but had not yet put an applied to do level 4 NVQ. The acting manager was asked what support they were getting from the owner; they advised that the owner was available at the end of a phone line, but that they did not have scheduled meetings. DS0000066149.V319691.R01.S.doc Version 5.2 Page 24 The acting manager was asked to provide copies of Regulation 26 visits. These were not available in the home and the acting manager was unable to advise that the owner attended at least once a month. The visitors’ book stated that owner had attended the home on 21st September between 9.30pm and 10pm, during the afternoon of 26th August for the purpose of conducting a Regulation 26 visit and for 55 minutes on 27th July 2006 for the purpose of a Regulation 26 visit. The acting manager advised that they had composed a survey for residents and relatives, and there were copies of this available near the front door. These had not yet been returned for analysis. Minutes of staff meetings were seen to have appropriate content. These were occurring every 6 weeks. A staff communication book exists. One carer spoken with said how she now enjoyed her job –since the new manager in post, she attributed this to there being more time available to spend talking with residents socially and beginning to do life story work. A relative spoken to who visits the home most days advised that the home had improved considerably in many respects, including the atmosphere. The acting manager confirmed that currently no residents’ monies were held. They advised that the home intended to start a system to do this on behalf of residents; advice was given regarding the regulations on joint accounts for this purpose. A schedule was seen of planned supervision of twelve staff by a senior carer. This carer had only actually done one of these supervisions, timescales proposed had not been kept. The acting manager confirmed the senior’s advice that they had not had any training to provide supervision; it had been identified as a training need along with update on Protection of Vulnerable Adults. They had recently received manual handling training and first aid. All fire doors throughout the home were inspected. The home confirmed in writing that a sonic fire safety door release mechanism had been fitted to the kitchen door on 25th July 2006, and this was seen to be in place. Other fire doors were found to be appropriately closed, with the exception of the staff room at the top of the building, the door to which was propped open. The large number of requirements made at the pharmacist inspection is a concern for residents’ health and safety. DS0000066149.V319691.R01.S.doc Version 5.2 Page 25 Whilst accident records were maintained, there was no accident analysis available; given the challenges of the building analysis of accidents should be conducted and maintained so that the information generated can be used to improve provision. A recommendation that had not been acted on an assessment of the suitability of the premises for the care group should be made by a suitably qualified person, and acted upon. Evidence was seen that a copy of the revised fire risk assessment must be forwarded to the fire officer. A tour of the building was conducted and there were no substances that were hazardous to health inappropriately stored. Matches were found at the bottom of the boiler cupboard in the kitchen close to the gas supply. A recent satisfactory report from the fire officer was seen. The home had commissioned an electrical report which identified many hazards requiring urgent attention. Evidence was seen that the work required had been booked to be done, but there were no risk assessments in place to manage as an interim measure. DS0000066149.V319691.R01.S.doc Version 5.2 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 3 2 X N/A 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 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 2 X 2 X X X 3 STAFFING Standard No Score 27 1 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X 3 1 X 1 DS0000066149.V319691.R01.S.doc Version 5.2 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(1)(c) Schedule 1 4(1)(c) Schedule 1 5 Care Standards Act 2000 15(2)(c) Requirement The Statement of Purpose must be updated to show that the current manager is an acting manager and not the registered manager. The Statement of Purpose must clearly and correctly state the home’s policy on emergency admissions. Residents must be provided with a copy of the Service User’s Guide. A variation must be applied for in respect of one resident who falls outside of the categories the home is registered to provide care for. Care plans must be reviewed thoroughly and any changes recorded. This is a repeat requirement from the previous inspection. Records of appointment with health professionals must be made on care plans. Care plans should clearly state Doctors advice ad whether it has been given on the basis of a telephone call or a visit. DS0000066149.V319691.R01.S.doc Timescale for action 30/11/06 2. OP1 30/11/06 3. 4. OP1 OP4 15/12/06 30/11/06 5. OP7 30/11/06 6. 7. OP8 OP8 15(1) 15(1) 30/11/06 30/11/06 Version 5.2 Page 28 8. OP8 12(1)(a)( b) 13.2 13.4 13.2 13.4 9. OP9 10. OP9 11. OP9 13.2 13.4 12. OP9 13.2 13.4 13. OP9 13.2 13.4 13.2 13.4 14. OP9 15. OP9 13.2 13.4 16. OP9 13.2 13.4 17. OP9 13.2 13.4 A health and medication review should be requested for a resident who has had longstanding chronic pain. The registered person must make arrangements for the secure storage of medicines requiring refrigeration. The registered person must take action to ensure medicines requiring refrigeration are stored within the accepted temperature range at all times. The registered person must undertake a review of morning medicine administration ensuring medicines are safely administered. The registered person must take steps to ensure medicines prescribed on PRN (as required) basis are administered only when clinically justified. The registered person must take steps to ensure medicines of limited life are safely handled on opening. The registered person must take steps to ensure full and accurate records are completed at all times for both the administration or non-administration of prescribed medicines. The registered person must take steps to ensure full and accurate Records for the receipt of medicines are completed at all times. The registered person must take steps to ensure full and accurate MAR chart medicine entries are written at all times against which medicines can be safely administered. The registered person must take steps to ensure medicines are administered in line with DS0000066149.V319691.R01.S.doc 30/11/06 03/11/06 03/11/06 03/11/06 03/11/06 03/11/06 03/11/06 03/11/06 03/11/06 03/11/06 Version 5.2 Page 29 18. 19. 20. OP10 OP15 OP18 21. 22. 23. OP19 OP19 OP19 24. OP20 25. OP22 26. 27. OP28 OP31 28. OP33 prescribed instructions at all times and that this can be demonstrated by record-keeping practice. 12(4)(a) Medicine Administration records must not be left on top of cabinets whilst unattended. 16(2)© The dining room must be able to accommodate all residents. 17(2) The acting manager must sch4 familiarise them self with Suffolk Protection of Vulnerable Adults procedures. This is a repeat requirement from the inspection on 10th July 2006. 23(2)(b) The curtain pole in the dining room must be repaired so that curtains can hang properly. 23(2)(b) The badly cracked window pane on the stair well must be made safe. 23(2)(n) The fire escape door on the first 13(4) floor leading to a steep set of stairs must be risk assessed in respect of the danger of falls, and appropriate action taken. 13(4) An accessible cupboard containing electrical equipment in an under stair toilet area must be risk assessed. 23(2)(n) The environment must be enhanced with sensory and reminiscent stimulation and safety features suitable for the client group. 18(1)(a)(c The home must develop the ) number of carers with NVQ 2. 12(1) The manager’s job description must clearly show their distinct responsibilities for meeting the aims and objectives of the home. This is a repeat requirement from the previous inspection. 26 Regulation 26 visits must take place and copies of reports provided to the manager and the CSCI. DS0000066149.V319691.R01.S.doc 30/11/06 15/12/06 16/10/06 30/11/06 30/11/06 30/11/06 30/11/06 20/12/06 31/03/07 30/11/06 30/11/06 Version 5.2 Page 30 29. OP36 19(1) 30. OP38 23(4) 13(4)(a) Staff must receive regular formal supervision in line with the standard. This is a repeat requirement from the last three inspections. Fire Doors without automatic closures must not be propped open. This is a repeat requirement from the previous four inspections. 31/12/06 16/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP2 OP9 Good Practice Recommendations Service User Guides are not user friendly and would benefit from being revised to this effect. It is recommended that care planned guidance is developed to ensure staff are informed of the exact circumstances when such medicines may be considered for use once all non-pharmacological interventions have been exhausted. It is recommended that steps are taken to ensure medication prescribed for residents (particularly those prescribed psychoactive medicines) is regularly reviewed by the prescriber. It is recommended that photographs are named to ensure they cannot be erroneously located against incorrect MAR charts. It is recommended that a list of specimen signatures/initials is made for members of care staff trained and authorised to access, handle and administer medicines. It is recommended to enhance medicine administration safety that MAR chart entries for medicines not supplied in MDS are highlighted. It is recommended that close supervision of MAR charts prior to use and regular and frequent monitoring of use is implemented. Activities and outings should be developed. There should be a working catch on the front garden gate DS0000066149.V319691.R01.S.doc Version 5.2 Page 31 3. OP9 4. 5. OP9 OP9 6. 7. 8. 9. OP9 OP9 OP12 OP19 10. 11. 12. 13. 14. 15. OP20 OP22 OP22 OP27 OP31 OP38 The external electrical meter should be made inaccessible to residents and kept free of combustible material. A schedule should be put in place for wheel chair maintenance of this is to be carried out by a nonspecialist. An assessment of the suitability of the premises for the care group should be made by a suitably qualified person, and acted upon. Consideration should be given to replacing the administrator. An application for a Registered Manager should be submitted. Accident records should be regularly analysed. DS0000066149.V319691.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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 DS0000066149.V319691.R01.S.doc Version 5.2 Page 33 - 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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