Inspection on 20/02/07 for Hilbre Court

This inspection was carried out on 20th February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Hilbre Court 12/02/08

Hilbre Court 20/06/07

Hilbre Court 21/06/06

Hilbre Court 01/03/06

Hilbre Court 07/11/05

Hilbre Court 01/02/05

Hilbre Court 28/06/04

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

CARE HOMES FOR OLDER PEOPLE Hilbre Court 2 Barton Road Hoylake Wirral CH47 1HH Lead Inspector Peter Cresswell Unannounced Inspection 09:00 20 and 21 February 2007 th st 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 Hilbre Court DS0000018895.V324023.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. Hilbre Court DS0000018895.V324023.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hilbre Court Address 2 Barton Road Hoylake Wirral CH47 1HH 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) 0151 632 2220 Mrs Delrose Haynes-McManus Miss Tracey Dawson Care Home 14 Category(ies) of Dementia - over 65 years of age (14) registration, with number of places Hilbre Court DS0000018895.V324023.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The number of persons for whom residential accommodation (with both board and care) is provided at any one time is fourteen (14). Only elderly persons with mental disorder may be accommodated. Date of last inspection 21st June 2006 Brief Description of the Service: Hilbre Court is a large detached property with a pleasant, secluded garden at the rear. The seafront, public transport and shops in Hoylake town centre are a short walk from the home. The home provides care and personal support for fourteen older persons with dementia. There are eight single rooms and three that can be shared; all of them have an en-suite toilet facility. There is a passenger lift to the first floor. There are two lounges and a separate dining room on the ground floor. A small extension has been built to the side of the building, creating some potential extra space in the dining room and improved laundry facilities. Fees for Hilbre Court start at £385 a week. Hilbre Court DS0000018895.V324023.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included an unannounced site visit, followed by a return visit the following day to see the Registered Manager. On the first day the inspector looked at all parts of the home, spoke to several residents, three staff and a relative who was visiting the home. On the second visit he spoke to the Registered Manager. Over the two visits the inspector examined documents, including care plans, reviews, daily reports, fire safety documentation, accident reports, recruitment files and medication. What the service does well: What has improved since the last inspection? What they could do better: Few of the issues raised at the last inspection had been addressed. There was no evidence that the Registered Person carries out adequate pre recruitment checks on staff, thereby putting residents at the potential risk of being cared for by unsuitable staff. There are not yet sufficient trained staff at Hilbre Court and there is very little staff training. The home is understaffed so the Registered Manager does most of the cooking, inevitably detracting from her management and leadership role. The Registered Person must tell the Commission for Social Care Inspection in writing if any further changes are proposed to the premises. Hilbre Court DS0000018895.V324023.R01.S.doc Version 5.2 Page 6 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. Hilbre Court DS0000018895.V324023.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 Hilbre Court DS0000018895.V324023.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, 3, 4. Quality in this outcome area is adequate. Residents are properly assessed before being admitted, ensuring that the service can meet their needs. The Statement of Purpose and service user guide are inadequate, meaning that prospective residents and their relatives do not have access to satisfactory information about the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The most recently admitted resident had been assessed by the Registered Manager and relevant professionals before she had been admitted. Copies of the assessments were on file as was a detailed letter from a relative, painting a brief pen picture of the resident. This information had been used to prepare a care plan. The Commission for Social Care Inspection report of the last inspection (in June 2006) stated that Hilbre Court’s Statement of Purpose was being revised as it was out of date and did not contain all of the information required by the regulations. The home’s service user guide was also inaccurate, out of date and needed to be updated. The existing guide included Hilbre Court DS0000018895.V324023.R01.S.doc Version 5.2 Page 9 much information that was not strictly necessary but did not include all of the items required by the regulations and standards. Neither the Statement of Purpose nor the service user guide have been updated since then and this matter has now been outstanding at the last three inspections. Fees for Hilbre Court range from £385 to £450 a week, depending on the facilities provided in each case. Hilbre Court does not provide intermediate care so Standard 6 does not apply. Hilbre Court DS0000018895.V324023.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, 11. Quality in this outcome area is adequate. Care plans set out how the home meets residents’ needs. Residents’ interests are protected by the efficient storage and administration of medication, though some minor changes would be helpful. The privacy and dignity of all residents in shared rooms is not adequately protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All of the residents appeared to be clean and well cared for. Three residents’ files were examined and each contained detailed care plans dealing with separate aspects of the resident’s life, such as communication and nutritional assessments. The Registered Manager reviews care plans every month and these reviews were recorded, though not always in much detail. The manager still rewrites care plans by hand when significant changes are necessary as they are not held on a computer. Staff make daily reports for each resident and separate records are kept of visits by GPs, nurses and other medical professionals. It may help the daily reporting process if a brief summary of each care plan was filed with the report sheets. Hilbre Court DS0000018895.V324023.R01.S.doc Version 5.2 Page 11 None of the residents deal with their own medication. The home uses a monitored dosage system, where most tablets are dispensed by the pharmacist in individualised blister packs. Controlled drugs are kept in a Controlled Drugs cabinet and their administration is recorded in a CD register, with each dose being countersigned by a second member of staff. As it happens, at the time of the site visit none of the drugs being administered in this way are in fact listed as Controlled Drugs and the home may wish to check this with the pharmacist. However, the home cannot be criticised for taking additional security measures. The records checked were found to be accurately recorded, and all medication was securely stored. Not all entries on the Medication Administration Record (MAR) sheets had been updated by the pharmacist and this could lead to some confusion, especially with drugs to be taken ‘as required’ (PRN). In one case, for instance, a prescribed laxative was on the MAR sheet to be taken every day, though the manager knew that this was not the case. It can be difficult for the Registered Manager to deal with this if the pharmacist declines to bring the records up to date, but in those circumstances the MAR sheets should be amended by hand in line with the doctor’s prescription and signed by the Registered Manager and another competent member of staff. Stocks of a prescribed food supplement are kept in the external dry food store. The Registered Manager said that the pharmacist had agreed that this was suitable but if it is to be kept there, care must be taken to keep the store locked at all times when not in use (not the case during the inspection) or ensure that the cupboard in which it is kept is lockable. At the last two inspections the Registered Person has been required to put screens in all shared rooms to ensure that personal care could be provided in private. There is a screen in one such room but the other shared room still does not have screens. One other room is considered big enough to share if residents choose to do so and although there is no screen in this room either there was only one resident living there. The Registered Manager said that she had concerns about portable screens’ safety and would prefer a fixed curtain arrangement. This may be satisfactory but there is no evident reason why it has not been done. This situation is unacceptable and suitable screens or other measures must be put in place without delay. There was information on file about residents’ wishes when they die. Terminally ill residents can stay at Hilbre Court for as long as the home can meet their needs. Hilbre Court DS0000018895.V324023.R01.S.doc Version 5.2 Page 12 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 adequate. Friends and relatives are made welcome in the home, ensuring that residents can remain in touch with their families if they want to. There are insufficient activities to stimulate residents. A varied, well-cooked menu is provided, ensuring that residents receive a balanced, nutritious diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans list activities which residents enjoy but the home does not yet employ a dedicated activities organiser. Activities which the residents enjoy include looking at videos, television and make up sessions. A record is kept of activities but for the most recent week this only included ‘nails’ and a visit by the hairdresser. The Registered Manager pointed out that because of their dementia it could be very difficult to find activities which the residents enjoyed and to motivate then to take part. This is of course one of the difficulties of caring for people with dementia but many services do successfully involve them in activity, the Registered Manager should contact the National Association for Providers of Activities for Older People (NAPA) – website http:/www.napa-activites.net/. The fact that the home is not adequately staffed means that care staff do not always have the time to engage the Hilbre Court DS0000018895.V324023.R01.S.doc Version 5.2 Page 13 residents in suitable activities. A dedicated activities organiser would have the time to identify activities which suit each individual. There was an orientation display in the main lounge to tell residents the day etc. Unfortunately on the days of the inspection this gave the wrong day and said it was snowing (it wasn’t). Orientation boards can be helpful but are – obviously – worse than useless if they display misleading information. Relatives and friends are always welcome in the home. Relatives also visited during the inspection and it was clear that staff made them welcome. One relative said that she was happy with the care provided, and said she ‘would recommend it’. Hilbre Court still does not have a permanent chef and most of the cooking is done by the manager, with the assistance of other staff. The food prepared on the days of the inspection was fresh and of good quality and the residents said that they enjoyed the food in the home. The relative who spoke to the inspector confirmed this and said that her relative had put on weight since moving into the home. Meals are liquidised or cut up to help residents to eat if that is needed and at a mealtime staff were observed helping residents in a respectful and discreet way. There is always a choice of at least two sweets. If residents do not like the main meal on offer then the manager will prepare something else for them, but she said that she knows the residents very well and the menu is based around their likes and dislikes. For instance they do not like beef and in her experience enjoy sweets and puddings more than the main meals. She therefore prepares a lot of home cooked desserts. On the first day of the inspection residents were told that they were having chicken or turkey for lunch whereas in fact the meal was mince (despite their dislike of beef). Life can appear confusing enough for people with dementia without their being given - inadvertently of course – misleading information. There appear to be two reasons for this. First of all there is no written, pre planned menu available. Secondly, sometimes the main part of the meal (e.g. a roast joint) is prepared at the Registered Person’s nearby home, Hilbre House, and brought to Hilbre Court by car. This does not happen if the Registered Manager is cooking and seems to be done to compensate for the fact that care staff who are not skilled cooks are asked to do the cooking when she is not on duty. The Registered Manager said that this unusual arrangement has been approved by the Environmental Health Officer. A record of menus is kept and show that a range of different meals is provided. Hilbre Court DS0000018895.V324023.R01.S.doc Version 5.2 Page 14 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 poor. There is a complaints procedure to ensure that residents and other people can complain if they wish to. Staff are not trained in the Protection Of Vulnerable Adults and there is not information on local procedures to be followed in the event of an allegation of abuse, meaning that residents’ safety is potentially at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Hilbre Court has an appropriate complaints procedure and has received one complaint since the last inspection. The Registered Manager said that it had been investigated and resolved, though the records were not available in the home; the Registered Manager said that the Registered Person had the documents on file. There was no copy of the Wirral procedures on the Protection Of Vulnerable Adults (“No Secrets”) and staff had not received training in this area. Hilbre Court DS0000018895.V324023.R01.S.doc Version 5.2 Page 15 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, 21, 23, 24, 25, 26. Quality in this outcome area is good. The home is clean, comfortable, well maintained and well furnished. Some minor repairs and replacements are needed to ensure residents’ continued comfort. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Hilbre Court was clean and generally well maintained, and has a homely atmosphere, though there were a number of areas which need minor repainting or repairs. Work to repair the bay window wall in the large lounge – identified at the last inspection – was just starting on the first day of this visit. The large cabinet in the same room was still damaged and the carpet was in part badly damaged, apparently by cigarette burns. Some other replacements or repairs are needed, in particular: chairs in the dining room; bedside cabinets, sofa and beds in the shared ground floor bedroom; bath near the kitchen needs to be boxed in, and the door repaired; stained ceiling in room 9. Hilbre Court DS0000018895.V324023.R01.S.doc Version 5.2 Page 16 The larger lounge is less used by the residents, partly because the smaller lounge overlooks the garden and main corridor and residents like to see the comings and goings and be near to staff. Both are well furnished, though the bay in the larger lounge needs some redecoration. There is a large, attractive garden to the rear of the home and residents enjoy using it in good weather, though this was not the case on the day of the inspection. The extension to the dining room is now complete but is not in use. The Registered Manager said it will be brought into use when the new dining room furniture is bought. Most bedrooms are bright and spacious, though in general they could do with some redecoration and brightening up. Two have French windows leading on to the grounds. Some of the furniture needs to be replaced or repaired. All rooms have ensuite toilets. Three bedrooms are available for sharing, though only two were actually shared at the time of the inspection. Anyone sharing should be given the opportunity to move into a single room should the opportunity arise. One ground floor bedroom was being used to store large picture frames, which is not appropriate. There are two bathrooms, both with assisted bathing equipment. The home was extremely clean and was entirely odour-free. The Registered Manager said that the Registered Person intends to extend the home and showed the inspector some plans. The extension would provide space for three extra residents. The Commission for Social Care Inspection had not previously been advised of these plans. Any changes to the building should be notified to CSCI and the Registered Person must of course apply to the Commission for registration for any increase in the number of residents. Hilbre Court DS0000018895.V324023.R01.S.doc Version 5.2 Page 17 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 poor. Staff were caring and efficient during the inspection but it was not evident that all of the appropriate checks had been carried out on all staff to ensure that residents are cared for by suitable staff at all times. Staff do not receive regular training to help ensure their competence and the home does not yet have sufficient trained care staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On 16 September 2004 the Commission for Social Care Inspection wrote to the Registered Person to advise her that there should be three care staff on duty at all times during the waking day. At the last inspection the home did not meet this requirement. On six days a week the current rota provides for three care staff between 10am and 8pm, but out of those hours (early morning and late evening) there are only two carers on duty. On Tuesdays there were also only two carers on duty between 2pm and 4pm. At night, which starts at 8pm in Hilbre Court, there is one waking member of staff and one sleeping in. A cleaner is employed for twenty hours a week and night staff are expected to do some cleaning. There has been no cook at the home for some time and most of the cooking is done by the Registered Manager. Staffing therefore falls short of what is required and the Registered Person needs to review the staffing situation, in particular to ensure that the Registered Manager is able to concentrate on management duties rather than cooking. The Registered Manager said that the Registered Person has tried to recruit Hilbre Court DS0000018895.V324023.R01.S.doc Version 5.2 Page 18 staff via the local Job Centre and newspapers. Some of the present staff are from overseas and the recruitment of additional overseas staff is one possibility under consideration. New staff receive induction training but apart from some NVQs there has been no training since the last inspection. Only four staff have been trained in Moving and Handling, none in the prevention of adult abuse and none have had special training in the care of people with dementia. As the home specialises in the care of older people with dementia all staff should receive some training in the care of residents with that condition. Three care staff have NVQ3 and it is intended that others start NVQ2 training but none actually have that qualification. The report of the last inspection pointed out that some of the overseas staff’s qualifications could possibly be officially recognised as equivalent to NVQ and the Registered Person should consult NARIC (the government agency for the recognition of overseas qualifications) at www.naric.org.uk for advice on this issue. In the absence of such recognition the home remains short of the national standard of 50 qualified care staff. The Registered Manager said that staff had been asked to pay to check their qualifications with another agency (she could not recall the name) to see if they are NVQ equivalents. In the absence of further information it is not possible to say if these checks will be regarded as valid, as NARIC is the officially recognised agency. Because few staff had been properly checked when the home was last inspected the inspector asked to see the recruitment records for nine staff. These were kept at Hilbre House, the Registered Person’s other nearby home and were brought to Hilbre Court during the site visit. Only two of them had valid Criminal Records Bureau (CRB) certificates and none had evidence that the applicants had been checked against the Protection Of Vulnerable Adults (POVA) register. Only one member of staff had appropriate references. The Care Standards Act requires that new staff have a CRB check and are checked against the POVA list before they can start employment; an old CRB from another employer does not provide this. Staff can work under supervision if POVA First (fast tracked) checks have been obtained. Administrative staff at Hilbre House told the Registered Manager that POVA First checks had been completed but no evidence was available to prove this. It is essential that all new staff are cleared against the POVA list, using the POVA First system, before they are allowed to work in the home. Once POVA clearance has been received the member of staff may start work under supervision. The Care Homes Regulations 2001 also require that the Registered Person obtains two written references for each member of staff. It is quite unacceptable that the Registered Person is not ensuring that proper checks are completed on all staff before they start work at the home. Hilbre Court DS0000018895.V324023.R01.S.doc Version 5.2 Page 19 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. The home’s day-to-day management rightly focuses on the interests of the residents but food supplies need to be regularly checked to guarantee residents’ safety. Using a recognised food safety programme would help to ensure residents’ safety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Registered Manager has an NVQ3 and is starting a course for NVQ4 later in the year, though this was meant to be started last year. She has a very “hands on” style of leadership and communicates her enthusiasm and commitment to her staff. She has continued with staff appraisals but now needs to extend this to a system of formal, recorded one to one supervision. She would, of course, have more time to do this and other management functions if she was not also the home’s cook. The home’s Statement of Hilbre Court DS0000018895.V324023.R01.S.doc Version 5.2 Page 20 Purpose states that the home has an annual development plan and publishes the results of service user surveys. This does not in fact appear to be the case and Hilbre Court does not have a formal quality assurance procedure. The Registered Person visits the home several times a week but still does not prepare a written report as required by the Care Homes Regulations. In view of the absence of a quality assurance system the Registered Person should forward copies of the reports made under Regulation 26 to the Commission for Social Care Inspection. Accidents are recorded in an Accident Book, but the individual pages should be removed from the book and then filed together to enable the home to comply with the Data Protection Act. This was pointed out at the last inspection. One accident which resulted in an ambulance being called had not been notified to the Commission for Social Care Inspection. Incidents which result in an injury to a resident, leading to intervention by a medical professional should be notified to the CSCI and the inspector will forward a copy of the relevant CSCI guidance to the Registered Manager. Fire safety checks are carried out though the names of staff who have received fire safety training is not recorded. The home still does not have gas and electrical safety certificates though the Registered Manager said that the checks have been completed and she is awaiting the actual certificates. Copies of these must be forwarded to the Commission for Social Care Inspection when they are received. A fire safety risk assessment was in place. Most fire doors have electro magnetic closers fitted, however, the door to the most popular lounge was propped open by a service user’s (occupied) chair. Fire doors are ineffective if they are propped open so this door – which is kept open for understandable reasons – should be kept open using an approved hold-open device, such as ‘DorGard’. The well equipped kitchen was clean but the outside dry store was not, and the fridge in that store was particularly dirty. The inspector identified twelve separate food items which were beyond their sell by date. Many of these were things which may be rarely used – herbs and flavourings - but this indicates that the stores are not routinely checked and rotated. It is essential that all food stocks are checked regularly to ensure that nothing is used that may not be fit for consumption. The requirements made by the Environmental Health Officer in September 2006 were being addressed though the fly screen had not yet been properly fitted. The EHO stated that the home needed to introduce a food safety management system, preferably the Food Standards Agency programme Safer Food, Better Business, ‘as a matter of urgency’. This should be introduced as soon as possible. In the meantime the fridge and freezer temperatures are being recorded every day (except for the fridge in the dry stores, which must not be used unless it is cleaned and the temperatures monitored). Hilbre Court DS0000018895.V324023.R01.S.doc Version 5.2 Page 21 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 2 x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 x 3 2 x 2 Hilbre Court DS0000018895.V324023.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4 Requirement Timescale for action 01/04/07 2. OP18 13(6) 3. OP19 23 The Registered Person shall ensure that the home’s Statement of Purpose and service user guide are reviewed and amended to ensure that they contain all of the matters set out in the regulations. (Originally required in 2005). The Registered Person must 01/04/07 make arrangements to prevent service users being placed at risk of harm or abuse and must therefore obtain a copy of the Wirral procedures for the protection of vulnerable adults. The Registered Person must 01/05/07 ensure that the premises are kept in a good state of repair and must: * repair the sideboard in the main lounge; * repair or replace the damaged carpet in the large lounge; * replace the chairs in the dining room; *repair or replace the bedside cabinets, sofa and beds in the shared ground floor bedroom; * box in the bath near to the kitchen and repair the door; DS0000018895.V324023.R01.S.doc Version 5.2 Hilbre Court Page 23 * redecorate the stained ceiling in room 9; *carry out minor maintenance work to paintwork and walls. In general, some of the bedroom furniture and décor is looking a little worn and should be replaced through a planned renewal programme to maintain the quality of the residents’ environment. The registered shall not employ a person to work at the home unless the person is fit to do so and must therefore ensure that satisfactory CRB and POVA checks are carried out on all staff and no staff begin work at the home under any circumstances unless they have been checked against the POVA register. All other checks required by Schedule 2 to the Regulations must be obtained. (Originally required in 2005). The Registered Person must ensure that all staff receive training appropriate to the work they perform. This shall include: *training to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse; *training in the care of people with dementia. The registered person must establish a system to review the quality of care provided at the care home at regular intervals. (Originally required by 30/01/06). The registered person must visit the home least once a month, prepare a written report on the conduct of the care home and supply a copy of the report of their findings to the Commission DS0000018895.V324023.R01.S.doc 4. OP29 19 01/03/07 5. OP30 13(7); 18(1). 01/06/07 6. OP33 24 01/06/07 7. OP33 26 01/04/07 Hilbre Court Version 5.2 Page 24 8. OP10 12, 16(2) 9. OP27 18 10. OP36 18 11. OP38 13(4) 12. OP38 23(4) for Social Care Inspection. (Originally required by 30/04/06). The Registered Person must ensure that the home is conducted in a manner which respects the privacy and dignity of the residents and must therefore provide privacy screens for service users in shared bedrooms. (Originally required in 2005). The Registered Person shall ensure that at all times staff are employed in such numbers as are appropriate for the welfare of residents and must therefore review staffing levels and ensure that sufficient, suitable staff are employed to prepare the residents’ meals without impinging on direct care of the residents and the management of the home. (Originally required by 01/11/06) The Registered Person must ensure that staff are appropriately supervised. (Originally required by 01/11/06) The Registered Person shall ensure that unnecessary risks to service users are eliminated and must therefore ensure that foodstocks are regularly checked to ensure that they are not kept beyond their use-by date. The Registered Person shall take adequate precautions against the risk of fire and must therefore ensure that: *up to date electrical and gas safety certificates are obtained; * staff receive proper training in fire safety and this training is recorded; * fire doors must be kept closed unless they are held open by an approved hold-open device. DS0000018895.V324023.R01.S.doc 01/04/07 01/04/07 01/05/07 01/03/07 01/03/07 Hilbre Court Version 5.2 Page 25 13. OP38 23(2) 14. OP38 13(5) All parts of the home must be kept clean so the external dry food store must be thoroughly cleaned and the fridge must not be used until it has been cleaned and its temperatures regularly checked. The Registered Person shall make suitable arrangements for the safe moving and handling of service users and must therefore ensure that all staff are suitably trained. 01/04/07 01/06/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations If a printed Medication Administration Record sheet is out of date or incorrect the Registered Manager should amend the record in line with the GP’s instructions and ensure it is countersigned. The Registered Person should consider the appointment of a dedicated activities organiser who does not have other care responsibilities. Steps need to be taken to increase the number of care staff with NVQ2 in order to meet the standard of 50 of care staff with this qualification (or equivalent). The adoption of the Food Standards Agency programme Safer Food Better Business would improve the home’s food safety. Accidents should be recorded in compliance with the Data Protection Act. 2. OP12 3. OP28 4. 5. OP38 OP38 Hilbre Court DS0000018895.V324023.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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 Hilbre Court DS0000018895.V324023.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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