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Inspection on 26/09/08 for Holly House (Milton Malsor)

Also see our care home review for Holly House (Milton Malsor) for more information

This inspection was carried out on 26th September 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home understands the importance of having enough information when choosing a care home. Admissions are not made until a full assessment of needs has been carried out, so that prospective residents and their representatives can be sure their needs will be met. It was apparent that people using the service were registered with local GP`s and the home had a good relationship with community health professionals and could seek advice from them if they needed to. We saw an array of walking aids around the home, all being used appropriately. All of the residents that required it, had a moving and handling risk assessment in place, and all moving and handling practices that we observed were safe and appropriate. There were a number of complimentary letters on display in the home that thanked staff for the care they had provided to loved ones.

What has improved since the last inspection?

There were no specific areas of improvement noted during this inspection.

What the care home could do better:

Care plans are not adequately reviewed to identify that changing needs are being addressed efficiently. Medication records are not accurate. The current practice and lack of recording could put people in this service at risk. There was an activity plan for a week on the notice board. However the notice did not suggest what week it was for, and it did not bear any resemblance to what we saw during the inspection. Generally staff are aware of the need to support residents to develope their skills however the language barriers that we observed may obstruct this process. Some residents are consulted and listeded to regarding the choices of daily living, but this process could be improved. This home has a complaints policy on display, however there was no evidence of any records to identify how complaints were being managed, investigated or resolved. The home was unable to locate their safeguarding policy, and discussions with the manager identified that there is some confusion over safeguarding reporting processes. Residents can personalise their rooms to make them homely, however some areas are in need of decorating and maintenance, so that residents are not at risk. Non compliance in some of the key outcome areas of this inspection, indicated that the manager lacks control and understanding of some of the main components of the running of this care home, and the protection of the people who live here.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Holly House (Milton Malsor) 36 Green Street Milton Malsor Northampton Northamptonshire NN7 3AT     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Louise Trainor     Date: 2 6 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Holly House (Milton Malsor) 36 Green Street Milton Malsor Northampton Northamptonshire NN7 3AT 01604859188 01923840278 info@hollyhouseresidential.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Parvin Kumar Menon Type of registration: Number of places registered: Mr Parvin Kumar Menon,Mrs Madhu Menon care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Holly House (Milton Malsor) care home is registered to provide personal care to male and female service users who fall within the following categories: Old age: not falling within any other category (OP) - 22 Dementia: over the age of 65 years (DE(E)) - 22 The maximum number of persons to be accommodated at Holly House (Milton Malsor) is 22 Date of last inspection 0 0 Over 65 22 22 Care Homes for Older People Page 4 of 31 Brief description of the care home Holly House is a residential care home situated in the village of Milton Malsor, south east of Northampton. The home provides care for 22 older people. The premises consist of a detached house, and all rooms are single with en-suite facility. A service users guide to the services the home offers is supplied to applicants and the last Inspection Report is available on request. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was carried out in accordance with the Commission for Social Care Inspections CSCI policy and methodologies which require review of the key standards for the provision of a care home for older people that takes account of service users views and information received about the service since the last inspection Evidence used and judgements made within the main body of the report include information from this visit This was the first Key Inspection for this year for this service. Regulatory Inspectors Mrs Louise Trainor and Mrs Sally Snelson carried it out on the 26th of September 2008 between the hours of 08:00 and 14:00 hours. Care Homes for Older People Page 6 of 31 The home owner/manager was present throughout most of the visit to assist with any required information. Verbal feedback was given periodically throughout the inspection and at the end of the visit During the inspection the care of three people who use this service were case tracked. This included a recent admission to the home. This involved reading their records and comparing what was documented to the care that was being provided Documentation relating to staff recruitment, training and supervision, and medication administration, complaints and health and safety in the home were also examined. We also spent some time in the communal areas of the home talking to staff and residents, and observing the care practices including, the service of the midday meal, that were carried out during this six hour inspection hour inspection by two inspectors. The fees for this home are presently between 359.00 pounds - 525.00 pounds per week. We would like to thank everyone involved for their support and assistance during this visit to the home. What the care home does well: What has improved since the last inspection? What they could do better: Care plans are not adequately reviewed to identify that changing needs are being addressed efficiently. Medication records are not accurate. The current practice and lack of recording could put people in this service at risk. There was an activity plan for a week on the notice board. However the notice did not suggest what week it was for, and it did not bear any resemblance to what we saw during the inspection. Generally staff are aware of the need to support residents to develope their skills however the language barriers that we observed may obstruct this process. Some residents are consulted and listeded to regarding the choices of daily living, but this process could be improved. This home has a complaints policy on display, however there was no evidence of any records to identify how complaints were being managed, investigated or resolved. The home was unable to locate their safeguarding policy, and discussions with the manager identified that there is some confusion over safeguarding reporting processes. Residents can personalise their rooms to make them homely, however some areas are in need of decorating and maintenance, so that residents are not at risk. Non compliance in some of the key outcome areas of this inspection, indicated that the manager lacks control and understanding of some of the main components of the running of this care home, and the protection of the people who live here. Care Homes for Older People Page 8 of 31 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home understands the importance of having enough information when choosing a care home. Admissions are not made until a full assessment of needs has been carried out, so that prospective residents and their representatives can be sure their needs will be met. Evidence: This home had a Statement of Purpose and a Service Users Guide that had been updated and included enough information for a person using the service, and their representative, to know what to services to expect from Holly House. The documents were colourful and easy to read. Prior to admission the manager visited prospective residents and carried out a full assessment to ensure that the service could offer the correct care. We looked at the care files of three people living in Holly House, and saw good examples of preCare Homes for Older People Page 11 of 31 Evidence: admission assessments which were written in detail and described how the individuals liked their care to be carried out. Holly House offers people the opportunity to visit the home in advance of making the decision of whether or not to move in, and also initially offer a four-week trial period to new residents. This home does not provide intermediate care. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are not adequately reviewed to identify that changing needs are being addressed efficiently. Medication records are not accurate. The current practice and lack of recording could put people in this service at risk. Evidence: During this inspection we looked at the care plans for three of the people living at Holly House. Care plans had been written sensitively and in detail. For example the care plan for one person who required assistance with their personal care, described what help they needed, and how this should be given. Unfortunately the plans were not reviewed each month, and although the manager stated that he tried to do them every month, we noted that they were done far less often. One plan that we looked at, had only been reviewed three times since the beginning of the year. The manager felt that this was because the needs had not changed, but we could not see any evidence that this had been considered. Care Homes for Older People Page 13 of 31 Evidence: We also noted that the care planning process was such, that review pages were completed when reviews took place but the initial plan was not altered. We believed this could lead to confusion. It was apparent that people using the service were registered with local GPs and the home had a good relationship with community health professionals and could seek advice from them if they needed to. We saw an array of walking aids around the home, all being used appropriately. All of the residents that required it, had a moving and handling risk assessment in place, and all moving and handling practices that we observed were safe and appropriate. When we arrived at this inspection at 08:00 hours, one member of the care staff was dispensing the morning medication. When she had completed this we examined the Medication Administration Record (MAR)sheets for eight of the residents living in this home. We found a variety of errors and anomalies that indicated that not all residents were recieving the correct medication as it was prescribed. Two residents charts had not been signed for the day in question. The tablets were missing from the stock blister packs and the carer confirmed that she had given then. Another resident was prescribed a medication regime, that consisted of a boxed set of two different drugs. 14 Didronel tablets and 76 effervescent tablets. The instructions stated that the Didronel should be given for 14 days, and be followed up by the effervescent tablets. We found that none of the Didronel had been given, however three of the effervescent tablets had been administered. We spoke to the manager and a senior carer about this. Neither were aware of the instructions for the administration of this medication, and the carer told us that the family had advised them just to give the effervescent tablet. Other medications that were not supplied in blister packs, could not be reconcilled. For example one resident was prescribed Adcal. There were 56 tablets delivered to the home, 9 signatures on the MAR sheet indicating tablets had been given, but only 8 tablets missing from the stock. Other medication that could not be reconcilled included, paracetamol for various residents, and Sodium Valpourate for one resident. MAR sheets had not been completed on the reverse to identify why omissions were made. We asked to look at the controlled Drugs (CDs) in this home. They were stored in a safe in a locked cupboard, and the CD register was not in line with required guidelines. We advised the manager to read the most recent guidelines on storage and record keeping for CDs. Although we were eventually able to reconcile the CDs, with the help of the manager, these records were not acceptable. Whilst we were visiting residents in their rooms, we found creams in bedrooms that did not belong to the resident living in that room, and we found antibiotic capsules and eye drops in one of the fridges in the kitchen. These were not locked away. Care Homes for Older People Page 14 of 31 Evidence: During this inspection we observed relationships between staff and residents to be friendly and relaxed, however we felt that there were some rather undignified practices occurring in this home. For example, whilst talking to one resident in her room, a voice suddenly came through an intercom on the wall, saying. -----s shouting for the toilet. This was clearly how the staff summon assistance, however was very undignified for the resident in question. The manager has addressed this with the member of staff involved, and there are plans to disconnect this system. There were also two occasions when residents were taken to use the toilet in the entrance hall, and we found the door left open. This was not promoting the individuals privacy or dignity. Following discussions with the manager, we appreciate that some residents may not feel comfortable having doors closed behind them, however their privacy and dignity must be maintained. There are plans to install a slow closure facility to this door. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Generally staff are aware of the need to support residents to develope their skills however the langauge barriers observed may obstruct this process. Some residents are consulted and listeded to regarding the choices of daily living, but this process could be improved. Evidence: This home has a three week rolling menu plan in place which offered a variety of meals. Although each day only had one main meal listed, there was an alternative menu, with choices such as pies, omelettes, bacon egg and beans or lasagne, which were available on a daily basis if a resident requested it. We were concerned that some of these residents with dementia would not have the capacity to request an alternative. We were also told that the three plated meals of chicken from the previous day, that were in the fridge, would be given as an alternative to those who did not like the fish that was on the menu for today. The cook assured us that she was properly trained and these meals would be reheated appropriately. We observed the midday meal service and the residents enjoyed the meal. There was minimal waste. The fridges and freezers in the home were well stocked, however the lid of one freezer was Care Homes for Older People Page 16 of 31 Evidence: off its hinges and in need of repair. Food temperatures and fridge temperatures were being appropriately recorded. There was an activity plan for a week on the notice board. However the notice did not suggest what week it was for, and it did not bear any resemblance to what we saw during the inspection. The manager informed us that activities did not take place until 14:00 hours, by which time we had left this inspection. Although there was no evidence of scheduled activities taking place, we did see staff spending time talking with residents, and interactions we friendly, gentle and respectful. The residents all looked comfortable, and at ease with the staff, although communication and language was clearly a problem. We spoke to numerous residents in the home during this visit, and although generally content, one resident told us. Its no life really here, but they work hard and its not their fault. Care Homes for Older People Page 17 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This home has a complaints policy on display, however there was no evidence of any records to identify how complaints were being managed, investigated or resolved. The home was unable to locate their safeguarding policy, and discussions with the manager identified that there is some confusion over safeguarding reporting processes. Evidence: This home has a complaints procedure that is displayed in the dining room and easily accessible to residents and visitors to the home. It also forms part of the service users guide. There were a number of complimentary letters on display in the home that thanked staff for the care they had provided to loved ones. We were shown the complaints file, which was empty. We were aware of a complaint that had been recieved approximately one year ago. The manager was unable explain why the documentation to support this investigation had not been kept. We were also told of a complaint made about bed linen that was not recorded in the file. The managers understanding was that, when he had spoken to, written to, or e-mailed a response to a complainant, this was the end of the process, and had not kept any supporting documentation of how the matter had been manager or resolved. We asked to look at the homes safeguarding policy. The manager showed us the Local Care Homes for Older People Page 18 of 31 Evidence: Authority Policy but was unable to locate the homes policy at the time, and therefore agreed to fax it to us. He faxed us a recruitment flowchart. This was not the document we had requested. We spoke the the manager/owner and his wife about safeguarding, and asked what action they would take in the event of any allegations being made within the home. We were told. I would talk to the resident, look at evidence, talk to staff and investigate, if I thought I needed to, I would report it, I would take statements and look for more evidence. We explained that this was not the correct procedure, and that all allegations should be reported to the Safeguarding team as any investigation by the home may contaminate any investigation which it may be necessary for the Police to carry out. Care Homes for Older People Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can personalise their rooms to make them homely, however some areas are in need of decorating and maintenance, so that residents are not at risk. Evidence: During this inspection we undertook a tour of the premises. The home was generally free from offensive odours, and is surrounded by beautiful gardens that are easily accessible for the residents. However some areas, such as the kitchen did not appear particularly clean, and there was a general feeling of disorganisation and untidiness about the place. There were two microwave ovens in the kitchen, one of which was filthy and contained a burnt, melted plate. When brought to the managers attention he advised us that this was no longer used. We recommended he disposed of it. Also in one of the fridges in the kitchen, we found a large open cash box that contained various medication and eyedrops. There were seven prescriptions pinned on a notice board in the kitchen. The dining room, has an allocated area, which is used as an office for the manager and staff. There was a large dresser at one end of the room, that stored crockery, however we also found a stock of urine sample bottles and catheter leg bags on this dresser. This felt somewhat inappropriate. There was a lockable cabinet in the dining room, which was open when we arrived at Care Homes for Older People Page 20 of 31 Evidence: the home. This contained the residents files and other information which we felt should have been stored more securely, such as money. A cheque for more than 1800 Pounds was on display as the cupboard was opened. We visited residents individual bedrooms. These were clean and tidy and had been furnished with personal assetts, ornaments and photographs that reflected individuals life histories. However we found one ensuite bathroom, which was very dark and had no light bulb in it, and had a commode in the doorway to block it off. This was rather unsafe for the frail resident who lived in this room. One of the bathrooms that we visited was being used as a store room for, 2 matresses, 3 seat cushions, 2 large pictures, 9 zimmer frames, 1 quad walker, 1 rotary standing hoist, 6 walking sticks, 1 lifting hoist and 2 black bin bags full of clothing or curtains. The manager advised us that this bathroom was not in use a present, however it was open and easily accessible to residents therefore presenting a risk to anyone confused who may wander in. Care Homes for Older People Page 21 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can personalise their rooms to make them homely, however some areas are in need of decorating and maintenance, so that residents are not at risk. Evidence: We arrived at this home at 08:00 hours, and we were greeted at the door by a carer who was doing the morning medication round. We enquired who was in charge. She was unable to understand what we were asking and called for assistance from the cleaner, who advised us that the carer in charge was busy and would join us shortly. We were invited to wait in the library. After about ten minutes no one had come to assist so we started the inspection unassisted. At this point we found out that there was one carer working upstairs with residents, one carer who was doing the medication round, and the cleaner who was serving the breakfasts. This was insuffient staffing for the twenty one residents presently in this home. At 08:55 we were talking to a resident in her room. A member of staff entered the room and introduced herself as the cook. She told us. Im in charge until the manager arrives. He should be here by about 10:00 hours. She then proceeded to the kitchen to take over her kitchen duties, and the cleaner resumed her cleaning duties. At 09:45 hours the owner/manager and his wife arrived at the home. They informed Care Homes for Older People Page 22 of 31 Evidence: us that normally there would be three care staff on duty, but due to an emergency personal situation, one carer had been unable to work and therefore the cleaner had come in early to assist with breakfasts. However this still left only one carer to assist the residents, as the other was doing the medication round. We asked to look at the rotas. These had not yet been completed for the following day. The manager told us that everyone knew they would have to work, they were just not aware of what shifts as yet. This again was due to the personal emergency of one carer. We viewed the personal files of three staff in this home. Two were from overseas and had been recruited via an agency. All appropriate documentation, including Criminal Record Bureau (CRB) checks, personal identifiaction and references were appropriately in place. We looked at the training files for staff in this home, and although mandatory training was in place, there were about half the staff who had not attended safeguarding training, and one or two who had not done Moving and Handling training. These are essential training sessions that all staff must attend. Records indicated that some staff were attending English lessons, however it was concerning that one member of staff that was on duty was unable to understand the simple questions that we asked. We were also concerned that there was no evidence to indicate that this carer had done any medication training, however she was doing the medication round. Care Homes for Older People Page 23 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Non compliance in some of the key outcome areas of this inspection, indicates that the manager lacks control and understanding of some of the main components of the running of this care home, and the protection of the people who live here. Evidence: The owner of this home is also the registered manager. He has been here for several years, and runs this home with his wife and a small team of staff who are clearly committed to these residents. Throughout this inspection we were concerned that documentation and records were incomplete, and insufficient to provide any evidence that the manager understands the function of The National Minimum Standards for running a care home. We found non compliance and a poor level of understanding in many outcome areas, including, care plan reviews, staff training, safeguarding and complaints, medication administration and reporting processes. Care Homes for Older People Page 24 of 31 Evidence: We were told about one resident that had recently gone missing from the home, and the police had been called. We had not been made aware of this at the time. We also found reports relating to a resident having bruised ribs. This had not been reported. The manager lacked understanding of what incidents or accidents should be reported to what authorities. We asked about staff supervision. The manager informed us that he has staff meetings, which he refers to as supervision. We appreciate that there is a place for group supervision, however it is important that all staff have individual supervision that is documented, with their line manager. Similarly we asked about residents meetings, and we were told these informal chats are held regularly, however there had been no minutes recorded since March 2008. We looked at the health and safety file. There was a fire risk assessment with a suggested review date of 30/04/08, but no evidence to indicate this had been done. Fire call points were being tested weekly and emergency lighting tested monthly, however the manager did not seem to be aware that water temperatures throughout the home should be taken and recorded regularly. Although the water tanks had been tested for legionella. The manager told us that audit processes were in place for medication procedures and care planning, however we found an array of errors on the MAR sheets, and care plans that had not been reviewed to reflect the changing needs of the residents. The home does not hold personal allowances for residents in this home, any purchases are invoiced monthly to individuals or their families, however we were concerned to find a cheque for more than 1800 Pounds, in an open cupboard in the dining room, along with the residents files. We appreciate that there is a complete trust and openness between the manager and staff in this home, but safety and confidentiality practices need to be implemented. Care Homes for Older People Page 25 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 27 18 Staffing must be such to ensure the needs of residents are met at all times. 31/10/2007 Care Homes for Older People Page 26 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The registered person shall 28/11/2008 keep the service users plans under review. People who use this service must have their changing needs addressed efficiently, and this must be reflected in their individual care plans. 2 9 13 The registered person shall 31/10/2008 make suitable arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines recieved ito the care home. People who use this service will be protected by safe medication policies and procedures. 3 10 12 The registered person shall 14/11/2008 make suitable arrangements to ensure that the care home is conducted in a manner which respects the privacy and dignity of service users. Care Homes for Older People Page 27 of 31 People who live in this home must be treated with dignity and respect at all times. 4 16 17 The registered person shall maintain in the care home the records specified in schedule 4. People who use this service must be protected by the complaints policy and all related records. 5 18 13 The registered person shall make arrangements by the training of staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. People who live in this home must be protected by the safeguarding reporting processes 6 19 23 The registered person shall ensure all parts of the home are kept clean and reasonably decorated and maintained. People who live in this home must be provided with a clean, comfortable and safe environment in which to live. 7 27 18 The registered person shall 03/11/2008 ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are 28/11/2008 14/11/2008 28/11/2008 Care Homes for Older People Page 28 of 31 appropriate for the health and welfare of service users. People who live in this home must be cared for by sufficient staff that are appropriately trained. 8 28 18 The registered person must 31/10/2008 ensure that all persons employed by the care home have appropriate training for the work they are to perform. People who live in this home must be cared for by staff that are appropriately trained. 9 30 18 The registered person shall make arrangements to ensure that all staff are appropriately trained in moving and handling and safeguarding. People who live in this home must be protected by staff being appropriately trained in mandatory subjects such as safeguarding and moving and handling. 10 36 18 The registered person shall 07/11/2008 ensure that persons working in the home are approrpiately supervised. The people who live in this home must be cared for by staff that are appropriately supervised. 11 37 17 The registered person shall maintain in the care home all records in schedule 3 & 4 31/10/2008 14/11/2008 Care Homes for Older People Page 29 of 31 People who live in this home must be protected by accurate record keeping. 12 38 37 The registered person will notify the commission of accidents, injuries and safeguarding issues efficiently. People who live in this home must be protected by accurate reporting processes. 07/11/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 14 This home should consider different ways of encouraging residents to make a choice about their daily lives. Particularly those with cognitive impairment. Suitable provision is made for storage purposes in the home. 2 19 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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