Inspection on 27/09/07 for Howards

This inspection was carried out on 27th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Howards 24/09/08

Howards 05/03/07

Howards 08/12/05

Howards 16/08/05

Howards 20/12/04

Howards 13/08/04

Similar services:

Old Hastings House

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

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

CARE HOMES FOR OLDER PEOPLE Howards Howards 24 Rowtown Addlestone Surrey KT15 1EY Lead Inspector Pauline Long & Vera Bulbeck Unannounced Inspection 09:45 27 September 2007 th 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 Howards DS0000013683.V339253.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. Howards DS0000013683.V339253.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Howards Address Howards 24 Rowtown Addlestone Surrey KT15 1EY 01932 856665 01932 856665 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) Greydales Limited Nicola Crossley Care Home 21 Category(ies) of Dementia - over 65 years of age (0), Old age, registration, with number not falling within any other category (0), of places Sensory impairment (0) Howards DS0000013683.V339253.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - (PC) to service users of the following gender: Either Whose primary needs on admission to the home are within the following categories: Old age, not falling within any other category - (OP) Dementia (DE) maximum number of places 10 2. 3. Sensory Impairment (SI) 4 The maximum number of service users to be accommodated is 21 The age/range of persons to be accommodated will be 60 years and over 5th March 2007 Date of last inspection Brief Description of the Service: Howards is a care home situated in a quiet residential area on the outskirts of Addlestone. The home provides care for twenty-one residents who are over 60 years of age and ten service users over 6o years of age who also have dementia Accommodation is arranged on two floors, with nineteen single bedrooms, fifteen with en-suite facilities and one double bedroom. Stairs or a shaft lift reaches the first floor. There are two lounges and a conservatory, which, is also the dining room. The conservatory overlooks a well-maintained garden with two fishponds. There is off road parking at the front of the premises. The current level of fee range from £525.00 to £575.00 per week. There are separate charges for personal items, hairdressing and chiropody. Howards DS0000013683.V339253.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit formed part of the key inspection process and took place over eight hours commencing at 09.45 am and ending at 18.45pm. Mrs V Bulbeck and Mrs P Long, Regulation Inspectors carried out the visit. A full tour of the premises was undertaken. Four care plans were looked at and the care observed for the four individuals. A number of records were examined. The inspectors spoke with all the residents living in the home. The inspectors were also able to speak to two relatives who were visiting the home, and all the staff on duty were spoken to during the visit. Telephone discussions were had with 10 relatives/friends, 2 care staff, 2 General Practitioners and 2 Social Services Care Managers. The registered manager Miss Nicola Crossley was present throughout the inspection, together with her deputies. The proprietor was present for part of the inspection and a care consultant was also present. From the evidence seen by the inspectors and comments received, the inspectors considers that this service would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. There were nineteen residents living in the home on the day of the site visit and there were two vacancies. The inspector would like to thank the residents and staff for their co-operation and hospitality during the inspection. The service users living in the home wish to be called residents, therefore service users will be referred to as residents throughout the report. What the service does well: Resident’s views are continually sought to improve the service the home provides. The manager speaks with the residents on a daily basis and addresses issues as they arise. The inspectors spoke to all the residents; all were complimentary towards the staff, regarding the care provided and the staff team. Several residents living in the home stated they were happy to be living in such a nice place; they were well dressed and several stated they enjoyed their lunch on the day of the site visit. Relatives commented that the care provided at the home was tailored to individual needs and that staff knew their relatives likes and dislikes Lunch is served in the main dining area and all the residents were able to comment on the food being very good. The tables were nicely laid the food Howards DS0000013683.V339253.R01.S.doc Version 5.2 Page 6 was plentiful and appeared appetising and nourishing and there is a choice of menu, one resident commented that she was always asked what she would like to eat. On the day roast beef and all the trimmings was served and the residents clearly enjoyed their lunch. The inspector spoke with all the staff on duty on the day of inspection; staff commented they feel supported by the management of the home. Staff also commented they work well together and the team is stable, with very few changes in the team. Relatives commented that the staff group were friendly and appeared to be well trained and know what they are doing and were very caring. The home was homely and welcoming and the majority of areas in the home were nicely decorated and furnished. Some residents had some items of furniture in their bedrooms, which they had brought into the home with them. One relative commented that the home was always clean, had good food and her relative was always happy living in the home. What has improved since the last inspection? What they could do better: Howards DS0000013683.V339253.R01.S.doc Version 5.2 Page 7 There were some concerns in respect of health and safety which had the potential to have a considerable impact on the health, safety and wellbeing of residents. Residents who self medicate must be provided with a locked facility. The cleaning cupboard was found unlocked on the day of the site visit, one of the kitchen cupboards also contained cleaning materials and was without a lock. There are two fishponds in the garden that are easily accessed by residents and the management team need to take action to ensure the safety of the residents. All the radiators in the home require protective covers to ensure residents are protected from burns. The hot water tank cupboard needs to have a lock fitted to ensure residents do not have access to the area. All areas of the home must be appropriately maintained, the carpet identified must be kept clean, the toilet and bath identified during the site must be deep cleaned and maintained in a clean condition thereafter. A hole in the wall must be repaired and the ceiling in a residents bedroom needs attention. Any accidents or incidents must be reported to CSCI under Regulation 37. 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. Howards DS0000013683.V339253.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Howards DS0000013683.V339253.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents care needs are appropriately assessed prior to them being admitted to the home. The home does not provide intermediate care EVIDENCE: The care needs assessments were not available on the four residents files that were sampled. However, the management of the home stated they are in the process of reviewing and updating all resident’s files, including the care needs assessments. Discussion was had with the registered manager regarding the need to ensure that a copy of the care needs assessment is retained in the residents file. The home has employed a care consultant, who has been working with the management of the home for the last four weeks. An audit has been undertaken and the care consultant confirmed this, the audit includes work in Howards DS0000013683.V339253.R01.S.doc Version 5.2 Page 10 respect of care needs assessment. This document was sampled by the inspectors and evidenced the work currently being undertaken. The management stated that all the residents had received a full needs assessment prior to admission. The registered manager stated that she or the deputy manager would carry out the pre admission assessment. The deputy manager confirmed this. Intermediate care is not provided in the home. Howards DS0000013683.V339253.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements have been made in respect of the care planning and review process. Residents are not fully protected by the homes medication policies and procedures, and are at risk from the lack of lockable storage facilities in the bedrooms of self-medicating residents. EVIDENCE: Whilst it was noted that care plans are in place for each individual resident, the inspectors would advise the management of the need to further develop the care plans to ensure all activities of daily living are recorded with clear action plans in place. This would ensure that staff are aware of resident’s goals and help ensure resident’s needs are fully met. As referred to earlier in this report, care planning is part of the audit currently being undertaken. Improvements have been made regarding the review of care planning. All care plans are reviewed on a monthly basis. Howards DS0000013683.V339253.R01.S.doc Version 5.2 Page 12 Discussions were undertaken with all the residents who confirmed they received visits from their G.P, Chiropodist, Optician and some with hospital appointments. The inspectors contacted the Health Care Professional who visits the home on a regular basis. They commented that the home would always contact them if they had any concerns regarding a resident’s health. The overall medication procedures and practices were managed to a satisfactory standard and records were well documented with no gaps in signatures noted. There were large photographs of each resident on file, which enabled staff to clearly identify each resident and minimise any errors. There was no list of signatures in respect of the staff, who, are responsible for administering medication. The member of staff on duty stated that a list of staff signatures had been completed, however could not evidence this on the day. No controlled drugs were being administered at the time of the site visit. The member of staff confirmed the procedure for administering controlled drugs. Two residents are responsible for administering their own medication and it was noted that risk assessments had been completed, however, there were some concerns regarding the review of the risk assessments. This was discussed with management at the time and the inspectors advised the risk assessments be reviewed more frequently particuarly in respect of one of the residents. The overall storage of medication was satisfactory, however, the management must review the storage facilities for residents who are responsible for administering their own medication, neither of the residents had a lockable facility. This was a concern as the majority of bedroom doors were not locked and some of the residents living in the home have dementia and may wander into these bedrooms. Discussions were had with the manager, who agreed that the medications would be stored safely until alternative lockable storage was supplied in the resident’s bedrooms. The deputy manager informed the inspectors that the registered manager and deputy managers undertake staff training in house. The deputy manager also stated that the pharmacy that supplies the medication has also provided medication training to staff. However these certificates were not available on the staff files sampled. Discussion with the health care professionals indicated that medication was well managed. Discussions with residents indicated that they were treated respectfully and the inspectors observed staff to be polite and courteous, for example knocking on bedroom doors prior to entering. One health care professional commented that when he visits the home the staff always advise him to see his patients in their bedrooms in order to promote and protect their privacy and dignity. Howards DS0000013683.V339253.R01.S.doc Version 5.2 Page 13 The majority of resident’s bedroom did not have locks on the doors. This was discussed with the registered persons who stated that, residents were asked on admission if they required a lock on their door, otherwise locks were not provided. The management of the home must review and revise the current arrangements in this respect, and the reason for any resident not holding a key should be fully documented in their care plan to ensure that their privacy and dignity is fully promoted and protected. A Requirement and a recommendation has been made in respect of these areas. Howards DS0000013683.V339253.R01.S.doc Version 5.2 Page 14 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 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are encouraged to lead fulfilling lives and to join in with the local community. The food provided at the home is good and meal times were observed as being a positive and pleasant experience for the residents. EVIDENCE: Discussions were had with all of the residents about life in the home. Some commented that they were roused at 6am in the morning for breakfast, and that the staff appeared to be very rushed. One resident commented that she liked to rise early but could always go back to bed when she wanted. One resident was observed in her dressing gown at 11am, she confirmed that she had, had a lie in. The home has recently recruited an Activities Organiser; the registered provider stated that he expected that residents would have the opportunity to take part in activities three days a week. Residents commented that they had been taken on outings and that some activities are provided in the home. In the morning all of the residents were taking part in a music and movement session, in the afternoon they were having a sing along. The activity schedule indicated that there should have been a cake baking class. This was discussed Howards DS0000013683.V339253.R01.S.doc Version 5.2 Page 15 with the staff at the time. The registered provider stated that the arranged sing-a-long had been booked prior to the new Activities Organiser being recruited, this caused some confusion amongst the staff group. Relatives spoken with commented, that various entertainment and outings are organised through out the year. One relative made a particular comment about the activity organiser; she was impressed with receiving a questionnaire in respect of her relatives likes and dislikes. The residents regularly visit the pub next door to the home, the proprietor of the pub confirmed that residents attend their quiz evenings and often have parties there. The majority of residents in the home have family or friends. Relatives spoken with commented that they were welcome at the home at any time. Residents were observed moving freely around the home and making choices as to what daily activities they wished to take part in, some confirmed they did not wish to take part in an activity. A resident commented that she had chosen the carpets for her bedroom, another resident had a wipe board in her room in order to remind her of daily activities. Meal times at the home were observed as being a pleasant and positive experience for the residents. The tables were nicely laid and residents chose where they sat. The food served appeared wholesome and appetizing, residents and relatives commented that, the food is always good in the home. All staff on duty are provided with a meal. Discussions were had with the cook in respect of the residents likes and dislikes, she has worked in the home for a number of years and had a good understanding of their needs. It was noted that the menu had been changed on the day, the cook confirmed that at times the menu is changed, however had not recorded the changes. The menus reflected only one choice of main meal, however residents commented that if they wished something different the cook would make it. The Environment Health Officer visited the home on 10/04/07 and as result made 2 recommendations, one in respect of procedures, which had been met, and one in respect of renewing the meat probe. The registered provider stated that the meat probe had been replaced, however there were no records available to evidence this. On the day of inspection the meat probe was broken. The provider stated that the meat probe had been replaced and he was not aware that it had broken again. He stated that a new meat probe would be ordered straight away. A recommendation has been made in respect of these areas. Howards DS0000013683.V339253.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, 17 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected by the homes complaints and safeguarding procedures. EVIDENCE: The homes complaints procedures had been reviewed and updated, however it was noted in the complaints folder that the details for the Commission were not accurate, this was an oversight and the registered manager stated that it would be addressed. The majority of relatives spoken with commented that they had not seen the complaints procedure, but confirmed that they would know who to speak to if they had a complaint or a concern. One relative commented that she had been given an information pack when her relative was admitted to the home and there could be a copy of the complaints procedure in this pack. The provider confirmed that information packs contained a copy of the complaints procedure. The home had not received any complaints since the last inspection. The Commission have not received any complaints about this service since the last inspection. There were several letters on file complimenting the home. No safeguarding referrals have been made since the last inspection. The inspectors were told that all staff had undertaken training in respect of Safeguarding Adults from Abuse. Training records evidenced this. Discussions were had with staff and scenarios put to them in respect of possible abusive practice. Their responses indicated a good understanding of the homes Howards DS0000013683.V339253.R01.S.doc Version 5.2 Page 17 procedures. The homes safeguarding procedures have been reviewed and amended to reflect the Local Authority Multi Agency Procedures. The home is awaiting an up to date copy of the new Local Authority Multi Agency Procedures. Howards DS0000013683.V339253.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 25 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Further improvements are required to ensure residents live in a safe well maintained home. Standards of cleanliness were satisfactory ensuring the residents live in a clean and hygienic environment. EVIDENCE: The inspectors undertook a full tour of the home. The atmosphere in the home was welcoming, warm and homely. Overall the home was found to be clean and hygienic. Improvements had been made following the last inspection. A number of bedrooms had been redecorated and re-carpeted and new furniture supplied. One bedroom has been fitted with impervious flooring. The entrance hall, stairs and landing have recently been decorated and new carpet has been fitted in some areas of the hall, stairs and landing. The furniture and fittings in the home were domestic in design; residents commented that Howards felt like home. One resident commented, that she could not have chosen a better home. Howards DS0000013683.V339253.R01.S.doc Version 5.2 Page 19 It was noted that the window restrictors in two of the bedrooms were broken. This was discussed at the time with the Registered Manager, who confirmed that one of the bedrooms had recently been decorated and the window was not closing properly. The handy man was called and the issue addressed at the time of the inspection. None of the radiators in the home had protective covers, this was discussed with the registered provider, who stated that he had identified this as an issue and was in the process of obtaining covers. This will ensure the continued health and safety of the residents. It was noted in one of the first floor bathrooms, that the hot tap had been dismantled; the deputy manager stated that this was due to a resident leaving the tap running and wasting all the hot water. Discussions were had in respect of the home ensuring that all resident’s rights were promoted and protected and that all of the residents had access to a hot water supply. The inspectors advised the management of the home to review the arrangements in respect of providing appropriate equipment. There were a few areas that require attention as discussed with the registered manager on the day of inspection these include, a carpet that requires cleaning or replacing, a hole in the wall made by the door handle, a lock to be fitted on the hot water tank cupboard door, a toilet was badly stained and needs to be deep cleaned and a bath was also badly stained and needs attention. It was also noted that there was a stain on the ceiling of one of the bedrooms and this was brought to the attention of the registered manager who confirmed they had a leak. It was unclear what action had been taken in respect of this leak. The management needs to review the arrangements in place for paper towels, currently the home is using kitchen rolls. This practice does not promote good infection control measures and was discussed with the manager at the time of the inspection. It should be noted that there were some empty dispensers for paper towels in place. Requirements and a recommendation have been made in respect of these areas. Howards DS0000013683.V339253.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels need to be reviewed in order to ensure that the staffing numbers and skill mix of staff reflect the dependency levels of the residents and ensure the resident’s needs are appropriately met. Resident’s health, safety and wellbeing is protected by the recruitment and selection process and staff training. EVIDENCE: The staff rota was sampled and evidenced a diverse staff group were employed at the home. There were two care staff and a deputy manager on duty during the waking day and two waking night staff on duty. Discussions with residents, staff and relatives indicated that at certain times of the day residents felt very rushed, a resident informed the inspectors that staff are not able to communicate with resident’s as they are too busy in the mornings. The inspectors were informed that five residents are got up by the night staff, because the day staff are very busy and find it difficult to manage twenty one residents. This was discussed with the deputy manager who stated that some residents like to get up early. This needs to be recorded in the residents care plan of those who prefer to get up early. The inspectors advised the management of the home to undertake a staffing matrix to ensure the staffing levels reflect the dependency levels of residents, particularly, at busy periods of the day, for example in the mornings. Howards DS0000013683.V339253.R01.S.doc Version 5.2 Page 21 Staff files were sampled and evidenced improvements have been made in respect of Criminal Record Checks (CRB) and POVA checks. However a recommendation was made at the previous inspection that the home review the guidance on the disposal of the disclosure forms. It was noted that staff files still contained CRB disclosure forms. This was discussed with the management team at the time and they were advised again, to refer to the guidance in respect of the retention and disposal of these documents. Four staff files were examined and there was evidence that some training had been undertaken since the last inspection, for example certificates referred to dementia care training and food hygiene. Some of the staff spoken with confirmed that they had undertaken this training. Two recently recruited members of staff spoken with indicated they had not undertaken any training since they started work. This was discussed with the management team following the feedback from these members of staff. The management team expressed surprise that these staff had not undertaken any training, and stated that the records would be checked. The inspectors advised that, all new staff employed must undertake mandatory training, this should include health and safety, food hygiene, first aid, COSHH, infection control and fire training. It should be noted that the majority of staff have undertaken this training and that the home is proactive in respect of staff training. All of the residents, relatives, care management and health care professionals spoken with commented that the staff were very friendly and helpful. A requirement has been made in respect of these areas. Howards DS0000013683.V339253.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is. adequate This judgement has been made using available evidence including a visit to this service. Improvements are required in respect of the health and safety practices at the home to ensure the continued health, safety and wellbeing of the residents. EVIDENCE: Since the last inspection the manager has been registered with the CSCI. The registered manager confirmed that she is undertaking the Registered Managers Award, and has completed a number of other courses including dementia care and protecting vulnerable adults from abuse. The care consultant employed by the provider has undertaken an audit. The care consultant explained the audit had identified some short falls in the homes quality assurance process. It was also stated that the care consultant was working closely with the management team in order to develop a service Howards DS0000013683.V339253.R01.S.doc Version 5.2 Page 23 user survey in order to seek the views of residents and other stakeholders. Discussions were had about the benefit of having residents meetings. Monthly reviews of care plans have been undertaken; policies and procedures have been updated. Observation by the inspectors evidenced that residents were consulted on a number of issues for example; they were asked if they would mind the inspectors going into their bedrooms and if they were happy to speak with the inspectors. The home manages one resident’s finances; the records were checked in relation to the individual and found to be accurate. The provider stated that on occasions if residents required any expenditure the home would invoice the relatives. The accident and incident records were sampled and it was noted that some accidents had not been reported under Regulation 37. This was discussed with the management team at the time of the inspection. It was a concern that a deputy manager was not aware of the need to report any serious accidents or incidents to the Commission for Social Care Inspection (CSCI). The inspectors would advise the management of the home to ensure all staff are aware and have an understanding of the National Minimum Standards for Older People and the Care Homes Regulations 2001 as amended (2006). It was noted in one of the bedrooms the water was extremely hot. This was discussed with the manger at the time who’ stated she would get the handyman to have a look and ensure the water temperature was adjusted and safe for residents to use. Water temperatures must be checked regularly and records maintained. Whilst it was noted that risk assessments have been undertaken regarding the two fish ponds, appropriate action must be taken to ensure that both ponds have robust barriers between the water and residents in order to ensure the continued health, safety and welfare of all the residents living in the home. It was noted that cleaning materials were stored in the cupboard under the kitchen sink; this was discussed with the deputy manger at the time of the inspection. The cupboard was without a lock, however the provider stated the lock would be fitted as a matter of urgency. The cupboard situated in the laundry area was also unlocked and contained various cleaning materials including bleach. This was also discussed with the management team at the time of the inspection. An inspector checked the cupboard again before leaving the premises and it was noted the cupboard was locked, however, the doors of the cupboard were not secure and easily accessible by the gap between the doors and the cupboard. The provider took note of the situation and agreed to fit a bolt on the inside of the cupboard door. Discussions were Howards DS0000013683.V339253.R01.S.doc Version 5.2 Page 24 had with the management team on the 04/10/07, they confirmed that all cleaning materials were stored appropriately and safely in locked cupboards. Requirements have been made in respect of these areas. Howards DS0000013683.V339253.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 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 3 2 X X X X X 2 3 STAFFING Standard No Score 27 2 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Howards DS0000013683.V339253.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No 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 2 Standard OP9 OP19 Regulation 13(2)(4 (a)(c) Requirement Timescale for action 27/10/07 27/10/07 3 4. OP19 OP27 5. 6. 7. OP19 OP38 OP25 OP38 OP38 Residents who self medicate must be provided with a locked facility. 23(2)(d) All areas of the home must be appropriately maintained: a) The carpet identified must be kept clean b) The toilet as identified must be deep cleaned c) The bath as identified needs to be deep cleaned d) The hole in the wall as identified needs attention e) The ceiling in a residents bedroom needs attention. 23(2)(j) All residents must have access to hot water. The hot tap must be in working order. 18(1)(a) Staffing levels in the home must be reviewed to ensure that all resident’s needs are being appropriately met. 13(4)(a)(c A lock needs to be fitted on the ) cupboard containing the hot water tank. 13(4)(a)(c The radiators must have ) protective covers. 17 Any accidents or incidents must Schedule be reported to CSCI under DS0000013683.V339253.R01.S.doc 27/10/07 27/10/07 27/10/07 27/01/08 27/09/07 Howards Version 5.2 Page 27 8. 9. OP38 OP38 4 Number 12 13(4)(a)(c ) 13(4)(a)(c ) Regulation 37. A more robust barrier must be fitted around the two fishponds. Cleaning materials must be stored appropriately at all times in a locked facility. 27/10/07 27/09/07 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. 3. 4. Refer to Standard OP24 OP38 OP38 Good Practice Recommendations Doors to resident’s rooms are fitted with locks that are suitable for resident’s capability and accessible to staff in an emergency. The meat probe to be replaced. The arrangements for the use of paper hand towels to be reviewed to promote good infection control measures. Howards DS0000013683.V339253.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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. 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