Inspection on 16/08/06 for Hulton Care Home

This inspection was carried out on 16th August 2006.

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

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

Other inspections for this house

Hulton Care Home 07/06/07

Hulton Care Home 12/01/06

Hulton Care Home 04/08/05

Hulton Care Home 01/02/05

Hulton Care Home 16/08/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Hulton Care Home Hulton Drive Off Halifax Road Nelson Lancashire BB9 0EY Lead Inspector Mrs Pat White Unannounced Inspection 16th August 2006 10:00 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 Hulton Care Home DS0000022503.V301448.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. Hulton Care Home DS0000022503.V301448.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hulton Care Home Address Hulton Drive Off Halifax Road Nelson Lancashire BB9 0EY 01282 617773 01282 614445 hultonnelson@schealthcare.co.uk 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) Southern Cross Care Homes Limited Care Home 30 Category(ies) of Dementia (2), Dementia - over 65 years of age registration, with number (5), Old age, not falling within any other of places category (22), Physical disability (1) Hulton Care Home DS0000022503.V301448.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. Within the overall registration of 30, a maximum of 22 service users requiring personal care who fall into the category OP shall be accommodated. Within the overall registration of 30, a maximum of one service user who falls into the category PD shall be accommodated. Within the overall total of 30, a maximum of 5 service users (over 65 years) requring personal care who fall into the category of DE(E) Within the overall total of 30, a maximum of 2 service users (under 65 years) requiring personal care who falls into the category of DE The registered provider, shall at all times, employ a suitably qualified manager who is registered with the Commission for Social Care Inspection. 12th January 2006 Date of last inspection Brief Description of the Service: Hulton Care Centre is a purpose built care home situated in a residential area on the outskirts of Nelson. It is owned by a national organisation called Southern Cross. The grounds to the front of the home are pleasant and accessible. Extensive lawned areas surround the home and there is adequate car parking space. The home is able to accommodate up to thirty people, both men and women. Twenty-two places are available for older persons who require personal care and one is for a physically disabled service user who is under 65 years. There is a seven-bed unit, for service users who have dementia. All the bedrooms in the home are single rooms, and include ensuite toilet and hand basin. There are a number of lounges, including a smoking lounge, and dining areas. An activities organiser was employed in the home and there was a programme of activities. Fees charged per week are between £324.50 and £500, with additional charges for hairdressing, chiropody and some activities. Hulton Care Home DS0000022503.V301448.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced “key” inspection, the purpose of which was to determine an overall assessment on the quality of the services provided by the home. This included checking important areas of life in the home that should be checked against the National Minimum Standards for Older People, and checking the progress made on the matters that needed improving from the previous inspection. Pharmacy inspector, Maggy Howells, inspected the medication management in the home. The inspection took one and a half days. The inspection included: talking to residents, touring the premises, observation of life in the home, looking at residents’ care records and other documents, discussion with members of staff and discussion with the manager, Mrs Donna Laird. Survey questionnaires from the Commission were sent to the home for residents and relatives to complete. However none were returned. Five residents were spoken with in some detail and there views are included in the report. Others were spoken to but were unable to give their views about the home. The residents in the dementia unit were spoken with and observed for a short period but were unable to give their views. Some relatives were also spoken with and some comments are included in the report. What the service does well: The admission procedures in the home made sure that people’s care needs were assessed and written down so that a decision could be made about whether or not Hulton care was a suitable place for them. Some residents who were spoken with said they felt they were well looked after and that “the staff did the best they can”. The written plans for residents’ care were detailed and well written, and contained useful information regarding the residents’ health, personal and social care needs. These plans for care were regularly reviewed and updated. There were good links between the “risks” identified, for example the risk of pressure sores, and the action taken by carers to reduce the risks. The residents’ health was monitored carefully and appropriate action taken. Routines were flexible enough to suit individual preferences. Hulton Care Home DS0000022503.V301448.R01.S.doc Version 5.2 Page 6 The home employed an activities organiser, and there was a wide programme of interesting and enjoyable activities, including trips out. Hulton Care Home provided modern, pleasant, bright and well - maintained accommodation throughout, which was decorated and furnished to a high standard. Residents said they appreciated their bedrooms and the outside areas. A high proportion of the staff in the home had gained the qualifications recommended for people working in care homes. The home provided a safe place for residents to live in and for staff to work in. What has improved since the last inspection? What they could do better: The written information about the home could be made clearer so that people know that Hulton Care does not have practicing nurses working in the home, and that some people with dementia live in a specific unit. Hulton Care Home DS0000022503.V301448.R01.S.doc Version 5.2 Page 7 Medication administration in the home must be improved for the well being of the residents, and in particular all residents must be given their medication as prescribed, and accurate records must be kept. Staff should make sure that complaints and grumbles are treated seriously and should reassure people that residents will have nothing to fear if they express any concerns or dissatisfaction. The unpleasant odours in all parts of the home must be eradicated. The staffing levels in the home could be improved so that residents don’t have to wait for care. The staff recruitment procedures could be further improved and the details of applicants’ employment history, gaps in employment and choice of referees should be investigated more fully. 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. Hulton Care Home DS0000022503.V301448.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 Hulton Care Home DS0000022503.V301448.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, & 5. Standard 6 not applicable Quality in this outcome area is adequate. This judgement has been made using available evidence, including a site visit to this service. Information about the home was given to all residents but this was not completely accurate. The home’s admission procedures, including pre admission assessments and prior visits by prospective residents and relatives to the home, helped to determine whether or not the home could meet people’s needs. Not all residents and relatives were confident that there were always enough staff on duty to meet residents’ needs at the right time. EVIDENCE: The Statement of Purpose and the Service User Guide provided information about the home to residents, prospective residents and visitors. However these documents inaccurately implied that practicing nurses worked in the home and did not explain that the home had a specific dementia unit for those people needing specialist care. This is outstanding from previous inspections and must be rectified with priority. Hulton Care Home DS0000022503.V301448.R01.S.doc Version 5.2 Page 10 All residents, including those who were privately funded and those having short term care, had a contract and the home’s terms and conditions so that residents and their representatives knew what their rights and responsibilities were. There was evidence from the records viewed, and talking to a relative, that a suitable assessment of needs was undertaken with prospective residents before admission, to help determine whether or not the home could meet their needs. Social work assessments that had been carried out were also obtained. One relative spoken with confirmed that she had visited the home prior to her father coming to live in the home and that the manager had undertaken an assessment. Hulton Care Home DS0000022503.V301448.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence, including a site visit to this service. The care plans were detailed and well written and contained useful information about all aspects of residents’ health, personal and social care needs, to assist the care staff in providing care to residents. The residents’ medical care needs are promoted and maintained, but medication management in the home must be improved to safeguard residents’ health. Residents’ privacy and dignity respected. EVIDENCE: All the residents had detailed care plans that were developed from the assessment. The records looked at had detailed risk assessments for all aspects of care, including for pressure areas, continence, nutrition, moving and handling, medication, falls, bed rails etc., and care plans developed from these assessments/risk assessments. These were detailed in most areas assessed including care plans for pressure areas. There was evidence that the care plans were reviewed frequently and that residents and relatives were involved in the care plans. Hulton Care Home DS0000022503.V301448.R01.S.doc Version 5.2 Page 12 There was evidence that the residents’ health was monitored and maintained and residents had access to all the health care services. Most health matters were recorded in detail on the care plans, including pressure areas and continence issues. The intervention required to prevent pressure areas was also detailed. However on the care plans viewed there were no details of the oral and denture care required and no plan of care relating to diet and nutrition though the risk assessments had indicated that intervention was needed. Also for one resident with diabetes and who was subject to case tracking there was no reference on the care plan. These matters were subsequently rectified before the completion of the inspection. In one care plan viewed the risk assessment for the use of bed rails had not been fully completed, and the bedrails for this resident did not fit properly. This was a potential hazard to the resident and was rectified before the completion of the inspection. Medical appointments and district nurses’ visits were recorded and showed that residents had access to the appropriate medical services including the mental health services for older people. Detailed policies and procedures for handling and recording medication were available, but these were not always followed in practice, and residents were potentially at risk from not receiving the medication as prescribed. Staff were unaware of the procedures for receiving and recording verbal dose changes from doctors and did not follow the home’s procedure for providing medication to residents who were going out of the home for short periods. On at least one occasion a resident who was absent for an afternoon received no medication. Not all residents had medication available for them. One resident had not received one of their tablets for seven days as it had run out and no further supply had been obtained. This potentially put the health and wellbeing of residents at risk. Examination of Medication Administration Record charts, together with an audit of medication present showed that on a number of occasions medication had been signed for but not administered. Failure to administer medication as prescribed places the health and wellbeing of residents at risk of harm. A medication audit tool was in place, however this was not used effectively to highlight and manage shortfalls within the service. The importance of respecting residents’ privacy and dignity was part of the Induction training. Bedroom doors had appropriate locks and some residents had keys. There was a lockable facility in the bedrooms and all bedrooms were single and en - suite. Residents could spend time in their bedrooms if they wished. In the home’s own quality monitoring survey all residents stated that staff respected their privacy and dignity Hulton Care Home DS0000022503.V301448.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence, including a site visit to this service. Routines were flexible enough to suit individual preferences. Enjoyable and interesting activities and outings were arranged which benefited the residents. Residents were encouraged to maintain links with family and the outside community. They had reasonable choices in their everyday life. The food served was appetising, wholesome, enjoyed by most residents. EVIDENCE: Some routines were flexible to suit individual preferences such as rising and retiring times and being able to spend time in the privacy of their own room. Some of these preferences and hobbies and interests were recorded on the care plans. Records kept in the home indicated activities such as board games, quizzes, beauty care, concerts, a trip out and a car wash to raise money for charity. The home employed an activities organiser. The residents in the dementia unit also had the opportunity of taking part in activities. There was a reminiscence area and the dementia unit had sensory plaques. There was evidence that residents’ religious preferences were respected including residents of a non - Christian faith. Hulton Care Home DS0000022503.V301448.R01.S.doc Version 5.2 Page 14 . Visitors were welcome in the home at any reasonable time. The two relatives spoken with at the time of the inspection confirmed this. The visiting policy was outlined in the SUG. There was sufficient space in the home for people to visit residents in private. Residents kept in touch with the local community through visits by clergymen, events for the local community held in the home and trips out. Residents were encouraged to be as independent as possible and exercise choices. They wore their own clothes and had the opportunity of smoking in the smoking room if they wished. Residents could bring items of furniture with them and bedrooms were personalised. The food served on the day of the inspection was appetising, wholesome and nutritious and offered the residents a choice of food at tea - time. The dietary preferences and cultural requirements of residents were accommodated, such as the provision of Halal meat for one resident. Residents ate in the dining room but could have their meals in their bedrooms if they wished. There was no choice of meals at lunch – time, though the cook knows what people like and dislike and would make alternatives. Residents were assisted as required. There was written information in the kitchen about the requirements of those residents with diabetes. The residents spoken with at the inspection stated that the food was good but some stated that they wanted to be served smaller portions. Following the residents’ survey some matters regarding the meals served, including the portion sizes, had been addressed in a residents’ meeting. Hulton Care Home DS0000022503.V301448.R01.S.doc Version 5.2 Page 15 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a site visit to this service. There was a clear complaints procedure accessible to residents and relatives in the information pack given to people on admission. Residents and relatives knew how to make a complaint but some were reluctant to do so as they were not confident that all staff would react positively. The home had appropriate policies and procedures to protect the residents from abuse. EVIDENCE: The home had a complaints procedure that was given to residents and relatives as part of the admission pack. Information supplied stated that 1 complaint had been made to the home in the last 12 months and which had been substantiated. This was regarding company policy about fees and not about care issues in the home. It had been investigated according to company procedures. No complaints had been made directly to the CSCI. One person spoken with stated that she was concerned that voicing complaints and grumbles might adversely affect staff attitude and another person felt a member of staff had dismissed her concerns abruptly. Some rights of residents’ rights were upheld. For example, residents have the right to smoke and a smoking room is provided. All residents have postal votes and are encouraged to vote in elections. There was information about Hulton Care Home DS0000022503.V301448.R01.S.doc Version 5.2 Page 16 independent advocacy in the home and over the years a number of residents have used this service. There were policies and procedures to protect the residents from different kinds of abuse. These included a “whistle blowing” procedure and step –by step procedures for staff to follow in the event of a suspicion or allegation of abuse. There had been no recent allegations or suspicions of abuse from staff towards a resident. However there had been a recent investigation into an incident of theft of a resident’s fees that were stored in the home. The Police were not involved, and the manager was reminded of the responsibility to refer this person to the Protection of Vulnerable Adults list. Hulton Care Home DS0000022503.V301448.R01.S.doc Version 5.2 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 23, 24 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a site visit to this service. The home provided a safe, clean, pleasant and comfortable environment for the residents. There were spacious and pleasant communal areas and the residents’ bedrooms were comfortable and suited their needs. There were policies and procedures for the control of infection. EVIDENCE: Hulton Care is a purpose built care home and there was a separate unit for seven residents with a diagnosis of dementia and as being in need of specialist care. The premises at the time of the inspection were well maintained and pleasantly decorated and furnished. Since the previous inspection the lounge in the dementia unit had been redecorated, 4 bedrooms redecorated and two bedroom carpets had been replaced. The communal areas comprised of a Hulton Care Home DS0000022503.V301448.R01.S.doc Version 5.2 Page 18 dining room, a non - smoking lounge, a smoking lounge and a conservatory and offered the residents space and choice. The “dementia unit” was self contained. The home was a pleasant environment for residents. The grounds were also well maintained with seating areas. There had been a recent fire safety inspection that had confirmed that the home met the Fire Regulations. All bedrooms were single and en suite with WC and hand basin. The bedrooms were pleasantly decorated and furnished. Residents had small items of their own furniture and the bedrooms met individual’s needs. The downstairs bathroom had a new floor and a new hoist and had been made fully operational again since the previous inspection. The home was adequately clean but there was an unpleasant odour in some bedrooms and the entrance to the dementia unit. There was a spacious laundry situated in the basement and which was easy to clean. There were policies and procedures for infection control. However it was advised that the practice of taking dirty and soiled laundry through the dementia unit be reviewed. The majority of staff carried out infection control training in June 2006. Hulton Care Home DS0000022503.V301448.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a site visit to this service. Not all residents and visitors were confident that there were sufficient staff on duty to meet the needs of all the residents at certain times. The home’s staff recruitment policies and procedures had improved but could be further improved to protect the residents from unsuitable staff. The home had a good staff training programme that was being developed to meet the needs of the residents and the staff group EVIDENCE: On the day of the inspection the home was staffed according to the minimum levels recommended by the previous registration authority, for 22 older people. However there was only one member of staff in the dementia unit at certain times of the day, for example early morning and evening when residents are getting up and going to bed. The rotas showed that this was typical of the staffing levels. Staff confirmed that sometimes a member of staff is called from the main part of the home to assist in the dementia unit. There were therefore potential delays for assistance in both parts of the home because of this, particularly at weekends, when there is no manager on duty. Staff gave examples of when the residents had waited an unacceptable length of time. Some residents and relatives commented that they had to wait an uncomfortable length of time for assistance. A visitor commented that sometimes there were no members of staff around and that there was Hulton Care Home DS0000022503.V301448.R01.S.doc Version 5.2 Page 20 sometimes a long wait at the door to be let in. However one resident spoken with stated that the “staff were very nice” and another said the staff “do the best they can”. A cook and a cleaner were employed in the home for sufficient hours to enable good standards of food and hygiene to be maintained. Information supplied for this inspection stated that 12 out of 19 care staff were qualified to at last NVQ level 2,that is, 63.15 . Staff records showed that staff recruitment procedures had improved since the last inspection and staff did not commence work until all police checks and written references had been obtained. However the procedures could be further improved. For one member of staff whose records were viewed the application form had not been completed properly and gaps in employment had not been explained. Also the identity and status of one referee was not clear and there was no evidence of a comprehensive Induction programme having been completed. Staff had undertaken a variety of short training courses, in addition to NVQ courses, and according to their own needs and those of the residents. Staff working in the dementia unit had undertaken a short course on caring for people with dementia to help them understand these people’s needs. The home’s induction training programme had been developed in accordance with the “Skills For Care” specifications. Records showed that staff had undertaken essential training in fire safety, first aid and moving and handling and a variety of more specialised short courses for the benefit of both the residents and staff. Hulton Care Home DS0000022503.V301448.R01.S.doc Version 5.2 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence, including a site visit to this service. The manager had been in post for about 12 months and was qualified and competent to run the home. There were suitable quality monitoring procedures and the residents were consulted about their views on the home. Residents’ finances were managed safely. Corporate health and safety policies and procedures ensured a safe environment for residents and staff. EVIDENCE: The manager had been in post for about a year and had successfully completed the Registered Managers Award earlier this year. She also had an application pending for registration as manager with the CSCI. The Operations Manager visited the home weekly and submitted reports of monthly visits to the CSCI under Regulation 26 of the Care Homes Regulations. Hulton Care Home DS0000022503.V301448.R01.S.doc Version 5.2 Page 22 Hulton Care carried out quality monitoring measures according to Southern Cross company policy. Annual residents’ opinion surveys were carried out, using questionnaires, and relatives were also involved. Results were published and a graph was posted on the notice board. Matters raised, for example food and meals, were addressed. Internal audits are carried out e.g. medication, health and safety and environment. Residents’ finances were managed safely. Residents’ personal allowances were pooled, and though this is not regarded as good practice, there was no evidence that residents were disadvantaged because of this. Individual’s withdrawals and deposits were recorded giving a running total of each resident’s amount. Receipts of goods purchased by individuals were also kept. A check showed that the amount of money pooled balanced with the total of all residents’ money in the records. The heath and safety of the residents and staff was promoted. According to the pre inspection questionnaire, and records kept in the home, all appliances and equipment had been tested appropriately and had current certificates. A new fire alarm had been fitted. All fire precautions and equipment were satisfactory. Hot water tested at random outlets was at a safe temperature and water temperatures were regularly monitored. There was a rolling programme of moving and handling training to ensure that all staff had up to date skills and assisted residents safely. Staff also undertook first aid training Accidents were recorded appropriately and the records showed that there had been a gradual reduction in the number of accidents throughout 2006. Hulton Care Home DS0000022503.V301448.R01.S.doc Version 5.2 Page 23 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 3 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 1 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 2 17 3 18 3 3 X 3 X 3 3 X 2 STAFFING Standard No Score 27 2 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Hulton Care Home DS0000022503.V301448.R01.S.doc Version 5.2 Page 24 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&5 Requirement The Statement of Purpose and the Service User Guide must remove references to nurses working in the home and also explain that the residents with dementia are accommodated in a specific unit. (Previous timescale of 31/03/06 not met) Timescale for action 31/10/06 2. OP9 13(2) Sch 3 (i) The registered person must ensure that full and accurate records are kept of all medicines received, administered and leaving the care of the home. The registered person must ensure that all medication is always administered in accordance with the General Practitioners instructions (Previous timescale of 21/01/06 not met) The registered person must ensure that medicines are only administered to the resident for whom they were prescribed. DS0000022503.V301448.R01.S.doc 15/09/06 3. OP9 13(2) 15/09/06 4. OP9 13(2) 15/09/06 Hulton Care Home Version 5.2 Page 25 There must be no sharing of creams or other preparations. 5. OP9 13(2) The registered person must ensure that there are adequate supplies of medication available for each resident at all times. The registered person must ensure that there is an effective system in place to audit the handling, administration and recording of medication within the service. The registered person must ensure that the member of staff identified is referred to the Secretary of State for inclusion on the POVA list. The registered person is required to review the staffing levels within the home and ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. The registered person must uniform the Commission about the outcome of this review. The registered person must ensure that all the recruitment procedures are carried out according to the Regulations, including fully recording reasons for the gaps in employment, ensuring the authenticity of employment based referees and ensuring records are kept of the Induction programme completed. 15/09/06 6. OP9 13(2) 15/09/06 7. OP18 8. OP27 Care Standards Act Sec 82(1)(2)( 3) 18(1a) 30/09/06 30/09/06 9. OP29 Amended Reg19, sch 2 30/09/06 Hulton Care Home DS0000022503.V301448.R01.S.doc Version 5.2 Page 26 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 Criteria for the administration of when required and variable dose medication should be clearly defined and recorded for all service users prescribed such items. Sticky labels supplied by the pharmacy should not be attached to Medication Administration Record charts. A second member of staff should witness/countersign all hand written entries on Medication Administration Record charts Verbal dose changes and new medication should be accurately entered onto Medication Administration Record charts with staff signature, date and authority where appropriate. Verbal dose changes should be confirmed in writing by the prescriber. Staff should familiarise themselves with the homes policies and procedures for medicines management. It is recommended that portions of food be served according to the wishes of individual residents. The registered person should ensure that people feel able to raise issues of concern with staff without fear of adverse repercussions or reaction from staff. It is recommended that the practice of pooling residents’ money ceases. 2 3 4 OP15 OP16 OP35 Hulton Care Home DS0000022503.V301448.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB National Enquiry Line: 0845 015 0120 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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