Inspection on 21/05/08 for Ideal Home

This inspection was carried out on 21st May 2008.

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

Ideal Home 19/11/08

Ideal Home 22/05/07

Ideal Home 02/05/06

Ideal Home 03/11/05

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Ideal Home Knowsley Drive Gains Park Shrewsbury Shropshire SY3 5DH Lead Inspector Sue Woods and Martin George Key Unannounced Inspection 21st May 2008 09:30 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 Ideal Home DS0000064647.V363235.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. Ideal Home DS0000064647.V363235.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ideal Home Address Knowsley Drive Gains Park Shrewsbury Shropshire SY3 5DH 0870 6092432 0870 6092435 debbie.byrne@btconnect.com 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) Minster Care Management Limited Pamela Johnson Care Home 50 Category(ies) of Dementia (12), Mental disorder, excluding registration, with number learning disability or dementia (26), Old age, of places not falling within any other category (6), Physical disability (6) Ideal Home DS0000064647.V363235.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd May 2007 Brief Description of the Service: Ideal Home is situated in the village of Gains Park approximately 5 miles from the centre of Shrewsbury. It is located in a residential area, within walking distance of a local post office, shops and pub, with its own car parking and gardens. It is a private care home registered to provide care and accommodation for up to 50 people, including people with a mental disorder, both under and over 65 years old, older people and a small number of people with a physical disability. The home is owned by Minster Care Management Limited. Ms Pamela Johnson is the registered manager and is responsible for day-to-day running, staffing and the development of effective policies and procedures within the home. The accommodation has 3 fairly distinct areas, the main house and converted coach house, which provide accommodation on ground and first floors and a purpose built extension to the rear of the property, which is all on one level. The manager stated that consultation with people who live at Ideal Home takes the form of annual questionnaires and residents meetings. Inspection reports about this service can be obtained direct from the provider or are available on our website at www.csci.org.uk Ideal Home DS0000064647.V363235.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means that people who use this service experience poor quality outcomes. Two inspectors carried out the unannounced key inspection of Ideal Home on behalf of the Commission for Social Care Inspection (CSCI). The inspection took place on 21st May 2008 between 09:25 am and 04:30 pm. We reviewed all twenty two of the key standards for care homes for older people and information to produce this report was gathered from the findings on the day and also by review of information received prior to the inspection date. A quality rating based on each outcome area for service users has been identified. These ratings are described as excellent/good/adequate or poor based on findings of the inspection activity. As part of the inspection we, the commission, observed routines, met with a number of people living at the home and with staff on duty at the time of the visit. We also handed out surveys for completion by staff and people living at the home. Fourteen were returned. Support for the inspection came from the registered manager and a senior manager from the organisation. Eight care files were reviewed in detail and extracts were seen from others. Other records referred to within the report were also seen. Prior to the inspection visit the manager completed and returned an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Of the six requirements made at the time of the last CSCI inspection in May 2007 four were still not met at the time of this latest inspection visit. What the service does well: People who live at Ideal Home are supported by a team of dedicated staff who work hard to meet people’s needs. One person said that staff ‘know what I need’. Someone else said that the staff treat him well. One person said we have ‘Nice staff and nice food’. Ideal Home DS0000064647.V363235.R01.S.doc Version 5.2 Page 6 Staff think they provide a homely environment. One person said that the home was ‘home from home’. All staff thought that they do well by caring for individual needs and ‘look after people well’. A senior manager felt that Ideal Home offers people the opportunity to be ‘individuals’. What has improved since the last inspection? What they could do better: Generally people who spoke with us said that the home ‘couldn’t do anything better’ however one person said the home needed more staff and this comment was echoed by the majority of staff who were also asked what the home could do better. On occasions the lack of staffing means that people cannot be supported to have even their basic care needs met. Although care plans are in the process of being updated not everyone has one. Some care plans do not reflect current care needs and some are missing essential information required by staff to provide a safe and consistent service. Risk assessments and other formal assessment processes were basic and on occasions not available to support safe practice. One staff member would like to ‘spend more time with the residents’. Some staff wanted to see more activities. The home’s own quality assurance system identified that a common theme of dissatisfaction was related to activities, where it was felt much more could be done to stimulate and occupy the people living at the home. A total of ten requirements were made as a result of this inspection. Four of these had been made at the previous inspection and had not been actioned. New requirements related to promoting independence, providing a safe environment for people to live in and offering the staff team effective support Ideal Home DS0000064647.V363235.R01.S.doc Version 5.2 Page 7 and supervision. Nine recommendations for good practice were also made, again reflecting the need to improve communication and safe working practices. The manager and the senior manager for the organisation acknowledged all shortfalls and committed to improving practices within the home and monitoring progress. 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. Ideal Home DS0000064647.V363235.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 Ideal Home DS0000064647.V363235.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): Standards 2, 3 and 6 Quality in this outcome area is adequate. People who live at Ideal Home have their basic care needs assessed before they move so that staff are aware of those needs when they arrive; however because more detailed information is not always available the home may find that they are unable to meet more complex needs meaning that the home is unsuitable for some people who are admitted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Of the eight care files seen at the time of this inspection all contained some form of assessment carried out either prior to or upon admission to the home. The latest person to stay at the home for respite was admitted as an emergency. His assessment was very basic and a subsequent review suggests that the home cannot meet his needs. There was evidence on one file seen that the home has not used the information provided in the initial assessment to inform a care plan that identifies how the home can safely meet a person’s Ideal Home DS0000064647.V363235.R01.S.doc Version 5.2 Page 10 needs. Contracts seen for two people who share a room do not identify that they are sharing. One contract had not been signed by anyone. The home’s Statement of Purpose is in a standard format and reflected that there are some shared rooms and that the home can accept people in an emergency. Ideal Home DS0000064647.V363235.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): Standards 7,8,9 and 10 Quality in this outcome area is poor People who live at Ideal Home do not all have a care plan that accurately reflects their individual needs and some risk assessments do not identify safe support for people. As a result people may not have their care and support needs met or managed safely. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager reported that the home is currently introducing a new careplanning format to the home and this was seen to identify more personalised information and more detail than the previous ones. This process started in August 2007. Where the new format has been introduced, individual needs and choices were seen to have been identified and this will mean that staff can work consistently and offer care and support in a way that people prefer. However not all plans have been updated and the latest person to be admitted to the home did not have one at all. This caused concern given the complex needs of this person. The senior manager who also reviewed the file shared this concern. Ideal Home DS0000064647.V363235.R01.S.doc Version 5.2 Page 12 Likewise risk assessments were either missing or were very basic and did not identify how people could be empowered or enabled to take appropriate risks. Records are kept on each care file to show when people attend routine health care appointments such as GP visits and dental and optician’s appointments however they do not show that people attend for regular check ups. One person last saw a dentist in 2003 yet at her review it was identified that her dentures were broken. The senior staff member stated that they were still broken on the day of the inspection and they were waiting for an appointment. The manager later stated that this wasn’t the case and that she had a spare set. The care plan did not identify any resolution for the resident. The situation also demonstrates poor information sharing and poor recording practice. On a number of occasions the care plans seen contradicted care practice and this could place people at risk and make them vulnerable. For example the care plan for one person said for staff to monitor her food and drink intake yet the senior on duty said that they weren’t doing that at the moment as it wasn’t needed. There was no written explanation recorded to support this decision. Falls risk assessments and nutritional risk assessments were in place and used for some people, but not all, and on occasion were missing for people whose care plan suggests that they would be valuable. One person who can become ‘ aggravated and agitated’ according to her care plan had no support plan to help staff manage this. The staff member on duty stated that the behaviour ‘no longer applies’. Again the care plan had not been updated. Some reporting and recording practices were good in relation to identifying health needs and responding to them. There is good support for the home from district nurses although sometimes a delay was noted before they were contacted. Medication arrangements on the whole were satisfactory and staff on duty reported that they have made positive changes to systems as a direct result of the training they had recently received. Controlled medication was being stored, recorded and monitored appropriately. The senior manager for the organisation had recently identified that there is no information available to support the use of medication to be taken as and when required. This was also evident on the day of the inspection with care records not accurately reflecting current medication and medication administration record (MAR) sheets not identifying all medication taken for one person. The home had enabled someone to administer his own medication however they had not assessed the risks involved or considered the person’s history prior to making this decision and as a result this persons good health is at risk. Staff, on the day of the inspection, were seen to be polite and courteous towards the people they were supporting. However during the morning of the Ideal Home DS0000064647.V363235.R01.S.doc Version 5.2 Page 13 inspection interactions were minimal. People were able to spend time in their rooms if they chose to. Ideal Home DS0000064647.V363235.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): Standards 12, 13, 14 and 15 Quality in this outcome area is adequate People who live at Ideal Home enjoy a relaxed lifestyle and enjoy family visits and contact, however the home should continually look for new and stimulating activities to meet peoples social and recreational needs. Menus take into account peoples special dietary needs and personal preferences although some people may benefit from having more opportunities to be more independent in preparing and serving meals and this would better reflect the ethos of the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the morning of the inspection the older people living at the home were either relaxing or sleeping. One person was seen to be knitting and one person was listening to her personal CD player. In the afternoon more organised activities were taking place such as art and craftwork and jigsaws. The younger adults in the afternoon were seen to be watching television and walking around the home making drinks as and when they liked. The file seen for a younger adult contained a record of hobbies and plans to achieve personal goals in relation to using public transport and doing a course of his choice however Ideal Home DS0000064647.V363235.R01.S.doc Version 5.2 Page 15 records in general of activities maintained on the care files suggested that very few activities actually take place. Three staff survey responses identified that activities need to be improved at the home. Staff say that family support and contact is encouraged and it was seen recorded when staff had tried to contact people on behalf of people living at the home. One person’s religious beliefs were recorded identifying what is important to her on a daily basis. One person who enjoyed a conversation with us said that the people she was sitting with people who ‘never say anything’. One person was unsure if he would be watching the football match later that day. He hoped he would. One staff member suggested that better staffing levels would mean that staff could then’ spend more time with the residents’. On the day of the inspection two people did not receive the support they required to eat their breakfast and eventually it was taken away. This suggests that staff may be struggling to meet people’s most basic of care needs on occasions. (See requirement in staffing section) Meals served on the day of the inspection looked appetising and there was a choice available. Everyone living at the home was seated for lunch and it was served plated by staff. It was suggested that maybe some people could become more independent in this area especially as the homes AQAA states that they want people to develop independent living skills. Ideal Home DS0000064647.V363235.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): Standards 16 and 18 Quality in this outcome area is good People who live at Ideal Home have access to a complaints procedure and other opportunities that enables their views to be listened to and the home involves outside agencies to ensure that concerns are investigated openly and in the best interests of vulnerable people. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been no complaints made about the home within the last twelve months. People living at the home who spoke with the inspector all said that they knew how to make a complaint if they needed to. The home’s complaints policy was not reviewed on this occasion however on previous inspections the procedure was described as ‘robust’. The manager stated in the AQAA that ‘we seem to be able to listen and deal with any issues before they develop into a formal complaint. We will ensure this high standard is maintained to avoid any complaints in the future’. The home has recently worked with the Safeguarding Adults team in respect of concerns raised about the health of one person living at the home. At the time of the inspection this investigation had not been concluded but the manager stated that she had worked with health care professionals and had been able to provide full documentation to demonstrate that the home had supported the person appropriately. Ideal Home DS0000064647.V363235.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20, 22, 24, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment at Ideal Home is generally satisfactory however further improvements and actions to reduce the risk of fire will make the home a safer place to live EVIDENCE: The general state of the décor was reasonable but some areas of the home were in better order than others. Communal areas were clean and functional. The bedrooms we looked at were small but neat and tidy and service users we spoke to expressed satisfaction with their room. Radiators throughout the home were guarded and grab rails were situated as required to help safeguard service users. The manager told us that very few service users in the older people part of the home had their own room keys, but there were no recorded reasons why that was the case. Ideal Home DS0000064647.V363235.R01.S.doc Version 5.2 Page 18 During the tour of the building we noted that at least one service user had been smoking in their own room and we noted the smell of cigarette smoke in at least three other areas of the home. To try and alleviate the risk of service users smoking in areas of the home where it is not allowed there is a designated smoking room. The risk assessments we looked at did not satisfactorily deal with the potential fire risk to service users and staff. The kitchen is a compact, well kept area. The cook explained the regular checks that she undertakes, including temperatures of fridges and freezers, checking temperature of cooked foods etc. The records confirmed that these checks are carried out regularly. We were also shown the weekly and monthly cleaning and hygiene checks she carries out. The food storeroom contains the fridges and freezers and all the dry goods. This room has a skylight, which we were informed needs to be kept open during warm weather. There was no fly screen over the skylight and this presents a potential cross contamination risk. The laundry area was very well organised and the system being used seems to ensure that clothes get returned to the right person in the majority of cases, which is good to note in a home that caters for up to 50 people. The washing machines are equipped with sluicing facilities. The garden area is a pleasant environment, suitable for the needs of service users with limited mobility. Unfortunately one of the entrances into the garden requires people to walk under a metal stairway (a fire exit) and this presents a health and safety risk as it has no protective covering to prevent injury to anyone who hits their head while passing under it. Also just outside the entrance there were several cigarette butts all over the ground. Ideal Home DS0000064647.V363235.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29, 30, Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People who live at Ideal Home are supported by a team of staff who work hard but are not always able to meet their care and support needs due to staffing levels. Training opportunities for staff are improving and this will mean that staff will be more competent to meet peoples needs in the future and thus improve peoples overall quality of life. EVIDENCE: The staff files we looked at were well organised. We noted that the most recently appointed member of staff had been recruited and appointed in accordance with requirements. We also examined two files of staff who had been with the home for periods exceeding one year and those files were also consistent with requirements. The manager confirmed that all staff are only allowed to commence employment once the Criminal Records Bureau (CRB) checks have been received. We noted one file did not have a photograph of the member of staff and the contract of employment did not include a start date, although the manager did provide us with the start date. We were satisfied that the recruitment process used by the home safeguards service users. Ideal Home DS0000064647.V363235.R01.S.doc Version 5.2 Page 20 Due to some staffing shortages the home has recently been using agency staff. We checked the agency file and noted the home had ensured the agency workers were suitable to work with the service users. The training officer explained the induction and training programmes being adopted by the home. The induction programme is now consistent with Skills for Care expectations and we saw the quality of evidence expected from inductees, which satisfied us that staff were acquiring the baseline knowledge and skills required to provide safe care to service users. In order to meet Skills for Care requirements the manager needs to sign off the induction once an employee has completed it. The training schedule now clearly shows all training that has been completed and training that is planned, which includes refresher training. The records show that only three staff have completed Protection of Vulnerable Adults (POVA) training, although we also noted that there has been an internally run adult protection course. We examined the rota, which under normal operating circumstances appears to have sufficient numbers of staff to meet the needs of service users. However we were made aware, and observed, that when staff are called away from their primary responsibilities there is insufficient flexibility to cover for any gaps created by reallocating staff to other duties. This significantly increases the vulnerability of service users. Almost all the staff surveys we received identified shortages of staff as being a concern. Our observations on the day evidenced that the level of interaction between staff and service users was minimal. Ideal Home DS0000064647.V363235.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 36, 38 Quality in this outcome area is adequate. The quality of people’s lives who live at Ideal Home is being compromised because the manager is failing to act on requirements for improvements made by professional bodies and also ideas for improvements by the service users are being sought but as yet not acted upon. The lack of formal supervision and poor communication on occasions has meant that peoples needs are going unmet and the manager is not acting upon issues that are raised by her staff team in order to improve the service and keep people safe. This judgement has been made using available evidence including a visit to this service. Ideal Home DS0000064647.V363235.R01.S.doc Version 5.2 Page 22 EVIDENCE: The manager holds the Registered Manager’s Award (RMA) and NVQ 4 (Care). She has several years experience of working with both older people and younger adults. The deputy manager is currently undertaking her RMA. The manager cooperated fully with us during the inspection however on occasion seemed unaware of issues that were affecting the quality of the service provided. Some information held by the manager had not been passed on to the staff team and as a result issues relating to peoples care and support needs were not being addressed The quality assurance systems in the home are underdeveloped. Although we were shown several in-house surveys from service users and family members there was no evidence of how the information acquired was being used to influence practice. The manager informed us that surveys had been sent out to professionals but very few had been returned at the time of the inspection. General responses from family members indicated overall satisfaction, whereas professional responses received to date were mixed. A common theme of dissatisfaction was related to activities, where it was felt much more could be done to stimulate and occupy service users. Our observations on the day supported the survey comments that there was a lack of activities. We examined the record of activities that had been undertaken and noted that a small percentage of service users were involved in a high percentage of activities. The manager expressed the view that most service users declined any activities that were offered. We checked staff supervision records and noted that there are significant shortfalls in supervision frequency. Some senior care staff are falling seriously short of the national minimum standard (NMS) of 6 formal supervisions per year. One senior had attended two sessions in the last year and another senior only one. The potential impact on the quality of service provision to those living at the home is significant and more effective monitoring by the manager is essential to address this shortfall. We examined the most recent Environmental Health Officer (EHO) report. The manager confirmed that most of the actions required had been completed (and our tour of the premises confirmed this) but when asked about the requirement to complete risk assessments regarding the use of ladders and the management of stress at work we were informed that they might have been done, but we were not provided with any evidence of this during the visit. The most recent fire officer report also contained some requirements but we were satisfied that these had been acted upon, following our examination of fire records. We were concerned though that the home has not conducted a comprehensive fire risk assessment to ensure that service users and staff are fully protected from preventable fire risks, especially as there is an issue with Ideal Home DS0000064647.V363235.R01.S.doc Version 5.2 Page 23 service users smoking in non-designated smoking areas, including their own rooms. Health and safety related training has taken place and records show that it has covered areas such as safe handling of food, infection control and manual handling. What was not evident was how the manager monitors the effectiveness of health and safety practices in the home and ensures that service users and staff are safeguarded from potential harm. We checked the recent reports arising from Regulation 26 visits. No visit took place in April 2008 and although visits have been happening regularly there is no set format for the reports. We noted three different formats had been used in the past few months. At the time of the last key inspection carried out by CSCI it was found that the home had adopted safe systems for managing people’s money. The manager stated there have been no changes to this system Ideal Home DS0000064647.V363235.R01.S.doc Version 5.2 Page 24 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 2 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 X 3 X 2 X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Ideal Home DS0000064647.V363235.R01.S.doc Version 5.2 Page 25 YES Are there any outstanding requirements from the last inspection? 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 OP7 Regulation 15 (1) Requirement The home must produce a plan of care from robust initial needs assessments for all people living at the home in order to ensure that peoples care and support needs can be identified and met. These plans should be reviewed regularly and updated as people’s needs change. This is to ensure that staff know how to meet a persons care and support needs and can work consistently to ensure that all needs are met Previous timescale for compliance 31/08/07 2 OP9 13 (2) The home must ensure that MAR sheets accurately reflect the medication that a person has been prescribed and decisions for people to administer their own medication must be made using all information available about the risks involved and monitoring processes should identify when this process is failing and having a detrimental effect on a persons health. DS0000064647.V363235.R01.S.doc Timescale for action 04/08/08 24/06/08 Ideal Home Version 5.2 Page 26 3 OP7 13 (4) (b)(c) 13 (5) 15(1) 4 OP12 Unnecessary risks must be 08/07/08 identified and minimised through use of risk assessments. This is to ensure that as far as is possible people remain safe. Plans must be developed which 04/08/08 show how the home is assisting people to develop their social opportunities. The home must ensure that people have regular opportunities to access leisure and recreational activities. This is to ensure that people are stimulated both mentally and physically on a regular basis. Previous timescale for compliance 31/08/07 5 OP27 18 (1) (a) There must be sufficient staff on duty at all times to ensure people’s basic care needs are met and that people have opportunities to enjoy activities both within and outside of the home. This is because the home has a responsibility to ensure that everyone’s care and support needs are met at all times and that people are stimulated mentally and physically to enjoy their lives to the full. Written guidelines must be in place for each individual with complex behaviours living at the home that reflects current safe and best practice. Staff must receive training to manage behaviour that challenges the service and put people at risk of harm. This is to keep both themselves and people living at the home as safe as possible using consistent and appropriate techniques that promote the wellbeing of the person DS0000064647.V363235.R01.S.doc 08/07/08 7 OP18 13 (6) 08/07/08 Ideal Home Version 5.2 Page 27 8 OP36 18(2) challenging the service. The staff must receive recorded professional supervision at least 6 times a year so that issues of practice and care can be discussed regularly and formally. Previous timescale for compliance 31/08/07 08/07/08 9 OP33 24(1) The home must develop an effective quality assurance monitoring system based on seeking the views of the service users that checks whether or not the home is meeting their needs. The findings of such systems must be evaluated and used to improve the quality of the service provided. Previous timescale for compliance 31/08/07 The home must carry out fire risk assessments for all people living within the home (and for the home environment). This is because a number of people living at the home smoke and as a result increase the risk of fires starting accidentally within the home. 04/08/08 10 OP38 13 (4) 08/07/08 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 OP2 Good Practice Recommendations It is recommended that the home ensures that contracts and statements of terms and conditions provided to people who move in to the home accurately reflect the service DS0000064647.V363235.R01.S.doc Version 5.2 Page 28 Ideal Home that they will receive and exactly what they will get for their money. 2 OP14 It is recommended that people living at Ideal Home should have opportunities to develop independent living skills in relation to preparing and serving of meals. This would then reflect the ethos of the home as detailed in the AQAA submitted to CSCI by the manager of the home It is recommended that the manager records that people have been offered a key to their bedrooms and the reasons why they have not got one if that is the case. This will demonstrate that people have been offered a choice and will also identify any risks that have been assessed if a person is unable to have a key. It is recommended that the manager take action to ensure that insects cannot get into food storage areas through open windows. This is to reduce the risk of cross contamination of food. It is recommended that the manager review health and safety risks to people walking under the metal stairway in the garden. This is to reduce the risk of injury to people. It is recommended that the home have a register of all the CRB disclosure numbers, when they were received and dates for renewal. This is to demonstrate that the process has been followed after the original disclosures have been destroyed. It is recommended that the home access an external training provider to provide an accredited POVA course as soon as possible. This will ensure staff receive current best practice guidelines that are consistent with other providers. The home must consider the impact of the arrangement for placing someone at the home short term in a shared room It is recommended that the home action requirements made by Environmental Health Officer. 3 OP24 4 OP19 5 6 OP19 OP29 7 OP30 8 9 OP23 OP19 Ideal Home DS0000064647.V363235.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ideal Home DS0000064647.V363235.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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