Inspection on 20/04/08 for Isard House

This inspection was carried out on 20th April 2008.

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

Other inspections for this house

Isard House 25/03/09

Isard House 25/04/07

Isard House 19/04/06

Isard House 11/12/05

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Isard House Glebe House Drive Hayes Bromley Kent BR2 7BW Lead Inspector Miss Rosemary Blenkinsopp Key Unannounced Inspection 08:50 15 and 20th April 2008 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 Isard House DS0000063943.V361499.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. Isard House DS0000063943.V361499.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Isard House Address Glebe House Drive Hayes Bromley Kent BR2 7BW 020 8462 6577 020 8462 0952 isard.manager@shaw.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) Shaw Healthcare Ltd Lesley Janet Walker Care Home 45 Category(ies) of Dementia (45), Old age, not falling within any registration, with number other category (45) of places Isard House DS0000063943.V361499.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 (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (maximum number of places: 45) 2. Dementia - Code DE (maximum number of places: 45) The maximum number of service users who can be accommodated is: 45 25th April 2007 Date of last inspection Brief Description of the Service: Isard House is a large two-storey building built around two secure quadrangles. The home is set at the end of a cul-de-sac with open fields bordering onto the rear and side of the home’s grounds. Isard House is situated within walking distance of public transport links and local shops. Since April 2005 Shaw Healthcare have been responsible for the management and provision of this service. Referrals are made through the Local Authority Social Services Department. The home does have two beds available for private purchasers. This home provides care and accommodation for 45 older persons who may or may not have dementia. In the last year Shaw Healthcare have reduced the number of double beds to one and the remainder are all single rooms. Resident’s accommodation is mainly on the ground floor. There are grab and hand rails in corridor areas, stairs, toilets and bathroom. Specialised bathing and toilet equipment and lifting aids are available for residents use. There are various lounges and sitting areas available. Fees range from £458.17 to £624.00. The fees for Local Authority placement Isard House DS0000063943.V361499.R01.S.doc Version 5.2 Page 5 and those purchasing care privately are different as are the fees for those with Dementia. Items such as toiletries, hairdressing, and private chiropody are paid from individual’s personal monies and not included in the fees. The home provides information on the service through a Statement of Purpose, which can be supplemented on request with a copy of the latest inspection report. Isard House DS0000063943.V361499.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating of the service is 1 star. This means the people who use this service experience adequate. The site visit was conducted over a one and a half day period. The second visit was conducted Saturday afternoon. The inspector spent time on all three units although the majority of the first day was spent on Keston unit. During the second visit observation periods were conducted on Langley and Hayes units. Prior to the inspection the Manager had completed the AQAA document and forwarded this to the inspector. Comment cards had been sent the home for completion. During the course of the site visit further comment cards were given out to relatives, staff, residents and health professionals. At the point of writing this report three comment cards had been received from relatives Four staff were interviewed including a Team Leader and an agency worker. The inspector met with several relatives over the course of the two site visits. The Manager supplied all information requested including staff personnel files, health and safety service records as well as quality assurance documentation. Other records, which were considered, were those, which the CSCI had received, in the previous year including Regulation 37 notifications and Regulation 26 reports. What the service does well: Comments received from visitors indicted that they were pleased with the service. They felt staff were caring and felt confident that their loved ones received good care. Comments related within comment cards from relatives indicated that the Manager was available and approachable. The open management ethos was evidenced during the site visit. The company has placed great emphasis on quality assurance and introduced a number of measures to audit quality. Staff training is another area where there is significant investment to ensure staff are competent in their roles. Shaw Healthcare have developed a number of systems for financial accounting to ensure that resident’s finances are safe and measures are in place for ease of auditing. These systems make in easy to identify any errors in accounting, which can be addressed speedily. Isard House DS0000063943.V361499.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Comments received from relatives indicated that brochures and other information were not always received prior to admission. Many of the prospective residents are unable to take advantage of trial visits to the home and in such cases pre admission information is important. The admission information must be comprehensive in content to ensure staff are furnished with enough detail to provide the care required. Care plan documentation needs to be fully reflective of needs, and when risks are identified action implemented. A period of observation was undertaken on one unit. Within this unit, the interactions, communication and contact with residents were very limited and only evident when tasks were performed. Lack of supervision of residents introduced an element of risk. There was lack of fluids on two units Keston and Hayes. Fluid charts were not specific in the amount of intake that residents had taken; therefore it would be difficult to detect signs of dehydration. More care needs to be taken by staff to ensure reality orientation measures are accurate. Isard House DS0000063943.V361499.R01.S.doc Version 5.2 Page 8 Shaw Healthcare needs to continue with a programme of works to ensure that until the closure of the home areas are maintained in a safe and comfortable manner. 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. Isard House DS0000063943.V361499.R01.S.doc Version 5.2 Page 9 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 Isard House DS0000063943.V361499.R01.S.doc Version 5.2 Page 10 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The pre-admissions procedures do not always provide staff or residents with the information they require to ensure they can meet individuals’ needs and that residents are able to make a decision on whether the service is right for them. EVIDENCE: The home had available a Service User Guide and a Statement of Purpose. At the time of the inspection there were 43 residents in the home, three of which had been recent emergency admissions. The assessment information for four residents was inspected. Shaw Healthcare has standard documentation for all aspects of assessments and care planning. The home had completed the assessment documentation, following a pre assessment visit. Gaps were evident in parts of these documents. In particular Isard House DS0000063943.V361499.R01.S.doc Version 5.2 Page 11 the section headed “Background and Social” was limited in what information it provided about the resident. Other information obtained prior to admission included in one file a hospital discharge letter. Social Service’s assessments and documentation were available in all. Some good information was contained within these documents and would provide staff with useful information on which to base a care plan. Omissions in information need to be avoided as this limits the amount of information staff have access to, and on which to base an initial care plan. Further information regarding the resident should be obtained from the multi disciplinary team relating to their wider health care needs. Relatives confirmed that they had been to visit the home prior to admission one stating that they had made an unannounced visit one evening. Comments related to the inspector verbally and within a questionnaire advised that a brochure was not received prior to admission. There was no documentation in relation to trial visits by the families’ of residents or reference to what information had been provided pre admission. It is essential that comprehensive assessment information be obtained, as this is the basis on which care is provided to the resident. Once admitted residents are issued with service agreements which itemises fees to be paid and includes reference to the trial period. The inventory of property and valuables received in to the home was in some files, incomplete. This introduces a margin for error where discrepancies in relation to personal possessions brought into the home could occur. It was evident in the resident’s records that these had been audited and gaps in recordings commented upon, which highlights that monitoring is taking place. Please see requirement 1. Isard House DS0000063943.V361499.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The inspector observed that care needs were addressed by staff in the home, and that they have the support of the multi disciplinary team. The supporting records need to be fully completed and comprehensive in content to ensure that they provide sufficient information for staff to deliver the care. Medications are safely managed which provides protection to residents. EVIDENCE: There was a long period of observation on Keston unit during the first site visit. On the second site visit time was spent on Hayes and Langley units. Issues around the provision of health care, privacy, dignity and respect were monitored. During the tour of the home it was observed that equipment was in use including hoists and pressure relieving mattresses. The Manager explained that obtaining some equipment was difficult and delays often occurred. The Isard House DS0000063943.V361499.R01.S.doc Version 5.2 Page 13 Manager identified one resident who required specific equipment, which had not been obtained despite her best efforts. Further enquires by the Manager were being made to ensure that the equipment required could be obtained. A selection of care plans were inspected. In general the care plans were to a variable standard. The actual care issues identified within care plans followed the activities of daily living structure. They were reviewed although without evidence of input from the resident or their advocate. Night care plans are in operation in this home. There were some good records under the interventions section of the care plan detailing the actions to take to address the identified care needs. This provides staff with good information on how to provide the specific care for the individual resident. Risk assessments were in place for general and specific issues pertaining to the individual residents. Documentation for risk assessments covered areas such as the use of bedroom keys, manual handling nutrition and falls. In these assessments some of the records indicated that high risks were present, in particular those areas relating to skin integrity and nutrition. Where a high risk is identified action must be taken to address the risk and the frequency of the review period increased. Deterioration can occur very quickly in older people and this must be closely monitored. The weight records for two residents indicated significant weight losses and the nutrition risk assessment identified the risk. The weight continued to be checked monthly and no comment was recorded regarding the concern over the loss of weight. Supporting records included a food preference list and a diet information sheet dated 1/7/07, which identified resident’s likes and dislikes. One resident had been admitted the day before the site visit and her documentation was in the main blank. Some of this could have been completed by night staff including the manual handling risk assessment and the property list. The records of multidisciplinary visit were completed with GP entries in the main. This confirms that residents have domiciliary visits by specialist and GP services to meet their full health care needs. Records relating to fluid balance were not completed with sufficient information. Entries such as “ one glass “ were commonly recorded. The totals for the 24 period were not complete hence it would not have been possible to establish if residents were drinking sufficient amounts to prevent dehydration. The medication systems were inspected. Medications were safely stored. Records for the fridge and room temperature were in place. The medication charts were completed with a clear photograph of the resident and allergies recorded. Those medications received in to the home were signed as received. Medications which are prescribed, “ as required “ need to have full instructions Isard House DS0000063943.V361499.R01.S.doc Version 5.2 Page 14 completed including the maximum dose, where applicable duration and reasons for the administration. Hand transcriptions need to have two staff signatures to confirm the accuracy of the information recorded. A list of staff signatures was in place of all staff that administer medications. Those medications, which were to be returned to the pharmacy, were itemised although without the staff signature in place. The collecting pharmacist had signed the record that the medications received in to their care were accurate. The records for controlled drugs were accurate and the amount correct. The controlled drugs cabinet is due to be replaced, as the current one is unsatisfactory. The first aid boxes were depleted of blue plasters in particular those in the kitchenette areas. Regulation 37 reports regarding incidents are forwarded to the Commission and action taken when required. These reports provide good information on what incidents occur in the home and home is working to effectively to manage them. Good feedback was received from a Social Worker who had recently placed a resident in Isard House. She relayed favourable comments regarding staff interactions and the fact that they had worked hard to settle the resident and support the relative throughout the process. One comment card received after the two sites visit indicted staff communicated any developments to relatives quickly although more attention to personal hygiene was required. Please see requirement 2 and 3. Please see recommendation 1. Isard House DS0000063943.V361499.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The lack of appropriate activities and engagement does not ensure that residents are stimulated physically or mentally. Limited choices means residents are not enabled to input into their day. This reduces resident’s independence and will negatively impact on individuals’ well-being. EVIDENCE: In Hayes Unit the TV was playing children’s cartoons. The dining tables were laid in preparation for breakfast with clear print menus. Two residents spoke to the inspector one commenting, “ They make a lovely plate of porridge “. They seemed quite content about the home and care they received however commented “ not much in the way of activities” then added that he did enjoy feeding the fish. Residents on this unit were fairly well presented. The inspector visited Keston Unit and spent a long time observing. On this unit the TV was playing no other activities were taking place. There were daily newspapers available magazines and games although these were not used. Isard House DS0000063943.V361499.R01.S.doc Version 5.2 Page 16 Residents were sleepy and three were slumped forward sleeping in their chars. Staff did not engage with them except when they needed to address care issues, for instance take them into the dining area. Some very poor interactions were observed. One particular incident was following a comment, made by the inspector to a staff member, about the residents “ pop socks,” suggesting they may be too tight. The staff member went to the resident and without any explanation or introduction pulled the “ pop socks” up and pulled her dress down, came back and said to the inspector, that they were not too tight. This was of concern as the staff member made no attempt at engaging with the resident communicating or explaining. This was more concerning as this staff member was in the process of completing Dementia training. The breakfast was observed on Keston Unit. The porridge and tea, which were being served, were tested. The porridge was in an open plastic bowl and the tin foil covering it to one side. The trolley was the non-heated type. The porridge was tepid, the tea very strong and cold. This was still being served to residents some time after it was tested. The feeding of one resident was done standing next to her with no engagement. After a few spoonfuls this staff member went to another resident and said, “ wake up and eat your porridge” whilst patting her back. She then returned to the first resident and continues feeding her. The meal was not a pleasant affair. Mealtimes are important in resident’s lives and should be an activity, which is enjoyed. The demeanour of residents, the lack of choice and task orientated method of feeding the residents left a very negative impression. Of the six residents in the dining area four were in wheelchairs and three were sleepy. Fresh tea was made at 09: 50 am. Residents looked dishevelled in particular their hair was untidy and little evidence of grooming. One lady in the sitting area was noticed to be wearing slippers, which were far too big for her. Staff did not notice this although once pointed out acted upon the information and changed the slippers. There were few signs of well being amongst the resident population. One staff member was observed during the late afternoon, sat in the corner of the lounge to complete charts. Engagement with residents was negligible. There were periods on Keston Unit where there were no staff supervising residents this was particularly noticeable prior to lunch when the door to the kitchette area was open. During the second site visit observations were undertaken on Hayes and Langley units. The TV was on silent and the radio playing. The TV was showing an old movie so staff stepped in and turned of the radio and put the TV on although from the back of the room it could not be heard. Isard House DS0000063943.V361499.R01.S.doc Version 5.2 Page 17 Interaction between staff and residents was better more spontaneous and not always task orientated. There were lots of visitors in the home all of whom made positive comments about the staff and the care they provided. There was evidence of a lack of fluids in communal araes on both visits. Please see requirements 4 and 5. Please see recommendations 2 and 3. Isard House DS0000063943.V361499.R01.S.doc Version 5.2 Page 18 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 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents feel they are listened to, any concerns they have responded to and acted upon. Together with sound adult protection procedures this ensures people feel safe and protected. EVIDENCE: Shaw Healthcare has a comprehensive policy on dealing with complaints. It includes time frames for responses and includes information on contacting and referral to external bodies. Staff with whom the inspector met were aware of the need to report incidents of suspected or actual abuse. They related the internal reporting structure and knew that Social Services could also be contacted. The staff’s knowledge in this area affords protection to residents, as employees are fully aware of the significance of reporting and acting upon any suspected or actual abuse incident. Within the complaints documentation there was one complaint recorded, dated December 2007. Complaints are recorded on a standard form. Head office monitor complaints to identify if there are any emerging themes. Isard House DS0000063943.V361499.R01.S.doc Version 5.2 Page 19 Staff confirmed that they had received training in dealing with abuse although some needed this to be updated. Staff were aware of the need to report incidents of suspected or actual abuse. Isard House DS0000063943.V361499.R01.S.doc Version 5.2 Page 20 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): 19,26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are provided with an adequate standard of accommodation where improvements would provide further comfort to those living there. EVIDENCE: The home is part of a re provision programme which Shaw Healthcare are undertaking. This home is ear marked for closure 2011. The home is an older building, which requires considerable maintenance and investment to retain it to an adequate standard, although bedrooms were comfortable and personalised. Until the closure takes place upgrading and maintenance needs to be continued to maintain the building in a clean and comfortable manner. There have been some improvements made to the home. Redecoration and some new carpets have been addressed. New flooring was evident in Keston Dining Room. New flooring is planned for the kitchens on Keston and Hayes. Isard House DS0000063943.V361499.R01.S.doc Version 5.2 Page 21 Bedrooms were selected for viewing as well as some bathrooms. Bedrooms were in the main personalised with photographs ornaments sweets etc. More care needs to be taken when edible items are brought in to the home as a box of chocolates and a box of jelly babies were found to have expired. There were odours present in the hall area and a few bedrooms. It was noticeable that the majority of call bell leads were tied up to the wall panel – this was early morning before cleaning had taken place. Call bells must be in reach for residents to use so that they can call assistance in an emergency. In the event that they are unable to use the call bell, additional risk assessments must be in place with sufficient precautions to maximise resident’s safety. Shaw Healthcare have allotted money for further upgrading in the home, which includes plans to replace the curtains in individual bedrooms. Some areas required attention including bathrooms, which had cracked wall tiles, the carpets in these bathrooms also needed attention. Several of the clocks in bedrooms were showing the incorrect time. When people suffer Dementia, disorientation is very evident and all efforts to maximise orientation must be made whilst retaining a domestic feel. The garden was beautifully presented and in warmer weather was said to be well used and enjoyed by residents. Please see requirement 6. Please see recommendation 4. Isard House DS0000063943.V361499.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are provided in sufficient numbers to address individuals’ needs. Training provided is not always reflected in practice meaning residents needs are not consistently addressed or met. Robust recruitment procedures of those staff working in the home, afford protection to the residents who live in the home. EVIDENCE: The staffing levels during the morning are as follows: two Team Leaders and six care staff. One Team Leader manages Langley Unit whilst the second one manages the other two units. It is perhaps because of the lack of management on these two units that some poor practice was observed, as previously referred to. The Manager is supernumerary. The home has two administrators, a handyman who works part time, cooks and domestics. The staffing levels were raised in two comment cards received from relatives indicating more staff were needed. The Team Leader facilitated the inspection until the Manager arrived. Isard House DS0000063943.V361499.R01.S.doc Version 5.2 Page 23 During the afternoon shift there were three agency care workers on duty. Agency staff are used to cover the vacancies. The home is also in the process of appointing an activities person as the previous one left. Several staff met with the inspector over the two site visits. The staff confirmed that they had received Shaw Healthcare induction and this included those staff that had previously worked with BUPA. They confirmed that a lot of training was provided including NVQ training and Dementia in addition to updates on mandatory topics. Staff who were interviewed had some knowledge of residents in their care likes etc, although were less competent in clinical matters. Knowledge of Dementia was variable and in some cases limited. Approximately 55 of staff have or are in the process of completing NVQ level 2 or 3. There is minimal staff turnover, which ensures that residents are provided with a consistent staff team. There is a mix of male and female care staff so residents can have their gender preferences addressed. A selection of staff files were inspected. They contained evidence of POVA first and CRB clearance. Application forms, references, identity checks and health questionnaires were also on file. These checks confirm that staff are authentic both in terms of their past employment, experience and identity. References had been sought and obtained; some had been received with company stamps to verify authenticity, however some were without. If references are without company stamps it would be difficult to ascertain authenticity. The Manager indicated that supervision of staff was not fully operational this was confirmed by staff some of whom had received it, some of whom had not. Please see requirement 7 and 8. Isard House DS0000063943.V361499.R01.S.doc Version 5.2 Page 24 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed with systems in place to continually improve the quality of care provided and to ensure the safety and well-being of those living there. EVIDENCE: The Manager is an experienced individual who has had experience of managing care home in the past. She was the Deputy Manager in the home before her appointment to the permanent Manager’s position November 2006. One comment card indicated that the Manager was always available and tours the home frequently. Another comment card stated that they were “ Pleased they have an open door policy “. Home always appears calm “. Isard House DS0000063943.V361499.R01.S.doc Version 5.2 Page 25 A selection of health and safety documentation was inspected and found to reflect regular servicing and checks of equipment in use in the home. The records were well organised and easily accessible. The home had a clear fire risk assessment in operation. Fire drills had been conducted frequently and staff signatures were in place to evidence that they had attended the training. Servicing of fire equipment had taken place March 08. Other records confirmed regular checks on fire exits, weekly alarm testing and emergency lighting. Staff meetings were said to be held regularly although not minuted. Without minutes of meeting it is difficult to establish if and when they were held, and the content of them. The last relatives meeting had been held 12 April 2008, which was well attended. The home has a fund raising committee, which is made up of relatives. This has been successful in raising money and the profile of Isard House. The quality department of Shaw Healthcare visit every six months and audit the home. Following these audits a report is produced and an action plan to address shortfalls implemented. Comment cards are sent out via post to relatives to seek their views on the service on a three monthly basis. The information obtained through this process is collated and any shortfalls actioned. Regulation 26 visits are conducted and a report on the findings left. Two resident’s monies were checked. Staff signatures were in place to confirm transactions. Petty cash vouchers verified expenditure for the hairdresser and the chiropodist. Financial audits and undertaken regularly by Shaw Healthcare. Isard House DS0000063943.V361499.R01.S.doc Version 5.2 Page 26 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 2 X X X 2 X X X X X X 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Isard House DS0000063943.V361499.R01.S.doc Version 5.2 Page 27 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 OP3 Regulation 14 Requirement The Registered Person must ensure that full assessments are completed on all residents prior to admission, to ensure staff have the information they require to meet residents needs. The assessments must be sufficiently detailed, signed and dated by the individual completing the assessment. This is an outstanding requirement. The previous timescales of 1/11/05 and 1/12/06 has not been met. The Registered Person must ensure care plans and all of the supporting documentation reflects the resident’s needs so that staff have sufficient information on which to base the care. These must be reviewed regularly with residents and relatives involved in the process. The Registered Person must ensure that privacy dignity and respect are implicit in all contact and engagement with residents. DS0000063943.V361499.R01.S.doc Timescale for action 01/08/08 2. OP7 15 01/08/08 3 OP10 12 31/05/08 Isard House Version 5.2 Page 28 4 OP12 12 5. OP15 16 The Registered Person must ensure that appropriate and sufficient activities are provided for residents to ensure mental stimulation whilst living in the home. The Registered Person must ensure that service users are provided with the support and assistance specific to their needs to ensure their nutritional needs are being met. This is an outstanding requirement. The previous timescales of 1/11/05 & 1/02/06 have not been met. The Registered Person must ensure that the home is free from malodours to provide residents with a fresh environment. This is repeated requirement with previous timescales not met. The Registered Person must assess the dependency of residents in the home to ensure the staffing levels meet the needs of the residents. The Registered Person must ensure that staff training is incorporated into the everyday practices and care of residents 01/06/08 01/06/08 6. OP26 16 01/06/08 7 OP27 18 01/06/08 8 OP30 28 01/06/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Isard House Refer to Good Practice Recommendations DS0000063943.V361499.R01.S.doc Version 5.2 Page 29 1. Standard OP8 The Registered Person should ensure that food/fluid charts are accurately completed to ensure staff are able to determine that residents nutritional and hydration status is adequate. The Registered Person should ensure that staff provide appropriate activities, stimulation and interaction with residents on the dementia units. The Registered Person should ensure that adapted crockery and cutlery are provided to assist residents at meal times. The Registered Person should ensure that there is appropriate guidance and orientation for residents on the dementia units. 2. OP12 3. OP15 4. OP22 Isard House DS0000063943.V361499.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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 Isard House DS0000063943.V361499.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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