CARE HOMES FOR OLDER PEOPLE
Kara House Residential Care Home 29 Harboro Road Sale Manchester M33 5AN Lead Inspector
Sylvia Brown Unannounced Inspection 29th January 2008 8:00am 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 Kara House Residential Care Home DS0000005617.V357725.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. Kara House Residential Care Home DS0000005617.V357725.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Kara House Residential Care Home Address 29 Harboro Road Sale Manchester M33 5AN 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) 0161 973 0754 0161 969 0223 Trinity Merchants Limited Mrs Gail Dunwoodie Care Home 22 Category(ies) of Dementia - over 65 years of age (22), Old age, registration, with number not falling within any other category (22) of places Kara House Residential Care Home DS0000005617.V357725.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. A maximum of 22 service users may be accommodated. Service users will be aged 65 years or over, requiring personal care only by reason of old age or dementia. They may additionally have a physical disability. The bedroom situated on the ground floor, previously used as an office, is for the use of service users on a short stay or respite basis only. 3rd September 2007 2. Date of last inspection Brief Description of the Service: Kara House is a private residential care home that provides accommodation and care for up to 22 service users. It is owned by Trinity Merchants Limited. The large Victorian property has the main garden to the rear of the property with car parking spaces to the front of the building. The home currently offers service users the use of two lounge areas where they can meet with each other to socialise and have company during the day and evening. There is also a dining room which, when not in use at mealtimes, is used for activities. Currently, there are 15 single bedrooms and three double bedrooms. A stairlift to the first floor enables service users to reach bedroom and bathing facilities. The home is situated in a residential area of Sale, within easy reach of the motorway network, public transport and the local shops. The total refurbishment and upgrading of Kara House continues. Upon completion and registration, the home will offer approximate 15 additional places and service users will have the use of upgraded accommodation that includes additional dining space. Most bedrooms will have en-suite facilities with showers suitable to support those people with mobility difficulties and disability. The current fees for accommodation at the home are £374 to £520 per week. The fee structure is dependent upon individual financial arrangements and type of room. Additional costs may be incurred for hairdressing, dry cleaning and private chiropody treatments. Kara House Residential Care Home DS0000005617.V357725.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 1 star. This means the people who use this service would experience adequate quality outcomes.
The inspection report is based on information and evidence gathered by the Commission for Social Care Inspection (CSCI) since the last key inspection, which was completed in September 2007. During the inspection process we gathered information from a number of people, which included talking with and seeking the views of service users. We sent out surveys to service users, relatives and members of staff. This gave them an opportunity to talk with us about their opinions on the services provided at Kara House. On the day of the inspection visit we were able to share a meal time with service users and observe care and support practices by staff as they went about their daily routines. In October 2007 the then manager of Kara House, completed a selfassessment form which is called an Annual Quality Assessment Audit (AQAA). This told us what the home had been doing since the last key inspection to meet and maintain the National Minimum Standards. Since that AQAA was completed, there has been a change in the management of the home, in that, a new manager has been recruited, as has an operations manager whose responsibility it is to ensure standards are maintained within the three homes run by Trinity Merchants. As a consequence, the managers voluntarily updated the AQAA, to ensure that it reflected their views and present day standards, as well as their future development plans. We also gathered information through general contact with the home through their reporting procedures and through information we received from the, other people, such as the general public, including concerns and complaints procedures. During this inspection a pharmacist inspector completed a full audit of the home’s medication procedures; this included looking at how the home ordered, received, stored and administered medication. Medication administration records were also looked at. We looked in depth at records and the care support of two people living at the home. This helped us get a better view about how people living at home are looked after and supported from admission to present day. Kara House Residential Care Home DS0000005617.V357725.R01.S.doc Version 5.2 Page 6 This visit was unannounced, the manager and staff were not told that we would be visiting. As a consequence of the outcome of the last inspection, the registered provider was required to provide us with an improvement plan, which had to clearly tell us how they were going to meet the requirements given to protect and ensure the health, safety and wellbeing of service users. From the information gathered we made the judgment about how the home was meeting the National Minimum Standards (NMS) and we made the overall judgement on the quality of the service. What the service does well: What has improved since the last inspection?
Many care practices have been developed and improved in order to ensure that people living at the home receive a good, consistent standard of support to meet their individual needs and preferences. As well as the new manager, it is recognised that the new operations manager has also influenced how the home has developed, by frequently visiting the home, talking with service users, observing staff practice and working alongside the manager to improve standards.
Kara House Residential Care Home DS0000005617.V357725.R01.S.doc Version 5.2 Page 7 Comments received from relatives told us that the new manager has had a positive effect on the home. Some of the comments made include “The change in manager is making things clearer and easier”, “the new management takes more of an interest in the individual needs and requirements of the service users.” Focus group meetings have been developed which means that people who use the service and their relatives are able to meet in a group with the management and staff of the home. Service users are now offered more choice, for instance, they are able to get up in the morning at times suitable to themselves, have more choice at mealtimes, have individual bathing routines and are able to choose their own routines at night-time. This means that, generally, routines in the home are now based around the individual needs of service users rather than staff. Improved medication administration procedures have been put into place which include how medication is managed, given to service users and recorded. Service users are now more likely to receive their medication as prescribed and in a safe manner. Infection control procedures have also been improved. Observation of the environment showed that improved hygiene standards were in place and that staff practice had improved, which means the risk of the spread of infection within the home has been minimised. Fire safety procedures had also been improved. Routine fire safety checks were being completed at the required frequency; staff received training in fire safety matters, including routine unannounced practical fire drill training. All of this will ensure that staff will know and be more confident to support service users in the event of a fire safety emergency. The home continues with its extensive upgrading programme. Some service users have moved into the new and improved bedrooms, which are furnished to a high standard. The information we received from staff told us that the new management procedures at the home have not been too disruptive and they feel more positive about many of the changes that have occurred. Kara House Residential Care Home DS0000005617.V357725.R01.S.doc Version 5.2 Page 8 What they could do better:
Though many areas of practice have been improved, there still remains opportunities for the home to develop and maintain standards. They need to make certain that medication is always administered to service users as prescribed. In order to ensure service users’ health and wellbeing are not placed at risk, they should also ensure that enough staff are trained to give out medication when required, which includes night-time. The managers should make sure that accurate records are kept about the process completed for the recruitment and selection of staff. They should be able to demonstrate that robust recruitment and selection procedures are in place, which include interviewing procedures, the offer of employment, any probationary periods completed by new staff and contracts issued. Such practices should minimise the risk of service users receiving support from people who may place them at risk. Kara House must be managed by someone who has successfully completed the registration process with us. The registration process reduces the risk of homes being managed by unsuitable people. The manager needs to submit an application for registration to us without delay. Care plans should reflect service users’ individual personal preferences for care support; they should also detail how support should be provided by staff. This would increase consistency of care support and ensure service users’ needs are met as they prefer. Service users’ independence and choice should be promoted at meals times. Opportunities should be in place to enable them to make daily choices on what meal items they want and be able, wherever possible, to serve themselves. In order to ensure staff have the required knowledge and understanding in the general aspects and requirements of supporting older people, they should receive essential and mandatory training suitable for the position they hold and duties expected of them. This includes ancillary staff. Records should be accurately maintained to demonstrate that the home is following robust recruitment and selection procedures, including interviewing procedures, offers of employment and staffing contracts and any probationary periods undertaken. Kara House Residential Care Home DS0000005617.V357725.R01.S.doc Version 5.2 Page 9 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. Kara House Residential Care Home DS0000005617.V357725.R01.S.doc Version 5.2 Page 10 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 Kara House Residential Care Home DS0000005617.V357725.R01.S.doc Version 5.2 Page 11 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): 2&5 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. People thinking about moving into Kara House are visited and have their needs assessed. They are able to visit the home before making any decisions about their future. The home does not offer a service which relates to standard 6. EVIDENCE: There has been one new service user admitted to the home since the last inspection. The manager told us that she visited the service user in their own home and assessed their needs. This ensured that the home was confident they could meet the service user’s needs before they decided if they wanted to move in. The service users’ records identified that the home had completed pre-assessment records which told us the service users had been consulted about their needs before moving in.
Kara House Residential Care Home DS0000005617.V357725.R01.S.doc Version 5.2 Page 12 Service user surveys told us that service users were usually given enough information about the service and were able to visit the home before making any decisions about their future. Surveys also confirmed that prospective service users were able to visit the home with a relative and/or friends before making any decision about moving in. Kara House Residential Care Home DS0000005617.V357725.R01.S.doc Version 5.2 Page 13 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. Service users have their health and personal care needs recognised and recorded. They receive their medication as prescribed and are treated with dignity and respect. EVIDENCE: As part of this inspection, the pharmacist inspector looked at how safely medicines were handled. Records about medicines were looked at together with medication held for service users to make sure service users’ health was not at risk. Medication handling had improved a great deal since the last inspection and service users’ health was no longer at risk due to poor practice. Kara House Residential Care Home DS0000005617.V357725.R01.S.doc Version 5.2 Page 14 The medication policies had not been reviewed or rewritten. As a result, it still did not to cover some basic areas of safe medication handling and administration. However, during the inspection staff were seen to handle medicines well and the good practices observed should be included in the written policy. The storage of all current medicines was good. One service user was able to manage their own medication in a special locked cabinet in their bedroom, which allowed them to take their medicines in the privacy of their own room. Unwanted medication was packed up ready to be collected by the pharmacy for destruction. However, this medicine was not locked away securely which could be a risk to the health of service users. The records regarding medication had improved. The records clearly showed what medication had been given to service users. The records were very clear when medication doses had been changed and new medicines started. If medication had not been given to service users, the records showed the reason why. Most medication could be accounted for because the records were clear. Records showed that service users were usually given their medicines as prescribed. There were concerns that some service users did not have medication given to them as prescribed because the medication was unavailable, either because it had ‘run out’ or because staff could not find the right tablets. Medication that was not given properly included medicines for constipation, diabetes and asthma; the health of these service users could have been placed at risk from harm because they had not received their medication. Sometimes, medicines were not given when service users were away from the home; special arrangements must be made to make sure that service users can have their medication if they are not in the home. It was of concern that sometimes medication could not be given to service users when they needed it, because there were no staff on duty who were trained to administer medicines. On one occasion, the manager had been telephoned to come to the home to administer an inhaler, this is not acceptable. Service users must be able to have medicines given to them when it is needed, without delay. The home does not have a quality assurance system in place that makes sure medication is being administered safely and as prescribed. We were told after the last inspection that a regular checking system would be put in place, this has not been done. It is important to check that medicines are being handled safely to make sure the health of service users is protected. Kara House Residential Care Home DS0000005617.V357725.R01.S.doc Version 5.2 Page 15 The care files of two service users were looked at, they contained up-to-date relevant information. Whilst care plans recorded the needs of service users, they still need to be developed further to ensure that they included how staff should meet the individual needs people using the service. For example, how individual bathing and personal care support should be provided, what support the service user needs when dressing and identify what service users can and are willing to do for themselves. Risk assessments were in place and for those who had mobility issues, falls risk assessments were completed. Service users receive additional health care support services to maintain and ensure they maintain good health, wherever possible. Doctors and district nurses visit the home. Routine checks are completed for hearing, eyesight and dental needs. Furthermore, professional chiropodist treatments are completed. When asked, service users spoke positively about the staff and the support they received, with most saying they felt treated in a dignified and respectful manner. Throughout the inspection visit staff were observed to be courteous, carry out support in a relaxed and caring manner, and taking time to talk with service users as they went about their daily tasks. Kara House Residential Care Home DS0000005617.V357725.R01.S.doc Version 5.2 Page 16 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 good. This judgement has been made using available evidence, including a visit to this service. Service users are able to have control of their own lives and are supported to make most decisions for themselves. They receive a good diet which they enjoy. EVIDENCE: Since the last inspection, the home’s activities programme has been increased. The manager has met with both service users and relatives to discuss future plans, which include visiting outside places of interest. The manager told us that service users have the opportunity to join in communal activities twice daily. From information received and from observations made, service users appeared satisfied with the activities offered. One service user told us “I enjoy arts and crafts”. Another said “I enjoy taking part in activities”. Service users are able to choose if they wish to join in activities or not. One service user said, “I like to stay in my room and watch TV. I am happy as I am”. Kara House Residential Care Home DS0000005617.V357725.R01.S.doc Version 5.2 Page 17 On the day of the inspection visit a number of service users were observed joining in activities and socialising with each other. Service users are able to receive visitors whenever they wish and are able to meet with them in private. Relatives told us they are made to feel welcome and that they believe their relatives are well cared for. The home maintains a record of all visitors which was looked at during the visit and found to be upto-date. The manager has met with service users and relatives to discuss the home’s menu, which has been improved since last inspection. The menu is in the early stages of development but still offers service users improved variety and choices. Service users told us they were satisfied with the food served, with comments “I am a good eater and I enjoy the meals on offer”, “The meals are good” and “Meals are very nice” being made. Even though the menu has improved and service users are consulted more, routines at mealtimes need looking at to make sure they are able to make individual choices, and their independence is supported and promoted at each mealtime. Observations at breakfast were that service users were automatically given cereals with milk and sugar already added. Furthermore, drinks were automatically served with milk and, where required, sugar. Some service users are able to pour their own drinks, and prepare cereals for themselves, particularly pouring of milk and adding their own amount of sugar. It was also observed that service users automatically received toast which was buttered but without the offer of jams/marmalades, etc. As stated previously in the report, action has been taken to support service users to make their own choices about their daily living routines. Staff practice has been amended to ensure that service users are no longer routinely encouraged to rise before 7:00am. The manager told us that should service users wake early, they are offered the opportunity of receiving a drink in their rooms, or should they wish to get up early, are supported to the lounge areas, where they receive drinks and a light snack. Magazines and newspapers are also made available. Night-time records confirmed this practice. Service users were observed getting up when they wished, and independently arriving for breakfast throughout the morning. Records of night-time practices identified that service users have varied and differing times for getting up and going to bed. Records detailed the individual type of bathing routine supported, which showed us that service users are listened to and their preferences recognised. The home is developing focus groups which include consultation with service users and relatives on a regular basis. Kara House Residential Care Home DS0000005617.V357725.R01.S.doc Version 5.2 Page 18 Relatives told us they are kept informed of all relevant and significant events affecting their respective relative. Service users spoken with all spoke positively about the staff and the care and support they received. Kara House Residential Care Home DS0000005617.V357725.R01.S.doc Version 5.2 Page 19 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 & 18 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Service users know and feel confident to use the home’s complaints procedure. Policies and procedures are in place, and staff have commenced adult protection training which safeguards service users from harm. EVIDENCE: When asked about their satisfaction with the services offered, service users were generally happy. They seem to know about the complaints procedure and had the confidence to raise any issues of concern with staff or the management team. Three service users told us they would talk to staff if they had any worries or concerns; they told us “I have not needed to make a complaint, but if I did, I would speak to the staff” and “I can speak to all the girls”. A record of complaints is kept by the home, it records the nature of the complaints and the action taken by the home to resolve all matters. Currently, the complainant is verbally informed of the outcome, however the manager told us that future practice will be developed to ensure that complainants will also receive the outcome in writing. The manner in which the home manages complaints told us that complaints received are taken seriously. Kara House Residential Care Home DS0000005617.V357725.R01.S.doc Version 5.2 Page 20 The previous inspection identified that training was outstanding in Protection of Vulnerable Adults (POVA). Training records identified that not all staff have received formal POVA training. However, at induction new staff receive information regarding recognising aspects of abuse and reporting procedures. Training records looked at confirmed that planned training is in place, which should ensure that all staff have received the appropriate training by the end of March 2008. Returned staffing surveys and information directly from staff indicated that staff were aware of adult protection procedures and what to do in the event of a suspicion of abuse. One staff said “If I had any concerns, I would pass them on to my manager”. Kara House Residential Care Home DS0000005617.V357725.R01.S.doc Version 5.2 Page 21 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, 20, 21, 23 & 26 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Service users live in a home which is clean, comfortable and suitable to meet their needs. EVIDENCE: Since the last inspection, the living conditions have improved for service users. The outside of the home has been painted in part and the front garden tidied. Observations of the internal parts of the home identified that cleaning routines had significantly improved. The home was clean and tidy and free of odours. Kara House Residential Care Home DS0000005617.V357725.R01.S.doc Version 5.2 Page 22 There were improved hygiene standards within the home, and the manner in which bathing and toileting areas are now managed has significantly improved. At this visit they were observed to be clean and well maintained. During the inspection new furniture was arriving, which included a selection of new lounge chairs. Service users were being given the opportunity of trying out the chairs and making a decision about which was most comfortable and suitable to meet their needs. We were able to look at the new parts of the building during this visit. The new bedrooms were furnished to a high standard, and those with en-suite facilities include a wet/shower room. These rooms remain vacant until they have been passed and registered by us as of a suitable standard. In addition to completion of new rooms, some older rooms have been totally upgraded, a proportion of which are now available to service users. Those already living in the home have been offered the opportunity of moving from the older parts of the home into the upgraded facilities. Observations of these rooms were that they were bright and airy and offered a good standard. The records of maintenance were looked at. There was clear information about when repairs were reported and completed. The records told us that carpet cleaning was continuous and repair work and maintenance was, on average, completed within two days of being requested. Two service users told us “The home is definitely clean and fresh” and that they thought, “The home is nice”. It is the intention of the home to upgrade the lounge and dining areas once the new extension has been completed and is registered with us. Kara House Residential Care Home DS0000005617.V357725.R01.S.doc Version 5.2 Page 23 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. Service users receive support from people they know and trust. Staff should have completed all essential training and thoroughly detailed records of their recruitment and selection process should be in place, all of which promote the safety of service users. EVIDENCE: Three staff files were looked at; all had completed application forms. We were told by the managers that staff had attended for interview, however the interview process was not always recorded. Even though the home had obtained verbal references, systems should be in place to ensure written references are also received. Not all staff had written references in place and some references were from people in a management position within the home. Where a reference is obtained from people within the home, a third character reference should be sought. This practice would improve objectivity and support the home to demonstrate best practice to safeguard service users. Kara House Residential Care Home DS0000005617.V357725.R01.S.doc Version 5.2 Page 24 The previous inspection identified that training records were not well maintained and we were aware that a number of staff required essential training. There was evidence at this visit that action had been taken to have accurate training records in place. While some staff still need essential and basic training in some areas, records confirmed that training was planned for and that training and development issues were now discussed with staff. Staff have received training in infection control which previously was poorly managed and placed residents at risk. Observations were that staff were following best practice and that the risk of the spread of infection has been reduced. Records were in place to confirm new staff were completing induction procedures that included the Skills the Care induction programme. All new staff have CRB checks in place. Where there is a delay in receiving a full CRB check, a POVA first check is received before staff commence duties. The manager has told us that four staff have started training for a National Vocational Qualification (NVQ) at level 2, with another member of staff undertaking such training at level 3. The manager also told us that a further two staff have made a commitment to NVQ training during the next year. Records looked time told us that staff now discuss their training needs with their manager and plans are in place to ensure they receive all the required training a timely manner. Such practices ensure that service users receive the support they require from staff who are trained and knowledgeable about the needs of older people. Kara House Residential Care Home DS0000005617.V357725.R01.S.doc Version 5.2 Page 25 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, 32, 33, 35, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Service users live in a home which is well managed and run in their best interests. The home is not yet managed by a manager who is registered with the CSCI. EVIDENCE: Since the previous inspection a new manager has been recruited. As a consequence, many of the home’s direct care practices have been reviewed and improved. Kara House Residential Care Home DS0000005617.V357725.R01.S.doc Version 5.2 Page 26 Currently, the manager has not been registered with us as a fit person to run a care home and an application for registration has not been submitted to us to begin the process. Inspection of the manager’s employment file could not confirm what procedures were undertaken to recruit and select her. Though the registered provider and operations manager gave assurances that the correct interview processes had been undertaken, there were minimal records to support this. Furthermore, there were no records to support that the manager had been given in a planned structured induction. Because of the outcome of the last inspection, action had been taken to provide the manager with additional support whilst care practices were reviewed and new systems implemented to develop the general standards within the home. The manager has successfully completed NVQ training at level 4 and is currently completing training to achieve the Registered Manager’s Award. Although not all staff have received supervision at the required frequency, formal supervision has commenced. Good records were in place of supervision sessions and staff meetings were clearly recorded, all of which demonstrated the management and leadership style of the manager. Focus group meetings have commenced, this means that the manager now meets with the service users and their families in a group session to ascertain their views and satisfaction on the services and routines in the home. The home has minimal involvement with service users’ individual finances. Where money is spent on behalf of service users, they and/or their families are given a bill for outstanding monies owed. The home was inspected by fire safety officers in September 2007. The fire safety systems were also serviced in November 2007. This means all aspects of fire safety have been monitored and confirmed as in good working condition in the last four months. The Fire Risk assessment was dated 2005, this needs to be reviewed, updated and confirmed as correct by the home’s Fire Safety officer, particularly in view of the changes within the building. Records were available to confirm that the home completes weekly, monthly and periodical checks and tests on fire safety equipment. The manager told us that staff now receive more unannounced fire safety practices and instruction; fire safety records confirmed this. All accidents relating to staff and service users are recorded. Service users’ files contain copies of the accident reports and are made available to their relatives, where appropriate and agreed. Kara House Residential Care Home DS0000005617.V357725.R01.S.doc Version 5.2 Page 27 In order to identify any common experiences and/or patterns, accident reports are looked at collectively each month. Where appropriate, action is taken to reduce further risk of accidents. The outcome of the accident evaluation is giving each month to the operations manager, whose job it is to monitor such occurrences. Such practices completed by the home in respect of fire safety and accidents ensure, as far as possible, that service users’ health and safety are promoted and that risks to their safety are minimised. Kara House Residential Care Home DS0000005617.V357725.R01.S.doc Version 5.2 Page 28 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 3 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 3 X 3 X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 3 X 3 Kara House Residential Care Home DS0000005617.V357725.R01.S.doc Version 5.2 Page 29 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 OP9 Regulation 13(2) Requirement Timescale for action 30/01/08 2 OP9 18 3 4 OP18 OP31 13 9 All medication must be administered to service users as prescribed, to make sure their health is not placed at risk. (Timescales of 01/08/07 and 11/9/07 not met). 30/01/08 Ensure there are sufficient staff who have been trained to give medicines safely, who are competent and on duty at all times, in order to ensure service users’ health and wellbeing are not placed at risk, with immediate effect. (Timescales of 01/08/07 and 11/9/07 not met). All staff must receive training in 15/03/08 safeguarding adults. (Timescale of 15/10/07 not met). Action should be taken to ensure 15/03/08 that the manager of the home submits an application for registration and that the home is managed by a person who has been registered as a fit person to run a care home by us. Kara House Residential Care Home DS0000005617.V357725.R01.S.doc Version 5.2 Page 30 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 2 3 4 5 6 Refer to Standard OP1 OP7 OP9 OP9 OP9 OP14 Good Practice Recommendations Review the home’s statement of purpose and ensure it contains all the required information, is up to date and is service user friendly. Care plans should include how personal care support is to be completed and be reflective of the individual service users’ preferences. A system to ensure that the quality of the medication service (auditing) should be in place to make ensure service users’ health is not at risk. Medication policies and procedures should be reviewed and updated to reflect current good practice and give clear guidance to staff who give out medication Unwanted medication should be stored securely whilst awaiting collection by the pharmacy. Service users’ independence and choice should be promoted, particularly at meals times. Opportunities should be in place to enable them to make daily choices on what meal items they want and be able to serve themselves, wherever possible. All members of staff, including ancillary staff, should receive essential and mandatory training suitable for the position they hold and duties expected of them. Records should demonstrate the home’s robust recruitment and selection procedures as they are completed for all new staff, including interviewing procedures, offers of employment, staffing contracts and any probationary periods undertaken. 7 8 OP30 OP29 Kara House Residential Care Home DS0000005617.V357725.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Manchester Local Office Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ 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
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