Inspection on 03/09/07 for Kara House Residential Care Home

This inspection was carried out on 3rd September 2007.

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

Kara House Residential Care Home 29/01/08

Kara House Residential Care Home 24/07/06

Kara House Residential Care Home 19/03/06

Kara House Residential Care Home 14/10/05

Kara House Residential Care Home 22/02/05

Kara House Residential Care Home 18/08/04

Kara House Residential Care Home 27/02/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Kara House Residential Care Home 29 Harboro Road Sale Manchester M33 5AN Lead Inspector Sylvia Brown Unannounced Inspection 12:00 3 & 11 September 2007 rd 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 Kara House Residential Care Home DS0000005617.V348242.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.V348242.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 Carol Richards 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.V348242.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st July 2007 Brief Description of the Service: Kara House provides accommodation and personal care for up to 21 service users within the category of old age (OP), but any of the service users could have a physical disability (PD/E) or dementia (DE/E). Kara House is a private residential care home, owned by Trinity Merchants Limited and the home is managed by the registered manager, Mrs Carol Richards. The home is a large Victorian property, set in pleasant and spacious grounds. There are car parking spaces at the front of the building. The two-storey building has a newer extension to the rear of the property. There is a stair lift to the first floor. The home has 15 single bedrooms and three double bedrooms. The home is situated in a residential area of Sale, within easy reach of the motorway network, public transport and the local shops. The current fees for accommodation at the home are £400 to £475 per week. The fees include all meals, laundry, domiciliary chiropody and entertainment. Additional costs include hairdressing, dry cleaning and telephone calls. Kara House Residential Care Home DS0000005617.V348242.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The key unannounced inspection site visit of Kara House was undertaken over a period of two days. Site visits are part of the key inspection process. A key inspection looks at all the key National Minimum Standards to see what the home is doing to meet them. Other standards were also looked at. Prior to the site visit, and as part of the overall key inspection process, the home completed an Annual Quality Assurance Assessment (AQAA) which is a self-assessment and dataset completed once a year by all providers, whatever their quality rating. It is one of the main ways that the Commission for Social Care Inspection (CSCI) will get information from providers about how they feel they are meeting outcomes for people using their service. The AQAA also provides the CSCI with statistical information about the individual service. The AQAA completed by the registered manager was detailed; however, many of the good practices highlighted within the AQAA could not be evidenced by the manager during the site visit. During the site visit two people were case tracked; this means the care of two people was looked at in depth, from the point of their admission to the home. The term preferred by people during the site visit was service users; this term is, therefore, used throughout the report when referring to people living at the home. Comment cards were sent to the home for distribution to service users, their families and staff. One comment card had been returned prior to the report being written. Comments received after the report is completed will be included in the next inspection process. We also spent time observing service users and how staff engaged with them. Since the last inspection, in July 2006, the CSCI has received an anonymous complaint regarding the over-medicating of service users. As a consequence, a CSCI pharmacist inspector completed an inspection that looked specifically at the home’s procedures for the safe management, handling, administration and recording of medicines. Kara House Residential Care Home DS0000005617.V348242.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: It was identified that three requirements relating to medication had not been met sufficiently to ensure the safety of service users. Furthermore, additional requirements were issued as a consequence of the pharmacist inspection in July 2007. The current inspection identified more shortfalls which means service users are at risk from not receiving their prescribed medication as required. Immediate requirements in respect of medication were issued during this inspection to ensure action was taken to protect and safeguard service users in a timely manner. Infection control practice within the home was not good. Soiled items were left exposed in bathing areas, waste containers with used continence aids were without lids. Infection control bags were left undone, exposing the contents. Some bedroom doors were wedged open. Without up-to-date risk assessments and adapted fire safety procedures being in place, such practices mean service users may be at increased risk of smoke inhalation in the event of a fire. The home should develop ways in which to support and occupy service users with dementia. It was observed that the activities provided by the home were infrequent and not suitable for those who required additional support and understanding. Staff should be appropriately trained and supervised to ensure they are trained and competent to meet and support the needs of service users. Kara House Residential Care Home DS0000005617.V348242.R01.S.doc Version 5.2 Page 7 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.V348242.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 Kara House Residential Care Home DS0000005617.V348242.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): 1, 3, 4 & 5 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Prospective service users are able to visit the home and have their needs assessed prior to making decisions about their future. EVIDENCE: Prospective service users are provided with information about the home prior to making any decisions about their future placement. The service user guide was not available at the time of the inspection. The information presented by the registered manager as being provided to prospective service users was not clear and not appropriate for people who are older and who may have varying degrees of dementia or mental health related conditions. Kara House Residential Care Home DS0000005617.V348242.R01.S.doc Version 5.2 Page 10 Prospective service users have their needs assessed and are able to visit the home to meet with others and observe day to day routines before making any decisions about moving in. Pre-assessments had improved since the last inspection; however, they should continue to be developed to include more indepth information regarding all aspects of the service user’s abilities and strengths, including consultation with health care professionals involved with the service user. Kara House Residential Care Home DS0000005617.V348242.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. Service users’ health and safety was compromised due to poor medication management, record keeping and administration systems. EVIDENCE: Care planning records looked at confirmed they had improved since the previous inspection. They still need further details, particularly service users’ personal preferences for support. For example, morning and night-time routines and bathing preferences. There was no information in care plans about the support provided to individuals to maintain their continence. Practice indicated that staff were managing incontinence rather that supporting service users to be continent. Observations were that set routines for toileting were in place, rather than supporting service users as they individually required. Kara House Residential Care Home DS0000005617.V348242.R01.S.doc Version 5.2 Page 12 Records did not confirm that service users received annual health checks for such things as eye, dental and hearing tests. The home provides support to a number of service users who have dementia related conditions. Care plans did not detail any specifics regarding the service users’ individual dementia or mental health condition and how that may affect them. There were no management systems in place or guidance for staff to follow. This meant that service users’ mental health conditions and behaviours could go unnoticed and their needs unmet. A number of service users were observed wandering around the ground floor who appeared agitated. A full audit of the home’s medication stocks, recording and management systems was undertaken. It was found that practice was poor and shortfalls could compromise the health and safety of service users. A new medication policy had been put in place, which failed to cover some basic areas of safe medication handling and administration. The new policy still did not give sufficient information for staff to refer to in order to ensure that medication was administered safely. Record keeping was poor and failed to provide evidence that all medication was being given safely. Staff failed to record the quantity of all medication when it was received, which made it difficult to track if medicines were administered properly. There were a number of missing signatures or gaps on the Medication Administration Record sheets (MAR’s) and there were a number of alterations to signatures, making it unclear as to whether medication had been administered or not. At the previous inspection, serious concerns had been expressed regarding service users’ health being placed at risk because medicines were not being given at the right times. This practice appears to continue. Medication was still not being administered as prescribed by the doctor. The registered manager had still not put in place a quality assurance system to make sure medication was being administered safely and as prescribed. Due to the seriousness of these findings, an immediate requirement was issued. Kara House Residential Care Home DS0000005617.V348242.R01.S.doc Version 5.2 Page 13 Serious concerns remain that there were no staff on duty at night who had been trained to administer medicines. Whilst some night staff had been on medication training courses, the registered manager said they are still not allowed to give service users their medicines. Because of this, the registered manager had decided that most medicines, which are prescribed at night, should be given at 4:00pm. There was no evidence that the doctors had consented to this time or the reason for the change. Labels on the current drugs did not indicate they should be given at 4:00pm. Service users’ health is put at risk if medicines are not given at the correct time or if the intervals between doses are too short or too long. Due to the seriousness of these findings, an immediate requirement was issued. Other serious concerns were noticed on the second day of the medication cycle and a number of service users’ had been given their medication incorrectly during this period. One service user did not have medication available because staff were unsure if it had run out or if the course was complete. Some service users’ had been given too many doses and some service users’ had not been given enough of their medicines. Examination of the medication records for the previous cycle showed there were further concerns for service users’ safety because medication had ‘run out’. One service user was not given medicines for four days because the medicine had ‘run out’. Another service user was not given a very strong analgesic, a controlled drug, for three days because it had ‘run out’. Examination of records alongside the actual medication held for service users’ identified a number of instances when medication was not in the container prepared by the pharmacist and there was no record that medication had been administered. There were also instances when medication had been signed for as administered but remained in the containers. Staff also failed to record how many tablets they administered when a variable dose was prescribed. There was no information available for staff to refer to which explained under what circumstances different doses should be given to service users. The records in the controlled drug register were also poor; there were a number of alterations to dates, making it difficult to tell if service users’ had been given these medicines on the correct days. The records regarding the return of medicines to the pharmacy for destruction were poor. It was not possible for the registered manager to show that all medicines were accounted for. These tablets included sleeping tablets and warfarin. Service users’ health could be at risk if medication is unaccounted for. Kara House Residential Care Home DS0000005617.V348242.R01.S.doc Version 5.2 Page 14 The storage of medicines awaiting collection for destruction was unsafe. The medicines were observed to be stored in an unlocked box under the table in the kitchen. Service users’ were seen to have access to this area when staff did not lock the gate to prevent them from doing so. The registered manager stated that care plans for service users’ who were being given medicines covertly had not been updated and staff had not followed the guidelines on covert administration. To ensure the safety and well being of service users’, proper arrangements must be made to ensure those administering medication covertly know why they are completing this practice and follow precise, agreed and up to date professional guidance. Because of the significant number of concerns found during this inspection regarding all aspects of medication handling, an immediate requirement notice was issued to make sure that things were done immediately to make sure service users’ health was not put at risk. Kara House Residential Care Home DS0000005617.V348242.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 poor. This judgement has been made using available evidence, including a visit to this service. Service users health was not safeguarded regarding weight loss and food intake. Activities were not specific to meet the needs of service users with dementia and mental health type conditions. EVIDENCE: The home had an activities programme. Daily records should detail activities undertaken and how service users responded to any given activities. There was no evidence that service users were able to visit outside places of interest or that such outings were routinely planned, either on an individual or group basis. There was no system in place for the monitoring the effectiveness of activities. Kara House Residential Care Home DS0000005617.V348242.R01.S.doc Version 5.2 Page 16 Observations were that one lounge designated to support those with dementia, did not have appropriate staff support. Service users were left for long periods to occupy themselves. Some service users persistently walked in and out of the room constantly interrupting other service users who were able to actively watch the television. When staff were observed interacting with service users, they were generally polite and caring. One service user received their drink whilst asleep. There was no system in place to ensure that they were served a hot drink when they awoke. Some service users were supported to maintain their own routines and were observed sitting in their rooms. However, the majority of service users required varying degrees of support to make choices. It became apparent that a large number of service users go to bed early and rise early in the morning. Records did not identify whether these routines were chosen by service users or were part of the general routines completed by the home. Visitors are able to visit and sit with the service users. Inspection of service users’ care plans identified that some service users’ had fluctuating weight, including continuing weight loss. The home did not operate a system which ensured that service users received an appropriate diet to meet their individual needs or routinely sought professional advice when weight loss continued. There were no records or information to confirm that service users with diabetes received a correct diet that offered choice and variety. Not all service users had nutritional assessments in place and their personal preferences and dislike regarding food were not recorded. Training records did not identify that the persons responsible for meal preparation had received sufficient training in meal preparation. Routines within the home indicated that staff did not have the knowledge of or understood the complex issues of dementia and mental health and how such conditions can impact on a person’s dietary preferences, behaviour in relation to food and how their condition may affect their dietary intake. The menus displayed were incorrect and in two formats, which meant service users could tell what meal was to be served or the alternative options. The home does not provide menus in a way which could be better understood by people with dementia. The menus displayed did not offer hot food items at breakfast and record supper snacks available. The home routinely serves biscuits mid-morning, afternoon and for supper. Kara House Residential Care Home DS0000005617.V348242.R01.S.doc Version 5.2 Page 17 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 adequate. This judgement has been made using available evidence, including a visit to this service. Service users are protected by the home’s policy and procedures regarding adult protection and complaints. EVIDENCE: The completed AQAA stated “We have a written complaints procedure which encourages residents and family to approach management and staff if they have any concerns”. The home has a written complaints procedure in place. The home did not maintain an accurate record of all complaints received; rather it recorded only those that went through the formal complaints procedure. Three complaints had been recorded, the outcomes of the complaints were not upheld. It was unclear how the complaints had been investigated and if the complainants had been informed of the outcome. Training records could not identify that staff had been trained in the home’s complaints procedure or on how to receive and record complaints. Adult safeguarding procedures were in place and though some staff were booked for training, training records indicated that at least nine staff are awaiting training. Kara House Residential Care Home DS0000005617.V348242.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 23, 25 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The layout and design of the home is suitable to meet its stated aims. Standards of hygiene were compromised by poor infection control systems. EVIDENCE: Kara House is currently being upgraded and extended. The large, two storey extension being added to the home will, should registration be granted, increase the registered numbers of service users to be accommodated. The company has recognised that the home needs modernising and upgrading. Once the work has been completed, the registered person stated that environmental standards will be significantly improved and be more suitable to meet the needs of all service users’. Kara House Residential Care Home DS0000005617.V348242.R01.S.doc Version 5.2 Page 19 It was observed that parts of the home were not managed appropriately, the landing area, where three service users’ remained in their rooms, was dark on a number of occasions when the inspector viewed it. Items such as a wheelchair, pictures, large curtain rail with attached valance and curtains were all stored there. This placed service users’ at increased risk of accidents. Observations were that one toileting area contained used continence equipment and the container was without a lid. A bathing area evidenced poor practice regarding infection control, looking after people’s clothing and personal items. For example, bath towels were stacked openly in an area where people used the toilet. Large quantities of incontinence pads were openly displayed and packs of incontinence pads lay opened beside the bath, open colostomy packs were present and shelving contained a basket, which held a large amount of used hairbrushes, prescribed medication and a set of dentures. One bath/toilet room was observed to have soiled clothing and bedding stacked in the bath. Later, different clothing items were observed in the bath. Whilst the two lounges are homely, their close proximity to each other failed to prevent the behaviours of the most mentally frail from impacting on others. The responsible individual gave assurances that when the upgrading is completed, the home would be fit for purpose and suitable to meet the specific needs of those with dementia type illness. Throughout the inspection the home was clean and free from odours. Kara House Residential Care Home DS0000005617.V348242.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 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 staff who are recruited appropriately. EVIDENCE: During the inspection two staff files were looked at. Application forms were completed, however interview procedures could not be confirmed, nor could the procedures for completing initial inductions and probationary periods. It could not be established when new staff started on duty, therefore it could not be confirmed that references and CRB checks had been received prior to new staff commencing employment. The registered individual gave assurances that references and statutory checks were received prior to employment commencing. Some staff had completed training in dementia and challenging behaviour, however how the home had supported staff to implement their training could not be demonstrated. One service user requires colostomy care support, however there was no indication that staff had received training to provide such support. Kara House Residential Care Home DS0000005617.V348242.R01.S.doc Version 5.2 Page 21 The home could not demonstrate that it was properly staffed. The staff rota presented did not detail staff’s full names or actual hours worked. Their position of employment was not recorded and where one staff held two positions, for example, cook/senior carer, the individual hours for each position were not defined. Care staff also complete domestic duties, but the individual hours for each position were not defined. Furthermore, the rota did not detail who was in control in the absence of the registered manager. Formal deployment of staff was not evident, therefore it was unclear if staff were delegated to particular areas when on duty or had specific responsibility for supporting individual service users, for example, those in their rooms. When staff were observed to support service users’ they were, in the main, caring and considerate. However, some routines were carried out with little thought, culminating in some practices being inappropriate. The AQAA stated that nine staff had completed NVQ training at level 2 or above and that a further three were currently completing such training. Once training is completed, the home will exceed the standard required. Kara House Residential Care Home DS0000005617.V348242.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,&38 Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. Service users do not live in a home which is well managed. EVIDENCE: The statement made in the AQAA: ‘We provide a home which is run by people with a clear sense of direction and leadership’ could not be demonstrated. The registered manager had completed NVQ training at level 4 and achieved the registered manager’s award. However there was evidence that system were not in place to fully protect the health, safety and welfare of service users. Kara House Residential Care Home DS0000005617.V348242.R01.S.doc Version 5.2 Page 23 The home primarily supports service users’ with dementia and associated conditions. The registered manager attended a two-day training course in dementia and challenging behaviour in March 2007. The registered manager could not demonstrate how support services had been improved and or developed as a consequence of the training. Staff have not received supervision at the required frequency during the last 12 months. The AQAA stated that the home operated a staff training and development procedure. There was no evidence of this at inspection. Staff did not have individual training and development records in place and training remained outstanding in moving and handling, basic food hygiene, first aid and infection control. Procedures in the home to reduce or minimise the risk of spreading infection were poor. The completed AQAA stated that the home used the Department of Health’s guidance ‘Essential Steps’ to assess current infection control management. There was no evidence of this. In addition to practices stated in standard 26, one service user, diagnosed with the condition MRSA, was observed to be sitting in their room with two open clinical waste bags that contained used products. When asked about procedures, the registered manager was vague about how appropriate infection control procedures should be implemented. There were no set procedures for staff to follow. Hand wipes and gels were not in place, protective clothing not used and hand washing procedures were not undertaken when staff entered the food preparation and kitchen area. Fire safety regulations were breached by placing obstructions in front of doorways as a means to keeping them open. Records did not confirm risk assessments had been completed or that fire safety procedures were amended to reflect this practice and detail action to be taken in the event of a fire. Health and safety records confirmed that the home’s lift and hoisting equipment had been appropriately serviced. The home records all accidents to service users’, however there was no system for analysing them to identify patterns or actions taken to reduce the risk of accidents within the home. The CSCI did not receive any notifications between November 2005 and January 2007; the manager needs to keep us informed of incidents affecting the well being of the service users. Kara House Residential Care Home DS0000005617.V348242.R01.S.doc Version 5.2 Page 24 The AQAA stated that three service users’ being escorted notified of these occurrences Regulation 37. Similarly, the MRSA. accidents had occurred which had resulted in to accident and emergency. The CSCI was not or of the eventual outcome, in accordance with CSCI was not notified that one service user has Furthermore, it was not evident that the registered individual has systems in place or had completed Regulation 26 visits as required. Kara House Residential Care Home DS0000005617.V348242.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 2 2 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X x 2 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 1 2 X X X 2 X 1 Kara House Residential Care Home DS0000005617.V348242.R01.S.doc Version 5.2 Page 26 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 11/09/07 2 OP9 18 3 OP9 24(1) All medication is given to service users as prescribed, with immediate effect. All records regarding medicines handling are accurate, this must include records of receipt, administration records and records of disposal, with immediate effect. All medication must be accounted for, with immediate effect. All service users’ have an adequate supply of medication, within 48 hours. Ensure there are sufficient staff 11/09/07 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 is not placed at risk, with immediate effect. A system to ensure that the 11/09/07 quality of the medication service (auditing) is in place to make ensure service users’ health is not at risk. Kara House Residential Care Home DS0000005617.V348242.R01.S.doc Version 5.2 Page 27 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. 4 Standard OP9 Regulation 13(2) Requirement Medication policies and procedures must be written which provide sufficient information for staff to refer to in order to ensure that medication is administered safely. (Previous timescale of 01/09/07 not met). All records regarding medication, including those for controlled drugs, must be clear, accurate and up to date to ensure that residents are receiving their medicines as prescribed. (Previous timescale of 01/08/07 not met). All staff must receive training in safeguarding adults. Cease wedging fire doors open. Where service users request bedroom doors to be open, consultation with the fire safety authority should be undertaken to identify how this can be done safely. All areas used by service users must be kept free from obstacles and obstructions which increase the risk of accident or harm. Ensure infection control systems are implemented and followed, and that standards of hygiene are maintained in the home at all times. Timescale for action 30/10/07 5 OP9 13(2) 11/09/07 6 7 OP18 OP19 13 13 & 23(4) 15/10/07 13/09/07 8 OP19 13 & 23(4) 16 (2)(j) 13/09/07 10 OP21 24/09/07 Kara House Residential Care Home DS0000005617.V348242.R01.S.doc Version 5.2 Page 28 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. 11 Standard OP27 Regulation 18(1)(a) Requirement Timescale for action 13/09/07 12 OP31 37 13 OP31 26 There must be a sufficient number and skill mix of staff on duty to meet service users’ needs and to ensure their health and safety. (Previous timescale of 01/08/07 not met). The CSCI must be notified, 15/09/07 without delay, of any significant events relating to service users including: serious illness, infections, accident, allegation, injury, etc. The registered person must, until 15/09/07 further notice, provide the CSCI with a report following all Regulation 26 visits conducted at the home. Kara House Residential Care Home DS0000005617.V348242.R01.S.doc Version 5.2 Page 29 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 Refer to Standard OP1 OP3 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. Pre-assessments should be more detailed and include consultation with service users’, people who are important to them and professional health care services that support the service user. All conditions should be assessed, including mental health. Care plans should include all the service users’ details, their personal preferences for care and how this is to be completed. This should ensure care support is individualised and personal, and improve consistency for service users’. Systems should be implemented which ensure that service users’ weights are kept under review and that when weight loss is evident, procedures of reporting are followed, including referring The home must develop meaningful activities suitable for those who have failing mental health conditions. Consideration should be given to individual and group needs. Staff should be trained and competent to support service users with dementia or mental health related conditions. Make sure all service users receive a nutritious diet which offers choice and which is suitable to meet their individual needs. Menus should be reviewed and developed to ensure they offer choice and variety, including snacks and other options which are made available to service users. The staffing rota should be sufficiently detailed to identify staff’s full name, their position and times worked each duty. Record initial induction procedures and probationary periods completed by new members of staff. 3 OP7 4 OP7 5 OP12 6 7 OP12 OP15 8 9 OP27 OP29 Kara House Residential Care Home DS0000005617.V348242.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. 10 Refer to Standard OP36 Good Practice Recommendations Systems should be introduced which ensure that staff receive appropriate supervision, support and guidance to complete their role and responsibilities and that there practice is evaluated to ensure they are competent. Kara House Residential Care Home DS0000005617.V348242.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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