Inspection on 01/03/07 for Karistos

This inspection was carried out on 1st March 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 33 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Karistos 01/09/10

Karistos 04/08/10

Karistos 26/07/10

Karistos 02/06/10

Karistos 17/03/10

Karistos 10/12/09

Karistos 12/11/09

Karistos 09/11/09

Karistos 22/10/09

Karistos 07/07/09

Karistos 25/07/08

Karistos 29/08/07

Karistos 09/05/06

Karistos 18/11/05

Karistos 09/06/05

Karistos 14/12/04

Karistos 01/07/04

Karistos 09/03/04

Karistos 28/10/03

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

CARE HOME ADULTS 18-65 Karistos 29 Chantry Road Moseley Birmingham B13 8DL Lead Inspector Ann Farrell Key Unannounced Inspection 1st March 2007 08:00 Karistos DS0000052442.V332238.R01.S.doc Version 5.2 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 Karistos DS0000052442.V332238.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 Adults 18-65. 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. Karistos DS0000052442.V332238.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Karistos Address 29 Chantry Road Moseley Birmingham B13 8DL 0121 442 4794 0121 442 4794 karistosnursinghome@yahoo.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) Dr Harminderjeet Singh Surdhar Mr Surjit Singh Surdhar, Mr Gursharn Singh Surdhar Mr. Akinwumi Olusegun Akinpelu Care Home 17 Category(ies) of Physical disability (17), Terminally ill (17) registration, with number of places Karistos DS0000052442.V332238.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Registration for 17 younger adults (18-65 years of age) categories physical disability and terminally ill Care home providing nursing care The proposed programme of works is completed within 24 months of purchase as attached schedule The home may continue to provide care for eight existing service users over 65 years of age. 9th May 2006 Date of last inspection Brief Description of the Service: SUMMARY This is an overview of what the inspector found during the inspection. Karistos DS0000052442.V332238.R01.S.doc Version 5.2 Page 5 The unannounced inspection was conducted over two days and is the second key inspection for 2006/2007. The registered manager was present for the duration of the inspection. During the inspection process the inspectors toured the home, undertook case tracking to determine the care provided in the home, residents files and other documentation were also inspected plus direct and indirect observation. The manager, four members of staff, two residents and one visitor were spoken to. A number of residents currently in the home are unable to communicate their views verbally. The home is registered to provide accommodation for people aged 18 to 65 years of age, but have a number of residents over 65 who have been living in the home for a number of years. Currently residents have a diverse range of medical, nursing and social needs. A manager was registered approximately ten months ago, which has brought stability to the home. In addition, a senior nurse from the Primary Care Trust has been working closely with the staff and providing training and this has lead to improvements in a number of areas, but continued efforts are required to enhance outcomes further for residents. The visitor stated the standard of cleanliness and range of activities had improved and they found staff kind and helpful. Residents were content and one stated they had enjoyed the Christmas festivities. What the service does well: What has improved since the last inspection? The staff have worked hard since the last inspection. Two of the overseas nurses who undertook adaptation training to be registered as nurses in this Karistos DS0000052442.V332238.R01.S.doc Version 5.2 Page 6 country have been successful. They are still working in the home and their contribution has proved to be very positive in the developments that have taken place. In addition, a nurse form the Primary Care Trust has been working closely with the staff to assist with training, developments and aspects of care. The new manager has brought stability to the home so ensuring a more coordinated approach to care. There has been considerable improvement in care plans and staffs knowledge about them so leading to a more consist approach to care of residents. An activities co-ordinator is employed in the home and there is a range of activities for residents so improving stimulation. There has been an improvement in the medication systems so ensuring residents receive the medication prescribed by health professionals. A further en-suite facility has been provided so providing bathing facilities in the privacy of resident’s own room. Wheelchair access has been provided to the front of the building enabling residents to enter by the front door with assistance or independently. There has been an improvement in the standard of cleanliness so proving a more pleasant environment for residents. What they could do better: The quality assurance system needs to be developed further and action must be taken to address any issues identified by residents or stakeholders. Also polices and procedures need to be reviewed and a system of auditing developed in the home to lead into the quality systems. The arrangements for resident’s finances need to be reviewed and information sought regarding the benefits received and available to residents and the arrangements where families do not handle it. The training in respect of safeguarding residents needs to be enhanced to include the whistle blowing procedures. Also training is required in the action to take in the event of a fire. The management need to further develop the recruitment procedures for staff employed in the home to ensure up to date documents are available in the home and residents are safeguarded. Karistos DS0000052442.V332238.R01.S.doc Version 5.2 Page 7 Re-decoration and refurbishment with replacement of vanity units and bedside lockers is required. Also attention to the garden area is required to enhance the surroundings and provide a homely environment for residents. 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. Karistos DS0000052442.V332238.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Karistos DS0000052442.V332238.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2,5 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Information is available for prospective residents and their families to advise them about the services and facilities provided by the home to enable them to make an informed choice about moving in. The contract of residence needs to be developed further to ensure residents and their representatives are aware of the terms and conditions of residency. EVIDENCE: The home admits residents who require long term care for reason of physical disability. Information about the services and facilities is available in typed format on entering the home plus a copy of the last inspection report. The manager should consider alternative formats suitable for the current client group. The manager has not admitted any new residents since the time of the last inspection and the admission process could not be evaluated. However, it was stated that a system has been set up to inform all prospective residents if the home is able to meet their needs following pre-admission assessment. Therefore the requirement in respect of admission assessments has been carried forward at this time and will be reviewed at the next inspection. Karistos DS0000052442.V332238.R01.S.doc Version 5.2 Page 10 A contract of residence was observed on resident’s files, but it lacked information about fees, costs for extras etc. This will need to be reviewed, updated and a new one issued to all residents or their representatives so that they are aware of the terms and conditions of the home. Karistos DS0000052442.V332238.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There have been considerable improvements in the care planning system and staff interviewed were aware of their contents ensuring aspects of care are provided in a consistent manner. Residents are supported in risk taking. Systems for resident’s finances are lacking and this needs to be addressed to ensure resident’s money is managed effectively. EVIDENCE: The manager has developed a named nurse and key worker system ensuring that each resident and their family have a member of staff to approach who has responsibility for the resident to improve consistency and communication. A care plan is in place for each resident and on inspection it was noted they had been reviewed and changed since the last inspection. They gave good detail as to the action required by staff to meet resident’s needs and staff are congratulated on the work they have undertaken in this area. On discussion with some staff they were aware of the contents of residents care plans, but Karistos DS0000052442.V332238.R01.S.doc Version 5.2 Page 12 there were some areas that were not consistently followed e.g. oral care or care of teeth. The manager has set up joint resident and relatives meetings of which there has been two and this is facilitated by the relatives. Inspection of records in respect of resident’s personal finances indicated there were shortfalls and auditing demonstrated records did not match monies held in the home or spent on behalf of residents. Receipts were not consistently available and two signatures were not available to confirm transactions. The home had also raised some money for a residents fund and there was no indication of the amounts raised or how the money was used to benefit residents. Karistos DS0000052442.V332238.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There has been an improvement in respect of social activities and stimulation of residents through the employment of an activities co-ordinator. The meals are of a good standard with a choice and cultural options are available so meeting resident’s cultural needs. EVIDENCE: Since the last inspection and member of staff has taken on responsibility for activities. On discussion the member of staff and residents it was confirmed that there had been visits to the safari park and zoo. Also there had been a Christmas party and celebration of Valentines Day. Some residents also attend a day centre, the cinema or go on shopping trips. In house activities consist of exercises, games, drawing and a musician visits monthly. Arrangements were also being made for two of the residents to go on holiday. The member of staff stated she had undertaken some training in this area and further training Karistos DS0000052442.V332238.R01.S.doc Version 5.2 Page 14 had been arranged in respect of activities for people with dementia. Feedback and findings of the inspection indicated that there had been improvements in this area so ensuring residents were receiving more stimulation. One resident is able to go out unaccompanied and is free to go and come as they please and safety measures have been put into place. Another resident goes out each day to visit their family. There is a cat in the home belonging to one of the residents and this is a positive aspect. However, there was no evidence of any occupation or involvement with the community for the remaining residents. The residents’ telephone is situated in the hall and did not afford privacy when being used. It was stated that residents may use the hands free set if privacy is required and one resident has their own mobile telephone. The inspectors had opportunity to talk with relatives who were visiting. On discussion with them they stated they could visit at any time that suits them and they found the staff friendly and kind. They stated the activities had improved and the food was of a good standard. The cook is popular with residents and has considerable experience in the catering trade. She stated she is reviewing the menus and on discussion with residents they stated they enjoyed the meals and choices provided. The cook tries hard to meet resident’s individual preferences. The inspector had lunch with the residents and found the food to be of a good standard, tasty, hot and well presented. Pureed meals and special diets are catered for, but it was noted that food for pureed meals was mixed together. This does not look attractive and appetising and does not enable individual tastes to be recognised. The cook has agreed to serve pureed foods individually. It became apparent during inspection that appropriate plates and dishes were not used at weekends 9I.e. paper) and this practice must cease. A small group of residents take their meals in the dining room, which cannot accommodate all seventeen residents at one sitting. Other residents have their meals on a tray in the lounge or in their bedrooms. Staff were observed to give assistance in a discreet manner. It was noted that staff placed bibs on residents before eating, but there was a lack of interaction with residents during the meal. Karistos DS0000052442.V332238.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There were improvements in meeting residents personal and nursing needs. However, further attention to detail is required to ensure a holistic approach to care. The systems for the administration of medicines have improved and residents receive the medication prescribed by health professionals. EVIDENCE: All residents are registered with local G.P’s who are called when required. It was stated that all residents are receiving a review in respect of their condition and this was confirmed on discussion with the nurse from the PCT, however, this was not consistently recorded. The manager will need to ensure robust records are maintained to demonstrate the process. There was evidence of visits from other members of the multidisciplinary health care team ensuring residents health care needs are met. On inspection residents looked fairly well presented and appeared relaxed, but it appears that oral care is not being undertaken regularly. It was stated that Karistos DS0000052442.V332238.R01.S.doc Version 5.2 Page 16 two new special beds and a special chair had been ordered for some residents in order to meet their medical needs. Some wheelchairs did not have footplates in use and this may create a risk to residents. Risk assessments must be undertaken and appropriate action taken to ensure their safety. Lap belts were used with residents sitting in wheelchairs. It was stated that this was due to episodes of restless behaviour. It is recommended that the assessments be obtained from the wheelchair assessment service to ensure appropriate practice is in place. The home had portable hoists and sliding sheets for moving and handling residents. However, residents did not have individual slide sheets and this must be addressed in order to reduce the risk of cross infection. Fluid balance charts are used for a number of residents to monitor if adequate fluids are taken, but this does not appear to be taking place as they were not reviewed at the end of each day and some of the records indicated that some residents had a poor fluid intake. The manager will need to review this process to ensure fluid intake is monitored where appropriate and action taken where necessary. Another area of concern was in respect of the lack of observations following a fall that involved a head injury in order to detect any complications that may arise following. The call bell system enables staff to answer it via an intercom and if there is more than one call at the same time one can be silenced. Call bells should be answered at the point of call to ensure that assistance is given appropriately and privacy maintained. Since the last inspection staff have received training in respect of catheter care and continence management by the nurse from the Primary Care Trust. There was no protocol for dealing with residents who had epilepsy. Although some staff had undertaken training in respect of tissue viability there are still some staff whose knowledge was lacking and training will be required to ensure they are aware of early identification of pressure damage in order to prevent any sores. There are three communal bathing facilities in the home, but it was stated that one was for the sole use of one resident. One is a domestic type bath and is not suitable for residents and the other is a shower facility on the ground floor. Action will need to be taken to ensure that there are suitable bathing facilities in the home to enable all residents to have a bath or shower on a regular basis as it was noted that some residents were not receiving a bath regularly. The medication is stored in a separate room that is rather small. On inspection of the medication it was a good standard and audits were correct. The morning medication round had been changed from early morning to breakfast, but there had been no change in the times of other medication rounds. This resulted in residents receiving medication at unsuitable intervals, as there Karistos DS0000052442.V332238.R01.S.doc Version 5.2 Page 17 should be 4 hours between rounds. This area needs to be reviewed and suitable changes made. Also the following requires attention; • The system of checking mediation when entering the home against prescriptions was not consistently occurring to ensure the correct medication was received. • Review the system of recording of destroyed medication to ensure it is correct to enable accurate auditing and it must be stored in a locked cupboard. • There was no policy of the use of PRN rectal diazepam to ensure consistency in its use. Karistos DS0000052442.V332238.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. There have been no complaints since the last inspection and training has been providing and safeguarding residents. The training needs to be developed further to ensure residents are fully protected. EVIDENCE: A record of complaints is available and none had been recorded since the last inspection. On discussion with the manager he stated no concerns had been raised. On discussion with residents and relatives they raised no complaints and stated that if they had concerns the manager would deal with them. The Commission had not received any complaints about the home. Records indicated that staff had recently undertaken training in respect of safeguarding residents and the local guidance was available. On discussion with staff they were aware of causes of abuse and the reporting system inside the home, but were not aware of the whistle blowing procedures. These areas will need to be addressed in order to safeguard residents appropriately. Karistos DS0000052442.V332238.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27,30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is furnished to basic standards and work needs to be undertaken to improve aspects to meet conditions of registration and meet resident’s needs. There has been an improvement in the standard of cleanliness and wheelchair access has been provided to the front of the property so improving the environment for residents. EVIDENCE: Karistos Nursing home was registered with the current providers on 24th October 2003. At the time of registration a programme of works was agreed with the proprietors, which was to be completed within 24 months of purchase. Work has recently been completed on providing wheelchair access to the front of the building, an en-suite facility has been provided on the ground floor and one of the first floor bedrooms, but there is not a separate smoking room, dining room extension and relocation of existing kitchen, staff room and laundry room, first floor and second floor bathrooms had not been re-planned and enlarged to facilitate assisted use from both sides and to manoeuvre a hoist, the patio and banister had not been addressed. The timescales for these Karistos DS0000052442.V332238.R01.S.doc Version 5.2 Page 20 works to be carried out has now expired and so the home is in breach of its Conditions of registration. The proprietors must submit an action plan indicating when the works will be undertaken, but no communication has been received to date. The home is a three storey detached property which was found to be warm. The standard of cleanliness and odour control had improved since the last inspection providing a more pleasant environment for residents to live. There are three double rooms and eleven single rooms. All have a call bell and wash hand basin and two rooms have an en-suite shower facility. Some of the other areas were looking tired, walls were marked/damaged from the movement of furniture/equipment and paint was damaged making it difficult to clean. New furnishings had been provided in the form of wardrobes and drawers, but some of the vanity units and bedside lockers were damaged and will need replacing. Also there were no usable lockable facilities in bedrooms for the storage of valuables etc and residents could not access some of the bedside lighting if they wished to switch on a light when they were in bed. An audit of all areas should be undertaken and a plan of re-decoration and refurbishment undertaken. The hydraulics on some of the beds was found to be faulty and this has implications in respect of manual handling. All beds must be audited and be fit for use. The communal space consists of a lounge, dining room and a small sensory room. The tables in the dining room could comfortably seat one person in a wheelchair at either side therefore providing seating for 8 residents. There was no suitable smoking area in the home and residents smoked in the dining room outside of meal times. The furniture in the dining room was functional and there was little furniture in the lounge as most of the residents use specialised seating. The bathing facilities in the home are not suitable for the client group as identified earlier in the report and at previous inspections. There were some aids and adaptations in the home to assist in the care of adults with physical disabilities, namely hoists, wheelchairs, emergency call system and passenger lift connecting all the floors. Access to the garden is via ramped access from the dining room. A summerhouse at the end of the garden was found to be open and contained an assortment of items such as bedrails, beheads, wheelchairs, tins of paint etc. There were also some cracked panes of glass in the garden, which are potentially dangerous and should have been disposed of in the correct manner. Action will need to be taken to address these issues and make the area safe. Karistos DS0000052442.V332238.R01.S.doc Version 5.2 Page 21 Also it was noted that the clinical waste bin was not secured so increasing the risk of infection. The laundry was too small for the purpose. The laundry was used to store some chemicals and when the laundry assistant used the ironing board the doors to the tumble dryer and washing machine could not be opened due to the limited space. The home has two sluices, only one of which has a sluicing disinfector. At the time of inspection both rooms required cleaning, there was no raking, soap or paper towels in one of them. The kitchen is adjacent to the dining room and was clean and orderly. The dishwasher and fridge have been replaced since the last inspection to ensure food hygiene standards are met. The environmental officer had visited and made requirements in respect of a new extractor fan to ensure adequate ventilation. Karistos DS0000052442.V332238.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35,36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staff group on the whole were pleasant and there has been a good range of training since the last inspection so ensuring staff have the skills and knowledge to care for residents. The recruitment procedures need to be more robust to ensure residents are safeguarded effectively. EVIDENCE: The duty rots indicated that there is a nurse on duty 24 hours per day and adequate staffing levels were maintained to meet residents needs. The manager works Monday to Friday and is on call when not in the home. The cook, domestic staff plus maintenance operative (who is in the home one day a week) support the care staff There is a fairly stable staff group and two overseas nurses had been recruited since the last inspection and were undertaking adaptation training in order to be registered as nurses in this country. Their recruitment, references and checks had been organised by an agency and were satisfactory. On inspection of files for other staff it was noted that some of the work permits and visas were out of date. The manager must audit all files for overseas staff and Karistos DS0000052442.V332238.R01.S.doc Version 5.2 Page 23 ensure a valid work permit and visa is available on file or takes appropriate action. No new carers had been employed since the last inspection and therefore the induction programme was not inspected. 50 of care staff have now completed NVQ level 2 training so providing them with the knowledge and skills to care for residents. Staff had undertaken a range of training in respect of core areas such as basic food hygiene, fire prevention, moving and handling plus aspects such as Huntington’s disease, catheter care, continence, etc. However, training is still required in respect of equality and diversity, equal opportunities, cultural awareness and end of life etc. The manager stated that since he took up post he has undertaken an appraisal interview with all staff and supervision has commenced. However, the manager has only supervised one nurse and they have been made responsible for supervising other staff. The manager should supervise all nurses and ensure that where supervision is allocated to other members of staff they have the appropriate skills to undertake the process. In some cases weakness had been identified, but there was no indication of any action taken to support the member of staff to undertake their role effectively. This will need to be addressed to ensure there is an effective staff team. Karistos DS0000052442.V332238.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,40,42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A registered manager has been in post for approximately one year and this has brought stability to the home. However, management systems need to be further developed to ensure all issues are addressed and there is an ethos of continuous improvement to ensure the well being of residents. EVIDENCE: The manager has been in post for approximately one year and has been registered with the Commission. Since he took up post there have been two residents/relatives meetings and staff meetings are occurring fairly regularly. Minutes are retained in the home of discussions and issues raised. The nurse from the Primary Care Trust has undertaken a quality framework assessment in respect of aspects of care, but the home has no formal quality assurance system in place to review aspects of the home and implement a plan of improvement. Also policies and procedures have not been reviewed since Karistos DS0000052442.V332238.R01.S.doc Version 5.2 Page 25 2004 and there is no system of audits of accidents, infections etc to inform a quality assurance process. The record of visits by the proprietor indicated they were not undertaken regularly as required under the regulations. These should must be undertaken at least once a month and include discussion with staff and residents. Samples of records were inspected in relation to maintenance/servicing of equipment to ensure adequate health and safety precautions in the home. A number of areas were up to date, but areas that remain outstanding and need attention include: • The in house testing of the fire points did not cover all of the points plus the fire stops on fire doors were not tested on a regular basis, some were not working effectively and fire doors were wedged open. Records did not demonstrate that all staff had undertaken two fire drills in the last year and there was a lack of clarity about the procedure on discussion with some staff. This puts residents at risk in the event of a fire. There was no evidence of thorough inspection of the passenger lift by the insurance company. The risk assessments in respect of fire, the building and COSHH need developing. The record of water temperature of the shower stated variable. This is not adequate as there could be a risk of scalding. All hot water from outlets accessible to residents must be maintained at 43 degrees plus or minus 1 degree. Some extinguishers needed replacing and the fire officer identified that some doors did not fit properly into the rebate, which could create a fire risk. • • • • Karistos DS0000052442.V332238.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 Adults 18-65 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 X 2 X 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 2 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 x 2 x LIFESTYLES Standard No Score 11 X 12 2 13 1 14 X 15 2 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 x 2 X 1 1 X 2 x Karistos DS0000052442.V332238.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 YA5 Regulation 5(1)(b) Requirement The registered person must review the contract of residence and ensure that the information in the document is accurate, includes fees, payable by whom, range of services etc. and there is a copy on each residents file. Timescale 30/6/06 not met. Timescale for action 30/07/07 Karistos DS0000052442.V332238.R01.S.doc Version 5.2 Page 28 2. YA7 17(2)Sch 4(9)(a) The registered person must: Ensure receipts are available for all transactions made on behalf of the residents. There must be two signatures for all transactions and records must clearly indicate the reasons for expenditure. 30/07/07 3 YA9 13(4) 4 5. YA15 YA17 16(2)(j) 23(2)(g) The acting manager must ensure that all funds used for residents are available at all times. Timescale of 21/12/05 not met. Records must be available to demonstrate transactions in respect of the residents fund. The registered person must 30/06/07 ensure comprehensive risk assessments are undertaken on individual residents and plans are put in place to manage the risks effectively to include footplates on wheelchairs. The registered person must 15/06/07 ensure appropriate crockery is used at weekends. Adequate dining space must 30/06/07 be provided for all residents. An action plan must be forwarded to the CSCI. Timescale of 01/11/05 not met. Karistos DS0000052442.V332238.R01.S.doc Version 5.2 Page 29 6 YA18 12(1), 13(4) 7. YA18 12(1)13(5) 8. YA18 12(1)18(1) The registered person must: Ensure there are systems in place to meet resident’s personal needs that are in line with good practice e.g. oral care. Timescale of 30/05/06 not met. • To include effective use of fluid balance charts and monitoring of fluid intake. • Neurological observation following head injuries. • Regular bathing. • Risk assessments for wheelchairs. The registered person must: Undertake a review of the handling equipment and ensure there is adequate equipment to meet the needs of residents. Timescale of 30/06/06 not met The registered person must: • Ensure all staff receive training in respect of tissue viability in line with their position in the home. • Draw up a protocol for the management of epilepsy. Timescale of 30/7/06 not met. 30/06/07 30/06/07 30/08/07 Karistos DS0000052442.V332238.R01.S.doc Version 5.2 Page 30 9 YA20 13(2) The registered person must ensure: • There must be guidelines in place for administering PRN medicines. Timescale of 25/06/05 and 30/05/06 not met. • 30/06/07 10. YA23 13(6) Review and update the medication policy to include all aspects of medication that is relevant to the home. Timescale 30/05/06 partially met as the policy was generic and not unique to the homes practice. • Review the times of medication rounds. • A safe system of checking medication in to the home. • Maintain an accurate record of discarded medication and ensure they are stored in a locked cupboard. The registered person must 30/06/07 ensure all staff undertake training in respect of the adult protection procedures, and whistle blowing and are fully aware of the action to be taken in the event of an allegation. Timescale of 21/02/05 not met. Karistos DS0000052442.V332238.R01.S.doc Version 5.2 Page 31 11. YA24 23(2)(a) The registered person must forward an action plan to the CSCI indicating the new timescales for the works to be carried out as detailed under the conditions of registration. Timescale of 01/02/05 and 21/07/05 not met. 01/07/07 12. YA24 13. YA24 14. YA24 15. YA26 An application for variation for the timescales for the completion of the works agreed as part of the registration conditions must be forwarded to the CSCI. Timescale of 30/06/06 not met. 23(4)(c)(i) The registered person must ensure all fire doors close properly, they are not propped open and the doorstop releases are in working order. Timescale of 01/09/04 not met. 23(2)(d) The manager must undertake an audit of all areas and draw up an action plan for re-decoration and forward it to the Commission. Timescale of 30/06/06 not met. 23(2)(p) The registered person must ensure all residents can access lights when they are in bed. Timescale of 20/06/06 not met. 12(1)(4)16(2)(c) The registered person must undertake and audit of all beds and ensure hydraulics are working and they are fit for purpose Timescale of 30/06/06 not met. 11/06/07 30/06/07 30/06/07 30/07/07 Karistos DS0000052442.V332238.R01.S.doc Version 5.2 Page 32 16. YA26 16(2)(c) 17 YA27 23(2)(j)(n) 18. YA28 23(2)(b) 13(3)(4) The registered person must ensure that as part of the on-going replacement of furniture vanity units and bedside cabinets are replaced as required. Timescale of 01/06/05 not met. The registered person must review the bathing facilities and ensure action is taken to provide suitable bathing facilities and equipment to enable all residents to have a bath or shower. Timescale of 30/09/06 not met. The registered person must ensure; • The summerhouse is kept locked and the glass is removed and the garden made safe. Timescale given 01/09/04 and 21/07/05 not met. The clinical waste bin is kept locked. The registered person must: • Provide a separate smoking area. Timescale of 30/010/06 not met. The registered person must ensure that the call system can only be cancelled at the point of call and any subsequent calls do not mask the original call. Timescale of 01/09/04 and 01/09/05 not met. • 30/07/07 30/08/07 30/06/07 19. YA28 23(2)(a)(g) 30/06/07 20. YA29 23(2)(n) 30/06/07 Karistos DS0000052442.V332238.R01.S.doc Version 5.2 Page 33 21. YA30 13(3) 22. YA30 12(1)(a) The registered person must 30/06/07 ensure: • Liquid soap and paper towels are available in all areas where infected material or incontinence pads are handled. • Racking is provided for the storage of bedpans etc. Timescale of 30/07/06 not met. The registered person must 01/07/07 ensure that the laundry facilities are suitable for the needs of the home and hand washing facilities are provided. Timescales of 01/06/05 and 21/07/05 not met. An action plan for providing suitable laundry facilities must be forwarded to the CSCI. Timescale of 30/110/06 not met. The registered person must ensure all overseas staff have a current work permit and visa and copies are available in the home. The registered person must ensure all newly employed care staff undertake induction to the Skills Council standards. This requirement was not assessed during this inspection as no new staff had been employed and the date for completion was 30/08/06 23. YA34 19 30/06/07 24. YA35 18(1) 30/06/07 Karistos DS0000052442.V332238.R01.S.doc Version 5.2 Page 34 25. YA35 18(1) 26. YA36 18(2) The registered person must 30/08/07 undertake training and development assessment of the staff team and individuals and draw up a plan of training to include specialist area such as equal opportunities, equality and diversity end of life etc Timescale of 30/8/06 not met. The registered person must 30/07/07 ensure there are systems in place for all staff to receive a minimum of 6 supervision sessions a year. Timescale of 01/02/05 and 21/07/05 not met. • Staff who undertake staff supervision must be suitably trained. The registered person must ensure there is a quality monitoring system in place that seeks the views of those using the service and various stakeholders and a development plan is drawn up. Timescale of 01/06/05 and 01/09/05 not met. • Policies and procedures and reviewed and updated where necessary. The responsible individual must visit the home at least once a month and write a report on the conduct of the home. A copy of the report should be forwarded to the Commission. Timescale of 30/5/06 not met. 27. YA39 24(1) 30/08/07 28. YA39 26 30/06/07 Karistos DS0000052442.V332238.R01.S.doc Version 5.2 Page 35 29 YA40 26 30. YA42 23(4) 31. YA42 23(2)(c)13(4) 32. YA42 13(4) 33. YA42 23(4)(c) The registered person must ensure policies and procedures and reviewed and updated where required. The registered person must ensure all staff undertake at least two fire drills each year and a record is maintained in the home. Timescale of 30/06/06 not met. The registered person must ensure: • A through inspection of the passenger lift by the insurance company is undertaken and a record is retained in the home. Timescale of 30/06/06 not met. • Ensure hot water from points accessible to residents is maintained at 43 degrees plus or minus 1 degree. The registered person must ensure risk assessments are undertaken in respect of chemicals, fire and the environment. Timescale of 30/08/06 not met. The registered person must ensure regular checks are undertaken in respect of all fire points and the fire stops used to hold fire doors open. Timescale of 30/06/06 not met. • Replace identified fire extinguishers. 30/08/07 30/06/07 30/06/07 30/07/07 30/06/07 Karistos DS0000052442.V332238.R01.S.doc Version 5.2 Page 36 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 YA18 YA18 Good Practice Recommendations It is recommended that a policy be drawn up in respect of pets, alcohol and drug use. The home obtain copies of wheelchair assessments from the wheelchair assessment unit Karistos DS0000052442.V332238.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Karistos DS0000052442.V332238.R01.S.doc Version 5.2 Page 38 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!