Inspection on 18/11/05 for Karistos

This inspection was carried out on 18th November 2005.

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 57 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 01/03/07

Karistos 09/05/06

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 Karistos 29 Chantry Road Moseley Birmingham B13 8DL Lead Inspector Kulwant Ghuman Unannounced Inspection 18th November 2005 08:00 Karistos DS0000052442.V267283.R01.S.doc Version 5.0 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.V267283.R01.S.doc Version 5.0 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.V267283.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Karistos Address Karistos 29 Chantry Road Moseley Birmingham B13 8DL 0121 442 4794 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 Care Home 17 Category(ies) of Physical disability (17), Terminally ill (17) registration, with number of places Karistos DS0000052442.V267283.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 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 9th June 2005 Date of last inspection Brief Description of the Service: Karistos is a privately owned care home providing nursing care for up to 17 residents who have a physical disability or terminal illness. There is accommodation for residents on all three floors of the home. There are four shared bedrooms and nine single bedrooms. Bedrooms do not have en-suite facilities. There are four toilets and two bathing facilities throughout the home. There are some adaptations and aids available in the home to meet the needs of the residents. There is a lounge, assisted bathroom, small dining room, sensory room and kitchen on the ground floor. There is access to the rear garden patio area via the dining room, lounge or through a side entrance to the home. The remainder of the garden is difficult to access due to the steep ramp. There are steps up to the front of the home and access for wheelchair users is by a side entrance. There is a passenger lift that connects all three floors in the home. Karistos DS0000052442.V267283.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by two inspectors over one day during November 2005 and was the second statutory inspection for 2005/2006. This report should be read in conjunction with the report of the inspection in June 2005 to get an overall view of the home. There were 14 residents in the home at the time of the visit and the inspectors were able to speak with 4 of the residents, two visitors and three staff and sampled some records. Placements at the home continued to be suspended. What the service does well: What has improved since the last inspection? What they could do better: 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. Karistos DS0000052442.V267283.R01.S.doc Version 5.0 Page 6 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.V267283.R01.S.doc Version 5.0 Page 7 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,5 There was some information available for prospective residents and their relatives however the information needed to be updated in line with the regulations to help them make a decision about whether to move into the home. EVIDENCE: There was a copy of the service user guide in the residents’ bedrooms. These documents needed to be updated in line with the Care Homes Regulations and a copy forwarded to the CSCI. There had been no new admissions to the home so that the opportunity to visit and admission process to the home were not assessed. There was no evidence in the care plans regarding how staff were to communicate with residents who had limited or no verbal communication. One of the relatives indicated that although the resident did not have any verbal skills he was able to communicate through his eyes and squeezing of the hands. The home needed to speak with the relatives and use this information to aid their communication with the resident. Care plans indicated how basic needs were to be met. There were contracts held on the files for residents. Karistos DS0000052442.V267283.R01.S.doc Version 5.0 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9,10 Residents or their relatives were encouraged to take part in making decisions about their lives and some risk taking was evident. The manager needed to ensure that care plans were implemented to ensure that the residents’ needs were met in the way most appropriate to their wishes. EVIDENCE: Care plans were developing and were better organised but did not include all the information that was required. For example, the GP had advised that a resident’s catheter was flushed on a daily basis however the care plan had not been updated to include this. There was also inconsistency in some of the care plans for example, in one section of the care plan it stated that the individual had a soft and high fibre diet, in the eating and drinking section it stated that the food should be cut up into small pieces, to be offered a normal diet and more fluids but not how this would be achieved. One of the residents was being left in the bedroom for long periods of the day when her care plan stated that she needed to be brought back down into the lounge for tea. The fact that she had been moved to a single room meant that she could be even more isolated and the manager needed to ensure that the care plans were being put into practice. One of the residents had been prescribed rectal diazepam for seizures however, there were no instructions on the care plan (or with the Karistos DS0000052442.V267283.R01.S.doc Version 5.0 Page 9 medication) regarding how long after a seizure started the medicine was to be administered. The nurse stated that she would give it straight away. Discussion with one resident indicated that she had some insight into what was included in her care plan, however, she was unsure of how to access her records. The majority of residents were unable to take part in discussing their care plans. The acting manager had taken some steps to encourage relatives to become involved in reviewing care plans on behalf of the residents. At the time of inspection it was noted that an area of care had not been implemented according to the care plan. On discussion with staff about the area of care they gave varying accounts as to the action required. This suggests that all staff are not aware of the details of care plans and the manager will need to take action to address this issue. Following this he will need to introduce systems to ensure that they are fully implemented. Some of the residents could be more involved and consulted on the running of the home in matters such as deciding on menus and staff recruitment. There was one resident who was able to take risks and could go out alone and manage their own finances, the monies for all other residents were managed by solicitors, social care and health or the family. Records for expenditures carried out by the home were easier to audit than in the past, however, the manager needed to ensure that there were two signatures for all transactions and there were individual receipts from the chiropodist and hairdresser. The home had recently set up a residents fund for activities. The inspectors were unable to inspect the system as the activities co-ordinator held the key and the manager had not taken possession of it whilst she was on holiday. The inspector noted that there was a care plan and review of care carried out by the social worker three years earlier in one of the bedrooms. There was no need for this information to be there as the resident would not be able to read it and it was out of date. There were also lists of which incontinence pads were used by each of the residents; again, this was inappropriate information to be put up on the bedroom walls. Karistos DS0000052442.V267283.R01.S.doc Version 5.0 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16,17 Residents were able to maintain contact with family and some used community facilities such as daycentres. Other residents appeared to spend all their time in the home. More able residents were able to come and go to the local shops. The records of food provided in the home did not determine that varied and nutritional food was provided and that all identified dietary needs were being met. EVIDENCE: One of the residents indicated that she was able to go to the local shops alone, meet with family at the home and go out with them. Another resident was going to spend the weekend with family directly from the day centre. Another of the residents was able to explain to the inspectors that a meal and visit to the pantomime had been arranged in December. There was evidence in the home of celebrations that had taken place in the home including Halloween, Asian and Caribbean days. The residents’ telephone did not afford privacy when being used due to its location outside the office. Karistos DS0000052442.V267283.R01.S.doc Version 5.0 Page 11 One of the visitors told the inspectors that their relative spent time in the sensory room, this was also recorded in the care plan to occur twice a week however, examination of the daily progress sheets did not confirm that this had been happening on a regular basis. Following the inspection in June 2005 the home had started to take the resident out for an occasional walk or out onto the garden patio area. One of the care staff had been given responsibility for organising activities. There was a programme of activities identified in the dining room, however, at the time of the inspection the activities organiser was on holiday and the identified activities did not take place. The manager must make arrangements for the activities programme to be maintained in the absence of the activities organiser. The menus showed a variety in meals was being provided but the food records indicated that residents could choose to eat something other than the meal on the menu and that chips were served on a regular basis as the residents’ choice. The records did not determine that all residents were receiving a varied and nutritional diet that met their needs. The food records needed to be more detailed. All the residents in the home had fish fingers and chips and mixed vegetables for lunch during the inspection. This would not have met the needs of the residents on a high fibre or low in calorie diet. There was no evidence that fruit and vegetables were being promoted for those needing a high fibre diet. There were a variety of items available at breakfast including cereals, toast and eggs. Some residents had their breakfast in the dining room whilst others had trays taken up to their bedrooms. The manner in which some residents were being served breakfast was not appropriate and did not show respect for them. The dining area was functional and small and could not seat 17 residents, including those needing space to manoeuvre wheelchairs around the tables. A chest freezer took up some of the space. Karistos DS0000052442.V267283.R01.S.doc Version 5.0 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 The home could not meet the personal care needs of all the residents due to the lack of appropriate bathing facilities. The physical health needs of the residents were being met however; it could not be determined whether the emotional needs of residents were being met, as there were few interactions between the staff and residents. The systems for the administration of medicines needed to be improved to ensure that all residents received their medication as prescribed. EVIDENCE: The bathing facilities in the home mean that some residents were able to have a shower in the showering facilities on the ground floor, however, it was too small for others and their was not an appropriate chair available for them. The bath on the second floor was not fully assisted. Some of the residents could therefore only have a bed bath. One of the residents had had her hair washed and plaited whilst it was still wet. There was no evidence that the resident who needed to wear splints on his hands was wearing them as required, for another resident it had been instructed that the catheter was flushed on a daily basis but this was not evidenced. There was little evidence of communication between the staff and residents. One of the residents indicated that his catheter bag needed to be emptied and one of the carers was asked for this to be done. A message was Karistos DS0000052442.V267283.R01.S.doc Version 5.0 Page 13 relayed over the intercom system asking for someone to deal with it. This was an inappropriate way to deal wit the issue and took no consideration of the resident’s privacy and dignity. A member of staff then took the wheelchair out of the lounge but did not say anything to the resident and did not check to see that his feet were not trapped under the wheelchair. One of the resident’s relatives had stated that the resident liked to be spoken to however there was no interactions noted with the resident at any time. There was evidence that the residents had been seen by the dentist, chiropodist, dietician and were visited by the GP. The medication fridge temperature was found to be too low at between –1 and 1 degrees centigrade. When the nurse in charge on the day was asked why one of the residents had been on an antibiotic for several weeks the nurse was unable to say, the care plan for the individual did not identify this either. Not all medicines had been appropriately booked in. Handwritten MAR charts had not been countersigned; the amounts of tablets had not been entered. The MAR chart for one medicine indicated that it would be administered on a gradually decreasing amount, and the plan for the decreases was documented. The plan had not been fully completed however, for the following the MAR chart had been crossed off, indicating to the inspectors that the medication was not to be given, and stated that a GP review was to take place. The following two days were over the weekend and no review had been arranged. The inspectors were concerned that there would be a sudden stop in the administration of the medicines and raised the issue with the acting manager. He assured the inspectors that the medication would not be stopped and was not aware that the MAR chart had been crossed off. There were no details with the MAR charts of when medicines that were ‘PRN’ (as required) were to be administered. The copies of the most recent prescriptions could not be located at the time of the inspection. The audit of medicines did not indicate that they could all be accounted for. Not all staff administering medicines were aware of the controlled medicines procedures in the home. There was no suction equipment or oxygen available in the home. The home needed to ensure that there was adequate and accessible suction equipment available in the home. Karistos DS0000052442.V267283.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed. EVIDENCE: Karistos DS0000052442.V267283.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,27,28,29,30 The premises were generally well maintained but the home had not met the conditions of registration and was failing to meet the needs of the residents. EVIDENCE: Karistos was registered to provide care for up to 17 residents, with physical disability or terminal illness between the ages of 18-65 years, with the current providers on 24th October 2003. At the time of registration a programme of works was agreed with the proprietors to be completed in two phases within 24 months of purchase. The agreed timescales had passed. Some of the issues had not been addressed including the provision of an ensuite facility in the ground floor bedroom, smoking room to be re-sited, removal of threshold and step between the sitting room and patio, dining room extension and relocation of the existing kitchen, staff room and laundry room, ground floor, first floor and second floor bathrooms to be re-planned and enlarged to facilitate assisted use from both sides and to manoeuvre a hoist, layouts of single bedrooms (less than 12 square metres) and shared rooms (under 16 square metres) to be re-divided to increase remaining room sizes, larger patio to garden and raise banister height. The timescales for these works to be carried out had expired and so the home was in breach of its Karistos DS0000052442.V267283.R01.S.doc Version 5.0 Page 16 conditions of registration. There had been no information from the providers as to when these conditions were likely to be met. One of the agreed conditions of registration was that the laundering of bed linen would be contracted out. This was initially done, however, due to the cost of contracting out the laundry a sluice cycle washing machine was then installed in the laundry room, which was very small, until the extension work was carried out. This work had still not been carried out at the time of this inspection. The home had experienced some difficulties in obtaining planning permission for the works to be carried out on the entrance of the home to include a platform lift. The inspectors were verbally informed during the inspection that this had now been agreed. The proprietors needed to make an application to vary the conditions of registration and submit plans for the works to be undertaken with identified timescales for the CSCI to consider and a variation for the residents in the home who were over 65 years of age. The communal space in the home consisted of a lounge and dining room, a small sensory room and a small patio area. 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 a chest freezer located in it. There was little furniture in the lounge as most of the residents use specialised seating. The Huntingdon’s chair needed to be replaced as the upholstery by the arm rests was torn and could catch on fragile skin. The wall by the radiator in the lounge needed to be redecorated. The carpet on the first floor by the lift was lifting and was a health and safety risk. There was a cracked pane of glass in bedroom 5 and in the fire door in the corridor on the first floor. The bathing facilities in the home did not adequately meet the needs of the resident group. There was a small shower unit on the ground floor that could be used by some residents. One resident explained to the inspectors that in order for her to have her hair washed she had to lie across the bed with her legs hanging down one side and her head off the other side. The proprietors had begun to install an en-suite shower facility in the bedroom but the works had not been completed. The proprietors needed to get professional advice on installing these en-suite facilities so that they met the needs of people with physical disabilities and the equipment they would need to be assisted to use them safely. Karistos DS0000052442.V267283.R01.S.doc Version 5.0 Page 17 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. There were three shared rooms in use at the time of the inspection. Bedrooms were of an acceptable standard but some of the furniture needed to be replaced. There were notices in some of the bedrooms listing the size of continence pad used by all the residents. This was inappropriate and when raised with the acting manager he said that he was unaware that they were in the bedrooms and there had been a miscommunication with his lead nurse. There was adequate heating in the home and there were no odours. The hot water from the shower was not hot enough at 32 degrees centigrade. The homes record of hot water temperatures recorded on 4.11.05 varied from 20 degrees in one of the bedrooms to 53 degrees in the bathroom. The laundry was too small for the purpose. The wash hand basin needed to be thoroughly cleaned and the chair in the laundry room needed to be removed because it was torn and did not promote hygiene control. Staff were seen to take their breaks in the laundry. This was inappropriate, especially as afterwards they were going into the kitchen. The flooring in the laundry needed to be levelled and made safe. Karistos DS0000052442.V267283.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,34,35,36 There were defined roles in the home but the staff did not evidence during the inspection and through the documentation that they were meeting the needs of all the residents in the way identified in the care plans. The homes recruitment procedures had improved ensuring that the right individuals were employed in the home. EVIDENCE: During the day of the inspection there were two nurses (including the manager) on duty until 5pm. During the mornings there were 4 care assistants and during the afternoon/evening there were 3 care assistants on duty. During the night there was one nurse and two carers on duty. At the time of the inspectors’ arrival the two night care assistants had left the building and all the day care assistants were in handover. The worker in the kitchen was supervising the resident’s in the dining room and lounge and was preparing breakfast for them. The person preparing the food cannot be supervising the residents adequately. There were staff allocated to cooking, laundry and domestic duties, however the staff preparing the meals were care assistants undertaking the cooks role. The proprietors needed to ensure that a suitably qualified and experienced person was responsible for planning and preparing the meals so that residents were provided with a varied, nutritional and on occasions specialised diets. Karistos DS0000052442.V267283.R01.S.doc Version 5.0 Page 19 The inspectors observed and heard residents being spoken to in an inappropriate manner by staff, for example, one resident was told to ‘stop spitting on the floor’ although the resident was not spitting but dribbling and was not in control of this. Also staff were observed to put a slice of toast directly onto the table without a plate and no tablecloth on the table. Another resident was given an egg sandwich on a plate. This indicated that those who were unable to communicate verbally were treated in a less favourable manner. The acting manager and proprietors must be assured that staff have the practical and linguistic skills to meet the residents’ needs. The manager must ensure that the written care plans for residents are put into practice and staff respect the residents dignity irrespective of their cognitive abilities. Three staff files were sampled. The recruitment procedures had improved. All files evidenced a criminal records bureau check having been made and a Pova First check made prior to employment of the individuals. There was evidence on the files sampled of adequate checks on identity and the eligibility of all individuals to take up employment. All staff had been provided with a contract of employment although not all had been dated or signed. For one member of staff the employment application form had not been dated and for another it was dated as having been completed after the interview. If applicants have been asked to complete another application form the original needed to be kept on the file. The manager needed to ensure that there was a full employment history for all staff, this was not evidenced on all the application forms. None of the files evidenced that induction training had taken place. The manager stated that these had been done but he did not know where they had been filed. Staff spoken to during the day indicated a variable knowledge of the residents needs. Some aspects of care described did not match with the documented care plans. Although staff meetings were due to be carried out monthly this had not recently happened. Staff described having meetings with the lead nurse but were unsure whether they were documented. Staff had undertaken some basic training including lifting and handling, basic food hygiene and fire training. Some staff had completed NVQ 2 and others were undertaking it. Karistos DS0000052442.V267283.R01.S.doc Version 5.0 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,42,43 The acting manager has introduced some stability into the home that made the life for residents more acceptable. The acting manager needed to ensure that he had systems in place to monitor the way the home was operating and ensuring that the residents’ physical and emotional needs were being met. The views of the residents needed to be sought and residents encouraged to be involved in the day to day running of the home. There were some issues of health and safety that needed to be addressed. EVIDENCE: There was an acting manager in place at the home who had not yet been registered as the care manager. He had made some positive changes in the home, however, he had not demonstrated that he had been able to make a significant change in the way that residents in the home were being cared for. There were some difficulties in the communications between staff and residents. Karistos DS0000052442.V267283.R01.S.doc Version 5.0 Page 21 One of the residents had been brought into the dining room for breakfast in stocking feet with no slippers on and could be at risk of slipping. Another resident did not have footplates on the wheel chairs and there was no indication in the care plan that they were not required. In another resident’s care plan it was identified that a safety belt and headrest should be used when being transported in the wheelchair, neither of these items of equipment were seen to be in use. Care plans were not always being followed. One care plan indicated that the service user was to be brought down stairs at 5pm for tea after having had a rest in bed after lunch to relieve the pressure on pressure points. The records, and conversations with staff, indicated that this was not always happening and the resident was being left in bed after lunch until the following morning. Several fire doors were observed to be wedged open including the lounge door and door between the kitchen and dining room. There was no evidence available that the fire extinguishers had been serviced, The insurance certificate displayed in the home had expired on 3rd of November 2005. The inspectors were informed by the acting manager that discussions with the insurance company were ongoing and that there had been some problems with leaking pipes and that at the time of the inspection the home was not insured. An immediate requirement was left at the home that required evidence that the home was appropriately insured to be passed to CSCI by 23rd November 2005. A copy of the new certificate was forwarded to the CSCI following further telephone calls by the inspector on 24th November 2005. Most of the wheel chairs in the home had been serviced but some were still outstanding. There was evidence in the home that the passenger lift and portable electrical equipment had been tested. The hoist had been serviced however one of them required a new handset. The weighing scales needed to be serviced and the Gas Safety Certificate was last undertaken in July 2004. The infection control systems in the home needed to be improved. All foods in the freezer needed to be dated on freezing, freezer and fridge temperatures needed to be recorded on a daily basis. Hot foods needed to be probed and the temperatures recorded. Meats needed to be stored on the lower shelf in the fridge and not the top. The shower on the ground floor needed to be thoroughly cleaned. Karistos DS0000052442.V267283.R01.S.doc Version 5.0 Page 22 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 X 2 X 3 Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 1 1 2 2 Standard No 24 25 26 27 28 29 30 STAFFING Score 1 2 2 1 1 2 2 LIFESTYLES Standard No Score 11 X 12 1 13 2 14 2 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score 1 1 1 2 1 2 CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Karistos Score 1 2 2 X Standard No 37 38 39 40 41 42 43 Score 2 2 1 X X 2 2 DS0000052442.V267283.R01.S.doc Version 5.0 Page 23 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 YA1 Regulation 4(1) Requirement Timescale for action 21/01/06 2. YA3 18(1)(c) (i) 3. YA3 12(4)(b) 4. YA6 15(1) The registered person must ensure that the statement of purpose and service user guide contain all the required information. Copies to be forwarded to the CSCI. (Previous timescales of 01/09/04 and 21/07/05 not met.) Information must be 01/02/06 provided to staff regarding communication with residents with limited verbal communication skills. (Previous timescales of 01/10/04 and 01/09/05.not met.) Arrangements must be in 21/12/05 place to meet the needs of residents from minority ethnic communities. (Compliance not assessed at this visit. Previous timescale given 21/07.05.) The registered person must 21/12/05 ensure that each resident has an individual care plan that identifies all the needs of the resident and how these needs are to be met DS0000052442.V267283.R01.S.doc Version 5.0 Page 24 Karistos by staff. (Previous timescales of 01/09/04 and 01/08/05 not met) The acting manager must ensure that the written care plans are put into practice. The residents care plans must be kept under review and updated as changes occur. (Previous timescale of 01/08/05 not met.) The registered person must ensure that either residents or their representatives are involved in drawing up the care plan. (Compliance not assessed at this visit. Previous timescales given 01/09/04 and 01/08/05.) The registered person must ensure that a nurse key worker system is put into operation. (Compliance not assessed at this visit. Previous timescale given 01/08/05.) Residents must be made aware of their rights to access of information held about them and how they can be accessed. Receipts must be available for all transactions made on behalf of the residents. There must be two signatures for all transactions. The acting manager must ensure that all funds used for residents are available at all times. Records must be able to 21/12/05 evidence why decisions have been made that impact on residents’ lives, eg DS0000052442.V267283.R01.S.doc Version 5.0 Page 25 5. YA6 15(2)(b) 21/12/05 6. YA6 15(1) 01/02/06 7. YA6 12(1)(a) 01/02/06 8. YA6 12(1)(a) 21/12/05 9. YA7 17(2) Sch 4(9)(a) 21/12/05 10. YA7 12(1)(a) Karistos 11. YA8 12(2)&(3) 12. YA10 12(4)(a) 13. YA14 12(1)(a) 14. YA15 12(1)(a) 15. YA17 23(2)(g) 16. YA17 17(2)Sch 4(13) 17. YA17 16(2)(i) 18. Karistos YA18 18(1)(a) spending most of the day in bed. (Previous timescale of 21/07/05 not met.) Residents must be given opportunities to be involved in the day to day running of the home. (Previous timescale of 01/08/05 not met.) The acting manager must ensure that all information held about residents is kept confidential and accessible only to those with a right to it. The activities programme must be maintained even when the activities organiser is not at work. There must be facilities in place to enable residents to make phone calls in private. (Previous timescale of 21/07/05 not met.) Adequate dining space must be provided for all residents. An action plan must be forwarded to the CSCI. (Previous timescale of 01/11/05 not met.) The registered person must ensure that individual records of food eaten by service users are maintained. (Previous timescales of 21/02/05 and 01/07/05 not met.) The registered person must ensure that brown bread and semi-skimmed or full fat milk are available in the home as a matter of choice. (Compliance not checked at this visit. Previous timescales given 01/02/05 and 21/07/05.) Personal care must be provided by carers and 21/12/05 21/12/05 21/11/05 21/01/06 21/12/05 21/12/05 21/12/05 21/12/05 Page 26 DS0000052442.V267283.R01.S.doc Version 5.0 nurses of the gender preferred by the resident. Records of their preferences must be recorded in their care plans. (Previous timescale of 21/07/05 not met.) Staff must be mindful of the residents’ rights to privacy and dignity. 19. YA19 12(1)(a) Appropriate support must be 21/12/05 given to residents in respect of their emotional and psychological health. (Previous timescale of 21/07/05 not met.) The acting manager must 21/12/05 ensure that any instructions given by medical professions were followed in the home. There must be an 21/12/05 agreement from the GP stating which homely remedies can be used for each resident. There must guidelines in place for administering PRN medicines. (Previous timescale of 25/06/05 not met.) Audits to check the efficiency of staff administering medicines must be carried out. (Previous timescale of 21/07/05 not met.) 20. YA19 12(1)(b) 21. YA20 13(2) Tablets obtained, dispensed Karistos DS0000052442.V267283.R01.S.doc Version 5.0 Page 27 and left in the boxes must tally. A record of all prescribed creams applied to residents must be in place. (Previous timescale of 21/07/05 not met.) 22. YA20 13(2) The medication procedure must be robust and ensure that medicines are booked in and given as prescribed. There must be a record of all complaints, formal and informal, made in the home and the actions taken and the outcome of any investigation. (Compliance not assessed at this visit. Previous timescales given 01/02/05 and 21/07/05.) Staff must be provided with training in respect of adult protection procedures. (Compliance not assessed at this visit. Previous timescale given 1/09/05.) Adult protection procedures must be accessible at all times. (Compliance not assessed at this visit. Previous timescale given 21/07/05.) The registered person must ensure that all staff are fully conversant with the adult protection procedures. (Previous timescales 21/02/05 and 21/07/05 not met.) 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 21/11/05 23. YA22 17(2)4(11)22(3) 21/12/05 24. YA23 13(6) 01/02/06 25. YA23 13(6) 21/12/05 26. YA23 13(6) 21/12/05 27. YA24 23(2)(a) 21/12/05 Karistos DS0000052442.V267283.R01.S.doc Version 5.0 Page 28 registration. (Previous timescale of 01/02/05 and 21/07/05 not met.) An application for variation for the timescales for the completion of the works agreed as part of the registration conditions and for residents in the home over the age of 65 years of age must be forwarded to the CSCI. The registered person must ensure that the home meets the requirements of the fire service, that is, all fire doors close properly, fire doors are not propped open and that door stops release in the case of a fire. (Previous timescales of 01/09/04 and 21/07/05 not met.) The registered person must ensure that as part of the on-going replacement of furniture vanity units and bedside cabinets are replaced as required. (Previous timescale given 1.6.05. Compliance not checked at this visit.) The registered person must ensure that the cracked windowpane in bedroom 5 and the glass in the corridor on the first floor is repaired. The registered person must ensure that all bedroom furniture is suitable for its stated use and is replaced where required. (Previous timescales given 01/06/05 21/07/05. Compliance not checked at this visit.) The registered person must ensure that all extraction fans, including the laundry, DS0000052442.V267283.R01.S.doc 28. YA24 23(4)(c) (i) 21/07/05 29. YA26 16(2)(c) 21/07/05 30. YA26 23(2)(b) 21/12/05 31. YA26 16(2)(c) 01/04/06 32. YA27 23(2)(c) 21/01/06 Karistos Version 5.0 Page 29 33. YA28 23(2)(b) 34. YA28 13(4)(c) 35. YA28 23(2)(d) are in good working order. (Previous timescales given 14/01/05 and 21/07/05. Compliance not checked at this visit.) The registered person must ensure that the summerhouse is kept locked and the glass is made safe. (Previous timescale given 01/09/04 and 21/07/05. Compliance not checked at this visit.) The registered person must ensure that all accessible areas of the garden are safe for service users. (Previous timescales given 01/09/04 21/07/05. Compliance not checked at this visit.) The lounge area must be redecorated. The Huntingdon chair must be replaced. 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. (Previous timescales given 01/09/04 and 01/09/05. Compliance not checked at this visit. There must be sufficient assisted bathing facilities that meet the residents’ needs throughout the home. The hot water available throughout the home must be maintained at the appropriate temperatures set by Health and Safety. An action plan to be 21/12/05 21/12/05 01/04/06 36. 37. YA28 YA29 23(2)(n) 23(2)(n) 21/01/06 01/09/05 38. YA29 23(2)(j)(n) 21/12/05 Karistos DS0000052442.V267283.R01.S.doc Version 5.0 Page 30 forwarded to CSCI. 39. YA30 13(3) The registered person must ensure that the floor of the laundry is made safe and impervious. (Previous timescale of 21/09/04 21/07/05 not met.) The registered person must ensure that the laundry facilities are suitable for the needs of the home. (Previous 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. The shower on the ground floor must be thoroughly cleaned. The registered person must ensure that there are job descriptions in place for all staff. (Previous timescales of 01/03/05 and 21/07/05 not met.) An individual with knowledge of meal preparation and nutrition must be employed. The registered person must ensure that at least 50 of care staff are qualified to NVQ level 2 or equivalent by 2005. (Previous timescale not elapsed.) There must be an accessible record of the induction undertaken by staff. The acting manager must ensure that a full employment history for staff is obtained. The registered person must DS0000052442.V267283.R01.S.doc 25/11/05 40. YA30 12(1)(a) 21/12/05 41. 42. YA30 YA31 13(3) 18(1)(a) 19/11/05 21/12/05 43. YA31 18(1)(a) 01/02/06 44. YA32 18(1)(a) 31/12/05 45. YA34 19 Sch 2 21/12/05 46. Karistos YA36 18(2) 01/04/06 Page 31 Version 5.0 47. YA38 12(1)(a) 48. YA39 24(1) 49. YA42 23(4) 50. YA42 23(2)(c) 51. 52. 53. YA42 YA42 YA42 13(4)(c) 23(2)(c) 23(2)(c) 54. 55. 56. YA42 YA42 YA42 23(2)(c) 23(2)(c) 23(4)(c)(iv) ensure that there is a plan in place that will enable staff to receive a minimum of 6 supervision sessions a year. (Previous timescale of 01/02/05 and 21/07/05 not met.) The registered person must ensure that there are regular service user meetings. (Previous timescale given 01/02/05 and 21/07/05. Compliance not checked at this visit.) The registered person must ensure that there is a quality monitoring system in place that seeks the views of those using the service. (Previous timescale of 01/06/05 and 01/09/05 not met.) Training in fire procedures must be provided to staff. (Previous timescale of 09/07/05 not met. The servicing of wheelchairs must be followed up. (Previous timescale of 25/06/05 not fully met. The carpet in the corridor on the first floor must be made safe. The gas safety certificate must be forwarded to the CSCI. The leak at the base of the toilet pan in the ground floor shower must be attended to. The handset for the identified hoist must be replaced. The weighing scales must be serviced. Fire doors must not be wedged open. DS0000052442.V267283.R01.S.doc 21/07/05 01/09/05 09/07/05 21/01/06 25/11/05 25/11/05 10/12/05 01/12/05 18/12/05 19/11/05 Karistos Version 5.0 Page 32 57. YA42 23(4)(c)(iv) Fire extinguishers must be serviced. 18/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Karistos DS0000052442.V267283.R01.S.doc Version 5.0 Page 33 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: 0845 015 0120 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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