Inspection on 25/07/08 for Karistos

This inspection was carried out on 25th July 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 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 29/08/07

Karistos 01/03/07

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 08/11/2008.

CARE HOME ADULTS 18-65 Karistos 29 Chantry Road Moseley Birmingham B13 8DL Lead Inspector Lisa Evitts Key Unannounced Inspection 25th July 2008 09:10 Karistos DS0000052442.V368823.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.V368823.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.V368823.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 www.karistos.co.uk Dr Harminderjeet Singh Surdhar Mr Surjit Singh Surdhar, Mr Gursharn Singh Surdhar Mr. Akinwumi Olusegun Akinpelu Care Home 17 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) Category(ies) of Physical disability (17), Terminally ill (17) registration, with number of places Karistos DS0000052442.V368823.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Currently under review 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. 29th August 2007 Date of last inspection Brief Description of the Service: Karistos Nursing Home has 17 beds and is registered to provide care to younger adults for reason of physical disability and terminal illness. The home is situated in Moseley and is within short walking distance of shops and bus routes. There are no parking facilities at the home and cars would need to be parked on the main road at the front of the building. It is a large three storey converted house and bedrooms are available on all floors. A passenger lift provides access to all floors of the building. There is a lounge and separate dining room. The accommodation consists of four shared bedrooms; nine single bedrooms and two have en-suite shower facilities. Wheelchair access and a platform lift have been provided to the front of the building, as the steps are rather steep. There is a garden to the rear of the home with a small patio area, which is accessible via the dining room. However, the incline to the garden makes it difficult for people to use it. There are toilets and two communal bathing facilities throughout the home, but they are not all suitable, to meet the needs of the entire current client group and corridors are rather narrow. The home has three hoists and a stand aid to assist people with mobility problems and has specialist mattresses to prevent people’s skin from becoming sore. Information is available about the services and facilities on entering the home and this includes a copy of the most recent inspection report, for anyone who may wish to read this information. Current fee rates range from £400 - £600 per week and this information is provided in the service user guide. These fees Karistos DS0000052442.V368823.R01.S.doc Version 5.2 Page 5 are reviewed annually. Additional costs include newspapers, hairdressing, clothing and personal effects, chiropody, dentist and optician. Karistos DS0000052442.V368823.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The focus of inspections we, the commission, undertake is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. The visit to the home was undertaken by one inspector over seven and a half hours and was assisted throughout by the Registered Manager and deputy manager. The home did not know that we were visiting that day. There were 16 people living at the home on the day of the visit and one of these people was receiving hospital care. Information was gathered from speaking to two people who live at the home and three staff. Due to peoples communication needs discussions with people about the home and the care they receive was limited. Two people were ‘case tracked’ and this involves discovering individual experiences of living at the home by meeting or observing them, discussing their care with staff, looking at medication and care files and reviewing areas of the home that are relevant to these people, in order to focus on outcomes. One further file was partly reviewed. Case tracking helps us to understand the experiences of the people who use the service. Staff files and health and safety records were reviewed. Prior to the visit we randomly sent out surveys to four of the people living at the home and five staff. We received all of the surveys back and these were all positive about the home. Prior to the inspection the Registered Manager had completed an Annual Quality Assurance Assessment (AQAA), which tells us about how well the Home thinks it is performing and achieving good outcomes for the people who live there. The AQAA was completed and returned to us within the required timescale. This gave us information about the home, staff and people who live there, improvements and plans for further improvements, which was taken into consideration. Reports of any accidents, complaints or incidents reported to us involving people using the service were also reviewed in the planning of the visit to the home. No immediate requirements were made on the day of the visit, which means there was nothing urgent that needed to be addressed to ensure the safety of the people living at the home. What the service does well: Karistos DS0000052442.V368823.R01.S.doc Version 5.2 Page 7 Before people move into the home their needs are assessed to ensure they can be met. Support to people who live in the home is given in a warm and friendly manner, and staff were seen to be polite, considerate and patient. Access to a range of healthcare professionals is good and this ensures that all healthcare needs are met. People are encouraged to participate in activities and outings. Meetings are held so that people can discuss what they would like at the home. A choice of meals is offered to the people living at the home so that preferences and healthcare needs are met. People can personalise their own rooms to reflect preferences and tastes. Complaints are acted upon in a timely manner and resolutions are found to meet the needs of the people who live there. Maintenance checks are completed to ensure equipment is safe and in working order. People told us: “Its lovely” “Its excellent” “We had a great day out to the safari park, it was a change of scenery” “We get excellent food” “The food is nice, lots to choose from and you can have biscuits or sandwiches if you are hungry” “I get help when I need it” “I have a shower every day” “I haven’t got any complaints” “My room is comfortable, I have everything I need” “I have a small and comfortable bedroom, it suits me fine” What has improved since the last inspection? The management have addressed outstanding requirements, which suggests that they are keen to provide a home that complies with regulations and in the best interests of the people who live there. People are encouraged to make decisions about participating in activities or interests outside of the home. Many areas of the home have been redecorated to provide a homely and comfortable environment for people to live in. Karistos DS0000052442.V368823.R01.S.doc Version 5.2 Page 8 Staff have received training to enhance their knowledge and a training matrix has been devised to enable the manager to plan training for the future. 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. The summary of this inspection report can be made available in other formats on request. Karistos DS0000052442.V368823.R01.S.doc Version 5.2 Page 9 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.V368823.R01.S.doc Version 5.2 Page 10 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): 1,2,3 & 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have information to enable them to make an informed decision about whether they would like to live at the home. Pre admission assessments ensure that people know their needs can be met prior to moving in. EVIDENCE: A comprehensive statement of purpose and service user guide is available and these documents give people information about the home. They are available in the reception area, in each bedroom and are on the website, which enables people to access this information if they want to read it. These guides can be made available in large print if required. It is recommended that consideration is given to producing this document using some photographs or pictures in an easy read format so that it is more meaningful to some of the people who may live there. The certificate of registration and public liability insurance are on display in the reception area of the home, which enables anyone to view these when visiting. A copy of the previous inspection report is displayed so that people can read this if they choose to. Comprehensive pre admission assessments are undertaken prior to people coming to live at the home and this ensures that people are confident that Karistos DS0000052442.V368823.R01.S.doc Version 5.2 Page 11 their individual assessed needs can be met upon admission to the home. Following assessment the manager sends a confirmation letter that the home is able to meet individual assessed needs so that people know their needs can be met before they move in. The AQAA told us that people are given the opportunity to view the home before they are admitted and is possible come and stay at the home to see what it is like to live there. We were not able to confirm this with people at the home due to communication difficulties. People told us: “Its lovely” “Its excellent” Karistos DS0000052442.V368823.R01.S.doc Version 5.2 Page 12 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. Staff have most of the information they need so they know how to support individual’s to meet their needs and help them make choices about their dayto-day lives. EVIDENCE: Each person has a written care plan. This is an individualised plan about what the person is able to do for themselves and states what assistance is required from staff in order for them to meet their needs. Care plans gave staff good details about how they are to support people to meet their communication, social, cultural, spiritual, health, personal care, dietary and mobility needs. They also stated what the person’s preferences, likes and dislikes were. Staff told us that one person did not always use the toilet and would use inappropriate places to pass urine. There was no care plan in place for how staff were to assist this person to maintain their independence and privacy while using the appropriate facilities. Karistos DS0000052442.V368823.R01.S.doc Version 5.2 Page 13 In the daily records of another person we found entries relating to ‘aggressive behaviour and shouting’ but there was no care plan or risk assessment in place as to how staff should deal with these outbursts so that the person and people in the surrounding area were safe from harm. One person who goes out of the home independently had a detailed risk assessment in place. She had been encouraged to purchase a mobile phone so that she could maintain contact with the home whilst she was out. There was also a ‘movement folder’ which people completed as they went out of the home so that staff knew they were not in the building. One person had a risk assessment written for being at risk of falling out of bed, this stated to use bed rails but there was no risk assessment in place for use of these. This was of concern as when reviewing this person’s room, there were rails on the bed but there were no protective bumpers in place to minimise the risk of any injury occurring. This person also had additional health needs and therefore was at a high risk, this was brought to the attention of the manager at the time. Residents and relatives meetings have been held at the home and minutes of these were available for review. These meetings give people the opportunity to share ideas or concerns about the home and enable them to make decisions about what the home could do better. The meetings also provide an opportunity for people to socialise. During the day we observed people being given choices. For example about where they wanted to sit or what activities they would like to join in. Surveys from people living at the home indicated that they can ‘always’ make decisions about what they want to do. Karistos DS0000052442.V368823.R01.S.doc Version 5.2 Page 14 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 good. This judgement has been made using available evidence including a visit to this service. People are able to exercise choice regarding the activities they participate in which promotes their individuality and independence. People are offered a choice of meals, which meet any dietary or cultural needs and preferences. EVIDENCE: The home has an activity coordinator who is currently on maternity leave and a carer is covering this role for four days a week. There is a monthly activities programme, which includes games, music, church services, movies and 1-1 time. People can have newspapers delivered if they choose to and a church service is held once a month for people who wish to continue to practise their religious beliefs. The manager was trying to contact a Muslim preacher to come and see one of the people living at the home, so that their religious needs could be continued. External entertainment is provided on occasions and a magician had recently been to the home. One person attends a day centre twice a week and was waiting for transport when we arrived at the home, he Karistos DS0000052442.V368823.R01.S.doc Version 5.2 Page 15 told us he was looking forward to going out. At our last visit the home had assisted people to gain access to college courses but both of these people had chosen not to continue with these. People at the home had recently been on a day trip to the safari park and one person said, “We had a great day out to the safari park, it was a change of scenery”. Venues for further trips were being explored. One person was planning a meal at a Chinese restaurant for her birthday and staff escorted another person out for walks during the week. One person had a holiday planned for two weeks. Last year five people went on holiday to Blackpool but no plans were in place for a holiday this year. The home has a committee, which consists, of residents, relatives and staff who organise holidays. The payphone is situated in the main entrance of the home, which does not ensure privacy, however the home has a mobile phone, which people who live there can use. The home has an open visiting policy, which means that people can maintain the relationships that are important to them. There is a four-week rolling menu in place at the home. There are choices of cooked breakfasts or cereals, a choice of two hot meals at lunchtime and a lighter meal for supper. A new menu had been devised following consultation with the people living at the home. The cook told us that fresh fruit was offered at every mealtime. Some people have special diets such as blended food because of swallowing difficulties and diets for medical conditions, and staff spoken to were aware of these needs. Some people are fed through a PEG tube, which has been surgically inserted into the person following assessment and discussion with health professionals. This may be because they have had difficulty swallowing and are at risk of choking. It ensures that the person receives the nutrition they need but are not at risk of choking whilst eating. People told us: “We get excellent food” “The food is nice, lots to choose from and you can have biscuits or sandwiches if you are hungry” Karistos DS0000052442.V368823.R01.S.doc Version 5.2 Page 16 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. Care plans provide information for staff to assist people to meet their individual needs and preferences. People’s health and personal care needs are well met so they are supported to maintain good health. EVIDENCE: Each person has a written care plan. This is an individualised plan about what the person is able to do for themselves and states what assistance is required from staff in order for them to meet their needs. The files were well-organised making information easy to retrieve. The care plans contained good details for staff to follow and included some preferences. Staff spoken to were able to tell us about the individual needs of the people living at the home and this means that people receive their care in a way that they like. People told us: “I get help when I need it” “I have a shower every day” Karistos DS0000052442.V368823.R01.S.doc Version 5.2 Page 17 People who live at the home are registered with local general Practitioners and there was evidence of visits from external professionals such as dentists and chiropodists. This ensures that specialists review people’s needs. One care plan for a person with epilepsy was very detailed and gave staff guidance to follow if this person were to have a fit. A plan for catheter care was very detailed but didn’t say when this should next be changed. The deputy manager stated that this was in the diary, however this information should formulate the working care plan so that all staff know when this was to be done. Care plans in relation to tube feeding were very detailed. A plan for diabetes didn’t give staff details of what signs to look for if someone had a high or a low blood sugar. This may mean that staff would not act appropriately to the change in the person’s health. Monthly risk assessments for sore skin, nutrition, falls and moving and handling are undertaken and these help staff to identify any changes in health. One persons weight had been found to be greatly increasing over a period of time and the manager had contacted the GP in relation to this. During the review of bedrooms and equipment, we observed that some beds with air mattresses had fitted sheets on and this may affect how the mattress works. One person was noted to wear pads for incontinence and was on an air mattress, the care plan also said to use a ‘kylie’ sheet and this will increase the risk of sore skin developing and this was brought to the manager’s attention at the time. Turn charts, which record when people’s positions are changed, were not fully completed and this does not ensure that people are having their position changed in order to reduce the risk of sore skin developing. Staff had received training in prevention of skin soreness and further training was planned, however this knowledge should then be put into practice. No one in the home had any sore skin at the time of our visit. Monthly evaluations of care plans did not provide much information. For example the majority of evaluations stated, “Care plan continues”. This does not show whether the plan was working and meeting people’s needs and should provide more details. The management of medication was reviewed and was good meaning that people receive their medication as prescribed. Five peoples medications were reviewed and these were found to be correct. The exception was one tablet, which had not been carried forward so there was not an accurate audit trail. Medication was signed into the home by two staff and copies of prescriptions were kept so that staff could check what they received was what was prescribed. Medication Administration Records (MAR) were all completed and there were no Controlled Drugs in use at the home. One MAR chart or the prescription did not state how many tablets to give, staff had been giving one (which is a usual dose) however this had not been checked with the GP or the pharmacy. The deputy manager attended to this at the time of the visit. Karistos DS0000052442.V368823.R01.S.doc Version 5.2 Page 18 People appeared to be well supported by staff to choose clothing appropriate for the time of year, which reflected individual cultural, gender and personal preferences. Karistos DS0000052442.V368823.R01.S.doc Version 5.2 Page 19 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 good. This judgement has been made using available evidence including a visit to this service. People can be confident that their complaints are listened to and acted upon. Arrangements are in place to protect people from the risk of harm and the management of people’s finances is robust. EVIDENCE: The complaints procedure is displayed in the home and is included in the service user guide so that people know how to make a complaint if they need to. The procedure is not available in an easy read format and consideration should be given to this so that all people can access this information. There is a suggestion box in the reception area where people can write down their suggestions about how the home could do things better. The home had received two complaints since our last visit and these were recorded, including actions taken in order to resolve the complaints and the outcome. One person said “I haven’t got any complaints” and four people who returned surveys told us that they knew how to make a complaint. We have not received any complaints about the home since our last visit. The home has a copy of the Birmingham Multi Agency guidelines, which gives staff guidelines to follow should there be an allegation of abuse. Staff spoken to were able to tell us what they should do if an allegation was made to ensure that people are safeguarded from harm. There has been one adult protection case raised since our last visit to the home and this had now been closed. Karistos DS0000052442.V368823.R01.S.doc Version 5.2 Page 20 Staff spoken to and the training matrix confirmed that they had received training in relation to the Protection Of Vulnerable Adults. This should ensure that their knowledge is up to date in order to safeguard people from harm. We looked at the money of three people, which the home hold for safekeeping and the balances were found to be correct. There are individual records kept and two signatures recorded for all transactions. Receipts were kept as proof of any expenditure. This should mean that people’s money is kept safely. Recruitment procedures require further improvements to ensure the safety of people living at the home, and this is discussed under ‘staffing’. Karistos DS0000052442.V368823.R01.S.doc Version 5.2 Page 21 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): 24,25 27 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are provided with a clean and comfortable environment to live. Lack of dining space and bathing facilities may not meet the needs of all the people who live at the home. EVIDENCE: The home is a three-storey property, which was warm and clean on the day of the visit. Access to the home is via steps but a platform lift enables people who use wheelchairs to access the building safely. There is a passenger lift inside the home to enable access to all floors. Communal areas consist of a lounge, dining room and small sensory area. The dining room does not provide enough space if all 17 people wanted to sit at the dining table for their meals and consideration should be given to this. During the morning the dining room became very hot due to the sunny weather, one person was sitting in this room and was offered a drink at a drinks round which he drank in one go. Staff should be mindful about people being in the dining Karistos DS0000052442.V368823.R01.S.doc Version 5.2 Page 22 room when the weather is warm and drinks should be readily available as people may become thirsty. Many areas of the home have been redecorated in order to enhance the environment for the people who live there. Two bedrooms of people case tracked were reviewed and were found to have appropriate equipment to meet their needs. Bedrooms were adequately decorated and had some personal possessions so that the rooms were comfortable and familiar to the occupants. One of the rooms had a very strong odour and the manager stated that the carpet would be replaced with lino as this person had a continence problem. This will make the environment more pleasing for the person living in the room. People told us: “My room is comfortable, I have everything I need” “I have a small and comfortable bedroom, it suits me fine” There are showering facilities in the home but the bath does not meet the needs of the people living in the home. It is a domestic style bath without any kind of hoist and some people are unable to access it. This means that they do not have a choice about whether they would like a bath or a shower. This has been an outstanding requirement of the home. The AQAA stated that there were plans for a new bath and on the day of the visit the manager showed us a quote for the work to be completed. This should now be addressed to meet the needs of the people living at the home. The garden is accessed by a steep incline from the dining area or lounge. The grass and trees were overgrown and there were no seating areas. The path has weeds, which may pose a trip hazard, and there was old furniture stored at the bottom of the garden making it unsafe and uninviting for people to use. This was a recommendation at the last visit for the garden area to be made safe and attractive for people to use and it was disappointing that the garden area was still in need of a general tidy up. The manager requested a skip on the day of the visit so that the furniture could be removed. One person living at the home told us that he liked gardening and used to like to grow flowers and vegetables. This is something that the home could support him to do if the environment was conducive to this. Karistos DS0000052442.V368823.R01.S.doc Version 5.2 Page 23 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): 32,33,34 & 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are supported by staff who have received training to ensure that they have the knowledge and skills to meet individual needs. The recruitment procedures have not been robust in some cases and so have not fully safeguarded people who live in the home. EVIDENCE: During the day there is one qualified nurse and four care staff and one qualified nurse and two care staff during the night. Care staff numbers were adequate on the day of the visit to meet the needs of the people living at the home. All of the staff surveys returned indicated that staff felt there was “always” enough staff to meet people’s needs. The home had recently appointed three new care staff and were waiting for their checks to be received prior to them commencing work at the home. There had been temporary use of agency staff to cover these vacancies however the manager conformed that the same agency was used and that the same staff were used where possible so that people knew who would be meeting their needs. In addition to care staff the home has domestic, laundry, maintenance, activity and kitchen staff to meet all the needs of the people living at the Karistos DS0000052442.V368823.R01.S.doc Version 5.2 Page 24 home. The manager works Monday to Friday but is on call when not in the home to support staff. There are male and female staff working at the home, so that people can choose the gender of the staff they wish to have them assist them with their personal needs. One person said, “Staff are excellent, they help when I need help”. There was good interaction observed between people living in the home and care staff. One person who lived at the home accompanied the inspector for the majority of the day; it was clear that this person often sat in the manager’s office and joined in conversations and that he felt comfortable at the home. Nine of the eleven care staff have completed a National Vocational Qualification (NVQ) Level 2 in care and the remaining staff are working towards achieving this. This should ensure that the staff have the knowledge and skills to care for people individually and collectively. Three staff files were reviewed, one did not have a complete work history and had people as referees who’s organisations were not in the employment history. One qualified nurse had a standard Criminal Records Bureau (CRB) completed not an enhanced one, although had been checked against the Protection Of Vulnerable Adults (POVA) register. One file had a CRB which had not been checked against the POVA register. These checks are completed for the home by an external organisation and this lapse in recruitment does not ensure that people are safeguarded from harm. The manager must check the CRB upon receipt to ensure the safety of the people living there. A training matrix has been devised since our last visit to the home and staff told us about training they had received. Certificates were available on their files to confirm this. Staff had received training in Fire safety, food hygiene, infection control, manual handling, first aid and POVA. Qualified staff had attended training in Tissue Viability (skin care) with the Primary Care Trust. Minutes of staff meetings indicate that regular monthly meetings take place and there was evidence of discussions about health and safety in the home, training updates and communicating effectively with service users. One staff survey commented, “We have staff meetings where we discuss and resolve issues”. Karistos DS0000052442.V368823.R01.S.doc Version 5.2 Page 25 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 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Systems for consultation with people are good to ensure a service that is run in their best interests. The safety of people who live at the home is generally promoted and protected. EVIDENCE: The Registered Manager has been at the home for approximately two and a half years. The manager is keen to learn alongside the staff and has enrolled onto a Business Degree Course commencing in September 2008. This ensures that he remains updated and learns new skills to continue to lead the staff group. We observed good interactions from the manager with the people who live at the home and one person said, “I know who the manager is”. Staff told us: Karistos DS0000052442.V368823.R01.S.doc Version 5.2 Page 26 “I have seen lots of changes and lots has improved, all residents needs are met” “Karistos is operating well, we have a good qualified manager” The five staff surveys all indicated that staff felt supported by the manager and that they could discuss and resolve concerns with him. The manager and deputy were responsive to discussions about how the home could further improve and this suggests that they are keen to provide a service, which is in the best interests of the people who live there. Progress had been made for addressing previous requirements and work was planned to further improve the home. However, the recruitment procedures are not being consistently followed to ensure that people living in the home are safeguarded. The Responsible Individual visits the home and completes regulation 26 visit reports, which comment on the quality of service being offered. The last one available in the home was for March 2008, the manager stated that these had been completed but was unable to locate them on the day of the visit. Following the visit the manager informed us that these had been completed and sent to us, however we no longer require that these are sent to us and it is recommended that they are available for review. Prior to the inspection the Registered Manager had completed an Annual Quality Assurance Assessment (AQAA), which tells us about how well the Home thinks it is performing and achieving good outcomes for the people who live there. The manager completes a monthly home audit which is then reviewed by the providers in order to action any areas which require attention. Satisfaction surveys had been sent to people living in the home and their relatives earlier this year. The responses had been coordinated and an action plan devised to address areas that people had raised. No relatives had returned questionnaires. All of the information collected should be formalised into an annual report about the quality of the home. Health and safety and maintenance checks had been undertaken in the home to ensure that the equipment was in safe and full working order. Fire equipment was checked to ensure that it was safe and in full working order. All staff had recently received fire training but the last records for a fire drill were dated May 2007. This was discussed with the manager at the time of the visit, as staff should receive fire drills twice yearly in order to ensure that they know what to do should a fire occur. We asked one staff member about how they would respond to a fire to safeguard people living in the home and they were able to give us a good response. Systems are in place to monitor incidents and accidents in the home so people’s well being is promoted. Karistos DS0000052442.V368823.R01.S.doc Version 5.2 Page 27 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 2 2 3 3 3 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 X 27 2 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 3 X 2 X X 2 X Karistos DS0000052442.V368823.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO 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 YA9 Regulation 13(4) Requirement Detailed risk assessments need to be available for any people who use bed rails to ensure they are not put at risk by the use of the rails. Recruitment procedures must be thorough, robust and consistently followed so that people living in the Home are protected from harm. Timescale for action 05/09/08 2. YA34 19 19/09/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Karistos Refer to Standard YA1 YA6 YA19 YA19 Good Practice Recommendations The format of the service user guide should be reviewed to try and make it more accessible to potential new service users. Care plans need to make clear the exact type of support an individual needs to make sure they get the care they need. Care plans should give staff instructions of what symptoms to look for so that health needs can be monitored. Bed linen and continence aids should be reviewed so that DS0000052442.V368823.R01.S.doc Version 5.2 Page 29 5. 6. 7. 8. 9. 10. 11. 12. YA19 YA24 YA24 YA27 YA30 YA39 YA39 YA42 people are at minimum risk of skin soreness. Evaluation of care plans need to be improved to ensure they reflect if peoples needs are being met. Staff should ensure people have access to drinks in the dining room, particularly during warm weather. The garden area should be made attractive and available for people to use. (Previous recommendation) Bathing facilities should meet the needs of all the people living in the home, so that they can have a choice. Any offensive odours should be addressed so that people live in a homely environment. Regulation 26 visit reports should be available for inspection so that the quality of the service offered can be monitored. An annual report should be compiled to inform people about the quality of the service provided. Staff should receive fire drills so that they know how to safeguard people from harm. Karistos DS0000052442.V368823.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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.V368823.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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