Inspection on 29/08/07 for Karistos

This inspection was carried out on 29th August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 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 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 09/07/2008.

CARE HOME ADULTS 18-65 Karistos 29 Chantry Road Moseley Birmingham B13 8DL Lead Inspector Lisa Evitts Unannounced Inspection 29th August 2007 08:55 Karistos DS0000052442.V350863.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.V350863.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.V350863.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.V350863.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. 1st March 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, and accommodation consists of four shared bedrooms and 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 residents to use it. There are four toilets and two communal bathing facilities throughout the home, but they are not all suitable, to meet the needs of the 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 are available from the home and are included in the statement of purpose. Karistos DS0000052442.V350863.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by us 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 provisions that need further development. The visit to the home was undertaken by two inspectors over nine and a half hours and was assisted throughout by the Registered Manager. The home did not know that we were visiting on that day. There were 17 residents living at the home on the day of the visit and one of these was receiving hospital care. Information was gathered from speaking to people who live at the home and one visitor. One relative and one healthcare professional were spoken to on the telephone, two staff were spoken to and staff were observed performing their duties. Four 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 relevant to these people, in order to focus on outcomes. Case tracking helps us to understand the experiences of people who use the service. Staff files and health and safety records were also reviewed. Three questionnaires were sent out but none of these had been returned at the time of writing this report. Prior to the inspection the Registered Manager had completed an Annual Quality Assurance Assessment (AQAA) and returned it to us. This gave good information about the home, staff and residents, improvements and plans for further improvements, which was taken into consideration. Regulation 37 reports pertaining to accidents and incidents in the home were also reviewed in the planning of the visit to the home. No immediate requirements were made on the day of the fieldwork visit. What the service does well: People are provided with a range of information about the home so that they can make an informed decision about whether they would like to live there. Access to a range of external healthcare professionals is good and this ensures that all healthcare needs are met. People are encouraged to participate in activities, educational courses, outings and holidays. Meetings are held so that people can discuss what they would like to do. Karistos DS0000052442.V350863.R01.S.doc Version 5.2 Page 6 There is a friendly atmosphere at the home and people can personalise their own rooms to reflect preferences and tastes. Personal allowances can be held safely by the home if requested. Any complaints received are acted upon in a timely manner and resolutions found to meet the needs of the people who are living at the home. Maintenance checks are completed to ensure that equipment is in full working order and safe to use. People told us: “I can visit anytime” “You get wonderful meals” “I can ask for a shower at anytime” “I have always found the care to be good” “Staff are good, they look after me” “The plus about the home is the staff” What has improved since the last inspection? What they could do better: Risk assessments to support people in their daily lives must be written and evaluated regularly to ensure that they reflect the current needs of the person who is at risk. Karistos DS0000052442.V350863.R01.S.doc Version 5.2 Page 7 The majority of care plans sampled had good details and staff must ensure that this good practice is consistent across all files, so that information is available to meet people’s needs in a way that they like. The bathing facilities should be reviewed so that there are facilities to meet all the needs of the people who live at the home. A staff-training matrix should be devised so that training can be reviewed easily to ensure that staff have received the appropriate training to meet the needs of the people living at the home. The skills for care course should be implemented to provide staff with a basic induction into the home and their role. The quality assurance system needs to be further developed and an annual report, including an action plan with timescales, should be written so that the home makes continuous improvements to the service offered. 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.V350863.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Karistos DS0000052442.V350863.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information is available for prospective people and their representatives to make an informed decision about whether they would like to live at the home. Comprehensive pre admission assessments are undertaken so that people know that the home can meet their needs prior to moving in. EVIDENCE: The manager has devised a comprehensive statement of purpose and service user guide, which gives people information about the service provided. Some amendments were required to ensure that these documents reflected the current details about the home, and the manager started to action this at the time of the visit. These documents were available in the main entrance of the home, in each bedroom and are on the website, which enable people to access this information if they want to read it. Comprehensive pre admission assessments were seen on four files reviewed and this ensures that the person requiring the service and the home know that their needs can be met prior to moving into the home. Following assessment the manager sends a confirmation letter that the home is able to meet the assessed needs of the individual so that they know their needs can be met. Karistos DS0000052442.V350863.R01.S.doc Version 5.2 Page 10 People who live at the home are issued with a contract and this means that they know what the terms and conditions of residency are for their stay. All services included and excluded in the fee rate are recorded so that people know what they need to pay for as additional costs. It is recommended when there are changes in the fee rates, a letter is sent to each person to inform them of this change. A copy of the last inspection report is displayed in the main entrance of the home so that people can read this if they wish to. Karistos DS0000052442.V350863.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are supported to make their own decisions and to take risks. There are systems in place to ensure that people’s money can be held safely in the home. EVIDENCE: Each person has a written care plan. This is an individualised plan about what the person is able to independently and states what assistance is required from staff in order for the resident to maintain their needs. Some care plans gave really detailed information for staff to follow to ensure that needs could be met, but further work was required to ensure that this was consistent across all files. Some risk assessments were seen regarding people going out of the home to pursue their interests but other people did not have them. Some risk assessments had not been reviewed for over a year and reviews are required to ensure that the risk assessment remained up to date and reflective of needs. Karistos DS0000052442.V350863.R01.S.doc Version 5.2 Page 12 In the main entrance of the home was a “movement folder”, which was completed for people who lived at the home, when they went out, so that staff knew where people were. This book had not been completed since March 2007 and therefore staff may not always be aware that people have gone out of the home and it is recommended that this book is completed. One person told us that someone else who lived at the home wandered into their room at night and while staff were aware of this, there was no care plan or risk assessment in place as to how staff should deal with the situation. Residents and relatives meetings have been held at the home and minutes of these were available to 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. The manager had reviewed the system for the management of people’s personal money and three peoples money checked was found to be correct, with supporting documentation. Karistos DS0000052442.V350863.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are able to choose who they see and what activities they participate in, which promotes their independence and individuality. People receive a varied and wholesome diet, which meets any specific dietary, cultural needs or preferences. EVIDENCE: The home has a dedicated activities coordinator. An activity board is displayed in the dining room and included activities such as coffee mornings, games, quizzes, music and mobility, beauty treatments, shopping, lottery, reading and aromatherapy which people could join in if they chose to. During the visit staff were seen playing games such as connect 4 with people and one person was completing a large jigsaw. Special occasions such as birthdays are videoed so that people at the home and their relatives can watch the celebrations again at a later date, and a number of photograph albums confirmed participation in activities and celebrations. Karistos DS0000052442.V350863.R01.S.doc Version 5.2 Page 14 A holiday had been arranged for six people to go to Blackpool and a relatives and residents committee had been devised to discuss and arrange trips outside of the home. Other people at the home had arranged to go on holiday with relatives and this enables people who live at the home to maintain their independence and make their own choices. A trip to the safari park had been arranged but had to be cancelled as the mini bus had broken down, this was to be re scheduled. People are able to go outside of the home to go shopping and a staff member had accompanied one person out for an evening meal to celebrate a birthday. One person attends a day centre and two people had enrolled onto local training courses, one for cookery and one for knitting and sewing. One of these people told us that they were looking forward to starting college in September. The home has a cat, which belongs to someone who lives at the home, and this is positive as it enables her to continue with this interest. The Church of England visits the home each week and this enables people to continue to follow their religion if they choose to do so. There was no one living at the home that wished to follow any other faith but the manager confirmed that this would be explored if requested by anyone. The telephone is situated in the main entrance of the home and this does not ensure privacy can be maintained, however the home does have a mobile phone, which could be used by the people who live there. Some people have their own telephones in their rooms. There is an open visiting policy and one visitor told us “I can visit anytime” which means that people can see their visitors as they choose. There is a four-week rolling menu devised at the home and people told us that they were satisfied with the meals provided. There are various choices available for breakfast including cereals or cooked breakfasts and a choice of two hot meals at lunchtime. The dining room is not large enough to accommodate everyone at the same time and some people sit in their own rooms or stay in the lounge. Consideration needs to be given to this shortfall. People told us: “Food is alright, my favourite is pie and potato” “Food is nice” “You get wonderful meals” One person told us that the meals had not been to their satisfaction but this had been discussed with the manager and systems were in place to ensure that they were able to decide what they would like to eat on a daily basis. This means that people can be confident that their individual preferences can be met. Karistos DS0000052442.V350863.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans identify some personal preferences about how people wish their care to be delivered but this was not evidenced for everyone. In practice peoples’ healthcare needs are being met but this is not always evidenced in the care planning. The management of medication is good and means that people receive their medication as prescribed. EVIDENCE: Four care files were reviewed and these contained some good information about how the person’s needs could be met; however some of the files did not contain all the required information, and this does not ensure consistency. A nurse from the Primary Care Trust told us “documentation was generally good”. People who live at the home are registered with local General Practitioners and there was evidence that other external healthcare professionals such as the rehabilitation team, dietician, optician, dentist, chiropody and speech and language therapist see them. This ensures that the specialists in that area review their entire identified healthcare needs. Karistos DS0000052442.V350863.R01.S.doc Version 5.2 Page 16 The care file of the most recent person to be admitted into the home did not have a fully completed assessment of needs and this does not ensure that all needs have been identified. A consent to photography form had not been signed but photographs had been taken of one person. When meeting this person they would not have been able to sign the form but it is recommended that staff record this and state if verbal consent was given. There were some personal preferences recorded such as “likes to wear her perfume”, “uses a disposable razor and shaving foam” and “likes to go to bed at 10pm”. More information is needed about peoples personal preferences to ensure that they influence the way in which personal care is delivered to them. Monthly risk assessments for sore skin, nutrition and moving and handling are undertaken and this should identify any changes in conditions so that appropriate action can be taken. Personal hygiene plans were basic and did not contain much detail about personal preferences, but oral care plans were very detailed. One person who had an infection had a good care plan but this did not contain information to tell staff of the need to wear gloves and aprons and this may place the staff at risk of harm. Two people had a history of epilepsy but had no care plans and therefore no instructions for staff to follow. There were good plans in place for people who needed to be fed through a tube and this will minimise the risk of infection or the tube becoming blocked. Risk assessments for bed rails and use of wheelchairs had been written but had not been reviewed for over a year and this does not ensure that they are reflective of current risks. People we spoke to told us: “I can ask for a shower at anytime” “I have always found the care to be good” “Everyday they shave me” “The care is adequate” The management of medication was found to be good, meaning that people receive their medication as prescribed. Four peoples medication was reviewed and was found to be correct with the exception of one boxed medication, where three tablets could not be accounted for. Staff must ensure that boxed medications are given as prescribed and that records reflect administration so that other staff know what medication has been administered. Drugs were signed into the home upon receipt and photocopies of prescriptions are kept so that the staff can check that the correct drug has been received. The Controlled Drugs were securely stored and balances were correct. Karistos DS0000052442.V350863.R01.S.doc Version 5.2 Page 17 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. The home has a complaints procedure, which is accessible to people who live at the home and their representatives if they need to make a complaint. There are procedures in place for staff to follow and this should safeguard people from harm. EVIDENCE: There is a comprehensive complaints procedure on display in the main entrance of the home. This is in large print to assist people with visual impairments to access the information. Since the last visit to the home, we had received one complaint and this had been referred back to the providers to investigate using their own complaints procedure. The home has a record of complaints and two had been recorded. There were good details documented about the nature of the complaint, actions taken and the outcomes for the person who made the complaint. One person told us that they could talk to any of the staff if they had a complaint and others said that the manager would sort out any problems. People were confident that their complaints would be listened to and acted upon. The home has a copy of the Birmingham Multi Agency guidelines, which gives staff guidelines to follow should there be an allegation of abuse. We spoke to staff and they were able to clearly tell us what action they would take if an Karistos DS0000052442.V350863.R01.S.doc Version 5.2 Page 18 allegation of abuse was made and this should ensure that people are safeguarded from harm. All of the staff have received in house training in the Protection Of Vulnerable Adults and the Primary Care Trust has supplied further training. This should mean that staff have the knowledge to keep people safe from harm. Karistos DS0000052442.V350863.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 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 environment to live in. Bathing facilities do not meet the needs of all the people who live at the home. EVIDENCE: Since the last visit to the home a number of improvements had been made to the home environment in order to provide a homely place for people to live in. 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. The passenger lift had broken down on the day of the visit, however staff had taken immediate action and had called the engineer. This meant that some people had to remain in their rooms, as they were unable to manage the stairs. There are three double rooms and eleven single rooms. Two of these rooms have an en suite shower facility. All rooms have a call bell so that people can Karistos DS0000052442.V350863.R01.S.doc Version 5.2 Page 20 call for help as they choose. All of the rooms have had new wardrobes, chest of drawers and bedside cabinets to promote a homely environment. Bedrooms were personalised with items to reflect the age, culture and personal interests of people who lived at the home. Two of the bedrooms had an offensive odour due to soiled carpets and the manager arranged for these to be changed the following day to ensure a pleasant environment for people to live in. Communal space consists of a lounge, small dining room and a small sensory room. The lounge has a number of specialist chairs, which have been assessed for individual people. A new carpet had been laid in the lounge area to improve the environment. The dining room is small and not big enough to accommodate everyone at the same time and the home is awaiting planning permission to extend sideways in order to address this. A small sensory room with fibre optic lights has been created and is used by one particular person. There was a small hole in the flooring of the main entrance and this requires repair as it could pose a potential access point for pests. Lino at the entrance to the kitchen required repair, as was beginning to lift and could be a potential trip hazard. The laundry area was tidy, although the laundry is quite small. The kitchen area was clean and tidy and had plenty of stock including fresh fruits and vegetables. Bathing facilities in the home do not meet all the needs of the people who live at the home. A walk in shower had been created on the first floor of the home and further work had been completed on this to improve the drainage and a dividing wall had been installed to separate it from the toilet area. There is only one bath in the home and this does not meet the needs of the people who live in the home as it is domestic in style and there is limited room in which to manoeuvre. There is no bath hoist to assist people into the bath. The managers and providers had devised a plan to make the bathroom assisted and larger however we would not support this plan, as it would mean creating a new-shared room. An alternative solution to this problem must be identified. One person told us “There is a shower I can use”. Access to the garden is via a ramped access from the dining room, which leads onto a small paved area, which was in need of a general tidy. A steep pathway leads onto a grassed area but there was no furniture should people want to sit and enjoy the garden. There was a summerhouse at the end of the garden however this was locked as was being used to store old equipment and tins of paint. The garden fences behind the laundry are in need of repair and it is recommended that the garden area is reviewed and action taken so that people who live at the home can use it. Karistos DS0000052442.V350863.R01.S.doc Version 5.2 Page 21 There is no designated smoking room for people to use and this must be addressed, as there are people at the home who like to smoke and they are required to go out into the garden at the present time. Karistos DS0000052442.V350863.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 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 adequate numbers of staff, who receive training, to ensure they have the knowledge to perform competently in their roles. EVIDENCE: The home has four care staff and one trained nurse on duty throughout the day and two care staff and one trained nurse during the night. There are currently no staff vacancies and the home generally maintains a core group of staff, which provides consistency for people who live at the home. In addition to care and nursing staff the home has daily laundry, domestic and kitchen staff and a maintenance person once a week, to meet all the needs of people who live at the home. The manager works Monday to Friday but is on call when not in the home, to support the staff. The manager has increased the number of male care staff so that the staff gender mix reflects the current needs of people living at the home. People we spoke to told us: “Staff are friendly and polite” “Staff are good, they look after me” Karistos DS0000052442.V350863.R01.S.doc Version 5.2 Page 23 “The plus about the home is the staff” “The staff are nice” Induction records were seen for a new member of staff and the induction process takes three days. The home must obtain a copy of the Skills for Care induction pack and implement this into the home to ensure that staff receive a full induction into their role. Three staff recruitment files were reviewed and were found to contain all information as required ensuring that the staff are fit to work with vulnerable people. One file did not have confirmation that the person was eligible to work in this country, however the manager has now provided confirmation of this. 70 of the care staff have achieved a National Vocational Qualification (NVQ) level 2 in care and the remaining 30 of staff are working towards achieving this. This provides a workforce that should have the knowledge and skills to care for people individually and collectively. Staff have undertaken training in Protection Of Vulnerable Adults, conflict management, verification of death, risk assessment, pain management, tissue viability, equality and diversity, medication management and training in the management of HIV (Human Immunodeficiency Virus). While the records were available to show which staff had received this training, it is recommended that a staff training matrix is devised in order to easily retrieve information about what training staff need and to assist in planning of further training. Karistos DS0000052442.V350863.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager has brought stability to the home and is keen to make further improvements to ensure that the home is run in the best interests of the people who live there. EVIDENCE: The Registered Manager has been at the home for approximately 18 months and has completed the Registered Managers Award. He has completed training courses alongside the staff and this ensures that he has the knowledge to continue to lead the staff group. The manager is currently working towards a National Vocational Qualification (NVQ) level 2 in conflict management. Staff told us that they liked working at the home and commented that they felt comfortable working there. It was clear that staff had a good rapport with the manager. We met one of the provider’s briefly during the visit and spoke to Karistos DS0000052442.V350863.R01.S.doc Version 5.2 Page 25 two other providers on the telephone. The Responsible Individual visits the home and completes Regulation 26 visit reports; however the last one we received was for May 2007. The Responsible person must ensure that these reports are written each month and that reports are available for review. Prior to the inspection the Registered Manager had completed the Annual Quality Assurance Assessment (AQAA) and this gave us good information about the service provided, how it had improved and how it planned to improve further over the next year. This shows that the manager has a clear vision of how the home could move forward. Staff meetings are held and this gives staff the opportunity to discuss and share ideas about the home. There are questionnaires available for residents to complete, which enables them to share their views about aspects of the home including food, personal care and support, premises, management and activities. A monthly home audit tool has been devised and this is reviewed by one of the providers in order for action to be taken. A suggestions box is located in the main entrance, which enables people who live at the home or visitors to express their opinions if they choose to. While some feedback is being obtained the home must now work towards formalising this information into a quality assurance system and produce an annual report on its findings, including an action plan to address any areas where improvements could be made. Maintenance records of equipment and utilities were reviewed and indicated that appropriate health and safety checks were maintained to ensure the safety of people living at the home. The exception to this was no monthly checks could be located for the emergency lighting and this must be addressed. The fire alarm is tested weekly and staff attendance at fire training is documented. This should mean that staff have the knowledge to safeguard residents in the event of a fire. Accidents are recorded along with any action taken to prevent the same incident occurring again, and the home informs us of any accidents or incidents as per Regulation 37. Karistos DS0000052442.V350863.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 X 5 3 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 2 29 2 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 1 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 1 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 2 2 2 X 3 X 2 X X 2 X Karistos DS0000052442.V350863.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA9 Regulation 13(4) Requirement Risk assessments must be written for risks and be reviewed to ensure people are safe. Care plans for specific needs such as epilepsy must be written so that staff know what they need to do. Boxed medication must be recorded so that people receive their tablets as prescribed. Flooring in the kitchen and main entrance must be made safe to prevent any injury or pest’s occurring. Suitable bathing facilities and equipment to enable all residents to have a bath or shower must be provided. (Timescale of 30/09/06 & 30/08/07not met) A designated smoking area must be identified to ensure safety of people. (Timescale of 30/10/06 & 30/06/07not met) A call system that can only be cancelled at the point of DS0000052442.V350863.R01.S.doc Timescale for action 10/10/07 2. YA19 15(2) 10/10/07 3. YA20 13(2) 28/09/07 4. YA24 13 (4)(a)(c) 05/10/07 5. YA27 23(2)(j)(n) 16/11/07 6. YA28 23(2)(a)(g) 16/11/07 7. YA29 23(2)(n) 09/11/07 Karistos Version 5.2 Page 28 8. YA35 18(1) 9. YA39 24(1) 10. YA39 26 11. YA42 23(4) call and not mask any subsequent calls must be provided to ensure people are safe. (Timescale of 01/09/04, 01/09/05 & 30/06/07 not met) Newly employed care staff must undertakes induction to the Skills Council standards so they have the knowledge to look after people. (Timescale of 30/08/06 & 30/06/07 not met) A quality monitoring system that seeks the views of those using the service and various stakeholders including a development plan must be implemented to ensure a constantly improving service. (Timescale of 01/06/05 & 01/09/06 not met) The responsible individual must visit the home at least once a month and write a report on the conduct of the home so that quality is monitored. A copy of the report should be forwarded to the Commission. Timescale of 30/5/06 & 30/06/07 not met) Systems must be in place to ensure the emergency lighting is in full working order to ensure safety of people at the home. 26/10/07 30/11/07 31/10/07 05/10/07 Karistos DS0000052442.V350863.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. Refer to Standard YA1 YA5 YA9 YA18 YA24 YA35 Good Practice Recommendations The statement of purpose and service user guide should be updated with current information. A letter should be sent to people to inform them of changes in their fee rates. The movement folder should be completed so that staff know where people are. If people are unable to sign documentation this should be recorded. The garden area should be made attractive and available for people to use. A training matrix should be devised to monitor training needs. Karistos DS0000052442.V350863.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Karistos DS0000052442.V350863.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. 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