Inspection on 09/06/05 for Karistos

This inspection was carried out on 9th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 58 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 18/11/05

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 Kulwant Ghuman Un announced 9th June 2005 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 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 Stationary 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 E54_S52442_Karistos_V232551_090605 - UI stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Karistos Address 29 Chantry Road, Moseley, Birmingham , B13 8DL Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0121 442 4794 Dr Harminderjeet Singh Surdar Vacant Care Home 17 Category(ies) of Terminally Ill - Physical Disability (17) registration, with number of places Karistos E54_S52442_Karistos_V232551_090605 - UI stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Registration for 17 younger adults (18-65 years of age) categories physical disability and terminally ill 2.Care home providing nursing care 3. The proposed programme of works is completed within 24 months of purchase as attached schedule Date of last inspection 14th December 2004 Brief Description of the Service: Karistos is a privately owned care home providing nursing care for up to 17 service users who have a physical disability or terminal illness. There is accommodation for service users on all three floors of the home. There are four shared bedrooms and nine single bedrooms. Bedrooms do not have ensuite 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 service users. 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 E54_S52442_Karistos_V232551_090605 - UI stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by two inspectors and was the first statutory inspection for 2005/2006. There were 15 residents in the home, one was in hospital and there was one vacancy. Since the last inspection in December 2004 the home has had 4 monitoring visits. The home has also been issued with notices in respect of records regarding recruitment procedures. The Birmingham Social Care and Health Directorate have suspended placements at the home. During this visit inspectors spoke with 4 staff, a family visiting a resident, 4 residents and sampled some records. What the service does well: What has improved since the last inspection? What they could do better: The home must appoint a manager as soon as possible to ensure that there is suitable leadership, oversight of the care given and development of the service provided. Karistos E54_S52442_Karistos_V232551_090605 - UI stage 4.doc Version 1.30 Page 6 Staff needed to be developed with respect to the skills they required to care for this resident group and to develop the ability to improve working together as a team. The majority of residents at the home were younger adults and the care planning system needed to ensure that objectives for their social activities and involvement in the running of the home were clearly identified. Issues related to the premises which will improve the home for residents were agreed at registration must be addressed without further delay. 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 E54_S52442_Karistos_V232551_090605 - UI stage 4.doc Version 1.30 Page 7 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 Standards Statutory Requirements Identified During the Inspection Karistos E54_S52442_Karistos_V232551_090605 - UI stage 4.doc Version 1.30 Page 8 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 standard(s) 1,2,3,5 There was no available information for visitors to the home that would enable prospective residents to make an informed decision as to whether the home was appropriate for them. There were no contracts or statement of terms and conditions on residents’ files that would inform them of what they could expect from the home. For the majority of resident’s their aspirations were not taken into account when care was being planned leading to a life where basic needs such as health, warmth and food were provided for but no long term goals were identified. EVIDENCE: There were no copies of the statement of purpose or service user guide available for prospective residents or their representatives at the time of the inspection. There were copies of service user guides in residents’ bedrooms as one was retrieved by the proprietor. These documents were not examined during this inspection but an updated version needed to be forwarded to the CSCI. There had been no new admissions to the home since the last inspection. There were a number of residents in the home who had limited or no verbal communication skills. There was little evidence to indicate how staff were to communicate with them apart from getting to know gestures and facial expressions. Staff had not received specific training to address these needs. Karistos E54_S52442_Karistos_V232551_090605 - UI stage 4.doc Version 1.30 Page 9 There needed to be documented evidence of how staff were to communicate with residents and use any identified tools or known indicators of satisfaction or dissatisfaction. There were no specific needs and preferences identified for residents from minority ethnic communities in respect of their social/cultural, religious or catering requirements. In general there was no evidence that residents or their representatives had been involved in devising plans to meet the social needs of the residents. There continued to be difficulties in the management of one of the residents in the home and an alternative placement was being sought. The home needed to ensure that one to one care continued to be provided as agreed with the Department of Social Care and Health until such time that an alternative placement was found. There were no contracts or terms and conditions of residence available on the files sampled. Karistos E54_S52442_Karistos_V232551_090605 - UI stage 4.doc Version 1.30 Page 10 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 standard(s) 6,7,8 Care plans for residents needed to be further developed to cover all aspects of care including personal goals and social needs to ensure that they have a fulfilled life. EVIDENCE: Gradual improvements to care plans were being made but they still needed to have full details of how their personal care, social, dietary, health, cultural and religious needs were to be met. For example, one residents care plan stated that diabetes would be managed by compliance with dietary needs and to observe fluctuating blood sugar levels. There were no further details of how this was to be achieved. Care plans were not being updated when changes in needs and management were put in place, and numerous examples of this failure were noted. There were no care plans regarding mobility for some residents and for others there was inadequate detail regarding the hoist and sling sizes to be used. Two of the residents went to bed during the early afternoon and did not return downstairs until the following morning. Staff were unsure why this was happening except that they had had pressure sores in the past and they were put back to bed so that two hourly turns could be carried out. Karistos E54_S52442_Karistos_V232551_090605 - UI stage 4.doc Version 1.30 Page 11 Clear records needed to be maintained of why some of the residents spent a lot of time in their bedrooms and indicate what other options had been explored and how their social needs would be met whilst in the bedrooms. A clear record of the visits made by medical professionals, the reason for the visit and any outcomes needed to be put in place. A key worker, who was a nurse, needed to be allocated to each resident to oversee that the resident’s health care needs were being adequately met. During one of the monitoring visit it was determined that the records for the management of residents monies were not acceptable. A new system has been put in place and the system must continue to be operated to show income received and where from, the expenditures made and for what with receipts. Receipts must be numbered and the records needed to have double signatures, including the resident if possible. The home needed to develop ways in which residents could be involved in the running of the home, for example, in determining the menus in the home, what activities or events are organised in the home or externally for residents and some input into the recruitment of staff in the home. Where residents exhibited challenging behaviours risk assessments need to be in place with strategies for managing these behaviours. Where PRN (as and when required) medicines were prescribed there needed to be clear guidance available relating to signs, symptoms, methods for diversion, amounts of medication given and times after which a second dose can be given. These instructions must be made clear to all staff in the home to ensure that a consistent approach can be followed. Karistos E54_S52442_Karistos_V232551_090605 - UI stage 4.doc Version 1.30 Page 12 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 standard(s) 14,15,17 Some residents were able to go out on a regular basis however more dependent residents were never taken out which could mean that there social and emotional needs were not being identified or met. Resident’s families and friends could visit at reasonable times. Adequate nutrition was being provided to the residents. EVIDENCE: One resident was taken out by staff on a regular basis as part of managing her behaviour. It was recommended that there was a pre-arranged plan in place to vary the destination rather than going to the same shop each day. Where the individual needed to make purchases this needed to be incorporated into her daily routine. Another resident was able to go out to the local shops independently and another attended a day centre on a regular basis. None of the resident group attended a college or training either because they were unable to do so or because they did not want to. Some of the more dependent residents were never taken out and the proprietors were concerned about how appropriate this would be. Discussions with occupational therapists or physiotherapists should be instigated to ensure Karistos E54_S52442_Karistos_V232551_090605 - UI stage 4.doc Version 1.30 Page 13 that this was safe and to provide any equipment that may be required to facilitate this. For residents who were unable to go out, or who did not go out through choice, there needed to be a programme of appropriate activities within the home. Residents were able to have visitors at any time. During the inspection two sets of visitors were observed in the home. One family spoken to by the inspectors indicated that they were happy with the care being provided. There was a public phone available for residents to maintain contact with families, friends and others however it was not sited so that calls could be made in private. Residents were provided with a variety of meals and the residents stated that they were happy with the food provided. There were a number of special dietary needs in the home including peg feeding and diabetic diets. There were instructions in place for peg feeding however there were no details of how diabetic diets were being met in the home. The cook had undertaken the basic food hygiene training however, she needed to undertake training on the management of specialised diets and menu planning. Residents were unable to choose where they were able to take their meals as the space in the dining room was limited and as some residents taken back to their bedrooms during the early afternoon and not brought back downstairs they had to have meals in their bedrooms. Dining tables had been replaced since the last inspection. Karistos E54_S52442_Karistos_V232551_090605 - UI stage 4.doc Version 1.30 Page 14 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 standard(s) 18,19,20 Daily routines in the home were flexible for some residents. Not all residents were able to decide on how their needs were met due to limited facilities available in the home. Residents’ health care needs were being met. The medication procedures had improved and the administration of medicines was safe. EVIDENCE: It was clear that residents who were able to express an opinion were able to make choices about what time they got up or went bed and where residents were going out their times of rising were dictated by the time needed to get them ready for the transport. For service users unable to express their wishes it was the staff who made these decisions and the reasoning behind these decisions was not clear from the documents sampled. In discussions with staff it was determined that some residents were unable to have a bath or shower as appropriate equipment was not available. Some of the residents were therefore only able to have a fully body wash in their bedroom. Comments were made to the inspectors that there was not always gender appropriate care in the home. During recent months the inspectors were aware that some of the residents able to make their wishes known were unhappy with the behaviour of two Karistos E54_S52442_Karistos_V232551_090605 - UI stage 4.doc Version 1.30 Page 15 particular residents in the home. There was no evidence to show that any actions had been taken to assist these residents with their feelings of unhappiness. There was some input from the community psychiatric nurses in the home. The residents had access to GP and local NHS services including chiropody. At the time of the inspection the chiropodist was seen to be dealing with residents in the lounge. Health care professionals needed to be encouraged to take residents to their bedrooms for any treatment required. There had been an incident where one of the residents had had to use a taxi to access a GP and the local hospital. This was due to a lack of knowledge of the staff on the rights of the residents in respect of accessing health services. Following an earlier complaint it was determined that the staff in the home had not been following the medication policy and MAR charts were being completed several hours before the medicines were being administered. Inspectors were advised that this practice had now ceased. The management of medicines had improved over recent months and regular audits were being carried out by the nurse in charge. It was suggested that audits were carried out in future immediately before and after a medication round to identify who was not following the procedures closely enough if discrepancies were still occurring in the records. There needed to be a procedure in place for PRN medicines to indicate when the medicines were to be administered. Amounts of medicines received into the home must be signed in. Records needed to be in place to show that prescribed creams had been applied. Karistos E54_S52442_Karistos_V232551_090605 - UI stage 4.doc Version 1.30 Page 16 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 standard(s) 22,23 The management of complaints and adult protection was not adequate to ensure that resident’s dissatisfactions were addressed. Residents did not feel that their views were listened to and acted on. EVIDENCE: There was a complaints leaflet on display and this was an appropriate procedure. A complaint had been lodged with the CSCI indicating that: night staff were not carrying out their night checks, this was upheld; that service users were not being changed during the day, this was upheld; that there was a shortage of disposable gloves, (not checked); that there was no professional cook at the home, this was not upheld; night staff did not respond to the emergency buzzers at night and that appropriate manual handling procedures were not being used, this was unresolved. Residents stated that they had raised their discontent at the behaviour of two of the residents in the home and dissatisfaction with the laundry however, these had not been recorded as complaints within the home. There had been ongoing issues with the behaviour of one of the residents and there had been allegations that the individual had been inappropriately handled by staff in the home. These issues were still under investigation. The staff in the home had failed to make the appropriate notifications following the incidents. The home needed to make residents aware of the different authorities they could contact in the event that they did not feel comfortable raising issues within the home and that they would not be victimised for making a complaint or raising issues regarding the operation of the home or actions of staff. Karistos E54_S52442_Karistos_V232551_090605 - UI stage 4.doc Version 1.30 Page 17 There were adult protection procedures in the home but these were not accessible to staff. They could not be located by staff at the time of the inspection. Staff had little understanding of what actions they needed to take in the event of an allegation or suspicion of abuse. Staff must be provided with training about what constitutes abuse, what actions they must take if an issue comes to their attention and their responsibilities in respect of reporting abuse or poor practice. The proprietors had been requested to forward evidence that staff dismissed from the home or suspended due to an allegation of abuse had been referred for inclusion onto the Protection of Vulnerable Adults (POVA) list and the NMC following the complaint. To date this had not been received. Any staff suspended due to an allegation of abuse needed to be referred to the POVA list. Karistos E54_S52442_Karistos_V232551_090605 - UI stage 4.doc Version 1.30 Page 18 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 standard(s) 24,30 Several issues agreed at the point of registration related to the environment remained outstanding leading to a shortfall in some of the facilities in the home. The premises are generally well maintained which reduces any health and safety risks for residents. EVIDENCE: The premises were not inspected during this visit. There appeared to be no progress in respect of the improving access facilities for people with physical disabilities at the front of the home. Timescales for this work to be carried out had not been met as the proprietors had been liaising with the planning department. The ground floor bathroom had been converted into a shower facility. The timescales for the works agreed at the time of registration have not been met. Outstanding issues are the provision of an en-suite facility in the ground floor bedroom, the smoking room to be re-sited and the removal of the threshold and step between the sitting room and the patio, all of which were required to be completed within 6 months of registration. These are all now breaches of registration. At the last inspection an action plan indicating how Karistos E54_S52442_Karistos_V232551_090605 - UI stage 4.doc Version 1.30 Page 19 these works were to be achieved was requested. This has not been forwarded to the CSCI and CSCI has not pursued it as there were significant difficulties in the home to be attended to as a priority. The CSCI will need to consider enforcement actions if these conditions are not met in a in a timely manner. During discussions with the proprietor it was indicated that the bathroom on the second floor was to be converted to a walk in shower. The home were advised to consult with and take advice from an occupational therapist regarding the conversion of these facilities as the plan appeared to be provide only showering facilities in the home and it had been identified that some residents could not sit in the shower chairs that have been provided to have a shower. At the time of the inspection the ground floor communal areas were found to be clean and odour free however it was noted that urine on the floor in the ground floor bathroom was not cleared up quickly and could have posed a potential risk to residents. Karistos E54_S52442_Karistos_V232551_090605 - UI stage 4.doc Version 1.30 Page 20 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,33,34,35,36 There was a lack of continuity of care by regular staff and in terms of skills and consistency of approach. To ensure residents are appropriately supported staff in the home need to ensure that residents daily living needs as well as their social and emotional needs are met. EVIDENCE: There was clarity between the nurses and carers roles. There were ancillary staff who had specific duties. Staff did not demonstrate that they had the abilities to deal with the challenging behaviours exhibited by some residents, or that they understood policies and procedures in the home including adult protection and fire procedures. It had been brought to the attention of the inspectors that some staff had difficulty communicating clearly with the residents in English. This was particularly important as some of the residents did not have good communication skills. There has been a significant turnover of qualified and full time nursing staff at the home over recent months. This means that at the current time the majority of qualified staff work on a part time basis at the home, undertaking a couple of shifts a week and having other full time jobs. It is important that the home builds up a staff team of which the majority work mainly at Karistos. Where it is known that staff have other jobs the home must ensure that staff are not working excessive hours making them tired and unsafe to work at the home. Several staff had begun to undertake NVQ 2 training in care but it was Karistos E54_S52442_Karistos_V232551_090605 - UI stage 4.doc Version 1.30 Page 21 not checked how many had completed this training. Until recently the recruitment procedures in the home had not demonstrated robustness with adequate checks to ensure that only the appropriate people were being employed. Systems have now been put into place to ensure that the process is thorough and robust and must be followed in every case. A statutory notice had been served in respect of the recruitment procedures. During examination of the rotas it appeared that the appropriate number of staff were not on duty. The nurse in charge was sure that there were the appropriate members of staff on duty however examination of agency staff invoices, signing in sheets and other documents in the home could not evidence that the staff on duty were in the home. It took over 1.5 hours to determine the staffing levels for one day. Signing in sheets were not actually signed by staff or the nurse in charge of the shift and shifts had been written up in advance. There was no evidence that staff were receiving supervision on a one to one basis. Karistos E54_S52442_Karistos_V232551_090605 - UI stage 4.doc Version 1.30 Page 22 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,42,43 The home was in urgent need of having an appropriately qualified and experienced manager in place in order that there was leadership for the staff, development of the service so that the needs of the residents can be met in the most appropriate manner. Health and safety in the home was well managed. EVIDENCE: There had been no registered manager in post since the last inspection. The home lacked direction and there was no adequate management system in place. One of the providers took on the role of overseeing the home but due to lack of knowledge and experience in the management of care homes appeared to be struggling to manage the situation. The proprietors needed to ensure that a manager is recruited as soon as possible. Some staff meetings had been held by the nurse in charge however, there had been difficulties in getting all staff to attend on their days off. Meetings should Karistos E54_S52442_Karistos_V232551_090605 - UI stage 4.doc Version 1.30 Page 23 be held during handovers or at times when additional staff had been organised to be on duty to supervise the residents. There was no monitoring of the quality of the service provided in the home and no systems for seeking the views of residents. The responsible individual had been undertaking some visits however records indicated that they were not comprehensive in what had been sampled. The last regulation 26 visit was carried out in the afternoon of the day in which an incident had occurred in the home, however, no mention was made of this in the report of the visit. Health and safety in the home was generally well managed. Evidence could not be found at the time of the inspection of fire training for staff, of fire drills for staff or evidence that the passenger lift had been regularly serviced and maintained and that wheelchairs have been serviced. Karistos E54_S52442_Karistos_V232551_090605 - UI stage 4.doc Version 1.30 Page 24 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 1 1 1 x 1 Standard No 22 23 ENVIRONMENT Score 1 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 1 1 x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x x 2 Standard No 11 12 13 14 15 16 17 x x x 1 2 x 2 Standard No 31 32 33 34 35 36 Score x 1 1 1 1 1 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Karistos Score 2 1 2 x Standard No 37 38 39 40 41 42 43 Score 1 1 x x x 2 1 E54_S52442_Karistos_V232551_090605 - UI stage 4.doc Version 1.30 Page 25 Yes Are there any outstanding requirements from the last inspection? 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 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. (Compliance not assessed at this inspection. Previous timescale given was 1.9.04) Information must be provided to staff regarding communication with residents with limited verbal communication skills. (Previous timescale of 1.10.04 not met.) An alternative placement must be pursued with the Department of Social Care and Health for the resident requiring an alternative placement. (Previous timescale of 1.2.05 not met.) Arrangements must be in place to meet the needs of residents from minority ethnic communities. The registered person must ensure that individual plans are put in place indicating how the social needs of service users are to be met following consultation with the service users or their representatives where Timescale for action 21.7.05 2. YA3 18(1)(c) (i) 1.9.05 3. YA3 12(1)(a) 1.8.05 4. YA3 12(4)(b) 21.7.05 5. YA3 16(2)(n) 21.7.05 Karistos E54_S52442_Karistos_V232551_090605 - UI stage 4.doc Version 1.30 Page 26 6. YA5 5(1)(b) & (c) 7. YA6 15(1) 8. 9. YA6 YA6 15(2)(b) 15(1) 10. 11. 12. YA6 YA6 YA7 12(1)(a) 13(1)(b) 17(2) Sch 4(9)(a) 12(1)(a) 13. YA7 14. YA8 12(2)&(3) 15. YA9 13(6) appropriate. (Previous timescale of 1.3.05 not met.) The registered person must ensure that all residents are given a copy of the statement of terms and conditions of residence. (Previous timescale of 1.9.04 not met) The registered person must 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 by staff. (Previous timescale of 1.9.04 not met) The residents care plans must be kept under review and updated as changes occur. The registered person must ensure that either residents or their representatives are involved in drawing up the care plan. (Previous timescale of 1.9.04 not met) The registered person must ensure that a nurse key worker system is put into operation. A record must be maintained of any visits from any health care professionals. Accurate records must continue to be maintained for expenditures made on behalf of residents. Records must be able to evidence why decisions have been made that impact on residents lives, eg spending most of the day in bed. Residents must be given opportunities to be involved in the day to day running of the home. The registered person must ensure that risk assessments are in place, and staff are made aware of the way in which any challenging behaviours are to be 21.7.05 1.8.05 1.8.05 1.8.05 1.8.05 1.8.05 9.6.05 21.7.05 1.8.05 1.9.05 Karistos E54_S52442_Karistos_V232551_090605 - UI stage 4.doc Version 1.30 Page 27 16. YA12 15(1) 17. YA12 12(1)(a) 18. YA14 12(1)(a) 19. 20. YA15 YA16 12(1)(a) 12(1)(a) 21. 22. YA17 YA17 23(2)(g) 17(2)Sch 4(13) 23. YA17 16(2)(i) 24. YA18 18(1)(a) managed. (Previous timescale of 1.2.05 not met.) The registered person must ensure that there is an individual plan for each service user identifying the activities to be carried out. (Previous timescale of 1.9.04 not met) Advice must be taken from professionals who can advise on the possibility of the resident being taken out from the home and for the provision of any equipment required. Residents who are unable, or do not wish to go out must have activities and entertainment arranged in-house for them. There must be facilities in place to enable residents to be able to make phone calls in private. The registered person must ensure that all bedroom doors are fitted with locks that are suited to residents needs and can be accessed by staff in an emergency. (Previous timescale given 1.12.04. Compliance not checked at this visit.) Adequate dining space must be provided for all residents. The registered person must ensure that individual records of food eaten by service users are maintained. (Compliance not checked at this visit. Previous timescale given 1.2.05.) 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 timescale given 1.2.05.) Personal care must be provided by carers and nurses of the gender preferred by the resident. 1.8.05 1.8.05 1.8.05 21.7.05 21.7.05 1.11.05 21.7.05 21.7.05 21.7.05 Karistos E54_S52442_Karistos_V232551_090605 - UI stage 4.doc Version 1.30 Page 28 25. YA19 12(1)(a) 26. YA19 12(1)(a) Records of their preferences must be recroded in their care plans. Appropriate support must be given to residents in respect of their emotional and psychological health. Residents must be supported to have an annual review of their health and medication. Privacy must be provided to residents when medical care is given eg by the chiropodist. There must be an agreement from the GP stating which homely remedies can be used for each resident. There must guidelines in place for administering PRN medicines. Audits to check the effeciency of staff administering medicines must be carried out. All medicines must be checked and the amounts received recorded on receipt into the home. Tablets obtained, dispensed and left in the boxes must tally. A record of all prescribed creams applied to residents must be in place. 21.7.05 21.7.05 12(4)(a) 27. YA20 13(2) 21.7.05 25.6.05 28. 29. 30. YA20 YA20 YA20 13(2) 13(2) 13(2) 25.6.05 21.7.05 21.7.05 21.7.05 21.7.05 31. YA22 17(2) Sch 4(11) 22(3) 32. 33. YA23 YA23 13(6) 13(6) There must be a record of all 21.7.05 complaints, formal and informal, made in the home and the actions taken and the outcome of any investigation. (Previous timescale of 1.2.05 not met.) Staff must be provided with 1.9.05 training in respect of adult protection procedures. Adult protection procedures must 21.7.05 be accessible at all times. Version 1.30 Page 29 Karistos E54_S52442_Karistos_V232551_090605 - UI stage 4.doc 34. YA23 13(6) 35. YA23 13(6) 36. YA24 23(2)(a) 37. YA24 23(4)(c) (i) 38. YA26 16(2)(c) 39. YA26 23(2)(b) 40. YA26 16(2)(c) The registered person must ensure that all staff are fully conversant with the adult protection procedures. (Previous timescale of 1.2.05 not met.) Evidence that staff dismissed or suspended from employment due to an allegation of abuse or dereliction of duty have been referred to POVA and the NMC must be forwarded to the CSCI. The registered person must forward an action plan to the CSCI indicating the new timescales for the works to be carried out as detailed under the conditions of registration. (Previous timescale of 1.2.05 not met.) 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 timescale given 1.9.04. Compliance not assessed at this visit.) The registered person must ensure that 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 broken window pane is repaired. ( Previous timescale given 1.9.04. Compliance not checked at this visit.) The registered person must ensure that all bedroom furniture is suitable for its stated use and is replaced where required. (Previous timescale given 21.7.05 21.7.05 21.7.05 21.7.05 21.7.05 21.7.05 21.7.05 Karistos E54_S52442_Karistos_V232551_090605 - UI stage 4.doc Version 1.30 Page 30 41. YA27 23(2)(c) 42. YA27 23(2)(c) 43. YA28 23(2)(g) 44. YA28 23(2)(b) 45. YA28 13(4)(c) 46. YA29 23(2)(n) 47. YA29 23(2)(n) 1.6.05. Compliance not checked at this visit.) The registered person must ensure that the tiles in the bathroom on the second floor are secured in place and the extractor fan is cleaned. (Previous timescale given 1.2.05. Compliance not checked at this visit.) The registered person must ensure that all extraction fans, including the laundry, are in good working order. (Previous timescale given 14.1.05. Compliance not checked at this visit.) The registered person must ensure that there are sufficient facilities for service users to be able to sit in communal areas for the provision of social activities. (Previous timescale given 1.12.04 . Compliance not checked at this visit). The registered person must ensure that the summer house is kept locked and the glass is made safe. (Previous timescale given 1.9.04. Compliance not checked at this visit.) The registered person must ensure that all accessible areas of the garden are safe for service users. (Previous timescale given 1.9.04. Compliance not checked at this visit.) 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. (Previoys timescale given 1.9.04. Compliance not checked at this visit. The registered person must ensure that all emergency call points are accessible to service 21.7.05 21.7.05 21.9.05 21.7.05 21.7.05 1.9.05 21.7.05 Karistos E54_S52442_Karistos_V232551_090605 - UI stage 4.doc Version 1.30 Page 31 48. YA30 13(3) 49. YA30 12(1)(a) 50. YA30 23(2)(k) 51. YA30 16(2)(k) 52. YA31 18(1)(a) 53. YA32 18(1)(a) users with the appropriate extensions in place. (Previous timescale given 16.12.04. Compliance not checked at this visit.) The registered person must ensure that the floor of the laundry is made safe and impervious. (Previous timescale given 1.9.04.Compliance not checked at this visit.) The registered person must ensure that the laundry facilities are suitable for the needs of the home. (Previous timescale given 1.6.05. Compliance not checked at this visit.) The registered person must ensure that the sluice facilities in the home are in working order. (Previous timescale given 22.12.04. Not checked at this visit.) The registered person must ensure that the issue of odour control was attended to in the bedroom identified. (Previous timescale given 1.2.05. Compliance not checked at this visit.) The registered person must ensure that there are job descriptions in place for all staff. (Previous timescale given 1.3.05. Compliance not checked at this visit.) The registered person must ensure that records evidence that there are sufficient staff on duty with the skills and competencies necessary to carry out the job. There must be an accurate record of the hours worked by staff that co-incides with the rota. The registered person must 21.7.05 21.7.05 21.7.05 21.7.05 21.7.05 21.7.05 25.6.05 54. Karistos YA32 18(1)(a) Dec 2005 Page 32 E54_S52442_Karistos_V232551_090605 - UI stage 4.doc Version 1.30 55. YA 34 19 Sch 2 56. YA36 18(2) 57. YA38 12(1)(a) 58. YA39 24(1) 59. YA41 37 60. 61. 62. 63. 64. Karistos YA 42 YA 42 YA 42 YA 42 YA 42 23(4) 23(4) 13(4)(c) 23(2)(c) 23(2)(c) ensure that at least 50 of care staff are qualified to NVQ level 2 or equivalent by 2005. The registered person must ensure that all the information required by Schedule 2 of the Care Homes Regulations 2001 are in place prior to staff commencing employment. (Previous timescale of 21.1.05 not met.) The registered person must 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 1.2.05 not met.) The registered person must ensure that there are regular service user meetings. (Previous timescale given 1.2.05. 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 1.6.05 not met.) The registered person must ensure that all notifications required by regulation 37 of the Care Homes Regulations 2001 are forwarded to the CSCI. (Previous timescale of 16.12.04 not met.) Training in the fire procedures must be provided to staff. A fire drill must be carried out. Evidence that the lift has been serviced must be forwarded to the CSCI. Evidence that the lift servicing and insurance certificate to be forwarded to the CSCI. The servicing of wheelchairs 21.7.05 21.7.05 21.7.05 1.9.05 21.7.05 9.7.05 9.7.05 21.7.05 15.6.05 25.6.05 Page 33 E54_S52442_Karistos_V232551_090605 - UI stage 4.doc Version 1.30 must be followed up. 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. Refer to Standard Good Practice Recommendations Karistos E54_S52442_Karistos_V232551_090605 - UI stage 4.doc Version 1.30 Page 34 Commission for Social Care Inspection Birmingham & Solihull Local Office qst 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. Extracts may not be used or reproduced without the express permission of CSCI Karistos E54_S52442_Karistos_V232551_090605 - UI stage 4.doc Version 1.30 Page 35 - 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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