Inspection on 09/05/06 for Karistos

This inspection was carried out on 9th May 2006.

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 73 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 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 Karistos 29 Chantry Road Moseley Birmingham B13 8DL Lead Inspector Ann Farrell Unannounced Inspection 9th May 2006 09:00 Karistos DS0000052442.V293126.R01.S.doc Version 5.1 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.V293126.R01.S.doc Version 5.1 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.V293126.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Karistos Address Karistos 29 Chantry Road Moseley Birmingham B13 8DL 0121 442 4794 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Dr Harminderjeet Singh Surdhar Mr Surjit Singh Surdhar, Mr Gursharn Singh Surdhar Mr. Akinwumi Olusegun Akinpelu Care Home 17 Category(ies) of Physical disability (17), Terminally ill (17) registration, with number of places Karistos DS0000052442.V293126.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Registration for 17 younger adults (18-65 years of age) categories physical disability and terminally ill Care home providing nursing care The proposed programme of works is completed within 24 months of purchase as attached schedule 18th November 2005 Date of last inspection Brief Description of the Service: Karistos Nursing Home is a seventeen bedded home situated in the Moseley suburb of Birmingham and is registered to provide accommodation for reason of physical disability and terminal illness. It is a large three storey converted house with accommodation for residents is available on all floors and a passenger lift provides access. Accommodation consists of four shared bedrooms and nine single bedrooms and one has an ensuite shower facility. The home is within a short walking distance of shops and bus routes. Access to the front of the home is by some steep steps with wheelchair access available to the side of the property. Currently work is being undertaken to the front of the property to provide wheelchair access. 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. There are four toilets and two communal bathing facilities throughout the home, but they are not suitable for the current client group. Karistos DS0000052442.V293126.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection was conducted over two days commencing at 8.30 am on 9th May 2006. This was the first statutory inspection for 2006/2007. The registered manager was present for the duration of the inspection. During the inspection process the inspectors toured the home, sampled residents files and other documentation. The manager, five members of staff, two residents and two relatives were spoken to. A number of residents were unable to communicate verbally. The home provides accommodation for a wide range of ages, medical, nursing and social needs. A manager has recently taken up post and has been registered by the Commission, as the home has been without a manager for some time. Currently there are twelve residents in the home. Placements by Social Care and Health have just re-commenced with the registration of a manager. At the time of inspection the manager had been to the hospital to undertaken a pre admission assessment for a prospective resident. There are many requirements outstanding from previous inspections and a number of the conditions of registration in respect of the environment have not been completed to date. What the service does well: What has improved since the last inspection? There is now a registered manager in post and Social Care and Health have recommenced placements with the home. Referrals have been made to various members of the multidisciplinary health team to review resident’s needs. Karistos DS0000052442.V293126.R01.S.doc Version 5.1 Page 6 A new cook has been employed and there has been a significant improvement in the meals with the provision of a nutritionally healthy balanced diet with choices. Fresh fruit and vegetables are now available. A new laundry assistant has been employed and the presentation of residents clothing has improved. Work has commenced on the front of the building to provide wheelchair access. What they could do better: There has been little development since the last inspection and many of the requirements still need to be addressed. The proprietors will need to take more positive action to address these issues in a timely manner and demonstrate the home is being well managed. Re-decoration and refurbishment with replacement of vanity units and bedside lockers is required and attention to the garden area is required to enhance the surroundings and provide a homely environment for residents. Further improvements in infection control procedures are required with staff training, practices and equipment. The management need to further develop the recruitment procedures before staff commence employment to ensure residents are adequately protected. Staff training is required to ensure staff have the appropriate skills and knowledge to care for residents and fully meet their needs. The assessment and care planning process needs to be enhanced to ensure resident’s needs are identified and appropriate plans of action put into place. The quality assurance system needs to be developed further and action must be taken to address any issues identified by residents or stakeholders. The systems for dealing with concerns and complaints needs to be reviewed and a more pro-active approach taken to ensure residents are adequately protected. The arrangements for resident’s finances need to be reviewed and information sought regarding the benefits received and available to residents and the arrangements where families do not handle it. A number of areas in respect of the maintenance and servicing of equipment need to be addressed with some urgency to ensure a safe environment for residents. The arrangements for activities, occupation and stimulation of residents need to be reviewed and enhanced to ensure resident’s needs are being met. Karistos DS0000052442.V293126.R01.S.doc Version 5.1 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Karistos DS0000052442.V293126.R01.S.doc Version 5.1 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.V293126.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4, 5 Quality in this outcome area is poor. The judgement has been made using available evidence including a visit to this service. The information available for prospective residents and their families is not accurate. It needs to be reviewed, updated and available in other formats for the client group. The admission documents did not cover all the standards and were not fully completed and without these it cannot be guaranteed that residents needs will be identified and met. EVIDENCE: The manager provided the inspectors with a copy of the service user guide and statement of purpose. He stated that a copy had been provided in each of the resident’s rooms. It was noted that it was a combined document, was not up to date, the print was rather small making it difficult to read. Also the manager needs to consider providing it in other formats for the current and prospective residents to the home. On inspection of the contract of residence it was also noted that it was not an accurate reflection of the service provided. All these documents need to be reviewed and updated providing accurate information. There had been no new admissions to the home, but the manager was expecting a resident and had undertaken a pre-admission assessment to determine if they could meet their needs. Karistos DS0000052442.V293126.R01.S.doc Version 5.1 Page 10 On inspection of the document it was found that it did not meet the standards as there was no reference to cultural/faith needs, management of risk, specialist input, equipment required, rehabilitation or treatment programmes, methods of communication etc. The manager will need to review the assessment tool and ensure it meets the standards and staff are trained on the completion of the document. Karistos DS0000052442.V293126.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 Quality in this outcome area is poor. The judgement has been made using available evidence including a visit to this service. Care plans are based on physical needs, they do not reflect personalised care, how decisions are made and are ineffective in meeting the holistic needs of residents. EVIDENCE: The home has care plans for each resident, which the manager stated he had reviewed. It was noted they were problem focused and based on physical needs. They were not comprehensive, some gave conflicting information and they lacked detail in some areas. Although they had been reviewed monthly the reviews lacked information as to any progress etc. Risk assessments had been undertaken for some areas, but they had not been updated in some instances, they had not been put into practice or they lacked detail on how to manage the risk. The risk assessments in respect of bedrails were very poor and examples of bed rail risk assessments have been sent to the home following the inspection. In one case there was no risk assessment in respect of a resident who smoked. Karistos DS0000052442.V293126.R01.S.doc Version 5.1 Page 12 Also there was no evidence of personal goals or aspirations or how residents were involved in making decisions about their lives. Night staff practice involves completing records at the end of the shift for all residents rather than at the time of an intervention. They were kept in the lounge and all stated the same time for all residents, which cannot be an accurate record of what actually happened. The nursing staff must revise this procedure and they are referred to the NMC guidelines on record keeping and adhere to it. One resident who was able to take risks, could go out alone and manage her own finances, but the risk assessment did not reflect current arrangements. Solicitors, social care and health or the family managed the finances for all other residents, although this was not clearly documented on resident’s files. On discussion with staff they outlined care provided, but were unable to give clear details as to the care plans. The majority of residents were unable to take part in discussing their care plans. There was no evidence to indicate that residents are involved or consulted on the running of the home and there was no evidence that advocacy services were used. Records of monies held by the home had improved since previous inspections. However, it was noted that receipts were not always available for money spent, some of the receipts were plain pieces of paper without any companies details, there was a receipt for a taxi for one residents and there was no evidence that the residents had gone out of the home on that day. Also it appears that a bank account had been opened for one resident and there was a lack of records in respect of the money in the account, if money was paid in regularly and how the resident would access money from the account. The manger will need to follow up all these issues and advice the Commission of the outcome of his findings. On discussion with staff about confidentiality there was some conflicting responses, suggesting that some staff are not fully aware of the boundaries in respect of confidentiality. This area will need to be explored more fully with them and the manager will need to ensure the policy is up to date. Karistos DS0000052442.V293126.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17 Quality in this outcome area is poor. The judgement has been made using available evidence including a visit to this service. There is limited opportunity to develop social, spiritual and independent living skills. There has been a significant improvement in the diet and residents are now receiving a more varied and nutritionally balanced diet, but consideration needs to be given to inclusion of more culturally appropriate diets. EVIDENCE: Records indicated that residents were consulted about their preferences in respect of television, radio, music and they type of activities they would like to undertake approximately a year ago, when an activities co-ordinator was in post. At that time there were some structured activities such as art, crafts, music and bingo with a weekly programme of activities. However, there is no activities co-ordinator in post at present and records indicated there had been a lack of activities over several months. Karistos DS0000052442.V293126.R01.S.doc Version 5.1 Page 14 On the first day of inspection it was noted that some staff were sitting in the lounge with residents watching television and there was a lack of interaction. On another occasion a nurse was observed to enter the lounge and did not acknowledge or communicate with residents until they saw the inspector sitting in the lounge. On discussion with residents they stated they had recently celebrated a residents birthday and celebrated a Caribbean and Asian day with a buffet, which they enjoyed. Another resident stated that she had been out to church recently and this had been the first time in a long period. The ring and ride booking process was discussed with the care manager. Also residents who were able to communicate confirmed that they had the opportunity to vote at the elections recently. However, there was no evidence to indicate that special days such as Easter, Eade, and Diwalli etc had been celebrated. One resident is able to go out unaccompanied and is free to go and come as they please and safety measures have been put into place. Another resident goes out each day to visit their family. However, there was no evidence of any occupation or involvement with the community for the remaining residents. The residents’ telephone did not afford privacy when being used due to its location outside the office. One resident has her own mobile telephone, but arrangements will need to be in place for any other residents in the home who wish to use the telephone. The inspectors had opportunity to talk with relatives who were visiting. On discussion with them they stated they could visit at any time and they found the staff polite and welcoming. They stated that there had been a lack of activities recently and that the food had improved, but one stated they would like more Asian food. Two relatives confirmed that the resident liked the staff and had no complaints. However, one of them stated they had not been informed about an accident that had occurred until arriving at the home. One relative confirmed that residents do go out with the assistance of carers into Moseley village. There is a cat in the home belonging to one of the residents and this is a positive aspect. However, a policy should be drawn up regarding the care and responsibility for animals in the home. A new cook has been employed since the last inspection, who has considerable experience in the catering trade. She has reviewed menus and there is a four weekly rotating menu with a choice available. There had been considerable improvements in this area with healthy options plus fresh fruit and vegetables. On discussion with the residents and relatives there was noted to be an improvement in the food and residents stated the meals had improved and they enjoyed them. The inspector had lunch with the residents and found the food to be of a good standard, tasty, hot and well presented. Karistos DS0000052442.V293126.R01.S.doc Version 5.1 Page 15 A small group of residents take their meals in the dining room, which cannot accommodate all seventeen residents at one sitting. Other residents have their meals on a tray in the lounge or in their bedrooms. Staff were observed to give assistance in a discreet manner. It was noted that staff placed bibs on residents before eating and in some cases for those who had a PEG feed in place and at times did not communicate to residents what they were doing. It is recommended that an alternative to bibs be sought. The staff had undertaken nutritional risk assessments and it was noted in some cases that the risk had been identified as medium or high risk, but there was no evidence that any other action had been taken. Where a risk is identified staff must indicate action to taken to address it and ensure that the risk assessment is reviewed on a regular basis. The home is also advised that they should ensure there is a policy in place regarding any restrictions of the use of alcohol and drugs. Karistos DS0000052442.V293126.R01.S.doc Version 5.1 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is poor. The judgement has been made using available evidence including a visit to this service. Feedback indicated that staff were pleasant and helpful. Overall it could not be evidenced that the home was meeting the personal, emotional, psychological or nursing needs of the residents effectively and in line with good practice. The systems for the administration of medicines need further development to ensure that all residents receive the medication prescribed. EVIDENCE: The home has a key worker system in place, but it appears that some of the key workers work on night duty, which does not allow for appropriate support and communication to take place. It is recommended that this system be reviewed. Since the new manager took over he has made referrals to the multidisciplinary team including the dentist, occupational therapist, dietician, speech and language therapist and physiotherapist. Currently one resident is seen by a physiotherapist, which is privately funded. The manager stated the dietician had visited, but visits had not been undertaken by other health professionals where referrals had been made. Karistos DS0000052442.V293126.R01.S.doc Version 5.1 Page 17 All residents are registered with local G.P’s who are called when required. It was noted in one residents file that the care plan had not been updated with the GP’s instructions following the visit and there was no information about another issue that had been raised. There was no evidence of regular health checks despite the fact that there had been letters from G.P’s surgery’s in some cases. There was evidence that the chiropodist had visited the majority of residents regularly, but some had not seen one and there was no indication how this area of care was managed. Records in relation to multidisciplinary health professionals visits lacked detail as to the reason for the visit and outcome. There was no reference to any emotional or psychological needs and it is not clear if these areas are being addressed. Some care plans indicated that residents should be turned regularly when in bed, but on discussion with staff this was not occurring. In other plans it stated that passive movements should be undertaken, but again on discussion with staff there was no indication that they performed these as part of their daily routine. One care plan indicated that the resident should be referred to the dietician soon after admission to the home, but there was no evidence that this had occurred. One handling assessment indicated that a resident could not weight bear, yet a standing hoist was being used for toileting purposes. In some cases it could not be evidenced that oral care was being attended to and it appears that cotton buds are being used to clean residents ears. The manager was advised that cotton buds should not be used for cleaning the inner ear as it may cause impaction of wax and this practice should be reviewed. Dentures for one resident were found in another resident’s room and the arrangements for barrier nursing a resident with an infection were poor. The call bell system enables staff to answer it via an intercom. During the inspection there was an incident when the inspectors activated a call bell and the response from the nurse was abrupt and inappropriate. This was concerning as such a response may inhibit residents from using the call bell and it a very poor example set to junior staff. At the time of inspection it was also noted that a member of staff was changing a residents shirt in the lounge and another female residents top was not arranged properly so exposing her mid-rift. Continence was poorly managed and there was no evidence of an assessment or appropriate plans of care in place. This area will need to be addressed and staff provided with training where required. There was no protocol for dealing with residents who had epilepsy and staff knowledge in respect of tissue viability needs developing further On discussion with some staff they stated there were two sliding sheets in the home, but they were not used. Karistos DS0000052442.V293126.R01.S.doc Version 5.1 Page 18 This suggests that staff are not using correct handling procedures. It was also stated that there were only two slings for the hoist. This was especially concerning as one of the residents was being barrier nurses due to an infection. A review of the handling equipment and practice for moving residents must be undertaken and adequate equipment provided and staff training, where appropriate, to ensure safe practices are followed. Once this has been completed systems must be put in place to ensure that correct procedures are followed. There are three communal bathing facilities in the home, but it was stated that one was for the sole use of one residents. One is a domestic type bath and is not suitable for residents and the other is a shower facility on the ground floor. However, it was too small for some residents and appropriate equipment was not available to enable them to have a shower. There is one en-suite shower facility, but there was no extractor fan in the room. Action will need to be taken to ensure that there are suitable bathing facilities in the home to enable all residents to have a bath or shower. Care plans did not indicate the care of PEG tubes and PEG sites or any instructions as to the administration of medication via the PEG tube. On discussion with one nurse it was stated they followed generalised guidelines that were available on the wall of the medication room. Another stated there were certain criteria that had to be followed when giving some drugs e.g. the medication had to be stopped for a number of hours before administration of the medication. Therefore it could not be evidenced that practice was consistent in this area. Also single use syringes were being used more than once and this poses a risk in respect of cross infection. There was little evidence of communication between the staff and residents. On one occasion a resident indicated that his catheter bag required changing and the carer took the resident to the toilet without changing apron etc. The medication is stored in a separate room that is rather small. The room required cleaning and the temperature is above 25 degrees, which is the recommended level for the storage of medication. Some of the audits undertaken were not satisfactory. During the inspection the engineer visited and a quote was given for an air conditioning unit to be fitted. The home has confirmed that this has now been fitted. Areas that require attention include: • • • • • Medicine pots had been left wet and may pose a risk of cross infection. Medication had not been given for 13 days for one resident and there was no explanation for this. It had not been clearly recorded how much medication was administered when variable doses had been prescribed. Codes were not consistently recorded properly. There was no policy of the use of PRN rectal diazepam Karistos DS0000052442.V293126.R01.S.doc Version 5.1 Page 19 • • • • • • • • Staff had used the same MAR chart to record the administration of several months’ medication. Copies of prescriptions were not stored with the MAR chart. Medication had been signed as administered, but remained in the medication trolley Medication for destruction was not stored in a locked cupboard. The medication policy consisted of various documents that had been drawn up a different times and lacked clarity. The policy will need reviewing and updating. Oxygen was stored in the home and is not prescribed for any residents. The manager will need to either draw up a policy of the use of oxygen or arrange to have it removed. One resident’s records indicated that inhalers should be used with a spacer, but on discussion with the nurse he stated it was not used. Single user syringes were being re-used There was a suction machine in the medication room and there were no catheters available, the tubing was dirty and water was stored in the bottle. The bottle should be cleaned and dried after use and a supply of disposable equipment should be available in case of emergency. Karistos DS0000052442.V293126.R01.S.doc Version 5.1 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is poor. The judgement has been made using available evidence including a visit to this service. The complaints procedure is not being adhered and this does not provide assurance that issues will be addressed appropriately. EVIDENCE: At the time of inspection there was a record of one complaint that had been investigated by the manager. On discussion with the residents concerned they stated they were not kept updated with progress by the manger and found out details from other members of staff. On discussion with residents they stated they had no complaints, but were not aware of the procedure. One stated she had raised a complaint previously with the home and they had addressed them satisfactorily. However, there were no records relating to the complaint. On discussion with a relative it appears they raised some concerns about the laundering of some items of clothing. However, there was no record of this and the manager stated he was not aware that concerns had been raised. The manager will need to review the process and ensure all staff are aware to pass on any concerns so that they can be investigated properly. In addition a record of all complaints and concerns must be maintained in the home indicating the nature of the complaint, the investigation, findings, outcome and resolution. The inspectors were informed that staff had recently received training in respect of the vulnerable adult procedures. However, there was still a lack of clarity in some areas on discussion with staff and it appears that some staff have not seen the procedure. Karistos DS0000052442.V293126.R01.S.doc Version 5.1 Page 21 It was noted that the home has a copy of the multi-agency guidelines, but these have recently been updated and the manager will need to obtain a copy of them. Karistos DS0000052442.V293126.R01.S.doc Version 5.1 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29, 30 Quality in this outcome area is poor. The judgement has been made using available evidence including a visit to this service. The home is furnished to basic standards and a considerable amount of redecoration and maintenance is required. Also a number of areas in respect of infection control and general cleanliness need to be addressed in order to provide a more homely and safe environment for residents. EVIDENCE: Karistos Nursing home was registered with the current providers on 24th October 2003. At the time of registration a programme of works was agreed with the proprietors, which was to be completed within 24 months of purchase. Currently work is being undertaken in respect of providing wheelchair access to the front of the property, but some issues have not been addressed including the provision of an en-suite facility in the ground floor bedroom, smoking room to be re-sited, removal of threshold and step between the sitting room and patio, dining room extension and relocation of existing kitchen, staffroom and laundry room, ground floor, first floor and second floor bathrooms to be replanned and enlarged to facilitate assisted use from both sides and to manoeuvre a hoist, layouts of single bedrooms (less than 12 square metres) and shared rooms (under 16 square metres) to be re-divided to increase Karistos DS0000052442.V293126.R01.S.doc Version 5.1 Page 23 remaining room sizes, larger patio to garden and raise banister height. The timescales for these works to be carried out has now expired and so the home is in breach of its Conditions of registration. The proprietors have asked to submit an action plan indicating when the works will be undertaken, but no communication has been received to date. The home is a three storey detached property which was found to be warm. However, the generally cleanliness in the home was poor, there was an odour in isolated areas and there was a lack of storage. There are three double rooms and eleven single rooms. All have a call bell and wash hand basin and one room has an en-suite shower facility. However, the shower facility does not have an extractor fan and the shower curtain was torn. One resident had recently moved rooms and the bedroom had been redecorated for him with colours chosen by his mother, which was very positive. Some of the other areas were looking tired, walls were marked/damaged from the movement of furniture/equipment and some carpets were worn. New furnishings had been provided in the form of wardrobes and drawers, but some of the vanity units and bedside lockers were damaged and will need replacing. Also there were no usable lockable facilities in bedrooms, residents could not access some of the bedside lighting if they wished to switch on a light when they were in bed and the wall in room 8 was cracked. An audit of all areas should be undertaken and a plan of re-decoration and refurbishment undertaken. The privacy screening in some double rooms was poor and this will need to be reviewed to ensure residents privacy and dignity is respected. It was also noted that wash bowls and toiletries in double rooms were not labelled and this may have an implication in respect of infection control. Some of the mattresses were damaged or had bottomed out. An audit of all mattresses should be undertaken and any damaged items replaced. Tins of paint were found in one of the empty bedrooms and at the foot of the stairs and air freshener was found in the corridor. All just items should be stored in locked cupboard when not in use. The hydraulics on some of the beds were found to be faulty and this has implications in respect of manual handling. All beds must be audited and be fit for use. The communal space consists of a lounge, dining room and a small sensory room. The covers to the light fittings were missing in the sensory rooms. The tables in the dining room could comfortably seat one person in a wheelchair at either side therefore providing seating for 8 residents. There was no suitable smoking area in the home and residents smoked in the dining room outside of meal times. Karistos DS0000052442.V293126.R01.S.doc Version 5.1 Page 24 The furniture in the dining room was functional and chest freezer was also stored here so reducing the space available. There was little furniture in the lounge as most of the residents use specialised seating. The Huntingdon’s chair needs to be replaced as the upholstery by the armrests was torn and could catch on fragile skin. The manager stated they are in the process of purchasing some new chairs. The lounge needs redecorating as stains were noticed on the wallpaper. The carpet in the corridor was starting to wear and will need replacement. The bathing facilities in the home are not suitable for the client group as identified earlier in the report and at previous inspections. There is a small shower unit on the ground floor that could be used by some residents. The bathroom on the upper floor is a domestic type of bath and has no adaptations. It was noted that there was an odour from the ground floor shower room, the floor was wet and the inspector queried if there was a leak from the radiator, the door handle was loose, tiles were damaged or missing in bathrooms, some extractor fans were not working, a number of toilet seats were damaged and unsafe and a number of wash hand basins did not have a stopper in place. There were some aids and adaptations in the home to assist in the care of adults with physical disabilities, namely hoists, wheelchairs, emergency call system and passenger lift connecting all the floors. Access to the garden is via ramped access from the dining room. However, there is a step to the garden from the lounge, which is also a fire exit and this is not suitable for the client group. Also one of the windows in the lounge needs securing around the edge. The garden is slightly higher than the house and the rails proceeding up the garden path are unstable and need to be stabilised for the client group in the home. A summerhouse at the end of the garden was found to be open and contained an assortment of items such as bedrails, be heads, wheelchairs, tins of paint etc. There were also some cracked panes of glass in the garden, which are potentially dangerous and should have been disposed of in the correct manner. Action will need to be taken to address these issues and make the area safe. The laundry was too small for the purpose, there were no hand washing facilities and the staff go into the staff toilet to wash their hands. This situation is not acceptable and impacts on cross infection safety measures. The laundry was used to sore some chemicals and when the laundry assistant used the ironing board the doors to the tumble dryer and washing machine could not be opened due t o the limited space. The home has two sluices, only one of which has a sluicing disinfector. At the time of inspection both rooms required cleaning, the disinfector was not working, there was no raking, soap or paper towels in one of them and bedpans vomit bowls etc were found to the dirty in the other one. Karistos DS0000052442.V293126.R01.S.doc Version 5.1 Page 25 A number of waste bins were damaged or had no lids. It is recommended that the manager contact the health protection unit for advice regarding infection control and an audit to assist them. The kitchen is adjacent to the dining room and was clean and orderly. At the time of inspection it was noted that the cook was undertaking the washing up. It appears that the dishwasher only achieves temperatures of 65 degrees. In order to maintain adequate hygiene in the kitchen temperatures for washing up should be 82 degrees. It was also noted that the chopping boards need replacement, some of the crockery was chipped and needs replacing. The large fridge was leaking, the extractor fan required cleaning, the fire blanket should be attached to the wall and some equipment is required to enable to cook to store food samples. On discussion with the cook she stated she had undertaken a course in baking and was hoping to start some baking in the home, but she required some equipment e.g. mixer, sieve and baking trays. This would be very positive for residents. Karistos DS0000052442.V293126.R01.S.doc Version 5.1 Page 26 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35, 36 Quality in this outcome area is poor. The judgement has been made using available evidence including a visit to this service. The staff group on the whole were pleasant and have potential to develop their skills and knowledge with training. Arrangements in respect of the deployment of staff need to be reviewed and changes implemented. There have been improvements in the recruitment procedures, but further developments are required to ensure a fully robust system. EVIDENCE: The duty rots indicated that there is a nurse on duty 24 hours per day with four carers in the morning, three in the afternoon and two overnight. The manager works Monday to Friday and is on call when not in the home. The cook, domestic staff and a maintenance operative who is in the home one day a week support the care staff On the first day of inspection it was noted that all care staff and nurses from the morning shift with the exception of one was taking their lunch break at the same time. It is not appropriate for the majority of staff to take their break at the same time and this practice must be reviewed to ensure breaks are staggered during the shift. Karistos DS0000052442.V293126.R01.S.doc Version 5.1 Page 27 On the morning of the second day all the day staff and night staff were observed to enter residents room for a handover. The inspectors felt that this was not appropriate as it disturbs residents and does not give then the opportunity of sleeping past 8am in the morning. On discussion with staff it was stated that this was normal practice each morning and evening at handover period. The procedures for handovers should be reviewed taking into account resident’s choice as time to rise and go to bed. There had generally been some improvements in the recruitment procedure. However, it was noted that a new member of staff had recently been employed and the manager had not undertaken a POVA check prior to them commencing work at the home and one of the references had been obtained after they commenced employment. The member of staff did have CRB check from a previous employer, but these checks are not portable and each home has a responsibility to under take a POVA check before anyone commences employment in the home. Staff records did not consistently include information about the number of hours worked, the date employment commenced and the position held in the home. Newly employed staff undertake the home’s induction training, but this does not meet the standards of the Skills Council. There was evidence that two staff have completed NVQ level 2 training. It was stated that another three had completed the training and were waiting for the certificates plus another eight had been registered for it. There was evidence that staff had commenced a Health and Safety distance learning pack, which includes moving and handling, fire prevention first aid and COSHH. On discussion with the manger he stated he did not have a training and development plan, staff did not have a training and development assessment or a staff training needs assessment had not been undertaken for the team. There had been no training in respect of equal opportunities including disability equality, race equality and anti racism. Other areas where training will be required are basic food hygiene and infection control to ensure all the core training is completed. In addition areas such as communication, challenging behaviour, cultural awareness and end of life. The manager stated that since he took up post he has undertaken an appraisal interview with all staff, but staff supervision has not been undertaken to date. The home currently has two nurses from over seas undertaking their adaptation training. Karistos DS0000052442.V293126.R01.S.doc Version 5.1 Page 28 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is poor. The judgement has been made using available evidence including a visit to this service. The quality assurance system needs to be developed further and systems put in place to address issues raised to ensure an approach of continuous improvement. The prompt servicing of equipment and provision of training to staff in basic areas could enhance Resident’s health safety and well being. EVIDENCE: The manager has been in post for approximately three months and has been registered with the Commission in another area. He has previous experience in managing a home for residents with similar conditions. The manager stated he is arranging regular staff and management meetings. Currently the home does not have a quality assurance process in place although the manager has stated to get feedback from some of the residents/relatives. Karistos DS0000052442.V293126.R01.S.doc Version 5.1 Page 29 This area will need to be developed and a development plan drawn up indicating outcomes for residents once the process has been undertaken. There was a record of one visit by the proprietor as required under Regulation 26, which indicated discussion with two of the residents. These should must be undertaken at least once a month and include discussion with staff and residents. Samples of records were inspected in relation to maintenance/servicing of equipment and a number of areas had been addressed. Areas that remain outstanding and need attention include: • • Testing of gas equipment had been undertaken and a warning notice had been issued. Since the inspection the home has provided evidence that the issues have been addressed. The in house testing of the fire points did not cover all of the points plus the fire stops on fire doors were not tested on a regular basis, some were not working effectively and fire doors were wedged open. Records did not demonstrate that all staff had undertaken two fire drills in the last year and there was a lack of clarity about the procedure on discussion with some staff. The bath chair and weighing scales had not been serviced There was no evidence of thorough inspection of the passenger lift by the insurance company. The check of the electrical wiring in 2002 identified some problems and there was no evidence that they had been addressed. The risk assessments in respect of fire, the building and COSHH need developing. • • • • Karistos DS0000052442.V293126.R01.S.doc Version 5.1 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 2 3 X 4 1 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 1 25 2 26 2 27 1 28 1 29 1 30 1 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 1 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 2 1 2 LIFESTYLES Standard No Score 11 X 12 1 13 1 14 X 15 2 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 1 2 X 3 X 1 X X 2 X Karistos DS0000052442.V293126.R01.S.doc Version 5.1 Page 31 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 4(1) 5(1) Requirement The registered person must review the statement of purpose and service user guide, ensure they are separate documents, they are up to date, accurate and contain all the information required under the regulations. Copies to be forwarded to the CSCI. Timescales of 01/09/04 and 21/07/05 not met. The registered person must: Review the assessment process and ensure that the tool used includes all the information outlined in the standards. • Ensure the assessment document is fully completed for all residents entering the home and where necessary provide staff with training in this area. Arrangements must be in DS0000052442.V293126.R01.S.doc Timescale for action 30/08/06 2. YA3 18(1)(c)(i) 30/06/06 • 3. Karistos YA3 12(4)(b) 30/06/06 Page 32 Version 5.1 4 YA5 5(1)(b) 5 YA6 12(1)(a) 6. YA6 15(1) place to meet the needs of residents from minority ethnic communities. Timescale of 21/07/05 not met. The registered person must review the contract of residence and ensure that the information in the document is accurate and there is a copy on each residents file. Residents must be made aware of their rights to access of information held about them and how they can be accessed. This area was not assessed and has been carried forward from 21/12/05. The registered person must ensure that each resident has an individual care plan that identifies all their needs and outlines in detail the action to be taken to meet their needs. Timescale of 01/09/04 not met. There must be systems in place to ensure all staff are aware of the care plans and they are implemented. Timescale of 21/12/05 not met. The residents care plans must be kept under review and updated as changes occur. Timescale of 01/08/05 not met. The registered person must ensure that either residents or their representatives are involved in drawing up the care plan and it clearly identifies their wishes in DS0000052442.V293126.R01.S.doc 30/06/06 30/06/06 30/07/06 7. YA6 15(2)(b) 30/07/06 8. YA6 15(1) 30/07/06 Karistos Version 5.1 Page 33 9. YA6 12(1)(a) 10. YA7 17(2) Sch 4(9)(a) respect of aspects of care. Timescale of 01/09/04 not met. The registered person must review the current arrangements for the key worker system and implement an appropriate system. The registered person must: Ensure receipts are available for all transactions made on behalf of the residents. There must be two signatures for all transactions and records must clearly indicate the reasons for expenditure. The acting manager must ensure that all funds used for residents are available at all times. Timescale of 21/12/05 not met. The manager must follow up the finances in respect of residents whose family are not managing their monies to determine if they are receiving the benefits they are entitled to and the arrangements for managing their money including the bank account for one resident and inform the Commission about the arrangements. The registered person must ensure that care plans clearly demonstrate how individual choices are made by residents and any instances where others have made decisions. DS0000052442.V293126.R01.S.doc 15/06/06 30/06/06 11 YA7 12(1)(a) 30/07/06 Karistos Version 5.1 Page 34 12 YA7 17(2) 13. YA8 12(2)(3) 14 YA9 13(4) 15 YA12 12(1) 16(2) 16 YA13 14 15 18 17 YA14 16(2)(m)(n) Timescale of 21/07/05 not met. The registered person must ensure records are completed at the time of interventions undertaken e.g. turns etc. in line with NMC guidelines The registered person must ensure that residents are given the opportunities to be involved in the day to day running of the home and evidence must be available to demonstrate this. Timescale of 01/08/05 not met. The registered person must ensure comprehensive risk assessments are undertaken on individual residents and plans are put in place to manage the risks effectively to include bedrails. The registered person must undertake a review and consult residents as to any age, peer and culturally appropriate activities they would like to take part in. The registered person must undertake a review of local community facilities and put systems in place to support residents to participate in the local community in accordance with their wishes. The registered person must undertake a review and consult residents about leisure activities, draw up a plan to meet individual’s needs and ensure systems are in place for the plan to be implemented including a holiday or days trips. DS0000052442.V293126.R01.S.doc 05/06/06 30/06/06 30/06/06 30/06/06 30/06/06 30/06/06 Karistos Version 5.1 Page 35 18. YA15 12(1)(a) 19. YA17 23(2)(g) There must be facilities in 30/06/06 place to enable residents to make phone calls in private. Timescale of 21/07/05 not met. Adequate dining space must 30/08/06 be provided for all residents. An action plan must be forwarded to the CSCI. Timescale of 01/11/05 not met. The freezer should be removed from the dining room and situated in a more appropriate place. Timescale of 30/06/06. The registered person must: Ensure that where a risk is identified at the time of undertaking a nutritional assessment appropriate action is taken. • Nutritional risk assessments are reviewed on a regular basis. The registered person must ensure that semi-skimmed or full fat milk are available in the home as a matter of choice. Timescale of 01/02/05 not met. The registered person must ensure systems are put into place to ensure residents privacy and dignity is respected at all times. Timescale of 21/12/05 not met. The registered person must ensure: • All staff undertake training in respect of • 20. YA17 14 12(1) 30/05/06 21. YA17 16(2)(i) 30/05/06 22. YA18 12(4) 12(1) 18(1) 13/06/06 Karistos DS0000052442.V293126.R01.S.doc Version 5.1 Page 36 23 YA18 12(1) 24 YA18 12(1) 13(5) 25 YA18 12(1) 18(1) customer care and the approach to use when communicating with others in the home. The registered person must: • Ensure there are systems in place to meet resident’s personal needs that are in line with good practice. • Ensure a proactive approach to care with follow up of any concerns in a timely manner. The registered person must: • Undertake a review of the handling equipment and practices in the home. • Ensure correct procedures are undertaken providing staff with appropriate training. • Ensure there is adequate equipment to meet the needs of residents. • Ensure there are systems in place to monitor practice and ensure safe procedures are used. The registered person must: • Undertake a review of continence management within the home. Ensure staff are trained, assessments are undertaken and appropriate plans of care put in place to manage it. • Staff receive training in respect of tissue DS0000052442.V293126.R01.S.doc 30/05/06 30/06/06 30/07/06 Karistos Version 5.1 Page 37 26 YA18 12(1) 13(3) 18(1) 27. YA19 12(1)(a) 13(1) 28. YA20 13(2) viability. • Draw up a protocol for the management of epilepsy. The registered person must review the arrangements for barrier nursing residents who have an infection and provide staff with training in this area. The registered person must ensure that systems are in place for residents to have regular health checks and support in respect of emotional and psychological issues. The registered person must ensure: • There is an agreement from the GP stating which homely remedies can be used for each resident. • There must be guidelines in place for administering PRN medicines. Timescale of 25/06/05 not met. Audits to check the efficiency of staff administering medicines must be carried out. Timescale of 21/07/05 not met. • The accurate administration and recording of medication. Contact the drug companies for advise regarding the administration of medication via the • 30/06/06 30/06/06 30/05/06 • Karistos DS0000052442.V293126.R01.S.doc Version 5.1 Page 38 29. YA22 17(2) 4(11) 22(3) PEG tubes and ensure it is recorded in residents care plans. • All codes should be used according to instructions. • Where variable doses are prescribed staff must clearly indicate what medication has been administered. • The medication room needs cleaning. • Single use syringes must not be re-used. • Medicine pots must be washed and dried thoroughly after use. • A new MAR chart must be used each month. • A policy must be drawn up in respect of the use of oxygen or it should be returned if it is not prescribed for any resident. • The suction apparatus must be stored clean and dry and a supply of equipment must be available for use. • Review and update the medication policy to include all aspects of medication. • Ensure that medication to be destroyed is stored in a locked cupboard. • Ensure all doctors’ instructions regarding medication are carried out and if they are not for any reason ensure the doctor is informed. The registered person must 30/05/06 ensure a record of all complaints made in the DS0000052442.V293126.R01.S.doc Version 5.1 Page 39 Karistos home, formal and informal, are recorded and indicate the nature of the complaint, the investigation, outcome and resolution. Timescale of 01/02/05 not met. The registered person must ensure all staff are aware of the complaints procedure and the action to take in the event of any complaint. The registered person must ensure all staff undertake training in respect of the adult protection procedures, whistle blowing and confidentiality and are fully aware of the action to be taken in the event of an allegation. Timescale of 21/02/05 not met. The registered person must obtain an up to date copy of the Multi Disciplinary Guidelines and ensure all staff are ware of them. The registered person must forward an action plan to the CSCI indicating the new timescales for the works to be carried out as detailed under the conditions of registration. Timescale of 01/02/05 and 21/07/05 not met. An application for variation for the timescales for the completion of the works agreed as part of the registration conditions must be forwarded to the CSCI. The registered person must ensure all fire doors close properly, they are not DS0000052442.V293126.R01.S.doc 30. YA23 13(6) 30/06/06 31. YA23 13(6) 30/06/06 32. YA24 23(2)(a) 30/06/06 33. YA24 23(4)(c)(i) 30/05/06 Karistos Version 5.1 Page 40 34 YA24 23(2)(d) 35 YA24 23(2)(d) 16(2)(k) 36 YA24 23(2)(p) 37 YA24 13(4) 38 YA24 13(3) 16(2)(j) 39 YA26 12(1)(4) 16(2)(c) propped open and the doorstop releases are in working order. Timescale of 01/09/04 not met. The manager must undertake an audit of all areas and draw up an action plan for re-decoration and forward it to the Commission. The registered person must ensure that all areas of the home are kept clean and free from offensive odours at all times. The registered person must ensure: • Residents can access lights when they are in bed. • Provide covers to the lights in the sensory room. The registered person must ensure all chemicals or cleaning equipment are stored in a locked cupboard when not in use. The registered person must ensure: • A dishwasher is available that attains temperatures of 82 degrees. • The chopping boards are replaced. • Chipped crockery is replaced. • The fire blanket is attached to the wall. • The fridge is replaced/repaired • Equipment is available for food sampling. The registered person must: • Undertake an audit of mattresses and DS0000052442.V293126.R01.S.doc 30/06/06 30/05/06 20/06/06 30/05/06 30/06/06 30/06/06 Karistos Version 5.1 Page 41 40 YA28YA26 16(2)(c) 41. YA26 16(2)(c) replace any that have bottomed out or are damaged. • Ensure privacy screening shared rooms is effective. • Undertake an audit of all beds and ensure hydraulics are working and they are fit for purpose The registered person must undertake an audit of all areas and replace and damaged/worn carpets. The registered person must ensure that as part of the on-going replacement of furniture vanity units and bedside cabinets are replaced as required. Timescale of 01/06/05 not met. Any damaged furnishing must be replaced. The registered person must: • Determine the reason for the leak in the ground floor shower room and take action where required. • Replace damaged or missing tiles in bathrooms. • Provide stoppers in sinks. • Replace damaged toilet seats. • Replace the door handle in the ground floor bathroom. The registered person must review the bathing facilities and ensure action to taken to provide suitable bathing facilities and equipment to DS0000052442.V293126.R01.S.doc 30/06/06 30/07/06 42 YA27 23(2)(b) 30/05/06 43. YA27 23(2)(j)(n) 30/09/06 Karistos Version 5.1 Page 42 44. YA27 23(2)(c) enable all residents to have a bath or shower. The registered person must ensure that all extractor fans are clean and in working order. Timescale of 14/01/05 not met. A extractor fan is provided in the en-suite shower facility and the shower curtain is replaced The registered person must ensure that the summerhouse is kept locked and the glass is removed and the garden made safe. Timescale given 01/09/04 and 21/07/05 not met. The registered person must: • Provide adequate dining space and remove the freezer from the dining room. • Provide a separate smoking area. • Provide ramped access from the lounge to the garden area. The registered person must: • Ensure the lounge is redecorated. Timescale of 01/04/06 not met. Make safe the glass in the patio windows in the lounge Timescale: 30/05/06 The registered person must ensure that all accessible areas of the garden are safe for residents. Timescales given 01/09/04 and 21/07/05 not met. The registered person must DS0000052442.V293126.R01.S.doc 30/06/06 45. YA28 23(2)(b) 30/06/06 46 YA28 23(2)(a)(g) 30/10/06 47 YA28 13(4) 30/07/06 • 48. YA28 13(4)(c) 30/05/06 49. Karistos YA29 23(2)(n) 30/05/06 Page 43 Version 5.1 50. YA30 13(3) 51 YA30 13(3) 52 YA30 13(3) 53. YA30 12(1)(a) ensure that the call system can only be cancelled at the point of call and any subsequent calls do not mask the original call. Timescale of 01/09/04 and 01/09/05 not met. The registered person must ensure that the floor of the laundry is made safe and impervious. Timescale of 21/09/04 and 21/07/05 not met. The registered person must ensure procedures in respect of infection control are addressed to include the labelling of washbowls and toiletries in shared rooms. The registered person must ensure: • The sluicing disinfector is repaired. • Liquid soap and paper towels are available in all areas where infected material or incontinence pads are handled. • Racking is provided for the storage of bed pans etc. The registered person must ensure that the laundry facilities are suitable for the needs of the home and hand washing facilities are provided. Timescales of 01/06/05 and 21/07/05 not met. An action plan for providing suitable laundry facilities must be forwarded to the CSCI. The registered person must ensure that at least 50 of care staff are qualified to DS0000052442.V293126.R01.S.doc 30/10/06 10/06/06 30/07/06 30/10/06 54. YA32 18(1)(a) 30/12/06 Karistos Version 5.1 Page 44 NVQ level 2 or equivalent by 2005. Timescale of 31/12/05 not met. There must be an accessible record of the induction undertaken by staff. The registered person must undertake a review of arrangements for staff breaks and handovers and ensure effective deployment of staff. The registered person must ensure a robust recruitment procedure at all times obtaining references and POVA checks before a member of staff commences work in the home. The registered person must ensure all staff records include the dates employment commenced and ceased, the position held in the home and the number of hours worked. The registered person must ensure all newly employed care staff undertake induction to the Skills Council standards. The registered person must undertake training and development assessment of the staff team and individuals and draw up a plan of training to include specialist area such as equal opportunities, communication, cultural awareness, end of life etc 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. DS0000052442.V293126.R01.S.doc 55 YA33 12(1)(4) 10(1) 30/05/06 56. YA34 19 30/05/06 57 YA34 17(2) Sch 4 30/05/06 58 YA35 18(1) 30/08/06 59 YA35 18(1) 30/08/06 60. YA36 18(2) 30/08/06 Karistos Version 5.1 Page 45 61. YA38 12(1)(a) 62. YA39 24(1) 63 YA39 26 64. YA42 23(4) 65. YA42 23(2)(c) 66. YA42 13(4) 67. YA42 23(2)(c) 13(4) Timescale of 01/02/05 and 21/07/05 not met. The registered person must ensure systems are in place for regular residents meetings. Timescale of 01/02/05 and 21/07/05 not met. The registered person must ensure there is a quality monitoring system in place that seeks the views of those using the service and various stakeholders and a development plan is drawn up. Timescale of 01/06/05 and 01/09/05 not met. The responsible individual must visit the home at least once a month and write a report on the conduct of the home. A copy of the report should be forwarded to the Commission. The registered person must ensure all staff undertake at least two fire drills each year and a record is maintained in the home. The registered person must ensure the weighing scales are serviced and calibrated. Timescale of 18/12/05 not met. The registered person must ensure the bath seat is serviced and records are retained in the home. The registered person must ensure: • A through inspection of the passenger lift by the insurance company is undertaken and a record is retained in the home. DS0000052442.V293126.R01.S.doc 30/08/06 30/10/06 30/05/06 30/06/06 30/06/06 30/06/06 30/06/06 Karistos Version 5.1 Page 46 68 YA42 13(4) 69 YA42 13(3) 70 YA42 16(2)(j) 71 YA42 13(4) 72 YA42 23(4)(c) The issues identified in the electrical wiring check are addressed and records are retained in the home. The registered person must ensure risk assessments are undertaken in respect of chemicals, fire and the environment. The registered person must ensure all staff undertake training in respect of infection control and records are retained in the home. The registered person must ensure all staff undertake training in respect of basic food hygiene and records are retained in the home. The registered person must undertake remedial work to the gas appliances, obtain a gas safety certificate and forward a copy to the Commission. The registered person must ensure regular checks are undertaken in respect of all fire points and the fire stops used to hold fire doors open. • 30/08/06 30/07/06 30/08/06 10/06/06 30/05/06 Karistos DS0000052442.V293126.R01.S.doc Version 5.1 Page 47 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA4 YA7 Good Practice Recommendations The manger should review the admission process and ensure that opportunities to undertake introductory visits are offered to all prospective residents. It is recommended the manager obtain information about advocacy schemes, make it available to residents and determine if they wish to avail themselves of such a service. It is recommended that the manger review the procedures in respect of confidentiality and all staff are made aware of them. It is recommended that systems are put in place to ensure that relatives are informed of any accidents at the time of the accident or soon afterwards. It is recommended that a review of the use of bibs is undertaken and a more suitable alternative used. It is recommended that a policy be drawn up in respect of pets, alcohol and drug use. It is recommended that the Health Protection Team are contacted for advise in respect of infection control and an audit. (0121 224 4722) Review the records of health professional visits ensuring they provide more specific and detailed information. 3 4 5 6 7 8 YA10 YA15 YA17 YA18 YA30YA18 YA18 Karistos DS0000052442.V293126.R01.S.doc Version 5.1 Page 48 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Karistos DS0000052442.V293126.R01.S.doc Version 5.1 Page 49 - 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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