Inspection on 18/12/06 for Ker Maria

This inspection was carried out on 18th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 but made no statutory requirements on the home.

Other inspections for this house

Ker Maria 30/09/09

Ker Maria 07/04/09

Ker Maria 30/10/08

Ker Maria 17/04/08

Ker Maria 29/11/07

Ker Maria 29/06/07

Ker Maria 25/05/06

Ker Maria 16/11/05

Ker Maria 11/04/05

Ker Maria 18/12/04

Ker Maria 02/08/04

Ker Maria 10/02/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Ker Maria The Retreat Aylesbury Road Princes Risborough Aylesbury Buckinghamshire HP27 0JG Lead Inspector Stewart Mynott Unannounced Inspection 18th December 2006 9:30 X10015.doc Version 1.40 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 Ker Maria DS0000019236.V317403.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. 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. Ker Maria DS0000019236.V317403.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ker Maria Address The Retreat Aylesbury Road Princes Risborough Aylesbury Buckinghamshire HP27 0JG 01844 345474 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) kermaria@anh.org.uk The Augustinian Sisters Mr Horace Grazette Care Home 41 Category(ies) of Dementia (41), Old age, not falling within any registration, with number other category (41) of places Ker Maria DS0000019236.V317403.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Elderly Physically Frail Elderly Mentally Impaired Date of last inspection 25th May 2006 Brief Description of the Service: Ker Maria is situated within walking distance of the market town of Princes Risborough, which has many facilities including bus, train and road links. The home is purpose built on two floors and has well maintained gardens. The home provides nursing care for forty-one residents, a significant number of whom are diagnosed with dementia. All residents have individual rooms with fifteen bedrooms having en-suite facilities. The proprietors for the home are the Augustine Sisters who delegate the day-to-day management of the home to the registered manager. Information to support potential Service Users and their families to make a decision for admission to the home is provided in the homes Statement of Purpose and the Service Users Guide. Both of these documents are provided to potential Service Users, with additional copies held in the home. The fees charged are presently between £525.00 and £625.00. Additional costs exist for such things as hairdressing, newspapers and personal toiletries. Information pertaining to the current fees was received from the Home on the 17th November 2006. Ker Maria DS0000019236.V317403.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was conducted over a six-day period between the 1st and 18th December 2006, with an unannounced visit to the establishment conducted by two inspectors occurring on the 18th December 2006 lasting for 8 hours. During the site visit a full tour of the premises was facilitated. Over 50 of the visit was spent with the service users, as well as the staff on duty observing the everyday life at the home. Discussions took place with fourteen of the service users to gain their views and experiences living at the home, a number of service users have difficulty communicating verbally due to a prevalence of dementia and their views about their experiences were gained indirectly through observations and interactions with staff. Discussions also took place with most staff on duty, including the registered manager. Some of the service users and the homes records were examined to support observations made during the day. The requirements made at the previous key inspection were followed up during an additional visit made on the 25/09/06. Progress was again reviewed during this inspection process. The inspection also included reference to documents completed and supplied by the home to include a pre inspection questionnaire and staff training record. What the service does well: The home ensures that all prospective service users care and support needs are fully assessed prior to admission to ensure such needs can be catered for and fully met. The home provides a good level of information to assist service users to make a positive choice about the home. The home provides a relaxing atmosphere for service users. Service users and observations confirmed that service users are treated with dignity and respect and wherever possible are encouraged to retain control and independence over their lives. Staff observed during the inspection were kind and caring There are suitable social and recreational activities planned and provided for service users who wish to participate. This has included visits to places of interest outside the home. The home is appropriately maintained and has an effective housekeeping team to keep the environment clean, hygienic and odour free. Ker Maria DS0000019236.V317403.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The home still needs to place a greater emphasis on ensuring requirements made at previous inspections are met within timescales. This will ensure a consistent approach to raising standards and improving quality of care and management systems in the best interests of service users. It is recommended that a review be conducted to gauge whether some administration support is required to ensure the manager can concentrate solely on management tasks until the home meets accepted standards. Further work needs to occur to ensure the standard of care documentation is consistent for all service users. Support plans need to be more individual in line with service users wishes and preferences and more detail provided to describe the actions needed to ensure a fully clear and consistent approach is taken by all staff. Further work needs to occur to detail the actions that staff will take when a risk of harm has been assessed as high, for example, the actions in place if a service user is at high risk of falling. Not all service users had plans in place to inform staff of their moving and handling requirements. It was noted that there were gaps in the recording of medicines administered to service users downstairs, which requires rectifying to ensure that medicines are always signed for, or the reason for non-administration is made clear to further protect service users. Further work is required in the support systems for the staff team to ensure that their practise and understanding is monitored formally through supervision sessions. Further monitoring is required to ensure existing staff training in safe moving and handling is more regularly updated and new staff receive this training formally during induction. Ker Maria DS0000019236.V317403.R01.S.doc Version 5.2 Page 7 Whist the home does monitor the ongoing health, safety and welfare of service users and staff, some further deficiencies were noted. Fire safety records need to be more carefully maintained to evidence that weekly fire alarm tests occur and that fire drills occur on a regular basis so everyone is clear on how to respond in the event of an emergency. A review is required to the practise of leaving gloves in an evident and accessible place in bedrooms for those service users who have a dementia. There was no assessment in place to show that this practise posed no risk to individual service users safety, for example, through accidental ingestion. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ker Maria DS0000019236.V317403.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ker Maria DS0000019236.V317403.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 5 Quality in this outcome area is good. The home uses a pre admission assessment tool to fully assess the care and support needs of a potential service user prior to admission to ensure that their needs can be fully met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Five service users who have been admitted since the last key inspection were case tracked. Each service user had their needs fully assessed utilizing the homes pre assessment template to evidence that each individual needs could be met prior to their admission. The assessment on record is thorough covering twelve areas of daily living and relevant medical, physical, social and wishes for the end of life. In all cases these had been completed with only minor omissions to some areas of baseline observations to include pulse, weight and blood pressure, of which information was collected upon admission. Ker Maria DS0000019236.V317403.R01.S.doc Version 5.2 Page 10 The registered manager has in the past been responsible for completing assessments, however the patient care manager has recently assisted in this process with support from the registered manager. Four service users that were able to express a clear opinion, recollected that a pre admission assessment had been completed and felt that they had received all necessary information to assist them in making a positive choice to move into the home, including an opportunity for either their relative or themselves to visit the home. Of the service users spoken to, all confirmed that they felt that the home has lived up to their personal expectations and that they had made the correct choice of home for their individual needs and preferences. Ker Maria DS0000019236.V317403.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. Care plans and associated documentation to describe service users personal, health and social care are in place, however the standard is not consistent leaving service users and staff vulnerable. There are significant gaps in the recording of the administration of service users medication downstairs, which requires rectifying to ensure that medicines are always signed for, or the reason for non-administration is made clear to further protect service users. Staff ensure that service users are treated with dignity and respect. This judgement has been made using available evidence including a visit to this service. Ker Maria DS0000019236.V317403.R01.S.doc Version 5.2 Page 12 EVIDENCE: At previous inspections, requirements have been made surrounding improving the quality of the overall care planning for service users. It was noted from discussions with the registered manager, patient care manager and staff that work has continued to address the deficiencies noted at prior inspections, however this work has yet to be fully completed. Five service users were focussed on, to represent a diversity of service users health, personal and social needs. Each service user has individual support plans in place based on assessed and identified need. These are generally clear and easy to read. However the quality of these support plans remains variable, in particular with insufficient information as to how actions are to be achieved. For example, entries seen included, “Offer emotional and psychological support whenever necessary” and “Ensure that ... is provided and assisted with meaningful activities that matter most throughout the remaining years of life”. These entries are vague and are not individual or person centred and need further information to explain what, why, when and how actions need to be taken, to ensure staff are consistent in their approach and actions are in line with service users wishes and preferences. A repeated requirement is made to ensure care plans contain further relevant detail in relation to action plans and are completed in a person centred manner to evidence the good standard of care observed being provided by the staff team. One service users support guidelines were not reflective of their current situation, as their general health has recently deteriorated since the original care plans were written. Whilst this care plan had been evaluated by the nurse responsible to indicate that their needs had changed, the care plan needs to be rewritten to reflect the current situation. This is also subject to requirement. The patient care manager, nurses and staff described how service users medical needs are met. Service users nursing needs are met with clinical tasks organised and evaluated appropriately. There is a good relationship with the two GP surgeries used and evidence of access to local NHS care facilities. Service users health records were case tracked. Currently health records are held in different locations, however are accessible to evidence access to local NHS care facilities. Service users health needs are generally well documented to include assessments such as tissue viability, nutritional and ongoing regular monitoring of service users weights. However in two cases, not all documents to include full nutritional assessments for those service users at high risk of pressure areas, medical conditions or poor appetites had been completed as expected. Of the service users being case tracked risk assessments were viewed. Risk assessments again have been mostly completed but not fully. For example service users assessed as high risk of falling have no action plans to support Ker Maria DS0000019236.V317403.R01.S.doc Version 5.2 Page 13 how this risk could be reduced. In addition not all service users had moving and handling plans in place. The patient care manager confirmed that this has been completed for upstairs but not completed for those service downstairs at present. It was also noted again a lack of information in some instances, for example, a service user who requires assistance to stand, lists “the assistance of 2 carers”, with no further information about how to assist the service user. It is important that the documentation supports the practise being delivered by the staff team. Two nurses explained the medication system in place. There is an appropriate system to order, administer and dispose of medicines. The home uses a MDS system with a trolley located on each floor. The storage of medication was found to be clean, tidy and organised with no out of date medicines seen. The medication records for several service users on each floor were examined. Records upstairs had been completed appropriately with no omissions in recording evident. However it was noted that there were a number of gaps where medication had not been signed or an explanation for nonadministration using the key on the MAR sheets for service users downstairs. The registered manager and patient care manager were made aware of this and it is required that the registered manager take the appropriate action to ensure that the trained staff involved in medication administration complete the medication administration records accurately. It also recommended when hand written entries are made onto the printed MAR sheets to indicate a change that two staff sign such entries to confirm their correctness. Controlled drugs are maintained appropriately with two signatures in place for all administrations. During the visit to the home service users that were spoken to confirmed that the staff are helpful, supportive and polite to them. Comments include, “The staff here are always friendly and polite to me” and “The staff that assist me always treat me with respect”. Service users confirmed that their personal care is carried out in private with their wishes are always taken into consideration and that staff explain how support will be provided, for example, “I cant walk very well, they always explain what is going to happen to me first”. Observations throughout the inspection supported this view and staff were seen to provide assistance in a calm, sensitive and professional manner. During the visit staff were seen to knock on door before entering and speak to service users appropriately. The standard of care observed was of a good standard with a clear commitment to ensure service users care and support needs are met. Staff spoken to about specific service users needs, demonstrated a good understanding about individual care needs to include personal preferences. Many service users have a high level of dependancy and require a lot of support with many apsects of daily life and care. Staff were observed to attend to residents in a quiet and discreet manner without drawing attention to each resident requiring such assistance. Ker Maria DS0000019236.V317403.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. Service users are provided with a suitable lifestyle that matches their expectations to include suitable social activities and recreational interests. Visitors are made welcome in the home supporting service users to maintain their relationships. Service users are encouraged to maintain choice and control in line with their individual abilities. Service users are provided with a suitable and varied menu and provided with support as required. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home maintains a calm and relaxing atmosphere and service users appeared to enjoy their time. Service users that were able to express an opinion confirmed that they were happy with their experiences in the home and were able to choose their own activities and routines. These included Ker Maria DS0000019236.V317403.R01.S.doc Version 5.2 Page 15 routines of daily living, where they wished to spend their time, choice of newspapers and participating in organised activities. Service users stated, “ I like to sit where I am as I can see what’s going on” and “I like to join in with some of the events when they are of interest”. Service users and staff also described support in religious observances with Holy Communion. All service users spoken to were aware of planned activities and felt that the current arrangements are satisfactory and require no further development. Comment cards received from service users and relatives also confirmed this view. There are two activity organisers employed by the home. The activities organiser on duty was able to describe the range of activities on offer, to include group activities and involvement with community groups. During the visit an activity had been prearranged to show a popular film and serve sherry and snacks. Service users confirmed that they are able to maintain their contact with friends and relatives as they wish. Service users confirmed that visitors could use the lounges or their rooms for privacy. Comments received from relatives also confirmed that they are made to feel welcome by the staff at the home. Service users that were able to comment stated that their care is received flexibly with a choice of timings for personal support in line with their preferences. Service users confirmed that staff respected their choices on a day-to-day basis. Staff were seen to ascertain service users views and opinions before assisting with personal care. The menus for a four-week period were viewed prior to the visit to the home. These are currently planned centrally and the chef confirmed during the visit that these are changed on a regular basis to ensure an ongoing variety. The menu viewed was varied throughout the four week period with different choices available at each main meal. Service users were complimentary about the food confirming that it is well prepared and there is always a choice from the menu and they are able to request alternatives as they prefer Observations were made during lunchtime in both dining rooms. Service users were able to choose where they ate their meals and the experience was relaxed and unhurried. All meals served were attractively presented. Many service users required assistance to eat their meal and staff offered discreet assistance and explained to service users what they had chosen when presenting their meals. Staff spoken to had a good awareness of individual preferences and dietary requirements. Ker Maria DS0000019236.V317403.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. Service users views are listened to and acted upon, however improvements to ensure leading staff can access the complaints records when the manger is not present will further ensure all concerns and complaints are addressed and monitored. Service users are protected from abuse through the homes policies and procedures together with staff that have received further relevant training. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has an appropriate complaints policy and procedure in place. Comment cards and surveys returned to the commission confirmed that service users and relatives are aware of the complaints procedure and how to report expressions of dissatisfaction. During the visit service users that were able to confirmed that they felt they could complain if the need arose, but the majority had not felt the need and were satisfied with the services and facilities offered by the home. The manager maintains a log of all complaints received and examination revealed four formal complaints recorded since the last key inspection. Ker Maria DS0000019236.V317403.R01.S.doc Version 5.2 Page 17 There was a clear audit of the complaints to evidence how the complaint was investigated and the outcome reported to the complainant. With the exception of one complaint all had been responded to and investigated in a timely fashion. (One complaint took longer to investigate but evidence that an explanation that a delay would occur was seen on record). The CSCI was made aware of one concern by a relative, the outcome of which was contained in the complaint log. To ensure the manager is made aware of all complaints or concerns it is recommended that all nurses in charge have access to the complaints form to record any issues when the manager is not present. The home has an appropriate policy to safeguard service users from abuse and harm that has been reviewed this year. There have been two allegations of abuse made since the last key inspection. There was a clear record of these instances and appropriate procedures had been followed, following local inter agency policy guidelines. In both cases after investigation these allegations were not upheld. Training has been provided to the majority of the staff in the protection of vulnerable adults during the last year. Further training has been arranged for staff yet to attend, including new staff over the next four-week period. Ker Maria DS0000019236.V317403.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. Service users benefit from a clean, safe, comfortable and well-maintained environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A full tour of the building was facilitated by the registered manager, during which both units were viewed to include all communal areas, bathrooms and several service users bedrooms. It was noted that the home was generally well decorated and maintained with no obvious areas requiring attention. There is a spacious lounge and separate dining room downstairs and service users were seen to be relaxed and enjoying the use of these areas, which had been decorated for the Christmas season. Upstairs there is a lounge/diner and a quiet lounge that staff advised is also used by relatives as a private area. During the visit all identified doors requiring to be either shut or locked were so and no items of cleaning products were left unsecured. Ker Maria DS0000019236.V317403.R01.S.doc Version 5.2 Page 19 Service users rooms seen were clean tidy and contained personal items. Several service users commented that they were satisfied with their rooms. During the visit, members of the housekeeping team were spoken to and observed working. They described a good approach to ensure the home is kept clean and described good practise for the prevention of spread of infection. It was noted that the standards of housekeeping were excellent with no odours present during the site visit. Comments received by service users and relatives also confirmed that the home is always clean and tidy and were satisfied with the overall environment in the home. Since the last inspection there has been a program of cyclical maintenance to include redecoration of five service users bedrooms. The registered manager advised that there are plans to relocate the lift serving both floors and enhance some of the rooms to the upstairs unit in this process, which was viewed as a positive step. Ker Maria DS0000019236.V317403.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. Service users are supported by staff that are available in sufficient numbers that have been recruited following good practise to safeguard service users welfare. Service users benefit from staff that receive a varied training program to ensure that they have the necessary skills and knowledge, however lapses in moving and handling training must be addressed. Training to fully understand service users with a dementia has been planned but has not yet occurred. This judgement has been made using available evidence including a visit to this service. EVIDENCE: From information contained in the pre inspection questionnaire and examination of rotas the staffing level for the home is one trained nurse per unit supported by five care assistants during the morning shift and four in the afternoon shift. During the night there is one nurse and four care assistants. During the visit this staffing level has been maintained. Staff and service user spoken to felt that generally that this staffing level was sufficient with service users confirming that call bells are answered promptly to include during busier times. The home continues to use agency staff to maintain the staffing levels, however from discussion and examination of rotas the manager requests the same staff to ensure a continuity of care, wherever possible. During the visit staff were viewed to work well together as a team with duties being carried out Ker Maria DS0000019236.V317403.R01.S.doc Version 5.2 Page 21 without undue pressure or stress further confirming that staffing levels were correct at the time of the inspection. The registered manager is currently responsible for the recruitment and selection of prospective staff to the home. There is a continual process of recruitment and the manager described the systems in place to select and collect all necessary pre employment checks based on accepted good practise. The registered manager advised that much of the process for the recruitment of staff would soon be centralised to include collection of all necessary pre employment checks. Recruitment records for staff have already been transferred to the head office recently with information to be stored on computer. The records for three staff identified were faxed over from the head office towards the end of the site visit. Due to how this information was faxed it was impossible to make a full determination to verify all the processes and checks in place for these three staff. However it appeared that pre employment checks to include application form, two references, identification and a CRB clearance have been obtained. There was no concern in regards to recruitment raised at the last inspection. The training program since the last inspection and future planned training was viewed. The training provided and offered covered expected areas to include mandatory training in areas to include health and safety, moving and handling and protection of vulnerable adults, as well as more specialist topics to include dementia in line with needs of the service users. Staff spoken to felt that generally there was sufficient training on offer to assist them in their role. Records relating to the attendance of training provided and planned for indicated a good attendance with all grades of staff included. The manager advised that training in dementia from an accredited source has been arranged for February next year. It is essential that staff attend this training to further develop their knowledge base in this area. The registered manager has updated a training matrix to indicate the training that staff have competed and when refresher training is due. It was noted that some staff training in essential areas such as moving and handling has lapsed and in at least one case a new staff member has been working without this formal training for some time. It was seen that this update training has been planned in the near future. It is required that all new staff receive this training in a timely period in the best interests of staff members and service users. Individual staff training records are computerised and it was evident that these are still not completely up to date and require further work. From information contained in the pre inspection questionnaire currently twelve care staff have completed at least an NVQ level 2, representing 40 of the care staff team. The registered manager advised that training in this area is ongoing. Ker Maria DS0000019236.V317403.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36 and 38 Quality in this outcome area is poor. The registered manager continues to fail to address identified requirements within reasonable timescales to improve the overall quality of the services and management systems in the best interests of service users. Staff at the home are not adequately supervised. Further improvements to ensure the ongoing protection of service users and staff safety and welfare in relation to fire safety are required. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager has been in post for over one year and is suitably qualified to undertake the duties of a home manager. Currently a patient care manager and nurses taking charge of each individual shift to support the management of the home. It was noted that the Provider continues to Ker Maria DS0000019236.V317403.R01.S.doc Version 5.2 Page 23 centralise many of the administrative functions, and as such it was felt that the home no longer requires an administrator. However not all of these functions have been completely transferred, particularly with recruitment (All correspondence and checks will be completed centrally). During the visit it was evident that the home manager was undertaking administrative duties to include dealing with a large volume of post and having to visit the post office. It is recommended that the registered persons undertake a review to determine the need for some administration hours to be provided at the home during the transition period for centralisation of all administrative tasks. This will ensure that the registered manager is concentrating solely on management tasks and addressing identified deficiencies within timescales. The organisation has further supported the manager with a consultant to begin to implement a quality audit system and a way forward to address requirements made at previous inspections. The registered manager confirmed that the home will be sending out surveys to service users and relatives early next year to gain feedback and will then formulate an action plan based on these views. The home now has audit systems in place to check the quality of the services and facilities provided by the home. It was noted at this inspection that a number of requirements were not completed within timescale and the manager had not advised the CSCI that an extension on timescales was needed. Staff spoken to during the visit confirmed that they are not receiving formal supervision sessions, with most staff only having received one formal session and in some cases none. The registered manager and patient services manager were aware that significant improvements were required to ensure staff are supported through formal supervision to discuss all areas of practise, philosophy and training needs in the best interest of staff and service users. The registered manager confirmed that nurses have now received training in this area and a program of supervision is to be implemented very soon to ensure that staff are formally supported on a regular basis. One nurse spoken to also confirmed that she was preparing to supervise staff confirming that she had prepared supervision folders and described how supervision would be conducted. It is a requirement that a robust and organised system of formal supervision is introduced into the home, without delay, to ensure the aims of supervision are met to further support the staff team. From information contained in the pre inspection questionnaire, all relevant checks and servicing of equipment has been completed to ensure the continued health, safety and welfare of service users and staff. During the inspection visit a sample of records was viewed to crosscheck information already provided. Records viewed included fire safety records, COSSH assessments, gas safety certificates and hot water temperature monitoring. The fire records revealed that weekly fire alarm testing had not been recorded weekly during October and November, leaving it unclear whether a test had been conducted or a failure to record this event. It was also evident that fire Ker Maria DS0000019236.V317403.R01.S.doc Version 5.2 Page 24 drills have not been occurring at reasonable frequencies with the last recorded drill occurring on 31/05/06. It is a requirement that fire safety records need to be more carefully maintained to evidence that weekly fire alarm tests occur and that fire drills occur on a regular basis so everyone is clear on how to respond in the event of an emergency. Staff observed during the day were seen to work in a safe manner and able to describe their knowledge in relation to the safety and welfare of service users. However a review is required to the practise of leaving gloves in an evident and accessible place in bedrooms for those service users who have a dementia. There was no assessment in place to show that this practise posed no risk to individual service users safety, for example, through accidental ingestion. Ker Maria DS0000019236.V317403.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 ENVIRONMENT CHOICE OF HOME Standard No Score 1 2 3 4 5 6 Standard No 19 20 21 22 23 24 25 26 Score X X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X 1 X 2 Ker Maria DS0000019236.V317403.R01.S.doc Version 5.2 Page 26 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 OP7 Regulation 13(4) Requirement Timescale for action 15/03/07 2. OP7 15 The registered manager must ensure all individual service user risk assessments are • to be completed in full and kept under review. • strategies put in place when a risk is assessed as high to reduce the likelihood of harm. • That all service users have an appropriate moving and handling plan in place. This is a repeated requirement – original timescale of 31/07/06 not met. The registered manager must 31/03/07 continue to address the recurrent deficiencies in service users care planning to ensure • care plans are written in a person centred manner, reflecting service users preferences and wishes. • contain sufficient information as to how actions are to be achieved in relation to assessed needs. • Care plans are updated DS0000019236.V317403.R01.S.doc Version 5.2 Ker Maria Page 27 3. OP8 14(2) 4. OP9 13(2) 5. OP30 13(5) & 18(c)(i) 6. OP36 18(2) 7. OP38 23(4) when significant changes to a service users condition occurs This is a repeated requirement – original timescale of 31/08/06 not met. That the registered manager ensures that all assessments in relation to the monitoring of service users health are fully completed in the best interests The registered manager must take the appropriate action to ensure that the nursing staff involved in medication administration complete the medication administration records accurately. In the case of non-administration that entries are made using the provided key to account for any omissions. This is a repeated requirement – original timescale of 31/05/06 not met. That the registered manager ensures that all new staff receive moving and handling training during their induction period and ensure that current staff members training in this area does not lapse. That the registered manager ensures that an effective system is introduced to ensure all staff are formally supervised on a regular basis. Such supervision must include discusion of practise, philosophy of the care in the home and career devlopment needs. That the registered manager ensures records in relation to fire safety are maintained to include • Weekly recording of fire alarm tests DS0000019236.V317403.R01.S.doc 28/02/07 15/01/07 15/02/07 28/02/07 15/01/07 Ker Maria Version 5.2 Page 28 8. OP38 13(4)(c) Recording of fire drill at regular intervals. That the registered manager reviews the practise of leaving gloves in service users bedrooms with a dementia to ensure that there is no risk to service users. • 31/01/07 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 OP9 OP16 Good Practice Recommendations It also recommended when hand written entries are made onto the printed MAR sheets to indicate a change that two staff sign such entries to confirm their correctness. To ensure the manager is made aware of all complaints or concerns it is recommended that all nurses in charge have access to the complaints form to record any issues when the manager is not present. That the registered persons undertake a review to determine the need for some administration hours to be provided at the home during the transition period for centralisation of all administrative tasks. This will ensure that the registered manager is concentrating solely on management tasks and addressing identified requirements and deficiencies within set timescales. 3. OP33 Ker Maria DS0000019236.V317403.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ker Maria DS0000019236.V317403.R01.S.doc Version 5.2 Page 30 - 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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