Inspection on 25/05/06 for Ker Maria

This inspection was carried out on 25th May 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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 18/12/06

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 Sue Smith Unannounced Inspection 09:30 25th May 2006 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 DS0000019236.V292772.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 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. DS0000019236.V292772.R01.S.doc Version 5.1 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 Care Home 41 Category(ies) of Dementia (41), Old age, not falling within any registration, with number other category (41) of places DS0000019236.V292772.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Elderly Physically Frail Elderly Mentally Impaired Date of last inspection 16th November 2005 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. The Manager of the home has submitted an application for registration, which is being processed by the Link Inspector. The fees charged are presently between £525.00and £600.00. 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 24th May 2006. 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. DS0000019236.V292772.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first key inspection of the service since the implementation of IBL2 (Inspecting for Better Lives). The inspection was undertaken on the 25th May 2006 by Sue Smith (Regulatory Inspector) and Gill Wooldridge (Regulatory Inspector). The Manager was available throughout the inspection. The Inspectors used a triangulated methodology to complete this inspection, pre-inspection information and documentation was used in the planning process to ensure hypotheses were formulated to support the inspector to explore issues of concern and verify practice and service provision. The information used to formulate the hypotheses also included feedback from Service Users, Family and Professionals from the comment cards received at the Commissions office. During the inspection a variety of documentation was assessed, which included Careplans, Risk Assessments, Pre-Admission Assessments, Menus, Rota’s, Training records, Recruitment records, Health & Safety Records and monitoring tools and Quality audit systems. The Inspectors identified four Service Users for Case tracking, speaking with these Service Users and available family members, as well as assessing the available information held in the home pertaining to the care provision for these Service Users. In addition other Service Users were spoken with during the day to gain their views on care provision. Staff members were also spoken with during the inspection to gain their views and experience of service delivery, at all times staff conveyed an honest and transparent approach when discussing their professional practice and areas for improvement. Generally Service Users and family members were happy with the care and support offered by the staff, they were complimentary of the friendly, sensitive and flexible approach of the team. Issues of concern were also taken into consideration and have been reflected in the main body of this report. The Inspectors observed positive practice throughout the day with areas identified for improvements conveyed to staff and the Manager. Unfortunately the hands-on approach to care has been let down by the insufficient and at times out of date records maintained, this has reduced the number of met standards for the home and needs to be addressed by the Manager and Proprietors as a priority for improvements. As a result of this inspection fifteen requirements and two recommendations were made to support the home to further improve its practice. DS0000019236.V292772.R01.S.doc Version 5.1 Page 6 The Inspector acknowledges the hard work of the staff in maintaining the standard of care implemented in the home and the impact staff shortages and the present lack of direction is having on them, it is hoped this inspection report will support the Manager to plan and implement improvements which will enable the home to continue to meet its regulatory responsibilities. The Inspector would like to thank the Service Users, Families, Staff and Management of the home for their hospitality and support in completing this inspection. What the service does well: Individual support is implemented in a professional and sensitive manner. Staff ensure a flexible approach to implementing individual support plans. Training to support staff is offered with some staff receiving additional training to support their professional development. Staff continue to show commitment towards their duties and as far as they are able ensure the equality and diversity of Service Users is represented when implementing the care package. The home has implemented an excellent Induction process for all new Carers with a mentoring system undertaken by suitably trained and experienced staff. Staff are open and honest when discussing their duties and are proactive in identifying areas for improvement. Meals are provided in a relaxed and pleasant environment, with a choice of menu offered. Visitors are welcomed at the home, with no unreasonable restrictions in place. Thorough pre-admission assessments of all potential Service Users are undertaken to ensure the home is able to meet their needs. This assessment includes obtaining information from significant others which supports the equality and diversity of Service Users. Suitable and meaningful activities are provided which include support to access the community. The home is generally well maintained with an evident programme of redecoration and refurbishment in place. Robust recruitment procedures are in place, which ensure all relevant security checks take place before a start date is offered. DS0000019236.V292772.R01.S.doc Version 5.1 Page 7 What has improved since the last inspection? What they could do better: The home needs to ensure its record keeping systems are kept up-to-date; presently important information held in relation to Service Users was not found to be maintained to an acceptable standard with some information not available for inspection. This has been discussed fully within the main body of the report. A thorough Quality Audit system that will support the Manager to maintain the standard of the home and identify areas for improvement needs to be implemented. An aggressive recruitment drive needs to take place to fill the vacant posts and support the team to continue to maintain the standards of care in the home. This needs to include as a priority the engagement of a replacement Administrator to support the Manager. A review of how concerns are actioned, investigated and recorded needs to take place, written evidence of actions taken need to be sent to the person raising the concern. The home needs to ensure all staff receive POVA training, as presently night staff have not undertaken this training. In addition the home must ensure that DS0000019236.V292772.R01.S.doc Version 5.1 Page 8 any perceived POVA issues are reported to the appropriate authority for consideration and if necessary investigation. The home must ensure all information required under regulation is received at the Commissions local office by the requested return date. This includes such things as pre-inspection questionnaires and regulation 37 notifications. The home will need to continue with its planned programme of redecoration and refurbishment to ensure it continues to maintain and improve on its standards. 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. DS0000019236.V292772.R01.S.doc Version 5.1 Page 9 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 DS0000019236.V292772.R01.S.doc Version 5.1 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The Quality Outcome for this area is adequate. This judgement was made using the available evidence held in the Home. The home undertakes thorough pre-admission assessments to ensure they are able to meet the needs of potential Servide Users. EVIDENCE: The home uses a pre-admission assessment template to ensure it is adopting a consistent approach to assessing whether or not they are able to meet the needs of an individual. This form is thorough, covering physical, medical, family, activities of daily living, baseline observations of B.P., Weight, Pulse and other relevant medical information. At all times when assessing a potential Service User the Home ensures they are able to meet the individual’s cultural and spiritual needs ensuring equality and diversity is addressed in the assessment process. In addition the form also includes name of solicitor, funeral director and arrangements for burial or cremation. The Inspector was concerned that this last section could be to much information to request when someone is making DS0000019236.V292772.R01.S.doc Version 5.1 Page 11 a decision to admit their loved one to the care of the home, to be discussing funeral arrangements at what is already a sensitive time might need to be reviewed. DS0000019236.V292772.R01.S.doc Version 5.1 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. The Quality Outcome for this area is poor; this judgement was made using the available evidence in the home. Careplans are in place for all Service Users, however these were not always reflective of the individual and changing needs of Service Users, leaving Service Users and Care Staff vulnerable. Medication procedures are in place to ensure the safety and protection of Service Users, however the amount of gaps evident on Medication Administration Sheets is leaving Service Users at risk. EVIDENCE: The Inspector would like to draw attention to the hard work and dedication exhibited by the Nurses and Carers of the home. They are to be commended for their honest approach when discussing their difficulties and their professional capabilities. The Inspector agrees that they are working under immense pressure due to staff shortages and commends them for endeavouring to provide a consistent and professional service. Service Users were generally complimentary of the service delivery and were appreciative of the additional support offered to them. Carers and Nurses were described as DS0000019236.V292772.R01.S.doc Version 5.1 Page 13 friendly, flexible in their routines, prompt when answering call bells and providing personal care in a sensitive manner ensuring their privacy was maintained. Unfortunately Ker Maria is not managing to maintain its records to an acceptable standard. Careplans continue to be computerised, which in itself is not an issue of concern and the Inspectors did note that improvements have been made to these plans. However at Ker Maria there are limited numbers of staff who possess the computer skills to access the careplan for updating, leaving the task to specific Nurses to complete for the whole home. This has caused gaps in recordings, and out of date assessments reflected as current in the careplan. The home does maintain fluid and turning charts for those Service Users nursed in bed, however these are not always completed therefore they are not providing the staff with accurate information when reviewing the care needs of an individual. This was also raised as an issue of concern in the comment cards received prior to inspection. A requirement is made to ensure all assessment tools are fully completed and are subject to regular review. Whilst assessing the Careplans it was evident that several of the assessment tools have not been completed to a satisfactory standard, in one careplan the consent for bed rails which has the assessment tool within the document was found to be blank with only the relatives signiture and date of signing reflected. A requirement is made for all risk assessments to be completed in full. In addition S.U. who are exhibiting challenging behaviour do not appear to have any management plan to support them in the home, this is leaving both the S.U. and staff vulnerable as no clear guidance is available as to how best to implement strategies that could decrease the exhibited behaviours. A requirement is made for the home to provide risk management plans within the careplan for all identified Service Users with challenging and high risk behaviours. An incident on the day of inspection has caused the inspector concern when assessing the staffs knowledge and level of training received when dealing with Service Users with dementia, the inspector is making a requirement for further dementia training to be carried out by an accredited dementia trainer, a list of such trainers is to be obtained from the Alzheimers society to support the home in making a decision on appropriate training. Generally individual support plans are clear, however more detail does need to be included, for example the inspector noted additions such as allow…….. to sleep in his bed. Observe ………. frequently at night, create a calm atmosphere to promote sleep, Assess …………general physical health on a regular basis. To ensure these plans are comprehensive and a consistent approach to care DS0000019236.V292772.R01.S.doc Version 5.1 Page 14 delivery is maintained the Inspector suggests when developing these plans the Nurse asks herself why, what, how and when these actions are to take place, ensuring all actions and implementations are individual to the Service User this needs to be done in consultation with the Service User or significant others e.g. family and friends, to ascertain how best to achieve such things as a calm atmosphere for that particular Service User. Presently when reading Careplans the Inspector did not feel the plans were reflective of the individual and how best to support that person. A requirement is made for further work to be undertaken to ensure all Careplans are reflective of a person centred plan, which is based on the assessment of the individual needs of Service Users. All Careplans must be reflective of regular review. The home have recently implemented the MDS (Monitored Dosage System) this has been an integrated process with the second floor using this system for the past two months and the first floor using this system for one month. Generally this is going well with clear guidance available to staff. Pulse rates are reflected on MAR (Medication Administration Records) sheets when using such medication as Digoxin, and regular B.P. monitoring is reflected in the Careplan. Controlled drugs are stored appropriately with a new Service User I.D. page implemented, which includes a picture of the Service User, room number, D.O.B. allergies, G.P. name and named Nurse/Keyworker. The MAR sheets are now coming directly from the Pharmacist, training in their use has been received from the contracted Pharmacy and staff appear to have a good knowledge of how to complete these forms. The first floor Nurses had ensured all administrations were correctly signed and the key had been used for all omissions. Unfortunately the same standard was not present on the second floor where a large number of gaps in MAR sheets were noted with no use of the key for omissions. A Requirement is made for all medication administrations to be recorded appropriately on the MAR sheets with entries made using the provided key for any omissions. There were no out of date medications held in the home and the storage facilities were found to be clean, tidy and well organised, the home is using a 28 day cycle for all medication with an appropriate method of storing returns and spoilt medication in place. A recommendation is given to ensure the dates of opening are recorded on all bottles, tubes and creams as a further measure to ensure no out of date medication is used. DS0000019236.V292772.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. The Quality outcome for this area is adequate. This judgement is made using the available evidence in the home. The home provides activities for Service Users that are meaningful and enjoyable, ensuring service users are able to access the local community as well as pursue hobbies and activities that bring them social enjoyment. Menus are generally wholesome and nutritious, however the central menu planning system does not reflect the likes and dislikes of the current service user group which could lead to deficits in meeting some Service Users dietary requirements. Visitors are welcomed at the home during all reasonable times, which supports Service Users to maintain relationships. EVIDENCE: Service Users and family members spoken with during the inspection were complimentary of the activities offered at the home. One of the activity coordinators has recently left the home leaving one Co-ordinator working with Service Users. During the inspection Service Users were engaging in meaningful activities with a painting session taking place, this was greatly enjoyed by those participating, this was undertaken in the main lounge giving DS0000019236.V292772.R01.S.doc Version 5.1 Page 16 the opportunity for late arrivers to join in if they wished. The atmosphere was calm and relaxed with staff chatting with Service Users in a friendly and respectful manner. In addition the PAT dog service arrived in the mid afternoon, visiting Service Users in their rooms as well as in the lounge, the Inspector commends the time staff took to supporting Service Users who were bed bound to access this service. One Service User spoken with was supported by the activities co-ordinator to go out once a week, visiting local shops, this support was greatly appreciated and beneficial to the Service User. There were no complaints or ideas for improvement in activity management raised with the Inspector, with all Service Users generally happy with the service provided. Meals offered at the home have improved, however menus are planned centrally which leaves little room for planning meals for special occassions and providing meals in line with the current Service User groups likes and dislikes. Some Service Users who were having difficulty with their appetite felt there was little on the menu that enticed them, these are individual needs that the Chef does his upmost to meet providing homemade soups and snacks. Other Service Users were happy with the food provided and felt there was plenty offered with a three course main menu and lots of fresh fruit available. Presently there is not enough kitchen staff employed at the home, with only one chef and one kitchen assistant, this needs to be assessed by the Proprietors with additional staff employed as needed. The Inspector has suggested to the chef ways in which the menu planning can be improved using a quality audit system. Generally the kitchen is maintained, clean and tidy, however it is in need of a refurbishment, this is not reflected as a requirement or recommendation as its suitability will be assessed by the Environmental Health Inspector. The inspector looked at records of temperature recordings, risk assessments for the kitchen, cross contamination prevention, hazard analysis and training, these appeared to be in good order and up-to-date. Visitors spoken with generally reflected they felt welcomed at the home and were supported to visit their family or friend in private with refreshments offered throughout the visit. DS0000019236.V292772.R01.S.doc Version 5.1 Page 17 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. The Quality Outcome for this area is poor. This judgement was made using evidence available in the home. A complaints system is in place, which is reflective of timescales for action, however the system for recording concerns raised and investigated is inadequate leaving Service Users at risk. The home ensures staff are receiving POVA training, however not all staff have received this training leaving the service users vulnerable. EVIDENCE: There has been conflicting feedback when assessing this standard, some Service Users and relatives were happy with the way staff address any concerns they may have with others feeling that their concerns were not handled professionally or sensitively. On checking the complaints log, there appears to be an insufficient system in place for logging concerns, and how these have been addressed. It is imperative that the Manager ensures clear records reflecting the method in which a concern was investigated and the findings or outcomes with the actions to be taken to remedy the situation held on file. The Inspector can appreciate that this is not always a necessary course of action however there has been ongoing issues of concern raised by families which do not appear to have been resolved satisfactorily for the family, this could lead to a more formal complaint. The manager needs to ensure when he has investigated and formulated actions for resolving an issue of concern this is conveyed to the DS0000019236.V292772.R01.S.doc Version 5.1 Page 18 family both verbally and when an agreement has been reached this should then be sent in writing, thus eliminating any confusion as to what the home is doing to rectify the situation. A requirement to this effect is made. Staff have received POVA (Protection of Vulnerable Adults) training with the exception of some night staff, this needs to be addressed to ensure all staff are aware of reporting procedures and categories of abuse. A requirement is made for all staff to receive POVA training, this includes night and bank staff. In addition the home receives a requirement requesting that any perceived POVA issue must be reported using the Buckinghamshire inter-agency POVA policy guidance and reporting systems. Staff appeared unclear as to what constitutes abuse and for example how the act of restraint without clear guidance and a management plan could be perceived as abuse, to ensure Staff are not left vulnerable to accusations further awareness training is necessary. DS0000019236.V292772.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. The Quality Outcome for this area is adequate. This judgement is based on the evidence available in the home. The home is generally well maintained with an evident programme of decoration and refurbishment in place, to ensure the safety and comfort of Service Users. EVIDENCE: The home have ensured they have met the previous environmental requirments set after the inspection held on the 16th November 2005. There were no offensive odours present during the inspection with designated cleaning staff on duty who at the time of inspection were working as a team to ensure the home is maintained to a high standard. The inspector was pleased to note the friendly and respective manner in which the cleaning staff entered Service Users bedrooms, taking the time to explain what they were doing, chatting and making sure those requests for a cup of tea were filled. DS0000019236.V292772.R01.S.doc Version 5.1 Page 20 All items of C.O.S.H.H. are stored appropriately in lockable facilities, with none found laying around the home, the cleaning staff ensured they kept their cleaning trolleys close by whilst in use and when finished were then locked away appropriately. Some bedrooms have been redecorated with a programme of redecoration and refurbishment in place. Curtains have been rehung, improving the overall appearance of the home. Staff need to be reminded to ensure all doors that are designated as locked when not in use are locked. Some of these were found to be open at the time of the environmental inspection, however those left unlocked did not pose an immediate risk to Service Users. There were no identified issues of concern with the environment causing a risk to service users, the home will need to continue with its programme of decoration and refurbishment to ensure they maintain the standard. A requirement is made to this effect. DS0000019236.V292772.R01.S.doc Version 5.1 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. The Quality Outcome for this area is poor. This judgement is made using the available information and evidence in the home. Staff are employed following robust recruitment procedures, possessing the necessary skills to fulfil the role. The staff employed are knowledgeable and are implementing a good quality of care, however staff shortages and a lack of clear guidance are causing difficulty in maintaining these levels of care, which could leave Service Users at risk. EVIDENCE: It has to be said that the care provision at Ker Maria is of a good standard and staff are doing their upmost to maintain a consistent and sensitive approach in their care practices. However, staffing is a major issue of concern for the home, staff shortages have caused problems with the maintenance of records as there is a high level of Agency usage who are at times unable to access these records. The home has recently recruited an additional Nurse to support the team, however this process will take three months due to her coming from an Agency used by the service. The shortage of Carers has been somewhat rectified with the home now employing on a short term contract x4 Agency Carers to work soley at Ker Maria, they have been interviewed by the home and excellent information in line with schedule 2 has been made available to the home. It is hoped with DS0000019236.V292772.R01.S.doc Version 5.1 Page 22 the full time employment of these staff the current pressure experienced will be eleviated, at the end of the contract the home are then able to make an offer of fulltime employment if the candidate is suitable. Care staff have been receiving training to support them in their roles, however the lack of an up to date tracking system caused difficulty in assessing who had actually received the training provided. It was found that some care staff had not received training since 2004 whilst others had received an ubundance of training in the past twelve months. A training matrix was held on the computer but this had not been updated since 2004, all other training information is held in the individual computer records of staff which were also not up-to-date. The Manager has received a requirement that the training matrix needs to be updated to reflect training undertaken, planned training and identify staff who require additional training. The home have implemented an induction process which includes mentoring, this is undertaken by two Carers who have received training to implement this role. This is a positive step to ensuring care staff receive the right information when first joining the team and the home are to be commended for its introduction. Training for the night staff is lacking which could be attributed to the time constraints of night staff, the Manager has been asked to address this and ensure that up-to-date training is provided for all Mandatory training as well as POVA training for night staff. A requirement is given to this effect. In addition as the home provides care to a high number of Service Users with Dementia the Inspector is making a requirement for all Agency staff to have Dementia Training to support them in their role when working at Ker Maria, at this time all other relevant training for these staff is up-to-date. Recruitment procedures are in place, with copies of documents held on file, these files were completed however information has not been transferred to the computer files due to the shortage of an administrator. DS0000019236.V292772.R01.S.doc Version 5.1 Page 23 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 & 35. The Quality Outcome for this area is poor. This judgement is made using the available evidence in the home. The manager possesses the necessary skills and qualifications to fulfill this role, however presently the Organisation and the Manager are not efficiently running the service leaving the service users and staff at risk. The home has limited systems in place which enable them to self-audit and highlight areas for improvement, this currently leaves Service Users and the home at risk. The home ensures health and safety systems are in place which support the Service Users to live in a safe and pleasant environment. DS0000019236.V292772.R01.S.doc Version 5.1 Page 24 EVIDENCE: The Manager is under immense pressure to perform, however at this time he does not have the necessary support of adequate staffing numbers and an administrator to accomplish the tasks set, his time presently is taken up with covering nursing shifts and trying to keep up-to-date with the administration tasks, this is detrimental to the home and cannot continue long term as the management tasks cannot at this time take priority. The Providors need to implement some positive action to support the Manager and the Inspectors have made a requirement for an administrator (either from within the organisation or an agency administrator) to be placed at the home until the post can be filled permanently. A lack of direction and clear management is causing high anxiety and stress for staff, taking this into consideration with the staff shortages the Inspector is concerned as to how long the Manager and his team are going to be able to maintain the level of professional practice without it having a negative impact on the care delivery. Moral is at a low level which needs to be addressed before further staff decide to leave the home. These issues need to be addressed by the Proprietors as a matter of urgency with support mechanisms put in place to enable the Manager to achieve. However much the day to day management of the home is the responsibility of the Manager, the Inspector feels unless some positive action is taken to provide the resources necessary to achieve in this role then the Manager is not able to work efficiently or productively. A strategy to consider is the need to include a more structured supervision process that is conducive to problem solving the current issues. Quality audit systems have not been kept up to date. The Inspector also noted there are limited systems to begin with. The Organisation needs to explore more efficient ways to audit its systems and implement change from the findings of audits. This should include weekly, monthly, quarterly and annual audits. There needs to be more emphasis placed on reviewing the work undertaken and from the records of review, planning actions that can be implemented to raise the standard of the home. The inspector appreciates this could be down to the current lack of time and resources. The Inspector discussed with the Manager how an effective quality audit system would support him to identify areas that need addressing as a priority and those which need further work to bring the home up to standard. A requirement for a thorough quality audit system to be implemented at the home is made. Health and safety procedures are in place with staff knowledgeable as to their responsibilities. As has been previously mentioned this must include the up dating and reviewing of risk assessments to ensure a safe environment is provided to Service Users. A requirement has been made to this effect. DS0000019236.V292772.R01.S.doc Version 5.1 Page 25 A process of 1:1 supervision is in place, these have been booked through the homes diary. The Nurses supervise Carers and the Manager supervises Nurses. The home needs to formulate a supervision list that can identify booked supervisions and when the next supervision is planned. Presently the diarised list does not indicate whether or not the supervision took place and the reader has to flick through pages to check when a supervision is due. The present method of recording does not support the Nurses to maintain the system in such a high pressure environment. The home have received a recommendation for improvements in this system. The home does not handle any service user monies therefor a system is not required. All purchases made on behalf of a Service Users are paid using an invoice and billing system. Familes reported receiving regular itemised bills from the Organisation. DS0000019236.V292772.R01.S.doc Version 5.1 Page 26 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 CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 DS0000019236.V292772.R01.S.doc Version 5.1 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 17 Requirement A requirement is made to ensure all assessment tools are fully completed and are subject to regular review. A requirement is made for all individual Service User risk assessments to be completed in full. A requirement is made for the home to provide risk management plans within the careplan for all identified Service Users with challenging and high risk behaviours A requirement is made for further work to be undertaken to ensure all Careplans are reflective of a person centred plan, which is based on the assessment of the individual needs of Service Users. All Careplans must be reflective of regular review. A requirement for further dementia training to be carried DS0000019236.V292772.R01.S.doc Timescale for action 31/07/06 2. OP7 13 (4) 31/07/06 3. OP7 15 (1) 31/07/06 4 OP7 15 31/08/06 5 OP7 18 (1) c, i. 30/09/06 Version 5.1 Page 28 out by an accredited dementia trainer, a list of such trainers is to be obtained from the Alzheimers society to support the home in making a decision on appropriate training. 6 OP9 13 (2) A Requirement is made for all medication administrations to be recorded appropriately on the MAR sheets with entries made using the provided key for any omissions. A requirement is made of the manager to ensure when he has investigated and formulated actions for resolving an issue of concern this is conveyed to the family both verbally and (when an agreement has been reached) in writing, thus eliminating any confusion as to what the home is doing to rectify the situation. A requirement is made for all staff to receive POVA training, this includes night and bank staff. A requirement is made that any perceived POVA issue must be reported using the Buckinghamshire inter-agency POVA policy guidance and reporting systems. The home will need to continue with its programme of decoration and refurbishment to ensure they maintain the standard. A requirement that the training matrix needs to be updated which will reflect training undertaken, planned training and identify staff who require additional training. A requirement is made for all Agency staff to have Dementia Training to support them in their DS0000019236.V292772.R01.S.doc 31/05/06 7 OP16 22 Schedule 4, (11). 31/07/06 8 OP18 13 (6) 30/09/06 9 OP18 13 (6) 30/05/06 10 OP19 23 (2) 31/12/06 11 OP30 18 (10 c. 31/07/06 12 OP30 18 (1) b. 31/07/06 Version 5.1 Page 29 13 OP37 18 (1) a. role when working at Ker Maria. An immediate requirement is made for an administrator (either from within the organisation or an agency administrator) to be placed at the home until the post can be filled permanently. A requirement is made for a thorough quality audit system to be implemented at the home is made. The Manager must ensure all information in relation to the home requested by the Commission arrives by the requested date of return. 25/05/06 14 OP33 24 30/10/06 15 OP32 37 30/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP99 Good Practice Recommendations A recommendation is given to ensure the dates of opening are recorded on all bottles, tubes and creams as a further measure to ensure no out of date medication is used. The home needs to formulate a supervision list that can identify booked supervisions and when the next supervision is planned. 2 OP36 DS0000019236.V292772.R01.S.doc Version 5.1 Page 30 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR 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 DS0000019236.V292772.R01.S.doc Version 5.1 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!