Inspection on 07/04/09 for Ker Maria

This inspection was carried out on 7th April 2009.

CQC found this care home to be providing an Poor service.

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 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 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 16/02/2010.

CARE HOMES FOR OLDER PEOPLE Ker Maria The Retreat Aylesbury Road Princes Risborough Aylesbury Buckinghamshire HP27 0JG Lead Inspector Barbara Mulligan Key Unannounced Inspection 09:00a 7th April 2009 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.V377753.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.V377753.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) swhitcombe@anh.org.uk The Augustinian Sisters Manager post vacant 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.V377753.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 20th January 2009 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, in two units across two floors. Each unit is self-contained and has a kitchenette area, a lounge/dining area, bathrooms and toilets. The ground floor has 20 single bedrooms, eight of which are en-suite. The first floor has 21 bedrooms of which six have en-suite facilities. The proprietors for the home are the Augustine Sisters. Two of the Sisters are sharing the management of the home. Information to help potential residents and their families to make a decision for admission to the home is provided in the home’s Statement of Purpose and the Service User’s Guide. Both of these documents are provided to potential service users, with additional copies held in the home. The fees charged are presently between £670.00 and £700.00 per week. Additional charges are made for such things as hairdressing, newspapers and personal toiletries. Ker Maria DS0000019236.V377753.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is zero star. This means the people who use this service experience poor quality outcomes. This unannounced key inspection was conducted over the course of a day and covered all the key National Minimum Standards for older people. Prior to the visit, a detailed self-assessment questionnaire was sent to the manager for completion. Information received by the Commission since the last inspection was also taken into account. The inspection officer was Barbara Mulligan. The inspection consisted of discussion with the management of the home, discussion with other staff, opportunities to meet with some people who use the service, examination of some of the home’s required records, observation of practice and a tour of the premises. A key theme of the visit was how effectively the service meets needs arising from equality and diversity. Twenty-six of the National Minimum Standards for Older people were assessed during this visit. Eight standards were assessed as almost met, standard 31 was assessed as not met, and standard 6 was assessed as not applicable and the remaining standards were fully met. As a result of the inspection the home has received ten requirements. Feedback on the inspection findings and areas needing improvement was given to the management of the home at the end of the inspection. The management of the home, the staff and service users are thanked for their co-operation and hospitality during this unannounced visit. What the service does well: Potential service users receive a needs assessment, undertaken by staff trained to do so, ensuring that the home can meet the care needs requirements of service users. The home has facilities in place to enable people to promote their spiritual interests. There is a motivated and established staff team that consists of nursing and care staff who respond to service users in a respectful and appropriate manner. Ker Maria DS0000019236.V377753.R01.S.doc Version 5.2 Page 6 The home provides a pleasant and comfortable environment in which people can live. Individuals are encouraged to personalise their own rooms with their own furniture and personal belongings. All bedrooms are single occupancy to ensure that the privacy and dignity of people using the service is promoted. The home ensures that people using the service are provided with a choice of wholesome and appealing meals in pleasing surroundings. The home makes sure that relatives and friends are able to visit at anytime within reason. Training for care staff is good and people who use the service benefit from a staff team who are appropriately trained to do the job. The care staff are undertaking National Vocational Qualifications training. The evidence seen and comments received indicate that this service meets the diverse, racial, cultural, disability of individuals within the limits of its Statement of Purpose. What has improved since the last inspection? What they could do better: Each person who has been assessed as “at risk” of pressure sores must have a plan of care in place that details the action to be taken by staff. Risk assessments must be in place for any person using the service who has been assessed as “at risk” of leaving the home without support from the staff. The home must provide a detailed protocol for the individual with epilepsy that provides informative guidelines for the staff on how the condition and needs should be managed and met. Staffs practice in the recording, handling, safekeeping, safe administration and disposal of medicines in the home must be consistent. This is to ensure that the health and welfare of people using the service is not compromised. The home must implement a complaint log which records the nature of the complaint, the action taken and the outcome of the complaint. Ker Maria DS0000019236.V377753.R01.S.doc Version 5.2 Page 7 The organisation must ensure the cause of the damp, in the quiet room on the first floor, is investigated and resolved. The homes gas appliances and Portable Appliance Testing (PAT) testing must be completed annually. 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.V377753.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.V377753.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 6. Quality in this outcome area is good. Service user’s needs are assessed prior to admission ensuring that staff are prepared for admission and have a clear understanding of the service user’s requirements. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During this visit the inspector examined six files including those new to the service. Each file had a completed needs assessment and each one contained further information about the family and friends, likes, dislikes and preferences. The assessment tool covers breathing, communication, control of body temperature, dying, eating and drinking, elimination, expressing sexuality, maintaining a safe environment, sleeping, skin, washing and dressing and work and play. Ker Maria DS0000019236.V377753.R01.S.doc Version 5.2 Page 10 It is noted that the service users have been asked their preferred name which is indicated throughout any further documentation seen. The assessment demonstrates that prospective service users, family members or representatives are included in the assessment process if this is appropriate. A Mental Health Risk Assessment and a Physical Health Risk Assessment commence upon admission to the home. Each needs assessment was signed and dated by the person completing the initial assessment. The home does not admit service users for intermediate care. Ker Maria DS0000019236.V377753.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. The health, personal and social care needs of people who use the service are not adequately identified in the care plans, preventing the home from meeting all the needs of the individual. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care of six service users was case tracked and their care plans examined, including those new to the service. Overall care plans provide adequate information about the person using the service and how staff are to meet the needs of that person. The care plans consist of a standard format addressing the following core areas: breathing, communication, control of body temperature, dying, eating and drinking, elimination, expressing sexuality, skin, sleeping, maintaining a safe environment, mobility and personal hygiene. The care plans examined contain guidance for staff to follow in each area. However, some entries are lacking relevant information. For example, in all the care plans seen under the Ker Maria DS0000019236.V377753.R01.S.doc Version 5.2 Page 12 section for eating and drinking the entry states “ascertain likes and dislikes”, however there is no information about people’s likes and dislikes recorded in the care plan. Another entry records “establish individual toileting regime” but there is no information recorded within the care plan about the toileting regime. In one care plan it records that the service user has mental health needs and presents behaviours that can challenge. However, the care plan does not record what the behaviours are or what the possible triggers may be. Numerous entries in care plans are vague and need to be expanded upon to provide information about residents in a holistic way. For example, one entry records, “apply moisturisers all over body” and “assist to wash and dress” and “assist with personal hygiene” and “assist to bathe weekly”. These are vague statements and should describe in more detail the actions staff need to take to fully meet the needs of the service user. It is a requirement of the report that care plans contain all relevant information about the individual and information in the care plans contains more specific details for staff to follow so they can fully meet the needs of the individual. In each care plan there are numerous standard statements. These statements are not always applicable to each individual and do not reflect a person centred care planning process. N In one care plan under the section for sleeping, the plan of care referred to a different service user. In another care plan under the section “expressing sexuality” it describes the person’s religious needs and not how they need to express their sexuality. All the care plans make excellent reference to people’s privacy and dignity. For example under the section “maintaining a safe environment” it records “maintain dignity and respect throughout the (moving and handling) procedure”. Another example seen is recorded under the section for “elimination” which tells the carer to “respect and maintain privacy and dignity at all times” and another entry records, “give x privacy to say their prayers”. Care plans were seen to be reviewed monthly or when the needs of a person have changed. The annual quality assurance assessment (AQAA) tells us that a number of care plan review meetings have taken place with residents and family members. Additional support is accessed through the local GP surgeries, where people who use the service can access physiotherapists, occupational therapists and speech therapists. Residents of the home are registered to local surgeries. One surgery provides a Doctor’s round every Thursday. Liaison and support is provided by both the surgeries as is and out-of-hours medical support. Care plans contain tissue viability risk assessments (Waterlow) for each person. In one file examined, the Waterlow scores the individual as “very high Ker Maria DS0000019236.V377753.R01.S.doc Version 5.2 Page 13 risk” and recommends that this is reviewed weekly and this was seen to be completed weekly for this person. There was no information in this file about the pressure relieving equipment used for this person and when the inspector spoke to this person there was no pressure relieving equipment observed on their armchair where they had been sitting all day. In another file the Waterlow assessed the individual as “very high risk” but there was no plan of care in place for staff to refer to. There is a physical health risk assessment in place for each person and this made no mention of the potential risk of developing a pressure sore for this person. A requirement is issued for improvement in this area to ensure the promotion of tissue viability and prevention of pressure sores is maintained. At the previous key inspection a requirement was issued for turning charts to be appropriately maintained. The inspector observed three turning charts in service user’s bedrooms and these were fully completed. In two files examined the individuals’ were described as being at “risk of absconding” and “suffers from poor memory loss and wanders around the unit and out of the building and will not find their way back”. There were no risk assessments or guidance for staff to follow in place for either of these two service users regarding the risk of leaving the home unattended and a requirement is issued for improvement in this area. One person whose care was case tracked as part of this inspection suffers from epilepsy. There was a risk assessment in place for this but no protocol that provides staff with informative guidance on how the condition and needs of this person should be managed and met. A requirement is issued for improvement in this area. Further risk assessments seen are in place covering areas such as falls, moving and handling, nutrition, mental health and use of bedroom and keeping gloves in bedrooms. Chiropody support is contracted on a weekly basis and residents are attended to every six to seven weeks. Dental Care is delivered by a local dental surgery based in Aylesbury. Dental support may be on site or the resident may be escorted and supported at the surgery. Opticians support is accessed locally through a local optician or through individual residents’ personal opticians. Ophthalmology support is accessed through the NHS PCT. The inspector observed staff assisting people who use the service in a kindly and respectful manner. Staff are obviously aware of the importance of privacy and dignity and were seen to always knock on doors before entering and always addressing the individual by their preferred term of address. The homes induction programme includes training regarding privacy and dignity. Ker Maria DS0000019236.V377753.R01.S.doc Version 5.2 Page 14 The procedures for the administration of medicines were examined during this inspection. At this visit we looked at the medication administration record (MAR) charts, medication supplies and care plans for the six people whose care was being case tracked as part of this inspection and at the MAR charts for the rest of the people using this service. Six MAR charts for people whose care was being case tracked showed that there were hand written entries on two of these charts and a further two charts had hand written entries on them. All handwritten entries were signed and dated either by two staff or by the GP and a nurse. MAR charts were examined and showed 2 omissions on one MAR chart and 1 omission on another MAR chart. One chart showed that there were 4 days where the service user had not received one of their medicines as this had been out of stock. The inspector was told this was due to a mistake by the supplying pharmacy. All other charts had been completed to show that medicines had been given or if not the reason why. The procedures were examined for the storage and administration of controlled drugs. The controlled drug register was checked and all medication in the cupboard corresponded with the controlled drugs register which had two signatures for all transactions. The home produce the MAR charts themselves on the computer. All dietary supplements and creams and ointments were not recorded on the MAR charts. However the dietary supplements are recorded in the care plans when they have been administered. In each bedroom there is a chart which carers sign when the creams have been administered. There are no written guidelines for many “as required” (PRN) medicines and this is often left up to individual care staff’s discretion to administer. There must be clear guidance recorded within care plans for the management of PRN medicines and this will be a requirement of the report. Sister Stephen showed the inspector a list of PRN medicines which she has identified as needing to be included in the care plans. A requirement is issued for staffs practice in the recording, handling, safekeeping, safe administration and disposal of medicines in the home must be consistent. This must include a system to be put in place to ensure that there are no gaps in the recording of the administration of medication, a system to be put in place to ensure that all prescribed medications are in stock so that they can be administered to service users as prescribed and for the home to have guidelines in place for the administration of all PRN (when required) medication, so that this is administered consistently and in line with the needs of the individual service users. Ker Maria DS0000019236.V377753.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. There is a range of activities available to residents who are encouraged and supported to remain in contact with their families and friends and to use local community facilities ensuring people do not become socially isolated. The presentation and standard of food is good and meets the nutritional needs of people who use the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans show some routines of daily living and include bathing, rising and retiring times. However in some care plans there is limited information regarding meeting the social or recreational needs of residents. For example, in one file for a person who is registered blind, under the section for work and play, it states “ascertain what X enjoyed doing” but no further information about his social care needs have been recorded. In another file observed under the section for work and play it has been recorded “provide with assistance as required”. However there is no further information as to the activities the individual likes and what areas of their social care needs they may need assistance with. Ker Maria DS0000019236.V377753.R01.S.doc Version 5.2 Page 16 The home employs a part-time activity organiser. The inspector was told that a monthly calendar of daily activities is in the process of being produced. The Annual Quality Assurance Assessment (AQAA) tells us that the approach to daily activities is Person Centred and begins with the Profile developed upon or soon after admission by the Activities Co-ordinator. At the time of the inspection the Activities Co-ordinator was off on sick leave. The inspector did observe several people going out for a walk and going out to enjoy the garden. Staff support residents to promote their spiritual needs. The home has a chapel and the local Catholic priest and Church of England priest visit weekly to facilitate Holy Communion. There is good information about individuals spiritual needs in the care plans examined. Residents spoken to said that family and friends can visit when they wish. One individual said, “My wife comes to see me most days. There are no strict rules on visiting which I like”. Relatives and friends are welcome at any time and a visiting relative spoken to on the day was able to confirm this. Another person spoken to on the day said his son was visiting that afternoon and the staff always make him feel welcome”. Examples of involvement in the home by local community groups and individuals are visits by mobile hairdressers, various visiting entertainers and a church service. Service users are able to receive visitors in the privacy of their own rooms and are able to choose whom they see and do not see. Service users and/or their families are encouraged to look after their own financial affairs whenever possible. If this is not practicable a chosen solicitor will be responsible for individual’s financial dealings. The inspector was able to join service users for lunch on the day of the inspection. The dining area was attractive with tables laid with tablecloths and napkins. The lunch served was attractively presented and service users were offered a choice of main meal and sweet. Comments made from people using the service about the food include the food is lovely, it’s good home cooking and they try really hard with the food, there is always a choice if you want. Care plans contain a section under eating and drinking. There is a standard statement that says, “ascertain likes and dislikes” but the likes and dislikes of service users are not recorded in the care plans. This should be addressed. There is evidence in care plans of nutritional screening and weights are recorded on a monthly basis. Ker Maria DS0000019236.V377753.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is poor. Procedures for managing complaints and adult protection are in place but need some revision and updating to ensure people have accurate information to hand. Management of records in this area needs improving to ensure clear audit trails and to safeguard sensitive material. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure called “the handling and processing of complaints” dated February 2007. A copy of the complaints procedure is included in the homes brochure and a copy of this is kept each persons bedroom. A laminated copy of the complaints procedure is displayed on the homes notice board. There is a suggestion box in the main hallway. The complaints log was examined during this inspection. This was very disorganised and it was difficult to assess the number of complaints received within the previous twelve months. Separate letters and pieces of paper were placed loosely in a file with pieces of paper stapled to handwritten pages and some information contained within envelopes that was also stapled to pages. For many of the complaints there was no evidence of the action taken and the outcome of the complaint. A requirement is issued for improvement in this area. The Annual Quality Assurance Assessment (AQAA) tells us that the home has received fourteen complaints within the last twelve months and two of these were upheld. Ker Maria DS0000019236.V377753.R01.S.doc Version 5.2 Page 18 The Commission has received information of two complaints about this service since the previous key inspection. At the previous inspection the manager informed us of a incident and the action taken at that time. Local safeguarding procedures had not been followed and a requirement was issued for the manager to ensure they follow the appropriate protocol in relation to any reported alleged allegations. The AQAA tells us that there has been one safeguarding referral and investigation since the previous inspection and this was dealt with appropriately. The home has a copy of the local authority safeguarding policy and they have their own policy that is dated June 2000. This should be updated and to bring it line with the local authority procedures and is a requirement of this report. Training records show that staff had undertaken updated training in the safeguarding of vulnerable adults. Ker Maria DS0000019236.V377753.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 25 and 26. Quality in this outcome area is adequate. The standard of the environment within the home provides people who use the service with a homely place to live, however several improvements and upgrading of some areas of the home would be beneficial. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home provides accommodation for forty-one residents in two units across two floors. Each unit is self-contained and has a kitchenette area, a lounge/dining area, bathrooms and toilets. On the lower floor it was noted that in the kitchenette area the worktops were worn and the cupboards and drawers chipped. The lounge areas are comfortably furnished and spacious and on the whole these are in adequate decorative order. Efforts have been made to make these Ker Maria DS0000019236.V377753.R01.S.doc Version 5.2 Page 20 areas look homely, with many personal touches such as pictures, side lamps, books, plants and ornaments. In many of the corridors the carpets and walls are a little grubby and shabby in places. There is a quiet room on the upper floor. This has a large area of damp on the ceiling, the carpet is stained and there is a strong unpleasant odour in this room. This does not make a pleasant or congenial setting for residents to meet with their relatives or friends. The organisation needs to investigate the cause of the damp before the ceiling becomes hazardous. The AQAA does not detail any planned improvements for the above mentioned areas. It is a requirement of this report that an action plan is sent to the Commission detailing how the repairs will be undertaken along with timescales for completion. There are accessible toilets available for service users throughout the home and several are close to the lounges and dining area. There are good adaptations to the home to support service users mobility that include grab rails, hoists and bath aids. The home has policies and procedures for the control of infection including the safe handling and disposal of clinical waste. Staff training records examined reflected that infection control training was up to date. Ker Maria DS0000019236.V377753.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. Training for staff at the home is good but records must show that staff have completed an induction to the home to ensure they are trained and competent to support service users. The home has improved its recruitment procedures to ensure the safety and protection of people who use this service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staff who were met during the inspection were knowledgeable and presented as good advocates for service users. The staff rota demonstrates that there are adequate numbers of staff on duty at all times to ensure that the needs of the service users are always met. The rota shows one registered nurse and five care staff are on duty on each floor during the morning shift and one registered nurse and four carers during the afternoon/evening shift. During the night there is one registered nurse and four carers are on duty. There are sufficient numbers of ancillary staff to support the smooth running of the home. People spoken to on the day said “there has been an improvement in the consistency of the staffing” and they dont seem to use as much agency staff any more which is much nicer for the people living in the home” and “you dont have to worry so much because you know the staff know your relative. Ker Maria DS0000019236.V377753.R01.S.doc Version 5.2 Page 22 The home continues to support staff on NVQ training and the AQAA tells us that twenty six out of forty staff, including relief staff have completed NVQ level 2 training or above and a further seven are working towards this. The recruitment files for a selection of staff were examined including those new to the service. All files looked at contain the necessary documentation as detailed in schedule 2. There is evidence that all staff CRB checks had been obtained and references had been undertaken before the staff member started work. The inspector was told that all new staff undertake an in-house induction. This includes orientation to the home and moving and handling is completed before the staff member is expected to undertake personal care. Sister Stephen showed the inspector a new induction programme which incorporates the common induction standards. This has not been used by any trainees yet as it has only recently been implemented. It was recommended at the previous inspection that the manager must consider keeping copies of individuals induction programme in their personnel files to verify that they have been appropriately inducted. Evidence of induction was not available in staff files and this will be a requirement of this report. Staff spoken to on the day of the inspection said that they had an induction to the home which covered everything they needed to know to do the job and the AQAA stated that staff receive annual updates in all mandatory training through a combined strategy of in-house training, directly contracted training providers and training through the local authoritys cluster group training which is conducted on-site. Training records observed on the day show that this is the case and staff are up to date with mandatory training. Ker Maria DS0000019236.V377753.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is poor. There has not been a registered manager in post at the home since 2007, and evidence of poor procedures taking place does not ensure the service users best interests and could compromise the health safety and welfare of those using the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of the inspection the manager had left the home and two of the Augustine Sisters were managing the home together. The inspector was told that this will be a short term arrangement until standards in the home have improved and a new manager has been appointed. The registered nurses, carers and support staff will support the Sisters in the day-to-day operation of the home. Staff spoken to said that morale in the home had improved. Ker Maria DS0000019236.V377753.R01.S.doc Version 5.2 Page 24 Staff spoken to confirmed that regular staff meetings are held and they are given the opportunity to raise concerns and make suggestions. There is also a suggestion box in the home for staff and relatives to volunteer suggestions on how the service could be improved. The home aims to ensure that staff receive one to one supervision every six weeks. Staff spoken to confirmed that they were receiving supervision. Copies of regulation 26 report visits were seen reflecting that the registered provider had undertaken monthly visits to the service. The home uses a shift handover and allocation sheet to prompt staff on the level of dependency of the residents along with any infection control issues. The annual quality assurance assessment (AQAA) was returned to us by the date it was requested and was completed fully and in detail. The evidence to support the comments made in the AQAA was satisfactory and detailed plans for improvement within the next twelve months. The inspector was told that the home does not look after residents money. Individuals are invoiced for purchases made on their behalf such as, toiletries, hairdressing and chiropody. A sample of health and safety records was examined and these were generally in good order. The fire building risk assessment was reviewed in November 2008 and fire training for care staff was up to date. Service reports are in place for the maintenance of hoists and the lift. The Annual Quality Assurance Assessment (AQAA) states that the home has gas appliances and these were serviced in December 2007. Portable Appliance Testing (PAT) testing was last undertaken in December 2007. These must be completed annually and a requirement is issued for improvement in this area. There is a disinfection certificate in place to prevent the risk of Legionella and this was completed on 07/03/2009. Ker Maria DS0000019236.V377753.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 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 N/A 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 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 2 3 3 3 x x 3 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 1 x 3 X 3 X X 2 Ker Maria DS0000019236.V377753.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 15 Requirement Timescale for action 30/07/09 2 OP8 13 3 OP8 13 4 OP8 13 The registered person is required to ensure that care plans contain all relevant information about the individual and information in the care plans contains more specific details for staff to follow so they can fully meet the needs of the individual. The registered person is required 30/06/09 to ensure that each person assessed as “at risk” of pressure sores has a plan of care in place that details the action to be taken by staff to ensure the promotion of tissue viability and prevention of pressure sores is maintained. The registered person is required 30/06/09 to ensure that risk assessments are in place for any person using the service who has been assessed as at risk of leaving the home without support from a carer. The registered person is required 30/06/09 to ensure that a detailed protocol is in place for the individual with epilepsy, that provides informative guidelines for DS0000019236.V377753.R01.S.doc Version 5.2 Ker Maria Page 27 5 OP9 13 6 OP16 22 7 OP18 13 8 OP19 23 9 OP30 18 10 OP38 23 the staff on how the condition and needs should be managed and met. The registered person is required to ensure that staffs practice in the recording, handling, safekeeping, safe administration and disposal of medicines in the home must be consistent. This is to ensure that people using the service health and welfare is not compromised. (Previous timescale of 04/12/08 not met) The registered person is required to ensure that the home implements a complaint log which records the nature of the complaint, the action taken and the outcome of the complaint. The registered person is required to ensure that the organisation update its Safeguarding policy to bring it in line with the local authority safeguarding procedure. The registered person is required to ensure that an action plan is sent to the Commission detailing how the repairs will be undertaken along withy timescales for completion. The registered person is required to ensure that copies of the staff induction programme be kept in their personal files to verify that they have been appropriately inducted. The registered person is required to ensure that the homes gas appliances and PAT testing is completed annually. 30/06/09 30/06/09 30/07/09 30/10/09 30/08/09 30/06/09 Ker Maria DS0000019236.V377753.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP7 OP15 OP19 OP19 Good Practice Recommendations It is recommended that the care plans do not contain standard statements but are more individualised to reflect the needs of each person. It is recommended that the likes and dislikes of the individual be recorded in their care plans. It is recommended that the kitchenette on the lower floor has the cupboards and worktop surfaces replaced. It is strongly recommended that the quiet room on the upper floor is redecorated and has new carpets fitted. Ker Maria DS0000019236.V377753.R01.S.doc Version 5.2 Page 29 Care Quality Commission South East Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 0300061 61 61 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries.southeast@cqc.org.uk Web: www.cqc.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.V377753.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. 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. 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