Inspection on 13/02/07 for King Charles Court

This inspection was carried out on 13th February 2007.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

King Charles Court 14/05/08

King Charles Court 19/11/07

King Charles Court 25/06/07

King Charles Court 16/02/06

King Charles Court 01/09/05

King Charles Court 15/02/05

King Charles Court 17/08/04

King Charles Court 08/01/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE King Charles Court Marlborough Road Falmouth Cornwall TR11 3LR Lead Inspector Paul Freeman Unannounced Inspection 13th February 2007 10:00 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 King Charles Court DS0000009186.V329167.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. King Charles Court DS0000009186.V329167.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service King Charles Court Address Marlborough Road Falmouth Cornwall TR11 3LR 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) 01326 311155 01326 319548 kcc@comfortcaregroup,co,uk King Charles Court Limited Mrs Ann Mayne Holmes Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30), Physical disability (30), Terminally ill (30) of places King Charles Court DS0000009186.V329167.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Service users to include up to 30 adults of old age (OP) Service users to include up to 30 adults under pensionable age with a physical disability (PD) Service users to include up to 30 adults with a terminal illness (TI) Total number of service users not to exceed a maximum of 30 Date of last inspection 16th February 2006 Brief Description of the Service: King Charles Court is a Care Home located in Falmouth. It is situated above the town, although close to the amenities. Many of the rooms have lovely views over the Carrick Road and Falmouth Docks. The home is registered for up to 30 residents who require personal and/or nursing care. Accommodation is provided on two floors with a stair lift and a shaft lift to access the first floor. All bedrooms have en-suite toilet and washing facilities and all bedrooms have accessible call bells. There is a large dining room, with a lounge area at one end, on the ground floor; this is next to the kitchen. There is a smaller lounge on the first floor. There is a small kitchenette on the first floor where staff can make drinks and serve snacks for residents. There is a very small garden in the grounds at the back of the home; this is not accessible to residents. The car parking space to the front of the building is limited. There is a qualified nurse on duty at all times and community nurses visit regularly. There are no barriers to residents receiving visitors and the visiting arrangements are flexible. Needs to have the fees in here King Charles Court DS0000009186.V329167.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. On 26 January 2007 three inspectors made an unannounced inspection visit. The purpose of the visit was to prepare for the key inspection. At this visit the Inspectors consulted with residents, visitors, the registered manger and staff about the services and facilities provided. The environment and some documents and records were also considered. Two inspectors visited to undertake the key inspection on 13 February 2007. The purpose of this inspection was to consider the work that had been undertaken on the requirements set at the last inspection on 16 February 2006 and to inspect other core standards. Therefore some of the key standards considered included care planning, health, staffing arrangements and safe working practices. Further consultations took place with staff, residents and the registered manager. Records and documents were also considered. What the service does well: All prospective residents needs are assessed before they are admitted to the care home. Each resident has a care plan that summarises their needs and provides staff with some direction about the care and support required. Satisfactory arrangements are in place to meet residents health needs and medical services are accessed when required. Residents are provided with a varied and nutritional menu that meets their needs preferences and choices. Residents and visitors describe the food as “good”. Flexible visiting arrangements are in place and residents said the staff positively welcomed visitors. Good arrangements are in place to protect residents from abuse and any allegations or concerns are reported to the statutory authorities for investigation. There are no apparent barriers to residents or interested parties raising any issues or concerns. Generally the environment is homely and the providers have established a redecoration and replacement plan. Many of the residents’ rooms have been personalised by the occupants and a wide range of disability equipment is provided to assist residents. King Charles Court DS0000009186.V329167.R01.S.doc Version 5.2 Page 6 Resident and visitors were positive about the majority of staff who they described as “kind” and “lovely”. Positive arrangements are in place to make sure that staff are well trained and their skills and knowledge are up to date. What has improved since the last inspection? What they could do better: More detailed assessments should be undertaken on prospective residents. The providers will then be confident the facilities and services are suitable to meet the person’s needs, preference and choices. The care plans require more detailed information in order that the best possible care and support is in place. The plans also need to be regularly reviewed so that residents’ needs are met at all times. A number of improvements are necessary regarding the storage disposal and administration of prescribed medicines in order that residents are safeguarded. There are very limited opportunities for residents to participate in stimulating social and recreational activities. This has a negative impact on their stimulation and does not promote a varied lifestyle. The arrangements to deal with complaints need to improve to make sure issues are dealt with promptly and the complainants are given clear information about the outcomes. The setting is cluttered in communal areas and more storage space is required to minimise potential hazards. The equipment at the home also needs to be kept in good working order so that residents’ needs and safety are not potentially compromised. The hoist that is currently out of commission severely impacts upon residents’ lifestyles and needs. Resident have two major issues about the staffing arrangements. Many residents do not believe that sufficient numbers of staff are employed each day and night. Furthermore residents said that some staff had negative attitudes toward them and their work. This does result in residents being treated negatively or disrespectfully. The arrangements to complete Criminal Records Bureau and POVA checks for new staff are not reliable. This could place residents at risk. King Charles Court DS0000009186.V329167.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. King Charles Court DS0000009186.V329167.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 King Charles Court DS0000009186.V329167.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): The standards considered were 3. (6 is N/A) Quality in this outcome area is adequate. More detailed needs assessments need to be completed to make sure the providers have a comprehensive picture of prospective residents needs, preferences and choices. The providers will also be more confident the services and facilities are suitable to meet the assessed needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each prospective resident is assessed to make sure that the services and facilities are appropriate to meet the needs of the individual concerned. The registered manager said the prospective resident and there relatives or representatives are invited to participate in the assessment. In addition the views of any professionals involved are taken into account. The assessments summarise the prospective residents needs but do not always comprehensively address their needs, preferences and choices. In addition King Charles Court DS0000009186.V329167.R01.S.doc Version 5.2 Page 10 there were occasions when consultations did not appear to have taken place with all the interested parties. Therefore more detailed assessments are required in order that the providers can be confidant they are able to meet the prospective residents needs. The assessment documentation is not signed or dated and does not record or indicate who participated. However the Inspectors witnessed the admission of a resident. It was evident the residents and their relatives were positively welcomed and the staff actively helped the resident to settle in their new environment. The providers do not offer dedicated intermediate care or rehabilitation services but are committed to supporting residents to be as independent as possible. King Charles Court DS0000009186.V329167.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): The standards considered were 7, 8, 9 and 10. Quality in this outcome area is poor. The care planning and review arrangements require improvement to make sure that residents receive the care and support they require. Resident’s health needs are generally met well but the administration of medicines was found to be potentially unsafe. This requires immediate attention to make sure that residents are safeguarded. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each resident has a care plan that generally summarises their needs and in some instances provides appropriate information, guidance and direction for staff. The care plans are typed but do not specify the date they were put into place. The quality of the contents of care plans is variable and in a number of situations there was inadequate information to appropriately guide, direct and inform the staff about the care and support required. King Charles Court DS0000009186.V329167.R01.S.doc Version 5.2 Page 12 The review arrangements appear to be inconsistent and reviews do not regularly take place. Certain elements of the care plan are reviewed but others appeared not to have been taken into account. The residents that are able to direct their own care were generally unaware of the care plans or their contents and could not recall being consulted. The registered manager stated that arrangements are in the planning stage for care plans to become electronic. It is envisaged this will address any shortfalls. Residents were generally satisfied with the care and support provided but a number commented that staff did not respond promptly when called. In addition some residents said the quality of the support was variable amongst the staff group. These issues will be addressed in more detail later in this report. Residents also stated staff generally treated them with respect and were positive and flexible in the care and support provided. Some residents said that certain staff appeared negative in their approach and this adversely impacted upon the care and support provided and the staffs attitudes towards the resident. There were examples when the inspectors witnessed very positive, caring and respectful interactions between residents and staff. Residents were satisfied with the manner in which their health needs are met and generally expressed confidence in the staff. It is clear that medical services are accessed when required and specialist health professionals visit the care home when needed. Medicines are appropriately stored and residents are able to administer their own medication when it is safe to do so. The qualified nurses assist residents with prescribed medicines where required and a policy and procedure has been established to guide, direct and inform the staff. This document requires improvement to make sure that safe and comprehensive arrangements are in place to guide staff and promote resident’s health and well being. The administration records were found to be up to date but the Inspectors noted that the records were sometimes completed before the medicine was administered. This is not an acceptable practice. The security of the medicines requires review. The policy states that the medicine trolley is secured to the wall when not in use, this was not found to be the case. It was also noted that certain liquid medicines were administered to a number of residents from the same container even though only one resident’s name was on the label. This is also not an acceptable practise. King Charles Court DS0000009186.V329167.R01.S.doc Version 5.2 Page 13 The arrangements to administer medication require review given it took some time for the “round” to be completed. The round finished about an hour and a half before the next was due on both days. Student nurses were being taught about medicines on the second visit during the round. Disposal arrangements require improvement given the current arrangements do not comply with the guidance laid down by the Pharmaceutical Society. The registered manager said she would sort this. The breaches in regulation were discussed with the registered manager who said she would ensure that legislation is complied with in future. King Charles Court DS0000009186.V329167.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): The standards considered were 12, 13, 14 and 15. Quality in this outcome area is poor. The opportunities for residents to participate in social and recreational activities are very limited. This results in a lack of stimulation and restricts the residents’ opportunities to experience a varied lifestyle. A varied and nutritional menu is in place that meets residents’ preferences and choices and promotes their health. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents said that very limited social and recreational opportunities were available and one resident said “it’s boring, there is nothing to do here”. The resident’s care plans and assessments are not very strong in identifying social, leisure and recreational interests and needs and this further inhibits residents opportunities. Residents stated that an activities coordinator had previously provided a regular programme of activities, which they valued. The post does not appear to exist any longer and this has severely impacted upon the lifestyle and stimulation of the residents. King Charles Court DS0000009186.V329167.R01.S.doc Version 5.2 Page 15 There are no restrictions to residents accessing the community when this is safe. However a high percentage are frail and vulnerable and do not have the opportunity to access the community. This highlights the importance of a varied and stimulating lifestyle within the home. Residents said they had opportunities to decide their own patterns of daily living and generally staff were responsive and supportive towards the choices they made. Residents are provided with a varied and nutritional diet and residents said the food was “good”. Visitors also said the “staff are very kind and the food is very good”. Residents have a choice of the food they have. The kitchen is well organised and good standards of cleanliness are maintained. The visiting arrangements are flexible and residents and visitors said the staff were always welcoming. King Charles Court DS0000009186.V329167.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): The standards considered were 16 and 18. Quality in this outcome area is adequate. There are no barriers for residents or interested parties to raise issues or concerns but the records about complaints need improvement. This will make sure that issues are dealt with promptly and in line with the home’s procedures. Suitable arrangements are in place to protect residents for abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The providers have received five complaints over the last year and each has been investigated. The registered manager stated that all the complaints had been amicably resolved. The record keeping arrangements for complaints would benefit from improvement and there was little evidence to indicate that each complainant had been advised of the outcome in writing. In addition certain of the concerns related to staffing matters and should have been dealt with in a different manner. An acceptable policy and procedure is in place and there do not appear to be any barriers preventing residents from raising issues or concerns. King Charles Court DS0000009186.V329167.R01.S.doc Version 5.2 Page 17 It is advised that a complaints and compliments log is established to make sure that a record of the action taken for each complaint is in place. The home has an adult protection policy and a copy of the local multi-agency code of practice. In house training takes place and the Registered Manager and some of the staff have attended Department of Adult Social Care adult protection training. King Charles Court DS0000009186.V329167.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): The standards considered were 19, 22 and 26. Quality in this outcome area is adequate. The facilities are clean and homely and arrangements are in place to maintain the environment to the required standard. Certain areas do require attention so that good facilities are provided throughout for residents. There are a number of communal areas around the home that are cluttered and storage is a key concern. The provider also needs to pay close attention to a range of equipment that is currently out of commission to make sure that residents are safeguarded. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents live in a well-maintained environment, which is clean, homely and comfortable. The providers have an ongoing maintenance programme and a King Charles Court DS0000009186.V329167.R01.S.doc Version 5.2 Page 19 re-decoration and refubishment programme is in place. There are however areas of the home that look tired or where and furniture needs replacing. Personal laundry is dealt with in house, the sheets and towels are contracted out. COSHH data sheets are available in the laundry. There are suitable handwashing facilities for staff and alcohol hand cleansing gel is used. Protective clothing is also provided. Residents were generally satisfied with the facilities provided and many have personalised their bedrooms. A key issue at the home is storage given there appears to be very limited space and this results in wheelchairs and other equipment being stored in corridors and bathrooms. One of the fire exits was also partially restricted with a range of items many of which are waiting to be removed. The impact is that corridors and other areas present as cluttered and the equipment stored in communal spaces could be a hazard to residents, staff or visitors. There is a range of communal disability aids and equipment provided to assist residents. Where appropriate individual residents have their own equipment following a specialist assessment. It is of concern that one of the mobile hoists was out of commission and this severely inconvenienced residents. This is because a number of residents are reliant on the hoists. This could compromise a resident’s safety and well being. A further concern was that cot sides were in place but a suitable risk assessment had not been completed and there was no evidence that appropriate protectors were available. This is an unsatisfactory situation and could result in a serious injury to a resident. The sluice on the first floor requires attention given the extractor was not in good working order. This resulted in an offensive odour that was pervasive when the door was open. King Charles Court DS0000009186.V329167.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): The standards considered were 27, 28, 29 and 30. Quality in this outcome area is poor. The staffing arrangements require urgent review to make sure that sufficient numbers of staff are on duty at all times to provide the care and support required. In addition the staff attitudes, skills and abilities also need to be examined to make sure that residents are safeguarded and treated with dignity and respect. The recruitment arrangements need to be improved so that robust vetting arrangements are in place. This will provide further protection for residents. Good training arrangements are in place for all staff. Therefore staff are provided with up to date knowledge and information so that good standards of care can be maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The providers have recently reorganised the staffing arrangements so that three teams of carers have been established. The Teams provide care and support to residents that reside in three distinct zones. A qualified nurse is on duty at all times and oversees the work of the care staff and meets the residents health needs. The registered manger envisages the arrangements will improve the service and result in residents having more accessibility to King Charles Court DS0000009186.V329167.R01.S.doc Version 5.2 Page 21 staff. Staff generally felt this arrangement was good but did not work when staff were sick or on leave, it also did not work in the afternoons. The residents considered that insufficient numbers of staff were employed each day and night and many commented on the delays they frequently experienced to access staff. The residents commented that certain staff had a poor attitude and did not communicate in a positive or respectful manner. It is clear that a number of residents are highly dependent on carers to meet their daily needs. Residents said the majority of carers were reliable and provided a good standard of care. Residents described the majority of staff as “kind” and “lovely”. There are also occasions when alternative staff were not provided when the planned staff were unable to undertake their duties. The Inspectors consider this to be unsafe given the layout of the building, high dependency, frailty and vulnerability of residents. The staff consider they work well as a team and are mutually supportive to each other. Staff are concerned about the lack of cover for colleagues that are unable to undertake their planned duties. The staff were positive about the training opportunities and were confidant their training needs were well met. This makes sure that staff have up to date skills and knowledge to meet residents needs safely. Staff did comment that if their rostered care duties clash with a training session alternative staff are not employed to undertake their duties. This is an unacceptable arrangement and could compromise residents well being. The recruitment vetting and selection arrangements require improvement. This is because staff are commencing care duties before a POVA check has been completed. This potentially places residents at risk. The other recruitment records required by providers were in good order. King Charles Court DS0000009186.V329167.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): The standards considered were 31, 33, 35 and 38. Quality in this outcome area is adequate. The registered manager is experienced and has worked at the care home for some time. The Registered providers also maintain regular contact and visit the care home at least once a week. There are management arrangements that require attention in order that good standards of care and support are in place. Health and safety measures need to be improved to make sure that resident’s health, safety and well being are not compromised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: King Charles Court DS0000009186.V329167.R01.S.doc Version 5.2 Page 23 The registered manager is an experienced qualified nurse who has managed the services and facilities for sometime. It is unfortunate that she had a six month absence from work, due to unforeseen personal circumstances, as she is still striving to get things in order. The Registered Providers are experienced in care home management and a Director makes weekly visits to monitor the quality of the services and facilities provided. Unfortunately no records of the provider’s visits or findings were available for consideration. Staff said they would appreciate meeting with the providers when they visit. Unfortunately it appears the service has deteriorated during the managers absence and the lost ground has subsequently not been recovered. The registered manager is aware of the shortfalls and is beginning to take steps to address the areas of non-compliance. Residents had mixed views about the management arrangements and these appeared to be shaded by the negative treatment they considered some staff display. Other residents were positive about the arrangements and considered the home was run in their best interests. Staff were generally satisfied about the management arrangements and considered that support, advice and guidance was available when required. The registered manager said quality assurance measures are currently reliant upon a range of informal consultations with residents, staff and visitors. The manager is in the process of establishing more formalised arrangements in order that services and facilities can be robustly assessed. The financial arrangements and records at the home appear to be in good order. The providers have established a range of measures to promote safe working practices. Certain measures were successfully making sure that good standards were in place that safeguarded residents. These include infection control, servicing and maintenance of equipment and COSH guidance and information. In addition the providers have improved the fire safety and fire precaution arrangements and regular staff training takes place. However the provider must ensure that no fire exits are blocked or inhibit access at any time. Other aspects did not meet the standard required because the risk assessment and risk manage arrangements were not sufficiently robust. This potentially places residents in a position where their health, safety and welfare could be compromised. King Charles Court DS0000009186.V329167.R01.S.doc Version 5.2 Page 24 Therefore the current arrangements to assess risks that individual residents encounter require improvement to make sure that comprehensive assessments takes place that produce good risk management plans where required. This is particularly important in respect of residents that experience accidents or incidents and as part of the needs assessment process. This will make sure that residents are safeguarded and are not subjected to unreasonable risks. The providers also need to improve the call bell arrangements in the communal lounge. Frail and vulnerable residents spend time in this area but have no reliable mean of calling for assistance other than shouting. These arrangements need to be improved. King Charles Court DS0000009186.V329167.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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X 2 X X X 2 STAFFING Standard No Score 27 2 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 X X 2 King Charles Court DS0000009186.V329167.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 OP3 Regulation 14(1)(a-c) (1) Timescale for action The registered person shall 30/03/07 not provide accommodation to a service user at the care home unless, so far as it shall have been practicable to do so— (a) needs of the service user have been assessed by a suitably qualified or suitably trained person; (b) the registered person has obtained a copy of the assessment; (c) there has been appropriate consultation regarding the assessment with the service user or a representative of the service user; Detailed assessment must be completed on each prospective resident to make sure the providers have a comprehensive King Charles Court DS0000009186.V329167.R01.S.doc Version 5.2 Page 27 Requirement 2. OP7 15(1) picture of the service users needs, preferences and choices. 1) Unless it is impracticable to carry out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan (“the service user’s plan”) as to how the service user’s needs in respect of his health and welfare are to be met. 30/09/07 3. OP7 Each resident must have a care plan that details their needs and provides staff with the information, guidance an direct required to provide the care and support required. 15(2)(b-c) (2) The registered person shall— (b) keep the service user’s plan under review; (c) where appropriate and, unless it is impracticable to carry out such consultation, after consultation with the service user or a representative of his, revise the service user’s plan; and Each care plan must be regularly reviewed and developed when necessary so that service users needs are met at all times. This is re-notified from 02/05/07 30/03/07 4. OP9 13(2) (2) The registered person shall 30/03/07 make arrangements for Version 5.2 Page 28 King Charles Court DS0000009186.V329167.R01.S.doc the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. The medicines policy must be updated and refer to the The Royal Pharmaceutical guidelines for the administration of medicines in care homes This is re-notified from 02/05/07 (2) The registered person shall 30/03/07 make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. The Registered Provider must make sure that medicines are stored and administered safely. (2) The registered person shall 30/03/07 make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. Medicines that are no longer required must be safely disposed. (4) The registered person shall 30/04/07 make suitable arrangements to ensure that the care home is conducted— (a) in a manner which respects the privacy and dignity of service King Charles Court DS0000009186.V329167.R01.S.doc Version 5.2 Page 29 5. OP9 13(2) 6. OP9 13(2) 7. OP10 12(4)(a) users; Staff must treat service users with dignity and respect at all times. (m) consult service users about their social interests, and make arrangements to enable them to engage in local, social and community activities and to visit, or maintain contact or communicate with, their families and friends; (n) consult service users about the programme of activities arranged by or on behalf of the care home, and provide facilities for recreation including, having regard to the needs of service users, activities in relation to recreation, fitness and training. A range of stimulating recreational and social opportunities must be provided. 9. OP16 22(3-4) (3) The registered person shall 30/05/07 ensure that any complaint made under the complaints procedure is fully investigated. The registered person shall, within 28 days after the date on which the complaint is made, or such shorter period Version 5.2 Page 30 8. OP12 16(2) (m-n) 30/04/07 (4) King Charles Court DS0000009186.V329167.R01.S.doc as may be reasonable in the circumstances, inform the person who made the complaint of the action (if any) that is to be taken. Good records must be maintained in order that complaints can be rigorously investigated and good information is provided to the complainant. 10. OP19 13(4)(a-c) (4) The registered person shall 30/07/07 ensure that— (a) all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety; (b) any activities in which service users participate are so far as reasonably practicable free from avoidable risks; and (c) unnecessary risks to the health or safety of service users are identified and so far as possible eliminated, Satisfactory arrangements must be established to store and keep equipment in a manner that safeguards service users. 11. OP22 23(2)(c) (2) The registered person shall 30/03/07 having regard to the number and needs of the service users ensure that— Version 5.2 Page 31 King Charles Court DS0000009186.V329167.R01.S.doc (d) equipment provided at the care home for use by service users or persons who work at the care home is maintained in good working order; Sufficient hoists that are in good working order must be provided. 12. OP22 13(4)(a-c) (4) The registered person shall 30/03/07 ensure that— (a) all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety; (b) any activities in which service users participate are so far as reasonably practicable free from avoidable risks; and (c) unnecessary risks to the health or safety of service users are identified and so far as possible eliminated, Cot sides and other similar equipment must only be used following a suitable risk assessment from an appropriately qualified staff member and the required safety measures are in place. 13. OP26 13(3) 3) The registered person shall 30/03/07 make suitable arrangements to prevent infection, toxic conditions Version 5.2 Page 32 King Charles Court DS0000009186.V329167.R01.S.doc and the spread of infection at the care home. The first floor sluice room must be in good working order and there must not be any unpleasant odours. 14. OP27 18 (1)(a) (1) The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users— (a) ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users; There must be sufficient staff on duty at all times to meet the assessed needs of the residents whilst taking into consideration the size and layout of the home, dependency of service users and the number of residents accommodated. 15. OP27 18(1)(a) 19(1)(a) 18 (1) Staffing The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users— (a) ensure that at all times suitably qualified, competent and experienced King Charles Court DS0000009186.V329167.R01.S.doc Version 5.2 Page 33 30/05/07 30/04/07 persons are working at the care home in such numbers as are appropriate for the health and welfare of service users; 19 (1) Fitness of workers The registered person shall not employ a person to work at the care home unless— (a) the person is fit to work at the care home; The registered providers must take steps to make sure the staff providing care and support is fit and has the integrity and competence to meet service users health and welfare needs to the required standard. 30/03/07 19 (1) The registered person shall not employ a person to work at the care home unless— (a) the person is fit to work at the care home; (b) subject to paragraphs (6), (8) and (9), he has obtained in respect of that person the information and documents specified in paragraphs 1 to 9 of Schedule 2; Staff must not commence work in the home without a satisfactory POVA check and must work under constant supervision until a satisfactory King Charles Court DS0000009186.V329167.R01.S.doc Version 5.2 Page 34 16. OP29 19(1)(b) CRB check has been obtained This is re-notified from 16/2/06. (2) Where the registered provider is an organisation or partnership, the care home shall be visited in accordance with this regulation by— (a) the responsible individual or one of the partners, as the case may be; (b) another of the directors or other persons responsible for the management of the organisation or partnership; or (c) an employee of the organisation or the partnership who is not directly concerned with the conduct of the care home. (3) Visits under paragraph (1) or (2) shall take place at least once a month and shall be unannounced. 17. OP31 26(2-5) 30/04/07 (4) The person carrying out the visit shall— (a) interview, with their consent and in private, such of the service users and their representatives and persons working at the care home as appears necessary in order to form an opinion of the King Charles Court DS0000009186.V329167.R01.S.doc Version 5.2 Page 35 standard of care provided in the care home; (b) inspect the premises of the care home, its record of events and records of any complaints; and (c) prepare a written report on the conduct of the care home. (5) The registered provider shall supply a copy of the report required to be made under paragraph (4)(c) to— (a) the Commission; (b) the registered manager; and (c) in the case of a visit under paragraph (2)— (i) where the registered provider is an organisation, to each of the directors or other persons responsible for the management of the organisation; and (ii) where the registered provider is a partnership, to each of the partners. The registered providers must King Charles Court DS0000009186.V329167.R01.S.doc Version 5.2 Page 36 make arrangements for a visit to take place each month to assess the services and facilities provided. A written report of the findings must be provided to the Commission and Registered Manager. 18. OP33 24(1) Quality of Care (1) The registered person shall establish and maintain a system for evaluating the quality of the services provided at the care home. 30/08/07 Reliable and measurable quality assurance arrangements must be established to evaluate the service and facilities provided. 19. OP38 23(4)(b) (4) Subject to paragraph (4A) the registered person shall after consultation with the fire and rescue authority — (a) take adequate precautions against the risk of fire, including the provision of suitable fire equipment; provide adequate means of escape; Fire exits must not be blocked or obstructed in any way. 13(4)(a-c) (4) The registered person shall 30/04/07 ensure that— (a) all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their King Charles Court DS0000009186.V329167.R01.S.doc Version 5.2 Page 37 30/04/07 20. OP38 safety; (b) any activities in which service users participate are so far as reasonably practicable free from avoidable risks; and (c) unnecessary risks to the health or safety of service users are identified and so far as possible eliminated, Robust and reliable risk assessments and risk management arrangements must be in place where any situation arises that could potentially compromise a services users health, safety or well being. 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 OP7 Good Practice Recommendations The resident or representative should sign and date the needs assessment and care plan. Where it is not possible to obtain a signature the individuals participating in the assessment and reason should be recorded. The manager should undertake a dependency study to ensure that sufficient care staff are on duty overnight A satisfaction survey of residents and their relatives should be undertaken. 2. 3. OP27 OP33 King Charles Court DS0000009186.V329167.R01.S.doc Version 5.2 Page 38 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI King Charles Court DS0000009186.V329167.R01.S.doc Version 5.2 Page 39 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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