Inspection on 19/11/07 for King Charles Court

This inspection was carried out on 19th November 2007.

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

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

Other inspections for this house

King Charles Court 14/05/08

King Charles Court 25/06/07

King Charles Court 13/02/07

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 Kerensa Livingstone Unannounced Inspection 19th November 2007 09:00 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.V350487.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.V350487.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 Post Vacant 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.V350487.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 25th June 2007 Brief Description of the Service: King Charles Court is a care home with nursing located in Falmouth. It is situated above the town, although close to the amenities. Many of the rooms have 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 lift to access the first floor. Two rooms are accessed by a chair lift. A number of bedrooms have en-suite facilities and all the bedrooms have 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. The front door to the home is locked at all times and accessible by a keypad. The visiting arrangements are flexible. King Charles Court DS0000009186.V350487.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection that was undertaken by two inspectors over two full days. The Annual Quality Assurance Assessment (AQAA) was not returned prior to this inspection, it was agreed that this would be returned by the 26th of November, the document has not been received. The Improvement plan required following the last inspection has not been returned to the Commission for Social Care Inspection as required by law. The inspectors met with the residents, Manager, staff and relatives. The inspectors were assisted during the inspection by one of the Directors of the company who owns the home. The Inspectors looked at records, care documentation, Policies and Procedures and inspected the environment. Case tracking and direct observation were used. Considerable information had been gathered from residents, relatives, health and social care professionals; this information was gathered prior to the inspection. The current fees range from £475 up to £715.00, this does not include toiletries, newspapers, equipment purchased solely for the benefit of the resident, costs arising from trips and visits outside the care home. A double shared room is £475, standard single £620 and Premium single £715. What the service does well: What has improved since the last inspection? What they could do better: King Charles Court DS0000009186.V350487.R01.S.doc Version 5.2 Page 6 Residents are not being provided with detailed written information about the home. The Statement of Purpose and Service user’s Guide do not include the required information. Pre admission information must be comprehensive and person centred. The registered persons must be sure that the home can meet the individual and collective needs of the person who is moving into the home; this is not currently the case. There are not enough staff on duty to meet the individual and collective needs of the residents. The individual’s plan of care does not set out the health, personal and social care needs in an individualised way. They are inadequate to direct and inform care. Generally health care needs are met, Access to Dental and Optical care must be improved. The residents do not find that the lifestyle offered meets their expectations and more opportunities for choice must be offered. The lack of clinical and managerial leadership has impacted on the resident’s confidence that their concerns will be heard and acted upon. There are parts of the care home that require cleaning, redecorating and tidying up. It is not possible to determine whether the residents live in a safe well-maintained environment, as the records were not provided for inspection. The administration and management of the home require urgent attention. The home is not being run in the best interests of the residents. All confidential records are not being stored securely. 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.V350487.R01.S.doc Version 5.2 Page 7 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.V350487.R01.S.doc Version 5.2 Page 8 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): 1, 2, 3 & 6 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents are not being provided with detailed written information about the home. The registered persons must be sure that the home can meet the individual and collective needs of the person who is moving into the home; this is not currently the case. EVIDENCE: The Statement of Purpose and Service User’s Guide does not include the required information. Current and prospective residents are not currently being provided with detailed information to enable them to make an informed choice. Draft documents were available on the day of the inspection as they are currently being updated, the need to include the information required was discussed and detailed feedback was given. No information is included about the physical environment standards or that two rooms are accessed by a chair lift. The Service User’s Guide does not include a copy of the most recent King Charles Court DS0000009186.V350487.R01.S.doc Version 5.2 Page 9 inspection report or service user’s views of the home. The Statement of Purpose must accurately reflect the practices in the home, for example it states that ‘the home will offer a range of activities that will take place in the recreation lounge’. A statement of terms and conditions are provided to new residents. The room occupied sometimes differed from the one recorded on the contract, the contract is not updated to reflect this. There is little information in the contract about the rights of the service user and/or their representative. The contract states that the home can give the resident seven days notice to leave if there is a breach of contract, but the resident must give four weeks notice unless this is agreed by the home. Concerns have been raised that additional monies are being requested to top up the fees. There is a comprehensive preadmission document. New documentation is currently being introduced; therefore it was not always possible to evidence the pre admission information on some residents. The inspectors were informed that each prospective resident is assessed to make sure that the services and facilities are appropriate to meet the needs of the individual. The prospective resident and their relatives or representatives are invited to participate in the assessment. There is evidence that the views of any professionals involved are taken into account. The documentation available at inspection did not always include detailed information and did not comprehensively address all of their needs, preferences and choices. Therefore more detailed assessments continue to be required in order that the providers are confidant the appropriate care and support required is provided. At previous inspections, the inspectors have been informed that this service does not provide intermediate care or rehabilitation services as there are no specialised facilities, dedicated accommodation and designated staff that have had specific training. Since the last inspection concerns have been expressed about the level of service provided when intermediate care was offered. This was discussed at inspection and the inspectors were informed that the home is not equipped to provide this service. King Charles Court DS0000009186.V350487.R01.S.doc Version 5.2 Page 10 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 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The individual’s plan of care does not set out the health, personal and social care needs in an individualised way. They are inadequate to direct and inform care. Generally health care needs are met, access to Dental and Optical care must be improved. EVIDENCE: As identified at the previous inspection the care plans do not fully inform and direct care staff on how to support the service user’s own capacity for self care and meet their needs. Typed care plans were observed to be undated and unsigned. At the previous inspection a new system was planned for introduction, this has not been completed, therefore there are two systems running alongside each other, which are incomplete. Staff informed the inspectors that it was possible that another system would be introduced now. Some residents did not have a plan of care. The documentation inspected did not reflect the complexity of need and invariably key aspects of care were not included or updated. There was no evidence that this documentation was King Charles Court DS0000009186.V350487.R01.S.doc Version 5.2 Page 11 reviewed at least monthly, drawn up with the resident or any resident and/or representative involvement. Residents and their relatives did not feel that they had been consulted about the plan of care nor had they seen it. Some residents were satisfied with the manner in which their health needs are met and expressed confidence in the staff. It is clear that visits are made by the General Practitioner and District Nurses. One person said that they felt that there were occasions when the Doctor could be called earlier and another person commented that they were unaware of any issues until they visited the home and asked the staff. Access to dental, optical and audiology care did not appear to be consistent. Some relatives stated that they were left to arrange visits e.g. by the General practitioner or dentist. Pressure relieving equipment is available in the home. No regular exercise activities are provided in the home. Residents were observed to be sitting for prolonged periods of time without being assisted to the bathroom or to have a walk. Brief continence information is gathered, however there was little information about toileting needs. Care plans did not reflect the level of need. The inspectors were informed that where interventions were identified it was not always possible to do them due to the staffing levels, particularly the lack of trained nurses. A chiropodist visits the home regularly. Care staff allocate the work on a daily basis. Several concerns have been received regarding the lack of opportunity for regular bathing. Records at the inspection demonstrated that some residents were going for several weeks without a bath. A qualified nurse administers all medication and a Monitored Dosage system is used. The lunchtime medication round was observed and medicines were administered safely. Medication Administration Records (MAR) were observed during this inspection as at the last one to be signed prior to the resident taking their medication. Handwritten Medication Administration records (MAR) should be checked and signed by two staff. Each resident has a photograph held on their medication sheet to ensure their protection during the administration of meds. Records of medication received into the home and disposed of are kept. There are policies and procedures in place. There is a designated fridge to store medication that requires this facility, temperatures are due to be recorded daily, however gaps were noted on days when there had been temporary staff (agency). The fridge was locked on the day of the inspection. There is a Controlled Drugs (CD) cupboard and a CD register. A check of the controlled drugs identified there had been an error in the records. The controlled drug register was full, another one had been ordered, however this impacted on the staff’s ability to record accurately. A tube of steroid cream was observed as having been left in a bathroom. No residents self administer their medication and no lockable facility is provided in rooms for this purpose. The staff were observed to knock on resident’s doors prior to entering. There is no evidence to confirm that residents have chosen to share a double room, screening is provided. One relative commented that when visiting the home the resident was wearing someone else’s clothes. Communal toiletry items King Charles Court DS0000009186.V350487.R01.S.doc Version 5.2 Page 12 were observed in the bathrooms. There were a lot of unclaimed items of clothing in the laundry and the inspector was advised unlabeled socks are worn by anyone. An individual’s preferred name is not recorded on the documentation. The staff were observed to speak to the residents respectfully. One person commented that the carers were very kind. One person stated that it was not always possible to meet individual preferences for choice of gender of carer providing personal care i.e. if a female resident wishes to have her needs met by a female carer this is not always possible due to staff on duty. There was no evidence in resident documentation that this information had been gathered. The names of previous residents were observed in some rooms. King Charles Court DS0000009186.V350487.R01.S.doc Version 5.2 Page 13 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The residents do not find that the lifestyle offered meets their expectations and more opportunities for choice must be offered. The residents enjoy the meals that are provided. EVIDENCE: At previous inspections the residents have said there are very limited social and recreational opportunities available. The feedback gathered before and during this inspection confirmed that this is still the case. One person commented ‘the activities are very limited… but I strongly feel that more could be done to stimulate the residents other than television’ and another said ‘need more activities and outdoor space’. The resident’s care plans and assessments contain limited information about social, leisure, spiritual and recreational interests. The activities coordinator works between this home and the sister home, so this equates to eighteen hours a week. A lifestory and pen picture has been developed by the activities coordinator. There is little evidence of personal choice in relation to any activities of daily living. A combined church service was held on one of the days of the inspection, the residents already sat in the lounge were not invited to participate or whether they wished to leave, residents in their room were unaware that the service King Charles Court DS0000009186.V350487.R01.S.doc Version 5.2 Page 14 was taking place. Requests for activities or trips out identified in the care documentation are not being offered due to the current staffing situation. No information about activities taking place in the home had been circulated for November. For the month of December information has been posted throughout the home about different entertainment that is on offer. Visitors are able to visit at any time, relatives commented that they had not been provided with information about visiting the home. There are no restrictions to residents accessing the community, 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. One relative felt the home could do more to enable the resident to keep in touch with friends and family. The front door of the home is locked, relatives are not provided with the keypad code. During the inspection visitors often had to wait outside for sometime whilst they waited for staff to answer the door. Individual choices and preferred routines are not recorded, where wishes are recorded for example with activities, these are not carried out. Some residents commented that they were not able to have a bath when they wished. Several relatives complained that their relative had not been bathed for some time. One relative commented that the way the home could improve was to ‘treat residents with respect and as individuals’. Residents were unaware of the documentation that is held on them and that they also have access to it. The home provides three varied meals each day, the menu operates on a fiveweek rotation. Food records are kept, they did not include all the food consumed however the head cook had started this prior to the end of the inspection. The staff discuss daily choices with the residents. A full continental style breakfast is provided, a cooked breakfast is not on offer. Fresh fruit and vegetables are available. On the days of the inspection there was the Head Cook and Kitchen Assistant on duty all day. On the day of the inspection the menu was as follows; Stew and dumplings or Scampi and Chips with peas. This was followed by Chocolate sponge pudding and custard or icecream. Water, orange juice and/or sherry were observed to accompany lunch. The Head Cook has completed her Intermediate Food Hygiene, other staff who work in the kitchen have completed their Foundation Food Hygiene Certificate. Special diets are catered for individually. The dining room is comfortably decorated and enjoys views across the sea. Over the lunchtime period the mealtime was observed, seven residents were observed to be eating sat at the dining room tables. The Residents were satisfied with the food, some spoke highly about what was available. ‘Oh yes the food is very good’ one person commented. Tea time residents were offered a choice of sandwiches or a prawn salad. A menu was written up on the lounge notice board, however this was for the 16th of November. King Charles Court DS0000009186.V350487.R01.S.doc Version 5.2 Page 15 King Charles Court DS0000009186.V350487.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The lack of clinical and managerial leadership has impacted on the resident’s confidence that their concerns will be heard and acted upon. There are procedures in place to safeguard residents. EVIDENCE: Due to the recent managerial and staffing changes residents and their relatives were not always confident that they knew who to speak to if they had any concerns. They were also not confident that their concerns would be acted upon. There is a complaints procedure for the home, this states if the process is unsuccessful the person can refer onto CSCI. Anyone can contact the Commission at anytime, however it is unrealistic to invite people to refer on unresolved disputes, as the CSCI is not a complaints investigation agency. Some complaints procedures seen at inspection included the Department of Adult Social Care, one did not. Information about how to complain must be provided to all residents and their representatives. The complaints log was not available for inspection on the day of the inspection as it could not be located. Between June and August there had been four formal complaints to the home, it is not known how many have been made since then. The Commission has received two complaints and several concerns. Complaints have related to a variety of issues cleanliness of the rooms, requesting more activities and entertainment, management of the home, safety of equipment. King Charles Court DS0000009186.V350487.R01.S.doc Version 5.2 Page 17 Concerns expressed to the inspectors prior and during the inspection included the above issues; also end of life care, moving and handling procedures, accessibility of trained nurses, gaining information from trained nurses, the frequency of bathing, the quality of care provision, staffing levels, how their relative is dressed and lost property. There is a procedure for the Protection of Vulnerable Adults, however this needs to state that the Commission must be informed without delay and that any member of staff can report an allegation of abuse. The procedure does not include the support/care to be offered to the resident. All staff are provided with training on the Protection of Vulnerable Adults. King Charles Court DS0000009186.V350487.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24 & 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There are parts of the care home that require cleaning, redecorating and tidying up. It is not possible to determine whether the residents live in a safe well maintained environment, as the records were not provided for inspection. EVIDENCE: The home is located in Falmouth overlooking the harbour, there is a car park to the front of the home. The environment is comfortable and homely. During a tour of the premises areas of the home were observed to be in need of refurbishment and redecoration, some furniture needs replacing. One room was observed to have no wardrobe. The maintenance person is shared with the sister home. A maintenance book is in operation, however it was not possible to evidence that routine maintenance is taking place, as this information could not be located during the two days of the inspection. One person commented King Charles Court DS0000009186.V350487.R01.S.doc Version 5.2 Page 19 that the ‘furnishings and carpets need replacing’. Another relative stated the home would benefit from a reception area. Some rooms have sea views. Generally the residents informed the inspectors that they liked their accommodation. There is a maintenance record book and a person is employed to do the maintenance in the home. Alarms are fitted on external doors and the front door of the home is locked. The environment was inspected during this inspection. There is a lounge/dining room on the ground floor, which enjoys pleasant views of the sea and a small lounge on the first floor. The bathrooms are clinical, not homely and in need of upgrading. The inspectors observed personal items and equipment left in the bathrooms. One of the bathrooms is being converted into an assisted shower room, this was being done at the time of the inspection, the Commission had not been informed that this work was underway. Additional toilets are located near the communal areas of the home. Service user’s preferences in relation to bathing should be recorded. The home was observed to be untidy and cluttered in places. The inspectors were informed that hoists and wheelchairs are not being stored where they should. The inspectors were informed that specialist equipment is sought on an individual basis. There is a range of communal hoists and equipment provided to assist residents. There was no evidence that the hoists had been serviced. Residents were generally satisfied with the facilities provided and many have personalised their bedrooms. No lockable facility or door lock is provided in individual accommodation. There are twenty single rooms and five double room, the inspectors were informed that all the rooms were ensuite i.e. a toilet and a wash hand basin. There is no evidence that individuals choose to share with another person. At previous inspections storage has been a problem, the registered persons have started to address this issue; equipment and other supplies continue to be inappropriately stored. This therefore continues to be a potential hazard for residents, staff or visitors. There is a passenger lift to the first floor, one resident commented that this breaks down quite often and it is not possible to come downstairs. Two bedrooms are accessible by a chair lift. There are two sluices in the home. The downstairs sluice was observed to be difficult to access due to the large bin in front of it and staff seemed reluctant to use it. The housekeeping staff work hard to kept the home clean, however there are only two staff and evidently there are areas that require “deep” cleaning on a regular basis. Several residents and relatives commented that the home needed ‘more cleaning’. There were odours in some areas of the home. The laundry room has two industrial washing machines with a sluice facility and three tumble driers. Red bags are used for soiled linen. Individual King Charles Court DS0000009186.V350487.R01.S.doc Version 5.2 Page 20 baskets are provided to each person. There are no handwashing facilities in the laundry room, wall are painted but are not impermeable. A large pile of lost laundry was evident. King Charles Court DS0000009186.V350487.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are not enough staff on duty to meet the individual and collective needs of the residents. Residents are safeguarded by the recruitment procedures. EVIDENCE: On the day of the inspection there was one nurse and six carers on duty. There were two nurses covering the twenty-four hour period due to sickness and senior staff leaving. However there was a two hour period where it was not clear who was the qualified nurse on duty. One relative commented ‘there are not enough trained staff,’ this was evident at inspection. The duty rota includes the care and nursing staff, the housekeeping and catering staff have separate rotas. At the start of the inspection the inspectors were informed that the home was probably ‘overstaffed’. This was not reflected in practice, with qualified nursing shifts being arranged on a daily sometimes hourly basis. Throughout the inspection the lounge area was observed not to have any care staff sitting with the residents who were in there. When a resident asked for some assistance considerable delays were noted through direct observation to assist the person to the bathroom. One relative commented ‘there are not a sufficient amount of trained staff in the home there have been so many cutbacks’. It had been identified by the registered persons to undertake a dependency study to determine staffing, however this could not be confirmed King Charles Court DS0000009186.V350487.R01.S.doc Version 5.2 Page 22 at inspection. Relatives commented that there are not enough housekeeping staff and hours to keep the home clean, this was confirmed at inspection. Thirteen out of eighteen staff have completed their National Vocational Qualification training the inspector was informed, six have NVQ level 2 and six have level 3, one person has level 4. This equates to seventy two percent of the staff. Three more staff are currently undertaking their training. A robust recruitment procedure is in operation. New staff complete an application form, written references and an enhanced Criminal Records Bureau check are obtained. There is evidence of an interview assessment. Evidence of registration is sought from the Nursing and Midwifery Council. All staff are provided with terms and conditions of employment. No volunteers are employed in the home. The home’s induction training has recently been reviewed, this must comply with the skills for care requirements. There is a structured three day induction training course provided internally which incorporates fire training, moving and handling, infection control, POVA and food handling. End of life care is going to be added at the end of the year. Two days are compulsory and the third day is optional, this day includes end of life care and introduction to dementia care. Records of training are kept, these must be kept up to date. Registered nurses must be supported to undertake training to ensure that they remain up to date. There is limited evidence of training specific to the needs of the residents, all staff must be provided with training to ensure that they can meet the specific needs of the residents. King Charles Court DS0000009186.V350487.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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The administration and management of the home require urgent attention. The home is not being run in the best interests of the residents. All confidential records are not being stored securely. EVIDENCE: The Commission for Social Care Inspection had understood that a Manager was in post and due to make an application to become the registered manager. At the beginning of the inspection we were informed this person had left and a new Manager had started that day. This home has been without a Registered Manager since May 2007. No evidence of Regulation 26 visits was available at inspection. One person commented that the home is ‘badly run’ and several people commented that there had been a lack of leadership. There are a King Charles Court DS0000009186.V350487.R01.S.doc Version 5.2 Page 24 number of outstanding requirements, which have not been met within agreed timescales since the last inspection. There is no annual development plan for the home. There is no evidence that views of the residents, relatives, staff and stakeholders have been sought and acted upon. There is no evidence that the quality of care including the quality of nursing is being reviewed. The inspectors were advised that no personal monies are kept for the residents and any expenditure is invoiced. No lockable space is provided for residents to keep their valuables safely. Supervision has not been taking place as required. No supervision records were available during the inspection. At the time of the inspection there were two nurses covering the twenty-four hour period due to sickness and senior staff leaving the home. Care records were observed to be left in an open office at times during the inspection. There is a visitor’s book in the reception area of the home. The accident book in use did not have the pages removed as required under the Data Protection Act. A communication book is in use with resident’s names in it. The records required by law must be kept in the care home e.g. contracts, complaints records, Regulation 26 reports, and recruitment information. A fire safety enforcement order was issued in August 2007, the inspectors were informed that this work had been done and evidence will be obtained from the fire service. A company had visited the home to look at the health and safety issues. However no health and safety action plan or environmental risk assessments were available for inspection. The hot water provided to the sinks is unregulated and there are no risk assessments in place. No maintenance or servicing information was available at inspection e.g. electricity, gas, legionella, hoists, lift. King Charles Court DS0000009186.V350487.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 1 2 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 1 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 2 2 3 2 2 X 1 X 2 STAFFING Standard No Score 27 1 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 1 1 1 King Charles Court DS0000009186.V350487.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 OP1 Regulation 5 Requirement The Service user’s guide must include all the required information, this must be made available to all residents and a copy forwarded to the Commission on completion. The registered person shall compile a written statement of purpose, which shall include all the matters listed in Schedule 1. A copy must be supplied to the Commission and be available on request to any resident or their representative. Detailed assessment must be completed on each prospective resident to make sure the providers have a comprehensive picture of the service users needs, preferences and choices. Previous timescales not met 30/10/07 Timescale for action 01/02/08 2. OP1 4, Sch. 1 01/02/08 3. OP3 14(1abc) 01/02/08 4. OP7 15 The registered person shall prepare a written plan after consultation with the service user or a representative as to how the service user’s needs in respect to his health and welfare are to be met. This shall be made available to the service DS0000009186.V350487.R01.S.doc 01/01/08 King Charles Court Version 5.2 Page 27 user and be kept under review. The service user or representative should be involved in any revisions and notified of changes. Previous timescales not met 5. OP8 12(1 & 2) 6. OP10 12(4) 7. OP12 16(2)(mn) 8. OP16 22 9. OP22 23(2c) 10. OP26 23(2d) 11. OP27 18 (1)(a) 02/05/07 The registered person shall make proper provision for the health and welfare of residents and so far as practicable enable service user to make decision in respect to the care they are to receive. The registered person shall make suitable arrangements to ensure that the care home is conducted in a manner which respects the privacy and dignity of residents with due regard for their sex, disability and background. The registered person shall consult with service users about the programme of activities and provide facilities for recreation including fitness. The complaints procedure shall be appropriate to the needs of the residents and a record of complaints must be provided to the Commission on request. The registered person shall ensure that the equipment provided at the car home for the use by residents or person who work at the care home is maintained in good working order. The registered person shall ensure that all parts of the care home are kept clean and reasonably decorated. 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 DS0000009186.V350487.R01.S.doc 30/12/07 30/12/07 30/12/07 30/12/07 30/12/07 01/02/08 30/12/07 King Charles Court Version 5.2 Page 28 accommodated. 12. OP27 17(2) Sch. 4 18(1c) Previous timescales not met 30/09/07 13. OP30 14. OP31 8(1) The registered person must keep a copy of the duty roster of all the persons working at the care home. The registered person shall ensure that the persons employed receive training appropriate to the work they are to perform, e.g. induction, specific role, PREP. A registered manager must be appointed to manage the care home. Previous timescales not met 30/10/07 30/12/07 01/02/08 01/02/08 15. OP31 37 16. OP31 26 17. OP33 24 18. OP36 18(2) 19. OP37 Data Protection Act 1998 The registered person shall give written notice to the Commission without delay of the occurrence detailed under this regulation including any event in the care home adversely affecting a service user and any allegation of misconduct. Where the registered provider is an individual, but not in day-today charge he shall visit the home monthly, prepare a written report and supply a copy to the Commission. Reliable and measurable quality assurance arrangements must be established to evaluate the quality of care, including the quality of nursing and facilities provided. A copy must be sent to the Commission and made available to residents. The registered person shall ensure that the persons working at the care home are appropriately supervised. States that anyone who processes personal information must comply with eight principles, for example make DS0000009186.V350487.R01.S.doc 30/12/07 30/12/07 30/12/07 01/02/08 01/10/08 King Charles Court Version 5.2 Page 29 20. OP37 21. OP38 sure that personal information is secure. Confidential information must be locked away securely. 17(2) The registered person is required Sch. to keep all the records in 2,3&4 Schedules 2, 3 & 4 in the care home. 13(4)(a-c) 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. Previous timescales not met, this has been re-notified twice 30/04/07 01/01/08 01/01/08 22. OP38 23(2c) The registered person shall 01/02/08 ensure that the home is routinely maintained and kept in a good state of repair, there is evidence of this. 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 OP1 Good Practice Recommendations For the statement of purpose to include the physical environment information detailed in NMS 1.1 and specific information about the environment for example two bedrooms being accessible by a chair lift. For the service user’s guide to include resident’s views of the home. For more parity and information in the contract about the rights of the resident. Handwritten Medication Administration Records (MAR) should be checked and signed by a second person. For residents to share a room only when they have chosen to do so. For the resident’s preferred name to be recorded. DS0000009186.V350487.R01.S.doc Version 5.2 Page 30 2. 3. 4. 5. 6. OP1 OP3 OP9 OP10 OP10 King Charles Court 7. 8. 9. 10. 11. 12. 13. 14. 15. OP12 OP13 OP18 OP19 OP21 OP24 OP24 OP26 OP38 For information about the activities taking place to be circulated to the residents in the home. For the home to review their existing procedures about visitors accessing the home. For the role of the staff supporting the resident to be included in the Protection of Vulnerable adults procedure. For records of routine maintenance and renewal of fabric and decoration of the premises to be kept. To make the bathrooms less clinical and more homely. For residents to be provided with lockable storage and provided with the key unless the reason is explained in the care plan. For doors to accommodation to be fitted to an overrideable lock accessible to staff in emergencies. For hand washing facilities to be provided in the laundry. For the Registered persons to provide evidence to the Commission for Social Care Inspection that the Fire enforcement notice has been withdrawn. King Charles Court DS0000009186.V350487.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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.V350487.R01.S.doc Version 5.2 Page 32 - 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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