Inspection on 07/08/06 for Kingfishers Nursing Home

This inspection was carried out on 7th August 2006.

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

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

Other inspections for this house

Kingfishers Nursing Home 05/07/07

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Kingfishers Nursing Home Fieldhead Gardens Bourne End Buckinghamshire SL8 5RA Lead Inspector Barbara Mulligan Unannounced Inspection 10:50a 7 August 2006 th 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 DS0000066749.V302487.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. DS0000066749.V302487.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kingfishers Nursing Home Address Fieldhead Gardens Bourne End Buckinghamshire SL8 5RA 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) 01628 520020 Kingfisher Carehome Limited Mrs Shelley Ackland-Snow Care Home 46 Category(ies) of Old age, not falling within any other category registration, with number (46) of places DS0000066749.V302487.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1 That the home is registered for 46 (forty six) service users. That the home is registered to provided care for 46 (forty six) service users with Nursing needs and 10 (ten) service users without Nursing needs, subject to an overall limit of 46 (forty six) service users. 9th February 2006. Date of last inspection Brief Description of the Service: Kingfishers is a privately owned care home providing personal and nursing care to 46 older people. The home is situated in Bourne End, close to the shops and amenities of a small town. Marlow and the river Thames are a short drive away. The building dates back to 1904 and has been sympathetically restored and adapted for its current use. There are 22 single rooms and 12 shared rooms. Many of the rooms have ensuite facilities. Access to the upper floors is via a passenger lift. The gardens are well maintained and easily accessible to older people. There is an experienced management team who are supported by qualified nurses and carers on duty at all times. Fees range from £650 per week for a shared room to £850 per week for an ensuite single room. DS0000066749.V302487.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place on 7th August 2006 at 10.50am on a Monday morning. The visit consisted of discussions with service users and their relative, support staff and the Registered Manager. Records, policies and procedures were examined and a tour of the premises was undertaken. The inspection officer is Ms. Barbara Mulligan. The Registered Manager is Mrs Shelley Ackland-Snow. Twenty-five of the National Minimum Standards were assessed during this visit. Sixteen of these are fully met and nine almost met. As a result of the inspection the home has received ten requirements. Eight comment cards were received from service users, relatives and/or representatives; one was received from a care manager and another from a general practitioner. Comments received, both from people interviewed and those who responded to the survey, expressed a high level of satisfaction with the care received from support staff. Some positive comments received include “My wife has been in Kingfishers for the past three months, I am pleased with their services. Very kind and attentive at all times” and “ excellent communication with staff who are always helpful” and “patients are extremely well tended and cared for, with every attempt to meet their needs”. Some comment cards received identify areas of dissatisfaction and these include, “there should be more day time occupation offered” and “some staff cannot speak English very well and my mother finds this very difficult” and “usually enough staff but sometimes residents can wait uncomfortably for toileting”. Visiting relatives spoken to on the day of the day of inspection conveyed their satisfaction with the care and the environment. However, their visits usually take place in their relative’s room, as this is where she prefers to be. They would like staff to visit them in the bedroom just to ask if everything is satisfactory. The evidence seen and comments received indicate that this service meets the diverse needs [e.g. religious, racial, cultural, disability] of individuals within the limits of its Statement of Purpose. The inspector would like to thank the registered manager, the staff team and service users and relatives for their cooperation and assistance during this inspection. What the service does well: DS0000066749.V302487.R01.S.doc Version 5.2 Page 6 Service users are assessed prior to moving into the home, giving both staff and service users the confidence that their needs will be met. Service users privacy and dignity is maintained as far as possible. The activities provided give service users variety and diversion during the day. Service users are encouraged and supported to maintain links with family and friends. Individuals are encouraged to personalise their rooms with their own furniture and personal belongings. There is a motivated and established staff team that consists of nursing and care/support staff. The staff team are motivated, committed and respond to service users in a respectful and appropriate manner. There is an effective complaints procedure with all complaints and concerns being acted upon promptly, within stated time scales. There is an extensive range of policies and procedures, providing care staff with relevant information about all aspects of care and the home/organisation. What has improved since the last inspection? Redecoration and maintenance work has been carried out in the home since the new provider took over. This has greatly improved the living environment for service users, providing a homely warm and safe environment for service users to live in. The home has managed to maintain a good standard of care ensuring the personal, emotional and health care needs for service users continue to be met. Health and safety matters have improved, with generic risk assessments now in place. Regulation 26 visits have recently recommenced and these are received by the Commission. Height adjustable beds have been purchased for all service users who require them. DS0000066749.V302487.R01.S.doc Version 5.2 Page 7 What they could do better: 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. DS0000066749.V302487.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 DS0000066749.V302487.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users needs are thoroughly assessed prior to admission ensuring that staff are prepared for admission and have a clear understanding of the service users requirements. EVIDENCE: Assessments of need are not kept in service users personal files, but in a separate file kept in a medical room. During the day this room was observed to be left open and unattended. This was discussed with registered manager and it is recommended that service users needs assessments are kept in their personal files and stored securely. Care needs assessments seen are comprehensive and the registered manager said she will visit a potential service user in hospital, or occasionally in their own home before they are admitted. The home does not offer intermediate care. DS0000066749.V302487.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care planning systems do not adequately provide staff with the information they need to satisfactorily meet service users needs. Overall, healthcare support for service users is good, however, there must be a plan of care in place for pressure area care and nutritional screening to ensure service users health and wellbeing is promoted and protected. Staff conscientiously undertake the management of medicines within the home, however recording practices must be improved to effectively protect service users. Service users privacy and dignity is maintained as far as possible. EVIDENCE: The home use the Standex system. The front sheet of this is titled “ Long term need assessment and care plan”. This sheet is more of a needs assessment than a care plan. There is limited space to record relevant information on this sheet. The inspector observed four plans of care. Care needs have been adequately identified, however there are no detailed plans of care in place to demonstrate DS0000066749.V302487.R01.S.doc Version 5.2 Page 11 how these needs will be met. For example, identified on the “ Long term need assessment and care plan” it is recorded “ can become very disorientated at time, muddled and aggressive”. However there is no plan of care that informs care staff how to deal with this. Another entry states under personal care “all help needed” but gives no detail how care staff are to support and assist with personal care. Under the headings of “eating and drinking” there is nothing recorded in two files. It is unclear if this is because the service users have no needs in this area or because this area has not been completed yet. Under the heading of “elimination, urine” it is recorded in one care plan that the service user is continent if toileted. However, there is no information about how often the service user needs to be toileted, whether they use the toilet or a commode or how mush assistance they require. Overall the care plans do not set out in detail the action which needs to be taken by care staff to ensure that all aspects of the health, personal and social care needs of the service user are met. This will be a requirement of the report. Not all care plans are signed by the service user or their representative and this will be a recommendation of the report. There are assessments in place to identify service users who have, or are at risk of developing pressure sores. The inspector looked at four of these assessments. The first scored a rating of 21. A guide/key to the scores is on the side of the assessment. This records that a score of 21 is a very high risk. However, there is no plan of care to inform care staff how to prevent pressure sores developing. The second assessment scored the service user at 25, again the guide states this is a very high risk but there is no plan of care in place. This was last reviewed on the 04/07/06. The third assessment seen scored the service user at 17 which is high risk Again, there is no plan of care in place. This assessment has been reviewed monthly up until January 06. A nutritional assessment for this service user scores a rating of 17 which the assessment deems as high risk and states that there must be consultation with a dietician and the individual must be weighed weekly. The registered manager said the home is in contact with the dietician, however there is no evidence of weight monitoring. The nutritional assessment has been reviewed monthly until February 2006. The registered manager is required to ensure that where a nutritional assessment deems a service user to be at risk, appropriate intervention is recorded in the individual care plan. This must be reviewed monthly. The registered manager must ensure that a record of nutritional screening is undertaken on a periodic basis, including weight gain or loss and records the appropriate action to be taken. The fourth pressure area assessment scored the service user as at risk but there is no plan of care in place. A nutritional assessment of this service user DS0000066749.V302487.R01.S.doc Version 5.2 Page 12 gives a score of 12 which the assessment deems as at risk and underweight. The assessment states that there must be consultation with a dietician and the individual must be weighed weekly. There is evidence of two recorded weights undertaken in June 2005 and the second in Sept 05. However, it must be noted that at the time of the inspection there were no service users with pressure sores. It is a requirement of the report that appropriate intervention regarding the treatment of or the prevention of pressures is recorded in individual care plans and these are reviewed monthly. The manager informed the inspector that the home tries hard to promote continence. Service users are encouraged to keep their own G.P. Each service user is seen by an optician and the manager said that service users receive an annual eye test. Referrals for hearing tests are via service users G.P. Chiropody and physiotherapy services can be accessed on a needs only basis. Dental services are accessed on a needs only basis via the community dental services or a local dentist. Comments received both from service users interviewed and from comment cards received indicate that there is a high level of satisfaction with the standard of care received. Medication is kept in three secure trolleys, one on each floor. These are secured to the wall and are lockable. On the ground floor there is a medical room where the storage of surplus medicines are kept. Medication is administered via a monitored dosage system and the home uses a local pharmacy. Inspection of MAR charts showed several signature omissions. One of these is for the administration of insulin. It is a requirement of the report that staff sign to record the administration of medication and the home implement regular medication audits to reduce the number of omissions. Several N.M.C. booklets were observed regarding the administration of medicines. There is a medication policy in place and this covers all areas detailed in standard 9. Records of all medication received and returned are accurate and well maintained. The home uses controlled drugs and these are stored in a metal cupboard, which complies with the Misuse of Drugs Regulations 1973. There is a register in place to record all administrations of controlled drugs and the signatures of two staff are recorded in the register. The manager is aware of the need to retain medication for a period of seven days after a service user has died. Single rooms ensure service users receive care from staff and health care professionals in complete privacy. Adequate screening in shared rooms ensures complete privacy for the service user. Staff were observed during the inspection to knock on service users bedroom doors before entering. The home’s Statement of Purpose includes information about maintaining the privacy of service user’s. If service users wish to have a key to their room then this can be facilitated. DS0000066749.V302487.R01.S.doc Version 5.2 Page 13 Preferred terms of address are recorded in service users care plans and likes and dislikes are recorded in most service users plans. DS0000066749.V302487.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The activities provided give service users variety and diversion in the day. However, to fully meet the social, cultural, religious and recreational interests of service users the home must fully develop and complete individual, as well as group activity plans. The home promotes ‘flexible’ visiting, which enables service users to maintain contact with their friends and family. The presentation and standard of food is of a good standard and appears to meet the nutritional needs of service users. However the presentation of pureed meals needs to be improved and the individual techniques of staff when providing assistance need to be enhanced. EVIDENCE: There is some information available in care plans regarding service users interests. The weekly activities are posted in the main entrance to the home. Service users spoken to on the day of the inspection were positive about the activities available. The only criticism conveyed was that there should be more of them. An activities coordinator visits the home twice a week. She was in the home on the day of the inspection and in the afternoon was hosting a quiz in the larger of the two lounges. Service users appeared to be enjoying this. On the DS0000066749.V302487.R01.S.doc Version 5.2 Page 15 morning of the inspection there was a musician in the home and service users could be heard singing and applauding. The inspector spoke to the activities coordinator. She said her role is more of a reminiscence therapist. She carries out quizzes, discussion groups and undertakes one to one time with service users. Following the previous inspection a requirement was issued for individual, as well as group activity plans to be drawn up with families. There is evidence of service users interests recorded in care plans but there do not appear to be any activity plans in individual care plans. Although there has obviously been an improvement in this area, it is recommended that further work is undertaken to enhance service users access to suitable activities that match their expectations and preferences and satisfies their social, cultural, religious and recreational interests. Service users are able to receive visitors in the privacy of their own rooms, and are able to choose whom they see and do not see. There are no restrictions on visiting, and this is documented in the Service Users Guide. Involvement by the local community includes a regular church service in the home, regular visits by the hairdressers and barbers and visiting musician. Service users are encouraged to look after their own financial affairs whenever possible. However families, or on occasions a chosen solicitor will be responsible for an individuals financial dealings. There are notices in the main hall giving service users the contact details of local advocacy agencies. An invitation to bring in personal items of furniture and other belongings is included in the Service Users Guide and evidence of this was seen during a tour of the premises. The inspector was told that service users can have access to their personal records if they wish. Service users are offered a choice at every mealtime. The main meal is served at lunchtime with a choice of main meal and sweet. The inspector observed a lunchtime meal taking place in the High Dependency Unit. This area is used for service users who require extra help in eating. There were approximately ten service users having lunch in this area. Some individuals were seated in wheelchairs and some were in personal armchairs. The food is stored in a hot trolley and this is wheeled into the room. The inspector observed several areas of bad practice. Three staff put the lunchtime meal in front of service users without a word spoken. One of these was a puréed meal and was unidentifiable. During the meal, while service users were being assisted to eat it was observed that some staff were talking to service users and others were not. One staff member was observed to get up from her chair seven times whilst assisting a service user to eat. She was then observed to commence feeding the service user sat next to the individual she was assisting, resulting in a rushed and impersonal mealtime. Comments received from service users regarding the standard of the food are all positive. Comments include “the food is first class” and “ the food is as good as my own”. DS0000066749.V302487.R01.S.doc Version 5.2 Page 16 The menu is rotated on a four weekly cycle. The dining area is used by service users who are more independent. This is bright and spacious. The inspector was informed that independent eating is encouraged for as long as possible. It is a requirement of the report that the presentation of pureed food is improved and the individual techniques of staff when providing assistance to service users must be enhanced. DS0000066749.V302487.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has effective complaints procedures to ensure that service users or their representatives are listened to. Policies and procedures to protect service users from abuse are in place, including financial protection. Care workers have a good knowledge and understanding of Adult Protection issues that protect service users from abuse. EVIDENCE: The relaxed and open style of the manager indicates that complaints are listened to, service users and relatives support this finding. The manager has encouraged a regular exchange of views with service users at regular meetings. The home has a complaints procedure in place and this is included in the homes Service Users Guide and gives details of the Commission for Social Care Inspection. Copies of the complaints procedure are available by the main reception area. There is a dedicated complaints log where formal and informal complaints are recorded. However, this does not fully record the action taken and the outcome of the complaint. This will be a recommendation of the report. The inspector looked at an Adult Protection Policy and within this there are guidelines for staff about the responsibilities of the staff, types and signs of abuse and what to do if you suspect abuse. Training records demonstrate that care staff have completed POVA training and thirteen staff recently completed DS0000066749.V302487.R01.S.doc Version 5.2 Page 18 this on 07/06/06, 09/06/06 and the 13/06/06. The inspector looked at the homes policies and procedures regarding service users money and financial affairs. These ensure service users have access to their money, valuables and safe storage of valuables. DS0000066749.V302487.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There has been some investment regarding the refurbishment of the home. There are some further improvements needed to ensure that the environment meets the service users needs. The overall quality of the furnishings and fittings is adequate, ensuring the safety and comfort of service users. However, bedroom furniture still needs to be replaced. The garden is regularly maintained to keep it safe and accessible for service users. EVIDENCE: Kingfishers Nursing Home is a large three story Edwardian House and has been adapted for its present use. There are ramps and grab rails and access to the upper floor is via passenger lift. Following the previous inspection a requirement was issued for a room audit to be undertaken to prioritise the rooms most in need of redecoration and in need DS0000066749.V302487.R01.S.doc Version 5.2 Page 20 of new furniture, and a timetable for refurbishment and purchase of new furniture is set. The inspector observed a copy of the room audit. The inspector was unable to see all rooms on the day of inspection and it is unclear if the timescales set are being adhered to. This remains an on-going process and will be monitored at the next inspection. A further requirement was issued for all service users who require nursing care to have height adjustable beds and it is pleasing to see hat this has been complied with. The inspector visited two service users who were spending the afternoon in their rooms. This room was uncomfortably hot and there was little ventilation. Visiting relatives went to find an electric fan to cool the room down. Staff must ensure regular visits to service users in their rooms to make certain that individuals are safe and comfortable. Communal areas are comfortable, bright, cheerful, airy, clean and free from offensive odours. The lounge and the dining area are decorated tastefully and the furnishings and fittings are of good quality and domestic in character. However, comments received by service users and/or their representatives indicate that the lounges can become overcrowded when all service users are gathered there. There are twelve shared rooms and twenty-two single rooms. These vary in size and décor. Shared rooms provide screening to ensure the privacy of the occupants. The laundry facilities for the home are sited so that soiled washing does not come into contact with the kitchen. Hand washing facilities are sited in the laundry. The floors in the laundry are washable and the walls easily cleanable. Instructions were observed in the laundry regarding the washing of foul linen. Policies and procedures were observed by the inspector for the control of infection, which includes the safe handling and disposal of clinical waste. A tour of the home showed that cleanliness in the bedrooms and the communal areas is maintained. The inspector observed sluice areas appropriately sited around the home. DS0000066749.V302487.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels are sufficient to meet the needs of service users. Service users benefit from well informed staff, ensuring that their care and support needs are appropriately and effectively met. Recruitment procedures have not been consistently followed resulting in service users receiving care from staff members who have not been properly vetted. There is a staff training and development programme that ensures staff fulfil the aims of the home and meet the changing needs of service users. However some updating of mandatory training is required to ensure that service users are cared for by skilled staff at all times. EVIDENCE: Rotas demonstrate that appropriate levels of staff are on duty across a twentyfour hour period. There is one vacancy for a deputy manager and the home is presently recruiting for this post. At the time of inspection there were twenty-two care staff and seven nurses employed by the care home. There is ancillary and administration staff. There were no staff members under the age of eighteen and there is no staff under the age of twenty-one left in charge of the home at any time. The levels of night workers was assessed during an inspection carried out on 3rd June 2005 and these were deemed satisfactory. There have been no changes to the levels of night staff. DS0000066749.V302487.R01.S.doc Version 5.2 Page 22 The registered manager is committed to National Vocational Training for care staff. Currently there is one staff member with NVQ level 3 training and two with NVQ level 2. The current percentage of staff holding the National Vocational qualifications in care at Level 2 or above does not meet the required standard that fifty percent of care staff hold this qualification by 2005. This was made a requirement following the previous inspection and the timescale for this does not elapse until 30/09/06 and will be fully assessed at the next inspection. Four newly recruited staff files were examined. One file contained only one written reference and the second reference was gained via telephone. Another file contained only one written reference. In two files there was no firm evidence of CRB checks. There is a letter available in these two files, written by the home, that confirms the receipt of CRB checks. However there needs to be further evidence. For example a disclosure number, date the CRB check was received or a copy of the CRB check. One CRB check has not included a POVA check. Some files contain proof of identity and others are lacking this information. It is a requirement of the report that all recruitment files contain all the information specified in Regulation 19, schedules 2 and 4 of the Care Homes Regulations. Staff induction programmes are available in some staff files but not in others. The registered manager said that the home is presently using the homes own induction package but are due to implement the Skills to Care induction programme. All newly appointed staff will complete this and the staff will keep a copy of this when it is completed. Mandatory training on the whole is good, with records demonstrating that all the health and safety training is offered and some specialist training is undertaken by staff. However there is some updating to be completed by care staff. For example one file looked at showed that moving and handling training had not been undertaken since 2004 and this will be a requirement of the report. DS0000066749.V302487.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The registered manager is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. The home does not regularly review aspects of its performance through a programme of self-review and consultations, which include seeking the views of, service users, staff and relatives. There are good systems in place to ensure the safe keeping of service users money. Overall the health and safety procedures are in place, however serious consideration needs to be given to alternative ways to keep bedroom doors open without using door wedges, and providing suitable storage for vinyl gloves, ensuring the safety of service users. DS0000066749.V302487.R01.S.doc Version 5.2 Page 24 EVIDENCE: The manager is a registered nurse and has experience of managing a care home. She has been in post as manager for approximately three and a half years. The home has new owners and the staff team are still getting used to new systems that have been put in place. Following the previous inspection it was identified that the role of the manager had changed considerably and a requirement was issued for the managers job description to be revised to reflect the new operating arrangements of the home, under the new owners. When questioned the registered manager said this is still being updated. This will remain a requirement of the report and the timescale will be extended to 30/09/2006. The registered manager is undertaking a management award equivalent to the National Vocational Qualification in Management at level 4. There are regular team meetings and meetings for service users. Minutes are maintained for these and individuals spoken to say they felt confident that any matters raised at meetings are dealt with and actioned. Feedback from service users is gained via house meetings. Minutes of these are kept and demonstrate the issues raised and how these are resolved. During a discussion with a relative of a service user, the inspector was informed that the relative had never received a service satisfaction questionnaire. Following the previous inspection a requirement was issued for the new proprietors to introduce a quality assurance system. The timescale for this has not elapsed yet and will be fully assessed at the next inspection. A requirement was issued at the previous inspection for the registered provider to send the Commission regular quality monitoring reports undertaken inline with Regulation 26 of the Care Homes Regulations. It is pleasing to see that this is being complied with. The registered manager informed the inspector that service users or their families manage their finances. A small amount of personal allowance is kept at the home and records are maintained of all financial transactions. Fire alarm testing is undertaken weekly and fire drills are carried out with the full involvement of the service users. The home has an infection control policy that is detailed and comprehensive. Following the previous inspection a requirement was issued for the Health and Safety policy to be revised in line with guidance from the Health and Safety Executive. Generic risk assessments should be undertaken. The registered manager said that this has been contracted out to a company who have completed a thorough risk assessment of the home. The manager stated that the homes staff are now being provided with the tools and information to ensure this is an on on-going process. The inspector observed the completed risk assessment and this is very comprehensive and detailed. DS0000066749.V302487.R01.S.doc Version 5.2 Page 25 During a tour of the premises the inspector observed boxes of vinyl gloves in bathrooms and service users bedrooms. It is required that these are stored out of view to avoid the risk of ingestion by service users who may be confused. There were no service certificates for gas appliances in the home. However the registered manager said this had last been undertaken on 24/05/06. The inspector requests that a copy of the certificate is sent to the Commission. The inspector was unable to find the latest service certificate for PAT testing, however the inspector was informed that has been undertaken. The inspector requests that a copy of this is sent to the Commission. During a tour of the premises the inspector observed several door wedges laying on the floor. The registered manager said that all the homes wedges had been removed but service users have their own to keep their bedroom doors open. Te registered manager must ensure that door wedges are not used to hold open fire doors and that serious consideration is given to alternative ways to keep doors open. Hazardous substances are stored appropriately and the COSHH sheets were looked at. These are up to date. There are insurance certificates on display in the home. DS0000066749.V302487.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable DS0000066749.V302487.R01.S.doc Version 5.2 Page 27 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 X 3 X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 X X 3 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 DS0000066749.V302487.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement The registered manager is required to ensure that the care plans set out in detail the action which needs to be taken by care staff to ensure that all aspects of the health, personal and social care needs of the service user are met. The registered manager is required to ensure that appropriate intervention regarding the treatment of pressure sores is recorded in individual care plans and these are reviewed monthly. The registered manager is required to ensure that where a nutritional assessment deems a service user to be at risk, appropriate intervention is recorded in the individual care plan. This must be reviewed monthly. The registered manager is required to ensure that a record of nutritional screening is undertaken on a periodic basis, including weight gain or loss and records the appropriate action to be taken. The registered manager is DS0000066749.V302487.R01.S.doc Timescale for action 30/11/06 2 OP8 13 30/09/06 3 OP8 12 30/09/06 4 OP8 12 30/09/06 5 OP9 13 30/08/06 Page 29 Version 5.2 6 OP15 12 7 OP29 19 Schedules 2 and 4 8 OP30 18 9 OP38 13 10 OP38 23 required to ensure that all staff sign to record when they have administered medication to a service user and the home must implement regular medication audits to reduce the number of errors. The registered manager is required to ensure that the presentation of pureed food is improved and the individual techniques of staff when providing assistance to eat must be enhanced. The registered manager is required to ensure that all recruitment files contain all the information specified in Regulation 19, schedules 2 and 4 of the Care Homes Regulations. (Previous timescale of 30/04/06 not met.) The registered manager is required to ensure that mandatory health and safety training for staff is up to date. The registered manager is required to ensure that vinyl gloves are stored out of view to avoid the risk of ingestion by service users. The registered manager is required to ensure that door wedges are not used to hold open fire doors and that consideration is given to alternative ways to keep doors open. 30/08/06 30/09/06 30/01/07 30/08/06 30/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. DS0000066749.V302487.R01.S.doc Version 5.2 Page 30 No. 1 2 3 4 Refer to Standard OP3 OP7 OP12 OP16 Good Practice Recommendations It is recommended that individual needs assessments are kept in service users personal files. It is recommended that care plans are signed by the service user or their representative It is recommended that individual, as well as group activity plans are drawn up with families and recorded in care plans. It is recommended that the complaints log records the action taken and the outcome of each complaint. DS0000066749.V302487.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000066749.V302487.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. 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