CARE HOMES FOR OLDER PEOPLE
Korniloff Warren Road Bigbury-on-sea Kingsbridge Devon TQ7 4AZ Lead Inspector
Andrea East 18 and 23
th rd Unannounced Inspection January 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Korniloff DS0000003732.V352203.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. Korniloff DS0000003732.V352203.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Korniloff Address Warren Road Bigbury-on-sea Kingsbridge Devon TQ7 4AZ 01548 810222 F/P 01548 810222 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) Mrs Georgina Suzanne Phillips Mrs Georgina Suzanne Phillips Care Home 17 Category(ies) of Dementia (17), Old age, not falling within any registration, with number other category (17), Physical disability (17) of places Korniloff DS0000003732.V352203.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 16th January 2007 Brief Description of the Service: Korniloff is situated in Bigbury on Sea and has extensive sea views. Bigbury on Sea is a small coastal village with limited facilities. The home is registered to provide care for seventeen older people who may have physical disabilities or dementia. The accommodation comprises of eleven single and three double rooms. All of the rooms are currently used as single accommodation. The property is a detached three storey building with the bedrooms situated on the lower ground floor and the first floor. These can be accessed by two chair lifts. There are three spacious lounges and a dining room. Fees are charged weekly; at present fees range between £372 and £475 per person. The homes service users guide including the last inspection report was available on request and stored in the homes office. Korniloff DS0000003732.V352203.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality services. The inspection site visit was carried out over two days. A range of documents including staff and individuals’ files, policies and procedures were examined. People were spoken to in the homes lounge and in private rooms and members of staff were also spoken with. The homes owner/registered provider was present on part of the first day and throughout the second day of the inspection. The homes acting manager (who is not yet registered with the Commission) was present throughout the inspection. Feedback about the home was also received by post in survey questionnaires, and in the homes Annual Quality Assurance Audit. What the service does well:
People were well cared for and people said that they received care and attention throughout the day from the staff on duty. Staff offered support to people who needed assistance and helped people at a pace that suited them in a kind and patience way. There was a good system of medication administration in place and medicines administration records were up to date and in good order. This ensured that people received medication safely. Routines in the home were flexible so that people were able to choose how they spent their time, what time to get up and what time to go to bed. This also extended to open and flexible visiting arrangements so that visitors were always made welcome and could visit at any time. There were positive links with the local community outside of the home in regular coffee mornings, visits from relatives and church representatives. People enjoyed the contact with the local community and felt “as if we still belong”. There was a good meal service that one person described as “excellent”. People said that they enjoyed the meals provided and were able to eat meals in their rooms or in the homes dining room. Korniloff DS0000003732.V352203.R01.S.doc Version 5.2 Page 6 A written complaints procedure was available to staff and was included in the service users guide. This meant staff and the people using the service had access to information about the Commission and how to raise concerns. People said that they knew how to raise concerns and complaints with staff, the registered provider and the new acting manager. People said “I complain verbally” and just talk to somebody” The home presented as clean and tidy. There was a good recruitment system in place for the recruitment of new staff. This ensured that people were protected from those who are unsuitable to work with vulnerable people. People were positively supported to deal with their own finances, through relatives and outside advocates such as solicitors. Any finances dealt within the home were fully recorded, including receipts and records showing purchases made on behalf of the person living in the home. What has improved since the last inspection?
The service users guide and statement of purpose had been updated since the last inspection. Providing up to date information about the home. A number of documents had been updated including a new pre admission form and new formats for care planning and assessments. This when fully implemented will provide detailed information to staff to help them care for people safely and meet peoples needs. Basic guidance concerning the use of “as required” or “as needed” medicine had been completed. This included the circumstances under which it is to be administered and the maximum dose. This helped to ensure that people receive medication safely. Large parts of the home had been redecorated and refurbished, including large lounge areas that had been redecorated, fitted with new heaters, additional lighting and new carpets. People were pleased with improvements to the environment and said that they enjoyed using these areas. A risk assessment for the upstairs bathroom and hot water temperatures had been completed and displayed so that staff could refer to it. It also instructed staff to carry out water temperature checks and record them, which staff were completing. This helps to reduce the risk of scalding, burning and injury to the people using the service. Korniloff DS0000003732.V352203.R01.S.doc Version 5.2 Page 7 What they could do better:
Recommendations and requirements were made at the inspection. Some requirements were also carried over from a previous inspection. The new assessment format for people planning to move into the home should be implemented. So that peoples needs are assessed prior to them moving into the home The letter sent to people before they come into the home that confirms the home can meet their needs should be held on each persons file. So that it will be readily available. Care plans and assessments need to be clear and detailed so that staff have the information they need to meet peoples’ needs. Staff training in the use of medicines should be kept up to date for all staff. Staff records showing the training staff had received training on medication administration should be fully completed and kept up to date. Peoples’ individual routines must be recorded, in detail, in care plans and assessment, so that it is clear that people had chosen their routine. Peoples’ choice of foods and drinks must be made clear in assessment and care planning information. Nutritional assessments must be consistently completed. Complaints and concerns must be recorded. Recording complaints and concerns are important so that the manager or registered provider can look at the concerns and how they have been resolved. This gives an overview to enable the manager or provider to address any re-occurring problems and helps to maintain the quality of the service provided. Staff records of training must be kept, so that it is clear that staff had received up to date training on safeguarding adults (dealing with abuse issues). Training on safeguarding issues must be completed by the staff and the registered provider to ensure that any safeguarding issues are dealt with positively and in line with current guidance. This relates to an issue that was not well managed. Risk assessments identifying and addressing potential or existing hazards in the home environment should be completed. Risk assessments concerning un-regulated hot water supplied to hand washbasins must be completed. When measured the water temperatures from the hot tap in this bathroom and the wash-basin exceeded 43 degrees. This continues to pose a risk to the people using the service, from scalding. Korniloff DS0000003732.V352203.R01.S.doc Version 5.2 Page 8 This had been raised at previous inspections and the provider re-iterated the reasons it was difficult to reduce the water temperatures. (This would mean a significant reduction in water pressure resulting in baths taking a long time to fill). Locks should be fitted to all private doors and it should be clearly recorded that they had been offered the choice of having a lock on their private doors. The home must not be cold. People were sat wrapped in blankets and wearing additional knitwear. When asked people said they were cold. One person, who was unable to communicate verbally, was very cold when touched. There must be systems in place for checking the heating, room temperatures and ensuring that people are warm. The staffing arrangements including the role of the manager must be reviewed and staffing increased to ensure that people’s needs are fully met. This would also enable the manager to complete management tasks, as management tasks such as; ensuring staff had supervision and training and documentation such as care plans and assessments were up to date, had not been completed as planned. Staff records must show that members of staff receive updated training in key areas such as adult protection, health and safety and manual handling. There should be an overview of training for staff so that it was difficult to be sure what training had been completed, when and by whom. Mrs Phillips was aware that the home needs a registered manager with the qualifications and skills to run the home. So that Mrs Phillips must either obtain the qualifications or register a manager for the home. Members of Staff must be supervised. The new system of supervision should be introduced consistently across all staff. A quality assurance system that measured the quality of the services provided and had taken into account peoples’ views should be introduced, as planned. 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. Korniloff DS0000003732.V352203.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Korniloff DS0000003732.V352203.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. 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. The people using the service were confidant that their care needs had been assessed and that their needs could be met, right from the start of their stay in the home. The services provided did not include intermediate care. EVIDENCE: The service users guide and statement of purpose had been updated since the last inspection. Three files holding a range of information on peoples needs were examined. One file held information on the last person to live in the home. This file held basic information about the care needs, likes, dislikes and medical history of, which appeared to have been completed prior to the person moving in. Korniloff DS0000003732.V352203.R01.S.doc Version 5.2 Page 11 The registered provider said that since the last inspection a new pre admission form had bee created. This document was completed prior to someone moving into the home. The document on file for the new person moving into the home had not been fully completed. The registered provider said that letters confirming that the home could meet people’s needs were now routinely sent out before people moved in. Copies of the letters sent where not on each persons file. A sample copy of a letter was available. The registered provider and the acting manager had plans to introduce new assessment formats that would be held on each persons file. The assessments would be more detailed, make clear that they were completed prior to people moving in and kept on individuals’ files. Korniloff DS0000003732.V352203.R01.S.doc Version 5.2 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. 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. People’s care needs were not clearly or fully set out in an individualised plan of care. People using the service did have their health, personal and social care needs met. People were protected by the policies and procedures in the home for dealing with medication. Staff training in this area could be improved. People were not involved in decisions about their lives, and did not play an active role in planning the care and support they receive. EVIDENCE: Three files holding a range of information including care plans were examined. The care plans fluctuated in the information provided to staff. The registered provider and the acting manager said that they were in the process of introducing a new system of care planning and assessment.
Korniloff DS0000003732.V352203.R01.S.doc Version 5.2 Page 13 This had resulted in a mix of formats and Information in care plans and assessments that were confusing to read. It was difficult to be clear what peoples needs were or how the home was addressing them. Care plans and assessments need to be clear so staff have the information they need to meet peoples’ needs. Care plans and assessments did not make clear if people had been involved in their care. In addition to the care plans and assessments, daily diaries were maintained for each person living at the home. The diaries were much more detailed than the information held on files and showed how people had spent their time, how there personal care needs had been met and if outside health professionals had been called in. The diaries gave a running account of things that may have changed and what had happened that day for that person. The diaries also repeated information and added to the confusing information so that it was not clear what system staff were working with consistently. Reviews of care plans and assessments were not specific enough. For example they said “care plan written up”. This did not show what had been reviewed or if the persons care had been considered and changed. The registered provider and the acting manager were aware of the need to introduce one consistent system and were working towards this. People said that they felt cared for and that they received care and attention throughout the day from the staff on duty. On the second day of the site visit a district nurse was visiting the home demonstrating that health professionals are called into the home. The district nurse had no concerns about the care provided. There was a good system of medication administration in place. For example; People were administering all or some of their own medication, risk assessments had been completed and a lockable storage area was available for medication in their rooms. In addition a “treatment room” was available to staff, in which medication was securely stored. A separate refrigerator was available specifically for medicines requiring cool storage. Korniloff DS0000003732.V352203.R01.S.doc Version 5.2 Page 14 Since the last inspection basic guidance concerning the use of “as required” or “as needed” medicine had been completed. This included the circumstances under which it is to be administered and the maximum dose. Medicines administration records were up to date and in good order. Staff training in the use of medicines had not been kept up to date for all staff. Staff records showing the training staff had completed did not show if or when staff had received training on medication administration. Korniloff DS0000003732.V352203.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People’ s lifestyle in the home did not meet their expectations or satisfy their needs. People who used the services were able to make some choices about their life style, and were supported to develop some life skills. Social, educational, cultural and recreational activities did not meet individual’s expectations. People enjoyed the meals provide but it was not clear if peoples diets were, varied, to their choice or taken at a time that suited them. EVIDENCE: People said that the routines in the home were flexible so that they were able to choose how they spent their time, what time to get up and what time to go to bed. Korniloff DS0000003732.V352203.R01.S.doc Version 5.2 Page 16 Peoples’ individual routines were not recorded, in detail, in care plans and assessment, so that it was difficult to say if people had chosen their routine or if they had fitted in to the staff routines. People said that Visiting arrangements were open and flexible and that their visitors were always made welcome and could visit at any time. On both visits to the home people received from relatives and friends in their private rooms and in the homes lounge area. The registered provider said that in the past there had been a programme of activities. This program was not in place at the time of this inspection. The registered provider described activities in the home as; discussion over newspapers and nail care, a monthly relaxation class, slide shows twice monthly and communion monthly. People were unable to describe activities in the home. Two surveys returned by staff highlighted their concerns at the low numbers of staff sometimes on duty. So that it was difficult for staff to spend time on activities and one to one time with the people living at the home. One Survey from the people using the service said that there were ‘never; activities. One survey said there were activities ‘sometimes’. Contact from the local community is good with monthly charity coffee mornings and regular Communion services held at the home. Other ways that the home supported people to make choices was in supporting people to look after their own finances, medications and planning the decoration and furnishing of the their rooms, to suit their personal preferences. People said that they enjoyed the meals provided and were able to eat meals in their rooms or in the homes dining room. Peoples choice of foods and drinks were not made clear in assessment and care planning information. Nutritional assessments had not been consistently completed. The registered provider and the acting manager had a format for capturing people’s preferences and assessing needs, this was planned to be introduced the near future Staff offered support to people who needed assistance and helped people at a pace that suited them in a kind and patience way. Korniloff DS0000003732.V352203.R01.S.doc Version 5.2 Page 17 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. People who used the service were able to express their concerns, and complaints and suggestions from those using the service, relatives or other visitors to the home were treated seriously. People were not protected from abuse. EVIDENCE: People said that they knew how to raise concerns and complaints with staff, the registered provider and the new acting manager. Surveys from people using the service said that they knew how to make a complaint “just talk to somebody” “I complain verbally”. Surveys from relatives said that they knew how to make a complaint if they needed to. A written complaints procedure was available to staff and was included in the service users guide. This meant staff and the people using the service had access to information about the Commission and how to raise concerns. No complaints had been recorded in a ‘complaints book’. The registered provider had purchased a new complaints book that gave clear direction to staff in how to record complaints. There were no entries in the new book.
Korniloff DS0000003732.V352203.R01.S.doc Version 5.2 Page 18 Recording complaints and concerns are important so that the manager or registered provider can look at the concerns and how they have been resolved. This gives an overview to enable the manager or provider to address any reoccurring problems and helps to maintain the quality of the service provided. Staff records of training were poorly kept, so that it was difficult to confirm that staff had received up to date training on safeguarding adults (dealing with abuse issues). Staff spoken with, were unable to confirm that they had received recent training in this area. Since the last inspection there had been one safeguarding issue raised through social services and the Commission. The way the registered provider dealt with the initial safeguarding alert and subsequent action with staff was poor. The registered provider did not protect the member of staff or the people in the home, as the member of staff was not initially removed from the situation. After the incident the registered provider did not record the findings and outcomes and did not formally feedback or supervise the member of staff concerned. Korniloff DS0000003732.V352203.R01.S.doc Version 5.2 Page 19 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. People did not live in a safe, clean or well -maintained environment EVIDENCE: All areas of the home were toured accompanied by the registered provider. This included communal areas and bathroom and toilet facilities. Some time was also spent in people’s private accommodation. The home presented as clean and tidy. Since the last inspection large parts of the home had been redecorated and refurbished. This included large lounge areas that had been redecorated, fitted with new heaters, additional lighting and new carpets. Risk assessments identifying and addressing potential or existing hazards in the home environment had not been completed.
Korniloff DS0000003732.V352203.R01.S.doc Version 5.2 Page 20 Risk assessments concerning un-regulated hot water supplied to hand washbasins had not been completed. This puts people at risk of scalding. A risk assessment for the upstairs bathroom and hot water temperatures had been completed. This was displayed on the back of the bathroom door so that staff could refer to it. It also instructed staff to carry out water temperature checks and record them, which staff were completing. When measured the water temperatures from the hot tap in this bathroom and the wash-basin exceeded 43 degrees. This continues to pose a risk to the people using the service, from scalding. The bath on the lower ground floor has the same difficulties in the arrangement of the hot water supply. The registered provider said to resolve this the bathroom was no longer used. This had been raised at previous inspections and the provider re-iterated the reasons it was difficult to reduce the water temperatures. (This would mean a significant reduction in water pressure resulting in baths taking a long time to fill). There was no evidence of the provider obtaining outside advice about how this could be resolved. Locks had not been fitted to all private doors and it was not clear from peoples’ records if they had been offered the choice of having a lock on their private doors. People could not remember being asked if they wanted a lock on their doors. The home was cold. People were sat wrapped in blankets and wearing additional knitwear. When asked people said they were cold. One person who was unable to communicate verbally, was very cold when touched. One survey from a person living at the home said that they were cold. When this was bought to the attention of the registered provider no reason for why the heating was not on was given. The heating was checked and put on. There were no systems in place for checking the heating, room temperatures or ensuring that people were warm. Korniloff DS0000003732.V352203.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 poor This judgement has been made using available evidence including a visit to this service. Staff, had not been consistently trained, so people could not be sure that the staff were skilled and competent. Staff had been subject to rigorous recruitment checks. The low numbers of staff employed in the home sometimes affected the care people received. EVIDENCE: Six out of six surveys from staff highlighted their concerns at the low numbers of staff on duty and how this affected peoples’ care. Surveys said “we have only two carers on shift day and night and we do laundry and cleaning” “We don’t have time to spend with the service users” “not enough staff for service users” “not enough staff to give correct care to service users. One survey from a health professional said that ‘the home could be improved’ by “more staff on duty”. One survey from a relative said ‘that they could be improved’ “by having more staff”.
Korniloff DS0000003732.V352203.R01.S.doc Version 5.2 Page 22 People said that most of the time staff were “busy” and “sometimes rushed”. Staff rosters showed that the numbers of staff on duty sometimes fell to two care staff on duty to care for up to fourteen older people, with a variety of physical frailties and needs. The acting manager and registered provider were also working as part of the staff team. Due to staff sickness the acting manager had been working as part of the care staff. This meant the acting manager was unable to complete management tasks. Care staff completed a range of tasks including domestic, catering, laundry, medication administration and caring. The Registered Provider (who lives on the premises) and one member of staff sleeping in, provide the care at night. The registered provider said that waking night staff were provided when required (for example, when people were ill). The arrangements for staffing the home both at night and day may place people at risk; Low staff numbers in the day were not meeting peoples needs. Staffing at night did not take into account possible risks to people in the event of a fire and moving people. Staffing at night also does not take into account of peoples needs if they are taken ill suddenly. Two files containing Staff records including recruitment records were examined. Staff files holding recruitment information had been updated so that they included staff roles and responsibilities in job descriptions, interview checklists and questions, references and police checks and identity checks. Staff records showed that some staff had not received updated in key areas such as adult protection, health and safety and manual handling. There was no overview of training for staff so that it was difficult to be sure what training had been completed, when and by who. The acting manager was addressing this. Korniloff DS0000003732.V352203.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. People did not live in a well managed home. The home did not provide a stimulating or safe environment. EVIDENCE: Mrs Phillips retains overall control of the home, as the registered provider and manager. Since the last inspection a new acting manager had been appointed. Mrs Phillips said that the acting manager would be registered with the Commission, as she no longer wished to actively manage the home on a full time basis. Korniloff DS0000003732.V352203.R01.S.doc Version 5.2 Page 24 The acting manager had a range of qualifications and skills in care and had been previously registered with the Commission for another home. The new manager had not yet made an application to register with the Commission. At previous inspection another person had been acting as assistant manager with a view to registering as the manager. Mrs Phillips was aware that the home needs a registered manager with the qualifications and skills to run the home. So that she must either obtain the qualifications herself or register a manager for the home. Management tasks were shared between the manager and Mrs Phillips. People were supported to deal with their own finances, through relatives and outside advocates such as solicitors. Any finances dealt within the home were fully recorded, including receipts and records showing purchases made on behalf of the person living in the home. Members of Staff were not properly supervised. The acting manager had developed a system of supervision, which had not yet been introduced consistently across all staff. Peoples’ health and welfare was not always protected. For example people were cold, complaints were not dealt with formerly and risk assessments for the premises were not in place. Management tasks such as; ensuring staff had supervision and training and documentation such as care plans and assessments were up to date, had not been completed as planned. This appeared to be due to the acting manager working as part of the care staff so that she was unable to complete management tasks. A quality assurance system that measured the quality of the services provided and had taken into account peoples’ views had not yet been introduced. The acting manager was working on a quality assurance system and a form had been devised to ask people what they thought of the service. Korniloff DS0000003732.V352203.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 18 1 x x x x x x 3 STAFFING Standard No Score 27 2 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 2 x 1 x 1 Korniloff DS0000003732.V352203.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes Korniloff DS0000003732.V352203.R01.S.doc Version 5.2 Page 27 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 OP12 Regulation 16 Requirement People must have the opportunity to participate in and be consulted with regarding social, recreational and educational activities that suit them. Complaints must be recorded and clearly show the response the home has made to complaints raised. All staff, including the registered provider must be aware of adult protection issues and how to safeguard the people who use the service and staff from harm. This relates to the lack of training on adult protection and safeguarding issues. The registered person must ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated Risk assessments and a risk management plan must be produced concerning the premises and in particular the use of wash hand basin, bathing facilities This requirement has been carried over from the previous
Korniloff DS0000003732.V352203.R01.S.doc Version 5.2 Page 28 Timescale for action 06/06/08 2 OP16 23 06/06/08 3 OP18 13 06/06/08 4 OP19 13(4)(c) 06/06/08 5 OP19 13(4)(a) inspection with a deadline of 16/02/07 not met. The registered person must ensure that all parts of the home to which service users have access are so far as reasonably practicable are free from hazards to their safety In particular, the hot water supply to the bath and wash hand-basin on the first floor must be regulated so that water is supplied at or close to 43 degrees This requirement has been the subject of previous requirements where timescales have not been met. Although the risk has been partly addressed by the introduction of risk assessments the hot water temperature remains a risk to service users. The last timescale given was 16/03/07 and was not met 06/06/08 6 OP19 12 7 OP27 18 8 OP27 18 There must be a system of checking the heating system so that the home is kept at a temperature that keeps people warm. Staff records must show that staff receive updated training in key areas such as adult protection, health and safety and manual handling. The arrangements for staffing the home both at night and day Must be reviewed and increased to ensure that peoples needs are fully met. 06/06/08 06/06/08 06/06/08 Korniloff DS0000003732.V352203.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP3 OP3 Good Practice Recommendations The new assessment format for people planning to move into the home should be implemented. So that peoples needs are assessed prior to them moving into the home. The letter sent to people before they come into the home that confirms the home can meet their needs should be held on each persons file. So that it will be readily available. The New care planning system should be consistently introduced to staff and the people using the service and be monitored and reviewed The new assessment process should be consistently introduced, monitored and reviewed Care planning and assessment should make clear that the person receiving the service or/and their advocate have been involved in these processes. Staff should receive updated training on medication administration to ensure that medication continues to be administered safely. Peoples’ individual routines including social and recreational activities should be recorded, in detail, in care plans and assessments. People’s choice of foods and drinks should be made clear in assessment and care planning information. This should include consistently completed nutritional assessments. Peoples should have the choice of rooms that have been fitted with locks and have been offered a key unless sufficient reasons for not offering this service are recorded in the care plan. Locks must be lockable from the inside and capable of being overridden in an emergency. An overview of training for staff should be completed as planned so that it is clear what training had been completed, when and by who. Mrs Phillips should either obtain the qualifications to manage the home affectively herself or register a manager for the home. 3 4 5 6 7 8 OP7 OP7 OP7 OP9 OP12 OP15 9 OP19 10 11 OP27 OP31 Korniloff DS0000003732.V352203.R01.S.doc Version 5.2 Page 30 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
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