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Inspection on 10/12/07 for Lady Forester Residential & Day Care Centre

Also see our care home review for Lady Forester Residential & Day Care Centre for more information

This inspection was carried out on 10th December 2007.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

People are assessed by an appropriately qualified person before they are admitted to the home. People are encouraged to take control of their lives and are supported to maintain contact with family and friends. The home provides a clean and comfortable place to live. People who use the service told us that it`s an excellent place to live and that the staff treat them well. The meals provided are well-balanced and people told us that the introduction of a menu now provides them with more choice.

What has improved since the last inspection?

Drugs requiring refrigeration are now stored in a separate refrigerator. The medication policy has been reviewed. Menus have been introduced, people told us that there is more choice made available to them. Requirements made by the Fire Officer at the last inspection have been met.

What the care home could do better:

The home`s statement of purpose and service user guide are not up to date and need to be reviewed. Care plans are not being reviewed monthly, and are not being reviewed more frequently when circumstances require it. Secondary dispensing of medication had continued and this must cease immediately. This is putting people at risk and the manager must ensure that safe practices for medication administration and recording are put in place. People are not being consulted about the activities that they would like to take part in. Service users` privacy and dignity should be upheld at all times. Staff must be made aware of this and guided to promote this within their practice. Not all staff have undertaken safeguarding of adults training, which they must do, and new staff to the home must be provided with fire safety training. Current management arrangements do not fully cover the responsibilities expected of a registered manager. During this inspection it has been highlighted that the impact of this is having an overall effect on service delivery and training, development and supervision of staff is inconsistent.

CARE HOMES FOR OLDER PEOPLE Lady Forester Residential & Day Care Centre Church Street Broseley Shropshire TF12 5BQ Lead Inspector Karen Powell Unannounced Inspection 10th December 2007 09:30 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 Lady Forester Residential & Day Care Centre DS0000020681.V347206.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. Lady Forester Residential & Day Care Centre DS0000020681.V347206.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lady Forester Residential & Day Care Centre Address Church Street Broseley Shropshire TF12 5BQ 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) 01952 884539 01952 884552 Lady Forester Residential & Day Care Centre Mrs Beryl Stephanie Wickstead Care Home 11 Category(ies) of Old age, not falling within any other category registration, with number (11) of places Lady Forester Residential & Day Care Centre DS0000020681.V347206.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th December 2006 Brief Description of the Service: Lady Forester Residential and Day Care Centre is registered with the Commission for Social Care Inspection to provide accommodation and personal care to a maximum of eleven elderly people. Nine rooms are provided for permanent service users and two beds are provided for respite purposes. The home is situated on the outskirts of Broseley, Shropshire and set in well maintained grounds. The building was formerly the Cottage Hospital. The centre is a charitable organisation and managed by a board of Trustees. The home is situated on the ground and first floor of the centre, which is accessible via a passenger lift. A small lounge and dining area is situated on the ground floor. All bedrooms are single. Day Care is provided Monday to Friday on the ground floor and the service users of the home are able to participate in activities arranged by day care staff if they wish to do so. Lady Forester Residential & Day Care Centre DS0000020681.V347206.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place on 10th December 2007, conducted by one inspector over seven hours. A range of evidence was used to make judgements about the service including a tour of the home, discussions with service users, staff, the acting manager and the responsible individual. We also looked at a number of records and observed aspects of care provided for people using the service. In preparation for the inspection we received nine surveys from people using the service, a relative and five staff. Some of the comments that we received have been included in this report. Prior to this inspection an Annual Quality Assurance Assessment (AQAA) document was posted to The Lady Forester Centre for completion. The AQAA is a self-assessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service and is an opportunity for them to share with us areas that they believe that they are doing well. By law they must complete this and return it to us within a given timescale, which they did and some of their comments are included in this report. The purpose of this inspection was to assess “key” National Minimum Standards for older people and to review all twelve requirements that were made as result of the previous inspection. A quality rating is provided throughout the report based on each outcome area for the people who use the service. These ratings are described as excellent/good/adequate/poor based on findings of the inspection. What the service does well: People are assessed by an appropriately qualified person before they are admitted to the home. People are encouraged to take control of their lives and are supported to maintain contact with family and friends. The home provides a clean and comfortable place to live. People who use the service told us that it’s an excellent place to live and that the staff treat them well. The meals provided are well-balanced and people told us that the introduction of a menu now provides them with more choice. Lady Forester Residential & Day Care Centre DS0000020681.V347206.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Lady Forester Residential & Day Care Centre DS0000020681.V347206.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 Lady Forester Residential & Day Care Centre DS0000020681.V347206.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&3 Quality in this outcome area is adequate. People have their needs assessed before moving into the home by an appropriately qualified person. However, information about the home is insufficient and does not give prospective residents or their families comprehensive information about the service they can expect to receive. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Statement of Purpose submitted with the AQAA does not contain all of the information required, as described within Schedule 1 to the Care Homes Regulations 2001. A requirement was made at the last inspection that both the statement of purpose and the service user guide must be reviewed. There was no service user guide available for the care home and the acting manager cannot recall seeing one on the premises. A service user guide must be made available to all prospective residents and/or their families. Lady Forester Residential & Day Care Centre DS0000020681.V347206.R01.S.doc Version 5.2 Page 9 On discussion with the acting manager it was established that the person most recently admitted to the home had not been given information about the home, what to expect from the service, or how to make a complaint. The AQAA submitted by the Registered Manager stated that “The home strived to ensure that service users have a comprehensive assessment of their needs. A detailed care plan is compiled from the needs assessment, care plans are undertaken with the full interaction of service users and if they wish their family” The file for the person most recently admitted to the home was examined for evidence of the assessment documentation. The admission was arranged by a social worker who was seeking an emergency placement for the person concerned. An assessment was provided to the home by the social worker involved. The home accepted the individual based on a verbal assessment and written assessment provided by the social worker. Lady Forester Residential & Day Care Centre DS0000020681.V347206.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, 2, 9 & 10 Quality in this outcome area is adequate. Medication administration procedures are poor and potentially place people who use the service at risk. The health and personal care that people receive is based on individual needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The AQAA stated that “Care plans encourage individual views and must be signed by the service user. Monthly screening of service users’ weight is monitored to assist best practice in nutrition for service users”. Three care plans examined, one for the newest admission to the home and two for people who had lived at the home for some time. The acting manager explained that the care plan had not yet been formulated for the newest admission although they had been living at the home for three weeks. The acting manager explained that it had been difficult to formulate a care plan because the individual’s needs were changing and they had been admitted to hospital for one week during their stay. Discussions with the acting manager and staff members demonstrated that they had a good overview of the individual’s Lady Forester Residential & Day Care Centre DS0000020681.V347206.R01.S.doc Version 5.2 Page 11 needs that could now be entered into a care plan. Although the assessment documentation detailed that a falls history was unknown, accident records showed that this person had fallen on two occasions during their two-week stay at the home. This had not triggered a falls risk assessment. The acting manager agreed to compile a care plan and falls risk assessment. On examination of the daily records for the individual, it was noted that a carer had entered into the record a further fall that had not been recorded in the accident records. This was discussed with the acting manager who agreed to pursue the matter with the carer. The acting manager explained to us that she had implemented a new care plan format for all service users. Examination of two further care plans for people who had been living at the home for some time showed details of how their care was to be delivered by carers. Care plans included the service users’ capabilities of carrying out activities of daily living, they also included information about the person’s likes and dislikes. Both care plans were signed by the service users involved. Service users spoken to during the inspection told us that they were happy with the way their care was delivered, they felt their privacy and dignity was upheld by a caring and sensitive staff group. People told us “it’s an excellent place to live”, “the staff treat us well”. People told us that they feel that they receive the medical support they need, this was also conveyed to us by service users who completed surveys. One service user commented in a survey how “they felt they received excellent carers”. A relative who responded to a survey stated “I am quite satisfied with the care that my mother receives during her stay in respite. She is always happy there and she says they are like one big happy family”. The delivery of personal care is individual and is flexible, reliable and tailored to meet individual needs. Although all service users have had new care plan documentation implemented they are all now in need of review. The medication administration records for all service users were examined at this inspection. It was identified that there were some gaps on the medication administration records (MAR), where staff had not signed to say whether medication had been given or refused by a service user. In the case of one service user the use of Paracetemol had been discontinued and this had been indicated on the MAR by the carer. This had been done in consultation with the service user’s general practitioner. An alternative analgesic had been prescribed for use and had been appropriately recorded on the MAR. The person had side-effects from this medication and again the general practitioner was consulted and staff were advised to revert to the use of Paracetemol. Staff had entered this onto the MAR but had not transcribed accurately as described on the packet. When checking the storage of medication within the cabinet there were two medicine pots each containing tablets. In one pot there was a piece of paper which stated the person’s name and the fact that they had not taken their 1p.m. drugs; the piece of paper was not dated or signed. The other pot had no indication of who it belonged to or why the drugs Lady Forester Residential & Day Care Centre DS0000020681.V347206.R01.S.doc Version 5.2 Page 12 were there. The home has a receipt and return of medication record, which was completed when stock was received or returned to the pharmacy. The medication found I the cabinet was not documented in the returns book. The lunchtime medication round was observed. It was noted that the carer was secondary dispensing the medication to two service users. This aspect of poor practice was discussed at the time of this inspection with the carer and the acting manager. A requirement was made at the last inspection (14 December 2006) stating that secondary dispensing must cease immediately. It was established through discussion with the acting manager that all carers are administering medication in this way at lunchtime despite the fact that the Registered Manager has purchased a drugs trolley and staff have undertaken appropriate training. The carer was also observed to sign the MAR before she had witnessed the service user take their medication. This aspect of poor practice was again discussed with her. The issue was also discussed with the acting manager and responsible individual during the inspection. The acting manager took immediate action by writing a memo to all carers to inform them that this practice must stop immediately and that care staff must follow the home’s policy on safe handling of medication. A copy of the policy was attached to the memo and care staff were informed that failure to follow the policy will result in disciplinary action being taken. All carers were asked to read the policy and to state that they had read and understood the document. The two requirements made at the last inspection relating to eye drops being dated on the day of opening and appropriate separate storage of drugs requiring refrigeration have been met. Lady Forester Residential & Day Care Centre DS0000020681.V347206.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): 12, 13, 14 & 15 Quality in this outcome area is adequate. People who use the service are able to make choices about their lifestyle and keep in contact with their family. Although improving further opportunities to meet peoples social, cultural and recreational needs should be explored. Menus provide variety taking into account special dietary needs and personal preferences. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People were happy to tell us about their experience of living at the home. What was clear through the discussions was that the service is very homely and allows people to come and go as they please. There are no restrictions on visiting. People are able to choose their rising and retiring times and can access all parts of the home, including the day centre at the weekend, although the centre is not open to the public at weekends. One day care service user was observed to be chatting to someone who lives at the home and both welcomed us for a discussion during the inspection. It was clear that friendships are promoted and encouraged by the staff who see the importance of this to individuals. Lady Forester Residential & Day Care Centre DS0000020681.V347206.R01.S.doc Version 5.2 Page 14 People are encouraged to access the day centre, where an activity plan is available for all service users to see. On the day of the inspection local school children were attending to sing Christmas songs. Although the activity plan contained a number of activities it was clear from discussion that people would like to be involved with selecting the activities that they would like to take part in at the centre. When we spoke to the staff about how they design the activity plan it was evident that they hadn’t consulted service users in drawing up the plan. Feedback received through our staff survey forms included suggestions such as “organise more activities for service users”, “we could have more activities and things to help stimulate the brain” and “perhaps a wider choice of activities”, and “introduce more activities for all the clients to get involved with, be able to get more use from the day centre facilities”. The AQAA told us “as much support is given to promote service users bringing their treasured furniture that will fit into their room”. All rooms were personalised and individual. On a tour of the home a number of portable heaters were seen in bedrooms. The central heating radiators felt cool to the touch. This was discussed with the acting manager. One person told us that she did not like the central heating radiator on and preferred the portable heater. The acting manager confirmed this and enquired with staff why portable heaters were used in other bedrooms. It was stated that this was done through service users’ choice. A generic portable heater risk assessment was seen at the home but not for the use in individual bedrooms. This must be addressed and individual risk assessments undertaken and placed on files. Feedback from our service user and relative surveys indicated some concern about the quality and choice of food available. This was discussed with the responsible individual and acting manager; they explained that a couple of months before the inspection they had introduced menus, which now include a least two choices at the main meal. They were quite surprised by the response in the survey forms. We looked at the menus, which are on a four-week programme and saw that they offer a choice and variety of food. The cook was spoken to as well as service users. The cook and service users said that the new menu plans were working well. People were generally happy with the new menus and choices made available to them. People were seen to be able to choose where they ate, some preferred to eat in their rooms which was respected by staff on duty. Service users told us that they are asked each morning what they would like for lunch and that this arrangement works well. All service users spoken to said they had enjoyed the meal during the inspection. We sampled a meal, were offered a choice, the meal was tasty and well presented. Home-made mince pies were also available during the day. Lady Forester Residential & Day Care Centre DS0000020681.V347206.R01.S.doc Version 5.2 Page 15 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 good. People who use the service are able to express their concerns and have access to a complaints procedure. They are protected from abuse by trained staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The AQAA stated that “All new staff are guided through whistle blowing, service users’ rights and complaints procedures. All new service users are given easily understood guidance in areas of their rights and how to make a complaint, this guidance is also available to family members. Protection of vulnerable adults abuse training is ongoing”. Generally most service users and relatives stated that they would know who to speak to if they had a complaint. Although written information was not available to all service users spoken to they were clear on their rights to use the complaints procedure. It was stated in the AQAA that there had been no complaints received at the service in the last 12 months. However records held at CSCI are that one complaint had been received and dealt with through the home’s complaint procedures. Records relating to this complaint were examined and found to be satisfactory. Lady Forester Residential & Day Care Centre DS0000020681.V347206.R01.S.doc Version 5.2 Page 16 The manager has partly addressed the requirement made at the last inspection to ensure that all staff are trained in the topic of protection of vulnerable adults. This has been ongoing with a number of staff completing their training since the last inspection. Certificates for this training were seen on staff files. The two latest recruits to the home have not received adult protection training and should do so as soon as possible. Individual legal rights are protected, the acting manager discussed with us a situation where a service user’s bank card and “pin” number had been held in the office of the care home, with staff going to the bank on the person’s behalf to withdraw money as required. This practice has now stopped and the person is enabled to withdraw the money themselves. The handling of service user finance policy has been implemented following the requirement made at the last inspection. An independent advocacy service is available to service users requiring this support. Lady Forester Residential & Day Care Centre DS0000020681.V347206.R01.S.doc Version 5.2 Page 17 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 & 26 Quality in this outcome area is good. The home is well maintained and provides a comfortable environment for those people who live there This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is generally well maintained. Those service users who took part in the inspection process stated that the home is always fresh and clean. This was observed during the tour of the home. The AQAA told us that the manager has mapped the home to support numerical testing of the fire alarm points and to numerically index and reference the emergency lighting. New emergency signage has been put up to comply with the latest risk assessment requirements. Matters pertaining to the last fire officer’s report have been complied with as stated in the AQAA. Matters relating to fire safety are reported on in the management and Lady Forester Residential & Day Care Centre DS0000020681.V347206.R01.S.doc Version 5.2 Page 18 administration section of this report. A ramp and hand rails have been added to the opening doors in the new day centre extension. The home has had the roof repaired and the upstairs bathroom is scheduled to be refurbished in the annual development plan. The refurbishment will be funded through the “dignity in care” allocated grant. Currently the upstairs bathroom, which has a shower is not used as people prefer to use the bath in the downstairs bathroom. Service users’ choice has been considered and a bath is to be installed in the upstairs bathroom. During the home tour it was disappointing to see the use of communal toiletries and a number of communal razors kept in the bathrooms. This was discussed at the last inspection as an issue which compromises people’s privacy and dignity. Clean laundry was also seen to be piled on top of a clinical waste bin in the upstairs bathroom, this was raised with the carer who told us that it was due to be put away. She removed it immediately. On discussion with the carer regarding infection control procedures within the home it was established that clinical waste bags are also used for transferring soiled linen to the laundry. The home must have procedures in place which identifies the appropriate bags to transfer soiled linen throughout the home to the laundry. Safety data sheets have now been obtained for all chemical products in use at the home since the last inspection. The cupboard for these chemicals was seen to be locked at the time of this inspection, although antibacterial spray was left in the downstairs bathroom. Lady Forester Residential & Day Care Centre DS0000020681.V347206.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. Staff at the home are trained, skilled and provided in sufficient numbers to support the people who use the service. There are robust recruitment procedures in place to protect service users This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home ensures that a good skill mix of staff are on duty at all times. Discussion with staff members on duty confirmed that shifts are always covered and the appropriate staffing levels provided. All new staff undertake induction training in the Skills for Care induction programme and the records for the two newest recruits to the care home were examined. Induction records were found to be complete. The training needs analysis section of the induction document had been completed and it was clear that the manager had identified further training needs. On examination of the individuals’ files it was found that the identified training had not yet been completed. This included protection of vulnerable adults training and fire safety. Both the employees had been in post over six months. There is a robust recruitment procedure in place. The files for the two newest recruits were examined to monitor recruitment procedures. Pre-employment checks had been carried out. Lady Forester Residential & Day Care Centre DS0000020681.V347206.R01.S.doc Version 5.2 Page 20 It was stated on the AQAA that 61.9 of staff have achieved national vocational qualifications at Level 2 (NVQ2) or above. A further 14 are working towards achieving NVQ2 or above. The percentage of qualified staff exceeds the National Minimum Standard. In discussion, two staff members on duty explained to us that they had undertaken training in diabetes and Parkinsons disease, which had been provided by the local general practitioner who is also a trustee for the centre. Other planned training includes palliative care and mental health. This was also confirmed on the AQAA we received. Lady Forester Residential & Day Care Centre DS0000020681.V347206.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is poor. The home is not being managed in the best interests of people using the service. The lack of staff training, formal supervision and record keeping does not fully promote the health, safety and welfare of service users and staff potentially placing people at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager has been absent from post since July 2007. CSCI was notified that the manager was suspended from duty in September pending an investigation. Arrangements have been made by the trustees for the registered domiciliary care manager to oversee the day to day running of the home. However these duties do not involve staff development and training or Lady Forester Residential & Day Care Centre DS0000020681.V347206.R01.S.doc Version 5.2 Page 22 supervision of staff on a regular basis. It was confirmed by staff and supported by the absence of supervision records that supervision has not been undertaken for some time. Discussion with staff also revealed that there have been no service user or staff meetings since the manager’s suspension. Training needs have not been fulfilled by appropriate training courses as noted in the staffing section of this report. Discussion with the responsible individual who attended the beginning of the inspection and the closing feedback meeting could not give us any indication regarding the progress of the investigation being undertaken regarding the registered manager. Concerns about the shortfalls identified during this inspection and the impact of the absence of a registered manager was fully discussed with the responsible individual, who was asked to keep us fully informed of the situation. The home has its own quality assurance system in place. This includes surveys sent to families of service users, service users and visiting professionals. An analysis of the survey carried out in May 2007 was shared with us. Generally the feedback was positive in all areas. The manager acknowledged in the AQAA that the home could improve by carrying out more frequent quality assurance monitoring. This would ensure that the home is being run in service users’ best interests. This would support what people told us during the inspection about being consulted with regard to activities. It was stated in the AQAA that requirements made by the fire safety officer have been carried out. All necessary health and safety checks have been carried out appropriately with the exception of the emergency lighting which was last tested in June 2007. Lady Forester Residential & Day Care Centre DS0000020681.V347206.R01.S.doc Version 5.2 Page 23 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 3 2 3 2 Lady Forester Residential & Day Care Centre DS0000020681.V347206.R01.S.doc Version 5.2 Page 24 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(1)(2) Requirement All service users must have a plan of care, which sets out in detail how individual care needs are to be met. This will give care staff clear guidance on individual care needs and preferred choice of care delivery (Previous timescale 31/01/06 and 14/03/07 not met) Secondary dispensing of medication must cease immediately. This will ensure service users are not placed at risk through poor medication procedures (Previous timescale of 15/12/06 not met) All items of medication must be entered onto the MAR sheet exactly as instructions appear on the original packaging, to ensure carers are clear about correct medication times All staff must undertake adult protection training so that they know how to identify abuse and protect service users. A risk assessment must be in place for the use of the portable heater. DS0000020681.V347206.R01.S.doc Timescale for action 29/02/08 2. OP9 13(2) 29/02/08 3. OP9 13(2) 29/02/08 4. OP18 13(6)18(1 )(a) 13(4)(a) 29/02/08 5. OP38 29/02/08 Lady Forester Residential & Day Care Centre Version 5.2 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP1 OP10 OP31 OP36 Good Practice Recommendations The statement of purpose and service user guide must be reviewed Communal toiletries should not be in use and service users’ dignity must be promoted at all times Management arrangements need to be in place so that people live in a home which is run and managed effectively All staff must receive regular supervision to support them in their role as carer. Lady Forester Residential & Day Care Centre DS0000020681.V347206.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection West Midlands Regional Office 77 Paradise Circus Queensway Birmingham West Midlands B1 2DT 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. 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