Inspection on 24/09/08 for Lorraines Residential Home

This inspection was carried out on 24th September 2008.

CSCI found this care home to be providing an Poor service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Lorraines Residential Home 07/07/09

Lorraines Residential Home 13/01/09

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 19/12/2008.

CARE HOMES FOR OLDER PEOPLE Lorraines Residential Home 44 School Street Church Gresley Swadlincote Derbyshire DE11 9QZ Lead Inspector Claire Williams Unannounced Inspection 24th September 2008 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Lorraines Residential Home DS0000071736.V372713.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. Lorraines Residential Home DS0000071736.V372713.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lorraines Residential Home Address 44 School Street Church Gresley Swadlincote Derbyshire DE11 9QZ 0115 942 5840 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 Parvin Riaz Khan Mr Inam Rehman, Mrs Abida Parveen Ashraf Mrs Barbara Harrington Care Home 17 Category(ies) of Old age, not falling within any other category registration, with number (17) of places Lorraines Residential Home DS0000071736.V372713.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is 17 This is the first inspection 2. Date of last inspection Brief Description of the Service: Lorraines is a care home registered to provide personal care and accommodation for up to 17 people in the category of older persons. Lorraines is an existing service, which has recently had new providers who have been successful in registering with us. Lorraines Care Home is located in the small village of Church Gresley, South Derbyshire and is 1 mile from Swadlincote. Lorraines Care Home has a front garden and a patio area, and a car park. Lorraines has 9 single rooms, and 4 double rooms. A variety of lounge and dining room space is provided. There are sufficient bathing facilities to meet the needs of the residents. Information about the service is provided through the Statement of Purpose and Service User Guide, it is one document that is made available to residents. The fees for the home are £335 to £360 per week. Items not covered in the fees include hairdressing, chiropody, toiletries, transport and holidays. A copy of the Commission of Social Care Inspection report is available and is displayed in the corridor near the back entrance in the service. Lorraines Residential Home DS0000071736.V372713.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 the service is zero star. This means the people who use the service experience Poor quality outcomes The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for people and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provisions that need further development. The inspection visit was unannounced and took place over a period of day. In order to prepare for this visit we looked at all the information that we have received. This included: • What the service has told us about things that have happened in the service, these are called ‘notifications’ and are a legal requirement. • The annual quality assurance assessment (AQAA). This is a selfassessment that focuses on how well outcomes are being met for people using the service. We used the AQAA that was sent to us in February for the purpose of this report. A new AQAA has been requested following the registration of the new providers. This AQAA will be used as evidence for the next inspection. • Surveys – we sent these to the people that live in this service and the staff team. We received 4 surveys from people and 5 from the staff members. Comments and evidence from these have been included in this report. During the site visit case tracking was included as part of the methodology. This involved the sampling of a total of four people representing a cross section of the care needs of individuals within the home. Discussions were held with those individuals as able, together with a number of others about the care and services the home provides. Their care planning and associated care records were also examined and their private and communal facilities inspected. Discussions were also held with staff about the arrangements for peoples care and also for staffs’ recruitment, induction, deployment, training and supervision. We also spoke with two visitors who were in the home at the time of this visit. For the purpose of this report it was requested for the people who live in this service to be referred to as ‘residents’. Lorraines Residential Home DS0000071736.V372713.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The service has received ten requirements following our visit. The areas that require improvements include the following; Each person who lives in this service must have a detailed, person centred care plan. This is to ensure the staff have access to information to direct and guide them on how to deliver care and support. Each person must have risk assessments completed in areas such as mobility, pressure area care, falls and nutrition. This is to ensure any risks are identified. A plan of care must then be implemented to monitor and reduce these risks. A monitoring system of the medication practices and records needs to be implemented to ensure staff maintain good standards, and ensure detailed and accurate records are completed. There have been changes in the law to the Lorraines Residential Home DS0000071736.V372713.R01.S.doc Version 5.2 Page 7 way controlled medication is stored; therefore the service must ensure their storage meets the new requirements. This is to ensure people’s controlled medication is stored appropriately. Residents must be consulted about the provision of activities. This is to ensure there social needs’ are recorded and met by the service. The manager and the staff team need to have refresher training so they can respond appropriately and confidently to safeguarding situations. A review must be undertaken to ensure the staffing levels in place are sufficient to meet people’s needs including social needs. Sufficient staff should be on duty to supervise residents at all times. The manager must ensure that staff receive formal supervision and access team meetings. This is to ensure they are supported in their role and aid communication within the service. A system needs to be implemented to seek resident’s feedback about the service they receive. This is to ensure the service provided is meeting their needs. The provider is required to undertake unannounced monthly visits to the service in order to monitor standards. We have made 16 good practice recommendations which cover a variety of areas. If addressed and responded these will improve outcomes for residents whom use this service. 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. Lorraines Residential Home DS0000071736.V372713.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 Lorraines Residential Home DS0000071736.V372713.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): National Minimum Standards 1, 3 and 5 (standard 6 not applicable) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are assessed and have access to information to enable them, to make a decision about moving into this service EVIDENCE: In the self-assessment the manager told us they provide a loving caring homely atmosphere. She said that the service has improved by fitting a wet room. The new providers have produced a statement of purpose and services user guide, which provides residents with information about the service. The statement of purpose contained majority of the information that is required, but there was a few areas that were not covered. We spoke to residents about the admission process, and they confirmed they were encouraged to visit the service to meet the staff and to see the layout of the building. Lorraines Residential Home DS0000071736.V372713.R01.S.doc Version 5.2 Page 10 People told us they had an assessment completed before they moved into the service, and these were available in the two files we viewed. A person had been admitted into this service as an emergency, without any assessment. However some information was then compiled after they had lived in the service for a few days. It was reported that a letter is sent out to people to confirm the service is able to meet their needs following the initial assessment. However a copy of this letter is not kept on file, so there was no evidence available to support this. The service does not provide intermediate care and there were no residents accommodated at the time of the site visit with diverse cultural or religious needs. The documentation in place does not cover the six areas of diversity, and therefore is not inclusive to all people. Lorraines Residential Home DS0000071736.V372713.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): National Minimum Standards 7, 8, 9, and 10 Quality in this outcome area is Poor. This judgement has been made using available evidence including a visit to this service. Residents healthcare needs are not met due to shortfalls in the care plans and in the administration of medication. EVIDENCE: In the self-assessment the manager told us they ensure that residents see their GPs as and when they need to and district nurses call when needed. She told us that the service has improved as more staff have achieved a national vocational qualification. Some staff have also attended medication and healthcare training. We examined four care files for resident’s who use this service; two of which were new admissions and two for residents that had lived in this service for a period of time. Each file contained a pen portrait about the resident, which provides a brief overview of their needs and some of their preferences. The files contained a care plan which provided information about their personal care, but this was Lorraines Residential Home DS0000071736.V372713.R01.S.doc Version 5.2 Page 12 not written in a person centred way. The care plans contained very little information and guidance about how to meet residents needs in other areas such as health, social, emotional, and physical. This means the staff team do not have access to detailed person centred care plans, which cover a persons needs in a holistic way. This has the potential to compromise the care they receive as the staff are not working from a current and detailed plan of care. We also identified that two of the care files did not contain a photo of the resident and some of their personal details was incomplete. Residents told us that their needs were met and this is because a stable staff team is in place, and they have a good knowledge and awareness of each persons support needs. The staff demonstrated this knowledge during discussions and observations supported that they were able to support residents in a way they preferred. Resident’s spoke positively about the staff team and with told us they were cared for in a manner that suited their needs, and with respect and dignity. Comments made included: “ the staff do a great job, they are really caring people” “they look after me well and do their best, but they are very rushed”. “they always get the GP or district nurse when I need them they are responsive and they listen” The files we examined did not contain all of the required risk assessments that should be undertaken to monitor people’s mobility, pressure areas, nutrition and falls. We identified that residents weight was only monitored and recorded if the individual was able to weight bear. Therefore some resident’s weight had not been recorded for a period of time. An example of this was demonstrated in one persons file, whose weight was last recorded in March 2007. A care plan was not in place for this person advising staff to monitor their weight using other methods such visual or to report any changes to the clothes they wore i.e reporting if they were too big or too small. During discussions with a visitor we were told their relative had an accident and fell in their bedroom a few weeks ago. However we were unable to locate the accident record and no information was recorded about this fall in the daily logs. There was a log stating the resident felt a little better a few days later. The lack of information means the staff are unaware of significant events and therefore are unable to monitor residents well being, which has the potential to place them at risk and compromises the care provided. The relative told us she was most distressed as she was not formally told about this fall. She found out about this incident, when a staff member asked how if her relative was recovering. As a consequence of the fall we were told by the visitor the resident had lost their confidence and therefore they required more support with personal care Lorraines Residential Home DS0000071736.V372713.R01.S.doc Version 5.2 Page 13 tasks. However when we examined the care plan, we found no evidence to support this change in need. Evidence was available in the care plans to support that monthly reviews had been undertaken on a regular basis. However the content of these reviews consisted of a general overview of the resident’s well being rather than a review of their care plan. When we examined the medication records we identified that medication was not administered as prescribed. We identified shortfalls with the medication and some of these included: • • • • • Codes were used on the medication record without any explanation of why the medication had not been administered. One person was prescribed eye drops but the chart had not been signed on 6 occasions, to state it had been administered. Handwritten medication instructions had not been signed or validated by two people Medication had been signed as administered but was still in the blister pack. Medication was stored without the prescription label. We were informed that all staff has undertaken medication training which included an observation of their practices, but no evidence was available to support this. These shortfalls have the potentially to place individuals at risk, and results in people’s healthcare needs not being met. Lorraines Residential Home DS0000071736.V372713.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): National Minimum Standards 12- 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents do not have access to opportunities to meet their recreational or social needs and expectations. EVIDENCE: In self-assessment the manager told us residents have home cooked meals, and visiting times was flexible. Residents have regular entertainment and good links were maintained with the local community. Residents that we spoke to said they were “bored, and had very little to do”. They said they receive a daily paper and can watch the television, but no activities are planned on a weekly basis, other than the hairdresser. We were told that an entertainer does visit the service every 6 weeks, but individuals would like more to do. Comments from the surveys include: “now there is less staff we don’t so much at all” “since the changes in the staff number they do not have time for activities”. We were told that residents no longer have access to a pay phone which they can use for personal calls. They are able to use the office phone but one resident told us “this is embarrassing asking for permission to use the office Lorraines Residential Home DS0000071736.V372713.R01.S.doc Version 5.2 Page 15 telephone, I used to use the phone regularly now I don’t as I don’t want to block this office line. This means I have reduced contact with my families. We were not consulted about the pay phone the line was just cut”. We were told that it was the provider’s decision to end the phone contract for this telephone. On the day of our visit we observed the local vicar undertaking a service. No other activities were observed, and people were observed sleeping for most part of the day. The staffing levels have been reduced which has impacted on the delivery of activities. There are two members of staff that work each shift, and their roles include supporting residents with their daily needs, laundry tasks, assisting people to have a bath, and providing drinks. The staff are responsible for providing activities but due to their dual role, time was not available for this provision. Staff told us that they would like to spend quality with residents and undertake activities, but this was low priority as they had to complete other tasks. This also results in people with high dependency needs not receiving one to one time. Visitors spoken with said they “always feel welcome into the service” and the staff are always friendly”. They spoke of many changes that have impacted on the service and in particular they told us about the reduction in the staffing levels. They told us that from their observations the staff members always work in a respectful way, maintaining their relative’s dignity. The care plans we looked at contained very little information about people’s preferences and likes/dislikes, in respect of activities. There was limited information about people’s background history and life experiences, other than what was provided in the pen portrait. This information is beneficial as it enables the staff to be more informed about people’s previous lives and experiences. We received a complaint about the food which we referred back to the provider to investigate. Evidence was available to support this had been responded to. Residents told us that some improvements have been made to the quality and quantity of the food provided, but some individuals still felt the standards had dropped. We were told by residents that they did not like “cheap teabags” which were being provided. We were told that supplies often run out resulting in staff having to visit the shop to buy items. During our visit the temporary cook had to visit the shop to purchase potatoes and flour in order to cook the meal. One resident told us “they are monitoring what we eat and they are careful about what they buy, it’s not like it used to be”. Several comments were made in the surveys we received and in peoples opinion they said the quality of the food had deteriorated. Menus were in place, and these are based on four weekly programme. There were no choices recorded on the menu. However observations during our visit supported that choices to the main meal were provided. Lorraines Residential Home DS0000071736.V372713.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): National Minimum Standards 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The systems in place are not followed to ensure concerns and safeguarding issues are responded to appropriately. EVIDENCE: In self-assessment the manager told us; they have a complaints policy in place and visitors, staff and residents are all made aware of how to access it. Residents spoken to told us they knew how to complain and have raised issues with the manager and provider. Visitors spoken to also said they would “speak with the manager if they had any concerns”. The complaints procedure is displayed in the service for people to access. The complaint file was examined and this contained one complaint which we referred to the provider. As mentioned there was evidence to support the investigation and outcome of this complaint. We were told that a copy of the Multi-agency Safeguarding adult’s procedures was in place, in addition to the internal policy. These included a whistle blowing procedure. Staff told us they had completed training in safeguarding adults and certificates in their files supported this. The staff spoken to were able to describe an understanding of their responsibilities in reporting suspicions of abuse. However there is a current safeguarding investigation that is ongoing and this has raised concerns about the way information and concerns have been reported and responded to. Lorraines Residential Home DS0000071736.V372713.R01.S.doc Version 5.2 Page 17 The manager told us they had not yet received information about the Mental Capacity Act. Access to this information is required so that training can be accessed. It was also advised that forms form the training should be obtained so staff could record decisions people made, which are in line with the requirements of the Mental Capacity Act. Lorraines Residential Home DS0000071736.V372713.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): National Minimum Standards 19, 23, and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in an environment that is safe and meets their needs EVIDENCE: In the self assessment the manager told us; they provide a safe clean and happy environment. We were told a renewal programme was in place. We undertook a brief tour of the building; visits to some of the bedrooms demonstrated that the building was safe and that people are encouraged to personalise their rooms. Residents spoken with said they were very comfortable and liked their rooms. Residents and visitors commented that the home was always clean, and never smelt, this was observed on our visit. Residents told us they liked the communal areas and the layout of the service. They said they have access to various aids and equipment in order to assist them in their mobility and to get around the home. Some individuals spoke Lorraines Residential Home DS0000071736.V372713.R01.S.doc Version 5.2 Page 19 about how they liked the garden area, and how much they: “enjoy sitting in the patio area on sunny days”. Some residents share a bedroom and we told that they have made a positive choice to continue to share their room. Facilities and curtains were available to ensure each person’s dignity was maintained. Lorraines Residential Home DS0000071736.V372713.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): National Minimum Standards 27- 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Insufficient staffing levels and shortfalls in the recruitment of staff impacts on the delivery of care provided to residents, and means they are not safeguarded from risks. EVIDENCE: In the self assessment the manager told us they provide trained staff to cover every shift. The staff are dedicated to the residents and would do anything for them. Examination of the duty roster and information received confirmed there are two staff on duty for every shift. The staffing levels have been reduced from two to three. This is in response to a reduction in the numbers of residents living in this service. The manager is on duty during the morning and there is a staff member who work’s in the kitchen. During the afternoon shift only two staff members work and their role includes providing the evening meal to residents. We were told that there are at least 3 residents with high dependency needs, who require two staff members to support them with personal care tasks and mobility. This means that when these individuals are being supported the remainder of the residents are left unsupervised. This has the potential to place residents at risk due to the lack of supervision and support available Lorraines Residential Home DS0000071736.V372713.R01.S.doc Version 5.2 Page 21 during peak times. Staff spoken with told us, “we struggle to fit everyone’s needs in, especially when we have to support individuals to have a bath” “early mornings and evenings are very busy”. Comments received in the staff surveys also highlighted that staff are very busy and one comment included: “sometimes it’s dangerous because we cannot always supervise residents”. Residents told us that the staff are “always rushing around” and “have no time for us anymore”. Although they said the staff “do their best”, they said they “are often rushed”. Comments received in the surveys also supported that residents felt the reduction in the staffing levels has impacted on the care they receive. How this had impacted was in relation to not being able to undertake activities and lack of quality time when someone is being supported to have a bath. Observations during this visit confirmed that the staff members were busy undertaking various tasks and supporting people’s needs. They spent majority of their time with individuals and they were not in present in the communal areas apart from when they provided drinks for residents. However we did observe that the staff often took their breaks together, which means residents have no staff support or supervision for that period of time. We were told that a key worker system is not in place. This means residents do not have one named staff member they can refer to, in order to assist them in personal tasks such as personal shopping, or sorting out their drawers etc. Both the staff members and residents told us they would welcome this system to be implemented. We were told that staff have access to resources to assist them with their role. However we were told that at times they have nearly ran out of gloves, which could impact on the infection control practices and standards in the service. We looked at the files of three staff for evidence of the procedure that had been followed for their recruitment. When looking through the file containing the police checks we identified that three people had CRBs that had been transferred from their previous work place. These staff members had commenced employment up to 5 years ago. An audit check of the file had not been undertaken to ensure all information was in accordance with the current legislation. One file we examined was for a staff member who had previously worked in this service but who left to work elsewhere and returned six months later. A new police check had not been processed for this individual. We were told that she would be supervised at all times and a Povafrist check would be undertaken as soon as possible in addition to a new CRB. These shortfalls in Lorraines Residential Home DS0000071736.V372713.R01.S.doc Version 5.2 Page 22 the recruitment practices have the potential to place residents at risk if staff members are not appropriately vetted before they commence employment. The staff files examined demonstrated that staff have access to regular training, and there were certificates to support the training received. We were told the service provided their own internal induction to new staff. However when we examined this it did not meet the specifications required by the skills for care. A copy of the skills for care common induction standards were available in the service, and we were told that these would be provided to all new staff from this date forward. Discussions with staff demonstrated their understanding and knowledge of peoples needs. Lorraines Residential Home DS0000071736.V372713.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): National Minimum Standards 31, 33, 35, and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The service is not managed in the best interests of the residents due to the lack of systems in place to obtain feedback and to monitor the standards in the service. EVIDENCE: In the self assessment the manager told us she has an open door policy and is very flexible. Resident’s finances are kept in order and the home is well run and residents needs come first. Feedback from residents, relatives and the staff team indicated that the manager was approachable and supportive. The manager was described as being “very helpful”, and “always on hand”. However it was reported that she Lorraines Residential Home DS0000071736.V372713.R01.S.doc Version 5.2 Page 24 may not be “strong enough” to respond to situations that may arise. This is because she is “too nice”. As mentioned within this report the communication processes within the service are not robust and have affected outcomes for residents. The staff told us they do not have access to team meetings or supervision which means they do not receive formal support, guidance and leadership. This also means that the communication channels within the service are limited and based on verbal handovers. We were told that during these handovers information is not provided about all of the people living in the service, which has the potential to affect the support provided to individuals. Systems are not in place in order to obtain residents feedback. Surveys are not distributed and residents meetings are not held. We were told feedback is provided informally. This means that there is no evidence in the service to support how or when they have been consulted. Residents did tell us they were consulted about the food, but there was no evidence of this, other than the response provided to the complaint. The systems in place for looking after people’s money were found to be satisfactory. Residents told us they can access their money when they choose to. Since the new providers have taken over the responsibility for this service they have not undertaken any monthly visits to monitor the standards, records and completed a report of the findings. This is a legal requirement and should form part of the quality monitoring systems in place. From our observations and feedback we have received, there does not seem to be any audits undertaken to ensure standards are being maintained. This means that shortfalls are not identified quickly and rectified. During the tour of the building we observed some hazards and risks and these included: bottles of cleaning liquids without labels in the bathroom and laundry area, creams and homely remedies on the manager’s desk. Once identified these items were removed and the areas made safe. We observed that some of the wheelchairs in use did not have the footplates attached and there was no evidence in the residents file to support why these were not in place. This is not good practice and could place residents at risk of injury to their legs and feet. Lorraines Residential Home DS0000071736.V372713.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 2 X 3 2 3 n/a HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 x x x 3 x x 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 Lorraines Residential Home DS0000071736.V372713.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? N/a 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) Requirement Timescale for action 01/12/08 2. OP8 Schedule 3 3. OP9 13.2 4. OP9 13.2 Every resident must have a detailed care plan which covers all of their needs. This plan must be developed in consultation with individuals and be kept under review. The plan must include reference to the individual’s ability to make decisions under the requirements of the mental capacity Act. This is to ensure peoples current needs are being met, and their rights promoted. Risk assessments must be 01/12/08 completed in all of the required areas for all individuals to assess any potential risks. These must be kept under review and reflect peoples current needs to ensure they receive appropriate support and intervention. A system must be implemented 01/12/08 to monitor and audit the medication records and practices. This is to ensure people receive their medication as prescribed. Staff must sign the Medication 01/12/08 record when they have DS0000071736.V372713.R01.S.doc Version 5.2 Lorraines Residential Home Page 27 5. OP12 16 (2) (n) 6. OP18 13 (7) 7. OP27 18 (1) (a) 8. OP29 19 (1) (b) 9. OP33 26 10. OP33 24 11. OP36 18 (2) administered medication. The reasons for not administering medication must also be recorded. This is to ensure residents receive their medication as prescribed. Residents must be consulted about a programme of activities. This is to ensure their recreational and social needs are met by the service. Arrangements by training or by other measures must be taken, to ensure the staff and manager are fully aware of their responsibilities under the local safeguarding multi-agency procedures The staffing levels must be reviewed in accordance with the dependency levels of the residents to ensure sufficient staffing levels are available at all times to meet resident’s needs. All of the required legal recruitment checks must be undertaken on new employees before they commence work in the service. This is to ensure residents are safeguarded from any risks. The registered person must carry out the monthly unannounced visits and prepare a written report. This report must be available in the service. This is to ensure they are monitoring the standards in the service. A system for reviewing the quality of care provided must be implemented. This is to ensure that residents are regularly consulted about the service they receive. A system must be put in place to ensure all staff have access to formal supervision. This is to DS0000071736.V372713.R01.S.doc 01/12/08 01/12/08 01/12/08 01/12/08 01/12/08 01/03/09 01/12/08 Lorraines Residential Home Version 5.2 Page 28 ensure they receive appropriate support. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP2 Good Practice Recommendations The assessment of need should be reviewed to incorporate the following areas of diversity: race, gender identity, disability, sexual orientation, age, religion and belief. Each file should contain a photo and personal information about the resident including their wishes after their death. A copy of the letter confirming that the home can meet a persons needs should be kept in peoples file. Care plans should be completed in a person centred way to ensure it reflects the needs and preferences of the individual. A key worker should be implemented so that each resident has named staff member they can refer to. A system should be implemented to monitor residents weight who are unable to weight bear. The staff members that administer medication should have a re-assessment of their practice to ensure it is safe and in accordance with the policies and procedures. Information about residents preferred social activities should be recorded in their file and be part of their social care plan. Residents should be consulted about accessing the office telephone for personal calls. The menus should reflect the choices available. Residents should be regularly consulted about the food provided and records kept. A copy of the local multi-agency safeguarding procedures should be obtained and followed. Staff members should not have breaks together when this results in no staff support being available to residents. The staff recruitment files should be audited to ensure they contain all of the required information to meet the current legislation and standards. Staff members should access training in dementia care to DS0000071736.V372713.R01.S.doc Version 5.2 Page 29 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. OP4 OP7 OP7 OP8 OP9 OP12 OP13 OP15 OP18 OP27 OP29 OP30 Lorraines Residential Home 14. 15. 16. OP33 OP33 OP38 assist them in their role. A system for audits should be implemented to monitor the standards in the service. Staff members should have supervision six times a year. They should also have an annual appraisal and access to regular team meetings. Footplates should be attached to wheelchairs, unless the residents request otherwise. Evidence should be available in resident’s files to support the reasons for this. Lorraines Residential Home DS0000071736.V372713.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Lorraines Residential Home DS0000071736.V372713.R01.S.doc Version 5.2 Page 31 - 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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