Inspection on 24/06/08 for Maidment Court

This inspection was carried out on 24th June 2008.

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

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

Other inspections for this house

Maidment Court 26/01/09

Maidment Court 14/07/06

Maidment Court 28/02/06

Maidment Court 06/05/05

Maidment Court 06/10/04

Maidment Court 07/05/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Maidment Court 47 Parkstone Road Poole Dorset BH15 2NX Lead Inspector Martin Bayne Unannounced Inspection 24 June 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 Maidment Court DS0000004051.V362613.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. Maidment Court DS0000004051.V362613.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Maidment Court Address 47 Parkstone Road Poole Dorset BH15 2NX 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) 01202 674423 01202 676410 HOME.POO@MHA.ORG.UK home.fxg@mha.org.uk Methodist Homes for the Aged Post Vacant Care Home 46 Category(ies) of Old age, not falling within any other category registration, with number (46) of places Maidment Court DS0000004051.V362613.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The twin suite, bedrooms 45 (a) and (b), is only to be let to a couple who have clearly expressed a desire to occupy such a room. 14th July 2006 Date of last inspection Brief Description of the Service: Maidment Court is a care home registered with the Commission to accommodate a maximum of 46 older people. The home is purpose-built and has a passenger lift to access the four floors of the home. Residents’ bedrooms are for single occupancy and have ensuite toilet facilities. The main communal rooms of two lounges and dining room are provided on the ground floor. There are five assisted bathrooms, one conventional bathroom and a walk-in shower room. The home offers one room for respite care. The home overlooks Poole Park and is in within a short walk from the town centre. Parking for staff and visitors is available at the back of the home. There are well-maintained gardens to the front and back of the home. The fee range is from £443 to £537 per person, the latter amount being for the twin suite of rooms. Maidment Court DS0000004051.V362613.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 outcomes. We the Commission, carried out an unannounced key inspection of the home between 10am and 5:30pm. The aim of this inspection was to follow up on the two requirements and one recommendation made at the last key inspection of July 2006 and to evaluate the home against the key National Minimum Standards for Older People. Since that last key inspection the Registered Manager has ceased working at the home and a new manager was appointed in February 2008. The new manager is currently applying to become Registered Manager of the home. The new manager assisted us throughout the inspection, providing records that the home is required to keep by Regulation and discussing how care services were managed within the home. During the inspection we spoke with four members of staff and with 10 of the residents. Other information that helped form the judgements contained in this report was obtained through; the returned Annual Quality Assurance Assessment document and comment cards returned by 5 staff, 20 residents of the home, 5 healthcare professionals who have involvement with the home and 18 relatives of people living at the home. We also carried out a tour of the premises. What the service does well: Residents’ needs are assessed before being offered a place at the home to ensure that needs can be met. Residents spoke highly of the staff and how they tried to meet their needs. Residents’ social and recreational needs are met through a dedicated activities coordinator being employed at the home. Residents are supported to maintain links with families and friends. A good standard of food is provided at the home. Maidment Court DS0000004051.V362613.R01.S.doc Version 5.2 Page 6 Residents are enabled to maintain independence, choice and control over their lives. The home has a complaints procedure and residents felt confident that complaints would be taken seriously with appropriate action taken. Infection control measures are in place to maintain a healthy environment. What has improved since the last inspection? What they could do better: Care planning systems need to be improved to ensure that residents’ needs are fully met. Risk assessments must be carried out for residents who manage their own medication. Moving and handling risk assessments must be kept up to date and systems should be in place to ensure that staff abide by moving and handling plans. The systems for managing medication in the home could be improved. Proposed increases in staffing should be implemented and monitored to ensure that they meet needs of residents. The current levels of staffing do not meet needs. Staff must be recruited in line with Schedule 2 of the Regulations. Maidment Court DS0000004051.V362613.R01.S.doc Version 5.2 Page 7 Staff must receive supervision in line with the Standards for older people. The manager must ensure that mandatory training is provided to the staff and that their training needs are up to date. Some areas of the home are in need of redecoration. 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. Maidment Court DS0000004051.V362613.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 Maidment Court DS0000004051.V362613.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): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from their needs being assessed prior to being offered a place at the home. EVIDENCE: Throughout the inspection we used the personal files for three residents as examples of the records that the home is required to keep by Regulation concerning the care of residents. We found that when a person is referred to the home their needs are assessed and recorded before they are offered a place at the home. Whilst some of these records would have benefited from further detail they were sufficient to ensure that the home is able to meet the Maidment Court DS0000004051.V362613.R01.S.doc Version 5.2 Page 10 needs of the person referred. One of the pre-admission assessment forms that we saw was not dated and we recommend that this is part of general practice when completing forms. If a person is offered a place at the home they are informed with a letter to this effect. Prospective residents or their relatives are made welcome to view the home to aid their decision of choosing an appropriate placement. As reported at the last key inspection when a person moves into the home they are provided with an information pack, ‘Welcome to your new home’. Maidment Court DS0000004051.V362613.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): 7 8 9 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The care planning and monitoring systems do not meet their primary purpose of adequately informing the staff of how to care for residents. This could lead to health needs of residents not being met; specifically those with high care needs. Ordering and monitoring of medication must be improved to ensure the well being of service users. The management of Controlled Drugs medication was unsafe and places service users at risk. Residents benefit from being treated with respect and their privacy respected. EVIDENCE: At the last key inspection a requirement was made regarding care planning. At that time it was found that care plans were not providing sufficient information Maidment Court DS0000004051.V362613.R01.S.doc Version 5.2 Page 12 to instruct staff on how to meet residents’ care needs. We looked at the care plans for the three residents tracked through the inspection. We found a photograph of the resident concerned on the front of their care plan and there was key information and contacts contained in their file. We found the care planning system to be complex, aiming to provide person centred care, but the way in which the plans were being completed by staff, did not provide a coherent clear plan of how residents were to be looked after. The majority of the plans were not outcome focused but task centred. The daily recording sheets were not completed on a daily basis and the care plan interventions sections were used to record care given. Evaluation sheets were not used consistently. This inconsistent and confused recording meant that staff did not have clear instructions about how to care for people and did not provide a clear trail to evaluate the effectiveness of care provided. We found that there was little evidence that service users were consulted about their wishes although the system did allow for this. We also found, as at the last inspection that where instructions were given they were often too generalised. Examples being: • One care plan informed that a resident should be turned during the night to maintain their skin integrity. There was however no recorded frequency as to how often staff should be doing this. Another care plan concerning a resident’s emotional well being, recorded that they were distressed. However, there was no plan on how the staff should support this person. Another plan instructed staff to do hourly checks regarding fluids and mouth care, however there were no details on exactly how staff should be doing this. We found that one person who had been referred to a dietician for weight loss did not have a care plan or monitoring in place to reflect this. We visited service users who were cared for in bed. Whilst they looked well kempt and staff were endeavouring to meet their needs there was no meaningful monitoring of their care in bed and no plans in place to support this level of care. Positional change charts and food and fluid charts were not maintained regularly and did not confirm or inform about the care provided. Both service users remained in the same position for the duration of the inspection. One plan informed that a resident had returned from hospital with tissue viability, but there was no plan on how to support this person and no evidence as to why they were in hospital or what care was needed on their return. • • • • • Maidment Court DS0000004051.V362613.R01.S.doc Version 5.2 Page 13 • We found examples of residents with dementia but no plans were in place on how to support their condition. We spoke to members of staff about the care planning system and they informed that they found it confusing, time-consuming and not overly helpful. There were indications that staff were relying on verbal communication between one another, rather than referring to the care plans. An example of this was where a GP had instructed that staff should no longer give pain control medication to one resident. The staff were aware of this but there was nothing recorded within the person’s care plan and there was no audit trail of this decision or instruction. We discussed our findings with the manager, who told us that she was developing summary care plans to improve communication. These plans would also be useful should a resident need to go to hospital or to inform agency staff. We saw examples that had been written, however for these to be effective they need to provide more specific information with care needs broken down, as detailed above. We also found evidence that not all care plans were being reviewed monthly as required by the Standards and there was no evidence within some plans that residents had been involved in the development of their care plan. Concerning risk assessments and how to minimise the risk of harm to residents in managing care, we also found shortfalls. In the case of one resident who manages their own medication there was no risk assessment concerning their ability to manage their medicines. We also found that one person had experienced falls but their falls risk assessment had not been updated. The residents we spoke with told us that the staff team were very caring and respectful. Through the inspection we observed that there were good relations between the staff and residents. Residents commented however, that there were insufficient staff. They said staff were always busy catering to the needs of people with high dependency and that those who were self caring therefore did not have not much contact with the staff. This is reported in more detail in the staffing section. Whilst hoists and slide sheets are available to assist with moving residents we found evidence that appropriate techniques are not always used. We saw one person who was moved in bed without a slide sheet, when one was required and a resident told us that they are lifted under the arms, which is poor practice. Both these practices place both the service user and staff at risk of injury. We looked at how medication is administered in the home. We were told that the senior member of staff who had accountability for medication had recently left the home. Another senior has been delegated to take responsibility for Maidment Court DS0000004051.V362613.R01.S.doc Version 5.2 Page 14 medication, however they informed that they had not been trained in how to reorder medication and the manager was doing this. The manager told us that a trainer from the pharmacist, who supplies the home, was due to provide training to the senior staff in July. We looked at the medication administration records for residents and found that these were being completed correctly but there were some gaps in the recording. We also saw that there were photographs at the front of their medication administration records, which is good practice. We found that the storage of non-controlled medication was satisfactory. We did however find instances where improvements could be made to make medication administration safer: • We found that creams and prescribed nutrition supplements were not signed for as given. This does not allow for monitoring of the effectiveness of these prescribed items and ensure that they are given as prescribed. • We found some examples of where hand entries had been written on medication records. Some entries, including controlled drugs, had not been signed and others had not been checked and signed by a second member of staff. This practice should be adopted, as it reduces the risk of errors being made in transcribing information. • We also recommend that dates are recorded when creams are opened or expire to ensure that they are used with the recommended dates. • We saw an example of where one resident was prescribed a variable dosage of medication ‘as required’, but there was no instruction for staff on when this should be given. • We found that the management of the Controlled Drugs was not sufficiently robust. We found open bottles of liquids without dates of opening so that it could be ensured that they are used within the required time. We found a large quantity of drugs for return that had been out of use for some weeks and months. This stock had not been routinely audited and must be returned without delay once not required. (CSCI Professional Advice: The safe management of controlled drugs in care homes Jan 2008)- When a resident’s controlled drugs are no longer required they should be disposed of safely and a record kept of who returned them, the quantity and date.) We found 2 examples of where medication had been out of stock and not given to the service users for a week. We spoke to staff who told us that they regularly run out of medication since the staff member left who was responsible for ordering of medication. Maidment Court DS0000004051.V362613.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): 12 13 14 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from their leisure and social interests being met, from being able to maintain contact with friends and families and being provided with a good standard of food. EVIDENCE: The home employs an activities coordinator. Comment cards returned by relatives and residents informed that this is one area where the home provides good support to residents. We saw on the residents’ notice board that group activities were organised every weekday, including some evening activities. The activities coordinator ensures that individual one-to-one time is spent with people who do not wish to take part in communal activities. This is recorded within their personal file. We found within the care records we sampled, that Maidment Court DS0000004051.V362613.R01.S.doc Version 5.2 Page 16 reference was made to residents’ interests and hobbies. In some cases there was some life history information provided through relatives; useful for meeting residents needs should they have memory difficulties. Each year the home holds a Summer Fayre. Many of the residents of the home share the Methodist faith and services and fellowship meetings are held in the home each week. Should residents be accommodated from other dominations they are supported to have visits from ministers or attend churches of their choice in the community. Comment cards return from relatives informed that there are always made welcome at the home and that there were no restrictions on their visiting. The home has quiet areas where residents can receive visitors. Residents’ mail is put in individual pigeonholes allocated to room numbers. We saw that residents are free to come and go from the home and that there is an ‘in/out board’ to inform staff who has gone out from the home. The residents we spoke to said that they were free to make their own decisions and could get up and go to bed when they chose, although we were told of instances that impinge on this owing to staffing levels. (See staffing section). Returned comment cards from residents were positive about the standard of food offered in the home. These informed that food likes and dislikes are known and that where possible alternative choices are provided should a person not like the meal on offer. On the day of our visit the main meal was pot beef with cauliflower, leeks and mashed potatoes followed by a dessert. We spoke with one of the cooks who was aware of specialist dietary needs of the some of the residents. At the time of inspection there were six people with special diets for diabetes and two residents who required their food to be puréed. We observed staff assisting residents who had difficulty with eating. Residents are encouraged to eat in the dining room but those who are unable or prefer to eat in their room are provided with trays that are taken to their rooms. Maidment Court DS0000004051.V362613.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): 16 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a well-publicised complaints procedure and through the staff being trained in adult protection. EVIDENCE: The complaints procedure for the home is displayed on the residents’ notice board in the reception area. At the time of our visit an incorrect address was displayed for contacting the Commission. During the inspection, the manager updated the procedure, providing the new contact details for the Commission. The complaints procedure is also detailed within the Service User Guide and the Terms and Conditions of Residence. Returned comment cards indicated that residents knew how to make a complaint and that they had confidence that a complaint would be dealt with fairly. We looked at the complaints log and saw the formal complaints were taken seriously and responded to. Maidment Court DS0000004051.V362613.R01.S.doc Version 5.2 Page 18 The manager told us that she had recently obtained an updated copy of the local adult protection procedures and she had ensured that the home’s complaints procedure complemented arrangements for referring to the local authority procedures. Since the last inspection there has been one adult protection investigation and this was referred appropriately to Social Services and the Commission informed. The allegation was investigated and not substantiated. Some good practice recommendations were made for the home to follow-up. It was agreed that the manager would inform us on progress in this area. All the staff are provided with training in adult protection. Maidment Court DS0000004051.V362613.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): 19 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Generally the home provides a safe and homely environment, however there are some areas of the home that would benefit from redecoration. Infection control measures are promoted in the home. EVIDENCE: On the day of visit we found the home to be generally clean and reasonably maintained. There were however some areas of the home that required redecoration and some carpets were worn and in need of replacement. The manager informed that there were plans for redecoration and upgrading some areas of the home. We were shown a maintenance plan and progress in this Maidment Court DS0000004051.V362613.R01.S.doc Version 5.2 Page 20 area will be monitored at future inspections. Two returned comment cards returned by relatives told us that occasionally they felt that some standards of cleanliness were not being maintained. The home employs domestic staff throughout the week. We were able to see by visiting some residents in their rooms that they were able to personalise their space with their possessions and furniture. We saw that radiators were covered to protect residents from hot surfaces and that thermostatic mixer valves are fitted to hot water outlets to protect residents from hot water. The home has a dedicated laundry area equipped with two commercial washing machines and two commercial drivers. Walls and floors are impermeable and easily cleaned. Hand washing facilities are available in laundry area. The home employs a laundry assistant. Staff told us that gloves and aprons are provided to the staff in the interests of infection control. Maidment Court DS0000004051.V362613.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): 27 28 29 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home does not currently provide sufficient staff to meet the needs of the residents. Recruitment practices could be improved to better protect residents. EVIDENCE: We discussed the staffing levels with the manager, as there were some concerns raised by residents and relatives through returned comment cards that staffing levels did not meet the needs of residents. We also found at this inspection evidence to support this. Residents we spoke to told us that the staff were very stretched and that those who are independent were very much left to themselves as the staff did not have time to devote to them. One resident we spoke to said that they woke at 7am that morning but had to wait until 10am for staff to assist them with washing and dressing, as the staff could get round before then. We also found another resident who was still in their nightclothes at lunchtime and a staff member informed that this was because they had not had time that morning to get them dressed. Residents Maidment Court DS0000004051.V362613.R01.S.doc Version 5.2 Page 22 also said that very often staff would have to leave them when receiving care to answer call bells. We spoke with members of staff who said that levels of dependency of residents had increased and that staffing levels had not increased sufficiently to match the increased dependency. They said they were very stretched in meeting the needs of the residents. They told us that this was in part due to staff vacancies and the reliance at times on agency staff, but that even when fully staffed they had difficulty meeting the needs of residents. They told us that currently staff morale was low. We established that at the time of the inspection; two residents required high care support with their being cared for in bed, 21 residents required assistance with washing and dressing, five residents required hoisting when two people were required and five people needed assistance with feeding. The manager provided us with duty rosters showing that between 7am and 9pm there is one duty senior and four carers on duty during the daytime. During the night time period the home is staffed by three awake care staff. She informed that from July new members of staff will have started work and it is proposed that between 7am and 2pm there would be five carers and one senior on duty and between 2pm and 9pm four carers and one senior. In addition there will be an extra senior on duty between 9am and 5pm. The manager told us that she expected this increase in staffing level would meet needs of residents. We require that the proposed increase in staffing be implemented and that there be a period of monitoring of residents’ dependency against staffing levels to ensure that residents needs are met. The rushed moving and handling practices and lack of monitoring are also indicative of a lack of staff. Concerning staff training, we were shown a matrix of training needs for the staff. The manager told us that this was out of date and it was agreed that an updated matrix of the mandatory training achievements of staff would be sent to us within a week. We never received a copy of this and a requirement is made that staff receive mandatory training to the required timescales. We found that 62 of the care staff team are trained to NVQ level 2 or above, thus meeting the National Minimum Standard of at least 50 of the staff trained to this level. We looked at the recruitment records for three members of staff recruited since the last inspection in July 2006 and also for the recruitment of the manager. Two members of the care staff were recruited in line with the Regulations. In the case of the third member of staff, we found that only one reference had been received. This reference was supposed to be from a person’s last employer, however on scrutiny it appeared that this reference had actually been signed by a colleague at that work place and was not from the employer as required. In the case of the manager’s recruitment we saw that a thorough recruitment procedure had been undertaken. However we recommend that in employing a manager, references should be taken up from a place of work where they were employed as a manager. On the day of inspection two agency members of staff were on duty. We asked to see the Maidment Court DS0000004051.V362613.R01.S.doc Version 5.2 Page 23 letter that the agency should supply to inform that the agency staff had been subject to all the recruitment checks of Schedule 2 of the Regulations. We found in the case of one person that a letter to this effect had been supplied, but there was no letter for the second agency staff member. A requirement was made that all the criteria of Schedule 2 are satisfied before a new member of staff begins working in the home. We found that the staff application form for the organisation requested a reference from the person’s last employer. It is recommended that the wording be changed in line with the Regulations, that the reference be sought from the person’s last place of work of not less than six months duration when working with children or vulnerable adults. We also saw that the application form did not request information about gaps in an employment history or the reasons why a person left a care position. It is recommended that the wording be changed to seek this information Maidment Court DS0000004051.V362613.R01.S.doc Version 5.2 Page 24 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 adequate. This judgement has been made using available evidence including a visit to this service. Management structures are in place but action needs to be taken to address staffing levels, care planning and medication administration in order to achieve good outcomes for residents. EVIDENCE: Staff recruitment findings are reflected in the above judgement, in line with KLORA, (Key Lines of Regulatory Activity). Maidment Court DS0000004051.V362613.R01.S.doc Version 5.2 Page 25 The manager showed us certificates concerning her attainment of NVQ level 4 in management and care and the Registered Manager’s Award. The manager is currently seeking registration with the Commission to become the Registered Manager of the home. We discussed the organisational structure for the management of the home. We were shown copies of Regulation 26 visits, (visits made on the half of the management, demonstrating accountability). Volunteers from the organisation undertake these, some of whom are exmanagers within the organisation. We saw that these were being carried out monthly as required by the Regulations. We also found that senior managers of the organisation visit the home regularly to review the service. We were shown examples of the organisation’s own audit of how the home meets the National Minimum Standards. We saw that a health a safety representative of the organisation had visited in June to carry out a health and safety audit to ensure that the service is managed well. We discussed how supervision of staff was managed. The manager provides supervision to senior members of staff who in turn then supervise the carers and ancillary staff. We found that the manager was slightly behind in giving senior staff supervision but that senior staff had fallen behind supervision of the care staff. This also supports the judgement that the care staff and senior staff are stretched. It is recommended that all staff receive supervision in line with the Standards. The manager told us that 12 residents have deposited small sums of money for safekeeping. We checked the balance of money and records for five of the residents. The records detailed money received and returned together with a balance of money held. Both staff and residents sign for any transactions. We found that the balances of monies tallied with the records in all cases. We were told that as part of the visits by line management, auditing of records and money takes place. The home was found to report notifiable incidents to the Commission as required under Regulation 37. Concerning whether the home was managed in the interests of residents we found conflicting evidence. On the one hand, residents meetings are held regularly and we saw that the home had undertaken a quality assurance survey of residents and relatives within this last year. On the other hand, the dissatisfaction of some residents concerning their needs not being met by current staffing levels, does not reflect that the home is run in residents’ interests. We saw the fire log book and found that tests and inspections of the fire safety system were taking place to the required timescales. Maidment Court DS0000004051.V362613.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable 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 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 1 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 3 Maidment Court DS0000004051.V362613.R01.S.doc Version 5.2 Page 27 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 & 12 • Requirement Assessments and care plans must provide sufficient information as to how care is to be delivered to meet the social, health and personal care needs of residents and these must be reviewed monthly. Timescale for action 24/07/08 This requirement is repeated from the inspection of July 2006. Moving and handling plans must be kept up to date and systems in place to ensure that staff abide by these. You are required to ensure that health needs of residents, with particular reference to those being cared for in bed, are met. Risk assessments must be recorded when considering whether a resident can manage their own medication. • Surplus controlled medicines must be returned to the DS0000004051.V362613.R01.S.doc • 2. OP8 12 (1) (a) 24/07/08 3. OP9 13 (4) (b) 24/07/08 4. OP9 13 (2) 24/07/08 Maidment Court Version 5.2 Page 28 5. OP27 18 (1) 6. OP29 Schedule 2 18 (c) 7. OP30 pharmacist. The manager must ensure that medicines prescribed to residents are available through stock control and ordering. You are required to implement the proposed increases in staffing and must monitor whether these levels meet the needs of the residents. You are required to ensure that all requirements of Schedule 2 are complied with when recruiting new members of staff. You are required to ensure that staff receive mandatory training and that their training is kept up to date. • This requirement is repeated from the last key inspection of July 06. 24/07/08 24/07/08 24/07/08 Maidment Court DS0000004051.V362613.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 OP9 Good Practice Recommendations It is recommended that pre-admissions assessments are signed and dated at the time they are completed. It is recommended that: • Creams and prescribed nutrition supplements are signed for as given. • Hand entries written on medication records should be signed and checked by a second member of staff. • Dates are recorded when creams are opened or expire to ensure that they are used with the recommended dates. • Medications prescribed as a variable dosage ‘as required’, should include instruction for staff on when this should be given. It is recommended that when recruiting a manager, a reference should be taken up from a person’s previous position of management. • It is recommended that the staff application form be amended to seek information in line with the Regulations, that the reference be sought from the person’s last place of work of not less than six months duration when working with children or vulnerable adults. The form should also ask about gaps in an employment history or the reasons why a person left a care position It is recommended that staff receive supervision at least bi-monthly. • 3. OP29 4. OP36 Maidment Court DS0000004051.V362613.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Maidment Court DS0000004051.V362613.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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