Inspection on 08/06/05 for Miranda House Nursing Home

This inspection was carried out on 8th June 2005.

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.

Other inspections for this house

Miranda House Nursing Home 29/07/10

Miranda House Nursing Home 25/03/10

Miranda House Nursing Home 06/04/09

Miranda House Nursing Home 06/10/08

Miranda House Nursing Home 24/09/07

Miranda House Nursing Home 15/09/06

Miranda House Nursing Home 24/02/06

Miranda House Nursing Home 01/02/05

Miranda House Nursing Home 21/06/04

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

CARE HOMES FOR OLDER PEOPLE Miranda House High Street Wootton Bassett Wiltshire SN4 7AB Lead Inspector Tim Goadby Unannounced 8th & 21st June 2005 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 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. Miranda House D51_S15930_MIRANDAHOUSE_v179308_080605_Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Miranda House Address High Street Wootton Bassett Wiltshire SN4 7AH 01793 854458 01793 953951 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Quality Care (Wiltshire) Limited Mrs Gillian Gray Nursing Home 43 Category(ies) of DE Dementia (43) registration, with number DE (E) Dementia - over 65 (43) of places MD Mental Disorder (43) MD(E) Mental Disorder - over 65 (43) Miranda House D51_S15930_MIRANDAHOUSE_v179308_080605_Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. No more than 2 persons not less than 50 years in receipt of day care at any one time. 2. No more than 43 persons not less than 45 years of age with a mental disorder 3. No more than 43 persons not less than 45 years with dementia Date of last inspection 1st February 2005 Brief Description of the Service: Miranda House provides care with nursing, and accommodation, for up to 43 adults. These may be people with dementia, or other mental health problems. The home’s registration conditions enable it to offer a place to anyone over the age of 45. But the majority of service users tend to be older people. The home is therefore inspected using the standards for this group. The service is also able to offer 2 day care places for people, aged 50 and over. The home is operated by a private company, Quality Care (Wiltshire) Limited. The responsible individual is Mr Peter Saunders. He lives locally, and has regular contact with the service. The registered manager is Mrs Gill Gray. The home is in Wootton Bassett, near Swindon, Wiltshire. It opened in July 1996. The purpose built accommodation spreads over 2 floors, with a passenger lift between them. Most bedrooms have en-suite facilities. 3 double rooms are available. The rest are singles. Externally, there is a pleasant, accessible garden. The service also offers adequate parking spaces. Work is underway on the construction of extensions on either side of the existing building. The intention is to increase the service user places in the home to around 65. This will require a further application to the CSCI. Miranda House D51_S15930_MIRANDAHOUSE_v179308_080605_Stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place in June 2005. The lead inspector was accompanied for part of the first visit, on 8th June, by the pharmacist inspector, who checked medication systems and practice. The lead inspector returned by appointment on 21st June to meet with the registered manager, to conclude this inspection process. A total of 8 hours were spent in the home. The following inspection methods have been used in the production of this report: indirect observation; sampling of records, with case tracking; sampling activities; discussions with service users, staff and management; tour of the premises. What the service does well: What has improved since the last inspection? Major building work has commenced on site, to construct 2 new extensions, one at either end of the property. Disruption to the existing service has been kept to a minimum. Attention has also been given to some necessary areas of repair and redecoration within the home. Miranda House D51_S15930_MIRANDAHOUSE_v179308_080605_Stage4.doc Version 1.30 Page 6 A physiotherapist has been appointed to give relevant input to those service users who will benefit from this. What they could do better: A number of significant concerns were identified at this inspection, and from other issues reported around the same time. The home will need to demonstrate that appropriate and timely action is taken to address these serious deficits. Miranda House provides care for a service user group who are likely to present with some problematic needs, due to their behaviour and mental state. The home was failing to demonstrate in records that all such needs are properly planned for and managed. In particular, there was evidence that measures for the control of behaviour, including physical interventions, are being applied without any suitable framework in place. There must be clear general procedures and individual guidelines for any use of such restrictive approaches. Management strategies must be devised with input from all relevant parties, and must be kept under regular review. Staff developing and practising such interventions must be appropriately trained. All significant events must be recorded and reported, which includes notification of the CSCI and other agencies when required. Failure to address all of these measures places service users at significant risk of harm. There were also serious failings in recruitment practices. A requirement for all new employees to have been satisfactorily checked against the national list of people deemed unsuitable to work with vulnerable adults remained unmet from the previous inspection. It was also found that all care and nursing staff in post, with the exception of the registered manager, have not had criminal record checks carried out at the required level. The views of service users about their own care need to be given greater importance. Where possible, they should be involved in planning this. When people are clearly unhappy with the way in which their needs are managed, much greater attention must be given to demonstrating that these strategies are appropriate. And when individuals complain about the actions of staff, all such concerns must be followed up effectively. This again includes the need to involve the CSCI and other agencies. Care plan and review systems need attention to ensure that records provide updated evidence when there are changes in needs. When particular issues have been identified, there must be evidence of how these are being monitored. Fire safety measures showed some deficits. The use of bed sides also needs to be appropriately supported with evidence of risk assessment, and consent. Miranda House D51_S15930_MIRANDAHOUSE_v179308_080605_Stage4.doc Version 1.30 Page 7 The provision of bath and shower facilities for the home is below the ratios now required for new registrations. This problem was heightened during this inspection, because an adapted bath that normally receives much use was out of action. Alongside the proposed increase in service user numbers, and therefore the required number of baths and showers, it would be sensible to review the overall suitability of the home’s facilities in this area. 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. Miranda House D51_S15930_MIRANDAHOUSE_v179308_080605_Stage4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Miranda House D51_S15930_MIRANDAHOUSE_v179308_080605_Stage4.doc Version 1.30 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 & 4 Service users have their needs assessed before they move into the home. The home is failing to demonstrate that all current service users’ needs are appropriately met. This places some individuals at risk. EVIDENCE: Initial assessment of prospective service users takes place before admission. This continues over the period when somebody first moves in. Beyond this, there is ongoing monitoring. People are assessed by senior staff of the home. Relevant input is also obtained from the user, where possible, their family or carers, and any professionals who have been involved. Mostly people will be visited in their present setting. This might be their own home, or a hospital or other care home. If people are transferring from another part of the country, then assessment might have to be done through telephone discussions. Miranda House D51_S15930_MIRANDAHOUSE_v179308_080605_Stage4.doc Version 1.30 Page 10 Miranda House provides for service users with dementia, or other mental health problems, who are over the age of 45. The majority of service users tend to be older people. People at the younger end of the home’s age range, perhaps with early onset of dementia, are likely to have other significant needs. For instance, many of the user group may also have associated physical health difficulties. Various adaptations and equipment are in place, to make the environment suitable for service users. There are also certain security arrangements, to assist with promoting safety. Miranda House has qualified nursing staff on duty at all times. Nurses work alongside carers. The service also has links with other local health professionals. Where people’s needs change significantly, decisions about whether placement at the home can continue are made in consultation with all concerned. The nature of the service group cared for at this home mean that periods of disturbed behaviour and mental state can be anticipated. Certain controls and restrictions may need to form part of the agreed overall care approach, to manage such needs safely and effectively. But not all such topics were being suitably addressed in the records sampled at this inspection. This issue is discussed in more detail elsewhere within this report. Miranda House D51_S15930_MIRANDAHOUSE_v179308_080605_Stage4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 & 10 Service users’ care plans are in place, and systems ensure that they are kept under regular review. Review is not always evidenced promptly, in response to changing needs, which creates the risk that some service users may not receive appropriate care. Service users with significant needs associated with behaviour and mental state do not have these clearly and effectively planned for. This places their safety and welfare at risk. The system of medication handling is generally good, but care needs to be taken with records, to ensure clarity. Service users were observed to be treated respectfully, and their privacy was upheld. EVIDENCE: Miranda House D51_S15930_MIRANDAHOUSE_v179308_080605_Stage4.doc Version 1.30 Page 12 There is a primary nurse for each of the 4 areas in the home. They have lead responsibility for the care plans of the service users in that part. Standard practice is to denote in records that people have been unable to contribute to planning their own care, due to their reduced mental capacity. This should be kept under review, as it is not necessarily always true of all individuals. There are template care plans for some common areas. The relevant individual details can be entered into these. They are also expanded with further information, where necessary. Beyond this, for each service user more specific care plans are also devised, as indicated. Related risk assessments may also be put in place. Sampled care plans and associated records showed that not all key needs are being effectively planned for and supported. For example, one person was presenting with difficulties when their behaviour produced clear personal care needs, but they were resistant to allowing staff to intervene. No suitable guidance was in place for this dilemma. Records showed that potential harm to the person was arising when staff attempted to give support. People’s rights of access to care plans are set out in the home’s policy. This includes information about the arrangements if it is a service user’s representative who wishes to see the documentation. Arrangements are in place for the regular review of care plans. Examples were seen of this system working well. Some care is needed to ensure that the frequency of review is clearly shown in the record. In some cases review had not been documented clearly in response to particular changes in needs. For example, issues regarding medication and diet for a service user recently discharged from hospital were reported verbally by nursing staff, but were not reflected in the written record. Records also need to show that needs identified in care plans are being monitored. One person had guidelines in place due to concerns about them eating sufficient at mealtimes. But the record then had no information to show whether or not this issue was being followed up, or with what effect. Miranda House has input from a local GP, and a consultant psychiatrist. Other sources of health advice are accessed as necessary. People’s placement in the home arises because of mental health needs. But most users also tend to have significant physical health needs. A physiotherapist had recently been appointed to give input to those people who would benefit from some rehabilitative work. Medicines are all kept securely and records completed. 2 entries in the record had been amended by correction fluid; this means that the original entry cannot be read. A new system is in place for the collection of waste Miranda House D51_S15930_MIRANDAHOUSE_v179308_080605_Stage4.doc Version 1.30 Page 13 medication, and there was evidence of consultation with residents’ GPs to enable compliance with medication. On one floor the medication round is conducted with a trolley. This practice should be extended to the other floor, particularly in light of the home’s planned increase in beds. Arrangements for privacy and dignity are set out in Miranda House’s policies. There is a stated commitment to upholding people’s rights in this area. Intimate personal care can be provided by people of the same gender. All service users at Miranda House tend to have high support needs in this area. There are 3 shared rooms, which have screens available to maintain privacy. However, they do offer relatively limited floor space. The extension now under construction will create additional service user rooms. But it is likely that a couple of shared rooms will be retained, as occasionally some people prefer this option. Miranda House D51_S15930_MIRANDAHOUSE_v179308_080605_Stage4.doc Version 1.30 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 & 13 Service users are provided with opportunities to undertake activities in line with their preferences and capacities. Service users are able to maintain contact with family and friends. EVIDENCE: Miranda House has taken substantial steps towards developing practice in the provision of activities. One staff member leads on this topic. Other staff also help out at times, as do some voluntary helpers. At this inspection, staff on the first floor were encouraging a group of service users in the lounge to participate with singing along and moving to recorded music. A positive response was gained from some individuals. Downstairs, a set room is used for activity sessions with small groups of more able and active people. An art and craft session was observed taking place. It was also reported that small groups are being escorted to access community opportunities, such as shopping, going to the pub, or trips to the theatre. Information about people’s life history, and preferred activities and hobbies, forms part of their care records. This helps with identifying things likely to be Miranda House D51_S15930_MIRANDAHOUSE_v179308_080605_Stage4.doc Version 1.30 Page 15 of interest to them. Records are kept of the activities offered, and people’s engagement with them. Visitors are welcome at any reasonable time. Service users can receive guests either in their own rooms, or in communal areas. As at previous inspections, it was seen that people are regularly coming in to visit residents. Miranda House D51_S15930_MIRANDAHOUSE_v179308_080605_Stage4.doc Version 1.30 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 Service users’ complaints had not all been followed through appropriately, so they could not be confident that their concerns would be taken seriously. Service users were placed at risk of abuse, due to a lack of effective planning for management of needs associated with behaviour and mental state. EVIDENCE: There is a complaints procedure in place. This is on display in the main entrance hallway of the home. It is also incorporated into the Service User Guide. Contact details for the CSCI are included. Sampled records showed that at least 1 service user had made complaints against staff members, associated with a dislike of the way in which their behaviour had been managed. The complaints had not been notified to the CSCI, as required. Nor did they appear to have been followed up effectively, either by the home’s own procedures, or by other avenues. The home supports some people who may present with episodes of disturbed behaviour. Sampled records showed that staff may practice various control measures in response. This had included the use of physical interventions, such as removing people from one room to another, or holding hands and arms whilst giving personal care. Records made clear in some cases that the actions taken were against the expressed wishes of the service user, and for the benefit of others rather than the individual themselves. No suitable care plan or risk management guidelines were in place for the people concerned. Miranda House D51_S15930_MIRANDAHOUSE_v179308_080605_Stage4.doc Version 1.30 Page 17 So the home was unable to demonstrate that all relevant ethical and legal considerations were being addressed. Miranda House D51_S15930_MIRANDAHOUSE_v179308_080605_Stage4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21 & 26 Service users live in a safe, well maintained environment, which is kept to appropriate standards of cleanliness and hygiene. Service users’ access to suitable bath and shower facilities is limited, due to the lack of suitability of some of the present rooms. The temporary failure of an adapted bath was adding to this problem. Steps should be taken to ensure more suitable arrangements in future. EVIDENCE: Miranda House D51_S15930_MIRANDAHOUSE_v179308_080605_Stage4.doc Version 1.30 Page 19 Miranda House is a purpose built care home. Service user accommodation is over 2 floors, served by a lift and stairs. A security lock system is used on the doors to the stairwells and exits, to reduce the risk to any service users who are confused. There is a large garden to the rear of the property, and several off road parking spaces are available at the front. The home has a full time handyman. There is ongoing maintenance and redecoration. Rooms are usually refurbished whilst they are vacant. Work on construction of 2 extensions, on either side of the existing property, was well underway. Disruption to the home was being kept to a minimum. Risk assessments were in place. 2 bedrooms had been taken out of use, and the ground floor dining room had been made slightly smaller. The expected timescale for completion of building work was September or October 2005. As the process of applying to vary the current registration is likely to take some time, the provider was advised to submit this application as soon as possible. There is a need for additional storage space. Items such as wheelchairs and hoists are particularly difficult to find room for at the moment. This leads to some areas of service user accommodation being used inappropriately. For instance, a ground floor bathroom felt to be unsuitable for users has instead become an additional general storage area. Space for storage must not impact on the accommodation for service users. The proposals to extend the home include allocation of a large area for storage. This should help to remedy this problem. Present communal space consists of lounge and dining areas on both floors. The extension to the home will include the provision of more communal space. This will include larger rooms than those currently in use. Miranda House also has a pleasant garden area, which service users enjoy accessing when weather permits. Some of this has been lost to the building work. But the remaining grounds should still provide a valuable resource. The home currently has 4 bathrooms, although effectively only 3 of them are suitable for use. There is also a shower. One of the adapted baths was out of use around the time of this inspection, due to problems with its hoist mechanism. Efforts had been made to repair it between the 2 inspection visits, but the problem remained unresolved at the time of concluding these. The extensions under construction are planned to provide a further 3 assisted bathrooms. A final decision on the exact number of additional service user places to be applied for had not been reached. But care will be needed to ensure that ratios of bath and shower facilities are at the prescribed level. National minimum standards for people aged 65 and over require that new extensions provide a ratio of 1 assisted bath or shower to 8 service users. Miranda House D51_S15930_MIRANDAHOUSE_v179308_080605_Stage4.doc Version 1.30 Page 20 Existing accommodation must continue to provide at least the same number of assisted baths as at 31st March 2002. All current bedrooms except one have en-suite toilets and handbasins. All rooms in the new extension will also have these facilities. The home was clean and tidy in all areas seen, and free of odours. Repair and redecoration of the laundry room had been completed since the previous inspection. Miranda House D51_S15930_MIRANDAHOUSE_v179308_080605_Stage4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 & 30 Staff are provided in suitable numbers to meet the needs of service users. Service users are placed at significant risk by serious deficiencies in the home’s recruitment process. Staff are not fully trained and competent in the planning and use of physical interventions, which places service users at risk of harm. EVIDENCE: Miranda House D51_S15930_MIRANDAHOUSE_v179308_080605_Stage4.doc Version 1.30 Page 22 Miranda House is registered to provide nursing care. This means that a qualified nurse is on duty at all times. Staff are allocated to both of the 2 floors. People will rotate between the 2, so that they get to know all service users. Each shift on each floor is led by a nurse. They are supported by senior carers and other care staff. The division of rooms in the home means that more service users are on the first floor. So there are slightly higher numbers of staff allocated to that area. In the mornings, 2 nurses and 4 or 5 carers are on the first floor. A nurse and 3 carers are on the ground floor. For afternoon shifts, there are 1 nurse and 5 carers on the first floor, with a nurse and 2 carers on the ground floor. Night shifts are covered by waking staff. The majority of these employees work nights only. A nurse and 2 carers are on the first floor, whilst a nurse and a carer work on the ground floor. Staff have assigned responsibilities for particular groups of service users. But they may also be deployed to work in other parts of the home. So they get to know and support all the residents of Miranda House. The home generally enjoys a stable staff team, with low turnover. Any gaps in cover are filled by staff working additional hours, or by relief workers. Agency workers may also be used, if necessary. Serious deficits were identified in relation to staff recruitment. As from April 2002, criminal record checks for all nursing and care staff have had to be carried out at a higher level, known as an Enhanced Disclosure, because of their regular direct contact with vulnerable people. But all such checks at Miranda House, with the exception of those for the registered manager and the provider, have been done at the lesser Standard level. This must be remedied as soon as possible. In addition, new staff have been starting without a satisfactory check of the national list of people deemed unsuitable to work with vulnerable adults. This was an unmet requirement from the previous inspection of February 2005. Miranda House D51_S15930_MIRANDAHOUSE_v179308_080605_Stage4.doc Version 1.30 Page 23 Staff training covers various required areas, such as health and safety topics. Courses have also been attended on issues relevant to the care of service users. Nurses tend to go to certain sessions that are most suited to their roles. They may choose to specialise in particular areas, such as wound care. Carers receive opportunities to progress to a senior level via gaining qualifications. As well as attending training away from Miranda House, there is also lots of work done at the home. Learning packages on certain topics have been purchased. These can include videos which are watched, with tests to follow. Some of the professionals who have contact with the home can also give input. The home has also developed resource and information packs on some relevant topics. New staff receive instruction from more senior colleagues during their induction period. This includes an introduction to working with people who have dementia. Training over the initial 6 weeks, and subsequent 6 months, is linked to national standards for the social care workforce. Individual training records and plans are in place for all staff. Sampled service user records showed that some planned and unplanned physical interventions had been used with certain individuals. There was no evidence that the staff involved had received suitable training in such techniques. This was partly due to a lack of clear frameworks for the use of such significant measures. Relevant training cannot be given if there are no proper guidelines to define its content. This indicated an additional need for further training for senior staff, to assist them in devising and implementing any such interventions appropriately. Miranda House D51_S15930_MIRANDAHOUSE_v179308_080605_Stage4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37 & 38 Recording and reporting systems have failed to safeguard the best interests of some service users. Service users are placed at risk by deficits in the home’s fire safety arrangements. Use of bed sides without appropriate evidence of proper decision processes places the safety and welfare of service users at risk. EVIDENCE: Sampled records, and information from other agencies, produced examples of significant events affecting the safety and welfare of service users. These had not been notified to the CSCI at the time of their occurrence, as is required in Regulations. Such records as did exist regarding the incidents failed to provide clear evidence that the issues arising had been followed up appropriately. Issues appeared to have been addressed in house, rather than being referred Miranda House D51_S15930_MIRANDAHOUSE_v179308_080605_Stage4.doc Version 1.30 Page 25 for consideration under multi-agency adult protection procedures, as is required. Service user records were otherwise generally well maintained. An example was seen in daily notes of the use of a euphemistic and ambiguous term to describe a particular behaviour. This was more precisely described in the person’s care plan. Records relating to fire safety were checked. Staff are now receiving training in this topic at regular intervals. But records indicated that there had been no fire drill for the year so far; the last check of fire fighting equipment had been in December 2004; and the last check of means of escape in January 2005. It was also observed that a chair was placed directly in front of a designated fire exit door in a ground floor corridor. A sampled service user file showed that bed sides were in use for that individual. There was no evidence of an appropriate risk assessment to support this. Documented consent dated from July 2002, and did not appear to have been reviewed since then. The service user had not given consent on their own behalf, although apparently capable of doing so. Miranda House D51_S15930_MIRANDAHOUSE_v179308_080605_Stage4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 x COMPLAINTS AND PROTECTION 2 3 2 x x x x 3 STAFFING Standard No Score 27 3 28 x 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 1 x x x x x x 2 2 Miranda House D51_S15930_MIRANDAHOUSE_v179308_080605_Stage4.doc Version 1.30 Page 27 Yes Are there any outstanding requirements from the last inspection? 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 OP4 Regulation 12(1); 14 Timescale for action The persons registered must Initial demonstrate the homes capacity review to to meet all assessed needs of be individual service users, via an completed initial review of care plans, not later leading to an action plan with than 05/08/05. suitable timescales. Action plan to be produced not later than 19/08/05. There must be evidence that From service user plans are evaluated 21/06/05. and updated as necessary, in response to changing needs. The persons registered must ensure that care plans effectively set out arrangements for supporting needs associated with behaviour and mental state. The persons registered must ensure that all key health needs of service users are monitored, planned for, and reviewed. As per Requirement no. 1 above. From 21/06/05. Requirement 2. OP7 3. OP7 4. OP8 5. OP9 14(2); 15(2); 17(1)(a), Schedule 3(1) 12(1); 15; 17(1)(a), Schedule 3(1)(b) 12(1); 15; 17(1)(a), Schedule 3(1)(b); 3(3)(k) & (m) 13(2) The medication records must be From Page 28 Miranda House D51_S15930_MIRANDAHOUSE_v179308_080605_Stage4.doc Version 1.30 6. OP16 37(1)(g) 7. OP18 12(1); 13(6), (7) & (8); 17(1)(a), Schedule 3(3)(p) & (q) 23(2)(j) & (l) 8. OP19 clear and unambiguous; any alterations must be initialled and dated and made in a way that ensures the original entry is visible. Any allegation of misconduct by any person working at the home must be notified to the CSCI without delay. There must be clear, objective guidelines for staff management of potential disturbed behaviour from service users. In particular, any use of physical interventions must be applied appropriately, to ensure suitable individual approaches. The persons registered must ensure appropriate storage arrangements are available for aids and equipment, avoiding the use of bathrooms. COMMENT: The situation remains as at previous inspections. This area is being addressed within the extension of the home. The first floor bathroom must be reinstated for use. 21/06/05. From 21/06/05. As per Requirement no. 1 above. Not later than 31/03/06. 9. OP21 23(2)(j) 10. OP29 7; 9; 19; Schedule 2 Confirmation to be provided COMMENT: Efforts were ongoing when to resolve this issue around the achieved. time of the inspection. In any case, not later than 22/07/05. From New employees must not commence work in care positions 21/06/05. until a satisfactory result has been received from a POVAFirst check. (Timescale from 01/02/05 not met) COMMENT: Continued failure to address this requirement by the appropriate timescale will lead to further enforcement action. Miranda House D51_S15930_MIRANDAHOUSE_v179308_080605_Stage4.doc Version 1.30 Page 29 11. OP29 7; 9; 19; Schedule 2 All care and nursing staff employed by the home must have CRB Disclosure checks carried out at the Enhanced level. 12. OP30 12(1); 13(6); 18(1)(c) (i) Use of physical interventions with service users must only be carried out by staff who have received appropriate training. 13. OP37 12(1); 13(6); 37(1)(e) 14. 15. OP38 OP38 13(4); 23(4)(b) & (c)(iii) 23(4)(c)(i v) & (v) 12(1), (2) & (3); 13(7) & (8) 16. OP38 Any event in the care home which adversely affects the wellbeing or safety of any service user must be notified to the CSCI without delay. Where issues of adult protection arise, appropriate multi-agency procedures must also be activated. All designated fire exit routes must be kept clear of obstructions. All required fire safety checks must be carried out and recorded at the prescribed frequencies. The persons registered must ensure that documented risk assessments, and written evidence of consent, are in place for any decision about the use of bed sides. Applications to be submitted to the CRB not later than 31/07/05. Training action plan to be provided not later than 31/07/05. From 21/06/05. From 21/06/05. From 21/06/05. To be completed for all service users affected not later than 19/08/05. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Miranda House D51_S15930_MIRANDAHOUSE_v179308_080605_Stage4.doc Version 1.30 Page 30 No. 1. 2. 3. 4. 5. 6. 7. Refer to Standard OP4 OP7 OP7 OP9 OP9 OP21 OP37 Good Practice Recommendations An application for variation of the homes existing registration should be submitted without delay. Review frequencies for care plans should be clearly shown within records. Decisions regarding the capacity of service users to contribute to their own care planning should be kept under review. All additions to the medication administration record should be signed, including attached labels. The procedure for administration of medicines on the downstairs floor should be reviewed. The home should review the appropriateness of the bath and shower facilities provided. The use of ambiguous terminology should be avoided in service user records. Miranda House D51_S15930_MIRANDAHOUSE_v179308_080605_Stage4.doc Version 1.30 Page 31 Commission for Social Care Inspection Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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