Inspection on 04/04/08 for Miriam Kaplowitch House Care Home

This inspection was carried out on 4th April 2008.

CSCI found this care home to be providing an Adequate 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

Miriam Kaplowitch House Care Home 05/04/07

Miriam Kaplowitch House Care Home 31/01/06

Miriam Kaplowitch House Care Home 16/08/05

Miriam Kaplowitch House Care Home 21/03/05

Miriam Kaplowitch House Care Home 23/12/04

Similar services:

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Byars Care Home

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

CARE HOMES FOR OLDER PEOPLE Miriam Kaplowitch House Care Home 470 Mansfield Road Sherwood Nottingham NG5 2EL Lead Inspector Linda Hirst Unannounced Inspection 4th April 2008 10:45 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 Miriam Kaplowitch House Care Home DS0000002212.V362095.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. Miriam Kaplowitch House Care Home DS0000002212.V362095.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Miriam Kaplowitch House Care Home Address 470 Mansfield Road Sherwood Nottingham NG5 2EL 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) 0115 962 2038 0115 969 2326 mkhouse@tiscali.co.uk Nottingham Jewish Housing Association Limited Maria Elizabeth Baddoo Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Miriam Kaplowitch House Care Home DS0000002212.V362095.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: 2. Code OP The maximum number of service users who can be accommodated is 22 5th April 2007 Date of last inspection Brief Description of the Service: Miriam Kaplowitch House an adapted detached house in a residential area in Mapperley Park. It is registered to accept up to 22 older people and it offers care specifically to the Orthodox Jewish Community and prides itself on providing a culturally appropriate service. The accommodation is over two floors and there is a vertical lift for those who have mobility difficulties, there are three lounges available and a separate dining area. There are two kitchens for the separate preparation of dairy and meat products and Kosher products are used for all meals. The home is situated a ten minute walk away from the shopping areas in Mapperley Park and Sherwood, though people with mobility difficulties may struggle with the hills. Public transport can be accessed easily and the home is on a bus route to the Synagogue in Nottingham City Centre. There is a large well-maintained front garden area, which has some seating and there is a large car park for visitors. The current fees range between £331.44 and £600, this does not include private chiropody, hairdressing, newspapers or taxis. All prospective residents receive a copy of the service user guide. The service tells prospective residents and relatives that they can download a copy of the Miriam Kaplowitch House Care Home DS0000002212.V362095.R01.S.doc Version 5.2 Page 5 latest inspection report on the internet. There is a copy of the report available in the office for people living at the service or they can download a copy and print if in larger print if needed. Miriam Kaplowitch House Care Home DS0000002212.V362095.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The Quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for service users and their views on the service provided. This process considers the provider’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. We have introduced a new way of working with owners and managers. We ask them to fill in a questionnaire about how well their service provides for the needs of the people who live there and how they can and intend to improve their service. We received this back from the manager, and although it was later than we asked for, we had time to use it to help us to plan our visit and to decide what areas to look at. The form was generally well completed although care must be taken to make sure the information is put in the right sections. We also reviewed all of the information we have received about the home since we last visited and we considered this in planning the visit and deciding what areas to look at. We sent out 5 surveys to people living at the home, 4 to relatives and 3 to staff to get their views on the service being provided. We received all five back from residents, most people were very happy with the service being provided, but issues around the availability of staff and the quality of meals were raised as concerns. Comments included, “they are very hard working staff but when they are short staffed things sometimes get left,” and “I know that I am difficult to please, but there is not any taste in the food.” The all said the staff are nice to them. Relatives were very happy with the service and their comments included, “All of the staff go out of their way to make her feel safe and happy. So far as we can see, the provision of care is first-rate,” and, “They are so good that it’s really hard to think of anything they could do better.” The staff survey also said that staffing levels can be a problem, but commented, “The home I work in is a very good home, staff work well together, and I enjoy my job and helping the service user and make their time with us a happy time.” The main method of inspection we use is called ‘case tracking’ which involves us choosing three residents and looking at the quality of the care they receive Miriam Kaplowitch House Care Home DS0000002212.V362095.R01.S.doc Version 5.2 Page 7 by speaking to them, observation, reading their records and asking staff about their needs. One person speaks German as their first language, but all of the residents use English to communicate. The people living at the home are from diverse backgrounds, although they are all Jewish and the staff team come from a wide variety of backgrounds and experiences. We spoke to two members of staff and three residents to form an opinion about the quality of the service being provided to people living at the home. We read documents as part of this visit and medication was inspected to form an opinion about the health and safety of residents at the home. What the service does well: The care plans have lots of information in them about what residents do and don’t like and about their routines and their families. They told us that the staff let them choose how to live their lives and there are no restrictions placed on them. We found that residents’ health care needs are well met at the home and that they get help from other Health professionals when they need it. Residents feel their health is well looked after. The staff are kind to the people living at the service and very respectful, the residents like the staff and tell us they are kind and caring. We found that residents have their religious and cultural needs met well at the service and the residents said this was one of the reasons they chose to live at the home. This is a real strength of the service. We also found that activities are provided which are frequent and varied. The residents also go on outings and some of the people we spoke with said they enjoy their own company and this is respected. Family and friends are welcomed into the home, and they told us that they are pleased with the care being provided at the home. The residents we spoke with know they can complain and how to do this, they feel their concerns would be acted upon. We found the accommodation to be of a high standard, all rooms have en suite facilities and the home is well maintained, homely comfortable and clean. It is a nice place for people to live. We found a high number of staff have already done their National Vocational Qualification Level 2 and the people we spoke with said the staff are very good, know what they are doing and are very caring. Miriam Kaplowitch House Care Home DS0000002212.V362095.R01.S.doc Version 5.2 Page 8 We found that the recruitment checks that are done on staff are thorough and this means that the staff are suitable to work with vulnerable people. We found that the arrangements for handling residents’ money are very safe and the records are clear and very well kept meaning their financial interests are properly protected. What has improved since the last inspection? What they could do better: The manager must make sure that people who come to live at the home have needs which the service are set up to meet to avoid unnecessary moves for residents and to make sure they satisfy our legal requirements. We found that the information staff have about minimising risks could be much better and could offer them clearer guidance. We found that the recording of medication could be better to show what medication residents have taken so staff can be assured they are getting their tablets as their Doctor prescribed. The arrangements for checking that those people who look after their own tablets are safe to do this could be much better to make sure they are getting their tablets when they need them and that others can’t take their medication by mistake. Some of the bedroom doors have glass panels and we found that you could see into the rooms from the corridor which invades the privacy of the residents, these must be blocked off so residents can maintain their dignity. Miriam Kaplowitch House Care Home DS0000002212.V362095.R01.S.doc Version 5.2 Page 9 The residents told us the food is not very good and could be much better, the manager is looking into this once Passover is finished. We found that the manager and owners are not clear about the local safeguarding procedures and have not followed these when incidents have occurred. We found that they do not understand key pieces of legislation which are there to protect people from harm or abuse. They need to get this information so they know how to act and how to protect people if allegations are made. The residents and staff told us that there are not always enough staff on duty and things get missed or they have to wait for help. Some staff and residents told us that the manager has gaps in her knowledge and we think she needs to make sure she works on the areas of concern we have found on our inspection so people live in a safe and well run home. We found that the hoist had not been serviced at the right intervals and that this could result in it not working properly. 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. Miriam Kaplowitch House Care Home DS0000002212.V362095.R01.S.doc Version 5.2 Page 10 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 Miriam Kaplowitch House Care Home DS0000002212.V362095.R01.S.doc Version 5.2 Page 11 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 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents have their needs assessed before admission but they cannot be assured that these can be met as people are being admitted with needs the service is not set up to meet. EVIDENCE: We looked at the initial assessment of the last person to be admitted to the home and found there was a detailed pre admission assessment which the manager completed. The staff and residents we interviewed said that everybody who is admitted to the home is visited to check that their needs can be met at the service. However when we looked at the assessment, it became clear that the resident has mental health needs which the home are not registered for, and which are not specified in the home’s statement of purpose. By admitting people outside Miriam Kaplowitch House Care Home DS0000002212.V362095.R01.S.doc Version 5.2 Page 12 of their registration category the service is failing to comply with their conditions of registration and this is an offence under the Care Standards Act 2000. An application to vary the conditions must be made to us BEFORE any decision is taken about admitting people with mental health or Dementia care needs. Intermediate care is not provided at the home and the standard is not applicable. Miriam Kaplowitch House Care Home DS0000002212.V362095.R01.S.doc Version 5.2 Page 13 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 adequate. This judgement has been made using available evidence including a visit to this service. The health and personal care needs of residents are met at the service in line with their preferences. The arrangements for medication need to improve to make sure that residents receive their medication safely and as prescribed by their Doctor. EVIDENCE: We looked at the care plans for three people and found that these contain clear and detailed information about people’s likes, dislikes and routines along with their personal histories. We saw evidence that people had read their care plans and those we spoke with said this was the case. We found that although the care plans were being reviewed every month, these were not as in depth as they could be. The care staff we spoke with said they know the residents very well and know their needs and moods. They feel they have enough information to guide them on meeting needs. Miriam Kaplowitch House Care Home DS0000002212.V362095.R01.S.doc Version 5.2 Page 14 There is good evidence in care plans and from our interviews with staff and the people living at the home to indicate that health needs are being met. We found that the risk assessments which are used to give guidance on minimising risk were not detailed enough (for example those for people who are at risk of falls.) But when we spoke with one of the people who has frequent falls, they told us, “ I know I have to be careful when I’m walking not to fall.” The staff told us that people living at the service have support from physiotherapists, the Tissue Viability Nurse (who has provided specialist mattresses and cushions) and they told us about the checks they do to make sure people do not develop pressure sores. We looked at the storage of medication and found that this was safe and well managed. When we observed a senior carer giving out medicines we found that she followed best practice guidelines and did this safely. She told us she has had training on giving out medication and said that more is planned. The staff and residents we spoke with all said that the staff wait and make sure people have taken their tablets before leaving them. However, we found that some practices need to improve to make sure that the arrangements for medication are safe and that residents receive their medicines as prescribed by their Doctor. There was evidence of gaps on the Medication Administration Record sheets without an explanation, when we raised this with the manager she was aware of the issue and had a meeting planned to discuss this. We checked and the medication had been given as prescribed but the records were not accurate. We found that the Controlled Drugs were being signed for correctly and that the countdowns tallied with the tablets remaining. However, we found that staff are not giving Controlled Drugs in sequence from the blister pack which could make auditing and checking more difficult. Most significantly we found that the arrangements in place for people to self medicate were not robust enough to maintain the safety of residents. The risk assessment was not comprehensive enough to assess all of the risks that self medicating presents to the person and other residents living at the home. When we spoke to the staff they shared our concerns and said that the person hoards and hides medication making it difficult to determine the exact stock and how many should remain. The staff and manager also told us that the resident does not always use a locked facility to store medication and leaves their door open sometimes. The arrangements need reviewing to make sure they are safe. Our observations and the comments made by residents show that the staff treat residents with dignity and respect. All of the residents described the staff as, “lovely and kind.” One person told us he likes to spend time with his wife and the staff respect their privacy. The staff we interviewed gave us good examples of how they make sure they show respect for the people living at the Miriam Kaplowitch House Care Home DS0000002212.V362095.R01.S.doc Version 5.2 Page 15 home and they showed good levels of awareness about the need to challenge poor practice. (See also comments under OP19). Miriam Kaplowitch House Care Home DS0000002212.V362095.R01.S.doc Version 5.2 Page 16 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 excellent. This judgement has been made using available evidence including a visit to this service. People who live at the service can be assured that their cultural, religious and lifestyle needs and preferences will be met. EVIDENCE: We found that the religious and cultural needs of the residents at the home are well met and this is a real strength of the service. Residents told us that they chose the service as it is specifically for Jewish people, and they can be assured that the diet is correct and that staff understand their festivals and understand their cultural needs. There are specific care plans in place which highlight the rites of passage on death and these offer clear guidance to staff. The staff we spoke with told us that the Rabbi has also given them advice and guidance in these areas. We found that the performance of the service in this area exceeds the National Minimum Standard. Miriam Kaplowitch House Care Home DS0000002212.V362095.R01.S.doc Version 5.2 Page 17 The staff and residents told us that there are activities provided and they can choose whether to join in, one person commented, “I make my own choice when I want to do activities.” We saw some residents having a video afternoon during our visit, and the people we interviewed told us they enjoy reading newspapers, watching current affairs programmes, gardening, playing bridge, visiting relatives and friends and everyone said they enjoy the festival celebrations of Beth Din. The staff told us there are both in house activities and outings arranged for people living at the home. We found the performance of the service in this area exceeds the National Minimum Standard. The staff and residents told us that relatives and friends are welcomed into the home at any time; one person told us their relative visits once a week as, “I told him to, he has his own life and I’m alright here.” All of the people we spoke with told us that they can spend their day as they wish, they said, “there are no restrictions.” The staff told us that they try and promote the independence of residents if this is safe and one person told us, “I like to manage myself. I get up very early as it takes me a long time to get washed and changed and to make my bed, but it is good for me to be independent.” We saw evidence that residents’ meetings are held quarterly and when we looked at the minutes there was clear evidence of consultation taking place with the residents. None of the residents we spoke with like the food, comments included, “it’s not like traditional cooking,” and, “it doesn’t taste right, not like I am used to. They need to change their butcher, the meat is not of good quality.” The staff said they feel the cook really tries hard, and the manager said that the menus would be changed in consultation with residents after Passover. The menus we saw looked varied and nutritious and when we observed lunch one person told us she was enjoying her lunch. The kitchens have segregated areas for dairy and meat preparation and kosher products are used. Miriam Kaplowitch House Care Home DS0000002212.V362095.R01.S.doc Version 5.2 Page 18 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 adequate. This judgement has been made using available evidence including a visit to this service. Service users are able to complain and have their concerns responded to appropriately, but the lack of understanding of the Law, safeguarding procedures and whistleblowing places residents at risk of harm and abuse. EVIDENCE: We saw the complaints procedure for the home displayed in the main entrance. When we looked at the record of complaints, none were recorded and we have not received any directly since our last inspection of the service. None of the residents we spoke with said they have made any complaints, one person told us they would not complain as, “I’m not that sort of person I don’t like to,” others said they would and they thought it would be handled appropriately. The staff we spoke to knew what action needs to be taken when complaints are made, they told us they aim to deal with concerns straight away, though they did say, “residents are more likely to make verbal complaints, they are reluctant to put it in writing.” There has been one incident where staff blew the whistle on poor practice since our last inspection and there have been two safeguarding alerts, one involving verbal abuse and physical abuse, the other involved unexplained fractures. Adult Social Care staff were involved in both incidents. The latter Miriam Kaplowitch House Care Home DS0000002212.V362095.R01.S.doc Version 5.2 Page 19 was inconclusive; the former was the subject of a formal investigation and disciplinary proceedings. We looked at the records of the incidents and found that the manager had undertaken a comprehensive investigation, however there was no records of the disciplinary hearing and the findings need to be shared with us and Health and Social Care staff as soon as possible. We were told that the advice from consultants was not to share information with Adult Social Care staff which is both contrary to the local safeguarding procedure and does not take account of the exemptions in the Data Protection Act 1998 which exist to protect vulnerable adults. Comments from staff indicated that the whistleblowing incident was very poorly managed, and actions were taken that were contrary to the home’s own whistleblowing policy and this has resulted in them losing faith in the system. Although the residents told us they feel safe and well cared for at the service, we found there is an urgent need for the management (including representatives of the providers) to have training on the local safeguarding procedures and to obtain correct information and guidance on Whistleblowing, the Public Disclosure Act 1998, and the exclusions to the Data Protection Act 1998 to ensure they act appropriately to protect the vulnerable people in their care. Miriam Kaplowitch House Care Home DS0000002212.V362095.R01.S.doc Version 5.2 Page 20 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. The home is safe, well maintained and clean and provides the residents with comfortable and homely accommodation. EVIDENCE: We did a partial tour of the accommodation and found that the home is homely, comfortable, clean and tidy in all areas. There are some bedroom doors which have glass panels and these must be covered to ensure the privacy and dignity of the people living at the home. We found evidence that the staff take steps to prevent cross infection and maintain the health and wellbeing of the residents. Miriam Kaplowitch House Care Home DS0000002212.V362095.R01.S.doc Version 5.2 Page 21 The residents we spoke with said they like their rooms, and the staff said they work hard to keep the home clean, tidy and fresh. The quality of the accommodation is very good, all bedrooms have en suite facilities and several are above the minimum standard in terms of space available. Miriam Kaplowitch House Care Home DS0000002212.V362095.R01.S.doc Version 5.2 Page 22 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 adequate. This judgement has been made using available evidence including a visit to this service. The home is staffed by competent, trained and caring staff but the staffing levels do not enable the holistic needs of residents to be met. EVIDENCE: Two of the residents we spoke with said there are not enough staff around, comments included, “I sometimes have to wait, but they are so busy I don’t like to bother them so I manage myself,” “the staff are lovely, very kind, very hardworking, but there are not enough of them, sometimes people ring in sick at short notice and it’s hard for the staff.” This was echoed in our resident surveys. The staff we interviewed said it is possible to do the work with two staff on a shift, but they said that “what goes is being able to take our time with residents or to chat to them,” they feel it affects the quality of life of the residents. We looked at the rota and found that shifts are mostly covered by a senior carer and two care staff, though sometimes there are only two staff on a shift. The manager explained that this was caused by staff having to take annual leave before the year end. Miriam Kaplowitch House Care Home DS0000002212.V362095.R01.S.doc Version 5.2 Page 23 The Annual Quality Assurance Assessment from the manager indicates that the service has over the suggested 50 of care staff trained to National Vocational Qualification Level 2, and the two staff we spoke with had both achieved the qualification. This exceeds the National Minimum Standard. The training records show that staff have undertaken training on Basic Food Hygiene, Health and Safety, Infection Control, Moving and Handling, safeguarding training. Fire training and Dementia care. The staff we interviewed confirmed they have done these courses. One staff member commented in a survey that the manager should, “make sure all staff have training for individual residents with bipolar, depression etc. We should go on more courses that help the service user and for the staff to understand their needs more and about their medical condition so all staff understand the service user better.” (See also OP3). The residents told us the staff are very good at their jobs. The staff we spoke with told us they had supplied all of the information and documentation to prove they are suitable to work with vulnerable people and the records we saw proved that this is the case. There was one file with no evidence of a Criminal Records Bureau check but the umbrella agency was able to bring in the reference number and the date on which the check was done before the inspection ended. One staff member told us in a survey, “this is a very good home, staff work well together, I enjoy my job and helping the service user and make their time with us a happy time.” Miriam Kaplowitch House Care Home DS0000002212.V362095.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, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management of the home needs to improve to make sure that our concerns are addressed and the service runs in the best interests of the people who live there. EVIDENCE: The surveys that relatives completed indicated they feel the home is well run, one said, “the business-side is also extremely well-run.” Two of the residents we spoke with agreed with these comments and said the manager was a “lovely person.” However, one resident and two staff felt differently, commenting, “she is very nice but not a manager, she does not seem like the Miriam Kaplowitch House Care Home DS0000002212.V362095.R01.S.doc Version 5.2 Page 25 old manager who was very hands on,” and, “she is not always sure of how to do things as she has not worked in a home before.” Staff feel there are gaps in her knowledge around safeguarding and medication. We have some concerns about the knowledge base of the manager around the responsibilities which come with being the registered manager and the responsible individual (see OP3, OP9, OP18, OP27.) These issues must be addressed to ensure the service runs in the best interests of the people who live there. Quality Assurance questionnaires have gone out to residents and feedback so far has been that the accommodation is good; the food needs improving (need a new butcher.) One person wants the manager to adopt a firm attitude. The ones for relatives and staff have not gone out yet. We looked at the arrangements for supporting residents with their finances. Residents’ valuables and money are stored safely and we found the records are well maintained. All of the balances held were correct and tallied with records. One relative commented in a survey that, “all financial transactions are recorded clearly, openly and efficiently.” The staff we interviewed told us they have no input with residents’ finances and all of the residents we spoke with either manage their own money or have a solicitor to help them. The information the manager gave us on the Annual Quality Assurance Audit indicates that all tests and servicing on equipment has been done at the correct intervals. The hoist servicing is due now and the manager needs to arrange this as soon as possible. The staff we spoke with said they have enough equipment and they feel their Health and Safety is properly protected. Miriam Kaplowitch House Care Home DS0000002212.V362095.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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Miriam Kaplowitch House Care Home DS0000002212.V362095.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No 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 *RQN Regulation Section 24 Care Standards Act 2000 Requirement You must not admit people to the home whose needs are not reflected by the registration categories and the content of your statement of purpose in order to ensure their assessed needs can be met. You must ensure that accurate records are maintained in respect of medication given to show that residents have been given their medication as prescribed. You must make sure that residents are safe to self medicate by: • Undertaking a robust assessment of all of the risks to the resident and others by the failure to self medicate safely. • By having an accurate picture of the medication the person holds and making sure this stock is not excessive. • By making sure the medication is stored safely so other residents could not accidentally ingest it. DS0000002212.V362095.R01.S.doc Timescale for action 30/05/08 2. OP9 17(1)(a), Sch 3(3)(i) 15/05/08 3. OP9 13(2) 30/05/08 Miriam Kaplowitch House Care Home Version 5.2 Page 28 4. OP10 12(4)(i) 5. OP18 6. OP18 17(2), Sch 4(6)(f), Section 31(1) Care Standards Act 2000 13(6) By ensuring you have systems in place to check whether the medication is being taken as prescribed. You must cover the glass panels on bedroom doors to preserve the privacy and dignity of the residents. You must provide us and Adult Social Care with a copy of the minutes of the disciplinary hearing you held regarding the safeguarding issue and arrange for a copy to be held at the service. Representatives of the providers and the manager must have safeguarding training. You must also obtain correct information and guidance on Whistleblowing, The Public Disclosure Act 1998 and the exclusions to the Data Protection Act 1998 to make sure you are aware of your obligations to protect the people in your care. You must review the dependency needs of your residents and show us how your staffing levels meet the holistic needs of the residents. You must provide appropriate training for the staff on the mental health needs of the people using your service so they can understand and support them appropriately. You must address the areas of concern about the management of the service to make sure the service is run in the best interests of the residents. You must make sure the hoist is serviced every 6 months. • 30/05/08 15/05/08 05/07/08 7. OP27 18(1)(a) 30/05/08 8. OP30 18(1)(c)(i ) 05/07/08 9. OP31 10(1) 05/07/08 10. OP38 23(2)(c) 15/05/08 Miriam Kaplowitch House Care Home DS0000002212.V362095.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. 3. Refer to Standard OP7 OP8 OP9 Good Practice Recommendations Reviews of care plans should be more detailed to evidence that they reflect the needs of residents and are up to date. Risk assessments should be more detailed and clearly highlight the action taken to minimise the risk of harm to residents. You should make sure that staff administer Controlled drugs in sequence from the blister packs to enable easy checks on whether these have been given as prescribed to residents. You should take steps to improve the quality of the catering so that residents’ appetite, health and wellbeing are maintained. 4. OP15 Miriam Kaplowitch House Care Home DS0000002212.V362095.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 Miriam Kaplowitch House Care Home DS0000002212.V362095.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. 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