Inspection on 19/08/08 for Mitchell House

This inspection was carried out on 19th August 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

Mitchell House 11/07/07

Mitchell House 22/06/06

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

CARE HOMES FOR OLDER PEOPLE Mitchell House Mitchell House 2 Mitchell Road Canford Heath Poole Dorset BH17 8US Lead Inspector Gloria Ashwell Unannounced Inspection 19th August 2008 09:55 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 Mitchell House DS0000067219.V369358.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. Mitchell House DS0000067219.V369358.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mitchell House Address Mitchell House 2 Mitchell Road Canford Heath Poole Dorset BH17 8US 01202 681446 01202 852248 manager.mitchellhouse@careuk.com 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) Care UK Community Partnerships Ltd Care Home 50 Category(ies) of Dementia (50) registration, with number of places Mitchell House DS0000067219.V369358.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home providing personal care only- Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Dementia- Code DE The maximum number of service users who can be accommodated is 50. 11 July 2007 Date of last inspection Brief Description of the Service: Mitchell House is a care home accommodating a maximum of 49 older people. Residents admitted for permanent care have dementia; the home has beds available for respite care which may be used to accommodate people with a variety of diagnoses. The home comprises one building on the ground floor, divided into 5 bungalows each containing bedrooms, a kitchenette, communal areas and hygiene facilities. All bedrooms are for single occupancy; all have wash-handbasins but do not have en suite toilets. The home is located at Canford Heath and is within easy reach of Poole town centre. Public transport operates close to the home. The fee range quoted in the service user guide at the time of inspection was £492 to £517 per person per week. Up to date fee information may be obtained from the service. Information regarding the subjects Value for Money and Fair Terms in Contracts can be obtained from the web link: www.oft.gov.uk A report entitled Care Homes in the UK - A Market Study is available on web link http:/www.oft.gov.uk/NR/rdonlyres/5362CA9D-764D-4636-A4B1A65A7AFD347B/0/oft780.pdf Mitchell House DS0000067219.V369358.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. This was a statutory inspection required in accordance with the Care Standards Act 2000. This inspection was unannounced and carried out by two inspectors who arrived at 09:55 on 19 August 2008, toured the premises and spoke to residents, staff, observed staff interaction with residents and the carrying out of routine tasks and together with the deputy manager and other staff discussed and examined documents regarding care provision and management of the home. The duration of the inspection, being the combined total for both inspectors who each took 30 minutes lunch break, amounted to 14 hours. During the inspection, particular residents were ‘case tracked’; for example, for evidence regarding Standards 3, 7 and 8, records relating to the same residents were examined and the residents spoken with. In advance of the inspection an Annual Quality Assurance Questionnaire was completed and returned to the Commission; the information it contained has been used to inform the findings of this inspection. During this inspection compliance with all key standards of the National Minimum Standards was assessed. Immediate Requirements relating to care records and medicine handling were issued during the inspection. The previous key inspection took place on 11 July 2007. A random unannounced inspection took place on 17 July 2008 during which records relating to a resident were removed, subject to ongoing investigation in accordance with protocols for ‘safeguarding vulnerable adults’. The report of the random inspection contained 2 requirements and 4 recommendations; the report is not published but will be made available on request to members of the public or other enquirers. What the service does well: Mitchell House DS0000067219.V369358.R01.S.doc Version 5.2 Page 6 Staff of Mitchell House treat residents with respect, patience and kindness. Contact with family and friends is promoted and there are good links within the local community. Meals are home cooked with a range of fresh produce and a good selection of fruit and sweets are available. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Mitchell House DS0000067219.V369358.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Mitchell House DS0000067219.V369358.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (The home does not provide intermediate care so St 6 does not apply) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The information obtained from pre-admission assessment is not always sufficient to ensure the home will be properly able to meet the needs of the proposed resident. EVIDENCE: The files for three residents who had recently moved into the home were inspected. All contained evidence of pre-admission assessments but the information recorded was frequently minimal and did not include all essential aspects; there may thereby be insufficient and inaccurate details about the needs of the person to enable a plan to be made giving the staff information about how to meet their needs. Mitchell House DS0000067219.V369358.R01.S.doc Version 5.2 Page 9 As more fully described in the ‘Health and Personal Care’ section of this report, the failure to record comprehensive pre-admission details of recently admitted residents resulted in lack of clarity regarding the medicines brought with them at admission and thereby may have placed them at risk of harm. The home writes to prospective residents confirming agreement and ability to accommodate and care for them; the sample letter examined during the inspection was undated – it is recommended that all documents be dated. Mitchell House DS0000067219.V369358.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is insufficient evidence that residents receive the care they need. Associated records and care practices require improvement to ensure staff have sufficient guidance to enable them to properly care for and protect residents from the harm and ill health that unplanned and potentially inappropriate care, risks of cross-infection, and incorrect medicine administration might cause. EVIDENCE: Care records of 5 residents were examined and found to be of generally poor standard, frequently omitting essential information regarding the changing condition of residents. A handwritten notebook not compliant with data protection is used; the details of a number of residents are recorded on the same page. Much of the information contained in the notebook is not reflected in care plans and daily progress records and care plans and there was evidence Mitchell House DS0000067219.V369358.R01.S.doc Version 5.2 Page 11 that the care needs of residents are not reliably met and on occasion are not understood by staff. For example, for one person the notebook described signs of pressure damage to skin, stated that a skin cream was to be used. There was no other record of the condition of the skin relating to pressure, the care plan did not reflect this circumstance and there was no record of progress of this aspect. The notebook stated that there was a resident with a ”dressing on heel leaking and smells offensive” but there was no other record of this circumstance, description of the wound, its treatment and progress. The notebook stated that a resident had a chest infection and a dressing on a heel; these aspects were also stated in daily progress records but not referred to in the care plan and a description of the wound could not be found. The notebook stated that a fall sustained by a resident resulted in injury requiring staff to “place ice pack on it twice a day” but the care plan did not reflect this circumstance and there was no record of progress of this aspect. The notebook stated that a resident may have experienced a stroke; the care plan did not reflect this circumstance and there was no record of progress of this aspect. The care plan of a resident stated that the person has diabetes, but gave no guidance to staff on the condition e.g. any testing required, specific precautions including the likely indications of health deterioration and the action to be taken in such event. The deputy manager stated that pressure mats were routinely used each night to monitor the movements of 27 residents; the home has not recorded associated risk assessments and has not obtained the consent of the residents (or their representatives) for these potential restraints. From examination of records there was evidence that although one resident has recently objected to the use of a mat it remained in place. A resident was observed to have a leg dressing in place. Records stated that a wound this person had was now healed, and the use of a dressing had ceased. No record could be found regarding the current application of a dressing and when staff investigated they confirmed the wound had healed as previously recorded, and they were unable to discover who had applied the dressing, when or why. There home does not assess residents for risks of falls and there was insufficient evidence that all accidents to residents are thoroughly investigated with findings reflected in the care plan, to ensure that future risks are minimised. Mitchell House DS0000067219.V369358.R01.S.doc Version 5.2 Page 12 Staff spoken to stated that they had access to the computerised care records. However the practice observed during the day was that staff used a handover sheet and only senior staff had time to access the computer. This was also borne out by the range of handwritten records examined that failed to provide a consistent audit trail of care needs and provision. An Immediate Requirement for the improvement of care records was issued during the inspection, to ensure staff have sufficient information upon which to base their practice and to provide reliable evidence that the care needs of all residents are properly met. It is also required that risk assessment be recorded for the use of pressure mats, and that a process of consent be developed and implemented, to safeguard against the use of inappropriate and unacceptable restraints. An Immediate Requirement for the improvement of medicine handling was issued during the inspection to safeguard residents from the risks of harm that incorrect administration and poor practices may cause. For medicine handling the home uses a monitored dosage system, whereby most of the medications are stored in blister packs, to simplify the process of administration. Staff trained in this work carry out medicine handling; two of the currently accommodated residents manage their own medicines in accordance with recorded risk assessment. From examination of a sample of Medication Administration Records (MARs) and discussion with the deputy manager there was evidence that on a number of recent occasions medicines have not been properly administered in accordance with the prescriber’s instructions. Some medicines had been omitted for a number of consecutive days because the home had run out of stocks and had failed to promptly obtain replacements. Other medicines had been omitted because the particular residents had been asleep at the time of administration; medicines so omitted included an antibiotic and medication to manage high blood pressure. The practice of frequently omitting prescribed medicines indicates that staff may be unaware of the likely impacts upon residents who do not receive the necessary medicines; the home does not reliably record the reason for each medicine having been prescribed. One resident was prescribed an antibiotic but there was no record of the reason for this prescription and the staff on duty in the home at the time of inspection were unsure of the reason. Mitchell House DS0000067219.V369358.R01.S.doc Version 5.2 Page 13 The failure to comprehensively record pre-admission details including the medicines of some recently admitted residents resulted in the home being unclear regarding the medicines prescribed to these people, which they had brought with them to Mitchell House from their private addresses. On occasion the pharmacy supplying the ‘blister packs’ places all the tablets for administration at the same time in the same blister; in this circumstance staff have signed only once i.e. confirming administration of all tablets by one signature. It is required that a separate signature be made on the Medication Administration Record (MAR) for each medicine, thereby adhering to a reliable process involving checking that all prescribed medicines have been properly administered. During the tour of the home many containers of creams were seen in residents bedrooms; many had no label and no opening or expiry dates recorded to ensure the efficacy and shelf life of the cream. Many bore prescription labels with the name of a person different to the room occupant indicating they were not being used on the person for whom they had been dispensed. This practice must cease; medications must be administered only to persons for whom they have been prescribed and dispensed. There was evidence that Controlled Drugs were reliably checked and properly managed. To improve medicine handling processes it is recommended that all handwritten MAR instructions be signed and dated by the author and countersigned by a person who has checked the accuracy of the record. Mitchell House DS0000067219.V369358.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are few opportunities for the residents to engage in recreational and social activities; in consequence many are likely to become bored, apathetic and restless. Residents are encouraged to maintain contact with the local community and visits by their friends and relatives are welcomed by the home. Meals are appetising and of good quantity and quality but residents do not have sufficient choice of the meals that are provided to them. EVIDENCE: To enable provision of more frequent and varied social and recreational activities to residents the home has recently employed an additional Activities Organiser; the combined total of hours worked by the 2 persons now dedicated to this work is 30 per week. Mitchell House DS0000067219.V369358.R01.S.doc Version 5.2 Page 15 During the morning of inspection a quiz was taking place in a large lounge, but many of the residents present in the room were unable to participate due to their physical and mental frailty. During the afternoon one resident was playing a table game (Connect 4) with the Activities Organiser but for other residents there appeared to be no activity. There was little evidence of ‘best practise’ with particular regard to residents with dementia; there are few opportunities for residents to engage in activities and throughout the day many were asleep, while others restlessly wandered the corridors. This means that people living in the home do not benefit from a person centred approach to meeting their needs and spending their social time. Some relatives were spoken to; they expressed appreciation of the increase in activities although felt that more could be done to encourage socialisation of people sharing similar needs and interests. Staff were kind and friendly in their interactions with residents, but were fully occupied with care-related work and had little, if any, time available to engage residents in social pastimes. Residents select main meals a day in advance from a menu; at the time of serving there is no opportunity for choice because meals arrive in each unit ‘plated’. This process is not suited to persons with dementia; most are unlikely to remember what they have chosen and may prefer to have an alternative meal, when they see what others are having. Menus were not displayed in the various parts of the home so staff encountered difficulties when residents asked them what would be the lunch, because the staff were also unaware. With regard to all aspects of daily life the home is recommended to introduce processes designed to benefit the special needs of the residents in their care. Mitchell House DS0000067219.V369358.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The complaints procedure and the procedure for safeguarding vulnerable adults require improvement to ensure they provide accurate information and that staff have sufficient guidance enabling them to properly protect people in their care. EVIDENCE: The complaints procedure is prominently displayed in the home; it bears outdated and consequently inaccurate contact details of the Commission and should be updated at the earliest opportunity. The Complaints Register indicated that since the last key inspection 4 complaints against the home have been received and investigated. 3 were raised during May, June and July of 2008 and related to the condition of the premises, notably the unpleasant odour, standards of care and medicine handling. On investigation by the provider organisation they were upheld. The fourth complaint, raised during March 2008 also related to the poor condition of the premises, stating that the bedroom had been cold and the resident had not received sufficient care. The deputy manager said the complaint is being investigated by Social Services and a Case Conference is arranged to take place during September 2008. Mitchell House DS0000067219.V369358.R01.S.doc Version 5.2 Page 17 The home has a written policy and procedure for the protection of vulnerable adults, but the document provides incorrect instruction on the reporting and investigation of alleged or suspected abuse, so staff may not have appropriate guidance and may thereby fail to properly protect residents from risks of harm and abuse. However, discussion with the deputy manager confirmed her understanding of the correct procedure. During July 2008 concerns arose involving aspects of safeguarding vulnerable adults relating to standards of care provided to one resident. An investigation led by Social Services is ongoing. Mitchell House DS0000067219.V369358.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 23, 24 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Many parts of the home present an institutional aspect; much of the premises, decoration and furnishings are shabby, outmoded, heavily worn and some areas smell of stale urine. EVIDENCE: Much of the decoration and furnishing has become shabby and many parts of the home look ‘tired’ with damaged paintwork, heavily stained carpets and worn furnishings and equipment, including the pressure relieving cushions upon which many residents sit. Throughout the home is a pervasive and unpleasant odour of stale urine. Mitchell House DS0000067219.V369358.R01.S.doc Version 5.2 Page 19 The ‘smoking room’ smelt strongly of smoke although no resident was using it at the time. Many items including mattresses, cushions, mobile hoists and wheelchairs were stored in the ‘smoking room’ and were thereby likely to retain the odour, in addition to increasing risks of accidental fire, and decreasing the ‘lounge’ aspect of the room. ‘Best practice’ for the accommodation of people with dementia is not evidenced; signage throughout the home is poor and the use of colours has not been employed to assist residents find their way about the home. Standards of infection control are compromised by the presence of many open (i.e. without a lid) waste bins in toilets, bathrooms and communal areas, and by the repeated use (i.e. without laundering after use by each resident) of cloth bath mats. The policy and procedure for handling potentially infected laundry refers to the use of dissolvable bags yet none were available in the home; laundry staff may therefore be exposed to risks of infection when handling contaminated items. A programme of updating and improvement has commenced but more must be done to ensure the comfort of residents by provision of an environment suited to their needs, and the protection of all service users from risks of infection. Mitchell House DS0000067219.V369358.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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. There is insufficient evidence that there are enough staff to meet residents needs. Recruitment and training processes do not reliably ensure staff are able to meet the needs of residents and do not place them at risk of harm. EVIDENCE: During the inspection there was evidence that staffing levels are on occasion insufficient to enable staff to properly meet the needs of residents. In consequence aspects of health and social care are sometimes delayed and residents needs are not met. Staffing numbers do not alter in accordance with the dependency levels of residents; this means that apart from the variation in staffing numbers throughout the 24 hour period, with lower numbers at night, the same number of staff are on duty whether the home is busy or quiet. Staff were observed to be kind and considerate in interactions with residents but they often have insufficient time to spend with individual residents. Particularly at night the home places reliance on the use of monitoring equipment in the form of ‘pressure mats’ placed close to residents beds to alert Mitchell House DS0000067219.V369358.R01.S.doc Version 5.2 Page 21 staff to the movement of the resident when the mat is stepped on. On the date of inspection 27 of these mats were in regular use. During the day residents are frequently bored and restless possibly because they are unoccupied and few staff are available for them to interact with. The provider organisation has recently engaged additional Activity Coordinator hours and intends to engage dedicated laundry staff in order to remove these tasks from care staff. The records of 3 recently employed care staff were examined and found to contain essential information including Criminal Records Bureau (CRB) disclosures obtained in advance of employment. However, full employment history had not been provided by 2 of the applicants and written references did not always include at least one from a previous employer. Records confirmed that of the 48 care staff currently employed by the home, 26 hold a National Vocational Qualification (NVQ) in care so the standard of 50 holding this award is met. From discussion with staff and examination of records there was evidence that not all staff have received training in core subjects, including fire safety, at the desired frequencies. In addition to improving the frequency of training provided to staff the home is recommended to introduce a matrix chart to enable ‘at a glance’ monitoring of the training status of each employee, and to ensure that all staff are sufficiently trained in dementia care to enable them to fully meet the needs of the residents. Mitchell House DS0000067219.V369358.R01.S.doc Version 5.2 Page 22 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. Recent monitoring of the operation of the home by the provider organisation has identified a number of weaknesses described in this report but the longterm weak management of the home means that people who use the service cannot be assured it is run in their best interests and that they are properly protected from harm. EVIDENCE: The registered manager has been on sick leave since January 2008 and has now resigned. The deputy manager said that a replacement manager has Mitchell House DS0000067219.V369358.R01.S.doc Version 5.2 Page 23 been recruited and is soon to commence work in the home, and will in due course apply for registration. During recent months the home has been managed between the Operations Manager and the deputy manager. The provider organisation has ongoing systems for quality assurance and a nominated person from the provider organisation monitors the operation of the home and carries out monthly visits, as required under the Regulations. The most recent visit took place on 15 August 2008 and the associated record shows that a number of weaknesses in care planning and medicine handling were identified for improvement. The home does not act as appointee for any of the residents living at the home. Money held for residents is securely stored and records are kept of all transactions. During the inspection boxes of examination gloves were observed to be in communal areas for use by staff; it is recommended that risk assessment be recorded with regard to the potential of accidental choking if these items are found and misused by confused residents. A number of wheelchairs were seen to be without footplates; the home is recommended to review these items for safety and suitability – the absence of footplates places residents being transported at risk of discomfort, harm and injury. Records are kept of accidents and their investigation; to minimise risks of accident recurrence it is recommended that periodic audit e.g. of time, place, person, activity, be recorded to identify any trends or high aspects of risk. Records indicated that fire safety equipment has been checked and tested at the required frequencies. It is recommended that the fire safety assessment be expanded to include a detailed escape plan including reference to the currently accommodated residents and that staff fire safety training includes periodic drills. In addition, the home should investigate the frequency at which staff have received fire safety training; examination of records indicated that fewer than 50 of staff have received training at the required frequency but from discussion with staff there were indications that the records may be inaccurate and training frequency has been higher. Mitchell House DS0000067219.V369358.R01.S.doc Version 5.2 Page 24 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 1 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Mitchell House DS0000067219.V369358.R01.S.doc Version 5.2 Page 25 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 Timescale for action The registered person shall, after 31/08/08 consultation with the service user, or a representative of the service user, prepare a written plan (‘the service users care plan’) as to how the service users needs in respect of health and welfare are to be met, and shall keep the plan under review. Care plans and other care records must be improved to ensure provision of accurate information to staff to enable them to properly care for residents. Risk assessment must be 01/10/08 recorded for the use of pressure mats, and a process of consent must be developed and implemented, to safeguard against the use of inappropriate and unacceptable restraints. There must be reliable evidence 01/10/08 that the care needs of all residents are properly met. The registered person shall make 22/08/08 arrangements for the recording, handling, safekeeping, safe DS0000067219.V369358.R01.S.doc Version 5.2 Page 26 Requirement 2. OP8 12 & 13 3. 4. OP8 OP9 13 13 (2) Mitchell House administration and disposal of medicines received into the care home. This means that: There must be reliable evidence that residents receive their prescribed medicines. Medications must be administered only to persons for whom they have been prescribed and dispensed. A separate signature must be made on the Medication Administration Record (MAR) for each medicine. Where handwritten entries are made onto medication administration records these must be signed and counter signed, for accuracy, by competent persons. 5. OP19 16 (2) (k) At all times, whenever possible 01/10/08 all parts of the home used by residents must be free from offensive odours and there must be suitable arrangements for the disposal of general and clinical waste. The registered person shall make 01/10/08 suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. 6. OP26 13 (3) Mitchell House DS0000067219.V369358.R01.S.doc Version 5.2 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP3 Good Practice Recommendations Comprehensive assessment of each prospective residents needs and circumstances should be recorded in advance of admission. All documents should be dated. There should be a record of the reason for prescription of each medicine. With regard to all aspects of daily life the home is recommended to introduce processes designed to benefit the special needs of the residents in their care. The policy and procedure for complaints should be updated to provide the correct contact details of the Commission. The policy and procedure for the management of alleged or suspected abuse of vulnerable adults should be amended to ensure that every such concern is promptly reported to the Commission and to the local Social Services office, enabling the latter to direct the investigation in accordance with established protocols for safeguarding vulnerable people. The programme of general improvements to the decorative and furnished condition of the home should be accelerated. A full employment history should be recorded for all employment applicants and whenever possible, written references should include one from the most recent/current employer. The home should improve the frequency of training provided to staff the home and is further recommended to introduce a matrix chart to enable ‘at a glance’ monitoring of the training status of each employee. There should be reliable evidence that all staff receive sufficient training in fire safety, moving and handling, and dementia care. The fire safety risk assessment and plan should identify persons who cannot get out of their rooms without help DS0000067219.V369358.R01.S.doc Version 5.2 Page 28 2. 3. 4. 5. 6. OP7 OP9 OP12 OP16 OP18 7. 8. OP19 OP29 9. OP30 10. 11. OP30 OP38 Mitchell House and describe how they will be evacuated. 12. 13. 14. 15. OP38 OP38 OP38 OP38 There should be reliable evidence of the frequency of staff fire safety training which should include periodic drills. Risk assessment should be recorded with regard to the potential of accidental choking if these items are found and misused by confused residents. There should be reliable evidence that wheelchairs are regularly checked for safety and completeness. Periodic audit should be recorded of all accidents e.g. of time, place, person, activity, to identify any trends or high aspects of risk. Mitchell House DS0000067219.V369358.R01.S.doc Version 5.2 Page 29 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 Mitchell House DS0000067219.V369358.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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