Inspection on 30/05/07 for Morecambe Re-enabling Unit

This inspection was carried out on 30th May 2007.

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 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

Morecambe Re-enabling Unit 22/11/07

Morecambe Re-enabling Unit 23/02/06

Morecambe Re-enabling Unit 13/10/05

Morecambe Re-enabling Unit 26/10/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Morecambe Re-enabling Unit 29 Morecambe Road Morecambe Lancashire LA3 3AA Lead Inspector Mrs Joy Howson-Booth Unannounced Inspection 30th May 2007 09:30 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 Morecambe Re-enabling Unit DS0000059653.V334677.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. Morecambe Re-enabling Unit DS0000059653.V334677.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Morecambe Re-enabling Unit Address 29 Morecambe Road Morecambe Lancashire LA3 3AA 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) 01254 420303 Calderdean Ltd Mrs Margaret Smith Care Unit 11 Category(ies) of Old age, not falling within any other category registration, with number (11) of places Morecambe Re-enabling Unit DS0000059653.V334677.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The unit shall at all times employ a suitably qualified and experienced manager who is registered with the National Care Standards Commission The unit is registered to accommodate a maximum of 11 service users to include: Up to 11 service users in the category OP (older persons). Up to 2 service users in the category PD (physical disability) aged 45 years or over. 23rd February 2006 Date of last inspection Brief Description of the Service: The purpose of Morecambe Re-Enabling Unit is to work with older residents discharged from hospital and, with support, return to their own units. A fulltime Manager and a team of staff manage the Unit. Ordinary living facilities are available within the Unit to enable residents to regain their daily living skills. To enable residents to develop the skills and confidence to return unit, the staff at the unit work alongside a variety of professionals, including occupational therapists, physiotherapists, rehabilitation social workers and health visitors. The re-enabling programme normally lasts for a period of one to six weeks but this can be extended to meet the residents’ needs, if required. The Unit is situated in a residential area of Morecambe and is close to the shops and amenities in Torrisholme. It is situated on the main bus route into Morecambe town centre. Residents are encouraged to maintain their links in the community by attending Day Centres and Over 60’s Clubs and recommence their hobbies and interests. Opportunities are provided for them to engage in social activities both insides and outside the Unit. Visitors are made welcome at anytime. The current range of fees are from £399.00 to £399.00 per week. Further details over fees can be obtained from the general manager or manager of the unit. Morecambe Re-enabling Unit DS0000059653.V334677.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first site visit and was unannounced so the registered providers, general manager, manager, staff and people who use the service were not aware of the visit. The site visit was carried out by the inspector for the service and forms part of the overall inspection for the unit which makes sure residents are being cared for properly and to make sure the unit is a safe place for residents to live in. As well as the site visit, judgements have been made about the service based on information supplied by the general manager and the unit’s manager. Comment cards were made available. Unfortunately, no comment cards were received. The site visit took place over two days and included taking time to sit and speak with residents who use the service, speaking with staff and speaking with health and social care professionals. As well as this, a selection of documents were examined. The unit’s manager made herself available during the inspection to answer questions and provide additional information. The inspector looked around parts of the unit, including communal rooms, a small number of personal rooms, bathrooms and toilets to see first hand if the unit was a comfortable, clean and safe for residents to live in. Additional information was also supplied from a pre-inspection questionnaire completed by the general manager. People who use this service are referred to in this inspection report as ‘the residents’. Following the two site visits, a feedback meeting was arranged with the general manager where the findings of the inspection were discussed. The feedback meeting enabled the issues and concerns noted in this inspection to be discussed with the unit’s general manager and current responsible individual who indicated that these would be addressed as a matter of priority. Morecambe Re-enabling Unit DS0000059653.V334677.R01.S.doc Version 5.2 Page 6 What the service does well: The unit’s ethos is that residents are supported to re-learn their skills and confidence to enable them to return home. The service is described as being “dynamic” as all service users have their own individual presenting needs, wishes and circumstances from the point of referral. The unit continues to ensure there is a range of equipment and facilities available which can enable the residents to relearn their skills and preadmission meetings ensure any specific pieces of equipment are in place prior to admission. Staff work alongside with a range of multi-disciplinary professionals (occupational therapists, speech therapist, dietician, G.P.’s, amongst others) to ensure that service users are appropriately supported and encouraged to regain their life skills. Appropriate training is supplied by these professionals to the staff team. Residents spoken with at the site visits were complimentary about the unit and felt it has given them an opportunity to regain their confidence and independence. The service continues its involvement on an arms-length basis to ensure that, on returning unit, residents continue to receive support and input (as required) to ensure they are not “set up to fail”. The environment is generally well maintained and provides a pleasant environment for the residents to live in. Morecambe Re-enabling Unit DS0000059653.V334677.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Care plans we read do not give enough information over the day-to-day needs of the residents or the care provided by staff. Care plans are documents that give information over the needs of each of the individual residents and the care and support the staff need to give. We also found that when individual healthcare needs arise the day-to-day records do not show that staff take the appropriate action or any follow up information. There are no risk assessments on file. Risk assessments make sure that when residents are at risk in a particular area (for example, falling), a plan is put in place so that any risk is made known and reduced. Medications and medication records were looked at and the manager advised that these are not being given as prescribed, nor are the records adequate. Staff are giving out medications without having received any formal training to do so. This means that the staff cannot be confident about giving medications nor can the residents be sure they are getting what their GP has prescribed. From discussions with residents and from comments made, we felt that the food provided is not to a good quality and needs to be reviewed. From looking at the records, it was also felt that it is important to look at the night staffing arrangements so that residents who are in the home can be confident that there is a member of staff available should they need assistance in the night. A number of the mattresses in the home had springs sticking through which means they would be very uncomfortable for residents to sleep on. Whilst some had duvets put on top this is only a temporary measure and mattresses need to be replaced with ones that ensure residents can be comfortable. It was also seen that some areas of the kitchen need cleaning. As well as this, the lid on the overspill freezer must be repaired or replaced. A selection of training records were seen for staff and there was no evidence that staff had received any training in important basic areas, for example, food hygiene, infection control, moving and handling and first aid. This is something that must be provided to ensure residents and staff are kept safe. As well as this, when a new member of staff is to be employed, the manager must make sure that a reference is provided by their last employer. Morecambe Re-enabling Unit DS0000059653.V334677.R01.S.doc Version 5.2 Page 8 The law requires the commission to be told when a serious accident or incident has happened in the unit – at present this is not happening. Some certificates were seen but the certificate to say that all the portable appliances in the unit are safe to be used by the rseidents. The general manager has been asked to forward a copy of this certificate to the commission. The current manager is to submit an application for registration to the commission and this must be done by the end of June 2007. A number of recommendations have also been made at the end of this report. 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. Morecambe Re-enabling Unit DS0000059653.V334677.R01.S.doc Version 5.2 Page 9 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 Morecambe Re-enabling Unit DS0000059653.V334677.R01.S.doc Version 5.2 Page 10 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): Standards 3 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst good assessment information is provided, the service is not ensuring that each resident is consulted about their care, which means they are not receiving a needs-led re-enabling service. EVIDENCE: Three residents files were examined and found to contain a good range of assessment information provided by the social workers on which needs were documented. The three files also had client contracts, although the printing on one was so feint that it was barely readable which means the person may not be able to read what they were signing for. Morecambe Re-enabling Unit DS0000059653.V334677.R01.S.doc Version 5.2 Page 11 Personal property sheets were not completed, although the general manager confirmed these were only used for specialist equipment brought in or provided. Care files did not evidence that residents were being asked information about their own routines, preferences, etc. This is particularly important to ensure that care staff are made aware of any equality and diversity issues that need to be taken into account when providing the service. The residents spoken with could not remember ever being involved in their care plan/goal plan or being asked about what they want to achieve whilst at the unit. Morecambe Re-enabling unit is an intermediate care facility which has previously worked hard to ensure a high quality service. Information gained during this inspection raised concerns about the facilities within the unit and also the skills of the staff team to meet the needs of the residents who use the service. Concerns were raised over : Furniture, specifically the mattresses on beds in the unit Rehabilitation programmes not always being carried out and staff not always ensuring residents are supported to do these Lack of activities in the unit Food provided All the above issues are dealt with within the specific areas of this report – i.e. furniture and mattresses within the Environment section; rehab work within Health and Personal Care; Activities and Food within Daily Life and Activities. Morecambe Re-enabling Unit DS0000059653.V334677.R01.S.doc Version 5.2 Page 12 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): Standards 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care information lacks consistency which means health and personal care needs are not always being met. Medication systems are inadequate and need improving to ensure residents are safeguard. Residents are treated with dignity and respect EVIDENCE: Three care files were examined. The care files are split into different sections covering admission, mobility, daily living skills, personal care, medication and health and a final section for discharge from the unit. The information gained from these was, as follows : Morecambe Re-enabling Unit DS0000059653.V334677.R01.S.doc Version 5.2 Page 13 Concern was raised by healthcare and social care professionals that they felt rehabilitation programme are not always continued as they specify. Care files examined did not evidence daily input for any of the areas outlined above – these and discussions evidenced that there appears to be a lack of knowledge of specific issues. Some daily records for rehabilitation and care input have been made by care staff and other healthcare professionals but these are not consistent and do not enable a picture of care to be built up. On a number of occasions healthcare issues have been noted but there is no evidence these have been followed up or monitored. There are no risk assessments on file, including risk assessments for those residents who self medicate. There are weekly multi-disciplinary meetings held at the unit at which all of the current residents are reviewed. Concern was raised by health and social care professionals that full feedback information is not always provided by the management team. Residents spoken with all confirmed that the staff treated them with dignity and respect. However, recordings of “well done” noted in records should cease as these are patronising to the person concerned and do not help staff to view residents as adults. Medication stocks and records were examined for the resident’s case tracked and a number of anomalies were raised. No medication training has been provided to the staff who administer the medication. The general manager was advised that a referral has been made to a Pharmacist Inspector over the issues raised. Information about changing care needs of the residents in the unit are passed on by the manager during handover at the start of each shift. 9 residents were spoken with and all said that they were very happy with the care provided and felt that the unit were helping them to regain their skills and confidence before going home. Residents spoken with were unaware they had a key worker or who that person was. When asked about bathing, residents said they could have a bath or shower at any time – they only had to ask. Morecambe Re-enabling Unit DS0000059653.V334677.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): Standards 12, 13, 14 and 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents are not able to have a good quality of lifestyle as insufficient activities are provided. Food provided by the unit is inadequate to ensure a nutritious and wholesome diet EVIDENCE: From information recorded on records, the question is raised as to whether the residents who use the service are asked about their own preferred routines and activities. The comment “morning routine explained” and “told about morning and evening routines” appears to indicate that residents are not asked. There is little on the care files about individual preferences, routines, social interests, wishes and aspirations for the residents’ stay at the re-enabling unit, which means staff may not be aware of important issues to do with equality and diversity. However, the manager provided sight of a new information booklet that is to be put in each person’s room, along with information on key workers. Morecambe Re-enabling Unit DS0000059653.V334677.R01.S.doc Version 5.2 Page 15 The admission procedure is to be revised so that staff can ensure information is properly obtained. Whilst there was a notice on the wall about activities, during the two site visits no activities were seen being carried out. Health and social care professionals also raised concern about the lack of activities in the unit. Discussions with residents in the unit confirmed that residents do tend to go to their own rooms in the afternoon and little in the way of activities are organised. A big part of the unit’s ethos is to re-introduce residents into independence and to do this access to the local community is vital. This normally takes the form of walking to the local shops – initially with staff support but, once confidence on both parts is gained, residents are free to walk out as they wish. Often, as part of a rehabilitation programme, walking into the local community is encouraged, again once confidence has been built up. During the site visit, one lady was taken back to her own home for a visit prior to permanently returning home the following week. Other residents confirmed that they go to their local church and shops, with support. Residents spoken with confirmed that there are no restrictions on visiting and friends/relatives can visit at any time. Concern was raised over residents having to go to their own rooms by 10.00 p.m. of an evening as the fire doors are closed. This was discussed with residents who confirmed that it is accepted practice that residents go to their own rooms by 10.00 p.m. and staff encourage them to do so. This was discussed with the general manager who confirmed this is the practice of the unit. The general manager is to ensure that this information is included in information so that residents are made aware of these arrangements. However, it was also recommended that this system be reviewed as residents should be free to use the communal lounges whenever they wish to do so. Records indicated an incident at night time between two residents which was discussed with the general manager who is to remind staff about supporting residents at night. In addition, advice is being sought from the social worker for physical disabilities so that residents have access to a range of facilities/equipment to watch TV, etc., at night without disturbing others. A concern was raised over the meals provided at the unit. To assess this, stocks of food were seen and discussions with the residents also took place. The food stocks and the budget for food was discussed with the General Manager who was informed that the quantity and quality of food available to residents is not adequate to ensure a nutritious and wholesome diet. Comments of residents were also passed on and included - meals are “just okay”; “food is adequate but usually cheap Asda produce”; “we can’t complain as we don’t really do enough to warrant big meals” and “food not too good – Morecambe Re-enabling Unit DS0000059653.V334677.R01.S.doc Version 5.2 Page 16 no fresh veg and no fresh fruit – I only have fresh fruit if my relatives bring some in”. The General Manager confirmed she is to review the provision of food with the manager of the unit and will ensure the issues raised are addressed. Crockery available for residents to use is mismatched and should be replaced. Observations during the site visit also confirmed that there is a need for staff to undertaken food hygiene training. Morecambe Re-enabling Unit DS0000059653.V334677.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents are unclear who to make their views known to. Issues raised in relation to aspects of the unit indicate residents may be at risk. EVIDENCE: No complaints have been received by the unit and the Commission has not received any complaints, although concerns were raised during the site visit by social and healthcare professionals over activities, care plans, food and furniture. The unit has a formal complaints procedure which is contained in the service user guide. Residents spoken with were not aware of the complaints procedure and who they would speak with if they had any concerns. Discussion with staff indicated that any concerns would be passed to the manager of the unit to deal with. They were aware there was a complaints procedure in the unit. Morecambe Re-enabling Unit DS0000059653.V334677.R01.S.doc Version 5.2 Page 18 Both the manager and the assistant manager were unclear about the safeguarding adults protocol in place. The general manager was advised that the safeguarding adults procedure should be reviewed in the unit’s policies and procedures file which can then be made available to the management team for future use. Staff confirmed that abuse awareness has been covered within the National Vocational Qualification training programmes undertaken. During this inspection, concerns were highlighted over the lack of action when medical issues are raised, medication issues and the lack of risk assessments in place which mean residents are not always safeguarded. Morecambe Re-enabling Unit DS0000059653.V334677.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 24 and 26 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Aspects of the environment are poor which mean that the rehabilitation needs of the residents are being compromised. The lack of infection control training and awareness means that the health of the residents is at risk. EVIDENCE: The unit was toured and a number of rooms seen. Generally, the unit is clean and tidy, although some areas needed hovering. The ceiling in room 8 needs attention as it is stained and there may have been a leak. Each resident has their own individual room with its own ensuite facility. Some rooms are looking tired and need refreshing. There were no valences in place on any of the beds. The manager confirmed that redecoration work is Morecambe Re-enabling Unit DS0000059653.V334677.R01.S.doc Version 5.2 Page 20 being planned for some rooms, and a couple of rooms had just had their carpets replaced. Concern was raised over the fire doors being too heavy for some residents to open. As a result, these are being wedged open. The general manager was advised to consult with the fire department over the provision of door release mechanisms, so that fire doors can be open but close when needed so that residents are safe in the event of a fire. However, serious concern is raised over parts of the kitchen, including : Cupboards are dirty inside Both freezers are ice packed The lid on the overspill freezer has come off its hinges and is loose which means there is the potential of food defrosting and then being refrozen unknowingly. The extractor fan above the cooker is full of dirt and dust. Cupboard doors not closing. Concerns have also been raised over the condition and quality of mattresses. To assess this, during the inspection a number of mattresses were seen – at least four mattresses had additional duvets put on top as the springs were sticking through. Healthcare professionals have also raised concerns over the furniture (chairs and beds) in the unit and the general manager confirmed they are currently awaiting advice from these professionals so that appropriate furniture can then be purchased. Lockable facilities are provided in each room, although one bedside cabinet had no key - the manager needs to ensure all rooms have this facility in place. Residents who use the service were spoken with. No major concerns were raised over the cleanliness of the unit. Residents felt their rooms were clean and tidy and confirmed staff do the cleaning on a regular basis. The cleaning schedules were examined and evidenced that staff do ensure that individual rooms and ensuites are cleaned fairly regularly. However, due to the needs of the residents who are now being admitted staff do not appear to be able to undertake both the care tasks and cleaning tasks which result in neither being completed to an satisfactory level. Information supplied by the general manager confirms that there is an infection control policy and procedure in place. However, from discussions with staff and from observations, infection control is something that needs to be addressed with a formal training programme provided. Morecambe Re-enabling Unit DS0000059653.V334677.R01.S.doc Version 5.2 Page 21 Discussions over infection control confirmed that there are a supply of plastic aprons and plastic gloves for use. However, full information and guidance needs to be provided to all staff to ensure infection control in the unit. Morecambe Re-enabling Unit DS0000059653.V334677.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 and 30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Staffing levels and training are not always adequate and may put the residents at risk. EVIDENCE: Information supplied by the general manager and gained at the site visit indicated that five staff left changed employment since the last inspection. One change included the registered manager of the service who was promoted to become the general manager. Two staff files were examined and found to contain the required information outlined in the Regulations. However, one personnel file evidenced three references but could not evidence a reference from their last employer. Advice was given to the general manager regarding this. Both members of staff had the necessary clearances which confirms that they are safe to work with vulnerable adults. From reading the accident book and from talking with staff and residents, the night staffing may need to be reviewed. At present, there is a sleeping in with Morecambe Re-enabling Unit DS0000059653.V334677.R01.S.doc Version 5.2 Page 23 on-call assistance if needed. Records examined indicate that there have been times when residents have needed assistance in the night and, unless they are able to get to their call system, they are not able to summon help. In view of the concerns over the cleanliness of some parts of the unit, there is a need to review ancillary staffing and consider employment of a full-time cleaner. Training files evidenced that the unit’s induction had been carried out but no training in the mandatory areas (moving and handling, first aid, food hygiene, infection control) has been provided, although one member of staff has a first aid certificate. However, information from the general manager confirmed that 50 of staff have been trained to National Vocational Qualification (NVQ) levels II and III. As well as this, fire awareness, speech therapy, physiotherapy and induction training have been provided, with fire awareness update training planned for the future. Staff confirmed that some training had been provided by the Speech and Language Therapist. Other than induction training records, there were no other training or update training records held on staff files. Staff files did, however, evidence training previously undertaken but some of these are out of date and refresher training is needed. Residents spoken with were all very complimentary about the staff and said that they looked after them well. Morecambe Re-enabling Unit DS0000059653.V334677.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): Standards 31, 33, 35, 36 and 38 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The management of the unit is poor which means residents and staff are not being safeguarded. EVIDENCE: The current registered manager for the service has been promoted to the general manager and now oversees both this and the other two services within the company. However, the general manager retains overall responsibility for the service and is the company’s responsible individual. Morecambe Re-enabling Unit DS0000059653.V334677.R01.S.doc Version 5.2 Page 25 The new manager is currently awaiting CRB clearance being received before submitting her formal application for registration with the Commission for Social Care Inspection. Once this has been obtained she confirmed that she intends to submit her application for formal registration as manager. Previously the manager worked as an assistant manager in another care setting and has worked as an assistant manager in this unit for several months. She is currently undertaking the Registered Managers Award and hopes to complete this by the end of July 2007. Discussions with the manager and assistant manager and from findings of the site visits, it was felt that neither have a clear idea of their roles and responsibilities. A number of key management tasks were not evidenced as being carried out, including : There are no staff meetings being held. There is no supervision in place for staff. There is no monitoring of care files/goal plans and comment has been made that the management team do not provide comprehensive feedback at the weekly multi-disciplinary review meetings. No risk assessments are being carried out, despite evidence in the accident book that a number of residents have had serious falls, necessitating admission to A & E. In addition, the general manager was advised that there are a number of occasions when residents have sustained injury, necessitating them being taken to A & E but the Commission have not been notified as required under Regulation 37 of the Care Home Regulations. Issues to do with the administration of medications within the home were noted. The general manager was also advised that, during the tour of the unit, a number of downstairs bedrooms have windows that open wide – these should be risk assessed with a view to providing window restrictors as there is the potential for an intruder to enter the unit. In terms of quality assurance, the general manager undertakes a monthly visit to the unit. The Regulation 26 reports note various areas are inspected. However, it was recommended that the visit should also include a formal meeting with the manager so that all areas can be fully discussed and support given where appropriate. As well as this, the unit has the ISO 9001 Quality Assurance Award. Morecambe Re-enabling Unit DS0000059653.V334677.R01.S.doc Version 5.2 Page 26 Feedback is sought from residents once they leave the unit and this is done via a questionnaire. A number of letters and cards were seen on display with positive comments from ex-residents being noted. The general manager confirmed that policies and procedures are available for staff to read and are reviewed annually. It was advised that the safeguarding adults procedure be reviewed in line with the current protocols in place. No monies are currently being held for residents but there is a system in place to ensure recording and safekeeping. As noted earlier, there is no mandatory training provided to staff. Information supplied by the general manager confirmed that maintenance and safety checks are carried out on equipment and facilities in the unit. The manager confirmed that the unit has a fire risk assessment in place. The general manager also confirmed that update fire safety training is planned. Fire records evidence that both staff and residents are shown the unit’s fire procedure. Other maintenance checks within the unit are not being carried out on a weekly or monthly basis. A current Portable Appliance Test certificate (PATT) was not available at the site visit. The general manager is to confirm this has been carried out within the last year. It was also noted that the unit’s iron and vacuum cleaner were broken. Discussions with the manager confirmed that a new iron and vacuum cleaner were purchased for the unit from a donation made by a family. It is of concern that a donation is being used to purchase essential equipment that should be provided by the unit’s owners. This was discussed with the general manager who was advised it would be good practice to reimburse the cost to the residents’ fund so that something for the residents to use specifically can be purchased with the donation made. Morecambe Re-enabling Unit DS0000059653.V334677.R01.S.doc Version 5.2 Page 27 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 UNIT 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 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X 2 X 1 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 3 1 X 1 Morecambe Re-enabling Unit DS0000059653.V334677.R01.S.doc Version 5.2 Page 28 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 Units Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement The care plans must provide details of the residents’ needs and how these are to be met by staff When healthcare needs are highlighted the care records must evidence how these are being met Risk assessments must be carried out for residents, including risk assessments for anyone who wishes to self medicate Medications must be administered as prescribed and an accurate record made of administration. Staff who administer medications must be provided with formal training to do so Food provided must be reviewed to ensure meals are nutritious and wholesome and are provided in adequate quantities Night staffing must be reviewed to ensure that residents needs are met Mattresses must be replaced with ones that ensure residents’ DS0000059653.V334677.R01.S.doc Timescale for action 30/06/07 2. OP8 13(1)(b) 30/06/07 3. OP38 13(6) 30/06/07 4. OP9 13(2) 08/06/07 5. 6. OP9 OP15 18(1)(c)(i ) 16(2)(i) 31/07/07 30/06/07 7. 8. OP27 OP24 18 16(2)(c) 30/06/07 30/06/07 Morecambe Re-enabling Unit Version 5.2 Page 29 9. OP26 18(1)(c)(i ) 23(2)(d) 10. OP26 comfort Training in food hygiene, moving and handling, infection control and first aid must be provided to staff Cleaning must take place of the following areas : Kitchen cupboards Both freezers The extractor fan above the cooker In addition, the lid on the overspill freezer must be replaced 31/07/07 30/06/07 11. OP31 8 12. OP38 37 An application for registration with the Commission for Social Care Inspection must be submitted by the current manager The Commission for Social Care Inspection must be notified within 24 hours of any serious incident or accident as outlined in this regulation. The commission must be notified of all serious accidents, incidents that have taken place since July 2006. References must be obtained from any prospective employees last employer Confirmation must be sent to the Commission that the unit has a current Portable Appliance Test certificate in place 30/06/07 08/06/07 13. 14. OP29 OP38 19(1)(b) 23(2)(c) 08/06/07 30/06/07 Morecambe Re-enabling Unit DS0000059653.V334677.R01.S.doc Version 5.2 Page 30 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. 4. 5. 6. 7. 8. Refer to Standard OP7 OP12 OP16 OP18 OP27 OP36 OP38 OP31 Good Practice Recommendations Care plans should evidence individual routines and preferences to ensure the service is needs-led Activities should be developed within the unit and match the interests, skills and abilities of the current occupants A copy of the complaints procedure should be made available to all residents The unit’s safeguarding adults procedure should be updated to reflect current protocols A system so that residents who are not able to get to the remote alarm call box (i.e. if they have fallen) are able to summon assistance should be looked into Staff should receive formal supervision at least 6 times a year and this should be recorded Accident records should be completed thoroughly and correction fluid should not be used A formal monthly or weekly meeting should take place between the general manager and the unit’s manager to provide support and an opportunity to plan and review the service Recordings of “well done” noted in records should cease as these are patronising to the person concerned and do not help staff to view residents as adults. Consideration should be given to the employment of a cleaner or additional care hours provided to ensure the unit is given thorough cleaning Crockery available for residents to use is mismatched and should be replaced. The daily routine of the home should be reviewed as residents should be free to use communal areas at any time, including after 10.00 p.m. if needed. The general manager was advised to consult with the fire department over the provision of door release mechanisms, so that fire doors can be open to allow access but closed when needed so that residents are safe in the event of a fire Attention should be given to the kitchen cupboard doors so that they close DS0000059653.V334677.R01.S.doc Version 5.2 Page 31 9. 10. 11. 12. 13. OP10 OP27 OP15 OP12 OP38 14. OP38 Morecambe Re-enabling Unit 15. OP35 It is advised that money used from a recent donation to the unit to purchase an iron and a vacuum cleaner for use in the unit should be reimbursed to the residents’’ fund Morecambe Re-enabling Unit DS0000059653.V334677.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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 Morecambe Re-enabling Unit DS0000059653.V334677.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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