Inspection on 19/05/08 for Musmajas

This inspection was carried out on 19th May 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

Musmajas 06/10/08

Musmajas 05/11/07

Musmajas 11/09/06

Musmajas 21/03/06

Musmajas 13/07/05

Musmajas 11/08/04

Musmajas 17/05/04

Musmajas 27/08/03

Musmajas 17/06/03

Musmajas 29/08/02

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

CARE HOMES FOR OLDER PEOPLE Musmajas Priory Hall Wolston Nr Coventry West Midlands CV8 3FZ Lead Inspector Deborah Shelton Unannounced Inspection 19th May 2008 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 Musmajas DS0000004256.V364837.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. Musmajas DS0000004256.V364837.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Musmajas Address Priory Hall Wolston Nr Coventry West Midlands CV8 3FZ 02476 542701 02476 542737 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) Latvian Welfare Fund, Manager post vacant Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Musmajas DS0000004256.V364837.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th November 2007 Brief Description of the Service: Musmajas is a care home set in its own grounds approximately 1 mile from the village of Wolston. The property is owned by the Latvian Welfare Society and was developed into a care home to serve the Latvian community in the Midlands. The home can accommodate up to 18 service users in single room accommodation. Accommodation is sited in the large manor house and surrounding bungalows. Musmajas provides personal care to frail elderly people most of whom originate from Latvia. The home’s staff consists of English and Latvian speaking carers who can also converse in English. No intermediate or specialist care is offered at this home. Medical services are provided by the local GP practice. Musmajas DS0000004256.V364837.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. The focus of inspections undertaken by us is upon outcomes for people who live in the home and obtaining their views of the service provided. This process considers the homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. The following information in this report is the findings of an unannounced inspection visit that took place on Monday 19 May 2008. Eighteen people were living at Musmajas at the time of the visit. Three residents were ‘case tracked’, this involves finding out about their experience of living in the care home by meeting with them, or observing them, talking to them and their families (where possible). Looking at their care files, and discussing their care with staff and relatives. The environment in which they live is looked at and staff training records are reviewed to ensure training is provided to meet resident’s needs. During the inspection, the acting manager was on duty along with the three care assistants, a cleaner and the cook. A review of policies and procedures, discussions with the acting manager, staff and residents was undertaken. Other records examined included, care, staff recruitment, training, staff duty rotas, and health and safety and medication records. Notification of incidents received by us from the Home and any other information received are also included in this report where appropriate. The inspection process enabled the inspector to see residents in their usual surroundings and see the interaction between staff and residents. What the service does well: The acting manager had a good relationship with those under her care, residents appeared to be at ease in her company, chatting and joking with her. Bedrooms are large, bright and airy. These rooms had been personalised and had a homely and welcoming feel. The gardens at Musmajas are large and well looked after. All residents spoken to said that they enjoyed looking at the gardens or walking in them. Musmajas DS0000004256.V364837.R01.S.doc Version 5.2 Page 6 Residents spoke positively about life at Musmajas, some of the comments made are detailed below: “I am totally happy here and have no concerns” “I walk in the gardens two or three times a day, the gardens are lovely, I read the paper and watch the television, what else would I want to do” “My room is cleaned, my clothes washed and ironed I have nothing to do, its all done for me, I have no problems” “I have no worries, everything here is OK” “I am happy, there is nothing else I would rather do”. What has improved since the last inspection? What they could do better: Assessments must be undertaken on all of those who wish to live at Musmajas. These assessments are used to ensure that the Home have the necessary staffing, skills and equipment to meet the person’s needs. These assessments should also be used to inform the potential resident of the facilities and services that the Home has to offer. Care plans must be developed for all who live at Musmajas. The Home should have obtained information during the pre-admission assessment and this information should be used to develop plans of care. These plans of care are the information that staff need to be able to care for residents. Care plans were not available for all areas of need, for example areas of risk identified during risk assessments, short term care needs and any changes in care needs. Without detailed care plans, needs may be missed, which could affect the residents’ health and wellbeing. Musmajas DS0000004256.V364837.R01.S.doc Version 5.2 Page 7 Medication systems and practices in place were poor. There is no system in place for checking medication received against the original prescription. It could not be demonstrated if any of the medicines had been administered as prescribed. There were no medication audits to show that medication has been administered as prescribed. The methods used to administer medication were unsafe, the manager secondary dispenses medication into a “medi-dose pack” which contains all medication for one week. The whole process increases the risk of the resident being administered the incorrect medicine and puts them at high risk. Staff are not checking medicines received into the Home, which resulted in some residents not being given their medicines as the doctor intended. There was no evidence that some unlabelled cream was being administered to the correct person or whether the correct dose was being given. There were no risk assessments in place for those residents who selfadminister their medication. These should be in place to demonstrate that the resident is still safe to take their medication without assistance. Staff had purchased medications that were not recorded on their homely remedies policy. The medication of residents who had passed away had also been saved to be used for other residents. Without the policy there was no evidence that staff would know which minor ailments the medications should be use for or any cautions or warnings to be aware of. Care assistants were administering suppositories, which had not been prescribed by the doctor. Care staff are not qualified to administer medicines this way. Controlled drugs are not being stored in accordance with current regulations for the safe storage of medicines. There was no written information to tell us that residents’ social interests and needs have been discussed with them and an activity programme put in place to meet these needs. There was limited information to show that regular activities take place. The service user’s guide contains a sheet of paper that records alternatives from the menu which residents are able to have at lunchtime each day. Residents spoken to were not aware that they have a choice and there was no information available to show that the alternative from the menu is ever eaten by residents. The complaints procedure in place does not record the correct contact details for us. The shortened versions of this document do not record sufficient information to tell people of how to make a complaint and the procedure that the staff will follow when a complaint has been received. Musmajas DS0000004256.V364837.R01.S.doc Version 5.2 Page 8 Some changes are needed to the adult protection policy. The contact details of the agencies to contact if abuse is suspected should be available to staff. Infection control practices do not protect residents from risk of harm. The methods of cleaning and transporting soiled laundry have an infection control risk. Staff were seen emptying commodes and were not wearing disposable gloves or aprons which also has an infection control risk. Staff personnel files did not contain sufficient pre-employment checks. Without these checks the Home are not able to demonstrate that they have employed suitably experienced, qualified staff. Poor employment practices puts residents at risk of harm. Satisfaction surveys are now sent to residents on a regular basis, the results of the surveys are put onto a chart, which gives an easy to read and understand analysis of the results. However, quality assurance systems at the Home are limited to these surveys. There are no other audits of systems or practices and no other methods of seeking residents views i.e. meetings. The Home do not seek the views of other interested parties such as relatives, GP, district nurse, chiropodist. There is therefore limited means of ensuring that the quality of the service provided meets the needs and expectations of those that live at the Home. Some documentation required for inspection was unavailable on the day. This included hot water temperature records, residents spending records and the Landlord’s Gas safety certificate. These records should be available for inspection at all times. The Home have not obtained a Landlord’s Gas Safety Certificate because they are supplied by Calor Gas. However this certificate must be available even if the Home are not on the mains gas supply. Without this certificate the Home are not able to demonstrate that gas systems in place are safe. 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. Musmajas DS0000004256.V364837.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 Musmajas DS0000004256.V364837.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): 3 Quality in this outcome area is poor. Potential residents do not have sufficient information to be able to make an informed choice as to whether Musmajas will be able to meet their needs. Residents are not all assessed before admission to the Home. Lack of information about the person means that staff may not be able to meet individual needs This judgement has been made using available evidence including a visit to this service. EVIDENCE: A copy of the statement of purpose and service user guide are available in English and Latvian. Each resident has been given a copy of the service user’s guide as requested at the last inspection. These documents should give information about life at Musmajas, staffing levels, accommodation, meals and the aims and objectives of the Home amongst other things. However, neither document contained all information as required, i.e. a copy of the most recent inspection report or the service user’s views of the Home. The complaints Musmajas DS0000004256.V364837.R01.S.doc Version 5.2 Page 11 procedure included is brief and records the wrong contact address and telephone number for us. Information recorded is inaccurate and does not reflect the practices in the Home. For example there is no key worker system in operation yet the service user’s guide states that residents are allocated a named “key worker”. Other inaccurate information related to risk assessments and risk management plans, recording of resident’s social interests and activities. Information regarding social activities does not reflect the activities on offer or that take place. The statement of purpose was not fully completed and did not record the experience and qualifications of the manager. Information regarding staff training and induction is inaccurate. The document records that all staff hold a minimum of the National Vocational Qualification in care at level two, which is incorrect. Both documents require updating to ensure that information is accurate. People who may wish to move into Musmajas would be misled by the information recorded in the statement of purpose and service user’s guide. Three residents were case tracked on this occasion. This involves reviewing their care records, their accommodation, talking to them and any visitors they may have and looking at other documentation regarding health and safety and staffing. The care file of a resident who recently moved into the Home was reviewed. This was done to see what pre-admission checks are undertaken before agreement is reached to move into the Home. The care file seen did not have any documents to confirm that a pre-admission assessment was done. The Home had not written down any details regarding this person’s health or personal care needs. The person had been living at the Home for four days but there were no care plans. These documents tell staff the particular wants and needs of the people under their care. Without this information people’s care needs may be missed and the quality of their life at the Home may be poor. There was no evidence that the Home had found out about the person’s likes and dislikes, preferred routines for getting up, going to bed or what they like to do in the day. Care cannot be provided to meet individualised needs if these needs are not known. This can affect wellbeing and self esteem. The care file did have a copy of a care plan written by Social Services. This provided basic guidance for staff, and following discussion with the resident it was noted that staff are following this guidance. The resident had settled well into the Home and said that “everything was OK and staff were nice”. Musmajas DS0000004256.V364837.R01.S.doc Version 5.2 Page 12 At this inspection pre-admission practices were poor, with no documentary evidence to confirm that care needs have been assessed by staff from the home or that the Home have confirmed in writing that they are able to meet needs and have the necessary staffing and equipment to care for the person. Musmajas DS0000004256.V364837.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 and 10 Quality in this outcome area is poor. The care needs of residents appear to be being met but care plans do not provide staff with clear guidance on all aspects of residents needs, this may result in omissions or inappropriate care being given. Medication management is poor and puts residents at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care files of the three people chosen for “case tracking” were reviewed. The first file contained information regarding the person’s next of kin, social worker and doctor. No other information was recorded in this file. Staff would not be able to provide social stimulation, personal or health care for this person from the information they had recorded. Social services had provided a brief care plan, which recorded why the person needed to move into a residential care home. These basic needs were being met by staff. Musmajas DS0000004256.V364837.R01.S.doc Version 5.2 Page 14 There was no written information to show that any other needs had been discussed and an appropriate plan of care put in place to meet these needs. This is important to ensure that people’s wellbeing is maintained and health and personal care needs met. The resident had only moved into Musmajas four days ago and had settled well, complimented the staff and the food. This person said they were content watching television and having a chat to staff. The acting manager had made some improvements to the information recorded in the two care plans seen. One of the care plans had been signed by the resident. This shows that care needs had been discussed and the resident has agreed to the plan of care put in place to meet these needs. This is good practice and should be completed with all residents. Care plans in place contain standardised documents, which are used for all residents. Areas such as skin care, dressings, mobility and sight amongst other things are reviewed and comments recorded which say whether the person needs assistance or not and how many staff are needed to help. The Home’s care planning policy states that they are “outcome focussed”. Care plans looked at did not record what the desired outcome for each person is, for example if someone has dry skin which needs regular creaming, the outcome would be to maintain the suppleness and hydration for the skin. Recording the outcome gives staff an understanding how the care they undertake benefits the resident. The Home have developed a policy regarding individualised care planning. Information in this policy would be extremely helpful to staff for the recording of good quality care plans. Unfortunately the Home are not following their own policy which states that care plans are to take into consideration people’s “aspirations, wants and needs”, be person centred and outcome focussed. Care plans had not been written when a change in health was noted. These changes in health may require additional support from staff but this may be missed if it is not recorded in a separate plan of care. Residents have seen an optician recently, and see the GP, district nurse or chiropodist when needed. Residents told us that their health care needs are met by external professionals when needed. They said that staff are very good at calling the doctor if you feel unwell, the chiropodist visits every six weeks and the optician every year. In two of the care files the weight of the resident had been recorded monthly. Both show a steady weight increase. The weight of the resident most recently admitted to the Home had not been taken. Unless the weight is taken on admission staff will not know whether the resident has lost or gained weight Musmajas DS0000004256.V364837.R01.S.doc Version 5.2 Page 15 since admission. Monitoring weight is important as weight loss or gain could be because of a health problem that could go undetected. Risk assessments were available regarding tissue viability (possible damage to the skin due to pressure or friction) and nutrition and these were up to date. There were no risk assessments for falls or moving and handling. Moving and handling risk assessments were in place at the last inspection, however the acting manager said that she was changing these and would start to use them again soon. Risk assessments regarding the risk of falls and moving and handling are very important as they are used to tell staff if there are any risks and what equipment should be used and the number of staff required to reduce the risk. One of the tissue viability risk assessments seen gave a score that put the resident in the “at risk” category for getting a pressure sore. There was no care plan detailing any action that staff should take to reduce the risk. This is particularly important as a risk has been identified, the Home must take action to reduce this risk. Daily records were made twice per day. These did not always relate to the action that staff have taken to meet care needs, i.e. apply cream to legs twice per day and did not always record what the resident has spent their time doing. The pharmacist inspection took place on the same day as the main inspection. Five residents medicines were looked at together with their medicine charts, supporting care plans and daily records. The medicine management was poor. It was difficult to see if any of the medicines had been administered as prescribed. The home had hand printed medicine charts. They had no start date so information recorded would be meaningless later. Some of the directions were incorrect and no quantities had been recorded so audits could not be undertaken to show that they had been administered as prescribed. The home does not see any of the prescriptions before they are dispensed by the chemist, so they cannot check to see if they are exactly what has been prescribed by the doctor. Many doses recorded on the medicine chart did not match the prescribed dose recorded on the repeat slip indicating that staff are not adequately checking the dispensed medicines received into the home. This resulted in some residents not being administered the medicines as the doctor intended. Medicines were found in the medicine cabinet that had not been recorded on the medicine chart, so it could not be demonstrated when they had been administered or if actually still prescribed. One medicine had been prescribed but had not been used or recorded on the medicine chart. This indicates that Musmajas DS0000004256.V364837.R01.S.doc Version 5.2 Page 16 staff are not following directions from the doctor to treat the residents in the home. One resident was new to the home and bought in their own medicines. No checks had been made to confirm that these were the complete regime of medicines. The medicine chart recorded “blister pack” with no other supporting information as to what was in these packs. The record therefore did not record exactly what the staff had administered. Medicines prescribed for occasional use only had no supporting information to tell the staff when these should be use. This would not support care staff to administer these medicines as the doctor intended and therefore not look after the health and welfare of the residents in the home The acting manager secondary dispenses all the medicines into a blue “medidose” pack. (secondary dispensing is poor practice and even with a second person is unacceptable) They recorded the name and room number only. They did not record what actual medicines were in the container. No second member of staff checked these for accuracy. The whole process increases the risk of the resident being administered the incorrect medicine and puts them at high risk. The medicine round consisted of staff taking the “medi-dose” packs to the residents. The medicine chart did not relate to what had been administered from these packs. In addition these packs could not be securely held in the event of an emergency increasing the risk to the residents in the home. The manager admitted using one resident’s prescribed medicines to administer to another. This is very poor practice as all prescribed medicines are the property of that person they are prescribed to. One unlabelled cream was found. The cream was recorded on one residents chart but it could not be confirmed whether it was actually his, when it had been dispensed or what dose the doctor had prescribed. There was no supporting protocol detailing its use if it was to be used occasionally as the manager described. Residents are given the opportunity to self-administer their own medicines. No risk assessments had been undertaken to confirm they can safely do so and even when staff knew that one resident did not take his medication properly they continue to allow him to do so. The supporting care plans were scanty in content. It could not be found why some medicines had ever been prescribed or for what clinical condition. Without such information the care assistants would not be able to fully support the clinical needs of the residents. Doctor’s visits were recorded with some outcomes of the visits but again not comprehensive enough to support the residents. Musmajas DS0000004256.V364837.R01.S.doc Version 5.2 Page 17 The home had a homely remedy policy but did not purchase all the medicines on the policy. In addition they had purchased some medicines that were not recorded on the policy. Staff would not know which minor ailments they should be use for or any cautions or warnings to be aware of. Medicines had also been taken from residents, if for example, they had died, to be used as a homely remedy. This is very poor practice as all medicines remain the property of the resident and should be removed after seven days from the premise. It was found that care assistants were administering suppositories. These had not been prescribed by the doctor but used as a homely remedy. This is an invasive technique and care assistants are not qualified to administer medicines this way. The home did have a medicine policy. This was generic in content and did not relate to many practices within the home. All controlled drugs were kept in a wooden cabinet in the medication room. This did not comply with current regulations for the safe storage of medicines. Following the last inspection the manager had made a controlled drug register. This was a spiral bound book where the pages could be easily removed. Balances of controlled drugs were accurate at this inspection. All staff had received training in the safe handling of medicines but had failed to implement good practice learnt. The manager was keen to improve the practice but lacked any sound knowledge of how to improve the poor systems within the home. It was difficult to observe staff working practices regarding privacy and dignity during this inspection due to the layout of the Home. Residents spoken to confirmed that staff treat them with respect and maintain their privacy and dignity at all times. The acting manager knocked on resident’s bedroom doors before going in. Residents were dressed appropriately for the time of year, hair was neatly brushed and some of the ladies were wearing makeup/had their nails painted. Musmajas DS0000004256.V364837.R01.S.doc Version 5.2 Page 18 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 and 15 Quality in this outcome area is adequate. There is limited evidence to demonstrate that the lifestyle experience in terms of social and leisure activities meets the needs of all residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: How people spend their day and how they wish to spend their day was discussed with some of those that live at Musmajas during the inspection. Residents who were independently mobile said that they like to walk around the gardens and chat to other residents. Those who need supervision or assistance to walk said that they like to watch their television and look out of their bedroom windows. None of the residents spoken to expressed any interest in joining in regular activities. An activity log records the activity undertaken for each resident, some of these activities were “had cream put on legs” “combed hair” “cream applied to back and shoulders”. There was limited evidence of any pre-arranged activities, social stimulation or outings. There is no programme of activities. The service user’s guide records that regular activities take place such as draughts, connect four and armchair exercises. There was no evidence of this in the Musmajas DS0000004256.V364837.R01.S.doc Version 5.2 Page 19 social activity records. This is therefore misleading and could give a false impression to anyone who uses this information to help decide whether Musmajas is the place where they would like to live. On the day of inspection residents were either sitting in their bedroom watching the television or were seen walking around the gardens. None of the residents came into the lounge in the main building. Residents are encouraged to remain as independent as possible, this includes choosing times for rising and retiring, what they wish to do in the day, where they wish to eat. However, only one of the care files seen had been signed by the resident to confirm that they have had their care needs discussed and the proposed action to take to meet these needs. The acting manager said that she is in the process of asking those who are capable to sign and asking the next of kin of others to sign on their behalf. The menus show that there is a choice of breakfast but there is no written choice of the main lunchtime or evening meal. The acting manager said that staff go and speak to residents in the morning and tell them what is for lunch. If they do not like the meal they have a list of alternatives attached to their service user’s guide. Alternatives such as beefburgers, fish fingers, sausages, cottage pie are offered. There is no written information to show that residents are having any of the alternative meals. However the acting manager said that nobody ever asks for an alternative as they are always happy with the main meal. Residents spoken to said: “the food is OK, not as good as you make yourself” “the food is OK but it depends who cooks it” “they put too much cream in the sauce and then put it on without asking you” “we won’t mention the food” Menus show a variety of food is served on a daily basis. Musmajas DS0000004256.V364837.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area is adequate. Service users are confident that their concerns will be listened to and acted upon. Systems in place to protect residents from the risk of abuse require improvement. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents spoken to were aware of who to speak to if they had any concerns but all said that they were happy and had no worries or concerns. A copy of the complaints procedure is on display in the entrance by the manager’s office. This tells residents and visitors who to speak to if they have any concerns and the action that the Home will take when a complaint is received. A log book is available to record any complaints should they be received. We have not received any complaints since the last inspection and the Home report that they have not received any. Information regarding how to make a complaint should also be available in the service user’s guide and statement of purpose, however they do not contain a copy of the full complaints procedure. The brief versions do not give correct contact details of who to speak to if the person has any concerns. There have been no allegations of abuse at the Home. The acting manager was aware of the action to take should an allegation of abuse be made. Five staff, including the acting manager have undertaken protection of vulnerable adults training. This helps to ensure that staff are aware of abuse, what to look out for and what action to take. Musmajas DS0000004256.V364837.R01.S.doc Version 5.2 Page 21 The adult protection procedure has recently been amended. However, the policy does not mention that disciplinary action would be taken if abuse is substantiated. It does not mention the signs and symptoms of abuse, types of abuse or the contact details of the “agencies to decide future management action”. Staff may find it difficult to follow the correct procedure if they do not know who to contact if abuse is suspected. Some further information is attached to the procedure in a document called “protection of vulnerable adults – how to recognise when abuse may be taking place and what to do about it”. This records the signs and symptoms and gives some information to staff regarding abuse. This should always be available with the adult protection procedure to ensure that staff have guidance regarding signs and symptoms and what to look out for. Musmajas DS0000004256.V364837.R01.S.doc Version 5.2 Page 22 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 and 26 Quality in this outcome area is adequate Musmajas provides a homely environment that is maintained to a reasonable standard. Infection control practices put residents at risk of harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the premises was undertaken, this included the lounge, bedrooms in the main building and in two of the bungalow blocks and the laundry. The unpleasant odour noted at the last inspection in one of the bungalows has been removed. The flooring in the bedroom has been replaced with non-slip lino and this has removed the unpleasant odour. Musmajas DS0000004256.V364837.R01.S.doc Version 5.2 Page 23 All areas of the Home were clean, hygienic and free from unpleasant smells. Residents commented that staff clean their room very regularly and it is always clean and tidy. All five rooms visited had been personalised with furniture, pictures and ornaments. Bedrooms were large, bright and had a homely, welcoming feel. All residents said that they liked their rooms and “enjoyed looking out of their windows into the lovely gardens”. Doors are still being wedged open. The door to the lounge/bar, bedrooms on the first floor and bedrooms in the bungalow were all wedged open. This compromises fire safety as they would not close in the event of a fire and smoke would enter the room putting the residents at risk of harm. This issue has been identified at previous visits to the Home. It was a requirement of the last visit that work needs to be completed to the plaster work in the lounge/bar area and it was suggested that the lino on the first floor of the main building should be replaced. Work has been done to make good the plaster work and paint the lounge and the lino has been replaced with non-slip flooring which has improved the appearance of the first floor hallway. The lounge appeared cold, this was also identified at the last inspection. There was no thermometer, which should be used to ensure that the room is at a comfortable temperature. The lounge is available for use as an activity area for residents and the temperature should be suitably warm to ensure that residents are comfortable if they join in activities or use this room. The manager’s office was also cold. A gardener/handyman is employed for five days per week. The gardens were well kept and well planted with brightly coloured flowers and shrubs. All residents spoken to commented on how lovely the gardens are. A discussion was held regarding the laundry processes in use. A member of staff confirmed that soiled laundry (faeces) is emptied down the toilet. The clothing is then taken into the laundry, scrubbed clean in the sink, and put on a normal wash cycle. The staff member confirmed that the sluice cycle on the washing machine is not very effective and clothing usually requires washing again. Staff are handling the soiled laundry more if they do not use the sluice cycle, this increases the risk of cross infection. The baskets used to transport the laundry to the washing machines do not have lids and have open weave sides. This also increases the risk of cross infection when transporting soiled laundry to be washed. A vest and some towels were left in soak in a washing bowel in the sink. It was unclear whether these items were soiled and were left in soak before Musmajas DS0000004256.V364837.R01.S.doc Version 5.2 Page 24 being washed. Leaving soiled clothing in soak was identified as an issue for action following the last inspection visit as this increases the risk of cross infection. The washing machine was in good working order on the day of inspection. There was no backlog of items waiting to be laundered. The tumble dryer is located in a different room, the tumble dryer was in good working order. A shower curtain separates a large shower area from the tumble dryers. These showers are apparently occasionally used by members of the public who use the facilities at Musmajas. The manager was advised that members of the public should not be invited to use facilities, which give them direct access to resident’s personal belongings. The cleaning of commodes was discussed after each use the contents are emptied down the nearest toilet and they are wiped with a cloth and disinfectant. The cloths used are then put into the washing machine. Commode pans are sterilised once per week. This practice is not followed. A commode was emptied, not cleaned or sterilised and the staff member emptying the commode was not wearing disposable gloves or apron. The acting manager was advised to obtain advice regarding the current methods used for cleaning commodes and washing soiled laundry as methods currently used could put residents at risk of infection. Musmajas DS0000004256.V364837.R01.S.doc Version 5.2 Page 25 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. Care needs of those who live at Musmajas are met by appropriate numbers of trained staff on duty. Recruitment practices are not sufficient to ensure that suitably qualified and experienced staff support and protect residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staffing levels on the day of inspection were the same as those recorded on duty rotas. Three staff work between the hours of 8am to 8pm and two staff (one waking and one sleeping) between the hours of 8pm to 8am. A number of staff live on the premises and are available at all times to provide assistance if necessary, although a rota is available to provide sleep over cover. Eighteen residents live at Musmajas all with varying levels of dependency. Some are able to provide their own personal care and have no mobility problems whilst others require assistance with all aspects of personal care and mobility. The layout of the Home means that staff have to regularly walk around between the bungalows and the main house to check on residents. This is undertaken during the day and at night. People who live in the bungalows confirmed that staff come quickly if you need assistance. Daily records completed by night staff rarely record that they are completing two hourly checks. Evidence should be available to demonstrate that residents are checked during the day and at night. Musmajas DS0000004256.V364837.R01.S.doc Version 5.2 Page 26 Residents spoke highly of the staff saying that they had a “hard job to do but were always friendly”, they commented that they come quickly if you need assistance and were always helpful. Eight care staff are employed at Musmajas, five of these staff have gained the national vocational qualification in care at level two. Four staff files were reviewed. Each staff file contained an application form, criminal records bureau check and evidence of training undertaken. Large sections of two application forms seen were blank. One file contained a reference that was only partially completed with the employees name and address and the other was provided by Musmajas. No references were available on another file seen. The files of two recently employed staff were seen. A single page application form did not contain any employment or educational history and no references had been obtained. The second file also contained a single page application form that recorded one previous place of work and no educational information. The acting manager said that references had been requested for both of these members of staff but had not been returned. There was no documentary evidence to demonstrate that references had been requested. Staff files seen did not demonstrate that sufficient pre-employment information has been obtained. Poor employment practices put residents at risk of harm. Copies of training certificates in two files show that these staff have undertaken training regarding peg tubes, safe handling of medicines, moving and handling, first aid, continence, food hygiene, fire training and protection of vulnerable adults. The acting manager has devised a staff training log which shows training courses undertaken. From information recorded it was noted that two staff have not undertaken any fire safety or infection control training. Further training regarding food hygiene is booked for 9 July 2008. A copy of the Skills for Care progress log of standards was completed and available on one of the recently employed staff member’s file. There was no other documentary evidence available. The acting manager said that she had spoken to the staff member to provide evidence of her competence and knowledge. Further evidence is required to demonstrate that staff have the skills and knowledge required to meet induction standards. Criminal records bureau checks are now available for all staff although one seen requires updating as it was obtained in 2004. Criminal records bureau checks should be completed every three years. Musmajas DS0000004256.V364837.R01.S.doc Version 5.2 Page 27 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 and 38 Quality in this outcome area is adequate. Quality assurance systems in place are not robust enough to ensure that the quality of the service provided meets the needs and expectations of the Service users who live at the Home. Not all health and safety issues have been addressed to ensure that residents live in a safe environment. This puts residents at risk of harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The acting manager has been working at Musmajas, initially as a care assistant and then promoted to acting manager. She has undertaken some work to improve systems, although further work is required. There has been some improvement to care plan documentation and more written information is now included. However, further work is required to enable staff to have all Musmajas DS0000004256.V364837.R01.S.doc Version 5.2 Page 28 information to be able to meet health and personal care needs. Other management systems such as medication, care planning and health and safety also require improvements to ensure residents are safe. The systems that the Home uses to ensure that the quality of care provided meets resident’s needs were reviewed. Quality assurance questionnaires were found in some care files. Satisfaction surveys are sent out every six months. The results of the surveys are recorded on a bar chart. A log sheet is used to record any issues identified during the survey and the action taken to address these is recorded. Currently satisfaction surveys are only sent to residents and their relatives. There are no questionnaires for other stakeholders such as GP, District Nurse, Chiropodist etc. Residents and relatives meetings are not held. The systems for monitoring working practices are limited to the acting manager working with staff. There are no audits of working practices, care plans, medication, rooms or fixtures and fittings audits. Further work is required to improve quality assurance systems to ensure that the people who live at Musmajas are happy with the quality of the service provided. This will ensure that residents are happy at the Home, which will improve their self esteem and well being. The inspector was unable to review resident’s spending money records as the information was locked away and not accessible. From records seen it was noted that the administrator is the next of kin of two residents who do not have family in this country. The administrator also deals with the finances of these residents. Advocacy services should be offered to all residents who do not have a next of kin. Accident record books were reviewed and it was noted that the books in use do not comply with data protection legislation. Accident books that meet data protection standards must be used. A sample of records was requested to see if the health and safety of staff and residents is maintained. Hoist servicing records were requested, the hoist failed its last service due to a problem with the hydraulic arm. A new hoist is on order and should be received by Musmajas within the next week. The acting manager confirmed that in the meantime staff would not attempt to lift anyone off the floor if they fall and the emergency services would be contacted. There are no residents who require regular hoisting. Fire records were checked and in October 2006 a Notice of Fire safety deficiencies was issued at Musmajas. It recorded that “all wedges to be removed and fire doors be able to close freely onto rebates”. Fire alarm is to be tested weekly. Fire doors were again seen wedged open during this inspection. Bedroom doors in the main House and in bungalows were wedged open as well as the door to the lounge/bar. Musmajas DS0000004256.V364837.R01.S.doc Version 5.2 Page 29 Fire test records show that the fire alarm is now checked on a weekly basis, emergency lighting is serviced annually and checked monthly and fire fighting equipment is checked monthly. The last fire drill undertaken was 18 March 2008. Regular fire drills help to ensure that staff are aware of the action to take in the event of a fire. Hot water temperature records were not available for inspection when requested as they were locked away. A copy of the Landlord’s Gas Safety Certificate was also requested but was not available. The Home are not on the main gas supply but use Calor Gas and are finding it difficult to obtain a Landlord’s Gas Safety Certificate. The safety certificate must be provided on an annual basis to demonstrate that equipment is safe to use. Musmajas DS0000004256.V364837.R01.S.doc Version 5.2 Page 30 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 2 X 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X X X 2 Musmajas DS0000004256.V364837.R01.S.doc Version 5.2 Page 31 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 OP3 Regulation 14 Requirement All residents must receive a full assessment before admission. A copy of the completed assessment must be available in care files. This is to ensure that the resident knows that their needs can be met by the service. 2 OP7 12 Care plans must be developed upon admission to the Home and must set out in detail the action needed by staff to ensure all aspects of health, personal and social care needs are met. 04/07/08 Timescale for action 04/07/08 3 OP7 15 Care plans must be 04/07/08 developed/updated when residents needs change and if a risk is identified during the risk management process. To ensure that staff know the needs of the residents and these are consistently met. 4 OP8 13 All residents must have full assessments of potential risks to their health this must include the DS0000004256.V364837.R01.S.doc Version 5.2 04/07/08 Musmajas Page 32 risk of falling and moving and handling. To ensure that staff are aware of any risks and correct action can be taken. 5 OP9 13 The registered manager must ensure that regular audits are undertaken of controlled medications to ensure that the amount of medication available corresponds with clear and accurate records. (Outstanding since 5 November 2007) 6 OP9 13 All controlled medications in use at the Home must be stored in accordance with the Misuse of Drugs (Safe Custody) Regulation 1973. (Outstanding since 5 November 2007) 7 OP9 13 Appropriate arrangements for the recording, storage and safe and administration of medications must be made. The concerns identified in this report regarding the storage of medication to be returned, changing of medication regimes without written GP instruction, secondary dispensing of medication and unsafe transporting of medication must be addressed within a risk management framework. (Outstanding since 5 November 2007) 8 OP9 13 Copies of original prescriptions must be obtained at the Home and information recorded on MAR charts must be checked against DS0000004256.V364837.R01.S.doc Version 5.2 20/06/08 20/06/08 20/06/08 20/06/08 Musmajas Page 33 original prescriptions. (Outstanding since 5 November 2007) 9 OP9 13(2) All medicines must be administered from a pharmacy or dispensing doctor’s labelled container at all times. The practice of administering one service users medicines to another must cease. All medicine prescribed for occasional use must have a supporting protocol detailing its use and staff must be trained to ensure they administer them as the doctor intended. Any service user wishing to self administer their own medicine must be risk assessed as able and compliance checks undertaken on a regular basis to confirm that they do so safely. Action must be taken if they fail to take their medicines as prescribed. All medicines administered by invasive procedures must cease immediately. All new service users to the home must have their medicine regime confirmed with the doctor at the earliest opportunity. Staff practices that increase the risk of cross infection must be stopped, this includes the soaking of soiled laundry in a bucket before it is washed. The methods of cleaning commodes, the type of baskets used to transport soiled laundry. These practices put both staff and residents at risk of infection. DS0000004256.V364837.R01.S.doc Version 5.2 20/06/08 10 OP9 13(2) 20/06/08 11 OP9 13(2) 20/06/08 12 OP9 13(2) 20/06/08 13 OP9 13(2) 20/06/08 14 OP26 13 10/07/08 Musmajas Page 34 15 OP29 19 Robust recruitment practices must be in place to ensure that staff employed are safe to work with vulnerable adults. Employment history, qualifications and written references must be obtained as well as other documentation. The registered manager must ensure that there is a staff induction and ongoing training and development programme which meets the National Training Organisation workforce training targets. Mandatory training must be provided for all staff. (Outstanding since 11 September 2006) 04/07/08 16 OP30 18 04/07/08 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 OP1 Good Practice Recommendations A suitable Statement of Purpose and service user’s guide should be available which clearly and accurately records the facilities and services available at Musmajas. Residents should be involved in the care planning process. Documentary evidence should be available to demonstrate this. Daily records should contain sufficient detail to evidence that resident’s daily health, personal and social care needs have been met and any changes in care needs identified. Residents should be weighed upon admission to the Home and on a regular basis thereafter. 2 OP7 3 OP7 4 OP8 Musmajas DS0000004256.V364837.R01.S.doc Version 5.2 Page 35 5 OP9 It is recommended that all policies and procedures are reviewed in line with the Royal Pharmaceutical Society of Great Britain current guidelines and staff trained to adhere to them. It is recommended that the home purchase a bound controlled drug register to record all controlled drug transactions. Systems should be put in place for safe key custody of medication cupboard and other keys. Consideration should be given to undertaking an audit of as required medication. Organised activities should be available that meet the residents’ social, cultural and interest needs. Evidence should be available to demonstrate that residents have a choice regarding daily life including meals. The complaint policy should be updated to include the contact details of the Commission for Social Care Inspection. Contact details must be made available for the appropriate agencies as recorded in the adult protection policy. The policy should also detail the action that the Home will take if a member of staff is found guilty of committing an act of abuse. The Home should use a method of monitoring the temperature of rooms in all resident areas and room temperatures be set at suitable temperatures. The registered person should introduce systems that will effectively monitor and audit working and care practice in the home. These procedures must be ongoing. All health and safety issues should be addressed as a matter of urgency, the Home should have a copy of the Landlord’s Gas Safety Certificate and fire safety issues such as wedging open fire doors which puts residents at risk should be addressed. 6 OP9 7 8 9 10 11 OP9 OP9 OP12 OP14 OP16 12 OP18 13 OP19 14 OP33 15 OP38 Musmajas DS0000004256.V364837.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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. 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