Inspection on 05/11/07 for Musmajas

This inspection was carried out on 5th November 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 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 19/05/08

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Musmajas Priory Hall Wolston Nr Coventry West Midlands CV8 3FZ Lead Inspector Deborah Shelton Unannounced Inspection 5th November 2007 09:00 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.V354673.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.V354673.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, vacant post Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Musmajas DS0000004256.V354673.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th September 2006 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. The current scale of charges is £315 - £334 per week. Additional charges are made for outings (other than shopping), chiropody, hairdressing, dry cleaning and newspapers/magazines. Musmajas DS0000004256.V354673.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The following are the findings of an unannounced inspection visit that took place on Monday 5 November 2007 between the hours of 09:30am and 5:10pm. The Home manager was on duty along with three care assistants, the cook, a kitchen assistant and the administrator. Sixteen people were living at Musmajas at the time of the visit. Three residents were ‘case tracked’, this involves finding out about the individual’s experience of living in the care home by meeting with them, talking to them and their families (where possible) about their experiences. Looking at their care files, looking at their environment, and discussions with staff on duty. Reviewing staff training records to ensure training is provided to meet resident’s needs. The inspection process consisted of discussions with the manager and residents. Records examined during this inspection included, complaints, care, staff recruitment, training, social activity records, staff duty rotas, health, safety and medication records. Notification of incidents received by us from the Home and any other information received were also examined. The inspection process enabled the inspector to how residents spend their day and see the interaction between staff and residents. Annual Quality Assurance Assessment documentation was sent to the Home for completion and information recorded in this document was reviewed during the inspection process. Six feedback questionnaires were completed by residents and two by relatives. Comments made are included in the main body of this report. The inspector was introduced to some of the people that live at Musmajas and conversations were held with four people. Further information to identify the outcomes for residents’ was also gained through observation of residents and staff. The inspector wishes to thank the manager and her staff for the hospitality on the day of inspection. Musmajas DS0000004256.V354673.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: A large majority of issues identified at previous inspections remain outstanding. Although work has been undertaken on the Statement of Purpose Musmajas DS0000004256.V354673.R01.S.doc Version 5.2 Page 7 it was noted that residents do not receive a copy of the Service User’s Guide. This document must be given to each resident for them to keep. Further work should be undertaken on the pre-admission documentation in use. Information obtained is brief, not all of the standard documentation is completed and the details obtained would not be sufficient to enable staff to meet the health and personal care needs of residents. Care plans reviewed did not contain sufficient detail. Important information regarding the use of specialised equipment and healthcare regimes was missing from one care file seen. There was insufficient documentary evidence to demonstrate that staff would be able to or were meeting this resident’s care needs. Various issues were identified in care files, for example residents or their representatives are not involved in the care planning process, weight records were not satisfactory, risk assessments were confusing and where a risk was identified there was no appropriate care plan in place to reduce the risk. Some information was not dated or signed by the person completing the record. Daily records did not demonstrate on all occasions that resident’s health and personal care needs were being met. Systems in place for medication management were unsafe. The manager is secondary dispensing medication from the medication boxes delivered by the pharmacy into weekly dosette boxes. Controlled medications are also being dispensed into these boxes. This is extremely unsafe practice. Controlled medications are therefore not be stored appropriately and staff are administering and signing for medication that has been dispensed by a third party. The method of transferring medication from the main Home to the bungalows is not safe. Errors were found in controlled medication records and the amount of one controlled medication available did not balance with the amount recorded in the register. Various other issues were identified regarding medication receipt, storage, recording and administration which were considered to be unsafe and could put residents at risk of harm. There were no records to demonstrate that regular activities suited to the wants and needs of residents take place at the Home. Residents said that they stay in their rooms in bad weather and go out into the garden and chat to other people in good weather. Residents also commented that there were no activities taking place. The inspector was informed that residents are aware that if they do not like the main meal on offer on a daily basis they are able to have something else. However, residents spoken to and one who responded to out feedback survey was unaware of this fact. There were no records to demonstrate that residents are offered or receive a choice of meal. This issue remains outstanding from the last inspection of the Home. Musmajas DS0000004256.V354673.R01.S.doc Version 5.2 Page 8 Policies and procedures regarding complaints and adult protection require contact details including. Musmajas consists of a bungalow complex and an old manor house. Décor and furnishings in the main building are starting to look tired and worn. The lino in the first floor corridor must be non-slip so that residents are not at risk of injury. An unpleasant odour was noted in one of the bungalows. The manager is aware of this and has purchased odour neutralising liquids to try to remove the odour. Staff practices regarding the soaking of soiled laundry in a bucket before placing in the washing machine has a risk of cross infection. Washing machines in place have a sluice facility and should be used for this purpose. Staff recruitment practices put residents at risk of harm. Files seen did not contain fully completed application forms, work history, references or qualification details. It was noted that a majority of staff come from Latvia. However, appropriate employment practices must be undertaken to ensure the safety of residents. All staff must receive regular updates in mandatory training, this should include fire and moving and handling. Two staff require update training in these areas. The manager has worked hard to introduce quality assurance satisfaction surveys and send these out to residents. The results of the surveys are available and action has been taken to address some of the issues raised. However there are no audits in place to monitor staff working practice, no medication or care plan audits. Further work should therefore be undertaken on quality assurance systems so that they are not purely limited to surveying residents. Some health and safety issues were again identified at this inspection. These included wedging open of fire doors and fire equipment test records, which were not up to date. These issues were raised in a report by Warwickshire Fire Service in 2006. The Landlord’s Gas Safety Certificate is not up to date, this is an annual requirement. Other issues as identified about regarding risk of cross infection and slip risks affect the health and safety of residents at Musmajas. 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.V354673.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.V354673.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): 1 and 3 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Resident’s needs are not fully assessed before admission, staff therefore have limited information to be able to meet individual needs. EVIDENCE: A copy of the Statement of Purpose is available in the entrance hallway of the main house. The manager confirmed that residents are able to look at this copy but are not given a copy of this or a Service User’s Guide. The care file of the most recently admitted resident was reviewed. A preadmission assessment was undertaken on 30 August 2007. The manager completed the Home’s standardised one page pre-admission documentation. Some parts of the form i.e. medical history, reason for admission, were not completed and others contained only brief information. The pre-admission assessment noted that this resident receives his nutrition via a peg feed. No Musmajas DS0000004256.V354673.R01.S.doc Version 5.2 Page 11 other information was recorded regarding this, for example type of feed, times, type of equipment in use etc. Care plans were drawn up the day after admission (4 September 2007) and the care plan provided by the Assessment and Care Management Team was available. Neither the care plans nor information obtained during the preadmission assessment contained sufficient detail to enable staff to meet this person’s needs. The care plan records that the person has a “peg feed in situ”. There is a separate sheet provided by the District Dietician that records the amount of feed and water and what time the feed is to be given. The care plan is not cross referenced to the District Dietician instructions. Staff would therefore have to look throughout the file to find out about the feeding regime. There was no information in the care plan regarding how to give medication, what to do if the feeding tube comes out, how to remove a blockage and how to clean around the opening in the skin to keep this clean and free from infection. The resident was seen on the day of inspection and the inspector chatted to him in his bedroom. He appeared to be at ease in his surroundings and was taking a rest on his bed. During discussion it was noted that he was happy at the Home and had settled OK. The manager confirmed that potential residents are able to look around the Home, stay for a meal or any part of the day and speak to people who already live at the Home. Musmajas DS0000004256.V354673.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): 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 plans do not consistently describe what staff have to do to meet the identified needs of people living in the home, which could lead to an oversight in care. Medication practices put residents at risk of harm and improvements are required. EVIDENCE: Three residents were case tracked on this occasion. This involves reviewing their care files, medication records, discussing care needs with staff and the manager, looking at their bedrooms and other living space and talking to the resident and their relatives if possible. Care files were available for all three residents. The first reviewed was for the resident most recently admitted to the Home. Care plans in place contained brief information in the form of a tick list with space for input of additional comments as necessary. For some of the care needs insufficient information was recorded which would not enable staff to meet this person’s needs. Musmajas DS0000004256.V354673.R01.S.doc Version 5.2 Page 13 There was no documentary evidence to demonstrate that this resident or their representative had been involved in the care planning process. Care plans had not been signed by the person completing the information. Risk assessments are in place regarding nutrition, pressure areas and moving and handling. These risk assessments were up to date. The Home are completing two risk assessments regarding pressure areas, each giving conflicting results i.e. no risk or at risk. One risk assessment put this person “at risk”, this information was not linked to care plans and the information in the care plan did not record any actions that staff should take to reduce the risk of developing a sore. Information from the District Dietician was not cross-referenced to the risk assessment or care plan. There was no detailed guidance for staff regarding the management of the peg feed. A brochure provided by the manufacturer of the equipment used was available in the care file. A step-by-step picture guide for inserting the feeding tube was available. Daily entries are completed twice per day, some of the information recorded was detailed and some extremely brief. Information in daily entries rarely related to care plan issues and the actions that staff have taken to meet the residents daily personal care needs. Staff were not recording every night sufficient details regarding the amount of feed via the peg tube given to this resident. Separate records of water, medicine and calogen intake are available. These did not demonstrate that the instructions given by the District Dietician are being followed i.e. the district dietician requests that 30ml of Calogen is given at 8.30am, 12.30pm and 5.30pm. On 7 September 07 records show that 30ml of Calogen was given at 1.00pm, 60ml at 5.30pm and 60ml at 10.20pm These records did not record the amount or timings of the nutrison energy. Weight records demonstrate that the resident has lost 5lb between admission on 4 September and 31 October 07. There was no documentary evidence in the care file to demonstrate that activities take place. The resident said that he walks in the gardens and chats to other residents. The inspector chatted to this resident who confirmed that he had settled in to the Home. It was noted that this resident required a dental appointment. This had not been arranged yet. The next resident case tracked had lived at Musmajas for over three years. This resident’s health has recently deteriorated and he is no longer able to weight bare and requires hoisting into bed. A care plan is in place, which Musmajas DS0000004256.V354673.R01.S.doc Version 5.2 Page 14 contains standardised documentation. It is noted that this gentleman is dependent upon two members of staff for all assistance with activities of daily living. He is also at a high risk of developing pressure ulcers (a break in the skin due to sitting or lying for too long in one position). Monthly evaluations of care needs and care given during the previous month were very detailed and mention health problems i.e. chest infection, contacts with the GP or District Nurse. Short-term care plans had not been developed for short-term health problems such as chest infections. Risk assessments are in place regarding nutrition, mobility, the use of the hoist and the risk of developing a pressure area. All files seen had two risk assessments to determine if the person was at risk of developing breaks in their skin due to pressure. These risk assessments gave conflicting results, one indicating risk and the other indicating no risk. No care plans to prevent this break down in skin were available. It was recorded that staff recognise that one resident had a sore bottom and record action taken, but this is not done each time care is carried out and therefore any healing or deterioration is not monitored putting person at risk of further deterioration. There were no weight records since 26 January 2007, as the resident is no longer able to stand unaided. No other method of monitoring weight loss or gain is being used. This is particularly important as this gentleman’s health is deteriorating. Care plans are not updated following monthly evaluations unless there is a major change in care needs. Staff would need to read care plans and monthly evaluations to have full details of resident’s care needs. This may be confusing for staff and result in care needs being missed. There was evidence on this care file of visits from optician, GP and District Nurse. The manager confirmed that external professionals are contacted as and when needed. The third resident case tracked has been living at Musmajas since September 2005. As with the other care files reviewed, standardised documentation is used which is a tick list with space for additional information? Care plans were reviewed on a monthly basis. Information detailed in care plans was not specific, for example “Skin care – at risk. Carers required to regularly cream both legs”. There were no details regarding the type of cream or how many times per day the legs are to be creamed. Monthly evaluations were very detailed “… needs legs elevated. Legs red and swollen again, antibiotics prescribed”. Care plans do not mention this and there was no short-term care plan regarding antibiotics. Musmajas DS0000004256.V354673.R01.S.doc Version 5.2 Page 15 Body maps in place show areas of dry skin and areas of pain. This information was not dated or signed by the person recording the details. It is therefore difficult to tell whether this information is up to date. Risk assessments were in place regarding mobility, nutrition and pressure area risk. There were two risk assessments; (Waterlow) which put the resident “at risk” and the Home’s own assessment, which gave a rating of “no risk”. This conflicting information is confusing and could result in care needs being missed. Weight charts show that this resident has lost weight - a loss of 12lb in 10 months. The manager confirmed that the resident had requested to loose weight and had stopped eating snacks etc. However, there was no evidence in care plans regarding this and documentary evidence appeared to show that the resident was loosing weight with no action being taken to stop this from occurring. Daily entries for 22, 23, 24, 30 and 31 October record that this person either “refused lunch, refused to be weighed, ate only a small amount all day, ate very little today”. Care plans did not record the action that staff should be taking to encourage this resident to eat her meals or of any other action taken to assess why this lady is not eating. None of the care plans reviewed had any documentary evidence to demonstrate that residents are involved in the care planning process. Further work should be undertaken on the care planning process to ensure that risk assessments are linked to care plans and give specific guidance for staff on how to reduce the risk identified. Care plans also require more specific information regarding the “who, what, why and when” actions should be taken. The medication records of the three residents being case tracked were reviewed. Records for receipt, storage and administration were reviewed and issues that could result in medication errors were identified as follows: The keys to the medication cupboard and controlled drugs cupboard are stored in the key cupboard, which is closed but has the key in the lock. Therefore the keys to the medication cupboard are easily accessible. The Home do not have a copy of the original prescription. Medication received is checked against the last month’s MAR chart and not the prescription. Medication administration records (MAR) are sometimes hand written and information is copied from the last MAR. This could lead to errors if any medication has changed but has not been altered on the MAR chart. Controlled drugs are not being stored in line with regulations regarding the safe storage of controlled medications. The manager was advised of the Musmajas DS0000004256.V354673.R01.S.doc Version 5.2 Page 16 importance of correct storage of controlled medication and appropriate key custody. MAR charts do not record the amount of medication received, a separate book is used to record medication received, date and amount. There is no audit for “as required” PRN medication. The manager was advised to audit the amount of medication received, given and remaining and to record stock carried forward and whether or not more stock was ordered. Discrepancies were noted on MAR charts as follows: Mar states 2 x 5ml spoons Gaviscon when required. The pre-printed label on the Gaviscon states 2 x 5ml spoons twice per day. Staff are therefore not following the GP instructions. There are times when the resident has refused medication and there is no explanation recorded on the MAR chart. The controlled drugs register was checked and a discrepancy was noted. The book was not completed for Saturday 3 November to demonstrate that a resident had taken the controlled medication. The manager requested staff to sign the book during this inspection. The MAR chart had been completed. The register was also checked for another resident. The controlled drugs register states that there are 228 tablets available. The medication was checked and only 226 tablets could be accounted for. The manager could not explain the discrepancy but confirmed that she would check, speak to staff and complete a report regarding the missing tablets. The manager is secondary dispensing tablets, this involves taking them from the original boxes and putting them into weekly dosette boxes for staff to administer. This also includes controlled drugs, which are therefore not being stored appropriately. Secondary dispensing is a dangerous practice, which could result in errors. Tablets are taken across to individual bungalows in a non secure manner. On the day of inspection medications to be returned to the pharmacy were being stored in the same cupboard as medications to be administered. This is unsafe practice. Some of the pre-printed GP labels record “as directed” with no further instructions for staff regarding the amount or frequency of administration. Staff had written instructions on the MAR chart occasionally i.e. Senokot 10ml at night, label states as directed. However for Bactroban Nasal Ointment as directed was recorded on the MAR chart and the GP label. Musmajas DS0000004256.V354673.R01.S.doc Version 5.2 Page 17 There was no record of stock held for one resident, as the MAR chart did not record the amount of medication received when admitted, neither did the book that the manager records stock received. There was therefore no way of auditing to ensure that this resident’s medication stock balances with what should be available. The manager does not complete an audit of medication. There was therefore no quick and easy method of checking the amount of medication on the premises for each resident. Records appeared to show that instructions are changed to PRN for those residents who regularly refuse their medication. There was no documentary evidence of any discussions with GPs to confirm that this is acceptable. The Home’s policy for administering and documenting prescribed medications records that “medication is issued from a pharmacy and must not be transferred to any other container for storage or administration”. The Home are not following their own procedure as they are secondary dispensing medication, including controlled medication, from the boxes received from the pharmacy into weekly dosette boxes. Observation of the staff interaction with residents was difficult at this inspection due to the layout of the Home. The weather was cold and raining and a majority of residents stayed in their own room in the bungalow complex or in the main building. Some residents were seen walking around in the garden. Those residents spoken to said that they stay in their room during the winter and go out for a walk when the weather is not too bad. Residents spoken to were dressed appropriately for the time of year and one lady had her nails manicured. Residents confirmed that the staff are kind and friendly and treat them with respect. Musmajas DS0000004256.V354673.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 This judgement has been made using available evidence including a visit to this service. The lifestyle experience at the Home in terms of social and leisure activities and meals does not match the expectations of all residents. Resident’s views regarding this are not sought or acted upon. Lack of choice regarding food and daily activities can reduce resident’s self esteem EVIDENCE: Care files do not contain details of any social or leisure activities undertaken by residents. There was no evidence available to demonstrate that residents have been questioned about their preferences for activities, i.e. what activities they used to do, or would like to do now. There were no residents in the lounge area on the day of inspection and no activities taking place. Residents spoken to said that they like to take a walk in the garden and chat to other people. However, when asked what they do when it is raining it was noted that a majority stay in their bedrooms all day. The manager said that she had organised a film afternoon recently and a few residents had agreed to come over to the main building and watch a film in the lounge. Apparently only a few residents attended and some of these fell asleep. However, the manager Musmajas DS0000004256.V354673.R01.S.doc Version 5.2 Page 19 was advised that this should not discourage her to undertake such activities again as a small number of residents may have enjoyed the experience. There are no external entertainers for residents. One of the carers is a qualified hairdresser and does residents hair. One resident spoken to during the inspection said, “there are no activities”, another commented that “I would like to go out into the gardens but there are sixteen people here and the staff can’t help all of you all of the time”. According to the manager staff take residents for a walk around the grounds and sit and chat to them but they do not document this. There were no visitors to the Home on the day of the inspection. The statement of purpose says that there is an open visiting policy and visitors can attend at any reasonable time. There was limited evidence to demonstrate that residents have a choice in their activities of daily living at Musmajas. Residents are not involved in the care planning process and therefore do not have a say about the care they receive. The manager said that residents have a choice of meal each day but this is not recorded. Residents are apparently told what is the main meal of the day and are aware that there is an alternative if they do not like it. However, it was noted that residents generally have the main choice. There are no records to demonstrate that anyone has had an alternative to the main choice on offer. Comments on one of the feedback cards returned to us stated: “I think there should be a choice (or options) in the meals. I know that you can’t please everyone all the time but I do feel that if you do not like a particular meal then an alternative could be offered”. One resident spoken to during the inspection said: “You don’t get a choice of food but everything you get is good, I can make do, it is difficult to please everyone all of the time”. This demonstrates that not all residents are aware that there is a choice of meal on a daily basis. This issue was identified at the last inspection of the Home. Musmajas DS0000004256.V354673.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): 16 and 18 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Service users are confident that their concerns will be listened to and acted upon. Systems in place to protect residents from the risk of abuse require improvement. EVIDENCE: No complaints have been received by the Home or us since the last inspection. A copy of the complaint policy is on display in the entrance hallway of the main Home. However, contact details for us are out of date and are therefore incorrect. Residents spoken to confirmed that if they had any worries they would speak to the manager who would sort out their problems for them. There have been no adult protection issues at the Home. The abuse policy was reviewed and it was noted that this had been updated in September 2007. The policy states that any information is to be shared with the “appropriate agencies” to decide future management action. However, there was no details of who these “appropriate agencies” are or their contact details. There was not a copy of the Local Authorities adult protection policy on the premises and the “No secrets” document was not available. The manager said that she had taken these Home to use as she is in the process of developing a new adult protection policy. Musmajas DS0000004256.V354673.R01.S.doc Version 5.2 Page 21 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 This judgement has been made using available evidence including a visit to this service. Some improvements are required to the décor, furnishings and fittings to give a more homely feel. EVIDENCE: The inspector reviewed paperwork in the lounge/bar area. There was no method of monitoring the temperature in this room but the room felt cold. Décor in this area was dated but in reasonable condition. The door to this room was wedged open, thus compromising the fire resisting properties of the door. Musmajas DS0000004256.V354673.R01.S.doc Version 5.2 Page 22 An old fashioned style of lino flooring is in the corridor. The manager was advised to ensure that the lino used is a non-slip type and does not give rise to a risk of accident for residents. The bedroom of one of the residents being case tracked was viewed. This room was located in the main building. The room was light and airy and the resident said that she enjoys looking out of the window onto the beautiful gardens. Upon entering bungalow three complex there was an extremely unpleasant odour. The manager has purchased some odour neutralising liquid to try to remove the odour. One relative who responded to the question on our feedback cards “how do you think the care home could improve” stated “better furniture” The laundry room contains one washing machine and one tumble dryer. Both were in good working order. The sink in the laundry room was being used to soak soiled items. The washing machine has a sluice cycle and should be used for laundering of soiled items. The current method of soaking soiled items presents a cross infection risk and must be stopped. Commode pans are cleaned at the end of every day in a sanitizer machine that is located in a room outside of the main Home. The contents of commodes are emptied down the toilet. The living accommodation of a married couple was viewed. Both were extremely happy with their room, which comprised of a bedroom and doors leading through to a small lounge area. The room was bright and clean and had been personalised with pictures and ornaments. Musmajas DS0000004256.V354673.R01.S.doc Version 5.2 Page 23 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. Recruitment practices are not sufficient to ensure that suitably qualified and experienced staff support and protect residents. EVIDENCE: A copy of the duty rota was taken for review. The manager works five days per week between the hours of 8am – 4pm. Three care staff work between the hours of 8am – 8pm each day and one member of staff works a waking night shift from 8pm – 8am with a member of staff on sleep over duty. A gardener/handyman is also employed between the hours of 8am – 4pm Monday – Friday. A Cook works on a daily basis between 8am – 4pm and kitchen assistants Monday – Friday 9.30am – 2.30pm Eight care staff are employed at Musmajas, six of these (including the manager) have obtained their national vocational qualification in care at level two. The personnel files of three members of staff were reviewed each contained an application form, and criminal records bureau check. None of the files contained full employment history, details of qualifications or two written Musmajas DS0000004256.V354673.R01.S.doc Version 5.2 Page 24 references. The manager explained that a majority of the staff employed come straight from Latvia and it is extremely difficult to obtain references. Pre-employment information obtained is not robust and does not ensure that suitably experienced, qualified staff are employed. This could put residents at risk of harm. Training records were reviewed and it was noted that training is planned for infection control and health and safety within the next year. Protection of vulnerable adults, NVQ, food hygiene, palliative care, promoting continence, equality and diversity, dementia and medication training has been undertaken by some staff since the last inspection. Records show that update training is required for mandatory training such as moving and handling, two staff have not undertaken any training and other staff have not received any update training since 2005. Two staff have not undertaken any food hygiene or fire safety training. Musmajas DS0000004256.V354673.R01.S.doc Version 5.2 Page 25 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 This judgement has been made using available evidence including a visit to this service. 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. Lack of supervision and training could lead to unsafe working practices 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. EVIDENCE: Musmajas DS0000004256.V354673.R01.S.doc Version 5.2 Page 26 The manager has yet to register with us. The manager is been in post for approximately one year and is currently undertaking the registered manager’s award. Although the manager is working hard to update policies and procedures and implement systems, work is slow, as she has to work as part of the staffing establishment and provide hands on care on a daily basis. Support and supernumerary time should be given to enable the manager to address the issues identified at this inspection. Residents or relatives meetings are not held. The manager feels that as they work so closely with residents there is no need for a meeting. Satisfaction surveys were sent to residents and relatives in February and August 2007. The results have been correlated and some action taken to address issues recorded. The main issues of concern raised related to a lack of activities or social stimulation. The satisfaction survey of one of the residents being case tracked was seen on their care file. The question regarding social activities was rated as “poor”, comments noted were “I think some activities should be laid on during the winter months so the residents could interact with each other. No social activities during the winter”. Comments were also made regarding the décor, which was felt to be a bit dated. A brief action plan is generated following each satisfaction survey, however it was noted that issues raised in February 2007 were again raised in August 2007. In the opinion of these residents the Home had therefore not addressed the issues that they raised. The manager confirmed that currently she is not auditing working practice but does observe staff when working alongside them. Quality assurance systems in place are limited to a satisfaction survey of residents and relatives. Further work should be undertaken to ensure that the quality of the service provided at Musmajas meets the needs and expectations of those that live there. The administrator holds the personal finances for one resident. There has been no change to the systems in place. This resident is assisted to obtain his finances. Records of expenditure are kept but were not checked on this occasion. A random sample of records were reviewed to evidence whether the health and safety of residents and staff is maintained. The report of the Warwickshire Fire Service inspection of the Home conducted in October 2006 records that “all wedges to be removed from doors, fire alarm to be tested weekly, fire risk assessment to be reviewed”. Records for the weekly testing of the fire alarm were not up to date, the last test recorded was 9 October 2007 (three weeks, six days before the inspection). Doors were seen wedged open. Other records seen were up to date, emergency lighting was tested on Musmajas DS0000004256.V354673.R01.S.doc Version 5.2 Page 27 a monthly basis and received a regular service for an external company, fire fighting equipment is tested and serviced regularly and fire drills take place on a monthly basis. Portable appliances were tested in October 2007. The last Landlord’s Gas Safety Certificate was dated 11 July 2006, this is an annual requirement and requires updating. The stair lift was serviced in April 2007. Musmajas DS0000004256.V354673.R01.S.doc Version 5.2 Page 28 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 2 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 1 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 1 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 3 X X 2 Musmajas DS0000004256.V354673.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes Musmajas DS0000004256.V354673.R01.S.doc Version 5.2 Page 30 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 OP1 Regulation 4, 5Sch 1 Requirement A suitable Statement of Purpose and service user’s guide must be available. A copy of the Service User’s Guide must be given to each resident. (Outstanding since 7 July 05) 2 OP7 15 Care plans must set out in detail, 14/01/08 the action needed to be carried out by care staff to ensure all aspects of the health; personal and social care needs of resident are met. This must include details of any equipment needed to deliver their care and their uses. (Outstanding since 11 September 2006) 3 OP7 15 Residents must be involved in the care planning process. Documentary evidence must be available to demonstrate this. Care plans must be updated when residents needs change and/or following monthly review. 14/01/08 Timescale for action 18/02/08 4 OP7 15 14/01/08 5 OP8 14, 15, 17 All residents must have full Sch. 3, assessments of potential risks to their health and, where a risk is DS0000004256.V354673.R01.S.doc 14/01/08 Musmajas Version 5.2 Page 31 demonstrated, an appropriate plan of prevention must be devised. These risk assessments must be assessed regularly and changes in risk factors clearly recorded. (Outstanding since 21 March 06) 6 OP8 13 Residents must receive support as necessary from external professional such as GP, District Nurse, Chiropodist, Dentist etc. Documentary evidence should be available to demonstrate this. Instructions for care given by external professionals such as District Nurse etc must be followed to ensure that residents care needs are met. The controlled medications register must contain a clear and accurate record of all controlled medications administered and available. The name of medication to be administered and correct dosage and strength must be recorded in the controlled medications register at all times. 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. All controlled medications in use at the Home must be stored in accordance with the Misuse of Drugs (Safe Custody) Regulation DS0000004256.V354673.R01.S.doc 14/01/08 7 OP8 12 14/01/08 8 OP9 13 14/01/08 9 OP9 13 14/01/08 10 OP9 13 31/12/07 Musmajas Version 5.2 Page 32 1973. 11 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. Copies of original prescriptions must be obtained at the Home and information recorded on MAR charts must be checked against original prescriptions. All parts of the Home must be in good decorative order and well maintained. Unpleasant odours must be removed. A risk assessment must be undertaken on the lino in corridors to ensure that it does not present a slip hazard to residents when wet. 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. These practices put both staff and residents at risk of infection. 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. DS0000004256.V354673.R01.S.doc 14/01/08 12 OP9 13 21/01/08 13 OP19 23 14/02/08 14 OP26 13 14/01/08 15 OP29 19 14/02/08 Musmajas Version 5.2 Page 33 16 OP30 18 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) 14/02/08 17 OP38 13 The registered manager must ensure that all issues that relate to the health and safety of staff and service users detailed in the main body of this report are addressed as a matter of priority i.e. fire safety issues, wedging open doors, Landlords Gas Safety Certificate. 14/01/08 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 OP3 Good Practice Recommendations All residents must receive a full assessment before admission. A copy of the completed assessment must be available in care files. Assessment information should include those details as per standard 3.3. All information in care plans should be signed and dated by the person recording the details. Daily records should contain sufficient detail to evidenced that residents daily health, personal and social care needs have been met and any changes in care needs identified. DS0000004256.V354673.R01.S.doc Version 5.2 Page 34 2 3 OP7 OP7 Musmajas 4 OP7 Information in care plans should be dated and signed to demonstrate who has completed the record. Consideration should be given to the use of only one risk assessment regarding pressure areas as the two in use sometimes give conflicting results which can be confusing. Where residents are unable to weight bear some other method should be used to monitor the weight gain or loss of residents. Appropriate action should be taken where weight loss or gain is identified. 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 registered person should introduce systems that will effectively monitor and audit working and care practice in the home. These procedures must be ongoing. 5 OP8 6 OP8 7 8 9 10 11 OP9 OP9 OP12 OP14 OP16 12 13 OP18 OP33 Musmajas DS0000004256.V354673.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Musmajas DS0000004256.V354673.R01.S.doc Version 5.2 Page 36 - 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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