Inspection on 06/10/08 for Musmajas

This inspection was carried out on 6th October 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Musmajas 19/05/08

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 30/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Musmajas Priory Hall Wolston Nr Coventry West Midlands CV8 3FZ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Deborah Shelton     Date: 0 6 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Musmajas Priory Hall Wolston Nr Coventry West Midlands CV8 3FZ 02476542701 02476542737 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Latvian Welfare Fund, Type of registration: Number of places registered: care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 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 homes 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. 0 Over 65 18 Care Homes for Older People Page 4 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service experience adequate 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. The following information in this report is the findings of an unannounced inspection visit that took place on Monday 6 October 2008. Fifteen 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 Care Homes for Older People Page 5 of 35 possible). Looking at their care files and the environment in which they live. Staff training records were reviewed to ensure training is provided to meet residents needs. Documentation regarding staffing, health and safety, medication and complaints were also reviewed. During the inspection the acting manager was on duty along with a three care assistants, a cook, gardener and an administrator. The inspection process consisted of a review of policies and procedures, discussions with the acting manager, staff and residents. Other records looked at during this inspection included, care, staff recruitment, training, staff duty rotas, health and safety and medication records. Notification of incidents received by us from the Home and any other information received were also looked at. The inspector was introduced to a 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. What the care home does well: What has improved since the last inspection? Pre-admission assessments are now undertaken on all potential residents. Those who wish to move into the Home are assessed by the acting manager with family members present. They are then given information about the Home to enable them to make a decision as to whether they wish to move in. The pre-admission assessment gives staff basic information to be able to meet the needs of those that move into the Home. Care plans were in place for all residents. Information obtained from the pre-admission assessment is used to form initial plans of care. Improvements were noted to the information recorded in care plans. These plans of care recorded enough information for staff to be able to care for those that live at Musmajas and have a better understanding of their health and personal care needs. Care plans had been reviewed on a monthly basis and updated as needs change. Improvements had been made to medicine management systems and practices. A controlled drugs cabinet has been ordered and is due to be delivered in November. The acting manager no longer secondary dispenses medicine which is now given to residents from the original pharmacy container. A protocol has been developed for the use of as needed medicines, this was available for each resident. A risk assessment was in place for the resident who self administers their medication. New laundry bins have been purchased with closed in sides and lids to transport soiled items to the laundry. This reduces the risk of cross infection. The acting manager confirmed that soiled clothes are no longer soaked in the sink in the laundry - this practice increased the risk of cross infection from over handling of soiled linen. Care Homes for Older People Page 7 of 35 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get Care Homes for Older People Page 8 of 35 printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 35 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Pre-admission practices ensure that residents are assessed as being suitable to live at Musmajas and that staff have information to be able to meet their identified needs. Residents are not provided sufficient information before admission to enable them to make an informed choice about moving into the Home. Evidence: The Statement of Purpose and Service Users Guide are in the process of being amended. It was identified at the last inspection that the documents were misleading or did not contain sufficient information about some of the practices that take place and services available. The acting manager confirmed that once the required changes have been made each resident will be given a copy of the up to date documents. Both of these documents are available in both English and Latvian language. Contracts of residency were not reviewed at this inspection as they are in the process Care Homes for Older People Page 11 of 35 Evidence: of being amended and re-signed by the Home and individual residents. These will then be re-issued. There have been no residents admitted to Musmajas on a long stay basis since the last inspection. Two people have been staying at the Home for a period of respite care. One of these care files was reviewed to see whether a robust pre-admission process had been followed. The care file seen contained a pre-admission assessment which was undertaken by the acting manager of Musmajas, the potential resident and other family members were also in attendance. Standardised documentation is used during the pre-admission assessment which has improved since the last inspection. The documentation requires the person completing the assessment to indicate from standard statements the level of assistance required with a task. This will give the Home an idea of the persons individual needs and the number of staff required to assist. Areas covered during the pre-admission assessment include communication, mobility, personal hygiene, toileting as well as other activities of daily life and health issues. The care plan provided by the Social Worker/Assessment and Care Management Team was available and gave a brief description of the tasks that the person required assistance with. This was in accordance with the information recorded in the Homes pre-admission assessment. Although improvements were noted in the documentation used during the preadmission assessments, some information was brief or not recorded for example, the assessment did not fully record individualised information i.e. likes and dislikes, preferences. It did not record whether aids and equipment were needed i.e. glasses, dentures, walking frame etc and did not record on each occasion the number of staff that are required to help with a task such as mobility. In-depth care plans had been completed on the day of admission to the Home, these contained more information about hobbies, social activities and preferences as well as how staff are to meet care needs. Two other care files were seen during this inspection both contained pre-admission assessment documentation demonstrating that their needs had been assessed and systems put in place to meet these needs. There was no documentary evidence on file to demonstrate that the Home writes to potential residents to confirm that following the pre-admission assessment it has been identified that they will be able to meet their care needs. Care Homes for Older People Page 12 of 35 Evidence: Overall improvements were noted to the pre-admission processes in place but further individualised information and that which is recorded in National Minimum Standards should be recorded to further improve this process. Care Homes for Older People Page 13 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The recording of residents health, personal and social care needs are much improved and give staff guidance to enable them to meet the care needs of those that live at Musmajas. Improvements are required to medication storage and administration practices. Residents are treated with respect and their rights to privacy and dignity are maintained. Evidence: Three people were chosen to case track this involved looking at their care file, talking to them, looking at their living accommodation and talking to the staff who care for them. Each person had a care file which had been regularly reviewed and was up to date. All three files contained pre-admission assessment documentation. This shows that the Home has as much information as possible about the person so that they can decide Care Homes for Older People Page 14 of 35 Evidence: whether they will be able to meet their needs, and the person has information about the Home so that they can decide whether they want to move in. Plans of care which record individual health and personal care needs and the action that staff are to take to meet these needs were available. Care plans have been developed regarding areas such as personal care, dietary needs, communication, medication, toileting, mobility, social activities and spiritual needs. Care planning documentation in place has changed since the last inspection. They now have more detail of the action that staff are to take to meet the identified need. However more information is needed regarding the use of aids and adaptations such as glasses, dentures and hearing aids. Two of the files seen had both the old and new style care plan documentation available. Too much information on different paperwork may be confusing for staff and might make information difficult to find. Monthly evaluation sheets had been completed with details of monthly reviews and also other details of changes in health, i.e. visits of GP, Chiropodist etc. Letters received from hospital, GP and details of medical appointments with the outcome are kept on file. Each file contained a dependency profile, completed on a monthly basis. This document details changes in dependency and health which may result in the need for more assistance with tasks of daily living. Individual manual handling profiles record whether the individual walks independently or uses a walking frame/wheelchair or is immobile. They also record the number of staff required to assist with mobility and transferring from bed to chair etc. Nutritional risk assessment are completed and are used to identify whether a person is at risk of malnutrition, needs a special diet, encouragement or assistance from staff with eating meals. Each resident had been weighed monthly until August but not since. It was therefore difficult to identify whether residents weight had changed recently. Two of the files seen had a risk assessment regarding the risk of developing a pressure area. This would be used to identify whether any specialist equipment is needed to prevent the person getting a pressure sore. One file did not contain this risk assessment. There was therefore no method of identifying whether this person was at risk of developing a sore or whether specialist equipment is needed. Other individualised risk assessments were in place, for example the risk of using a Care Homes for Older People Page 15 of 35 Evidence: kettle in the bedroom, the use of walking sticks etc. All information completed had been reviewed and updated as necessary. Daily reports are available for both day and night shifts. These monitor changes in health or wellbeing. The daily reports in one file recorded whether assistance was given during the night and where the individual had spent their day. Information for night time in the other two files was not so detailed. Some night entries recorded - in bed at start of shift, happy lady or slept all night. They did not record whether staff have checked on the person throughout the night. None of the care files had been signed by the resident or their representative to demonstrate their involvement in the care planning process. The acting manager said that now she has finished writing up each care plan she intends to sit with the residents and discuss the care plans and ask them to sign. There were no photographs of residents on care files to aid identification for staff. Information recorded in care files had improved and would be sufficient to enable staff to meet identified needs. All residents spoken to during this inspection confirmed that their care needs were being met, and confirmed that they receive their medication on time. The medication for the three residents case tracked was reviewed. Each resident now has an individual protocol for the use of as needed medication. There was no photograph of residents on the front of Medication Administration Records, a photograph would help staff identify residents. There were no copies of original prescriptions. The manager had obtained one copy of the prescription but the GP has not given these to the Home on a monthly basis. The medication of the resident on respite care had not been checked with the GP to ensure that the medications bought into the Home are those that should currently be taken. This should be done to ensure that the resident has brought the correct medication into the Home with them. Medications available were checked against records, some errors were identified. One medication was recorded on the original box and on the Medication Administration Record as one tablet to be given twice per day. Staff have only been giving one tablet once per day. The Medication Administration Record states that seventy three tablets were received, however following the count it was noted that there were seventy four Care Homes for Older People Page 16 of 35 Evidence: tablets. Two other medications checked were also incorrect and there was no signature on the medication Administration record to demonstrate that medications were given on the night of 5 October 2008. Records for one resident noted that two tablets had been refused in October, however the medication refusal chart had not been completed since August 2008. Controlled medications available were checked against records held. It was noted that the controlled medications received on Friday 3 October 2008 had not been recorded in the controlled medications register. Staff had administered medications over the weekend. The acting manager corrected the records during the inspection and wrote an explanation. A new controlled drugs cabinet was ordered during the inspection, this is apparently to be received in November. A hard backed, bound, controlled drugs register has been purchased and is being used to record controlled drugs received and administered. Appropriate medication storage key custody practices are in place. Medication is now transported to the bungalows in a secure manner. The acting manager no longer secondary dispenses medication into a dosette box. Medications records are being audited at least twice per month currently. There is no lockable medication fridge available. This should be available for the safe storage of any medication that requires refrigeration. Medication to be returned to the pharmacy was not securely stored whilst awaiting return. One resident self administers medication, the care file contained a self administration service users consent form and an assessment to determine whether the resident is safe to administer their own medication. These forms were signed by the acting manager and the resident. Residents spoken to appeared well groomed and were dressed appropriately for the time of year. All spoken to said that staff respect their privacy and dignity and treat them with respect. It was difficult to witness whether staff respect individuals privacy in practice due to the layout of the Home. Care Homes for Older People Page 17 of 35 Care Homes for Older People Page 18 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lifestyle experience in terms of meals and social/leisure activities does not meet the expectations of all residents. The service ensures that visitors are made welcome. Evidence: There is no activity programme in place at Musmajas. The acting manager said that she has tried to encourage residents to come over to the lounge in the main building and chat, join in an activity or watch a film/listen to music. However, she said that nobody is interested. The main activities recorded in social activity records held in care plans are, a walk in the grounds or chatting to other residents outside or in their room. Some of the comments made by residents regarding activities were as follows - it is really lonely, they dont do any activities, when it is cold or wet outside you just sit in your room and watch TV. We walk around outside and chat. I cant get around myself any more so I tend to stay in my room and read. One resident said that if activities took place in the main lounge she would definitely join in. Nine of our satisfaction surveys were returned, five people responded that there are Care Homes for Older People Page 19 of 35 Evidence: sometimes activities arranged by the Home that you can take part in, two people said that there is always activities, one person said that this usually happens and one person said that there are never activities to take part in. One person further commented - besides a church service and occasional Latvian function the Home are having a difficult time organising activities. Staff spoken to said that when the weather is nice they take those with mobility difficulties into the grounds in their wheelchair. There were no activities provided by external companies and no evidence of staff providing stimulating activities suited to the wants and needs of those that live at Musmajas. The results in one of the Homes satisfaction surveys seen completed by a resident rated the activities as poor on one occasion and fair on another. Staff have started to complete personal history/life story books with residents. These are a good way for staff to find out about residents and initiate conversations with them about their past. The Home has an open visiting policy and visitors are welcomed at any reasonable time. One resident spoken to said that she had celebrated her golden wedding anniversary and many of her friends, family and neighbours had visited her. The Home had made some sandwiches for them to eat and a family member had bought a cake. The resident said that they had cleared the conservatory for everyone to meet and she had really enjoyed the occasion. Menus seen demonstrated that residents receive a wholesome and varied diet, comments received by residents regarding the meals served were generally good, however two people commented that they did not like the fish fingers or beefburgers that were served. None of the people spoken to were aware that they had a choice of meal. All said that they just eat what is put in front of them, they were not aware that they had a choice and said that they were not told what was for the meal, they didnt find out until it was on the table. A list of meals served on a daily basis is now available. Records between 8 September 08 and 6 October 08 show that on two occasions a resident had an alternative to the main meal served. On each occasion the alternative was poached fish. On all other occasions residents were recorded as having the main meal. Care Homes for Older People Page 20 of 35 Evidence: One resident said that the food is always hot and fresh and the cooks try very hard. They also commented that there was plenty of food and a drink at supper time. Five of the nine people who responded to our survey said that they always like the meals at the Home and the remaining four said that they usually like the meals. Fridge and freezer temperature records were reviewed and these showed that temperatures are taken twice per day and were within the required limits. Care Homes for Older People Page 21 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are confident that their concerns will be listened to and acted upon. Systems are in place to protect residents from the risk of abuse and staff are trained to recognise and report suspicions of abuse so that residents are protected from harm. Evidence: There have been no complaints made to the Home or to us since the last inspection. The complaints procedure was on display on the wall in the main entrance hallway and had been amended to include our correct address and phone number as requested at the last inspection. A log book is kept to record any complaints should they be made. All four of the residents spoken to said that they had no concerns but if they did they would speak to the manager or to a member of staff. All said that they felt that their concerns would be listened to and acted upon. All nine people who responded to our survey said that they know how to make a complaint. There have been no adult protection issues at the Home since the last inspection. The adult protection policy has been amended to include the people who should be contacted if abuse is suspected. A copy of the Coventry Vulnerable Adults Multi-agency policy and No Secrets documents were available for staff to read. Care Homes for Older People Page 22 of 35 Evidence: A member of staff was spoken to about the action that she would take if she witnessed abuse. The staff member was aware of the action to take and the location of the policy if needed. The staff member was not fully aware of the action to take regarding whistle blowing bad practice. The acting manager should ensure that all staff are aware of the whistle blowing procedure. Care Homes for Older People Page 23 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of the environment within this Home is generally well maintained providing an attractive and homely place to live therefore improving the quality of life for residents. Evidence: A tour of the premises took place, this included looking at the communal lounge in the main building, the laundry and some bedrooms in each bungalow complex. Rooms were clean and hygienic and had been personalised with pictures and ornaments. All people spoken to said that they loved their rooms which gave space for entertaining guests if they wish. All bedroom doors are lockable and residents are able to have a key to their room. There is a bathroom with shower or bath, storage area for towels, bed linen etc and a fire extinguisher in each bungalow complex. A domestic style settee has been purchased for the lounge area and gives a homely feel. This room felt cold on the day of inspection and there was no method of monitoring the temperature to make sure that the room was warm enough. The managers office was also cold. Monitoring of room temperatures was identified as an issue for action at the last inspection visit. The acting manager confirmed that she was going to buy some room thermometers. Care Homes for Older People Page 24 of 35 Evidence: The communal areas in the main building and the rooms in the bungalow complex are in reasonably good decorative order. Doors throughout the premises were seen wedged open. The door to the lounge and bedroom doors 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 residents at increased risk of smoke inhalation. This issue has been identified at previous inspections of the Home. All residents spoken to said that they enjoyed the garden areas, they said that they enjoyed taking a walk around and looking at the plants and the birds. The gardens were well kept and attractive to look at. Five people who responded to our survey said that the Home is always fresh and clean and four residents said that it is usually fresh and clean. Discussions were held regarding the laundry processes. Previously a member of staff said that soiled laundry is first cleaned in the sink and then washed. This increases the risk of cross infection. The staff member said that the sluice cycle on the washing machine did not get the clothing sufficiently clean. The manager was advised to use the sluice cycle on all occasions for soiled laundry. Currently staff are still handling soiled laundry more than is necessary which increases the risk of cross infection. The baskets used to transport the soiled laundry have been changed. The manager has purchased bins with closed in sides and lids. This is an improvement on the laundry bins used at the last inspection. The washing machine and tumble dryer were both in good working order at the time of the visit. Disposable gloves and aprons were available in the laundry for staff use. The method of cleaning commodes has not changed since the last inspection. The contents of the commodes are emptied down the toilet, the commodes are wiped around with a cloth and disinfectant and they are put into the sterilising machine once per week. The manager confirmed that they intend to sterilise commodes at least twice per week in future. The manager was advised to obtain advice from an infection control specialist regarding laundry processes and the methods used for cleaning commodes. Care Homes for Older People Page 25 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient numbers of trained staff are on duty to meet the health and personal care needs of residents. Improvements should be made to recruitment systems to ensure that suitable staff are employed. Evidence: The number of staff on duty on the day of inspection was in accordance with the numbers recorded on the duty rota. Staffing levels appeared to be sufficient to meet the needs of those that live at Musmajas. Residents spoken to said that staff are attentive to their needs, kind and friendly. Two residents said that they are fairly independent and do not require a lot of support from staff but feel happy that they are there if you need them and happy that they supply the drinks and food throughout the day. Five residents who responded to our survey said that staff are always available when you need them and four responded that they are usually available. Three care staff work between the hours of 8am to 8pm and two between the hours of 8pm to 8am (one waking and one sleeping on the premises). An acting manager, administrator, handyman and a cook are also employed at the Home. Care Homes for Older People Page 26 of 35 Evidence: The bungalows are located across a courtyard, staff are responsible for completing checks on residents throughout the night. At the previous inspection there was no documentary evidence that staff are completing these checks. Some of the daily records seen at this inspection recorded when staff had been called to provide assistance to a resident i.e. assisted to the toilet, others recorded - slept all night, however staff are still not recording how often they are checking on residents throughout the night. There have been no new staff employed since the last inspection. There have therefore been no change to the induction process in place. However, the manager was aware that staff must undertake induction training in line with Common Induction Standards and confirmed that this will be implemented when any new staff are employed. Three staff files were reviewed, these staff have been employed at Musmajas for some time. Issues were identified with staff personnel files at the last inspection, it was difficult to identify improvements as there have been no new staff employed since the last inspection. It would be difficult for the Home to address issues identified at the last inspection due to the length of time the staff have been employed. Issues such as partially completed application forms and no written references were identified. The acting manager is aware of the need to ensure that the recruitment procedure at the Home is robust and includes obtaining as much information as possible about potential employees employment and training history to ensure that suitable staff are employed. Criminal records bureau and protection of vulnerable adults checks are available for all staff employed. Training was discussed with the manager, all staff have completed moving and handling, food hygiene training, and first aid training, however some staff require update training regarding first aid. Three staff need to complete fire training. Nine staff are currently completing infection control training. Nine staff are employed at Musmajas, five of these have gained the national vocational qualification in care at level two. Training certificates seen on staff files show that staff have undertaken a variety of training to enable them to meet residents needs. The manager must ensure that all staff receive mandatory training within the required timescales. Care Homes for Older People Page 27 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of 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. Not all health and safety issues have been addressed to ensure that residents live in a safe environment. Evidence: There have been no change to the management arrangements in place since the last inspection. The acting manager has been working at Musmajas initially as a care assistant and then promoted to acting manager. There have been some improvements in management systems and practices in place since the last inspection. However, further improvements are required in order to meet standards. Quality assurance was discussed. Satisfaction surveys are sent out to residents and Care Homes for Older People Page 28 of 35 Evidence: visitors. The administrator had filled out satisfaction surveys as the visitor in two of the three files seen. This does not give an unbiased response as this person is employed by Musmajas. 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. There are no questionnaires for other stakeholders such as GP, District Nurse, Chiropodist etc. There are no formally documented audits taking place. The acting manager showed some quality audits which she intends to implement in the near future. There are no residents or relatives meetings as the acting manager said that residents do not appear to be interested in these meetings. Further work is required to improve quality assurance systems to ensure that the people who live at Musmajas are happy with the quality of service provided. The manager observes working practices and would discuss any issues identified during supervision. However, from files seen it could not be demonstrated that formal supervision takes place at least six times per year. The spending money records for four residents were reviewed. Assistance is given with the collection of personal expenses allowance monies for one resident. Records show that money is held by the Home one week and given direct to the resident the next week. The spending money records for this resident did not balance. All other spending money records checked were correct. Following the audit of spending money records the administrator corrected the amount of money available to balance with records held. All income and expenditure should be recorded and an audit of spending money records should be held to ensure that funds available balance with records held. A new accident record book has been purchased which now meets data protection act requirements. A sample of records were reviewed to see if the health and safety of staff and residents is maintained. Throughout the inspection it was noted that fire doors are still being wedged open. This compromises fire safety and increases the risk of smoke inhalation if there were a fire. Fire fighting equipment was serviced on 10 September 2008. Seven staff undertook a fire drill in September 2008 and records showed that there have been seven fire drills Care Homes for Older People Page 29 of 35 Evidence: throughout 2008. Emergency lighting is checked to ensure that it is in good working order on a monthly basis. The hoist has been removed from service as it required repairing. According to the acting manager none of the residents require hoisting. She confirmed that staff would call paramedics to move any resident who had fallen. A member of staff was also questioned about the use of the hoist and said that they would not attempt to move a resident from the floor but would call the paramedics. No other health and safety issues were identified during this inspection. Care Homes for Older People Page 30 of 35 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 9 13(2) All new service users to the home must have their medicine regime confirmed with the doctor at the earliest opportunity. 20/06/2008 2 9 13 All controlled medications in 20/06/2008 use at the Home must be stored in accordance with the Misuse of Drugs (Safe Custody) Regulation 1973. (Outstanding since 5 November 2007) Care Homes for Older People Page 31 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 All new service users to the home must have their medicine regime confirmed with the doctor at the earliest opportunity. This is to ensure that all residents are taking the required medication at the required time as prescribed by the GP 21/11/2008 2 9 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, storage of medication requiring refrigeration, signing of medication administration records, and recording details of medication refused must be addressed within a risk management framework. 21/11/2008 Care Homes for Older People Page 32 of 35 This is to ensure that residents are protected from harm from unsafe medication practices 3 30 18 Documentary evidence must 02/12/2008 be available to demonstrate that staff receive regular mandatory training. Fire training must be undertaken on a regular basis. This is to ensure that the staff have the skills and abilities to meet the needs of those under their care Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 A suitable Statement of Purpose and service users guide should be available which clearly and accurately records the facilities and services available at Musmajas. All residents should receive a full assessment before admission. Care needs should be identified and details of any aids and adaptations to be used should be recorded along with sufficient guidance for staff regarding how to meet these care needs. This gives staff as much information as possible to enable them to look after those under their care. 2 3 3 7 Documentary evidence should be available to demonstrate that staff have undertaken regular checks on residents throughout the night in accordance with their care plan requirements. Residents should be involved in the care planning process. Documentary evidence should be available to demonstrate this. Care files and medication administration records should contain a photograph of the individual resident to aid staff with identification. All old care planning documentation should be removed Page 33 of 35 4 7 5 7 6 7 Care Homes for Older People from care files as too much old style information may make up to date records harder to find and confusing for staff. 7 9 Copies of original prescriptions should be obtained at the Home and information recorded on MAR charts must be checked against original prescriptions. Organised activities should be available that meet the residents social, cultural needs and interests. A system should be put in place to ensure that resident are aware that they have a choice of meals on a daily basis. All staff should be aware of the whistle blowing procedure and the action to take to blow the whistle on poor practice. The Home should use a method of monitoring the temperature of rooms in all resident areas and room temperatures be set at suitable temperatures Further advice should be sought from an infection control specialist regarding the current methods of cleaning commodes and storage of soiled laundry waiting to be sluice washed. Systems that will effectively monitor and audit working and care practice in the home should be introduced. These procedures must be ongoing and should include obtaining the views of stakeholders regarding the quality of service at the Home. Formal, documented supervision of staff should take place at least six times per year. Health and safety issues such as the wedging open of fire doors should be addressed as soon as possible. 8 9 10 11 12 15 18 19 12 26 13 33 14 15 36 38 Care Homes for Older People Page 34 of 35 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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