Inspection on 03/10/07 for Nelson House

This inspection was carried out on 3rd October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Nelson House 1-3 Nelson Road Dudley West Midlands DY1 2AG Lead Inspector Mrs Jean Edwards Key Unannounced Inspection 3rd October 2007 08:00 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 DS0000068841.V337711.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. DS0000068841.V337711.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Nelson House Address 1-3 Nelson Road Dudley West Midlands DY1 2AG 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) 01384 237717 01384 237717 Quality Care Home (Midlands) Limited Leah Robertson Care Home 17 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (2), Old age, of places not falling within any other category (12), Physical disability over 65 years of age (4) DS0000068841.V337711.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One service users accommodated at the home may also be A(E). This will remain until such time that the current service users placement is terminated. Date of last inspection New Registration Brief Description of the Service: Nelson House is a private care home in a residential area within walking distance of Dudley town centre. The premises are adapted from three large traditional terraced properties, extended and adapted to offer the accommodation currently registered for up to 17 older people, including four older people with a physical disability and one older person with dementia. There are thirteen bedrooms and two double bedrooms located on the ground and first floors. The bedrooms have a variety of layouts, with some wellproportioned rooms. The first floor can be accessed via a 5-person passenger lift. The home has a communal lounge and separate dining area on the ground floor. The home offers a number of aids and adaptations, these including some adapted bathing facilities, portable lifting equipment, and an emergency call system. The home has level wheelchair access to the side of the building, which is accessible from the front and rear of the property. There is an enclosed rear garden and limited off road parking at the front of the premises. A new proprietor, registered by the CSCI, purchased Nelson House on 12 March 2007. The Home has a staff team of 18 people including the Registered Manager. The level of fees for this home, has not been provided by the home, and is not currently published in the homes service user guide. People may wish to obtain up to date information relating to fees from the care home. DS0000068841.V337711.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the unannounced key inspection visit for 2007 - 8, undertaken by an inspector from the Commission for Social Care Inspection (CSCI), over a weekday for approximately 11 hours. All Key National Minimum Standards have been assessed at this visit. The range of inspection methods to obtain evidence and make judgements includes: discussions with the registered provider, registered manager, and staff on duty during the visit, together with examination of records and documents and discussions with residents, where possible. Other information was gathered before this inspection visit from the homes Annual Quality Assurance Assessment (AQAA), incident, accident and other notifications submitted by the home. Service user surveys, relatives, social care and healthcare, and staff surveys have been sent out by the CSCI, and the analysis of surveys returned is contained throughout this report. There are currently 13 residents living at the home, including one person in hospital. During the visit the inspector has spoken to the majority of residents. Longer discussions have taken place with the residents whose care was looked at in depth. Comments indicate that staff are friendly and helpful. There has been a tour of the premises, including the grounds, communal areas of the home, the bathrooms, toilets, laundry, kitchen areas, and residents’ bedrooms, with their permission. What the service does well: The majority of residents at Nelson house feel that they had enough information about the home to make a decision about whether they wanted to live there. A new resident states, I have heard about the home from friends and I am happy to be here. The owner has written a welcome card to the new resident, who has been cheered by the gesture and the card is on display in her bedroom. All residents have received a contract with terms and conditions of their residency, though the contracts still need to be revised to reflect guidance from the Office of Fair Trading. Comments from the service user survey forms indicated two residents could not remember having a contract; however there is satisfactory evidence from records and discussions with residents and relatives that everyone has a signed and dated contract, with a copy on their care file. Residents generally regard Nelson House as their home and are able to arrange their bedrooms according to their liking. Two residents continue to DS0000068841.V337711.R01.S.doc Version 5.2 Page 6 make their own drinks and snacks in their bedrooms. Some people also choose to have their meals in their rooms. The staff group are caring, committed and flexible, often willing to work extra shifts. There is a genuine and warm rapport between staff and residents. Comments from the CSCI relatives surveys about what the home does well include, kindness, TLC, cheerfulness and welcoming when I visit and generally look after mom very well and always make us very welcome and the caring of the residents is good and it has a friendly homely feeling and the staff are very nice and informative This inspection was conducted with the co-operation of the Proprietor, Registered Manager, staff and residents. The Inspector would like to thank the proprietor, manager, staff and residents for their hospitality during this inspection visit. What has improved since the last inspection? The registered manager has introduced new care plans and assessments of risks, and improved health care screening for each resident. There is evidence of attention to the majority of each persons care needs and generally of the active involvement of the residents and their relatives. There is progress to show that the health and well being of all residents is properly safeguarded. Efforts are continuing to improve the way medication is stored, administered and recorded, and the additional areas requiring improvement at this visit, mainly relate to medication records and the need for agreed protocols for the use of calming medication. Some progress has been made to the maintenance and decor of the home, such as the redecoration of the main lounge, which also has new curtains and a new carpet. New dining tables and chairs have been provided, which create greater flexibility, easier access and more choice for residents to eat in small groups, with their friends. There is a new dishwasher in the kitchen, which frees up some staff time and provides improved food safety and better infection control. The registered provider has plans to introduce the Internet for residents, and to install broadband so that they can communicate with relatives and friends. There are some additional activities such as the weekly baking day when one or two residents help to make cakes and puddings, an initiative praised by Dudley NHS. There are efforts are being made to improve staff training to make sure that all members of staff understand what is expected of them and how they should carry out their duties. DS0000068841.V337711.R01.S.doc Version 5.2 Page 7 The standard of record keeping continues to generally improve in the majority of areas. What they could do better: Previously there were improvements to staffing levels with the recruitment of the new registered manager and additional care staff, made in response to the serious warning issued to the previous proprietor. However the new proprietor has decreased staffing levels to two carers during parts of the day. We found that this has resulted in unsatisfactory levels of support and a decreased quality of service for residents, which includes having to wait for attention at times. In addition carers have to cover essential cleaning due to the lack of domestic staff over weekends. The new registered provider is required to take action to increase the numbers of competent staff to safe levels, with immediate effect. The registered persons have given a commitment that staffing levels will be increased at the conclusion of the inspection visit and they must provide weekly staffing rotas, as evidence to the CSCI until further notice. One member of senior staff has been recruited without full clearances in place. This action does not provide adequate safeguards for residents and the registered persons must take remedial action and make sure robust staff recruitment procedures are followed in future. The registered persons need to provide a wider range and more opportunities for residents to be involved in activities and outings of their choice, supported by sufficient numbers of staff. Comments about what the home could do better include, would be nice if more outings could be arranged, for people to be taken out more and more activities where possible and more outdoor activities and in-house activities and special events to be organised. The registered persons must make arrangements for a resident to have a meeting with the social worker to discuss decisions and restrictions on unescorted outings from the home. The outcome and agreements must be notified to the CSCI. The home is currently revising the menus in consultation with residents however in the interim the cook is not using planned menus, which may mean that not all residents have sufficiently nutritious diets. There must also be improved records of residents food and fluid intake to show that they have adequate nutrition, or fortified meals or food supplements and show action has been taken where there are concerns or weight loss. Some improvements have been made to the home’s complaints procedure, however this must be produced in a form that is understandable to the people DS0000068841.V337711.R01.S.doc Version 5.2 Page 8 needing to use it. For example for people unable to read or understand written information, alternative formats must be provided. It has been noted again during this visit that a ground floor residents bedroom (room 4) is being used for the hairdresser to tend to all residents hairdressing needs. Although it is stated that the resident has given consent, this practice must cease with immediate effect and the registered persons must provide an alternative, which does not infringe any residents rights to privacy or compromise infection control measures. The registered persons must continue progress with a documented prioritised, programme of maintenance, repair and redecoration for the home, which still needs attention in a number of areas, particularly the bathing facilities on the ground floor and kitchen, identified as a legal requirement in a report from Dudley MBC Directorate of the Environment in April 2007. The registered persons must put in place a quality assurance and monitoring system, based on seeking the views of the residents, relatives and other professionals about how well the home is meeting the National Minimum Standards for Older People. There must be regular residents meetings, with notes of discussions and actions. The registered person must also put in place an annual development plan for the home based on a systematic cycle of planning, monitoring and review. The registered persons must put in place a formal system of staff supervision meetings for support and development, to equip staff to recognise and effectively meet residents care needs. There should also be regular staff meetings to improve communication. There a small number of areas of health and safety, which need improvement, such as actions to improve the control of infection particularly in the laundry. 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. DS0000068841.V337711.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 DS0000068841.V337711.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): 1,2,3,4,5 Quality in this outcome area is adequate The home has a new statement of purpose and service use guide, which are made available to residents and families. The information in these documents is not entirely accurate and does not contain information about the level of fees charged. This has the effect that residents and their advocates do not have sufficient information regarding their rights and entitlements and any agreed restrictions. The registered manager now generally ensures that there are continued reassessments of the residents’ needs. Standard 6 is not applicable, as the home does not provide intermediate or short stay care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a new statement of purpose; setting out the objectives and philosophy of Nelson House and this is supported with a service user guide. However this does not provide sufficiently clear information about the home, DS0000068841.V337711.R01.S.doc Version 5.2 Page 11 for example it does not reflect the current provision of staffing levels, which have been reduced. There is insufficient documentary evidence, such as residents or their relatives signatures to demonstrate receipt of the new service user guide and contract, on the sample of residents case files assessed. Responses from the CSCI service user surveys are that 4 residents feel they had adequate information and 3 did not with comments such as, unsure. Additionally the information about level of fees charged for the service is not currently published in the service user guide. There is some evidence from the sample of 2 residents files examined that the new provider has issued new contracts, however there are some terms, which may not comply with the Office of Fair Trading guidance for Care Homes. Four residents responded that they had received contracts, one resident states no contract and there is a comment, maybe but not certain. The home has currently accommodates 12 residents, and one person is in hospital. The registered manager has advised the CSCI of this event with a Regulation 37 notification. One new resident has been admitted since the new provider has been registered. She is described as an independent person able to make her own decisions. Discussions with this 90 year old resident shows that she was fully involved in her admission to Nelson house. She states that she had lived in her own home, owned by three generations of her family previously. She explains that due to her deteriorating mobility through arthritis she has had two previous stays care homes before deciding to come to live at Nelson House. She says she was aware of Nelson House, though friends and declined an offer to visit before her admission. The manager visited her at her home prior to the admission so that she had more information and staff were aware of her needs. She says her bedroom was cold, she told the manager and owners and it has been put right. The owner has written a welcome card to the new resident, who has been cheered by the gesture and the card is on display in her bedroom. There are a mix of views from the responses to the CSCI relatives surveys such as, we are very pleased with the way we are kept informed to there has been a change of management & ownership, I sometimes feel that relatives have not been informed of staff changes etc. Another relative comments, the client review was carried out this year with me not present. I do have a mobile phone and my wife has been at home, but they state they were unable to contact me. Due to my fathers deafness he would not have been aware of what was being said The homes response is that the review meeting arrangements were made by the Social Services Department. The registered provider has reduced staffing levels and in addition there are at least two care staff on long term sick absence. In addition not all staff have the necessary skills and ability to care for residents who are accommodated and the additional staff training to meet the needs of people with mental health DS0000068841.V337711.R01.S.doc Version 5.2 Page 12 needs, dementia and behaviours, which challenge the service has not been fully completed. DS0000068841.V337711.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. The improved care planning and monitoring provides staff with the information they need to adequately meet residents needs. There is multi disciplinary working taking place on a regular basis, which results in the health needs of residents generally being met. There are not sufficiently robust arrangements for the administration of medication in all areas, which means there is potential to place residents at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: From the sample of residents files examined there is evidence that each resident has a care plan, in a new format, good practice involving residents in the development and review of the plan. The plan in most cases includes essential basic information necessary to plan the individuals care and includes a risk assessment element. From examination of a sample of residents case files, some care plans still have small omissions. Examples are missing areas from care plans are where residents need more specialist support or need DS0000068841.V337711.R01.S.doc Version 5.2 Page 14 special diets. There is some guidance in the care plan to meet a residents care needs relating to depression and Parkinsons disease. The new residents assessment of need indicates a low fat, low salt diet, however this is not referred to in the care plan or in the kitchen. An assessment of the new residents care plan shows there are comprehensive monthly reviews, which cover all aspects of care plan, with a record useful information, for example, mobility continuing to improve, carries out all personal care tasks, now watches TV, enjoys The Archers, conversation, and activities in home but not outings. The plan also recognises the resident goes to her bedroom for privacy in the evenings. One person continues to indicate dissatisfaction with decisions about restrictions relating to trips out of the home. The resident has been treated in hospital for some physical deterioration and the registered manager is advised to contact the Social Worker, requesting that a further review be held to allow the resident to discuss the issues again, with decisions and agreements recorded and also notified to the CSCI. Residents generally have improved access to health care services to meet their assessed needs both within the home and in the local community. Some residents are able to choose their own GP within the limits of geographical borders. There is improved documentary evidence to demonstrate that residents have access to dentists, opticians, chiropodists and other community services. There is evidence from records and discussions that each resident’s health is generally monitored with action taken. There is evidence in the care plans examined of health care screening and assessments, including weight monitoring, nutritional and tissue viability information. The home has sit on scales for residents unable to stand and weight bear, however the equipment is stored in a ground floor residents bedroom, which is not appropriate. Nutritional screening is undertaken on admission and subsequently on a periodic basis with a record maintained. From assessment of residents records it is noted that one resident has a weight loss from 51.5kg to 48.1kg, although she has also has a recent short stay in hospital in October 2007. There are insufficient records to demonstrate appropriate referral for advice and support, monitoring of adequate nutritional food intake or fortified meals to increase the calorific value. From the sample of residents files assessed daily records, personal care and daily routines are well documented, for example one person likes a bath between 10-11am each Friday. Daily reports are well structured giving details of assistance by whom, visits, Doctors visits, any activities, other visitors, and any concerns. For example when the new resident commented that her DS0000068841.V337711.R01.S.doc Version 5.2 Page 15 bedroom was cold; the room was checked and thermometer was put in room on 29/9/07, with remedial action to the radiator. However examination of the monthly personal care log sheets show that they are not fully completed, and for the whole of September only 1 bath on 16/9/07 has been recorded. Similarly records are insufficient to demonstrate how personal care has been provided for the resident with dementia who dislikes being bathed. Her daily routine is in place with times recorded as varies according to her state and day - bathing at time when opportunity arises - dislikes baths but will have good wash. The monthly personal care records for August has gaps on 12,13,14,25. The registered provider and manager state that they have reminded staff about the importance of good record keeping. Medication is provided by BOOTS Pharmacy, which also provides regular medication audits and reports for the home. The majority of medication is provided in an MDS system, with a small amount in original containers. The home has a medication policy, which the registered manager states is being revised and updated. There is evidence that where medication systems are in need of action that the registered person is working towards improvement. The proprietor and manager discussed the findings of a recent BOOTS audit, which identified a discrepancy with the amount Temazepam, stored as a controlled drug. The provider has sent a Regulation 37 notification to the CSCI received 4/11/07 giving full details. The BOOTS Pharmacist conducted an investigation and identified an error made booking in a new supply of Temazepam, and concluded no medication was missing. The error, acknowledged by manager, occurred because there was no physically check made of the balance. The registered persons have agreed an action plan with BOOTS pharmacist to avoid any future mistakes. During an examination of the case file of a resident diagnosed with dementia we noted that she has been prescribed Promazine 5ml or 10ml as required, up to three doses daily. The home received 300mls on 20/09/07 and all but 2 variable dosages have been recorded on the MAR sheet. A calculation of dosages administered indicated that 220mls should have been used. However a container of 150mls has been commenced for two days. Meaning that correct dosages may not have been administered. During discussions staff say a measuring spoon is used to administer dosages because the resident is reluctant to take the medication from a medicine tot. The manager is advised to seek advice from the Pharmacist and use an accurate measuring system. From examination of the MAR sheets it is evident that some staff administer 5mls other times 10mls of Promazine, with no clear explanation in records or verbal discussion as to how the decision for dose has been reached. For example examination of daily records when Promazine has been administered on some days there are no indications of agitated, restless or aggressive DS0000068841.V337711.R01.S.doc Version 5.2 Page 16 behaviour. On several days there are notes that the resident is sleeping until late morning and during day. There are several night reports that she has been wakeful and shouting out during night. There is no written protocol for the need for administration of Promazine, its variable dosage or its results. This must be in place and be reviewed by the health professionals. The medication regime for the new resident is well documented. This person administers her creams and has a MAR sheet, which staff monitor and assist to order more when needed. There is a documented, agreed risk assessment in place for this resident dated 3/10/07, which demonstrates good practice. The carried forward medication is recorded on MAR sheets, which is good practice. Random audits of medication stocks at this visit show that one resident prescribed Co-codamol 500mgs had a balance of in excess of 3 tablets another had a deficit of 2 Paracetamol 500mg tablets and a third balance of Paracetamol 500mg tablets was accurate. It is positive that BOOTS pharmacy has provided the home with supply of clear plastic bags & tags for a more accurate system for medication returned, in addition to the returned medication records maintained at the home. The shelving in the medication room has been improved to ensure internal and external medication can be stored separately. It is positive that measures are in place for all staff involved with the administration of medication to have undertaken accredited medication training. However the list of specimen signatures of staff administering medication is not entirely up to date. Members of staff strive their best to treat residents in a way, which maintains their dignity and independence with residents generally looking groomed and appropriately dressed. However there have been times during this visit when staff have struggled to meet some residents needs because they have been involved elsewhere in the home. A comment from the CSCI relatives survey states, they are not always very quick in responding to requests for the toilet. Sometimes was there I have had to ask more than once. It would be nice to have some space to be able to talk privately. The dining room is often being used by the staff. Another relative has commented, There was a period when he was not being shaved correctly, this has improved During a tour of the premises the registered manager and provider informs us that the hairdresser no longer uses the ground floor bedroom 2, to attend to all residents hairdressing needs, as required at the previous inspection and now uses bedroom 4, with the residents consent. We have informed the registered persons that this situation is also unacceptable, as it continues to infringe the residents rights to privacy and does not promote effective infection control measures. DS0000068841.V337711.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate There is very limited evidence of progress to make planned and spontaneous activities available on a regular basis to offer residents opportunities to take advantage of and develop socially stimulating activities. The majority of residents are able to maintain good contact with family and friends. The home has not demonstrated that it proactively seeks independent advocacy for residents, without the close support of relatives or other representatives. Whilst attempts are made to offer residents a nutritious diet, there is still insufficient evidence that the dietary needs of all residents are always catered for with a balanced, nutritional and varied selection of food that meets residents tastes and choices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is evidence from case files examined and discussions with residents they are asked about their preferred times of rising, retiring, bathing and preferred gender of staff to assist with personal care. The new registered provider and DS0000068841.V337711.R01.S.doc Version 5.2 Page 18 registered manager state that improvements are being made to consult residents about how the home can work to achieve changes to provide them with a flexible lifestyle. The home does not currently have a key worker system, which would enable closer resident / staff relationships where residents likes, dislikes and needs could be facilitated in a more individual way. Key workers could use information to plan activities on an individual as well as a group basis. Although there is an understanding for the need to increase the level and variety of activities and to improve access to social stimulation, there is limited evidence of progress to make this happen, since the last inspection. There is some evidence that some residents prefer to spend some time on their own or choose not to be involved in group activities. The home does not have an activities coordinator and the majority of activities have to be undertaken by care staff employed at the home, who also currently undertake some catering duties daily and cleaning and laundry duties at weekends in addition to personal care, which means time for activities and outings is limited. The home has an activities programme displayed in the home, with some activities from outside sources, such as NJR fitness and the Dudley Christian Fellowship, which visits the home every two weeks. The staff provide the majority of activities, when they have sufficient time. One residents assessment information states she used to enjoy involvement with the Salvation Army and it is recommended that the home tries to re-establish contact. A care plan for a resident with dementia dated, 4/2/07 states not much interest in activities. The resident has a short attention span and currently presents the home with some behaviours, which challenge the service and though staff have received recognised dementia training, no dementia specific activities are being provided. The registered provider states that the home now has visits from the library service. There are a high number of comments about the need for more social stimulation, activities and outings from CSCI surveys received from residents, relatives and staff. Residents responded there are always activities I can take part in - 3, usually- 1, sometimes - 2 and never - 1, with the comment there is very little or even no indoor or outside activity as far as good TV, films, games, or talks and general conversation. A relative has commented, often the TV seems to be not tuned in correctly this being his only source of entertainment. There is an aerial socket in his room but this does not work. They say he does not watch the TV at night. In addition there are comments from the majority of staff surveys indicating there are insufficient activities, due to lack of staff, with comments for improvements such as, encourage indoor/outdoor activities, more communication between management and staff. DS0000068841.V337711.R01.S.doc Version 5.2 Page 19 The registered manager states the majority of residents are registered to use Ring & Ride and home has had notification regarding new free bus passes to be issued. However staffing levels are not adequate to take full advantage of this positive initiative. Some changes are being made which help to achieve residents’ wishes, such as having more activities and outings. Relatives have commented that the home could do better, would be nice if more outings could be arranged and for people to be taken out more and more activities where possible. The home has open visiting arrangements, with a written visiting policy and residents are aware that they can entertain their family and friends in their own room. Comments from the CSCI relatives survey include, we visit my mother nearly every day but if she is upset they phone us to talk to her and they encourage her to talk to me on the phone. Many people prefer to use community areas of the home to talk to visitors, although this may not always provide privacy, and can sometimes be seen as intrusion by other residents. A relative has commented, my father is profoundly deaf and due to his stroke is unable to write. When I visit I am sometimes annoyed by other residents being able to hear what I am saying due to having to speak loudly. Residents are able to have personal possessions in their room, but may be unable to bring large items of furniture due to for example, limited space or health & safety considerations. The sample of inventories on residents case files is up-to-date, signed and dated by staff and the resident or their representative. For example the inventory for the new resident includes, a perch stool, tea trolley, clock mobile phone brought in from home. However the homes contract / terms & conditions suggests only small items be brought into the home. The manager states that forms have been completed for postal vote for all residents wishing to exercise their right vote in any forth-coming elections. The registered provider and manager state that there are 2 cooks, one person working 7:30am - 2:30pm each week day and another person working Saturday and Sunday. The weekday cook also has contract as senior carer and is also covering care shift on the day of this inspection, from 2:30-9:30pm. The staffing rotas do not show adequate catering hours. For example there are only 2 carers on duty on the day of the inspection (and subsequent days) from 2:30 - 9:30 to provide care for the residents and provide nutritious meals, snacks and drinks. The staff say that sometimes the manager and proprietor stay until 5 or 6 pm to help, though this is not clear on the staff rota. Additionally the staff rotas do not demonstrate that there is a designated cook over weekend periods and a number of staff appear to have more than one role. Examples are part time cook / senior care support. DS0000068841.V337711.R01.S.doc Version 5.2 Page 20 In discussion with the cook, who has an up to date food hygiene training certificate, she states that the menus are in the process of being reviewed and changed. She states that this is being done in consultation with the residents and their food preferences are being sought. There are no planned menus available for the current week. During this inspection visit some residents have had a cooked full English breakfast, which looked appetising; others have had toast / cereal according to their preference. It is positive that two residents have helped with baking cakes with cook, during the visit. This practice has been commended in a letter dated 11 May 2007 from Dudley Public Health, following two focus group discussions at Nelson House. Lunch on the inspection visit comprised mainly soup (tomato or vegetable or chicken) and bread roll. Staff asked residents for their preferences. Though there are no set menus at present the proprietor stated that residents would be having a cooked evening meal. However at around 4pm, when there was no evidence of cooking in kitchen, we are informed by the cook, now on duty as a carer that she has prepared a selection of sandwiches. Following discussions with the provider and manager about the potential lack of nutrition in some residents diet, an option of corned beef hash has been offered. We have provided the home with the telephone contact of community dieticians based at Amblecote High Street for advice, and who will take direct referrals and offer training. The cook states that some residents who did not have a cooked breakfast have been offered this as a mixed grill at lunch-time and there are some records of food intake on sheets in file, however these are insufficient and do not comply with the Data Protection Act. It is positive that there are improved food stocks and that there are bowls of fresh fruit around the home. Additionally each afternoon residents are offered a fruit platter, with peeled fruit segments, which are enjoyed by most people. Residents are also offered milky drinks at night, and one person likes an OXO drink. Reponses to the CSCI service user survey indicate 4 residents always, 2 usually and 1 sometimes like the meals at the home. DS0000068841.V337711.R01.S.doc Version 5.2 Page 21 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is adequate There is improved evidence that complaints are listened to, with action taken to look into them and there is an improved potential for clear recording of investigations, outcomes and lessons learned. Policies, procedures, guidance and staff training have been improved, though not fully implemented, in order to provide residents with satisfactory safeguards from abuse. Residents rights to exercise their democratic choices are not better protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a revised complaints procedure displayed in the reception area and contained in the service user guide and individual contracts. The homes complaints log shows that there are no recorded complaints since the new proprietors were registered in March 2007. All residents who can answer questions meaningfully know how to complain. The new resident has raised the issue about her bedroom being cold and she states that she was told the radiator was not working and this was dealt with promptly. The registered provider states that a thermometer has been provided in the bedroom to monitor the temperature. DS0000068841.V337711.R01.S.doc Version 5.2 Page 22 There is evidence that 8 members of staff have attended training provided by Dudley MBC and places have been identified for remaining staff in the next training programs. Training certificates are available on the sample of staff files examined. The home has the up-to-date copy of Dudley MBC Safeguard and Protect procedure for safeguarding adults, dated January 2007. At the date of this inspection visit five staff have signed to demonstrate their awareness of the policy and procedure. The home has had one incident, an allegation of abusive behaviour by night staff, which has been referred appropriately to the adult protection coordinator and investigated using the procedure. The manager states it has been helpful for staff to understand that the home has the procedure to follow in the event of any allegation of abuse of residents. Dudley Social Services and the Police were involved with initial interviews and an investigation, which concluded there was no evidence and no case for the staff to answer. The suspension of the 2 staff was lifted and they returned to work with support, with residents pleased to see them return. The manager states she kept in touch with the families throughout, who were pleased with the level of communication and confidentiality and were also happy for the staff to return to work. The two night staff concerned have been given additional training provided by social services. In addition the registered manager and provider have worked nightshifts with the staff and have no concerns. The manager states that the areas needing improvement, which came out of the investigation, were the level of supervision of residents at night and record keeping on night duty. The manner in which the home has responded to a difficult situation is very positive. During discussions the majority of staff, especially senior carers can appropriately describe how they would respond to a complaint or an allegation of potential abuse. DS0000068841.V337711.R01.S.doc Version 5.2 Page 23 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): 19,20,21,22,24,25,26 Quality in this outcome area is adequate The standard of the décor within this home is improving with some evidence of forward planning for positive changes to the design, décor and furnishings. The standards of cleanliness and infection control have improved in most areas, which has reduced the residents being at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Nelson House is a series of adapted and extended traditional town houses. There are interesting shaped and sized rooms. However some of the corridors are narrow and would need to be more spacious, especially if there are residents who are dependent on wheelchairs for their mobility. The space in the dining room is limited however new dining tables and chairs have been provided so that all residents can be comfortably accommodated at mealtimes, should they all wish to eat their meals at the tables. There are also improvements with additional small tables in the large communal lounge. DS0000068841.V337711.R01.S.doc Version 5.2 Page 24 The home has one bathroom on each floor, however the ground floor bathroom is not suitable for residents with physical disabilities and the provider and manager state that this is still not much used. This means that residents are generally transferred to the first-floor to be bathed for their comfort and safety. As indicated in previous inspections, should the new registered provider wish to continue to provide care for the category of older people with physical disabilities she must give serious consideration to upgrading the aids and adaptations and general facilities of the physical environment of the home. During the tour of the premises all residents bedrooms have been viewed, with their permission. There is evidence that they are able to have personal possessions and limited furniture arranged to their own preference. Two residents have their own fridges and they continue to be able to make drinks and snacks in his bedroom. Another person has an attractive trunk and drum brought with her from overseas. The decor of the home is generally much improved with the proprietors spouse undertaking the minor repairs and most of the redecoration and maintenance. Some of the improvements made since the new registration in March 2007 include: New carpet in the main lounge. Redecoration of the main lounge Redecoration of a number of residents bedrooms, including No.3 New security lights for the rear of the building Improved security at the rear of the home The registered persons have contacted the crime prevention officer based at Brierley Hill police station for security advice and with the additional measures in place; there are no further reports of incidents. The registered provider states that there are plans to make the home more energy efficient, with replacement boilers and plans for the refurbishment of the kitchen, which has also been highlighted as an outstanding legal requirement in the Report of Food Safety & Hygiene from Dudley MBC Directorate of Urban Environment dated 10 April 2007. Although the registered persons indicate positive intentions there is still no documented programme of maintenance, repair and replacement for the home to demonstrate forward planning. The general cleanliness of the home shows continued improvement. The home employs one domestic housekeeper, on Monday to Friday, and additional domestic duties at weekends are covered by care staff, which is discussed at DS0000068841.V337711.R01.S.doc Version 5.2 Page 25 the Daily Life & Social Activities, Staffing and Management sections of this report. During the tour of the premises the provider has been requested to remove out of date documents on display relating to previous provider and previous registered manager. The following is a summary, though not an exhaustive list of areas to be included in the programme of maintenance, repairs and renewal: To provide a timescale for the renovation or replacement of the identified external window frame and store on the ground floor rear of the property To cease to use the ground floor residents bedroom (room 4) for the hairdressing for all residents, with immediate effect and provide an alternative venue, which does not infringe any residents rights to privacy or hinder infection control measures To seek advice from the health protection agency and environmental services regarding the laundry and provide a plan and timescale for improvements To provide a suitable commercial dryer in the laundry To provide comprehensive COSHH information in the laundry and storage areas for chemical products Fire Escape to be cleaned and maintained to be free from rust and algae Continue to renovate the paintwork throughout the home, particularly downstairs - door frames, skirting boards Redecorate the dining room First floor corridor carpet to be re-stretched or replaced Ground floor WC to be redecorated and flooring renovated or replaced Bedroom 13 - call point to be repositioned to enable resident to use, this also applies to any bedroom where layout or furniture is changed Bedroom 13 - carpet to be replaced All unfinished radiators throughout the home to be painted or appropriate finish applied DS0000068841.V337711.R01.S.doc Version 5.2 Page 26 Refurbishment of the kitchen, including cupboards, work surfaces and appliances replaced where necessary to be completed in an identified timescale Defective refrigerator to be replaced with an appropriate commercial model Drawer front on kitchen unit is repaired or replaced as an interim measure That the frayed joins in the new carpet in the lounge be rectified That all parts of the home are heated to an ambient temperature at all times to be comfortable for residents DS0000068841.V337711.R01.S.doc Version 5.2 Page 27 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is poor Staffing levels have been decreased and as a result residents are not receiving safe and consistent care. There is low staff morale in this home and recruitment practices are not robust, with appropriate vetting and checks not completed, not providing adequate safeguards for vulnerable residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are currently 12 residents accommodated and 1 resident in hospital, with a variety of dependency levels and diverse needs. Assessment of staffing rotas shows deterioration in staffing levels, both in terms of numbers and stability. There is insufficient evidence that the registered manager is formally and regularly identifying residents dependencies and occupancy levels and regularly reviewing staffing levels, making appropriate adjustments. The new registered provider has taken the decision to reduce staffing levels based on her own assessment and judgement. Although she has written to the CSCI with a proposal to reduce staffing levels. The decision and risks rest with the registered persons. There are 19 staff recorded in Homes register of persons employed, in the AQAA submitted to the CSCI and the homes Statement of Purpose indicates that there are 6 senior staff, 7 part time care staff (days), 3 care staff nights, 2 cooks, 1 housekeeper, 1 part-time administrator and a gardener/ handyman in DS0000068841.V337711.R01.S.doc Version 5.2 Page 28 addition to the registered manager and registered proprietor. Assessment of staff rotas shows 17 staff of whom, 2 are on long-term sickness absence. In addition to the registered manager and provider there are 4 senior carers, 1 long term sickness, another without full CRB clearance; 6 part time carers, 1 long term sickness, 1 part time cook / part time senior carer, 1 housekeeper / part-time carer, 1 full time cook / part time senior carer, 1 senior night care supervisor, 1 senior and 2 night carers. On the day of this inspection visit the morning shift has 3 carers, including the senior in charge of the home and one being the housekeeper / domestic assistant, working as a carer for one hour. However a member of staff has been observed to be doing some vacuuming at 8:20am, at the time the inspector arrived at the home. Following a telephone call the manager and proprietor have arrived around 9:00, which they state is their usual start time and they both work in the home until about 5-6:00pm. The proprietor states her spouse is at home doing maintenance from 5:30 until late most evenings. There are only 2 care staff, 1 senior, and 1 carer on duty in the home from during the evening shift. There are two wakeful night staff, who undertake some cleaning and laundry duties during the night. Some outcomes for some residents observed during this visit are not satisfactory and staffing levels must be increased to a minimum of three care staff on all wakeful day shifts, with immediate effect. Furthermore there must be sufficient ancillary staff on duty; including afternoons and weekends to ensure that catering and cleaning duties do not negatively impact on the care for residents. Some examples are, at 8:30 am there were 6 residents unsupervised in lounge, with staff in other parts of home assisting residents elsewhere in the home, when a resident tipped hot tea on lounge carpet and another resident had swallowed her drink and began chocking, the inspector called for staff to help. In addition some calls for assistance during the day had waits ranging from a few to several minutes before staff were free to offer assistance. The home has three residents who choose to stay in their rooms for most of the day and one very frail resident cared for in a first floor bedroom, who is immobile, needing 2 staff to hoist her to move position frequently, to use the commode, to change her clothing, and to bathe, she also needs a member of staff to assist to eat or be fed on some days. A resident with increasing dementia needs considerable amounts of supervision, support and diversion strategies. The registered provider states that she has undertaken 1-2-1 meetings with the majority of staff and currently chairs staff meetings. We have discussed with the registered manager and registered provider their roles and strongly recommend that the registered manager resume managerial responsibility in relation to the staff team in order to re-establish her managerial role and responsibilities in the home. DS0000068841.V337711.R01.S.doc Version 5.2 Page 29 The AQAA submitted by the home indicates that 5 staff have left the homes employ, including the administrator since the new provider was registered in March 2007. One new senior care assistant has been appointed and is on the care rota as senior in charge of the home, responsible for the administration of medication and all aspects of residents care. However examination of her personnel file at the home shows that she has been appointed on a POVA first basis, whilst awaiting full CRB clearance. There is no risk assessment or appointed, named supervisor in place. This serious matter has been discussed with the registered persons, who are required to remedy the situation with immediate effect. The registered provider and manager have given assurances that this member of staff will not be used in a senior capacity and will be supervised by a suitably trained member of staff, named on the rota and written risk assessment. The provider and manager state that advertisements have been placed to recruit additional seniors and care assistants. The AQAA submitted 25 May 2007 by the home indicates that 10 of 15 care staff have achieved an NVQ level 2 or 3 care award, with 4 new candidates registered to undertake NVQ level 2. However the information is now out of date and an accurate percentage of care staff with an NVQ 2 (or equivalent) award has not been verified at this visit. The registered manager demonstrates a commitment to staff training and development. The manager and 2 senior carers have undertaken an ASET accredited certificate level 2 dementia training course at Dudley College. The home has a training plan and individual staff training profiles. However the benefits of staff training are depleted by the staff turnover and current staff shortages. Discussions with a senior carers, states she has worked at the home for one year, really enjoys working here, she feels more involved in writing things down, care planning and doing practical things and says, I feel there is now more training available. However the majority of the views from the 11 CSCI staff surveys returned, are that staff feel strongly about shortages that make it difficult to care for residents properly, and staff are not supported, with a lack of good communication between staff, management and the new provider. Comments include, need more meetings and better communication between management and staff, staff are getting tired and residents are more dependent, and often require assistance of two carers, staff look after residents the best they can, and we have been short-staffed for several months, high dependency levels, only two staff on sometimes, and late shift: one senior and one carer, no staff on floor when assisting three residents to bed, who require two carers in each, one who requires a hoist, and sometimes one person does two jobs, and care well done when fully staffed, feel we cant give the service users the care when we are short-staffed. DS0000068841.V337711.R01.S.doc Version 5.2 Page 30 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): 31,33,35,36,37,38 Quality in this outcome area is adequate The registered provider and manager strive to provide some leadership, though communication systems are not always in place or effective and staff are anxious and feel less supported. There is limited progress to regularly review aspects of the homes performance through a good programme of self-review and consultations, which include seeking the views of residents and relatives, staff and other professionals. Residents can generally be assured their financial interests are safeguarded and the standards of records are generally improving, which reduces risks to residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: DS0000068841.V337711.R01.S.doc Version 5.2 Page 31 Leah Robertson is the registered manager for Nelson House. She is an experienced registered manager, with the NVQ4 care management and Registered Managers Award (RMA) completed at Bourneville College. The CSCI registered the new Provider Mrs Linda Kular on 12 March 2007. She has experience working in the NHS and this is her first venture as a Care Home Proprietor. At the previous inspection visit in November 2006 the registered manager stated that she recognised that she did not at that time have the skills and experience to deliver an effective one-to-one staff supervision system and stated that she planned to organise formal supervisory training for herself and senior staff before implementing a formal structured staff supervision system. To date this has not been implemented and it is a matter of concern that the registered manager frequently undertakes senior care duties to cover for staff shortages. Whilst it is acknowledged that managers may need to provide cover as a short term arrangement, registered managers must have sufficient managerial hours to supervise and monitor the running of the home to maintain quality standards are ensure safeguards are in place for residents. The registered provider states that she has taken responsibility relating to staff, because she believes that the registered manager finds this area challenging. She states that she has had one-to-one meetings with the majority of staff and she has conducted staff meetings. However there are no records to show the topics discussed in either one-to-one meetings or staff meetings. The most recent staff meetings were in December 2006 and August 2007. The registered manager needs to be supported and provided with a formal supervisory training. The registered provider needs to ensure that manager receives regular documented formal supervision meetings to support her role and professional development and all care staff must receive 6 documented formal supervision sessions in each 12 month period, as a minimum. The results of the CSCI staff surveys given out at the time of this inspection visit provide evidence of a general lack of confidence and trust in the registered provider and the registered manager. The majority of staff express concerns that the interests of the residents are not being put first. In addition there are some responses from CSCI relatives surveys, which also echo concerns about the lack of communication, comments about what the home could do better are, try to ensure relatives are present at reviews and where major changes to staff and management take place, a meeting for relatives. The registered provider has decided to dispense with the services from the care management consultants who provided support to enable the previous provider to make improvements and demonstrate compliance with legislation. The registered provider and her spouse, although usually at the home daily, make the required visits to the home and reports of monthly unannounced DS0000068841.V337711.R01.S.doc Version 5.2 Page 32 visits relating to the conduct of the home, which are available at the home, and submitted to the CSCI office, Halesowen. The registered manager states she plans to introduce a new quality assurance system, which includes feedback from residents and relatives, stakeholders in the community, in which staff feel they are involved. There is some evidence of planned audits across the national minimum standards. However the home does not currently have a formal documented annual development plan, though the registered provider and registered manager are able to describe some planned targets to develop and improve the service. Discussions have taken place relating to the new Regulation 24 requiring the home to submit an annual AQAA on request from the CSCI and it is recommended that the registered manager proactively use this as an additional tool. In addition the evidence to support statements made in the AQAA needs to be more detailed and accurate, as the evidence will be tested and verified during inspections. The Home holds temporary safekeeping money on behalf of 10 residents. The newest resident deals with all her own finances. Residents money is held securely in the home, with the manager, proprietor and one senior designated as key holders. The records of two residents finances have been examined, both balances are correct. However the records of one resident have four entries where there is only one staff signature. The records for the other residents transactions show all entries except one have two staff signatures. The registered persons must ensure that there are two signatures (on may be the resident, where capable) on records of all financial transactions made on behalf of residents. There are improvements to records keeping, which include comprehensive preadmission proformas, personal profiles, care plans, risk assessments, tissue viability assessments, falls risk assessments, nutritional assessments, and daily records. The random assessment of a sample of health and safety training, health and safety and service maintenance records examined shows that they are generally satisfactory. The home uses bedrails for one resident and there are currently no recorded checks in place. The registered manager states there is a system for auditing and analysing accidents involving residents. It has been recommended that the records be expanded to demonstrate any additional control measures implemented. DS0000068841.V337711.R01.S.doc Version 5.2 Page 33 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 2 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 2 2 2 X 2 2 2 STAFFING Standard No Score 27 1 28 X 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 1 2 X 2 1 2 2 DS0000068841.V337711.R01.S.doc Version 5.2 Page 34 Are there any outstanding requirements from the last inspection? New Registration 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 OP8 Regulation 13(1) 13(4) Requirement 1) To ensure that any resident with significant weight loss, poor appetite or assessed as nutritionally at risk is referred to the GP and community dietician for advice and support It is the home’s responsibility to notify the CSCI when this requirement is met. 2) To ensure records of residents food / fluid intake demonstrate adequate nutrition, any fortified meals, food supplements and action taken where there is concern It is the home’s responsibility to notify the CSCI when this requirement is met. 3) To ensure records of personal care are fully accurately recorded It is the home’s responsibility to notify the CSCI when this requirement is met. 2. OP9 13 (2) 1) The process of updating and expanding the homes medication DS0000068841.V337711.R01.S.doc Timescale for action 01/12/07 01/11/07 Page 35 Version 5.2 policy and procedures must be completed 2) To seek advice from the Pharmacist and use an accurate measuring system for the administration of liquid Promazine. 3) To provide a written protocol for the administration of the variable dose of liquid Promazine and document the results, which must be reviewed by the health professionals 4) To ensure all variable dosages are recorded 5) The registered persons must liaise with the appropriate G.Ps to ensure that prescriptions carry more specific directions for the administration of service users medication as opposed to ‘as directed’. It is the home’s responsibility to notify the CSCI when this requirement is met. 3. OP12 12(1) 1) The registered person must 01/12/07 undertake a documented audit of residents preferences regarding activities, from which a structured weekly programme must be devised and displayed in appropriate formats to encourage participation 2) and introduce weekly activity planners for each person to record planned and spontaneous activities, refusals and evaluation of activities offered It is the home’s responsibility to notify the CSCI when this requirement is met. DS0000068841.V337711.R01.S.doc Version 5.2 Page 36 4. OP12 12(1) To arrange a multidisciplinary review for JS for further discussions and agreement of the arrangements for outings It is the home’s responsibility to notify the CSCI when this requirement is met. 01/12/07 5. OP15 16(i) 17(1) Schedules 4(13) 1) To complete the revised menus, in appropriate formats, ensuring residents current food preferences are included 2) To demonstrate that the new menus have been assessed by the community dietician to provide adequate nutrition and meet any special dietary needs for residents 3) To provide planned meals on the menus with options displayed for residents preferring alternatives or special dietary requirements 4) To ensure that there are detailed records to demonstrate nutritious food intake, especially for any residents nutritionally at risk It is the home’s responsibility to notify the CSCI when this requirement is met. 01/12/07 6. OP19 23(2) 13(4) To provide a timescale for the renovation or replacement of the external window frame and store at the ground floor rear of the property It is the home’s responsibility to notify the CSCI when this requirement is met. DS0000068841.V337711.R01.S.doc 01/12/07 Version 5.2 Page 37 7. OP24 12(1) 13(4) To cease to use the ground floor 01/11/07 residents bedroom (room 4) for the hairdressing for all residents, with immediate effect and provide an alternative venue, which does not infringe any residents rights to privacy or hinder infection control measures It is the home’s responsibility to notify the CSCI when this requirement is met. 8. OP26 13(4) 16(2)(j) 1) The registered person is 01/12/07 required to seek advice from the health protection agency and environmental services regarding the laundry and provide a plan and timescale for improvements 2) The registered person must provide a suitable commercial dryer in the laundry 2) The registered person is required to provide comprehensive COSHH information in the laundry and storage areas for chemical products It is the home’s responsibility to notify the CSCI when this requirement is met. 9. OP27 18(1)(a) 1) The registered persons must 11/10/07 ensure that there are at all times suitably qualified, competent and experienced staff working at the care home in such numbers as are appropriate for the health and welfare of service users 2) The registered persons must increase the care staff on duty throughout the day to a minimum of 3 suitably qualified, competent and experienced DS0000068841.V337711.R01.S.doc Version 5.2 Page 38 staff, including a designated senior carer, with immediate effect 3) The registered persons must ensure that there are sufficient ancillary staff on duty during each day, including weekends, so that catering and cleaning duties do not detract from care hours provided, with immediate effect 4) The registered persons must formally assess and document residents dependency levels and demonstrate on the staff rotas that staffing levels are being maintained at adequate levels to meet residents needs 5) The registered persons must submit weekly staff rotas to the CSCI for consideration until further notice It is the home’s responsibility to notify the CSCI when this requirement is met. 10. OP29 17(2) 19(1) 1) The registered persons must cease to use the senior carer appointed on a POVA first basis in a senior capacity, responsible for the running of the home until full CRB clearance has been received 2) The registered persons must put in place a documented risk assessment, which includes name(s) of appropriately qualified and experienced staff to supervise staff appointed on POVA first basis, a copy to be submitted to the CSCI 3) The registered persons should DS0000068841.V337711.R01.S.doc Version 5.2 Page 39 11/10/07 ensure that the named supervisor(s) are identified on staffing rotas It is the home’s responsibility to notify the CSCI when this requirement is met. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP1 OP1 Good Practice Recommendations That clear information about level of fees be included in the service user guide That the statement of purpose and service user guide provide clear and accurate information about staffing levels at the home That the contract / terms & conditions of residence should be reviewed and revised, taking account of the Office of Fair Trading publications relating to Care Homes Contracts That there is documentary evidence that relatives or advocates are invited and involved in residents reviews and reassessments, especially if residents have sensory or other impairments which may limit their understanding and involvement That the complaints procedure should be produced in additional formats, appropriate to residents capabilities such as pictorial, audio etc. That the registered provider draws up and implements a planned programme for the redecoration and refurbishment of the property that shows forward planning That the following maintenance and improvements are given a timescale in the maintenance and repair programme: 3. OP2 4. OP4 5. 6. OP16 OP19 7. OP19 DS0000068841.V337711.R01.S.doc Version 5.2 Page 40 Fire Escape to be cleaned and maintained to be free from rust and algae Continue to renovate the paintwork throughout the home, particularly downstairs - door frames, skirting boards Redecorate the dining room First floor corridor carpet to be re-stretched or replaced Ground floor WC to be redecorated and flooring renovated or replaced Bedroom 13 call point to be repositioned to enable resident to use, this also applies to any bedroom where layout or furniture is changed Bedroom 13 - carpet to be replaced All unfinished radiators throughout the home to be painted or appropriate finish applied Refurbishment of the kitchen, including cupboards, work surfaces and appliances replaced where necessary to be completed in an identified timescale Defective refrigerator to be replaced with an appropriate commercial model Drawer front on kitchen unit is repaired or replaced as an interim measure 8. 9. 10. 11. OP19 OP25 OP26 OP27 That the frayed joins in the new carpet in the lounge be rectified That all parts of the home are heated to an ambient temperature at all times to be comfortable for residents That food safe wipes be provided to clean food probe That there are sufficient numbers of staff available to explore and facilitate suitable community based opportunities for the residents to make realistic choices to experience a social life outside their home DS0000068841.V337711.R01.S.doc Version 5.2 Page 41 12. OP31 That the registered manager is supported and provided with a formal supervisory training That the registered manager receives regular documented formal supervision meetings to support her role and professional development 13. OP33 That the registered persons should devise a documented annual development plan for the home as part of a comprehensive quality assurance system, based on continuous self assessment and improvement That a schedule of residents meetings be devised and displayed together with agendas and minutes of meetings to encourage participation That an annual schedule of staff meetings is devised and displayed, together with agendas and minutes of meetings That the homes Annual Quality Assurance Assessments (AQAA) submitted to the CSCI should contain accurate, verified information and fuller details of the supporting evidence of what the home does well and the improvements made That there are two signatures (on may be the resident, where capable) on records of all financial transactions made on behalf of residents That all care staff receive 6 documented formal supervision sessions each 12 months as a minimum That recorded weekly checks are undertaken on bedrails That the laundry procedure and guidelines be displayed in the laundry area That a cleaning schedule for the laundry be devised and implemented, which includes: - floor to be mopped daily - mop heads to be laundered daily at thermal disinfection temperatures 14. 15. 16. OP33 OP33 OP33 17. OP35 18. 19. 20. OP36 OP38 OP38 DS0000068841.V337711.R01.S.doc Version 5.2 Page 42 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA 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 DS0000068841.V337711.R01.S.doc Version 5.2 Page 43 - 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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