Inspection on 31/01/06 for Osborne House Residential Home

This inspection was carried out on 31st January 2006.

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

Osborne House Residential Home 15/10/08

Osborne House Residential Home 23/01/08

Osborne House Residential Home 15/06/06

Osborne House Residential Home 23/06/05

Osborne House Residential Home 14/12/04

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

CARE HOMES FOR OLDER PEOPLE Osborne House Residential Home 16 Bay Road Clevedon North Somerset BS21 7BT Lead Inspector Caroline Baker Unannounced Inspection 31st January 2006 10:00 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 Osborne House Residential Home DS0000062278.V271855.R01.S.doc Version 5.0 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. Osborne House Residential Home DS0000062278.V271855.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Osborne House Residential Home Address 16 Bay Road Clevedon North Somerset BS21 7BT 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) 01275 872600 Osborne House (Ladye Bay, Clevedon) Limited To be appointed Care Home 26 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (26) of places Osborne House Residential Home DS0000062278.V271855.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. The Responsible Individual to visit the home on a weekly basis until a registered manager is in place. The two additional bedrooms are not to be used until minimum standards have been achieved and checked by the inspector. May accommodate one named person under 65 with Dementia care needs. Home will revert when named person leaves. May admit one named person aged 59 years and over. This condition lapses when the person leaves or becomes 65. May provide resiential personal care for up to 26 persons, aged over 65 years, with Dementia. 23rd June 2005 Date of last inspection Brief Description of the Service: Osborne House is registered with the Commission for Social Care Inspection to provide a personal care service for up to 26 persons with dementia over the age of 65 years. There are also added conditions of registration imposed as listed above. Mr Rex Mackrill is the registered provider. At the time of this inspection there was no registered manager. The home is a pleasant period building with panoramic views over the Bristol Channel. It has three floors and twenty-two bedrooms, two of which are shared. At present the home can take up to 24 persons. There is a call system throughout the home. There is a conservatory, dining room and two good-sized lounges. One room has en-suite facilities. There are ample assisted baths and communal showers and toilet facilities. Osborne House Residential Home DS0000062278.V271855.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The last inspection was announced and took place on 23rd June 2005. This inspection was unannounced and took place from 10:00 hrs over one day (7.5 hours) and was conducted by Caroline Baker. The home remains without a registered manager, however the provider has asked for an application to register as the manager. Twenty-two service users were residing at the home. Staffing levels appeared adequate on the day of the inspection. An assessment of the premises took place where a selection of bedrooms and communal areas were seen. At least seven service users were spoken with, including four who were case tracked. Members of staff on duty were spoken to and the inspector was able to speak with visitors to ask for their views on the conduct of the care home. Throughout the day the inspector was able to observe interactions between staff and service users. Records relating to the care of the service users, staff and health and safety were examined. What the service does well: Osborne House provides a warm, secure and comfortable environment, which meets the needs of the current client group. Service users were observed using all communal areas and appeared comfortable and relaxed in their environment. Service users spoken to and able stated that they liked their bedrooms and were happy and felt safe at the home. Service users were well attired and looked well cared for on the day of inspection. Service users able praised the food. A good choice of wholesome food was given. Staffing numbers and the skill mix of staff appeared sufficient to meet the needs of current service users on the day of inspection. Staff spoken with stated that they felt well supported and happy working at the home. Staff training was well documented and the provision of training for staff is good. Service users who become poorly are sensitively cared for. Osborne House Residential Home DS0000062278.V271855.R01.S.doc Version 5.0 Page 6 The home has an open model of care that is flexible and client centred and continues to be sensitively and passionately implemented by the provider. What has improved since the last inspection? What they could do better: Issues regarding health and safety, care planning, medication recording and infection control were identified which require action without delay. Service users would be potentially at less risk of harm if all radiators were guarded following individual risk assessments being carried out. Service users would benefit and be at less risk of harm if all high furniture and wardrobes being secured and if all windows above the ground floor were restricted following individual risk assessments being carried out. Service users and staff would benefit and be at a less risk of catching an infection if staff had the facilities to wash their hands, unclean worn slip mats were replaced, and tablets of soap, and disposable razors were removed from all communal areas in line with Infection Control Guidelines. Service users would benefit from their individual care plans being up to date and reflecting their current care needs for staff to be able to effectively deliver the care. Service users would be less at risk if medication receipt and recording were correct, with particular regard to homely remedies and hand written mediations. Service users would benefit and be at a less risk of harm if hot water outlets and emergency lighting were tested on a monthly basis. Also if all substances, hazardous to health, were stored securely. The provider acknowledged these shortfalls and agreed to take action within agreed timescales. The inspector was satisfied that requirements and recommendations issued as a result of this inspection would be complied with. Osborne House Residential Home DS0000062278.V271855.R01.S.doc Version 5.0 Page 7 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. Osborne House Residential Home DS0000062278.V271855.R01.S.doc Version 5.0 Page 8 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 Osborne House Residential Home DS0000062278.V271855.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2; 3; 4 and 5. NMS 6 does not apply to the home. The home takes appropriate steps to ensure the needs of prospective service users can be met prior to a decision being made about admission. Service users and/or their representatives know the terms and conditions of residence. Staff individually and collectively had the skills to enable them to meet the current service users needs. EVIDENCE: The inspector audited one pre-admission assessment. It was comprehensive and detailed. This allowed the home to ensure it could meet the service users needs before admission. Each service user receives a contract. A service user contract was audited as part of the inspection process and through case tracking. It detailed the fees of £425 per week and what is not included, for example private chiropody and hairdressing. One month’s notice is expected should the service user decide to leave. Osborne House Residential Home DS0000062278.V271855.R01.S.doc Version 5.0 Page 10 Staff training records seen evidenced that staff receive training in dementia awareness, which is updated periodically and as new staff commence employment. It was evident on the day of inspection that staff have a good understanding of the current service users needs, by the way they were interacting with them. The registered provider and deputy manager had both attended a Dementia Voice manager’s course, which will enhance the way the staff are given in-house training in dementia. The provider informed the inspector that service users and their families are invited to visit the home prior to a trial period to assist in their decision to move in. Osborne House Residential Home DS0000062278.V271855.R01.S.doc Version 5.0 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7; 8; 9; 10 and 11. Although each service user had a care plan the processes needed improving and there was no evidence of service user input. There were minor shortfalls noted and improvement needed in the homes procedures for the management and administration of medication, the discrepancies noted potentially placed service users at risk of harm. The privacy and dignity of service users was respected. Service users who were very ill were treated with kindness and sensitivity. EVIDENCE: As part of the case tracking process four care plans were sampled and the individual service users were met during the inspection. The provider explained that a new care plan was developed and the systems were in the process of being changed over. The inspector was able to sample a new care plan format and sampled three current formats. Osborne House Residential Home DS0000062278.V271855.R01.S.doc Version 5.0 Page 12 The findings were as follows: • none of the care plans had been reviewed since May 2005 • one care plan although incomplete and not signed or dated by the person who developed it reflected some current care needs and had an individual risk assessment • three care plans sampled did not reflect the individual service users current care needs • there was no evidence of falls risk assessments • there was no evidence of service user input • and there were risk assessments for the development of pressure ulcers, which needed review. The home was able to provide pressure relieving equipment where there was an assessed need and this was evident on the day of inspection when a very poorly service user being cared for in bed had been given a pressure relieving mattress to minimise the risk of developing a pressure ulcer. As discussed a risk assessment should be carried out to ensure the type of pressure relieving equipment used is appropriate and this can be achieved with the help of a district nurse. The home had recently purchased scales, which enabled wheelchair users to be weighed. All service users had been weighed to ensure their nutritional needs were met adequately. Evidence was seen in the daily records kept that service users had access to chiropody, dental treatment and GP visits. One service user case tracked had intervention from a district nurse for a wound dressing. Daily records were comprehensive, however on some occasions there was no evidence of bathing, or nail care reflected. Following discussion in regard to the care planning systems it was agreed that the home be given until the end of February 2006 to have care plans developed that meet the National Minimum Standards (NMS) which will enable care staff to deliver the correct care to individual service users. On examination of the Medication Administration Records (MAR), which commenced on 30/01/06, the following shortfalls were identified: • • according to the current MAR charts the medication received into the home had not been recorded or signed for hand transcribed medication did not carry two signatures and on two occasions had no signatures. Also on one occasion a homely remedy had been hand transcribed without consultation with the GP and it had not been written up correctly to match the manufacturers labelling and instructions. DS0000062278.V271855.R01.S.doc Version 5.0 Page 13 Osborne House Residential Home • • on three occasions the ‘maximum dose in 24 hours’ was not reflected and the homely remedies charts were unclear. These shortfalls put service users at risk of harm. As discussed only staff trained to do so must administer and hand transcribe medications with support and advice from the GP in particular regard to homely remedies. The provider agreed to have a consultation and assessment from CSCI’s local pharmacist inspector. On the day of the inspection one of the service users passed away peacefully. The inspector was impressed by the attitude and kindness of the staff during that sad time. The service user had been made comfortable and was pain free throughout the day. The provider gave good support to the staff on duty. Osborne House Residential Home DS0000062278.V271855.R01.S.doc Version 5.0 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12; 13; 14 and 15. The home’s arrangement for meeting service users social needs was adequate and being further developed. Service users are supported to maintain contact with friends or family. Service users were encouraged to choose their way of daily living. Service users benefited from a varied, wholesome diet. Recorded prepared menus were not available. EVIDENCE: The home had recently purchased the Alzheimer’s Activity planner to enable it to develop activities to suit all individual service users at the home. The provider told the inspector that to date no records had been kept of any activities that had been provided to the service users. This is recommended and will be followed up at the next inspection. There are plans to involve the staff more in the planning and provision of social activities. The provider told the inspector that each service user had an individual social plan and life histories were being recorded and developed. Osborne House Residential Home DS0000062278.V271855.R01.S.doc Version 5.0 Page 15 Visitors were seen taking service users out on the day of inspection and those spoken to expressed their satisfaction of the care provision at the home. The visitor’s book indicated many visitors to the home. It was evident throughout the inspection that service users were allowed to choose how they spent their day. Those spoken to and able indicated that they could do as they pleased. Some service users enjoyed being in the conservatory and others in the hallway or main lounges. The inspector was able to join service users at lunchtime and have a meal. The meals presented to service users looked well presented and appetising. There was a choice of chicken tikka or cottage pie. The meal was tasty chosen by the inspector was tasty and filling. Service users spoken to and able told the inspector that they always enjoyed the food. Evidence was seen that each day the cook asks the service users what they would like for lunch and records were kept in a diary of the individual choices. Lunchtime and suppertime meals are recorded in a diary on a daily basis ensuring a running record. Hot and cold drinks were offered to service users throughout the day. Homemade cakes were available. Evidence of fresh fruit and vegetables being available was seen. The lunchtime meal was unhurried and staff were seen assisting service users where needed. As discussed and to promote dignity it would be nice to have serviettes available and offered for use to service users at mealtimes. Also menus should be available as stated in NMS 15.7. Osborne House Residential Home DS0000062278.V271855.R01.S.doc Version 5.0 Page 16 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16; 17 and 18. The home has a satisfactory complaints system in place. The home’s procedures for ensuring that service user’s legal rights are protected were good. The home’s recruitment procedures for staff protect service users from the risk of abuse. Policies and Procedures were in place to enable staff to understand the action to take should they suspect any form of abuse taking place. EVIDENCE: Each service user has a copy of the complaints procedure in their room and it is also displayed in the main hallway and forms part of the contract. There had been no complaints recorded since the last inspection. Complaints received by the Commission were not upheld. Service users had been registered to vote. Postal votes were mainly used. The home had the North Somerset multi-agency policy on Safeguarding Vulnerable Adults. The home had a Whistleblowing Policy, which is comprehensive and details outside bodies that staff can approach. Staff spoken to on the day of inspection were sure of the steps to take and lines of communication to be taken if they should suspect abuse. Evidence was seen that staff, before commencement of employment, are police checked via an enhanced CRB disclosure for the protection of vulnerable adults. Osborne House Residential Home DS0000062278.V271855.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19; 20; 21; 22; 23; 24; 25 and 26. Service users live in a warm and comfortable environment, which is able to meet the assessed needs of service users living there. Radiators throughout the home were not guarded or risk assessed putting service users at a potential risk of harm. Emergency lighting and hot water outlets had not been tested in line with HSE guidelines. Service users have access to specialist equipment where there is an assessed need. There were no malodours noted in the home; the standards of cleanliness were generally good. Infection control measures however were inadequate. EVIDENCE: The inspector assessed the premises and saw all of the communal areas and sampled at least nine bedrooms. Osborne House Residential Home DS0000062278.V271855.R01.S.doc Version 5.0 Page 18 The home is on three floors and all floors are accessible by stairs and/or a passenger lift. The amount of communal space provided would meet NMS and provides sufficient space for the current service user group. All bedrooms sampled, two of which were shared, appeared to meet NMS environmental requirements. The building complied with the requirements of the local fire service and environmental health dept who both visited in 2005. Shared rooms seen were pleasantly decorated, clean and warm with screens to enable privacy. The dining area was large enough for all service users at the home to access at the same time. Communal areas were furnished to a high standard and there had been refurbishment of the lounge and conservatory since the last inspection with new carpet and/or flooring throughout the communal areas. This evidenced on-going investment into the home. There were adequate communal bathrooms, showers and toilet facilities for service users. The home has one sluice with a disinfector on the first floor. There were grab rails throughout the home to promote independence. Wheelchairs were available for those with an assessed need. A mobile hoist is available for emergency use at this time, as service users currently at the home had not been assessed as needing a hoist. Baths are assisted with hoist type aids. Since the last inspection the provider had purchased a number of new divan types beds, which were hoist accessible. None of the radiators throughout the home had been guarded and/or individually risk assessed to prevent the risk of harm to service users. As discussed this is required within agreed timescales. Many windows on the first and top floor were not restricted in line with HSE guidelines. As discussed this is required to minimise any risk to service users within agreed timescales. Many wardrobes and tall furnishings were not secured to a wall. As discussed this is also required to minimise any risk to service users within agreed timescales. The home was generally clean and tidy throughout the areas assessed. There were no malodours evident. Infection control was in need of improvement. There were no hand washing facilities for staff to include liquid soap and paper towels in any of the communal, toilets, baths/shower rooms, in any of the bedrooms where personal care was delivered, or in the sluice area. The laundry area was next to the hairdressing room where there were hand-washing facilities for staff. The staff toilet had liquid soap and no paper towels. It was difficult to Osborne House Residential Home DS0000062278.V271855.R01.S.doc Version 5.0 Page 19 determine how staff were following infection control guidelines and the homes policies, and this identified a further training need. Tablets of soap were noted in many of the communal toilets/bathrooms, which must be removed in line with Infection Control Guidelines. Disposable razors were seen in two of the bathrooms assessed and hairbrushes had been left in two of the bathrooms assessed, suggesting communal use. One assisted bath hoist had a slip mat on it that needed replacing as it was black with mildew and the cover to the bath chair was in need of a deep clean. Another slip mat in a shower room was noted to be in need of replacement. The provider was with the inspector when the above issues were identified and agreed to take action immediately. Osborne House Residential Home DS0000062278.V271855.R01.S.doc Version 5.0 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27; 29 and 30 The numbers of staff were appropriate to meet the needs of current service users. The home’s recruitment procedures for staff were robust and protected service users from the risk of abuse. Staff morale was good. Although staff spoken to confirmed receiving induction there was no recorded evidence. EVIDENCE: The home records duty rotas reflecting the staff on duty 24 hours per day. The deputy manager was off sick on the day of the inspection. There were two-care staff working to meet the needs of twenty-two service users. The registered provider was available should the care staff require his assistance. According to the copied duty rotas given to the inspector from 07:00 until 14:00 Monday to Sunday there are two care staff and on Monday to Friday the Care Manager is available form 07:00 – 15:00 hrs. There is an on-call system at the weekends. From 14:00 until 21:00 there are two care staff on duty. From 21:00 until 08:00 there are two members of staff on duty. This gives the home extra support during the busy morning routine between 07:00 and 08:00. Osborne House Residential Home DS0000062278.V271855.R01.S.doc Version 5.0 Page 21 At this time there appears to be adequate care staff on duty however care staffing must be kept under constant review by the management team and be responsive to the varying needs of service users with a special regard to the number of accidents occurring at the home which was 26 since the last inspection, and where social activities should be provided. There is a cook on duty 7 days per week with support from a kitchen assistant Monday to Saturday. According to the rotas there is only one member of staff in the kitchen on a Sunday. A cleaner is employed each day from 09:00-13:00. The provider informed the inspector that one of the cleaners also does routine maintenance work at the home – the hours are not clear on the rota. A gardener works once a week. Staff on duty and spoken to on the day of inspection indicated that they were happy at the home. A recent member of staff from overseas told the inspector that they thoroughly enjoyed their job and that they had received some induction and had felt welcomed by the staff team. The provider acknowledged and agreed that induction should be recorded and signed by the staff member as evidence of receipt. The provider was exploring and wanting to implement the use of the TOPSS Skills for care induction programme. Two staff recruitment files of recently employed staff were assessed. Both contained items in line with the Care Home Regulations 2001 for the protection of vulnerable adults. Osborne House Residential Home DS0000062278.V271855.R01.S.doc Version 5.0 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33; 34; 36; 37 and 38 The registered provider appears to be effectively managing the home in the absence of a registered manager. Staff training is on a rolling programme providing the staff with the skills to care for the current service users group. The systems in place for ensuring the health and safety of service users and staff were in need of improvement. EVIDENCE: Standard 31 and 32 were not fully assessed at this inspection, as there was no registered manager in place. The provider Mr Rex Mackrill told the inspector that he has decided to apply to the Commission to be the registered manager as well as being the registered provider. As soon as the Commission receives the application the process will begin. Osborne House Residential Home DS0000062278.V271855.R01.S.doc Version 5.0 Page 23 Staff spoken to spoke highly of the provider and felt well supported at the home. The provider has not implemented any quality assurance monitoring systems to date, based on seeking the views of service users, their friends, family and other stakeholders. An annual development plan is not in place. The provider has agreed to implement monitoring systems within 6 months. Evidence was seen through the on-going refurbishment and development of the home that it is financially viable. An Employers Liability Insurance certificate was displayed with an expiry date of: 18/01/07. The business plan was not assessed at this inspection. Evidence was seen that all staff had received supervision. Records were clear and detailed. All records required at inspection were in line with current legislation. Care planning and medication records needed review as mentioned earlier. All records were stored securely in line with the Data protection Act 1998. All staff according to training records had received training in: • Manual Handling • Fire safety • First aid • And Food hygiene Infection control training should be updated for all staff. On assessment of the premises substances hazardous to health were seen not stored securely in line with COSHH regulations 1988. For example – denture cleansing tablets, washing liquid and a cleansing materials. As discussed and agreed these must be stored securely for the safety of the service users. Hot water outlets had not been tested in-house at the home and staff do not check the bath temperature before a service user is bathed. As discussed and agreed this must be implemented for the safety of the service users. All service histories were up to date. As mentioned before all radiators must be guarded and/or risk assessed. Window restrictors must be fitted in line with HSE guidelines. Accident records were maintained and must be audited to identify any risks and/or patterns occurring. The kitchen was clean and well organised. As discussed cleaning schedules should be signed to evidence it being carried out. Osborne House Residential Home DS0000062278.V271855.R01.S.doc Version 5.0 Page 24 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 X 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 1 1 STAFFING Standard No Score 27 3 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 3 X 3 3 1 Osborne House Residential Home DS0000062278.V271855.R01.S.doc Version 5.0 Page 25 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 17(1)[a] Timescale for action All care plans must be reviewed 28/02/06 with the service user and/or their representatives and reflect individual service users current care needs. Requirement 2 OP9 13(2) All staff must follow the Royal Pharmaceutical Guidelines and the homes policies, when receiving, recording, administering and disposing of medication with a special regard to hand transcribing and homely remedies. 14/02/06 3 OP25 13(4) The registered person must 28/02/06 commence guarding and/or risk assessing radiators in line with HSE guidelines to minimise any risk to service users, with a view to guarding all radiators by end March 2007. Also hot water outlets and emergency lighting must be tested in-house on a monthly basis. Osborne House Residential Home DS0000062278.V271855.R01.S.doc Version 5.0 Page 26 4 OP26 13(3) The registered person must 28/02/06 ensure that hand washing facilities to include liquid soap, paper towels and appropriate bins are available for staff in all areas where personal care is provided in line with Infection Control Guidelines. Also slip mats identified, as an infection risk must be replaced without delay. All tablets of soap, disposable razors, must be removed from communal bath/shower rooms and the bath hoist cover must be deep cleaned. 5 OP38 13(4)[a] The registered person must 05/02/06 [c] ensure that all wardrobes and high furniture are secure, to minimise any risks to service users. 13(4)[a] All substances hazardous to 05/02/06 [c] health must be stored securely in line with COSHH regulations, to minimise any risk to service users 13(4)[a] All windows must be restricted in 05/02/06 [c] line with HSE guideline to minimise any risk to service users. 13(4)[a] All accidents records must be 30/03/06 [c] audited to evidence recognition and action taken of any patterns emerging. 6. OP38 7 OP38 8 OP38 Osborne House Residential Home DS0000062278.V271855.R01.S.doc Version 5.0 Page 27 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 OP7 OP8 Good Practice Recommendations The registered person should consider planning training for all staff involved. formal care The registered person should implement the new careplanning format and ensure that all risk assessments including moving and handling, pressure relief, nutritional and specialist needs (diabetes and dementia) are reflected. And any recorded entries should be signed and dated. The registered person should consider formal training in the safe handling of medications for all appointed staff. The registered person should ensure that service users individual social care needs are met on a regular basis. The registered person should implement the recording of a regular menu in line with NMS 15.7. All staff induction must be recorded and evidenced by the staff member as receipt. The registered person should strongly consider monitoring quality assurance by end July 2006. The person cleaning, to evidence completion of the work, should sign implemented kitchen cleaning schedules. 3 4 5 6 7 8 OP9 OP12 OP15 OP30 OP33 OP38 Osborne House Residential Home DS0000062278.V271855.R01.S.doc Version 5.0 Page 28 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: 0845 015 0120 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 Osborne House Residential Home DS0000062278.V271855.R01.S.doc Version 5.0 Page 29 - 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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