Inspection on 02/09/08 for Pals Residential Home

This inspection was carried out on 2nd September 2008.

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

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

Pals Residential Home 21/09/07

Pals Residential Home 28/06/06

Pals Residential Home 18/11/05

Pals Residential Home 26/05/05

Pals Residential Home 08/11/04

Pals Residential Home 10/06/04

Pals Residential Home 23/04/04

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 20/03/2009.

CARE HOMES FOR OLDER PEOPLE Pals Residential Home 79 Ombersley Road Worcester Worcestershire WR3 7BT Lead Inspector Sandra Bromige Unannounced Inspection 2nd September 2008 09:15 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 Pals Residential Home DS0000018669.V372284.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. Pals Residential Home DS0000018669.V372284.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Pals Residential Home Address 79 Ombersley Road Worcester Worcestershire WR3 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) 01905 612439 Mr Sharanjit Singh Purewal Mrs Eileen Nellie Jeynes Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (14), Physical disability over 65 years of age of places (14) Pals Residential Home DS0000018669.V372284.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 14 Physical disability - over 65 years of age Code (PD(E)) 14 The maximum number of service users who can be accommodated is: 14 21st September 2007 2. Date of last inspection Brief Description of the Service: Pals Residential Care Home is registered to provide personal care for up to fourteen older people who are frail, and who may have physical disabilities. The service is provided at an extended Victorian house in a residential area of Worcester approximately two miles from the city centre. The property has an established garden that is accessible to people who use the service. The stated aim of the service is to meet the individual needs of the people who use the service, by providing high quality accommodation and personal care. Up-to-date information relating to the fees is available on request from the service. A copy of this inspection report is available from our website www.csci.org.uk Pals Residential Home DS0000018669.V372284.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. We, the commission undertook an unannounced key inspection – this is an inspection where we look at a wide range of areas. Before the inspection an Annual Quality Assurance Assessment (AQAA) document was posted to the service for completion. The AQAA is a self-assessment and a dataset that each registered provider has to complete each year and send to us within agreed timescales. The document tells us about how providers of services are meeting outcomes for people who use the service and is an opportunity for them to share with us what aspects of the service they believe they are doing well. Some of the provider’s comments have been included in the inspection report. During the visit to the home care records, staff records and other records and documents were inspected. Surveys were not sent out, as the service did not return the AQAA on time. We looked at parts of the accommodation and talked to the manager and staff. Time was spent speaking privately with people in their rooms as well as spending time observing what was happening in other areas of the service. We also talked to people in communal areas of the service and their relatives and visiting healthcare professionals. Since the last inspection on September 21st 2007 the service has made one referral to safeguarding about the safety of a person who was having frequent falls and was at risk of injury. This has been resolved through a review of the person’s care needs in consultation and agreement with the family of the person using the service. What the service does well: The people who live at the service looked well cared for and their clothes were nicely laundered. People told us the home is ‘great’, ‘can’t praise this place enough’, staff ‘do all they can to help you’. Relatives told us they ‘can’t fault the care’. A district nurse told us the staff are ‘very caring’. A general practitioner told us they had ‘no anxieties about care in this home’. People are offered a choice of food, which is tasty, well cooked and nicely presented and which meets their needs. There is plenty of food for people at mealtimes and they are offered snacks and drinks between meals. The service keeps a record of any complaints including the outcome of any investigation. The service takes any complaints seriously and responds appropriately so people can be confident that their views are listened too. Pals Residential Home DS0000018669.V372284.R01.S.doc Version 5.2 Page 6 People using the service benefit from having a bright, clean, warm and nicely decorated environment that is suited to their needs. Communal space consisting of a lounge and dining room is provided on the ground floor. The furniture is of a good quality. All parts of the service are accessible to people with a physical disability and people can move around freely. There is a friendly and homely atmosphere and visitors are made very welcome by the staff. The service accommodates people from both genders. All of the care staff working in the service had achieved an NVQ level two qualification in care which means people who use the service benefit from having their needs met by staff who are appropriately qualified. What has improved since the last inspection? What they could do better: People should have their needs assessed before they start to use the service and a record of the assessment held so that people who are considering using the service can be confident their needs will be met. The information recorded in care plans needs to be more detailed and include all the information about the person’s care needs so that people using the service can be confident these needs will be met. The care plans should be discussed with the person and/or if appropriate, their relative or representative so that they are aware of what has been agreed. People should be consulted about their hobbies and interests and this information included in the care plan Pals Residential Home DS0000018669.V372284.R01.S.doc Version 5.2 Page 7 so that staff are aware of people’s needs and are given an opportunity to pursue their hobbies and to explore any new interests. Potential risks should be identified and appropriate action taken to minimise the risk so that people’s health and welfare are promoted and maintained. Arrangements for storing, handling and administration of medication need to be improved. This is necessary to ensure medication is being managed in accordance with current legislation and so that people are not placed at risk of harm because their medication is not being stored at the correct temperature and may not therefore have the desired effect on their health. Staff should make sure they ask to see evidence of the identity of any visiting professionals if they are unknown to them. This will promote the safety of the people using the service. Effective arrangements need to be in place to minimise the risk of cross infection so that the people who use the service are protected from any avoidable infection. The procedures used for staff recruitment need to be thorough so that people the risk of unsuitable people being employed is minimised and people are protected from the risk of any possible abuse. All new staff need to attend induction training which meets ‘Skills for Care’ induction standards so that people who use the service can be confident their needs will be met by appropriately trained staff. A quality monitoring system must be introduced and the outcome used to improve outcomes for the people who use the service. 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. Pals Residential Home DS0000018669.V372284.R01.S.doc Version 5.2 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 Pals Residential Home DS0000018669.V372284.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People do not have their needs assessed and therefore cannot be confident that the service can meet their needs. EVIDENCE: The examination of care files belonging to two people who used the service did not show whether an initial care needs assessment had been completed before people had started to use the service. The manager told us she visited both people before they moved into the service, but there were no records of these visits. One person using the service told us their daughter visited the service before she went to live there. The service’s AQAA tells us they have ‘updated the initial assessment forms and they are now more detailed and thorough which help to determine if the needs of the potential person can be met by Pals’. Pals Residential Home DS0000018669.V372284.R01.S.doc Version 5.2 Page 10 We were unable to check the accuracy of this as there were no pre-admission assessments available for the two people identified. People must have a thorough needs assessment before moving into the service unless it is an emergency placement. This needs assessment should clearly identify and assess any risks for both the person using the service and any potential risks to staff, and other people living in or visiting the service. This should include any measures to be taken to minimise these risks. Staff should have access to these documents and be made aware of any potential risks. The service does not provide intermediate care so this standard was not looked at. Pals Residential Home DS0000018669.V372284.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The absence of detailed information recorded in care records and shortfalls in the management of medication place people at risk of not having their care needs met and present a risk to their health and safety. People cannot be confident that their health and personal care needs are met consistently. EVIDENCE: We looked at care plans and daily records belonging to two people. The format used for the care records had recently changed to try and make them more accurately reflect each person’s individual needs. Information held in the care records need to be improved to include details of the care to be provided, identify potential risks and ensure people are consulted about their care. For example, it was not clear how much personal care one person needed, such as how often they liked a bath/shower or how much support was needed with oral, nail and hair care. The care plan told us the person was ‘incontinent of both’ urine and faeces. The manager and a staff member told us the person went to the toilet independently and was Pals Residential Home DS0000018669.V372284.R01.S.doc Version 5.2 Page 12 continent. The person was new to the service (three weeks) and there were no risk assessments in place. The deputy manager told us the risk assessments had not been written. The service’s AQAA tells us ‘both care plans and risk assessments are done when the resident moves into Pals’. The inspection did not confirm this statement. A person who has diabetes and requires insulin had a care plan for diabetes but the care plan did not inform staff about how blood sugar levels were to be monitored and what to do if the person’s blood sugar levels were higher or lower than they should be. An entry in the daily records dated 19th August 2008 said the person was ‘not feeling good at lunchtime, said X was shaky and sweating’. There was no information to show whether staff checked the person’s blood sugar levels. The person told us they checked their blood sugar levels each morning and the staff do not look at them as ‘nobody has checked it up to now’. We looked at the blood sugar monitoring records, which showed that between 31st August 2008 and 2nd September 2008 the blood sugar levels were much higher than the expected range and should be monitored each day by the staff. The person told us they are waiting for the diabetic nurse to visit. An entry in the ‘professional visits’ section of the care plan dated 2nd July 2008 showed the district nurse had visited and had instructed the staff to ensure the person’s blood sugar levels were checked twice a day. The records showed this was not being done. The absence of effective monitoring of the person’s diabetes places them at risk of harm. There was no information to show that care plans had been discussed with the person at the point of admission or when staff reviewed the care records. Consultation with the person receiving the service is important so that they know what has been agreed. Staff we talked to told us about the care these people needed and said they (the staff) were able to access and read the care plans each day. The service may need to seek expert advice from a community nurse or other medical specialist and this would usually be available through the person’s GP surgery or more generally from the local health authority. Individual records showed evidence that health care advice was sought from the continence nurse. People appeared well cared for and they told us the home is ‘great’, ‘can’t praise this place enough’, staff ‘do all they can to help you’. Relatives told us they ‘can’t fault the care’. A district nurse told us the staff are ‘very caring’. A general practitioner told us they had ‘no anxieties about care in this home’. We looked at how the home managed medication. We saw medication was not being stored safely and securely. The medication was stored in cupboards in the laundry room. The temperature of the room was not checked each day to ensure the medication was being stored at the correct temperature, which Pals Residential Home DS0000018669.V372284.R01.S.doc Version 5.2 Page 13 should be below 25°C. One of the two locks on the medicine cupboard was not used, as staff did not have a key. Both locks should be used to ensure medication is being stored safely and securely. We saw medication being stored in the food refrigerator, which is unsafe as this may lead to cross contamination and does not ensure mediaction is being stored safely, and securely. The staff told us they do weekly random checks of the packs of medication, but these were not recorded. Some medication, which requires special lockable storage arrangements did not meet the required legal specifications, which means that some medication was not being stored correctly or in accordance with legislation. There were no risk assessments for a person who manages some of their own medication and the person told us they leave this medication in the lounge when they go to bed. This is unsafe as another person could access the medication. People told us their privacy and dignity is respected at all times. One person told us ‘the staff always shut the door when they shower me’ We saw bath sponges left in the shower room and staff told us they were used for washing people’s private areas and are then washed and reused. Staff practices do not show respect for the people who use the service and must cease. Staff must ensure that people have access to and use their own bathing sponges and toiletries so that they are treated and respected as individuals by those who support them. The risk of cross contamination has been included in the ‘Environment’ outcome section of the report. Pals Residential Home DS0000018669.V372284.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Activities do not meet the needs and preferences of the people who use the service. Visiting is flexible and takes into account people’s needs and wishes. People benefit from a range of nutritious and attractive food that meets their needs. EVIDENCE: The provision of social care for people is not person centred. For example, the care records do not include information about the things people like to spend their time doing based on their own interests and preferences. . A person told us it’s a ‘bit boring’ and they have ‘never been asked what they wish to do socially’. Care staff told us the home provide activities every day between 23pm and the activities are displayed on a board in the lounge. The activities are listed on the board for each day of the week. These include bingo, quoits, skittles, cards and music and movement. The service’s AQAA tells us they need to ‘encourage more daily activities with family members’. Visitors were seen coming in and out of the service throughout the day and were made very welcome by the manager and staff. Care staff told us they offer people choice, for example a choice of what they wish to wear, if they Pals Residential Home DS0000018669.V372284.R01.S.doc Version 5.2 Page 15 would like a bath or shower and a choice of food at meal times. This means staff respect people’s right to make decisions and people feel valued. People invited us to join them for lunch. The menu was displayed on the notice board in the dining room. We sat with five people at the dining table, which was nicely presented. We were served chicken casserole with fresh vegetables and homemade egg custard for dessert. The meals were served by the care staff and were individually portioned. People were asked is they wanted a second helping of lunch. The meal was hot, attractive and very tasty. An alternative pudding was provided for people with diabetes. People chatted to us and with each other over lunch and staff assisted people where needed in a discreet and very sensitive manner. A two-week rotating menu is offered showing a choice of food each day. The service’s AQAA tells us they have consulted people about the food and in response, changes have been made to the range of vegetables being offered. People told us the food ‘is magnificent’ and they ‘have biscuits with our mid morning drink’. The menu shows homemade cake, biscuits or fresh fruit are served with afternoon tea and a hot drink and snacks are available in the evening. Pals Residential Home DS0000018669.V372284.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Procedures are in place to address any complaints so people can be confident complaints are taken seriously. Staff are aware of safeguarding issues and know how to respond to any concerns but poor staff recruitment practices place people at risk of possible abuse. EVIDENCE: The complaints procedure was on display in the hallway. This requires reviewing as it refers to the previous regulator (National Care Standards Commission). We saw that records were held of any complaints that had been received and the last recorded complaint was September 2007. The service’s AQAA tells us they ‘have a complaint procedure which all people and families are aware of’. People we talked to told us that if they had any concerns they would ‘speak to Eileen’ the manager. Staff told us they were aware of the home’s complaints procedure. Since the last inspection in September 2007, the service has made one referral to safeguarding this was in response to concerns about a person who was having frequent falls. This was resolved through a review of the person’s care needs in consultation and agreement with the family of the person receiving the service. Staff told us they were aware of what to do if they had any concerns that people might be at risk of harm. Pals Residential Home DS0000018669.V372284.R01.S.doc Version 5.2 Page 17 On arrival at the service the manager invited us in without asking to see any proof of identification. In order to protect the people who use the service only authorised and known visitors should be allowed to enter the premises. The inspection of staff recruitment records showed that two people had been employed to work at the service before the outcome of all the necessary security checks where known. A Criminal Record Bureau (CRB) or POVAfirst disclosure and two employment references were not secured to determine the fitness of people applying for employment and are necessary to safeguard the people who use the service. The service’s AQQA tells us that during the last twelve months satisfactory preemployment checks had been carried out on all the staff that had worked in the service. This is not what we found. The service’s AQAA did not identify staff recruitment procedures as something they (the service) could do better or necessary to safeguard the people who use the service. Therefore, they have not recognised this as a shortfall in the service they provide. Pals Residential Home DS0000018669.V372284.R01.S.doc Version 5.2 Page 18 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 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People benefit from a warm and comfortable environment that meets their needs but they cannot be confident that the infection control measures will protect them. EVIDENCE: The service provides accommodation for 14 people in an extended and converted Victorian house. The home is bright, clean, warm and nicely decorated with communal space consisting of a lounge and dining room on the ground floor, which meet people’s needs. The service’s AQAA told us they have identified they ‘need to improve the garden area’. The accommodation is provided over two floors and a passenger lift provides easy access to the upper floor. People who use the service are encouraged to personalise their rooms and our observations showed that people had brought some personal items into the service with them such as pictures, photographs Pals Residential Home DS0000018669.V372284.R01.S.doc Version 5.2 Page 19 and ornaments so that they can keep the things that are important to them. People have a lockable draw in which to store personal items for safekeeping. We identified a number of environmental concerns that pose a potential risk to the people who use the service. For example, the fire extinguishers were due to be serviced in July 2008 and this had not been done. We saw that fire doors on the ground floor including doors leading into the kitchen and laundry rooms were wedged open. The entrance to the cellar was not secure. We issued two immediate requirements relating to these issues of concern to the registered provider to action and therefore safeguard the people who use the service. The floor covering in the laundry is worn and people entering may be at risk of trips or falls. Staff told us they hand sluice soiled clothing and soak items in disinfectant and soiled linen and clothing was washed at 60°C and below the recommended temperature (minimum 65°C) necessary to ensure laundry is thoroughly cleaned and the risk of cross infection reduced. There is no facility within the laundry room for staff to wash their hands. Staff told us they ‘use the shower room down the corridor’, which is also used by people who use the service. This increases the risk of outbreaks of infection and cross contamination. There were no disposable hand towels in the staff toilet and staff were using the same towel to dry their hands. Such practices increase the risk of cross infection and therefore place people’s health at risk. We looked at the fire records and weekly and monthly fire safety checks were recorded. This means fire prevention and fire safety is promoted by the service and people are not placed at unnecessary risk of harm or injury. We asked for the records of checks for window restrictors and staff told us they do not keep any records of the window restrictor checks. The service’s AQQA states ‘all the windows have risk assessments done in review of first floor bedrooms which don’t have window restrictors’. Therefore, information in the service’s AQAA does not accurately reflect what we found. We saw bath sponges left in the shower room and staff told us they were used for washing people’s private areas and are then washed and reused. These practices are unsafe and fail to protect people from cross infection. Pals Residential Home DS0000018669.V372284.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area adequate. This judgement has been made using available evidence including a visit to this service. People benefit from having their needs met by suitably qualified staff but there may not always be sufficient numbers of staff available to meet their needs. Staff recruitment procedures fail to safeguard people. EVIDENCE: On the day of the inspection the inspection and in addition to the manager there were two care staff in the morning and three care staff in the afternoon. One of the care staff were carrying out cleaning tasks as we were told and the staff rota confirms the cleaning staff were on holiday. Two care staff were on duty between 5-9pm this included the carer designated to carry out cleaning duties. The home employed a cook who worked 10-1pm six days each week. Two staff were on duty each night. The staff rota shows the maximum staff rostered on duty for a two-week period including the manager was five in the morning, four in the afternoon and two in the evening from 5pm. The staff rota shows the minimum staff rostered on duty for a two-week period were three in the morning, three in the afternoon and two in the evening after 5pm. These numbers include catering, cleaning and laundry staff. We have included in the report a number of issues arising from staffing levels which may not be deemed as always sufficient to meet the needs of the people who use the service. For example, staff did not speak to people about their individual hobbies and interests or develop a plan to support people to Pals Residential Home DS0000018669.V372284.R01.S.doc Version 5.2 Page 21 continue to enjoy their hobbies or pursue new interests. One person told us it’s a bit boring’. Staff told us they provide activities between set times each afternoon. The information in the staff rotas indicated care staff were deployed to clean the home in addition to care tasks when the cleaning staff were on holiday and on their two days off each week (Saturday and Sunday). The rota showed that on three consecutive days after two o’clock there were two staff on duty to prepare supper and wash up, to provide personal care and any activities, administer medication to people, launder clothes and carryout any cleaning tasks as there were no domestic staff on duty. The people we talked to told us the staff are ‘fine’, ‘very good’, ‘do all they can to help you’. We asked staff how many staff they have on duty throughout the day and they told us the normal staffing levels provided are three to four care staff each morning and afternoon and two waking care staff at night. We looked at recruitment records belonging to two people. The first of these showed a Criminal Records Bureau (CRB) disclosure was not received before the person started working at the service and only one employment reference obtained. There was no information to show the person had been interviewed or gaps in their employment history identified on their application form explored. The second staff record we looked at held evidence of a CRB disclosure dated 21st April 2008, but this had not been requested by the service as required. There was only one pre employment reference held and their application form showed gaps in the person’s employment history and there was no information to show whether these gaps had been explored with the person. There was no documentary information to show whether the person had attended for interview and necessary to determine their fitness to work with vulnerable people. The registered provider told us he had not applied for CRB disclosures for these people and for one other named person who started working at the service in April 2008. We made an immediate requirement to the registered provider to address the issues identified and to safeguard the people who use the service. The first file we looked showed the person had achieved NVQ level 2 and that induction training included moving and handling, infection control, food hygiene, abuse and dementia. This person told us they were waiting to for training in health and safety and first aid. The second file we looked at held no information to show the employee had received any induction training since starting work at the service in May 2008. Common Induction Standards (CIS) have been developed by ‘Skills for Care’. They set down minimum expectations about the learning outcomes that need Pals Residential Home DS0000018669.V372284.R01.S.doc Version 5.2 Page 22 to be met so that new workers know all they need to know to work safely and effectively. The absence of appropriate induction training is unsafe and place people who live at the service at risk of not having their needs met and increase the risk of unsafe staff practices, which may result in people being harmed or injured. The manager told us all care staff held an NVQ level two. The service’s AQAA tells us five care staff were also working towards achieving an NVQ level 3 Award. This will ensure appropriately trained and qualified staff are available to meet people’s needs. The service’s AQAA tells us that the service benefits from a low staff turnover, having lost only two carers and one senior carer in the last twelve months. This ensures continuity and promotes positive relationships between the staff and the people who use the service. Pals Residential Home DS0000018669.V372284.R01.S.doc Version 5.2 Page 23 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 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people who use the service cannot be confident that the service is being managed in their best interests. EVIDENCE: The service’s AQAA tells us the manager has worked at the service for the last 11 years. She has ‘40 years of care experience’ and has ‘undertaken periodic training’. The service has recently employed a deputy manager. The service’s AQAA tells us the service plan to improve in the next 12 months as ‘the deputy manager will be qualified and in a position to start to learn the care managers role in full. This will result in having a stronger management in place in Pals’. The service’s AQAA tells us the deputy manager has an NVQ level 3 ‘and will Pals Residential Home DS0000018669.V372284.R01.S.doc Version 5.2 Page 24 now take the NVQ level four and registered manager award’. The manager told us the registered provider is at the home every day. The service’s AQAA tells us the owner ‘manages the finance, shopping and maintenance of the building’. The service’s AQQA was not returned to us within the timescale allowed, which meant we were unable to send surveys to the people who use the service. The service’s AQAA was received after the key inspection of the service took place. We do not consider that the service’s AQAA gave us reliable information about the service and we have included examples in the report to support this. The registered provider told us they have recently sent out questionnaires to the staff and families of people who use the service and are awaiting their return. He told us people who use the service had not been consulted and there had not been any recent meetings with them. We were told the last meeting was just after Christmas, but they were unable to locate the minutes from the meeting. The registered provider agreed to send this information, to us but at the time of writing the report we had not received it. Under the heading ‘what they could do better’, the service’s AQAA tells us they could ‘record meetings with the user’s of the service and date action taken by management in response to requests, requirements and wishes of the service users’. We were told that the service did not hold or manage any monies belonging to people who use the service. Robust staff recruitment checks were not carried out before people were employed and health and safety training, necessary to enable new employees to work safely and to protect the people who use the service, were not always carried out. We identified concerns about the environment, which place people at risk of harm. We have included information about these issues in other outcome sections of the report highlighting areas where unsafe working practices were being adopted by the staff. Pals Residential Home DS0000018669.V372284.R01.S.doc Version 5.2 Page 25 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 X 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X X X X X X 1 STAFFING Standard No Score 27 2 28 2 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X N/A X X 1 Pals Residential Home DS0000018669.V372284.R01.S.doc Version 5.2 Page 26 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 OP3 Regulation 14(1) Requirement A pre-admission assessment must be carried out before people move into the service and be recorded in sufficient detail to enable staff to formulate a care plan. Timescale for action 28/02/09 2. OP7 15(1) 3. OP7 13(4) 4. OP9 13(2) This is so that people who are considering using the service can be confident that their needs can be met. Care plans must be further 28/02/09 developed to include details of all the care to be provided so that staff understand what is required and people can be sure their needs will be met. 23/02/09 Risk assessments must be completed for each person upon admission and reviewed at regular intervals. This is to ensure any risks to people are identified and any action deemed as necessary to safeguard people implemented. To make arrangements to ensure 28/02/09 that controlled drugs are stored securely in accordance with the requirements of the Misuse of DS0000018669.V372284.R01.S.doc Version 5.2 Page 27 Pals Residential Home 5. OP9 13(2) 6. OP9 13(2) 7. OP9 13(2) 8. OP9 13(2) 9. OP9 13(2) Drugs Act 1971, the Misuse of Drugs (Safe Custody) Regulations 1973 and in accordance with the guidelines from the Royal Pharmaceutical Society of great Britain. The policy and procedure for the storage, handling and administration of medication must be reviewed and action taken to ensure medication is being appropriately managed. This must include all the short falls identified in the management of medication highlighted below. To relocate the storage of medication out of the laundry room to a more suitable and secure location so that all medication is stored in compliance with their product licences and people’s health is not placed at risk. Take action to ensure that medication held and managed by the service is stored securely at the correct temperature recommended by the manufacturer. So that all medication is stored in compliance with their product licenses and people’s health is not placed at risk. Provide a dedicated fridge to facilitate safe storage of medication so that the risk of cross contamination is removed and medication stored safely. To ensure procedures are in place to support people to keep and take their own medication (self administration) within a risk management framework. This is so that people who are willing and able can keep and take their own medication and 28/02/09 28/02/09 28/02/09 28/02/09 28/02/09 Pals Residential Home DS0000018669.V372284.R01.S.doc Version 5.2 Page 28 10. OP19 13(4) 11. OP19 13(4) 12. OP26 13(3) be confident that any risk this may present is being appropriately managed. A risk assessment must be 02/09/08 carried out for the staff practice of wedging fire safety doors open to ensure fire risk and prevention is not compromised and people are safeguarded. A copy of the risk assessment along with any agreed action plan must be sent to us. We issued an immediate requirement for this on the day of the inspection. A risk assessment must be 02/09/09 carried out for staff access to the cellar so that people who live at the service are not at risk of falling down the stairs leading to the cellar and/or injuring themselves as a result of gaining unsupervised access to the cellar. A copy of the risk assessment and any subsequent action plan must be sent to us. We issued an immediate requirement for this on the day of the inspection. 28/02/09 A review of infection control measures must be undertaken and effective systems implemented to control the spread of any possible infection so that people living at the service are protected from avoidable infections and are treated with respect and valued as an individual. This includes: Stopping the staff practice of using communal sponges for bathing people and taking action to ensure people have their own bathing sponges and toiletries that are only used for/by that person. Pals Residential Home DS0000018669.V372284.R01.S.doc Version 5.2 Page 29 13. OP29 19 The separation of soiled and clean laundry and ensuring that foul laundry is washed at appropriate temperatures (minimum 65ºC for not less than 10 minutes) to thoroughly clean linen and control risk of cross infection. Thorough staff recruitment procedures must be carried out to ensure all the information required to determine suitability is known before people start working at the service. So that people who use the service are not placed at risk of possible abuse because thorough recruitment procedures have not been followed. We made an immediate requirement for this on the day of the visit and gave it to the owner. A risk assessment must be carried out for the staff that have been employed and are working without the outcome of a Criminal Records Bureau disclosure or PoVA first check being known and any action identified as necessary taken. A copy of the risk assessment must be sent to us. This is to ensure that the health and safety of the people who use the service is being promoted and maintained. We issued an immediate requirement for this on the day of the inspection. 02/09/08 14. OP29 19 02/09/08 Pals Residential Home DS0000018669.V372284.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered provider/s to consider carrying out. No. 1. Refer to Standard OP3 Good Practice Recommendations The initial care needs assessment should include the following: • personal care and physical well-being; • diet and weight, including dietary preferences; • sight, hearing and communication; • oral health; • foot care; • mobility and dexterity; • history of falls; • continence; • medication usage; • mental state and cognition; • social interests, hobbies, religious and cultural needs; • personal safety and risk; • carer and family involvement and other social contacts/relationships. This is so that people who are considering using the service can be confident that their needs can be met before they decide whether to use the service. The recorded care needs should be based upon up to date assessments. The plan should include guidance on how the care will be implemented and that the care provision is current. Care staff will then be clear both as to the person’s wishes and the expectation on them as carers and people who live at the service can be confident their needs will be met. People should be consulted about their hobbies and interests and this information recorded and used to formulate a social care plan. People should be supported to continue to enjoy their hobbies and interests in and outside of the service, which suit their needs, preferences and capabilities. Particular consideration should be given to people with cognitive impairments, those with visual, hearing or dual sensory impairments and those with physical disabilities. This is so that people have access to social stimulation suited to their needs and expectations and which support them to retain their mental capacity DS0000018669.V372284.R01.S.doc Version 5.2 Page 31 2. OP7 3. OP12 Pals Residential Home 4. OP16 5. OP18 6. OP27 7. OP30 8. OP33 and physical capacity. The complaints procedure should be revised and the name of the previous regulator (National Care Standards Commission) removed so that people have access to up to date information about the complaints procedure. Staff should make sure they check the identity of visiting professionals to the home if they have not visited previously to ensure people and staff are not placed at risk of harm. A review of the staffing arrangements for when ancillary staff are unavailable should take place and if necessary changes made to the way the rota is managed. This is so that people can be confident there are always sufficient numbers of trained and competent staff available to meet their needs. All new employees should have induction training appropriate to their role and responsibilities and this should be done within six weeks of the commencement of employment. This will ensure the people who use the service have their needs met by appropriately trained and competent staff. There should continuous self-monitoring of the service using an objective and professionally recognised quality assurance system that involves people who use the service; and an internal audit at least annually. The outcome of any internal audit should be used to bring about any improvements identified as necessary for the benefit of the people who use the service. Pals Residential Home DS0000018669.V372284.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Pals Residential Home DS0000018669.V372284.R01.S.doc Version 5.2 Page 33 - 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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