Inspection on 13/07/05 for Peartree Care Centre

This inspection was carried out on 13th July 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Peartree Care Centre 10/07/08

Peartree Care Centre 08/11/07

Peartree Care Centre 01/11/06

Peartree Care Centre 17/08/06

Peartree Care Centre 07/08/06

Peartree Care Centre 01/06/06

Peartree Care Centre 31/01/06

Peartree Care Centre 08/12/04

Peartree Care Centre 13/07/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Peartree Care Centre 195-199 Sydenham Road Sydenham London SE26 5HT Lead Inspector Kate Matson Unannounced 13 - 14 July 2005, 10:00am th th 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 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. Peartree Care Centre G52-G02 S7038 Pear Tree V237951 13-14 07 05 Stage 4 Final.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Peartree Care Centre Address 195-199 Sydenham Road, Sydenham, London. SE26 5HT Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8488 9000 020 8333 5399 Springmarsh Homes Ltd CRH Care Home N N Care Home with Nursing 75 Category(ies) of DE Dementia registration, with number DE(E) Dementia - over 65 of places OP Old Age PD Physical Disability PD(E) Physical Disability - over 65 Peartree Care Centre G52-G02 S7038 Pear Tree V237951 13-14 07 05 Stage 4 Final.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 20 patients, elderly, frail persons aged 60 years and above (female) and 65 years and above (male). 55 Persons aged 65 years and above, and persons aged 60 years and above who are physically disabled, or have a mental health disorder. Date of last inspection 08/12/04 Brief Description of the Service: Peartree Care Centre is a care home providing personal care and accommodation for up to 75 older people. Of these, 20 older people are provided with nursing care. At the time of this inspection, there were five residential vacancies and two nursing vacancies. The home is owned and run by Excelcare Holdings Ltd, a private provider with several other homes in the nearby area, as well as outside London. The Head Office of the company is in Bromley. The home is located close to the centre of Sydenham and is easily accessible by public transport. It is also close to community facilities, shops, cafes and pubs. The property is purpose built with accommodation on four floors. On one floor nursing care for 20 people is provided; one floor is designated to provide residential care to older people with Dementia; the other two floors provide residential care to frail older people and older people with Dementia. There are 65 single and five double bedrooms. All but seven single rooms and one double room have en-suite facilities. There is a passenger lift. The home has a car park and a small paved area at the rear of the property. Peartree Care Centre G52-G02 S7038 Pear Tree V237951 13-14 07 05 Stage 4 Final.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced statutory inspection was completed over 18 hours, over two days. Since the last inspection there had been an incident reported under vulnerable adult procedures, which had resulted in a letter being sent to the provider requiring staffing levels to be increased and there had been a complaint about staffing levels prior to the inspection. The inspection included discussions with 23 service users, 4 visitors, 5 staff, the manager and the regional operations manager, a tour of the premises and examination of 8 care plans, staff records and other records. The CSCI Pharmacist conducted an inspection at the same time. What the service does well: What has improved since the last inspection? The manager had included the issues of death and dying in the in-house training programme and some service users’ care plans included the service users’ wishes in this area. However, a more consistent approach is required to ensure that all service users are consulted about this sensitive issue. An occupational therapy assessment of the premises had been completed to ensure that it suited the physical needs of service users. However, it is recommended that further assessment be completed, to ensure that the environment meets the needs and maximises the independence of those with dementia. Service users’ bedrooms included personal furnishings and several service users confirmed that they had been offered a choice of floor covering though this had not been recorded in their files to evidence that a consistent approach was being taken. Also some rooms lacked essential items and personal care supplies were on view not respecting the privacy and dignity of service users. Staff files showed that all staff now had two written references, however staff had started employment in the home before other essential checks were completed. A letter was written to the home immediately following the Peartree Care Centre G52-G02 S7038 Pear Tree V237951 13-14 07 05 Stage 4 Final.doc Version 1.40 Page 6 inspection to require the home to ensure essential checks were in place for the staff members concerned. The manager had drawn up a plan of in-house training to be offered over a 3 month period and a staff training matrix to show what training staff had undergone, but these were insufficient to show that the approach to training was well planned, based around mandatory requirements, the training needs of staff, and was adequate to meet the needs of service users. The manager had drawn up an annual development plan to reflect the home’s aims and outcomes for service users. However, the home needs to consult with service users, their representatives and other interested parties via satisfaction questionnaires in order to ensure that the home is run in the best interests of service users. The home has adopted a policy of not looking after service users’ money in order to protect their financial interests. Although several staff have undergone training to provide supervision, there was no evidence that staff were being supervised appropriately. What they could do better: Information given to service users is inaccurate and misleading. It needs to be reviewed to ensure that it is accurate and that it truly reflects the service offered. Not all service users have a contract with the home and must have one in order for their rights to be protected. Although all service users have a needs assessment before moving in to the home, more effort is required to ensure that information is sought about service users’ past lives in order to assist communication. Care plans do not reflect service user involvement or that changing needs are being recognised. Although the home has good access to a range of appropriate healthcare, exercise is not routinely provided, GP advice had not been followed in one instance, and insufficient regard had been paid to a service user’s weight loss. The home has appropriate procedures for medication handling; however, these were not being followed in many instances and this is placing services users at risk. There is a very low level of activity offered at the home, and nearly all service users confirmed this. An activities coordinator had been appointed though had not yet started; however, it is unlikely that one worker would be able to meet the needs of service users on all four floors. Service user choice and autonomy are reduced by insufficient information about activities and meals, environmental restrictions on choice of bath and showers on one floor, inconsistent provision of room keys and a lack of encouragement to use kitchenettes provided on all floors. Although there was some positive feedback about meals, there were sufficient negative remarks to indicate the necessity of a food survey as required by a previous inspection. Although the home had not received any complaints directly, those received by CSCI and passed to the provider, had not been recorded and the response was slow and incomplete. Peartree Care Centre G52-G02 S7038 Pear Tree V237951 13-14 07 05 Stage 4 Final.doc Version 1.40 Page 7 The level of staff training and number of staff trained in adult abuse is inadequate to ensure that service users are protected from abuse. The outside space has not been developed to make it more attractive for service users as recommended at previous inspections and this is now required because of the needs of the service user group and the low level of activity offered at the home. The bathing facility on the ground floor does not meet the needs of the service users on that floor. Service users continue to share bedrooms without making a positive choice to share and one shared room did not have a screen to protect the privacy and dignity of service users. Service users continue not being able to control the temperature in their own rooms and hot water temperatures were still too cool for comfort in some rooms. Cold water temperatures place service users at increased risk of Legionella and although the manager was alerted to this it was not clear what action the provider was going to take to reduce this risk. Department of Health guidance for hot weather was not being followed at the home. Staffing levels had not been increased as required and staff continue to work alone at night when colleagues are on a break. Staffing levels are inadequate to meet service users’ stimulation, supervision and individual care needs. Although service users confirmed that if they rang their alarm staff usually responded quickly, four service users stated that they thought staff levels were insufficient and one said, “The standard of care has decreased”. Another two said that their quality of life was affected commenting that “staff don’t have time to talk” and “staff don’t come and talk, they don’t have time”. Enough staff had undergone First Aid training to have a first aider on duty on each floor at all times; however, certificates for hoist safety, fire alarm testing, and fire drills and an unlocked sluice showed a disorganised approach to health and safety. Because of the high number of concerns that have remained over several inspections, CSCI is considering taking further action to ensure that the home complies with National Minimum Standards. Before the final publication of this report a meeting was held with the provider. An action plan was agreed and compliance will be monitored over the coming months. 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. Peartree Care Centre G52-G02 S7038 Pear Tree V237951 13-14 07 05 Stage 4 Final.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Peartree Care Centre G52-G02 S7038 Pear Tree V237951 13-14 07 05 Stage 4 Final.doc Version 1.40 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 standard(s) 1, 2, 3, and 4 Information provided to service users is inaccurate and misleading. Each service user does not have a statement of terms and conditions or contract with the home. Service users’ needs are assessed prior to admission though information about service users’ past lives needs to be more actively pursued in order to aid communication. The home’s staffing level, staff training, and activities provided do not ensure that the needs of service users are met. EVIDENCE: Previous inspections had noted missing and incorrect information in the statement of purpose and service user guide. Both documents had been updated however some errors still remained such as in the service user guide the number of rooms is quoted incorrectly and the Commission for Social Care Inspection is referred to by its old name, the National Care Standards Commission. There are also discrepancies between information included in the documents of services offered and evidence gathered at the inspection. For example under “financial matters” it is stated that small amounts of money can be held for people, however the inspector was informed that money is no longer held by the home. Also the documents state that service users are involved in care planning and it is stated that, “the home has an activities organiser who provides a wide range of activities and “we are available to chat Peartree Care Centre G52-G02 S7038 Pear Tree V237951 13-14 07 05 Stage 4 Final.doc Version 1.40 Page 10 with residents”. However evidence gathered at the inspection indicated that service users are not routinely involved in care planning, the activity organiser had not yet commenced work in the home and there is little activity. Several service users commented that staff do not have time to chat. (See standards 7 and 12). This information is therefore misleading for prospective service users. It had been noted at previous inspections that although most service users had a contract with the local authority, they did not have a statement of terms and conditions from the home. At this inspection it was found that some statements of terms and conditions had been issued but recent admissions to the home did not have one including a service user who was self funding. This means that the rights of service users are not protected, though the manager took action to begin to remedy this at the inspection. All of the service users files examined included a care management assessment where appropriate and an assessment completed by the home. This is completed where possible prior to admission in the service users home environment or hospital where necessary. Some service users had a life review in place though these were not always fully completed. Staff stated that these documents had been given to families to complete and some had not returned them. These documents are very important in aiding communication with service users but there was no evidence available of how these were being chased up. At previous inspections concerns had been expressed about the home’s ability to meet the needs of service users particularly those with dementia. Concerns were around staffing levels, staff training, (particularly around dementia and adult protection), activity provided and the absence of environmental assessment to ensure that the home meets the needs of this service user group. At this inspection it was noted that staffing levels had not increased, and the level of activity provided was poor (see standards 27 and 12). The home was making good progress in ensuring that at least 50 of staff are trained to NVQ level 2. However there was still a majority of care staff who had not undergone any training in adult abuse and dementia and the training offered was mainly in-house 1 or 2 hour sessions provided by the manager. Some training was accessed from the Care Homes Support Team, however this tended to be one staff at a time. This level of training is not adequate to ensure that the needs of this service user group are met. An occupational therapy assessment of the premises had been completed though this had not focussed on the needs of people with dementia as required. Peartree Care Centre G52-G02 S7038 Pear Tree V237951 13-14 07 05 Stage 4 Final.doc Version 1.40 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 standard(s) 7, 8, 9 and 11 Care plans do not reflect service user involvement or that changing needs are being recognised. The home has good access to a range of appropriate healthcare though GP advice had not been followed in one instance, insufficient regard had been paid to a service users weight loss and exercise is not routinely provided. The home has appropriate procedures for medication handling however where these are not being followed, this is placing services users at risk. The home had consulted some service users with regard to their wishes in terms of death though this was inconsistent. EVIDENCE: Previous inspections had noted that service users were not involved in care planning and that reviews did not reflect the changing needs of service users. At this inspection, only one file examined included a signature of a service user or relative and one service user was not aware that a care plan was in place. Although records indicated that care is reviewed monthly it was noted that the review date was written prior to the date and then staff initialled to state care was reviewed. However this was always on the same date and shift patterns were not reflected. On one floor this had been initialled although the date was in the future. Also some reviews did not evidence changes in peoples needs for example, on some floors every review stated “continue care as planned”. CSCI is considering taking enforcement action regarding these issues. One Peartree Care Centre G52-G02 S7038 Pear Tree V237951 13-14 07 05 Stage 4 Final.doc Version 1.40 Page 12 service user had been identified as having a loss of appetite and was appropriately referred to the GP who recommended being weighed every two weeks. The service user was only weighed monthly and although weight loss had been identified the nutritional risk assessment did not reflect this. Another service user was regularly throwing food away but the nutritional risk assessment did not reflect this. The home has a GP who visits the home on a weekly basis. The Care Home Support Team also gives valued input. Care plans indicated that service users had intervention from specialist services including continence advisors, tissue viability nurses and older adults mental health team. A previous inspection had noted that all service users did not have access to organised exercise activity to ensure that they keep physically active. At this inspection although the inspector was informed that a voluntary organisation was due to start taking people out for short walks and that exercise activity now took place on every floor, most service users stated that they were not aware of any organised exercise. Although some service users had lost weight and although the weather was currently very warm, none of the service users’ intake of food or drink was being formally monitored to ensure that their intake is adequate. Previous inspections had noted that the wishes of service users in terms of their death were not being sought. At this inspection it was noted that this sensitive topic had been included in the in-house training programme. There was a noted improvement with information available on several files examined. However there did not appear to be a consistent approach to the issue, as other files did not have any information recorded. The CSCI pharmacist inspector completed an inspection of the homes medications systems. The report follows below. Evidence was available that staff do notify the GP when medication is not being taken. Staff were aware of their residents conditions, what medication they were taking, and were able to explain any deviations from what was prescribed. This was a positive observation. One resident had not had morning medication and no reason was documented. Where items are not given, staff must use the back of the MAR chart to document the reason why, as these records must be kept for at least 3 years and must provide a full history of administration. The supplying Pharmacist is assisting the home with improving medication handling and has helped to devise a competence assessment, which is positive. The homes management must implement this assessment. As well as during this inspection by the CSCI Pharmacist, the homes own internal audits of medication handling have highlighted issues of stock discrepancies, where medication is being administered but not signed for, and more seriously, where medication is being signed for yet is still in the blisterpack so has not been administered. Peartree Care Centre G52-G02 S7038 Pear Tree V237951 13-14 07 05 Stage 4 Final.doc Version 1.40 Page 13 An example is where an item should be administered once weekly, yet staff had signed for 3 days in a row. Inspection of the stock showed that it had only been given once. Staff must always check the MAR chart, administer, and then document immediately. The home must continue to carry out these audits regularly, at least monthly, to identify why these issues are happening, and to re-train staff in accurate record keeping. One area of concern is the resolution of issues by the home and GP. One resident had not received methotrexate for several months while waiting for the GP to confirm the reason for prescribing this with the residents previous GP or hospital. This item is prescribed for cancer, severe psoriasis or rheumatoid arthritis. Staff did not know why it has been prescribed. The home must ascertain whether this treatment is to be re-started as stopping medication for several months has potentially putting this resident at risk. Most of the MAR chart records were accurate. Receipts were being recorded accurately although staff do not always count medication, but use the quantity stated on the pharmacy label. Returns were not done for 2 months on one floor. These must be done on a monthly basis in order to be able to carry out a justified stock check (quantity ordered minus quantity used tallies with the quantity returned). Brought forward quantities are not being added to MAR charts. This is also needed to be able to carry out a justified stock check. It is especially important for controlled drugs, as in one case there were 28 extra in stock from the previous month. Stock checks must be carried out on controlled drugs each time a dose is administered yet there was no triangle to carry out this count. The home must provide a triangle for each unit to carry out stock checks in a hygienic manner. The application of external products (creams etc.) and the administration of food supplements (e.g. Fortisip) must be recorded as these are also prescribed items. One item, eye drops, had no signatures for administration on the current MAR chart. One prescribed item was in a locked trolley but did not appear on the MAR chart. This item is given by the District Nurse. All prescribed items must be listed on MAR charts, and records of administration must be kept by the home for all of these items. Some items are being kept by the resident for self-administration. MAR charts must always indicate this. The Excelcare policy in the MAR chart folder is dated 1998. If there is a more recent version, staff must be trained in this, and the old copy replaced. This would be a good opportunity to provide refresher training and sign off the competency assessment. There was some confusion over whether Homely Remedies are kept on all floors. A Homely Remedies list was kept with the MAR chart folder was dated Peartree Care Centre G52-G02 S7038 Pear Tree V237951 13-14 07 05 Stage 4 Final.doc Version 1.40 Page 14 1999. If Homely Remedies are kept, this list must be authorised annually by the GP or at least when a new resident is admitted to ensure the items on the list are compatible with prescribed medication. One floor did have a stock of Homely Remedies and a stock list. The stock check did not tally; there were 30 fewer than there should be. This indicates poor control of medication, either medication being administered to residents and not being recorded, or staff using Homely Remedies for themselves. Two items were also out-of-date. Expiry dates must be checked regularly. All storage facilities are good. The temperature of medication fridges must be monitored and appropriate action taken if out of limits. One floor had not recorded temperatures for 4 months due to a broken temperature monitor. This must be replaced or repaired and until then a standard thermometer must be used. Another floor had been recording temperatures of between 0C and 11C and no action had been taken to rectify this. Dates of opening must be placed on all items with a finite shelf life after opening e.g. eye drops. Peartree Care Centre G52-G02 S7038 Pear Tree V237951 13-14 07 05 Stage 4 Final.doc Version 1.40 Page 15 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 standard(s) 12, 14 and 15 The level of organised activities offered in the home is insufficient to meet service users individual needs for stimulation and fulfilment. Insufficient information about meals and activities, inconsistent provision of room keys, some environmental restrictions on choice of bath and showers and lack of encouragement to use kitchenettes reduce service users’ choice and autonomy. Service users had not been appropriately consulted to ensure that they were happy with their diet. EVIDENCE: Previous inspections had noted that the amount of organised activities taking place in the home was insufficient to meet service users individual needs for stimulation and fulfilment. At this inspection it was noted that there had been a trip to a London Park and another trip was planned for later in the summer, however service users had to pay £15 for the trip, which some service users could not afford to pay. Staff from all four floors stated that planned activities took place everyday yet the inspector did not see any in the two days of the inspection and throughout the home service users were unaware of activity taking place though one mentioned painting once a week, another mentioned bingo twice a month and a few mentioned the singers that come in to the home occasionally. One service user stated that activity does not seem to be planned but “Spur of the moment stuff”. Two service users stated that staff do not have time to talk and one said, “I’m lonely”. The post of activities organiser had been filled though the person had not yet commenced work and Peartree Care Centre G52-G02 S7038 Pear Tree V237951 13-14 07 05 Stage 4 Final.doc Version 1.40 Page 16 it is unlikely that one organiser could ensure that the activity needs of seventyfive service users are met. Previous inspections had noted that the information provided to service users and their relatives, including information about meal choices was insufficient and that service users were not encouraged to use kitchenettes on each floor to maximise their independence. At this inspection although information had been updated it contained inaccuracies and was misleading (see standard 1) also information about meal choices was not available on each floor and one service user said that they did not know what the meal choices were in advance of meal times. Service users were still not being encouraged to use the kitchenettes where capable of doing so safely. The lack of assisted bath on the ground floor also meant that some service users did not have a choice between bath and shower and one service user stated that they preferred a bath but did not have one. Another service user on the nursing floor stated that they had been unable to have a shower that day because the water was too cold (see standard 25). Also although some service users had keys to their rooms, there was no consistency in ensuring that all service users had one unless a risk assessment indicated otherwise. CSCI is considering taking enforcement action regarding these issues. At the previous inspection feedback about the food had been varied but there had been a lot of negative comments. The manager was required to conduct a food survey and quickly action the results of this. At this inspection the feedback was again varied and comments included, “The food is very good”, “They feed you very well”, “The food is good, not very varied though”, “The food is adequate but if it was a restaurant I wouldn’t come back”, “I find it difficult to chew most foods and the meals are not hot enough most times”, “The food is not too good,” and “The food is bland and unappetising”. One service user stated that although water was always available in service users rooms it was not served at meal times. The manager stated that juice drinks are available but water must also be offered in order to give service users choice. The inspector was informed that a food survey had been conducted earlier in the year but this had been of relatives not service users’ views. The comments above indicate that a survey is required in order to ensure that the needs and preferences of service users are met as far as possible. CSCI is considering taking enforcement action regarding this issue. Peartree Care Centre G52-G02 S7038 Pear Tree V237951 13-14 07 05 Stage 4 Final.doc Version 1.40 Page 17 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 standard(s) 16 and 18 Service users had not made complaints but complaints sent to CSCI were not responded to promptly or fully and were not recorded in the homes record of complaints. Staff are not adequately trained to recognise abuse and adult protection cases are not formally recorded in order to be monitored. EVIDENCE: All but one of the service users and relatives spoken to stated that they had never made a complaint. Two service users stated that they would not be afraid to complain if they needed to and another said they would not want to complain in case they had to move. The service user who had complained said that the complaint was dealt with and resolved straightaway. However they added that they were told, “You only have to ask”, but they felt that they should not need to keep asking for things. The complaints record showed that no complaints had been received since December 2004. However three complaints had been received by CSCI and forwarded to the provider to investigate. These had not been recorded in the homes complaint book although one of these was only very recent. The inspector had needed to follow up one of these complaints as no response was received and another regarding staffing levels was only partially responded to as service users dependency levels were not supplied as requested although the manager gave the inspector these at the inspection. It was suggested that a delay might have occurred as correspondence was sent to head office. However this is because the Responsible Individual (RI) is based at head office. The organisation might wish to consider the possibility of appointing a locally based RI. The home has some appropriate adult protection policies and procedures in place. The previous inspection had required that all staff undergo adult protection training. At this inspection it was found that less than half of the Peartree Care Centre G52-G02 S7038 Pear Tree V237951 13-14 07 05 Stage 4 Final.doc Version 1.40 Page 18 staff had undergone training in this area and this was mainly provided in 1 or 2 hour sessions, offered by the manager who had not as yet been trained to offer this essential training. This is not sufficient to ensure that staff are trained to recognise and prevent abuse. CSCI is considering taking enforcement action regarding this issue. There had been a few incidents referred for investigation under vulnerable adult procedures though information about these investigations was not recorded formally and easily available in order for the manager or any other person to monitor. Peartree Care Centre G52-G02 S7038 Pear Tree V237951 13-14 07 05 Stage 4 Final.doc Version 1.40 Page 19 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 standard(s) 19, 20, 21, 22, 23, 24, 25 and 26 The home offers a pleasant, well-maintained environment. There is sufficient indoor communal space though the outdoor space has not been developed to make it an attractive space for service users. The bathing facility on the ground floor does not meet the needs of service users. An occupational therapy assessment has been carried out to ensure that the homes environment meets the physical needs of service users, however the environment has not been assessed to ensure that it meets the needs and maximises the independence of service users with dementia. Service users continue to share bedrooms without making a positive choice to share. Service users confirmed that they were able to bring furnishings from home and that they were offered a choice of floor covering though this was not recorded and some rooms lacked essential items. Service users are unable to individually control the temperature of their rooms and some hot water temperatures are too cool to be comfortable. Cold-water temperatures place service users at risk from Legionella. The home was not following Department of Health Guidance for hot weather. The home is clean and pleasant though an unlocked sluice potentially places service users at risk of infection. EVIDENCE: Peartree Care Centre G52-G02 S7038 Pear Tree V237951 13-14 07 05 Stage 4 Final.doc Version 1.40 Page 20 The home is purpose built and accommodation is offered over four floors. The premises are located close to the shops and facilities of Sydenham including public transport links. The premises are well maintained and well decorated. Accommodation includes 65 single rooms and 5 double rooms. There are lounges and dining areas on each floor. There is a hairdressing salon and a chapel on the ground floor. There is a paved area at the rear of the home with some chairs and tables. It has been recommended at previous inspections that this area is developed to make it more attractive. In view of the needs of the service user group and the low level of activity offered at the home this is now a requirement. There are toilets situated close to communal areas on each floor. All but seven single rooms and one double room have en-suite facilities. These consist of a toilet, washbasin and a shower suitable for wheelchair users. There is a standard bath on each floor and an assisted bath on 1st, 2nd and 3rd floors. It was required at previous inspections that an assisted bath is fitted on the ground floor, as it is on this floor that service users do not have en-suite accommodation. This has not been done and one service user stated that they preferred a bath and did not have one. CSCI is considering taking enforcement action regarding this issue. The home has a lift and is accessible to wheelchair users. Previous inspections had noted that the premises had not been assessed by an occupational therapist with specialist knowledge in dementia care to ensure that the premises met the needs of service users with dementia. It was also required that the need for hearing loops in some rooms is reviewed and that door signs are designed to maximise the independence of service users with dementia. At this inspection it was noted that there were some clear signs on doors, and an occupational therapy assessment of the premises had been recently completed, however it is recommended that further assessment be carried out to focus on the needs of service users with dementia. The manager had gathered some information on hearing loops but had not yet ordered equipment. One service user stated that they stayed in their room to watch television, as they could not hear the television in the lounge. This highlights the need for hearing loop equipment. CSCI is considering taking enforcement action regarding this issue. There are 65 single rooms and 5 double rooms. All of the rooms are of adequate size. Previous inspections had highlighted the need for shared rooms to be shared by people who had made a positive choice to share together. Statements of consent to share were in place, but these were signed mainly by service users’ relatives. Also on the first floor the inspector was informed that one of the service users who shares, disturbs the other throughout the night and it is therefore unlikely that these two service users had made a positive choice to share. CSCI is considering taking enforcement action regarding this issue. In addition it was noted that in the ground floor shared room, there was no screening between the beds to protect the privacy of the service users. Peartree Care Centre G52-G02 S7038 Pear Tree V237951 13-14 07 05 Stage 4 Final.doc Version 1.40 Page 21 Service users rooms were well furnished and some service users had brought personal items from home. It was noted that not all rooms had comfortable seating for two people, meaning that visitors had to sit on the bed or in some rooms, plastic chairs. It was also noted that incontinence pads were stored visibly in some rooms, which does not respect service users privacy and dignity. Previous inspections had noted the large number of linoleum floors in the home and required that carpet must be provided unless there is a documented reason why it is not. At this inspection many of the service users confirmed that they had been offered alternative flooring but were happy to have lino though this was not documented to evidence a consistent approach. Previous inspections had noted that heating was not controllable in service users bedrooms and that hot water temperatures were quite cool. At this inspection it was noted that the heating system had not been changed and some service users stated that hot water temperatures were too cool. One said that they never got hot water in their sink and another said that they had been unable to shower that morning due to the carers saying the water was too cold. The record of water temperature checks indicated that one room’s hot water was only 12 C. The maintenance worker stated that the water pressure often caused the heating system to cut out if it was too low. CSCI is considering taking enforcement action regarding this issue. Following the inspection the manager was asked to find out what was being done about this. Temperatures were re tested and showed all hot water temperatures ranged from 37 C, which is too cool for people’s comfort, up to 43 C. Cold temperatures in all rooms were 21 C and 22 C, which is warm enough for the bacteria Legionella to develop. The home had undergone a Legionella assessment in August 2004 but no action had been taken regarding the current water temperature readings and the manager was not sure that there was a contract in place for annual testing. It was also noted that on the top floor the lounge area had potential to get very hot, as there was a glass roof without any blinds. Also on the top floor it was noted that there were risk assessments in place relating to hot weather that stated, “open all windows”. This is not in accordance with Department of Health Guidance that states windows must be kept closed until the outside temperature is below the indoor temperature. The home was clean on the day of the inspection and no unpleasant odours were detected. Laundry facilities were appropriate and staff were seen to wear gloves and aprons. However it was noted on the ground floor that the sluice door was not locked as required to protect service users from the risk of infection. Peartree Care Centre G52-G02 S7038 Pear Tree V237951 13-14 07 05 Stage 4 Final.doc Version 1.40 Page 22 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30 Staffing levels are insufficient to meet service users stimulation, supervision and individual care needs. Some elements of recruitment practice place service users potentially at risk of abuse. Although progress has been made in the area of training, it is insufficient to ensure that the needs of staff and service users are met. EVIDENCE: Previous inspections had raised concerns, also voiced by relatives and service users that staff levels at the home are insufficient to meet the needs of service users. Since the last inspection a situation leading to a vulnerable adult investigation and the dismissal of two staff members highlighted the need for increased staffing and that carers must never be alone on duty. There was also a recent complaint from a visitor that staffing levels had been decreased. Prior to this inspection copies of rotas and service users dependency levels were requested. Rotas were received and the manager gave the inspector dependency levels at the inspection. The Head of Care confirmed that staff had not been reduced since the previous inspection, however rota’s show that there are frequently only three carers on duty instead of four on the first, second and third floors. It was also discovered that staff are still on duty alone at night when their colleague is on a break. This is not acceptable for service users with such a high level of need and where there has been a number of vulnerable adult investigations. Although service users confirmed that if they rang their alarm, staff usually responded quickly, four service users stated that they thought staff levels were insufficient and one said, “The standard of care has decreased”. Another two said that their quality of life was affected commenting that “staff don’t have time to talk” and “staff don’t come and talk, Peartree Care Centre G52-G02 S7038 Pear Tree V237951 13-14 07 05 Stage 4 Final.doc Version 1.40 Page 23 they don’t have time”. The low level of activity has been discussed further under standard 12. CSCI is considering taking enforcement action regarding this issue. Previous inspections had raised concerns about staff starting work in the home before appropriate checks were completed. At this inspection it was noted that all of the staff files examined were well laid out and clearly indexed. All staff had two written references as required and checks with the Criminal Records Bureau (CRB) had been made. However two staff had started work before the CRB had been returned and there was no evidence that a check had first been made against the list of people considered unsuitable to work with vulnerable adults (POVA). One staff member had started work with a CRB that pre dated the POVA list so had not been checked against that list at all. Immediate requirements were made about this and shortly after the inspection the Head of Care confirmed that appropriate documentation had been dispatched and the staff would not be working until a POVA check had been completed. Previous inspections had raised concerns about the assessment of staff training and development needs, the training and development plan for the home and induction and foundation training at the home not meeting standards set by the National Training Organisation (NTO). At this inspection it was noted that the manager had prioritised NVQ training and the home was making good progress towards over half of the staff achieving minimum qualifications. She had also developed an in-house training plan from end of April until mid-July, and was making efforts to provide training to staff herself, on a weekly basis. However the training plan does not evidence any strategic planning towards meeting training goals for the whole year based on statutory requirements, an assessment of staff needs and include external training. Whilst the personal commitment of the manager to training is recognised, it is unlikely that 1 or 2 hour training sessions can ensure that staff are equipped to meet the needs of service users, for example, in areas such as adult abuse and dementia care. The manager had also produced a matrix for staff training so that it is easy to identify what training staff have undergone, however this had not been completed on an individual basis as required. There was no evidence in staff files that they had undergone induction or foundation training to the standards set by the NTO. Peartree Care Centre G52-G02 S7038 Pear Tree V237951 13-14 07 05 Stage 4 Final.doc Version 1.40 Page 24 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 35, 36 and 38 The home needs to increase consultation with service users to evidence that it is run in their best interests. To ensure that service users financial interests are safeguarded, the home no longer deals with service users money. Although staff have undergone training to provide supervision, staff are not being supervised appropriately. A disorganised approach to health and safety records means that the health and safety of staff and service users is not fully protected. EVIDENCE: The manager had prepared an annual development plan as required by previous inspections. Unannounced monthly visits are made by the registered provider in order to monitor the quality of the service. Although the provider periodically conducts satisfaction surveys these are of relatives views and do not include the views of service users. The registered provider needs to address this in order to improve the quality of the service offered in accordance with the views of those people using it. Peartree Care Centre G52-G02 S7038 Pear Tree V237951 13-14 07 05 Stage 4 Final.doc Version 1.40 Page 25 Since the last inspection the provider has introduced a policy of not looking after service users money. The inspector was concerned that this may cause difficulties for service users without relatives. Staff stated that the system was working well and that the social services department was involved as appointee for those service users without relatives. Previous inspections had raised concerns about the frequency of staff supervision at the home and recommended that those providing supervision are trained to do so. At this inspection it was noted that all but one staff member providing supervision had undergone some training to do this. However on examination of staff files it was found that there were no records of supervision on some files and only records of supervision completed under the previous manager on other files. Previous inspections had noted that there were insufficient first aiders amongst the staff of the home. At this inspection the manager stated that there were now sufficient first aiders to allow one on duty on each floor at all times, and certificates were shown to the inspector of the training completed. Generally the files for maintenance and health and safety certificates etc were disorganised with old and new documentation mixed in together. The manager should audit the files and archive old documentation so that current information is more accessible. Certificates of inspection/safety were available for the gas, electrical installation, electrical equipment and fire alarm and equipment. However the certificates for the hoists were dated May 2003 and the fire alarm record showed that fire alarms had not been tested since January 2005. The fire drill record showed that there had been two drills in the previous three months but there was no evidence of any drills before that and the times of the drills were not recorded to evidence that they are held at different times of day. As discussed under Standard 25 the provider needs to take action to reduce the current increased risk of Legionella developing. There had also been several incidents and accidents that had not been reported to CSCI or there had been a delay in notification to CSCI or to service users relatives. Peartree Care Centre G52-G02 S7038 Pear Tree V237951 13-14 07 05 Stage 4 Final.doc Version 1.40 Page 26 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 1 1 2 1 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 x 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 x 14 1 15 1 COMPLAINTS AND PROTECTION 3 2 1 2 1 2 1 2 STAFFING Standard No Score 27 1 28 x 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 1 x x 2 x 3 1 x 1 Peartree Care Centre G52-G02 S7038 Pear Tree V237951 13-14 07 05 Stage 4 Final.doc Version 1.40 Page 27 Yes Are there any outstanding requirements from the last inspection? 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 1 Regulation 4 and 5 Requirement The registered person must ensure that the statement of purpose and service user guide contain correct information and include all details as required by regulation.(Timescales of 31/12/03, 31/10/04, 31/03/05 not met) The registered provider must ensure that all service users are provided with a statement of terms and conditions on admission to the home (or contract if purchasing their care privately) that includes all information listed under Standard 2.2 (Timescales of 31/10/04 and 31/03/05 not met) The manager must ensure that information about service users past lives is sought and attempts to gather this information are recorded in the service users file. The registered provider/manager must ensure that the home has the required facilities and staff competencies to meet the needs of all service users.(Timescales of 01/04/04, 01/08/04 and 31/03/05 not met) The manager must ensure that Timescale for action 30/09/05 2. 2 5 (b) (c) 30/09/05 3. 3 14 (1) (c) 31/09/05 4. 4 12 (1) (d) 31/10/05 5. 4 12 (1) (b) 31/10/05 Page 28 Peartree Care Centre G52-G02 S7038 Pear Tree V237951 13-14 07 05 Stage 4 Final.doc Version 1.40 6. 7 15 (1) 7. 7 15 (2) (b) 8. 8 16 (2) (n) 9. 8 17 (1) (a) 10. 11 12 (3) 11. 12 16 (2) (m) and (n) the needs of service users are fully assessed prior to admission and proper provision is made to meet their requirements.(Timescales of 01/04/04, 01/08/04 and 31/03/05 not met) The registered provider must ensure that care plans are drawn up in conjunction with service users or their representatives and that they cover all aspects of the service users individual health, personal and social care needs.(Timescales of 31/10/04 and 31/03/05 not met) The registered provider must make certain that care plan reviews reflect the changing needs of service users to ensure those changing needs are met.(Timescales of 31/10/04 and 31/03/05 not met) The registered provider must ensure that all service users are encouraged to take part in organised exercise where they are able.(Timescales of 31/10/04 and 31/03/05 not met) The manager must ensure that advice from the general practitioner is followed and where there are concerns about service users weight, or intake of food or fluid, this is closely monitored and formally recorded. The registered provider must ensure that service users or their relatives are asked about their wishes concerning terminal care and arrangements after death; if they prefer not to discuss it, this must be recorded.(Timescales of 31/10/04 and 31/03/05 not met) The registered provider must ensure that organised activities offered in the home are 31/10/05 31/10/05 30/09/05 31/08/05 31/10/05 30/09/05 Peartree Care Centre G52-G02 S7038 Pear Tree V237951 13-14 07 05 Stage 4 Final.doc Version 1.40 Page 29 12. 14 12 (2) 13. 14 12 (1) and (2) and 12 (5) (h) 14. 14 12 (4) (a) 15. 15 16 (2) (i) 16. 17. 15 16 16 (2) (i) 17 (2) 18. 16 22 (3) and (4) increased to ensure that the individual needs of service users for stimulation and fulfilment are addressed.(Timescales of 31/10/04 and 31/03/05 not met) The manager must ensure that service users and their families are provided with as much information as possible about life in the home so that they can make decisions about the care that they receive. This includes choices available at mealtimes.(Timescales of 01/03/04, 31/10/04 and 31/03/05 not met) The registered provider must ensure that service users capacity to autonomy and independence is maximised and that they are encouraged to use the kitchenette areas on each floor unless a risk assessment indicates otherwise.(Timescales of 31/10/04 and 31/03/05 not met). The registered provider must ensure that all service users are provided with a key to their room unless a reason for not doing so is recorded in their personal file. The registered manager must ensure that a food survey is conducted within the home and the results of this quickly actioned.(Timescale of 31/01/05 not met) The manager must ensure that water and a choice of drink are available at meal times. The registered provider must ensure that all complaints received about the service, from any source, are recorded in the homes complaints record. The registered provider must ensure that all complaints are 30/09/05 30/09/05 30/09/05 31/08/05 31/08/05 31/08/05 31/08/05 Page 30 Peartree Care Centre G52-G02 S7038 Pear Tree V237951 13-14 07 05 Stage 4 Final.doc Version 1.40 fully and promptly investigated. 19. 18 13 (6) The registered provider must ensure that all staff have appropriate training in adult protection.(Timescale of 31/05/05 not met) The manager must ensure that a record is kept of cases referred for investigation under adult protection procedures. The registered provider must develop the outside space in accordance with good practice in dementia care. The registered provider must ensure that an up to date assisted bath is fitted on the ground floor.(Timescale of 31/01/05 not met) The registered person must review the need for hearing loops in some rooms, and ensure that the signs on doors are designed to maximise the independence of service users with dementia.(Timescales of 1/06/04, 30/11/04 and 31/03/05 not met) 30/11/05 20. 18 24 (1) 31/08/05 21. 20 23 (2) (o) 31/12/05 22. 21 23 (2) (j) and (n) 30/11/05 23. 22 23 (2) (a) (n) 30/09/05 24. 25. 23 23 (2) (e) 26. 23 16 (2) (c) 31/08/05 The manager must ensure that where rooms are shared, they are occupied by no more than two service users who have made a positive choice to share with each other. Also when a shared place becomes available, the remaining service user must be offered the choice of not sharing by moving, if necessary, to the first spare room in the home available to them.(Timescales of 01/04/04, 30/09/04 and 31/03/05 not met) The registered provider must 31/08/05 ensure that if rooms are shared, screening is provided to ensure privacy. Version 1.40 Page 31 Peartree Care Centre G52-G02 S7038 Pear Tree V237951 13-14 07 05 Stage 4 Final.doc 27. 24 16 (2) (c) 28. 24 16 (2) 29. 24 12 (4) 30. 25 23 (2) (p) (j) 31. 25 23 (2) 32. 25 16 (2) 33. 25 13 (4) 34. 35. 26 27 13 (4) 18 (1) The registered person must ensure that carpet in residents’ rooms is the norm, unless there is a documented reason to say why there should be lino.(Timescales of 31/01/04, 31/10/04 and 31/03/05 not met) (c) The registered provider must ensure that all service users bedrooms include all of the required furnishings including comfortable seating for two people. (a) The manager must ensure that supplies of a personal nature are kept out of view to respect the privacy and dignity of service users. (c) The manager must ensure that hot water to which service users have access is maintained at a temperature close to 43ºC and that service users are able to control the heating level in their bedrooms.(Timescales of 01/06/04 and 31/01/05 not met) (p) The manager must ensure that in hot weather, practices in the home comply with current DoH guidance. (c ) The registered provider must ensure that blinds are provided for the conservatory style roof in the top lounge. (a) The registered provider must take action to ensure that the current increased risk of Legionella is reduced and follow the HSE Approved Code of Practice and Guidance for the control of Legionella bacteria in water systems. (a) The manager must ensure that sluice doors are kept locked when not in use. (a) The registered provider must ensure that staffing levels at the home are sufficient to meet 31/10/05 31/10/05 30/09/05 31/12/05 31/08/05 31/10/05 31/08/05 31/08/05 31/08/05 Peartree Care Centre G52-G02 S7038 Pear Tree V237951 13-14 07 05 Stage 4 Final.doc Version 1.40 Page 32 36. 27 18 (1) (a) 37. 29 19 (1) (b) 38. 29 19 (1) (b) 39. 29 19 (1) (b) 40. 30 18 (1) (a) (c) (i) (ii) service users stimulation, supervision and personal care needs. Contingency plans must be in place to ensure that staff absences can be covered.(Timescales of 31/10/04 and 31/03/05 not met) The registered provider must increase staffing levels, particularly on the second floor, to reflect the needs of service users. There must never be one carer, alone, on duty at any time.(Timescale of 30/06/05 not met) The registered provider must ensure that no new staff commence employment in the home before the receipt of a satisfactory CRB disclosure at the appropriate level and CRB checks that are still outstanding for existing staff are actively pursued.(Timescales of 31/10/04 and 08/12/04 not met) The registered provider must ensure that new staff do not commence employment in the home before a negative result has been received from a check against the POVA list.(Timescale of 08/12/04 not met) The registered provider must ensure that appropriate application is now made for the staff member without a recent CRB and POVA check and any other staff who have commenced employment since July 2004 without a POVA check being made. The registered provider/manager must ensure all staff receive appropriate assessment of their training and professional development needs to help ensure they are able to fully meet the changing physical and 31/08/05 31/07/05 31/07/05 Immediate 15/07/05 30/11/05 Peartree Care Centre G52-G02 S7038 Pear Tree V237951 13-14 07 05 Stage 4 Final.doc Version 1.40 Page 33 41. 30 42. 30 43. 33 44. 36 45. 38 46. 38 47. 38 48. 9 mental health care needs of service users.(Timescales of 01/08/04 and 31/03/05 not met) 18 (1) (a) The registered person must ensure that staff receive induction and foundation training in line with standards.(Timescales of 31/01/04, 31/10/04 and 31/03/05 not met) 18 (1) (c) The manager must ensure that (i) there is a training and development plan for the home to ensure that staff fulfil the aims of the home.(Timescales of 01/04/04, 31/10/04 and 31/03/05 not met) 24 The registered provider must ensure that feedback is actively sought from service users, their representatives, and visiting professionals via satisfaction questionnaires, and the results of these surveys are published and made available to all stakeholders. 18 (2) The registered provider must ensure that all nursing and care staff receive supervision at least six times per year.(Timescales of 31/10/04 and 31/03/05 not met) 23 (2) (c) The registered provider must ensure that certificates for safety are up to date and available for hoists and all equipment in the home. 23 (4) (c) The registered provider must (v) and 23 ensure that fire alarm tests are (4) (e) carried out weekly and that the times of fire drills are also recorded. 37 The manager must ensure that notifications of all incidents and accidents are made to relatives and CSCI without delay. 17 (1) The registered manager must ensure that there is a record of all prescribed medication, G52-G02 S7038 Pear Tree V237951 13-14 07 05 Stage 4 Final.doc 30/09/05 30/09/05 31/12/05 31/10/05 31/08/05 31/08/05 31/08/05 31/08/05 Peartree Care Centre Version 1.40 Page 34 49. 9 18 (1) (c) (i) 50. 9 13 (2) 51. 9 13 (2) 52. 9 17 (1) 53. 9 17 (1) 54. 9 13 (2) 55. 9 17 (1) including:-The application of all external preparations-The administration of food supplements-Medication given by the District Nurse The registered manager must ensure that all staff who handle or administer medication, have received appropriate training, and have been assessed by the manager as competent in this area. The registered manager must ensure that medication audits are carried out regularly, at least monthly, to identify why stock discrepancies are occurring, and to carry out any necessary training/re-training. The registered manager must ensure that staff are flexible in administering medication so that doses are offered again if staff are unable to administer during a drug round. The registered manager must ensure that reasons for missed doses of medication are documented on the back of the MAR chart. The registered manager must ensure that staff record the administration of medication immediately. The registered manager must ensure that the temperature of all medication fridges is monitored daily, preferably using a maximum-minimum thermometer and appropriate action is taken if the temperature goes outside of limits. The registered manager must ensure that all any queries with medication are dealt with in a timely manner to avoid withholding treatment 31/08/05 31/08/05 31/08/05 31/08/05 31/08/05 31/08/05 31/08/05 Peartree Care Centre G52-G02 S7038 Pear Tree V237951 13-14 07 05 Stage 4 Final.doc Version 1.40 Page 35 56. 9 13 (2) 57. 9 17 (1) 58. 9 13 (2) 59. 9 13 (2) 60. 9 13 (2) 61. 9 13 (2) unnecessarily (specific issue methotraxate). The registered manager must ensure that all returns are recorded on a monthly basis and quantities of all items brought forward to the next month are added to the MAR chart in order to be able to carry out a justified stock check (quantity in stock minus quantity used tallies with the quantity returned). The registered manager must ensure that MAR charts indicate which items are being kept by residents for self-administration after an appropriate compliance risk assessment. The registered manager must ensure that the most up to date version of the Excelcare medication policy in kept in the MAR chart folders as the current copy is dated 1998. Staff must be trained in any updated versions. The registered manager must ensure that dates of opening are added to all items with a finite shelf-life after opening e.g. eye drops. The registered manager must ensure that a triangle is provided for each unit to carry out medication stock checks in a hygienic manner The registered manager must:clarify the position with regard to the use of Homely Remediesensure the list is reviewed at least annually by the homes GP or when a new resident is admitted-ensure that all instances of use are recorded to prevent stock misuse-ensure expiry dates are checked regularly 31/08/05 31/08/05 31/08/05 31/08/05 31/08/05 31/08/05 Peartree Care Centre G52-G02 S7038 Pear Tree V237951 13-14 07 05 Stage 4 Final.doc Version 1.40 Page 36 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 16 38 Good Practice Recommendations It is recommended that the organisation considers the possibility of appointing a locally based Responsible Individual. It is recommended that the files of maintenance inspection and health and safety certificates etc are audited to archive old documentation and ensure current information is more accessible. It is recommended that further assessment of the premises be completed by a suitably qualified person, such as an OT, that focusses specifically on the needs of those with dementia to ensure that the environment meets their needs and maximises their independence. 3. 22 Peartree Care Centre G52-G02 S7038 Pear Tree V237951 13-14 07 05 Stage 4 Final.doc Version 1.40 Page 37 Commission for Social Care Inspection 46 Loman Street Southwark London SE1 0EH 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. 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