Inspection on 18/05/08 for Penkett Lodge

This inspection was carried out on 18th May 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

Penkett Lodge 04/05/07

Penkett Lodge 25/05/06

Penkett Lodge 30/11/05

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Cherryhaven Care Home 39 Penkett Road Wallasey Wirral CH45 7QF Lead Inspector Julie Garrity Unannounced Inspection 18th June 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cherryhaven Care Home DS0000064844.V366778.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. Cherryhaven Care Home DS0000064844.V366778.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cherryhaven Care Home Address 39 Penkett Road Wallasey Wirral CH45 7QF 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) 0151 691 2073 F/P 0151 691 2073 No email Mr Russell Stanley Oakden Karen Ann Groves Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27) of places Cherryhaven Care Home DS0000064844.V366778.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Date of last inspection 4th May 2007 Brief Description of the Service: Cherry Haven is registered to provide care for 27 older persons, who need personal care only. The Home is a converted detached, three storey Victorian building close to other similar properties in a quiet suburban area of Wallasey. There are 15 single bedrooms and 6 shared bedrooms. However there are plans to change this to fewer double rooms and more single rooms. There home is no smoking for people who live in the home. A variety of communal space is provided there are two lounges and a dining room. The building also has a basement, this has one of the double bedrooms and the laundry There are plans to develop this space to make new bedrooms. There is a passenger lift that accesses all the floors of the building and handrails throughout. There are no other moving and handling arrangements such as a portable hoist. External space includes a garden that residents can sit in and car parking facilities at the front The home is within a mile of a town centre, local shops, a post office and other community facilities such as the riverfront are only a short walk away. Bus routes run nearby. Cherryhaven Care Home DS0000064844.V366778.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 one star. This means the people who use this service experience adequate quality outcomes. The inspection was carried out over a period of one day. The inspector arrived at the home at 10:15 and left at 18:10. The inspector spoke with 6 people who live in the home, 1 relatives, 5 staff and the manager. The inspector completed the inspection by a site visit to Cherryhaven, a review of records available in the service, these included care plans, medications, staff training, staff recruitment, policies and procedures, daily records and maintenance records. Records held in CSCI offices were also looked at. The main emphasis was discussions with the people who live in the home, staff and management. Questionnaires were sent to the home for people who live in the home and eight were returned prior to completion of this report. We also received information from staff and social services this is included in the report. The inspector followed an inspection plan written before the start of the inspection to ensure that all areas identified in need of review were covered. All of the Key standards were covered in this inspection, these are detailed in the report. Feedback was given to the manager during and at the end of the inspection. The arrangements for equality and diversity were reviewed throughout the visit and are detailed in this report. Particular emphasis was placed on the methods that the home used to determine individual needs and the practices that they put into place to meeting those needs. What the service does well: There is a staff team that feel that they work well together to make sure that they can support the people who live in the home. All of the staff work very hard and this is noticed by the people who live in the home who said, “the staff are excellent”, “great girls that work very hard to make life good for me” and “I generally like the staff, they are always running around, cleaning, cooking, tidying, doing the laundry and looking after us”. All of the people who live in the home spoken with or received questionnaires from the Commission were very positive about the care that they received. Cherryhaven Care Home DS0000064844.V366778.R01.S.doc Version 5.2 Page 6 Individual personal funds are well managed with good records that make sure the individuals financial interests are safeguarded. A float is available that makes sure that people who live in the home always have access to some of their money. What has improved since the last inspection? What they could do better: Information available in the home although updated does not clearly detail the needs of people that the home can meet or what criteria is in place that would help make sure that staff are aware of how to make sure that only individuals whose needs the home can meet are admitted. This information is not readily available to the people who live in the home. Care plans do not reflect the needs of the individuals living in the home ands as such do not provide staff with clear guidance. There is a format in place that does not cover individual social needs or personal preferences. This has lead to menus and activities in place that are not based on individual’s needs or personal preferences. Medications management needs further improvement, documentation needs to be clearer in order for the manager to be able to carry out audits that will help make sure that if medications are given correctly. There are no arrangements in place that will make sure that if an individual has a head ache as an example this can be dealt with quickly and meet individual needs. Staff overnight have no training in medications and this needs to be in place in order to meet individual needs safely. Individuals who deal with their own medications are not always supported to do this safely and in a manner that meets their needs. Cherryhaven Care Home DS0000064844.V366778.R01.S.doc Version 5.2 Page 7 Changes in medical needs are nor always dealt with and referred to the relevant external professionals. Staff are not familiar with how adult protection issues are dealt with once they have passed the information to the manager . This runs the risk of concern of a serious nature not being dealt with appropriately. There are a number of areas in the home that are in need or redecoration and refurbishment. It is not possible to determine what plans the home has in place to make sure that these areas are addressed in line with individual preferences. Although arrangements for training has increased an number of areas of training have not been addressed. There is no quality arrangements in the service that would identify the areas of development and make sure that plans are in place to increase the quality of the service provided. 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. Cherryhaven Care Home DS0000064844.V366778.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 Cherryhaven Care Home DS0000064844.V366778.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): Standards reviewed in this area are 1, 2, 3, 4, and 5. Standard 6 is not applicable Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. All the people who live in the home have an assessment done before they move in. This supports the staff to determine what the needs of individuals are. Not all individuals get the information they need to decide if the home is for them, this prevents them from always being able to make an informed choice. EVIDENCE: The manager stated that she makes sure that the home gets information from all who are involved in the support or care of the individual including social services. The homes policy is available for assessments but is out of date and does not reflect the current practice. We looked at three assessments for people who live in the home done before the person moved in. These have improved and now have a section for mental health and social needs. Of the Cherryhaven Care Home DS0000064844.V366778.R01.S.doc Version 5.2 Page 10 three viewed these were not always completed or contained very brief details. All the assessments were signed by the manager who said that currently she does all assessments, as until they recently recruited a new deputy there was no other member of staff who was trained to assess individuals. The home does have information about how they will deliver the services they provide. Copies of this were available for review when entering the home. We discussed this information with three people who live in the home, none had copies available for themselves and all said that they had not seen this information before. Although this information was updated in January 2008 it did not contain the correct fees being charged by the home. Further review showed that the information did not contain clear information as to the needs of individuals that the home can meet or the criteria of admittance. Without clear information both staff and individuals wishing to move in will not have clear information as to the needs that the service can meet. Discussions with the manager showed that presently the information is available in the home in one format, however “on request” different size print can be ordered. Although the home does have individuals with visual impairment or need assistance with reading no different formats have been made available. This does not support individual’s equality and diversity needs and make sure that information they need is accessible to them. The home has contracts for each individual who lives in the home. The contracts did not detail where individual fees came from such as pensions agency or local authority and as such did not detail their personal allowances. Additionally the contracts were out of date as they detailed last year’s fees and not those currently being charged. Questionnaires returned detailed that five individuals said that they did not have a contract. Cherryhaven Care Home DS0000064844.V366778.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): Standards reviewed in this area are 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans are reviewed monthly changes in need have not been reflected in the care plans. This has meant that the instructions to staff are not accurate and as such they run the risk of not giving appropriate support to the people living in the home. Medications management is sufficient to make sure that in general medications are given as prescribed. There are insufficient arrangements in place to make sure that the people living in the home can access medications as needed or be supported appropriately to manage their medications themselves. EVIDENCE: All of the people who live in the home are registered with local doctors of their choice. District nurses are contacted as appropriate for nursing care. Records regarding external professionals are much clearer they are designed to detail which professional visited and what the care to be put into place is. Cherryhaven Care Home DS0000064844.V366778.R01.S.doc Version 5.2 Page 12 In one instance an individual had gained a significant amount of weight in two months, no contact had been made to their GP regarding this weight gain. The manager explained that the individual needed a special diet and that they often did not eat what they were supposed to. The care plan for this individual showed that staff were aware of the need for the person to have a special diet, but not that there was any issues with them not sticking to it or actions regarding their weight gain. The care plan was out of date and directed staff to undertake blood monitoring, which was not occurring. No details were available as to who was monitoring the individual’s condition such as district nurses, dietician, GP or the specialist nurse. The manager explained the individual often refused to attend health check ups. This was not available in the care plan or evidence that the individual had had appointments that they did not wish to attend. The service has not made sure that the relevant health care professionals have been contacted or involved in the monitoring of the individuals health. Additional the care plan did not reflect the individual’s needs and was inaccurate for a number of actions that needed to be taken to appropriately support the individual. We looked at another two care plans. All had been reviewed monthly in all cases information regarding changes of need had not been used to update the care plans. One care plan contained information stating that a person had a skin condition. The daily records for this person showed that this skin condition had re-occurred and “blisters” were seen. Records stated that care staff applied cream. The care plan did not mention the use of the cream and the medication administration records were unclear as to which cream was to be applied, where and how often. Additionally there were no records on the medications records for this person or any others that detailed when creams had been used. The manager explained that often the individuals skin condition settled and did not need treatment. This was not reflected in the care plan and the staff were making decisions as to when to apply the cream and when not to without clear instructions. Additionally medical records did not show what consultation had taken place with the GP or any specialists involved in reviewing the skin condition. Staff spoken with do read the care plans saying “there is a handover everyday and we get told the needs of the residents” and “we only have fifteen residents at the moments so we know them very well. I do read the care plans when I have a chance. Most of what I know about the residents is what other staff tell me and what they tell me themselves”. Medication management continues to improved. The manager used to audit medications on a regular basis but this has ceased and there are no longer written audits that looks at the practice of the staff. Staff giving out medications during the day have undergone training to do. Night staff have not received training in medications. Night staff do give out painkillers, the manager explained that she has given them instructions on how to do this. The Cherryhaven Care Home DS0000064844.V366778.R01.S.doc Version 5.2 Page 13 manager does not have training experience or qualifications in training staff to give out medications. This is practice places individuals at risk as only staff trained in giving out medications should do so. It also limits the choices of the people who live in the home and means the majority of their medications must be given out during the day and does not take account of their choices. There are no arrangements in place for “homely” remedies such as painkillers for a headache and as such unless the person has been seen by a doctor staff will not give a painkiller. This practice does not meet individual needs and means that they would have no access to painkillers for single events such as a headache. One individual had received an incorrect dose of a medication for three days, the manager explained that the instructions that they received had been unclear. The staff realised that the dose was incorrect and contacted the GP for clarification. They still had not obtained written instructions from the GP that detailed fully how the medications were to be given. One individual deals with some of their medications themselves, there was no risk assessment available that detailed to staff how they were to support the person safely. Discussions with the person showed that staff did not monitor the medications and they had been without painkillers for three days. A member of staff said that it had been reported to them the day before but no arrangements had been made to obtain further painkillers, or to check that the person was taking them correctly. Observations of the staff during the day detailed that they did treat individuals with dignity. The majority of staff demonstrated a genuinely kind and caring attitude towards the people who live in the home. Cherryhaven Care Home DS0000064844.V366778.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): Standards reviewed in this area are 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A choice of activities and menus are supplied on a daily basis. The needs, personal choices and preferences of individuals living in the home are not used to determine the activities or the menus in place. Without determining individual choice the services provided may not meet the expectations of the people of in the home. EVIDENCE: An activities co-ordinator works in the home 6 afternoons a week and delivers a variety of activities. Records from the co-ordinator showed a list of activities delivered to each individual. There was no programme available on display in the home that would inform people of what is available. We looked at individual care records in all the manager had included a daily routine that described how individuals liked their routine. The activities co-ordinator explained that she was initially booked to attend a course that would help her plan activities to meet the needs of those individuals less able to communicate. This was cancelled and as yet she has no date as to when she can attend. The Cherryhaven Care Home DS0000064844.V366778.R01.S.doc Version 5.2 Page 15 activities programme in operation sis not taken from individuals expressed needs and is not available for them to review. Individuals spoken to thought the activities co-ordinator was “very friendly” and “very nice”. Surveys from the home showed that the majority of the people who live in the home liked the activities in place. Two individuals said that the activities did not meet their needs. One said “ I don’t like joining in with a group. I find playing games very boring”. One individual leave the home on a regular basis to go out and about. Several of the individuals spoken with said “I’d like to get out more, we never go anywhere”, “ a trip out to the shops would be nice” and “I like some of the stuff we do but it’s always the same thing”. The main meal is served at lunchtime and the teatime meal has the option of a cooked snack as well as sandwiches and provides different choices for individuals. The manager has redone the menu and each meal offers a variety of choices. The chef explained that the menu is not passed on individuals expressed preferences and choices and there are no records available to determine this. The menus available do not detail specialised diets such as diabetic or weight lose programme. The chef say that he has no training in this area but would like to develop these skills. Individuals are asked what he or she would like for their meal and this was arranged at the mealtime. Discussions with staff detailed that they thought they “know what the residents like and don’t like”. But this was not supported as the residents choose not to eat some of the foods supplied. The opportunity to determine exactly what resident’s preferences are has not been taken, there are no written records to enable staff to determine choices, and verbal communication is not providing the information needed. Cherryhaven Care Home DS0000064844.V366778.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): Standards reviewed in this area are 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home feel confident that their concerns will be listened to and acted on. Staff have been trained in recognising and reporting serious concerns, this helps protect the individuals who live in the home. EVIDENCE: Information on how to make a complaint in the home is available. This is displayed in the entrance of the home. Questionnaires sent to the home show that all individuals living in the home felt that their concerns would be looked at and addressed. Those spoken with said that the staff were “very kind, always willing to help and would do whatever they could to make sure that everything in the home was okay”. No complaints have been made to the home, although three concerns have been raised with commission since the last inspection. These were discussed with the manager at the site visit who agreed that she would review the concerns raised by a relative for an individual no longer living in the home. The other issues were used to inform the inspection plan and are further discussed within the report. All staff receive an induction that covers serious concerns (Protection of Vulnerable Adults) and training in how to recognise and deal with issues. A training matrix is available that shows this training, it was not possible to Cherryhaven Care Home DS0000064844.V366778.R01.S.doc Version 5.2 Page 17 determine from staff files who had received the training. Staff spoken with confirmed that they were aware of the policy in the home and of how to raise their concerns. Cherryhaven Care Home DS0000064844.V366778.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): Standards reviewed in this area are 19, 20, 21, 22, 23, 24, 25 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The maintenance of the home has not been maintained with a number of areas in need or redecoration and refurbishment. There is a lack of suitable arrangements in preventing the spread of infection this may place individuals at risk. EVIDENCE: The home is no longer admits people who smoke. This action has not been include included in the information about the home. There is a dining room that has been re-arranged to provide people who live in the home easier access to dining facilities. Two different lounge areas are available for individuals to choose where to sit, additionally personal bedrooms are available if people wish to see family in private. Some people living in the home do not use the lounge or dining room, preferring to spend their time in their Cherryhaven Care Home DS0000064844.V366778.R01.S.doc Version 5.2 Page 19 bedrooms. The staff support people who prefer to be in their bedrooms, by making sure they get their meals and drinks during the day. There are fifteen single bedrooms six double rooms. Of those double rooms viewed one had the facility to screen one bed from another. Records showed that one individual in a shared room was disruptive over night and had frequently woken other people living in the home in particular the person who shared their bedroom. The service currently has fifteen people living in the home and there are another twelve places available. As such it was possible to put into place arrangements for the individuals disturbed overnight to get a better nights sleep. The manager agreed to arrange this following this site visit. We looked at the general environment of the home. Individuals spoken with thought the home was “comfortable”, “my bedroom has everything in it just as I like” and “I like the home, but there are bits that could be better decorated”. The service is refurbished and decorating the basement floor to include further bedrooms with ensuite facilities and a medicines storage area. A fire inspection two months previously had not been addressed, following the site visit the owner of the home confirmed that the identified actions were now in place and would continue to be monitored. The service has invested in a new fire alarm, emergency call system and lift. The work has not been completed and areas such as decorating around the lift have not been finished leaving exposed plaster to view. The manager was unaware of when the work would be completed. No maintenance plan was in place that would inform people living in the home and staff as to when outstanding work would occur or when the necessary on- going The general environment is in need of redecorating in many areas including bathrooms, some bedrooms, some carpets, the lift area and radiator guard need replacing. None of the bathrooms viewed had hand drying facilities available such as disposable paper towels in shared bathrooms or bath towels in individual bedrooms. Liquid soap was not available in any area of the home. Of the bathrooms viewed one had a bin available for the disposal of soiled items. The lack of suitable equipment to reduce the spread of infection may place the people who live in the home at risk. The service does not have a portable hoist available for people who are not able to stand. As such they cannot meet the needs of individuals who cannot stand. This information is not included in the admittance criteria of the home. Individuals are encouraged to make their bedroom spaces their own and those bedrooms we viewed included personal items such as pictures, storage furniture and other furniture brought from peoples own homes. Cherryhaven Care Home DS0000064844.V366778.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): Standards reviewed in this area are 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Training has increased in the service and staff have attended a number of course in recent months. There is a lack of suitably qualified staff for giving out medications and cooking the evening meal. Some staff have not been safely recruited or hand their initial introduction to the home managed in a manner that makes sure they can understand the individual needs of the people living in the home. EVIDENCE: Prior to the site visit we received information that a member of staff had not been recruited appropriately. The manager was not able to locate the individual’s recruitment file. In discussion with the manager it was identified that the individual had worked in the home for six weeks in total. For the first five weeks a police check was not available for them. The staff member was working on nights with one other member of staff and there was no records available that this person had worked supervised at all times. Additionally the staff member declared that they had recently been prosecuted for an offence. The manager confirmed that this was correct and that one of the owners had discussed this with the staff member. She was able to confirm that there was no record of this discussion or a risk assessment in place. The home can recruit Cherryhaven Care Home DS0000064844.V366778.R01.S.doc Version 5.2 Page 21 staff without a police check in exceptional circumstances as long as the people in the home are protected. There is no evidence that the recruitment of the staff member was managed in a manner that safeguarded the people living in the home. Other files viewed showed that the majority of staff were recruited appropriately, although a senior member of staff was in post for four days before the police check was obtained and has been in post for two months without a full induction. One member of staff had done a training qualification that included induction standards. The manager explained that as they had done this elsewhere they did not need to do them in the home. However this action did not make sure that both these members of staff had been given the opportunity to identify the needs of the people living in the home, the policies and process of the home or the health and safety needs that are individual to Cherryhaven. The home has a training plan that showed planned training for staff. The amount of training in place has improved since the last site visit. On the day of the visit several staff were in attendance to speak to the assessor for a qualification they were undertaken, others were attending training in another home. It was difficult to identify from the training plan and the staff records what training staff had received. A number of gaps in staff training were identified. Two members of staff had requested specific training in one case this was arranged but cancelled no new date was available. The chef leaves each day at 2pm and care staff need to prepare and cook the evening meal. Training records and discussion with the staff showed that none of the staff had food hygiene training that would support them to do this. Further review showed that none of the staff on duty overnight had not received training in medications but were giving out painkillers overnight. The manager stated that she had observed staff giving out medications but had not recorded this in order to discuss with the staff members their competency in this area or identify any training needs. Due to the fact that there are less people living in the home at the moment the owner has reduced the number of care staff. Staff spoken with and people living in the home all said that in their opinion there was enough staff. Comments from the staff included “we are a good team and we work well together”. People who live in the home said, “staff are lovely”, “they are always available such nice girls” and “the staff here are excellent I just can’t fault them”. Cherryhaven Care Home DS0000064844.V366778.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards reviewed 31,32, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of individual personal allowances means that individual’s financial interests are safeguarded and met their individual needs. There is no quality system in place that makes sure that the manager can identify areas of development and plan how to increase the quality of the service provided. EVIDENCE: The home was without a deputy manager for several months, during that time the manager assessed all individuals, wrote and renewed all care plans, supervised staff, maintained all the administrative work and on several occasions worked as a carer. This meant that on several occasions she was Cherryhaven Care Home DS0000064844.V366778.R01.S.doc Version 5.2 Page 23 working above and beyond her allocated hours and was not always able to commit fully to her role as a manager. This has reflected in some areas of quality in the home, such as organising staff files, keeping care plans up to date and carry out audits on the quality of care provided. Areas have increased in quality such as a greater choice over meals and redevelopment of the assessments. As her role has been very demanding the manager has not had the opportunity to increase her own skills such as fully understanding the care plan formats that meet the needs of the home and undertaking training. With the recruitment of a new deputy that is still relatively new to the home the manager is intending to review the quality of the service provided and to make sure that an action plan is in place to develop the quality. At present there has been no on-going quality audits, such as medicines, staff training, staff files, care planning and environment. This has lead to some areas of poor quality not being addressed. Staff spoken with said that morale in the home was very good and that the manager organised the home in a good way. They all said that they found her supportive and keen to improve the quality of the home. Since the last site visit the manager has attended an interview with us and is now registered. The majority of staff have undertaken training in health and safety and arrangements are in place to make sure that the rest of the staff also have the appropriate training. There are several areas of health and safety that need to be developed such as appropriate risk assessments for all individuals who need one including those managing their own medications. A fire officer visited in April and gave some advice. This included fire doors wedged open and fire sensors left covered up. It was noted at the site visit that these areas had not been addressed. Since the site visit the owner has sent information detailing that these areas have now been addressed and appropriate equipment has been ordered. The home managers personal allowances for individuals as requested. Receipts are kept for all spending and good records are available that detail how the money has been spent. Some individuals take all their own funds and manage this themselves, others instruct the manager as to how they want their money managed and which bank account they prefer their money to be in. This is arrangement meets individual need and is good practice. Cherryhaven Care Home DS0000064844.V366778.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 2 2 3 3 2 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 x 3 X X 2 Cherryhaven Care Home DS0000064844.V366778.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 (1) (2) (a) (b) (c) (d) Requirement Care plans need to clearly reflect the assessed needs of individuals and be up to date and accurately describe the support that staff need to give. This will assist in making sure that staff have clear instructions on how to appropriately support people living in the home. All individuals who are self medicating need to have a risk assessment in place that includes how the service will monitor the medications and make sure that they always have the correct medicines available. All medication errors need to be reported to us and investigated by the home to make sure that they do not re-occur. Timescale for action 18/09/08 2. OP9 13(2) 18/07/08 3. OP27 18 (1) (a) (c) (i) 18/07/08 Staff training is not sufficient to meet the needs of the individuals in the home. Staff who give out medications all need training and a determination that they are competent to do so. Staff who cook and serve meals need training and qualifications DS0000064844.V366778.R01.S.doc Version 5.2 Page 26 Cherryhaven Care Home 4. OP8 5. OP19 6. OP29 7. OP33 relevant to that role. Medical input needs to be obtained where changes in an individual’s health and welfare have been identified. 23 (1) (a) A maintenance plan needs to be (2) (b) (d) developed and shared with the individuals living in the home to make sure that the quality of the decoration and furniture is reviewed and addressed. 19 (1) (a) All staff need a police check (b) (i) (ii) (CRB) in place before they start (iii) (c) work. In exceptional (5) (d) (i) circumstances staff can be (ii) (iii) recruited as long as they do not work unsupervised. Were staff are identified as having a declaration on the CRB a risk assessment needs to be in place to make sure people living in the home are not placed at risk. 24 (1) (a) A quality assurance system (b) (2) (3) needs to be in place that will recognise the strengths or the service and identify the weaknesses. This needs to include the expressed views of the people who live in the home and develop a plan as to how to increase the quality of the service provided. 13 (1) (b) 18/07/08 18/08/08 02/08/08 18/09/08 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 OP1 Good Practice Recommendations The service users guide and statement of purpose, need to be updated to supply sufficient information to prospective and current residents and follow schedule 1 of the Care Homes regulations 2001 and include areas such as criteria DS0000064844.V366778.R01.S.doc Version 5.2 Page 27 Cherryhaven Care Home of admissions and the needs of individuals that the home can meet. 2. OP9 Arrangements need to be in place to update the medications policy and procedure. This needs to include making sure that all medications left over from each month are recorded on the Medication administration record, external preparations such as creams have clear instructions, variable dose medications are properly recorded and the script is viewed by the home before being sent to the pharmacy. Opportunities to find out, record, monitor and act on residents personal choices, such as activities, meals, personal allowances, refurbishment of the building need to be in place. This will help develop the services provided to be lead by the people who live in the home. The facility for individuals to wash and dry their hands needs to be available in every sink and bathroom area in the home. Suitable bins for the disposal of soiled items needs to available. 2. OP12 3. OP26 Cherryhaven Care Home DS0000064844.V366778.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Merseyside Area Office 2nd Floor South Wing Burlington House Crosby Road North Waterloo, Liverpool L22 OLG 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. 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