Inspection on 25/06/07 for Perrygrove

This inspection was carried out on 25th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Perrygrove 08/05/08

Perrygrove 05/09/06

Perrygrove 02/09/05

Perrygrove 11/04/05

Perrygrove 26/04/04

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 Perrygrove Rectory Fields Crescent Charlton London SE7 7EN Lead Inspector Ms Pauline Lambe Unannounced Inspection 25th June 2007 09:30 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 Perrygrove DS0000006855.V340480.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. Perrygrove DS0000006855.V340480.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Perrygrove Address Rectory Fields Crescent Charlton London SE7 7EN 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) 020 8856 3995 020 8319 1663 www.kcht.org Kent Community Housing Trust ** Post Vacant *** Care Home 43 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (6), Old age, not falling within any other of places category (36) Perrygrove DS0000006855.V340480.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. As agreed on 19th July 2006, one named service user with Dementia, under the age of 65 years, can be accommodated. 5th September 2006 Date of last inspection Brief Description of the Service: Perrygrove is a Care Home for up to 43 older people. Accommodation and personal care is provided to 36 older people and to 7 older people with dementia in s separate unit. Kent Community Housing Trust manages the service. The property is situated in a quiet road in Charlton close to local shops and bus routes and the town centres of Lewisham, Greenwich and Woolwich are within easy access. Accommodation is provided over three floors. The home has one shared room and the rest are for single occupancy. Fifteen rooms have en-suite toilet and wash hand basin and there is adequate communal space on the ground floor. To the rear of the property is a pleasant enclosed small garden, which is accessible to residents and to the front there is some parking space. The current fees ranged from £429.22 - £498.72. Residents pay privately for items such as hairdressing, private chiropody, toiletries, newspapers and outings. Perrygrove DS0000006855.V340480.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site visit for this unannounced key inspection was completed over two days the 25th June and 3rd of July 2007. On the first date there were thirtyone residents in the home, two in hospital and seven vacancies. The assistant managers helped with the inspection. The service had a key inspection on 5th September 2006 and a random inspection on the 1st March 2007. The inspection included a review of information held on the service file, a review of the information provided by the registered person in the preinspection documentation, a tour of the premises, inspection of records, talking to residents, staff and management and reviewing compliance with previous requirements and recommendations. Only three survey forms were returned to the commission by relatives. Two were positive about the service and one raised some concerns about care issues. One relative was seen during the inspection and residents who were able to comment on the service were satisfied with the care provided but not with the lack of activities. It was disappointing to find that a number of requirements made and issues raised at the previous two inspections had not been addressed. Following the inspection contact was made with the responsible individual for the service to discuss the service. In view of this discussion the responsible individual said action would commence to address requirements and the date for the new manager to start was brought forward. The commission were also informed that a ‘sit on scale’ was ordered and an advertisement placed to employ a temporary activity organiser. What the service does well: What has improved since the last inspection? The administration of topical medicines was recorded. The armchairs in the small lounge on the ground floor had been cleaned. Some areas of the home had been redecorated this included a number of bedrooms, the small lounge on the ground floor and the dining room. Perrygrove DS0000006855.V340480.R01.S.doc Version 5.2 Page 6 What they could do better: 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. Perrygrove DS0000006855.V340480.R01.S.doc Version 5.2 Page 7 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 Perrygrove DS0000006855.V340480.R01.S.doc Version 5.2 Page 8 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 3 and 4. Standard 6 did not apply to the service. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Not all residents had an assessment of need completed on behalf of the provider prior to admission. There was no evidence to show that residents received written confirmation that the home could meet their needs. EVIDENCE: An admission policy and procedure was provided. An assessment officer was employed by the organisation and they completed all pre-admission assessments. In two care plans viewed there was no evidence that a preadmission assessment was completed on behalf of the provider however both files included social services care manager assessments. Recommendation 1. There was no evidence on the files seen to show that residents received written confirmation that the home could meet their needs based on assessment. This issue was raised at previous inspections. Requirement 1. Perrygrove DS0000006855.V340480.R01.S.doc Version 5.2 Page 9 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 7 – 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans required improvement to ensure they were kept up to date. Medicines were generally well managed but some concerns were noted regarding homely remedy medicines. Resident’s healthcare needs were generally met and residents were satisfied with the way staff respected their dignity. EVIDENCE: Three care plans were viewed. Neither included a per-admission assessment completed by staff however both files included a social services care manager assessment. All files had been changed to the new care plan format introduced prior to the last inspection. The care plan for one resident was not up to date and did not reflect their current needs. The following issues were noted with the care plan; it did not reflect how the resident’s current mobility problems were to be managed, the moving & handling risk assessment was out of date, records said a ‘pressure relief mattress’ was being used but this piece of equipment was not provided, the resident ‘slept all day’ and was awake all Perrygrove DS0000006855.V340480.R01.S.doc Version 5.2 Page 10 night but no action had been taken to try to resolve this for the resident’s benefit, the body map used to highlight bruises or injuries had a number of different dated entries which made it difficult to assess and identify when issues were resolved, the personal hygiene planned said to bath the resident ‘very often’ due to continence issues, however there was little evidence to show that the resident was bathed regularly or frequently but there was evidence that they wee washed regularly. The issues with this resident’s care plans were noted at the last inspection and despite the care plan being reviewed since then it had not been updated to reflect current needs. A relative had signed the care plan to show their agreement with it. This care plan was brought to the attention of the assistant officer who agreed it was not up to date and did not reflect the resident’s current needs. On the second visit to complete the inspection staff said that a pressure relief mattress had been obtained for the resident. The second care plan viewed was better and mainly reflected how the resident’s needs were to be met. The exception to this was in relation to catheter care and personal hygiene. The catheter care plan did not show how frequently this was to be changed and referred to emptying the urine bag ’frequently’. The resident said that this was not done often enough and caused some discomfort. The personal hygiene care plan referred to ‘regular baths’ however the resident said they did not have general baths for various reasons. This care plan had not been signed by the resident despite their ability to do this. The third care plan viewed showed that staff referred the resident to the GP for advice on a toe ulcer. The GP referred the resident to the foot clinic in September 2006 and recommended daily dressings. The district nurse saw the resident and applied dressings but records did not show this had been done daily. There were long periods between dressing changes. There was no record to show what action staff had taken to ensure the wound was appropriately monitored and there was no care plan prepared to show what care, if any, staff were to provide in relation to the management and monitoring of the wound. There was no evidence to show that staff followed up the referral to the foot clinic and a podiatrist did not see the resident until April 2007. A relative raised concerns about the nutritional care of a resident and a lack of monitoring of weight loss. It was recommended at a previous inspection that staff were provided with a weighing scale suitable to monitoring resident’s weight. The scales provided was a basic step on style and not suitable for many residents to use. Records generally did not provide evidence that residents had regular baths or had their weight monitored. Requirements 2 and 3. All residents were registered with a GP. A district nurse visited the home regularly to provide advice and nursing care. Residents were supported to access other healthcare such as dental and optical care. Specialist services were accessed through GP referral. Staff could refer residents to a psychiatrist Perrygrove DS0000006855.V340480.R01.S.doc Version 5.2 Page 11 and the community psychiatric nurse (CPN). Residents paid privately for chiropody care, as this was difficult to access from the NHS. Medicines were safely stored. Senior staff took responsibility for medicine management. Medicines and records checked for two residents were found to be correct. Controlled drugs were correctly managed and no inaccuracies noted in recording. Inaccuracies were noted for stocks of three homely remedies and one medicine being used as a homely remedy was not included in the list agreed with the G.P. A record was kept to show that topical medicines were being administered however some jars of ‘creams’ were seen in bedroom and were not labelled. Photographs of the residents were used, as one form of identification on medication administration records however a number of these did not have the name of the person. Requirements 4 recommendation 2. A number of residents spoken with and those who completed survey forms indicated that staff listened to them and that they were satisfied with the way staff treated them. Comments received from relatives supported these comments. Care plans seen included information on the residents ‘daily routine’ which indicated preferences were considered. However a number of residents spoken with did not seem to know or understand what care plans were and there was little or no evidence to show that residents who may have able to had signed their own care plans. Recommendation 3. Perrygrove DS0000006855.V340480.R01.S.doc Version 5.2 Page 12 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 12 – 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A number of residents were unhappy with the current lack of activities provided. Residents said they enjoyed contact with family and friends and relatives indicated they were welcome when visiting the home. Overall residents were satisfied with meals provided. EVIDENCE: Care plans seen included social histories but social care plans were scanty. A number of residents said there had been very little activities provided lately. An activity organiser was employed for four days a week but was on sick leave for some weeks. Another member of staff had not been allocated to cover this gap although management said that when time allowed care staff tried to provide some activities. Several residents enjoyed sitting in the pleasant landscaped garden to the rear of the property. Residents smoked in the hairdressing room or in the garden. The hairdressing room was not seen as either relaxing or an appropriate environment to smoke. This was the situation at the inspection undertaken in September 2006. The inspector was told that plans were in place to rectify this situation but there was no date available for the work to start. Perrygrove DS0000006855.V340480.R01.S.doc Version 5.2 Page 13 In the dementia unit residents were seen sitting in the lounge, some were asleep and some were watching television. The social care plan for one resident in this unit said they were not interested in activities but there was no evidence that the person was given any one to one time. Records showed that the resident ‘slept all day’ but also said they ‘were awake all night’. It was not evident that any action had been taken to review this situation. Another care plan viewed did not have a social care plan however this resident said they choose not to participate in activities but preferred to spend the day as they wished. On the second morning of the inspection an hour was spent observing residents and staff in the dementia unit. During this time staff did not initiate interaction with most of the residents except when offering them a cup of tea. The TV was on but nobody was particularly interested in this. Staff sat at the table writing records while five of the seven residents slept most of the time. Requirement 5 and 6. The home had an open visiting policy, which supported residents to maintain contact with family and friends. A number of residents said they enjoyed outings with and visits from their family. Completed comment cards received from relatives did not indicate there were any problems when visiting the home. Residents who spoke to the inspector said staff invited them to make choices about things such as meals, what to wear and taking part in activities. However as previously mentioned there was little evidence in care records seen to show that residents were involved in preparing their care plans. See recommendation 3. Lunch was observed in the dining room. The meal was nicely served and staff attentive to resident needs. Resident comments included ‘the food is satisfactory’, ‘the food is good’ and ‘the food is not bad and we get a choice’ Residents were seen having lunch and a number said they enjoyed the meal and there was a choice of meal provided. Some residents commented on the small portion of fish being served. Consideration should be given to offering larger or extra portions of food to suit residents. The meals for the day were not displayed and many residents did not remember what meal they had chosen. Staff offered residents a meal choice both verbally and by showing them the meals that were on the menu. In the dementia unit, which had seven residents, there was two care staff to assist with lunch. Staff were assisting residents with their meal and residents seemed to enjoy their food. Recommendation 4. Perrygrove DS0000006855.V340480.R01.S.doc Version 5.2 Page 14 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 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Adequate procedures were in place to manage complaints and adult protection. However the registered person must ensure staff receive up to date training on safeguarding adults. EVIDENCE: A complaints policy and procedure was provided. Residents spoken with knew how to make a complaint. Residents knew the home manager and deputy by name. A copy of the service user guide was seen in some of the bedrooms viewed. Surveys and comment received from relatives showed they were aware of the home’s complaints procedure. A system was in place to record complaints made about the service and to show how these were managed. Since the last inspection two complaints were recorded and records showed these had been managed appropriately. Since the last inspection a number of compliments were received about the service. An adult protection policy and procedure was provided. Staff spoken with displayed a good understanding of adult protection and how to manage an allegation or suspicion of abuse. No allegations of abuse had been reported since the last inspection. In the last year no adult protection training had been provided for staff. Training records seen showed that two members of staff received safeguarding adult training since the last key inspection. Recommendation 5. Perrygrove DS0000006855.V340480.R01.S.doc Version 5.2 Page 15 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 19, 20, 24 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although the home was safely maintained and did not pose a risk to residents, the environment required attention to decoration and improvements. Residents did not have access to a comfortable smoking or hairdressing room. The home was generally clean but waste had been allowed to accumulate to an unacceptable level and was not properly stored. EVIDENCE: The home was bright, tidy, free of offensive odours and well ventilated. The maintenance technician completed weekly safety checks on areas such as lights, call bells, wheelchairs and emergency lighting. Residents continued to use the very small hairdressing area as a smoking room. This room was not suitable as a smoking room and residents were seen sitting in chairs with hairdryers above them when having a cigarette. Neither was this room suitable for hairdressing as it was not possible to get residents in wheelchairs Perrygrove DS0000006855.V340480.R01.S.doc Version 5.2 Page 16 to the washbasin. The atmosphere in the room was not very pleasant due to the dual use of the space. A hairdresser visited the home weekly and although she managed to provide this service for the residents said the room was not suitable for residents in wheelchairs. The inspector was given two maintenance programmes for 2007/8 which had different items included. The programmes indicated that plans were in place to undertake maintenance and improvement work such as redecoration of some bedrooms and communal areas, attention to the garden fence, alterations to the dementia unit to create more communal space, the activity room to be changed into an en-suite bedroom, a new smoking room to be created on the first floor and electrical maintenance work. Staff were unclear what stage these plans were at and did not know where the new smoking room was to be located. The second programme faxed to the Commission said that the plans had not yet gone out to tender. The regional manager said that the budget had been agreed. The registered person should discuss some of these planned changes with the Commission as by changing the activity room to bedrooms will reduce the communal space provided for residents and a possible to the number of beds registered. The inspector was told that some redecoration had been undertaken since the last inspection, which included painting some bedrooms, both lounges on the ground floor and the dining room. However the ground floor corridor remained unchanged although the attention this needed was included in the last inspection report. This area of the home was well used by residents either to just relax in or to sit and listen to music. Currently the area did not provide a pleasant space to spend time. The walls and paintwork needed redecorating and the carpet must be cleaned or replaced. The provider had applied for some Department of Health Capital Grant money to improve the environment. The carpet on the staircase leading to the administrators office and staff room was dirty and should be cleaned or replaced. Requirement 7 and 8 and recommendation 6. Adequate bathing, assisted bathing and toilet facilities were provided and those seen were clean. Assisted baths were last serviced on 25/1/07. Hand washing facilities were provided where waste was handled and staff were provided with protective clothing. Supplies of cleansing hand gel were located round the home. At the start of the inspection it was noted that a large number of full clinical waste bags were stored on the ground beside the bins. The clinical and general waste bins were overflowing. Bins were stored opposite the kitchen door and the area was accessible to everyone and to animals. There was also a number of discarded furniture items such as chairs and mattresses stored close to the bins. This issue was discussed with staff who said they were currently having problems with waste collections. On the second visit to the home to complete the inspection the bins had been emptied and a skip had been hired to remove the discarded furniture items. Requirement 9. Perrygrove DS0000006855.V340480.R01.S.doc Version 5.2 Page 17 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 27 – 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staff team had the skills and experience needed to meet the needs of the resident’s. More attention was need to complying with recruitment procedures and staff training. EVIDENCE: At the time of this inspection the staff team comprised of a part time manager, two assistant managers, team leaders, care assistants, domestic and ancillary staff who worked together to meet the needs of the residents. For some time the home had two managers sharing responsibility for the service. One manager has now left and for about 6 weeks the home has had only 15hours a week management cover. A new full time manager had been employed and was due to commence work in the home on 16th July 2007. Following the inspection the Commission were informed that the new manager’s start date was changed to 9th July 2007. Staff rosters seen for three weeks in June 2007 showed that adequate staffing levels were maintained and that a high percentage of shifts were covered by agency and bank care staff. The inspector was told that new care staff had been recruited but management were waiting for CRB checks and references to finalise the recruitment process. Efforts were made to use regular bank and agency staff. At the last inspection the staffing rosters did not clearly identify staff on duty in the dementia unit at all times and did not always include the full name of the employee. This Perrygrove DS0000006855.V340480.R01.S.doc Version 5.2 Page 18 situation remained unchanged and rosters still did not reflect this information. The current practice was to have one carer in the dementia unit in the morning and afternoon with a ‘floating’ carer assisting when needed. At night the home was staffed as one unit with a team leader and two carers. These were the same staffing levels provided at night prior to opening the dementia unit. Opening the dementia unit did not increase the total number of residents accommodated in the home. Management should keep staffing levels at night under review as it was noted a number of residents in the dementia unit were quite confused, mobile or did not sleep well at night. Residents spoken with were complimentary about the staff team and many knew their key workers. Surveys and comments received from relatives showed they were satisfied with the contact staff made with them. Requirements 10 and 11 and recommendation 7. Sixteen of the twenty-one permanent care assistants employed had achieved NVQ2 or above, which exceeded the standard. Recruitment policies and procedures were provided. Three staff files were viewed and a fourth file for a recently employed carer could not be found. The files seen contained most but not all of the information required by regulation. For example none of the files contained a recent photograph of the employee, one reference in one file had not been verified as genuine and two references in another file were not signed by the referee or verified as genuine. Evidence of staff induction was seen on one file. Requirement 12. A staff matrix was provided and individual employee training records were viewed. These showed that not all staff had access to three days training yearly. Since the last inspection some staff had received training on topics such as NVQ, infection control, moving & handling and managing challenging behaviour. Individual files for six employees were viewed and three of these showed that the person had not received any training in the last year. Requirement 13. Perrygrove DS0000006855.V340480.R01.S.doc Version 5.2 Page 19 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 31, 33, 35, 36 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A new manager was due to start on 9th July 2007. From the evidence provided attention was generally given to providing a safe environment and to manage resident’s money. Some safety systems must be reviewed. EVIDENCE: The service has not had a registered manager for over a year. At the time of this inspection a manager was provided for two days a week. A new manager was employed and due to start work on 9th July 2007. The registered person must ensure the service has a registered manager as required by the Care Standards Act 2000 and ensure continuity in management to improve meeting the national minimum standards. Requirement 14. Perrygrove DS0000006855.V340480.R01.S.doc Version 5.2 Page 20 A number of residents had the ability to voice their opinion on the service. No resident meetings had been held since January 2007. At the last inspection it was planned to hold a resident / relative forum in October 2006 but there was no evidence to show that this had happened. Residents spoken with said staff listened to them and acted on what they said. An external provider completed the quality assurance assessment under ISOQQA 9001. Action plans to improve deficits in the service were prepared based on the quality assurance findings. The organisation had a system in place whereby managers completed audits on services they did not manage. Action plans were prepared based on audit findings as to how issues identified would be addressed. Copies of these audits were seen. Visits were made to the home as required by regulation 26 and reports sent to the Commission but not always monthly. The provider should use these reports as a way to keep the Commission informed as to progress made meeting the requirements made in this report. Recommendation 8. Some residents managed their own finances and some had family who helped them to do this. Management supported some residents to manage personal allowances. The systems in place ensured resident’s money was safely managed, that residents had access to personal allowance and where appropriate money held for residents earned them interest. Records seen in relation to resident finance were very well kept and up to date. Receipts were kept for money received and spent. Personal finance records were available to residents/relatives on request. The system in place to provide supervision was that the manager supervised assistant managers who then supervised team leaders and team leaders supervised care assistants. There was evidence to show that some supervision did take place however this was not being done on a regular basis. Recommendation 9. Safety records viewed included lift service, hoist service, electricity, gas and legionella. All of these were up to date. New boilers were fitted since the last inspection. The maintenance said it had not been possible to monitor hot water temperatures due the frequency of the boiler breakdowns. Fire safety records were viewed and showed the system and emergency lighting was last serviced on 16/5/07, weekly alarm tests were undertaken and the last fire drill was held on 26/5/07. There was no evidence to show that staff had access to fire safety training in the last year apart from reinforcing fire safety procedures after fire drills. Accident records were kept and regulation 37 notices sent to the Commission. Accident records were viewed and these showed that a number of residents had sustained injuries when being assisted to mobilise, when receiving care or were unexplained. There was no evidence to show that these incidents were investigated or that any action was taken to prevent a recurrence. This issue Perrygrove DS0000006855.V340480.R01.S.doc Version 5.2 Page 21 was raised at the last inspection. The quality of accident reporting could also be improved to ensure full details of the incident were recorded. Requirements 15 and 16 and recommendations 10. Perrygrove DS0000006855.V340480.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 X X X 3 X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 4 2 X 2 Perrygrove DS0000006855.V340480.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes 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 OP4 Regulation 14 Requirement Timescale for action 10/08/07 2 OP7 15 3 OP8 12 The registered person must ensure residents receive written confirmation that based on assessment the home is suitable to meet their needs in respect of health and welfare. (Timescales of 24/10/06 and 20/04/07 were not met.) 10/08/07 The registered person must ensure: Care plans are prepared for all residents to show how identified needs will be met. A system must be in place to monitor resident’s weight. Efforts must be made to involve residents in preparing their care plans. (Timescales of 24/10/06 and 20/04/07 were not met.) 03/08/07 The registered person must ensure residents referred by the GP to other professionals are seen within an acceptable timescale. Staff must have access to scales suitable to monitor resident’s weight. Staff must ensure they monitor care provided by the district DS0000006855.V340480.R01.S.doc Version 5.2 Perrygrove Page 24 4 OP9 13 5 OP12 16 6 OP12 16 7 OP19 23 nurse and have a care plan in place relevant to additional support they provide based on the advice of other professionals involved including wound management. The registered person must ensure that: Accurate records are kept for all medicines brought into the home to enable an audit trail to be completed including homely remedies. Homely remedies must only be used with the agreement of the G.P. Topical preparations must be properly labelled. The registered person must ensure that: Social and leisure care plans are prepared with individual residents and that adequate activity and leisure activities are provided. (Timescale of 20/04/07 was not met). The registered person must ensure that staff have and display an understanding of the needs of residents with dementia and ensure appropriate mental stimulation and activities are provided to this group of residents. The registered person must ensure the environment is maintained to a satisfactory standard. The carpet in the ground floor corridor must be cleaned or replaced. The walls and paintwork in the ground floor corridor must be cleaned and repainted. Residents must have access to a suitable smoking area. The hairdressing room must provide a clean and pleasant DS0000006855.V340480.R01.S.doc 10/08/07 10/08/07 10/08/07 31/08/07 Perrygrove Version 5.2 Page 25 8 OP20 23 9 OP26 13 10 OP27 17 11 OP27 16 12 OP29 19 13 OP30 18 14 OP31 8 15 OP38 13 environment for residents. (Timescale of 20/04/07 was not met). The registered person must supply an accurate maintenance programme to the Commission and keep them informed in writing of the start and end dates for the completion of the planned work. The registered person must ensure clinical and general waste are properly stored and removed from the property regularly. The registered person must ensure that staff rosters accurately show names of staff on duty at all times and identify staff allocated to the dementia unit. (Timescale of 20/04/07 was partly met). The registered person must ensure that designated staff are employed to provide appropriate social activities and mental stimulation for residents. The registered person must ensure that references received for employees are verified as genuine if appropriate. Employee files must be kept in the home and available for inspection at all times. The registered person must ensure that all staff receive training relevant to the work they perform. The registered person must ensure the service has a registered manager and keep the Commission informed in writing of progress made to achieve this. The registered person must ensure that all accidents to residents are recorded. A system must be in place to follow up unexplained injuries DS0000006855.V340480.R01.S.doc 03/08/07 03/08/07 10/08/07 10/08/07 10/08/07 31/08/07 10/08/07 03/08/07 Perrygrove Version 5.2 Page 26 16 OP38 13 sustained by residents. (Timescale of 20/04/07 was not met). The registered person must ensure that fire safety training is provided for staff by an appropriate. Hot water temperatures must be monitored to ensure they are kept within safe limits. 10/08/07 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 3 Refer to Standard OP3 OP9 OP10 Good Practice Recommendations The registered person should ensure residents are admitted to the home based on a pre-admission assessment of need completed on behalf of the provider. The registered person should ensure medicine audits include homely remedies. The registered person should ensure that where possible care plans are discussed and agreed by the residents to ensure their personal preferences are respected and taken into consideration. The registered person should ensure the menu for the day is made available to residents and that residents are offered extra or larger portions if needed. The registered person should ensure that staff receive update training on safeguarding adults. The registered person should ensure that plans to change the environment are discussed with the Commission. The registered person should keep staffing levels at night under review to ensure they meet the needs of the all residents. The registered person should use regulation 26 reports as a method of informing the Commission monthly on progress made to meet requirements and improve standards within the home. The registered person should ensure all staff receive regular supervision in line with the requirements of this standard. DS0000006855.V340480.R01.S.doc Version 5.2 Page 27 4 5 6 7 8 OP15 OP18 OP19 OP27 OP33 9 OP35 Perrygrove 10 OP38 The registered person should ensure that accident records include full details of the incident. Perrygrove DS0000006855.V340480.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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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