Inspection on 08/09/08 for Primrose

This inspection was carried out on 8th September 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 15 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Shanty Coley Avenue Woking Surrey GU22 7BT     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Joseph Croft     Date: 0 8 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 36 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 36 Information about the care home Name of care home: Address: The Shanty Coley Avenue Woking Surrey GU22 7BT 01483772344 Telephone number: Fax number: Email address: Provider web address: shahidshanty@aol.com Name of registered provider(s): Name of registered manager (if applicable) Mr Shahid Sheikh Type of registration: Number of places registered: SN Care LLP care home 16 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users to be accommodated is 16. The registered person may provide the following category/ies of service only: Care home only ? (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Mental disorder, excluding learning disability or dementia (MD) Date of last inspection Brief description of the care home The Shanty is a detached house in its own grounds close to Woking town centre. The home is registered to accommodate sixteen residents in single and double bedrooms over two floors that are accessible by a passenger lift and stairs. The home has its own garden to the rear, and there is a small parking area at the front of the property. Care Homes for Older People Page 4 of 36 Over 65 0 0 16 16 Care Homes for Older People Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is Zero star. This means that the people who use this service experience poor quality outcomes. The Commission For Social Care Inspection (CSCI) (us, we) undertook an unannounced site visit on the 8th September 2008 using the Inspecting for Better Lives (IBL) process. Regulation Inspector Mr Joe Croft and Regulation Manager Mrs Rosemarie James undertook the site visit that took over five hours to complete, commencing at 10:00 and concluding at 15:15. The registered manager, who is also the registered person, was not at the home at when we arrived, but did attend from approximately 11:00 and Care Homes for Older People Page 6 of 36 remained for the duration of the visit. The home has previously had two site visits. One was a random inspection that took place on the 5th June 2008, the second was a site visit on the 3rd July 2008 to monitor compliance in regard to the requirements that were made during the previous site visit. The inspection process included a tour of the premises, observation of practice and sampling of service users care plans and risk assessments. Other documents sampled included the menu, records of medication, training records, staff duty rota and staff recruitment files. The inspectors had discussions with the manager, one member of staff and four service users. Some service users had dementia and therefore discussions were limited, however, they told us that they do activities and the food provided at the home is good. Staff are nice and they do as they ask them to do. They see the GP who visits the home regularly and they receive their medication. During lunch time observations, staff and service users were interacting in an appropriate manner, and the meal they were eating was appealing and included fresh vegetables. The manager did not send us their completed Annual Quality Assurance Assessment (AQAA) when we asked for it, and a Statutory Enforcement Notice was issued to the manager. We received the completed AQAA in August 2008, and this has been used as a source of evidence in this report. Surveys were sent to service users, staff and health care professionals, however, at the time of writing this report we had not received any completed surveys. The weekly fees at the home range from 365.19 to 506.00 pounds per week. Feedback was provided to the manager at the end of the site visit, and the manager was informed that the evidence collected during the site visit would be analysed, and there may be other requirements made that had not been discussed during the feedback. What the care home does well: What has improved since the last inspection? What they could do better: Records of food provided to service users must be recorded in sufficient detail to evidence that food being provided corresponds with the menu, and that wholesome and balance meals are being provided to service users living at the home. The registered person must ensure that only fresh food is stored in the fridge and storage areas of the home. The strong malodour from bedroom number 7 must be eliminated and the service user must move to another bedroom until this has been completed. The malodours in the four identified bedrooms must be eliminated. Wedges must not be used in the fire doors. Fire escape point 5 must have all the obstructions removed. The registered person must submit an action plan, including dates, to the CSCI of how the identified issues in regard to the environment will be addressed. Staff employed at the home must not work straight shifts of twenty-four hours. The identified person who does not have a POVA first or Criminal Record Bureau clearance must not work at the home until these checks have been completed. The two identified members of staff who only have POVA checks completed must not work the night shifts together. Staff recruitment files must contain all as stated in Regulation 19 and Schedule 2 of The Care Home Regulations 2001. Records of induction training undertaken by staff must be completed to evidence this training has been undertaken. The manager must commence delivering formal recorded one-to-one supervision to staff working at the home, and ensure that all staff receive the minimum of six formal one-to-one supervisions per year. Care Homes for Older People Page 8 of 36 Confidentiality in respect of service users living at the home must be upheld at all times. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 36 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are provided with the information they need to enable them to make a choice about living at the home. Assessment documentation was not assessed as no new residents have been admitted to the home since registration of the new provider. Evidence: The manager has updated the Statement of Purpose and Service Users Guide. These documents were viewed during the random inspection of the 5th June 2008. The inspector advised the manager to ensure all service users are provided with a copy as detailed in The Care Home Regulations 2001, Schedule 1. The manager told us that there have not been any new admissions since he purchased the home. During the previous inspection, the manager stated that he has a tool for the purpose of pre-admission assessments but this was at his other care home being Care Homes for Older People Page 11 of 36 Evidence: used for pre-admission assessments there. Following an enquiry, the manager told us that he would take initial details to ensure that the prospective service user falls within the homes category of registration. New prospective service users would be invited to stay at the home for one week free of charge. If the service user decided to stay then they would be charged for that week. The Annual Quality Assurance Assessment (AQAA) completed by the registered person informs that the home has an admissions policy and procedure that was reviewed in May 2008. The home does not offer intermediate care. Care Homes for Older People Page 12 of 36 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have care plans and risk assessments in place, however, these must be further developed to ensure their physical and health care needs are fully met. Service users are not fully protected by the storage of medication. The dignity of service users is not being promoted or safeguarded. Evidence: Two care plans were viewed as part of the case tracking process, and were noted to have been recently reviewed. Care plans included information in regard to personal care, social interaction, medication, emotional well-being, mobility and religion. Care plans included a column headed Care Objectives that record what action the staff need to take to meet the identified needs. These require further developing to ensure they clearly detail exactly what staff are to do to meet the assessed needs of service users. There was no cross-referencing in the care plans to the identified risk assessments. During the site visit one service user was observed to be in unkempt state, their Care Homes for Older People Page 13 of 36 Evidence: glasses were dirty and their teeth and oral hygiene required attention. The care plan for this service user was viewed, and there was no recorded information in regard to their oral hygiene. There had been two appointments with the hygienist, but there was no information recorded in regard to the support this service user required with their oral hygiene. This was discussed with the manager who told us that the identified service user wears dentures, which was not true. A requirement has been made in regard to this. Risk assessments were in place on the care files sampled. These included risks in regards to falls, using the wheelchairs and hoists. The moving and handling risk assessments had been undertaken, however, these had not been cross-referenced into the care plans, for example, it did not state in the care plan how many staff are required to assist with the moving and handling. Health care appointments were recorded in the care plans viewed. These included appointments with the GP, district nurse, dentist, chiropodist and the physiotherapist. The manager has recently purchased a new set of weighing scales for the home. Weight charts were recorded in the care plans, however, one service user had not been weighed since the 27th June 2008, where there was a recorded weight loss from the previous month. The manager must ensure that when a weight loss has been identified it must be monitored on at least a monthly basis. A requirement has been made in regard to this. The home uses the local pharmacist blister packs and Medication Administration Record sheets (MARs) that were viewed during the site visit. The MARs sheets were accurately maintained and no omissions were observed. There is a code for medication not administered, however, the reason for this omission had not been recorded. This was discussed with the manager and a requirement in regard to this has been made. Medication was appropriately stored in a locked metal medicine cupboard in the office. During the site visit the keys for this cupboard were left in the office with the office door wedged open, therefore were accessible to anyone. An immediate requirement was made in regard to this. MAR sheets did not include photographs of service users to minimize the risk of mistakes being made. Evidence that staff had received training in regard to the administration of medication were evidenced during the site visit. The local pharmacist had provided this training on the 24th July 2008, and certificates of attendance had been provided . The AQAA informs that the home has a Medication policy and procedure that was reviewed in May 2008. During the previous random inspection staff informed the inspector that during the final hours of a service users life, they would sit with the person and talk and listen to them so they are not alone. Service users families would Care Homes for Older People Page 14 of 36 Evidence: be contacted at that time. During the tour of the premises evidence was noted that the dignity of service users is not being fully promoted due to the general decor and condition of the premises. Requirement and comments have been made under the Environment section of this report. Care Homes for Older People Page 15 of 36 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are provided with some activities, and where possible they are able to maintain contact with their family. Meals provided are cooked at the home, however, there was no information to evidence that residents are being offered an appealing and balanced diet on a daily basis. Evidence: On the day of the site visit service users were observed in the lounge. Some were talking to each other and others were asleep. The television was switched on but noone was watching it. During discussions service users told us that activities provided include having a sing-a-long and bingo. This was confirmed during discussions with one member of staff who told us that activities take place at 11:30 and 15:30 each day. These activities included music, dancing, board games and massage. Discussions took place with the manager in regard to the recording of activities that are provided to service users, and for a list of the daily activities to be displayed to enable service users to know what activities are available. A good practice recommendation has been made in regard to this. Staff and service users told us that their relatives can visit the home and they can go Care Homes for Older People Page 16 of 36 Evidence: out with them if they wish to. The previous random inspection recorded that service users do go out with their families, and one goes out for coffee. One service user, through their own choice, prefers to spend time in their bedroom with their own cat that they are allowed to keep. This service user also told us that they have visitors, one who recently brought a present for their cat. Service users told us that church leaders do not visit the home, but they were not concerned about this. The home had a four-week rolling menu in the kitchen. The menu was viewed and provided meals that included meat, fish, vegetables and desserts. On the day of the site visit the menu did not correspond to the lunch that was provided. This was discussed with the manager who told us that the food is always freshly cooked at the home. Fresh vegetables were evidenced in the kitchen and were provided with the meal served on the day of the site visit. The manager told us that his wife does the food shopping and fresh meat and vegetables are always bought. Due to the home not following the written menu it was not possible to evidence that service users are being provided with wholesome balanced meals. A requirement has been made in regard to this. On the day of the site visit the food was freshly cooked and service users were observed enjoying their meal in a relaxed atmosphere with staff available in the dining room to offer support as and when required. Service users told us that the food is good and they have enough to eat. The kitchen had a list of residents likes and dislikes, and there was a Safer Better Food manual that staff use. Training records evidenced that only two members of staff had attended training in regard to food hygiene in 2005 and 2006. This has been addressed under the Management and Administration section of this report. The fridge temperatures are being recorded. The fridge requires attention as it was not stable. The dishwasher was broken and requires repair. Food in the fridge was covered and dated, however, there were some carrots that had gone beyond being fit for human consumption, which the manager immediately removed. The manager must ensure that only fresh food is kept in the fridge and storage areas of the home. Requirements have been made in regard to these. The AQAA informs that the home enables service users to take part in activities of their choosing, and varied, healthy food is offered. Care Homes for Older People Page 17 of 36 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have access to a satisfactory complaints system that enables them and their families to raise concerns. Residents are not being protected by the recruitment practices of the home, training or the cleanliness of the environment. Evidence: The home has a complaints procedure in place that includes the time scales for responding to complainants and the contact details for the Commission For Social Care Inspection (CSCI) regional contact team. The CSCI has received one complaint about the care home that was referred under the Surrey Safeguarding Procedures, and is currently ongoing. The manager told us that the home had not received a complaint since he brought the home in April 2008. The home does not have a complaints book for the recording of complaints. A good practice recommendation has been made that the home should have a complaints book that records the date, nature and outcomes of complaints received. The manager is aware of the Surrey Multi-Agency procedures for Safeguarding Adults, and a copy of the 2008 procedures were evidenced during the site visit of the 5th June 2008. The manager told us that he had undertaken training in Kent that enables him Care Homes for Older People Page 18 of 36 Evidence: to provide training to his staff in regard to Safeguarding Adults, however, the manager did not have the certificates at the home to evidence this. The manager has not applied to attend the Surrey Multi-Agency training in regard to Safeguarding Adults and a requirement has been made in regard to this. Staff training files provided evidence that two members of staff had attended training in regard to Safeguarding Adults on the 19th August 2008. Three new members of staff have recently been employed at the home, and the manager told us that this topic was covered during their induction period, however, there was no evidence at the home of induction having taken place. The manager told us that all staff would receive training in regard to this subject by the 13th September 2008. During discussions, one new member of staff was able to demonstrate an understanding of Safeguarding issues, who to report to, and the Surrey Safeguarding Procedures. The manager is not ensuring that service users are safeguarded from abuse, as he is not following the correct recruitment procedures as required by The Care Home Regulations 2001. New members of staff are commencing work at the home without the appropriate checks being undertaken. Requirements and immediate requirements have been made under the Staffing section of this report. Other identified issues in the home do not ensure service users are protected from harm. For example, the medication keys were not kept in a secure place, Control Of Substances Hazardous to Health (COSHH) were accessible and the infection control at the home is not sufficient to maintain the home in a clean and odour free environment. Requirements in regard to these have been made in the appropriate sections of this report. The manager told us that the home has nothing to do with service users finances, this is the responsibility of their relatives. The home does not hold any amounts of service users money. The AQAA informs that there are policies and procedures in place to address issues in regard to abuse and adult protection. Care Homes for Older People Page 19 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment of the home does not protect or promote the health and safety of service users. People using the service do not live in a safe or well maintained environment. Evidence: A tour of the premises was undertaken. The home accommodates sixteen service users in single and double bedrooms on two floors. Bedrooms have their own sinks and there is a communal bathroom, shower room and toilets. The first floor is accessible by a passenger lift and stairs. There is a communal lounge, day room, kitchen, sluice and laundry room on the ground floor. The laundry room was open during the site visit and there was an item relating to a Control Of Substance Hazardous to Health (COSHH) was left on the work top and therefore accessible to service users. The manager addressed this as soon as it was brought to his attention. The home has its own garden area that can be used in the appropriate weather conditions. On the day of the site visit work was being undertaken to fit a new boiler and central heating system. The engineers told us that this work should be completed on the day of the site visit. Four bedrooms viewed had malodours. A requirement in regard these was made. Care Homes for Older People Page 20 of 36 Evidence: Bedroom 7 had an extremely strong malodour and an immediate requirement was made that this must be eliminated and the service user must be moved to another bedroom until this has been completed. The manager told us that he had just purchased a carpet cleaner and shampoo that is to be used for the cleaning of the bedroom carpets. The general decor of the home requires attention as many of the bedroom walls were worn and some had damage to the wallpaper. One bedroom ceiling had the aertex coming off. Other issues identified in regard to the environment included stained bed sheets in bedroom numbers 2, 4, 7, 8 and 12. Exposed water pipes require boxing in to ensure the health and safety of service users is maintained. Missing light covers require replacing on the ground floor and the stairway . The shower room on the ground floor had wall tiles missing and there was a six inch gap between the bottom of the door and the floor, which did not provide total privacy to service users when using the shower room. The bathroom has a bath seat that requires cleaning and the cleanliness of the bathroom requires attention. There is a patio door leading to the garden that requires a ramp and/or handrail to ensure service users with mobility issues are able to safely access the garden. A requirement has been made that the manager must produce and submit an action plan, with dates, to the CSCI of how and when these issues are to be addressed. The fire doors were observed being kept open by the use of door wedges. An immediate requirement was made in regard to this. Fire point number 5 was obstructed by a rail of clothes, commode and large seat cushions for the garden. An immediate requirement was made in regard to this. The diningroom door does not close properly, this must be addressed by the manager. The AQAA informs that the home is clean, hygienic and free from odour. This was not the findings on the day of the site visit. Care Homes for Older People Page 21 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are not being protected by the homes recruitment procedures. The arrangements for staffing are not satisfactory. Evidence could not be viewed that staff are provided with the required training to meet service users needs. Evidence: The manager told us that there are three members of staff on duty on each shift that always includes a senior member of staff. There is one person covering a sleep in duty and one waking night staff covering the night duties for eleven service users. The manager told us that he had recently dismissed three members of staff because they could not read English, therefore mistakes would easily be made when administering medication. The manager has employed three senior staff who hold a nursing qualification in their home country, however, they are employed at the home as senior care staff not nurses. The manager told us that he has checked that their nursing qualification is the equivalent of an NVQ level 3. Another two members of staff are currently undertaking the NVQ level 2 training. Staff on duty on the day of the site visit were observed to be interacting with the service users with a caring manner, talking to them and supporting as and when required. Care Homes for Older People Page 22 of 36 Evidence: The duty rota for the week of the site visit was viewed. This provided evidence that there are three members of staff on duty each shift. However, it was noted that some staff are working a twenty-four hour period without a break, for example, one member of staff commenced their duties at 13:30, worked as the waking night member of staff, and worked the following morning until 13:30. This was discussed with the manager and a requirement has been made that staff must not work twenty-four hour shifts. The recruitment files of the three new members of staff were viewed during the site visit. The manager told us that staff who have only received a Protection Of Vulnerable Adults (POVA) first check do not work unsupervised. It was noted that the application forms only requested the previous two years employment history. None of the files viewed contained two written references. One file had a written reference and a testimonial that was dated 2006. One file had no proof of identification. This was discussed with the manager and a requirement has been made in regard to the recruitment practices of the home. One member of staff had commenced working at the home without the results of the Protection Of Vulnerable Adults (POVA) first or a Criminal Record Bureau check. An immediate requirement was made that the identified member of staff must not work at the home until the checks have been completed. Two new members of staff, who only had the POVA first checks completed, were noted on the duty rota to be covering the night duties together. An immediate requirement was also made in regard this. Evidence that new members of staff had undertaken induction training could not be viewed, however, one member of staff told us that on her first day a long standing senior member of staff had told her everything. The manager told us that new staff have an induction, but the files sampled contained blank induction sheets. A requirement has been made that records of induction training undertaken by staff must be completed. The manager told us that staff had attended other training during their previous employments, but the staff had not provided copies of their training certificates to the manager. The manager told us that he would address this. The AQAA informs that the recruitment and training of staff is good. This was not the finding during this site visit. Care Homes for Older People Page 23 of 36 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for management and administration do not ensure the home is run in the in the best interests of residents, and their health and safety is not fully promoted or safeguarded. Evidence: The manager, who is also the registered person, was registered in April 2008 when he purchased the care home. The manager entered care work as the registered provider/manager of another care home in Kent in 1999. He has achieved qualifications relevant to his post as manager of the care home, including the City and Guilds Advanced Management for Care. The manager achieved the Registered Managers Award (RMA) in September 2006. Evidence of this training would have been viewed at the time of his application to register. On the day of the site visit the manager did not have his training file at the home, therefore it was not possible to evidence any other training undertaken. Care Homes for Older People Page 24 of 36 Evidence: The manager must address the identified issues in regard to health and safety, Safeguarding Adults training, the environment, the malodours, staff recruitment procedures, POVA first and Criminal Record Bureau checks, induction, staff training and staff hours being worked at the home. The manager told us that he has prepared a questionnaire to send out to service users, their relatives and other associated professionals to ascertain their views of the care being provided at the home. The manager stated that he would be sending these out by the 15th October 2008. The financial procedures of the home were submitted to the South East Regional Registration Team at the time of applying for registration, therefore these were not viewed during this site visit. The manager told us that staff do not manage service users finances, they are dealt with by service users and/or their relatives. The manager has not been conducting formal one-to-one supervision with staff working at the home. This was further discussed with the manager who told us that he supervises their work. The manager must conduct at least six formal one-to-one recorded supervision sessions per year. A requirement in regard to this has been made. Staff at the home maintain records on individual service users that include care plans, daily notes and records of medication. Individual daily record books were noted to be stored in the day room with the visitors book. This does not promote confidentiality as all visitors are able to have access to these personal and confidential records. During the feedback session to the manager at the end of the site visit, the inspectors were not using the names of service users as the office door was open. The manager did not realise the importance of this confidentiality and kept stating the names of the service users that were being discussed in a manner that could be heard in the lounge where service users and staff were sitting. A requirement in regard to this has been made. The viewing of staff training records provided evidence that two members of staff had attended training in regard to manual handling, fire, food hygiene and handling, Safeguarding Adults and medication. Three staff were new and should be receiving this training during their induction, although the manager stated that these staff had undertaken the mandatory training at their previous employment. As mentioned earlier in this report, the manager had not obtained the training certificates to evidence this training. The AQAA informs that all the homes policies and procedures had been reviewed in Care Homes for Older People Page 25 of 36 Evidence: May 2008, and the health and safety equipment used at the home had been serviced as per the manufacturers guidelines, with the exception of the portable electric appliance testing (PAT) and the heating system. Evidence of the PAT was viewed during the site visit. As stated earlier in this report, the home was was due to have the installation of the new heating system completed on the day of the site visit. Discussions took place with the manager in regard to the enforcement notice that was served by the Surrey Fire and Rescue Officer on the 12th May 2008. The manager told us that he was still working with the fire officer in regard to this and was expecting another visit from him in November 2008. However, we had a telephone conversation with the Surrey Fire Officer who told us that he is going to meet with the manager on the 17th September 2008. The enforcement notice was served on the previous owner of the care home. The fire officer told us that he had received a letter from the manager informing that compliance with the enforcement notice would be completed in eighteen months. The fire Office told us that he does not have that long to comply. Fire risk assessments were viewed during the site visit of the 3rd July 2008. Care Homes for Older People Page 26 of 36 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 9 13 The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. The medication keys must not be left in the open office. 09/09/2008 2 19 23 The registered person shall after consultation with the fire and rescue authority take adequate precautions against the risk of fire, including the provision of suitable fire equipment. Fire escape point 5 must have all the obstructions removed. 09/09/2008 3 19 23 The registered person shall 09/09/2008 after consultaion with the fire and rescue authority take adequate precautions against the risk of fire, including the provision of suitable fire equipment. Wedges must not be used to in the fire doors. 4 26 16 The registered person shall 09/09/2008 having regard to the size of the care home and the number and needs of service users keep the care home free from offensive odours and make suitable arrangements for the disposal of general and Page 28 of 36 Care Homes for Older People clinical waste. The strong malodour from bedroom number 7 must be eliminated and the service user must move to another bedroom until this has been completed. 5 29 19 The registered person shall 09/09/2008 not employ a person to work at the care home unless the person is fit to work at the care home, in respect of whom there has been obtained a criminal record certificate persuant to section 113 of the 1997 Act or an enhanced criminal record certificate persuant to section 115 of that Act. The identified member of staff who does not have a Protection Of Vulnerable Adults (POVA) first or a Criminal Record Bureau clearances must not work at the home until the checks have been completed. 6 29 19 The registered person shall 09/09/2008 not employ a person to work at the care home unless the person is fit to work at the care home, in respect of whom there has been obtained a criminal record certificate persuant to section 113 of the 1997 Act or an enhanced criminal record certificate persuant to section 115 of that Act. The two identified members of staff who only have a POVA first check must not work the night shifts together. Care Homes for Older People Page 29 of 36 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 The registered person shall 08/10/2008 ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users. Care plans must include information in regard to meeting the oral care needs of the identified service user. Care plans must clearly detail exactly what staff are to do to meet the assessed needs of service users. 2 8 12 The registered person shall 10/09/2008 ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users. The reasons why medication has not been administered musty be recorded. 3 8 12 The registered person shall 08/10/2008 ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users. The manager must ensure that when a weight loss has Care Homes for Older People Page 30 of 36 been identified that this is monitored on at least a monthly basis. 4 10 12 The registered person shall 08/10/2008 make suitable arrangements to ensure that the care home is conducted in a manner which respects the privacy and dignity of service users. The registered manager must monitor and ensure that residents are appropriately dressed and their dignity is promoted at all times. 5 15 16 The registered person shall having regard to the size of the care home and the numbers and needs of service users provide sufficient and suitable kitchen equipment, crockery, cutlery and utensils, and adequate facilities for the preperation and storage of food. The dishwasher must be repaired or replace, and the fridge must be made stable. 6 15 16 The registered person shall having regard to the size of the care home and the numbers and needs of service users provide, in adequate quantities, suitable, wholesome and nutritious food which is varied and properly prepared and available at such time as may 08/10/2008 08/10/2008 Care Homes for Older People Page 31 of 36 reasonably be required by service users. The registered person must ensure that only fresh food is kept in the fridge and storage areas of the home. 7 15 17 The registered person shall maintain in the care home records that are specified in Schedule 4 (13) of The Care Home Regulations 2001. The registered person must ensure that records of meals provided to service users are accurately maintained at the home. Menus must correspond to the meals taken. 8 18 10 The registered manager 31/10/2008 shall undertake from time to time such training as is appropriate to ensure that he has the experience and skills necessary for managing the care home. The manager of the home must make an application to attend the Surrey MultiAgency training in regard to Safeguarding Adults. 9 19 23 The registered person shall 08/10/2008 having regard to the number and needs of the service users ensure that the premises to be used as the care home are of sound construction and kept in a good state of repair externally and internally. 08/10/2008 Care Homes for Older People Page 32 of 36 The registered person must produce and submit an action plan, including dates, to the Commission For Social Care Inspection of how the identified issues in regard to the environment will be addressed. 10 26 16 The registered person shall 08/10/2008 having regard to the size of the care home and the number and needs of service users keep the care home free from offensive odours and make suitable arrangements for the disposal of general and clinical waste. The malodours in the four identified bedrooms must be eliminated. 11 27 18 The registered person shall, 08/10/2008 having regard to the size of the care home, the statement of purpose and the number of and needs of service users, ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. Staff employed at the home must not work straight shifts of twenty-four hours 12 29 19 The registered person shall 08/10/2008 not employ a person to work at the care home unless the Care Homes for Older People Page 33 of 36 person is fit to work at the care home, subject to paragraphs (6),(8),and (9), he has obtained in respect of the person the information and documents specified in paragraphs 1-9 of Schedule 2. Staff recruitment files must contain all as stated in Regulation 19 and Schedule 2 of The Care Home Regulations 2001. 13 30 19 The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users, ensure that persons employed by the registered person to work at the care home receive training appropriate to the work they are to perform including structured induction training. Records of induction training undertaken by staff must be completed to evidence that this training has been undertaken. 14 36 18 The registered person shall 08/10/2008 ensure that persons working at the care home are appropriately supervised. The manager must commence and ensure all staff receive formal recorded one-to-one supervision at least six times per year. 08/10/2008 Care Homes for Older People Page 34 of 36 15 37 12 The registered person shall 08/10/2008 make suitable arrangements to ensure that the care home is conducted in a manner which respects the privacy and dignity of service users. Confidentiality in respect of service users living at the home must be upheld at all times. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 12 A list of the daily activities should be displayed to enable service users to know what activities are available each day. Thee home should have a complaints book that records the date, nature and outcomes of complaints received. 2 16 Care Homes for Older People Page 35 of 36 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 36 of 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!