Inspection on 30/07/08 for Riverview Residential Home

This inspection was carried out on 30th July 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Riverview Residential Home 11/08/09

Riverview Residential Home 14/02/08

Riverview Residential Home 18/09/07

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

CARE HOMES FOR OLDER PEOPLE Riverview Residential Home 1 Hayfield Cottages Tittensor Road Tittensor Stoke-on-Trent Staffordshire ST12 9HG Lead Inspector Yvonne Allen Unannounced Inspection 30th July 2008 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000070051.V370571.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. DS0000070051.V370571.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Riverview Residential Home Address 1 Hayfield Cottages Tittensor Road Tittensor Stoke-on-Trent Staffordshire ST12 9HG 01782 374 451 01782 374 451 bellasingh@hotmail.co.uk 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) Mrs Rishpal Singh Manager post vacant Care Home 8 Category(ies) of Old age, not falling within any other category registration, with number (8) of places DS0000070051.V370571.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care home only - Code PC To service users of the following gender: either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP. The maximum number of service users who can be accommodated is 8. 14th February 2008 2. Date of last inspection Brief Description of the Service: Riverview is a residential home located in Stoke On Trent, Staffordshire, providing a service for eight older people. The two-storey property is located in a rural area with picturesque views, eight single occupancy bedrooms are provided on the ground and first floor level, six of which are equipped with en suite facility. One bathroom having an assisted bath is located on the first floor, a separate toilet facility is also provided on the ground floor. The home also consists of a lounge/dining area located on the ground floor, equipped with essential furnishings and fitments to provide a comfortable area for relaxation and to interact with people living in the home. A kitchen and a separate laundry are in place. There is a stair lift to assist individuals who have limited mobility. The homes Service User Guide identifies that the fees for the service and provision range from £346 - £395 per week. This information was correct at the time of this inspection. The reader may wish to contact the home for more up to date information. DS0000070051.V370571.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. All of the Key minimum standards were assessed and for each outcome a judgement has been made, based on the evidence gathered. These judgements tell us what it is like for the people who live in this home. Prior to the inspection visit the Providers had completed a self-assessment tool, which is known as the Annual Quality Assurance Assessment (AQAA). Completion of the AQAA is a legal requirement and it enables the service to under-take a self-assessment, which focuses on how well outcomes are met for people using the service. It was completed to a satisfactory standard. Several weeks prior to the inspection visit we sent a number of surveys to be completed by people who live in the home, relatives and staff members. We received 6 surveys back from staff members and 6 from people who live at the home. The ways in which in we gathered evidence to make our judgements were as follows – We looked at any information we had received about the home since the last Key Inspection. This included any compliments, complaints and Safeguarding referrals we had received. We spoke with the people who live in the home We spoke with the staff who work at the home Discussions were held with the acting manager and the Provider of the home. We examined relevant paperwork and documentation at the home. We walked around the home. We looked at how staff interact with and care for the people who live at the home. At the end of the inspection visit we discussed our findings with the acting manager and Provider. This Key Inspection showed us that most of the outcomes for the people who live at the home have improved since the last Key Inspection. The main area of concern to us is the poor maintenance of medication within the home. A number of urgent requirements in respect of medication were left with the Provider at the time of the inspection visit. DS0000070051.V370571.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The Statement of Purpose and the Service User Guide has been updated to meet our requirements. New copies have been distributed in the home for new referrals and people using the service have a copy of the Service User Guide in their bedroom. A new assessment tool has been implemented to assess individuals prior to admission, which will be supplemented by a Care Managers pre-admission report. DS0000070051.V370571.R01.S.doc Version 5.2 Page 7 The new Statement of Purpose does not include information about any of the current people using the service without their permission, if any is used a written consent will be placed in the person’s Care plan. The new symbol formatted Care Plans encourage people and their advocate/relative to participate in the Care plan reviews, which are now done, on a six monthly basis. Any person who suffers from incontinence is now referred to the Incontinence Advisor linked to the home through the GP service and appropriate aids are acquired. The home is being fitted with an appropriate door locking system and a Master Key for emergency access/egress. People now have their own door key, (or risk assessed if not able), to enable them to access their own room. The new Care Plan format for reviews allows people to comment on activities of their chosen desire and an activities plan is in the process of being devised. A schedule of resident/relatives meetings has been devised to ensure the home meets the needs of the individuals and they have a say in the running of the home for example- menu planning. An assessment of one of the residents with visual impairment has been done with the assistance of “Sight Services” and appropriate support and aids have been put in place. The new Policies and procedures have been put into place, which includes the new complaints procedure. This has been included in the new Statement of Purpose and Service User Guide. A new staff ‘Supervision and Appraisal’ system has now been put in place. We spoke with one of the people who live at the home and he told us that the new owners had made a positive difference. He said, “I hope that the new owners stay and make a go of it because they really care.” The new manager is very pro-active and has brought about some positive changes to the home since the last Key inspection. Previous requirements have been addressed. What they could do better: This is what staff members told us the home could do better – “Provide better activities including outings but some residents have specified that they would rather stay in.” DS0000070051.V370571.R01.S.doc Version 5.2 Page 8 “Improve the service from every angle and doing better in everything.” “All that it can do to give a good service to the service users.” There are issues of concern in respect of poor medication practises and the Pharmacist Inspector has made several urgent requirements for the Provider to address. We will be returning to the home to ensure that improvements have been made to the medication system. We will also be sending them an improvement plan, so that they can tell us about the action they have taken to address our concerns. This will help ensure that people are safeguarded from mal administration of medication. The staff training and development plan has highlighted some gaps in mandatory training and the manager and Provider will be making improvements in this area. Staff also require training and instructions in the local Vulnerable Adults policies and procedures. This is to ensure that people are safeguarded from abuse. The garden area would benefit from tidying up and making more accessible to the people who live at the home. The Provider has acknowledged this and will be improving the outside space. 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. DS0000070051.V370571.R01.S.doc Version 5.2 Page 9 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 DS0000070051.V370571.R01.S.doc Version 5.2 Page 10 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 1, 3 and 4 were assessed. Quality in this outcome area is good. People who come to live at this home can be assured that their individual needs will be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Provider has addressed the requirements and recommendations made in the last inspection report as follows The Statement of Purpose and the Service User Guide have been updated to meet our requirements. DS0000070051.V370571.R01.S.doc Version 5.2 Page 11 We saw these documents on display in the entrance to the home. New copies have been distributed in the home for new referrals and people have a copy of the Service User Guide in their bedroom. A new assessment tool has been implemented to assess people prior to admission, which will be supplemented by a Care Managers pre-admission report. We saw these documents in use at the time of the inspection visit. Discussions with the Manager and Provider identified that they go out to assess people when a referral is made and that they only offer a place to people whose needs can be accommodated at the home. We spoke with some of the people who live at the home and they told us that they felt the staff at the home met their needs very well. “I knew the place and the owners before I moved in” “I have everything I need – the staff are very good to us” DS0000070051.V370571.R01.S.doc Version 5.2 Page 12 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): We assessed standards 7, 8, 9 and 10 Quality in this outcome area is adequate. Personal and healthcare needs are met in a person-centred way. The Provider will need to improve the medication system considerably in order to ensure that this is safe and robust. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been some improvements made to this outcome area since the last inspection. These are as follows – DS0000070051.V370571.R01.S.doc Version 5.2 Page 13 The new symbol formatted Care Plans encourage people and their advocate/relative to participate in the Care plan reviews, which are now done, on a six monthly basis. Any person who suffers from incontinence is now referred to the Incontinence Advisor linked to the home through the GP service and appropriate aids are acquired. An assessment of one of the residents with visual impairment has been done with the assistance of “Sight Services” and appropriate support and aids have been put in place. We looked at documentation and records contained in individual care plans and spoke to people about the care they received. They told us – “I take my mother out regularly and am very happy with the care she receives here”. “I have everything I need - the staff are wonderful”. We observed staff interaction with the people who live at the home and this identified that people are treated with dignity and respect. People have access to health care services both within the home and in the local community. The majority are able to choose their own GP and attend local dentists, opticians and other community services. People unable to access local services are supported by visits to the home by health care professionals. Health needs are monitored and appropriate action and intervention taken. There is evidence in the care plan of health care treatment and intervention, and a record of general health care information. There are some gaps in information but staff are able to think in a person centred way and are able to give a verbal update. Staff encourage individuals to be independent and to take responsibility for their own personal hygiene. The views of people are sought about the way personal care is delivered. People receiving services are happy with the way that most staff deliver their care and respect their dignity and rights. The pharmacist inspector visited the home as part of the key inspection and carried out an inspection of the medicines management systems being practiced within the home. In summary the medicines management systems within the home were poor and as a result five urgent action conditions were left with the Provider in order to ensure that the poor medication practices were eradicated. DS0000070051.V370571.R01.S.doc Version 5.2 Page 14 We found that the policies and procedures document for the handling of medicines did not describe in enough detail how the handling of medication within the home should be safely carried out by the staff. We found that the home was failing to record the receipt of all medication received into the home. We found that medication that had been carried over from previous months had not been accounted for on the records and as a consequence the home did not know whether this medication was being used appropriately. We found that some medication could not be accounted for when auditing the records. We found that some medication for one of the people had not been administered as prescribed by his doctor. Where variable doses had been prescribed the records did not show what quantity had been given. We found overall that the records were poor for containing information about the administration of medicines. In particular we found little or no information about the administration of when required medication, the administration of as directed medication, and the changes made to the doctor’s original prescription. We found that a person was holding and administering part of their own medication. We found that there was no documented assessment of the risks, to either the resident themselves or other residents in the home, associated with this activity. We also found that there was no monitoring programme in place to ensure that the person was administering the medication as prescribed by the doctor. We found that some of the staff who were administering medication had not received any training on the safe handling of medicines and none of the staff had been assessed for their competency to handle and administer medication safely. We found that staff were carrying out blood sugar monitoring for a tablet controlled diabetic. We found that none of the staff had received any formal training or had been assessed as competent by a healthcare professional. We found that the home had to store the residents’ medication that required cold storage condition in the home’s food fridge because of a noise problem with their designated medication fridge. We found that the home was using a metal cash box to ensure that the medicines were kept secure. We found that the temperature of the fridge was not being properly monitored to ensure that the medication remained at a temperature of between 2 and 8°C. We also found that Latanoprost and Timolol eye drops had been opened on the 13th June 2008 and the 16th June 2008 respectively. Eye drops must be discarded 28 days after opening but the Latanoprost had been open for 47 days and the Timolol for 44 days. The home had therefore been applying out of date eye drops to a person for more than two weeks. DS0000070051.V370571.R01.S.doc Version 5.2 Page 15 Our concerns about the medication have caused some serious deliberation about the overall rating for this outcome group. However, we have noticed a real commitment to comply with all of our previous requirements. The home makes sure that people’s health is monitored and they are supported by external health professionals, care planning has dramatically improved with people using the service being consulted and people are pleased with the way in which they are supported. Even so, we require the Home to address all of our concerns and requirements regarding medication to ensure that all people are fully safeguarded. We will be returning to the home to ensure that improvements have been made to the medication system. We will also be sending them an improvement plan, so that they can tell us about the action they have taken to address our concerns. DS0000070051.V370571.R01.S.doc Version 5.2 Page 16 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): We assessed all the standards for this outcome. Quality in this outcome area is good. The activities of daily life in the home are made flexible and varied and are based around meeting the needs of individual people. Wherever possible people have their choices and preferences upheld. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staff at the home respect the human rights of people living there, with fairness, equality, dignity, respect and autonomy underpinning the care and support being provided. The staff team help with communication skills, both within the home and in the community, to enable people to fully participate in daily living activities. DS0000070051.V370571.R01.S.doc Version 5.2 Page 17 People are involved in meaningful daytime activities of their own choice and according to their individual interests, diverse needs and capabilities. They can access and enjoy the opportunities available in their local community, such as using public transport, library services, the local pub, and local leisure facilities. Where appropriate, people are involved in the domestic routines of the home. They take responsibility for their own room, menu planning and, sometimes, helping to prepare meals, making sure that they are able to enjoy the food they prefer and like. The menu is varied with a number of choices. It includes a variety of dishes that encourage individuals to try new and sometimes unfamiliar food. The meals are balanced and nutritious and cater for the varying cultural and dietary needs of individuals. Care staff are sensitive to the needs of those residents who find it difficult to eat and give assistance with feeding. They are aware of the importance of feeding at the pace of the person, making them feel comfortable and unhurried. The new Care Plan format for reviews allows people to comment on activities of their chosen desire, an activities plan is in the process of being devised. A schedule of meetings for people using the service and/or their relatives has been devised to ensure the home meets the needs of the individuals and they have a say in the running of the home for example- menu planning. It was identified that spiritual needs are catered for. These are documented in individual plans. Also people told us about it - I receive holy communion every month. Personal autonomy is very much encouraged and promoted at this home. People tell us that they feel, part of an extended family. The Providers tell us - The care home encourages people to become involved in activities such as cooking, cleaning and gardening. The lunchtime meal was seen to be appetising and nutritious. Menus are varied and residents spoken to confirmed that, if they did not like what is on the menu they can have another choice. Preferred choices, likes and dislikes are displayed up on the wall in the kitchen. This is also documented in the care plans. DS0000070051.V370571.R01.S.doc Version 5.2 Page 18 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): We assessed Standards 16 & 18. Quality in this outcome area is adequate. The people who live at this home and their representatives can be assured that any concerns they might have will be listened to and taken seriously. People are safeguarded by the systems in place at the home but some staff should have further training in this area in order to ensure continuity. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection the Provider told us that they have made the following improvements in this area – “The new policies and procedures have been put into place, which includes the new complaints procedure. This has been included in the new Statement of Purpose and Service User Guide.” We found that the complaints procedure is supplied to everyone living at the home in the form of the Service User guide, and is displayed in the entrance to the home. This complaints procedure meets our regulations and is up to date. DS0000070051.V370571.R01.S.doc Version 5.2 Page 19 The home has an open culture that allows people to express their views and concerns in a safe and understanding environment. People and relatives involved with the home say that they are happy with the service provided, feel safe and well supported by staff and Providers. A relative told us, “I only have to mention it if I have a concern and it is dealt with – but I don’t have any concerns.” A person who lives at the home told us – “Bella has sorted things out straight away. We spoke with 2 staff members, the manager and a care assistant - both said that concerns are usually dealt with on a one to one basis and sorted before they become complaints. There are policies and procedures for safeguarding people who use the service. Some staff have had training around safeguarding adults but others have a limited understanding in this important area. This leads to inconsistent knowledge and needs to be addressed to ensure that people using the service are fully safeguarded. The manager is knowledgeable about safeguarding and the relevant policies and procedures. The carer was very new and her knowledge was limited about the procedures to follow when people need protection from abuse. It is recommended that all staff receive training in the Protection Of Vulnerable Adults and are made aware of the local policies and procedures on the reporting of abuse. DS0000070051.V370571.R01.S.doc Version 5.2 Page 20 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): We assessed standards 19 and 26. Quality in this outcome area is good. The home is a pleasant, safe place to live. It is domestic in character and bedrooms are adapted to meet individual needs and preferences. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last key inspection the Providers tell us that they have improved in this area by doing the following – DS0000070051.V370571.R01.S.doc Version 5.2 Page 21 “We have implemented a new health and safety audit tool Health and safety checks around the home are now completed and up to date with relevant certificates. Risk assessments have been changed and updated.” We found that the home provides a physical environment that is appropriate to the specific needs of the people who live there. The well-maintained environment provides specialist aids and equipment to meet their needs. Diverse needs are well met and health care needs are addressed – one person had a special mattress on her bed to help prevent the development of pressure sores. The lay out and design of the home allows for small clusters of people to live together in a non-institutional environment, people are encouraged to personalise their bedrooms. We saw how one person has his diverse needs met well and how his bedroom is very personalised and adapted to meet those needs. All the home’s fixtures and fittings meet the needs of individuals and can be changed if their needs change. The environment promotes the privacy, dignity and autonomy of residents. New locks have been installed on all of the bedroom doors and people will be given a key, following a suitable risk assessment so they can lock their door if they wish to. The shared areas provide a choice of communal space with opportunities to meet relatives and friends in private. The bathrooms and toilets are fitted with appropriate aids and adaptations to meet the needs of the people who use the service, and are in sufficient numbers and of good quality. The home is well lit, clean and tidy and smells fresh. The Provider was in the process of having a new boiler fitted in order to ensure the maintenance of central heating and hot water at the home. The outdoor garden area is in need of improvement and attention in order to make it more accessible for people to enjoy. The Providers have recognised this and tell us that they will be addressing this over the next few months. The general décor of the home would benefit from redecoration and, in some areas, refurbishment. DS0000070051.V370571.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): We looked at all the standards for this outcome. Quality in this outcome area is adequate. People are cared for by a staff team who are sensitive to meeting their individual needs. However staff training requires further development in order to ensure that staff remain competent and safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection the Providers have made the following improvements: All staff either already have or are working towards their NVQ level 2 in care. A new shift pattern has been introduced for nights. A new staff induction pack has been implemented. People are generally satisfied that the care they receive to meet their needs, but there are times when they may need to wait a short time for staff support and attention. We spoke with a resident who told us that, “sometimes staff are very busy and say ‘in a minute’ or ‘I’ll do that later’.” DS0000070051.V370571.R01.S.doc Version 5.2 Page 23 There are enough staff to meet the needs of people. Staffing rotas take into account the needs and routines of the people living at the home. We looked at the staffing rota and spoke with 3 staff members who all confirmed that staffing numbers have improved since the last inspection. The Provider recognises the importance of training, and tries to deliver a programme that meets any statutory requirements. The manager is aware that there are some gaps in the training programme and plans to deal with this. They are also able to recognise when additional training is needed, but are not always in a position to provide this training. We looked at 4 staff files in respect of staff training. Not all staff had received the required regular training updates in mandatory areas including manual handling training. The home has a recruitment procedure that meets statutory requirements. The procedure is followed in practice and there is accurate recording at all stages of the process. We looked at four files in respect of staff employed at the home. We also spoke with a new starter who confirmed the information in her file to be correct. No staff are offered employment at the home without first undergoing checks – Criminal Records, Protection Of Vulnerable Adults and 2 references. This means that people using the service can be confident they are supported by the right people. We also spoke with the new member of staff about her induction training. She confirmed that this training was very good and that she was being carefully introduced to care work. She said, “this is a lovely home to work at”, and, “the manager Jenny and owner Bella have been very supportive to me.” DS0000070051.V370571.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. The home is run in the best interests of the people who live there. All areas of management of the home are in need of further development so that outcomes for people continue to improve. This judgement has been made using available evidence including a visit to this service. EVIDENCE: DS0000070051.V370571.R01.S.doc Version 5.2 Page 25 The Provider has told us how the home has improved since the last inspection. “We have implemented a new supervision process. A new staff psychometric test is in place for use in interviews. We have appointed a new manager who is currently working towards her NVQ level 4 and has been a registered manager before. We have updated our service user quality questionnaires in order to gain more understanding of how the home is meeting their needs.” We have not yet received an application in respect of registration of the manager for this home and it is recommended that this be addressed without further delay. The manager is qualified and has the necessary experience to run the home. She is aware of and works to the basic processes set out in our regulations. The manager is aware of the need to keep up to date with practice and continuously develop management skills. The manager trains and develops staff who are generally competent and knowledgeable to care for the residents. The home focuses on the individual, takes account of equality and diversity issues, and generally works in partnership with families or close friends, as appropriate, and professionals. The home has a statement of purpose that sets out its aims and objectives. This has recently been reviewed and updated. The manager is improving and developing systems that monitor practice and compliance with the plans, policies and procedures of the home. There have been some improvements in this area since the last inspection but more work is still needed. The manager and provider are aware of this. All sections of the AQAA were completed and the information gives a reasonable picture of the current situation within the home. The AQAA gives us some detail about the areas where they still need to improve. The manager is aware of the need to promote safeguarding and has developed a health and safety policy that generally meets health and safety requirements and legislation. The manager has highlighted areas where they need to make improvements and has an action plan for undertaking the work. The Provider and manager have started to develop a Quality Assurance system; starting with questionnaires for people who live there. This now needs further development so that all the services offered by the home can be quality assessed and continually improved. People are supported to manage their own money where possible. Where this is not possible there is a clear reason why. People have access to their records whenever they wish. DS0000070051.V370571.R01.S.doc Version 5.2 Page 26 Formal staff supervision has commenced at the home and the Provider is developing this further in order to help ensure that staff are safe and competent and that this is monitored. There is a health and safety policy in place. The manager ensures risk assessments involve people in their production and they are fully completed and taken into account in planning the care and routines of the home. The Fire Safety Officer has visited the home and is satisfied that the home is meeting the Fire Safety Regulations. DS0000070051.V370571.R01.S.doc Version 5.2 Page 27 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 3 x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 2 x 3 DS0000070051.V370571.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement The records of the receipt, administration and disposal of all medicines for the people who use the service must be robust and accurate to demonstrate that all medication is administered as prescribed. Appropriate information relating to medication must be kept, for example, in risk assessments and care plans to ensure that staff know how to use and monitor all medication including “when required” and self administered medication to ensure that all medication is administered safely, correctly and as intended by the prescriber to meet individual health needs. Staff who administer medication must be trained and competent and their practice must ensure that residents receive their medication safely and correctly. Medication must be stored within the temperature range recommended by the manufacturer to ensure that DS0000070051.V370571.R01.S.doc Timescale for action 14/09/08 2 OP9 13(2) 14/09/09 3 OP9 13(2) 14/09/08 4 OP9 13(2) 14/09/09 Version 5.2 Page 29 5 OP30 18(1)(c) medication does not loose potency or become contaminated. The staff-training programme must be developed and must include training on safeguarding and local POVA policies, mandatory health and safety training and dementia care. This is in order to ensure that people are kept safe in the home. 14/11/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP9 OP9 OP9 Good Practice Recommendations To ensure that the policy and procedures for the handling and administration of medicines are updated to include a procedure for all tasks undertaken within the home. All staff administering medication should undergo regular assessments to ensure their ongoing competency to follow the home’s procedures correctly. The fridge temperatures must be monitored on a daily basis using a maximum and minimum thermometer to ensure that the fridge temperature is maintained at between 2 and 8°C. Quality Assurance system now needs further development so that all the services offered by the home can be quality assessed and outcomes for people continually improved. The Provider should submit an application for Registered Manager for the home in order to ensure continuity of management. The Quality Assurance system should be further developed so that all the services offered by the home can be quality assessed and continually improve outcomes for people who live at the home. The general décor of the home would benefit from redecoration and, in some areas, refurbishment. The programme of activities would benefit from being further developed to include trips out for people who wish to go. DS0000070051.V370571.R01.S.doc Version 5.2 Page 30 4. 5. 6 OP33 OP12 OP33 7 8 OP19 OP12 DS0000070051.V370571.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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