Inspection on 07/11/06 for Rosemead Care Home

This inspection was carried out on 7th November 2006.

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

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

Other inspections for this house

Rosemead Care Home 28/04/10

Rosemead Care Home 10/08/09

Rosemead Care Home 10/05/07

Rosemead Care Home 14/06/06

Rosemead Care Home 06/09/05

Rosemead Care Home 07/04/05

Rosemead Care Home 29/09/04

Rosemead Care Home 27/04/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Wynthorpe Rest Home, 10-12 Rectory Road Walthamstow London E17 3BQ Lead Inspector Rob Cole Unannounced Inspection 7th November 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Wynthorpe Rest Home, DS0000007217.V318522.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. Wynthorpe Rest Home, DS0000007217.V318522.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wynthorpe Rest Home, Address 10-12 Rectory Road Walthamstow London E17 3BQ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8520 6027 020 8520 6027 Mr Saeed Ahmed *** Post Vacant *** Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (14) of places Wynthorpe Rest Home, DS0000007217.V318522.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th June 2006 Brief Description of the Service: Wynthorpe Rest Home is registered to provide support and accommodation to fourteen service users over the age of sixty five. The home is situated in a residential area of Walthamstow in the London Borough of Waltham Forest, and is close to shops, transport links and other local amenities. The home consists of two houses that have been converted in to one, and is built over two floors. The home is privately run. Wynthorpe Rest Home, DS0000007217.V318522.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on the 7/11/06 and was unannounced. Inspectors had the opportunity of speaking with service users, staff from the home, and the home’s acting manager was present throughout most of the inspection. The inspection also included a tour of the premises, and an examination of records and other documents in the home. Overall, the inspector has serious concerns about the level of care and support provided within the home. A relatively high number of requirements have been made, (thirty nine, along with two good practice recommendations). The home has a considerable amount of work to do before it is fully compliant with National Minimum Standards and the Care Home Regulations 2001. Two areas are of such concern, medication and adult protection, that the CSCI is taking out Enforcement action against the home. What the service does well: What has improved since the last inspection? What they could do better: As stated, there is much that needs to be done. Areas of particular concern include the storage, recording and administration of medications, lack of staff understanding around adult protection issues, lack of staff supervision and health and safety training, poor standard of risk assessments, the quality of the food and the lack of social and leisure activities offered to service users. Wynthorpe Rest Home, DS0000007217.V318522.R01.S.doc Version 5.2 Page 6 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. Wynthorpe Rest Home, DS0000007217.V318522.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Wynthorpe Rest Home, DS0000007217.V318522.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 4. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. It was of concern that some previously repeated requirements remained unmet. The home currently accommodates service users with diagnoses not included on its registration and this must be remedied. EVIDENCE: The Statement of Purpose presented for inspection evidenced no amendments since the previous inspection when it was required that alterations were made to reflect the correct categories of registration and dated. Failure on the part of the registered provider to amend the document within the timescale given in this report will result in further action being taken. A Service User’s Guide of acceptable quality was available for inspection, however neither the most recent CSCI inspection report nor the views of existing service users were included or available. In order to comply with Minimum Standards and Regulations, a copy of the current CSCI report must be available at the home, and it is suggested that the views of service users Wynthorpe Rest Home, DS0000007217.V318522.R01.S.doc Version 5.2 Page 9 are added when the Service Users Guide is revised to include the qualifications and experience of the Registered Manager – when the post holder has been appointed. A random sample of contracts, terms and conditions were reviewed. These were of a satisfactory standard, signed and dated. No new admissions had been made to the home since the last inspection. At the time of inspection the home accommodated service users with diagnoses inconsistent with the category of registration. This is contrary to Regulations and the registered provider has been required to take action to regularise this situation. There was evidence that some basic needs of service users were being met in the home. However, the quality and frequency of assessments was not conducive to ensuring that all needs were fully met. Where assessments had been undertaken, there was a lack of appropriate response; for example where service users had been diagnosed with dementia care plans had not reflected this in terms of provision of appropriate activities and staff had not received training to equip them to support these. Observations were made of both satisfactory and inappropriate interactions between staff and service users. Current best practice in dementia care was not being implemented and as such service users received substandard care. The home was therefore not able to demonstrate capacity to meet the needs of those accommodated. Intermediate care is not provided in the home. Wynthorpe Rest Home, DS0000007217.V318522.R01.S.doc Version 5.2 Page 10 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): 7, 8, 9, and 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans were not accurate and reflective of assessed needs. Significant concerns were raised regarding errors and omissions in the administration and recording of medication. Enforcement action will be taken to protect service users from harm. EVIDENCE: Care plans, whilst present showed a lack of reference to assessments that were available on service users files. As previously described, those service users with a diagnosis of dementia did not have care plans reflecting their specialist needs, and necessary actions for staff delivering their care. This demonstrates a failure to take account of the needs of service users. There was evidence that care plans had been reviewed since the last inspection but the review process for all plans sampled included only re-dating the document with no amendment or development of the care plan itself. In some cases material changes had occurred between reviews and these had not been recorded or otherwise influenced the updated care plan. Evidence from daily records – for example – showed that one service user’s mobility had Wynthorpe Rest Home, DS0000007217.V318522.R01.S.doc Version 5.2 Page 11 deteriorated since the last inspection, however the care plan was unaltered during this period. Another service user’s care plan identified that her hearing was assisted by a hearing aid, however this was found in the medication cabinet and the inspector was advised that for several months the service user had refused to wear it. The requirement made at the last inspection, for care plans to be reviewed, is therefore repeated with the expectation that review comprises an assessment of changing needs and appropriately recorded actions where these have been identified. There appeared no improvement in the quality or range of risk assessments inspected and neither did care plans provide sufficient information regarding activities or interests of service users, and how or when these were taking place. Much work is required in order for care plans to become an accurate working tool providing the basis for provision of appropriate care and evidence that this is being delivered. It was positively noted that annual reviews for service users had (with the exception of one) taken place. In order to maintain satisfactory performance on this matter it was suggested that where a placing authority had not instigated the annual review in a timely manner, the registered person should formally invite that authority to attend an in-home review with adequate notice to facilitate attendance by a reviewing officer. The policy and procedure for the handling of medication was sufficient, however a policy and procedure for the administration of ‘as required’ medication could not be presented to satisfy a previous requirement made. This is unacceptable. It was also noted that the policy and procedure on ‘homely remedies’ did not make mention of the necessity to record administration of these ‘over the counter’ medications on a service users MAR chart to prevent misadministration. Some staff with responsibility for medication administration were unaware that the MAR sheet provided for such recording on its reverse. Healthcare and medication were reviewed. Records relating to healthcare, notably the recording of appointments, had considerably improved since the last inspection. Records were available to describe the reason for, outcome of, and - to some extent - follow up actions taken as a result of medical, dental, opticians and other appointments. In one serious case there was a lack of follow up, the outcome being a failure to evidence that important prescribed medications had been administered. Inspection of medication found that it was stored insecurely – the key to the insubstantial padlock being routinely kept on a nail in the wall immediately adjacent to the medication cabinet. Wynthorpe Rest Home, DS0000007217.V318522.R01.S.doc Version 5.2 Page 12 As this home is responsible for administering all service users medication, it was very concerning that for every case randomly sampled, errors in recording, supply, storage or administration were found. In respect of one service user a repeat prescription had not been sent on time so for three consecutive days a remark had been made on the MAR chart to state “waiting on stock”. For the same service user a further medication had not been signed as administered. For another service user an ‘as required’ medication was being routinely signed by staff as ‘refused’ – a remark only relevant for medication prescribed to be given at frequencies stated. For another service user prescribed medication to be given at stated frequencies had been signed as refused for the seven days prior to the inspection. There was no record on the service users care plan or any other record produced to evidence that medical advice had been sought. Whilst staff appreciated that it was the right of service users to refuse medication, their duty of care to refer occasions of repeated refusal to a medical practitioner was less well understood. Audit of medication stock was not always possible due to multiple supplies being held, and a failure to maintain an accurate record of balances. This was especially the case where medication was not blister packed in the Monitored Dosage System – where greater attention to detail is demanded. Additionally, over a period of less than two weeks for all service users there were more than ten instances of gaps in recording to confirm that staff had administered prescribed medication. Evidence was observed to suggest that service users are treated with respect and privacy preserved. Wynthorpe Rest Home, DS0000007217.V318522.R01.S.doc Version 5.2 Page 13 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): 12,13,14 and 15. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. It is the view of the inspector that the home needs to be doing far more to ensure that service users are supported to live valued and fulfilling lives. The home must offer a range of social and leisure actives, and the quality of food provided must improve. EVIDENCE: The homes Statement of Purpose states that the home will provide activities such as painting, bingo, card games, board games, arts and crafts, group activities and invite outside entertainers to perform musical songs and variety shows. The inspector was disappointed to note that there was no evidence to suggest that any of these activities has taken place recently. The homes acting manager had been in post for six weeks at the time of the inspection, and informed the inspector that they were not aware of any social and leisure activities taking place in that time. Daily records also indicated that there was no programme of activities in place. Records further indicated that service Wynthorpe Rest Home, DS0000007217.V318522.R01.S.doc Version 5.2 Page 14 users have had no recent access to the community, other then attending medical appointments. During the course of the inspection, staffing levels were such that staff had little opportunity for any meaningful social interaction with service users. For example, between 3pm and 10pm there were only two staff on duty. They had responsibility for preparing food, carrying out any domestic duties that needed to be done such as cleaning; administering medications, completing paperwork, dealing with any visitors and phone calls and supporting service users with personal care. It is required that service users are supported to participate in a variety of social and leisure activities, that are in line with their stated preferences and assessed needs. The home has a visitor’s policy in place, this states that visitors are welcome at any reasonable time. Service users spoken to informed the inspector that their relatives are indeed welcome, and they can see them in private. Service users have access to a telephone they can use in private if they so wish. The home does not hold service user meetings, it is recommended that they do so, and there was little evidence that service users have much say over the day to day running of the home. Further, service users informed the inspector that they did not always have control over their daily lives, for example the menu was the same every week, and where there were changes to the menu, these were decided by staff rather then service users. Although there was evidence that service users could go to bed at a time of their choosing, this was not always the case for when they got up in a morning. The acting manager in formed the inspector that the expectation was that the night staff would support three service users to get up, to ease the pressure of the workload on the early shift, and one service user informed the inspector that they were sometimes asked to get up before they wanted to. It is required that service users have as much control over their daily lives as possible. It is further required that service users are supported to be involved in the day to day running of the home as much as possible, and that this involvement is clearly recorded. The home has produced a weekly menu plan, this is repeated week after week. Throughout the week it included tinned meatballs, frozen fish, frozen pies and frozen beef burgers. The only day there was any fresh meat or fish was on a Sunday when the home had a traditional Sunday roast. Most of the vegetables used throughout the week were also frozen. Staff informed the inspector that fresh fruit was purchased once a week on a Wednesday, and that this was well liked by service users, but that it usually ran out by Sunday. Indeed, there was no fresh fruit available in the home on the day of inspection. Although service users spoken to informed the inspector that they are satisfied with the quantity of food provided, two service users said that the quality of food was not very good. It is required that service users are offered a varied, balanced and Wynthorpe Rest Home, DS0000007217.V318522.R01.S.doc Version 5.2 Page 15 nutritious diet. It is further required that fresh fruit is readily available throughout the week to all service users. The kitchen was clean and tidy, and food was stored appropriately. One of the cupboard doors in the kitchen was missing, and this must be replaced. Since the last inspection the home now tests and records the temperatures of all fridges and freezers in the homes used for food storage. However, the member of staff who prepared the main meal on the day of inspection informed the inspector that they had not undertaken any training in food hygiene. The acting manager informed the inspector that several members of the staff team had not undertaken this training, yet most of them were routinely expected to be involved in food preparation. It is required that any staff involved in food preparation within the home receive appropriate food hygiene training. Wynthorpe Rest Home, DS0000007217.V318522.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. It is the judgement of the inspector that service users are currently been placed at unnecessary risk of abuse in the home by poor practices and systems, and lack of staff training around adult protection issues. EVIDENCE: Since the previous inspection the home now has a complaints log in place, which evidenced that complaints have been appropriately recorded. The home also has a complaints procedure, which included timescales for responding to any complaints received. This was on display with the home. However, the contact details for both the homes manager and the CSCI were out of date, and this must be addressed. The home has a copy of the Local Authorities adult protection procedure, and also its own policy on adult protection. However, this was not in line with current legislation, for example it does not make clear the homes responsibility for reporting any suspicions of abuse to the host Local Authority. This must be addressed. Wynthorpe Rest Home, DS0000007217.V318522.R01.S.doc Version 5.2 Page 17 Staff spoken to on the day of inspection, including the homes acting manager, demonstrated only a very limited understanding of their roles and responsibilities with regard to adult protection issues. The inspector was very disappointed to note that this is the fifth successive inspection where there were concerns over staff’s understanding of adult protection issues, going back over a period of in excess of two years. Consequently the CSCI will be taking enforcement action against the home to ensure that they comply with the Care Homes Regulations 2001, in that all staff who work in the home must receive appropriate training in adult protection, and that they all must have a good understanding of their roles and responsibilities with regard to adult protection issues. Wynthorpe Rest Home, DS0000007217.V318522.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst the home is barely adequate in this outcome area, a number of material decorative and cleaning actions are needed in order for the home to meet standards to be able to admit further service users. Service users must be afforded full and free access to the grounds if desired. EVIDENCE: A comprehensive tour of the premises was conducted as part of this inspection. Externally the home was of a satisfactory standard, though discarded soft furnishings in various states of decay should be removed from the area to the side of the premises where this overlooked by service users rooms and neighbours. The pleasant garden to the rear of the home was of a size and layout appropriate to service users needs. Some patio furniture and benches were in place, though it was noted that access to the garden was restricted by the introduction of a bolt to the rear door. This effectively put the garden out of bounds to service users, contrary to a written policy available in the home, and contrary to the known wishes of service users. The registered provider should enable free movement of service users around the home – including the garden. Wynthorpe Rest Home, DS0000007217.V318522.R01.S.doc Version 5.2 Page 19 A number of health and safety issues were highlighted during the inspection; chemicals were left unsecured in the garden, under the kitchen sink, in the lean-to outside the kitchen and in the specified unlocked COSHH cupboard in the laundry (itself unlocked and unattended at the time of inspection) – all places easily or potentially accessible to service users. Lighting levels throughout the home were very poor indeed. Staff working areas; office, kitchen and laundry were dim and posed risk of eye-strain or injury. Common areas (hallways, corridors, bathrooms and lounges) were similarly poorly illuminated where blown bulbs had not been replaced – the entrance hall had no functioning light so visitors were received in darkness. In other rooms bulbs fitted were of insufficient intensity - one bathroom was so dark with the light on that proper observation of the skin condition of a service user whilst bathing would have been impossible. The risk of accidents in this environment was greatly enhanced by inappropriate lighting levels. From a fire safety perspective, several doors clearly marked “fire door - keep shut” were propped open throughout the inspection with unapproved devices such as black bags of clothing, walking frames and fire extinguishers. Other fire resisting doors did not close fully into their frames. Awareness raising and action is required to reduce the hazards posed failure to use systems designed to protect people in the event of fire. During the course of the inspection inspectors covertly activated the nurse call system to test response times. A call was activated in a single toilet, the door was then locked from outside with the privacy lock. For the first five minutes there was no audible alarm. When the alarm became audible after five minutes it was remotely cancelled by a member of staff. At this time a senior staff member had reported that they thought a service user was in the toilet and had activated the alarm. The senior staff knocked on the door and having received no response went about dealing with a delivery at the front door. The door was not opened until 16 minutes after the call had been activated. This is unacceptable and leaves service users unprotected and vulnerable. Two lounges were provided, one to the front, with a television and another to the rear, in a conservatory extension. It was noted that some new chairs had been purchased since the last inspection. This drew further attention to those others that were now in need of replacement where they had become scratched and their covers torn in places. It was positively noted that orientation boards were present in the home – although the inspector pointed out that the dates were not correct on the day of inspection. Several vacant service users rooms inspected did not meet standards appropriate for occupation. A bedroom being used for general storage at the time of inspection had curtains 30cms short of the windowsill. In another vacant room a radiator cover had been installed and fixed on top of a service Wynthorpe Rest Home, DS0000007217.V318522.R01.S.doc Version 5.2 Page 20 users slipper, the carpet in this room was dirty, furniture was broken and a prevailing odour of urine was present. The standard of decoration in further rooms made them unsuitable for new admissions and it is expected that these would not be offered to potential service users until they have been fully redecorated and furnishings made good. Wynthorpe Rest Home, DS0000007217.V318522.R01.S.doc Version 5.2 Page 21 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): 27,28,29 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. It is the inspector’s view that service users would benefit from having a well trained and supervised staff team in place. Further, the inspector believes that improved staffing levels would give staff more opportunity for positive interactions with service users. EVIDENCE: The home provides 24-hour care, including an emergency on-call system. There was a staffing rota on display within the home. Whilst this accurately reflected the actual staffing situation on the day of inspection, it did not indicate who was in charge of the home at any given time, and this must be addressed. Current staffing levels are three staff on duty from 8am to 3pm, this includes two care staff and the homes acting manager, who is expected to carry out their administrative duties as well as care duties. Two staff on duty from 3pm to 10pm and one waking and one sleeping night staff between 10pm and 8am. Although the home is registered for fourteen service users, at the time of the inspection there were only eight service users living at the home. The inspector Wynthorpe Rest Home, DS0000007217.V318522.R01.S.doc Version 5.2 Page 22 therefore was satisfied that current staffing levels do not present a safety risk to service users. However, the inspector does have concerns that staffing levels are of a level that they severely limit staff’s opportunity for meaningful social interaction with service users. This is reflected in the fact that over recent weeks there was no evidence of any social and leisure activities been provided for service users. It is required that the home carries out a review of staffing levels to determine how the home can meet the all the assessed needs of service users at all times. The homes policies state that all staff will undertake a structured induction on commencing work at the home. However, training records indicated that as at the last inspection this is still not happening for all staff. Indeed, the acting manager informed the inspector that they did receive any induction training, and a repeat requirement has consequently been set around this issue in this report. The inspector has serious concerns about the level of training available to staff. As already stated, staff have not received any training around adult protection, despite several previous requirements been made. The inspector was very disappointed to note that staff are not routinely receiving statutory health and safety training, including moving and handling, fire safety, food hygiene and first aid. It is required that all staff receive all statutory health and safety training as required. Several of the current service users have a diagnosis of dementia, yet none of the staff team have undertaken any training around this, and this too must be arranged. Of the nine care staff employed at the home, only three have achieved a relevant care qualification. It is required that at least 50 of the care staff employed at the home have an NVQ Level 2 in Care or equivalent qualification. The home had policies in place around equal opportunities and recruitment and selection. The recruitment policy stated that where practical any staff recruitment interviews should be carried out by at least two people. However, the acting manager informed the inspector that they were just interviewed by the proprietor. In the interests of good practice with regard to equal opportunities it is a repeat recommendation that staff recruitment interviews are carried out by at least two persons. The inspector checked staff employment files. These were found to contain proof of ID, including passports and birth certificates, and employment references. However, although there was evidence of a CRB in place for all staff, for two staff these were CRB’s from a previous employer, and the home had not undertaken its own CRB checks for these staff. It is required that the home carries out CRB checks for all staff working at the home. Wynthorpe Rest Home, DS0000007217.V318522.R01.S.doc Version 5.2 Page 23 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): 31,32,33,34,35,36,37 and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. It is the view of the inspector that the home would benefit from the appointment of a suitably qualified and experienced permanent manager who is registered with the CSCI. This would help improve current poor practices, for example around lack of staff supervision and the management of service users finances. EVIDENCE: The home currently has an acting manager in place. They had been in place for six weeks at the time of the inspection, and they informed the inspector that Wynthorpe Rest Home, DS0000007217.V318522.R01.S.doc Version 5.2 Page 24 they are currently on a probationary period. It was noted that they are the fourth person this calendar year to be employed as either the manager or the acting manager. It is a repeat requirement that the home appoints a permanent manager, who is registered with the CSCI. Staff and service users spoken to on the day of inspection informed the inspector that they found the manager to be approachable and accessible. The inspector was pleased to note that since the previous inspection, regular Regulation 26 visits are now carried out in the home, and forwarded to the CSCI. However, the most recent report that was in the home was from July 2006, and it is required that copies of Regulation 26 reports are kept in the home. There was a poor standard of record keeping generally in the home. Many records required were not maintained, or were not kept up to date, for example care plan reviews, hot water temperatures and the Statement of Purpose. It is required that the home maintains all records required by the National Minimum Standards and the Care Homes Regulations 2001, and that these are kept up to date. The only money held in the home was the petty cash. This is stored in a locked cabinet inside the office. However, this was used to purchase items for individual service users as well as general household goods like food and cleaning products. The acting manager informed the inspector that the homes proprietor would periodically leave money in the home as petty cash. When service users needed money, for instance for toiletries or a mini cab, this was paid for from the petty cash. Although records were kept of any monies spent, they did not indicate on whose behalf the money was spent. It was impossible to check from the records available how much money service users received, how much they had in any savings, how much they spent individually and what they spent their money on. Any monies that they do receive and have in savings is administered by the homes proprietor. It is required that clear individual records are maintained of each service users financial records, which include details of any money they receive, any monies the home holds on their behalf, any monies they spend, and what it is spent on. This is essential to help ensure that service users are not at risk from financial abuse. Staff spoken to on the day of inspection informed the inspector that they had not received any formal one to one supervision since the last registered manager left the home in March of this year, and records indicated that this was also the case for other staff not spoken to by the inspector. The acting manager informed the inspector that they intended to put in place a system of regular monthly formal supervision for all staff in the home, and it is a requirement that staff receive regular formal supervision. Fire extinguishers were situated around the home, these were last serviced in August 2006. The homes fire alarm system was last serviced on the 13/10/06. However, the home’s fire alarms had not been tested since the29/9/06, and it is required that they are tested at least weekly. Further, there was no evidence Wynthorpe Rest Home, DS0000007217.V318522.R01.S.doc Version 5.2 Page 25 that any fire drill had been carried out in the past year, and it is required that these are done at least once every three months. Hot water temperatures have been checked, but only sporadically, since the last inspection, and it is required that these are tested at least once a week. The home had in date certificates for gas safety, PAT testing and electrical installation. The home had in date employer’s liability insurance cover in place. During the course of the inspection, staff at the home informed the inspector that there had recently been an outbreak of scabies in the home. The home did not notify the CSCI of this, and it is required that the home notifies the CSCI of any significant events within the home, including the outbreak of any infectious diseases. Wynthorpe Rest Home, DS0000007217.V318522.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 X 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 1 3 3 3 3 2 2 STAFFING Standard No Score 27 2 28 2 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X 1 1 2 2 Wynthorpe Rest Home, DS0000007217.V318522.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP8 Regulation 13 Requirement The registered person must ensure that medical advice is sought whenever a material change in circumstances of service users is identified (including the refusal of prescribed medication for extended periods). The registered person must ensure that all documentation required by Schedule 2 of the Care Homes Regulations 2001 is in place for all staff working in the home. (Timescale 30/09/06 not met) The registered person must ensure that the home tests and records on a weekly basis all hot water temperatures used for personal care to ensure they do not exceed 43 degrees Celsius. (Timescale 30/09/06 not met) The registered person must ensure that risk assessments are undertaken for safe working practices and for service users undertaking any activities that involve risk taking. The risk assessments must be placed on DS0000007217.V318522.R01.S.doc Timescale for action 23/01/07 2. OP29 19 31/12/06 3. OP38 13 30/11/06 4. OP7 13 31/01/07 Wynthorpe Rest Home, Version 5.2 Page 28 5. OP9 13 6. OP9 13 7. OP9 13 8. OP12 16 9. OP30 13 10. OP36 18 11. OP1 4 and 6 service users files and be subject to regular review. (Timescales of 31/12/05 and 30/09/06 not met) The registered person must ensure that records are maintained of all medications that are returned to the pharmacist. (Timescales of 31/12/05 and 30/09/06 not met) The registered person must ensure that MAR charts are accurately maintained, and that all medications administered are accounted for. (Timescales 31/12/05 and 30/09/06 not met) The registered person must ensure that written guidelines are in place for the administration of all medications prescribed on an as required basis. (Timescales of 31/12/05 and 30/09/06 not met) The registered person must ensure that the home provides appropriate social and leisure activities in line with service users assessed needs and stated preferences. (Timescale 30/09/06 not met) The registered person must ensure that all staff receive statutory health and safety training in moving and handling, first aid and food hygiene. (Timescale 30/09/06 not met) The registered person must ensure that staff receive regular formal supervision, at least six times a year. (Timescale 30/09/06 not met) The registered person must ensure that the homes Statement of Purpose is in line with National Minimum Standards and the Care Homes Regulations 2001, and that it is dated and subject to regular review. (Previous timescale DS0000007217.V318522.R01.S.doc 23/01/07 23/01/07 23/01/07 31/12/06 31/01/07 31/12/06 31/01/07 Wynthorpe Rest Home, Version 5.2 Page 29 12. OP7 15 13. OP8 13 14. OP19 23 15. OP18 13 16. OP19 23 17. OP19 23 18. OP28 18 19. OP30 18 30/09/06 not met) The registered person must ensure that all care plans – reflective of assessed needs are subject to regular review, at least once a month (Previous timescale 30/09/06 not met) The registered person must ensure that comprehensive records are maintained of all service users medical appointments, including details of any follow up action required (Previous timescale 30/09/06 not met). The registered person must ensure that service users have free and unrestricted movement around the home, including the garden. The registered person must ensure that the home has its own policy and procedure on adult protection, and that this is in line with current legislation. (Timescale 30/09/06 not met) The registered person must ensure that the homes grounds and gardens are well maintained (Timescale 30/09/06 not met). The registered person must ensure that marked fire doors are not left wedged or propped open. The registered person must ensure that at least 50 of the care staff employed at the home have obtained a relevant care qualification. (Timescale 30/09/06 not met) The registered person must ensure that all staff undertake a structured induction training programme on commencing work at the home, in line with the homes policies and procedures. (Timescale 30/09/06 not met) DS0000007217.V318522.R01.S.doc 28/02/07 31/01/07 31/12/06 31/12/06 31/01/07 31/12/06 31/01/07 31/12/06 Wynthorpe Rest Home, Version 5.2 Page 30 20. OP30 18 21. OP31 8 22. OP37 17 23. OP38 13 and 23 24. OP7 15 25. OP14 12 26. OP15 16 27. OP15 23 28. OP16 22 The registered person must ensure that all care staff who work in the home undertake appropriate training on working with older persons. (Timescale 30/09/06 not met) The registered person must appoint a permanent manager to the home, and apply for their registration with the CSCI. (Timescale 30/09/06 not met) The registered person must ensure that the home maintains all necessary records, policies and procedures, as required by the National Minimum Standards and the Care Homes Regulations 2001. (Timescale 30/09/06 not met) The registered person must ensure that the homes fire alarms are tested at least once a week. (Timescale 30/09/06 not met) The registered person must ensure that all service users placed by a Local Authority, have a review meeting at least annually in conjunction with that Local Authority (Timescale 30/09/06 not met) The registered person must ensure that service users have control and choice in their everyday lives, for example when to get up and what to eat etc. The registered person must ensure that service users are provided with a varied, balanced and nutritious diet, and that fresh fruit is readily available to service users on a daily basis. The registered person must ensure that the missing cupboard door in the kitchen is replaced. The registered person must DS0000007217.V318522.R01.S.doc 31/01/07 31/12/06 31/12/06 30/11/06 31/01/07 30/11/06 30/11/06 31/01/07 30/11/06 Page 31 Wynthorpe Rest Home, Version 5.2 29. OP27 18 30. OP33 26 31. OP35 13 32. OP35 13 33. OP38 13 and 23 34. OP20 23 35. OP20 23 36. OP26 23 37. 38. OP38 OP18 13 13 and 18 ensure that the homes complaints procedure contains accurate contact details for the homes manager and the CSCI. The registered person must carry out a review of staffing levels to determine how the home can meet the assessed needs of service users at all times. The registered person must ensure that copies of all Regulation 26 reports are maintained within the home. The registered person must ensure that clear systems are in place to demonstrate how much money individual service users receive, how much they have in savings, and what their personal individual money is spent on. The registered person must ensure that service users receive any income generated from their personal savings, and that the home is able to demonstrate this with clear records. The registered person must ensure that the home carries out regular fire drills, at least once every three months. The registered person must ensure that the home is appropriately and sufficiently lit in all areas. The registered person must ensure that all furniture in communal areas is of a good quality, and fit for purpose. The registered person must ensure that all bedrooms are clean, and free from offensive odour. The registered person must ensure that all COSHH products are stored securely. The registered person must ensure that all staff working in the home undertake appropriate DS0000007217.V318522.R01.S.doc 31/12/06 30/11/06 30/11/06 30/11/06 30/11/06 31/12/06 31/01/07 31/12/06 31/12/06 31/01/07 Wynthorpe Rest Home, Version 5.2 Page 32 39. OP38 37 training in adult protection issues, and that all staff have a good understanding of their roles and responsibilities with regard to adult protection. The registered person must 31/12/06 ensure that the CSCI is notified of any significant events within the home, including the outbreak of any infectious diseases. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP29 OP14 Good Practice Recommendations It is recommended that all recruitment interviews are carried out by at least two persons, in line with good practice as regards equal opportunities. It is recommended that the home holds regular service user meetings. Wynthorpe Rest Home, DS0000007217.V318522.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection East London Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU 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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