Inspection on 21/08/07 for Rowans Care Centre

This inspection was carried out on 21st August 2007.

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 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

Rowans Care Centre 13/12/07

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Rowans Care Centre Merriden Road Macclesfield Cheshire SK10 3AN Lead Inspector June Shimmin Unannounced Inspection 21 and 23 August 2007 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 Rowans Care Centre DS0000069626.V344665.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. Rowans Care Centre DS0000069626.V344665.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rowans Care Centre Address Merriden Road Macclesfield Cheshire SK10 3AN 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) 01625422284 01625427006 Canterbury Care Homes Ltd Care Home 30 Category(ies) of Dementia (5), Old age, not falling within any registration, with number other category (30), Physical disability (10) of places Rowans Care Centre DS0000069626.V344665.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1 The registered person may provide the following category of service only: Care home with nursing: Code N, to people 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 (maximum number of places: 30). Physical disability: Code PD (maximum number of places: 10). Dementia: Code DE (maximum number of places: 5). The maximum number of people who can be accommodated is: 30. Date of last inspection 25th July 2006 Brief Description of the Service: The Rowans Care Centre is in a small residential community on the outskirts of Macclesfield town centre. It is run by Canterbury Care Homes Limited, which took over as the new owner in June 2007. There are local shops within walking distance of the home and a wider range of facilities in the centre of Macclesfield. The home is on a bus route. The home has two floors with a passenger lift and three staircases between them. The central core of the home has 8 single rooms and one double room. There are two separate lounges on the first floor and a dining room on the ground floor. There are two wings to the home, each with ten single bedrooms and a lounge. There is wheelchair access to all parts of the home and a variety of aids and adaptations around the building so that the people who live in the home can move about as independently as possible. There are open gardens to the front and rear of the building. The current weekly fees range from £390 to £600. Further details regarding fees are available from the manager. Rowans Care Centre DS0000069626.V344665.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit took place on the 21 and 23 August 2007 and lasted seven and a half hours. This visit was carried out by one inspector and a pharmacy inspector visited the home on 29 August 2007 as part of the inspection. These visits were just one part of the inspection. Other information received about the home was also looked at. Before the visit the home manager completed a questionnaire to provide up to date information about the Rowans Care Centre. CSCI questionnaires were also given to residents, families, and health and social care professionals such as social workers and doctors to find out their views. During the visit various records and the premises were looked at. A number of people who live at the home and their relatives were spoken with and they gave their views about The Rowans Care Centre. What the service does well: What has improved since the last inspection? What they could do better: Care plans and risk assessments are of a poor standard so people who live at the home are at risk of not receiving all the care they need. There are serious problems with the management of medicines at the home which puts the people who live there at risk of not receiving essential medication. Rowans Care Centre DS0000069626.V344665.R01.S.doc Version 5.2 Page 6 The adult protection policy does not follow current best practice guidelines and staff have not received any training on safeguarding, so people who live at the home may not be adequately protected from possible abuse and harm. The home is not kept as clean as it should be, so the people who live there are at risk of infection. Fire doors must not be wedged open at any time, to make sure there is adequate protection for the people who live and work at the home if there is a fire. Staff need to be given fire training and undertake fire drills so that they know what to do in case of fire. The number of serious problems found during the inspection visits indicates the home is not being run in a way that makes sure the people who live there are safe and well. 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. Rowans Care Centre DS0000069626.V344665.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 Rowans Care Centre DS0000069626.V344665.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 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have their needs assessed before they move in to the home so they know their needs can be met there, although improvements are needed to the assessments to make sure they cover all people’s needs. EVIDENCE: The Rowans Care Centre changed ownership on 21 June 2007. Although there was no written information (service user guide and statement of purpose) available about the home on the first inspection visit, the manager provided a copy of the service users’ guide at the second visit. The guide included relevant information about the home and the manager said that everybody who lives at the home or their representative would be given a copy of this information. Rowans Care Centre DS0000069626.V344665.R01.S.doc Version 5.2 Page 9 A copy of the terms and conditions of living at the home was available and included details about the accommodation as well as the fees and additional services. The manager said that all these would be updated to show the change of ownership of the home. The assessments of two people who had recently moved into the Rowans Care Centre were checked. One person had moved in before the change of ownership, as an emergency. The manager had made a very brief assessment of the person’s needs over the telephone and a social worker’s assessment for this person had been provided. A full assessment of the person’s needs had been carried out after they moved in but this was not dated or signed to show when it had been done. The content of the assessment needed to be more accurate. For instance, the person suffered from hypoglycaemic attacks but this was not recorded under risks. The assessment done for the second person before they moved in lacked detail and did not include information about possible risks. There was a copy of a social worker’s assessment on file and a further assessment had been carried out when the person moved into the home. This lacked detail and social care needs had not been identified although a separate cognitive assessment and information about the care they needed at night were available to help staff provide appropriate care. The home does not provide intermediate care so standard 6 does not apply. Rowans Care Centre DS0000069626.V344665.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. The health and personal care that people receive is not based on their individual needs so they may not receive all the care they need in the way they prefer. EVIDENCE: The care plans of three people living in the home were seen. Several pre-printed care plans had been produced for one person on the day they moved into the home but only dealt with two care needs. One further care plan was not relevant to the person’s needs. There were no care plans for other identified care needs such as diabetes, prevention of pressure sores, nutrition, and communication. The person had a dressing which needed to be renewed and reviewed frequently but the care plan for this was not written until two months after they moved into the home. After that, it had been reviewed regularly. When the person moved into the home, several risk assessments had been done but one for nutrition had not been done until two Rowans Care Centre DS0000069626.V344665.R01.S.doc Version 5.2 Page 11 months after the person had moved in. There was no record of the person’s weight taken when they moved in or since. The manager said that people’s weights were recorded separately but were not linked to a care plan. This person had unstable diabetes but there was no risk assessment for hypoglycaemia. An ambulance had to be called twice in one day because of this problem but there was no care plan for this. The two care plans that were provided had not been reviewed. Staff had signed two risk assessments but there was no record that the care being provided had been evaluated. Records of visits by a doctor were included in the daily records rather than the care files so that it was difficult to track what medical advice had been given and whether it had been followed. The care plan of a person who was identified as being quite underweight was seen. The person’s weight was tending to stay at the same level but no body mass index (BMI) calculation had been done to establish whether the person was very underweight. Pre printed care plans were being used. In some instances these were confusing. For example, a plan for the risk of falls referred to the use of bedrails in the review. Overall this care plan was of an adequate standard. The third care plan was for a person who had moved into the home recently. A brief assessment of care needs was completed when they moved in. However, there was no care plan in place for any of the person’s many care needs. A risk assessment for moving and handling was written on the day the person moved into the home and a risk assessment for the prevention of pressure sores a week later. Neither had been reviewed. Other forms for other risks such as nutrition, falls and behaviour were not completed, although these had been identified as risks when the person moved into the home. Several incidents recorded in the daily records for this person showed that care plans and risk assessments were needed but not provided. A visit by a doctor was lost in the daily records so that it was difficult to check whether advice had been followed up. During a tour of the building it was noticed that several people who had been identified as being at high risk of developing pressure sores were not sitting on chairs with pressure relieving aids. An initial check of the medicines for the people who live at the home identified serious problems so a pharmacist inspector visited the home on 29 August 2007 to inspect the medicines. Canterbury Care’s medicines policies and procedures are in use at the home. These do not explain in detail how to manage residents’ medicines, to be a guide for nurses who may not be familiar with the requirements of the Care Standards Regulations 2000. The inspector and the pharmacist inspector saw the medication records. Although most people had a photograph to identify them a number were Rowans Care Centre DS0000069626.V344665.R01.S.doc Version 5.2 Page 12 missing. The blood sugars of diabetic people were recorded on the MAR chart but there was no link to the care plan or of any actions to be taken. Medicine records did not show the complete audit trail of records of receipt, administration and disposal of medicines. When these records are well kept they can be compared with the amounts of medicines to show that they have been given properly. There were seventy-six unexplained gaps in the records of giving medicines. Three of the people who live at the home had medicines prescribed, such as painkillers, as a variable dose according to need. The actual dose given was not always recorded. This is particularly important with medicines containing paracetamol, to be sure that the maximum daily dose is not exceeded. When medicines are not given, the record shows a list of letters to use to describe why. “F” has no stated reason so that the nurse can include the reason, not one of the standard ones. Sometimes nurses used the “F” code but did not record the explanation. It was not possible to compare records and medicines to show that medicines had been given properly. There was a very large quantity of excess medicines that for many residents represented several months’ supply. The manager said that when medicine orders are done and a note is made that the medicine is not needed, a prescription is still supplied and dispensed. One resident was supplied with two months’ levothyroxine every month. However this was not the usual case. Many of the medicines were prescribed regularly every day and doctors usually prescribed the correct quantity each month. This evidence would suggest that some medicines may not have been given correctly. The method of receiving medication to the Rowans Care Centre from the pharmacy has recently changed so that medication is now stored in the original boxes rather than blister packs. Blister packs have the advantage of only supplying twenty-eight days medicines every four weeks. Five recorded examples were found of people who live at the home not having their medicines to doctors’ directions. Changes had been made to the directions on some of the records with no explanation. The previous directions had been heavily crossed out so it was not possible to see the dose before the change. The medicine for one resident had been out of stock for a week. Other people who live at the home did not have their own supply of laxative syrup and were being given someone else’s. There were a number of medicines that were no longer in use that had not been put to waste. There were also a lot of medicines that had no dispensing label and some that had inappropriate dispensing labels. Some minor points were passed to staff regarding the controlled drugs book. The temperatures of the room and the fridge on the ground floor were being monitored and recorded. The fridge temperatures were above the recommended temperature. A food supplement was not being stored properly Rowans Care Centre DS0000069626.V344665.R01.S.doc Version 5.2 Page 13 to be sure it is fit to use. The facilities were so overstocked and full that medicines were stored on top of high cupboards and staff climbed on to the sink to reach them. Chains were provided to tether the trolleys and secure oxygen cylinders but were not being used. There was also no running cold water in the ground floor medication room so that staff would not be able to use that room to wash their hands properly. Immediate requirements were made to manage medicines safely Rowans Care Centre DS0000069626.V344665.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at the home are helped to take part in a limited range of activities so they can stay stimulated and active. EVIDENCE: A part time activities organiser works at the Rowans Care Centre for 18 hours per week, spread over three days. There is no provision for the rest of the week. The Operations Director for Canterbury Care said that care staff would provide additional support for activities when they had time. There was little or nothing recorded in the care plans about people’s individual social and leisure needs. One relative wrote, “Mum is looked after physically in a better manner now for more of the time but her emotional needs are largely discounted. She needs stimulation/conversation a reason to be up each day but this is proving difficult. The TV seems to be her constant companion.” During the morning there were very few people in the dining room or lounge areas. Staff said that people stayed in their rooms in the morning. Three people said that they preferred to stay in their own room most of the day. The Rowans Care Centre DS0000069626.V344665.R01.S.doc Version 5.2 Page 15 activity coordinator said that her routine was to go to people in their rooms and spend individual time with them. One person said that she enjoyed doing a crossword with the activity coordinator. During the afternoon the activity coordinator organises group activities and a small group of people were playing floor games during the visit. The Rowans Care Centre had recently held a Summer Fair and raised some money for the Residents’ Fund. Staff also organise other events such as tabletop sales to help raise money for activities. Entertainers visit the home usually once a month. A barge trip is planned for later in the year for a small group of people. Birthdays are celebrated. There is a church service held at the home once a month. At lunch just over half the people living in the home were brought down to the dining room. Most of these people were sitting in wheelchairs rather than a dining chair. The manager said that there was a lack of dining chairs in the home. Drinks were served in polystyrene cups rather than in teacups and glasses. There were enough staff available in the dining room to help those who needed it with their food. Assistance was given in an unhurried way and care staff sat at the side of people to help them. One relative commented, “there is no menu so there is no choice of meal.” When the menu board was put up it was not easy for people in the dining room to see. The cook was asked said that people were asked in the morning what their preference was. She said that everyone wanted the main choice and that no one wanted the alternative. One person said that they had not been offered an alternative. The quality and quantity of food provided was good and there were alternatives available for dessert and for the evening meal. Six main meals were taken in an unheated trolley to the first floor for people who were going to eat in their own rooms. By the time some people received their meal it might have been lukewarm and two people taking meals in their rooms said that meals were not always warm enough. Rowans Care Centre DS0000069626.V344665.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 adequate. This judgement has been made using available evidence including a visit to this service. Although the complaints procedure is displayed so that people have information about how to make their concerns known, the adult protection procedure for the home does not follow up to date guidelines so people who live at the home may be at risk of not being adequately safeguarded. EVIDENCE: There is a complaints procedure for the Rowans Care Centre, which is displayed in the main entrance to the home. The manager is taking steps to resolve a complaint that was made recently and will send CSCI a copy of the outcome. Information about the complaints procedure is included in the information leaflet (service user guide) which the manager said would be given to people during the coming weeks. Several relatives commented that they did not know what to do if they had a complaint. Canterbury Care has provided the home with a copy of its policy and procedure for the protection of vulnerable adults. The policy indicates that any allegation received at the home should be investigated rather than making it clear that any allegation must be referred immediately to the local authority adult social services department. The policy also states that any allegations should be recorded as complaints. The manager said that no staff had undertaken recent training in adult protection so that staff may be confused about what to do if Rowans Care Centre DS0000069626.V344665.R01.S.doc Version 5.2 Page 17 an allegation of abuse was made, and people who live in the home may not be adequately safeguarded from abuse and poor practice. Rowans Care Centre DS0000069626.V344665.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): 19 and 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Cleanliness in the home is not well maintained so that people who live there are at risk of infection and do not live in safe, comfortable surroundings. EVIDENCE: On the morning of the first visit to the home, it was found to be in a dirty state with food debris on the floor in the lounge and other communal areas. Chairs and tables were also dirty. Two waste bins were overflowing, one of which was located outside the medication room and the other in the dining room near the kitchen door. Dried blood stains were noted on the wall in the dining room. Three cats were wandering round the dining room and the offices and one cat had an obvious wound to the side its head, as the fur was red. The inspector was later told that the dried blood on the wall was the cat’s. There were also bloodstains and cat hair on one dining chair. The door between the dining Rowans Care Centre DS0000069626.V344665.R01.S.doc Version 5.2 Page 19 room and the kitchen was wedged open and cats were seen jumping up on to window ledges and chairs. The cook said that the cats did not go into the kitchen even though the door was wedged open. During the second visit to the home the dining area and offices were much cleaner and the door to the kitchen was closed. However, when the pharmacy inspector visited on 29 August, the door between the kitchen and the dining room was again wedged open and one cat was seen in the home. There was one cleaner on duty. The manager and the Operations Director were made aware of the problems with cleanliness. The manager confirmed that a cleaner had been unwell for two days and the Operations Director arranged for extra cleaners to come to the home. There was no soap or sanitizer in the staff toilet and the Operations Director said that the previous owners had been in the process of removing hand sanitizers from all parts of the home. The new owners were planning to replace these. The Operations Director for Canterbury Care also said that new laundry trolleys have been provided in the last two months. An environmental health officer was inspecting the home during the CSCI visit and noted a number of problems regarding health and safety in the home. The Operations Director acknowledged that most parts of the home are shabby in appearance and said that Canterbury Care is committed to improving the environment for people living in the home to make it more pleasant and comfortable. For example, they have installed a new nurse call system so that staff will be able to answer calls more promptly. Rowans Care Centre DS0000069626.V344665.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff receive training in order for them to maintain and develop their skills when providing care. Recruitment procedures are not thorough enough to make sure that staff being recruited are suitable to work with the people who live at the home. EVIDENCE: The recruitment records for two staff members and two casual cleaning staff were requested. Very little could be provided as this information was stored at another of the Canterbury Care group homes. However, no further information was provided at visit two days later, as this documentation could not be found. The only available record for one staff member was an enhanced disclosure from the CRB, which was satisfactory. Part of an enhanced disclosure was available for another staff member. The records showed that the staff member started work eight days before a POVA first check on them was received but this was under the previous ownership of the home. However, this occurred during the management of the previous owners. No documentation was available for two casual cleaners provided by another home. The Operations Director said that they did not have an enhanced Rowans Care Centre DS0000069626.V344665.R01.S.doc Version 5.2 Page 21 disclosure from the CRB and that neither would be used to work in the home again. Care staff are well regarded by people living in the home and relatives. Comments were made such as, “Mother is well looked after” and “all staff including non-care staff have always been respectful and caring towards all the residents.” One nurse said that she felt there were enough care staff at the home. However, several people who live there and their relatives commented that they had to wait a long time for call bells to be answered; “ the staff do sometimes take a while to come when you press your buzzer.” Since Canterbury Care has taken over the home, there has been a reduction in the overall cleaning hours provided from 112 hours per week to 58 hours although there has been an increase of 2 and a half hours laundry. The manager said that care staff are not expected to take part in laundry or cleaning. The manager said that more than 50 of care staff have achieved NVQ 2 or above in care and more staff are undertaking this training Rowans Care Centre DS0000069626.V344665.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is not managed in a way that ensures the health and well being of people living at the home. EVIDENCE: Concerns about the management of the Rowans Care Centre were brought to the attention of the manager and the Operations Director of Canterbury Care during and following the site visit. The manager has been in post for just over sixteen months and said that she is hoping to start NVQ level 4 in management in the autumn. The manager has not yet been through the process to become the registered manager of the home as required by law. Rowans Care Centre DS0000069626.V344665.R01.S.doc Version 5.2 Page 23 Meetings have been held for staff in June and July 2007 during the transfer from one organisation to another. The manager said that no meetings had been held for people living in the home or relatives. One relative commented, “I am concerned about the change in ownership but have only received one letter about this”. The Operations Director said that monthly unannounced visits had been made to the home since the change of ownership but neither she nor the manager were able to find the reports by the time of the second visit two days later. The manager said that a quality assurance questionnaire had been sent out to families but the outcome of this survey was not available. The Operations Director said that a survey is to be sent to people living in the home from the new owners of the home to find out their views of the home. The manager said that she carried out audits into a number of care issues in July 2007. Concerns were raised with the manager about fire doors that were wedged open, including the front door of the home, the two office doors and the door between the kitchen and the dining room. This would be a serious hazard in case of an outbreak of fire. The doors were closed after pointing this out to the manager and were also seen to be closed at the second visit two days later. The fire risk assessment for the home was dated 18 February 2005 and has not been updated since so that the manager cannot be sure that effective measures have been put in place to ensure fire safety at the home. A number of staff undertook fire training in 2006 but it was unclear from records which staff had done this. Similarly, the records of fire drills for 2007 did not indicate which staff members had taken part in these drills. This means that some staff may not have undertaken appropriate training on what to do if a fire broke out. There was no record of the last visit from the fire officer and the manager was unsure when this visit took place. Records for moving and handling training done by care staff were also not available in the home. The manager said that only two staff members have not done this training. Information provided by the manager before the inspection visit identified that equipment and installations at the home had been serviced regularly, other than portable electrical appliances. The Operations Director said that these appliances would be checked by the end of September 2007. Rowans Care Centre DS0000069626.V344665.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 1 STAFFING Standard No Score 27 2 28 4 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Rowans Care Centre DS0000069626.V344665.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? N/A STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(1) Requirement All people living in the home must have a care plan which describes how the person’s needs in respect of his/her health and welfare are to be met to make sure that the people who live in the home get the care they need. All people living in the home must have appropriate risk assessments in place so that any risks to them are identified and reduced. Care plans and risk assessments must be kept under review so that people’s changing needs are recorded to show that appropriate action has been taken to make sure that people’s needs are being met appropriately. There must be written procedures to guide staff on how to manage medicines in the home properly to ensure that the people who live in the home receive their medicines safely as prescribed. Accurate records of medicines in DS0000069626.V344665.R01.S.doc Timescale for action 21/11/07 2 OP7 13(4) (b) & (c) 21/11/07 3 OP7 15(2) (a-d) 21/11/07 4 OP9 13(2) 21/11/07 5 OP9 13(2) 23/08/07 Page 26 Rowans Care Centre Version 5.2 6 OP9 13(2) 7 OP9 13(2) 8 OP9 13(2) 9 OP9 13(2) 10 OP9 13(2) 11 OP18 13(6) the home must be kept including a clear audit trail of signed, dated records of receipt, administration or otherwise and disposal of all residents’ medicines to make sure that the medicines are managed safely for all the people who live in the home. Steps must be taken to ensure that medicines are handled correctly, that they are held in a sufficient but not excess quantity and that they are fit for use so that the people who live at the home receive effective medicines as prescribed. Medicines must be stored according to directions on the label to make sure they remain effective. Take action to ensure medicines are kept safely by having appropriate hand washing facilities in the medicine room and ensuring that trolleys and gas cylinders are tethered by the chains provided for security and safety. Staff must always give medicines according to the doctor’s directions to residents that can be identified by a photograph to make sure they are giving the right medicines to the right person as the doctor prescribed. Regular audits of the medicines management at the home must be carried out to make sure that people who live at the home are receiving their medicines as prescribed. The home’s policy and procedure for the protection of vulnerable adults must be amended to reflect the current good practice and the local authority procedures. Staff must receive DS0000069626.V344665.R01.S.doc 23/08/07 07/10/07 07/10/07 23/08/07 23/08/07 21/11/07 Rowans Care Centre Version 5.2 Page 27 12 OP26 13(3) 13 OP27 19 14 OP31 Part 2 Section 2 Care Standards Act 2000 26 15 OP33 guidance about safeguarding adults so they know what to do if an allegation of abuse is made and the people who live at the home are protected from possible harm. The home must be kept clean and hygienic at all times and measures taken to prevent the spread of infection at the home so that people live in clean surroundings and are protected from cross infection. No staff can be employed unless all necessary recruitment documentation and security (CRB) checks have been obtained to make sure they are suitable to work with the people who live at the home. The manager of the home must apply to be registered with the Commission for Social Care Inspection in accordance with the requirements of the Care Standards Act 2000. Monthly visits must be carried out a senior management representative of the company to monitor the way the home is being run. A written report of the findings of the visit should be prepared for the manager and CSCI to show that the company is aware of how the home is being run. 21/11/07 21/11/07 21/11/07 21/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Rowans Care Centre DS0000069626.V344665.R01.S.doc Version 5.2 Page 28 1 OP3 2 3 OP8 OP8 4 5 6 7 8 9 OP12 OP14 OP15 OP20 OP27 OP31 Assessments of people coming to live in the home should include detailed information about the person’s care needs and in particular any identified risks so that these needs are identified on admission. Appropriate pressure relieving aids should be used to prevent people from developing pressure sores. Records of visits from doctors, health and social care professionals should be kept in a way that makes it easy to identify when these happened, what advice was given and what actions were taken to make sure the advice was followed. Care plans should show how the individual social and leisure care needs of people who live at the home will be met. Records should be kept to show that people are given choices in their daily lives, such as what they will eat. Food should be served at appropriate temperatures suitable for the individual needs of people who live in the home. Adequate numbers of dining chairs should be provided so that people are offered a choice of chair to sit in. The number of hours allocated for cleaning should be reviewed so that the home is kept clean and hygienic. The manager should complete NVQ level 4 in management as soon as possible to demonstrate that she has the knowledge and skills to perform her role. Rowans Care Centre DS0000069626.V344665.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT 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. Extracts may not be used or reproduced without the express permission of CSCI Rowans Care Centre DS0000069626.V344665.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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