Inspection on 13/02/07 for Royal Court

This inspection was carried out on 13th February 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Royal Court 28/09/09

Royal Court 07/10/08

Royal Court 25/09/07

Royal Court 15/05/06

Royal Court 02/02/06

Royal Court 16/06/05

Royal Court 23/11/04

Royal Court 19/05/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Royal Court Rock Mount King Street Hoyland Barnsley South Yorkshire S74 9RP Lead Inspector Mrs Jayne White Key Unannounced Inspection 09:30 13th February 2007 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 Royal Court DS0000006497.V324994.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. Royal Court DS0000006497.V324994.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Royal Court Address Rock Mount King Street Hoyland Barnsley South Yorkshire S74 9RP 01226 741986 01226 741986 admin@royal-court.net None Healthmade Limited 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) Post Vacant Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Royal Court DS0000006497.V324994.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The total persons who can be accommodated at the home cannot exceed 40 Persons accommodated shall be aged 60 years and above Staffing levels will be determined using the Residential forum for Care Staffing in Care Homes for Older People. 15th May 2006 Date of last inspection Brief Description of the Service: Royal Court is a care home providing personal care and accommodation for 40 older people. The homes registered owner is Healthmade Limited. It is a purpose built single storey building with an enclosed garden. All bedrooms are for single occupancy and have en-suite facilities. There are carparking facilities at the front of the building. Royal Court is located in Hoyland within the Barnsley area and is close to the shopping centre and a doctor’s surgery. Written information about the home is kept in the office. This includes the statement of purpose and the guide for service users that includes the range of fees and a sample contract/terms and conditions. The most recent inspection report from CSCI was on display in the entrance hall. The owner, prior to the inspection, gave written information to CSCI. This stated that fees were between £327.50 and £360.00 with extra charges for hairdressing and chiropody (if the community chiropodist wasn’t used). Royal Court DS0000006497.V324994.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place between the hours of 9:30 and 19:30. The inspectors Jayne White and Andrea Leverett visited without giving any notice. A meeting had been held with two of the owners and the CSCI on 5 February 2007, with CSCI identifying areas of the service where improvements must be made. Before the inspection questionnaires were sent to a range of people, asking them about the home. Five came back from residents, two from GP’s, twelve from relatives and none from staff. During the inspection, parts of the building were inspected, the inspectors read some records, observed care practices and talked to residents, one relative, three members of staff and one health care professional. The owners were present during the inspection. Also taken into account was other information received by CSCI about the service since the last inspection. The inspector wishes to thank the residents, staff and owners for their time and co-operation throughout the inspection process. What the service does well: The manager holds an appropriate qualification to manage the home. Residents and their relatives felt the information they received prior to moving into the home was sufficient for them to decide whether the place was right for them. They said “my brother and I were shown round the home with one of the senior cares” and “checked with inspection visit on internet. Looked at the home and its facilities on the Internet. Had two visits to Royal Court”. Residents, relatives, GP’s and health professionals were asked their opinion of the service. Positive comments included “good care given to residents”, “staff always willing to help and support when needed”, “mum looks really well and always looks nice when I visit her. She is really well cared for”, “my father is a very impatient person who always wants to do things his way and in his time. He can be very challenging. Royal Court staff cope very well with his demands”, “since moving to the home we have noticed a definite difference in close contact care and support, this being a much happier environment”, “the home and residents are always kept clean and there is a cheerful atmosphere (music playing etc)”, “the care my mother received on returning from hospital Royal Court DS0000006497.V324994.R01.S.doc Version 5.2 Page 6 was first rate”, “they look after my mother with more skill and patience than the family could”, “they keep the residents clean and warm”, “I have received more medical support since being in Royal Court”, “she’s watered and fed”, “he was well cared for, well fed and as happy as he could be”, “got a high standard which is transparent within a few minutes of entering the building”, “we are well looked after, very well and carers are very kind”. Residents and their relatives said “the staff on the whole appear to have skills to look after people”, “kind hearted and friendly towards residents, very approachable and carry out tasks that are quite often thankless”, “friendly staff”, “the care staff have a generous knowledge of resident’s well being” and “the staff are available when it is possible for them to be available. We have never had to wait for more than a few minutes. This is because of the time of our visit. We are very satisfied with the staff response”, “the manager is approachable and knowledgeable of any particular resident”. Residents maintained contact with family and friends and members of the local community as they wished. Policies and procedures to protect people who use the service from abuse were in place. Staff could describe the procedures they would follow should an allegation of abuse be made. Systems were in place to deal with monies/valuables held by the home on behalf of residents’ that safeguarded residents’ financial interests. What has improved since the last inspection? What they could do better: Royal Court DS0000006497.V324994.R01.S.doc Version 5.2 Page 7 The manager needs to demonstrate effective leadership and management skills to ensure a good quality of care is provided for residents. This needs to include open and transparent communication with residents, relatives and other stakeholders of the service through an effective quality assurance and monitoring system. Include in individual contracts/terms and conditions information about the total fee to be charged and who is responsible for paying different parts of that fee if a resident is being funded, in whole or in part, by another person, other than the resident. The contract/terms and conditions also needs to include a description of the standard services offered to residents and where this might be different if the resident is being funded, in whole or in part, by a person other than the resident. The arrangements in place for charging and paying for any services additional to those offered as standard must also be identified. A template of the contract/terms and conditions needs then to be included in the guide for service users. The contract/terms and conditions/information included in the guide for service users must identify the range of fees to be charged and whether this might be different if a resident’s care is being funded, in whole or in part, by a person other than the resident. Ensure appropriate mental health assessments are completed prior to residents’ moving into the home. Involve specialist services to ensure the mental health needs of residents are being met and document this clearly in their plan of care. This also needs to include their mental capacity to make decisions. Ensure care records provide an audit trail of the care provided and that this gives a full picture of what happens before an accident/incident, what was found at the time of the accident/incident and what happened after the accident/incident. Provide monitoring of these accidents/incidents so that where necessary action can be taken to prevent a further occurrence and/or reduce the number of occurrences. Detail in the plan of care the action to be taken by staff to meet the needs of those residents with pressure areas and ensure records demonstrate this care is provided. Ensure that when residents wear hearing aids they are working in order, so that they are able to communicate. Systems must improve so that laundry does not go missing or get lost, so that residents are able to wear their own clothes, promoting respect and dignity for them. There needs to be a more open and transparent communication channel between the home, residents, relatives and health professionals so that information about the residents can be shared and acted upon by those involved in their care to improve the quality of life for the resident. This Royal Court DS0000006497.V324994.R01.S.doc Version 5.2 Page 8 includes taking action to resolve any concerns raised to reduce the likelihood of the same complaint reoccurring. Comments by relatives to support this include “it could improve if there were more qualified staff and key workers were provided who would be responsible for liaising with family”. Notices that contain personal information about residents must not be displayed in toilet and bathroom areas. In contrast to the positive comments made by residents, relatives, GP’s and health professionals about the care provided there were comments made whereby they described what they were not happy with within the service and what they felt needed to improve. Their comments included “topical moisturisers seem not always to be applied as often as I would hope for”, “service could improve with continuity of care with better hand over and all staff aware of all individuals needs/problems”, “since being admitted she has lost 5 stones. The drinks weren’t kept up”, “not always told about small injuries. She also occasionally has bruises on her arm though I am informed ‘old people easily bruise’”, “mum is mostly cared for well apart from sometimes smelling of urine”, “I find the home only provide information on questioning and rarely offer information”, “there are a couple of occasions where they have required prompting to carry out certain tasks, but have done so once requested”, “as the service user is a private person and reasonably independent they do have a tendency to leave him to it”, “sometimes have to ask many times for things to be done for mother, for example, requesting nails to be cut and basic care like that. Last request for this took three weeks although we offered to pay privately for a chiropodist and frequently reminded staff”, “there have been occasions when we have not been informed that GP was called due to illness”, “clothes go missing despite being labelled and are left in bottom of wardrobe instead of being put on hangers. Xmas presents left unwrapped for a week. Clothes not being changed regularly and put back on mother dirty with stains on”, “I am forever looking and asking about lost items, all of which have name tags on” and “frequently we find my mother dressed in clothes that are not hers – sometimes in clothes with other residents names clearly visible. My mother clothes are all clearly marked with her name. Take more care with laundry” and “very poor hand over of details about individuals from one set of staff to another. Often staff not aware whether particular individuals have had their bowels opened that day or had other problems”. When the report was sent draft to the providers they said in respect of the comment “since being admitted she has lost 5 stones. The drinks weren’t kept up”, ‘that the resident has generally had a good appetite throughout their residence. The drinks referred to are prescribed by their GP, which are only given when their appetite subsides. Their GP has not shown any concerns regarding their natural age related weight loss’. For the comment “sometimes have to ask many times for things to be done for mother, for example, requesting nails to be cut and basic care like that. Last request for this took three weeks although we offered to pay privately for a chiropodist and frequently reminded staff”, the owners said ‘when residents are registered with Royal Court DS0000006497.V324994.R01.S.doc Version 5.2 Page 9 the community chiropodist, we have no control over timescales for appointments. Relatives always have the choice of paying privately for chiropody services, but often choose not to. The relatives themselves’ should do any such arrangements’. Medication records could be improved to promote safer practice. Document in the plan of care social activities to be provided for residents that suit their individual needs and capacities. Relatives cited social activities as something that the home could do better and their comments included “there could be more activities arranged for the people who are unable to go to the day centre”. “This is the thing I find that residents all sit around with no-one to talk to, falling asleep mostly, which I think wouldn’t hurt staff to have a little conversation with them at least”, “by providing some sort of activity or entertainment to keep the residents more motivated and happy”, “when mum first went into Royal Court it appeared to be happy and pleasant environment which has sadly gone”, “they could improve their social activities as this seems quite poor in relation of day to day activities. Whenever I visit the service users are all sat around the edge of the lounge and there are no apparent interactions between residents or staff”, “maybe higher staffing levels could offer more stimulation and engage in more activities – this appeared to happen in the early days of mum’s residence”, “take the residents on outings”, “not enough social skills” and “provide more in the way of entertainment or occupational therapy”. Improve the table layout and how residents who require assistance with eating are given this to promote equality within the resident group to maintain the respect and dignity of the resident. Consult residents about the types of meals they would like and provide them. Where they don’t like/eat the meal provided offer alternatives. Provide training for all staff in the protection of vulnerable adults and residents who have mental health needs, including dementia. This was confirmed by relatives who said “I think they would benefit from training regarding people with memory deficits” and “we feel that although most staff are caring emotionally, a lot of staff do not consider the needs of residents with memory problems i.e. the way the residents are not dressed in the way they would normally be if at home”. Adequate systems must be in place to remove the low level of odour present in the home. Increase the staffing hours available to meet the care needs of all residents. Comments by relatives about staffing levels included “care home staff are very helpful but do work under constraints i.e. short staffed”. Ensure the recruitment procedure is improved. Royal Court DS0000006497.V324994.R01.S.doc Version 5.2 Page 10 Ensure that written records demonstrate every member of staff receives a fire drill every six months. When wheelchairs are used to move residents that footplates are used unless there is a documented reason not to do so, so that they are moved safely. Report all serious injuries and/or accident that results in a consultation with a medical practitioner or where medical assistance is sought to CSCI, so that CSCI can make judgements about the quality of service being provided. 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. Royal Court DS0000006497.V324994.R01.S.doc Version 5.2 Page 11 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 Royal Court DS0000006497.V324994.R01.S.doc Version 5.2 Page 12 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): The outcomes for standards 1, 2 & 3 were inspected. The home did not provide an intermediate care service. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The contract/terms and conditions in the service user guide did not contain sufficient information about the details of the fees charged. Residents had individual contracts/statement of terms and conditions, but further information was needed so that residents and/or their representatives were clear of the services/items to be provided for the fee charged and what would be charged as extra. Residents moving into the home had, had their needs assessed, but lacked information in regard to specific mental health needs. Royal Court DS0000006497.V324994.R01.S.doc Version 5.2 Page 13 EVIDENCE: The service user guide was inspected. The guide contained the majority of information required and would give prospective residents sufficient information to make a choice of where to live in regard to the facilities and services. From the resident questionnaires returned all said they’d received enough information about the home before they moved in so they could decide the place was right for them. Their comments included “my brother and I were shown round the home with one of the senior cares” and “checked with inspection visit on internet. Looked at the home and its facilities on the internet. Had two visits to Royal Court”, “Royal Court did a good job to help the resident to come to terms with full time care”. The individual contracts/terms and conditions for three residents were inspected. The contract/terms and conditions included the total fee to be paid. The contract/terms and conditions did not identify who was responsible for paying the different parts of that fee if a resident is being funded, in whole or in part, by another person, other than the resident. The contract/terms and conditions also needs to include a description of the standard services offered to residents, for example, the provision of toiletries and where this might be different if the resident was being funded, in whole or in part, by a person other than the resident. The arrangements in place for charging and paying for any services additional to those offered as part of the fee must also be identified. A template of the contract/terms and conditions needs then to be included in the guide for service users. The contract/terms and conditions/information included in the guide for service users must identify the range of fees to be charged and whether this might be different if a resident’s care is being funded, in whole or in part, by a person other than the resident. The inclusion of this information in the guide for service users and contracts/terms and conditions is so that prospective residents and residents have sufficient information of the costs associated with living at the home and what those charges included. That this is important is demonstrated by a comment from a relative on a questionnaire when they said “why was I asked, several times, to supply soap, shampoo and bathing gel for my mother, when she has to pay high home fees”. A discussion with the owners took place re the payment for toiletries. They confirmed toiletries were provided within the fee, but if specific makes were required residents would be asked to provide their own. The inspectors suggested adding a further sentence in the contract/terms and conditions to make this clear. Questionnaires returned by residents demonstrated contracts had been received in all but one instance and in this case the relative said ‘they weren’t sure as they’d just taken over the responsibility of their mum’s welfare after Royal Court DS0000006497.V324994.R01.S.doc Version 5.2 Page 14 the death of their father and didn’t have a contract in place, but that wasn’t to say their father didn’t receive one”. Another comment received from a questionnaire by a relative included “we have received a contract with clear understanding of its contents”. A sample of residents’ assessments seen showed that mental health needs are not always fully assessed before a prospective resident moves in. Although one assessment acknowledged that a prospective resident had some memory loss this was not followed up with an appropriate mental health assessment before being admitted to the home. This lack of information undermined the home’s ability to demonstrate that the needs of the resident could be met. Royal Court DS0000006497.V324994.R01.S.doc Version 5.2 Page 15 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): The outcomes for 7, 8, 9 & 10 were inspected. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents had an individual plan of care where their health, personal and social care needs were identified. There were omissions, inaccuracies and lack of detail evident in the plan. Medication is administered appropriately, but records could be improved to promote safer practice. Comments received by residents and their relatives identified there were residents that felt staff treated them with respect and dignity, but equally observations and during the inspection identified this was not always the case. Royal Court DS0000006497.V324994.R01.S.doc Version 5.2 Page 16 EVIDENCE: Five individual care plans were inspected on a sample basis. The owners state some improvement had been made to care plans. The owners acknowledge however, ‘the information is not extensive as personal care plans needs to be built up over a period of time’. The plans contained relevant information on the care required to meet the resident’s health, personal and social care needs but omissions and lack of detail were evident. There are examples below. The daily report inspected for some residents identified the behaviour displayed by some residents was like that found in a specialist dementia unit. Although intervention had been sought from a GP in regard to the behaviour they displayed, there were instances where there was no involvement from a specialist mental health team to determine their particular emotional and psychological needs. As a consequence their mental health needs were being managed through medication. The resident’s capacity to make decisions was not identified in their plan of care, neither was the action to be taken by staff to meet their mental health needs. The social care plan in place was not specific to each resident, taking account of past social interests and what their interests were prior to moving into the home. This was not appropriate as it did not promote a person centred approach to meeting residents’ social care needs. The daily report contained basic information, for example, assisted with hygiene needs, but not what this had included. An inspection of the homes medication storage and administration systems was undertaken. Observation of staff administering medication and an inspection of medication storage areas showed that medication was being stored and administered appropriately, although record keeping was not in line with good practice and did not promote a safe system of medication administration. The home had an appropriate system for storing and administering controlled drugs and two staff appropriately signed the controlled drugs record. The medication returns book was not available for inspection; the inspector was informed that this was with the chemist. The home has a homely remedies record for each resident, which was signed by the residents GP. Training provided in the last 12 months included safe handling of medicines. MAR Sheets did not have individual file dividers or photos in the medication file to ensure safe identification of residents. Medication that was prescribed “as and when required” did not have any supporting guidelines to inform staff under what circumstances these medications should be administered. Medication records did not have a sample of signatures of staff that administer medication to ensure a robust audit trail of medication administration. Royal Court DS0000006497.V324994.R01.S.doc Version 5.2 Page 17 Feedback was given to the manager and owners of the home regarding the need to address these shortfalls and recommendations have been made. Accident reports were inspected. These are now filed in the resident’s file in order to maintain information as required under the Data Protection Act. However, because these are now completed and filed in resident’s files there is no system in place to identify who has had an accident, without searching through all the individual files. There was no monitoring of action as a result of accidents, such as a 72 hours follow up, to determine whether further intervention was required. There were occasions when the accident report, reported on what had been found, but when reading the daily report, what had happened prior/subsequent to the accident was relevant to the accident. It is important that this is referred to in the accident report so that appropriate judgements about action to be taken to prevent a further occurrence can be made. The three plans of care inspected for pressure area care all had risk assessments, but these were not being reviewed at the identified intervals. The district nurses were involved in the care of those pressure areas but the care to be provided by the home was not identified in the plan of care in two instances. In one instance a further pressure area was identified in the daily notes but there was no evidence this had been reported to the visiting district nurse. There were residents who wore hearing aids to assist with their communication ensuring they do not become isolated and withdrawn, however, there were some residents who said these were not in working order. One said theirs needed a new battery and another said they had been told to turn theirs off because it kept buzzing. One resident described how this stopped her from watching the TV programmes she enjoyed because she was unable to hear. When the owners responded to the draft report they stated that hearing aids are checked regularly and a supply of batteries is kept in the home. They stated batteries do go flat without warning and some residents remove hearing aids and forget they have done so. All residents who returned their questionnaire said they always received the care and support they needed, with four saying they always received the medical support they needed; one said they usually did. Their comments included “always willing to help and support when needed” and “I have received more medical support since being in Royal Court”. Of the two GP questionnaires returned one said the care service always sought advice and acted upon it to manage and improve individuals’ health care needs, one usually. One felt individuals health care needs were met by the service, one felt only sometimes. One said the care service always respected individuals’ privacy and dignity, one said usually. One said the care service supported individuals to administer their own medication or managed it Royal Court DS0000006497.V324994.R01.S.doc Version 5.2 Page 18 correctly where this is not possible, one said usually. Their particular comments included “good care given to residents”, “topical moisturisers seem not always to be applied as often as I would hope for”, “service could improve with continuity of care with better hand over and all staff aware of all individuals needs/problems” and “very poor hand over of details about individuals from one set of staff to another. Often staff not aware whether particular individuals have had their bowels opened that day or had other problems”. Of the twelve relative/advocate questionnaires returned nine said they usually get enough information about the care home to help them make decisions; two never get enough; one usually gets enough. Six said they were usually kept up to date with important issues affecting their friend/relative, three usually; three sometimes. Two said the home always gives the support or care to their friend/relative that is expected or agreed, six said usually, four said sometimes. Relatives/advocates were asked what they thought the home did well. Their comments included “mum looks really well and always looks nice when I visit her. She is really well cared for”, “my father is a very impatient person who always wants to do things his way and in his time. He can be very challenging. Royal Court staff cope very well with his demands”, “since moving to the home we have noticed a definite difference in close contact care and support, this being a much happier environment”, “the home and residents are always kept clean and there is a cheerful atmosphere (music playing etc)”, “the care my mother received on returning from hospital was first rate”, “they look after my mother with more skill and patience than the family could”, “they keep the residents clean and warm” and “she’s watered and fed”. In contrast there were relatives who were not happy with some of the care provided and one comment included “since being admitted she has lost 5 stones. The drinks weren’t kept up”. When responding to the draft report the owners said this relates to a resident who has lost weight due to her age and the drinks were only given when their ‘appetite subsides’. Other questionnaires said “not always told about small injuries. She also occasionally has bruises on her arm though I am informed ‘old people easily bruise’”, “mum is mostly cared for well apart from sometimes smelling of urine”, “I find the home only provide information on questioning and rarely offer information”, “there are a couple of occasions where they have required prompting to carry out certain tasks, but have done so once requested”, “as the service user is a private person and reasonably independent they do have a tendency to leave him to it”, “sometimes have to ask many times for things to be done for mother, for example, requesting nails to be cut and basic care like that. Last request for this took three weeks although we offered to pay privately for a chiropodist and frequently reminded staff”. The owners have stated in response to the draft report that they have no control over appointment timescales for appointments with the community chiropodist and that the relatives themselves should make arrangements for private chiropody. Further questionnaires stated “there have been occasions when we have not been informed that GP was called due to illness”, “clothes go missing despite being Royal Court DS0000006497.V324994.R01.S.doc Version 5.2 Page 19 labelled and are left in bottom of wardrobe instead of being put on hangers. Xmas presents left unwrapped for a week. Clothes not being changed regularly and put back on mother dirty with stains on”. The owners commented when they received the draft report the resident was offered help and refused it. Other questionnaires stated “I am forever looking and asking about lost items, all of which have name tags on” and “frequently we find my mother dressed in clothes that are not hers – sometimes in clothes with other residents names clearly visible. My mother clothes are all clearly marked with her name. Take more care with laundry”. Staff were observed approaching residents in a respectful manner. There were occasions where the privacy and dignity of residents was respected, for example, knocking on residents’ doors before entering and closing toilet doors when in use. Discussions with staff identified they were aware of the action to be taken to maintain the personal care needs of residents in a timely manner to respect their dignity. Personal information about residents continence wear was displayed in toilet and bathroom areas. This does not promote the privacy of and respect for the residents personal information. As indicated in the relative comments they have also noted their relative/advocate wearing other residents clothing and commented on how clothes go missing and/or lost. This indicates there has been no improvement to earlier comments in regard of the same issues and this does not promote respect for the resident and treating them as individuals. Royal Court DS0000006497.V324994.R01.S.doc Version 5.2 Page 20 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): The outcomes for standards 12, 13, 14 & 15 were inspected. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Discussions with residents’ and their advocates described how they were helped to exercise some choice and control over their lives, but for some residents their lifestyle within the home could be improved. Residents maintained contact with family and friends and members of the local community as they wished. Residents received a varied diet in regard to menu planning, in a pleasant dining area, but this could be improved by positively promoting the choices available. Improving the table layout and how residents who required assistance with eating were given this would promote equality within the resident group and maintain the respect for and dignity of the resident. Royal Court DS0000006497.V324994.R01.S.doc Version 5.2 Page 21 EVIDENCE: Despite the home saying they had provided some social activities over the Christmas period, there was still no formal programme of activity of social events that residents could recall apart from the day centre three days a week that a few of the more independent residents attended. This meant residents were provided with few opportunities for social interaction to meet their emotional and psychological needs except when physical care tasks were performed or at meal times. The pre inspection questionnaire described facilities/activities available for residents as an activity room having wide range of games, books, cards, dominoes, videos, separate day centre 3 days a week, periodic outside entertainers, church choir visits, children’s band visits, day trips to local heritage centre, markets and shopping centre. Residents’ spoken with described how they could choose to spend their day and confirmed that they could choose what time to get up and go to bed within reason, accepting the constraints as part of group living. The majority of residents were observed to spend time in the lounges with the television on, whilst others had chosen to spend their time in the privacy of their bedroom spending time as they wished. Personal items and furniture were brought into the home by residents to personalise their rooms. Interaction between staff and residents was observed when staff were carrying out tasks for residents, but both inspectors noted that staff did not spend quality time talking to residents. Of the five questionnaires completed by residents one resident said the home always arranged appropriate activities that they could take part in; three usually. Comments by residents and relatives about living at the home included “there are activities, but I prefer to read”, “activities not applicable to my father who is definitely a loner when it comes to social activities” and “it was better with other manager, Caddy. When she was here we had concerts and trips out, we don’t now”. On receiving the draft report the owners stated that the comment about no more concerts and trips out is incorrect. Of the twelve questionnaires returned by relatives, nine said the care service usually supported people to live the life they choose; one sometimes. Comments about how their relatives/advocates life could be improved included “there could be more activities arranged for the people who are unable to go to the day centre”, “this is the thing I find that residents all sit around with noone to talk to, falling asleep mostly, which I think wouldn’t hurt staff to have a little conversation with them at least”, “by providing some sort of activity or entertainment to keep the residents more motivated and happy”, “when mum first went into Royal Court it appeared to be happy and pleasant environment which has sadly gone”, “they could improve their social activities as this seems quite poor in relation of day to day activities. Whenever I visit the service users are all sat around the edge of the lounge and there are no apparent Royal Court DS0000006497.V324994.R01.S.doc Version 5.2 Page 22 interactions between residents or staff”, “maybe higher staffing levels could offer more stimulation and engage in more activities – this appeared to happen in the early days of mum’s residence”, “take the residents on outings”, “not enough social skills” and “provide more in the way of entertainment or occupational therapy”. Residents were observed receiving visitors throughout the day and on the whole spent time with their relatives/friends in communal areas. Residents confirmed that they maintained good links with their family and friends and that they could visit “at anytime”. The menu for each meal was displayed in the dining room after the previous meal had finished. The meal advertised for lunch was corned beef and onion pie or fish fingers for the main course and rice pudding, choc-ice or yoghurt for desert. Residents’ comments about the meal provided was varied and included “it’s alright”, “a hot choice is always provided at tea” and “it’s rubbish” (was actually a swear word and therefore amended for report). The lunch time meal was observed. There was one table that did not have a tablecloth or cutlery placed on it and some residents sat at the table were sat there for some time before their meal was served. It became apparent that these were residents that needed assistance with eating. This is not acceptable, as this does not promote equality within the resident group. One carer who was assisting a resident to eat stood up throughout the task, in addition to being stood at the side of the resident. Also staff were observed to be assisting more than one resident to eat at a time. This does not demonstrate the task is done with care and consideration of the residents needs and would not aid making the meal time a pleasant experience for the resident. Despite a choice being on offer all residents had the corned beef and onion pie and given the rice pudding if they didn’t ask for anything else. Carers were not heard offering the choice to residents when they were serving the meal. There were residents observed to have left the meat, the majority or parts of their dinner. When the plates were collected staff were not heard offering an alternative or what it was they did not like about the meal they had left. One resident commented about another resident “they always leave their meat – they’re vegetarian, but they still give them it”. This was not indicated in the resident plan of care and the resident themselves said “it’s alright” but staff must be vigilant about the likes and dislikes of residents, offering choice when necessary to ensure they receive an adequate diet. One resident said they bought muesli and banana for breakfast, as it wasn’t provided. Since the inspection the owners have stated, “this is an informed choice of the resident and their family”. The menus indicated a varied choice and the food and ingredients stored indicated good quality was bought, for example, Ross fish fingers and homemade potted meat. Choice could be improved, however, by providing butter as well as margarine and full fat milk as well as semi skimmed. In addition, using these in cooking would increase the calorific value, which is necessary for those residents who are at risk of weight loss. Royal Court DS0000006497.V324994.R01.S.doc Version 5.2 Page 23 Of the five questionnaires returned by residents, four said they always like meals at the home; one usually. Comments by residents about the meals at the home included “I especially like fish and chips on Friday and porridge for breakfast”, “the meals are well balanced and presented proportionally. The meals are hot and enjoyable”; “meals are excellent. We get good food and plenty”. Relative/advocates positive comments about the meals included “no complaints about mum not eating”, “they feed them well”, “if I have been there when they’ve been having a meal – it looks good”, “breakfast is the worst meal of the lot, because they’re short staffed” and “provide a good choice of food”. Relatives’ comments about what could improve include “give them a better choice of meals” and “provide more variation in choice of food e.g. more fresh fruit on offer. The menus seem to be rather basic”. The situation continued where there were no kitchen staff from 14:00. This meant that although the teatime meal was prepared it still meant care staff were taken away from care duties at times until the following morning. Discussions with the owners identified it is their intention to add another shift 11:00 – 18:00 to alleviate this. This would also enable more time for staff in the kitchen to meet the requirements and recommendations of the environmental health, as on certain days the kitchen was also responsible for preparing meals for the day centre and some residents in the bungalows. Royal Court DS0000006497.V324994.R01.S.doc Version 5.2 Page 24 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): The outcomes for standards 16 & 18 were inspected. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. A complaints procedure was in place, but not all residents, their relatives and advocates were confident that complaints are taken seriously and acted upon. Policies and procedures to protect people who use the service from abuse were in place. Staff could describe the procedures they would follow should an allegation of abuse be made. EVIDENCE: The complaints procedure ensured that residents and/or their advocates were aware of how to make a complaint and who would deal with them. The complaints procedure displayed in the entrance hall was resident friendly and comprehensive. The record of complaints identified the two complaints that had been referred to the home to be investigated, by the CSCI. The complaints had been from anonymous sources so the responses were asked to be sent to CSCI. The reply was received within the required timescale, demonstrating improvements in responding to complaints by the owners. It was discussed with the owners that no further complaints were recorded despite surveys that had been returned identifying complaints that had been made. When describing the nature of some of those complaints the owner challenged that they were complaints as she had asked at the time if they were and the person Royal Court DS0000006497.V324994.R01.S.doc Version 5.2 Page 25 always said no, I’m just letting you know. The inspectors agreed it was a judgement to be made, but the outcome was that the same complaints kept reoccurring because there were no improvements. All residents’ questionnaires that were returned identified residents knew how to complain and who to speak to if they weren’t happy. Their comments included “ not had to complain”, “the manager is approachable and knowledgeable of any particular resident”, “never had cause to use complaints procedure”, “I cannot complain about anything in the home”, “don’t put a name to any complaint or else get sent to Coventry” and “I would ask for Linda and speak to the carers if Linda was not here”. Of the two GP questionnaires returned, one said the care service responded appropriately if the GP or the person using the service had raised concerns about their care, one said sometimes. One GP said, “They were not aware of any concerns raised by individuals. They have mentioned a few concerns – no obvious actions taken although staff take notes about visit”. Of the twelve questionnaires returned by relatives nine said they knew how to make a complaint, three didn’t. Five said the care service always responded appropriately if they or their friend/relative using the service has raised concerns about their care, three sometimes, three usually and one never. Relatives comments included “they have lost clothes, trousers, nightdresses, bed jackets & false teeth. When I have asked they say they will find them but they never get back to me”, “they could improve the service by solving the problems”, “I am not satisfied but don’t want to upset anybody”, “I have reported to the home’s management that my mother had lost several pairs of shoes and a gold watch. So far, nothing has turned up”, “I have witnessed a few incidents that have appalled me. This was addressed on each occasion but sadly doesn’t seem to improve much”; “social services don’t seem to care. They listen but don’t take action. I know I should have put an official complaint to CSCI but I have always felt dealing with the management in Royal Court was a good way to build a good understanding”. An adult protection policy was in place and the home had copies of both Barnsley and Rotherham’s local multi agency procedures for the protection of vulnerable adults. The training records of five staff were inspected. One had received training in the protection of vulnerable adults, with other records indicating training was to be arranged for the other four staff. Discussion with one member of care staff demonstrated they knew who to report the abuse to if necessary. On recruitment, staff were appropriately checked against the ‘Protection of Vulnerable Adults Register’. Royal Court DS0000006497.V324994.R01.S.doc Version 5.2 Page 26 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): The outcomes for 19 & 26 were inspected. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements to the decoration and fabric of the home had provided a more pleasant, well-maintained environment for residents to live, the owners said that the decorating and maintenance programme was always ongoing. The building and its environment was on the whole clean, but there were areas where housekeeping arrangements needed to improve, for example, eradicating the low level of odour. Royal Court DS0000006497.V324994.R01.S.doc Version 5.2 Page 27 EVIDENCE: Of the five questionnaires returned by residents, four said the home was always fresh and clean, one usually. Their comments included “very good standard of cleanliness and hygiene”. Relatives comments about the environment of the home included “the home provides a safe environment for elderly people”, “my mother’s room is clean and tidy”, “the surroundings are kept quite pleasant, comfortable chairs”, “the carpets in some areas need cleaning”, “the smell of urine on along the bottom corridor is some days very strong”, “they could improve the long corridors that are stark and dismal” and “the smell of urine when entering the home is most off-putting”. It must be said that the inspectors also noted a low level odour on arrival. This got worse as the day wore on in the lounge area, but the inspectors were of the opinion this was because residents continence needs needed attending to. All bedrooms were single and met the minimum recommended size. There was appropriate storage space for aids and equipment. The home had sufficient baths, showers and toilets and these were close to bedrooms, lounges and dining areas. There were appropriate aids and adaptations e.g. raised toilet seats, grab rails, bath hoists. The owners had implemented a refurbishment programme. This had improved the living environment in the main lounges and conservatory tremendously. The conservatory was now a pleasant area of the home to sit. The owners said that the decorating and maintenance programme was always ongoing. Laundry facilities were situated away from all food preparation and storage areas. Hand washing facilities were provided. Royal Court DS0000006497.V324994.R01.S.doc Version 5.2 Page 28 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): The outcome for standards 27, 28, 29 & 30 were inspected. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of staff was not meeting all residents’ needs. A training programme had been implemented to equip staff with the knowledge and skills for their roles within the home, however, training for residents with mental health needs including dementia is required. Residents were not completely protected by the home’s recruitment policy and practices. EVIDENCE: All of the resident questionnaires returned said staff always acted and listened to what residents had to say and four of the five residents said carers are always there when they are needed, one said usually. Their comments included “staff are always there even if we are poorly in bed” and “I have no problems at the home. We are well looked after and carers are very kind”. Of the two GP questionnaires returned one felt the care staff have the right skills and experience to support individual’s social and health care needs and respond to the different needs of individuals, one they sometimes had. They Royal Court DS0000006497.V324994.R01.S.doc Version 5.2 Page 29 commented “staff seem to be concerned about individuals” and “the service could improve with continuity of care with better hand over and all staff aware of all individuals needs/problems” Of the twelve questionnaires returned by relatives one said care staff have the right skills and experience to look after people properly, seven said usually and two sometimes. Their comments included “the staff on the whole appear to have skills to look after people”, “I think they would benefit from training regarding people with memory deficits”, “care home staff are very helpful but do work under constraints i.e. short staffed”, “kind hearted and friendly towards residents, very approachable and carry out tasks that are quite often thankless”, “we feel that although most staff are caring emotionally, a lot of staff do not consider the needs of residents with memory problems i.e. the way the residents are not dressed in the way they would normally be if at home”, “it could improve if there were more qualified staff and key workers were provided who would be responsible for liaising with family”, “friendly staff”, “the care staff have a generous knowledge of resident’s well being” and “the staff are available when it is possible for them to be available. We have never had to wait for more than a few minutes. This is because of the time of our visit. We are very satisfied with the staff response”. The inspectors were of the opinion that staffing levels were not sufficient to meet the needs of all residents living at the home. Evidence to support this includes: The amount of support required from carers to manage the behaviour displayed from some of the residents who had dementia. The time required by carers to complete the physical care needs of residents and that all care needs are not always being met, such as ensuring residents wore their hearing aids. The lack of social care activities and staff spending quality time talking with residents because they were busy attending to the physical care needs of residents. Omissions and lack of detail in the plans of care. Care staff supporting a resident in one of the bungalows on an evening. Carers working in the kitchen at tea and supper time. The increasing odour in the lounge area, because residents continence needs needed attending to. Relative’s feedback also indicate staffing hours are insufficient with comments such as “ the staff don’t talk to residents and there are no activities” and “Mom Royal Court DS0000006497.V324994.R01.S.doc Version 5.2 Page 30 can use the toilet, but sometimes staff can’t respond in time and she has wet herself because of this”. The pre-inspection questionnaire identified 66 of staff hold NVQ Level 2 in Care and 14 hold a current first aid certificate. Training provided in last 12 months included ongoing NVQ Level 2 in Care, safe handling of medicines, fire safety theory, fire safety practical and infection control. Planned training included continue NVQ training to level 3, manual handling update, fire safety, 6 monthly and safe handling of medicines for new relief seniors. Discussions with staff and inspection of training records identified they had received a range of training including NVQ Level 2, food hygiene, manual handling, behavioural problems and dementia, infection control, protection of vulnerable adults, emergency first aid and fire safety. The staff files contained some copies of qualifications and certificates of training to verify the authenticity of the training. Although a training programme had been implemented for the mandatory training there was no indication of specialist training for residents with mental health needs, including dementia. Given the behaviour displayed by residents at the home that had these needs as described in the daily report this would benefit staffs knowledge and skills in caring for those residents. The recruitment process was checked. This demonstrated a full employment history was not in place. This had not been explored with the candidate with a satisfactory written explanation of those gaps in employment. The candidate had previous employment in a care home, but a reference had not been obtained. This had been sent for twice and the owner said a verbal reference had been sought, but at the time the manager was off sick. A CRB had been applied for and prior to commencing employment a satisfactory POVA first check had been obtained. The home had been provided with a part copy of part of a previous CRB but a risk assessment had not been completed. In addition, the home had not identified an experience and suitably qualified member of staff to supervise the carer until a full CRB was issued. Royal Court DS0000006497.V324994.R01.S.doc Version 5.2 Page 31 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): The outcomes for standards 31, 33, 35, 37 & 38 were inspected. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The manager has the appropriate qualification, however, management systems continue to require improvement to demonstrate a good quality of care is provided for residents. A quality assurance system was in place, but this was ineffective in monitoring residents and stakeholders views of the quality of the service provided, so that improvements could be made. Systems were in place to deal with monies/valuables held by the home on behalf of residents’ that safeguarded residents’ financial interests. Resident’s rights and best interest could be placed at risk by the homes failure to maintain all records adequately. Royal Court DS0000006497.V324994.R01.S.doc Version 5.2 Page 32 The health, safety and welfare of residents and staff may not be promoted and protected because: • All staff had not received a fire drill every six months • Residents were being moved without footplates in place on wheelchairs • All serious injuries and/or accident that results in a consultation with a medical practitioner or where medical assistance is sought was not being reported to CSCI, so that CSCI can make judgements about the quality of service being provided. • EVIDENCE: Comments by relatives and health professionals about the running of the home include “I think caring got a bit slack during the middle part of 2006, but the person in charge has now got things back to where it should be”, “during the last five years we have seen a great drop in all areas of the running of the home. It has a great turnover of staff; sadly the good and dedicated staff has left! This only proves that support they needed wasn’t given. A lot of areas of the day to day running needs to be improved greatly”, “there is a lack of education and ignorance with some of the health care needs of the residents and this results in a negative response by managers and staff”, “I have spoken with staff and Linda Bailey but sadly nothing changes”, “the manager is approachable and knowledgeable of any particular resident”. Since approximately October 2006 the CSCI have been informed that all the owners have been spending a substantial amount of time at the home. This demonstrates their commitment to improve the service, although there is still a lot of work to be done. At this inspection Linda Bailey told the CSCI she was going to apply to be registered as manager. Linda holds the relevant qualification, the Registered Managers Award and has at least twenty years experience as owner of the home. It is of paramount importance that effective leadership and management systems are put in place to ensure the home is run in the best interests of residents through an effective quality assurance and monitoring system. This needs to be an open and transparent process with systems in place for residents, relatives and other stakeholders to provide their opinions of the service provided, so that appropriate improvements can be made. The owners acknowledge their own quality assurance system needs to be reviewed. Monies held by the home for one resident was inspected. Monies withdrawn/deposited correlated with records kept. The procedure for dealing with any monies consisted of two signatures when financial transactions were made and receipts were maintained. Secure facilities were provided for the safekeeping of money and valuables kept on behalf of residents’. Royal Court DS0000006497.V324994.R01.S.doc Version 5.2 Page 33 A sample of records that the home was required to keep was inspected. Comments and requirements with reference to these are made throughout this report. Maintaining the required records and keeping them up to date and accurate demonstrates how residents’ rights and best interests are being maintained. There were appropriate measures in place to ensure the security of the premises and prevent intruders. Hazardous substances were securely stored. Inspection of the building identified fire exits were free from obstructions. A letter received by CSCI from South Yorkshire Fire and Rescue on 16 February 2006 identified a number of requirements in order to maintain fire safety at the home. The owners said the current agreement with the fire service was that the wall covering that was not fire retardant did not have to be replaced as the risk of harm could be assessed within the fire risk assessment. A fire risk assessment had been completed. Staff had received fire training; however, the fire drill record provided evidence of only one drill since August 2006 and the names of staff present on the fire drill were not listed. The residents’ safety and welfare was not wholly safeguarded as although staff training records identified staff some staff were up to date with moving and handling training they continued to be observed moving residents in wheelchairs without footplates. This is not safe working practice and may put residents at risk of falling and/or injury. The pre inspection questionnaire identified three admissions to hospital. These had not been reported to CSCI and there was no system for tracking the identification of those residents as accident/incident reports were filed on resident files as required under data protection. The preinspection questionnaire identified maintenance and associated servicing of fire equipment, the environmental health, gas, central heating, water temperatures, fixed wiring and hoists and adaptations were in place. Royal Court DS0000006497.V324994.R01.S.doc Version 5.2 Page 34 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 2 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 X 2 2 Royal Court DS0000006497.V324994.R01.S.doc Version 5.2 Page 35 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 OP2 Regulation 5 Requirement Individual contracts/terms and conditions must: • identify who is responsible for paying the different parts of that fee if a resident is being funded, in whole or in part, by another person, other than the resident. • A description of the standard services offered to residents, for example, the provision of toiletries and where this might be different if the resident is being funded, in whole or in part, by a person other than the resident. • The arrangements in place for charging and paying for any services additional to those offered as part of the fee must also be identified. A template of the contract/terms and conditions must then to be included in the guide for service users and include the range of fees to be charged and whether this might be different if a resident’s care is being funded, DS0000006497.V324994.R01.S.doc Timescale for action 31/05/07 Royal Court Version 5.2 Page 36 2. OP7 OP12 15 (1) in whole or in part, by a person other than the resident. The inclusion of this information in the guide for service users and contracts/terms and conditions is so that prospective residents and residents have sufficient information of the costs associated with living at the home and what those charges include. The individual plan of care must: 31/03/07 • contain specific information about how residents’ social care needs will be met using a person centred approach. identify the residents’ mental capacity to be able to make decisions. • 3. OP7 4. OP7 OP8 5. OP7 OP8 OP38 6. 7. OP7 OP8 OP10 Previous timescale of 31/10/06 not met. 15 (1) & The individual plan of care must 17 demonstrate all action that has been taken to meet the health and personal care needs of residents, including their mental health and pressure area care. 12, 13, 14 Intervention must be sought & 15 from a specialist mental health team where resident’s behaviour indicate their emotional and psychological needs, need assessing. 12, 13, 14 Accidents/incidents must be & 15 monitored, including documentation of any action to be taken to prevent a further occurrence. 12 & 15 Residents’ hearing aids must be in working order. 12 Notices displaying information about residents continence wear must be removed from toilet and bathroom doors. DS0000006497.V324994.R01.S.doc 31/03/07 31/03/07 31/03/07 31/03/07 31/03/07 Royal Court Version 5.2 Page 37 8. OP10 12 9. OP12 16 10. OP15 16 11. OP15 12 (4) (a) 12. OP15 12 (1) (a) 13. 14. OP15 OP16 23 (5) 22 (4) 15. 16. OP19 OP26 OP19 12, 13 & 23 16 & 23 Systems for ensuring laundry is returned to the correct resident and doesn’t get lost must be improved. Residents must be consulted about their social interests and a programme of suitable activities arranged. Previous timescale of 31/10/06 not met. Residents must be consulted about the types of meals they would like and these should be provided. • Residents who require assistance with eating must not be discriminated against, by not laying the table with a tablecloth and cutlery unless there is a documented reason not to do so. • Residents must be assisted to eat on an individual basis with carers sitting at the same level. • Alternatives available must be offered to residents, particularly when they do not like or eat their meal. • Feedback on the quality/enjoyment of the meal must be sought to enable residents to be provided with meals/food that they like. The requirements in the environmental health report of 13/12/06 must be met. The providers must demonstrate that they take action to address concerns/complaints made to them by stakeholders of the service and record this accordingly. All parts of the home must be kept clean. The entrance carpet must be DS0000006497.V324994.R01.S.doc 31/03/07 31/03/07 31/05/07 31/03/07 31/03/07 30/04/07 31/03/07 31/03/07 30/04/07 Page 38 Royal Court Version 5.2 17 OP27 18 (1) (a) 18. 19. OP28 OP30 OP29 18 19 (1) (b) Schedule 2, number 6 19 (1) (b) Schedule 2, number 4 20. OP29 21. 22. OP29 OP29 13 (6) 19 (11) (a) 23. OP31 8 24. OP33 24 replaced. Previous timescale of 30/10/06 not met. There must be staff on duty in sufficient numbers to be meet the health and welfare needs of all residents. Staff must receive training in the mental health, including dementia. A full employment history must be maintained for employees together with a satisfactory written explanation of those gaps. When a person has previously worked in a position, which involved contact with vulnerable adults, written verification of the reason why he ceased to work in that position must be obtained, unless it is not reasonably practicable to obtain such verification. A risk assessment must be in place when convictions/cautions are identified on a CRB check. When a member of staff commences work prior to a full CRB being issued an experienced and qualified member of staff must be appointed to supervise the employee pending receipt of the full CRB. A manager must be appointed to manage the home. Previous timescale of 30/10/06 not met. A quality assurance and monitoring system must be implemented. Previous timescale of 30/10/06 not met. Records as required by the regulations must be maintained, up to date and accurate. Safe moving and handling DS0000006497.V324994.R01.S.doc 31/03/07 31/07/07 31/03/07 31/03/07 31/03/07 31/03/07 31/03/07 31/03/07 25. 26. OP37 OP38 17 13 31/03/07 31/03/07 Page 39 Royal Court Version 5.2 27. OP38 23 (4) (e) 28. OP38 37 procedures must be undertaken at all times. Previous timescale of 31/08/05, 30/04/06 & 16/10/06 not met. • All staff must receive a fire 31/03/07 drill every six months. • The fire drill must contain the names of persons present on the drill. All notifiable incidents must be 31/03/07 reported to the CSCI as required. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP2 OP9 OP9 Good Practice Recommendations That the contract/terms and conditions make it clear whether toiletries are an additional charge. Individual MAR Sheets should have a photo of the resident in the medication file. Medication that is prescribed “as and when required” should have supporting guidelines to inform staff under what circumstances these medications should be administered. Medication records should have a sample of signatures of staff that administer medication. An inventory should be made of resident clothing and updated as required. All staff should receive training in protection of vulnerable adults. 4. 5. 6. OP9 OP10 OP18 Royal Court DS0000006497.V324994.R01.S.doc Version 5.2 Page 40 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR 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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