Inspection on 15/05/06 for Royal Court

This inspection was carried out on 15th May 2006.

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

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

Other inspections for this house

Royal Court 28/09/09

Royal Court 07/10/08

Royal Court 25/09/07

Royal Court 13/02/07

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 16th May 2006 09:15 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.V290536.R01.S.doc Version 5.1 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.V290536.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Royal Court Address Rock Mount King Street Hoyland Barnsley South Yorkshire S74 9RP 01226 741986 01226 741986 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) None Healthmade Limited 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.V290536.R01.S.doc Version 5.1 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. 2nd February 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. The home is a purpose built single storey building. All bedrooms are for single occupancy and have en-suite facilities. An enclosed garden area is provided. There are car-parking 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. One of the owners identified the fee on 16 May 2006 as £315.00. They did not know the upper limit, as this information was only available at head office. Extra charges were stated as hairdressing. The owner said all current residents had, had a copy of the service user guide for the home, but prospective residents were not given a copy. A CSCI report about the service was available in the entrance of the home but it was not the report from the last inspection on 2 February 2006, this was in the office. Royal Court DS0000006497.V290536.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection carried out between the hours of 9:15 and 17:45. On 27 March 2006 Ms Bailey, one of the owners had been asked to provide information of current residents, their advocates and a staff list to assist in the inspection process. The home had not provided this information prior to the visit and had also not completed a pre inspection questionnaire with details about the service sent to them on 7 April 2006. As a result this hampered the opportunity to seek wider stakeholder views of the service. Opportunity on the visit was taken to make a partial inspection of the premises, inspect a sample of records, observe staff carrying out their duties and talk to residents, relatives, staff and two of the owners, Ms Bailey and Mrs Pearson. Also taken into account was other information received by CSCI about the service since the last inspection. The inspector spoke to four members of staff on duty about aspects of their knowledge, skills and experiences of working at the home, eleven residents about their views on aspects of living at the home, six advocates and one social/health care professional. In addition the CSCI have reviewed their guidance on requirements, therefore, some requirements have been removed if they had no direct evidence of service user outcome, or reworded. 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: What has improved since the last inspection? Residents had been given a written contract/terms and conditions with the home, including the fee to be paid. Royal Court DS0000006497.V290536.R01.S.doc Version 5.1 Page 6 The recording of the administration of medication had improved to relate to the administration of medication in practice. Water temperatures had been adjusted to ensure water was provided that was close to forty-three degrees centigrade, the recommended temperature for hot water. What they could do better: The home could respond in a timely manner to requests by the regulator to provide information about the registered service to assist them with their regulatory function. The manager post at the home was vacant, therefore on a day-to-day basis there was no leadership or anyone to take responsibility for the service, which meant there were aspects of the service that were failing, for example, daily life and social activities, staff training and supervision and quality assurance. Comments by residents, advocates and staff about the current management arrangements of the home included “no-one in charge”, “it needs a bit of umph”, “no-one in authority or to supervise”, “when matron’s are there it’s good”, “those that own it never seem to be there looking after it”, “place gradually going down hill – there’s no manager supervising – staff are pleasing themselves”, “never seen Ms Bailey or Mr Pearson all the time I’ve been here”, “when Neil (the previous manager) was here we had meetings and he was visible”, “when Neil was here we got copies of reports – we don’t any more”, “impressed when Neil was manager”, “deteriorated since he’s gone”, “needs a manager – a home can’t run with just seniors – needs someone with qualification and authority that knows what they’re doing”, “Ms Bailey and Mrs Pearson come, but don’t do what a manager does”. A quality assurance and monitoring system involving all stakeholders of the service would seek to improve and enhance the service provided and what residents would like. For example, improving the social care needs of residents would improve the lifestyle they experienced at the home particularly if it was accommodated using a person centred approach. One resident described how it could improve - “it’s alright here, but you could do more – like sewing – I’m not bothered about going out”. Likewise, the menus for residents. Some residents said “meals had deteriorated – they used to have a buffet tea on Sunday but now it was every tea time because it suited staff and there wasn’t enough kitchen staff”, “sandwiches at tea time suit me because there’s always a hot meal at lunch time”, “meals ok”, “usually soup or sandwiches at tea”, “no real choice at meals – always same breakfast – choice of cereal, porridge or grapefruit, toast or poached egg on toast”. This meant that although residents and their advocates said they had no complaints, the owners not being proactive in seeking their views about the service meant their concerns about the service were not being addressed. Royal Court DS0000006497.V290536.R01.S.doc Version 5.1 Page 7 Some housekeeping arrangements needed to improve to ensure toilets were kept clean at all times, as far as possible, as did some of the decoration and fabric of the home, to provide a well-maintained environment for residents to live. Descriptions by residents, advocates and social/health care professionals to support this included “place nice enough – you have to take into consideration residents pulling wall paper off”, “it could do with a bit more bottoming”, “sparse home”, “first thing that hits you is that they’re using fresheners to try and cover up smells”. Information, including the service user guide should be provided to all current and prospective residents to ensure they know about what facilities and services are provided, how to make a compliment or complaint, the latest inspection report and the terms and conditions and fees charged by the home. Improvements were required with some of the records kept by the home to safeguard residents’ rights and best interests. Omissions and lack of detail were noted in the home’s records, for example, the care plan, recruitment records and quality assurance. In addition, not all residents’ information was securely stored which compromised the confidentiality of residents who lived at the home. Some areas relating to health and safety issues required attention, in order to maintain the safety and welfare of both residents and staff, for example, the moving and handling of residents and storage of hazardous materials. 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. Royal Court DS0000006497.V290536.R01.S.doc Version 5.1 Page 8 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.V290536.R01.S.doc Version 5.1 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The outcomes for 1, 2, 3 & 6 were inspected. The service user guide could not be inspected and the service user guide was not provided to prospective residents’ so they did not have the information they need to make an informed choice about where to live. Residents had a written contract/terms and conditions with the home. Residents had not moved into the home without having had their needs assessed. The home did not provide an intermediate care service. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Royal Court DS0000006497.V290536.R01.S.doc Version 5.1 Page 10 EVIDENCE: Ms Bailey stated the printer was out of ink and therefore a copy of the service user guide was unable to be inspected. Ms Bailey said all current residents had, had a copy of the service user guide for the home but prospective residents were not given a copy. A CSCI report about the service was available in the entrance of the home but it was not the report from the last inspection on 2 February 2006, this was in the office. This meant prospective residents did not have sufficient information to make an informed choice about where to live. The contract/terms and conditions for three residents were inspected. They contained the amount to be paid, the room to be occupied and were signed by the resident and/or their advocate. An assessment of need for three residents were in place. Ms Bailey confirmed the home did not provide an intermediate care service. Royal Court DS0000006497.V290536.R01.S.doc Version 5.1 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The outcomes for standards 7, 8, 9 & 10 were inspected. Residents had an individual plan of care where their health, personal and social care needs were identified, but omissions, inaccuracies and lack of detail were evident. Residents were provided with access to health care services but because of omissions and lack of detail it could not be determined that residents health care needs had been met. Residents were responsible for their own medication where appropriate and protected by the home’s policies and procedures for dealing with medicines. Residents were treated with respect and dignity, but the treatment room being left open and vacant meant their right to confidentiality was compromised. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Royal Court DS0000006497.V290536.R01.S.doc Version 5.1 Page 12 EVIDENCE: Three individual care plans were inspected on a sample basis. The plan 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. For example, what type of restraint to be used and when, confirmation that action had been taken as directed by another health professional to meet residents’ health needs and the mental capacity of residents to be able to make informed decisions. The social care plan in place was the same for all three residents stating “encourage … to join in any activities that are available”. This was not appropriate as no recent activities had been provided and it did not promote a person centred approach to meeting residents’ social care needs. The daily report contained basic information and did not always relate to the plan of care. Three residents’ medication was inspected on a sample basis. Residents, where appropriate, were responsible for their own medication and this was appropriately documented in the individual care plan and the medication was securely stored. Records were kept of medicines received into the home, together with medication carried forward from one month to another, enabling auditing of medication kept by the home. Medication requiring refrigeration was securely stored with refrigerator temperatures being maintained which assisted with medication being stored at the correct temperature. Medication administration records were fully completed. The senior care in charge stated currently there were no controlled drugs being administered. Residents spoken with said that they were well cared for, staff treat them with respect and they were able to spend time in their room if they wished. There were areas 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. The treatment room, however, was left open and was vacant. Personal information about residents was displayed and the care plan of a resident was left on the work surface. This compromised the privacy and confidentiality of residents. In addition, one resident was wearing clothing that did not fit. Also see standard 37. Royal Court DS0000006497.V290536.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The outcomes for standards 12, 13, 14 & 15 were inspected. Discussions with residents’ and their advocates described how they were helped to exercise 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 discussions with residents identified this could be improved. Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. Royal Court DS0000006497.V290536.R01.S.doc Version 5.1 Page 14 EVIDENCE: Individual care plans were inspected for three residents. The social care plan in place was the same for all three residents stating, “encourage … to join in any activities that are available”. This was not appropriate as no recent activities/social events had been provided since the manager had left in January 2006 and did not promote a person centred approach to meeting residents’ social care needs. 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. Comment by one resident included “it’s alright here, but you could do more – like sewing – I’m not bothered about going out”. 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. Staff described one resident went to a day centre run by the owners of the home. Interaction between staff and residents was observed when staff were carrying out tasks for residents, but staff were not observed spending quality time talking with residents. Relatives and social/health care professionals comments included “residents are just sat about doing nothing – staff are too busy looking after them”, “just sat staring.” Residents confirmed that they maintained 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 pork or salmon salad. Residents who had pork said, “the meat was tough”. A carer was observed cutting the pork for one resident and it bent the fork they were using. Other comments by residents about meals included “they had deteriorated – they used to have a buffet tea on Sunday but now it was every tea time because it suited staff and there wasn’t enough kitchen staff”, “sandwiches at tea time suit me because there’s always a hot meal at lunch time”, “meals ok”, “usually soup or sandwiches at tea”, “no real choice at meals – always same breakfast – choice of cereal, porridge or grapefruit, toast or poached egg on toast” and “nice meals”. It was apparent that staff that were cooking were not employed to work in the kitchen through discussions with staff and by comments made by residents and relatives which included “girls sufficient – they help out in kitchen, but while they’re helping out in kitchen they’re not looking after residents. They’re a chef less.” Staff confirmed they have been a chef down for some time and it was being covered by care staff, but the owners knew about it. Royal Court DS0000006497.V290536.R01.S.doc Version 5.1 Page 15 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The outcomes for standards 16 & 18 were inspected A complaints procedure was in place and although residents and their advocates said they didn’t have any complaints, the owners not being proactive in seeking their views about the service meant their concerns about the service were not being addressed. Staff had a reasonable understanding of the procedures to be followed should they suspect any abuse at the home, however, some had not had training in the protection of vulnerable adults which may mean allegations are not followed up promptly and appropriate action taken. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The complaints procedure displayed in the entrance hall was resident friendly, comprehensive, but did not include the telephone number of the CSCI. There had been no record of any complaint since the last inspection. Residents and their advocates said they had “no complaints” and “couldn’t grumble”, however, comments made by them identified aspects within the home that they were not happy with (see daily life and social activities and management and administration). Royal Court DS0000006497.V290536.R01.S.doc Version 5.1 Page 16 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. Discussions with staff and staff training records identified some staff had not had training in the protection of vulnerable adults, although the majority did describe appropriately what they would do if they became aware of any abuse. On recruitment, staff were appropriately checked against the ‘Protection of Vulnerable Adults Register’. Ms Bailey said there had been no allegations of abuse. Royal Court DS0000006497.V290536.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The outcomes for standards 19 & 26 were inspected. The building and its environment was on the whole clean, but there were areas where housekeeping arrangements needed to improve, as did some of the decoration and fabric of the home, to provide a well-maintained environment for residents to live. Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Residents, advocates and social/health care professionals comments about the environment included “place nice enough – you have to take into consideration residents pulling wall paper off”, “it could do with a bit more bottoming”, “bedroom nice and cleaned every week”, “sparse home”, “first thing that hits me is that they’re using fresheners to try and cover up smells”. Royal Court DS0000006497.V290536.R01.S.doc Version 5.1 Page 18 Room’s sizes met the minimum recommended and all accommodation was provided in single rooms. 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 furnishings and fittings were on the whole domestic in character, but there were areas that were not of an adequate standard, for example, the main lounge area had areas where pieces of wallpaper had been torn from the wall, the entrance carpet was marked and stained, occasional tables were worn and stained, blue tack was on the ceiling of the lounge, the carpet in the lounge from the entrance hall was soiled with dirt and worn and the carpet in the dining room from the main lounge was stained. The décor and fabric of the building was discussed with the Ms Bailey and Mrs Pearson who agreed a refurbishment in some areas was required. Housekeeping arrangements needed attending to as two toilets were observed to be dirty at 12:15 and were still dirty at 16:25. Laundry facilities were situated away from all food preparation and storage areas. Hand washing facilities were provided. Carers were observed using gloves and aprons, which would assist with the control of infection, however, dirty laundry on the floor in the laundry would not. There was confusion between care staff and laundry staff about residents who had special needs in regard to laundering of their clothing, which did not aid the control of infection. Discussions with laundry staff identified they held NVQ Level 1 in Laundry and Cleaning and health and safety. Royal Court DS0000006497.V290536.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The outcomes for standards 27, 28, 29 & 30 were inspected. The numbers and skill mix of staff was not meeting all residents’ needs. There was lack of detail in one area of the recruitment procedure followed by the home, but Ms Bailey and Mrs Pearson were aware what this was and it is expected that this will be adhered to in future recruitment. There had been staff training to equip staff with the knowledge and skills for their roles within the home, but this was now out of date and without a manager to lead the training and supervision of staff residents were not always in safe hands. Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Residents and advocates comments about staff at the home included “staff very friendly”, “girls sufficient – they help out in kitchen, but while they’re helping out in kitchen they’re not looking after residents - they’re a chef less”, “staff and place nice enough”, “staff have been magnificent while I’ve been poorly”, “staff good”, “staff alright”, “place gradually going down hill – there’s no manager supervising – staff are pleasing themselves”, “staff have seemed friendly”. Royal Court DS0000006497.V290536.R01.S.doc Version 5.1 Page 20 The printer was out of ink therefore an up to date residential staffing forum and staff rota could not be accessed to confirm agreed staffing levels had been met. The inspector observed and staff confirmed staffing numbers had increased but a member of staff in an afternoon was still doing teas and washing pots at tea and supper time, as there was only a cook on duty until 14:00. Staff said this took longer because the dishwasher was broken. Staff were observed interacting with residents when care tasks needed completing, but not spending quality time talking with residents, but spending time in groups away from contact with residents. The home had not recruited any members of staff since the last inspection. Inspection of three staff files identified lack of detail and omissions in obtaining documented evidence of a full employment history with written explanation of gaps in employment. This was discussed with Ms Bailey and Mrs Pearson and the requirements removed with expectation that this will be adhered to in future recruitment of staff. Ms Bailey said the printer was out of ink which meant information confirming the percentage of staff with NVQ Level 2 in Care could not be ascertained but Ms Bailey stated “I can’t see much having changed since last time you came which was only four months ago”. At that time fifty per cent of staff had obtained NVQ Level 2 in Care or equivalent. Discussions with staff and inspection of training records identified they had, had a range of training including food hygiene, moving and handling, first aid, health and safety, protection of vulnerable adults, but a lot of it was out of date and there were some staff who had, had no training. In addition, staff on duty had not had fire training or been present on a drill for some time. This meant staff may not be equipped with up to date knowledge and skills for their roles within the home, and without a manager to lead the training and supervision of staff residents were not always in safe hands. Royal Court DS0000006497.V290536.R01.S.doc Version 5.1 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The outcomes for standards 31, 33, 35, 37 & 38 were inspected. The manager post at the home was vacant. Effective quality assurance and monitoring systems based on seeking the views of stakeholders of the service was not in place. 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. Some areas relating to health and safety issues required attention, in order to maintain the safety and welfare of both residents and staff. Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. Royal Court DS0000006497.V290536.R01.S.doc Version 5.1 Page 22 EVIDENCE: Comments by residents, advocates and staff about the current management arrangements of the home included “no-one in charge”, “it needs a bit of umph”, “no-one in authority or to supervise”, “when matron’s are there it’s good”, “those that own it never seem to be there looking after it”, “place gradually going down hill – there’s no manager supervising – staff are pleasing themselves”, “never seen Ms Bailey or Mr Pearson all the time I’ve been here”, “when Neil (the previous manager) was here we had meetings and he was visible”, “when Neil was here we got copies of reports – we don’t any more”, “impressed when Neil was manager”, “deteriorated since he’s gone”, “needs a manager – a home can’t run with just seniors – needs someone with qualification and authority that knows what they’re doing”, “Ms Bailey and Mrs Pearson come, but don’t do what a manager does”. At the last inspection the manager had resigned and Ms Bailey and Mrs Pearson said they would be managing the home on a day-to-day basis until a manager has been appointed. Ms Bailey said the manager position had been advertised on the net and had two applications, but both were unsuitable. Ms Bailey said current position is that she and Mrs Pearson call at the home most days and are contactable by staff working at the home but the day-to-day running is left to senior cares in charge of the shift. This has meant there has been no leadership or management responsibility in ensuring the home is run in the best interests of residents through an effective quality assurance and monitoring system. No reports of visits undertaken by the provider, to determine the standard of care provided by the home, in their opinion, as required by the regulations had been submitted to the CSCI since the last inspection. Residents, where appropriate, were responsible for their own finances and this was appropriately documented in the individual care plan. Comments by residents and advocates about management of their monies included “dad looks after his own money, there are no problems there” and “monies and fees looked after ok”. Monies held by the home for two residents were 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. Auditing of those finances took place. Secure facilities were provided for the safekeeping of money and valuables kept on behalf of residents’. 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. Not all resident records were stored securely, which compromised residents’ confidentiality. Royal Court DS0000006497.V290536.R01.S.doc Version 5.1 Page 23 There were appropriate measures in place to ensure the security of the premises and prevent intruders. 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 home’s progress in meeting those requirements was discussed further with the fire service on 3 March 2006 and identified the home were doing everything they could to meet those requirements. The fire officer visited the home today and identified improvements were still required in regard to staff fire training and drills and that the home needed to implement a fire risk assessment. This was confirmed through discussions with staff and inspection of fire records. The residents’ safety and welfare was not wholly safeguarded as although staff training records identified staff had undertaken moving and handling training they were observed moving residents in wheelchairs without footplates. This is not safe working practice and may put residents at risk of falling and/or injury. Discussions with staff and inspection of training records identified moving and handling training was out of date. In addition, the medical room was found left open. Sharps disposal and residents’ records were on the work surface and cupboards did not have locks and held creams and dressings. This did not promote the health and welfare of residents and maintain their confidentiality. Notifiable incidents were reported as required. Recorded water temperatures identified these had been adjusted to ensure water was provided that was close to forty-three degrees centigrade, the recommended temperature for hot water. Royal Court DS0000006497.V290536.R01.S.doc Version 5.1 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 2 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 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.V290536.R01.S.doc Version 5.1 Page 25 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 OP1 Regulation 5 Requirement The service user guide must contain all the information required by the regulations. Previous timescales of 31/03/05, 31/10/05 & 30/04/06 not met. The individual plan of care must contain specific information about how residents’ social care needs will be met using a person centred approach. The individual plan of care must identify the type of restraint to be used and when. The individual plan of care must identify the residents’ mental capacity to be able to make decisions. The individual plan of care must demonstrate all action that has been taken to meet the health needs of residents. Residents must wear clothes that fit. Residents must be consulted about their social interests and a programme of suitable activities arranged. All parts of the home must be DS0000006497.V290536.R01.S.doc Timescale for action 03/07/06 2. OP7 OP12 15, 16 & 17 31/07/06 3. 4. OP7 OP7 15 & 17 15 31/07/06 31/07/06 5. OP7 OP8 OP10 OP12 OP16 OP19 15 & 17 31/07/06 6. 7. 12 16 31/07/06 31/07/06 8. 12, 13 & 31/07/06 Page 26 Royal Court Version 5.1 9. OP19 23 16 & 23 10. 11. 12. 13. OP19 OP38 OP19 OP26 OP38 OP26 OP28 OP30 OP38 OP28 OP18 OP30 OP31 OP33 OP33 16 & 23 16 & 23 12, 13 & 16 12, 13, & 18 13 & 18 8 24 26 14. 15. 16. 17. 18. OP37 17 19. 20. OP37 OP38 17 13 21. OP38 13 left clean. The main lounge area must be redecorated. The entrance carpet must be replaced. The chair in the smoking area with foam protruding from the fabric must be removed. A refurbishment programme for the fabric and décor of the building must be put in place. Dirty laundry must not be placed on the laundry floor. All staff must be aware of residents with health needs that require particular infection control measures. An audit of all staff training must be undertaken and a training programme implemented. A manager must be appointed to manage the home. A quality assurance and monitoring system must be implemented. The provider must submit a report of the unannounced visit to the home on a monthly basis, to report the quality of the service provided. All records holding information about residents must be securely stored. Previous timescale of 30/04/06 not met. Records as required by the regulations must be maintained, up to date and accurate. Safe moving and handling procedures must be undertaken at all times. Previous timescale of 31/08/05 & 30/04/06 not met. All hazardous equipment and substances must be securely stored. Previous timescale of 30/04/06 DS0000006497.V290536.R01.S.doc 30/09/06 16/05/06 31/07/06 31/07/06 16/05/06 31/12/06 30/06/06 30/09/06 31/07/06 16/05/06 31/07/06 16/05/06 16/05/06 Royal Court Version 5.1 Page 27 22. OP38 13 & 23 not met. The requirements made by the fire officer in regard to a fire risk assessment and staff fire training and fire drills must be met. 31/07/06 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. 4. Refer to Standard OP15 OP16 OP27 OP27 OP15 OP27 OP15 Good Practice Recommendations Residents should be consulted about the types of meals they would like and these should be provided. That the accuracy of the dependency of residents and/or the distribution of staff hours allocated using the staffing forum calculation are readdressed. That a member of staff should be appointed to perform kitchen duties at tea and supper time. That the dishwasher should be repaired or replaced. Royal Court DS0000006497.V290536.R01.S.doc Version 5.1 Page 28 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR National Enquiry Line: 0845 015 0120 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 Royal Court DS0000006497.V290536.R01.S.doc Version 5.1 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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