Inspection on 16/06/05 for Royal Court

This inspection was carried out on 16th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 15/05/06

Royal Court 02/02/06

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 S74 9RP Lead Inspector Jayne White Unannounced 16 June 2005 08:45am 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 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 J51 S6497 Royal Court V230018 16.06.05 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Royal Court Nursing Home Address Rock Mount King Street Hoyland Barnsley S74 9RP 01226 741986 01226 741986 Not known Healthmade Limited Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Vacant N Care Home with Nursing 40 Category(ies) of OP Old age - 31 registration, with number DE Dementia - 9 of places Royal Court J51 S6497 Royal Court V230018 16.06.05 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. The DE registered beds are a separate unit. 2. Of the 31 personal care (PC), 2 can be used as nursing care (N). 3. The total persons who can be accommodated at the home cannot exceed 40. 4. Persons accommodated shall be aged 60 years and above. Date of last inspection 23 November 2004 Brief Description of the Service: Royal Court is a care home providing personal care and accommodation for 40 older people. Included in the registration of 40 beds is a separate unit within the home for nine people with dementia. The homes registered owner is Healthmade Limited. Royal Court is located in Hoyland, within the Barnsley area and is close to the shopping centre and a doctor’s surgery. 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 J51 S6497 Royal Court V230018 16.06.05 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over seven and a quarter hours from 8:45 to 16:15. Amanda Lindley, regulation manager accompanied Jayne White on the inspection. Opportunity was taken to make a partial tour of the premises, inspect a sample of records, observe care practices and talk to residents, relatives, staff, one of the directors who currently manages the home and the new manager who will commence duty at the home in August. The majority of residents and staff were seen during the inspection and the inspector spoke in more detail to four of the staff on duty about their knowledge, skills and experiences of working at the home, three residents about their views on aspects of living at the home and three relatives. An additional visit was made to the home on 30 March 2005 as the result of an anonymous complaint to the CSCI. The findings of the visit are included in this report, in accordance with CSCI procedures. What the service does well: What has improved since the last inspection? One resident described how the food had improved since the last inspection and all residents spoken with said there was a good variety and choice of food. Royal Court J51 S6497 Royal Court V230018 16.06.05 Stage 4.doc Version 1.30 Page 6 What they could do better: Management arrangements at the home have not been satisfactory, however, a new manager is to commence at the home in the near future and is already familiarising themselves with the home. The service user guide did not contain all the required information to enable prospective residents to have the information they need to make an informed choice about where to live. Issuing residents with an individual plan of care continued to be a concern and another immediate requirement was issued on this inspection. Resident’s rights and best interest could be placed at risk by the homes failure to maintain all records adequately. Although records were not always in place, up to date and accurate, observation of some care practices and discussions with residents and staff of care needs it appeared that residents care needs were being met. Residents were protected by the homes policies and procedures for the receipt and storage of medication, however, previous improvements in the administration record to identify/confirm whether medication had been administered or not had lapsed. The time medication was administered on the DE unit was not acceptable. There had been no improvements in the provision of leisure and social stimulation within the home and not all residents were satisfied with the provision of activities in this regard. Staff said this was one aspect of care provision that could be improved if there was enough staff. Residents and advocates cannot be confident their complaints will be taken seriously and acted upon, as the company have failed to address requirements from previous complaints and investigate other complaints within an adequate timescale and respond to complainants with the outcome. Although an adult protection policy was in place the policy needed to refer to the local multi agency procedures for reporting abuse. Staff said they would report abuse, however they had not had training in adult abuse to be provided with the knowledge of the different types and signs of abuse. Improvements had not been made in the provision of soap and paper towels in toilet and bathroom areas to control the spread of infection. Staffing levels continued to remain insufficient to ensure residents health, personal and social care needs were met. Although there had been improvements in the recruitment information obtained for new staff it remained insufficient to adequately protect the welfare of residents who lived at the home. Staff were undertaking training, however, to ensure carers knowledge and practices remained up to date, updating training in moving and handling, fire safety, first aid, food hygiene and infection control was required. An appropriate quality assurance system was not in place for residents and relatives to express their views on the home and for the home to measure their own success in meeting their aims and objectives identified in the statement of purpose for the home. Staff were not being appropriately supervised. Some areas relating to health and safety issues required attention, in order to enhance the safety and welfare of both residents and staff. Royal Court J51 S6497 Royal Court V230018 16.06.05 Stage 4.doc Version 1.30 Page 7 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 J51 S6497 Royal Court V230018 16.06.05 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Royal Court J51 S6497 Royal Court V230018 16.06.05 Stage 4.doc Version 1.30 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 standard(s) 1, 2 & 3. Standard 6 is not applicable to this home. The service user guide did not contain all the required information for prospective residents to have the information they need to make an informed choice about where to live. Residents had a written contract/statement of terms and conditions with the home and had, had their needs assessed prior to moving in to the home. This confirmed the home was satisfied they were able to meet residents needs. EVIDENCE: The home has produced a service user guide and contract for residents; however, they did not contain sufficient information for prospective residents. A summary of the assessment for residents referred through care management arrangements had been received by the home. Royal Court J51 S6497 Royal Court V230018 16.06.05 Stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 & 10 There were a number of residents that did not have an individual plan of care where their health, personal and social care needs were identified. One care plan that was in place and inspected did not relate to the care provided. Although there was no documented evidence of residents health care needs in their individual plan of care, observation and discussions with staff of care practice appeared that residents health care needs were met. Residents themselves said that they were satisfied with the care they were receiving. Residents were protected by the homes policies and procedures for the receipt and storage of medication. Improvements were required to the administration record to identify/confirm whether medication had been administered or not. In addition the times medication was administered on the DE unit was not acceptable. Residents said their privacy and dignity was respected and staff were able to describe how they maintained residents privacy and dignity. Royal Court J51 S6497 Royal Court V230018 16.06.05 Stage 4.doc Version 1.30 Page 11 EVIDENCE: A care plan pack with relevant blank documentation was prepared in advance of the admission of a new resident. If completed appropriately this would provide a comprehensive guide of residents needs, however, a number of residents did not have a care plan that identified their health, personal and social care needs. There had been no improvement in this area since the additional visit when an immediate requirement was made. One care plan that was in place and inspected did not relate to the care provided for the resident. The care plan did identify when visits by health professionals had been made. The outcome of those visits were not identified on the care plan although there was evidence that the requirements from some of the visits were being carried out in regard to monitoring fluid intake and output. Likewise with continence needs. The daily report identified there was some care provided for pressure areas and staff were able to describe what they did, however, there was no documented evidence to confirm this. A resident and relative described how a change of GP had been facilitated by the home and that this was appreciated and the service much better. Discussions with residents identified that they felt their needs were met one comment being ‘health is very important to them here’. Medication administration was observed and was satisfactory. Medication was stored appropriately. The medication record was inspected. Improvements had not been maintained since the additional visit in regard to the recording of PRN medication and today this also included routine medication. The time when residents on the DE unit received their morning medication was unsatisfactory. This was not administered until 11:30 am. Residents said their privacy and dignity was respected and staff were able to describe how they maintained residents privacy and dignity. The regulation manager observed that residents were wearing clean clothes and appeared to have received an acceptable level of personal care. There was a telephone in the home for residents to use that was located in the hallway of the home, however, all residents rooms have telephone points and the telephone could be transported there when required. There were three areas that were identified to the new manager where practices could be improved to privacy and dignity of residents. Royal Court J51 S6497 Royal Court V230018 16.06.05 Stage 4.doc Version 1.30 Page 12 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 standard(s) 12, 13, 14 & 15 Residents were generally happy with their lifestyle within the home and they were able to maintain contact with family and friends. Not all residents were satisfied with the provision of social and leisure activities. Residents said there was a good variety and choice of food. Royal Court J51 S6497 Royal Court V230018 16.06.05 Stage 4.doc Version 1.30 Page 13 EVIDENCE: Residents spoken with by the regulation manager said they could choose how to spend their day. Residents confirmed that they were asked for their food choices for the day. They could choose what time to get up and go to bed. Personal items and furniture were brought into the home by residents to personalise their rooms. There were no activities taking place during the inspection. One resident said ‘there was no activities at the home but you could go to the day centre if you wanted’. Most residents appeared to sit in the lounges for long periods, with music and television playing in the background. Staff confirmed it was rare residents went to the day centre and only a few used the opportunity. Staff could describe activities that did take place on the DE unit although this appeared to be on an ad-hoc basis and the staff were not observed interacting with residents unless it was for the purposes of assisting with care or eating. A record/diary of activities was not available as wasn’t minutes of any residents meetings. Asked if there was anything that would improve the home a comment included ‘more trips out but there isn’t enough staff and would need to come in on days off’. Relatives said that visiting times were flexible and that they could see their relatives in private. One resident said they used the separate lounge for visits by their family and children. This promotes the wellbeing of residents. All of the residents spoken with said that there was a good variety and choice of food and there was enough to eat. One resident commented that the food had improved significantly since the last inspection with much more choice and variety. This promotes the health and wellbeing of residents. Staff were aware of the food and drink preferences of the residents. Three meals a day were served. The breakfast and lunch time meal were observed. Residents could be seen to have choice and the meal was well presented. The meals were unhurried and residents had plenty of time to eat their meal. Drinks were served regularly throughout the day. Royal Court J51 S6497 Royal Court V230018 16.06.05 Stage 4.doc Version 1.30 Page 14 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 standard(s) 16 & 18 Residents and advocates cannot be confident their complaints will be taken seriously and acted upon, as the company have failed to address requirements from previous complaints and investigate other complaints within an adequate timescale and respond to complainants with the outcome. There were adult protection policies in place, however, the actual policy needed to refer to the local multi agency procedures for reporting abuse. Staff said they would report abuse but had not had training in adult abuse. Royal Court J51 S6497 Royal Court V230018 16.06.05 Stage 4.doc Version 1.30 Page 15 EVIDENCE: The complaints procedure identified in the service user guide was resident friendly, comprehensive and included all the information required by the regulations, however, the one displayed in the entrance hall differed to that identified in the statement of purpose and service user guide and did not include a timescale to guide complainants. The home did keep a record of complaints, however, the record was still not clear how a complaint had been investigated and what action had been taken to address the complaint. The CSCI had made an additional visit to the home on 30 March 2005 to investigate an anonymous complaint made to the CSCI and the outcome was: 1. Conduct of one of the owners, Mr Pearson. Complaint unsubstantiated. 2. Advertising for a manager. Complaint partially substantiated. Since that additional visit an application to register a manager has been made to the CSCI. 3. Quality of care plans. Complaint partially substantiated. Requirements made in regard to care plans had not been met on this visit and the content within care plans had deteriorated. 4. Medicines. Complaint unsubstantiated. 5. Residents are left alone for long periods of time. Complaint partially substantiated. 6. Two staff are routinely on nights. Complaint partially substantiated. There had been no improvements on the requirements to provide agreed staffing levels on this inspection. 7. There is no time for staff to sit and talk to residents. Complaint partially substantiated. 8. Residents on the EMI unit have little or no choice with daily life. Complaint partially substantiated. 9. Staff cooking and attending to personal care inappropriately. Complaint unsubstantiated. On the 20 April 2005 another complaint was received by the CSCI and forwarded to the company on 26 April 2005 for themselves to investigate. A response has not been made to the complainant or the CSCI. The CSCI investigated the complaint as part of this inspection and found the complaint to be partially upheld. The director was asked to provide an interim response within two days. The homes adult protection policy was inspected. The policy did not include the reference to the local multi agency procedures to be followed should an allegation of abuse be made. The home had obtained the Barnsley and Rotherham Metropolitan Borough Councils Protocols for adult protection. Staff had not had training in adult abuse but said they would report abuse if they became aware of it. On recruitment, staff were appropriately checked against the’ Protection of Vulnerable Adults Register’. Royal Court J51 S6497 Royal Court V230018 16.06.05 Stage 4.doc Version 1.30 Page 16 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 standard(s) 19, 21, 22 & 26 The building and its environment were generally clean and on the whole well maintained, thereby enhancing its appearance and facilities. The residents spoken with said they felt the home offered a comfortable standard of accommodation. The home had sufficient number of baths, showers and toilets and specialist equipment was provided where required. Improvements had not been made in the provision of soap and paper towels in toilet and bathroom areas to control the spread of infection. Royal Court J51 S6497 Royal Court V230018 16.06.05 Stage 4.doc Version 1.30 Page 17 EVIDENCE: Room’s sizes met the minimum recommended and all accommodation was provided in single rooms. There were sufficient rooms for activities to take place. The designated smoking area is on the unit providing personal care. There were two other lounges that were smoke free and these were comfortably furnished. Residents could see visitors in private in their own rooms and one resident said they used the separate lounge for visits by their family and children. Residents comments on the environment included ‘it is bright and relaxing’, ‘my request for a change of room to an outside room was met’, ‘cleaners very good’, ‘they are very particular with cleanliness and ‘cleaned every day – no problem’. The courtyard areas of the garden had been maintained and appeared to be a safe area for residents to access. Outdoor space and all areas of the home were accessible to residents. There was appropriate storage space for aids and equipment. The furnishings and fittings were on the whole domestic in character, however, a previous recommendation to replace one of the dining tables in the dementia unit as it was more of a desk type table had not been actioned. Given tablecloths were not placed on the tables at meal times this did not give the impression of a domestic type dining area. Lighting and heating was satisfactory. 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. Residents spoken with were all happy with their rooms and one said the reason they liked it was ‘it was comfortable’. Inspection of bedroom areas were in the main satisfactory, however, one bedroom inspected was not clean – the drawers of a bedside cabinet were empty but had old dried food debris in them and the side of the cabinet had dried brown marks on them. The top surface of the bedside cabinet was worn. This partially upheld the complaint made to the CSCI on 20 April 2005. See complaints and protection section. Laundry facilities were situated away from all food preparation and storage areas and residents said the laundry service was satisfactory, however, two days ago it started to get mixed up. This was reported to a director of the company who was currently acting as manager. Liquid soap and paper towels were not consistently available in all toilet areas, which was not hygienic and would not aid the control of infection in the home. Carers said gloves and aprons were available to spread the control of infection. Royal Court J51 S6497 Royal Court V230018 16.06.05 Stage 4.doc Version 1.30 Page 18 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 & 30 Staffing levels were not sufficient to meet ensure residents health, personal and social care needs were met. Although there had been improvements in the recruitment information obtained for new staff it remained insufficient to adequately protect the welfare of residents who lived at the home. Staff were undertaking training, however, to ensure carers knowledge and practices remained up to date updating training that was out of date was required. Royal Court J51 S6497 Royal Court V230018 16.06.05 Stage 4.doc Version 1.30 Page 19 EVIDENCE: The inspector saw two weeks rotas. Information they contained was insufficient. Every day there were shifts when staff numbers were not at the required level. This has been an ongoing theme from previous inspections. The kitchen is staffed 7:00 – 14:00. This means the carers are responsible for doing tea and supper further reducing the amount of care hours provided. In regard to the two nursing beds that are still registered the CSCI are currently in discussion with the company, when staffing levels will be considered and appropriate measures taken. There was not a dedicated staff team for the DE unit that meant residents did not receive consistency of staff when their mental health needs is enhanced by this approach. Resident and relative comments regarding staff included ‘not enough staff’, ‘no problems with the staff’, ‘staff are very hard worked’, ‘biggest problem is on a morning, because of the number of people that needs help. Sometimes this makes breakfast late’, ‘I’ve told all the staff I think they’re understaffed’, ‘staff are good’, ‘they are short staffed but covering between them – deserve 110 how they’ve coped’, ‘all staff marvellous and ‘sometimes there seems to be a lot of staff, sometimes scarce’. Discussions with staff identified dependency levels were high with approximately seventy per cent requiring assistance with toileting. The home employed sufficient ancillary staff. During the inspection it became apparent that a care package was being provided to an occupant who lived in a bungalow close the home. This was discussed with a director of the company in regard to both staffing levels and their category of registration. The home’s recruitment policy had been reviewed to say offer of employment will only be offered when all checks required under the Care Homes Regulations have been completed satisfactorily and evidence of this is in the personnel file’, however, the home had not recruited to those requirements. Nearly thirty five per cent of staff had obtained NVQ Level 2 in Care. Discussions with carers identified either they were in the middle of mandatory training requirements and were covering this as part of their NVQ 2 in Care or had not done any training while employed at Royal Court and training needed updating. Staff’s training records were not always clear with dates training was completed not noted. Royal Court J51 S6497 Royal Court V230018 16.06.05 Stage 4.doc Version 1.30 Page 20 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 36, 37 & 38 Management arrangements have not been satisfactory, however, a new manager is to commence at the home in the near future and is already familiarising themselves with the home. An appropriate quality assurance system was not in place for residents and relatives to express their views on the home and for the home to measure their own success in meeting their aims and objectives identified in the statement of purpose for the home. Staff were not being appropriately supervised. 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 enhance the safety and welfare of both residents and staff. Royal Court J51 S6497 Royal Court V230018 16.06.05 Stage 4.doc Version 1.30 Page 21 EVIDENCE: An application to register a manager has been submitted to the CSCI. This should provide permanent leadership for staff and residents in the home. A director of the company who had been acting as manager acknowledged conditions of registration had not been maintained after questioning by the regulation manager. This identified management responsibilities had not been undertaken in a satisfactory manner. The director verbally agreed to maintain a vacancy on the DE unit to keep within agreed registered numbers. Minutes of residents meetings were not available. Previous requirements in regard to social activities and interests were therefore unable to be inspected, however, discussions with relatives and advocates appeared this requirement was not met. Discussions with staff did not clarify supervision as recommended by the standard took place. Inspection of a staff file did not demonstrate any supervision had taken place. Appropriate supervision would ensure residents interests were maintained by the promotion of good practice. A sample of the records that the home was required to keep was inspected. Comments and requirements with reference to these are made throughout this report including an immediate requirement for the formulation of care plans. Maintaining the required records and keeping them up to date and accurate would go some way to demonstrating residents rights and best interests were maintained. Records were stored securely which protected residents confidentiality. The residents safety and welfare were not wholly safeguarded as discussions with staff identified mandatory training such as moving and handling, fire safety, first aid, food hygiene and infection control had not been undertaken or required updating. One member of staff was seen moving a resident without footplates without a moving and handling risk assessment being completed. A resident also made a comment that ‘staff are so busy they have to move two residents at once in wheelchairs, one behind and one in front’. These are not safe working practices. Staff confirmed a health and safety policy was in place. There were appropriate measures in place to ensure the security of the premises and prevent intruders. Records when portable electrical appliances were last checked were inadequate as no dates were recorded. Some equipment identified that they had been checked, others hadn’t. Some fire extinguishers were inspected. Not all identified they had, had appropriate servicing and were not wall mounted on brackets. After the additional visit on 30 March 2005 confirmation of where fire extinguishers should be placed was held with Kevin Storey, fire officer. He stated fire extinguishers should be wall mounted on brackets and the reason for this was that they continued to be where they should be as identified on the fire plan. These examples did not demonstrate the health and safety of residents and staff were being maintained. Hoists had been appropriately serviced and appropriate water temperatures were being maintained. Royal Court J51 S6497 Royal Court V230018 16.06.05 Stage 4.doc Version 1.30 Page 22 Inspection of the building identified fire exits were free from obstructions and hazardous substances were appropriately stored. Notifiable incidents were reported as required. Royal Court J51 S6497 Royal Court V230018 16.06.05 Stage 4.doc Version 1.30 Page 23 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 2 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 x 3 3 x x x 2 STAFFING Standard No Score 27 1 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 1 x 2 1 x 1 x x 1 1 2 Royal Court J51 S6497 Royal Court V230018 16.06.05 Stage 4.doc Version 1.30 Page 24 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 1 Regulation 5 Requirement The service user guide must contain all the information required by the regulation and standard. Previous timescale of 31 March 2005 not met. All residents must have an individual plan of care completed. Where residents do have a plan of care this must be up to date and accurate. There must be no gaps in the medication administration record including medication prescribed on a PRN basis. Previous timescale of 31 January 2005 not met. Residents on the DE unit must receive their medication at an appropriate time. A planned programme of social activities must be devised and provided that are flexible and varied to suit residents expectations, preferences and capabilities. Previous timescales of 30 September 2003, 31 July 2004 & 31 March 2005 not met. Timescale for action 31 October 2005 2. 3. 4. 7&8 7&8 9 15 15 13 Immediate 20 June 2005 31 August 2005 31 August 2005 5. 6. 9 12 12 & 13 12 & 16 31 August 2005 31 October 2005 Royal Court J51 S6497 Royal Court V230018 16.06.05 Stage 4.doc Version 1.30 Page 25 7. 16 22 8. 16 22 9. 18 13 10. 11. 12. 13. 14. 18 19 26 26 27 13 & 18 16 23 13 18 15. 27 18 The complaints record must be clear about how the complaint has been investigated and what action has been taken to address the complaint. The complaints procedure displayed in the entrance hall must contain the timescales by which the complainant can expect to receive a reply to their complaint. Previous timescale of 31 January 2005 not met. An interim response must be provided to the complainant and the CSCI regarding the complaint forwarded to the home on 26 April 2005. The homes adult protection policy must be reviewed to include the procedure to be followed if an allegation of abuse was made. Previous timescale of 31 March 2005 not met. Staff must receive training in adult protection and the associated procedures. The identified bedside cabinet must be refurbished/replaced. Bedside cabinets must be kept clean and tidy. Liquid soap and dispensers for paper towels and toilet rolls must be provided in toilet areas. The staff rota must contain correct information in regard to where the staff have been deployed (residential or dementia unit) and the hours worked. Sufficient staff must be employed to meet the agreed staffing levels. Previous timescales of 31 July 2004 & 31 January 2005 not met. 31 August 2005 20 June 2005 31 August 2005 31 January 2006 31 October 2005 31 August 2005 31 August 2005 31 August 2005 31 August 2005 Royal Court J51 S6497 Royal Court V230018 16.06.05 Stage 4.doc Version 1.30 Page 26 16. 27 17. 27 & 31 18. 19. 29 30 20. 31 21. 33 22. 35 The DE unit must be supervised by at least one member of staff during the night. Previous immediate timescale of 11 April 2005 not met. 18 The company must inform the CSCI of their continued intentions in regard to the provision of care packages to bungalows close to the home in regard to their registration category and thus staffing arrangements for the packages. 19 Recruitment of staff must comply with regulation requirements. 18 Staff must be provided with training where they have not received mandatory training requirements or it is out of date. CSA A vacancy on the DE unit must Section 24 be maintained to ensure the home does not exceed its total registered numbers. 24 An effective quality assurance and quality monitoring system must be put in place, based on seeking the views of residents to measure success in meeting the aims and objectives of the home. Previous timescales of 31 August 2003, 1 September 2004 and 31 March 2005 not met. 17 & 25 Records of fees and personal allowances that are paid by/to residents must be kept or made available at the care home. 18 Care staff must receive supervision at least six times a year. This must include; all aspects of practice; philosophy of care and career development. Previous timescales of 31 March 2004, 1 September 2004 & 31 March 2005 not met. 18 31 August 2005 31 August 2005 31 August 2005 31 January 2006 Immediate 16 June 2005 31 October 2005 23. 36 31 January 2005 Not checked on this inspection 31 October 2005 Royal Court J51 S6497 Royal Court V230018 16.06.05 Stage 4.doc Version 1.30 Page 27 24. 25. 26. 37 38 38 17 13 13 27. 38 13 & 23 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. All electrical portable appliance equipment must be appropriately tested. Previous timescale of 31 August 2003, 1 September 2004 and 31 August 2005 not met. Fire extinguishers must be wall mounted on brackets. 31 August 2005 31 August 2005 31 August 2005 31 August 2005 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. 5. Refer to Standard 2 19 27 28 Good Practice Recommendations The contract/terms and conditions should include by whom the fees are payable. That a domestic type dining table is provided in the dementia unit. That a dedicated team of staff are employed in the dementia unit. 50 of staff should be qualified to NVQ Level 2 by 2005. Royal Court J51 S6497 Royal Court V230018 16.06.05 Stage 4.doc Version 1.30 Page 28 Commission for Social Care Inspection 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 J51 S6497 Royal Court V230018 16.06.05 Stage 4.doc Version 1.30 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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