Inspection on 05/05/06 for Ruksar

This inspection was carried out on 5th 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

Ruksar 06/02/09

Ruksar 29/04/08

Ruksar 28/09/07

Ruksar 10/04/07

Ruksar 09/01/07

Ruksar 12/09/06

Ruksar 08/03/06

Ruksar 15/12/05

Ruksar 14/09/04

Ruksar 21/04/04

Ruksar 16/12/03

Similar services:

Aston Court Nursing Home

Breme

Ravenhurst

Westmead

Ashcroft Hollow Nursing Home

Bricklehampton Hall Nursing Home

Briar Hill House

Radbrook Nursing Home

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Ruksar 26 Park Avenue West Park Wolverhampton West Midlands WV1 4AH Lead Inspector Joy Hoelzel Unannounced Inspection 5th May 2006 09:40 X10029.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 Ruksar DS0000017194.V290388.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 and Care Homes for Adults 18 – 65*. 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. Ruksar DS0000017194.V290388.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ruksar Address 26 Park Avenue West Park Wolverhampton West Midlands WV1 4AH 01902 420605 01902 561199 mariamathet@aol.com 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) Mr Mustak Jalal Maria Teresa Cendana Care Home 27 Category(ies) of Physical disability (27), Physical disability over registration, with number 65 years of age (27) of places Ruksar DS0000017194.V290388.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. No number division between categories Date of last inspection 8th March 2006 Brief Description of the Service: Ruksar is a care home that provides nursing, accommodation and personal care to 27 people. It is registered for adults with physical disabilities both over and under 65 years of age. The home is located close to Wolverhampton city centre, close to shops, pubs, local parks and other amenities. The home first opened in January 1993, Mr Jalal taking ownership of the home in 2002. It is a two-storey building with bedrooms, communal rooms, toilets and bathrooms on both floors. There is a passenger lift accessing the first floor. There is a ramp to the front of the house but limited access to the gardens for wheelchair users. Information on the service provision is available in the form of a statement of purpose and service user guide both documents are available in English and Punjabi. Ruksar DS0000017194.V290388.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection is the first of key inspections for 2006/07 and took place over six and a half hours on Thursday 20th April 2006. It was conducted by two regulation inspectors. The Pharmacist Inspector also formed part of the inspection team and was asked to review the home’s arrangements for the receipt, recording, handling, storage, safekeeping, safe administration, and disposal of all medicines received into the home. The inspection comprised of examining the home’s policies and procedures, the medication storage areas, the records kept and discussions with the nursing staff and residents. The findings of the pharmacy inspector are included in this report in the Health and Personal Care section of this report. Twenty seven of the thirty eight National Minimum Standards for older people were inspected in addition to standards for Adults age 18-65. Sixteen service users were on the premises with one service user in hospital receiving treatment. The registered manager was on the premises supported by one registered nurse, three care staff and ancillary personnel. Three case files were selected for case tracking, relevant documents were inspected and the medication administration procedure was inspected in depth. Discussions were held with numerous service users, visitors and staff. A tour of the premises was conducted. What the service does well: The home is very culturally and ethnically diverse and provides a service to people of all ages. Most of the staff are bi-lingual ensuring effective communication is maintained with people whose first language is not English. The home provides a good variety of the Asian, and English type meals and the cook must be commended for her continuous support in assisting with the diverse preferences of the people living at the home. One service user has a very active social and recreational programme; this level of support must be offered and available to other people. Ruksar DS0000017194.V290388.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Ten of the twenty seven requirements issued following the inspection in March 2006 remain outstanding and not been completely met. An additional thirty seven requirements have been issued following this inspection with twenty requirements being made in relation to medication administration with seven immediate requirements being issued. Further developments in the care planning process are urgently required to ensure that a persons assessed needs are fully attended to and staff are kept informed of the needs and any changes that are identified. All staff must be aware of the prescribed interventions for the people living at the home and carry out and record the interventions at the correct times. Attention must be given to arranging suitable social and leisure activities for all service users and in particular the older Asian ladies. The programme for the routine maintenance and renewal of furnishings and fabric of the home must continue. Sufficient numbers of staff must be available to ensure that all people living at the home have all their needs fully met. All staff must have full induction training and records kept. Further training and development needs of staff must be identified and a training matrix is operational. The recruitment procedures must be amended with all necessary checks being made for all staff, with records and copies of the checks obtained and kept in the personnel files. Staff must have regular recorded formal supervision with their line manager at least six times per year followed with an annual appraisal of their work performance. The health, safety and welfare of service users, staff and visitors to the home must be upheld with monitoring systems in place, records confirming this must be available for inspection. . Ruksar DS0000017194.V290388.R01.S.doc Version 5.2 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. Ruksar DS0000017194.V290388.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Ruksar DS0000017194.V290388.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 1, 3,6 YA 2 Quality in this area is adequate. This judgement has been made using available evidence including a visit to this service. Minor amendments are required to the statement of purpose and service user guide to ensure all information is accurate and current. EVIDENCE: The home has a statement of purpose and service user guide and is available in both English and Punjabi. Both documents must be reviewed and updated to contain accurate and current information in regard to staff personnel and the contact details of Commission for Social Care Inspection. The registered manager stated that there have been no new admissions since the inspection in March 2006. Three service users case files were selected for inspection, each contained a pre admission assessment of need from outside agencies and the staff at the home. An initial care plan is then generated from Ruksar DS0000017194.V290388.R01.S.doc Version 5.2 Page 10 this information at the time of admission to the home. The manager explained that whenever possible the service users and/or representative is involved in the process but at times this is difficult to achieve due to complex care needs or a reluctance to participate. Ruksar DS0000017194.V290388.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for the following standard(s): OP 7,8,9,10 YA 6,9,16,18,20 Quality in this area is poor but improving. This judgement has been made using available evidence including a visit to this service. Limited improvements have been made to the care planning process, however service users continue to be placed at risk of harm through the lack of attention in recording information. Quality in the area of medication administration is poor. . Medication is not being stored, handled or recorded properly. This could put at risk the health and wellbeing of people who use this service. EVIDENCE: Ruksar DS0000017194.V290388.R01.S.doc Version 5.2 Page 12 Each service user has an individual plan of care, which is reviewed on a monthly basis or more frequently is needed. The three case files selected all included risk assessments for falls and use of bedrails. Specific risk assessments for the individual had been completed for reducing the risk from scalding with hot drinks and maintaining safety within the home. Since the last inspection in March 2006 the home has introduced an evaluation of the body mass index to assist with nutritional screening, although this document is included in the case files it has not been completed and is not being used to monitor and determine weight gains or losses. Two case files had specific care plans for the management of diabetes. One indicating a monthly regime is required for urinalysis to test for ketones/ glucose. The care plan states the aim to maintain levels of blood sugar to be between 4-7 mmol and to ‘test urine when BM high’. There are no instructions for staff as to what levels are deemed to be high, and no particular document for recording the readings. One case files daily recording sheet indicated that the dietician had visited and had offered advice for weight gains, gluton free and diabetic diets. The cook discussed this and confirmed that the information is available in the kitchen for the other catering staff. A specific care plan had not been completed following the general advice from the dietician in regard to this particular person: • A plan of activities programme • Short walks for 10 minutes duration three times a day • Monitor milk intake. One person’s plan indicated the need for pressure ulcer dressings; a care plan has been formulated containing information on the type of dressing to be used and the frequency of the dressing change. This person is very frail and prefers to have a rest in bed after lunch this assists with the pressure area care and again is recorded in the plan. This person discussed the difficulties being experienced with maintaining continence, a plan has been completed to assist in this area but a referral to the specialist continence advisor has not been arranged. A comment was made that ‘ the staff are very good and helpful’. One service user became very distressed during the morning whilst she was sitting in the chair in the ground floor lounge, a member of staff was observed to be communicating to her in her own language (Punjabi), and established that she was experiencing some pain. The member of staff immediately arranged for pain relief to be given and then appropriately assisted and supported this person with personal hygiene in private. Later this member of staff discussed the complex care needs of this person in a knowledgeable and skilful way. One service users made an additional comment in the service users comment survey ‘ very happy with the care given. Staff always take time to sit with me’. Ruksar DS0000017194.V290388.R01.S.doc Version 5.2 Page 13 The pharmacy inspectors report – Medication Policy: The procedures document for the handling of medicines was reviewed and it was seen that the content was not sufficient to make the document a comprehensive description of how medicines were handled within the home. The home was asked to review, update and describe in more detail the practices expected to be undertaken by the staff. The home must then ensure that the nursing staff adheres to the procedures described in the document. Record Keeping: The home stated that a record of all medication received was kept however when requested to show the record it could not be found. The home must have this record accurate and accessible at all times so that a check of whether a resident had been administered the medication correctly could be carried out should the need arise. The home was using Medicine Administration Record (MAR) charts to keep a record of the current prescribed medication and of the compliance to take the medication for each resident. Reviewing a sample of these charts highlighted a number of issues, which could potentially be affecting the health and welfare of the residents: • A number of the MAR charts showed that the home was not administering some of the medication according to the directions displayed on the dispensing labels. No written evidence could be found to take account of the difference. Immediate requirement notices were issued to the home, concerning three residents, requiring them to obtain written clarification from the residents GPs of the correct administration instructions. There was an unacceptable amount of dispensing labels showing the directions “As directed”. An immediate requirements notice was issued requiring the home to obtain written confirmation, from the prescriber, of what the precise directions should be for the “As directed” medication. The home was also required to organise reviews if it was discovered that the home have not been administering the medication as the prescriber had intended. The home was also asked to ensure that any medication received into the home, with “As directed” labels attached, was returned immediately to the Pharmacy for alteration to the precise prescribed instructions. A resident was not receiving part of her medication because the home was out of stock of it. An immediate requirement was issued asking the home to investigate why this medication had run out and ensure that incidents like this do not happen again in the future. A once weekly-administered medicine had been administered a day later than it was due. • • • Ruksar DS0000017194.V290388.R01.S.doc Version 5.2 Page 14 • • • • Handwritten additions to the MAR charts were not being transcribed properly from the pharmacy label nor were they being countersigned to confirm the accuracy. The name, strength, form of the drug and the directions must mirror what appears on the pharmacy label and all entries must be double checked by another nurse. External medication for some residents had not been entered on to their MAR charts. The integrity of the MAR charts could not be guaranteed because some of the MAR charts showed gaps in the signature record and others confirmed the administration when it could be seen that the administration of the medication had not taken place. The MAR chart for a resident showed that Bisocodyl 5mg tablets were being administered every night when the label stated that one tablet was to be taken every other night Administration: One of the residents was being allowed to self-administer Ibuprofen gel to treat his pain. A risk assessment had not been carried out by the home to establish whether this resident was able to manage and administer the medication as instructed by the doctor. On visiting this resident’s room the gel was found in an unlocked draw of the bedside cabinet. The insecurity of this medication could potentially result in a resident obtaining medication that was not intended for them and could potentially put residents health at risk. There also did not appear to be any procedure in place to check whether the resident had complied with the doctor’s instructions. The home was issued with an immediate requirement to carry out a risk assessment on this resident and ensure that the gel is kept secure at all times. The home was also instructed to initiate a monitoring programme to ensure that the resident was administering the medication as instructed by the doctor. Three of the residents did not receive their morning medication until lunchtime. When the nurse in charge was challenged about this, just before lunch, the inspector was told that they were late risers and they had not come down yet. On further investigation, the residents were carrying out activities within their rooms so were not asleep all of the morning. There was no attempt by the nurse to take the trolley to these residents’ rooms and administer the medication there. The practice seemed to be to wait until the residents came down for lunch. This practice appeared to be happening quite regularly yet the home had not checked with the GP to see whether it was safe to do so. The home needs to review their practices to ensure that residents receive their medication as prescribed and the home does not rely on residents coming to the dining area for medication to be administered. Training: Ruksar DS0000017194.V290388.R01.S.doc Version 5.2 Page 15 The administration of medication appeared to be carried out by nursing staff all of the time. The nursing staff appeared to come from a number of backgrounds but there did not appear to be any evidence that the home had checked the nursing staffs competence or continued to check the nursing staff competence to follow the homes procedures and the NMC guidelines for administering medication. The home must develop a programme to monitor and ensure that the nursing staff are competent in handling and administering medication to the residents. Controlled Drugs: Two Controlled Drugs cabinets were found inside two different metal medication cabinets. Neither of the cabinets complied with the Misuse of Drugs (Safe Custody) Regulations 1973 because they had not been attached to the wall properly. The home also had a Controlled Drugs register, which was used to record the receipt, administration and disposal of Controlled Drugs used in the home. It was noted that this register had not been used since the 11th September 2004. The Manager said that the home had not had any Controlled Drugs prescribed for any of the residents since then. Storage: A mobile drug trolley was being used to store the residents’ current medication. The trolley appeared to be quite well organised but a number of issues were drawn to the inspectors attention and these included: • Paracetamol tablets and Lactulose solution were being used as stock items and these medicines prescribed for one resident were being administered to other residents. The home was reminded that the medication prescribed for a resident was the property of that resident and must not be distributed amongst other residents. A bottle of Chlorpromazine was found, which had a dispensing date of 7th March 2006. The home had not realised that this product expired one month after being opened. The home had not recorded the date of opening on the bottle and therefore, if assumed, the bottle was opened near the dispensing date the home was potentially administering out of date Chlorpromazine to this resident. Due to the risk to the resident’s wellbeing an immediate requirement was issues to the home to discard the current bottle of Chlorpromazine and replace with a new supply, which had been dated upon opening. • Ruksar DS0000017194.V290388.R01.S.doc Version 5.2 Page 16 • • The MDS system for one resident showed that an extra days medication had been used. There was no record within the home to explain why this was so and therefore the home did not know whether there had been a drug error and a potential overdose. The home had also failed to identify the need for an extra days supply of medication until the inspector highlighted it. If the issue had not been highlighted then the resident may well have had to go without their medication for one day, which potentially could be detrimental to the resident’s welfare. An immediate requirement was issued for the home to ensure they had enough supply of the resident’s medication to ensure that administration of the resident’s medication continued as prescribed by the doctor. A spacer device for a resident taking inhalers was found. The device was very dirty and appeared to be quite old. The home had not realised that this particular device needed to be washed regularly and needed to be changed every three to six months in order to ensure effective delivery of the medication. Within the treatment room there was a fridge that was used for storing the residents’ medication, which needed cold storage conditions. Five different types of eye drops were discovered in the fridge, which did not need to be subjected to cold storage conditions. The home was asked to remove these products and ensure in the future that medication was stored at the temperature specified by the manufacturers. A maximum/minimum thermometer was found in the fridge and it was seen from the records that since the 16th April 2006, the home had been monitoring and recording the maximum and minimum temperatures on a daily basis. Unfortunately the records showed that the minimum temperature had been maintained at between –2 and 0°C. This minimum temperature range would make the insulin stored in the fridge unfit to use and an immediate requirement was issued to the home to discard all of the insulin and replace with new stock. The home must ensure that the fridge is maintained at between 2 and 8°C and the residents’ medication is stored at the correct temperature. The insulin vials, in use, were being stored in the fridge, the home was told that the manufacturers expect the in use insulin vials to be stored at room temperature, not exceeding 25°C for a specified time period. Keeping the in use insulin at room temperature reduces the risk of painful injections for the residents. Other issues identified: Since the inspection on the 8th March 2006 following a complaint from a GP about the poor diabetes management carried out by the home there had been some improvements in the consistency and frequency of the monitoring of the residents blood glucose levels. The control of these diabetics, particularly the insulin dependant diabetics, was still very poor. The home needs to source specialist help to improve the residents’ diabetic control and must increase the Ruksar DS0000017194.V290388.R01.S.doc Version 5.2 Page 17 knowledge base of both nursing and care staff so that they have a better understanding of the condition. Ruksar DS0000017194.V290388.R01.S.doc Version 5.2 Page 18 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 12,13,14,15 YA 12,13,15,17 Quality in this area is poor in regard to social activities and adequate for the other standards inspected. This judgement has been made using available evidence including a visit to this service. Working time constraints and the lack of resources are influencing the effectiveness of a suitable activity and recreational programme suitable for the people living at the home. There is little evidence to suggest that service users views are being sought or that the activities are in any way stimulating or suitable for the majority of the people. EVIDENCE: Ruksar DS0000017194.V290388.R01.S.doc Version 5.2 Page 19 One service user has a very active social activity programme with classes arranged at the local community centre in art, pottery and flower arranging. The cook escorts this person to these sessions and goes shopping, visiting friends and other outings with her. A two weekly activity programme has been identified, with the main activity in the mornings as ‘mail delivery/ paper delivery (by request)’. No newspapers or magazines were observed in any areas of the home. Limited activities are arranged each afternoon again by the cook and with limited resources. A fitness session is arranged once a fortnight. One service user indicated in the service users comment card that he’ likes to participate when NJR fitness come and I also enjoy socialising with other residents’. The cook stated that she had escorted some people to the local polling booth earlier in the week and escorts some people to the local park for the various festivals that take place. The care staff appear to be very busy attending to the personal care needs of the service users and as such are restricted by time constraints for assisting with social and recreational activities. The older Asian ladies mostly spend their day in the ground floor lounge, very little interaction was observed either between themselves or with staff. One lady had a music centre close to her and liked to listen to the Asian music. Other people were sitting seemingly uninterested in the day with nothing to do. A staff member stated that as most staff speak Punjabi communication was not too difficult but stated that generally the older ladies cannot speak English. The pre inspection questionnaire supplied by the manager indicates that of the sixteen service users, English is not the first language for thirteen people. Once a week a talking book and video afternoon is arranged alternating between English and Asian. Newspapers and magazines are not available in either language. A member of staff stated that one lady goes to the temple with her husband on occasions. One service user stated that he liked watching television and had one in his bedroom. Another service user uses his electric wheelchair to access the local shops on a daily basis. Other service users were observed to be in the smoking lounge. The cook has obtained leaflets and brochures of community activities taking place throughout the summer and stated that the preferred opportunities will be discussed at the next service users community meeting. A visitor to the home confirmed that she visits weekly and feels that her relative is contented; he shares a room with another gentleman and seems happy with this arrangement. Some of the younger service users are assisted and supported with handling their own personal finances, when this is not possible cash and/or valuables are stored securely in the homes safe. The cook has a very good knowledge of the special diets required; the cultural and religious dietary needs are well catered for. At lunchtime the pureed diet was presented in a more acceptable manner and was served separately on the plate. Staff were observed to be assisting service users with the meal in an appropriate and unhurried manner. One service user stated that he did not like curries and that he was offered a substitute but generally he liked the food Ruksar DS0000017194.V290388.R01.S.doc Version 5.2 Page 20 on offer. One service user indicated on the comment card ‘ happy that I get Jamaican food made by the cook once a week’. The cook has introduced a system of recording any dietary restrictions or requests, together with any particular likes and dislikes, this document is readily available for reference of the catering staff. Records are now being kept of the food offered and taken on a daily basis. Ruksar DS0000017194.V290388.R01.S.doc Version 5.2 Page 21 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 16,18 YA 22,23 Quality in this area is adequate. This judgement has been made using available evidence including a visit to this service. The home has complaint and adult protection procedures in place; the effectiveness of the procedures will be measured over time. EVIDENCE: The complaint procedure is included with the service users guide and is also displayed on the main notice board at the entrance to the home. The details of how to contact Commission for Social Care Inspection if required are not included. Two complaints have been made directly to the manager, they have been documented with the required actions and outcomes following enquiry into the complaint. Further discussions have been held with the local general practitioner and Commission for Social Care Inspection regarding the care of people with diabetes. This was discussed during this inspection with the manager and staff nurse. A copy of the multidisciplinary adult protection procedures is available in the main office for staff reference. The procedure for dealing with the safe keeping of service users personal monies remains unchanged with records of all transactions being made, Ruksar DS0000017194.V290388.R01.S.doc Version 5.2 Page 22 receipts are kept and whenever possible the signature of service user is obtained. Ruksar DS0000017194.V290388.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 19,20,21,24,25,26 Quality in this area is poor but improving. This judgement has been made using available evidence including a visit to this service. Environmental improvements are being actioned in order to provide service users with a more comfortable home to live. EVIDENCE: Thirteen requirements were made as a result of the previous inspection in relation to the environment. As a result a programme for redecoration and renewal of fabrics for 2006 has been developed and forwarded to CSCI. A fax confirming the order of equipment for the first floor sluice and replacement of Ruksar DS0000017194.V290388.R01.S.doc Version 5.2 Page 24 flooring in a toilet, two bathrooms and the sluice room was provided to inspectors. It was reported that contractors are awaiting payment prior to undertaking works. The lighting in a number of bedrooms has improved however the replacement of a number of bulbs in communal areas remains outstanding. The manager reported that no new furniture has been purchased since the last inspection however the replacement of dining and bedside tables is documented on the programme of renewal in addition to the replacement of some soft furnishings. CSCI will continue to monitor compliance during future inspections to ensure timescales are adhered to. The manager confirmed that neither the environmental health nor fire departments have visited since the last inspection and that there are no outstanding requirements in relation to these departments. The lounge located on the first floor is much improved and is no longer used for storage. New net curtains have been purchased and the room made more welcome and accessible to service users. The parker bath on the first floor has been replaced as required from the previous inspection and bath water temperatures tested were found satisfactory on this occasion so too were the drainage of the baths. The shower although functioning continues to leak as confirmed by a service user and staff member. The cleanliness of the home is much improved and both domestic staff were on duty at the time of the inspection. Discussions with both staff evidenced that their working hours have been increased and they are now employed to work from 8am – 3.30 pm. Both staff reported that the extension of their hours has enabled them to take more time in ensuring the home is kept clean and free from odours. An inspection of the cleaning cupboard evidenced that a greater variety of cleaning products are now readily available. The cook is currently in the process of obtaining the relevant data sheets and compiling risk assessments for all of the cleaning products used within the home. Copies will then be available in the kitchen, cleaning cupboard and laundry. Staff spoken with confirmed that they are undertaking distance learning training in relation to infection control and a list of nominated staff were seen displayed in the office. Ruksar DS0000017194.V290388.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 27,28,29,30 Quality in this area is poor. This judgement has been made using available evidence including a visit to this service. There is insufficient staff employed to provide service users with a quality of life that meets their individual requirements and aspirations. Staff training is slowly improving however the homes recruitment procedures and lack of staff induction is potentially placing service users at risk. EVIDENCE: The duty rota reviewed during the inspection was an accurate reflection of the staff on duty at the home. There are three shift patterns in operation with three carers and one nurse on duty from 8am-3.30pm, two carers and a nurse from 3.30-9.30pm and one carer and one nurse performing night duty. Discussions held with three service users and a relative indicates that given the size and layout of the home and the dependency levels of a number of people currently accommodated that this should be reviewed. The duty rota evidenced that a nurse is undertaking twelve double shifts during the month of May and on 7.5.06 a nurse is working a late shift followed by a waking night. Ruksar DS0000017194.V290388.R01.S.doc Version 5.2 Page 26 It was observed that service users in the main lounge were left unsupervised for long periods of time throughout the inspection due to staff having to support other individuals within the home. Service users reported the length of time it takes for staff to answer call bells and also expressed their concern regarding staffing levels particularly of a night for reasons of health and safety. Interactions between staff and service users observed during the inspection were generally positive however discussions held indicated that more could be done to cater for the minority groups within the home. Three people spoken with reported that communication with non-English speaking staff is problematic. A requirement was made at the previous inspection in relation to staff being suitably qualified and competent to do their job. Perusal of training records available demonstrates that staff have undertaken some training however further training is required. Individual training Records were available for 2004 and 2005 however a number of these were incomplete and without a clear team training matrix it was not possible to establish which staff had attended health and safety related training. It was reported that four care staff have obtained an NVQ award at level 2. Certificates were available for three staff. A record of forthcoming training was seen on the training file with nominated staff to attend. Courses include Diabetes, Documentation/Record Keeping, Falls Prevention, Basic Fire Protection and training in Adult Protection. Of the three personnel files reviewed there was no evidence of induction available for two staff. A brief in-house induction was available on file of a third employee however this was very brief and consisted of ticks and was not signed by the manager or employee. The induction records for a number of other staff were incomplete. The personnel files were generally disorganised and did not contain the relevant documentation as required by Schedule 2 of The Care Home Regulations 2001. Two files only contained one written reference. One of these references was from an individual who had only known the applicant for one month and the reference was not signed or dated. An original criminal record bureau disclosure was only available on one of the files reviewed. The other two files only contained a photocopy that the applicant’s previous employer had obtained. On one applicant form there was no evidence of the applicants previous employment history even though the person has been working for an agency and another care home. Of the three people reviewed only one staff member had received formal supervision on 07.12.05 and there was minimal information recorded. Photocopies of training certificates were available on one file however this training had been undertaken during previous employment. Ruksar DS0000017194.V290388.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 31,33,36 and 38 Quality in this area is poor. This judgement has been made using available evidence including a visit to this service. The manager is approachable and supportive however she has not been provided with the necessary support to effectively manage the service. Quality assurance systems need to be further developed and health and safety procedures improved to protect and safeguard service users and staff. Ruksar DS0000017194.V290388.R01.S.doc Version 5.2 Page 28 EVIDENCE: The manager, Ms Teresa Cendana has resigned from the position of registered manager. She was due to leave the home at the end of April. Discussions with her indicated that she would remain at the home until new management arrangements are in place. At the time of the inspection the proprietor was out of the country and due to return on 08.05.06. Unannounced visits, as required under regulation 26, are not being undertaken and the manager was not aware of the need for the proprietor to undertake these. Such visits must take place monthly and a report of the findings forwarded to the Commission of Social Care Inspection and a copy retained at the home. A service user satisfaction survey was last undertaken on 10.06.05. The manager stated that she has not yet collated all of the responses however comments included “The cleanliness and refurbishment of the home could be improved”, “Staff have a good sense of humour”, “Social activities and communication and language barriers need improving”, “Staff look after me well”. The majority of ticks were recorded in the good or satisfactory box. No other surveys have been obtained from visiting healthcare professionals, relatives, stakeholder etc. A relative spoken with during the inspection reported concerns regarding compatibility of one individual in particular but stated that the home has generally improved however there are insufficient staff on duty and more entertainment, activities and physiotherapy could be provided. She was unaware of the homes formal complaints system however expressed that she had no major concerns and is a regular visitor to the home. A number of staff are now undertaking distance learning in infection control and a policy is in place as required by previous inspections. Bath water temperatures tested were found satisfactory. As previously stated relevant outstanding data sheets are currently being obtained and risk assessments being undertaken. Certificates to evidence that staff had undertaken food hygiene training were available. Certificates for the servicing of equipment were seen with the exception of a valid Landlord Gas Certificate and certificate for the hardwiring for the home. Records are maintained for the testing of fire and emergency lighting in addition to the testing of bath water temperatures however according to records water temperatures were last recorded on 10.02.06. Risk assessments are available for safe working practices however these require further development in relation to control measures. During an environmental tour adequate personal protective equipment was seen available. As previously stated due to training records being disorganised and Ruksar DS0000017194.V290388.R01.S.doc Version 5.2 Page 29 with the absence of a team training matrix it was not possible to establish which staff had attended mandatory health and safety related training. An odd pair of bedrails was seen on one bed. The homes health and safety policy was not reviewed on this occasion. Ruksar DS0000017194.V290388.R01.S.doc Version 5.2 Page 30 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 2 X 3 3 4 X 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 ENVIRONMENT Standard No Score 19 3 20 3 21 2 22 X 23 X 24 2 25 2 26 2 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No Score 31 2 32 X 33 2 34 X 35 X 36 2 37 X 38 2 Ruksar DS0000017194.V290388.R01.S.doc Version 5.2 Page 31 Yes Are there any outstanding requirements from the last inspection? 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 4(1) Requirement The statement of purpose and service user guide must be reviewed and updated to contain current and accurate information of the service provision. The service users plan of care must accurately detail and record all assessed needs. Previous requirement 01/01/06 and 21/04/06 Not met The specific instructions for diabetes care and the identified interventions must be accurately recorded and reviewed. Previous timescale 01/04/06, not met. The registered person must ensure that where there is an assessed need the appropriate healthcare professionals are contacted DS0000017194.V290388.R01.S.doc Timescale for action 31/07/06 2 OP7 15(1)(2) 30/06/06 3 OP8 12(1) 30/06/06 4 OP8 13(1)(b) 30/06/06 Ruksar Version 5.2 Page 32 5 OP8 12(1) 6 OP9 13(2) 7 OP9 13(2) 8 OP9 13(2) 9 OP9 13(2) 10 OP9 13(2) 11 OP9 13(2) The registered person must ensure that staff carry out the instructions regarding the care of a person at the stated times and record the findings. Previous timescale 01/04/06, not met. The home must develop a comprehensive policy and procedures document for the handling of medication within the home, which depicts all of the procedures that are and need to be carried out by the Nursing staff. The home must clarify with the GPs the correct administration directions for those identified residents who were taking Haloperidol, Risperidone and Promazine. All “as directed” doses must be clarified in writing by the prescriber and the MAR sheets must be amended accordingly. All medicines administered/non administered must be recorded immediately after the transaction with either a signature or a defined abbreviation. The records of medication handled within the home must be robust enough to ensure that all medication is accounted for. Where possible the home must ensure that the residents GP confirms any changes to the residents’ medication in DS0000017194.V290388.R01.S.doc 30/06/06 31/07/06 10/05/06 10/05/06 30/06/06 30/06/06 30/06/06 Ruksar Version 5.2 Page 33 writing. 12 OP9 13(2) For all handwritten entries the name, strength and form of the medication and the directions must mirror what appears on the dispensing labels. All handwritten entries written on to the MAR charts must also be double checked for accuracy by a second registered nurse. The MAR charts must exhibit all medication that the resident has been prescribed. The home must regularly audit the medication to ensure the integrity of the MAR charts and the consistency of supply is maintained. Any supply deficiencies must be rectified immediately. The prescriber’s directions must be adhered to without fail. If it appears that the directions are not appropriate for the circumstances of the resident then the GP must be consulted. All residents wanting to administer their medication must be assessed to determine whether they are capable. Written evidence of the assessment must be kept on the residents file. The home must also have in place a programme of monitoring that these residents are administering their medication as prescribed DS0000017194.V290388.R01.S.doc 30/06/06 13 OP9 13(2) 30/06/06 14 OP9 13(2) 06/05/06 15 OP9 13(2) 30/06/06 16 OP9 13(2) 10/05/06 Ruksar Version 5.2 Page 34 17 13(2) OP9 18 OP9 13(2) 19 OP9 13(2) 20 OP9 13(2) 21 OP9 13(2) 22 OP9 13(2) 23 OP9 13(2) 24 OP9 13(2) The home must discard all of the insulin found in the fridge on the day of the inspection and provide evidence that this requirement was adhered to. The home must obtain with immediate effect a new supply of insulin and ensure that it is stored at a temperature of between 2 and 8°C. Only medication requiring cold storage conditions must be stored in the fridge. Medication must be administered only to the resident it was prescribed for. Products that have a short shelf life when opened must be dated upon opening and discarded after the specified time period. The Controlled Drugs cabinet must comply with the Misuse of Drugs (Safe Custody) Regulations 1973. The administration procedure must be reviewed and adapted to include safe practices for those residents who wake late and remain in their rooms until lunchtime. The home must develop a programme to assess and monitor the staffs’ competency in administering medication to the residents. The home must attempt to seek specialist help for their diabetic resident to DS0000017194.V290388.R01.S.doc 06/05/06 30/06/06 06/05/06 05/05/06 10/05/06 30/06/06 30/06/06 30/06/06 Ruksar Version 5.2 Page 35 25 OP9 13(2) 26 OP12 16(2)(m)(n) 27 OP16 22(7)(a)(b) 28 OP21 23(2)(b)(c)(d) 29 OP21 23(2)(b)(c)(d) achieve their optimum blood glucose levels. The home must organise a training programme for both nursing and care staff on the subject of diabetes and it management. All service users must be given the opportunity for stimulation through leisure and recreational activities both in house and community based. The complaint procedure must be revised to contain all current and accurate information The leaking shower on the first floor must be repaired and fit for purpose. All lavatories and washing facilities must be clean and hygienic, repaired and/or replaced. Previous timescale 31st July 2005and 01/01/06 not met Service users rooms must be furnished according to NMS 24. Previous timescale 21/04/06, not met. Floor coverings must be fit for purpose and appropriate to the individual. Previous timescale 21/04/06, not met. Lighting in service user accommodation must DS0000017194.V290388.R01.S.doc 31/07/06 30/06/06 31/07/06 30/06/06 30/06/06 30 OP24 16(2)(c) 23(2)(b-d) 30/06/06 31 OP24 16(1)(2) (c) (d) 30/06/06 32 OP25 23(1)(a)(2)(p) 30/06/06 Ruksar Version 5.2 Page 36 meet recognised standards (lux 150). Previous timescale 21/04/06, not fully met. 33 OP26 13(3), 16(2)(j) The sluice disinfector situated on the first floor must be repaired or replaced. Previous timescale 31st July 2005, 01/01/06, 21/04/06 not met 30/06/06 34 OP27 18(1)(a) 35 OP28 18(1)(c ) 36 OP29 19(1)(2)(3)(4) 19(5) 37 38 OP29 OP30 19 18(1)(c)(i) The ratios of care staff 30/06/06 must be reviewed and levels appropriate to the assessed needs of the service users, the size, layout and purpose of the home at all times. The training plan must 30/06/06 evidence when the remainder of the care staff are to undertake training in NVQ level 2. Personnel files for staff 30/06/06 employed post April 02 must contain all the documentation required by Schedule 2 to include CRB disclosure and PoVA check. Recruitment procedures 30/06/06 must be robust in order to safeguard service users. The registered person 30/06/06 must ensure that all staff are suitably qualified and competent to do their job Previous timescale 21/04/06, not fully met. Staff induction must meet DS0000017194.V290388.R01.S.doc 39 Ruksar OP30 18(1)(c) 31/08/06 Page 37 Version 5.2 40 OP31 8(1)(a) 41 OP33 26 42 OP33 24(1)(2) 43 OP36 18(2) 44 OP38 23(2)(c )(j) 45 OP38 13(3)(4)(6) Skills for Care specifications. The proprietor must inform CSCI of the proposed managerial arrangments for the home in the absence of a registered manager. Unannounced visits as required under regulation 26, must take place monthly and a report of the findings forwarded to the Commission of Social Care Inspection and a copy retained at the home. The results of service user surveys must be published and made available to service users, interested parties and CSCI. Staff must be appropriately supervised and receive formal supervision at least six times per year. Bath water temperatures must be maintained close to 43ºC and results recorded on a weekly basis. Data sheets and risk assessments must be available for all the cleaning products used within the home and domestic staff made familiar with these. Previous timescale 21/04/06, not fully met. Bedrails must only be fitted based on a comprehensive risk DS0000017194.V290388.R01.S.doc 01/06/06 30/06/06 31/08/06 30/06/06 01/06/06 30/06/06 46 OP38 12(1) 01/06/06 Ruksar Version 5.2 Page 38 47 OP38 12,13 assessment; be appropriate to the bed; fitted as a set and included on the homes health and safety maintenance checklist. Records for the servicing of all equipment must be open for inspection. 30/06/06 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 Refer to Standard OP30 Good Practice Recommendations That a training matrix be developed. Ruksar DS0000017194.V290388.R01.S.doc Version 5.2 Page 39 Commission for Social Care Inspection Wolverhampton Area Office 2nd Floor St. Davids Court Union Street Wolverhampton WV1 3JE 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. Ruksar DS0000017194.V290388.R01.S.doc Version 5.2 Page 40 - 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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