Inspection on 08/03/06 for Ruksar

This inspection was carried out on 8th March 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 05/05/06

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 8th March 2006 09:45 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.V285317.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People 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.V285317.R01.S.doc Version 5.1 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.V285317.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. No number division between categories Date of last inspection 15th December 2005 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. Ruksar DS0000017194.V285317.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place over four and a half hours on Wednesday 8th March 2006, and was conducted by two regulation inspectors. This is the third statutory inspection in 2005/06 and was conducted in response to a complaint received by a General Practitioner in February 2006 in relation to diabetes management and poor standards of cleanliness and hygiene at the home. Eighteen service users were resident at the time of inspection and staffing numbers were at the agreed levels with the manager, one first level nurse plus three care staff. Catering and domestic staff were also on the premises. A tour of the premises took place, nine service users care plans were examined in depth, and discussions were held with service users and staff members. What the service does well: What has improved since the last inspection? What they could do better: Six of the requirements following the inspection in December 2005 have yet to be complied with. Five requirements remain outstanding, as they were not fully assessed on this occasion. The documentation and the recording of information in the care plans are poor and lacks clarity and detail. The specific instructions recorded for staff interventions have not been complied with and there are no systems or procedures in place for accurately reviewing the care plans. Improvements must be made to the presentation, content and choice of meals. The standard of the environment is poor; a plan must be developed urgently for redecoration and refurbishment of the building The home must ensure that all equipment within the home is in good working order and fit for the purpose. Ruksar DS0000017194.V285317.R01.S.doc Version 5.1 Page 6 A sluicing disinfector is urgently required to safely and appropriately dispose of bodily waste. Effective cleaning regimes must be adopted. All staff must be aware of the infection control procedures. Additional domestic staff must be employed in sufficient numbers to safely maintain a clean environment for service users to live. All staff must receive suitable and appropriate training linked to the service provision. Attention must be given to maintaining the health, safety and welfare of service users, staff and visitors. An action plan must be forwarded to the Commission for Social Care Inspection expediently detailing how and when the requirements will be fully complied with, with particular emphasis on prioritising those factors which are currently placing service users at risk. 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.V285317.R01.S.doc Version 5.1 Page 7 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.V285317.R01.S.doc Version 5.1 Page 8 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): EVIDENCE: These standards were not assessed on this occasion. Ruksar DS0000017194.V285317.R01.S.doc Version 5.1 Page 9 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 The documentation and recording in the care plans is very poor and is placing service users at risk in the management of specific medical conditions. EVIDENCE: Nine case files were inspected specifically to track the care being given to people with diabetes. Five people are non-insulin dependent and require tablets and diet to help control the diabetes. Four people are insulin dependent. Ruksar DS0000017194.V285317.R01.S.doc Version 5.1 Page 10 Each person has a plan of care for dealing with diabetes but all nine care plans were found to be deficient in the information that is required. All care plans stated that the aim is to maintain a blood sugar level between 47 mmol with the levels to be monitored at specific times of the day and week. One care plan instructed staff to monitor the blood sugar levels for a person who is insulin dependent three times on a Wednesday and twice each Sunday. Observation of the diabetic management charts evidenced that these clear instructions were not being complied with. Another care plan instructed for blood sugar monitoring three times a week, a record was made on 19/01/06 and not recorded again until 02/02/06 There are no clear guidelines or instructions for staff to follow in the event of a high or low blood sugar being recorded. Although one person is regularly being given a supplement in the evening when a low blood sugar reading is identified. There is only one blood sugar monitor set in working order; this is used for all nine people. The nurse explained that the only other set is not working and is being sent for repair. The inspector observed the procedure after gaining the consent of the service user; the nurse did not follow basic infection control procedures, did not wash her hands either before or after the procedure and took no precautions for the potential contamination of blood contact. One person has a specific problem with maintaining an adequate diet and nutrition and requires an alternative regime for maintaining a good diet and is also insulin dependent. This care plan did not contain any information on the required blood sugar levels to be maintained, no frequency for testing the blood sugar level or any instructions should an abnormal reading be identified. Another person has a specific problem and requires a ‘strict gluten free diet’ in addition to the difficulties with diabetes. A referral was made to the dietician for advice and a domiciliary visit was carried out with specific instructions left from the dietician. The cook confirms that she had had conversations with the dietician regarding this; there are no written instructions for the catering or care staff to follow. The care plan has not been updated and there is no formal plan for a review. All nine care plans identified a need to ‘maintain a normal body weight using BMI’ (body mass index). Staff confirmed that they do not carry out this method of monitoring weight and are unsure of how to measure this. All nine people had a record of their weight made each month using conventional weighing scales. One care plan evidenced that a GP had verbally instructed a change to a regime of medication for one person. The instructions had been amended on the Medication Administration Record (24/02/06) but the care plan had not been updated and written instructions from the GP had not been received. The registered manager was strongly advised to clearly document and record any changes to the regime of medication, to include any changes to the insulin levels. Ruksar DS0000017194.V285317.R01.S.doc Version 5.1 Page 11 The phials of insulin are stored in the fridge in the treatment room; the date of opening is placed on each phial. A maximum/minimum thermometer is used to monitor the fridge temperature on a daily basis and appeared to be within normal levels. The registered nurse was advised to check with the pharmacist of the storage instructions for the insulin phials in use. The registered manager stated that she had had recent contact with the Diabetic nurse at New Cross Hospital. All nine care plans identified a need for the routine monthly monitoring of a persons blood pressure. The documents indicate that this has been carried out each month but is now outstanding for the month of February 2006. Ruksar DS0000017194.V285317.R01.S.doc Version 5.1 Page 12 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 15 Meals are provided to meet the cultural needs of service users, improvements to the presentation would enhance this social aspect of life in the home. EVIDENCE: The main cook has a good knowledge of the special diets required and explained the different types of sabji that is provided each day. The food records are lacking sufficient detail to establish whether a satisfactory diet has been offered and taken. There is no record of any person having breakfast or the content of the breakfast. Each midday meal consists of a choice of two meals with one being a vegetarian option. The dessert offered consists of rice pudding, jelly, and tinned or fresh fruit. Ruksar DS0000017194.V285317.R01.S.doc Version 5.1 Page 13 One person was being assisted with a pureed diet, as this had all been processed together and served in a bowl it was impossible to establish what the person was being offered. The cook stated that she always prepared the pureed food in this way, as it was similar to the curries that are offered, in fact it was Cajun chicken, rice and vegetables. There are no clear instructions available for the catering staff for providing special or alternative menus, or when the healthcare professionals have prescribed changes to the diet. One care plan identified that a Halal diet is needed for cultural reasons, when questioned as to this preference the cook stated that all service users are given the Halal meat regardless of their preference, religion or culture. Ruksar DS0000017194.V285317.R01.S.doc Version 5.1 Page 14 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): EVIDENCE: This set of standards was not fully inspected on this occasion. However, a complaint was sent to Commission for Social Care Inspection from a local General Practitioner regarding the care of people with diabetes and poor standards of hygiene around the home. This unannounced inspection focused on the concerns raised and the findings are detailed in this report. Ruksar DS0000017194.V285317.R01.S.doc Version 5.1 Page 15 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 The lack of investment, poor levels of maintenance and ineffective cleaning regimes do not provide service users with a safe and pleasant environment to live. EVIDENCE: Requirements were made at the previous inspection in relation to the environment, facilities and equipment provided and the lack of cleanliness of the home. The findings of this inspection evidence that these requirements remain outstanding. Ruksar DS0000017194.V285317.R01.S.doc Version 5.1 Page 16 Following a complaint recently referred to the CSCI in relation to the poor cleaning regimes in the home a full environmental tour was conducted by one of the inspectors. Although some new pieces of furniture have been purchased over the last twelve months the majority of furniture and furnishings around the home are in need of replacement and rooms redecorated in order to provide people with a comfortable and safe home to live. It was reported that the home was redecorated last year however there were no records, receipts or a programme available for the routine maintenance and renewal of fabric and decoration of the premises except for notes jotted on a wall chart. The Fire Department last visited the home on 22.04.04 and a number of magnetic door catches have been fitted to some rooms to aid accessibility following a recommendation made. The manager reported that she has recently attended training in relation to fire risk assessment and committed to updating the homes fire risk assessment. The Environmental Health Officer’s report for the visit conducted on 15.12.05 was not available however the cook reported that most of the recommendations made had been actioned. Service users are provided with a lounge, dining room and a smoke room on the ground floor and a lounge on the first floor. However it was reported that the lounge situated on the first floor is currently not in use. Two unused sink units and various other pieces of equipment are currently being stored in this lounge and there are no curtains fitted to the windows. Whilst lighting in communal rooms is domestic in character, the lighting is insufficient, as numerous bulbs in the fittings require replacement. The proprietor reported that new light fittings have been purchased and that these are awaiting fitting. The environmental tour clearly evidenced that the home is not maintained to an acceptable standard. Numerous curtains were found hanging off rails and there were no curtains fitted to one room or to the bathrooms or toilets, which is clearly a privacy issue. Carpets in a number of bedrooms require replacement. Some are marked with cigarette burns, a number were pieced with odd carpet where furniture had been moved and a number of other carpets were not fit for purpose and contained holes and ridges, which may present a trip hazard. Some overhead bed lamps were found broken or bulbs missing and ceiling lighting was extremely poor through the use of energy saving bulbs. Bedrooms do not contain the required furnishings as required under National Minimum Standard 24.2. Requirements have been made at previous inspections regarding the lavatory and washing facilities and that these be clean and hygienic, repaired and/or replaced. All shared toilet and bath facilities are now provided with liquid soap and paper towels however the bathrooms do not provide service users with a comfortable and safe environment to bathe. Following the last inspection one bath located on the first floor has been replaced with a Parker bath. The Ruksar DS0000017194.V285317.R01.S.doc Version 5.1 Page 17 existing bath was removed and replaced with boarding to cover the plumbing elements which is both unsightly and poses a health and safety issue for staff when performing moving and handling duties and when stretching across to empty the bath. The draining of this bath and the Parker bath located on the ground floor is problematic. The drainage hose to the Parker bath on the first floor was found sellotaped up and was leaking providing a slip hazard. The toilet was also found leaking and evidence of stained watermarks left on the floor covering. A mop and bucket containing soiled water was left unattended in the bathroom. Bath water temperatures ranged from 32ºC to 42ºC (too cool to be comfortable), two baths were found unclean and a rubber mat in one bath was extremely mouldy. A number of sinks in service user rooms continue to be without plugs as identified at the last inspection. It was reported that the shower on the first floor had been repaired however the dial requires replacement, as it is broken. Requirements have been made at previous inspections for the sluice located on the first floor to be repaired or replaced. This requirement remains outstanding with staff having to continue using the sluice provided on the ground floor. Laundry facilities are provided and the home employs a laundry assistant six days per week. Washing machines have specified programmes to meet disinfection standards. Ruksar DS0000017194.V285317.R01.S.doc Version 5.1 Page 18 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, 30 Domestic staff are not employed in sufficient numbers to safely maintain a clean environment for service users to live in. Service users would benefit from a well trained and competent staff group. EVIDENCE: Two requirements were made as a result of the last inspection in relation to domestic staff being employed in sufficient numbers and that the equipment and cleaning substances must be available in sufficient quantities to enable the domestic staff to maintain the home in a clean and hygienic condition. The home employs two part-time domestic staff. One domestic is on duty 8am – 2pm each day in addition to someone coming into the home to dust high reach areas on an occasional basis. Observations made and discussions held with the domestic staff member on duty evidence that given the size of the home she is unable to provide a clean environment within the resources available. Cleaning lists are provided in each room however these just provide details of the date the room was cleaned. Rooms generally are in need of a thorough Ruksar DS0000017194.V285317.R01.S.doc Version 5.1 Page 19 clean as a number were found with drink stains to the walls and floors and the ceiling in one room was found marked with food. The cleaning trolley and cleaning store cupboard contained minimal cleaning products and the domestic was unfamiliar with COSHH and data sheets although she reported that she had received training from a rep that supplies the products to the home. The COSHH file was reviewed and did not contain the necessary data sheets or risk assessments for the all of the cleaning products used. Appropriate personal protective equipment is available and staff were observed wearing aprons and gloves during the inspection. The registered manager informed that she would enrol at the local university for a sixteen week course in diabetes care staring in September 2006. She confirmed that staff have attended a course in current issues in diabetes care in October 2005. The cook has received no specific training in providing special diets. Ruksar DS0000017194.V285317.R01.S.doc Version 5.1 Page 20 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 38 The health and safety of service users and staff are currently not being adequately promoted or protected by the home, placing people at risk EVIDENCE: Ruksar DS0000017194.V285317.R01.S.doc Version 5.1 Page 21 A requirement was made at the previous inspection for staff to be instructed in infection control procedures to gain an understanding in preventing the spread of infection. The manager reported that she has recently enquired about appropriate training courses for staff to refresh their skills in this area. The home’s policy for infection control was not available for inspection although the manager reported that a policy is in place. A number of health and safety issues are highlighted throughout this report concerning the cleanliness of the home, regulation of water temperatures, poor maintenance/replacement of equipment, moving and handling issues, COSHH data sheets and poor levels of lighting in communal and service users rooms. In addition to this a number of beds were found fitted with single bedrails and insufficient bumpers were available. Ruksar DS0000017194.V285317.R01.S.doc Version 5.1 Page 22 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 X 2 X 3 X 4 X 5 X 6 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X ENVIRONMENT Standard No Score 19 1 20 2 21 1 22 X 23 X 24 1 25 2 26 1 STAFFING Standard No Score 27 1 28 2 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No Score 31 2 32 X 33 X 34 X 35 X 36 X 37 X 38 1 Ruksar DS0000017194.V285317.R01.S.doc Version 5.1 Page 23 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 5(1)(b)(c) Requirement The terms and conditions/contract with the service user must be available at the point of admission to the home, completed and signed. A copy to be given to the service user and one kept on file. This requirement was not assessed on this occasion The service users plan of care must accurately detail and record all assessed needs. Previous requirement 01/01/06. Not met The specific instructions for diabetes care and the identified interventions must be accurately recorded and reviewed. The care plans must include clear instructions for staff to follow in the event of high/low blood sugar level being identified The registered person must ensure that staff carry out the instructions regarding the DS0000017194.V285317.R01.S.doc Timescale for action 01/01/06 2. OP7 15(1)(2) 21/04/06 3 OP8 12(1) 01/04/06 4 OP8 12(1) 01/04/06 5 OP8 12(1) 01/04/06 Ruksar Version 5.1 Page 24 6 OP9 13(2) care of a person at the stated times and record the findings. A procedure must be implemented for the safe disposal of unused or unwanted medications. This requirement was not assessed on this occasion External medications must only be used for the person for whom they were prescribed. This requirement was not assessed on this occasion All external and internal medications must have an appropriate dispensing label attached. This requirement was not assessed on this occasion The records of food provided to service users must be in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory, in relation to nutrition and to include any special diets that are prepared for individual service users. The registered person must ensure that all food and meals are prepared and presented in an attractive and appealing manner. The registered person must ensure that all service users have the opportunity to be served a diet suitable to their own personal preferences. The treatment room door must not be wedged open. This requirement was not assessed on this occasion 01/01/06 7 OP9 13(2) 01/01/06 8 OP9 13(2) 01/01/06 9 OP15 17(2) Schedule 4(13) 01/04/06 10 OP15 16(2)(i) 01/04/06 11 OP15 1294)(b) 21/04/06 12 OP19 23(4) 31/01/06 Ruksar DS0000017194.V285317.R01.S.doc Version 5.1 Page 25 13 OP19 14 OP19 15 OP20 16 OP21 The home must be safe, wellmaintained and meet service users individual and collective needs in a comfortable and homely way. 23(2)(d), 5 A detailed programme of 16(2)(c) maintenance and renewal of the fabric and redecoration of the premises must be produced and implemented with all records kept. A copy of the programme and timescales must be forwarded to CSCI. 23(1)(a) Service users must be 23(2) provided with access to all communal areas as stated in the homes Statement of Purpose and all excess equipment not in use must be removed. 23(2)(b)(c)(d) All lavatories and washing facilities must be clean and hygienic, repaired and/or replaced. Previous timescale 31st July 2005and 01/01/06 not met 13(4) 23(1(20(a) 16(2)(c) Service users rooms must be 23(2)(b)(c)(d) furnished according to NMS 24.2 16(1)(2) (c) Floor coverings must be fit for (d) purpose and appropriate to the individual. 23(1)(a)(2)(p) Lighting in service user accommodation must meet recognised standards (lux 150). 13(3), The sluice disinfector situated 16(2)(j) on the first floor must be repaired or replaced. Previous timescale 31st July 2005 and 01/01/06 not met 23(2)(d) The home must be kept clean DS0000017194.V285317.R01.S.doc 21/04/06 21/04/06 21/04/06 21/04/06 17 18 19 OP24 OP24 OP25 21/04/06 21/04/06 21/04/06 20. OP26 21/04/06 21 Ruksar OP26 21/04/06 Page 26 Version 5.1 13(3)(4)(c) 22 OP27 18(1)(a) and hygienic throughout and systems in place to control the spread of infection. Domestic staff must be employed in sufficient numbers to ensure that the home is maintained in a clean and hygienic state. Previous timescale 01/01/06 not met The registered person must ensure that the equipment and cleaning substances are in sufficient quantities to enable the domestic staff to maintain the home in a clean and hygienic condition. Previous timescale 01/01/06 not met The registered person must ensure that all staff are suitably qualified and competent to do their job The registered person must ensure that all staff are instructed in infection control procedures, to gain an understanding in preventing the spread of infection. Previous timescale 01/01/06 not met Bath water temperatures must be maintained close to 43ºC. Data sheets and risk assessments must be available for all the cleaning products used within the home and domestic staff made familiar with these. 21/04/06 23 OP27 23(2)(c) 01/04/06 24 OP30 18(1)(c)(i) 21/04/06 25 OP38 18(1)(c)(i) 21/04/06 26 27 OP38 OP38 23(2)(c)(j) 13(3)(4)(6) 01/04/06 21/04/06 Ruksar DS0000017194.V285317.R01.S.doc Version 5.1 Page 27 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 OP9 Good Practice Recommendations It is recommended that external medication within tubs be discarded 28 days after opening. It is recommended that the registered person implement a monthly audit to ensure the accuracy of the procedure for dealing with service users personal monies and valuables. It is recommended that the registered nurse check with the pharmacist of the storage instructions for the insulin phials in use. 2. OP35 3 OP9 Ruksar DS0000017194.V285317.R01.S.doc Version 5.1 Page 28 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.V285317.R01.S.doc Version 5.1 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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