Inspection on 22/11/07 for Russettings

This inspection was carried out on 22nd November 2007.

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

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

Other inspections for this house

Russettings 02/04/09

Russettings 03/04/08

Russettings 23/05/06

Russettings 08/11/05

Russettings 27/07/05

Russettings 28/02/05

Russettings 20/11/04

Russettings 29/04/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Russettings Mill Lane Balcombe West Sussex RH17 6NP Lead Inspector Elizabeth Dudley Unannounced Inspection 22nd November 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Russettings DS0000037746.V353425.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Russettings DS0000037746.V353425.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Russettings Address Mill Lane Balcombe West Sussex RH17 6NP 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) 01444 811630 01444 811932 www.alphacarehomes.com Alpha Health Care Limited Ms Julie Jones Care Home 45 Category(ies) of Old age, not falling within any other category registration, with number (45) of places Russettings DS0000037746.V353425.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd May 2006 Brief Description of the Service: Russettings is a care home with nursing registered to provide accommodation for forty-five service users within the category OP (Old age, not falling within any other category). The home is located in Balcombe village, close to local shops. The village is situated between Haywards Heath and Crawley town centres. The home consists of three floors, two of which provide service user accommodation and communal space. Both floors are accessible by passenger lift. The establishment was registered with the current provider in January 2003. Alpha Health Care owns Russettings and the Responsible Individual is Mrs Sian Sobti. There is a new manager in place, Julie Jones who was registered with the CSCI in September 2006. The current fees charged as quoted by the manager on the 22nd November 2007 range from £590-£690 per week. Extra services, which include hairdressing, chiropody and staff escorts to hospital appointments etc are available from the manager. Russettings DS0000037746.V353425.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place on the 22nd November 2007 over a period of eight hours. It was facilitated by the deputy manager who was joined by the manager, Ms Jones, later in the day, when the results of the inspection were discussed. Methods used to inform the outcomes of the inspection and judgements made in the report included a tour of the home, examination of documentation which included care plans, medication records, staff personnel files, health and safety and catering documents and discussions with residents, staff and visitors. All residents were seen, and the majority spoken with, but six were spoken with in depth to gain their views of life in the home. Prior to the inspection the CSCI sent out surveys for residents and visitors, one of these was returned and provided useful information about the home. Discussions took place with six members of staff and four visitors, which gave further insight into the home. Comments received about the home praised the efforts of the staff, with residents and visitors saying ‘ Staff are very good’, ‘ The care here is good and staff are very kind’. ‘ Pleased that I selected this home, there is laughter and cheerfulness which makes a difference’. All residents and all visitors commented on the apparent shortage of staff saying ‘Staff may not have enough time to help people improve their limited mobility’ ‘ One more member of staff would make all the difference’, ‘ Staff always seem to be chasing their tails’. The majority of residents spoken with commented that the standard of catering was only ‘average’. ‘ Very poor’. ‘Nothing to write home about’ and several residents said that the manager is rarely seen around the home. What the service does well: The home provides nursing and residential care for up to 45 residents in a pleasant environment. Care has been taken with the décor in the communal areas and residents’ rooms are homely and the standard of maintenance around the home is satisfactory. Russettings DS0000037746.V353425.R01.S.doc Version 5.2 Page 6 All prospective residents receive a thorough assessment to ensure that the home can meet their needs and to ensure that the staff are well prepared to commence the initial care that they will require. Residents receive information about the home to assist them in deciding whether they wish to live there, and all residents are provided with a copy of the Service User Guide, which gives clear details about the routines of daily life in the home. The recruitment systems for staff employment are robust with all the necessary checks taking place prior to them commencing work at the home. Visitors said that staff are friendly and welcoming and that they can visit at any reasonable time. What has improved since the last inspection? What they could do better: The home has not complied with the requirements made at the last inspection, which required regular review of care plans, that sufficient experienced staff were on duty, the standard of catering be addressed and that the safeguarding policy was in line with multi-agency guidelines. None of these were addressed to a satisfactory standard. Russettings DS0000037746.V353425.R01.S.doc Version 5.2 Page 7 Concerns at this inspection included the level of staffing and the continuing training of staff, residents’ perception of the food served, and medication administration including auditing of controlled drugs. The day before the inspection a representative from the company’s office had audited the care plans and medication, and had highlighted the same issues as found on this inspection, apart from the auditing of the controlled drugs. There were several health and safety issues, which need to be addressed: and these are discussed in the main body of the report. The CSCI requires that the provider visit the home on a monthly basis and makes a report on the running of the home, there were no records of these in the home since April 2007 and management said that these had not taken place. Surveys sent by the CSCI to be given to residents had not been given out and were left in the reception area, therefore those residents who do not go into the reception area and may have liked to have been able to make their views known to the CSCI, were unable to do so. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Russettings DS0000037746.V353425.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Russettings DS0000037746.V353425.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5,6. People who use the service experience good quality outcomes in this area. Sufficient information is provided to prospective residents to enable them to make a decision over whether the home can meet their needs and expectations. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Statement of Purpose and Service User Guide comply with the regulations, and all service users have a service user guide, which is user friendly and gives information about the daily life in the home. Some amendments are required in the Statement of Purpose; the complaints policy requires the current address of the CSCI to be included and other amendments relating to training of staff. Russettings DS0000037746.V353425.R01.S.doc Version 5.2 Page 10 The Terms and Conditions of Residence include the fees and the room numbers to be occupied, and all residents receive a copy of this on their admission to the home. A comprehensive assessment of prospective residents takes place prior to their admission to the home, in order to ensure that the home can meet the needs of the residents. This forms the basis of the care plan. Prospective residents or their representative are informed in writing of whether or not the home can meet their needs. The home admits residents for respite care but not for intermediate care. Russettings DS0000037746.V353425.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11. People who use the service experience poor quality outcomes in this area Care plans are not person centred and do not show evidence of regular review which could result in incorrect care being given. The ‘hands on care’ given by staff met the residents expectations and residents appeared comfortable. Processes in medication recording and administration do not safeguard residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Six (14 ) care plans were examined, and showed that care plans addressed the clinical needs of the residents including nutritional, wound care and to a lesser degree, social care. All contained some generic core care plans which were not person centred and parts of which where not relevant to that specific resident. Russettings DS0000037746.V353425.R01.S.doc Version 5.2 Page 12 Care plans had not been reviewed at intervals recommended by the standards and most of those looked at were only reviewed three to four monthly, Monthly observations were not up to date, and some care plans had not been formed in consultation with the resident or their representative. Consent forms were in place for the use of bedrails, but no specific risk assessments for these. Whilst care plans generally addressed the clinical needs of the resident, there was no evidence that current or changing needs were being added to the care plan or a new plan formed, and changed needs had been written down on the back of some of the care plans, where they could be missed. Care staff spoken with said that they rarely looked at the care plans and relied on staff handover or information from other staff in giving the required care. Pressure relief equipment was in place but the deputy manager said that no staff had updated training in wound care. Staff said that the local authority provides continence aids for residential residents, but there was sometimes insufficient aids provided for nursing residents. The home does not keep a supply of continence aids, therefore they either borrow from other residents or have to purchase extra supply for which the nursing residents are charged. The manager is the only registered nurse in the home with the skills required to catheterise male residents, but has not updated these. Registered nurses should be given the opportunity to gain these skills. Whilst it is accepted that residents’ choice regarding their wishes to sit in their rooms unclothed must be respected, it is equally important that staff realise other residents or visitors may be embarrassed by this, due to the residents’ preference for the door to be open. Staff should, with some thought, be able to provide some garment that is non restrictive and acceptable to the resident. Residents said that the staff were very kind and caring and ‘very good’, but senior staff said that there was often not time to address grooming needs such as makeup, hair and nails, and this was apparent with some of the residents seen on the day of the inspection. Residents also said that they often had to wait a long time for personal needs such as using the toilet. The regulation 37 notices (notices of events affecting residents required by the CSCI) and care plans identified that some residents in the home suffered from terminal illnesses and other conditions such as Cerebral vascular accident and some required Parenteral endoscopic gastric fees, all of which result in a heavy dependency on nursing intervention. Only one registered nurse is provided on each shift and whilst the home also admits residents for personal care only, on the day of the inspection there were 43 residents in the home of which only five did not require nursing care. Russettings DS0000037746.V353425.R01.S.doc Version 5.2 Page 13 Residents nursed in bed appeared comfortable and nursing documentation such as fluid and turning charts had been completed in line with the care required. One resident spoken with said that ‘The care is very good, they come in regularly and always do my care on time’. The controlled drug cupboard contained residents’ money and other items, which could invalidate the security of the cupboard, and there were controlled drugs, which had not been audited for several months and should have been returned to the issuing pharmacist. Not all eye drops were being stored at the correct temperature, and some medications had not been signed for on administration. The clinic room door was found to be unlocked when a tour of the home took place Residents receive end of life care in the home, and resuscitation wishes are in place, but the home should refer to the guidance given in the local and national end of life initiatives regarding wishes for resuscitation. No staff have taken part in specific training for caring for people at the end of their lives. Russettings DS0000037746.V353425.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 People who use the service experience poor quality outcomes in this area. The standard of catering does not meet residents’ expectations. There is scope for the range of activities and time allocated for these to be increased in order to provide leisure activities, which meet the mixed abilities and interests of the residents in the home. The choice of residents in the activities of daily living, such as times of retiring and retiring, are not being met, and dignity at mealtimes is compromised by staff feeding two residents at the same time. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is an activities programme and an activities co-ordinator, and whilst the range of activities provided is varied and includes some crafts and outings, there is no reference to the preferred interests of individual residents being included in the programme Residents are given a copy of the current activities programme and a monthly newsletter. Records of which residents participate Russettings DS0000037746.V353425.R01.S.doc Version 5.2 Page 15 in the leisure activities were seen; these were not completed on days when the activities co-ordinator was not on duty. The activities co-ordinator has to spend time doing tasks which are not related to the activities. There was little scope for outings to take place due to the difficulty of having sufficient staff on duty to help with these. Staff who take residents out in their cars should ensure that their insurance policy covers them to do this. Residents spoken with said that they could make choices in their activities of daily living but were unsure whether they had a choice of what time they get up in the morning, three saying that the staff come in at any time after 0600, whilst another said that he could be waiting to get up at 11am but his preferred time of rising was 8am. Staff said that they were still getting people up at midday on occasions. This compromises the choice of the residents and could also result in the care needs of the residents being rushed, particularly with those residents who are got up very early in the morning. There is an open visiting policy at the home with visitors saying that they were made welcome, ministers of religion visit the home and a monthly interdenominational service is held. The menu shows that two choices are provided at every meal and residents are given a copy of the menu. Food given to residents did not always correlate with what was on the menu for that day or the choices they had made. Residents made various comments about the food generally saying that it was ‘ poor’, ‘variable’, ‘OK’ ‘very bland and poor standard of nutrition and poor quality of food bought in’. However they said that the food had improved both on the day of the inspection and the day prior to it, but that these couple of days were not representative of the general standard of catering provided. The dining room was welcoming, with tables laid up in a homely way and staff were assisting residents in an empathetic manner. Staff were seen to be assisting two residents at a time, they said that they knew this was not appropriate but as there were thirteen residents requiring assistants there were not sufficient staff to attend to this in the given time. Liquidised meals were well presented. Residents can have meals in the dining room, lounge or their rooms. Russettings DS0000037746.V353425.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. People who use the service experience poor quality outcomes in this area Not all complaints have been addressed within required timescales, or actions taken to ensure that the issue is not repeated. Staff were not fully aware of their responsibilities relating to the safeguarding of the people in their care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints policy, which is displayed in the home and included in the service user guide, requires amendment regarding the current address of the CSCI. Residents and visitors to the home were aware of how to make a complaint and to whom it should be addressed. There are six complaints recorded as having been received. The time taken to address complaints is not always in line with company guidelines and the National Minimum Standards and regulations, and the concerns not always addressed in a manner that ensures residents safety. Concerns received included lack of staff, quality of the food, cold tea and coffee being served and resident safety, arrangements had not been made to ensure the resident’ s safety was not further compromised following the complaint. Russettings DS0000037746.V353425.R01.S.doc Version 5.2 Page 17 Relatives of a resident said that one complaint that they had made had taken almost a year to be addressed. Staff have received training in adult safeguarding issues but on being given a scenario where a senior staff member was verbally abusing a resident were not confident about to whom this should be reported. The home’s own safeguarding policy does not correctly reflect the multi agency guidelines of how to address a safeguarding issue. Russettings DS0000037746.V353425.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,24,25,26. People who use the service experience adequate quality outcomes in this area. The home is attractive clean and comfortable providing a pleasant place for residents to live. Water temperatures to some resident outlets were above recommended parameters and could put residents safety at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the home took place and in general the décor, maintenance and furnishings were satisfactory. Some areas of the home have been refurbished and new furniture purchased this year. Resident’s rooms are redecorated when vacated, or as required. Russettings DS0000037746.V353425.R01.S.doc Version 5.2 Page 19 Residents and relatives raised some concerns over the length of time it took to get minor maintenance issues addressed. Six residents’ rooms were looked at and were comfortably furnished with most residents being provided with a lockable drawer and able to bring in their own possessions to make the rooms more homely. The temperature of the hot water supplied to residents’ rooms is being checked by the maintenance person, but there was no evidence of what action was to be taken when the temperatures fell outside of the recommended parameters. There was no evidence that bath temperatures had been monitored and the water tested with the homes’ own thermometer in three assisted bathrooms showed this to be above recommended parameters. Care staff said that they check the temperature of the baths prior to bathing residents but these records were not in the bathrooms and were unavailable. Various adaptations have been made, and the appropriate equipment available to enable residents to maintain as much independence as possible. The home was clean with no odours apparent, and there are procedures in place to minimise the spread of infection. Discussions were held with the manager about the cleanliness of the assisted bathing seats and also the notice on the freezer which says it is unsuitable for certain food, and therefore may not be reaching the optimum temperatures which could cause infection. Russettings DS0000037746.V353425.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 People who use the service experience poor quality outcomes in this area. Staff are not employed in sufficient numbers to ensure that residents needs are met. Staff receive mandatory health and safety training but there is little additional training available to ensure that all grades of staff have sufficient knowledge to be able to give the care required, particularly to those residents with specialist needs. Residents are safeguarded by robust recruitment practices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff and residents spoken with expressed concerns that the number of staff currently rostered over the day time hours is not sufficient given the spatial area of the home and the dependency of the residents. There is one registered nurse on duty over the twenty-four hours, and the majority of the residents have nursing needs and are medium to high dependency. There was no evidence of any resident dependency tool being used to adjust the number of staff with relevant skills required, to the dependency needs of the residents in the home. Russettings DS0000037746.V353425.R01.S.doc Version 5.2 Page 21 Residents spoke of the time they have to wait for basic care including getting up in the morning, and the registered nurse expressed concern about the staff not having time to address areas of personal care such as nail care, hair and oral care, in a satisfactory manner. Registered nurses have to cover all the nursing needs of the residents and oversee staff, as well as having to deal with administrative tasks if the manager or administrator is not in the home. The managers role is solely management and does not participate in the care of the residents, the deputy manager’s role involves resident care. On the day of the inspection the deputy manager was the sole registered nurse on duty and neither the manager or the administrator were in the home, no attempt had been made to bring in another registered nurse. Whilst the company has undertaken various studies which has involved simplification of some systems in the home to alleviate staff pressure, staff said ‘you cannot re programme the residents or hurry them along’ – inferring that whilst certain tasks can be monitored or simplified, you cannot do this with resident care, which is entirely dependent upon changing needs. The registered nurse on duty also expressed concerns that the high numbers of falls which were occurring at busy times of day may be due to insufficient staff to supervise the residents. Concerns over the number of staff on duty over the twenty-four hour period have been raised at the past two inspections with the providers being required to address this. They have not complied with these requirements in a manner that has addressed the concerns. Concerns were raised about the lack of training available for both care staff and registered nurses, the company being good at providing mandatory training but there was not sufficient training on care aspects. The training matrix showed that the only study sessions that had been available, apart from the National Vocational Qualification level 2 in care, were dementia care and care planning training. The provider should reflect on the use of the phrase ‘extensive training is provided for staff’ which is used in the Statement of Purpose. Ten members of staff (20 ) have the National Vocational Qualification level 2 in care, some members of staff said that they would like to have participated in this but they did not qualify for the free training provided by government funding. All staff undertake an induction programme at commencement of employment and the recruitment systems are robust, five staff files were examined and Russettings DS0000037746.V353425.R01.S.doc Version 5.2 Page 22 these included all documentation as required by the regulations. The General Social Care Code of Conduct was available in the home but was no longer being given to staff; assurances that this would be recommenced were given. Russettings DS0000037746.V353425.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,38 People who use the service experience poor quality outcomes in this area. The management systems in the home are not sufficiently robust to ensure the wellbeing and safety of the residents in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has been in post for twelve months and is registered with the CSCI and is in the process of obtaining the registered managers award. The atmosphere in the home is good although staff say that there is little time to spend with residents, and residents, staff, relatives and the survey received Russettings DS0000037746.V353425.R01.S.doc Version 5.2 Page 24 identified that the manager does not visit residents on a daily basis and they do not often see her. The survey received from a visitor stated that ‘There is laughter and cheerfulness which makes all the difference’. The home has commenced quality monitoring in the form of sending out annual questionnaires to residents and relatives, the results are collated by the head office but there was no evidence that these are used t o change practice. There are regular residents meetings and staff meetings. Residents were not able to access surveys sent by the CSCI. The CSCI requires providers to undertake monthly visits and make reports on their care homes, records available showed that these had not been undertaken since April 2007 and the manager confirmed this. The home does not act as appointee for residents but keeps some monies for them, records were seen and these were in order. Supervision for staff has commenced and the majority of staff had undertaken this although not always within recommended time scales. Staff said they do not have their training needs discussed at supervision and there is no development plan for registered nurses. . There were concerns over health and safety issues in the home, the accident book was examined from August 2007 and showed that there have been a large number accidents of which many have been falls, some due to residents falling out of wheelchairs or trying to get up on their own. Few Regulation 37 reports (reports required by the CSCI relating to adverse incidents affecting residents) have been received and the home is now required to inform the CSCI of any falls other than trips and to audit and risk assess the amount of accidents, manager said that an audit has been done but this was not available to be seen at the inspection. In addition to the concerns raised about water temperatures in Outcome areas 19-26 in this report, other concerns relating to the environment were found There is a steep staircase to the 2nd floor that is accessible to residents, although staff said that residents had wandered up there, there was no risk assessment and no attempt to make this inaccessible. The kitchenette on the 1st floor had the door wedged open and there was no risk assessment, a resident’s door was also wedged open, which contravened the orders issued by the fire department. Fire notices to be complied with by 29th October had had an extension requested by the home but the fire authority was due to inspect on the 27th November 2007. The fire escape door which was the subject of a complaint as a resident had wandered out onto the fire escape, was easily opened, no attempt to obtain Russettings DS0000037746.V353425.R01.S.doc Version 5.2 Page 25 advice on securing this had been sought from the fire authority, and no risk assessment was in place especially relating to this specific resident and the danger to them. Risk assessments had been done in the building but not of those areas mentioned. The store/ heating room was unlocked, as was the clinic room; there were notices on both these doors instructing staff to keep them locked. The kitchen freezer may not be suitable for frozen food – temperatures may not be recorded correctly and the manager was not aware of this. The manager has identified the staffing deficit and has made the company aware of the perceived relationship to the number of accidents in the home, but is not proactive in carrying this forward, which could be detrimental to the health and well being of the residents in the home. One resident said that ‘ Things are very haphazard and those in charge do not seem to be able to organise things here’. Senior staff should ensure that staff are practising the procedures taught in the moving and handling training. Russettings DS0000037746.V353425.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 1 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 3 3 3 3 x 3 2 2 STAFFING Standard No Score 27 1 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 2 x 3 2 2 1 Russettings DS0000037746.V353425.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation Reg 15(2) (b) Requirement The registered person shall keep the resident’s care plan under review. (Previous requirement timescale of the 30/06/06 not met) Timescale for action 01/02/08 2 OP9 Reg 13(2) 3 OP9 OP38 Reg 13(4) 4 OP15 Reg16 (2) (i) That the registered person liaises 30/12/07 with the dispensing pharmacist regarding guidelines over auditing controlled drugs That the clinic room and the 30/12/07 store room are kept locked in line with the instructions given by the home. The registered person shall 01/02/08 provide suitable, wholesome and nutritious food, which is varied and properly prepared. (Previous timescale of the 30/06/06 not met) The registered person shall 30/12/07 ensure that the home’s policy and procedure on abuse is in line with the West Sussex County Council’s Vulnerable Adults Procedures. (Previous requirement timescale 30/06/06/ DS0000037746.V353425.R01.S.doc Version 5.2 Page 28 5 OP18 Reg13(6) Russettings not met) 6 OP26 Reg 13 (3) Reg 23(5) That the registered person liaises 30/12/07 with the Environmental Health authority regarding the maintenance of the freezer temperatures and recording of the temperatures. The registered person shall 01/02/08 ensure that at all times suitably qualified, competent and experienced persons are working at the care home in numbers such as are appropriate for the health and welfare of the residents. (Previous timescales of the30/11/05 and 31/07/06 not met) That the registered provider 01/02/08 undertakes visits as required by the regulation and that reports are kept in the home. That the registered person liaises 30/12/07 with the Environmental health authority regarding the monitoring of bath water temperatures. That the registered person liaises 30/12/07 with the fire authority regarding the use of door wedges and the means of securing the fire door to prevent inappropriate use of the fire exits. That reports of any incidents detrimental to the wellbeing of service users are reported to the CSCI. 30/12/07 7 OP27 Reg18 (1)(a) 8 OP36 Reg 26 9 OP38 Reg 13(4) Reg 23(5) 9 OP38 Reg 23(4) 10 OP38 Reg 37 Russettings DS0000037746.V353425.R01.S.doc Version 5.2 Page 29 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 OP26 Good Practice Recommendations That attention is given to the underneath of bath seats and to the maintenance of freezer temperatures. Russettings DS0000037746.V353425.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Russettings DS0000037746.V353425.R01.S.doc Version 5.2 Page 31 - 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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