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Inspection on 21/12/06 for Scalford Court Care Home

Also see our care home review for Scalford Court Care Home for more information

This inspection was carried out on 21st December 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Some activities are taking place on a one to one basis, with an activities worker. Comments made by a visiting relative "I am pleased my mum is here, she is very well taken care of" "Communicating with the staff is excellent, they put things right" "All the staff are very good, they keep mums room clean, and personal looking"

What has improved since the last inspection?

There have been few improvements since the last visit to this service in October of 2006. Some of the carpeted areas in bedrooms have been replaced which has led to an environmental improvement for some individual residents.

What the care home could do better:

The assessment process for residents is not detailed or effective; resulting in a lack of accurate and detailed information for staff to ensure care needs shall be met. Care plans for the three case tracked residents did not include the detail for staff to enable them to undertake health, personal and social care needs, on a consistent basis. Health care issues were not adequately detailed and no information regarding individual care toward pressure area care, nutritional screening or specialist continence care was included in any of the plans. A Pharmacy Inspector undertook the medication inspection. The Pharmacy Inspector found that the medication management is poor. A summary of the pharmacists report concludes that, people do not always receive their medicines as prescribed as a result of the service failing to keep sufficient supplies of medicines to give when they are needed. There is a risk of overdose because records are not signed when medicines are given to people. Issues around privacy and dignity were not adequately dealt with in the plans of care. There were also issues around inappropriate bedroom door locks, and ill-fitting toilet and bathroom door locks. There are no social care preferences recorded in pre- admission assessments, nor in plans of care, this resulted in residents not being stimulated in a positive and planned way. The complaints procedure has not yet been updated; this was highlighted at the last inspection. Staff have a knowledge of protection of Vulnerable Adults issues, however do not relate these to the inconsistent and dangerous practices within medication administration and continuing omissions in care practices. This was another requirement which has not been met from the last visit in October 2006. Generally the environment is adequate, though there are issues` surrounding the bedroom door locks being inappropriate, and the majority of bathroom and toilet doors failure to lock, which impinge on residents` privacy and dignity. The carpets in some areas require to be re-layed, to ensure a safe environment. Staff are not fully aware of the cross contamination and cross infection issues within the home.The recruitment practices within the home continue to give little protection to the current resident group. The questionnaires sent out for quality assurance purposes, were available for the Inspector to view. These have not been collated or findings circulated with any of the current resident group. Residents` and their representatives meetings have not yet re-commenced. Currently the management structures within the home do not fully support effective and safe care practices in the areas of medication, staff recruitment and Criminal Records Bureaux checks, this puts residents at risk within the home.

CARE HOMES FOR OLDER PEOPLE Scalford Court Care Home Melton Road Scalford Melton Mowbray Leicestershire LE14 4UB Lead Inspector Keith Williamson Key Unannounced Inspection 21st December 2006 09:00 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 Scalford Court Care Home DS0000054020.V323220.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. Scalford Court Care Home DS0000054020.V323220.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Scalford Court Care Home Address Melton Road Scalford Melton Mowbray Leicestershire LE14 4UB 01664 444696 01664 444499 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) V & L Corporation Limited Cheryl Ann Palmer Care Home 40 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (40), of places Physical disability over 65 years of age (40) Scalford Court Care Home DS0000054020.V323220.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. 7. To be able to admit the named person in category PD into Scalford Court Care Home as identified in correspondence with the previous registration authority dated 12th April 2004 No-one under the age of 55 years maybe admitted into Scalford Court Care Home To be able to admit the named person into Scalford Court Care Home within the category PD under 55 years as identified in correspondence dated 20th October 2003. No one falling within the category OP may be admitted into Scalford Court Care Home where there are 40 persons already accommodated in the home No one falling within the category PD(E) may be admitted into Scalford Court Care Home where there are 40 persons already accommodated in the home No one falling within the category DE(E) may be admitted into Scalford Court Care Home where there are 10 persons already accommodated in the home The maximum number of persons accommodated within Scalford Court Care Home is 40 27th October 2006 Date of last inspection Brief Description of the Service: Scalford Court is registered for 40 older people. It is registered to provide a service for older people with physical disabilities and for up to ten older people with dementia. The home is situated in its own grounds between the market town of Melton Mowbray and the village of Scalford and is mostly surrounded by farmland although there is a Conference Centre nearby. Public transport is limited but the home has its own minibus for the use of residents. The home is a converted and extended stable block with all rooms used by the residents being on the ground floor. Staff facilities and the Proprietors accommodation is located on the first floor. The main lounge/dining area has views of an internal courtyard that is well maintained with plenty of flowers and shrubs. This courtyard has seating and is used by the residents during the warmer months. There is a further lounge and a conservatory that overlooks another attractive internal courtyard. The home currently has 24 single and 8 double rooms although there is an ongoing improvement plan of developing an area to the back of the home to provide further single en suite bedroom accommodation. Currently eleven of the single rooms and six of the double rooms have en-suite facilities. Scalford Court Care Home DS0000054020.V323220.R01.S.doc Version 5.2 Page 5 The current fees charged weekly fall between £319 and £450 per week, there are additional charges for hairdressing. Scalford Court Care Home DS0000054020.V323220.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This is the second key inspection, and third inspection visit of this service this year. This is being carried out following a complaint to the Commission for Social Care Inspection. The outcome of the complaint investigation revealed a number of issues that required further investigation, resulting in this unannounced visit. A number of requirements made during the complaint investigation have not been completed and have been entered again. The focus of the inspections undertaken by the Commission for Social Care Inspection is upon outcomes for residents and their views of the service provided. The primary method of Inspection used was ‘case tracking’ which involves selecting residents and tracking the care they received through looking at their records, talking with them where possible, and looking at their accommodation. This inspection took place over three weekdays, commencing at 9.30am took fifteen and one half hours to complete. Two inspectors conducted the inspection visits; this included a specialist Pharmacy Inspector and the Registered Manager assisted both in the process. An opportunity was taken to look around the home, view records, policies and care plans and to talk to residents and their relatives and staff. Twelve of the residents and one relative was seen during the inspection process, due to the frailty of the resident group, few comments were made, some have been included in this report. Since the completion of the inspection visits, and the publishing of this report the Registered Manager has resigned her post. What the service does well: Some activities are taking place on a one to one basis, with an activities worker. Comments made by a visiting relative “I am pleased my mum is here, she is very well taken care of” “Communicating with the staff is excellent, they put things right” “All the staff are very good, they keep mums room clean, and personal looking” Scalford Court Care Home DS0000054020.V323220.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: The assessment process for residents is not detailed or effective; resulting in a lack of accurate and detailed information for staff to ensure care needs shall be met. Care plans for the three case tracked residents did not include the detail for staff to enable them to undertake health, personal and social care needs, on a consistent basis. Health care issues were not adequately detailed and no information regarding individual care toward pressure area care, nutritional screening or specialist continence care was included in any of the plans. A Pharmacy Inspector undertook the medication inspection. The Pharmacy Inspector found that the medication management is poor. A summary of the pharmacists report concludes that, people do not always receive their medicines as prescribed as a result of the service failing to keep sufficient supplies of medicines to give when they are needed. There is a risk of overdose because records are not signed when medicines are given to people. Issues around privacy and dignity were not adequately dealt with in the plans of care. There were also issues around inappropriate bedroom door locks, and ill-fitting toilet and bathroom door locks. There are no social care preferences recorded in pre- admission assessments, nor in plans of care, this resulted in residents not being stimulated in a positive and planned way. The complaints procedure has not yet been updated; this was highlighted at the last inspection. Staff have a knowledge of protection of Vulnerable Adults issues, however do not relate these to the inconsistent and dangerous practices within medication administration and continuing omissions in care practices. This was another requirement which has not been met from the last visit in October 2006. Generally the environment is adequate, though there are issues’ surrounding the bedroom door locks being inappropriate, and the majority of bathroom and toilet doors failure to lock, which impinge on residents’ privacy and dignity. The carpets in some areas require to be re-layed, to ensure a safe environment. Staff are not fully aware of the cross contamination and cross infection issues within the home. Scalford Court Care Home DS0000054020.V323220.R01.S.doc Version 5.2 Page 8 The recruitment practices within the home continue to give little protection to the current resident group. The questionnaires sent out for quality assurance purposes, were available for the Inspector to view. These have not been collated or findings circulated with any of the current resident group. Residents’ and their representatives meetings have not yet re-commenced. Currently the management structures within the home do not fully support effective and safe care practices in the areas of medication, staff recruitment and Criminal Records Bureaux checks, this puts residents at risk within the home. 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. Scalford Court Care Home DS0000054020.V323220.R01.S.doc Version 5.2 Page 9 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 Scalford Court Care Home DS0000054020.V323220.R01.S.doc Version 5.2 Page 10 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): Standards 2 & 3. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The assessment process for residents is not detailed or effective; resulting in a lack of accurate and detailed information for staff to ensure care needs shall be met. Standard 6, the home does not provide services for residents with Intermediate Care needs. EVIDENCE: Three residents were case tracked. One of the residents was admitted “privately”, and did not have an appropriate contract in place; the other two residents were Social Service funded, and require an alternative contract in place, though again these were missing. All residents must have appropriate Scalford Court Care Home DS0000054020.V323220.R01.S.doc Version 5.2 Page 11 information supplied by the Responsible Person of the terms and conditions in the home, prior to moving in. The Inspector viewed the assessment information for three recently admitted residents. The information gathered by the Manager for the residents was only partially complete, and was not adequate in providing the amount of detail from which a plan of care could be derived. This places residents at risk of not receiving the care that they require. Two residents had comprehensive assessments compiled by a Social Worker prior to their admission, though little detail had been transferred to the homes assessment. Scalford Court Care Home DS0000054020.V323220.R01.S.doc Version 5.2 Page 12 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): Standards 7, 8, 9 & 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents are not looked after well in respect of their health, medication and personal care needs, areas of risk are not assessed appropriately, resulting in residents being placed at risk in the home. EVIDENCE: Care plans for the three case tracked residents did not include the detail for staff to enable them to undertake health, personal and social care needs, on a consistent basis. For one resident who required full assistance with mobility, and hoisting for all transfers, no instruction existed. The same resident had an indwelling catheter; again no instruction existed as to how this should be cared for by staff. Care plans must include sufficient information to enable staff to fully care for residents in the home. Scalford Court Care Home DS0000054020.V323220.R01.S.doc Version 5.2 Page 13 Health care issues were not adequately detailed and no information regarding individual care toward pressure area care, nutritional screening or specialist continence care was included in any of the plans. A Pharmacy Inspector undertook the medication inspection and concluded that the management of medication at this service poor. A summary of the pharmacist’s report concludes that: Admission information did not contain details about medication or an individual’s health for all the residents, for example on admission information for resident X medication on arrival was not filled in. Care plans did not include detailed and complete information on medication or health to allow management of an individual’s conditions. Medication administration and record keeping was not of a good standard or accurate. For example: resident Y was allergic to antibiotics and antidepressants but this information was only in the file and the medication administration records (mar charts) said no allergies. Some of the Medication Administration Records (MAR) had gaps with no codes written or codes with no explanation, indicating that residents were not receiving their medication as prescribed. The MAR were not well organised and had no separators or photographs for different service users. The MAR were either handwritten or typed by the supplying pharmacy. Some of the handwritten MAR had errors, were not complete, had changes made which could not be backed up by records in care files or were not the same as the prescribed instructions on the label. Residents do not always receive their medicines as prescribed as a result of the service failing to keep sufficient supplies of medicines to give when they are needed. Residents were at risk of overdose because records are not signed when care staff give medicines to residents and another care worker may duplicate the dose. Systems were in place for checking in all new medication that had been received for the next month. However quantities of received medication were not being recorded on the MAR that were handwritten. Quantities already in stock were not carried over when new MAR were started. For medication prescribed as a variable quantity the service was not recording how many were given e.g. 1 or 2 tablets as required not recording on MAR if 1 or 2. There was a homely remedies policy that had been prepared with the help of the pharmacy but this policy did not include all of the homely remedies in use. The MAR that were looked at did not have any homely remedies recorded on them. Blood glucose monitors were not of a type suitable for use on multiple service users and were not labelled for individuals. This meant that there was a risk that infections may be transferred between service users Scalford Court Care Home DS0000054020.V323220.R01.S.doc Version 5.2 Page 14 The lack of care plans for residents who are prescribed medicines and lack of documented risk assessment before giving medicines for residents to look after themselves, means that residents are at risk of not receiving medication as prescribed and of not having their individual health needs met. Further issues around privacy and dignity were not adequately dealt with in the plans of care, no instruction existed informing staff of the need for nursing staff to perform dressings in privacy, one resident was witnessed having this done in a lounge. There were also issues around inappropriate bedroom door locks, and ill-fitting toilet and bathroom door locks. None of those viewed could be locked appropriately to assure dignity and privacy of residents in the home. Scalford Court Care Home DS0000054020.V323220.R01.S.doc Version 5.2 Page 15 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): Standard 12. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents are offered a limited lifestyle resulting in a lack of stimulation. EVIDENCE: There was no social care recorded in assessments, or plans of care, this resulted in residents not being stimulated in a positive and planned way. For example no details of the residents’ previous social interests, food and dietary preferences or routines of daily living were recorded, which would then inform staff how to engage residents on an individual basis. No specific plan for residents’ activities has yet been produced for the group in the home; this was a requirement in the last report in October 2006. Some activities are taking place on a one to one basis, with an activities worker, however these are not planned in advance, and do not lend toward good practice in caring for residents with Dementia. Scalford Court Care Home DS0000054020.V323220.R01.S.doc Version 5.2 Page 16 The remaining standards 13 – 15 were not visited on this occasion, for further information on those please refer to the first key inspection of this service on 20/04/06 and the subsequent “random” inspection on 08/08/06. Scalford Court Care Home DS0000054020.V323220.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Standards 16 & 18. Residents are not protected by updated complaints policies, or staff practicing appropriate medication procedures, resulting in residents being placed at risk in the home. EVIDENCE: The complaints procedure has not been updated to include the changes required from the complaints investigation in October 2006, therefore the Registered Manager has not complied with the requirement set at the last visit in October 2006. Complaints records continue to be incomplete, with the Inspector being aware of two complaints that were not recorded in any way within the homes’ records. These were brought to the attention of the inspector by concerns raised by the former employer of a newly appointed member of staff, and concerns forwarded from another office of the Commission for Social Care Inspection. The first related to an allegation of gross misconduct, the second relating to the non recording of information on the admission process, resulting in a newly admitted resident being admitted to hospital within 24 hours. Through the inspection process it became apparent neither of the complaints had been recorded or investigated. Scalford Court Care Home DS0000054020.V323220.R01.S.doc Version 5.2 Page 18 Issues of breaches in confidentiality were highlighted with outcomes arising from a recorded complaint being inappropriately stored in the complaints file, naming a member of staff. Staff have knowledge of protection of Vulnerable Adults issues, however do not relate these to the inconsistent and dangerous practices within medication administration and continuing omissions in care practices. This was another requirement, which has not been met from the last visit in October 2006. Staff training around Adult Protection must be strengthened to ensure the ongoing safety of residents in the home. There are further issues where residents are placed in danger due to the poor level of recording in specialist records such as fluid intake and turning charts, and staff awareness of cross contamination issues (this is fully covered in the Environment section of this report). Scalford Court Care Home DS0000054020.V323220.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Standards 19 & 26. Residents’ safety is put at risk, by a lack a poorly maintained home and key staff having a lack of hygiene knowledge. EVIDENCE: Generally the environment is adequate, though there are issues’ surrounding the bedroom door locks being inappropriate. A number of locks on bedroom doors could be locked from the outside, with no way of unlocking them from the inside. This means that residents could be potentially locked in their rooms. In addition, these locks do not afford privacy for residents, as they are unable to lock the door themselves from the inside. The majority of bathroom and toilet doors do not lock, which detracts from residents’ privacy and dignity. Scalford Court Care Home DS0000054020.V323220.R01.S.doc Version 5.2 Page 20 Some of the carpeted areas in bedrooms have been replaced which has led to an environmental improvement for some individual residents. However, carpets in the main corridor areas were ‘ruckled’ and presented a trip hazard for residents, visitors and staff. The home is clean though not all staff are fully aware of cross infection and cross contamination issues, and this compromises residents safety in the home. For example the laundry staff were observed using protective gloves when loading soiled linen, however they were not wearing a protective apron leaving open the possibilities of transferring infection to their own, and other residents clean clothes. Scalford Court Care Home DS0000054020.V323220.R01.S.doc Version 5.2 Page 21 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): Standards 27 & 29. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents are not supported or protected by the homes recruitment policies. EVIDENCE: The staffing rota was viewed and on the day of the inspection nine staff were on duty, this did not include kitchen and domestic staff. The recruitment practices within the home were viewed. Two new staff have commenced since the last visit to the home in October. One member of staff was employed without filling in an application form, without attending for an interview, and did not have the appropriate povafirst check, current Criminal Records Bureau clearance, nor any appropriate references. The other member of staff did not have the appropriate references in place. These practices are putting residents and staff at risk in the home, and must cease instantly. All future staff must have the appropriate pre-employment checks in place prior to commencing employment in the home. The poor practice displayed in the recruitment of staff, is a recurrent issue that the Manager and Responsible Individual failed to undertake appropriately and this continues to place residents at risk in the home. Scalford Court Care Home DS0000054020.V323220.R01.S.doc Version 5.2 Page 22 The two remaining standards 28 & 30 were not visited on this occasion, for further information on those please refer to the first key inspection of this service on 20/04/06 and the subsequent “random” inspection on 08/08/06. Scalford Court Care Home DS0000054020.V323220.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): Standards 33 & 37. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The management approach does not promote effective care practice in the home for residents’ care and protection. EVIDENCE: The questionnaires sent out for quality assurance purposes, were available for the Inspector to view. These have not been collated or findings circulated with any of the current resident group or relatives, concerned. The member of staff responsible for re-commencing the resident meetings has not yet done so. Scalford Court Care Home DS0000054020.V323220.R01.S.doc Version 5.2 Page 24 These issues are poor practice and do not go any way to ensuring the home is run in the best interests of the resident group. Currently the management structures within the home do not fully support effective and safe care practices in the areas of medication, staff recruitment and Criminal Records Bureaux checks, this puts residents at risk within the home. The record keeping in the home is poorly managed, residents have individual files, though these are not up to date, and the records contained in the files are not maintained in accordance with the Data Protection Act. Some of the records in the complaints file also breaches the Data Protection Act and raises confidentiality issues. Accident reports are completed but again there is no consistent correlation between these and the daily records, where one such accident report was not completed on one of the case tracked residents. The remaining standards, 31, 35 & 38 were not visited on this occasion, for further information on those please refer to the first key inspection of this service on 20/04/06 and the subsequent “random” inspection on 08/08/06. Since the completion of the inspection visits, and the publishing of this report the Registered Manager has resigned her post. Scalford Court Care Home DS0000054020.V323220.R01.S.doc Version 5.2 Page 25 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 X 2 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 X 29 1 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X X X 2 X Scalford Court Care Home DS0000054020.V323220.R01.S.doc Version 5.2 Page 26 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 2 Standard OP2 OP3 Regulation 17 (1) 14 (1) Requirement All Residents must have a written contract or statement of terms with the home. No Residents must move into the home without having their needs properly assessed, and been assured those needs could be met. All care plans must be sufficiently detailed to enable staff to fully care for individual residents personal social and emotional care. Care plans must be sufficiently detailed giving adequate instruction for staff to provide individual health care to residents. There must be an accurate record of all medication received, administered and disposed of by the service including: • • Defined codes for any nonadministration Quantity administered where a variable dose is prescribed Timescale for action 22/02/07 22/02/07 3 OP7 12 (1) 28/02/07 4 OP8 12 (1) 28/02/07 5 OP9 13 (2) 28/02/07 Scalford Court Care Home DS0000054020.V323220.R01.S.doc Version 5.2 Page 27 6 7 OP9 OP9 13(2) 13(2) 8 OP9 13(2) 9 OP9 13(2) 10 OP9 18 (1) (c) 11 OP9 13(2) 12 OP9 13 (3) 13 14 OP10 OP16 12 (4) 22 Quantity and date of any medication given to residents for self administration • Quantities received and balances carried forward from the previous month All prescribed medication must be administered as prescribed. Handwritten medication administration records must be accurate, include full dosage instructions, be signed and dated and referenced to who has authorised the change. All residents who are selfadministering medication must be doing so within a risk assessed framework. Homely remedies used must be included in the homely remedy policy and records of administration must be kept. All staff responsible for administering medication must have received appropriate training, be competent and follow written policy and procedure Where medication is prescribed as required or when necessary there must be sufficient information on the medication administration record or in care plans to ensure that staff know how much to give, when to give and why it is to be given. Blood glucose monitors which are not suitable for use on more than one residents must be identified as belonging to an individual for example by labelling. The door locks to toilets and bathrooms must be adjusted and enabled to work. A complaints procedure, which is appropriate to the needs of DS0000054020.V323220.R01.S.doc • 28/02/07 28/02/07 28/02/07 28/02/07 05/04/07 05/03/07 28/02/07 05/03/07 28/02/07 Page 28 Scalford Court Care Home Version 5.2 residents, must be put in place. Previous timescale of 27/10/06 not met 15 OP18 12.13 The care home must be conducted so as to promote and make proper provision for the health and welfare of residents. This relates particularly to: Ensuring that no omissions in care occur which could be harmful to residents. Previous timescale of 27/10/06 not met The bedroom door locks require to be adjusted or replaced, so that they can be locked/unlocked from the inside and the outside. ‘Ruckled’ carpets must either be made safe or replaced. All staff must be trained in the appropriate techniques in protecting residents from cross infection and cross contamination. Staff must not be employed unless the required checks have been carried out. These include PovaFirst/CRB checks References Full employment history Suitability to work with vulnerable adults Effective quality monitoring systems must be put in place, to ensure the development of the home is continual, and is to the benefit of residents. The outcome of any quality assurance exercise is used to inform any prospective residents to the home. All records in the home must be managed within the Data Protection Act, and DS0000054020.V323220.R01.S.doc 28/02/07 16 OP19 23 (2) 05/04/07 17 18 OP19 OP26 23 (2) 12 22/02/07 05/04/07 19 OP29 19 22/02/07 20 OP33 24 05/04/07 21 OP33 24 05/06/07 22 OP37 17 28/02/07 Scalford Court Care Home Version 5.2 Page 29 23 OP37 17 confidentiality ensured. Accident reports must correlate to entries in the daily records, and accurately reflect the scope of accidents in the home. 28/02/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP9 OP9 OP9 OP12 Good Practice Recommendations Any known medication allergies should be recorded in the medication administration records file Regular audits of medication should be carried out to ensure that medication stocks are adequate to maintain a continuous supply of all prescribed medication Individual residents files should contain details including consents to staff giving medication and medication profiles Residents must be offered recreation and activities through a planned process, and records made of individual resident intervention. Scalford Court Care Home DS0000054020.V323220.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Scalford Court Care Home DS0000054020.V323220.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. 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