Inspection on 23/01/09 for Seacliff Care Home

This inspection was carried out on 23rd January 2009.

CSCI found this care home to be providing an Adequate service.

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

Seacliff Care Home 29/07/08

Seacliff Care Home 28/01/08

Seacliff Care Home 26/10/07

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

CARE HOMES FOR OLDER PEOPLE Seacliff Care Home 9 Percy Road Bournemouth Dorset BH5 1JF Lead Inspector Martin Bayne Unannounced Inspection 23rd January 2009 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 Seacliff Care Home DS0000068785.V373908.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. Seacliff Care Home DS0000068785.V373908.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Seacliff Care Home Address 9 Percy Road Bournemouth Dorset BH5 1JF 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) 01202 396100 Mr Munundev Gunputh Mrs Dhudrayne Gunputh Manager post vacant Care Home 24 Category(ies) of Dementia (24) registration, with number of places Seacliff Care Home DS0000068785.V373908.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Dementia (Code DE) The maximum number of service users who can be accommodated is 24. 29th July 2008 Date of last inspection Brief Description of the Service: Seacliff Care Home is a large, detached property, situated in a residential area of Boscombe, Bournemouth. The main shopping area of Boscombe with all its amenities including bus services is less than half a mile away. The home is also situated less than half a mile from the cliff top and promenade at Boscombe, where there are a number of pleasant walks. The property is set back a little from the road and there is a small parking area for visitors. Additional parking is available on roads in the vicinity of the home. Seacliff Care Home is registered to accommodate up to 24 persons with dementia. The accommodation is arranged over three floors, with stairs or a passenger lift to aid access between the floors. There are two double and twenty single bedrooms. Approximately half of the bedrooms are equipped with en-suite W.C.s. There are five communal bathrooms/shower rooms available to residents, but no assisted bathing facilities at the present time. The home has a dining room with adjoining sitting area and large conservatory as well as a second lounge, all situated on the ground floor. The conservatory has views over the rear garden, which includes a lawn and paved patio area surrounded by mature trees and shrubs. Twenty-four hour care is provided. Laundering of personal clothing etc is carried out on the premises. Although no choice of menu is offered, alternatives can be made available to suit individual taste and preference. The fees for the home, as confirmed to us at the time of inspection, range from £490 - £575 per week. Additional charges include hairdressing, chiropody, Seacliff Care Home DS0000068785.V373908.R01.S.doc Version 5.2 Page 5 dry cleaning, toiletries and newspapers. For further information on fee levels and fair contracts you are advised to refer to the Office of Fair Trading website: www.oft.gov.uk. We have published ‘A fair contract with older people? A special study of people’s experiences when finding a care home’ and this can be accessed on our website www.csci.org.uk The registered provider says a copy of the most recent inspection report will be made available to anyone wishing to read it, upon request. Seacliff Care Home DS0000068785.V373908.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. We, the Commission, carried out a key inspection of Seacliff Residential Home between 11am and 5:15pm on 23rd January 2009. The inspection was carried out by two inspectors. Throughout the report the term we is used, to show that the report is the view of the Commission for Social Care Inspection. The aim of the inspection was to evaluate the home against key National Minimum Standards for older persons, and to follow up on requirements and recommendations made at the last key inspection of 29th July 2008 and random inspections of 17th November 2008 and 23rd December 2008. Since the last key inspection, the home has been subject to ongoing adult protection investigations involving Bournemouth Social Services and the local PCT. The initial concern involved the admission to hospital of a resident with bruising. This investigation led to more general concerns about away the home met health care needs of the residents. These concerns are reported upon later in the report. We were assisted throughout the inspection by the homes manager. One of the registered providers was available and feedback about the inspection was provided to them. At the time of this inspection, there were eight people living at the home, most of whom were seen and spoken with. Owing to their mental frailty, they were only able to provide a limited account of what it was like to live at the home. Throughout the inspection we checked the residents hourly to see that they were adequately supported and occupied. During the inspection we spoke with one relative who was visiting the home, and also to one doctor and a district nurse who were attending the home that day. We also spoke with two members of staff. We looked at the records that the home is required to keep up to date under the Care Homes Regulations 2001. We carried out the tour of the premises. What the service does well: Prospective residents have their needs assessed and recorded to ensure that anyone moving into the home can have their needs met. Seacliff Care Home DS0000068785.V373908.R01.S.doc Version 5.2 Page 7 Residents health needs are now being met at the home, although this has been attained through high levels of support through the district nursing service. The home has a well publicised complaints procedure. The home employs sufficient staff to meet the needs of residents. What has improved since the last inspection? What they could do better: A copy of the Service User Guide and Statement Purpose should be readily available and accessible to residents and their relatives. The monitoring of residents health needs, through completion of assessment charts, must link into the care planning to ensure that action is taken where there is an identified deterioration in a residents health. Seacliff Care Home DS0000068785.V373908.R01.S.doc Version 5.2 Page 8 Decisions about resuscitation of residents in the event of an emergency situation should involve mental capacity assessments, the involvement of health care teams and relatives. All medications must be kept securely. Handwritten entries on medication administration records should be checked and signed by a second person that the record is correct. As some areas of the home were found to be cold, room temperature should be monitored to ensure that all areas of the home are kept warm. In interest of infection control, WC closets should be sealed to the floor, tablets of soap should be removed from communal bathrooms, bins in the communal areas should be foot operated and in a good state of repair and cracked and damaged tiles should be replaced in the laundry area. The uncovered radiator in the upstairs bathroom should be covered. Long-term the home should consider the replacement of bedroom door locks to that of a single release unlocking action. The appointment of a head of care or deputy would assist the manager in ensuring that care planning actions are carried out by the staff. The staff application form should be changed to seek a candidates full employment history and a reference from a persons last place of work when working with vulnerable adults or children for not less than three months. The staff training matrix should be kept up to date to assist in planning training requirements for the home. The home must submit an application for a registered manager and must also inform the Commission in writing of the management arrangements that are in place with delegated responsibilities. Full recording of the visual inspection of the fire fighting equipment should take place each month. Please contact the provider for advice of actions taken in response to this inspection. Seacliff Care Home DS0000068785.V373908.R01.S.doc Version 5.2 Page 9 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. Seacliff Care Home DS0000068785.V373908.R01.S.doc Version 5.2 Page 10 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 Seacliff Care Home DS0000068785.V373908.R01.S.doc Version 5.2 Page 11 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): 13 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from having their needs assessed before the home makes a decision to offer a placement, to ensure that the home can meet these needs. However, information for prospective residents or relatives should be readily available. EVIDENCE: At the random inspection of November 2008 we found that pre-admission assessments for residents admitted to the home since the key inspection in July 2008 had been completed, thus meeting the requirement of the key inspection. At the time of this key inspection no new residents had been admitted to the home since November 2008. Seacliff Care Home DS0000068785.V373908.R01.S.doc Version 5.2 Page 12 We asked to see a copy of the homes Statement of Purpose and Service User Guide. The manager and the of the homes administrator had difficulty in locating these documents, which should be freely available. We recommend that both these documents are made freely available to residents or relatives and it was agreed that a copy of both of these documents together with a copy of the last key inspection report, be sited in the homes reception area so that these documents are available as required. We were told that should a person be referred to the home, relatives are provided with a copy of the homes Statement of Purpose. The home does not provide an intermediate care service. Seacliff Care Home DS0000068785.V373908.R01.S.doc Version 5.2 Page 13 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care planning has improved but is still not of the required standard to inform staff of how to meet health needs of people who live at the home. Health needs of residents were being met at this inspection but this was largely due to the support from the district nursing service. Failure to keep medicines locked away could pose a hazard to the residents of the home. EVIDENCE: Concerns about the home arose from an adult protection investigation where a resident was admitted to hospital with bruising. It was found that this person had suffered from a urinary tract infection that had resulted in a severe deterioration of their mental state, accounting for many of the bruises that were identified when they went into hospital. The adult protection Seacliff Care Home DS0000068785.V373908.R01.S.doc Version 5.2 Page 14 investigations carried out by Bournemouth Council revealed that there was a high incidence of people at the home suffering urinary tract infections. Care planning arrangements had not been adequate in ensuring that residents hydration and nutrition needs were met. As a result of these concerns, since December 2008 the home has received high levels of support through the district nursing service to ensure that these health needs are addressed. At the random inspection in November 2008 it was found that the care planning had improved since July 2008, however recommendations were made that there be further improvements, as some risk assessments were not being updated and fluid charts had not been put in place to monitor fluid intake of two residents who had been assessed as being at high risk of developing urinary tract infections when they entered the home. Due to the high level of concern, under safeguarding protocols the nursing notes supporting residents at the home were seen by inspectors. We looked at a sample of four care plans that the home had developed with residents. Generally we found that these were up-to-date and had been amended when residents needs had changed. We saw examples of good detail being recorded as to how staff should meet residents personal care needs. We also saw that the home had investigated residents life histories as part of their assessment. Due to the mental frailty of residents they had not signed their care plan, however we saw examples of where relatives had signed on their behalf. At the last key inspection a requirement was made that there must be full nutritional screening of residents. We found that all residents now had a nutritional assessment using the MUST, (malnutrition universal screening tool) and that of their weight was being regularly recorded. Over recent weeks there has been a high incidence of chest and winter infections affecting many of the residents at the home and consequently all residents have had fluid, food intake and bowel charts put in place. We found that when the charts were put in place there was some gaps in recording by staff, however more recently, charts were found to be completed in full. Although the home is now monitoring residents dietary and fluid intake, care planning was not pro-active in addressing action that staff should take where residents dietary and fluid intake was not satisfactory. For instance, we saw that care plans stated that staff should monitor fluid and dietary intake of residents, rather than direct staff to complete monitoring charts at specific time intervals. Also, there was no analysis at the end of each day of the amount of fluid a resident had consumed, as to whether this was adequate and what action should be taken if they were not receiving enough fluids. We require that care planning be improved to inform staff of how to meet residents health and welfare needs. We noted within one persons care plan the instruction, Not for resuscitation. The manager explained that this instruction was the wish of the nearest relative. In such cases there needs to be involvement of the health care team, an assessment as to the residents mental capacity and best interests and we recommend that action is taken to evidence this. Seacliff Care Home DS0000068785.V373908.R01.S.doc Version 5.2 Page 15 We found that at the time of the inspection, residents health care needs were being met at the home, although this may be in part to the amount of support that the home has received through the district nursing service. At this visit to the home we had the opportunity to speak with a visiting GP. We were told that timely referrals were made for doctors visits to the home and that generally instructions made by doctors were carried out. During the inspection we observed the interaction between the staff and residents. There appeared to be a good relationship between the two, with staff treating residents respectfully. We saw that residents looked well cared for, dressed in clean clothes with attention paid to their personal grooming. We spoke with one relative who told us that they had been pleased with the way the home had looked after their parent. We looked at how medication was administered in the home. It was noted that at one point during the inspection, the medication cabinet was left unattended with the keys in the cabinet and the office door open. We also found an example in a residents bedroom of dressings and creams being left out that could pose a hazard to residents. A requirement was made that all medication be kept locked away at all times and not left unattended. We looked at the medication administration records for the residents we tracked through the inspection. We saw that there was a photograph at the front of each persons record, so that staff could readily identify that person. We also saw that the persons GP was recorded together with any known allergies of the person. The home also keeps a record of sample staff signatures, so that the staff who administered medication can be identified. We saw within the district nursing records an occasion where it was not clear whether medications had been administered to residents that day. On checking the homes medication administration records, we found that residents had had their medication administered that day. In general we found medications were being administered as prescribed with no gaps in the recording. We were told that all staff who administer medication have had training in safe medication administration. At the last key inspection a recommendation was made that where hand entries have to be made to the medication administration records, a second person checks and signs that the record is accurate. We saw examples of this practice taking place, but not on all occasions. The recommendation therefore remains in place. Seacliff Care Home DS0000068785.V373908.R01.S.doc Version 5.2 Page 16 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents social, recreational and spiritual needs were being met and residents are able to receive visitors without restriction. Previous failure of the home in meeting residents’ nutritional and hydration needs has improved. EVIDENCE: At the last key inspection and the subsequent random inspection a requirement was in place concerning the provision of meaningful activities for residents. We saw on this visit to the home, that a programme of daily activities was displayed on one of the notice boards within the home and we saw some supporting evidence that these activities are taking place. During the inspection we checked on residents each hour. On all occasions we found that there were staff in attendance, at times providing one-to-one care to residents and at other times games and activities were taking place. At the Seacliff Care Home DS0000068785.V373908.R01.S.doc Version 5.2 Page 17 last key inspection it was reported that the home was developing memory boxes as a way of meeting of the residents of leisure and recreational needs. We were provided with examples of where some memory boxes had been put in place. The relative we spoke with during the inspection, told us that they could visit the home at any time and were made welcome when they visited. We saw that as part of the assessment process, residents spiritual and religious needs were identified. Weekly religious services take place in the home to meet these assessed needs. We found that residents likes and dislikes concerning food and any specialist diets were identified through the homes assessments. At lunchtime we looked at the food that was being provided and also the assistance being offered to residents by the staff. On the day of the inspection residents were provided with fish and vegetables and an omelette as an alternative. Meals looked adequate in portion and residents were being offered assistance appropriately. When walking around the building we saw that residents were provided with jugs of drinks. We were told that the cook is informed about residents dietary requirements and the MUST assessments to ensure that care planning around diet and nutrition is followed through. We were told that the staff were now acutely aware of the need to ensure that residents receive adequate intake of fluid and as reported earlier all residents hydration is now being monitored by means of fluid chart recording. Seacliff Care Home DS0000068785.V373908.R01.S.doc Version 5.2 Page 18 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a well-publicised complaints procedure and through staff being trained in adult protection. EVIDENCE: We saw that the complaints procedure for the home was displayed in the hall reception area and therefore relatives are adequately informed of how to make a complaint. The home maintains a log of complaints received and the action taken to address these. Since the last key inspection there have been two complaints made to the home and we saw that these had been recorded and action taken. The home has policies and procedures for the protection of vulnerable adults. We saw that all the staff are provided with training on the protection of vulnerable adults. Concerning safeguarding of residents, the home has been working with district nurses and Social Services in investigating and ensuring that poor practices concerning meeting health needs of residents improves. Seacliff Care Home DS0000068785.V373908.R01.S.doc Version 5.2 Page 19 Seacliff Care Home DS0000068785.V373908.R01.S.doc Version 5.2 Page 20 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 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Seacliff provides residents with a homely environment however some improvements could be made concerning potential hazards within the home and issues relating to infection control. EVIDENCE: We carried out a tour of the premises. Generally the home was found to be clean and free from adverse odours, providing a homely and comfortable environment for residents. At the last key inspection it was noted that the open access to an internal fire escape between the first and ground floor could pose a hazard to residents and it was agreed that until door was put in place, Seacliff Care Home DS0000068785.V373908.R01.S.doc Version 5.2 Page 21 the adjacent bedrooms would be left unoccupied. At the random inspection in November it was found that action had been taken to reduce this risk of harm to residents. At the last key inspection it was commented upon that residents should have better access to the garden area. We found at this inspection that a ramp leading from the lounge to the garden was put in place in November 2008. We found that some areas of the home felt cold and we recommend that some monitoring of room temperatures takes place to ensure that the home is warm in all areas. We found areas of the building where maintenance or other action was required. It was noted that in the some of the residents ensuite WC facilities, there was no sealant between the floor and the WC closet. At the random inspection in November it was noted that a radiator in one of the upstairs bathrooms was uncovered. The manager informed at that time that this was to be covered. This radiator was still uncovered at this key inspection. We found cracked and defective tiles within the laundry room that could pose an infection control hazard. We also noted that the laundry room door was not kept locked. We recommend that this is kept locked as chemicals harmful to health are stored within the laundry area. We also found that some bedrooms were being used as store areas and these should be kept locked. We found within several bathrooms that although liquid soap and paper towels were provided, bars of tablet soap were also evident. We recommend that these are removed. We also found that some bins provided were not foot operated and others where the lids were broken. At the November random inspection it was noted that one resident had managed to lock themselves within their bedroom and the lock had had to be removed. We recommend that the home consider the fitting of single release door locks on residents bedroom doors to reduce this risk. Seacliff Care Home DS0000068785.V373908.R01.S.doc Version 5.2 Page 22 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has sufficient care staffing levels to meet needs of residents however the home would benefit from the appointment of a head of care or deputy. Training records could be improved. EVIDENCE: When we arrived at the home there were three care staff on duty as well as the manager. We were told that each day between 8 a.m. and 8 p.m. there was always one senior carer working alongside two care staff members and that during the night-time period there were two awake members of staff on duty. We looked at a copy of the duty roster and this reflected the above staffing. The home also employs a manager, cook and domestic staff. We found that this level of care staffing met the needs of residents. Should the home attain higher levels of occupancy, staffing levels should be reviewed to ensure that the needs of residents are met. During the inspection we spoke with two members of staff who told us that they enjoyed working at the home and that they felt supported by the management structure. During the Seacliff Care Home DS0000068785.V373908.R01.S.doc Version 5.2 Page 23 inspection we also spoke with one relative who told us that the staff were helpful and that there appeared to be sufficient numbers of staff on duty to meet the needs of residents. The nursing notes that we saw made note of one day when there was staff sickness and there were concerns that staff had not been brought in to maintain staffing levels on that day. On checking duty rosters that day, it was evident that agency staff have been employed to maintain the above staffing levels. We had been told at the two random inspections that a head of care or deputy was to be employed to act as interface between the manager and care staff. Part of their role would be to ensure that care planning is carried through by the staff. We were told at this inspection that an advert had been placed over the Christmas period and that no suitable candidate had come forward and that the post was now being re-advertised. This issue will be followed up at future inspections. At the last key inspection the requirement was made concerning staff recruitment. At this inspection we looked at the staff recruitment records for three members of staff recruited to the home since the last key inspection. We found that all the required recruitment checks had been undertaken prior to the person starting working in the home. We recommend however, that the staff application form be changed to seek information required under the Care Homes Regulations 2001; such as requesting a full employment history and seeking a reference from a persons last place of work when working with vulnerable adults or children for not less than three months. At the last key inspection a requirement was made for the staff to be trained in moving and handling, and for a structured induction programme to be put in place. At the random inspection in November 2008 it was found that this training had been provided, however a recommendation was made that additional training be provided in nutrition and hydration and care of people with dementia. We were told by the manager that a distance learning course in care of people with dementia had been introduced and staff were currently undertaking this training. When looking at the staff recruitment files we also saw certificates of staff in key areas of mandatory training. We asked to see an overall training matrix to evidence the training staff had received. We found that this was out of date with more recent training omitted. We recommend that this be kept up to date to ensure that staff training is provided when required. Seacliff Care Home DS0000068785.V373908.R01.S.doc Version 5.2 Page 24 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 33 35 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Failure to register a manager of the home with the Commission reflects poorly on the Registered Providers and their responsibilities in running the home. EVIDENCE: The manager of the home has been employed since the time of the last key inspection in July 2008 and a requirement was made that inspection that they should submit an application to become registered manager. At the random inspection in November 2008 we were told that this was being actioned, Seacliff Care Home DS0000068785.V373908.R01.S.doc Version 5.2 Page 25 however to date no application has been submitted. The manager told us that they had made an error in completing their criminal record bureau application and were awaiting a new form and that the application would be submitted as soon as possible. The requirement for a manager to be registered remains in place with an extended deadline. We may take enforcement action as a result of the failure of the Registered Persons to comply with this requirement at repeated inspections. Through discussion with the manager and one of the registered providers we learnt that some management functions were also being carried out by the registered provider and the homes administrator. We require that the home write to the Commission to inform of the full management arrangements and how responsibilities are delegated. Under regulation 26 of the care homes regulations 2001, a representative of the registered providers must undertake unannounced monthly visits to the home and to report as to their opinion of the standard of care provided at the home. We saw that these monthly visits and reports were taking place as required by the area manager. In general it was found throughout the inspection that there was evidence to reflect that the home is run in the interests of the residents. We saw that staff meetings were being convened regularly. Some residents have small sums of money held on their behalf. We found that that there were signed records recording the balance of money held together with any transactions. The balance of money held tallied with the records. We looked at a sample of certificates for the servicing of equipment within the home and found that the equipment was being serviced appropriately. As detailed earlier in the report there were a number of infection control and health and safety issues identified that need to be rectified. We looked at the fire log book and saw that tests and inspection of the fire safety system were taking place as required, however the home should better evidence that a visual inspection of the fire fighting equipment was taking place as required. The accident records were not viewed on this occasion but at the random inspection in December it was found that all accidents were being recorded and being analysed. Seacliff Care Home DS0000068785.V373908.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 2 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X X X 3 X X 2 Seacliff Care Home DS0000068785.V373908.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 OP8 Regulation 15(1) Requirement We require that care plans identify action that needs to be taken when monitoring by staff indicates that residents needs are not being met. Timescale for action 23/02/09 2. 3. OP9 OP31 13(2) 8(1)(a) & 9 We require that medications are 01/02/09 secured safely. 20/02/09 The Registered Person must: • Appoint an individual to manage the care home and submit an application to the Commission for their registration. • Inform the Commission in writing of the management arrangements that are in place with delegated responsibilities of the people who manage the home. This requirement is repeated from the key inspection of 29/07/09 Seacliff Care Home DS0000068785.V373908.R01.S.doc Version 5.2 Page 28 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. Refer to Standard OP1 Good Practice Recommendations We recommend that the Statement of Purpose and Service User Guide are made freely available to residents or relatives. We recommend that there is better evidence and assessment for determining whether it is in the interests of the resident not to be resuscitated. Where instructions for medication are handwritten on the medication administration record by a member of staff they should be countersigned. We recommend that action be taken on the following issues to ensure that the premises are suitable for achieving the aims and objectives of the home: • Monitoring of room temperatures as some areas were found to be cold. • Covering of the upstairs bathroom radiator as this could pose a risk to residents of getting burnt. • Long term the home should consider replacing bedroom door locks to that of a single release action type, to reduce the risk of residents locking themselves in their rooms. We recommend that action be taken of the following issues in order to promote good infection control: • WC closets should be sealed to the floor. • Tablets of soap should be removed from communal bathrooms. • Bins in the communal areas should be foot operated and in a good state of repair. • Cracked and damaged tiles in the laundry area should be replaced. We recommend that the staff application form be changed to seek information required under the Care Homes Regulations 2001; such as requesting a full employment history and seeking a reference from a persons last place of work when working with vulnerable adults or children for not less than three months duration. OP7 OP9 4. OP19 5. OP26 6. OP29 Seacliff Care Home DS0000068785.V373908.R01.S.doc Version 5.2 Page 29 7. 8. OP30 OP38 We recommend that the staff training matrix is kept up to date to assist in planning training requirements for the home. We recommend that there should be full recording of the visual inspection of the fire fighting equipment each month. Seacliff Care Home DS0000068785.V373908.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Seacliff Care Home DS0000068785.V373908.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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