Inspection on 28/01/08 for Seacliff Care Home

This inspection was carried out on 28th January 2008.

CSCI found this care home to be providing an Poor 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 23/01/09

Seacliff Care Home 29/07/08

Seacliff Care Home 26/10/07

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

CARE HOMES FOR OLDER PEOPLE Seacliff Care Home 9 Percy Road Bournemouth Dorset BH5 1JF Lead Inspector Marjorie Richards Key Unannounced Inspection 28th January 2008 07:00 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.V360010.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.V360010.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 gerryseacliff9@hotmail.co.uk Mr Munundev Gunputh Mrs Dhudrayne Gunputh Mr Gerard Thomas Care Home 24 Category(ies) of Dementia (24) registration, with number of places Seacliff Care Home DS0000068785.V360010.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. 26th October 2007 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.V360010.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.V360010.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 0 stars. This means the people who use this service experience poor quality outcomes. This unannounced inspection took place over 11.5 hours on the 28th January 2008 and was carried out by two Inspectors. Because of concerns noted during the inspection, our Pharmacist Inspector also spent time looking at the home’s arrangements for the safe handling of medicines on 4th and 22nd February. Details of these visits are also included in this report. (See Standard 9.) The main purpose of this inspection was to review all of the key National Minimum Standards, check that the residents living in the home were safe and properly cared for and to look at progress in meeting the requirements and recommendations made following the previous inspection. A serious complaint about the provision of care within the home was made recently and this was investigated during the inspection on 28th January, lead by staff from Bournemouth Borough Council Adult Community Care Services. (See Standard 16.) The Annual Quality Assurance Assessment (AQAA) form was completed and provided to the Commission for Social Care Inspection after the inspection. Recent legislation has made it a legal requirement for all registered services for adults to complete an AQAA every year. The completed assessment is one of the ways in which we assess how well the service is delivering good outcomes for the people using it. At the time of the inspection ten residents were accommodated, including one currently in hospital. Tours of the premises took place at various times during the day and records and related documentation were examined, including the care records for six residents. Time was spent observing the interaction between residents and staff, as well as speaking with residents to obtain their views wherever possible. The daily routine was also observed during the inspection, including mealtimes and activities. Discussions took place with the interim manager and Mrs Dhudrayne (Marie) Gunputh, one of the registered providers. We also spoke with members of staff on duty. For the purposes of this report, people who live at Seacliff Care Home are referred to as residents as this is the term generally used within the home. The Inspectors were made to feel welcome in the home throughout the inspection process. Seacliff Care Home DS0000068785.V360010.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? Eight of the requirements made at the last inspection have been met and some others have been met in part. Four of six parts of the requirement made at the last inspection about medication have also been met. Record keeping and handling of medication had improved to protect residents and meet their healthcare needs. The management and staff have worked hard to make improvements, particularly around ensuring beds are made up with clean bed linen and clothing is presented well when being put away in drawers and wardrobes. A number of health and safety and infection control issues have also been addressed and the clutter in the laundry improved. Four staff have now enrolled for National Vocational Qualification level 2 training, to help ensure residents are in safe hands. There has also been an overall improvement in the general standard of documentation and the way in which it is stored. A start has been made in introducing quality assurance questionnaires to obtain the views of residents, relatives and visitors to the home. Staff supervision is also being implemented. Seacliff Care Home DS0000068785.V360010.R01.S.doc Version 5.2 Page 8 What they could do better: The requirement regarding pre-admission assessments could not be checked on this occasion, as there have been no new admissions since the last inspection. This requirement is therefore carried forward and will be assessed at the next inspection. We found a number of shortfalls in care planning and staff told us that they did not have access to the care plans. This has the potential to place residents at risk because the care provided may not always be safe and staff may be unaware of how to meet the resident’s individual needs. The medicines policy needs further updating to give staff clear instructions to follow and monitoring of the medicines fridge temperatures need improving. There should be evidence of quality monitoring of medication so that improvements seen are maintained and further developed to safeguard residents. Some of the practices we observed did not ensure that residents are treated with respect at all times. The choice of activities is very limited and therefore not based on residents’ needs or preferences. Staff have very limited materials available to them for activities and very little that is suited to the needs of residents in the home. Residents commented, There is nothing to do all day long. I try to keep busy but its not easy. “Why can’t we go outside sometimes? I have asked if I can go for a walk in the garden, but they won’t let me.” “I am bored. What is there to do?” When we arrived to commence the inspection at 7.00am, we found all but four residents were up, dressed and sitting in the lounge. We were informed that they had all had their breakfast and everything had already been washed up and cleared away by the night staff before 7.00am. Several of these residents were asleep in their chairs and later noted to be sleeping during the day. One commented that they were not given any choice about getting up early. We witnessed poor care practice at mealtimes, especially for those residents needing assistance with their meals. There is no choice of menu, although alternatives are offered to suit individual preference. Residents commented, I enjoy most of the food. I like the meals we have, but the puddings could be better. I like steamed puddings and crumbles but we don’t have that sort of thing in this place. Seacliff Care Home DS0000068785.V360010.R01.S.doc Version 5.2 Page 9 They dont like it if you leave anything. You are supposed to eat it all up as it is good for you. “I just eat what they put in front of me.” A complaints policy is in place, but this needs some amendment. The Adult Protection policy and procedure is also in need of slight modification to ensure that any allegations of abuse are managed effectively. Although the interim manager reported that staff had received Protection Of Vulnerable Adults training to ensure a proper response to any suspicion or evidence of abuse, this could not be fully evidenced. The home has five bathroom/shower rooms, but at present there is no assisted bath available for those residents who may find difficulty in accessing a conventional bath. Mr Gunputh and Mrs Gunputh provided a letter of undertaking upon registration to complete a schedule of work within three months of the home opening in July 2007. At the last inspection, Mr Gunputh said that an assisted bathroom would be provided in the near future, but there is still no evidence of this being achieved. We found that some of the bathroom/shower rooms felt cold and not very welcoming. Soap and towels were not always available in bathrooms and toilets and one toilet was in need of cleaning. There is evidence of water damage to the ceiling in one shower room and a strong unpleasant odour in another shower room. Although recruitment practice has been improved, there are still some gaps in the documentation required. This, coupled with shortfalls in staff training, do not ensure that residents are consistently protected and in safe hands at all times. Although we were informed that full induction training is taking place, in line with the Skills for Care Common Induction Standards, the home was not able to evidence this. Residents say they feel that most staff treat them with kindness. Comments include: The people here do their best for you, I suppose. Some of them are very nice and I get on well with them. They sit and talk to me sometimes and sometimes we do a puzzle but we never do anything very exciting.” The lady who helps me is kind. She does not mind if I am slow. One relative commented, “I think that the staff are very good. I feel that this home saved my relative’s life.” As the registered manager is on sick leave at the present time, two staff have been temporarily transferred from Mr Gunputh’s other homes and are sharing the management role between them. An ‘interim manager’ is now in charge of the day-to-day running of the home and the ‘area manager’ is providing support. Seacliff Care Home DS0000068785.V360010.R01.S.doc Version 5.2 Page 10 Because Mrs Gunputh, one of the registered providers, is also in the home for long periods of time on a daily basis, staff appear unclear about who is actually ‘in charge’ of the home. Mrs Gunputh says that the home prefers not to have any involvement with residents personal finances. However, we found that small amounts of money are being held for some residents, but no records are maintained and there are no receipts for any monies spent. Mrs Gunputh agreed to immediately review each resident and set up a system for dealing with residents’ finances, which could be audited. This system would take account of personal allowances and any other monies held within the home. In order to ensure that the health, safety and welfare of residents are both promoted and protected at all times, improvements must be made in the overall management of the home, care planning and the monitoring of residents’ healthcare needs, the recording, safe handling and administration of medicines; staff recruitment, staff training and record keeping, as detailed in the body of this report. A number of requirements and recommendations have been made and we will continue to monitor the situation until we are satisfied that the necessary improvements have been made. 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. Seacliff Care Home DS0000068785.V360010.R01.S.doc Version 5.2 Page 11 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.V360010.R01.S.doc Version 5.2 Page 12 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): 3 (Standard 6 is not applicable at Seacliff Care Home.) Quality in this outcome area is poor. This judgement has been made using available evidence including visits to Seacliff Care Home. Sufficient information is not always available prior to admission, to ensure that only those prospective residents whose needs can be met are offered places at Seacliff Care Home. EVIDENCE: The Annual Quality Assurance Assessment (AQAA) states that the home always carries out its own comprehensive pre-admission assessments for all prospective residents, to determine whether Seacliff Care Home can meet their care needs. The interim manager confirmed this during the inspection. At the last inspection on 26/10/07, the records we looked at demonstrated that pre-admission assessments did not consistently provide sufficiently detailed information to allow an informed decision to be made as to whether the home could meet a prospective residents’ needs. Following such an assessment there was nothing documented to demonstrate that the home Seacliff Care Home DS0000068785.V360010.R01.S.doc Version 5.2 Page 13 confirmed the outcome in writing; therefore prospective residents were not assured that their needs could be met at Seacliff Care Home. As we were informed that there had been no new admissions to the home, this standard could not be fully assessed on this occasion. The requirement made in respect of pre-admission assessments is therefore carried forward and repeated at the end of this report. This will be reviewed at the next inspection. We acknowledge that existing pre-admission assessments have now been completely re-written in retrospect, to provide much more detailed information in a clear and well laid out format. We look forward to seeing this standard of recording maintained when the next new pre-admission assessment is made. Seacliff Care Home DS0000068785.V360010.R01.S.doc Version 5.2 Page 14 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 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including visits to Seacliff Care Home. Shortfalls in care planning have the potential to place residents at risk, because the care provided may not always be safe and able to meet the resident’s individual needs. Progress has been made with improving the handling and recording of medication but an effective quality assurance system is needed to ensure that this improvement is maintained and developed to safeguard residents. Some of the practices we observed did not ensure that residents are treated with respect at all times. EVIDENCE: Care plans are intended to provide staff with the information they require to meet the health, personal and social care needs of residents. On the previous inspection visit care records were found to be of generally poor standard, sometimes written long after admission, frequently without relevant risk assessments and with many care plans not being reviewed or kept up to date, thereby providing inaccurate information about each person. Seacliff Care Home DS0000068785.V360010.R01.S.doc Version 5.2 Page 15 Following examination of six care plans during this inspection, it is clear that a number of improvements in care planning have now taken place. Care plans have all been re-written to provide staff with details about each resident’s care needs and how these are to be met. Files are now much better organised and care plans appear comprehensive and well laid out, including a photograph of each resident, appropriate assessments, charts where necessary (e.g., for recording weights,) and risk assessments etc. Informative daily notes are also written by care staff to support the care they are providing. However, when we looked closely at the care records we found discrepancies. For instance, we viewed the daily notes written by care staff. These are being used effectively by staff to record in detail the care they are providing to residents and any changes in their condition. However, it is not clear what action is being taken following a change in a person’s condition and any outcome achieved. Care plans are not always being updated to reflect the observations of care staff provided in the daily notes. For instance, one care plan describes a resident as being independent yet this is clearly no longer the case. This deterioration is well documented by staff in the daily notes, but the information had not been transferred to the care plan. When asked who took responsibility for checking the information in the daily notes, Mrs Gunputh said that she was in charge of the staff handover at change of shift, but she relied on verbal information and did not read the notes. Regular and frequent monitoring of the daily notes must be implemented, to ensure all actions and outcomes are evident and the care plans are updated whenever necessary. We found that the daily notes were not always written in chronological order. For instance, on one sheet, entries were made on 29/11/07, 30/11/07, followed by 31/12/07 to 02/01/08. We saw charts in place to record the food and fluid intake for residents who were unwell, also charts to record regular turning to help prevent pressure sores. Some of these were very poorly written, with a number of entries for different days on just one side of paper, often undated. The charts did not appear to be an accurate record of the care provided. For example, although the daily notes for one resident state that regular turning has been carried out at night, this was not evidenced on the turn chart. Staff informed us they do not have access to care plans, only the daily notes. They are reliant on what they are told by Mrs Gunputh or whichever manager is on duty and therefore may not be fully aware of each resident’s individual care needs. This is a serious concern and we discussed with Mrs Gunputh and the interim manager the importance of using care plans as a working tool and how a detailed picture of preferences and needs for each resident will assist staff to deliver care more efficiently and effectively. The continued failure to provide reliable and accurate plans of care for residents places them at risk of Seacliff Care Home DS0000068785.V360010.R01.S.doc Version 5.2 Page 16 poor and inappropriate care because their needs and circumstances have not been fully assessed and recorded in the care plans and may not be known to staff. There is evidence to demonstrate that appropriate intervention is not always sought in a timely manner from General Practitioners and other health professionals. For instance, records show that advice had not been sought when a resident lost a significant amount of weight in a short period of time. We were informed that one resident required hoisting “for most of the time” with the assistance of two staff. However, on the morning of the inspection, staff said the resident would have to wait until the interim manager arrived at 9.15am, to provide the second person needed with moving and handling training. Poor moving and handling practice was observed during the day and staff were not able to demonstrate competence in the use of the hoist. The daily notes record that one resident sustained three falls in the home, but only two accident reports were available. We were not shown any evidence to demonstrate that these accidents had been thoroughly investigated, with any significant findings reflected in the care plan to ensure that future risks are minimised. Poor care practice was witnessed during the inspection in dealing with a resident complaining of pain and another resident who was wandering. These issues were brought to the attention of Mrs Gunputh. We still could not evidence that residents’ social, psychological or religious needs have been meaningfully assessed and appropriate support provided, where necessary. We looked at medication during the inspection and found a number of concerns around the safe handling, recording and storage of medicines. There was a poor audit trail for medicines and the amounts in stock did not agree with the records, indicating that they may not have given as prescribed or not accurately recorded. Medicines are stored in a trolley but the device for attaching it securely to the wall was not working. Our Pharmacist Inspector therefore visited the home on 4th February and again on 22nd February when it was found that improvements had been made. The following is a report of the Pharmacy visit on 22/02/08: The medication policy did not include written procedures for some aspects of medication handling. Some sections needed improving or clarifying so that staff have clear guidance to follow to safeguard people, and advice was provided. No residents were self-medicating. Four staff currently administer medicines and we saw medication training certificates for 2 of them. The book they had on medicines was out of date and Seacliff Care Home DS0000068785.V360010.R01.S.doc Version 5.2 Page 17 did not contain information on one person’s medicine. The home had information in care plans about what medicines were for but some were not correct so that staff had clear information about people medication needs. We checked 5 people’s Medicine Administration Record (MAR) charts with the medicines in stock to see if they were given as prescribed, stored and recorded correctly. Most medicines were supplied in a blister pack monitored dosage system with others in packets or bottles and each person had their own supply. There was a good audit trail for medicines and the amounts in stock agreed with the records and indicated that they were given as prescribed and accurately recorded. Occasionally staff had not recorded the dose given when a choice (e.g. 5-10ml) was prescribed so that the person’s response to medication could be monitored. Details of medicine allergies, or “none known” as appropriate, were recorded on MAR charts and medicines that were handwritten on MAR charts were signed as checked by a second authorised carer to protect people. There was no record of applying one cream but we were told that the person applied it himself. The home keeps records of medicines received and returned for disposal but the reason for returning medicines was not recorded. There were no medicines requiring special storage and recording at the time but there was a cupboard for storing them. Other medicines were stored in a trolley that was attached to the wall. The maximum and minimum temperatures of the medicines refrigerator were not monitored although the home had an appropriate thermometer for doing this. Staff recorded the date of opening residents’ eye drops and none seen had been in use more than the recommended 4 weeks. There was no evidence of monitoring medication, but we were told that this was being done as part of overall monitoring visits by the registered provider. Many of the poor practices we noted during the last inspection, that did not embrace the key principles of treating residents with respect and upholding their dignity at all times, have now been satisfactorily addressed. For instance, items of clothing in wardrobes are now well presented and named to ensure correct ownership and we found beds to be properly made up with clean linen. Individual routines are respected and residents are able to bring their own possessions into the home to personalise their bedrooms. However, there are still some issues regarding respect for the individual that give cause for concern. For instance, one resident has a very good rapport with another resident and they told us they usually sit together at mealtimes. (Staff confirmed this.) However, both had been seated elsewhere at lunchtime and could not understand why they had been moved. No explanation had been given to them. During the evening meal, a care assistant kept leaning right over in front of one resident to feed another. The way in which staff offer assistance at meal Seacliff Care Home DS0000068785.V360010.R01.S.doc Version 5.2 Page 18 times often lacks sensitivity and consideration for the individual resident’s needs. (See also Standard 15.) A resident asked for a duster to “help with the housework” but was told to go and sit down. Mrs Gunputh and two staff tried to help a resident stand, who was complaining of pain in the knee. The three continued to have a debate with each other about the best course of action whilst the resident was left standing and complaining about the pain, before finally being placed in a wheelchair. It is important that steps are taken to ensure that all residents are afforded the support, dignity and respect they have a right to expect at all times. Seacliff Care Home DS0000068785.V360010.R01.S.doc Version 5.2 Page 19 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 and 15 Quality in this outcome area is poor. This judgement has been made using available evidence including visits to Seacliff Care Home. There is little evidence of any meaningful activities taking place in the home and opportunities for residents to make choices need improvement, to ensure they have more control over their lives. Open visiting arrangements are in place and residents are able to maintain contact with family and friends. Mealtimes need to provide a more pleasant experience for residents. EVIDENCE: Although some information is available about residents’ background and interests, little of this is being used to identify social needs and enhance the daily lives of residents. The choice of activities is very limited and therefore not based on residents’ needs or preferences. The home does not employ an activities co-ordinator and the staff group share responsibility for the provision of leisure activities between them. Observation throughout the day shows that staff still have very limited materials available to them for such activities and very little that is suited to the needs of residents in the home. Seacliff Care Home DS0000068785.V360010.R01.S.doc Version 5.2 Page 20 There is little evidence of any meaningful activities taking place in the home. Some board games and jigsaw puzzles are available. A quiz book was in use during the day. Staff confirmed that the same quiz book is used every day. Residents commented, There is nothing to do all day long. I try to keep busy but its not easy. “Why can’t we go outside sometimes? I have asked if I can go for a walk in the garden, but they won’t let me.” “They are playing games today, but we don’t usually play games. It is only because you are here.” “I am bored. What is there to do?” “I liked to help do the dusting, but they won’t let me do it any more.” A board in the dining room is used to help people with dementia and shortterm memory loss by displaying information, confirming which day of the week it is and what the day’s weather is like etc. Throughout the inspection the board was not updated and gave inaccurate details relating to the previous day. Observation and contact with residents confirms that they are able to maintain contact with friends and family, as they wish. Visiting is open and flexible and visitors are welcomed into the home. Residents are able to see visitors in their own rooms or in the lounge/dining areas. Residents say their relatives are well received. During the inspection we observed some residents being offered choices e.g., if they would like a drink or if they wanted to take part in an activity and play a game. However, residents could be given greater opportunities to make choices about how they live their lives. For instance, at present, there is no choice of menu. One resident commented, “You do have a choice. You either take it or leave it.” We observed that two residents were not able to sit with each other at lunchtime, as they would have chosen to do. When we arrived to commence the inspection at 7.00am, we found all but four residents were up, dressed and sitting in the lounge. We were informed that they had all had their breakfast and everything had already been washed up and cleared away by the night staff before 7.00am. Several of these residents were asleep in their chairs and later noted to be sleeping during the day. One commented that they were not given any choice about getting up early. At 11:30 a.m., two of the residents who had been given their breakfast early were overheard to say, Im hungry. Ive been here a long time waiting for my dinner. Why is dinner so late? It seems ages since I had breakfast. The home should consider providing more snacks between meals, for instance with the use of finger foods where residents can help themselves if hungry. Seacliff Care Home DS0000068785.V360010.R01.S.doc Version 5.2 Page 21 On the day of inspection, Mrs Gunputh said she was responsible for cooking the meals. The kitchen was found to be clean and tidy. We examined the contents of the fridge and some items were past their “use by” date. We found food left from previous meals, such as corned beef sandwiches with a hard boiled egg and some pureed food, possibly chicken, which were not labelled or dated. Mrs Gunputh was asked to dispose of these. Some of the fruit in the fruit bowl was going rotten. The lunchtime meal consisted of cottage pie with vegetables, followed by tinned rhubarb and custard. Mrs Gunputh said that lunch would be served between 12: 00 and 12:30 p.m. Residents started arriving in the dining room shortly after 12 p.m. but the first meals were not served until 12:40 p.m., after most residents had been waiting for some time. Throughout the mealtime, the radio was playing pop music. We observed one resident who required help from staff to eat their meal. Two members of staff provided assistance at different times, in between carrying out other tasks. There were constant interruptions and on two occasions, the resident was left with no help at all. There was virtually no conversation with the resident and very little encouragement or prompting throughout this process, which appeared totally disjointed, hurried, lacking in sensitivity and any consideration for the individual resident’s needs. During the evening meal, we witnessed tomato soup being fed to a resident with a feeder cup. The spout of the cup was pushed into the resident’s mouth so that the resident was almost choking. The member of staff placed their hand under the resident’s chin, forcing the mouth to stay closed. Soup was seeping out at the side of the mouth, soaking the tissue in the care assistant’s hand. The care assistant was immediately advised to stop this practice and use a spoon to feed the resident. The carer did not appear to understand the possible implications of such actions and this was then discussed with Mrs Gunputh and the interim manager. Residents commented, I enjoy most of the food. I like the meals we have, but the puddings could be better. I like steamed puddings and crumbles but we don’t have that sort of thing in this place. The food is alright I suppose, but not like I used to have at home. They dont like it if you leave anything. You are supposed to eat it all up as it is good for you. The food is not what Im used to but it is okay. Cheap and cheerful I would say. “We don’t usually have seconds, it is only because you are here.” “I just eat what they put in front of me.” Seacliff Care Home DS0000068785.V360010.R01.S.doc Version 5.2 Page 22 Seacliff Care Home DS0000068785.V360010.R01.S.doc Version 5.2 Page 23 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 and 18 Quality in this outcome area is poor. This judgement has been made using available evidence including visits to Seacliff Care Home. A complaints policy is in place, but this needs some amendment. The Adult Protection policy and procedure is also in need of slight modification to ensure that any allegations of abuse are managed effectively. It could not be evidenced that all staff have received Adult Protection training to ensure a proper response to any suspicion or evidence of abuse. EVIDENCE: This inspection was carried out jointly with Bournemouth Borough Council Adult Community Care Services, in response to a serious complaint. A number of concerns were raised and most of these were substantiated during the inspection. A meeting has been arranged with the registered providers to discuss these issues and how future compliance with regulations can be achieved. The home has a complaints policy and procedure in place and this is displayed in the entrance hall. Part of this document states, If the complaint cannot be resolved by the manager, the complainant can be referred to the service providers, Dave and Marie Gunputh and Raj Gunputh. The service providers are Mrs Dhudrayne (Marie) Gunputh and Mr Munundev (Raj) Gunputh, not Mr Dave Gunputh, so the complaints procedure must be corrected to provide accurate information. Seacliff Care Home DS0000068785.V360010.R01.S.doc Version 5.2 Page 24 The home has an Adult Protection policy and procedure, which has been updated since the last inspection. However, this document does not make reference to the multi disciplinary No Secrets protocol, so is in need of further modification. A “Whistle blowing” policy is also in place but some staff seemed unaware of the importance of this in reducing bad practice. We were informed that in-house and external Protection Of Vulnerable Adults training has been provided. However, we could not evidence that all staff had received such training, so they are able to identify different forms of abuse and know how to deal with any suspicion or allegation of abuse. Three Safeguarding Adults referrals relating to the care of residents were in the process of being investigated by Bournemouth Borough Council Adult Community Care Services at the time of the last inspection. All three were subsequently substantiated and the home is continuing to work towards making the necessary improvements. Seacliff Care Home DS0000068785.V360010.R01.S.doc Version 5.2 Page 25 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, 21 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including visits to Seacliff Care Home. The standard of accommodation is generally good, providing residents with comfortable surroundings in which to live, although there is no assisted bath available at present. Infection control measures within the home have been improved. EVIDENCE: The accommodation at Seacliff Care Home is arranged over three floors. The lounge and dining areas are situated on the ground floor, off of the spacious entrance hall. A spacious conservatory is also available, but residents did not use this during the inspection, possibly because the conservatory is cooler than the rest of the home. Bedrooms are available on all three floors and residents may use the stairs or a passenger lift to access them. Seacliff Care Home DS0000068785.V360010.R01.S.doc Version 5.2 Page 26 The standard of accommodation is generally good, with rooms comfortably furnished and decorated. Some of the bedrooms are well personalised by their occupants. The home has five bathroom/shower rooms, but at present there is no assisted bath available for those residents who may find difficulty in accessing the bath. Mr Gunputh and Mrs Gunputh provided a letter of undertaking upon registration to complete a schedule of work within agreed timescales. It was agreed to review the assisted bathroom provision and take action to improve the facilities within three months of the home opening in July 2007. At the last inspection, Mr Gunputh said that an assisted bathroom would be provided in the near future, but there is still no evidence of this being achieved. We found that some of the bathroom/shower rooms felt cold and not very welcoming. Soap and towels were not always available in bathrooms, toilets and ensuite facilities. One toilet was in need of cleaning. A large quantity of mould was growing inside the soap dispenser in one bedroom. There is evidence of water damage to the ceiling in the shower room near Room 8. The plastic coating on the shower chair is cracked and coming away, leaving a rough surface. A strong unpleasant odour was noted in another shower room. The home has a small laundry room equipped with a washing machine and tumble dryer. Soap and paper towels were available at the wash hand basin so that staff could wash their hands after handling dirty laundry. Much of the clutter has been cleared since the last inspection. All areas that were seen during the tour of the home were generally in a clean condition, with the exception of one toilet. Residents expressed general satisfaction with the laundry service. Seacliff Care Home DS0000068785.V360010.R01.S.doc Version 5.2 Page 27 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 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including visits to Seacliff Care Home. Staffing levels have been reviewed to ensure the care needs of residents can be met. However, poor recruitment practice and shortfalls in staff training within the home do not consistently protect the residents to ensure that they are in safe hands at all times. EVIDENCE: In response to the concerns expressed about staffing levels at the last inspection, Mr Gunputh agreed to recruit additional staff as a matter of urgency. Until this can be fully achieved, Mr Gunputh is providing experienced staff from his other care homes to assist at Seacliff Care Home. Many of the staff employed at Seacliff Care Home have little or no previous experience of care work. Most appear committed, enthusiastic and willing to learn. Those staff more recently recruited have greater experience of working in a care setting. The home has not achieved the minimum ratio of 50 trained members of care staff at National Vocational Qualifications (NVQ) level 2 or equivalent, to help ensure residents at Seacliff Care Home are in safe hands. However, four staff are now working to achieve National Vocational Qualifications in care and the home is hoping to encourage others to participate. Seacliff Care Home DS0000068785.V360010.R01.S.doc Version 5.2 Page 28 We asked to see the files for staff working in the home. We examined the files for six staff and found that much of the necessary documentation is now in place, e.g., a Criminal Records Bureau (CRB) disclosure, Protection Of Vulnerable Adults (POVA) check, full employment history, proof of identity and two appropriate written references. However, there are still gaps in some files. E.g., one member of staff commenced employment before a satisfactory Protection Of Vulnerable Adults check had been received. There are some discrepancies, for example the supervision record talks about “completing the second week of employment” but the commencement date recorded on file shows only one week in the home at the time the supervision session took place. The employment history is not always sufficiently detailed. For example, giving dates such as 2001 – 2005 without specifying which months. Some files do not contain photographs of staff, or the quality of the photo is poor. To promote the safety of residents, it is essential to achieve consistency and ensure that all of the required documentation is in place prior to the commencement of employment. The interim manager informed us that a great deal of staff training had taken place since the last inspection. However, the home does not have a training matrix, so it is difficult to ascertain exactly what training each member of staff has undertaken and what further training is planned. We did not see any training plans or any individual staff training profiles in place, to help ensure that staff have the knowledge they require to be able to care for residents and meet their needs. Some training certificates are held in staff files, but many of these are for training undertaken by staff before commencing working at Seacliff Care Home. The interim manager informed us that further training was planned for the following day and most staff, including newly recruited staff not yet working in the home, would be attending. We discussed the need to review all staff training and draw up a comprehensive training plan, to ensure all staff receive the training they need. This should include moving and handling training as a matter of priority. Although we were informed that full induction training is taking place, in line with the Skills for Care Common Induction Standards, the home was not able to evidence this. Residents say they feel that most staff treat them with kindness. Comments include, The people here do their best for you, I suppose. Some of them are very nice and I get on well with them. The girls who look after me are very nice. They sit and talk to me sometimes and sometimes we do a puzzle but we never do anything very exciting.” The lady who helps me is kind. She does not mind if I am slow. Seacliff Care Home DS0000068785.V360010.R01.S.doc Version 5.2 Page 29 One relative commented, “I think that the staff are very good. I feel that this home saved my relative’s life.” Seacliff Care Home DS0000068785.V360010.R01.S.doc Version 5.2 Page 30 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, 36 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including visits to Seacliff Care Home. The management role and responsibilities must be more clearly defined, to ensure that staff are given a clear sense of direction and leadership. Quality assurance questionnaires are being introduced to seek the views of residents, relatives and other visitors to the home. A more robust system for handling residents’ monies must be implemented, to ensure their financial interests are safeguarded. Improvements are in progress to ensure that the health, safety and welfare of residents and staff are promoted and protected. EVIDENCE: The registered manager is currently on sick leave and during his absence, alternative arrangements have been made for the management of the home. Seacliff Care Home DS0000068785.V360010.R01.S.doc Version 5.2 Page 31 Two staff have been temporarily transferred from Mr Gunputh’s other homes and are sharing the management role between them. An ‘interim manager’ is now in charge of the day-to-day running of the home and the ‘area manager’ is providing support. The manager should communicate a clear sense of direction and leadership, which staff and residents understand and are able to relate to the aims and objectives of the home. This is not being fully achieved at Seacliff Care Home at the present time. Because Mrs Gunputh, one of the registered providers, is in the home for long periods of time on a daily basis, staff appear unclear about who is actually ‘in charge’ of the home. Mrs Gunputh works as a member of staff when on duty, (usually as a care assistant or as the cook), but also participates in management tasks such as taking charge of staff handovers at the end of each shift. On the day of inspection, the staffing roster showed Mrs Gunputh as ‘Carer Number One’ but she informed us that she was only responsible for being in the kitchen all day as the cook. However, we saw instances where Mrs Gunputh participated in the provision of care and where staff sought her opinion on care issues. This has the potential to undermine the role of the interim/area manager and may be confusing to staff. We noted that Mrs Gunputh appeared very tired and she told us that she works long hours, seven days a week. She also sleeps on the premises and is ‘on call’ at night. Mrs Gunputh said she had only had four hours off duty on Boxing Day and the Sunday before the inspection. At the last inspection we found no system in place for seeking the views of residents, relatives and other visitors to the home, for example through anonymous questionnaires. We saw some evidence to demonstrate that Quality Assurance and quality monitoring systems are now being introduced. Questionnaires have been provided for residents and relatives to give feedback and four completed forms have been received so far. Regular auditing of care plans, medication etc will also be implemented. Mrs Gunputh says that the home prefers not to have any involvement with residents personal finances. Therefore, all residents who do not wish to handle their own affairs or are unable to do so have a relative or other representative to deal with their finances etc. The home pays for services such as chiropody and hairdressing and this amount is then invoiced to residents, relatives or representatives for payment each month. However, we found that small amounts of money are being held for some residents, but no records are available and no receipts for any monies spent. One resident said, “I would be grateful if you could sort out my money. I never see anything, not a penny.” Mrs Gunputh could not demonstrate that residents were receiving their personal allowances each week, to spend as they might wish on items such as clothing, hairdressing, toiletries etc. She agreed Seacliff Care Home DS0000068785.V360010.R01.S.doc Version 5.2 Page 32 to immediately review each resident and set up a system for dealing with residents’ finances, which could be audited. This system would take account of personal allowances and any other monies held within the home. Following the last inspection we required that regular staff supervision must be implemented as a means of ensuring good practice, emphasising the philosophy of care within the home and looking at individual training and career development needs etc. There is evidence that such a system has now been commenced and this will be reviewed more fully at the next inspection. Some measures are in place to promote the safety of residents. For instance, radiators are guarded to ensure residents do not come into contact with hot surfaces. The AQAA states there is regular servicing of equipment, such as portable electrical appliances, the lift, hoists etc and examination of a random sample of records confirmed this. Staff have worked hard to deal with issues health and safety issues highlighted at the last inspection. Suitable arrangements are in place for specialist servicing of the fire warning system, emergency lighting and fire fighting equipment. The fire risk assessment has now been updated to ensure it is fully relevant to Seacliff Care Home. However, fire records were not completely up to date. We were told, “A fire drill took place earlier in January, but it has not been recorded.” No one was sure who had overall responsibility for fire safety within the home. On arrival at Seacliff Care Home at 7.00am, the two care assistants on duty answered the doorbell swiftly. However, they inadvertently shut the inner door behind them and locked themselves out. Mrs Gunputh was asleep on the second floor but care staff did not know the telephone number of the home and informed us that she would not be able to hear the telephone anyway. Fortunately, a resident was able to open the door from the inside and let us in. The registered providers must consider what actions to take to make certain this cannot happen again in future and ensure there are suitable arrangements in place for contacting the person ‘on call’ in an emergency. There have been a number of improvements since the last inspection, but there is still much to do to further enhance the quality of life for residents day by day, e.g., the provision of greater opportunities for socialising and stimulation, a wider variety of activities etc. In order to ensure that the health, safety and welfare of residents are both promoted and protected at all times, improvements must be made in the overall management of the home, care planning and the monitoring of residents’ healthcare needs, the recording, safe handling and administration of medicines; staff recruitment, staff training and record keeping, as detailed in the body of this report. A number of requirements and recommendations have Seacliff Care Home DS0000068785.V360010.R01.S.doc Version 5.2 Page 33 been made and we will continue to monitor the situation until we are satisfied that the necessary improvements have been made. Seacliff Care Home DS0000068785.V360010.R01.S.doc Version 5.2 Page 34 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 X 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 3 X 1 X X X X 3 STAFFING Standard No Score 27 3 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 1 X X 2 Seacliff Care Home DS0000068785.V360010.R01.S.doc Version 5.2 Page 35 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 OP3 Regulation 14(1) Requirement The registered persons must ensure that residents are admitted only on the basis of a full assessment. There should be appropriate consultation with the prospective resident or their relative or representative. Pre-admission assessments undertaken by the home must be fully documented and contain detailed information. The registered persons must confirm in writing to prospective residents that, following assessment, the home is suitable to meet their care needs. Timescale extended as no new admissions since the last inspection. Timescale for action 01/05/08 Seacliff Care Home DS0000068785.V360010.R01.S.doc Version 5.2 Page 36 2. OP7 15(1) The registered persons must ensure that all aspects of each residents health and welfare needs, including social, psychological or religious needs, are recorded and regularly updated, as necessary. Regular and frequent monitoring of the daily notes must be implemented, to ensure all actions and outcomes are evident and the care plans are updated whenever necessary. Daily notes must be written in chronological order. The resident or their representative should agree care plans and any subsequent changes, wherever possible. (Previous timescale of 01/01/08 not fully met). Health care needs must be fully documented in each residents care plan. These should include detailed risk assessments and careful completion of any necessary documentation, e.g., fluid monitoring, dietary intake and turn charts, put in place as a result of such assessments. Staff must have access to care plans to ensure they can provide the care required. Any accidents involving residents must be thoroughly investigated, with any significant findings reflected in the care plan to ensure that future risks are minimised. 01/05/08 3. OP8 17(1)(a) 12(1) 01/04/08 Seacliff Care Home DS0000068785.V360010.R01.S.doc Version 5.2 Page 37 4. OP8 12(1) and 13(1) 5. OP9 13(2) The registered persons must ensure that all residents are given access to medical, nursing and support services whenever necessary, without delay. (Previous timescale of 01/01/08 not fully met). The registered persons must ensure that maximum and minimum temperatures of the medicines refrigerator are monitored so that medicines are stored at the correct temperature (-2-8°C) to maintain their effectiveness. The medication policy must be further updated so that staff have clear procedures to follow to safeguard people. (Previous timescale of 01/01/08 partially met). The registered persons must ensure that suitable arrangements are made to ensure that residents are always treated with dignity and respect. Issues identified in this report must receive attention. (See Standards 10 and 15 for details.) (Previous timescale of 31/01/08 not fully met). The registered persons must consult residents about their interests and provide a programme of activities suited to their individual needs and preferences. (Previous timescale of 31/01/08 not met). 01/05/08 01/04/08 6. OP10 12(4)(a) 01/04/08 7. OP12 16(2) (m) and (n) 01/05/08 Seacliff Care Home DS0000068785.V360010.R01.S.doc Version 5.2 Page 38 8. OP14 12(2)(3) 9. OP15 12(1) 16(2) 10 OP16 22 11 OP18 13(6) and 12(1)(5) The registered persons must, so far as practicable, enable residents to make choices and decisions about their lives within the care home, taking into account their wishes and feelings. This should include choosing when to get up in the morning. The registered persons must ensure that residents needing assistance at mealtimes receive proper care and attention in meeting these needs. Where possible, a choice of foods should be available and snacks, such as finger foods, provided for those residents feeling hungry between meals. The registered persons must ensure that the complaints policy and procedure is amended to ensure it accurately reflects the current situation. The registered persons must ensure that residents are safeguarded from all possible forms of abuse, e.g., physical, financial, sexual, psychological, discriminatory or neglect. The policy and procedure giving guidance to staff must be updated to ensure it takes into account the Department of Health No Secrets guidance. Staff must receive training in Adult Protection issues, to ensure a proper response to any suspicion or allegation of abuse. (Previous timescale of 01/01/08 not fully met). 01/04/08 01/04/08 01/04/08 01/05/08 Seacliff Care Home DS0000068785.V360010.R01.S.doc Version 5.2 Page 39 12 OP21 23(2)(a) (b) (c) (n) The registered persons must ensure that the design and layout of the care home can meet the needs of residents. Consideration must be given to ensuring that residents have access to an assisted bath, (as agreed prior to registration). (Timescale still current). 31/03/08 13 OP21 23(2)(a) (b) (c) (n) The registered persons must ensure that the design and layout of the care home can meet the needs of residents. Issues highlighted in this report must receive attention, e.g., the unpleasant odour in one shower room and the water damaged ceiling in another. (See Standard 21). The registered persons must increase the proportion of staff that has gained a nationally recognised qualification in care, e.g., National Vocational Qualification (NVQ) level 2. (Timescale still current). The registered persons must not employ staff to work with residents until satisfactory recruitment checks have been fully completed and all necessary documentation has been received. (Previous timescale of 01/01/08 not fully met). 01/05/08 14 OP28 18(1)(a) 31/03/08 15 OP29 19(1) 01/05/08 Seacliff Care Home DS0000068785.V360010.R01.S.doc Version 5.2 Page 40 16 OP30 18 The registered persons must 01/05/08 ensure that all staff receive training appropriate to the work they are to perform and that such training is evidenced in records. Training must also include mandatory topics, such as Moving and Handling and provide access to structured induction training. It is required that a detailed audit of training be carried out and a training programme implemented, to ensure that all staff are provided with the knowledge and skills necessary to carry out their work. A copy of this audit and training programme must be forwarded to the Commission for Social Care Inspection. (Previous timescale of 01/01/08 not fully met). The registered persons must manage the care home with sufficient care, competence and skill and communicate a clear sense of direction and leadership. (Previous timescale of 01/01/08 not fully met). The registered persons must establish and maintain a system for a) reviewing and b) improving the quality of care provided. This should include internal quality audits of care plans, medication and accident records etc. (Previous timescale of 31/01/08 not fully met). 17 OP31 10(1) and 12 01/04/08 18. OP33 24(1) 01/04/08 Seacliff Care Home DS0000068785.V360010.R01.S.doc Version 5.2 Page 41 19 OP35 20(1) 17 (2) Schedule 4 The registered persons must not pay money belonging to any resident into a bank account unless— (a) The account is in the name of the resident, or any residents, to which the money belongs; and (b) The account is not used by the registered person in connection with the carrying on or management of the care home. Suitable provision must be made for the safekeeping of any monies or valuables held on behalf of residents and detailed records and receipts for any transactions must be maintained. The registered persons must ensure that any unnecessary risks to the health and safety of residents are identified and, as far as possible, eliminated. This includes ensuring that: • Staff cannot lock themselves out of the care home by accident. • The member of staff on call is more easily contactable when needed. For full details, see Standard 38. 01/04/08 20. OP38 13(4)(c) 01/04/08 Seacliff Care Home DS0000068785.V360010.R01.S.doc Version 5.2 Page 42 21 OP38 18(1) 12(1) The registered persons must ensure that staff do not work excessively long hours and are give sufficient time off. This applies to Mrs Gunputh in her roles as cook and care assistant by day and being “on call” at night, seven days a week. This is not safe working practice and also has the potential to affect the wellbeing and safety of residents. Sufficient staff must be employed to ensure this is not necessary. 01/04/08 Seacliff Care Home DS0000068785.V360010.R01.S.doc Version 5.2 Page 43 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations It is recommended that there should be evidence of regular monitoring of medication to ensure that it is given as prescribed, stored, handled and recorded correctly. It is further recommended that the Registered Person ask the pharmacy to supply medicine information leaflets for all the medicines prescribed so that they could update care plan information, and keep them filed for individual residents, or alphabetically, for staff, residents or their advocate to refer to. It is recommended that information about each residents background, social history, previous hobbies and interests etc. is recorded and then used to ensure that the activities on offer will be meeting the individual needs, preferences and expectations of residents. It is further recommended that the reality orientation board in the dining room is kept updated to provide meaningful and accurate information for residents about which day of the week it is etc. 2. OP12 Seacliff Care Home DS0000068785.V360010.R01.S.doc Version 5.2 Page 44 Commission for Social Care Inspection South West Regional Office 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. 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