Inspection on 23/08/05 for Sedbury Park Care Centre

This inspection was carried out on 23rd August 2005.

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

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

Other inspections for this house

Sedbury Park Care Centre 04/07/07

Sedbury Park Care Centre 27/06/06

Sedbury Park Care Centre 11/01/06

Sedbury Park Care Centre 01/02/05

Sedbury Park Care Centre 10/08/04

Sedbury Park Care Centre 10/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Sedbury Park Care Centre Sedbury Park Sedbury Monmouthshire NP16 7EY Lead Inspector Janet Griffiths Unannounced 23 and 24th August 2005 10:00 rd th 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 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. Sedbury Park Care Centre D51_D03_S16574_SedburyPark_V240643_240805_Stage4_U.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Sedbury Park Care Centre Address Sedbury Park Sedbury Nr Chepstow Monmouthshire NP16 7EY 01291 627127 01291 622327 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Ashbourne Homes Limited To be appointed Care Home 105 Category(ies) of Old Age (82) registration, with number Dementia (23) of places Learning Disability - over 65 (5) Sedbury Park Care Centre D51_D03_S16574_SedburyPark_V240643_240805_Stage4_U.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: To accommodate 3 Named Service Users with Learning difficulties under 65 years of age Date of last inspection 01/02/05 Brief Description of the Service: Sedbury Park Care Centre is a large 19th century Victorian house that stands in its own grounds overlooking the Severn estuary. The care centre consists of three units: the Main House, registered for nursing care, Wye House registered for elderly residential care and The Marlings registered for residential elderly mentally ill. Although the home is registered for 105 beds in total, only 83 beds are operational, as the Company aims to offer single room accommodation only, unless a couple express the wish to share. All rooms offer en suite facilities and there are assisted bathrooms and toilets on all levels. The main catering and laundry facilities are in located Main House. Both Wye and Main House have shaft lifts and there are spacious lounges, a library, a ballroom and activities area (for the use of all the homes’ service users) and a dining room in Main and a lounge/diner and smaller lounge in Wye. The Marlings have two stair lifts, a lounge and dining area. There are extensive grounds around the home, which the more ambulant residents can access and some paths for wheelchair users. There is a sheltered courtyard and sitting area in the Main House and an enclosed garden for the residents in the Marlings. Sedbury Park Care Centre D51_D03_S16574_SedburyPark_V240643_240805_Stage4_U.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Three regulation inspectors and one pharmacy inspector carried out this unannounced inspection, over 8 hours on one day, in August 2005. One inspector checked each unit, looking at documentation, speaking to residents, relatives and staff and following -up requirements from the last inspection. The pharmacy inspector looked at the medication systems in Wye and the Marlings. The acting manager and care manager of the nursing unit were present during the day and the acting manager was joined by the regional manager for the feedback at the end of the inspection. Unit managers for both units were not available on this occasion. What the service does well: Staff throughout the home, were observed maintaining good standards of care for the residents. Both residents and relatives spoken with confirmed this. Staff spoken with showed a clear understanding of the needs of the residents they were caring for and how to meet those needs. A calm environment was created for the residents in the Marlings and staff were observed over lunchtime service dealing with this procedure most efficiently. The staff within Wye were also noted as working extremely hard throughout the day, and had created a ‘homely’ comfortable environment within the unit. Staff within the Main House appeared to have a good rapport with the residents and when spoken with all were clear about individual needs. The home has an excellent activities programme, providing both one to one stimulation, with hand and nail care, facials etc, and group activities. Residents were observed enjoying the hand care being given and several commented on the recent entertainment, a harpist, and the forthcoming boat trip. Sedbury Park Care Centre D51_D03_S16574_SedburyPark_V240643_240805_Stage4_U.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: There are still some outstanding environmental requirements from the last inspection, to include review of bathing facilities throughout. An immediate requirement has been given to improve bathing facilities in the Marlings specifically, where there is only one assisted bath in use for 21 residents. A new estates manager for the area has recently been appointed and this will be presented as priority. Staffing levels in Wye House were found to be inadequate at this inspection. The senior carer was engaged in administering morning medications throughout the morning, and a large proportion of the residents are dependent on staff to assist with most of their care needs. The acting manager reported that five residents are awaiting reassessment as their needs have changed and can no longer be met in this unit. In discussions following the inspection it was decided to issue a second immediate requirement to ensure that whilst these residents remain in the unit the numbers of staff increase to meet their needs. Organisers undertaking activities have limited time and cannot be in all units at all times and this was noted within Wye House on this occasion, when there seemed little stimulation and staff did not have time to spend chatting to service users. Recruitment procedures continue to have gaps in the required documentation, which must be addressed to ensure the safety of the residents. Sedbury Park Care Centre D51_D03_S16574_SedburyPark_V240643_240805_Stage4_U.doc Version 1.40 Page 7 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. Sedbury Park Care Centre D51_D03_S16574_SedburyPark_V240643_240805_Stage4_U.doc Version 1.40 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Sedbury Park Care Centre D51_D03_S16574_SedburyPark_V240643_240805_Stage4_U.doc Version 1.40 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Arrangements are in place to ensure that each prospective resident is fully assessed prior to admission and on admission, to ensure that all their particular care needs may be met in the Home. The philosophy of the home is that as needs change/increase residents may move to the appropriate units for their care. However this is very dependent on funding being available and does have implications on suitable placements within the home. EVIDENCE: Care records of a number of newly admitted residents were seen and preadmission assessments were in evidence, giving a clear picture of individual needs. However, since admission to a specific unit the needs of some service users had increased and this has implications on the staffing levels within the unit. The manager reported that they have requested that these residents are reassessed, as they feel their needs cannot be met where they are currently placed. Sedbury Park Care Centre D51_D03_S16574_SedburyPark_V240643_240805_Stage4_U.doc Version 1.40 Page 10 Newly admitted residents in each unit were spoken with and all expressed their satisfaction of the care received and felt that their needs were being met. Five service users’ files were case tracked within the Marlings. All had full assessments covering emotional, physical and medical needs. Some files case tracked had reports from Community Psychiatric Nurses – (CPN’s) practicing at assessment centres used by service users prior to admission at the Marlings. Moving and handling assessments were also available. Observations indicate the Marlings will not provide nursing care for EMI people. For example, a service user, who was in hospital, had the case discussed over the telephone by the senior in charge with a hospital representative. The assessment at this point clearly informed the hospital that the service user could not return to the Marlings as the needs included nursing care, which could not be provided in the unit. The local doctor visited one service user in the unit and advised admission to hospital due to recent on set of chest infection. Daily records, in files case tracked, had notes to show district nurses attended to apply dressings for skin care. Sedbury Park Care Centre D51_D03_S16574_SedburyPark_V240643_240805_Stage4_U.doc Version 1.40 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 There is a comprehensive care planning system in place with some inconsistencies in the Marlings regarding records of changes in care needs or minimising risks. Health needs are met with evidence of good multi disciplinary working taking place on a regular basis. Secure arrangements are made for storing medicines. A monitored dose system (MDS) and Medication Administration Record (MAR) charts provided by a local pharmacy are the basis of the arrangements for managing medicines. Staff spoken to demonstrated a good understanding about the medication but some more attention to detail is needed to ensure sound systems for managing medicines are in place. Service users are treated with respect and dignity EVIDENCE: A sample of records was checked within each unit. Following a recent company audit, further training in record keeping was given to staff and it was evident from the records seen that standards had improved. Each resident had an assessment completed and this now has much more information recorded. From this problems are identified and care is planned. Sedbury Park Care Centre D51_D03_S16574_SedburyPark_V240643_240805_Stage4_U.doc Version 1.40 Page 12 Some core care plans are used and although they are being individualised to a certain extent there were individual problems such as PEG, crash mat etc, that were not reflected in the appropriate core care plan. A number of risk assessments are also completed which in turn generate care plans according to the scores reached. Within Wye House care planning was generally good with just a few gaps for sections such as spirituality. The deputy manager was advised about this. All records show evidence of regular review but few as yet show reviews taking place with residents and/or their representatives. Daily records have also improved and care staff are now encouraged to contribute to these. Records confirmed multi disciplinary input is accessed where appropriate. Doctors from the local practice visit the home each week to see anyone who needs a visit. Reference to the continence adviser, speech and language therapy (SALT) departments and learning disability teams, among others, were made. Within Main House dependency levels remain high with a total of 35 residents classed as high dependency within the home and 35 medium dependency. There are at least 3 residents in Main House who remain on permanent bed rest and 9/10 to assist with their meal and a further 4 to prompt. One resident has a PEG tube to receive enteral feeding and is monitored by the SALT team. Pressure relieving equipment and turn charts were seen where appropriate, as were fluid/diet charts. Wound care charts were also being completed. It was reported that within Wye House there has been a high incidence of urinary tract infections recently and the pharmacy inspector noted the high use of antibiotics used for urinary tract infections. Staff described this as being a problem for a while. It is important that residents drink sufficiently and are confident that they have good access to the toilet otherwise this acts as a deterrent to adequate fluid intake. Advice should be obtained fro the Health protection Agency infection control team at Cheltenham (01242 548807) to exclude any environmental or procedural causes for this. Observation during the inspection showed that staff have a good awareness of how to protect residents’ privacy and dignity. They were seen to knock on doors and wait for a response before entering and spoke to residents in a respectful way. Residents spoken with confirmed that their privacy and dignity is respected and they are given choice in how and where they spend their days. One resident reported that she was very happy with the care staff from overseas ‘who gave her very good care’, but she also said that ‘all the staff work too hard’. Sedbury Park Care Centre D51_D03_S16574_SedburyPark_V240643_240805_Stage4_U.doc Version 1.40 Page 13 Within the Marlings records were consistent for monthly audits of care. These have sections to indicate changes in circumstances but are not consistently used. For example, a service user assessed with behaviour needs had indicators to show carers must contact seniors when problems occur, use PRN medications or contact the Multi Disciplinary Team. Two issues arise here: Firstly the senior on duty advised that the service user’s behaviours are less of a problem now but this has not been identified under the section to record changes. Secondly, the care plan does not set clear guides regarding when ‘as necessary’ medication should be used, what assessment or who should administer. In another case, a service user was assessed with high risk of falling but there were no indicators to show how to minimise risks. A daily record for another service user indicated challenging behaviour was recorded but the “Resident’s Review Form” had no record of this or how it was dealt with. One service user had an assessment indicating there was a problem of “Postural Hypertension”. The mobility section did not indicate if there were ongoing problems and there was no history of falls. This questioned the accuracy of the assessment and if the service user’s need was being regularly monitored. Not all files case tracked had “Resident Requirement Review Forms”. In the “Multi Disciplinary Contacts” sheets there were good records of doctors and other professionals visits. However in one case a sheet showed a family member had been involved at a review and comments were made reflecting aspects of the meeting. The information needs to be written where review details are kept. This was discussed at length with senior carer on duty and managers in the main house. Medications: There are no written plans to ensure correct use where medicines are prescribed ‘as required’. Controlled drug cupboards need fixing in accordance with The Misuse of Drugs (Safe Custody) Regulations 1973 and use of the controlled drug record book needs review. There is a medicine policy and procedures but these must be revised. Prescription directions were not always up to date so that some medicines do not appear to be administered as prescribed. The original prescriptions are not generally checked in the home before being sent to the pharmacy. A record of administration is not always made for prescribed medicines applied externally. Handwritten entries on MAR charts are not always signed and countersigned to check for correct transcription. Staff are not aware of the Medical Device Alert about lancing devices for obtaining blood samples. Staff must be formally trained to undertake the delegated nursing task of measuring blood glucose levels. Sedbury Park Care Centre D51_D03_S16574_SedburyPark_V240643_240805_Stage4_U.doc Version 1.40 Page 14 Storage and handling arrangements for oxygen cylinders need to be improved. In The Marlings the medicine storage room is too hot. Secure fridge storage for medication is also needed. There are no regular audits to demonstrate correct use of medicines and staff competence. Arrangements for the disposal of medicines must comply with recent changes in legislation. The medicine reference book needs to be updated. Some medicines from the morning medicine round on Wye house were still being given at lunchtime. Sedbury Park Care Centre D51_D03_S16574_SedburyPark_V240643_240805_Stage4_U.doc Version 1.40 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15 Residents can experience a stimulating and varied life at the home with visitors encouraged, various one to one and group activities made available and entertainments and occasional outings organised. The Marlings plans activities for in-house and other entertainment in written and pictorial form ensuring service users have a variety of experiences in their daily lives to include contact with peers in the main home for social interaction. Dietary needs of the residents are well catered for with a balanced and varied selection of food available. EVIDENCE: The homes’ two activities organisers plan variable monthly activity programmes, which are published and made available for the residents. A copy was provided for the inspection and the programme for August included manicures and facials, an afternoon of music, Ashbourne Ladies Club, library and mobile shop, cooking demonstrations, communion and a concert with a harpist performing. Sedbury Park Care Centre D51_D03_S16574_SedburyPark_V240643_240805_Stage4_U.doc Version 1.40 Page 16 Several residents commented on how much they had enjoyed the concert and were looking forward to the boat trip. Several others were enjoying the one to one attention of a manicure the morning of the inspection. The organisers do their best to ensure that residents in each unit receive daily stimulation/social activities but it is not always possible to give a lot of time to each unit. It was noted on this occasion that residents in Wye were not enjoying a very stimulating atmosphere and the staff really did not have the time to spend talking with them. The kitchen was not inspected on this occasion but lunch was seen and looked very appetising- roast pork broccoli, carrots and potatoes, followed by chocolate sponge and chocolate sauce. Residents confirmed that they enjoyed their lunch. One resident spoken with said that she enjoyed curries and the home had provided these for a while until she was told to stop them because of a medical problem, but she hopes to start them again soon. She also confirmed that alternatives are provided if she didn’t like what was on the menu. During this conversation a carer came in to collect the choice of menu for the next day. Most comments were favourable but a few said the menus lacked taste and were bland at times. It was very dependent on who was cooking. The Marlings: The unit’s office door and a service user’s bedroom, seen during a spot check on accommodation standards, had indicators to show what was available regarding activities and outings. Service users’ files case tracked had records of their interests, likes and dislikes to guide carers when focussing on activities and diversion. Visitors were seen during the day and two spoken with were happy with the care offered by staff and confirmed carers and seniors respect the views of families if things need attention. Carers’ approaches were observed and seen to be sensitive giving service users the opportunity to wander as they wished and were diverted quietly in a calm manner. Dining facilities were excellent. Lunch was observed and carers ensured food was delivered slowly; no one was rushed. Those who required more supervision were helped quietly. Those who required assistance when eating had a carer sitting at the table prompting or feeding service users. All staff were commended for their quality of care by the inspector. Sedbury Park Care Centre D51_D03_S16574_SedburyPark_V240643_240805_Stage4_U.doc Version 1.40 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 The Home has a satisfactory complaints system in place. Policies and procedures and staff training ensure a safe environment to protect service users from abuse. EVIDENCE: The homes’ complaints procedure was seen within the service users guide which is accessible to every resident/ their families. The home reported that they had received two complaints since the last inspection. Both were partially substantiated and were dealt with within 28 days. Records were kept and seen at inspection. Reference to the Commission in the complaints procedure still refers to the National Care Standards Commission and needs to be amended to the Commission for Social Care inspection. Staff records confirm that training on Protection of Vulnerable Adults is undertaken. The Marlings: Family members visiting expressed they had no difficulties in approaching seniors and carers if they were not happy. There are complaint forms for people to complete if they have complaints. The company has policies for abuse and the office has a notice for all staff about a confidential “whistle blowing” telephone number if they wish to disclose concerns. Sedbury Park Care Centre D51_D03_S16574_SedburyPark_V240643_240805_Stage4_U.doc Version 1.40 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 21,26 Residents live in a homely environment. The improvements made to the décor, greatly benefit the residents but there are other outstanding requirements, which do not provide the people living in the home with satisfactory facilities for bathing. EVIDENCE: A tour of each unit was undertaken not looking in every room but particularly following up requirements from the last inspection. In Wye House standards of maintenance and decor were generally satisfactory. At the Marlings, the environment is safe, with new security to all access points. The unit is mildly odorous of urine, noticeable when entering the unit. Standards of maintenance are generally good with clear methods to keep in touch with the home’s maintenance department. In Main House there has been a marked improvement in the décor and general maintenance since the appointment of the maintenance man 16 months ago. He reported that he has decorated 30 rooms in that time and several were Sedbury Park Care Centre D51_D03_S16574_SedburyPark_V240643_240805_Stage4_U.doc Version 1.40 Page 19 currently empty for refurbishment. There was evidence of several rooms that had already been refurbished to a high standard. Only one bedroom was noted as requiring redecoration, but wear and tear on the bottom of doors continues to be a problem. Most areas had a high standard of cleanliness with an odour only noted in one room. The kitchen was not inspected on this occasion but it was reported that the flooring and tiling has been replaced, the plumbing attended to, deep cleaning planned imminently and new colour coded crockery bought for each unit. There is still one bathroom, which is unventilated, and the bath is badly stained but it was reported that this is not in use at present. Within Wye House bathing facilities have not changed since the last inspection but staff confirmed that they had adequate facilities. There was one worn commode that needs to be changed. The Marlings: Accommodation around the unit was spot-checked. Dining and lounge areas were sensitively decorated with good lighting both on ground and first floors. A fireplace is near completion in the lounge diner. All areas were clean, but mild odours of urine were noticed and it was recommended stronger de-odorants be used. Bedroom 20 the en-suite the bath needs to be replaced due to ingrained staining, although it was reported that no residents currently use their en suite facilities. Bedroom 17 - wallpaper is coming off the ensuite wall and needs repair. Ground floor bathroom (in use) requires curtains for privacy and the light protector needs cleaning and dead insects removed. There is still only one assisted bathroom in use for 21 residents, which is an outstanding requirement from the last inspection. A requirement was made for the second bathroom to be made operational. This has not been undertaken. An immediate requirement was issued at this inspection for this bathroom to receive immediate attention. A recommend to re-positioning the bath and remove the hoist to install a pillar type model for ease of manual handling and moving. A heater is also required here. At the foot of stairway at the far end of the unit – ground floor, the carpet is broken and needs repair. It does not need replacing. The above need addressing in accordance with Regulations 16-(2)(j); (k): and 23-(2)(b). Within the Marlings no improvements have been made in the kitchen, which is also an outstanding requirement from the last inspection but Replacement alarm systems for the exits (a requirement at the last inspection) have been installed. Sedbury Park Care Centre D51_D03_S16574_SedburyPark_V240643_240805_Stage4_U.doc Version 1.40 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29 The deployment and numbers of staff available within one specific unit of the home is insufficient to meet the current needs of the residents. The procedures for the recruitment of staff are still not robust and do not provide the safeguards to offer protection to the service users. The Marlings: Rotas ensure qualified and experience staff are on duty with carers and are trained in specific care, some having NVQ qualifications EVIDENCE: Rotas showed that within Main House there were six care staff and one qualified nurse during the morning to care for 25 residents, reducing to three care staff and one qualified nurse during the afternoon. Although in Main House the minimum staffing requirements were in place, they did not take into account the geography of the building and dependency levels and there were periods of the day when there were did not appear to be any staff in attendance within the communal areas, because staff were engaged in putting residents to bed and serving drinks on the upper floors. Comments from residents ‘that they are always busy and work too hard’ appear to confirm this. Sedbury Park Care Centre D51_D03_S16574_SedburyPark_V240643_240805_Stage4_U.doc Version 1.40 Page 21 Within Wye it was very obvious that inadequate staffing levels were in place with four staff on-duty throughout the day to include the senior carer who was engaged in medication administration and attending the doctor for most of the time. It was reported that there are very few residents who are able to attend to personal needs independently, a number who always need two staff to meet all their needs and five whose needs have increased and are awaiting reassessment to move to either the nursing unit or Wye House if beds and funding are available. An Immediate Requirement Notice was given to the home on the 24th August, following the inspection, to increase staffing levels especially during the morning until dependency levels reduce again. The Marlings: Staff ratios remain as at the last inspection which is four staff each morning an early afternoon, three on duty on a late shift and two from 8 p.m. to 8a.m. A pre inspection questionnaire completed some time before the inspection showed that 13 staff have NVQ 2 and more are currently undertaking it. There has been a problem with the former training centre and a number who completed NVQ 2 two years ago have yet to receive their certificates. Staff receive levels of relevant training with a number who have taken the company’s in-house “Yesterday, Today and Tomorrow” dementia training. This seemed appropriate for staff’s awareness of general care of those with varying levels with dementia needs. This training is delivered to all staff on a “rolling programme”. Also the team have received input from a local CPN regarding care needs of those who are confused. Some staff have also undertaken the Boots Pharmacist’s training in the administration of medication. NVQ training for carers is available and staff are chosen on a phased basis in this unit and around the main home. The home now has four home trainers, one for each unit and one on nightduty. They are responsible for induction and mandatory training updates. Thirteen new staff have been appointed since the last inspection and fifteen have left. The files of all staff, newly appointed since the last inspection, were checked. Although the majority have had CRB/POVA checks before appointment it appears that there is still some confusion over checks required for overseas staff, who are appointed on the basis of their police checks from their country of origin. CRB guidance states that all staff commencing from overseas still require a CRB/POVA check prior to appointment. It also appeared that because of inadequate photocopying, none of the files seen had medical checks completed. It is a requirement that all staff provide a written confirmation of their physical and mental fitness. Sedbury Park Care Centre Version 1.40 Page 22 D51_D03_S16574_SedburyPark_V240643_240805_Stage4_U.doc Although most new staff had copies of passport photographs as proof of identification, many of these were not clear. Several did not have full career histories or a written explanation of gaps in their careers and few had interview records. Not all had two references, or one from their last employer; in some cases it was necessary to also gain a reference form the last care employer and references from staff at Sedbury are not acceptable. It was also evident that in several instances references needed to be followed up because of the type of reference given, for example in the case of a member of staff being dismissed from previous employment. One record had no application completed. Recruitment procedures must be reviewed and improved upon to ensure the safety of the residents. Sedbury Park Care Centre D51_D03_S16574_SedburyPark_V240643_240805_Stage4_U.doc Version 1.40 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,37,38 Although there have been complete management changes over recent months, attention needs to be given to formalising the position of the acting manager. There is a cohesive management team at the home who support the staff team well and staff can access their managers whenever they need to. Resident’s rights and best interests are not totally safeguarded by the homes’ maintenance and review of records, policies and procedures. EVIDENCE: The home has had an acting manager in post since earlier this year and steps are underway to register this person through an application and approval from the CSCI. In addition to this the home has appointed a senior nurse to Care Manager and has two senior care staff in positions of unit managers within Wye and the Marlings. Sedbury Park Care Centre D51_D03_S16574_SedburyPark_V240643_240805_Stage4_U.doc Version 1.40 Page 24 The Marlings: The unit’s unregistered manager was on leave at the time of inspection. The seniors and carers on duty were delivering care efficiently and sensitively indicating the ethos of good care was being maintained in the acting manager’s absence. There had previously been a registered manager within the unit but with now, with recent management arrangements at the home, this is being reviewed and it is felt that the home will have one registered/general manager in future with each unit having unit managers. Since the appointment of the acting manager there has been some confusion over Regulation 37 and 26 notices, which have been kept at the home, but have not been forwarded to the Commission. This is to be rectified. It was also noted that some medication policies in particular in one unit were very out of date and need to be reviewed. The maintenance person and manager confirmed that regular health and safety checks, such as fire alarms, emergency lights, hot water and wheelchair maintenance are carried out. Records were not checked on this occasion. Induction and training records seen within staff files also confirmed that all mandatory training is completed and updated regularly, as did one new member of staff who confirmed that she had just undertaken her fire and moving and handling training. There was concern that there was still no portable hoist on the Marlings. The manager confirmed that there had been one, but it must have been borrowed by another unit. This was to be investigated and assurance given that a hoist will be in place to assist carers in moving and handling. One hoist on Main House was very dilapidated and needs to be replaced. Hoists had been serviced earlier in the year and as a result there were three waiting for parts to rectify problems. The home has a new heated trolley, which is safer to manage. The senior on duty has just qualified as a “home trainer” for the company, which enables her to train others in areas such as Health and Safety. Sedbury Park Care Centre D51_D03_S16574_SedburyPark_V240643_240805_Stage4_U.doc Version 1.40 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 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 3 x 1 x x x x 3 STAFFING Standard No Score 27 1 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 2 x x x x x 2 2 Sedbury Park Care Centre D51_D03_S16574_SedburyPark_V240643_240805_Stage4_U.doc Version 1.40 Page 26 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 15 Timescale for action Ensure that care plans reflect the 30/9/05 current needs of residents and that they are reviewed regularly with the resident/their representative where possible. Written plans must be used for 1/11/05 medicines prescribed ‘as required’ Controlled drug cupboards must 1/11/05 be secured to a solid wall with rag or rawl bolts in accordance with The Misuse of Drugs (Safe Custody) Regulations 1973 The medicine policy and 1/12/05 procedures must be reviewed with the guidelines from the Royal Pharmaceutical Society to ensure they are complete and specifically cover all aspects of the handling of medicines in this home. All staff must be made aware of these and monitored for their understanding of them. Regular audits must be in place 1/11/05 to demonstrate the correct use and recording of medicines. Medicines must always be With administered as prescribed. The immediate administration of any prescribed effect and medicine must be recorded. ongoing Prescriptions must be reviewed 1/10/05 Version 1.40 Page 27 Requirement 2. 3. OP9 OP9 13(2) 17(2) 13(2) 4. OP9 13(2) 5. 6. OP9 OP9 13(2) 13(2)17(1 ) 13(3) 7. OP9 Sedbury Park Care Centre D51_D03_S16574_SedburyPark_V240643_240805_Stage4_U.doc 8. OP9 18(1) 9. OP9 13(2) 10. OP9 13(2) 11. 12. OP9 OP9 13(2) 13(2) 13. OP9 13(2) 14. 21 23(2)(j) 15. 27 18(1)(a) 16. 29 19 to ensure directions are up to date and these are subsequently included on MAR charts and medicine labels. The use of lancing devices for obtaining blood samples to be reviewed to ensure compliance with Medical Device Alert MDA/2004/044. Care staff monitoring blood glucose levels must be formally trained and delegated to undertake this task The statutory warnings must be displayed wherever oxygen cylinders are stored or used. Oxygen cylinders must be secured to prevent falling over. Provision must be made for stocks of oxygen cylinders to be stored outside of the home. The temperature of medicine storage areas to be monitored daily and action taken if needed to store medicines below 25°C. Secure storage for refrigerated medicines to be provided on The Marlings. Arrangements must be made to ensure that medication is disposed of legally, maintaining a full audit trail The registered person must ensure that there are adequate and appropriate bathing facilities available throughout the home to meet the dependency levels of the service users( timescale of 1/4/05 not met). Ensure adequate staffing levels are provided to meet the needs of the service users.(timescale of 10/10/04 and 1/3/05 not met). Ensure that all documentation required by Schedules 2 and 4 of the Care Standards Regulations are in place within staff files.(timescale of 10/10/04 and 1/11/05 1/11/05 With immediate effect and ongoing 1/12/05 With immediate effect and ongoing 1/10/05 30/9/05 30/9/05 30/9/05 Sedbury Park Care Centre D51_D03_S16574_SedburyPark_V240643_240805_Stage4_U.doc Version 1.40 Page 28 1/3/05 not met). 17. 31 8 The positon of the acting 30/10/05 manager must be formalised through interview and registration with the Commission. The registered person shall 30/9/05 maintain in the care home the records specified in Schedule 4, ensure that they are up to date and coipes provided for the Commission The registered person shall make 30/10/05 suitable arrangements to provide a safe system of moving and handling service users. 18. 37 17 19. 38 13(5) 20. 21. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. Refer to Standard OP9 OP9 OP9 OP9 OP9 OP9 Good Practice Recommendations All containers of medicines not supplied in monitored dose system (MDS) wallets to be dated when first opened for use. Entries for receipt and administration of controlled drugs, including temazepam preparations, to be fully completed in accordance with the printed sections in the register. The British National Formulary to be updated (September 2005 edition). FP10 prescriptions to be checked in the home before being sent to the pharmacy. Handwritten entries on MAR charts to be signed and countersigned as correct by two authorised staff. Arrangements for the administration of morning medication on Wye House to ensure there are sufficient staff to safely achieve this within the prescribed timescales. Sedbury Park Care Centre D51_D03_S16574_SedburyPark_V240643_240805_Stage4_U.doc Version 1.40 Page 29 Commission for Social Care Inspection 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester GL3 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Sedbury Park Care Centre D51_D03_S16574_SedburyPark_V240643_240805_Stage4_U.doc Version 1.40 Page 30 - 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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