Inspection on 07/01/08 for SEVA Care Home

This inspection was carried out on 7th January 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

SEVA Care Home 09/12/08

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE SEVA Care Home 33 Radnor Avenue Harrow Middlesex HA1 1SB Lead Inspector Clive Heidrich Key Unannounced Inspection 7th January 2008 10:30 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 SEVA Care Home DS0000070193.V354176.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. SEVA Care Home DS0000070193.V354176.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service SEVA Care Home Address 33 Radnor Avenue Harrow Middlesex HA1 1SB 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) 07961 180420 020 8997 7011 Akshay Chandrakant Barot Jacqueline Laurie Crowther Care Home 6 Category(ies) of Old age, not falling within any other category registration, with number (6) of places SEVA Care Home DS0000070193.V354176.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories of service only: Care home only - Code PC to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Old Age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 6 N/a Date of last inspection Brief Description of the Service: Seva Care Home is a new care home registered to provide personal care and accommodation for up to six older people. The home’s Statement of Purpose clarifies that the home specialises in providing a service to the Hindu Gujarati community, but welcomes people from any background. Additionally, food on the premises is strictly vegetarian. The home is owned and run by a small, private and independent care service provider. It is a three-storey building, which has been converted into a residential home. Accommodation for service users is provided on the ground, first and second floor. Four the bedrooms are single occupancy, with the one downstairs room being a shared room. One first-floor room has an en-suite toilet and shower. There is restricted parking at the front of the house, along with a drive that can take two cars. At the rear there is good-sized, well-maintained garden. There are ramps and grab-rails at the front and rear entrances. The range of fees at the time of the visit was £350 (shared room) to £480. The Service User Guide is available on request, including a Gujarati version. At the time of the inspection, there were two vacancies at the home. SEVA Care Home DS0000070193.V354176.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This is the first inspection of the home since its registration in July 2007. It was an unannounced inspection that took place across one cold day in early January. It lasted seven hours in total. The focus was on inspecting all of the key standards. The service was requested to complete an Annual Quality Assurance Assessment (AQAA) well in advance of the inspection. This provides the service with the chance to explain how it meets the National Minimum Standards. The AQAA was duly returned to the CSCI in good time. Surveys were sent to the home after receipt of the AQAA. These were distributed by the manager. Surveys have been received from two service users including via Gujarati survey in one case, one relative, one social worker, and two staff, at the time of drafting this report. Their views have been incorporated throughout the report. The inspector spoke with all three of the service users during the visit, via an interpreter hired by the CSCI. The inspection process within the home also involved case-tracking the support needs of two service users, observing how staff provided support to service users, discussions with staff, checks of the environment, and the viewing of a number of records. The manager was present and supportive throughout the visit. Feedback was provided to her at the end of the visit. An immediate requirement notice was sent to the registered people straight after the inspection. This was due to significant shortfalls with recruitment and medication processes that could put service users at risk. It was positive to receive a prompt and detailed response from the registered people, making appropriate plans to address all shortfalls without delay. See standards 9 and 29 for further details. The inspector thanks all involved in the home for their patience and helpfulness before, during, and after the inspection. What the service does well: The majority of feedback from service users and their representatives about the service was positive. As one person stated, “Clients’ needs are priority.” SEVA Care Home DS0000070193.V354176.R01.S.doc Version 5.2 Page 6 One service user stated, “I am cared in the home to my satisfaction.” People are treated respectfully and individually in the home. Feedback from service users about health support was positive. One person stated, “The care home staff make my appointment & I am always provided transport and accompanied by one of the staff.” The service attends to service users’ health needs to a good standard, backed by an appropriate careplanning process. Service users are able to pursue chosen lifestyles within the home, and make decisions for themselves. As one service user put it, “I have my will here.” Service users are listened to, and any concerns arising are addressed. The home has a small shrine within the lounge. Daily prayer sessions are promoted by staff. Bhajans take place twice a month, with significant support from the owner and his family. The home has adaptations to enable service users to get around more independently, for instance through stairlifts, a raising bath seat, and many grab-rails. Alongside standard facilities, each bedroom also has a television provided by the home. What has improved since the last inspection? What they could do better: Medication systems and practices were not sufficient to ensure that service users consistently received correct medication. Records of providing medications to service users were not always signed for, and there were no records of receiving medications on behalf of service users. Recruitment practices were very poor. They could easily allow an inappropriate person to work with service users. Current staff lacked up-to-date Criminal Record Bureau checks, and the service did not have written references from previous employers about current staff in place. As stated above, these particular areas were put to the registered people as immediate requirements shortly after the inspection. The registered people provided a prompt and detailed response, making appropriate plans to address all shortfalls immediately. Infection control systems in the home, that uphold cleanliness and prevent the spread of infection, were not sufficient in practice. The laundering area lacked a place to immediately wash hands, and the dining room table was not being kept sufficiently clean. SEVA Care Home DS0000070193.V354176.R01.S.doc Version 5.2 Page 7 Staff had had insufficient training relevant to the work, for instance in areas such as abuse-prevention and medication. This could allow for inconsistent and poor care practices to develop. There is a full list of requirements and recommendations at the back of this report. 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. SEVA Care Home DS0000070193.V354176.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection SEVA Care Home DS0000070193.V354176.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. People who use this service experience a good outcome in this area. This judgement has been made using available evidence including a visit to this service. People are provided with sufficient information about the home before making decisions about moving in. The service acquires sufficient assessment information about prospective service users before deciding whether they can meet the person’s needs and hence offer a placement. EVIDENCE: The home’s registration process established that the Statement of Purpose and Service User Guide has been prepared to meet the relevant regulations and standards. The Service User Guide has also been prepared in Gujarati. Service users confirmed through surveys that they, or their family, generally received enough information about the home, before making decisions about moving in. There was overall satisfaction about how well the home can meet SEVA Care Home DS0000070193.V354176.R01.S.doc Version 5.2 Page 10 needs, for instance one person stating, “I am always very happy living in this home.” The commissioning authority’s needs assessments had been acquired for the two service users whose files were checked during the inspection. One was in place a couple of weeks in advance of placement, the other on the day of an emergency placement. The manager stated that she aims to assess prospective service users’ needs and wishes in advance through meeting them, however she may rely on the commissioning body report if there is a lack of time. Assessment details were sufficient for judgements to be made about how well the home can meet the needs of the prospective service user, and there was evidence linking assessment documents to care plans. There was also positive feedback from a social worker about assessment arrangements by the home. Assessment processes are therefore judged as appropriate. SEVA Care Home DS0000070193.V354176.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use this service experience an adequate outcome in this area. This judgement has been made using available evidence including a visit to this service. Care plans set out the needs of each service user in an appropriately individual manner. Health needs are responsibly supported within the home, with appropriate liaison with community health professionals where needed. Staff treat service users respectfully, and privacy is enabled. Medication support is however not recorded about appropriately, which could result in errors occurring. Service users can look after their own medication, but the process of enabling this is not sufficiently safe. EVIDENCE: Discussions with service users found no concerns with how they are treated. One service user stated that, “staff knock at my bedroom door and wait until being asked in.” One service user stated by survey that, “The staff are always available and helpful to me.” Another survey stated that staff do not listen to service users, however this was the exception and there was no evidence of SEVA Care Home DS0000070193.V354176.R01.S.doc Version 5.2 Page 12 this during the visit. Feedback from a social worker about standards of privacy and dignity was also very positive. Staff were seen to respond to any comments made by service users, and at times spent time sitting with service users including for reading of religious books. At other times, service users sat in the lounge talking, watching the Asian TV channel, reading, or resting, whilst staff attended to cleaning and cooking. It was apparent that the electronic staff-call system was operable from one service user’s room, and that staff attended promptly. Service users also confirmed to the inspector that staff always attend promptly when they use the call-system from their rooms. Service users were seen to be well-dressed in appropriate clothing from the start of the inspection. Nail care was apparent, and two service users were wearing glasses as expected. A tour of the home found no lingering offensive odours, which helps to suggest that appropriate hygiene support is provided to service users. The care files of two service users were considered. The paperwork for each person was essentially up-to-date and appropriate for each person, in respect of the home’s assessments of need, planning of care, reviewing processes, risk assessing, and daily recording. Records showed that a detailed assessment of need is made once the person has moved into the home, with an interim care plan set up within a few days. Assessments of risk in relation to generic areas such as fall & mobility, nutrition, and manual handling, as well as those specific to individuals such as for fire safety, shower use and stair use, were in place. Detailed care plans had been set up within six weeks of moving in. They covered expected areas of support, such as for health matters, personal care needs, and diet, in an individual manner. For service users who have been living in this new service longer, reviews of the plans had taken place. None of the care plans had evidence of consultation with the service user or appropriate representative, to help ensure that the plans are meaningful to the service user and that they agree with what’s documented. The manager stated that this will be addressed at upcoming review meetings, where family would also be present to assist with the translations where needed. This process must be completed. It was positively noted however, from staff surveys, that staff feel that they are always given up-to-date information about service users. Feedback from service users about health support was positive. One person stated, “The care home staff make my appointment & I am always provided transport and accompanied by one of the staff.” Social worker feedback was similarly positive, stating that there is, “extra support like dentures, glasses and chiropodist appointments.” There were records of health professional visits and outcomes within each service user’s file, including about the district nurse, dentist, and chiropodist. SEVA Care Home DS0000070193.V354176.R01.S.doc Version 5.2 Page 13 There was evidence of having acquired pressure-care equipment for individual service users where needed. The manager also pointed out that they had acquired local GP support for individual service users as needed, through liaison with the PCT after some initial difficulties. Checks of care plan expectations against health records and feedback found there to be occasions when the service of a health professional is acquired but the record of the visit is not recorded about in the service user’s file. This can prevent sufficient continuity of service for the service user. Records must be made in the health section of the file for each health professional appointment. The home has secure and tidy storage of looked-after medication. A local pharmacist supplies medicines, however the manager noted that a new system of blister-packed medication was shortly to start, which will help to monitor the provision of medicines. The medication administration records (MAR) were checked through. It was found that there was a supply of each medication recorded about. There were usually records to show that medication had been administered, however there were some gaps where medication should have been recorded about, and one medication had been signed for two days ahead of the current date. All of this could cause medication errors to occur, which could have significant health effects on service users. This issue was included in the immediate requirement notice provided to the registered people straight after the inspection. Current and future prescribed medications must be administered to service users as per current GP instructions. Medication administration records must correspond with this. There were no records of medication being received into the home. This prevents accurate auditing of medicines, which is particularly important should any mistakes occur. Medication must be recorded about in appropriate detail when received into the home. The manager noted that one service user looks after some of her medications herself. There was a brief risk assessment about this in her file. The manager noted that secure storage is provided to this person in their room, but is not yet used. The risk assessment process for anyone self-medicating needs to be reviewed to include whether the person: • Wants to take responsibility for looking after and taking medicines; • Knows the medicines they take, what they are for, how and when to take them and what is likely to happen if they omit taking them; • Understands how important it is not to leave the medicines lying around where someone else may unintentionally take them and be harmed as a result. SEVA Care Home DS0000070193.V354176.R01.S.doc Version 5.2 Page 14 Outcomes from this assessment must then be included within the person’s care plan, with the whole process being regularly reviewed. This is so that the service user is supported to retain as much independence as possible, whilst taking reasonable steps to ensure their and other service users’ safety. The manager noted that the main carers have been provided with formal training by a pharmacy on the handling of medication. A certificate was provided as example. This is encouraging. There needs to be further internal auditing of staff capability, to show that the manager has assessed the relevant people as capable of safely supporting service users with their medication. This needs to happen for current staff who provide medication support, and any new staff before they start providing medication support to service users on their own. SEVA Care Home DS0000070193.V354176.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All of them. People who use this service experience a good outcome in this area. This judgement has been made using available evidence including a visit to this service. Service users’ lifestyles in the home can match their preferences and expectations. Service users are able to exercise choice and control over their lives, including with respect to maintaining family and community contact. The service makes strong efforts to meet service users’ cultural needs. Service users reported reasonable satisfaction with the food provided, and there are clear efforts to provide a balanced and appetising vegetarian diet. EVIDENCE: All service users fedback that there is enough to do. They gave examples of prayer, magazines and the television, and noted that staff assist with this. One person noted within very positive feedback about activities within a survey, “I take part in exercises, playing dominoes, playing with soft balls, morning prayers & other religious activities like bhajans etc. I also participated in Diwali Celebrations & the Xmas party.” The lounge had a variety of facilities for service users. There were magazines and books written in relevant languages, which for instance one service user SEVA Care Home DS0000070193.V354176.R01.S.doc Version 5.2 Page 16 read by herself. A staff member also read a religious book aloud to a couple of service users during the afternoon. The room also has a small shrine for religious activity, and a large wall-mounted television that accesses Asian television channels. A tour of the home established that each bedroom also has a television provided by the home, which can access whatever channel is being played in the lounge plus all terrestrial channels. Daily records for service users included about playing games, ball, prayer, and bhajans e.g. on New Year’s Day. The manager said that bhajans take place twice a month, with significant support from the owner and his family for instance through the food that they cook and bring. The owner has also arranged for service users to visit a local temple a couple of times, which a social worker confirmed by survey. All service users confirmed that visitors are welcomed into the home by staff. This was observed later when one family member made a short afternoon visit. Service users also agreed that they can make phone calls anytime they want. The manager was seen to provide a service user a phone when asked. The service user was left to make calls, which she could clearly manage herself. Service users collectively stated that there is enough to do, and agreed that they live the life they choose, for instance in terms of when to get up and go to bed. As one service user put it, “we have our will.” This was generally observed during the inspection, where staff and the manager always responded to service users’ requests. There was also documentation about this, for instance, that one service user was making a clear preference to walk the stairs rather than use the stairlift. Service users generally confirmed satisfaction with the food provided. One service user noted that the food can become too familiar, requesting for instance more variety of green vegetables. Checks of the menu and of supplies in the home found a reasonable variety in this respect, for instance frozen okra, courgettes, and a specific type of green bean. Staff and the manager nonetheless made note of the request. It was also clarified that service users are regularly asked about their meal preferences, and that efforts are made to accommodate new requests. Staff prepared a home-cooked lunch during the inspection. It included chapattis, a dhal, a green-vegetable dish, a fried-potato dish, rice, and salad. Staff provided service users with support as needed for the meal, for instance with adjusting seating to be more comfortable, but service users were generally independent with the meal, and ate well. The inspector also sampled the food, an it was found to taste fine. SEVA Care Home DS0000070193.V354176.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People who use this service experience an adequate outcome in this area. This judgement has been made using available evidence including a visit to this service. The home has a complaints system. People are reasonably confident about raising concerns and complaints. The home has systems to address abuse allegations, but has not specifically trained staff in this respect, which could lead to insufficient protection of service users. EVIDENCE: Service users fedback that they have no complaints, and that they can complain if they wish. Surveys from service users and relatives generally confirmed this, although some uncertainty was expressed by a couple of people. It is recommended that the complaints procedure, and how to raise concerns, be reminded to service users and their relatives, in case anyone is unsure about how to raise issues. It was however positive to note that social worker feedback was of confidence that the service responds appropriately to complaints, and that staff have confidence about what to do if anyone complains. The home’s complaint policy was judged as appropriate at point of registration. The home has a standard complaint form on which to make records of complaints. There was one record in this respect since the home opened, from a service user about an aspect of their care and support. Records of this were SEVA Care Home DS0000070193.V354176.R01.S.doc Version 5.2 Page 18 appropriate, and showed a positive outcome. There have been no complaints made to the CSCI since the home opened. It was noted that the owner’s one monthly-report on the service included about a damaged item of laundry that a service user mentioned. It was recorded that a replacement was being acquired. This also suggests that expressions of concern are dealt with appropriately. The home’s abuse-prevention policy was judged as appropriate at the time of registration. The manager provided records to show that it was being updated. This showed that the policy now includes details on, for instance, what constitutes abuse, and what happens to staff if accused of abuse. This is encouraging. The manager stated that all staff would be attending formal training on the prevention of abuse in due course. This must be duly addressed, to better ensure that staff have sufficient knowledge of abuse-prevention procedures and act appropriately should a scenario arise. One staff member noted that they have had abuse training through previous employment. It was also encouraging that service users collectively confirmed to the inspector that they feel safe in the home. Please also refer to standard 29, in respect of a lack of Criminal Record Bureau (CRB) checks of current staff. These shortfalls at the time of the inspection meant that potentially inappropriate staff could have been working alone with service users. CRB disclosures, in respect of employment by the provider, must be obtained by management before people may start working in the home. It was however encouraging to note that these issues were being clearly addressed by the registered people, following an immediate requirement notice about the issues being provided to them straight after the inspection visit. SEVA Care Home DS0000070193.V354176.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All of them. People who use this service experience a good outcome in this area. This judgement has been made using available evidence including a visit to this service. The home’s environment is well-maintained and is kept in a homely manner. There is reasonable provision of shared space, and of toilets and washing facilities. Bedrooms are comfortable and meet needs. Many adaptations have been made to provide service users with equipment to help maintain their independence. The home is kept adequately clean and hygienic, but a few areas of risk were identified which could cause service users illness through infections spreading. EVIDENCE: The home is located in a quiet cul-de-sac residential road near central Harrow. It has had some adaptations made to make the premises suitable for a care home but it is not designed or adapted for people who are very frail or have severe mobility problems. Service users collectively confirmed that it’s easy SEVA Care Home DS0000070193.V354176.R01.S.doc Version 5.2 Page 20 enough to get around. The home has many grab-rails fitted to walls, to ease movement if needed, and applicable service users have zimmer-frames easily available for independent use. Stairlifts have been installed across the stairways to the first and second floor. The lower stairlift was seen to be positively used by one service user during the visit. There is reasonable space to access the stairs independently, and written risk assessments are in place for stairway use for all service users including in respect of fire safety. Ramps and rails were seen to have been set up to the front and back entrances of the home, to enable easier overall access. The home has a wellmaintained, private back garden accessed through the conservatory. The home has a bath with raising-seat and overhead shower on the first floor, and a shower room with wall-fixed shower-seat on the ground floor. There are accessible toilets on the ground and first floor. Thermostatic control valves have been fitted to all hot water outlets that service users might use. A sample check during the inspection found water to come out of taps at a safe temperature. The locks to the downstairs toilet and shower were insufficient as they locked only from the inside. Emergency override facilities are needed, in case any service user gets trapped in them alone. Locks for the toilet upstairs was seen to be appropriate. The downstairs toilet had a waste-bin that needed hand-operation to open it, which is not sufficiently hygienic. A bin that can be used without the need to touch the lid is needed. The home has a living room that can seat six with comfort. It has a small area set aside for a shrine and prayer. The dining room is next to it, where a table also seats six comfortably. The whole house, including the dining room, was found to be appropriately warm throughout the visit. Service users confirmed that this is always the case. The registration process noted that bedrooms have been furnished in accordance with the National Minimum Standards. Brief checks of the bedrooms found them look comfortable and safe. The shared room downstairs was seen to have a portable divider available for use if needed to help uphold people’s privacy. Call bells were readily available at both beds, and within other bedrooms. Some bedrooms were also seen to have vibrating panels, to help alert service users with hearing difficulties to be aware of a fire alarm. The lock to all bedrooms was seen to be from the outside by key. There was no way to lock the room from the inside. This could prevent service users from having sufficient privacy when in their rooms, which should be considered with respect to the needs and wishes of each service users. SEVA Care Home DS0000070193.V354176.R01.S.doc Version 5.2 Page 21 There is a small utility room with washing machine and tumble dryer. The manager noted that the machines do not have a sluice facility, nor that there has been a need so far. Consideration should be given to upgrading the washing machine to that which has a sluice cycle, so that facilities are in place should the need arise and hence cross-infection would be better prevented. The utility room is accessible from bedrooms without needing to go into the kitchen or dining areas. However, the room lacks space to have, for instance, a wash-basin for infection control purposes. Written risk assessments gave very clear instructions about how staff are uphold infection control standards, however in practice this process is judged as difficult to uphold. To help ensure infection control systems are appropriate, it is necessary have hand-cleaning facilities located in the laundry area. There was a food stain on the dining table tablecloth at the start of the inspection. After lunch had taken place and things cleared away, a few other stains were present. This all compromises the hygiene standards in the home, and could be unattractive to service users. The table must be kept clean when not in use. SEVA Care Home DS0000070193.V354176.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All of them. People who use this service experience a poor outcome in this area. This judgement has been made using available evidence including a visit to this service. The service ensures that there are enough appropriately-skilled staff working with service users at all times. Staff have not received much training relevant to the work so far, which could lead to inappropriate care practices being followed. Staff recruitment processes were of a very poor standard, potentially allowing inappropriate people to work with service users. The CSCI took immediate actions to address this latter point. EVIDENCE: Service users fedback positively about staff, noting for instance that staff are responsive and that there is always someone around who speaks their language. Surveys from a relative and a social worker were also positive about staff. Analysis of two weeks of roster from just before the inspection showed that one person was working with the three service users present, at all times of the day, with there being an additional person often being present either in a domestic or caring role. Only the manager cannot communicate much in Gujarati, and she occasionally works alone with service users, but this was not reported as a problem by anyone. The manager noted that she can call people by phone if translation is needed. SEVA Care Home DS0000070193.V354176.R01.S.doc Version 5.2 Page 23 The manager noted that one staff member sleeps-over in the home at night. The call-alarm is directed into their room, should any service user need support during the night. The staff member does a check of service users at around 2am, and then assists from around 6am. As more people move into the home, waking-night staff will be provided, along with additional day staff. There was good feedback from staff about receiving training. One person stated that they were “very happy with induction.” The manager was able to show records of formal medication training for staff, and internal fire safety training for one staff member. The manager showed that induction records are available for use in the home for new staff. These have been downloaded from the website of the National Training Organization (Skills For Care). It was agreed that they need to be worked through with current staff, and that any new care staff must work through them during their initial time at the home, so that management can be sure that all new workers have a reasonable understanding of the relevant areas of care work. The manager explained that she has liaised with a local college to acquire key training courses for staff, including food hygiene, manual handling, abuse prevention, and infection control. She provided records in support of this. Systems should be set up so that current staff have had these training courses without undue delay, and that new staff are enabled to attend such courses within a reasonable time period of starting the work, so that staff become appropriately trained shortly after beginning work in the home. One of the two care staff employed has an NVQ at level 2 in care, according to feedback. They are being supported to begin the level 3 qualification shortly. The recruitment files of three staff who work in the home, either as carers or domestics, were checked. Significant shortfalls in following safe recruitment practices were found. None of these staff had Criminal Record Bureau (CRB) checks that were carried out in respect of employment with Seva Care. The manager explained that all had been applied for, however there was evidence that this was after service users began moving into the home. There was consequently no up-to-date information about possible criminal convictions, and whether or not the staff are on the list of people legally prevented from working with vulnerable adults. This puts service users at significant and unnecessary risk. Current and future staff and volunteers must not be employed without appropriate CRB checks in place that relate to the work with Seva Care. There were no written references in place for the three staff except for a ‘to whom it may concern’ reference for one of them. This again puts service users at significant and unnecessary risk, as for instance, the previous care-employer SEVA Care Home DS0000070193.V354176.R01.S.doc Version 5.2 Page 24 for any of these people could relay information of concern about the person’s fitness to work in a care position. The manager stated that reference requests had been sent off, and that phone checks of referees had been undertaken in some cases. Records of this were supplied after the inspection. Current and future staff must not be employed until two appropriate written references are received, including from their last employment of not less than three months duration that involved work with children or vulnerable adults. It is recommended, to ensure that confidential information is supplied where needed, that all such reference requests be directed to the manager of an organization, rather than from work colleagues. One staff member’s employment history failed to provide sufficient detail, for instance about who the employer had been. Where the information is not acquired, it is possible for there to be concerning reasons connected to this lack of information, which could again put service users at risk. Current and future staff must not be employed until there is a written and full employment history, including satisfactory explanation for any gaps, and written verification of the reasons for leaving any care employment. These issues were put to the manager and owner in writing through a formal letter immediately after the inspection. The CSCI consequently received a robust, detailed and prompt response from them. This included for immediately addressing all shortfalls, and ensuring that the owner or manager was present in the home much more until the shortfalls are addressed. SEVA Care Home DS0000070193.V354176.R01.S.doc Version 5.2 Page 25 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. People who use this service experience an adequate outcome in this area. This judgement has been made using available evidence including a visit to this service. Systems are in place to measure quality in the home, and to supervise staff. The home does not look after service users’ finances. Health and safety systems sufficiently protect people in the home. The home is adequately run by the management team, with some strong outcomes for service users but also some significant areas of weakness that fail to sufficiently protect service users. EVIDENCE: This is the registered manager’s first position as manager of a care home. She has many years’ experience working in the care sector, including within management teams. A certificate confirming her qualification at NVQ level 3 in SEVA Care Home DS0000070193.V354176.R01.S.doc Version 5.2 Page 26 care form 2005 was seen. She stated that she will be starting a course for the Registered Managers’ Award at a local college in February 2008. This is appropriate. A number of requirements in this report relate to the management conduct of the home. The requirements relate to pertinent service user issues such as ensuring that medication is safely provided, and that recruitment processes are robust enough to reasonably prevent anyone inappropriate from working in the home. There must be sustained evidence of improved capability of the registered people by the next inspection, to help ensure appropriate outcomes and care for service users. It is accepted that once made aware immediate requirements, management made prompt efforts to address the issues. Staff fedback positively about support. One staff member noted that there is “good communication” in the home, and that the manager is “always around.” Records of one staff member’s formal supervision meetings were seen. These showed that appropriate appraisal of performance is undertaken, and that training is planned for. There was feedback that the owner visits most days. There was a record of one formal visit by the owner, as required monthly under the National Minimum Standards. It was of appropriate detail, noting about discussions with key service users and staff, checking records and the environment, and making a summary that includes areas to improve on. The process also resulted in a complaint about care practices being made. The process is appropriate. The Service User Guide states that service user meetings would take place every other month. There were minutes of one ‘focus meeting’ between service users and management available. Discussions about key areas of the service were recorded about, such as for food and activities. This shows a further method by which service users can influence the care and support if needed. The manager stated that the home does not look after service users’ money or finances. Individuals may hold their own money if they wish, for which secure facilities are available in bedrooms. Where the service user incurs a charge, such as for newspapers of private chiropody, the service pays for this then invoices the relevant person. The home had a fire-safety risk assessment from before service users moved in. There was evidence that the manager was updating it to reflect current arrangements, including about the addition of stairlifts. To help ensure that risks are safely managed, it is recommended that a suitably-qualified professional oversee the review of the fire-safety risk assessment. SEVA Care Home DS0000070193.V354176.R01.S.doc Version 5.2 Page 27 The manager noted that the local council’s Environmental Health department had visited in November 2007, and had awarded the service a 2-star rating. The report from this visit showed that a number of shortfalls had been identified, but nothing of significant concern. The manager pointed out that many of the shortfalls had now been addressed. For instance, there was now a glass panel set up in the kitchen, to better cut it off from the passageway to the downstairs toilet that service users use. Records of fridge and freezer temperatures now showed that appropriate temperatures are being kept. Other health and safety checks were also evident, including weekly checks of the home in general, and weekly water-temperature checks. Professional safety checks were found to be appropriate during the home’s registration. An updated fire professional contract, for the fire equipment in the home, was seen as part of the inspection. SEVA Care Home DS0000070193.V354176.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 2 3 3 3 3 2 STAFFING Standard No Score 27 3 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X N/A 3 X 3 SEVA Care Home DS0000070193.V354176.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? N/a STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement Timescale for action 01/04/08 2 OP8 17(1)(a) S3 pt3(m) 3 OP9 13(2) 4 OP9 13(2) Each service user, or appropriate representative, must be consulted about their care plan, to help ensure that the plans are meaningful to the service user and that they agree with what’s documented. Records must be consistently 15/02/08 made in the health section of each service user’s file, each time health professional advice is acquired. Failure to do this could prevent health professional advice from being followed, to the service user’s detriment. Current and future prescribed 25/01/08 medications that the home looks after must be offered to service users as per current GP instructions. Medication administration records must consistently correspond with this. Failure to undertake this could have significant health effects on service users. There must be records of the 01/02/08 quantity of each medication received into the home for each service user. Otherwise, accurate DS0000070193.V354176.R01.S.doc Version 5.2 SEVA Care Home Page 30 5 OP9 13(2) auditing of medicines is not possible, which is particularly important should any mistakes occur. The risk assessment process for anyone self-medicating must be reviewed to include whether the person: • Wants to take responsibility for looking after and taking medicines; • Knows the medicines they take, what they are for, how and when to take them and what is likely to happen if they omit taking them; • Understands how important it is not to leave the medicines lying around where someone else may unintentionally take them and be harmed as a result. Outcomes from this assessment must then be included within the person’s care plan, with the whole process being regularly reviewed. This is so that the service user is supported to retain as much independence as possible, whilst taking reasonable steps to ensure their and other service users’ safety. There must be internal auditing of staff capability in respect of medication, to show that the manager has assessed the relevant people as capable of safely supporting service users with their medication. This needs to happen for current staff who provide medication support, and any new staff before they start providing medication support to service users on their own. All current and future staff must attend formal training on the prevention of abuse in due course. This is to help protect DS0000070193.V354176.R01.S.doc 01/03/08 6 OP9 13(2) 01/03/08 7 OP18 13(6) 01/04/08 SEVA Care Home Version 5.2 Page 31 8 OP21 23(2)(a) 9 OP26 13(3) 10 OP26 13(3) 11 12 OP26 OP29 13(3) 19 S2 pt7 13 OP29 19 S2 pt3 14 OP29 19 S2 pts 4&6 service users from abuse. The locks to the downstairs toilet and shower are insufficient as they lock only from the inside. Emergency override facilities are needed, in case any service user gets trapped in them alone. The waste-bin in the downstairs toilet must be operable without the need to touch it by hand. Otherwise infection could be spread. To help prevent the spread of infection, hand-cleaning facilities must be located in the laundry area. The dining table must be kept clean when not in use, to help prevent the spread of infection. Current and future staff and volunteers must not be employed without appropriate Criminal Record Bureau checks in place that relate to the work with Seva Care. This is to ensure that there is up-to-date information about possible criminal convictions, and whether or not the person is on the list of people legally prevented from working with vulnerable adults, before allowing contact with service users. Current and future staff must not be employed until two appropriate written references are received, including from their last employment of not less than three months duration that involved work with children or vulnerable adults. This is in case the references relay information of concern about the person’s fitness to work in a care position. Current and future staff must not be employed until there is a written and full employment DS0000070193.V354176.R01.S.doc 01/04/08 01/02/08 01/04/08 25/01/08 25/01/08 25/01/08 25/01/08 SEVA Care Home Version 5.2 Page 32 15 OP30 18(1)(c) 16 OP31 10(1) history, including satisfactory explanation for any gaps, and written verification of the reasons for leaving any care employment. This is needed in case there are concerning reasons connected to this information. Induction processes, as per the National Training Organization (Skills For Care) must be appropriately worked through with current staff, and must be promptly used for any new care staff during their initial time at the home. This is so that management can be sure that each person has a reasonable understanding of the relevant areas of care work. There must be sustained evidence of improved capability of the registered people by the next inspection, to help ensure appropriate outcomes and care for service users. 01/04/08 01/04/08 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 OP16 Good Practice Recommendations It is recommended that the complaints procedure, and how to raise concerns, be clarified to service users and their relatives, in case anyone remains unsure about how to raise issues. There was no way to lock bedrooms from the inside, which could prevent service users from having sufficient privacy when in their rooms. This should be considered with respect to the needs and wishes of each service user. Consideration should be given to upgrading the washing machine to that which has a sluice cycle, so that facilities DS0000070193.V354176.R01.S.doc Version 5.2 Page 33 2 OP24 3 OP26 SEVA Care Home 4 OP29 5 OP30 6 OP38 are in place should the need arise and hence crossinfection would be better prevented. It is recommended, to ensure that confidential information is supplied where needed, that all reference requests for potential staff be directed to the manager of an organization, rather than to work colleagues. Systems should be set up so that new staff are enabled to attend formal training courses (e.g. on food hygiene, manual handling, abuse prevention, and infection control) within a reasonable time period of starting the work. This is to help staff to become appropriately trained shortly after beginning work in the home. To help ensure that risks are safely managed, it is recommended that a suitably-qualified professional oversee the review of the fire-safety risk assessment. SEVA Care Home DS0000070193.V354176.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI SEVA Care Home DS0000070193.V354176.R01.S.doc Version 5.2 Page 35 - 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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