Inspection on 24/07/07 for Shenstone

This inspection was carried out on 24th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Shenstone 19/02/07

Shenstone 09/02/06

Shenstone 23/03/05

Shenstone 14/12/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Shenstone Kent Road Halesowen West Midlands B62 8PQ Lead Inspector Mrs Cathy Moore Key Unannounced Inspection 24th July 2007 07:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Shenstone DS0000036811.V346701.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. Shenstone DS0000036811.V346701.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Shenstone Address Kent Road Halesowen West Midlands B62 8PQ 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) 01384 813470 01384 813471 trishaghaley-rose@dudley.gov.uk N/K Dudley Metropolitan Borough Council Mrs Trisha Ghaley Care Home 41 Category(ies) of Dementia - over 65 years of age (14), Old age, registration, with number not falling within any other category (27) of places Shenstone DS0000036811.V346701.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. All requirements contained within the registration report of 10 and 11 February 2003 are met within the timescales contained within the action plan agreed between Dudley Metropolitan Borough Council and the National Care Standards Commission. Day care provision must not encroach on the facilities, staffing and services provided to residential service users. That the category of one OPx1 to change to one MDEx1 reverting back to original category once the named service user ceases to live at the home. One service user identified in the variation report dated 11 May 2005 who is in the category PD may access the home`s respite services. One service user (male) identified in the variation report dated 12 August 2005 may be accommodated at the home in the category DE(E) who is aged 57 years and over. This will remain until such time that the service users placement is terminated at which time the registration will revert back to DE(E). One service user identified in the variation report dated 5 June 2006 whos is in the category DE(E) may access the homes respite services. One service user identified in the variation report dated 5 June 2006 who is in the category MD(E) may access the homes respite services. 19 February 2007 2. 3. 4. 5. 6. 7. Date of last inspection Brief Description of the Service: Shenstone is a purpose built building of three - storey construction originally built in the 1960’s. It was refurbished in 1998 and is owned by Dudley MBC .It currently accommodates up to 41 service users. The building has 5 separate but interlinked units within the building of which one unit has 5 short stay beds for respite purposes, the remaining units having 9 beds. Each unit has its own kitchenette/ dining room lounge. Shenstone aims to provide 24 -hour care in a residential environment. The premises are light and airy and the décor and furnishings maintained to a good standard. All the windows are double-glazed. The home is situated on the main Kent Road close to nearby Blackheath and Halesowen Town centres. The home predominantly caters for the needs of older people and people who have a diagnosis of dementia. The home does not provide nursing care. The fees for this home are £ 355- £500 per week. Shenstone DS0000036811.V346701.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector carried out this key unannounced inspection on one day between 07.00 and 16.45 hours. I spent time on Ash and Steppingstones units to enable me to observe daily routines, meal times and staff and service user involvement. I spoke to three staff and seven service users’ to gain their views about the services provided by the home. I looked at three service user files to assess admission processes and the standard of care planning. I looked at three staff files to assess recruitment practices, training and supervision processes. I partially observed meal times on two units. I looked at medication systems to assess their safety and efficiency. I looked at service records concerning fire fighting and other equipment and also, general health and safety within the home. I randomly looked at parts of the premises, which included; three bedrooms, living areas on Ash, Steppingstones and the ground floor respite unit, bathrooms, toilets and the laundry. The seconded manager was involved with the inspection throughout the day. What the service does well: Although the home is large it is divided into five distinct units. Each unit has its only living; dining, toilet and bathing facilities making it feel homely. The home is fairly well maintained and is clean. There are no unpleasant odours. The homes’ atmosphere is positive, warm, welcoming and friendly. All bedrooms are single occupancy increasing privacy and dignity. The home has opening visiting times. Service users’ are very much encouraged to maintain contact with family and friends. Over 50 of the care staff team have achieved NVQ level 2 or above. Which means that a significant number of staff have, been assessed as being competent to do their work. Staff I observed during the inspection were polite to the people in their care. Staff receive one to one supervision on a regular basis. They also receive the required training. I spoke to seven service users’ during the inspection they told me their views on the home as follows; “ Think its very good”. “ I chose this home”. Home lovely”. “ Quite nice. Happy as can be. There is no where like home”. “ Its ideal for a rest”. Shenstone DS0000036811.V346701.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: 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. Shenstone DS0000036811.V346701.R01.S.doc Version 5.2 Page 7 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 Shenstone DS0000036811.V346701.R01.S.doc Version 5.2 Page 8 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): 2,3,4. Quality in this outcome area is good. Although terms and conditions were on file for service users,’ appropriate ones for persons‘ accessing the home for short stays have not been produced. Generally assessment of need processes were in place and are used for to ensure only appropriate service users’ are accepted. Letters confirming that the home can meet new service users’ needs are issued during the admission process. This judgement has been made using available evidence including a visit to this service. EVIDENCE: I looked at three service users’ files and saw that a contract was available informing service users’ of their rights during their stay at the home. These contracts however, need to be amended in one or two places to make sure that they are relevant for persons accessing ‘short stays’ at the home. I saw written documentation regarding assessment of need and admission processes. One service user had been admitted with little notice however, I Shenstone DS0000036811.V346701.R01.S.doc Version 5.2 Page 9 saw information to confirm that the staff had ensured that there was the required records in place for her. Service users’ that I spoke to confirmed that they had an assessment of need carried out. One told me; “ I came to look around the home. I was in respite before”. “ A staff member from here came to see me when I was at home”. I saw letters to confirm that service users’ are given written assurance that their needs can be met before being admitted to the home. Although, due to information being rearranged in different files it did take time for these letters to be found. Shenstone DS0000036811.V346701.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. Quality in this outcome area is good. Generally service users’ needs are set out in an individual plan of care and service users’ health care needs are met. I identified a number of shortfalls concerning medication which need to be addressed as a matter of priority to prevent risk to service users’. Staff are polite to service users’ and show them respect. This judgement has been made using available evidence including a visit to this service. EVIDENCE: I looked at three service user care plans. These were completed fairly well and contained important needs. For example; I found out during the inspection that one person due to religious beliefs has to comply with certain religious observances. I saw that this persons care plan mentioned prayer and diet. For another service user concerns about her diet were highlighted. I did identify however, that dates were not attached to all care plans making auditing difficult. Not all care plans had been signed by the service user to confirm that they had been involved in it’s production. Shenstone DS0000036811.V346701.R01.S.doc Version 5.2 Page 11 Generally there was evidence to confirm that healthcare is monitored in-house and that external professionals are secured where needed. I saw evidence that service users’ are risk assessed for nutrition and moving and handling. A service users’ file I looked at told me that he had been seen or treated by the dentist in January 2007 and had been seen by the nurse in July 2007. I saw evidence to demonstrate that service users’ are being weighed. However, it was unclear what actions are taken if weight loss occurs. One service user had weight loss. She went from 52 kg to 46.1 kg, yet there was no evidence to confirm that referral had been made to a dietician or other. However, her last weight recorded in July 2007 showed that some weight had been put back on from 46.1 kg to 48.1 kg. I spoke to a number of service users’ about healthcare and this is what they told me; “ Oh, yes if I need one they call the doctor straight away as they did for my back and shoulder”. “ The nurse came to see me yesterday”. “ See doctor if needed. They are very quick-don’t leave it”. When speaking to service users’ I looked at their teeth and nails. I saw that these were clean and well looked after. I looked at medication systems. I did find some good practice for instance; staff who have responsibility for medication have received training. An approved pharmaceutical guide was available in the home dated September 2006. I did however, identify a number of shortfalls which, must be addressed to make sure that there is no risk to service users’. When on Ash unit I heard one service user saying that she needed the cream for her face. She repeated this later saying that the cream was in the fridge. I looked in the fridge and saw a tube of Efcorlen cream unsecured on the shelf by food products. The label on the box told me that it had been dispensed on 7 June 2007 and for it to be applied twice a day. I looked at the tube and saw that only a small amount had been used. There was no date on the box to say when it was first opened or used. The agency worker applied the cream to the service users’ face. I heard the service user say to this agency worker; “ That’s good I haven’t had any for at least two days”. I looked at this person’s medication record and although the cream was recorded there were no initials to confirm that it was being applied as prescribed. Medication records are held in a ring binder. I saw that holes had been punched in the medication records to secure them in the folder. However, where the holes in some cases had been punched over the name of the medication or administration instructions, which meant that these could not be read properly. I saw that one service user was being prescribed Allendronic acid and another Risedronate. There were no instructions on the medication record for staff to follow. This medication needs be given well before any other medication is given and the person taking it must not lie down for thirty minutes after it has Shenstone DS0000036811.V346701.R01.S.doc Version 5.2 Page 12 been taken. As these instructions were not available for staff in all probability this medication is being administered incorrectly which places the service users’ at risk. There were no care plans in place for medications being prescribed on an ‘ as required basis’ such as Rispedal. A previous requirement had been made in order for medication to be stored at the correct temperature. Not above 25oc. I looked at medication cupboard temperatures on Ash unit and found that on a number of occasions they had exceeded this temperature. I noted that not all medication is counted and recorded when received. Medication boxes are not always date labelled when first used. These shortfalls prevent effective auditing. In the cupboard on Ash unit there was a container of eye drops date labelled 19.5.07, which should have been discarded on 19.6.07. The staff member told me that this service user is no longer at the home however, the eye drops should have still been discarded. I checked the controlled medication, which I found to be correct was correct against written balances. However, the staff member had to count over 50 tablets using her hands to get the total. She told me that these tablets were always checked at the start and end of each shift. To make this process safer and more hygienic a pharmacy counting ‘ triangle’ should be purchased. I observed and listened to staff during the inspection. I heard them speaking politely to service users’. On bedrooms doors on Ash unit I saw that a photo of the service user and their preferred name was attached. I saw that bedroom and toilet doors were kept shut when in use. I asked service users’ about the promotion of independence in the home and got the following answers; “ I do a lot for myself”. “ Got freedom you can go and do what you like”. I identified that one service user only likes a small number of preferred staff to bath him. When they are off duty a male staff member has to undertake this task which, he is happy with. One staff member told me about the personal care she provides. She said; “ They do what they can for themselves. They are all given a choice of clothes to wear. If someone is confused I get three garments from the wardrobe, show them, so they can choose”. Shenstone DS0000036811.V346701.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is good. The home tries to offer a service where routines are arranged to meet service user needs rather than be arranged around service needs. Activities are provided but could be further developed to increase opportunities for service users’. Visiting times are open and flexible. Service users’ are encouraged to maintain contact with family and friends. Efforts are made to enable service users’ to have personal choice and control in their lives. Meals varied are varied and nutritious. This judgement has been made using available evidence including a visit to this service. EVIDENCE: When I arrived at the home it was early. When I went onto Ash unit only one service user was up and dressed. Later ( 8 o’clock ) another two service users’ got up. I asked them their preferred rising times. One said; I like to get up fairly early”. The other said; “ I like to get up at about 8 o’clock”. Throughout the day I asked other service users’ about daily routines in particular rising and retiring times. They told me; “ I do what I want. I sit up late and watch TV. I Shenstone DS0000036811.V346701.R01.S.doc Version 5.2 Page 14 go to bed at midnight and get up at 5 am”. “ Get up and go to bed when I want”. I asked staff about rising and retiring times for service users’ and was told; “ All given a choice if they want to get up”. This evidence shows that daily routines are arranged around service user needs and wishes. I had a look at recent activity records and saw the following; 2007- 16 July watched TV or slept. 19 July Nearly all went to the fete. 21 July Grace Kelly film. 22 July watched soaps on TV. 23 July residents watched TV and sleeping in the chair . Played some music. These records were for people on the dementia unit. More variety would be beneficial for service users’ on this unit to promote occupation and stimulation. A number of service users’ however, are offered activity provision and enjoy it. I was told that one service user has been offered a place at an external day centre but does not want to attend. One service user told me; “ I go down to the Rowan day centre twice a week”. Service users’ are enabled to practice their chosen religion if they want to. Representatives from different religious faiths visit the home. One service user has a religious following whereby prayer is expected five times a day. To meet the needs of this person a large bedroom with a window facing in the right direction has been allocated to enable this prayer. The home has a policy of open visiting. Service users’ are encouraged to maintain contact with family and friends. One service user told me; “ People come yes”. This persons daily note showed that her husband visits her regularly. “ My daughters and son come and visit me”. I saw displayed within the home written information about external advocacy services which service users’ and their relatives can contact for support if they want to. All bedrooms I viewed held a range of service user belongings, which made the rooms feel homely and personalised. When walking around the home I saw plenty of written information displayed about healthy eating and recommended daily fluid intake, which is useful to both staff and service users’ to give them knowledge about nutrition and dehydration prevention. The home has written menus, which detail four meals per day. They also detail diabetic menus. The menus included plenty of fresh fruit and vegetables. I spoke with one service user partly through an interpreter. I discovered that staff who have the necessary knowledge are in the process of producing a menu specifically to meet this persons needs. A staff member told me; We are dong a menu but we let this person choose what they want. As long as it is not pork, anything else more or less can be eaten. I observed pre and part of the breakfast time on Ash unit. I saw that service users’ were given a cup of tea before their breakfast and were offered another one with their breakfast. One service user told me; “ Can have hot or cold for breakfast. Sometimes I have Shenstone DS0000036811.V346701.R01.S.doc Version 5.2 Page 15 egg or bacon”. Another service user told me; “ Good food. Certainly have enough”. I observed part of the lunch- time on Steppingstones unit. Lunch is generally sandwiches, salad and cakes. The main meal is served at tea- time. I saw that two service users’ had chosen a baked potato instead of sandwiches. Yoghurts, fresh fruit and cakes were also offered. Service users’ on this unit told me; “ Can have what you want to eat. Always plenty of food. Good”. “Meals so far good”. Shenstone DS0000036811.V346701.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. Quality in this outcome area is good. Complaints procedures are available in the home. Processes are in place to prevent harm and abuse. A number of incidents have occurred between service users on Ash unit,’ which need attention and exploration to prevent in future occurrences. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has complaints procedures on display. The home has received one complaint, which was due to a service user not being accepted as the home did not feel that they could meet their needs. I asked a number of service users’ what they would do if they had a complaint their answers are as follows; “ I would speak to the staff if I had a complaint”. “ I would go and see one of the staff”. A number of aggressive incidents have occurred between service users’ on ‘Ash’ the dementia care unit. It is positive that these incidents have been reported as required and that a meeting has been held between social services and the home concerning these incidents. Risk assessments are undertaken and incidents are recorded. One service user has one to one support as she has been assessed as needing this. Someone told me during the inspection that there are on-going concerns about this service user and her behaviour, which causes other service users’ to react negatively. This situation and the Shenstone DS0000036811.V346701.R01.S.doc Version 5.2 Page 17 mix of service users’ on this unit need careful monitoring and further exploration to prevent the risk of harm. It is positive, in an attempt to prevent the risk of harm and educate staff, the head of service has recently delivered abuse awareness training. I asked a number of service users’ and staff if they had any other concerns, or if any incidents such as shouting or rough handling had occurred. Their responses were as follows; “ None of that here. No shouting or anything. We are all equal as one”. “ No nothing”. “ No never”. “ Not aware of any concerns here”. “ No. I would report it straight away to a senior or manager”. Shenstone DS0000036811.V346701.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,24,26. Quality in this outcome area is good. Service users’ live in a fairly well maintained environment, which is comfortable, homely safe, and clean. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is a large detached building, which is divided within into five separate units making it feel homely and comfortable. Each unit has its own living and dining space. I found the home to be comfortable and clean. I did not detect any unpleasant odour. Due to the size of the home on-going work is needed to keep it up to standard. As stated in the previous inspection report only one maintenance person is employed to be shared between nine homes,’ which is quite a task. Shenstone DS0000036811.V346701.R01.S.doc Version 5.2 Page 19 Staff told me that they know what needs to be done in the home. One staff member told me; “ We get there in the end. All dining areas have recently been provided with new flooring. It has taken 3 years to get that done”. The senior manager discussed some future plans with me. One is to improve the stairwells in the home to make them more attractive and safer. There are also plans in hand to improve garden areas to make them safer and more accessible. I was pleased to see that that signage for toilet and bathroom doors has also been produced in Punjabi to aid the understanding of one service user. The home has a number of lounges and quite areas allowing service users’ to have a choice of where they spend their time and privacy when being visited. I looked at three service users’ bedrooms ( Two service users’ showed me their bedrooms themselves). I saw that these were adequately furnished comfortable and safe in that radiators were guarded and wardrobes secure. Service users told me; “ I like my bedroom”. “ Bedroom nice”. “ I have got a lovely bedroom”. The manager is fortunate as she has been able to secure input from an infection control specialist. This specialist carried out an infection control audit of the home and gave guidance to staff. When looking around the home I saw that ample gloves, liquid soap, paper towels and disposable aprons were available. Two of the three staff files I looked at confirmed that they have received infection control training. Shenstone DS0000036811.V346701.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is good. Generally staffing levels meet the needs of the service users’ although additional staff may be needed at times. Over 50 of the care staff team have achieved NVQ level 2 or above confirming that service users’ are in safe hands. Recruitment processes generally are sound. Induction processes are in place for new staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Generally the home is staffed during day- time hours by one carer on each unit. One carer and an extra staff member are provided on Ash unit. Night times three care staff are provided. The manager and seniors are additional to care staff hours. Laundry, catering and cleaning staff are provided every day. I was concerned to discover that both staff on the dementia unit on the morning of the inspection were agency staff. The seconded manager told me that this situation is a one off and that although agency, the staff had worked at the home for some time. I asked one of these staff how long she had been working at the home. She told me; “ 12 months”. No-one told me directly that staffing levels were a major problem. I asked a number of different people their views about staffing levels and got the Shenstone DS0000036811.V346701.R01.S.doc Version 5.2 Page 21 following responses; “ It differs, varies. Most times enough staff. Mainly problems when people phone in sick”. Late shift only 7. If someone gets aggressive we could do with another staff member”. “ Could do with one or two more”. “ From what I’ve seen ok”. “ Could do with more”. I observed staff during the inspection. They worked hard and were friendly and polite. I asked a number of service users’ their views about the staff their responses were as follows; “ Helpful”. The staff are good particularly the regular staff. The majority of agency staff are good as well”. “ Staff are very nice”. Records told me that out of the 34 care staff 18 have achieved NVQ level 2 or above. This is positive as this means that 18 staff have been assessed as being competent to undertake their work. Three more staff are working towards this qualification at the present time. I looked at staff files to check recruitment processes. I saw that most of the required documents were in place and checks have been carried out. The only thing I raised with the seconded manager was that the memos sent from the departments Human Resources Section do not confirm that an enhanced Criminal Records Bureau (CRB) check has been carried out. The memo only states CRB not the level. Similarly the memo does not confirm that a check has been made against the Protection Of Vulnerable Adult list. I saw evidence to confirm that new staff receive induction training. It is clear that the manager is proactive in securing required training for the staff. Shenstone DS0000036811.V346701.R01.S.doc Version 5.2 Page 22 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): 31,33,35,36,38. Quality in this outcome area is good. Although the manager for this home is on long term leave at the present time. A registered manager from another unit has been seconded until the leave has ended. Some further work is needed to fully demonstrate that the home is being run in the best interests of the service users’. Processes are in place, which effectively safeguard service users’ money. Evidence shows that staff receive regular one to one supervision. Generally health and safety within the home is promoted. This judgement has been made using available evidence including a visit to this service. Shenstone DS0000036811.V346701.R01.S.doc Version 5.2 Page 23 EVIDENCE: The manager is on long term leave at the present time. A manager who has recently been registered with the Commission has been seconded to the home until the substantive manager returns. I looked at quality assurance processes and saw that regular service user and staff meetings are held. I was told that the head of department has recently used questionnaires in the home to gain the views of the service users’ about certain areas of service provided. The seconded manager told me that at the present time there is not a process in place to audit the whole service provided against the national Minimum Standards for older people. The home holds in safekeeping money for a number of service users’. This money is held securely and records are maintained. I checked the money of the service users’ I had case tracked. One holds his own money and a lockable space has been provided for this purpose, which is positive. All other money that I checked was correct against records and balances. Two signatures as well as official receipts confirmed money spent. I checked three staff files for supervision regularity. All showed me that staff are receiving regular supervisions. For one staff member supervisions had been recorded for 15.5.07 and 17.6.07. Another, 23.2.07, 7.5.07 and 4.7.07. Staff I spoke to further confirmed that they do receive regular supervision. A problem with the lift has occurred in that it has broken down a couple of times. When the last incident occurred, unfortunately service users’ were stuck between floors. As the lift company could not attend quickly enough the fire brigade was called to rescue these service users’. The seconded manager confirmed that engineers had since been out to give the lift a thorough service ( weekend 21 and 22 July 2007). He also assured me that he would get more information about the lift and provide me with written details. When I looked at the toilets on Ash unit I saw that two bottles of hand wash solution were left unsecured on a work- top. I raised this issue with the staff and asked for them to be removed as if used incorrectly they could cause harm. I looked at staff training records and found that in general all staff have received all of the required mandatory training which is positive as this increases safety within the home. I looked at a range of temperatures recordings for fridges, freezers and hot foods. I found that these were satisfactory. I saw certificates which evidence catering staff have received food hygiene training. Shenstone DS0000036811.V346701.R01.S.doc Version 5.2 Page 24 I looked at a range of records and certificates relating to servicing and maintenance of equipment and supplies in the home. I saw that the five year fixed electrical wiring test is not due until September 2009. The fire alarm was serviced in June 2007. The lift was serviced in June 2007 and hoisting equipment was serviced in May 2007. It is good that these services and checks are carried out as again this means that, safety in the home is increased. Shenstone DS0000036811.V346701.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x 2 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 x x x x 3 x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 3 x 3 Shenstone DS0000036811.V346701.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(2) Requirement The manager must ensure that the medication is stored in a location, which can be maintained at the required temperature. Medication ( unless requiring refrigeration or specific instructions apply) should be stored at a temperature no higher than 25oc. Temperature recordings I saw on Ash unit were as follows;2007- 17 July pm 29oc. 18 July 27.2oc. 21 July pm 27.1oc. Timescale of 01/06/07 not fully met. This requirement was discussed with the seconded manager during the inspection 2 OP9 13(2) Service users’ must have applied all topical preparations as prescribed. Evidence that these have been applied as prescribed must be Shenstone DS0000036811.V346701.R01.S.doc Version 5.2 Page 27 Timescale for action 28/08/07 28/08/07 available at all times. This requirement has been made to prevent risk to service users and to ensure that their healthcare needs are met at all times. This requirement was fully discussed with the seconded manager during the inspection. Medication records must be kept intact at all times and efforts made to ensure that the full name of the medication and administration instructions can be fully read. This requirement has been made to prevent risk to service users and to ensure that their healthcare needs are met at all times. This requirement was fully discussed with the seconded manager during the inspection. 4 OP9 13(2) All medication coming into the home must be counted and recorded. AD Ibrufen. This requirement has been made to prevent risk to service users and increase medication safety. This requirement was fully discussed with the seconded manager during the inspection. 5 OP9 13(2) Care plans must be produced for all medications prescribed on an ‘ as required ‘ basis to ensure that staff have full instruction of DS0000036811.V346701.R01.S.doc 3 OP9 13(2) 28/08/07 28/08/07 28/08/07 Shenstone Version 5.2 Page 28 when these medications should be given For example; DS Risendronate. This requirement has been made to prevent risk to service users and increase medication safety. This requirement was fully discussed with the seconded manager during the inspection. 6 OP9 13(2) Full administration instructions must be made available on medication records for medications such as; Allendronic Acid. 28/08/07 7 OP9 13(2) Medication requiring refrigeration 28/08/07 must be stored appropriately and safely preferably in an approved medication fridge. This requirement has been made to prevent risk to service users and increase medication safety. This requirement was fully discussed with the seconded manager during the inspection. 8 OP9 13(2) All short life medication such as 28/08/07 optical and topical preparations must be date labelled when opened and discarded by the due date. This requirement has been made to prevent risk to service users and increase medication safety. This requirement was fully discussed with the seconded manager during the inspection. Shenstone DS0000036811.V346701.R01.S.doc Version 5.2 Page 29 9 OP9 13(2) Medication boxes and packets must be date labelled when first opened. The number of tablets left over in any month must be carried over onto the new medication record to enable effective auditing. This requirement has been made to prevent risk to service users and increase medication safety. This requirement was discussed with the senior who showed me the medication systems. 28/08/07 10 OP38 13(4)( c) Bottles of hand wash solutions must not be left unsecured ( ie whole bottles on surfaces) in areas where they may present as a risk to the service users’. ( Ash unit). This requirement has been made to prevent risk to service users’. This requirement was discussed with the seconded manager during the inspection. 28/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP2 OP8 Good Practice Recommendations Contracts/ terms and conditions should be produced in a format appropriate for short stays. ( respite care). Records should show what action is taken if weight loss is identified. DS0000036811.V346701.R01.S.doc Version 5.2 Page 30 Shenstone 3 OP9 It is recommended that use is made of medication trolleys on each floor. The seconded manger told me that trolleys have been ordered but have not yet been delivered or put into operation. 4 5 6 7 OP9 OP9 OP12 OP19 Where medication records are handwritten two staff should check and sign to confirm that the information written is correct. An approved pharmacists tablet counter ( triangle) should be purchased for the counting of the controlled medication. Meaningful and stimulating activities should be provided to meet service users’ needs. It is recommended that the manager should review the hours allocated for maintenance work in the building. Shenstone DS0000036811.V346701.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA 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 Shenstone DS0000036811.V346701.R01.S.doc Version 5.2 Page 32 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!