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Inspection on 12/04/06 for Silverdale House Care Home

Also see our care home review for Silverdale House Care Home for more information

This inspection was carried out on 12th April 2006.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Some very positive comments were made by residents about the quality of care at the home and how kind the staff are. All residents feel that staff treat them with dignity and respect their privacy. Residents can choose to be involved in a residents committee, which are responsible for raising money for activities. There are a range of activities provided in the home and money raised helps to pay for entertainers that the resident reported to thoroughly enjoy. Visitors book shows that visitors to the home are frequent. A relative confirmed that she is always made to feel welcome. Menu book shows that various healthy nutritious meals are offered to residents and those residents spoken with said the meals are nice. Staff understand their responsibilities in accordance with the Nottinghamshire Policy and Procedures for the Protection of Vulnerable Adults. The environment of the home is maintained to a good standard and on a tour of the premises it appeared clean.Residents` finances are safeguarded. Money kept in the home is held securely either by the home on behalf of residents or residents keep their own money in a lockable facility. The recommendation from the last inspection report still stands that the complex system for keeping large sums in a bank account is independently audited. Residents spoken with feel that they are still able to exercise choice and control in their lives in a number of ways; for example with meals, activities, when they wish to go to bed and get up.

What has improved since the last inspection?

There have been a significant number of improvements since the last inspection. All of the requirements from the last inspection except for medication practices have been responded to. Prospective residents know that the home will meet their needs because a letter is sent to them confirming this. Care plans are now being reviewed monthly, which ensures that changing and increasing needs of residents are being met. Some further care plans have been developed for pressure sore and dementia care. However, further information is needed on these plans, which was rectified during the inspection. The menu book has improved as there is more detail which shows all of the choice that is provided to residents. Criminal Record Bureau (CRB) checks and POVA first checks are being done properly now and there is evidence of supervisory arrangements in place for staff until their full CRB check is returned. This practice promotes the safety of residents. Fire safety tests are being undertaken and environmental risk assessments have now been carried, both tasks essential for promoting and protecting the health and safety of residents. The registered provider has carried out a monthly visit and reported back to the Commission, as required. In order for this requirement to be satisfactorily met this must continue.

What the care home could do better:

A pharmacy inspector visited the home and concluded that the medicine management must improve significantly to safeguard the service users within the home. A Statutory Requirement Notice was served to the home, as the practice found was poor. Seven separate requirements have been made in addition to the Statutory Requirement Notice in respect of medication practice.Residents are not being provided with contracts or terms and conditions when they are admitted to the home. This does not protect individuals` rights. One resident that was case tracked did not have an assessment on their file, which is required in order to confirm that the home is suitable in meeting that person`s needs and also to inform care plans. When residents have specific health needs, for example epilepsy, these need to be referred to in care plans. Monitoring and recording tools will also ensure that this particular need is managed safely. Staffing levels are not always at a safe and adequate level and given the increasing needs of residents the acceptable minimum staffing must be reviewed. There is still not enough evidence to prove that all staff are appropriately trained in meeting the needs of residents. Training records are not filled in fully and certificates are not obtained for courses attended. Recruitment practices are not safe enough if only one written reference is obtained for new staff. Two written references are required for all staff before they commence employment. Current management arrangements need further clarification and structure as at present the boundaries are blurred between the new manager and the previous manager now in an administrative role. The provider of the home is required to supply to the Commission copies of job descriptions for the manager and administrator. Further work to quality monitoring is required to ensure that any surveys conducted that obtain the views of residents then inform any changes to the service and that any reports as a result of surveys are made available to residents. A risk assessment for one resident`s use of bed rails has not been undertaken despite a requirement set at the last inspection in respect of this. This is therefore issued as an immediate requirement. A central record of for the summary of complaints must be kept so that these can be reviewed.

CARE HOMES FOR OLDER PEOPLE Silverdale House Care Home 3 Nottingham Road Hucknall Nottingham NG15 7QN Lead Inspector Joanna Carrington Unannounced Inspection 12th April 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Silverdale House Care Home DS0000008790.V288229.R01.S.doc Version 5.1 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. Silverdale House Care Home DS0000008790.V288229.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Silverdale House Care Home Address 3 Nottingham Road Hucknall Nottingham NG15 7QN 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) 0115 9640400 0115 9634880 Rodenvine Limited Jamil Akhter Mrs Fiona Elizabeth McShane Care Home 36 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (36) of places Silverdale House Care Home DS0000008790.V288229.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 1 named person may be in the category PD. 5 places for admitting service users over the age of 65 with dementia. 17/01/06 Date of last inspection Brief Description of the Service: Silverdale Care Home for older people is situated on a main road close to Hucknall town centre. It is registered for a maximum of thirty-six places. There are twenty-four single bedrooms and four double-sized bedrooms that can accommodate a couple, if they choose to share. The accommodation is on two floors with two lifts provided to give full access to the upper floor. There is a choice of sitting rooms and a spacious dining room. There are contained gardens to the rear, providing further seating areas. The fees are £277 to £320 per week. Recently, the registration for this home was amended to include a provision of care for up to five service users with dementia. Fiona Mcshane has now stepped down as Registered Manager and is taking the lead role in administration. Julie Shotton has been appointed as care manager and is in the process of applying to be registered as manager with the Commission. The inspection report as a result of this inspection and previous inspection reports are publicly available and are kept in the entrance hall of the home for residents and visitors to access. Silverdale House Care Home DS0000008790.V288229.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over ten hours on the 12th and 13th April 2006. This was the home’s key inspection for the inspection year. All of the key standards were assessed and a specialist pharmacy inspector also attended to assess and follow up requirements issued during a specialist pharmacy inspection that took place in February 2006. The pharmacy inspector’s report is contained within this report. The main method of inspection was called ‘case tracking’ which meant selecting four residents and tracking the support they receive through checking their records, observation of care practice and discussion with staff. Staff records were looked at and a partial tour of the premises also took place in order to assess environmental standards. Judgements made in this report are not only from what was found on the day of the inspection but also based on information and evidence gathered over the year. Altogether three of the four residents case tracked were spoken with as well as three other residents. A relative and three staff members were also spoken with. The manager was available for discussion and feedback throughout the majority of the inspection. What the service does well: Some very positive comments were made by residents about the quality of care at the home and how kind the staff are. All residents feel that staff treat them with dignity and respect their privacy. Residents can choose to be involved in a residents committee, which are responsible for raising money for activities. There are a range of activities provided in the home and money raised helps to pay for entertainers that the resident reported to thoroughly enjoy. Visitors book shows that visitors to the home are frequent. A relative confirmed that she is always made to feel welcome. Menu book shows that various healthy nutritious meals are offered to residents and those residents spoken with said the meals are nice. Staff understand their responsibilities in accordance with the Nottinghamshire Policy and Procedures for the Protection of Vulnerable Adults. The environment of the home is maintained to a good standard and on a tour of the premises it appeared clean. Silverdale House Care Home DS0000008790.V288229.R01.S.doc Version 5.1 Page 6 Residents’ finances are safeguarded. Money kept in the home is held securely either by the home on behalf of residents or residents keep their own money in a lockable facility. The recommendation from the last inspection report still stands that the complex system for keeping large sums in a bank account is independently audited. Residents spoken with feel that they are still able to exercise choice and control in their lives in a number of ways; for example with meals, activities, when they wish to go to bed and get up. What has improved since the last inspection? What they could do better: A pharmacy inspector visited the home and concluded that the medicine management must improve significantly to safeguard the service users within the home. A Statutory Requirement Notice was served to the home, as the practice found was poor. Seven separate requirements have been made in addition to the Statutory Requirement Notice in respect of medication practice. Silverdale House Care Home DS0000008790.V288229.R01.S.doc Version 5.1 Page 7 Residents are not being provided with contracts or terms and conditions when they are admitted to the home. This does not protect individuals’ rights. One resident that was case tracked did not have an assessment on their file, which is required in order to confirm that the home is suitable in meeting that person’s needs and also to inform care plans. When residents have specific health needs, for example epilepsy, these need to be referred to in care plans. Monitoring and recording tools will also ensure that this particular need is managed safely. Staffing levels are not always at a safe and adequate level and given the increasing needs of residents the acceptable minimum staffing must be reviewed. There is still not enough evidence to prove that all staff are appropriately trained in meeting the needs of residents. Training records are not filled in fully and certificates are not obtained for courses attended. Recruitment practices are not safe enough if only one written reference is obtained for new staff. Two written references are required for all staff before they commence employment. Current management arrangements need further clarification and structure as at present the boundaries are blurred between the new manager and the previous manager now in an administrative role. The provider of the home is required to supply to the Commission copies of job descriptions for the manager and administrator. Further work to quality monitoring is required to ensure that any surveys conducted that obtain the views of residents then inform any changes to the service and that any reports as a result of surveys are made available to residents. A risk assessment for one resident’s use of bed rails has not been undertaken despite a requirement set at the last inspection in respect of this. This is therefore issued as an immediate requirement. A central record of for the summary of complaints must be kept so that these can be reviewed. 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. Silverdale House Care Home DS0000008790.V288229.R01.S.doc Version 5.1 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 Silverdale House Care Home DS0000008790.V288229.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 and 4 Quality for this outcome group is poor. Residents are informed that the home will be able to meet their needs however this can not be guaranteed unless their needs are assessed before they are admitted to the home. Not all residents have a written contract / statement of terms and conditions with the home. EVIDENCE: Three of the four residents’ case tracked had copies of the placing authority’s community care assessment on their file. The most recent resident to the home was case tracked. This placement is self-funded. There was no preadmission assessment on their file. The manager reported that this resident has been for short breaks to the home quite recently, however the preadmission assessment could not be located during the inspection. Silverdale House Care Home DS0000008790.V288229.R01.S.doc Version 5.1 Page 10 For residents recently admitted that were case tracked there was evidence seen that before they moved to the home a letter was sent confirming that the home is suitable in meeting their needs and subsequently, an offer of a place. This requirement from previous inspection has therefore now been met. There was no evidence on the care files seen that residents sign a contract or Statement of Terms and Conditions when they move to the home. A copy of the home’s contract was seen during the inspection and is applicable to both residents funded by Social Services and those that self-fund. The fees stated within this document are now out of date. To promote and protect the rights of residents it is essential that all residents sign an up to date document, with a copy supplied. This is set as a requirement. Silverdale House Care Home DS0000008790.V288229.R01.S.doc Version 5.1 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Overall, mainly due to continued problems with medication administration, the quality for this outcome group is only poor. Some further improvements have been made to care planning which helps to assure that the health, personal and social care needs of residents are met. Service users are treated with respect and their right to privacy upheld. The medicine management has improved since the last inspection but significant work is still required to ensure the safety of the service users within. EVIDENCE: Requirements set at the last inspection around the need for further care plans and improving recording have evidently been addressed. Accident records are now in much better detail, and for the four residents case tracked any falls / accidents that have occurred are cross referenced in the relevant parts of their care plans. There were a number of recorded accidents that have resulted in the paramedics being called or visits to the hospital. Where a medical Silverdale House Care Home DS0000008790.V288229.R01.S.doc Version 5.1 Page 12 practitioner has been called upon then these accidents must be notified to the Commission. This is set as a requirement. There was evidence seen at this inspection that care plans are now being reviewed monthly, which ensures that any changing needs are identified. The majority of residents spoken with (those not displaying confusion) are fully aware of and have been involved in the development of their care plans and the relative spoken with also confirmed this and that they are always consulted over any changes to care given. It was noted how one particular resident has been having a high level of falls. There was evidence on their care plan that this was identified and subsequently a review of this residents care took place involving the resident, a relative, district nurse and GP. There are now care plans in place for what action staff need to take for managing residents’ diabetes and how to assist district nurses in the management of pressure sores. The information, provided on this form was still not detailed though as it did not specify what staff do. When asked, the manager explained how staff ensure that a pressure relieving cushion is taken to the lounge and that the resident is encouraged to walk regularly. It was explained to the manager that this is the type of information that must be recorded. This is not set as a requirement as during the inspection the form used was amended and the necessary information added. A complimentary letter from a relative received by the home at the time of the inspection was also copied to the Commission. This letter states that despite their relative in care “not necessarily being keen to follow clinical advice the staff at Silverdale really did their best to remind her not to sit on her bottom, to lie on the special mattress and to change from side to side when possible”. During the audit of medicines (see pharmacy report below) it was identified how one resident on epilepsy medication had not been administered the correct prescribed level. The Commission was notified in Feb 2006 that this resident had a seizure and was admitted to hospital. This resident was case tracked during the inspection. It transpires that this resident does not have frequent seizures and that this was a one off. Nevertheless, to promote and make proper provision for this resident’s health, the fact that this resident is diagnosed with epilepsy must be referred to in a relevant care plan and a detailed record taken of any seizures. This is set as a requirement. Staff were observed interacting with residents in a respectful and dignifying manner. All residents spoken with only had very positive comments to make about the staff and how they respect their privacy and treat them with kindness. Silverdale House Care Home DS0000008790.V288229.R01.S.doc Version 5.1 Page 13 Pharmacy Inspector’s Report Copies of repeat prescriptions are now being kept with Medication Administration Records (MAR) which promotes safer practice as it ensures that the correct medicines are supplied and are being administered. Where medicines had been discontinued as a result of GP advice this is stated on some MARS, unfortunately not on all however, which does not therefore give a true record of the service users current drug regime. One medicine had been crossed off and then correction fluid had been used to remove this direction. A further MAR chart recorded the same medicine potentially causing an error of this medicine being administered twice. Medicines had been signed as administered when they had not been. This indicates that the Medicine Administration Record (MAR) chart had not been referred to before the administration and the transaction recorded directly afterwards. Inadequate checking of the prescriptions before dispensing resulted in some service users not receiving regular prescribed medication for up to five days before an additional prescription was sought and in one instance one service user went without pain relieving tablets for 14 days before an additional supply was sought. Hand written MAR charts were poor. One did not record the start date of the MAR chart so all information recorded was meaningless. The pharmacist recorded medication on the MAR chart but there was none dispensed or available in the trolley to administer. This may have resulted in the service user receiving double the prescribed dose. One transcribing error was found resulting in the service user recorded as receiving half the prescribed dose of medicine. It was found in reality that she had not received any medication at all. One MAR chart recorded the same medication twice on two different MAR charts. The care assistant had signed that she had administered the same medication at the same time on the same day. In reality she had not but the MAR charts did not reflect this. Two inhalers had been recorded as administered but they were both unused at the time of the inspection. One service user was recorded as self-administering her medicine. The Commission supports this. However there was no risk assessment available to demonstrate that she could safely self-administer her medicine and no compliance checks to confirm safe administration. Gaps were found on the MAR chart. In some instances the medicine had been administered but not signed as such, in others not administered and the reasons for nonadministration not recorded. Silverdale House Care Home DS0000008790.V288229.R01.S.doc Version 5.1 Page 14 One medicine had been recorded as refused by the service user, but none was available to administer on the premise to offer to the service user to actually refuse. One medicine had been signed as administered four times a day on the day of the inspection when only one drug round had taken place. Three entries had been signed in advance of the actual administration and so did not accurately record what had occurred in the home. A number of requirements have been set in relation to the safe recording and administration of medicines. A statutory requirement notice has been issued in respect of medication practice. Silverdale House Care Home DS0000008790.V288229.R01.S.doc Version 5.1 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality for this outcome group is good. Residents’ social, cultural and recreational needs are met in the home and are helped to exercise choice in their lives. Residents are provided with wholesome nutritious meals, which with improved recording, is now well evidenced. EVIDENCE: All residents spoken with said that their family and friends are always made to feel welcome and they can have visitors whenever they want. The bedrooms seen show that residents can bring their own possessions when they move into the home and residents spoken with also stated that they can access their care plan whenever they request and in general are able to exercise choice and control of their life. For example, whether they wish to participate in activities or spend time alone, when they wish to get up, what meal they would like. Silverdale House Care Home DS0000008790.V288229.R01.S.doc Version 5.1 Page 16 Residents can choose to participate in their own committee meetings. Minutes of the last meeting documented what activities residents like to do such as bingo, family race night, sing-along, an organist, easter treats, proposed river trips and tram rides. Residents spoken with did state that at times staff struggle providing activities because they are too busy. (Please refer to Standard 27). Residents’ also regularly run a fundraising event that is open to the local community. The menu book was looked at as part of the inspection. It was evident that meals continue to be wholesome, nutritious and varied and there is now more detail recorded on what vegetables have been served and which residents have had any alternative meals provided. This is important in case of a food poisoning outbreak but also shows that residents are offered variety and choice. Residents spoken with said that the meals on offer are always very nice. Silverdale House Care Home DS0000008790.V288229.R01.S.doc Version 5.1 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality for this outcome group is adequate. Residents are not going to be fully protected unless all staff, residents and their relatives / representatives feel that information is dealt with sensitively and appropriately acted on. EVIDENCE: There have been no more concerns, complaints or allegations made since the last inspection. The Complaints Procedure is appropriate and refers to complaints being responded to within one month and also that the Commission can be contacted if they are not happy with any outcomes. At the last inspection it was recommended that all confidential information was taken out of the new Complaints File and instead, on the complaints file record the nature of complaint and a summary of action taken, which is then cross referenced to the more detailed information. What has actually happened is that all information has been taken out of the Complaints File. This is not correct because now the Complaints File is not a true reflection of complaints that have been received. This is a requirement. Residents and the relative spoken with said that they are aware of the home’s complaints procedure and all but one said that they felt comfortable raising any concerns or complaints they have with the manager. Silverdale House Care Home DS0000008790.V288229.R01.S.doc Version 5.1 Page 18 Someone spoken with during the inspection did report that there are times when what is passed on to the manager is not taken seriously or that anonymity is not maintained when something is said because other people find out. If this practice is occurring then this is unacceptable. All concerns, complaints and allegations that are made regardless of their nature and who they concern, must be taken seriously and people need to be assured that anonymity and confidentiality will aim to be protected. Otherwise, people will not feel comfortable disclosing things, which will ultimately compromise the safety and protection of residents. Despite the above comment made staff spoken with did demonstrate an understanding of the Protection of Vulnerable Adults Procedures and their responsibilities in respect to disclosing allegations of abuse / whistleblowing. Silverdale House Care Home DS0000008790.V288229.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality for this outcome group is good. Residents live in a safe and well-maintained environment that is generally kept clean and hygienic. EVIDENCE: On a partial tour of the premises it was noted how the décor in some parts is tired looking but on the whole it was evident the environment is maintained to a generally good standard. The maintenance book was looked at and showed that any maintenance work required is done without unreasonable delay. There was no malodour present, which means that the requirement set at the last inspection has now been dealt with. Silverdale House Care Home DS0000008790.V288229.R01.S.doc Version 5.1 Page 20 The home appeared clean throughout. There is a housekeeper that works Mondays to Fridays. One person spoken with during the inspection did point out that there are times when the toilets are not kept clean enough. This is at times when the housekeeper is not present and it is the responsibility of care staff. It is recommended that ways be looked into on how this task can be better achieved. Two hours of time per afternoon is set aside for laundry duties. The laundry and sluice facilities are appropriate to meeting the needs of residents. Silverdale House Care Home DS0000008790.V288229.R01.S.doc Version 5.1 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality for this outcome group is poor. Staffing levels are not always at a safe and adequate level. There is still not enough evidence to prove that all staff are appropriately trained in meeting the needs of residents. Although there have been some good improvements with recruitment practice, residents are still not protected if written references are not correctly obtained. EVIDENCE: There should be a minimum of four care staff on each shift. The rota was looked at for the past four weeks and showed that there have been some occasions, mainly on the late afternoon / evening shift when only three staff are working due to staff sickness. All residents spoken with identified how busy staff are and one person spoken with feels that the needs and dependency of residents has been increasing. Three staff for thirty to thirty six residents is neither acceptable nor safe. Four care staff should only be seen as the absolute minimum. It is required that staffing levels are reviewed to ensure they are appropriate to the needs of residents. Silverdale House Care Home DS0000008790.V288229.R01.S.doc Version 5.1 Page 22 Four staff files were looked at. Two of these staff have been recruited since the last inspection. There was clear evidence on their files that they did not commence employment until the return of a POVA First check, and that supervisory arrangements were in place until the return of their full Criminal Records Bureau disclosure. This was a requirement made at the last inspection, which has now been met. There were two written references for one of the new staff but one reference was not dated so it cannot be ascertained if this was received before they commenced employment. For the other new staff member only one written reference was on file. Two written references must be obtained before employment commences. Therefore, a requirement has been made. There was no evidence of any induction on any of the staff files looked at and the training records show that some training provided is now out of date or hasn’t been provided at all. For example, no dates were filled in for dementia awareness training and moving and handling. Staff spoken with indicated that they have not had adequate moving and handling training. However, there are courses that have been attended, including medication and food hygiene but the training provider has not supplied certificates. Certificates were seen for all staff attendance at Fire Safety training. It is recommended that the training record be extended to include other required courses such as Adult Abuse, Medication and any other courses that are relevant to individuals’ needs. The manager must ensure that an accurate record is kept of all training provided and what is due. Silverdale House Care Home DS0000008790.V288229.R01.S.doc Version 5.1 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality for this outcome group is adequate. Current management arrangements are not clear enough, which does not ensure the smooth running of the home. Residents’ finances are safeguarded. Improvements to quality monitoring are still required to ensure the home is run in the best interests of service users. Some progress has been made with promoting and protecting the health and safety of service users and with supervision of staff, which residents will ultimately benefit from. Silverdale House Care Home DS0000008790.V288229.R01.S.doc Version 5.1 Page 24 EVIDENCE: The previous registered manager is now being employed at the home in an administration role while a senior staff member has been promoted to acting manager and is in the process of applying for registration with the Commission. Concerns were identified during the inspection with this arrangement. Both staff and residents appeared unsure as to who is managing the home and whom they should go to with any issues etc. It is accepted that settling into a role is a gradual process and subsequently time for transition is needed however the boundaries do come across unclear. The provider is required to supply to the Commission copies of job descriptions for the manager and administrator. The acting manager needs to be more aware that she is now in charge of all staff at the home and is responsible to the registered provider and in ensuring that the National Minimum Standards are met. There is a robust procedure for managing residents’ finances. Money held on residents’ behalf is stored securely. Rather than keep large amounts of cash in the home some money is held in a bank account, which is then audited and checked regularly. The recommendation still stands that due to the complexity of this system it be financially audited. Some residents spoken with explained how they keep hold of some money themselves in their own lockable facility, which means that they are in control of their own money and also that it is safe. Quality Assurance Questionnaires went out to residents and their relatives prior to the inspection but this information has not been analysed or used to inform any changes or developments to the service. The results of this survey should be made available to residents and relatives and be accessed along with the inspection report, which is kept in the front entrance of the home. A requirement has been set in respect of this. Since the last inspection in response to an immediate requirement set at last inspection the registered provider has carried out a Regulation 26 monthly visit report. This is another important part of quality assurance and must continue in order for the requirement to be satisfactorily met. The acting manager has worked hard in getting supervision arrangements off the ground for all staff. So far a report on observation of professional practice has been undertaken for all staff but no time yet has been set aside for staff to discuss all aspects of their practice, philosophies and their developmental needs. This is an important element of supervision to ensure that staff are comfortable in their role and work to the best of their abilities. It is recommended that a system be set up for ensuring all staff are suitably supervised and that any senior staff assigned a supervisory role are given the necessary training and guidance. Silverdale House Care Home DS0000008790.V288229.R01.S.doc Version 5.1 Page 25 All the necessary fire safety testing is now being carried out so this immediate requirement has now been addressed. As recommended at previous inspections the administrator has now also obtained a pro-forma for environmental risk assessments, which will be carried out six monthly, important for promoting and protecting the health, safety and welfare of residents and staff. Since the last inspection another resident now has the use of bedrails, as advised by the GP and district nurse. It was made a requirement at the last inspection to do a risk assessment to make sure the bedrails and their use are appropriate and safe. It is of serious concern that this has been ignored and a risk assessment has not been carried out. This is therefore issued as an immediate requirement. Silverdale House Care Home DS0000008790.V288229.R01.S.doc Version 5.1 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 2 2 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 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 2 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 3 X 2 Silverdale House Care Home DS0000008790.V288229.R01.S.doc Version 5.1 Page 27 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP2 Regulation 5 Requirement Update the Statement of Terms and Conditions to reflect the current fee levels of the home and provide to each service user. Ensure that all residents have an assessment of their needs prior to their admission pre-admission assessment, which is retained. Promote and make proper provision for the health of all service users- this refers to ensuring specific health needs of individuals, in this case epilepsy, are included in care plans, with appropriate recording tools available and ensure that all accidents where a medical practitioner is called upon are notified to the Commission. All prescriptions must be seen prior to dispensing, checked and a system installed to check the dispensed medicines and MAR chart received into the home. Any discrepancies must be addressed before the new cycle begins. The right medicine must be available to administer and be DS0000008790.V288229.R01.S.doc Timescale for action 31/05/06 2. OP3 14 31/05/06 3. OP8 12 30/04/06 4. OP9 13(2) 10/05/06 5. OP9 13(2) 13/04/06 Silverdale House Care Home Version 5.1 Page 28 6. OP9 13(2) 7. OP9 13(2) 8. OP9 13(2) 9. OP9 13(2) 10. OP9 13(2) 11. OP16 17(2), 22 administered from a pharmacist labelled container to the right service user at the right dose at the right time as prescribed by the doctor The Medication Administration Record (MAR) must record the start date, the correct drug name and dose, the quantities of all medicines received and balances carried over. It must record the complete, current drug regime for each service user. The use of correction fluid to alter records must cease. The MAR chart must be referred to before any administration and signed directly after each transaction or the reason for non-administration recorded. Any service user wishing to self administer their own medication must be fully supported and a full risk assessment must be undertaken to assess the service user and regular compliance checks undertaken and documented to confirm safe administration The registered manager must undertake staff drug audits before and after a medicines round to confirm staff competence in medicine management and appropriate action must be taken if these fail All policies and procedures for medication must be reviewed and staff trained to adhere to them Ensure in accordance with Schedule 4 that a record is kept of all complaints made by service users or representatives or relatives or by persons working at the care home and the action taken by the registered person in respect of any such complaint. DS0000008790.V288229.R01.S.doc 13/04/06 13/04/06 26/04/06 12/05/06 12/05/06 31/05/06 Silverdale House Care Home Version 5.1 Page 29 12. OP27 18 13. 14. OP29 OP30 19 18 15. OP33 24 16. OP37 18 17. OP38 13 Review staffing levels to ensure that at all times suitable persons are working in such numbers as are appropriate for the health and welfare of service users. Ensure that two written references are obtained for all staff. Ensure that all persons employed to work at the care home receive training appropriate to the work they are to perform. Ensure there is a system for reviewing and improving the quality of care and that the report in respect of any such review is made available to service users and to the Commission. In accordance with Section 31 of the Care Standards Act 2000 the provider must supply copies of job descriptions for the roles of manager and administrator. Ensure individual risk assessments are carried out for the appropriate and safe use of bedrails. This is repeated as an outstanding requirement from the last inspection and is now issued as an immediate requirement. 30/06/06 30/04/06 31/05/06 30/06/06 31/05/06 12/04/06 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 Ensure all staff, relatives and residents are fully aware of the Complaints Procedure and that they are assured any concerns, complaints expressed will be taken seriously and acted on. DS0000008790.V288229.R01.S.doc Version 5.1 Page 30 Silverdale House Care Home 2. 4. 5. OP26 OP29 OP30 6. 7. OP35 OP36 For improved cleanliness and infection control ways must be looked at in how to ensure the toilets are kept clean throughout the day. For staff that have been in post for a while add character references to their file, so that when inspected again, the requirement will be met. Improve the system for monitoring and recording staff training needs. Produce an annual training programme for all staff. This recommendation was identified in the last inspection report. Independently audit the system for holding residents finances. This recommendation was identified in the last inspection report. It is recommended that a system be set up for ensuring all staff are suitable supervised and that any senior staff assigned a supervisory role are given the necessary training and guidance. Silverdale House Care Home DS0000008790.V288229.R01.S.doc Version 5.1 Page 31 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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