CARE HOMES FOR OLDER PEOPLE
Silverdale House Care Home 3 Nottingham Road Hucknall Nottingham NG15 7QN Lead Inspector
Joanna Carrington Unannounced Inspection 24th January 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Silverdale House Care Home DS0000008790.V325396.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. Silverdale House Care Home DS0000008790.V325396.R01.S.doc Version 5.2 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 Vacant 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.V325396.R01.S.doc Version 5.2 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. 12th October 2006 Date of last inspection Brief Description of the Service: Silverdale Care Home is registered to provide care and accommodation for up to thirty-six older people. Five of these places are also registered to allow the home to admit older people diagnosed with dementia. The home is situated on a main road close to Hucknall town centre. There are twenty-four single bedrooms and four double-sized bedrooms. 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 weekly fees are £277 to £320 per week. Silverdale House Care Home DS0000008790.V325396.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over eight hours on 24th January 2007. This was the home’s second key inspection in the inspection year. The home had a key inspection in April 2006 and two further random inspections in 2006. Copies of these reports are available to the public by request. Following a management review of the home it was decided that another key inspection was appropriate because of growing concerns regarding the management of complaints. The main method of inspection was called ‘case tracking’ which meant selecting three residents and tracking the quality of their care by checking records, discussion with them and with staff and observation of care practices. Altogether, two residents, three relatives and two staff members were spoken with during the course of the inspection. Staff records were looked at to make sure staff get the training they need and checks are carried out on staff before they commence their employment. A partial tour of the premises also took place in order to assess environmental standards. A new manager has been recruited and was available for feedback and discussion throughout the inspection. The manager reported to have officially been in post for three weeks. The conditions of registration, as stated on the registration certificate were checked. These conditions are still applicable to the home. What the service does well: What has improved since the last inspection?
Silverdale House Care Home DS0000008790.V325396.R01.S.doc Version 5.2 Page 6 A new manager has recently been appointed. The manager is making gradual changes and is addressing outstanding requirements: Staffing levels have now improved. Care staff can now concentrate on providing support and spending time with residents because they no longer have laundry and tea making responsibilities. A kitchen assistant has been recruited for making tea, preparing supper and washing up in the evenings. Both staff and residents have reported this has made such a difference. New care planning documentation is being used, which is intended to help staff in developing care plans, to ultimately meet the needs of residents. Pharmacy inspector’s report Only medication that is prescribed for the individual is given to the resident. The unacceptable practise of “borrowing” medication between residents is not happening at the home. What they could do better:
It is of serious concern that there are five outstanding requirements from the previous inspection. The timescale for compliance for these requirements is the day that the inspection took place so that enforcement action can be taken. Staff are still not adequately trained, which places both residents and staff at risk. Health and safety training, such as moving and handling, first aid and food hygiene are mandatory to ensure that people are safe. New staff are not getting the necessary induction and foundation training, which means they may not have a good enough understanding of the principles of care and insight into the needs of vulnerable people. Enforcement action is being considered in respect of this due to persistent non-compliance. Complaints are being poorly managed. Records are not being kept, despite the registered provider informing the Commission that the appropriate action is being taken, and complainants are not getting a response by the registered provider. This is unacceptable and again enforcement action is being considered in respect of this and also in respect of the lack of fitness the provider has demonstrated. A system for quality monitoring and quality assurance has still not been implemented. Without this in place, there is no way of ensuring the home is being run in residents’ best interests and that any necessary improvements to the service are being made. Enforcement action is also being considered in respect of this due to persistent non-compliance. Still not all residents have signed a contract / terms and conditions with the home. This does not safeguard residents’ rights and responsibilities.
Silverdale House Care Home DS0000008790.V325396.R01.S.doc Version 5.2 Page 7 Residents are still being admitted to the home without having their needs assessed, which means the home may not be suitable. Enforcement action is being considered in respect of both of these issues due to persistent noncompliance. Not all staff have had training in adult abuse and do not understand their responsibilities to report all allegations of abuse. This does not ensure residents are protected from abuse. New staff members are commencing employment before the return of two written references. This practice is against regulations and does not protect residents. A few areas of the home were identified as needing improvements, to make the home more comfortable for residents. There are tiles missing in the ceiling of one of the bathrooms. A new lock is required for a toilet, in order to maintain residents dignity. Improved standards of hygiene and cleanliness of toilets is required. All of the health and safety testing such as fire alarm tests and portable appliance testing must be carried out in order to avoid enforcement action by the relevant authorities. This is to ensure the health, safety and welfare of both residents and staff. Six recommendations are also made in this report. Three relate to further improvements to care planning and risk assessments, in order to maintain the dignity of all residents and to safeguard individuals’ human rights. Further progress is needed in getting at least 50 of the staff team qualified with a National Vocational Qualification. It is also recommended that an audit of staff files is undertaken and if there are any longstanding staff members that do not have two written references then character references must be added to their file, with an explanation so that the regulation is complied with. Pharmacy inspector’s report The management team need to undertake regular drug administration audits before and after medicine rounds to ensure all staff are administering and accurately recording the administration of medicines. This is to ensure that all residents are receiving medication as prescribed. Ensure all staff that have the responsibility of giving medicines to be given copy of the revised medication handling polices for the home. All staff must consistently follow a safe administration process. This is to ensure all resident receive medicines as prescribed and that this is accurately recorded. If medicines are not given the medication administration recording sheets should clearly indicate the reason.
Silverdale House Care Home DS0000008790.V325396.R01.S.doc Version 5.2 Page 8 All new medication administration record sheets are crosschecked at the home to ensure they state the correct drug regime and are for the correct person. Any alterations made by the Prescriber in a monthly cycle must be clearly referenced on the administration record sheets and in the drug profile kept in the individual’s care plan. Any unused medication remaining after a monthly medication cycle has passed must be accounted for. 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. Silverdale House Care Home DS0000008790.V325396.R01.S.doc Version 5.2 Page 9 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.V325396.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3 (6 is not applicable) Quality in this outcome area is poor. Residents have the necessary information about the home to make a choice about living there. But residents are being placed at risk of not getting the right care and support if their needs have not been assessed before being admitted to the home. The rights and responsibilities of residents are not being protected unless all residents are provided with a contract when moving to the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The resident case tracked that was most recently admitted to the home, since the appointment of the new manager, has a pre-admission assessment and the local authority’s community care assessment on their file. There is also a copy of a signed contract that states the weekly fees and the room being occupied. A requirement was made at the last key inspection that all residents must have an up to date contract stating fees and terms and conditions of their placement. This is to protect their rights. There was no evidence of signed
Silverdale House Care Home DS0000008790.V325396.R01.S.doc Version 5.2 Page 11 contracts for the two other residents’ case tracked. Therefore, this requirement remains outstanding. A requirement was made at the last key inspection to ensure all prospective residents have their needs assessed before being admitted to the home. This requirement is also identified as outstanding. No assessment documentation could be located for one of the residents’ case tracked. Issues around this resident’s freedom of movement were identified during the inspection. (Refer to the outcome area Daily Life and Social Activities in this report.) These issues should have been clarified during the assessment process, which would have ensured an appropriate care plan and risk assessment is put in place. The manager has developed and updated the Statement of Purpose and brochure, which contains useful information about fees, services provided and the philosophy of the home. This document is displayed in the main entrance hall and is handed out to new residents or their relatives. Two residents spoken with confirmed they had their own copy. Silverdale House Care Home DS0000008790.V325396.R01.S.doc Version 5.2 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. There are adequate arrangements in place for meeting the health and personal care needs of residents that upholds their right to privacy and respect. More attention on how to respond to behaviours and agitation is required. The medication management at the home continues to improve but there are areas of poor practise that puts one or more resident at risk of treatment failure and harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All three residents case tracked have individual care plans in place that cover all aspects of their health, personal care and social needs. There was evidence on the care plans that they are being reviewed on a monthly basis, so that any changes and amendments to care plans can be made. Relatives spoken with said they are aware of care plans being in place and also confirmed that staff will contact them with any problems or changes to care given. Two residents spoken with were unfamiliar with their care plans. It is recommended that there is evidence added to care plans, in the form of signatures, when residents have been involved. Care plans include individuals’ preferences, for example “[the resident] likes cushions at the back of her when sitting in a
Silverdale House Care Home DS0000008790.V325396.R01.S.doc Version 5.2 Page 13 chair” and preferring two pillows when sleeping. Care plans and daily records indicate that healthcare professionals such as dieticians and continence nurses are involved in residents care when there is a need. Nutritional screening tools and other assessments for moving and handling, falls and skin care are undertaken regularly, which are important for promoting and maintaining safety and good health. Visits from district nurses and their advice was clearly noted in the records seen. All staff spoken with explained how they ensure the dignity and respect of residents is protected at all times, such as assisting with personal care in private, explaining what support is being given and enabling the resident to do as much as they can for themselves. A relative spoken with commented on the helpfulness of the staff and that she has never observed staff talking to or treating residents wrongly. One resident was observed going to the toilet independently and leaving the door ajar, with her frame. The manager explained that according to staff, the resident chooses to toilet in this way in case she falls. It is recommended that the level of support this resident requires with going to the toilet is reviewed with the resident to look at ways the resident can feel safe whilst at the same time promote and uphold her dignity. For example, a staff member stands outside the toilet during this time and / or assists her getting on and off. A resident spoken with mentioned how there have been times he has not been allowed out. Daily records for this resident do make reference to these incidents, stating how the resident has become unsettled, and wanting to return home. The home has no powers to restrict this resident’s freedom of movement; this is a breach of human rights. If there are concerns about the resident’s safety a thorough risk assessment is required identifying the risks if the resident goes out independently and what are the appropriate measures for promoting their safety and wellbeing. Daily records indicate that some of these episodes have resulted in the resident being given medication to calm him down. The manager reported that it is the senior care assistant that makes the decision when to give this medication. To ensure the resident is not inappropriately restrained by medication then a care plan must be developed that gives clear guidance to staff on steps to take to relieve the resident’s anxiety and at what stage if this does not work does medication need to be given. Pharmacy inspectors report The home have recently switched to a different Pharmacy supplier and most of the resident’s medication enters the home in blistered in monthly packs. All the residents have their medicines administered to them with assistance from staff. Silverdale House Care Home DS0000008790.V325396.R01.S.doc Version 5.2 Page 14 Only trained staff would be allowed to administer medication and the home would ensure a senior trained staff member was available throughout a night shift. Medicines are stored securely at the home. On arrival the senior was bulk signing the medication administration charts. The senior stated he was aware “this was not good practise and would normally sign as he gave out the medication”. Anomalies were seen on the medication administration record sheets. These related to signatures for administration showing overdosing, lack of documentation why a “when required” medicines was not given and medication that was no longer required still remaining on the record sheets and a supply was in the current blisters. Also when hand written administration sheets was used there was lack of essential information required on it for the safe administration of the medicine. For example it was noted for one resident for one day, medication that was prescribed as a once daily dose had been recorded as given morning and at night (overdose). In addition a prescribed cream was not being recorded as being applied as prescribed by the doctor. The senior informed me that carers would apply creams. This would happen when they were dealing with the resident’s personal needs and then would not necessarily sign the administration record sheets. Lack of documentation made on what medication was carried forward for each resident made it difficult to carry out medication audits. Two audits that were carried out showed the records of administration and quantity of medicine held at the home did not tally. This indicated incorrect administration had occurred, as staff are not following prescribers instructions or inaccurate record keeping. An audit for a recently prescribed antibiotic reflected that this had been administered and recording correctly. The care plans for a new resident was viewed with regards to medication information. It contained a medication profile indicating what prescribed medication the resident was taking but it did not contain doses or quantities that had arrived in to the home. This resident had yet to receive a new prescription while at the home and the staff were using medication that had been brought in with them. An issue arose regarding a resident being prescribed a “when required” dose of a pain relief but the resident had no verbal communication. The senior was
Silverdale House Care Home DS0000008790.V325396.R01.S.doc Version 5.2 Page 15 keen to ensure that the prescriber is contacted regarding this matter. This is important as the home need to ensure they are dealing with her pain relief needs consistently and effectively. After observing a medication round it was concluded that the senior dealt with the residents with dignity and respect when giving out medication. A resident was spoken with regarding her medication. When asked did she get her medicines when she needs them she replied, “ all is ok with medicines, the home has changed a lot”. “The home respond to my needs and get my tablets on time”. Silverdale House Care Home DS0000008790.V325396.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. Meeting residents’ recreational needs and maintaining contact with family and friends is managed well in accordance with residents’ wishes. There are good arrangements in place for providing wholesome appealing meals. This judgement has been made using available evidence including a visit to this service. 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 in general they still feel in control of their lives by being able to choose to participate in activities or spend time alone, when they wish to get up and what meal they would like. Residents were observed enjoying their mealtime. Menu plans are currently being updated through consultation with residents. On the day of the inspection the main meal was fish pie or roast lamb with green beans and potatoes. Records show that choice and a variety of meals and vegetables are offered. Silverdale House Care Home DS0000008790.V325396.R01.S.doc Version 5.2 Page 17 Three residents spoken with talked about enjoying a game of cards and dominoes and playing bingo. There is an activity programme displayed in the hallway, which includes over the week quizzes, movement to music, bingo afternoon, old films, games and crafts. A staff member was always observed in the lounge spending time with residents talking with them and having a sing-a-long. Silverdale House Care Home DS0000008790.V325396.R01.S.doc Version 5.2 Page 18 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is poor. Concerns and complaints are poorly managed, which means residents cannot be assured that their concerns are taken seriously and appropriately acted on. Procedures need to be followed in the event of any allegation of abuse to help ensure residents are protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last key inspection there have been six complaints received by the Commission, mainly about staffing levels and medication practices. Two random inspections have been carried out to make enquiries in respect of two complaints. (Reports for the random inspections are publicly available, by request). Four of the complaints were referred back to the provider to be investigated using their own complaints procedure. Evidence found at the first random inspection indicated that the first complaint referred back to the provider had not been investigated thoroughly enough, with lack of records substantiating the outcomes of the investigation. All complaints referred back to the provider have not been recorded under the home’s Complaint Procedure and neither are there records of other complaints made by residents that came to light during discussion with residents. At the last random inspection the registered provider reported to have never received one of the complaints that was referred back to the provider for investigating. The information was resent to the registered provider, with a
Silverdale House Care Home DS0000008790.V325396.R01.S.doc Version 5.2 Page 19 request to send the Commission a copy of the investigation report by 30th November 2006. This was never received and there is no evidence in the home that any investigation has taken place. One of the complainants has remained in contact with the Commission to inform us that their complaint, regarding their relative’s healthcare, has still not been responded to. The complaint was initially made in August 06. The manager reported during the inspection that quite recently a care assistant alerted the manager to their concerns after hearing how another care assistant was talking to a resident when assisting with personal care. This issue is an alleged incident of abuse / misconduct, and therefore adult abuse procedures should have been followed and both the Commission and Social Services should have been notified. The manager explained that findings of an investigation were inconclusive. During the inspection it was identified that the care assistant concerned has outstanding induction and training needs that must be addressed. (See outcome area on Staffing) Staff members were spoken with about their responsibilities to whistle-blow / alert the manager of any allegation or suspicion of abuse. One staff member did not understand their responsibilities as they said they would pass it on depending on whether the allegation was a lie or the truth. Both staff members spoken with have not had training in adult abuse. This is a requirement for all staff, to ensure that all residents are protected from all forms of abuse. Silverdale House Care Home DS0000008790.V325396.R01.S.doc Version 5.2 Page 20 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, 24 and 26 Quality in this outcome area is adequate. Overall the environment is safe, comfortable and homely for residents, but some additional attention to general maintenance and cleanliness is required. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The bedrooms seen are personalised with residents’ own possessions such as items of furniture, ornaments and pictures. The bedrooms seen are pleasantly decorated and appear and smell clean. Communal areas are comfortably furnished. The chairs in the dining room still had their plastic covering on, which is not very dignifying for residents. This was identified to the manager, who then instructed for the plastic covering to be immediately removed, which was done so. The laundry and sluice facilities are appropriate to meeting the needs of residents. Laundry tasks are carried out by a laundry assistant, which means that care staff can concentrate on supporting residents. (See outcome area on Staffing.)
Silverdale House Care Home DS0000008790.V325396.R01.S.doc Version 5.2 Page 21 The maintenance book was looked at and showed that any maintenance work required is done without unreasonable delay. Areas in need of improvement are as follows: 1. There are square tiles missing in the ceiling in one of the first floor bathrooms. This is unsightly for residents have a bath. 2. The toilet next to the lounge does not have a working lock on it. This does not uphold residents’ right to privacy. 3. The toilet down the corridor on the first floor was found to have faeces on the toilet seat on two separate occasions. Toilet checks will need to be implemented to ensure they are clean and hygienic at all times. Silverdale House Care Home DS0000008790.V325396.R01.S.doc Version 5.2 Page 22 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. Staffing levels in the home have improved, which helps ensure residents needs are being met. However, limited improvements to training mean that the risk of residents’ needs not being appropriately and safely met continues. Not all the necessary recruitment checks are carried out, which place residents at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the new manager has been in post some positive changes have been made to staffing arrangements and numbers. The shift patterns are more simplified. The staff rota shows that there is now always a senior care assistant and three care assistants on during the day and two waking night staff at night. There is now also a deputy manager in post. Care staff are no longer responsible for laundry tasks and preparing teas in the afternoon. All staff spoken with only had positive comments about the new arrangements and confirmed that they are now able to spend more time with residents. A resident spoken with said that she has noticed a significant difference, with staff being around more to help. A requirement to ensure all the staff team are appropriately trained was made at the last key inspection in April 2006 and at the inspection in January 2006 it was highlighted that the evidence of training was not adequate. This is still the case now. Two out of the four staff files selected do not contain evidence of up to date training. Two staff members spoken with that have been in post six
Silverdale House Care Home DS0000008790.V325396.R01.S.doc Version 5.2 Page 23 months and four months have not been on any mandatory health and safety training such as moving and handling, first aid, food hygiene and infection control and neither has completed Skills for Care common induction standards. Training on dementia care and any other specific needs of residents is also required, so that appropriate support and understanding can be given. It is evident that since the new manager has been in post some progress is being made in training staff. The manager has devised a training matrix in order to identify training needs and six care assistants are soon commencing National Vocational Qualification (NVQ) level 2 and two care assistants NVQ 3. Nevertheless, the requirement to ensure all staff have all relevant training, including mandatory health and safety training should however been fully complied with before the new manager was appointed, therefore remains outstanding in this report. There was evidence of a satisfactory criminal record bureau check and a POVA first check on all four files. Ensuring that written references are obtained before a staff member commences employment was set as a requirement at the last key inspection. This requirement was found complied with at the following random inspection. On this occasion however, two of the four staff files selected, of staff that have commenced employment since the last key inspection, did not contain two written references. The requirement to ensure all necessary checks are carried out is made again in this report. Silverdale House Care Home DS0000008790.V325396.R01.S.doc Version 5.2 Page 24 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 and 38 Quality in this outcome area is poor. Financial procedures have improved, which will ensure residents money is safe and accessible to them. Lack of training and testing of equipment means the health and safety of residents and staff is at risk. Quality monitoring still needs to be implemented in the home, to ensure it is run in residents’ best interests. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The newly appointed manager is a qualified nurse and has the National Vocational Qualification (NVQ) level 4 Registered Managers Award. The manager is in breach of the Care Standards Act 2000 because she is not yet registered therefore an application is required as soon as possible to avoid prosecution. Both staff and residents spoken with praised the efforts of the
Silverdale House Care Home DS0000008790.V325396.R01.S.doc Version 5.2 Page 25 manager in making improvements to the home. It is evident that the manager is paying attention to the outstanding requirements and recommendations but because the manager has been in post for only three weeks it mainly intent at this stage rather than evidence that requirements are fully complied with. The manager has set up a more simplified system for holding residents monies on their behalf. The transaction records and money was examined for one resident and all was in order. Residents spoken with confirmed they have access to money when they want it and have a lockable facility for the security of their possessions. The requirement to ensure the quality of the service is being monitored and reviewed remains outstanding in this report because there has been no system in place since the requirement should have been fully complied as of 30th June 2006. The newly appointed manager is in the process of implementing a new system and supplied evidence of questionnaires that will be sent out to residents, relatives and stakeholders and the auditing tools were seen. The manager intends to undertake regular audits of different aspects of the service such as health and safety, environment, care planning, dignity and medication. Now what must happen is for this system to be implemented, to ensure that the necessary improvements are made to the service. Fridge and freezer temperatures are being recorded on a daily basis and fire extinguishers have been serviced. The fire safety logs shows gaps when weekly fire alarm testing has not been undertaken. Electrical portable appliance testing and the servicing of central heating and boiler system appear to be overdue. As already pointed out under the Staffing outcome area, not all staff members have had the required health and safety training in moving and handling, first aid, food hygiene and fire safety. Silverdale House Care Home DS0000008790.V325396.R01.S.doc Version 5.2 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 3 1 1 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 2 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 1 17 X 18 1 2 X X X X 3 X 1 STAFFING Standard No Score 27 3 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 X X 1 Silverdale House Care Home DS0000008790.V325396.R01.S.doc Version 5.2 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. Standar d OP2 Regulation 5 Requirement Timescale for action 24/01/07 2. OP3 14 3. OP9 13(2) 4. OP9 13(2) The Medicines Act 1968 Ensure all residents are provided with a signed contract, which states the amount and method of payment of fees. This is an outstanding requirement from the previous key inspection, initial timescale 31/05/06 not met. Ensure that all residents have an 24/01/07 assessment of their needs prior to their admission. This is an outstanding requirement from the previous key inspection, initial timescale 31/05/06 not met. Ensure all residents that have ‘as 30/03/07 required’ medication for controlling anxiety and behaviour that there are clear and detailed care plans on when it becomes necessary for this medicine to be administered. All medicines must be 23/02/07 administered following the Prescriber’s instructions. All nonadministered doses of regularly prescribed or “when required”
DS0000008790.V325396.R01.S.doc Version 5.2 Silverdale House Care Home Page 28 5. OP9 13(2) 17 6. OP9 13(2) 7. OP16 17(2), 22 8. OP18 13(6) 9. 10. OP26 OP29 16(2)(j), 23(2)(d) 19 medicines should be dealt with appropriately, consistently and ensuring the resident’s health and welfare is at the centre of any action taken. All medicines when entering the premises, being removed from the home and when taken by residents must be accounted for accurately for each resident All medicinal creams or ointments must be applied by appropriately trained staff, following the Prescriber’s instructions (as seen on the dispensing label and medication administration sheets) and be documented. Any period of nonadministration should be recorded with the reason. Ensure in accordance with Schedule 4 that a record is kept of all complaints made by service users or representatives / relatives or by persons working at the care home and the action taken by the registered person in respect of any such complaint. This is an outstanding requirement, which has been revisited at the two previous random inspections, and is still not complied with. Initial timescale, 30/05/06 not met. Ensure that procedures are followed in the event of any disclosure of abuse, and that all staff are trained to recognise abuse and know their responsibilities to report abuse / whistle-blow. Ensure the cleanliness and hygiene of toilets is maintained at all times. Ensure that two written references are obtained for all staff, before they commence
DS0000008790.V325396.R01.S.doc 23/02/07 23/02/07 24/01/07 30/03/07 01/03/07 30/03/07 Silverdale House Care Home Version 5.2 Page 29 11. OP30 18 12. OP33 24 13. OP38 23 their employment. This is to ensure residents are protected. Ensure that all staff members receive all required training appropriate to their role. This includes all mandatory health and safety training, induction, dementia training and any other training relevant to the needs of residents. This is to ensure that residents are in safe hands at all times. This is an outstanding requirement from the previous key inspection, initial timescale 31/05/06 not met. Ensure there is a system for quality monitoring and quality assurance, based on seeking the views of residents. This is to ensure that the home is run in their best interests and to measure success in meeting aims and objectives of service provided. This is an outstanding requirement, initial timescale 30/06/06 not met. In consultation with the relevant authorities ensure all fire safety, electrical safety and gas safety testing is carried out, to avoid enforcement action by them. 24/01/07 24/01/07 01/04/07 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. Refer to Standard OP7 Good Practice Recommendations Include evidence on care plans when residents have been involved in developing and reviewing them.
DS0000008790.V325396.R01.S.doc Version 5.2 Page 30 Silverdale House Care Home 2. 3. 4. 5. 6. OP7 OP10 OP19 OP28 OP29 Carry out risk assessment for the resident that is vulnerable when out in the community and ensure this risk assessment is regularly reviewed with the resident. For the resident that chooses to go to the toilet with the door ajar review this arrangement in order to identify type of support that promotes the resident’s dignity. Take action on the areas of the environment that need improvement, identified in the main body of the report. Ensure at least 50 of the staff team is qualified to at least national vocational qualification (NVQ) level 2 social care. 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. Silverdale House Care Home DS0000008790.V325396.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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
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