Inspection on 18/07/07 for Silverlea Residential Home

This inspection was carried out on 18th July 2007.

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

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

Other inspections for this house

Silverlea Residential Home 21/01/08

Silverlea Residential Home 20/02/07

Silverlea Residential Home 15/06/06

Silverlea Residential Home 02/03/06

Silverlea Residential Home 09/06/05

Silverlea Residential Home 09/11/04

Similar services:

Snydale Care Home

Abbey The

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Silverlea Residential Home 3 First Avenue Bradford Moor Bradford West Yorkshire BD3 7JG Lead Inspector Steve Marsh Key Unannounced Inspection 18th July 2007 09:50 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 Silverlea Residential Home DS0000061674.V340678.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. Silverlea Residential Home DS0000061674.V340678.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Silverlea Residential Home Address 3 First Avenue Bradford Moor Bradford West Yorkshire BD3 7JG 01274 661700 01274 660611 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) Mr Kevin Casey vacant post Care Home 35 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (35), of places Physical disability over 65 years of age (3) Silverlea Residential Home DS0000061674.V340678.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th February 2007 Brief Description of the Service: Silverlea Care Home is a large detached adapted property, located in the Bradford Moor area, overlooking the park and about one mile from the city centre. The home is registered to provide personal care to thirty-five people in both single and double bedrooms, situated on all four floors of the building. There are steps to the front of the home however level access is available to the rear of the property and there is a passenger lift to all floors. Internally the home is still in need of extensive refurbishment, which includes decorating many of the bedrooms and communal areas. Externally there is a patio area to the front of the property, which people are able to use during the summer months. The home is on a main bus route from the city centre and there is street parking to the front of the property. The fees range from £318.14p to £354.75p per week (£365.00 for self funding clients). Additional charges are made for services such as hairdressing, newspapers, private chiropody, outings and the sweet trolley. Silverlea Residential Home DS0000061674.V340678.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by two inspectors who visited the home between 09:50am and 6:15pm. The purpose of this inspection was to assess what progress had been made in meeting the requirements made at the last inspection and the impact of any changes in the quality of life experienced by people living at the home. The methods we used included looking at records, watching staff at work, talking to people living at the home, talking with staff and looking around the property. We also left questionnaires for relatives and people using the service, so that they can share their views and opinions of the service with the us. Two questionnaires were returned, one by a person living at the home and one by a relative. The manager had completed an Annual Quality Assurance self-assessment form and the information provided has been used as evidence in the body of the report. Detailed feedback was given to the Registered Provider and manager at the end of the visit. What the service does well: What has improved since the last inspection? Silverlea Residential Home DS0000061674.V340678.R01.S.doc Version 5.2 Page 6 The home is in the process of introducing a new, more simplified format for care planning, which should make it easier for staff to use the care plans as working documents. Moving and handling plans have been updated and now accurately reflect the individual’s needs. Steps have been taken to make sure that medication is administered and stored as prescribed. More emphasis has been placed on training and the manager is committed to making sure people are cared for by a skilled and experienced workforce. Quality assurance monitoring systems have started to be put in place, however they require further development before they are fully effective. Some improvements have been made to the environment and a new sluice room has been established. What they could do better: The service user guide needs updating so that people are provided with sufficient information to decide if the home is right for them. Needs assessments must be carried out for all people and care plans must accurately reflect the level of care to be provided, so that staff can use them as working documents. Nutritional assessments must be carried out for all people and care plans must reflect what action is being taken to address weight loss or gain, so people can be confident that their healthcare needs are being met. People must be offered a range of appropriate social and leisure activities so they have the opportunity to lead a full and active life. The home continues to need extensive refurbishment both to improve the quality of life for people that live there and to make sure their health and safety is not put at risk. All hoists in use at the home must be tested and serviced in line with the manufacturers instructions. All areas of the home must be kept clean and free from offensive odours. Soap must be provided in all toilets and soiled incontinence pads must be wrapped before they are placed in the clinical waste bags for disposal, so that people are protected from possible cross infection. Staffing levels must be reviewed to make sure that sufficient staff are employed to meet people’s needs and to allow the manager to manage the home effectively. Silverlea Residential Home DS0000061674.V340678.R01.S.doc Version 5.2 Page 7 The home should be working towards at least 50 of the care staff team achieving a NVQ at level two or above. This will make sure that people living in the home are cared for by competent and trained staff. The recruitment and selection procedure for all staff must be thorough, so that the home does not employ staff that are unsuitable to work with vulnerable people. A training programme must be put in place so that staff are able to meet the specialist needs of people in their care and for their own personal development. The manager must obtain a recognised management qualification equivalent to NVQ level 4, to evidence she has the qualification and skills to manage the home effectively. The manager must apply to be registered with us. The Registered Provider must prepare a monthly report on the conduct of the home and supply a copy to us. The manager must establish clear lines of communication with staff by holding regular meetings so that they are aware of any changes in policies and procedures and can act accordingly. Effective quality assurance monitoring systems must be developed so that the home can establish if it is meeting stated aims and objectives. All records relating to the safekeeping of the people’s personal money must be kept up to date. All care staff must receive formal staff supervision with their line manager at least six times a year and be offered the opportunity for personal development. Personal information relating to staff or people living at the home must be stored securely, so that confidentiality is maintained. Risk assessments must be completed for the building and to make sure that established work practices are safe and do not put staff or people living at the home at risk. Silverlea Residential Home DS0000061674.V340678.R01.S.doc Version 5.2 Page 8 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. Silverlea Residential Home DS0000061674.V340678.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 Silverlea Residential Home DS0000061674.V340678.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): 1,3 and 5 Standard 6 is not applicable to this service. People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People do not have up-to-date information to help them make a decision about moving in. People’s needs are assessed and they can visit or stay for a trial period to make sure that the home is right for them. EVIDENCE: The service user guide is out of date which means that people are not given any information about the care and facilities provided, to assist them when choosing a home. The records show that people’s needs are assessed before they are admitted to the home and this assessment forms the basis for the initial care plan. The manager confirmed that people are always invited to visit before admission so they can look round, meet the staff and people already living there and stay for a meal, this helps them decide if they want to move in. Silverlea Residential Home DS0000061674.V340678.R01.S.doc Version 5.2 Page 11 People are also able to move into the home for a trial period so that they can experience first hand the standard of care and facilities provided. The manager confirmed that people offered a place at the home are always supported throughout the admission process and care is taken to make sure they settle in to their new environment. Silverlea Residential Home DS0000061674.V340678.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 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Care records do not provide accurate and up to date information, which means that some people are not receiving the level of support and care they require to meet their health, personal and social care needs. EVIDENCE: We looked at the care records of 5 people in detail. Everyone living in the home has a care plan. The home is in the process of introducing a new, more simplified format for care planning, however progress on this is slow, and all the care plans have not yet been transferred to the new format. The process of care planning starts with a needs assessment, the plans are then drawn up to show how the needs identified by the assessment will be dealt with. In two cases new care plans had been put in place but there was no evidence that a needs assessment had been carried out. In another the needs assessment was not dated so it was not clear how current the information was. Silverlea Residential Home DS0000061674.V340678.R01.S.doc Version 5.2 Page 13 The care plans did not always address all the needs identified in the assessment. For example one person had needs related to confusion, agitation and aggression but there was no care plan to give staff information on how the deal with this. The care plans about personal care tended to focus on bathing and the help people needed getting in and out of the bath. There was little or no information about how people’s daily personal care needs were to be met. Nutritional risk assessments had not been completed in all the care records looked at. One person had lost weight since admission but this was not picked up in the evaluation of the care plan and there was no change to the plan to address this. The records for another person showed a small but steady weight loss, the care records did not identify this as an issue that needed to be dealt with. The manager said the person had been having some dental problems that had caused difficulty eating but this was not evident from the records. The moving and handling risk assessments have all been updated since the last inspection. The records show that people have access to GPs and other health and social care professionals as needed. The home has recently carried out a survey of GPs and questionnaires returned by two GPs indicate that they have no concerns about the standard of care provided. Generally staff have a good understanding of people’s care needs and preferences however this relies on informal systems of communication and is not supported by detailed, accurate and up to date care records. This creates the risk that people’s care needs may be overlooked. The daily records contain very little information about how people actually spend their time. The medication records were up to date. There is now a system for recording and checking the stock balances for medicines that are given on an “as required” basis. Some people continue to manage their own medicines and the appropriate risk assessments are in place. Silverlea Residential Home DS0000061674.V340678.R01.S.doc Version 5.2 Page 14 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 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. More could be done to provide people with a range of appropriate social and leisure activities both within the home and the wider community. EVIDENCE: The amount of information about people’s social care needs and how they would be met varied. Some people prefer to stay in their rooms following their own interests and choose not to join group activities. Generally, this information was well recorded. Other people are less able to occupy their time meaningfully and need support from staff. For this group of people the records provided very little information about their social care needs and how they were being addressed. Staff said they are trying to organise more activities for people but it depended on how busy they are. Because there is no dedicated activities organiser there is no regular programme of activities. The manager said there are plans to nominate someone for this role. Silverlea Residential Home DS0000061674.V340678.R01.S.doc Version 5.2 Page 15 Over the past 2 weeks two groups of people have been taken out for lunch. Staff said they always try to get entertainers in for birthday celebrations; there was a birthday party last Friday. There is an exercise and motivation group once a month run by an external company and staff organise bingo a couple of times a week. On the day of the visit there were no activities. In between meals people were sat in the lounges with televisions on. In one lounge occupied by four elderly ladies a children’s programme was on the television and although staff entered the room they showed no inclination to find a more age appropriate programme for them to watch. One person said the home was fine but there is nothing much to do. People said they enjoyed lunch, one person said, “we get some good meals here”. People said that sometimes they are asked what they want to eat and sometimes they are not, they said it depends on who is on duty. The meal at lunchtime was not what was on the menu, the manager said this was because the cook was off and someone else was cooking. The manager said the menus need to be reviewed but she has not yet had time to do this. Silverlea Residential Home DS0000061674.V340678.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Thorough complaint and adult protection policies and procedures now make sure that individuals are listened to and protected from any form of abuse. EVIDENCE: There is a clear complaints procedure in place and people living at the home said they would have no problems approaching the manager if they had any concerns about the standard of care being provided. The questionnaire returned by a relative also clearly indicated that they were aware of the complaints procedure and who to contact if they had any concerns. No complaints have been received since the last inspection. Adult protection policies and procedures are in place and staff have recently received appropriate training in the recognition and reporting of abuse. Staff spoken to confirmed that they were aware of the home’s policy on “whistle blowing” and were aware of what to do if they felt any practices at the home were not in the best interest of the people living there. Silverlea Residential Home DS0000061674.V340678.R01.S.doc Version 5.2 Page 17 Policies and procedures are available regarding staff involvement in the financial affairs of people living at the home, which does not allow them to become involved in the making of, or benefiting from their wills. Silverlea Residential Home DS0000061674.V340678.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,24,25 and 26 People that use this service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home continues to require extensive refurbishment, both to improve people’s quality of life and to ensure their health and safety is not compromised. EVIDENCE: Following a key inspection in June 2006 the Registered Provider provided us with an improvement plan setting out timescales for the refurbishment of the home, including the completion of outstanding fire safety work. We accepted the timescale given of 30 November 2006 for all work to be completed. The random inspection visit on the 7 November 2006 showed that very little work had been completed. Silverlea Residential Home DS0000061674.V340678.R01.S.doc Version 5.2 Page 19 The main reason for the lack of progress seemed to be that only one person was carrying out the majority of work. We met with the Registered Provider in January 2007 and we agreed to extend the timescale for completion of the refurbishment work to the end of May 2007. The registered provider agreed that additional resources would be brought in to make sure that the work was completed on time. At the last key inspection made in February 2007 progress remained very slow and there continued to be only one person employed to do the work. On this visit it was clear that while some work has been completed the building still requires extensive refurbishment. Work has now been ongoing for over a year to refurbish the home and the timescales agreed with the owner have not been met. All the communal areas are on the ground floor of the home and consist of four lounges and a dining room. The dining room was refurbished earlier in the year however the carpet tiles are badly stained and may not be suitable to use in this area. The standard of décor in the communal areas varies although nearly all the rooms would benefit from decorating and new carpeting as part of the refurbishment programme. The patio doors in one lounge also require replacing as they are beyond repair and there is condensation between the double glazed window units. This room is also currently being used as an office by the clerical assistant and for the storage of garden furniture. It was made clear to the provider that this is not acceptable as it not only poses health and safety issues, but also compromises people’s right to confidentiality as on the day of the visit confidential information was left on top of the desk for anyone to read. The provider was also advised to contact the Environmental Health Department regarding the continued use of the open lounge next to the dining room as a smoking area for people. Bedrooms are situated on all four floors of the home and consist of both double and single rooms. Many of the rooms still require refurbishing and old damaged furniture replacing. A number of seals have gone in double glazed units in the bedroom windows causing condensation and therefore they require re-glazing so that people can see out. Appropriate locks have still not been fitted to some bedroom doors and a number of rooms do not have a lockable cabinet or drawer. This means that people are unable to securely store personal belongings or medication. We noted that in one double bedroom no screens were available and therefore people have no privacy when dressing, washing or using the commode. Silverlea Residential Home DS0000061674.V340678.R01.S.doc Version 5.2 Page 20 Call alarms are located in every bedroom, however in some rooms we noted that the beds had been moved away from their original positions and people were unable to reach the leads for the alarm. They would therefore be unable to summon assistance in an emergency. The manager said that the call alarm system had been upgraded since the last inspection and now staff are unable to listen to private conversation thereby respecting the individuals right to privacy. The alarm cannot now be reset until you go in to the person’s bedroom and bleeps have been provided so that staff can hear the call bells wherever they are in building. There was no certificate or paperwork available to confirm the work had been carried out successfully. The standard of cleanliness in some bedrooms was poor and in two bedrooms in particular there was a strong smell of stale urine. Worn and poor quality towels were also found in some rooms however the manager confirmed that new towels were on order and they were waiting for delivery. To safeguard people from risk of harm the manager must check that radiator guards are fitting to all radiators throughout the building unless they have guaranteed low temperature surfaces. The standard of décor, fixtures and fitting in all bathroom and toilets varies but the majority require decorating as part of the refurbishment programme. Locks require fitting to at least two toilet/bathroom doors to ensure privacy. We noted a lack of soap in many toilets, which obviously means that people are unable to wash their hands after using the facilities. We also noted that in some bathrooms and toilets staff had placed soiled pads directly in the clinical waste bins without wrapping them first, which is poor practice. No records were available to indicate when the hoists had been tested and serviced, although a sticker on one bath hoist was dated 27/09/2004. The home is therefore unable to evidence that the equipment is safe to use and this puts both the people living at the home and staff at risk of injury. The carpet on the main staircase is threadbare in places and requires replacing as part of the refurbishment programme. The staircase in the process of being decorated and the work carried out is of a good quality. However, on the day of the visit the stairs were obstructed by the decorator’s paste table, which might have posed a risk hazard to people living at the home. A mattress had also been left on the floor on the second floor landing. The laundry still requires decorating and a new impermeable floor covering needs to be fitted as part of the refurbishment programme. However, a new sluice room with flushing sluice has been established adjacent to the laundry although minor work is required before the facility is full operational. Silverlea Residential Home DS0000061674.V340678.R01.S.doc Version 5.2 Page 21 Silverlea Residential Home DS0000061674.V340678.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): 27,28,29 and 30 People that use this service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff recruitment and selection procedures are not always followed, which means that people could be put at risk. EVIDENCE: The staff rota showed that on day and night duty the home continue to just meet the minimum staffing levels with little cover available for staff sickness or annual leave. This means that staff only have time to provide basic personal care needs and daily routines being based more around the availability of staff rather than people’s preferences. It is apparent that the present staffing levels continue to make it very difficult for the manager and senior staff to manage the home effectively as they are spending the majority of their time providing “hands on” care. Since the last inspection a part time clerical assistant has been employed but this has been of little benefit and not reduced the amount of administration work the manager is required to complete. There is a recruitment and selection procedure in place, which includes obtaining at least two written references and a Criminal Record Bureau check before new staff are employed. Silverlea Residential Home DS0000061674.V340678.R01.S.doc Version 5.2 Page 23 However on reviewing the employment records of four recently appointed staff we noted that in all four instances the references accepted by the home were not signed or dated and gave no clear indication who they had been requested from or who had actually wrote them. We also noted that the application form submitted by the recently appointed manager was very poorly completed and gave little information about her suitability to manage the home. It was apparent that as the manager had previously been employed at the home the Registered Provider had not carried out a thorough recruitment process. One reference had been requested and accepted from a person not able to comment on her management skills and there was no evidence on file to suggest that a formal interview had taken place. This is poor employment practice, which might lead to the home employing staff who are unsuitable to work with vulnerable people. The manager also confirmed that no staff have yet received contracts of employments although they do have job descriptions, which outline their roles and responsibilities. Training records are now available for staff and clearly indicate that since taking up post the manager has made every effort to make sure that staff undertaken at least induction and mandatory training, so they have the skills and experience to carry out their roles. However, specialist training to meet the needs of individuals and for their own personal development is still required. The manager confirmed that following induction training there is an expectation that they will achieve a National Vocational Qualification (NVQ) at level two or above depending on the post they hold. At present eleven staff have achieved the award and one is working towards it. Staff spoken with said that the level and quality of training provided is good and confirmed that the manager is committed to ensuring that people benefit from having a trained, skilled and experienced workforce caring for them. Silverlea Residential Home DS0000061674.V340678.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): 31,32,33,35,36,37 and 38 People that use this service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There are no clear lines of communication or accountability between the Registered Provider and manager, which means that the home is not being managed effectively and in the best interest of people living there. EVIDENCE: Mrs Jean Marlow was appointed manager of the home in February 2007 although as yet is not registered with the Commission. The home has been without a registered manager since October 2005. Mrs Marlow has many years experience in the caring profession and this is the second time she has managed Silverlea Care Home. Silverlea Residential Home DS0000061674.V340678.R01.S.doc Version 5.2 Page 25 Mrs Marlow has not yet achieved a NVQ in management and care (or equivalent), however she confirmed that it is her intention to start studying for the award in the near future. Staff confirmed that the manager has an open and approachable management style and people living at the home were very pleased that she had returned. However, it is clear that the manager is finding it very difficult to manage the home effectively as due to the staffing levels she spends the majority of her time providing “hands on “ care and not carrying out her managerial responsibilities. Currently the provider only allows the manager ten supernumerary hours per week to address all the outstanding issues at the home. This does not give the manager adequate time to carry out her managerial responsibilities. Staff do not have formal one-to-one supervision with the manager and no staff meetings have been held since she took up post. This means that there are no clear channels of communication within the home or systems in place to monitor staff practice and performance or develop skills. It is therefore essential that the manager is not used as a carer but is allowed to manage the home and move the service forward, for the benefit of the people living there. At the moment there is no evidence to suggest that the provider is allowing the manager to develop her role by taking charge of budget or involving her in management decisions. The last two managers employed at the home have experienced the same problems and therefore the provider must address this as a matter of urgency and establish clear lines of communication and accountability between himself and the manager. To assist in this process the Registered Provider must now provide us with a monthly written report on the conduct of the home as required under Regulation 26 of the Care Homes Regulations 2001. Since the last inspection some quality assurance systems have been put in place although the manager needs to develop the systems further before they are effective. A survey of relatives and other healthcare professionals was carried out in June 2007 and the initial response has been positive. Comments include “I have no concerns about the quality of care” and “staff are always friendly and make everyone feel at ease”. Once summarised the manager will provide the Commission and any other interested party with a copy. People living at the home continue to be encouraged to take control of their financial affairs if at all possible although the home still holds money in safe keeping for some people. Concerns were again raised about financial Silverlea Residential Home DS0000061674.V340678.R01.S.doc Version 5.2 Page 26 transaction sheets not being up to date, as the Registered Provider consistently fails to pay people their personal allowances on the date it is due. Record keeping at the home is generally poor as the office used by the manager is very small and disorganised, making it very difficult to access information easily. Policies and procedures are in place to safeguard the health and safety of the residents, visitors, and staff. However, additional risk assessments still need to be carried out for the building and to make sure staff follow safe-working practices. Silverlea Residential Home DS0000061674.V340678.R01.S.doc Version 5.2 Page 27 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 2 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 2 2 1 X 1 2 1 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 2 X 1 1 1 2 Silverlea Residential Home DS0000061674.V340678.R01.S.doc Version 5.2 Page 28 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 OP1 Regulation 4 -- 5 Requirement The service user guide must be updated so that people are provided with sufficient information to decide if the home is right for them. Outstanding from last inspection – timescale 30/04/07 not met. Care plans must accurately reflect the level of care to be provided. So that people living in the home receive the care they need. Outstanding from last inspection report – timescale 31/03/07 not met. Nutritional assessments must be carried out for all people. Care plans must accurately reflect what action is being taken to address weight loss or gain so people can be confident that their healthcare needs are being met. People must be offered a range of appropriate social and leisure DS0000061674.V340678.R01.S.doc Timescale for action 30/09/07 2. OP7 15 22/10/07 3. OP8 13 30/09/07 4. OP12 16(m) 30/09/07 Silverlea Residential Home Version 5.2 Page 29 activities so they have the opportunity to lead a full and active life. 5. OP19 23 The following areas of the home 30/11/07 must be refurbished: Ground Floor - Entrance and corridors. Lower Ground Floor - Corridors and staircase leading to ground floor. Main staircase - New carpet to be fitted. Bedrooms - Redecorating, refurbishment including replacing old/worn furniture. Appropriate locks must be fitted to all bedroom doors. Communal areas - Refurbish as required including replacing all old furniture. All work highlighted by the Fire Safety Officer must be included in the refurbishment programme. Outstanding from last inspection -- timescales 12/11/06 and 31/05/07 not met. 6. OP20 13(4)(a) The office equipment and garden 31/08/07 furniture must be removed from the lounge so that people are not put at risk. The patio door in the lounge must be replaced so that it can be locked securely and people can see through it. All bathrooms and toilets must be decorated as part of the refurbishment programme and locks fitted as required. A copy of the service certificate for the emergency call system must be forwarded to us. DS0000061674.V340678.R01.S.doc 7. OP20 23(2)(b) 30/09/07 8. OP21 23 30/11/07 9. OP22 23(2) 31/08/07 Silverlea Residential Home Version 5.2 Page 30 People living at the home must have easy access to the emergency call leads when in bed so that they are able to summon assistance if required. 10. OP22 13 To safeguard people from the risk of injury all hoists in use at the home must be tested and serviced in line with the manufacturer’s instructions. Double glazed window units must be replaced as required, so that people can see through them. Outstanding from last four inspection reports timescales 31/03/05, 31/12/05, 31/05/06, 31/08/06 and 30/04/07 not met. Screening must be provided in all double bedrooms, so that people’s right to privacy is respected. To safeguard people radiator guards must be fitted to all radiators throughout the building unless they have guaranteed low temperature surfaces. All areas of the home must be kept clean and free from offensive odours. Outstanding from last inspection – timescale 31/03/07 not met. Soap must be provided in all toilets and soiled incontinence pads must be wrapped before they are placed in the clinical waste bags for disposal so that people are protected from possible cross infection. Silverlea Residential Home DS0000061674.V340678.R01.S.doc Version 5.2 Page 31 30/09/07 11. OP24 23 30/09/07 12. OP24 16 31/08/07 13. OP25 13 30/11/07 14. OP26 23 31/08/07 15. OP27 18 The current staffing levels must be reviewed so that sufficient staff are employed, both to meet people’s needs and to make sure that the home can be managed effectively. Outstanding from last inspection – timescale 31/03/07 not met. The recruitment and selection procedure for all staff must be thorough, so that the home does not employ staff that are unsuitable to work with vulnerable people. A training programme must be put in place so that staff are able to meet the specialist needs of people in their care and for their own personal development. 30/09/07 16. OP29 19 31/08/07 17. OP30 18(c) 30/09/07 18. OP31 9(2)(i) The manager must obtain a 31/12/07 recognised management qualification equivalent to NVQ level 4, to evidence she has the qualification and skills to manage the home effectively. The manager must apply to the Commission for registration. The Registered Provider and manager must establish clear lines of communication and accountability, so that the home can be managed effectively and provide people with quality care. The Registered Provider must prepare a monthly report on the conduct of the home and supply a copy to the Commission. Effective quality assurance monitoring systems must be established and maintained. DS0000061674.V340678.R01.S.doc 19. 20. OP31 OP31 9 12(5)(a) 31/08/07 31/08/07 21. OP31 26 31/08/07 22. OP33 24 30/09/07 Silverlea Residential Home Version 5.2 Page 32 23. OP35 17(2) . All records relating to the safekeeping of the people’s personal money must be kept up to date. Outstanding from last inspection - timescale 31/07/06 and 31/03/07 not met. 31/08/07 24. OP36 18(2) 25. OP37 17 Formal staff supervision must 30/09/07 take place at least six times a year, so that staff receive the support they need to carry out their roles. Personal information relating to 31/08/07 staff or people living at the home must be stored securely, so that confidentiality is maintained. Outstanding from last inspection report – timescale 31/03/07 not met. Risk assessments must be completed/updated for the premises and to ensure safe working practices. Outstanding from last inspection report – timescale 30/04/07 not met. 31/08/07 26. OP38 13(4) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP26 OP26 Good Practice Recommendations It is recommended that a washing machine with a designated sluice programme be purchased. It is recommended that the laundry area is refurbished and a new impermeable floor covering fitted. DS0000061674.V340678.R01.S.doc Version 5.2 Page 33 Silverlea Residential Home 3. OP32 The manager should establish clear lines of communication with staff by holding regular meetings so that they are aware of any changes in policies and procedures. Silverlea Residential Home DS0000061674.V340678.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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