Inspection on 22/01/07 for Simonsfield

This inspection was carried out on 22nd January 2007.

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.

Other inspections for this house

Simonsfield 08/07/08

Simonsfield 14/02/08

Simonsfield 29/10/07

Simonsfield 21/10/05

Simonsfield 21/10/04

Simonsfield 26/04/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Simonsfield 1a Sunbury Road Liverpool Merseyside L4 2TS Lead Inspector Mrs Julie Garrity Key Unannounced Inspection 10:30 22 of January 2007 nd 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 Simonsfield DS0000059308.V323231.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. Simonsfield DS0000059308.V323231.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Simonsfield Address 1a Sunbury Road Liverpool Merseyside L4 2TS 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) 0151 260 7918 0151 260 0319 European Wellcare Homes Ltd Diane Moon Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places Simonsfield DS0000059308.V323231.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 36 nursing beds and 36 personal care in the overall number of 36. Two named adults (18-64 years) may be accommodated. Date of last inspection 21st October 2005 Brief Description of the Service: Simonsfield is registered with CSCI to provide nursing care and personal care for 36 residents aged 65 or over. Although registered for nursing care the home does not currently provide nursing care, as they do not have sufficient nursing staff employed within the home to provide this service. It is a purpose built care home with several sitting areas for residents to socialise, sit quietly or entertain visitors and friends. A separate smoking lounge is provided. Bedrooms are located on all three floors in the home and there is a passenger lift that provides access to all the floors. There are gardens located at the rare and side of the home and large parking area at the front of the building. Simonsfield is located on a quiet residential road near to Stanley Park. There are bus stops within 10 minutes walk on a main bus route to and from Liverpool. The home is owned European Wellcare Homes Ltd, which owns several homes that provide a variety of care and support to residents living in them. The manager has worked in the home for several years and is registered with CSCI. The fees for the home are at Local Authority rates. Simonsfield DS0000059308.V323231.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out over a period of one day. The inspector arrived at the home at 10:20 and left at 15.45. The inspector spoke with 9 residents, 1 visitor, 6 staff and the manager. The inspector completed the inspection by a site visit Simonsfield, a review took place of many of the records available in the home and CSCI offices. These included care plans, accident records, staff rota, staff files, maintenance records, menus, information sent to CSCI by Simonsfield and a pre-inspection questionnaire completed by the home. This site visit included discussions with residents, visitors, staff and management. The inspector followed an inspection plan written before the start of the inspection to ensure that all areas identified in need of review were covered. All of the Key standards were covered in this inspection, these are detailed in the report. Feedback was given to the manager during and at the end of the inspection. The arrangements for equality and diversity were discussed during the visit and are detailed throughout this report. Particular emphasis was placed on the methods that the home used to determine individual needs, promote independence and support to make informed decisions in line with individual choices. What the service does well: What has improved since the last inspection? Simonsfield DS0000059308.V323231.R01.S.doc Version 5.2 Page 6 The manager has put into place new care plans that cover a lot of areas of care and has also included in the majority of care records a social history of the resident before they moved into the home. A redecoration programme has been planned but as yet has not been put into place. Training has commenced for some staff in areas identified as needed such as dementia training. Staff spoken with said that they found this training very useful. What they could do better: Records within the home in particular the care plans are in need of development they do not reflect the resident’s needs and do not provide staff with clear instructions on how to meet resident’s needs including their personal choices and preferences. This includes the arrangements for residents accessing larger amounts of their own funds as limited amount of money is kept in the home. Medications are in need of development, as residents are not receiving their medications as prescribed. Although records for medications were generally very good there were a number of areas where instructions were unclear or had been altered without evidence that the GP who prescribed the medication was aware of this. Staffing levels have been reduced as there are fewer residents in the home and there is a shortage of staff to cover the night shift. Day staff are covering the night shift and the manager has on several occasions not been additional to the normal staffing levels as she has been in the past. Staffing levels have not been determined by assessing the resident’s needs. Some staff training is in place that meets the resident’s needs but this needs to be expanded to all staff who need it and cover all the areas identified from residents assessed needs. Staff training should also include logging all concerns and how any allegations would be dealt with. There have been 58 falls of residents in an 8-month period all but 5 of these were not seen by the staff and the resident either later told the staff or were found on the floor. It was identified that 6 residents had had 3 or more falls in this time period, however none of them had, had a risk assessment in place at this time. The certificate on display has a condition for two named residents aged under 65. The manager sate that there are no individuals aged under 65 living in the home. The registered person must write to CSCI in order that a new and accurate certificate can be issues. Simonsfield DS0000059308.V323231.R01.S.doc Version 5.2 Page 7 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. Simonsfield DS0000059308.V323231.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Simonsfield DS0000059308.V323231.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 was reviewed in this area. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All residents are assessed before they are admitted to make sure that the home can meet their needs. This assessment is shared with the residents and their relatives and they are supported to give personal information in a sensitive manner. EVIDENCE: The service users guide and the admissions policy contains information for residents and staff that supports this good practice. Residents and relatives said that they were “invited” to spend time in the home before an admission. All family members spoken with said came to “look around the home” and they were made very “welcome”. The manager said that she does an assessment on all residents they move in. Copies of assessments were seen in all of the care plans looked at. Relatives Simonsfield DS0000059308.V323231.R01.S.doc Version 5.2 Page 10 and residents spoken with said that the manager had been “helpful” whilst doing the assessment and that they had felt “it was easy to talk to her and make sure she knew about my needs”. All residents who have their stay paid for by Social Services have a copy of Social Services assessment obtained by the manager before admittance. Copies of these were seen in the resident’s files. The assessments can be used to help the staff write care plans that detailed how resident’s needs are to be meet. Information to new residents and their families about the home is readily available. Different formats are available for residents such as large print and Braille. These can be arranged by the home. A present the home does not have newsletters or information available on tape, video or in picture format. However they are exploring ways of making sure that all information in the home is available for residents in a variety of different formats that are easy to obtain and can be given to the residents quickly. Simonsfield DS0000059308.V323231.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 were reviewed in this area. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans are not in enough detail for staff to make sure that they deliver the right care to the residents. Medicines in the home were not being managed safely and residents were not receiving the medication that had been prescribed. Staff were aware of how to maintain residents dignity but were not always making sure that this was how they dealt with residents. EVIDENCE: Residents were very positive about the care they receive from the staff this included the manner in which staff attended to them. Comments included they are so lovely, very caring nature and staff are so kind they do everything that they can to help. Four care plans were looked at in full, care plans did not have any evidence that they had been written with the residents or their relatives. The care plans were written in two different forms and included a lot of areas. This had Simonsfield DS0000059308.V323231.R01.S.doc Version 5.2 Page 12 resulted in very long and complicated plans. When reviewed the plans did not contain specific detail as to the care or support of the residents. There was inconsistency in the format that had resulted in some plans containing information about the social needs of the residents and others not having any information of this nature available. Staff spoken with did not read the plans as they found them too long and difficult as such they had relied on the verbal conversations that they had with each other to tell them the different needs of the residents. Residents spoken with had not seen any of the written records or care plans that the home kept about them. One resident said, “it would be nice to read it. I think they do a good job, but I don’t need much anyway”. Discussions with staff detail that they relied on verbal communication. There was confusion as to precisely what individual care needs were needed for each resident. Staff were inconsistent in their approach and a comment made on several occasions was “we are told different things by different people. Residents are supported to choose their own GP or stay with their current GP and staff do contact external advice when needed such as dieticians, GP’s and District Nurses. Records in general regarding healthcare were brief and did not clearly state the purpose of the professional’s intervention or what the action the staff should take. This information could be written in one or all of three different places and added to staffs’ inconsistent approach. Medications were reviewed. Records for medications were good. Medications for eight residents were checked. In all cases the amounts received, the amounts given and the amounts left available did not add up correctly. This means that medications have not been given correctly. In all cases there was at least 3-6 tablets that should have been given since the medications were received. This had been signed for. Staff have been signing that the medications has been given on several occasions but have not given it. This is poor practice. Staff had altered the medication to give as required on one medication but there was no evidence that this had been done with the GP’s permission. Instructions to the dosage of a medication designed to prevent blood clotting given to one resident were unclear. This practice places this resident at risk of receiving an incorrect dosage. The manager said that audits had been regularly done on medications until recently and these had ceased as practice had improved. It is good practice to undertake regular audits as this helps identify poor practice rapidly. Discussions with staff detail that they were mindful all times about the dignity and privacy needs of the residents in their care. They discussed knocking on bedroom doors, keeping residents covered whilst assisting them to bathe and speaking to resident and respectful manner. However staff were observed on two occasions not to be mindful of residents dignity one example was observed in the dinning room and discussed with the manager. The second instance occurred in a toilet on the main corridor and was observed by the manager. Both these incidents did not retain the resident’s dignity. However residents Simonsfield DS0000059308.V323231.R01.S.doc Version 5.2 Page 13 spoken with said that staff were “very respectful”, “approachable” and “friendly and kind at all times”. Simonsfield DS0000059308.V323231.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): Standards 12,13,14 and 15 were reviewed in this area. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents enjoy the food in the home and are supported to exercise some choices in this and other areas. However this is not always enough information or training for staff to fully support the diverse needs of the residents as individuals. EVIDENCE: All the residents spoken with enjoyed the food. Comments such as I can have just what I want”, the food is very tasty, I really enjoy the food our cook is very good and its tasty enough. The cook asks residents when they are admitted to the home what kind of things that they would like to eat. Unfortunately this information is retained by the cook, is not recorded, staff over time gain knowledge of the food that residents like this to is not recorded and as such is not available for all staff. This practice relies on the memory of the staff to remember what residents less able to say what they like would choose. Residents are regularly weighed and records showed that all the residents were gaining weight or appropriately maintaining the weight that they were, when admitted. Simonsfield DS0000059308.V323231.R01.S.doc Version 5.2 Page 15 Information for the residents to enable them to make choices is available there are menus of the food available on each dinning table. This is in a small print two of the residents spoken with found that this was of no problem. Two others said “ I can’t read it” and “I ask the girls they tell me what it says. The menus do reflect a choice and the residents were seen to eat a variety of different food. Staff asked several what they would like and showed them the food that was available. This was good practice as it supported residents to make a choice. The menus did they meet equality and diversity and did not show any special needs such as soft diet or diabetic diet. The chef was keen to undertake further training in catering for diverse diet needs. The menus are not written by the home as they are decided on by head office. However it was clear that this had been altered as resident’s choices became apparent. There was an activities board, which had very little information on it and was in an area that residents do not readily access. However a several residents were doing small activities that they took responsibility for themselves such as knitting or crossword puzzles. The home does not record how residents would like to spend their time. Information of this nature was not detailed in the residents care plans. The manager said that the activities co-ordinator had asked all the residents what they would like to do and had written a programme to meet their choices. However there were no records available to detail this. This means that staff could get the residents choices wrong. There was no information that any activities were available on an on-going bases. Those residents who were able to detail their choices or attend to their own needs described that they choose where to spend their time and how. However there are residents who are not as able to express their choices and without clear instructions to support staff they are relying on information that may be incorrect and therefore may make the wrong choices. Relatives are encouraged to visit the home and arrangements can be made for residents to visit relatives and friends. One resident regularly goes by taxi to visit a friend. Simonsfield DS0000059308.V323231.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): Standrads16 and 18 were reviewed in this area. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are confidant that they can raise their concerns and that these will be addressed. Arrangements for protecting vulnerable adults are in place, which give staff basic information. EVIDENCE: Residents spoken with said that the home was lovely, a proper home from home, the next best thing and “the staff are great I really like it here. The residents detailed that if they did have concerns they just tell someone. The manager does not log information regarding complaints that are informally told to her. These are addressed on a day-to-day basis as they occur. This runs the risk that small areas of concern can re-occur and not be addressed. The complaints procedure is available and is displayed in the main entrance of the building. It is however in standard print and not in an area accessed by residents on a daily basis. Two residents spoken with said that they hadnt seen the complaints procedure. However if they did have any concerns they would discuss it with a member of staff. Simonsfield DS0000059308.V323231.R01.S.doc Version 5.2 Page 17 The home does have a copy of the social services policy regarding the protection of vulnerable adults. Staff members spoken with had not seen a copy of this and were unaware of its existence. Induction records do detail protection of vulnerable adults training. Staff spoken with had received training in protection of vulnerable adults. Discussions with them detailed that they had very little understanding of what would happen should and allegation arise. Staff were clear that they would report anything that they thought was untoward to the manager. Training records for the staffing files viewed did detail training in protection of vulnerable adults. Simonsfield DS0000059308.V323231.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): Standards 19, and 26 were reviewed in this area. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean and tidy. The residents are supported to make their bedrooms their own. There are some areas that need redecoration and the manager is aware of these areas. The home is due to be redecorated however there is no plans for this that the manager is aware of. EVIDENCE: Simonsfield is a purpose built care home that is fitted out to meet the needs of older people. Accommodation is provided on three floors with lift and stair access. Outside space is limited with a small garden. Residents spoken with said that they could sit out in the summer months but would like a nice seating area such as a patio area to make it “a little nicer”. The front car park is used in the summer months for parties and for residents who wish to sit outside. Simonsfield DS0000059308.V323231.R01.S.doc Version 5.2 Page 19 An ongoing programme of maintenance is in place and the home shares a handyperson with other homes in the European Wellcare Group. New carpeting has been fitted to the ground floor corridors. However the carpet on the first floor corridor was very badly stained and the carpet on the 2nd floor was uneven. The cleaning staff spoken with said that they regularly clean the corridor carpets but they struggle to make it clean. A number of paint work areas were scuffed and scratched and the windows of the home have peeling paint on the outside. The manager detailed that the home is scheduled for redecoration but she is unaware of when this will be. Regular audits of the home are undertaken and the areas identified have already been recognised as needing attention. All communal areas of the home were clean and tidy though some re-decoration will be required in the near future. Bathrooms and WC’s in the home were clean however an incident observed by the manager may need addressing as staff were finding it difficult to assist one resident to use the toilet facilities in a manner that maintained their dignity. Resident’s bedrooms seen during the inspection were appropriately fitted out with domestic style furniture. Residents are encouraged to bring some treasured possessions with them to personalise their own room. Residents spoken with said “my room looks like a toy fair, I have all my favourite cuddlies in there. I like it that way”, another said, “my room is nice, the lounges are okay”. Simonsfield DS0000059308.V323231.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 were reviewed in this area. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are suitably recruited and supported to undertake training that helps them fulfil their job role. Not all staff have received training that meet the assessed needs of the residents. Staffing levels have not been decided on taking into account the residents needs and their individual risks. EVIDENCE: As the home is not full staffing levels have been reduced. There is a shortage of staff on nights and the senior carers are assisting in maintaining good staffing levels over night. As a result the manager is included in the staffing numbers where as previously the manager’s hours were over and above the normal hours. Staff spoken with said that they found morning and evenings particularly difficult. Residents spoken with said that they had noticed that staff seemed to be a little more “rushed”. One resident said, “these girls work so hard, I don’t mind waiting for a bit”. Staffing levels have not been determined to meet the dependency needs of the residents. A review of the accident book noted that there had been over 50 falls of residents in an 8-month period, only 10 of these were seen by the staff with the majority of the residents “found” by the staff after the fall. Over the lunch time staff were having to assist in the Simonsfield DS0000059308.V323231.R01.S.doc Version 5.2 Page 21 feeding of two residents at once and as such were not able to give either their full attention or support them appropriately. The personnel files for three members of staff were reviewed. All had had the checks as to their suitability to work with older persons done before they were employed. They also included evidence that each member of staff was recruited in accordance with the homes equal opportunities policy. As with other homes the manager has difficulties in recruiting male members of care staff. European Wellcare has its own induction programmes for new staff and provides ongoing training. Adult protection, health and safety, moving and handling and fire awareness training are routinely provided. The home has service users with diverse needs including behaviour support, dementia needs, diabetes as examples. Some training has been started in this area but currently not all the staff have received the training identified from the residents assessed needs. Simonsfield DS0000059308.V323231.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 and 38 were reviewed in this area. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents, relatives and staff are confident in the manager and her abilities. Staff are given support to stay up to date regarding Health and safety and the home is regularly checked to make sure that the residents welfare is protected. Quality arrangements including audits on the practices in the home need to be further developed in order that they fully safeguard the residents. EVIDENCE: The home’s manager is a Registered General Nurse (RGN). She was previously employed as deputy manager and has worked as a senior carer in Simonsfield for a number of years. She is currently undertaking a management qualification and awaiting the completion of this course. Residents and staff Simonsfield DS0000059308.V323231.R01.S.doc Version 5.2 Page 23 spoken with were very supportive of the manager. Staff sated that she was “very open” and “supportive of staff”. Residents said “a very good manager”, “ always happy to help “ and a “lovely, kind person”. The home has a condition of registration for 2 named residents aged under 65. The manager explained that there are currently no residents living in the home under 65. The registered provider has not written to CSCI to inform of this change. The manager said that staff and residents meetings are regularly held but there were no minutes available. Staff spoken with said that staff meetings discussed a wide range of topics including any issues or training needs. Two residents spoken with could not remember attending a residents meeting. The manager stated that questionnaires are regularly sent out but did not have copies of ones recently sent. The area manager was spoken with via phone after the inspection and explained that a quality system is in place that the managers complete on a monthly basis. However a copy of this was not made available at the site visit. Monthly monitoring reports are done by the organisation and a copy of this report is forwarded to CSCI. Policies and procedures are available in the home and are regularly updated by the organisation. Staff spoken with were aware that policies and procedures were available but “did not have time” to read this. Certificates of maintenance such as gas, electricity and equipment were all up to date. Checks on the environment in accordance with health and safety legislation are regularly done. Any maintenance issues for health and safety are detailed to the head office maintenance team and arrangements are put into place to repair these. Recently a fridge in the Kitchen had broken down and new temporary one had been supplied but did not provide sufficient storage for all the chilled items. The manager and the chef were not aware when the fridge would be replaced. The manager had until recently done regular audits on medications but this had ceased and was no longer in operation. Had the audits continued the issues with medications would have been identified before this site visit. The accident records are were reviewed in an 8-month period residents had had 58 falls, of these 5 were observed by staff. On the other 58 occasions staff had found the resident on the floor. From the accident records 6 residents were identified as being at particular risk. The manager said that all of these no longer had the same level of falls, however 3 of these had had falls within the last month. None of the records for these residents had risk assessments in place for the period of time that the accident records related to. As these records are not regularly audited the manager cannot identify those residents who are at particular risk or when and where these accidents occur. The manager detailed that all residents are consulted about the arrangements for keeping their money. This information is detailed in the service users guide Simonsfield DS0000059308.V323231.R01.S.doc Version 5.2 Page 24 given to the residents before they are admitted. Small amounts of money are given to residents as they request it and records are maintained that detail who was given what amount. Information regarding how much money each resident has is in head office. If a resident wanted to find out how much money they have to spend they must do this when the manager is on duty or the head office is available for contact. As the home does not keep large amounts of money on site residents must ask in advance and not at weekends for large amounts of money. This limits their access to the own money. Simonsfield DS0000059308.V323231.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 X X 2 Simonsfield DS0000059308.V323231.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 (1) (2) (a) (b) (c) (d) Requirement The registered manager must ensure that a plan of care is written for each resident in the home that details how his or her needs will be met. Outstanding from a previous report Te registered person must make sure that all resident s receive the medications correctly. The registered person must make sure that staff are able to maintain the privacy and dignity of residents at all times. The registered person must review the current staffing levels and make sure that there is sufficient staff to meet the` assessed dependency needs of the residents. Timescale for action 22/04/07 2. 3. OP9 OP10 13 (2) 12 (4) (a) 22/02/07 22/02/07 4. OP27 19 (1) (a) (b) (c) (5) (a) (b) (c) (d) (i) (ii) (iii) 22/02/07 Simonsfield DS0000059308.V323231.R01.S.doc Version 5.2 Page 27 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 The registered person should review the current care plan arrangements and the methods for planning care made more accessible to residents and staff. Residents or their representatives should be involved in the arrangements for planning care and supported to access their plans. The registered person should put back into place the practice of regularly auditing medications and determine that staff involved in giving out medications remain competent to do so. The registered person should make arrangements to find out the residents personal preferences and daily routines. These should be clearly recorded in order that all staff are aware of them and do not rely on verbal communications to make choices for residents. This is particularly relevant for those residents less able to voice their opinions. Copies of resident’s meetings minutes should be made readily available for all residents. Consideration should be made in making the information in the home such as menus and activities more easily accessible by all residents. The registered person should consider logging all concerns raised even those made informally in order that this information can be used to increase the quality of the service provided. The registered person should make sure that staff are supported to understand the roles and responsibilities of all the services that would be involved in any potential protection of vulnerable adults investigation. The registered person should put into place a refurbishment and redecoration plan and make it available to the residents and the staff. The registered person should make sure that all staff receive training to meet the assessed needs of the residents such as diabetes, dementia as examples. This is also relevant to the chef who is keen to expand her knowledge in dealing with special diets. The registered person should review how residents are able to access their own funds and in the interests of equality make arrangements that do not restrict residents to less access to their own funds than they would have if DS0000059308.V323231.R01.S.doc Version 5.2 Page 28 2. OP9 3. OP12 OP14 OP15 4. OP16 5. OP18 6. 7. OP19 OP27 8. OP35 Simonsfield 9. OP38 they did not live in a care home. The registered person should make arrangements for regularly reviewing accident records and putting into place risk assessments for those residents identified as at risk. Simonsfield DS0000059308.V323231.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG 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 Simonsfield DS0000059308.V323231.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!