Inspection on 29/10/07 for Simonsfield

This inspection was carried out on 29th October 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

Simonsfield 08/07/08

Simonsfield 14/02/08

Simonsfield 22/01/07

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 29th October 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Simonsfield DS0000059308.V353817.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.V353817.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 simonsfield@europeanwellcare.com 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.V353817.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 22nd January 2007 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 rear 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 by 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.V353817.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 10:15 and left at 19. 10The inspector spoke with 9 residents, 3 visitors, 4 staff and the manager. The inspector completed the inspection by a site visit to Simonsfield, a review took place of many of the records available in the home and CSCI offices. These included residents care plans, assessments, accident records, staff rota, staff files, maintenance records, menus, staff rota, questionnaires, staff training, medications, information sent to CSCI by Simonsfield and a preinspection questionnaire completed by the home. This site visit included discussions with residents, visitors, staff and management. Observation from 11.45 until 1.15 was taken over the lunchtime to review staff interactions with the residents. Questionnaires were sent to the home for staff and residents, however none were returned. For several weeks before this inspection a postal strike had been in operation and this may account for the lack of response to the questionnaires. The inspector followed an inspection plan that was 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, additional standards were identified before and during the inspection these were also reviewed and detailed in the report. Feedback was given to the manager and deputy 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: Simonsfield has a caring staff team that work very well together. Staff have good verbal communication skills and discuss the residents care on a daily basis. Some staff demonstrated very good understanding of the best ways to communicate with residents less able to do so. Residents made positive comments about the staff these included “very friendly caring girls”, “very nice staff, can’t ask for better” and “the staff are great, they work really hard to help us”. Simonsfield DS0000059308.V353817.R01.S.doc Version 5.2 Page 6 The home has several different areas that residents can choose to sit in. They also have a smoking lounge that allows residents to make the choice of where to sit. The majority of residents spoken with enjoyed the food that was supplied most said that they had “put on weight” since they started living in the home. What has improved since the last inspection? What they could do better: There is no structured quality assurance in place that identifies the strengths and the weaknesses of the service and puts into place plans to address these. This has impacted on the quality of the service, although there has been some improvement in some areas, this has not been sufficient to increase the quality of the service provided. Other areas that were previously of reasonable or good quality have not been sustained and quality in these areas is no longer available. Several members of staff have good skills and a good approach to providing support, however this is not consistent amongst the staff or in their approach. The management of the home has not addressed two issues that remain outstanding from the previous report and as such cannot demonstrate that they can progress and provide a good quality service to the people who live in the home. Areas that are in need of further development are information to residents, proper assessments in order to make sure that only residents whose needs the home can meet are admitted, care plans that do not inform staff of what care residents will receive or inform staff as to how to deliver the care. Lack of activities to suit the residents needs, lack of consultation with the residents as to how they wish the home to be, lack of dealing with complaints, poor environment, lack of clear records for staff, lack of staff development and determining their competency and unclear management of residents personal finances. The management of the home will be sent a plan covering all of these areas and will need to detail how they intend to improve. Further monitoring from the commission will take place in order to determine that the home is meeting its obligations. Simonsfield DS0000059308.V353817.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.V353817.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.V353817.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): Standards 1, 2, 3, 4 and 5 were reviewed standard 6 is not applicable. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Assessments are not all completed in sufficient detail to make sure that residents needs can be identified. Essential information is either not available or inaccurate. The lack of full assessments and information does not support residents to make an informed decision about moving into Simonsfield. EVIDENCE: Information available to the residents has changed the manager explained that a vital document was lost and replaced. However the replacement contains a number of inaccuracies and does not give new residents full information. All new residents have to pay a “top up fee”, this is additional money above the fees paid by social services. There was no information available to say that this had been discussed with the residents or their relatives, contacts were not available that detailed this fee. The manager said it is discussed but is not in writing. Simonsfield DS0000059308.V353817.R01.S.doc Version 5.2 Page 10 The manager said that all residents have an assessment before they move in. Copies of assessments were seen in all of the care plans looked at. Relatives and residents spoken with confirmed that they had been given an opportunity to discuss their needs before they moved in. One resident said, “ I have lived here a long time. I did come to look around it was fine. The manager came to see me in the hospital before I moved in”. All residents who have their stay paid for by Social Services have a copy of Social Services assessment before they are admitted. Copies of these were seen in the resident’s files. The assessments viewed were not always completed fully or accurately. One of the members of staff said that the assessments covered too much about the residents physical needs and although areas such as social needs was available this was a very small section and very little information could be written in it. Without fully completed and accurate assessments staff and residents will find it difficult to decide if the home can meet their needs. Simonsfield DS0000059308.V353817.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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans have been simplified but are still not in sufficient detail to describe to staff the actions they need to take to meet the residents needs. The management of medications has improved but errors are still occurring and residents are not always getting the medications that they should. EVIDENCE: Three care plans were looked at, care plans did not have any evidence that they had been written with the residents or their relatives. Although one relative said she had received a copy through the post, she was not consulted at the time it was written. All the resident spoken with had not seen their care plan. Staff spoken with did not read the plans and relied on the verbal conversations that they had with each other to tell them the different needs of the residents. Care plans did not describe how staff were to meet individual Simonsfield DS0000059308.V353817.R01.S.doc Version 5.2 Page 12 needs and describe a summary of the residents needs without instruction to staff as to how to meet their needs. Without accurate care plans that give clear instructions to staff residents care will not be consistent and runs the risk of not meeting their individual needs. 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 to support the care in place. Medications were reviewed. Medications for eight residents were checked. In three cases the medications have not been given correctly. Staff had altered the medications instructions without full instructions readily available from the prescriber. Instructions to the dosage of a medication designed to prevent blood clotting given to two residents were unclear. The manager said that audits had been regularly done on medications however these had not addressed inaccurate drug counts, unclear instructions to staff or changes made by external professionals. Staff were observed during the day, in many cases they maintained the dignity of the residents, however this was not consistent. One staff member addressed a resident as in a manner inconsistent with their age, another resident was not attended to for over 25 minutes when she asked for assistance and a further resident was seated in manner that did not maintain her dignity. Simonsfield DS0000059308.V353817.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 were reviewed. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Resident’s personal preferences, choices and needs are not used to influence their lifestyle choices. Decisions are made for residents without consideration to maintaining their independence and a lack of recreational activities means that residents are not having their needs fully met. EVIDENCE: The manager stated that menus have been altered as residents say they want them changed, menus have been amended in recent months, however there is no evidence that this was done at the prompting of the residents. Residents and relatives meetings do not take place, to support residents in saying what they would like. Social assessments are done, but not for all residents and these are not used to influence the resident’s personal routines, such as activities, daytime and bedtime routine. Menus do not detail any special diets such as diabetes, the manager stated that the cook and herself decide the meals at the request of the residents but the menu has not had any professional review. Residents spoken with did say Simonsfield DS0000059308.V353817.R01.S.doc Version 5.2 Page 14 that, “the food is very nice”, “I have put on two stone since I came to live here”, “There’s lots to eat and always a choice” and “I like the food, but can be a little bland”. Observations over the lunchtime showed that all the residents were offered a choice, however several residents asked for something that was not available on the menu and this was refused. There was no readily available information to residents about the food available and were special diets were needed or support to eat meals this was not detailed in residents care plans. Staff were observed supporting a resident to eat and this was done in a considerate manner. However in discussion with the staff and the manager they all said that the resident could eat independently with prompting and finger food. This option to maintain this individuals independence was not made available to them. There have been no activities at all for sometime, the activities co-ordinator left and was not replaced. No additional staff have been allocated to arrange activities for the residents. All the residents and relatives spoken with were not happy with this situation comments included “nothing to do”, “only the television to watch”, “can be boring” and “there are not enough things to do”. Some of the residents are very independent and able to set their own routines with minimal support from the staff. Where residents are more dependent there is very little information that helps staff make informed choices for the residents and staff make choices based on what they think is best for the resident as apposed to what their choices may be. Simonsfield DS0000059308.V353817.R01.S.doc Version 5.2 Page 15 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): Standards 16 and 18 were reviewed. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The staff and management team are unable to recognise and deal with complaints. Residents are not confident that their concerns will be addressed. EVIDENCE: Records were reviewed regarding complaints. One complaint regarding a missing item was documented, however there was no investigation around this just the actions taken to resolve it. Without investigations it will be difficult for the home to prevent a re-occurrence. Speaking to residents, relatives and staff they raised a number of concerns that included, poor environment, lack of activities and laundry arrangements. Discussions with management showed that they were aware of these concerns but had not documented them or taken any actions to address them. Residents spoken with were not happy that no action had been taken one said, “we’ve been saying about days out for months but it makes no difference”. There have been two investigations from social services for serious concerns, in both instances this was reported by external parties to the home and not the management team who had not recognised it as potential serious concern. Both instances were investigated by social services and advice given to the home. Records regarding these concerns were not available in the home for review. Staff have received training in recognising potential abuse, however in Simonsfield DS0000059308.V353817.R01.S.doc Version 5.2 Page 16 discussion they were not aware of the responsibility of social services or of the social services policy. Their lack of knowledge ran the risk of preventing a proper investigation into serious concerns. The homes policy and procedures in these areas also did not detail how complaints of this nature should be dealt with, the policy in the home did not support the manager to deal with complaints of this nature in the same manner as detailed in social services policy. As an example it guided the manager to undertake an investigation. This may result in damaging any potential investigation and making evidence invalid. Discussions with the manager and staff detailed that they had no training in investigating complaints and there was no procedure in place to guide them. Simonsfield DS0000059308.V353817.R01.S.doc Version 5.2 Page 17 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, 20, 21, 22, 23, 24, 25 and 26 were reviewed. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The lack of maintenance and renewal of equipment and facilities mean that residents could be potentially at risk from equipment that may be unsafe. The poor condition of the décor and fixtures and fittings means that residents live in an inadequate environment. EVIDENCE: A review of the environment showed a number of areas in need of repair and redecoration. These included stained carpets in the main corridor, bathrooms with cracked and damaged tiling and ripped and damaged furniture as examples. The manager is aware that a review has been done in some areas but is not aware of what the plans are to improve the environment. There is no Simonsfield DS0000059308.V353817.R01.S.doc Version 5.2 Page 18 plan in place that informs the residents about any redecoration or consults them about their views. Residents and relatives spoken with were unaware what plans were in place but made a number of comments about the environment in general. These included “wasn’t always like this, is getting a bit scruffy”, “bathrooms smell, not nice places to go”, “I know they are looking to fix things but not sure when” and “I have my things in my bedroom, but would be nicer with some new furniture”. The home does not have policies available that details the prevention of infection, it was noted that some areas in the home were in need of cleaning including the dining room floor. Staff were observed over lunchtime to use protective clothing such as plastic aprons and this is good practice. There are liquid soap dispensers in each of the bathrooms however these were all empty hard soap had been made available and disposable hand towels to help prevent the spread of infection. There are no records available that staff have received training in the prevention of infection. A mop and mop bucket full of dirty water was left in one of the bathrooms, the manager said that it was to be changed daily. However even changing the water it is still contaminated and present a risk of infection. During the day it was noted that one resident was unable to sit comfortably in the chairs available in the home and the staff frequently had to attend to move the resident in the chair to maintain their safety and dignity. This was occurring both in the dining room and lounge and there is no different seating available. Wheelchairs were used by staff without footrests and this runs the risk of causing injury to the resident. In discussion staff said that the residents observed refused to use the footrests but there was no documentation or risk assessments to support this action. Additionally the wheelchairs were noticed to be in need of cleaning and not well maintained. Simonsfield DS0000059308.V353817.R01.S.doc Version 5.2 Page 19 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. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Recruitment and training of the staff is not sufficient to make sure that resident’s needs are meet. EVIDENCE: Three staffing files were viewed. They were disorganised and difficult to determine if all the staff checks, training and induction was in place. None of the records held evidence of recent staff training or of inductions when they started working in the home. One recently recruited staff member did not have a police check. The manager said that this was due to the postal strike in the areas and they had not been able to obtain one. However there was no risk assessment in place to determine the impact of this decision on the resident’s safety. None of the staff files had two references and gaps in individual working history had not been explored. Staff spoken with listed training that they have received and the majority have completed or are attending a training course in care, others have undertaken diabetes, others have done training in Alzheimer’s. However the home has residents with a variety of needs including Parkinson’s, epilepsy, dementia and behavioural needs as examples. There is no evidence that staff responsible for giving out medications have received sufficient training or on-going determination that Simonsfield DS0000059308.V353817.R01.S.doc Version 5.2 Page 20 they are competent to do so. There are practice areas of medication administration identified as in need of improvement. Staffing levels have been increased in recent months in order to increase the service provided however this has not been done in line with residents needs and may not be the correct amount to support the residents appropriately. The activities co-ordinator has left their post and has not been replaced no provision has been put into place to meet this need. Staff were observed during the day to be unhurried and relaxed in their approach. Residents spoken with said that “staff are very kind”, “such lovely, kind and caring people” and “really good, they work so hard, but are always smiling, laughing and joking, great company”. They also said that they thought staff were very busy in the mornings and sometimes they had to wait but in general this was a very short time and was always explained. Simonsfield DS0000059308.V353817.R01.S.doc Version 5.2 Page 21 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): Standard 31, 32, 33, 34, 35, 36, 37 and 38 were reviewed. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The lack of an opportunity to review and develop the quality of the service in line with residents’ views has not been taken. This has resulted in a service that has not recognised or addressed many areas of poor practice and not safeguarded the residents. EVIDENCE: The manager of the home has a qualification in nursing but no training in management. She did start a course in management but has not completed it and is not attending any management courses. She has been the manager for several years, residents, relatives and staff found her very supportive. In recent months the manager has become more familiar with the care standards Simonsfield DS0000059308.V353817.R01.S.doc Version 5.2 Page 22 regulations and has recently started to make the commission aware of incidents in the home were previously she was unaware that these needed to be reported. There is no quality assurance in the home that identifies the strengths and the weaknesses. The manager explained that she is not always able to be objective and see the areas that need improvement. There is a self-assessment available that the manager can use to look at the areas of quality, however this has not been completed. There is no plan that in place that is discussed with the residents as to how the home will improve the quality of the service that it provides. Some of the practice areas of the home are being audited, but this is not prompting an increase in quality and the audits in place are not working. The home has not been able to make or sustain improvements in any area other than improving some of the practice regarding medications. Residents or staff meetings have not been held for some time and consequently, no minutes available in the home to review. There is no evidence that residents are consulted with about the running of the home. European Wellcare is the company that owns the home and as such needs to undertake monthly visits to review the home and consult with the resident’s. Copies of these reports were not available in the home. There are no policies and procedures in the home regarding resident’s money. Additional fees are not detailed in the residents’ contracts and it is impossible to determine with the information provided at this site visit what arrangements are in place to safeguard resident’s personal funds. The manager said that the administrator responsible for this has left the company and records are unclear. A list was sent to the home that detailed residents no longer there. Residents cannot access their individual finance records are unless requested and a record of residents spending is unclear. Information sent to the home during this site visit did not identify that residents’ personal allowances were separate to the top up fee. Further confusion is in place as all the residents funds are held in bank accounts together and records provided did not detail the distribution of interest to the residents. The company has 9 homes and all the residents’ accounts are held together as such company policy is not protecting individual rights of the residents. Areas of risk have not been identified, such as self-medication, development of pressure ulcers, use of equipment, general environment, smoking, and fire risks as examples. Falls have been recognised but management plans and clear written structures that inform staff as to how they reduce the resident’s risk are not in place. Simonsfield DS0000059308.V353817.R01.S.doc Version 5.2 Page 23 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 2 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 2 2 2 2 2 2 2 2 1 STAFFING Standard No Score 27 2 28 1 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 1 1 1 1 1 2 Simonsfield DS0000059308.V353817.R01.S.doc Version 5.2 Page 24 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 (1) (a) (b) (c), 5 (1) (a) (b). Requirement The information in the home such as the statement of purpose and service users guide needs to be reviewed. An accurate and up to date description of the home needs to be in place. This needs to support prospective residents to make an informed choice. Management will need this in order to make sure that they can supply, monitor and develop the services detailed in this information. A copy of this needs to be sent to the Commission whenever it is reviewed and changed. All residents need an up to date contract that details what services the fees pay for. Including the amounts and methods of payment from all parties contributing to the fees. Clear information needs to be available in order to make sure that residents and their supports can make an informed choice and be aware of the services provided. DS0000059308.V353817.R01.S.doc Timescale for action 15/12/07 2. OP2 5 (1) (b) (c) (3) 15/12/07 Simonsfield Version 5.2 Page 25 3. OP3 4. OP7 14 (1) (a) All pre-assessments and 29/11/07 (d) (2) (a) assessments undertaken need to (b) be completed by individuals trained to do this. All relevant areas of the assessment needs to be completed in order to make sure that the resident and the management of the home can make an informed choice. 15 (1) (2) Each resident needs a plan of 29/11/07 (a) (b) (c) care that is written in (d) consultation with each resident or their representatives. The care plans need to detail how the residents needs will be met by the staff. This needs to be in sufficient detail for staff to provide consistent support to meet all the residents assessed needs. 13 (2) Outstanding from 30/11/05 Staff need to administrate medications correctly at all times. Residents need to have their medications given as they are prescribed by the GP 29/10/07 5. OP9 6. OP12 16 (2) (m) (n) 7. OP16 22 (1) (2) (3) (4) (6) (8) Outstanding from 22/02/07 15/11/07 Arrangements need to be made to determine resident’s personal preferences, choices and equality and diversity needs 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 in order that staff can support them in a consistent manner that meets their needs. Where concerns, complaints or 29/10/07 allegations are raised with staff in the home these need to be dealt with in accordance with the relevant policies and procedures. DS0000059308.V353817.R01.S.doc Version 5.2 Page 26 Simonsfield 8. OP19 23 (1) (a) (2) (b) (c) (d) 9. OP29 19 (1) (a) (b) (c) (5) (a) (b) (c) (d) (i) (ii) (iii) 10 OP27 18 (1) (c) (i) A full record of the complaint, the investigation and the outcome needs to be available. A review of the environment 29/10/07 needs to take place to look at the fabric of the home. A plan of maintenance needs to be drawn up, shared with the residents and their requests included in the redecoration and refurbishment. A copy of the plan needs to be available for all interested parties. Staff files need to be audited. All 29/10/07 staff need full records of recruitment including references for the individual validated as relevant, information regarding specific training and skills relevant to meeting the needs of the residents. Police and PoVA checks need to be available for all staff to identify that they are fit to work with older people. Where there are exceptional circumstances and the staff member starts before a police check the member of staff must be supervised at all times, have a PoVA in place, a relevant risk assessment and relevant references before they can work in the home. All staff need to receive training 29/10/07 to meet the assessed needs of the residents that they care for. Records of the training planned and when completed needs to be in place in order to make sure that staff receive the training that they need in order to support and safeguard the residents appropriately. A plan of training for staff needs to put into place taken from the residents assessed needs and monitored to make sure that training is undertaken. DS0000059308.V353817.R01.S.doc Version 5.2 Page 27 Simonsfield 11. OP28 18 (1) (a) (2) 12. OP31 13. OP33 14. OP35 Staff need to be competent to undertake the support and care that they give. The management needs to make sure that staff are given the opportunity to develop competency. Staff supervision, reviews and audits of their work and clear descriptions of their role needs to be in place in order to monitor and develop staff competency. 9 (1) (2) The manager needs to receive (i) (c) (i) appropriate supervision, support and training in order to develop the necessary skills to fully manage the service. 24 (1) (a) A quality assurance system (b) (2) (3) needs to be developed and put into place. This needs to include the expressed views of the residents a review of the services provided and identification of areas for development. A plan as to how the management intends to develop the quality of the service needs to be made available for all the residents and their supporters. 20 (1) (a) The current arrangements for (b) (3) the management of resident’s finances and personal finances needs to be reviewed. Clear information needs to be available that details the entitlement of personal allowances, where that money is kept, the interest earned and how that is distributed. Additional arrangements need to be commenced for residents to have individual separate accounts and not an account that is owned by the company. An exploration as to the funds contained in the social fund that was from the interest of residents funds needs to be undertaken and DS0000059308.V353817.R01.S.doc 15/11/07 15/11/07 15/12/07 29/11/07 Simonsfield Version 5.2 Page 28 15. OP38 13(4) (a) (b) (c) determination as to what purpose this money is held for and how it will distributed. Information that provides a full explanation needs to be forward to the commission. Where risks are identified for residents, such as wheelchairs without footrests, selfmedication, falls, smoking as examples. Full assessments and plans need to be in place that are negotiated with the residents and detail any restrictions in place. 29/10/07 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 RCN Good Practice Recommendations Consideration should be made in making the information in the home such as menus, statement of purpose, service users guide, care plans, fire instructions and activities information when available more easily accessible by all residents. The assessment and admittance policy in the home needs to identify the arrangements for emergency admissions and the criteria for admissions to the home in order that staff can determine if they can meet the needs of the residents. The current audits for care plans need to be reviewed in order to determine the quality of the plan as apposed to whether all the documentation is available Staff who write care plans need advice and guidance The home needs to review its policy and procedure and include best practice guidance available, all medications need to have full instructions to staff, handwritten instructions need to be double checked and have two signatures, changes to medications need official written notification from the prescriber, medications need to be DS0000059308.V353817.R01.S.doc Version 5.2 Page 29 2. OP3 3. OP7 4. OP9 Simonsfield 5. 6. OP12 OP16 7. OP18 stored at correct temperatures, audits need to identify the gaps in medication management and address the issues, staff need to be updated regularly in medications management and the policy and procedure needs to be readily available to staff who give out medications. The assessments and social care plans available in the home need to be completed, kept up to date and used to influence the residents lifestyle choices. Complaints and whistle blowing policy and procedure need to be reviewed, made readily available and reflect the practice that the manager needs to take in order to address any complaints. Training for manager in recognising and dealing with complaints would benefit the residents. Staff need to be supported to understand the roles and responsibilities of all the services that would be involved in any potential protection of vulnerable adults investigation. Recruitment policies need to be adhered too and staff files need to be organised sufficiently to make sure that all checks, training, induction and supervision is in place. Staffing levels need to meet the assessed needs of the residents and not determined on the basis of how many people are living in the home. 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 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. 8. 9. 10. OP29 OP27 OP35 11. OP38 Simonsfield DS0000059308.V353817.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Merseyside Area 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.V353817.R01.S.doc Version 5.2 Page 31 - 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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