Inspection on 21/01/09 for St Helens House

This inspection was carried out on 21st January 2009.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Helens House 27/02/07

St Helens House 09/02/06

St Helens House 11/08/05

St Helens House 31/01/05

St Helens House 21/09/04

St Helens House 24/02/04

St Helens House 29/01/04

St Helens House 29/11/02

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: St Helens House 3 The Ridge Ore Hastings East Sussex TN34 2AA     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: June Davies     Date: 2 1 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: St Helens House 3 The Ridge Ore Hastings East Sussex TN34 2AA 01424439239 01424439239 sthelens@house124.wanadoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Gloria Williams Name of registered manager (if applicable) Mrs Antoinette Kent Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 31. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP). Date of last inspection Brief description of the care home St. Helens House is a family owned and run care home on The Ridge in Hastings. Twenty-four hour care is provided for up to 31 older people, most of who have lower levels of dependency care needs. The Home is set out on three floors and a passenger lift provides access to all floors. It provides 27 single rooms and 2 double rooms. At the front of the building there is a small area providing off road parking facilities. Current fees range from #345 to #400 per week. Care Homes for Older People Page 4 of 34 care home 31 Over 65 31 0 Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection was carried out on the 21st January 2009 over a period of seven hours. During the inspection the inspector spoke with the registered provider, registered manager, three member of staff and four residents. A tour of the premises was carried out where communal rooms, toilets, bathrooms, laundry room, kitchen and four bedrooms were viewed. The inspector also carried out an audit of medication and observed a lunch time medication round. Observation took place in regard to staff respecting the privacy and dignity of residents. The inspector was present at a lunch time meal. Documentation was viewed in relation to the key standards inspected. Care Homes for Older People Page 6 of 34 Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: Where residents are funded by a local authority, the registered person must ensure that they obtain a care manager assessment together with a plan of care, this is to ensure that the home has the ability to meet with prospective residents assessed needs. Risk assessments in care plans should not be generic but written with each individual residents needs in mind and take into account their mental, and physical abilities. Some issues were found in regard to the manner in which medication is recorded and administered in the home. The inspector has now requested that a CSCI pharmacy inspector visits the home to carry out a full audit of medication. It would be good practice to keep information about individuals together in one care plan, which staff are then able to use as a working tool. In some files that record information about the residents this information is kept in list form with residents names being kept collectively this practice does not meet with the Data Protection Act 1998. Recently the home has used CCTV (closed circuit television) cameras in a residents bedroom, this practice is abusive and should not take place as it contravenes the residents rights to privacy. During a tour of the premises inspector noted that radiators throughout the home had not been covered, this was a requirement from the previous key inspection on 27th February 2007. Infection control procedures are not adherred to in that communal bathrooms, toilets and the laundry room did not have provision of liquid soap, and in some cases there were no paper hand towels this had been a previous requirement at the last key inspection on 27th February 2007. It was also noted that not all residents bedrooms had a call bell cord and in some cases in communal toilets and bathrooms the call bell cord had been tied up, and would not be accessible to the resident if they Care Homes for Older People Page 8 of 34 fell. While in general the recruitment of staff is good, the inspector noted that the application form does not request a full employment history, and written explanation for any gaps in employment. Not all the staff in the home have completed their mandatory training in moving and handling, food hygiene, first aid, infection control and safeguarding vulnerable adults. The work related induction for new staff should be based on the Skills for Care induction package. The quality assurance system needs to be further developed, by gaining the views of professional visitors to the home and monitoring the systems used in the home to ensure a good consistant quality of service is offered to the residents. Risk assessments must be carried out on the use of oxygen in the home, this must be assessed for each individual who uses oxygen in the home and should incorporate a fire risk assessment. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 34 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. While the home carries out its own pre-admission assessments for prospective residents these are not detailed and therefore do not insure that the home can meet the residents needs. Evidence: From three pre-admission assessments viewed only one had a local authority care manager assessment and plan of care. All three assessments carried out by the registered manager gave information in regard to mobility, psychological well-being, medication, continence, hygiene, dressing, mental condition, diet, speech, and medical history. None of the pre-admission assessments gave detailed information on any of the headings assessed. The pre-admission assessment did not include all headings as outlined in Standard 3.3 of the National Minimum Standards. There was no evidence that prospective residents had signed up to the pre-admission assessment. The inspector spoke with the registered provider and registered manager in regard to them Care Homes for Older People Page 11 of 34 Evidence: obtaining care manager pre-admission assessments and plans of care for those residents who are to be funded by local authority. Both stated that care managers do not give the home pre-admission assessments or plans of care even when this is requested. The home does not offer intermediate care. Care Homes for Older People Page 12 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care planning system does not provide staff with the information they need to meet each individual residents needs. The health needs of residents are adequately met, with some evidence of good multi disciplinary working, however further improvements need to be made to ensure that optician, dentist and continence nurse visits are recorded. The systems for medication administration are poor and potentially place residents at risk. Personal care is offered in a way to protect residents privacy and dignity and promote independence. Evidence: The inspector viewed four care plans, these care plans are written up by the registered manager, and based on the pre-admission assessments. Care plans were not specific Care Homes for Older People Page 13 of 34 Evidence: and did not give clear guidelines for example, care plans state in some instances needs help with bathing, but does not state what help is required and how many staff are needed to give the help. There was evidence that the care plans are reviewed monthly, but other information that should be available in the care plans is kept in many seperate files. Once care plans have been completed and staff made aware of new residents needs, these care plans are then locked up in a file in the office, and not used as a working tool by the care team. It was noted that in the file for recording personal hygiene the residents names are kept collectively and this contravenes the Data Protection Act 1998. The personal hygiene matrix does not record instances of dental or oral hygiene, and shaving. Risk assessments tended to be generic, and not written to meet the needs of the residents as individuals. For two residents who use oxygen machines there was no risk assessment drawn up for the use of oxygen. There is good recording on the cardex system of daily reports in regard to residents health care, and there is evidence that residents have contact with their general practitioner as and when required. Tthe Annual Quality Assurance Assessment states that staff have access to completed Waterlow charts, which shows that suspect pressure areas are being identified and that early intervention has lead to reduced instances. There was evidence in the chiropody file that residents have regular access to the chiropodist. Visits from other external health care professionals are recorded in a seperate file to the care plan. The inspector observed a medication round for lunchtime medications and noted that while the home uses a blister pack system of medication, the tablets are taken out of the blister packs and placed into pots with the residents names on, these pots are then taken round to the residents. Once all the residents have received their medication, the carer who has administered the medication then signs off all the Monthly Administration Records. Some medications have specialised instructions for example to be taken half an hour before food, but it was noted that the medication is still highlighted to be given at 08:00 hours, and there is not always specific instructions on the Monthly Administration Record. It was noted on one Monthly Administration Record, tippex had been used. Where residents are prescribed paracetamol PRN (as required) this medication was being dispensed into pots and residents were being required to take them whether or not they required them. There is no PRN (as required) policy and procedure in the home to give guidance to staff for dealing with PRN (as required) medication. During the course of the inspection the inspector noted that staff talk to residents in a professional and caring manner. Residents spoken to during the course of the inspection said that staff are very kind to them, and that their privacy and dignity is respected. Care Homes for Older People Page 14 of 34 Care Homes for Older People Page 15 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are able to make choices in regard to their daily living routines, and the activities they wish to participate in. Residents make their own arrangements for management of their finances. The meals offered in the home are good, with residents saying that they are offered choice. Evidence: There was evidence that residents are able to choose their daily living routine and this was verified through observation on the day of this key inspection. A resident said that she is able to remain in her bedroom if she wishes to. Other residents said that they are able to get up and go to bed when they wish to. Residents are happy with the activities provided by the staff in the home, on the day of this inspection some of the residents had requested a bingo session in the afternoon. One resident said that she was able to join in the activities provided as and when she wished to. Outside entertainers are brought into the home on a regular basis Care Homes for Older People Page 16 of 34 Evidence: to provide entertainment for the residents. On the day of the inspection the registered manager was making arrangements for a singer to visit the home. Other entertainers include, local choirs and musical groupsvisit the home to entertain the residents. Occassionally a theatre visit is arranged for residents. Information on one daily report suggested that a resident is able to attend church with a relative. The visitors book indicated that families visits residents on a regular basis. There is no restriction on relatives and friends visiting the residents in the home. When relatives and friends do visit they are able to use any of the communal rooms or visit the resident in their bedroom. Residents have made arrangements for next of kin to manage their financial affairs for them. From a tour of the home and some of the bedrooms the inspector evidenced that residents are able to bring personal possessions into the home when they move in. There is no evidence that residents would be able to have access to their personal records, as these are contained in many files in the office. In some cases names are used collectively in the files which contravenes the Date Protection Act 1998. From viewing the menus and observing a lunch time meal, residents are offered an appealing and nutritious diet. While residents confirmed that they are able to say what foods they do not like on the menu, and when this is the case they are offered a choice, the menu does not state what choices are available on each day. Breakfast is a self service meal, with staff present to assist if necessary. Breakfast consists of a variety of cereals, toast, coffee or tea. A likes and dislikes file is kept in the kitchen, but for most residents it states - likes most foods or will let staff know. There are no specific likes and dislikes recorded for individual residents. Where residents have difficulties using cutlery, specialised cutlery is purchased for them, to make mealtimes easier for them, and to enable them to maintain their independence. Specialised diets are catered for and the inspector saw evidence of diabetic diets being provided. The Annual Quality Assurance Assessment sent to the Commission for Social Care Inspection by the home states that dietary needs are assessed on admission and that likes and dislikes, assistance with feeding and specialised equipment needs are recorded. From observation the inspector witnessed that residents are able to take their meals at a leisurely pace and they are not hurried by the care staff. Residents stated that they enjoyed their food in the home, and if there was something they did not like, staff would offer them an alternative. One resident said that there was not a choice offered on the menu, but they were able to have a choice should they wish to. Care Homes for Older People Page 17 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints system with some evidence that residents feel that their complaints will be listened to and acted on. Arrangements for protecting residents are not satisfactory placing them at risk of abuse. Evidence: The registered manager is in the process of reviewing all the policies and procedures in the home, this includes the complaints policy and procedure and whistleblowing policy and procedure. The complaints file showed there have been no complaints made to the registered manager since the last key inspection. All staff working in the home are aware of the complaints policy and procedures, with staff signatures behind the policy and procedures. One resident said that she would know how to complain should the need arise. The Safeguarding Vulnerable Adults policy and procedure is in the process of being reviewed, and the registered manager was asked by the inspector to obtain the Sussex Multi-Agency Policy and Procedure for Safeguarding Vulnerable Adults. This document was obtained within twenty four hours of this key inspection. There has been one Safeguarding Vulnerable Adults referral since the last key inspection. This involved a Close Circuit Television camera being used in one of the residents bedrooms to Care Homes for Older People Page 18 of 34 Evidence: highlight poor practice, which inadvertently could have had an impact on the residents rights to their privacy and dignity being upheld. From discussion with the registered manager she said that none of the staff have to date received Safeguarding Vulnerable Adults training. From viewing three staff personnel files the inspector found the home has a stringent recruitment practice in that all prospective staff are Protection of Vulnerable Adults and Criminal Records Bureau checked and two written references are received prior to a new member of staff taking up employment in the home. Care Homes for Older People Page 19 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of the environment within the home provides residents with a homely place to live. Some improvements need to be made in the home to ensure that residents are safe and can call for assistance at any time. More attention needs to be made in infection control to ensure that residents and staff are not placed at risk of cross infection. Evidence: St Helens house provides a warm and homely atmosphere for its residents. Furniture and decorations throughout the home are satisfactory. Carpets were seen to be in good condition. There were no obvious maintenance issues. The rear garden of the home is well maintained and safe for residents to use, it is laid mainly to lawn, and there is a patio area where residents can sit when the weather is good. The building meets the requirements of the local environmental health officer. There has been an issue, with the use of a CCTV cameral, and this has been reported under Protection in this report. The inspector did note that in some communal bathrooms and toilets the call bell cord had been shortened and should a resident fall onto the floor they would Care Homes for Older People Page 20 of 34 Evidence: not be able to call for assistance. In some bedrooms while there was a call bell socket the cords were missing. A requirement made at the last key inspection on the 27th February 2007 has not been met in that none of the radiators in the home had been covered. On the day of this unannounced key inspection the home was in good clean condition and there were no offensive odours. Concern was raised with the registered manager as in some communal toilets and bathrooms, there was no liquid soap and in some cases no paper hand towels again this was a requirement at the last key inspection on the 27th February 2007. The laundry is situated away from the kitchen area, and was found to be clean and tidy, and fitted with a sluicing washing machine and industrial type tumble drier, another washing machine was out of order. At the present time none of the staff have received recent infection control training, but this has been booked for the 20th March 2009. Care Homes for Older People Page 21 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are employed in sufficient numbers to meet the needs of the residents. Over half the care staff have achieved their Social Care NVQ level 2 or above, which gives them the skills and knowledge to assist residents with the health, personal and social care needs. The recruitment practice in the home is stringent, but further improvements need to be made to the application form to ensure all staff are appropriately vetted. Some of the staff have completed some Mandatory training in health and safety issues, and further work needs to be done to ensure that all staff receive mandatory training, so that residents are not placed at risk. Evidence: The inspector viewed staff rota and found that there are sufficient staff on duty on all shifts during the day to meet residents needs. Residents themselves were able to confirm that staff are helpful and available when they need them. One resident said that she has never needed to wait for assistance when she has required it. The home employs ancillary staff in sufficient numbers for cooking, cleaning and maintenance. Care Homes for Older People Page 22 of 34 Evidence: Over fifty per cent of the care staff have achieved their NVQ level 2 and or 3 in Social Care. A further 5 staff are in the process of working on their NVQ qualification. The inspector viewed four staff personnel files and found that the home now has a stringent recruitment practice in that it ensures a Protection of Vulnerable Adults register check is carried out prior to a prospective member of staff being employed in the home. All files had a Criminal Records Burea check. There were two written references in each file, along with at least two forms of identification. The inspector did note that the application form does not require a full employment history. All application forms should contain a full employment history and ask for a written explanation for any gaps in employment. It was difficult to ascertain what mandatory training staff have received, as the training matrix was not available. From information obtained from the registered manager, the inspector found that 31 percent of care staff have up to date moving and handling training, none of the staff had up to date Food Hygiene training but evidence was available that this training had been booked to take place in February of this year, 84 percent of staff have completed their first aid training, none of the staff have infection control training but this has been booked to take place in March of this year, none of the staff have safeguarding vulnerable adults training and no training has been booked, all the staff who administer medication have received medication training all staff have fire safety training. There was some evidence in staff personnel files that staff also undertake work related training. The inspector viewed completed induction packs for two members of staff and found they were quite detailed but not in line with Skills for Care Induction training. Care Homes for Older People Page 23 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager has a good understanding of what needs to improve in the home, but requires the time for planning and implementation. Further work needs to be carried out on the quality assurance system in the home to ensure that the service is offering the best quality of care throughout. Residents manage their own personal allowances and are supplied with the facilities to do this. All staff are regularly supervised to ensure that they understand residents needs and individuals training needs are recognised. Health and safety issues in the home need to be improved upon, to ensure that residents live and staff work in a safe environment. Care Homes for Older People Page 24 of 34 Evidence: The registered manager has NVQ level 4 and Registered Managers Award, she is also an NVQ assessor, and has gained her diploma in Moving and Handling. Her management approach is open and positive. Through discussion she expressed her concerns that there are never enough hours in the day to complete all her administrative work, she is very resident focussed and spends a lot of time with the residents, re-assuring them and answering their queries, this was evident on the day of the inspection. It is also important that the registered manager has access to the internet so that she can update herself with changes either via the Commission for Social Care Inspection website or other work related internet sites. Further work needs to carried out on developing the quality assurance system within the home. The registered manager has obtained recent surveys from residents and relatives, but this needs to be extended to seek the views of professionals who visit the home, which might include, General Practitioners, District Nurses, Chiropodists, Dentists, Opticians and other health care professionals as well as the hairdresser, entertainers etc. The manager also needs to carry out recorded regular monitoring of the systems used in the home. The inspector was shown a health and safety risk assessment of the rooms in the home but this was not specific as to what had been checked, and the manager was unable to find a fire risk assessment for each room in the home. All this information should then culminate in an Annual Improvement Plan and Annual Quality Assurance Report. Residents have total control over their own personal allowances, and the home does not manage or look after residents personal allowances. Each resident has a lockable facility in their own bedroom where they are able to keep money and valuables. Evidence is available on staff personnel files that they receive at least six formal supervisions each year. Formal supervision covers all aspects of meeting residents needs, the understanding of the carer in meeting the philosophy of the home and highlighting any training needs. As mentioned previously in this report all staff need to receive mandatory training in health and safety issues. The inspector viewed maintenance certificates for all equipment used in the home and found them to be in date. It was noted that a Legionella check has not been carried out of the water system in the home. The inspector also viewed the fire call point check records and hot water outlet checks, both of these are carried out on a weekly basis by the maintenance man. The inspector does have some concerns in relation to two residents who need to use oxygen machines in that there is not an individual risk assessment for these residents, and there is no evidence that a fire risk assessment has been completed for these Care Homes for Older People Page 25 of 34 Evidence: residents. This matter has been reported to the Fire Safety Officer. None of the windows in the home have a window opening restrictors fitted. The registered manager is in the process of reviewing all the health and safety policies and procedures in the home. The inspector viewed the accident book and found the accidents to be recorded appropriately. There is one resident who has experienced more than one fall in a three month period the registered manager should monitor falls, and seek external professional assistance where there are areas of concern. Care Homes for Older People Page 26 of 34 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 25 13(4) The registered person shall 31/08/2007 ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety in that all radiators must be guarded or have guarunteed low temperature surfaces. This must be completed by the given timescale, if not sooner. 2 26 12(1), The registered person shall 31/08/2007 13(3)16(2)(j) make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home, in that appropriate soap dispensing and hand drying facilities must be provided in all communal toilets. This must be completed by the given timescale, if not sooner. Care Homes for Older People Page 27 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 The registered person shall 27/02/2009 not provide accommodation to a service user at the care home unless, so far as it shall have been practicable to do so (a) needs of the service user have been assessed by a suitably qualified or suitably trained person; (b) the registered person has obtained a copy of the assessment; (c) there has been appropriate consultation regarding the assessment with the service user or a representative of the service user. Where a prospective resident is funded by a local authority the registered person must obtain a care manager assessment and plan of care. The homes preadmission assessment must include items as detailed in Care Homes for Older People Page 28 of 34 3.3 of the National Minimum Standards. This is to ensure that the home is able to meet the needs of the prospective resident. 2 7 13 The registered person shall ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. Risk assessments should be drawn up for each individual resident, and should relate to the level of care and health needs for each individual resident risk assessments should not be generic. 3 9 13 The registered person shall 27/02/2009 make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. Medication should not be secondarily dispensed into pots. Monthly Administration Records, should be signed off seperately for each resident. All incoming medication must be recorded onto the Monthly Administration Record, with the date, the quantity and the initials of the person receiving the medication into the home. None of the Monthly Administration Records should have Tippex used on 27/02/2009 Care Homes for Older People Page 29 of 34 them. There should be a policy and procedure for the administration of PRN (as required) medication. Where medications have specialised instructions for example take half an hour prior to food, this should be clearly highlighted on the Monthly Administration Record. Eye drops/ointments and liquid medication should be dated on the bottle or tube on the day of opening. The list of medication trained staff must be reviewed regularly to ensure that it is up to date and contains the signatures and inititals of staff who are currently medication trained and working in the home. 4 18 13 The registered person shall make arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. Staff must receive training in Safeguarding Vulnerable Adults from abuse. Under no circumstances should CCTV (closed circuit television) cameras be placed in residents private space. 27/02/2009 Care Homes for Older People Page 30 of 34 5 22 23 The registered person shall 27/02/2009 having regard to the number and needs of the service users ensure that suitable adaptations are made, and such support equipment and facilities, including passenger lifts, as may be required are provided, for service users who are old, infirm or physically disabled. Each resident must have a call bell system that is easily accessible from their bed, this means that all bedrooms must have a call bell cord that residents can have easy access to from their bed. In communal toilets and bathrooms call bell cords should be of sufficient length, that will enable a resident to reach the call bell cord should they fall on the floor 6 26 13 The registered person shall 27/02/2009 make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. All communal toilets and bathrooms and the laundry room must be supplied with liquid soap and paper handtowels and not bar soap and cloth hand towels. This is to ensure there is not a risk of cross infection. 7 29 19 The registered person shall not allow a person to work 27/02/2009 Care Homes for Older People Page 31 of 34 in the care home unless the employer has obtained in respect of that person the information and documents specified in paragraph 1 to 9 of Schedule 2. Schedule 2 paragraph six states - A full employment history, together with a satisfactory written explanation of any gaps in employment. The application form should enable prospective employees to give a full employment history and request written evidence for any gaps in employement. 8 30 18 The registered person shall, 30/03/2009 having regard to the size of the care home, the statement of purpose and the numnber and needs of the service users - ensure that the persons employed by the registered person to work at the care home receive training appropriate to the work they are to perform including structured induction training. All staff working the home must complete mandatory training in moving and handling, food hygiene, infection control, first aid and safeguarding vulnerable adults. 9 33 13 The registered personb shall ensure that - unnecessary risks to the health and 27/02/2009 Care Homes for Older People Page 32 of 34 safety of service users are identified and so far as possible eliminated. Risk assessments should be carried out for each person who uses oxygen in the home. A legionella check must be carried out on the water system in the home. Window restrictors should be fitted to all opening windows. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 It is good practice to keep all information in relation to residents health, personal and social care needs in one care plan. This care plan should also be available to carestaff to be used as a working tool. Residents names should not be kept collectively in regard to physical, personal and social care recording as this contravenes the Data Protection Act 1998. Each resident is entitled to view information kept in the home and should not be able to view records of other residents which may be kept on the same page. Induction package should be updated to be in line with Skills for Care induction guidance. Further work needs to be done on improving the quality assurance system used in the home, to ensure that views are sought from stakeholders, that regular monitoring of systems used in the home take place, that the Health and Safety and Fire Risk Assessment is detailed and covers all rooms in the home. An annual improvement plan and annual quality assurance report should then be produced to reflect the quality of care offered by the home. 2 14 3 4 30 33 Care Homes for Older People Page 33 of 34 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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