Inspection on 12/01/09 for St Joseph`s Care Home

This inspection was carried out on 12th January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 18 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Joseph`s Care Home 19/01/08

St Joseph`s Care Home 26/01/07

St Joseph`s Care Home 18/01/06

St Joseph`s Care Home 29/07/05

St Joseph`s Care Home 23/02/05

St Joseph`s Care Home 20/07/04

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 Joseph`s Care Home St Joseph`s 38-40 Hindes Road Harrow Middlesex HA1 1SL     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: Ann Gavin     Date: 1 2 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 32 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 32 Information about the care home Name of care home: Address: St Joseph`s Care Home 38-40 Hindes Road St Joseph`s Harrow Middlesex HA1 1SL 02088632868 02084272146 vsaunders@hazelwoodcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Hazelwood Care Ltd care home 19 Number of places (if applicable): Under 65 Over 65 0 dementia Additional conditions: 19 The Registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - Code DE The maximum number of service users who can be accommodated is: 19 Date of last inspection Brief description of the care home St Josephs is a privately-owned care home for up to 19 older people who have dementia or related conditions. The home is part of the Hazelwood Care Organization. There were three vacancies at the time of this inspection. The home is a conversion of two semi-detached houses that interlink on the ground and first floor. Access at the front of the home can be assisted via a mobile ramp across the two steps. Resident accommodation is on the ground and first floors, with seven bedrooms downstairs including two double rooms. There is also accommodation provided on the second floor for four live-in staff. Access to the first floor is by stairs, or chair-lift on the house #40 side. The large lounge and dining area is split into two distinct sections. There is a private garden of a reasonable size to the back of the home. The home is situated Care Homes for Older People Page 4 of 32 Brief description of the care home close to local shops and transport facilities. There is a small, open forecourt at the front that has some parking facilities. Parking restrictions apply on the road outside the home. The Service User Guide and fee range are available from the home on request. At the time of finalising this report, the fees ranged between #485 and #630 a week. Care Homes for Older People Page 5 of 32 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 was an unannounced inspection on Monday 12th January 2009 which lasted from 11 am to 6pm. The manager , staff and relatives were very open and welcoming to the inspection. The care of four of the people who live in the home was tracked as the main way of carrying out the inspection. This involved talking with the residents, looking at their care plans and all documentation specific to them and talking with the staff as well as observing care practice throughout the day. The inspection also involved talking with four staff members, reviewing a selection of records and documentation and a tour of the home with the manager. The inspector spoke with two of the relatives who visited the home during the day and received very positive comments. Care Homes for Older People Page 6 of 32 The report highlights a number of areas that need improvement. The manager and owner met the day following the inspection to see what action they could do immediately to meet the requirements made. They carried out the following actions. Firstly they called in a builder to look at the lounges and a plumber for the bathroom so as to address the environment issues. Then they booked medication, first aid and moving and handling training for the first available dates in February. They also ordered furniture and planned for carpets to be fitted within the week. Addressing the environment issues will have a great impact on the other areas. What the care home does well: What has improved since the last inspection? What they could do better: 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 8 of 32 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 9 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Everyone who wishes to move into the home are given the opportunity to visit the home and have their care needs assessed. Evidence: The manager completes all the assessments on people who request admission to the home. Social Services complete an assessment of people needs and the manager uses this information to make the initial judgment as to whether the home would be suitable and be able to meet their needs. Four care files were seen and of those recent admissions all the assessments were in place and completed. The manager also confirmed how all prospective residents are given the opportunity to visit the home prior to admission. Care Homes for Older People Page 10 of 32 Evidence: There are four shared rooms in the home although only three are currently occupied by two people. The home need to make sure that people who are living in shared rooms have signed an agreement to do. Equally the home need to see how they can further safeguard peoples dignity and privacy within the current shared rooms. Care Homes for Older People Page 11 of 32 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. People who live in the home have a plan of their health and social support needs.The care plans need to become more personalised with greater detail as to how people wish to be supported. Greater care is needed in the administration of medication to ensure that medication errors do not occur and that staff are fully trained in the correct administrating of medication. There must be a more robust audit of medication in the home. Evidence: Observation of the interaction between staff and the people who live in the home was generally very positive. Staff did spend time supporting people who wished to walk around and then when they were more settled they were guided to an activity. The care of four people who live in the home was tracked. This involves speaking with them and their key worker, looking at their care plan and all documentation linked to their stay in the home. Care Homes for Older People Page 12 of 32 Evidence: Since the last inspection the home have changed the care plan documentation. It now has numerous sections but lacks an overall summary page where you can an overall profile of the person and their care needs. One of the people whose care was tracked was the most recent arrival in the home. Their social history was only two lines although they have frequent visits from relatives. It is important that staff gain an understanding of peoples life history.It is particularly important when people may have dementia so as to be able to make links with the areas of their lives which they are familiar with. One of the care plans seen had an excellent family history which would prove very useful to staff in supporting the person. One person who has no relatives in touch with them had no personal information at all. This person rarely speaks due to the level of their dementia. This person has been in the home some years. The staff must make all efforts to seek out some information to enhance the experience of care this person is receiving. All the care plans seen need to specify the actual support people require in all areas. This was discussed with the manager who spoke of how the staff are getting used to the new documentation. Entries that say that X needs one carer for support and toileting washing and bathing does not give any picture of how X likes to actually be supported, do they like to have a daily shower after a cup of tea in bed, do they prefer a bath at night. The section in the care plan on food and drink has columns for hot drinks, cold drinks etc and then column to mark preferences dislikes and comments. These need to specify what hot drinks people like and when. The risk assessments specified if people used a chairlift or zimmer frame and one plan spoke of how the person requires two carers but there was no detail as to how the person needs to be supported, what aids, equipment, techniques are used to ensure their safety and comfort. Staff also complete daily notes for each resident. The entries tended to be the same each day, for example saying the person had been assisted in the morning with personal care, supported with breakfast then went into the lounge for tea, biscuits and then either spoke or slept. The second entry was the night staff who commented on how the person slept. These notes need to give a flavour of how people spent their day, the activities, things they enjoyed, those that may have upset them etc. There is a daily handover sheet that staff complete plus a diary and also health care notes where any medical visits are noted. In order to provide continuity in their support it may be useful to use the daily notes more to reflect briefly all that their day Care Homes for Older People Page 13 of 32 Evidence: contains, illness, medical visits relaxation so as to make the care plan a helpful tool in assessing and meeting someones care health and social needs. The monthly reviews which have been taking place of each residents needs to involve the residents and or their relatives reflecting whatever changes may have taken place. Looking at the medication cupboard the majority of medication arrives in blister packs from the local chemist. Any other medication is kept in the medication cupboard in the dining room or the medication fridge which is in a small sitting room on the first floor. There were a number of errors on last months medication administration records where one member of staff signed repeatedly for medication when it was not due for example signing in the morning for a pm only medication. Another member of staff signed for medication which was to be given once a week and was signed for two days running when this drug was not available therefore could not have been administered. Another medication was highlighted on the MAR as needing to be administered in the morning and was signed for but was a night time only medication. The manager spoke immediately to the member of staff who had made the repeated errors. They need to be retrained in medication and refrain from any further administration of medication until this is done. There is no in house audit of medication this is apparently carried out by the homes area manager once a month. A robust audit of medication must be carried out frequently and all staff to have medication training as a matter of urgency. The manager had requested already that the local pharmacy complete an audit of medication and will also arrange urgent medication training. Care Homes for Older People Page 14 of 32 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. People were seen to be happy and actively engaged within the home. The relatives spoken with were happy with the care the staff gave their relative and with the activities. The relatives said they are always made welcome and accepted as part of the home. Staff need to be mindful of those residents who are unable to express their wishes clearly and offer support in a way that facilitates each person to relate. Evidence: During the day the people at St Josephs had a variety of one to one individual activities and group activities. The TV was on in the lounge and one or two people said that they were watching it. Two people put together a jig saw with a staff member, another group of people later on did some art work, colouring in drawings and copying them. A number of people enjoy and are good at singing and there were various moments of spontaneous singing enjoyed by all. One person was restless and wanted to know what to do they were guided to an activity which they relaxed into. Another person enjoyed sitting with staff or walking around with staff which they did happily. Care Homes for Older People Page 15 of 32 Evidence: The manager spoke of their links with the local community and the local church . There are parties and dancing organised which are enjoyed by all. One person celebrated a special occasion and was able to have a special meal with their relative in the home. The relatives spoken with were happy with the care the staff gave their relative and the activities. The relatives said they are always made welcome and accepted as part of the home. People were offered two choices at lunch time and were seen to relax and enjoy their meal. The majority of people were sat at two tables in the dining room. There was a small group of residents who had their meal in their chairs in the lounge, with a small cantilever table in front of them. The lounge is very crowded and staff were observed supporting people with their meals standing over them. This was mentioned to staff and how they must be seated with residents them talking and encouraging them so that people can relax and enjoy their meals and be able to see and relate to the person supporting them. It was also observed that people who required support with eating were given towels, some rather worn, to place over them to protect their clothing. A provision of more dignified clothing protectors rather than towels be sought for people who need support with eating Staff need to be mindful of those residents who are unable to express their wishes clearly and offer support in a way that facilitates each person to relate. The staff reacted straight away and moved chairs so as to make it possible to sit with residents. There was a good relaxed atmosphere in the dinning room and everyone seemed to have good appetites and were also offered extra portions. Care Homes for Older People Page 16 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to voice any concerns and they know who to talk to if they had any complaints. St Joseph does have a system to record and monitor any complaint. Evidence: We have an open door approach, any problem can be discussed at meetings or privately with the manger. A quote from the Annual Quality Assurance (AQAA )completed by the manager. There is a copy of the complaints procedure displayed in the hallway at St Josephs. There have been no complaints since the last inspection. The manager did start a book for grumbles as suggested in the last inspection though this was destroyed by one of the residents. The manager will start another book to note low level complaints or grumbles and keep it in the office so that staff can have access. The manger said that keeping the training up to date on safeguarding is really important and staff have been booked on training within the next few months. Staff spoken with were aware of safeguarding and the need to share any concerns. Care Homes for Older People Page 17 of 32 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in the home would benefit from a redecoration and reconfiguring of the home in order for them to have a bright and homely environment. Evidence: St Josephs is a conversion of two large houses in a residential area. Every space is used and the provider recently created a visitors sitting room on the first floor which is a welcomed quiet space though the old filing cabinet could be removed to enhance the homeliness of the space. There are stair lifts to access the upstairs floor. The layout of the home means that the lounges have no windows or natural light as they are in the centre of the building. The current layout means that people are sat close together in high back chairs around the edge of a small lounge with a TV in the corner. The adjacent lounge has two low sofas. Both lounges are open onto the dinning room which is used for most activities and also currently for staff handover though the manager said this practice will change to maintain the dignity and privacy of the residents. These lounges need to be reconfigured so that people can sit in groups and in a more homely environment. These is a need for new chairs, redecoration to give more light Care Homes for Older People Page 18 of 32 Evidence: into the area and for more personal decorations to be used to make the whole environment,a relaxed and comfortable place for the people who live there. The current layout of the lounge means that those people who are less mobile and less able to express themselves are supported in a small room with little personal space or stimulation of colour or comfortable furniture. The provider must consider the layout of the lounges and the provision of furniture to create a more homely arrangement and to facilitate people support needs. A tour of the building included visiting peoples bedrooms. There are a total of four double rooms in the home though currently three are occupied with two people in each and the remaining one has just one person. The rooms are divided by a short flimsy curtain the type you would see in a hospital ward though it stops about two feet from the ground. There is a sink in the corner but none of the rooms are en suite. Its is difficult to see how peoples privacy and dignity can be maintained in such an environment.The provider must consider the layout of the four shared rooms, the lack of any substantive screening to enhance people privacy and comfort. Written agreement must be in place for all those people in shared accommodation signed by all parties involved. The other bedrooms were also basically and sparsely furnished many had either old worn or torn carpet or no carpet at all but old lino. The provider must review the furniture in each persons room to be sure that it is of a good standard, is sufficient and creates a homely environment. The provider must give a timescale for replacing worn carpets and carpeting bedrooms which currently have lino.Also the wire mesh radiator cover seen in one bedroom must be replaced with homely and safe covers. Currently the residents all use one bathroom which has been adapted. The provider must make arrangements for sufficient accessible bathing or shower facilities for the residents. The bathroom in number 40The kitchen also requires is in urgent need of renewing it is not accessible for the residents. It is also in in need of decoration and the floor needs repairing.This is urgent as one bathroom for eighteen residents is insufficient. The adjoining toilet also needs to be accessible for residents. The kitchen also requires some updating and the replacement of some old furniture. The inside and outside of the home could be brightened with a redecoration. The home was generally clean. Care Homes for Older People Page 19 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at St Josephs are supported by a sufficient number of staff to meet their needs. All staff receive supervision from the manager. There needs to be a stronger emphasis on meeting all health and safety training to ensure the safety and comfort of residents. Evidence: If you need something they will help you, they are so kind. These were some of the comments from residents when asked about the manager and the staff.Observation of staff generally showed good interactions with residents. The manager explained that there are four care staff on in the morning, three in the afternoon one at night and one sleepover. The home also have their own cook who works as a carer in the afternoons.There is also one person who comes in daily from 7am to midday to do the cleaning and for three hours on both Saturdays and Sunday. The manager works during the week from early morning to mid afternoon. The manager explained that they currently have two staff vacancies which are being covered by existing staff doing bank work. One of the three staff spoken with said how they were linked to a local training college Care Homes for Older People Page 20 of 32 Evidence: for their NVQ training. They said that the manager was very supportive that they were good for the residents and the staff. Speaking with staff and reviewing their files highlighted the shortfall in their health and safety training moving and handling, medication and first aid. These are key areas of training that need to be undertaken to ensure the safety and comfort of the residents.When this shortfall was raised with the manager they explained that it was planned and the dates in February were confirmed by the manager the day after the inspection. The manager keeps a sheet of all training in their office and staff files hold their individual records and certificates. It is recommended that there is an at a glance record of each persons training noting when the statutory training has been completed and the next due date. A discussion was also held with the manager about the need to have all staff trained in person centred care planning for people with dementia so as to be able to continue to develop their support of residents. There are five senior carers who have trained and qualified overseas as nurses.Four of these are currently working towards NVQ level 3. The homes administrator is also working towards an NVQ level 3. The staff files seen were well kept with up to date records of supervision. There was clear evidence of good recruitment practice. The manager confirmed that the two staff who are currently staying in the home on the top floor. The staff have just a bedroom. They have to use the bathroom in the care home and the homes kitchen. The manager said this was only a temporary measure and that those rooms are normally only used as asleep over rooms. Care Homes for Older People Page 21 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. St Josephs is managed by an experienced manager who has the care of the residents as paramount. There is good record keeping to ensure the health and safety of the residents and staff. Evidence: They are one of the best managers I have had, they are a good manager both for the residents and the staff. Extracts from comments from staff. The manager is always very helpful and understanding. Comment from relative. The manager has had eleven years experience of managing a care home for older people. She holds an NVQ4 in management and demonstrated a clear understanding and knowledge of the people who live in the home and of the staff. The manager was observed during the day relating to staff and residents and showed their sensitivity and grasp of what needs to be done to develop the home. The feedback from Care Homes for Older People Page 22 of 32 Evidence: residents, relatives and staff was very positive as shown above. The manager explained that in their absence a senior carer, would be the person responsible and the provider is within fifteen minutes distance and is also readily available if needed be as indeed the area manager. The provider contacts the home daily and is very supportive. This was evidence by their quick response to the requirements made in this report and their immediate actions. The manager receives their supervision from the area manager. The area manager also completes the monthly unannounced visits and audits medication as part of these visits. Prior to the inspection the manager completed the Annual Quality Assurance Assessment(AQAA) which is a yearly requirement set by the Commission where managers give an account of what the home does well,what they could do better, how they have improved and their plans for the future. The manager was advised to complete the AQAA briefly. It is recommended that the AQAA is completed with greater detail, reflecting the home,es current situation as it forms an important part of the homes evidence of their ability to record, monitor and plan for the homes development for the benefit of the residents. The manager had to complete the AQAA by hand as there is no current Internet access to the home. This needs to be remedied immediately in order that the manager may continue to update their records and complete and update the AQAA on line as part of their quality assurance and record keeping. The manger needs to access all the on line information she requires to carry out her role and to keep up to date with good practice guides and information. As stated in the summary arrangements were made the week following the inspection to reconnect the Internet. During a tour of the home wedges were seen holding open a fire door. This is unacceptable and unsafe practice and the manager must make sure that all wedges are removed from fire door immediately and are replaced with devises approved by the fire brigade. Again this was action the day of the inspection and appropriate door guards were ordered.. The manager keeps a record of all incidents and accidents within the home and forwards the relevant information to the Commission as required. There were records of temperatures being checked regularly and the fire book with all checks was up to date. Care Homes for Older People Page 23 of 32 Care Homes for Older People Page 24 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Older People Page 25 of 32 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 7 15 The manager must ensure that all care plans are more personalised with greater detail as to how people wish to be supported. This is also true for the daily notes which should reflect a persons day to be sure that each person personal needs are met as they would like. 31/03/2009 2 7 15 Care plans should be reviewed with greater detail each month with the resident and or their family or representative to be sure that peoples needs continue to be met and any changes are required in their care are shared. 28/02/2009 3 8 13 The manager must make sure that all risk assessments and action plans contain sufficient information about the 31/03/2009 Care Homes for Older People Page 26 of 32 persons needs and how they require support so that continual and appropriate support is offered by all staff at all times 4 9 13 The manager must ensure 31/01/2009 that medication errors do not occur and that staff are fully trained in the correct administrating of medication. There must be a more robust audit of medication in the home in order that the people in the home can be sure that they receive their medication correctly and at the time it has been prescribed for. 5 15 16 Staff who are supporting people to eat must do so sitting alongside them talking and encouraging them not standing over them, so that people can relax and enjoy their meals and be able to see and relate to the person supporting them. 6 19 23 The provider must give a timescale for replacing worn carpets and carpeting bedrooms which currently have lino in order that people may live in a homely environment and have their 28/02/2009 31/01/2009 Care Homes for Older People Page 27 of 32 accommodation updated in a timely manner. 7 19 23 The provider must replace the carpet in room 7 which is torn and rippled. as the current carpet could be the cause of an accident and is unsightly. 8 19 23 The provider must forward a 28/02/2009 plan with timescales of planned maintenance and redecoration of the home both inside and outside in order to be sure that all decorations and repairs are carried out in a timely manner for the people who live in the home. 9 20 23 The provider must consider 28/02/2009 the layout of the four shared rooms , the lack of any substansive screening to enhance people privacy and comfort. Written agreement must be in place for all those people in shared accommodation signed by all parties involved. to ensure that the dignity and privacy of each person is considered and that good reasons offered as to why their care is best provided for in a shared space. 10 20 23 The provider must consider the layout of the lounges and the provision of furniture to create a more homely arrangement and to 31/03/2009 31/01/2009 Care Homes for Older People Page 28 of 32 facilitate people support needs. as chairs crammed around the edge of a room does not enhance people dignity or help their support needs to be met 11 21 23 The provider must make 31/03/2009 arrangements for sufficient accessible bathing or shower facilities for the residents. The bathroom in number 40 is in urgent need of renewing it is not accessible for the residents . It is also in in need of decoration and the floor needs repairing so that the residents may enjoy sufficient and homely bathing facilitates. 12 24 23 The provider must replace 31/03/2009 the wire mesh radiator covers with homely and safe covers for the protection of the people who live in the home. 13 24 23 The provider must review 31/03/2009 the furniture in each persons room to be sure that it is of a good standard, is sufficient and creates a homely environment so that people may enjoy a safe comfortable homely environment. 14 30 18 All new staff need to have training in person centred care planning for people with dementia 31/03/2009 Care Homes for Older People Page 29 of 32 so as to be able to support people at all times 15 30 18 The manager must ensure 28/02/2009 that all staff receive regular statutory health and safety training and that no member of staff undertakes any support of residents without appropriate training. In order to ensure the safety of the residents and the staff at all times 16 37 19 The provider must ensure that Internet connections are re established in order that the manager may continue to update their records and complete and update the AQAA on line as part of their quality assurance and record keeping 17 37 17 The manager must ensure 31/01/2009 that there is a photograph of every resident in their care plan for the protection of the residents. 18 38 13 The provider must make 31/01/2009 sure that all wedges are removed from fire door immediately. That they are then replaced with devises approved by the fire brigade in order to maintain the safety of the residents and staff and be in line with fire regulations. 31/01/2009 Care Homes for Older People Page 30 of 32 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 A front sheet, one page profile of each person who lives in the home with a brief overview of their details and support needs could be helpful to staff in supporting people The current system does not allow for an overall view of peoples health and care needs. It is recommended that these are brought together in one place and that the daily notes are used to record all events of that persons day, health, social and personal care A provision of more dignified clothing protectors rather than towels be sought for people who need support with eating. It is recommended that there is an at a glance record of each persons training noting when the statutory training has been completed and the next due date. That the manger complete the AQAA in greater detail so as to give a greater reflection of the homes current situation and their plans for the development of the home for the benefit of the residents. 2 8 3 15 4 30 5 33 Care Homes for Older People Page 31 of 32 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). 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. 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