Inspection on 23/03/09 for St Michael`s Rest Home

This inspection was carried out on 23rd March 2009.

CSCI found this care home to be providing an Poor 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 Michael`s Rest Home 06/02/09

St Michael`s Rest Home 31/03/08

St Michael`s Rest Home 05/06/07

St Michael`s Rest Home 30/11/06

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: St Michael`s Rest Home 107 Cooden Drive Bexhill-on-sea East Sussex TN39 3AN     The quality rating for this care home is:   zero star poor 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 3 0 3 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: St Michael`s Rest Home 107 Cooden Drive Bexhill-on-sea East Sussex TN39 3AN 01424210210 F/P01424210210 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) : Balwinder Singh Khera,Baljeet Kaur Khera care home 15 Number of places (if applicable): Under 65 Over 65 0 dementia Additional conditions: 15 The maximum number of service users to be accommodated is 15 The registered person may provide the following category 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 category: Dementia (DE) Date of last inspection Brief description of the care home St Michaels Rest Home is situated in a residential area of Bexhill-on-Sea. The home is a detached house with 12 bedrooms comprising of 9 single bedrooms and 3 double bedrooms all bedrooms are fitted with a washbasin and two rooms have en suite toilet. There is a large lounge with integral dining room. A stair lift provides access to the first floor. The front garden has been adapted for car parking, and there is a large rear garden, which is secure for the residents. Details of weekly fees charged can be obtained from the manager. Residents would be expected to pay extra for chiropody, newspapers and magazines, toiletries and other luxury items. Care Homes for Older People Page 4 of 34 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: zero star poor 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 inspection was carried out on the Monday 23rd March 2009 over a period of seven hours. An expert by experience was present at this inspection during the morning and through the lunch time period. The comments from this expert by experience are included within the main body of this report. The inspector received two completed resident surveys that had been completed by relatives of the residents. During the course of the inspection the inspector spoke with Boots the Chemist pharmacist, registered provider, manager, members of staff including the cook, carried out an audit of medication, viewed communal areas of the home, as well as the laundry, and some of the residents bedrooms. Documentation relating to the key standards inspected were also viewed. The AQAA - Annual Quality Assurance Assessment was not completed appropriately Care Homes for Older People Page 6 of 34 and did not cover or reflect how the home meets each standard, and therefore information contained within the AQAA has not been included within this inspection report. What the care home does well: What has improved since the last inspection? What they could do better: Pre-admission assessments need to include all the headings as outlined Standard three of the National Minimum Standards. Care plans need to clearly indicate residents preferences, likes and dislikes, in relation to their personal care, physical care and past hobbies and interests. Personal care is not recorded in sufficient detail to ensure that all personal hygiene needs are being met. The recording, receipt and administration of medication within the home needs to be improved upon to ensure that all prescribed medication is being properly administered, that medication is not being secondarily dispensed, that General Practitioners clearly write on prescriptions the quantity of medication and times when medication needs to be administered to give staff clear guidelines. Further policies and procedures need to be developed in regard to the the administration of PRN - as required - medication and homely remedies. The need for these improvements were also noted by the homes pharmacy supplier. Where residents require a vegetarian diet, a menu should be compiled to ensure that these residents receive a balanced, nutritious and varied diet. Where residents require assistance with eating, sufficient staff should be on duty to ensure that these residents receive assistance individually and in a sensitive manner. Staff should receive appropriate training in the Safeguarding of Vulnerable Adults. Residents should not be restrained with cot sides unless an there is a written assessment carried out by an external health care professional, to ensure this restraint complies with the Mental Capacity Act 2005. At the present time there is extensive building and refurbishment work taking place in the home. The registered provider must ensure that these works have the minimum of distruption to residents living in the home, and no resident should be temporarily placed in a bedroom with no natural light or heating. Further improvements needs to be made in relation to infection control and ensuring there are no underlying offensive odours in the home. Staffing levels need to be reviewed to ensure that assessed needs and day to day Care Homes for Older People Page 8 of 34 anxieties of resident can be met. The qualifications of staff and mandatory training of staff need to be addressed to ensure that resident are receiving care from appropriately qualified and trained and staff. The manager must apply to the Care Quality Commission for registration. An effective quality assurance system must be developed for the home to ensure that residents are receiving the best quality of care in all aspects of their lives. Further work needs to be done in improving the health and safety of residents in regard to the appropriate use of wheelchairs in the home. There are three outstanding requirements from the previous key inspection on the 31st March 2008 which have not been met and are still outstanding. 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.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 there some good evidence in the pre-admission assessments, some information was missing and did not give a true picture of the health, personal or social care needs of the residents. Evidence: The inspector viewed two most recent pre-admission assessments and found there was some information on which to base a care plan. It was noted that in one of the headings of the pre-admissions assessments, spiritual needs had not been completed for either resident. Therefore there was no evidence that the equality and diversity of the residents were being met. The inspector noted that there were no preferences in regard to daily choices recorded, for instance when the residents like to get up in the morning and go to bed at night, what food they liked or did not like, how many times a week and at what time of day they would like to bathe or shower, how often they would like their hair done, what clothes they preferred to wear. The pre-admission Care Homes for Older People Page 11 of 34 Evidence: assessment did not cover all the headings given in Standard 3 of the National Minimum Standards. 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 poor 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 show how individual needs in regard to personal, physical and social care are being met. The systems for the administration of medication in the home are poor and potentially place residents at risk. Personal support in the home protects the privacy and dignity of the residents. Evidence: The plans of care are more ordered than on previous inspections St Michaels Rest Home. Care plans and daily reports do need to be more informative in relation to each individual residents needs and wishes. There was no evidence to suggest that residents have been given the opportunity, to express their likes and dislikes, and how they wish their assessed needs to be carried out. Daily reports still do not give sufficient information regarding the personal hygiene tasks that have been carried out, or more detail of how the residents have spent their day. Expert by experience noted Care Homes for Older People Page 13 of 34 Evidence: every residents has two baths each week. Where residents become anxious or agitated this should be explained as to what forms of behaviour they are displaying and what actions staff have taken to reduce their agitation or anxiousness. There are some issues with medication that must be remedied for instance where a relative is secondarily dispensing medication for the home, this must be discussed with the relative in relation to the risks, and some compromise must be arranged so that medication is not secondarily dispensed. Where residents are prescribed creams the application of these creams must be signed off on the Monthly Administration Records. All liquid medications should be dated on the bottle on the day of opening. Policies and procedures in relation to medication should be reviewed and updated annually. Further policies and procedures should be in place in regard to PRN - as required medication and homely/over the counter remedies. There should be a seperate policy and procedure for each residents for PRN - as required medication - and homely/over the counter remedies. The manager must ensure that she contacts General Practitioners in regard to getting prescriptions changed for - as directed medication - each prescription should clearly state, when the medication is to be given and what amount of medication should be given at each administration. The inspector observed throughout the inspection that staff respect the privacy and dignity of the residents by ensuring that personal hygiene tasks are carried out in privacy. The two double bedrooms now have privacy curtains in place. Staff talked to residents in a kind and friendly manner. None of the residents have a private telephone in their bedrooms, but are able to use a mobile office telephone that they can take to their own bedrooms with them if they wish to do so. Expert by experience noted - The staff always appeared respectful and patient with the residents. Personal items - pictures, furniture, television sets etc. can be brought into the home by the residents; the home will provide a television set without charge if required. There is a portable home telephone that residents can use in privacy if they wish. Care Homes for Older People Page 14 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is evidence that there are a variety of activities on offer to the residents in home, that helps to enhance their social life. Visitors are welcome into the home at any reasonable time. While meals in the home are generally good there are some concerns relating to how dietary requirements and nutritional needs of one resident are being met, and how residents are able to make informed choices in regard to the normal menu. Evidence: There were no activities taking part in the morning of this key inspection. The television was playing in communal lounge throughout the whole inspection. DVD playing music latter part of morning and in the afternoon. Activities witnessed in the afternoon of this inspection were a member of care staff playing a ball game with residents and playing skittles with residents. The manager said that they do have a member of care staff who mainly runs activity sessions for the residents. Expert by experience noted - From discussion with the manager there are a variety of Care Homes for Older People Page 15 of 34 Evidence: activities held in the afternoons. These activities include painting with poster paints, producing collages, papier mache, bingo, table tennis, very mini golf on the lounge floor, and, less frequently, outside entertainers come in to entertain residents. A dog is brought in to the home by the manager and residents enjoy this. A visitor brings in cuddly bunnies. Residents sometimes go out for walk with the manager and her dog. Occasional activities include a Valentine party with buffet tea. Christmas dinner and Christmas party, relatives and friends were invited to both events. The registered provider is proposing to purchase an 8 seater mini bus so that residents can be taken out for drives in the country, for afternoon teas or a visit to the shops. There will be no charge for this. One a month the local vicar comes in to the home to hold a communion service. Expert by experience noted - Visitors can come into the home at any reasonable time. One resident comes in to the home for short stays as an when necessary. This resident was collected by a relative on the morning of this inspection. The relative stated that they were very happy with the way the respite resident was cared for. The relative was concerned that the deputy manager was leaving the home in a weeks time, and stated - she is the best member of staff. The manager will write letters for the residents, and this was confirmed by one of the residents. None of the residents manage their own financial affairs, and have elected a power of attourney or solicitor to deal with their finances for them. Expert by experience noted - Although a copy of the four week meal schedule was asked for many times, I did not get one. However I spoke with both the manager and the cook at some length and the overall understanding is that the meals are varied, that the meat and produce are locally sourced. I joined the residents for lunch and found the sausages to be the best I have ever tasted. Diabetics and other special diets are willingly catered for. A vegetarian resident will eat cold ham, but at other times is given appropriate food. There is not a specific alternative main dish, although one resident who would not eat the sausages, mash, carrots and cabbage with onion gravy was offered quiche, which he accepted and later declined - in the end he ate practically all of his original dinner. Several residents required assistance with feeding and an extra member of staff is necessary to ensure assisting residents with feeding is carried out appropriately. The meals are served fairly quickly and there was an option of either fruit cocktail and cream or jam sponge and custard. There was no fresh fruit on the tables so that residents could have fresh fruit whenever they choose. All residents spoken to said the food was - very good - excellent or very nice. I went into the kitchen on four seperate occasions and each time everywhere was spotless and well organised. I discussed with the cook the question of residents being offered alternative main courses when they sat at the table, and the cook confirmed that she always has Care Homes for Older People Page 16 of 34 Evidence: quiche or slad available if required. It is appropriate to have one main dish with an enjoyable alternative for the one or two residents who may not want the main dish of the day. The cook also confirmed that a relative or friend can stay for lunch if they wished and that there is no charge for this. The inspector viewed the four week rotating menu and found that each day offered a choice of meal. The second choice was mainly cheese, cold meat salad or omelette. There was no weekly menu for the resident who prefers a vegetarian diet, this should be arranged to ensure that this resident is receiving a varied and balanced diet. It was noticed by the inspector that staffing numbers at lunch time are low, and that several residents need assistance with feeding and encouraging to eat their meals. Therefore staffing levels at lunch time should be reviewed to meet the needs of the residents. The home has not produced the menu in any other format to assist residents in making an informed choices in regard to what choice they would prefer. Three residents spoken with stated they did not remember what they had ordered for lunch. 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 poor 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 satisfacotry complaints system with some evidence that residents views are listened to and acted on. Not all staff have knowledge and understanding of Safeguarding Vulnerable Adult issues which leaves residents as possible risk of abuse. Evidence: The complaints policy and procedure is displayed in the main entrance hall. Staff are aware that all complaints made to the home should be recorded. The home has a complaint file, but no complaints have been received by the home since the last inspection. Two complaints were received by CSCI in relation to the recent building work taking place in the home and the health and safety of the residents in the home. This was investigated by The Commission on 6th February 2009 and a random inspection report produced in relation to this. There have been no Safeguarding Vulnerable Adult referrals since the last key inspection in March 2008. The home has a protection of vulnerable adults policy and procedure which was reviewed in August 2008. All new staff have the appropriate Criminal Records Bureau and Protection of Vulnerable Adults register checks carried out prior to be employed to work in the home. Out of the ten staff employed in the home only four of the staff have received Safeguarding Vulnerable Adults training. This Care Homes for Older People Page 18 of 34 Evidence: will be referred to later under staffing in this report. In two bedrooms viewed it was noted that there were bed rails fitted to beds, while the home had permissions signed by relatives, there were no written assessments from District Nurses or Occupational Therapists in place. This contravenes the Mental Capacity Act 2005. Relatives are not able to give permissions for residents to be restrained, and the manager should have made the appropriate checks with external health professionals to ensure this form of restraint is appropriate. 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Current investment taking place in the home at the present time does not provide residents with a comfortable and homely environment in which to live, this should improve when extensions and refurbishment are completed. Further improvements need to be made in regard to infection control procedures to ensuring residents are not placed at risk. Evidence: At the present time the home is undergoing extensive building works and refurbishment. This will provide a further five bedrooms with en suite facilities, a laundry room, a managers office, larger communal living space and conservatory. The rear garden of the home was viewed by the expert by experience and was found not to be suitable at the present time for residents to use. The back garden has never been very appropriate for the residents; the grass is too uneven to have ever been a good lawn, flower beds are almost non-existent and there are no interesting trees or shrubs. Manager and the proprietor both said that there will be major improvements by the summer after the building work has been completed, including a conservatory, a patio all around the rear of the home, raised beds (one has already been built), paths and handrails will be put in place. Manager is going to visit a home in Hastings Care Homes for Older People Page 20 of 34 Evidence: that has a specially designed garden for residents. It is hoped that residents will be able to assist in the garden. The front of the home is concreted as a parking areas with three small flower beds. There are some existing bedrooms in the home which are in need of decoration and this decoration is due to be carried out. It was however noted by the inspection that one bedroom on the first floor was in the process of being refurbished and decorated, but that the resident had been moved with permission of a relative into a ground floor room that at a later date is intended to be used as the managers office. At the present time this room has been plaster boarded and there are no windows or raidators in situ. This arrangement is not acceptable, even as temporary accommodation for a resident to use as a bedroom. In the main entrance hall there was an underlying offensive odour and this was also noted in some bedrooms in the home this is an outstanding requirement from the previous key inspection that took place on 31st March 2008 The staff toilet had no provision of paper hand towels or liquid soap, and the inspector found that a cloth towel and bar soap were being used. There were no hand washing facilities in the laundry area of the home. 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Only limited progress has been made in addressing staffing shortages and as a result Service Users do not receive consistent care. The level of qualified staff or staff mandatory training is not sufficient to ensure that assessed needs of the residents are being met by appropriately qualified or trained staff. Recruitment policies are consistently followed ensuring that service users receive care from staff who have been appropriately vetted. Evidence: Since the last inspection there has been a cconsiderable turnover of staff in the home. The deputy manager is leaving the home within the next week. On the day of inspection it was observed especially at lunch time that staffing levels were low especially in view of the needs of the residents at lunch time. There are three residents who require some assistance in eating, and another resident was observed as being very restless, there were only two members of staff on duty to give assistance. During the course of the morning and afternoon two residents were observed as being restless and anxious and would have benefited from one to one attention from a member of staff, but there were not sufficient staff on duty to meet these residents Care Homes for Older People Page 22 of 34 Evidence: needs. There is no afternoon kitchen assistant on duty to prepare a tea-time meal for residents, this means that a member of the care staff needs to go into the kitchen to prepare the tea-time meal. On the day of this inspection there was no domestic on duty in the home. Less than half of the staff have obtained their NVQ level 2 or above. The inspector viewed two staff personnel files and found that recruitment procedures had been carried out appropriately. The manager had obtained on behalf of the two members of staff, application forms with full employment histories, two written references, two forms of identification and had carried out appropriate checks for each employee in regard to Protection of Vulnerable Adults register and Criminal Records Bureau. Evidence was also seen that the home has copies of General Social Care Council codes of conduct. Staff training in this home is poor with only four staff having received training in the Safeguarding of Vulnerable Adults training, one member of staff having received first aid training, one member of staff having received food hygiene training, one member of staff having fire safety training, four members of staff having received infection control training, two members of staff having moving and handling training. Only two members of staff have received accredited medication training. Three members of staff have received one days understanding Dementia Care 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager at the present time is not registered with CSCI. The quality assurance system has not been developed to ensure that residents receive the best quality of care. Residents personal allowance money is managed by relatives or solicitors. Some aspects of health and safety in the home have not been checked and this could leave residents and staff at risk. Evidence: The manager has worked at St Michaels Rest Home since June 2007, at the previous inspection the inspector was told by the manager that she was awaiting her Criminal Records Bureau check to come through then she would be applying to CSCI to become the registered manager. At this inspection the manager said that she had applied to Care Homes for Older People Page 24 of 34 Evidence: CSCI for registration and had undertaken her Registered Managers interview in the CSCI Maidstone Office two weeks previous to this key inspection, and that she had not received any communication of the outcomes of this interview. The inspector checked with registration as to why the manager had not been informed of the outcomes of her interview and was told that there had been no application for the manager to be registered with CSCI, and that an interview had not taken place. The manager has stated that she has achieved her NVQ level 4 and Registered Managers Award. She has several years experience at management level in other residential care homes for the elderly. At the present time the home has not got a system in place for quality assurance, and there was no evidence that the views of residents, relatives, friends and external stakeholders are sought. There is no evidence that the manager regularly monitors the systems used in the home, to ensure that the best quality of care is offered to the residents. The inspector was shown that the home has a Health and Safety and Fire risk assessment for all rooms in St Michaels Rest Home. A requirement for the home to develop a quality assurance system was made at the previous key inspection on 31st March 2008 and has not been met. The manager does not manage any of the residents personal allowances. At the present time next of kin, powers of attorney or the residents nominated solicitor has control of the residents personal allowances. From the fire log evidence was seen that fire points are checked weekly and emergency lighting is checked monthly. There was no evidence that hot water outlets in residents bedrooms are checked at all. There is a hot water check in communal bathrooms, and this showed that hot water is being delivered at between 37 and 38 degrees centigrade, which is well under the required 43 degrees centigrade. All windows in the home are fitted with window opening restrictors. At the present time residents do not have access to a safe garden area, this is due to all the building work being undertaken. The inspector spoke with the registered provider who said that as soon as building work is completed, the back garden will be made safe so that the residents are able to have free access. It was noted that a wheelchair being used to transport residents around the home, was being used without foot rests in situ. This was pointed out to the manager, and the inspector noted that later on during the course of the inspection that while this wheelchair had foot rests in place the foot rests were folded back and not being used while transporting a resident into the communal lounge. Care Homes for Older People Page 25 of 34 Evidence: All accidents in the home are recorded in an accident book. This was seen to be completed by the member of staff witnessing the accident. 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 15 12(2)(3) The registered person shall 02/06/2008 enable residents to make decisions with respect to the care they are to receive and their health and welfare, and therefore must ensure residents are offered a choice of meals in written or other formats to suit their capacity. 19/05/2008 2 26 12(1)(a)16(1) The registered person must (2)(j)(k) ensure that the whole home is kept free of offensive odours. 3 33 24(1)(a)(b)(2 The registered person must 02/06/2008 )(3) ensure that an effective quality assurance system is put in place to measure the success in meeting the aims, objectives and statement of purpose of the home. 13 The registered person shall ensure that: a. all parts of the home to which service users have access are so far as reasonably practicable free from hazard to their safety. b. Any activities in which service users participate are sop far as reasonably practicable free from avoidable risks; and c. Unnecessary risks to the 13/03/2009 4 38 Care Homes for Older People Page 27 of 34 health or safety of service users are identified and so far as possible eliminated. The registered manager must ensure from day to day while building works are taking place that all parts of the home are safe for residents to use. Care Homes for Older People Page 28 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 30/04/2009 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 suitable qualified or suitably trained person. Pre-admission assessments must be in place for all service users. 2 7 15 Unless it is impracticable to carry out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan - the service users plan - as to how the service users needs in respect of his health and welfare are to be met. Care plans must be individual to each service 27/04/2009 Care Homes for Older People Page 29 of 34 user in the home, and be specific in regard to their preferred choices. Daily records are a good source of evidence to show that care is being provided, as detailed in the care plan, - all care given - is not helpful or adequate. Daily records when well written, help ensure a consistanet approach and good quality of care for residents. Detailed daily records will help the manager to audit the care being provided and make sure that staff are following care plans. It is in the homes interests to be able to show what they have done, as well as providing evidence for the review. 3 8 12 The registered person shall 27/04/2009 ensure that the care home is conducted so as - a. to promote and make proper provision for the health and welfare of service users. The registered personal shall, for the purpose of providing care to service users, and making proper provision for their health and welfare, so far as practicable ascertain and take into account their wishes and feelings. Care plans must be specific in regard to preferred choices, meet care needs of individual service users, the Care Homes for Older People Page 30 of 34 Statement of Purpose objective and demonstrate care needs are being met. 4 9 13 The registerd person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home The registerd person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home 27/04/2009 5 15 12 The registered person shall 30/04/2009 ensure that the care home is conducted so as a. to promote and make proper provision for the health and welfare of services users. 2. The registered person shall so far as practicable enable service users to make decisions with respect to the care they are to receive and their health and welfare. Menus must be in a format that all service users can relate to. Care staff must be employed in sufficient numbers to ensure needs are met of those service users requiring assistance. Care Homes for Older People Page 31 of 34 6 18 13 6. The registered person 04/05/2009 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. 7. The registered person shall ensure that no service user is subject to physical restraint unless restraint of the kind employed is the only practicable means of securing the welfare of that or any other service user and there are exceptional circumstances. 8. On any occasion on which a service user is subject to physical restraint, the registered person shall record the circumstances, including the nature of the restraint. Bed rails should not be used unless the resident has undergone an appropriate written assessment by a health care professional. 7 23 23 The registered person shall 01/05/2009 having regard to the number and needs of the service users unsure that e. adequate private and communal accommodation is provided for service users; p. ventilation, heating and lighting suitable for service users is provided in all parts of the care home which are used by the service users. Care Homes for Older People Page 32 of 34 Residents should not be required to use bedroom facilities, even temporarily that do not provide natural light, ventilation or appropriate heating. 8 31 8 The registered provider shall 30/04/2009 appoint an individual to manage the care home where he does not intend to be, in full time day to day charge of the care home. The registered person must make sure the appointed manager is registered with The Commission. 9 38 13 The registered person shall ensure that c. unnecessary risks to the health or safety of service users are identified and so far as possible eliminiated. Risk assessments must be put in place for transporting service users in wheelchairs. 30/04/2009 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 26 Policiies and procedures must be in place and put into practice in regard to limiting the spread of infection by use of bar soap and cloth towels. Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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