Inspection on 25/07/06 for St Raphael`s Christian Care Home

This inspection was carried out on 25th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

St Raphael`s Christian Care Home 01/07/08

St Raphael`s Christian Care Home 24/05/07

St Raphael`s Christian Care Home 27/09/05

St Raphael`s Christian Care Home 07/03/05

St Raphael`s Christian Care Home 22/06/04

St Raphael`s Christian Care Home 06/11/03

St Raphael`s Christian Care Home 02/07/03

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

CARE HOMES FOR OLDER PEOPLE St Raphael`s Christian Care Home 32 Orchard Road Bromley Kent BR1 2PS Lead Inspector Wendy Owen Key Unannounced Inspection 25th July 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Raphael`s Christian Care Home DS0000010153.V296213.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Raphael`s Christian Care Home DS0000010153.V296213.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Raphael`s Christian Care Home Address 32 Orchard Road Bromley Kent BR1 2PS Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8313 1377 020 8460 1710 Southern Cross Care Homes No 2 Limited ** Post Vacant *** Care Home 58 Category(ies) of Old age, not falling within any other category registration, with number (58) of places St Raphael`s Christian Care Home DS0000010153.V296213.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Staffing Notice issued 28 July 1997 20 beds for nursing care Date of last inspection February 2006 & 25th May 2006 Brief Description of the Service: St Raphael’s is a large extended building situated in its own grounds with off road parking to the front of the building and within easy reach of local shops. The own is also on a bus route giving access to Bromley shopping centre and leisure facilities. St Raphael’s is part of the Southern Cross Healthcare Group, established in 1996, the company provides long term care for vulnerable people throughout the United Kingdom. St Raphael’s is divided into three units, one on two levels and the other on four levels, with passenger lifts for accessibility. The home offers good communal areas accessible to all its residents. The home is dual registered with an attached purpose built nursing wing on the ground floor. All of the bedrooms in the Mellifont unit have en suite facilities as do the majority of bedrooms in the nursing unit. The older part of the building, the Orchard unit, bedrooms are provided with a wash hand basin, with toilet and bathroom facilities within easy reach and therefore accessible to the residents. All the bedrooms are designed for single occupancy. The home has the benefit of central heating; radiators in the resident’s bedrooms are covered in line with health and safety requirements. There are grab-rails on the stairs and in the corridors, toilets, showers and bathrooms. Specialist bathing, toilet and lifting aids are available for residents use. All bedrooms, toilets, shower rooms and bathrooms are fitted with a lock, to ensure privacy, these locks can be accessed from outside in the event of an emergency. Information on fees has not been provided. The Statement of Purpose states that a copy of the latest inspection report is available on request from the home. There is also a copy available in the reception area. St Raphael`s Christian Care Home DS0000010153.V296213.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place over one and a half days with two inspectors for the full duration of the inspection and a Pharmacy inspector on day one. The inspection process included a tour of the home; viewing of records, discussions with relatives, residents, the Project Manager and staff and written feedback from 5 relatives; 2 healthcare professionals and 6 residents. What the service does well: What has improved since the last inspection? There has been some improvement in the way care plans have been developed with more information included. There is evidence of staff being provided with some training and formal supervision of staff has begun. A number of relatives and residents spoke of the more personal touches in place over the last few months making the environment more homely and comfortable in some areas. St Raphael`s Christian Care Home DS0000010153.V296213.R01.S.doc Version 5.2 Page 6 What they could do better: The home continues to admit residents outside of their category of registration and assessment, care planning and risk assessment documentation still require improvement to ensure staff have the information they need to care for the residents. There is a complaints procedure in place. The home must ensure that all relatives are made aware of the way in which they can raise concerns. The adult protection procedures must also be further developed to include a “Whistle-blowing” policy. Staff must be trained in these procedures. Whilst there have been some homely touches made to the environment there are still a number of areas which require either refurbishment or redecoration. There is also a need to review storage of foodstuffs and ensure the environment is safe to residents and staff, internally and externally. The home must also investigate how they can provide residents with private areas in which to meet their visitors including a private space for making telephone calls. There has been little in the way of formal training for staff over the last twelve months. There is some evidence that this is improving although staff knowledge and understanding in a number of core areas were not satisfactory, including adult protection and emergency procedures. There is a lack of formal induction for new staff and specific training in the needs of the client groups cared for. Medication procedures and practices require significant improvement in a number of areas to ensure the residents’ health is promoted. Recruitment procedures are not robust enough to protect vulnerable residents. The checks required under the Regulations must be complied with to ensure the safety of residents. The health and safety of residents and staff must be addressed to ensure their continued safety. This includes the completion of risk assessments for the use of bedrails to ensure the right decision is made; appropriate hand-washing facilities; call bells tested to check they are in full working order; the remedial work required in relation to the fixed wiring undertaken and an action plan for the removal of asbestos in the home must be provided detailing the timescale. The security and safety of residents who may go missing from the home on occasions must also be addressed. The Provider must ensure there is a manager in place who meets the criteria for “fitness” and an application for registration must be sent to the Commission without delay. St Raphael`s Christian Care Home DS0000010153.V296213.R01.S.doc Version 5.2 Page 7 The Provider must also ensure that they visit the home each month to monitor the quality of care. Whilst audits take place regularly these must be more objective and undertaken by staff who have the knowledge and understand of good practices. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Raphael`s Christian Care Home DS0000010153.V296213.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Raphael`s Christian Care Home DS0000010153.V296213.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3,4 & 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The assessment procedures do not ensure that the staff have the full information to assure the residents’ needs can be met. EVIDENCE: A Statement of Purpose and Service Users Guide have been developed. Both of these require updating. More information is required on staffing, the qualifications of staff and how the home accesses NHS services. In the case of the nursing care, there is very little information provided on this aspect. (See requirement 1) The organisation has comprehensive pre-admission procedures for prospective residents. This includes the assessment of any prospective resident to the home. The files of two “new” residents were viewed and found to have an assessment undertaken by the home. The home has, in the past, admitted residents outside of its category of registration. This appears to be continuing with one resident requiring much St Raphael`s Christian Care Home DS0000010153.V296213.R01.S.doc Version 5.2 Page 10 closer supervision and taking up of staff resources than evident in the original assessment. The assessment undertaken did not reflect the resident’s current needs with a dependency score rising from 7 on the 26th June to 24 on 21st July. The hospital discharge information provided evidence of infarcts and confusion and dysphasia. There was no falls risk assessment despite evidence of falls. One of the files of a resident transferred to the nursing unit was also viewed. This contained up to date information on the resident’s needs and showed records of discussions with family about the increased dependency and more appropriate placement on the nursing unit. Two Visitors spoken to said that they had been fully consulted about the transfer to the nursing unit from residential. (See requirement 2) The home appears, from the records, to transfer residents from the residential unit to the nursing unit rather than admit residents to the nursing unit from outside of the home. Four contracts were viewed for both local authority and private placements. Those residents who are placed by the Local Authority should also have the home’s terms and conditions of residency as detailed in the Statement of Purpose. The organisation must also be aware of the need to ensure all contracts include a breakdown of the fees, including nursing contributions, and how they are paid, as detailed in the recent changes to the Care Homes Regulations 2001. (See requirement 3) St Raphael`s Christian Care Home DS0000010153.V296213.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There has been some progress in improving the arrangements to ensure the health care needs of the residents are identified. However continued shortfalls mean that there is a potential to place residents at risk. EVIDENCE: Previous inspections have highlighted the need to improve the care planning documentation. Viewing of three files showed that these have improved over the last few months. This was also confirmed by the reviewing officer from Bromley Social Services, who had recently undertaken reviews of the Bromley funded placements. The files viewed were generally more ordered and user friendly and reflected some of the identified needs. There were however, a number of gaps in the information identified by the inspectors. The care plans covered core areas of personal and heath care needs and some detail in relation to social care needs. There is a need to ensure that pressure care; diabetes, food supplements used staff input into administering injections is fully documented on the care plan. Care plans should also detail how many staff are required to assist in personal care, especially where there are mobility problems. One file viewed did not St Raphael`s Christian Care Home DS0000010153.V296213.R01.S.doc Version 5.2 Page 12 contain a falls assessment despite recent falls and a separate care plan must be identified for wandering, mental status and cognitive impairment (See requirement 4) There was evidence of residents’ weights monitored and recorded and action taken in the event of increased loss of weight. Healthcare records showed regular visits by the GP and District Nurse. In those files viewed the records also showed visits by the dietician, chiropody and optician. There was also evidence of a tissue viability nurse advising the home and use of pressure relieving equipment, especially mattresses. Feedback from two health professionals was mixed with one stating that staff showed an understanding of the residents’ needs whilst the other said they did not. The needs of the residents had been recently reviewed and there was evidence of weekly progress reports. Health appointments had been made and kept up to date with information. Bromley reviews also bear this out. Where there are bedrails in use there is a need to have more than agreement from the family. There must be a comprehensive risk assessment. There was in one but not in another. (See requirement 5) Feedback from the reviewing officer, and residents and relatives spoken to on the day of the inspection, showed that they believed the care to have improved over the last few months and were happy with the changes. The pharmacist inspector reviewed the administration records of all 51 residents, examined all storage areas for medicines and looked in detail at the records and medicines for five residents. The findings were as follows: The medicine room on the Orchard unit contained a ground floor window that was open on the day of inspection allowing unauthorised entry to this medicine room. The temperatures of the two refrigerators, including minimum and maximum temperatures were not recorded correctly. The refrigerator probe in the Bungalow was not inserted correctly and was reading 28 °c. Records of disposal of medicines were clear and complete. The administration records and medicines for five residents were examined in detail. Gaps were found in administration records for two medicines where doses were not found in the monitored dosage system, so had probably been given, but the administration record had not been signed. Three doses of medicines had been signed as given but were still in the monitored dosage system. Three gaps were found on the administration records and the medicines were still in the monitored dosage system and had not been administered but no code had been inserted to explain why. Records of receipt for one medicine had not been completed, so it was not possible to complete St Raphael`s Christian Care Home DS0000010153.V296213.R01.S.doc Version 5.2 Page 13 an audit trail. An audit trail for another medicine showed four extra tablets available compared to administration records, implying that administration records had been signed on four occasions but the doses had not been given. These inaccuracies in recording of administration of medicines meant it was not known whether all medicines had been administered as prescribed. One medicine was prescribed as a variable dose, but the amount actually administered was not recorded. One of the residents had been admitted to the home for respite care. The administration record for this resident had been had been handwritten but did not stated the month and there was no signature to indicate it had been checked by a second member of staff. One medicine had been written on this administration record twice, as a generic and also as a branded product. Both doses had been signed as given. The morning doses of medicines for this resident had been supplied in a multi-compartment box which was not labelled so it was not clear what medicines or doses were prescribed. Staff were administering medicines from this box although it was not clear which medicines it contained. One of the residents was receiving an injectable medicine although this injection was not documented on the administration record. One member of staff had received training on how to administer this medicine. For the remaining residents, the administration records were reviewed. Several medicines were listed on the administration records, but no supply had been received. It was not clear whether these medicines were still prescribed or whether they had been discontinued and should have been crossed off the administration record. Some creams and ointments on administration records had not been signed as given. One medicine had been out of stock for 5 days. A prescription had been requested from the GP on the day the medicine ran out, but a new supply had not been received yet. Six residents were self administering some, or all, of their medicines. Five of these residents had a documented risk assessment. All of them were reviewed regularly, although the detail of the reviews was not documented. One of these residents did not have an administration record listing the medicines currently prescribed. The home had comprehensive policies relating to medicines. There was no policy for medicines for leave. Audits had been done on controlled drugs, storage of medicines, receipt records, disposal records, refrigerator temperatures, medicine rooms. However the audits had not identified any issues. The homely remedies list needed updating and indications were not specified for all medicines on the list. Six senior staff and 2 carers had received training on medicines from Boots earlier in the year. (See requirements 6-12 and recommendation 1) St Raphael`s Christian Care Home DS0000010153.V296213.R01.S.doc Version 5.2 Page 14 St Raphael`s Christian Care Home DS0000010153.V296213.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social activities are well organised, creative and stimulation and interest for people living in the home. Meals are nutritious and balanced and offer residents a healthy and varied diet. EVIDENCE: St Raphaels benefits from a full- time activity co-ordinator. The activity programme is displayed in various parts of the home. The Project Manager has asked that the schedule be reviewed to ensure there is more clarity on the activities on offer. On the day of the inspection some residents were painting whilst others were reading their daily papers or sitting in the garden enjoying the sunshine. The home had also arranged a trip to Eastbourne that week. This was being paid for through the monies raised in the recent fete. Staff and volunteers were escorting the residents for the trip. The garden area provides a pleasant environment for the residents who were able to sit under the gazebo or on any of the garden furniture situated under the shade of the trees. Residents who provided feedback said that they would like more outings, go to the local parks and have more entertainment brought into the home. Others agreed that the library area could be improved. St Raphael`s Christian Care Home DS0000010153.V296213.R01.S.doc Version 5.2 Page 16 The home arranges church services each Sunday and residents can use the beautiful church which is part of the home. (See recommendation 2) A four-weekly menu with alternatives is offered to residents. This was varied and showed freshly prepared meals incorporating fresh vegetables. Feedback from residents would suggest that they would like more involvement in the food provided. (See recommendation 3) The cook was aware of the special diets for residents and had also recently introduced a cooked breakfast onto the menu. This was a great favourite especially of the male residents. On the day of the inspection the lunch-time menu comprised corn beef hash, chicken vol-au-vents, vegetables with a dessert of lemon sponge pudding and custard or rice pudding. This seemed a heavy menu for such a hot day. However, salads had also been offered and from observations and discussions with residents this did not appear to be a problem. One lady, who is a diabetic, chooses her meal of poached fish each day. She said that she was very much involved in choosing what she wished to eat. The inspector noted staff offering seconds to residents. The home has a Clean Food Award until 08/06. Kitchen records were comprehensive but not always fully completed eg food serving temperature and food probe calibration records were incomplete; monthly reviews and generic risk assessments were not signed or dated. The fridge and freezers temperatures had been completed. Kitchen staff were in possession of appropriate qualifications. It was positive to note that there was plentiful supply of fresh fruit around the home and lots of cold drinks for the very hot weather. The home must investigate the continued use of the outdoor food store located next to a defunct toilet. The door was not locked and was slightly ajar with a sack of potatoes on placed directly on the floor. This is a potential risk of infection from vermin. (See requirement 12) Since the new project manager commenced in the home there is some evidence of residents’ meetings. Procedures state that these should be held once a month but in other documents it states they are to be held quarterly. This must be clarified. Residents felt the meetings were beneficial and they were able to air their views. The home no longer benefits from a separate visitors’ room. This is disappointing, as visitors must now see family members in communal areas or bedrooms. Residents have the use of a private telephone although once again this is situated in the staff room/office which is not a private area. (See requirement 13) Two relatives spoken to stated that they were made to feel welcome by the staff in the home and this was confirmed by the six written feedback received. St Raphael`s Christian Care Home DS0000010153.V296213.R01.S.doc Version 5.2 Page 17 St Raphael`s Christian Care Home DS0000010153.V296213.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Complaint procedure requires clarification to ensure residents and visitors’ concerns and complaints are dealt with in an effective manner. Adult protection procedures do not provide guidance to staff on what to do if they suspect abuse. Vulnerable people may be placed at risk of abuse. EVIDENCE: The home has a complaints procedure on display in the hallway. This meets with the Commission’s requirements. Viewing the full complaint procedure held on file there appears to be conflicting timescales in relation to the company response times. This must be clarified. Of the five written feedback from relatives two stated that they were unaware of the complaints procedures whilst the majority of residents stated they knew who to talk to if not happy or wished to raised any concerns. Complaints are recorded with eight complaints registered since January 06. The register notes the name of the complainant, the nature of the complaint and if it was resolved. There is a need to ensure the register, not only records who the complainant is, but if the complaint is in relation to a specific service user. (See recommendation 4) The Commission is aware of a one anonymous complaint covering a number of issues. The Commission, Local Authority and Providers were involved in the investigation. The Commission identified a number of requirements for St Raphael`s Christian Care Home DS0000010153.V296213.R01.S.doc Version 5.2 Page 19 improvement, in relation to the care planning and health records. The Provider highlighted a number of other shortfalls which are being addressed. The organisation also has comprehensive adult protection procedures, although discussions with staff on the day showed that they have a very limited understanding of adult abuse and the protection of vulnerable adults. There was a lack of awareness of “Whistle-blowing” and what this meant. The inspector could not locate any reference to Whistle-blowing in the procedures. (See requirement 14) St Raphael`s Christian Care Home DS0000010153.V296213.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,23,24 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There has been some improvement in the décor. However there are a number of areas which still require addressing which mean residents are not provided with a safe and comfortable environment. EVIDENCE: Feedback from residents and relatives showed that they felt the home has a more personal and homely feel over recent months. Generally the communal areas are satisfactory, although some more homely touches would benefit Mellifont dining room. The stairway on Orchard unit also had an asbestos warning placed on each stair. Whilst the report undertaken in 2003 show here is no significant danger action must be taken to address this. (See requirement 17) The front entrance had been double bolted in recent months due to residents leaving the home unescorted. This is dangerous as this is one of the fire exits. St Raphael`s Christian Care Home DS0000010153.V296213.R01.S.doc Version 5.2 Page 21 The side gate is also now chained to ensure it is secure for the reasons stated above. The garden provides a pleasant environment for residents with garden furniture and scattered about the grounds. All the bedrooms are single with those on the Mellifont being en-suite as are a number on the nursing unit. All other bedrooms benefit from a wash hand basin A tour of the home showed that it is of a mixed standard with a number of areas requiring improvement. One bedroom wash-basin was cracked and stained and although decorated adequately had limited furniture. Mellifont unit was slightly more equipped. There was no call bell in one room whilst in another the room had been personalised to the residents’ wishes. Window restrictors are required in many areas. The laundry still needs to be relocated and refurbished and bathrooms, whilst large and odour free, need some redecoration and a more homely feel. One bathroom on Mellifont unit had a commode chair and armchair stored and the unit kitchenette was tatty. Soap and hand towels were not available. Hand washing facilities were located in the main kitchen and laundry area. (See requirement 16, 18,19, 20 & 21) The external area near the kitchen had been used as a storage area for unwanted items from the home including furniture and a freezer ready for disposal. The boiler room was unlocked and not very clean with rubbish on the floor. (See requirement 15) St Raphael`s Christian Care Home DS0000010153.V296213.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The procedures for the recruitment of staff are not robust and do not offer the required protection for people living in the home. Staff are not provided with the training to ensure they have the knowledge and understanding to care for the residents living in the home. EVIDENCE: On the day of the inspection there were 51 residents in the home. Staffing numbers included 1 RGN plus four carers on nursing and 1 team leader, one senior and three carers on residential. The Deputy Manager was working as the RGN on duty. There was no other management in the home until they were called in on the inspectors’ arrival. The home requires supernummary management and whilst the Project Manager has stated that this day was an exception the Commission has requested confirmation of the management hours provided. One of the six relatives who provided written feedback stated they felt there were not enough staff on duty, whilst another stated there were “most of the time.” Residents’ feedback was positive with their needs met adequately by staff. Observations and viewing of records showed that some residents on the residential unit required a good deal of monitoring and supervision. Notifications of incidents received also show that some of the residents are confused and have left the building, at times, without being noticed. The staffing levels and dependency of clients admitted must be reviewed to ensure that the home is providing care within their category of St Raphael`s Christian Care Home DS0000010153.V296213.R01.S.doc Version 5.2 Page 23 registration and that there is adequate staffing to ensure all residents receive the appropriate level of care. (See requirement 22) The inspector requested details of staff with NVQ 2 or above. The Regional Manager later confirmed that the percentage falls below the 50 required. She also stated that they are expecting to meet this target over the next few months. (See requirement 23) The files of the last five members of staff were viewed. The files contained application forms, proof of identity, health declaration and references. However, whilst there was evidence of the Criminal Bureau check and POVA check being requested, there was no evidence of their receipt or that they were clear to work. In some application forms there was less than a ten-year employment history with one only went back to 2004. The references requested in three cases had not been sent to the employer but colleagues working with the previous employer. One file contained only one reference. This is not appropriate. There had been no confirmation in writing or verbally, as to the reason the applicant left their previous employment in the care sector. The files did not contain certificates in relation to the qualifications achieved. (See requirement 24) There was no evidence on the files of induction taking place, although one member of staff spoken to informed the inspector of the induction process which included being supernummary for the first week, being shown around the home, moving and handling, introduction to the residents and information about emergency procedures. However, the individual’s knowledge regarding fire procedures was limited and only basic guidance had been provided regarding moving and handling. Records had not been maintained regarding induction training and what was included (See requirement 26) One member of staff had difficulty with her command of the English language including comprehension. The inspector is aware of many staff undertaking English language courses. The Project Manager has set up competency training for staff which is currently being undertaken by senior staff. The inspector suggests that this be crossreferenced with Skills Sector induction and such training is provided for all new staff. Some training has taken place including care planning, food hygiene and first aid. There is evidence of moving and handling taking place this month and next. However, this is very out of date for some staff. Previous to this there has been limited amount of training taking place for care staff and nurses. (See requirement 27) St Raphael`s Christian Care Home DS0000010153.V296213.R01.S.doc Version 5.2 Page 24 St Raphael`s Christian Care Home DS0000010153.V296213.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The lack of registered manager and systems for monitoring the care provided does not ensure that residents receive consistent quality care. EVIDENCE: A Project Manager is managing the home in the absence of the Manager, who is on long term sick. The home has been without a registered manager for a considerable time. The Commission is aware of the appointment in near future of an Acting Manager. (See requirement 28) A full audit on residents’ monies was conducted recently. A copy of the report and any action taken was supplied to the Commission. Three residents’ monies were checked on this occasion. Appropriate systems were in place although the Commission would question the use of non-interest bearing account to hold residents’ monies. The Commission recommends, St Raphael`s Christian Care Home DS0000010153.V296213.R01.S.doc Version 5.2 Page 26 where resident are responsible for own monies, they sign receipts: eg hairdressing for cash handed over. (See recommendation 5) The inspectors found little evidence of any review of the service and whilst there were three service user questionnaires located, this does form a foundation for service user consultation. The Project Manager stated that the Head Office receives the questionnaires which are then sent to the home. The questionnaires must be collated and information analysed to determine the outcome of the feedback and any actions required by the home identified. (See requirement 29) There is evidence of procedures and practices being audited, although how objective and thorough these are in some areas is questionable, particularly in relation to medication practices. Audits should be undertaken by staff who are knowledgeable and up to date with good practice. The inspector noted that the last monthly Regulation 26 visit was undertaken in April 2006. (See requirement 30) Up to date insurance certificates were on display in the reception area. A number of service certificates were checked. Service checks were completed in relation to the fire system and fire extinguishers, gas certificates, hoists and lift servicing. The fixed wiring certificates show urgent remedial action is required. (See requirement 31) Security of the home has been an issue for some time with resident leaving the home. Whilst there are notices on the doors this does not help where residents are confused. The home has tried to alleviate this problem through double bolting of the front door and chaining of the side gate. This may not be appropriate in respect of fire regulations. The home must review the admission of prospective clients and also the security measures in place. There is further information on these safety aspects in the standards on environment. (See requirement 2) St Raphael`s Christian Care Home DS0000010153.V296213.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 2 2 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 3 3 X 2 2 x 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 X X 2 St Raphael`s Christian Care Home DS0000010153.V296213.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 5 Requirement The Registered Person must review and update the Statement of Purpose to ensure it reflects the current situation in the home. The Registered Person must ensure that assessments are fully completed and that written confirmation is provided by the home that they are able to meet the individual’s assessed needs. The home must only admit within their category of registration. This is a repeated requirement. The Registered Person must ensure that all residents are provided with the home’s term and conditions of residency. The Registered Person must ensure that care plans reflect the identified health, personal and social needs of the individual. This is a repeated requirement. The Registered Person must ensure that risk assessments are in place for those individual who use bedrails. The assessments DS0000010153.V296213.R01.S.doc Timescale for action 01/12/06 2 OP3 14 01/10/06 3 OP2 5 01/10/06 4 OP7 15 01/10/06 5 OP8 13 01/10/06 St Raphael`s Christian Care Home Version 5.2 Page 29 6 OP9 13 7 OP9 13 8 OP9 13 9 OP9 13 10 OP19 13 11 OP9 13 12 13 OP15 OP13 13 16 14 OP18 13 must fully identify the risks to the individual and how the risks are to be monitored and minimised. The Registered Person must ensure that restrictor arms are fitted to window of the ground floor medicine room to prevent unauthorised access. The Registered Person must ensure that the minimum, maximum and actual temperatures of the medicine refrigerators are recorded daily. The Registered Person must ensure that administration records list only currently prescribed medicines (including injections), are complete and accurate, and non-administration codes are used if medicines are not administered for any reason. Hand written administration records are checked and signed by a second member of staff. The Registered Person must ensure that all medicines are fully labelled with resident name, drug name, dose and frequency. The Registered Person must ensure that the homely remedies list is reviewed and agreed by the GP, and includes indications for all homely remedies. The Registered Person must ensure that there is a policy for supply of medicines for day leave. The Registered Person must ensure that food storage is appropriate and free from risks. The Registered Person must ensure that there are adequate areas for visitors to see residents in private and to make private telephone calls. The Registered Person must develop whistle-blowing and DS0000010153.V296213.R01.S.doc 01/12/06 01/10/06 01/10/06 01/10/06 01/12/06 01/12/06 01/10/06 01/12/06 01/12/06 Page 30 St Raphael`s Christian Care Home Version 5.2 15 16 OP19 OP19 23 23 17 OP19 23 18 OP22 23 19 OP26 13 20 OP21 23 adult protection procedures which provide staff with guidance on how to deal with suspicions of abuse. All staff must be provided with training in these procedures. The Registered Person must ensure the boiler room is kept clean and secure at all times. The Registered Person must ensure that all windows above ground floor are fitted with restrictors. Risk assessments must be produced in the meantime to ensure risks to residents are identified and minimised. Please supply an action plan of the timescales for the fitting of window restrictors The Registered Person must provide the Commission with an action plan on the removal of asbsestos from the home. The Registered Person must ensure that all private rooms are fitted with call bells. These must be in good working order. The Registered Person must ensure that the residents’ bedrooms is clean, odour free, decorated, furnished and equipped to meet their needs. Partly met 31/5/06 The Registered Person must ensure that toilet, washing and bathing facilities are provided to meet the needs of the residents. This is a repeated requirement timescale 31/05/06 The Registered Person must make sure that the laundry is clean, tidy and odour free and that all the equipment is in working order. This is a repeated requirement 31/5/06 DS0000010153.V296213.R01.S.doc 01/10/06 01/10/06 01/10/06 01/10/06 01/12/06 01/12/06 21 OP26 16 & 23 01/12/06 St Raphael`s Christian Care Home Version 5.2 Page 31 22 OP27 18 The Registered Person must 01/12/06 ensure that staffing numbers and skill mix of staff are appropriate to the assessed needs of the residents, the size, layout and purpose of the home. The Registered Person must provide the Commission with an action plan on how they intend to meet the requirement of 50 of staff qualified to NVQ 2 or above. The Registered Person must ensure that the required checks are completed on all new staff employed in the home. The Registered Person must ensure all new staff undertake induction training to Skills Sector specifications. The Registered Person must ensure that staff are provided with training specific to the needs of the individuals care for by the home. The Registered Person must ensure that the manager is registered with CSCI; and is registered to undertake the RMA award. This is a repeated requirement 31/5/06 The Registered Person must ensure that there is an annual quality survey and that the CSCI is advised of the outcome. This is a repeated requirements outcome 31/5/06 The Registered Person must ensure that monthly visits are required by Regulation 26 are carried out and the report on the visit supplied to the Commission. The Registered Person must ensure that all documentation DS0000010153.V296213.R01.S.doc 23 OP30 18 01/12/06 24 OP36 17 01/10/06 26 OP30 18 01/12/06 27 OP30 18 01/12/06 28 OP31 9 01/10/06 29 OP33 24 01/10/06 30 OP33 26 01/10/06 31 OP38 38 01/10/06 Page 32 St Raphael`s Christian Care Home Version 5.2 relating to health and safety issues are current. The remedial work required on the fixed wiring must be carried out without delay. Please send an action plan with timescales when the work is to be completed. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 Refer to Standard OP9 OP12 OP15 OP16 OP35 Good Practice Recommendations When residents, who are self-administering medicines, are reviewed, the content of the review is documented. Residents should be provided with the opportunity for more outings and entertainment brought into the home. Residents should have more involvement in the choosing of the menus The complaints records should have the name of the residents recorded, where applicable. Residents should sign receipts for monies handed over to hairdressers etc, where appropriate. St Raphael`s Christian Care Home DS0000010153.V296213.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St Raphael`s Christian Care Home DS0000010153.V296213.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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