Inspection on 19/01/09 for Stanbridge House

This inspection was carried out on 19th January 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 but made no statutory requirements on the home.

Other inspections for this house

Stanbridge House 28/07/08

Stanbridge House 13/06/06

Stanbridge House 06/02/06

Stanbridge House 31/08/05

Stanbridge House 14/03/05

Stanbridge House 04/11/04

Stanbridge House 06/05/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 20/03/2009.

CARE HOMES FOR OLDER PEOPLE Stanbridge House 56-58 Kings Road Lancing West Sussex BN15 8DY Lead Inspector Lesley Webb Unannounced Inspection 19th January 2009 10:20 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 Stanbridge House DS0000014744.V373423.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. Stanbridge House DS0000014744.V373423.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stanbridge House Address 56-58 Kings Road Lancing West Sussex BN15 8DY 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) 01903 753059 stanbridgehouse@aol.com Ms Kim Sanders Ms Kim Sanders Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (0) of places Stanbridge House DS0000014744.V373423.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category (OP). The maximum number of service users to be accommodated is 27. Date of last inspection 28th July 2008 Brief Description of the Service: Stanbridge House is a care home registered to provide accommodation and personal care for twenty- seven elderly (over the age of 65) persons. The establishment is privately owned by Ms Kim Sanders who is also the Registered Manager of the home. Stanbridge House is a large detached property, which has been extensively extended to provide accommodation on two floors. The home has twenty- five single and one double room, which is at present being used for single occupancy. Nine rooms have en-suite facilities. There are two sitting rooms and a dining room available for communal use and three garden areas provide a choice of private and attractive outdoor space for residents to enjoy. Situated in a quiet residential area of Lancing, the establishment is approximately one mile from the town centre and a similar distance from the sea. The fees for the home range between £480 and £550 and are dependent on size of room and assessment of needs by social services. Stanbridge House DS0000014744.V373423.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The purpose of this inspection was to assess how well the home is doing in meeting the key National Minimum Standards and Regulations. We also looked for evidence that the home has met Requirements made at our last key inspection of 28th July 2008. The Registered Manager was away on the day of our visit. The assistant manager assisted us throughout the visit. During our visit to the home we talked to three residents and three care staff. We also ‘case tracked’ three residents, examined staff records, policies and procedures and other documentation. In addition to this we looked around the home and indirectly observed interactions between residents and staff. Since our last key inspection of 28th July 2008 two pharmacy inspections have been undertaken. We have also been supplied with an Improvement Plan by the home. Information from these is included in this report. At the time of writing this report we have received nine residents surveys. Information from these is also included in this report. The quality rating for this service is 0 stars. This means the people that use this service experience poor quality outcomes. What the service does well: Residents have their needs assessed so that staff understand what areas individuals require support. Staff treat residents with respect and their rights to privacy are upheld. Residents are able to participate in activities appropriate to their age and cultural beliefs. Dietary needs are well catered for with a balance and varied selection of food available that meets residents’ needs and choices. Residents have access to a complaints procedure that supports them to raise concerns. Procedures are in place, which inform staff of actions to be taken if abuse to a resident occurs. Stanbridge House DS0000014744.V373423.R01.S.doc Version 5.2 Page 6 Residents have a pleasant, clean and homely environment to live in. What has improved since the last inspection? What they could do better: 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 Stanbridge House DS0000014744.V373423.R01.S.doc Version 5.2 Page 7 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Stanbridge House DS0000014744.V373423.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 Stanbridge House DS0000014744.V373423.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents have their needs assessed so that staff understand what areas individuals require support. EVIDENCE: We sampled three pre admission assessments (including that of the newest person to move into the home). The areas covered in the assessment included: sensory and communication difficulties, mental health, physical health, needs regarding personal care and for those that come for a short stay information on domestic tasks that they carry out whilst at home. The assessment consisted of several sheets with tick boxes in each section with space for any other relevant information. All had been signed and dated by the person who undertook the assessment. Stanbridge House DS0000014744.V373423.R01.S.doc Version 5.2 Page 10 In addition to the pre admission assessment each file contained an admissions form that details the persons next of kin, religion, General Practitioner and funeral wishes. Before we carried out our inspection we received nine surveys completed by residents. Seven state they received enough information about the home before they moved in so they could decide if it was the right place for them and two that they did not. Stanbridge House DS0000014744.V373423.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans are not in place for all identified needs and those in place do not contain sufficient information. This means that the personal and healthcare needs of residents are not being met consistently and safely. Medication systems now offer safeguards to residents. Residents are treated with respect and their rights to privacy are upheld. EVIDENCE: At our last key inspection of 28th July 2008 two Requirements were made with regard to care management. These being that residents must have clear individual care plans describing the support that staff give to meet identified needs and that where it has been identified that a resident is at risk from falls, a risk assessment must be put in place, which describes how the service will lessen those risks. We received an Improvement Plan from the home that informed us all care plans have been thoroughly reviewed and additional Stanbridge House DS0000014744.V373423.R01.S.doc Version 5.2 Page 12 information added and that a new risk assessment has been developed for each resident. Evidence gained at this inspection finds that the Requirements have not been met in full. This will be addressed separately to this report. We sampled three residents care plans. The care plans sampled were being used in conjunction with medication records and other health-monitoring tools that are used as part of the care planning for individuals. The care plans are pre typed on several sheets of paper with options that are ticked or offer a yes or no and a line to record individual needs and issues. As at the previous inspection there is little or no comment on individual issues on these tick sheets. We also found that care plans have not been completed for all identified needs, that care plans do not always include instructions for staff detailing how identified needs should be met and some contain conflicting information. For example one residents care planning documentation states they are independent with regard to personal care and require no assistance. A second document on the same persons file states they are assisted to bath. This person has a care plan titled ‘medication’ that lists what medication they are prescribed. It does not state why it is needed or when it should be administered. A care plan titled ‘personal hygiene’ states ‘chiropody – visiting 6-8 weekly’. We found no record of this taking place on the residents file. A care plan titled ‘general health’ informs that the resident wears glasses and that ‘will need new’. Again we found no evidence that this has taken place. The same plan states that the resident can have problems with hearing. No information instructing how staff need to assist in this area is included. Within the review records of the second residents care planning documentation that we looked at we found that the person is under a Court of Protection Order due to their vulnerability. No care plan or risk assessment is in place for this. Also other care plans on this persons file make reference to the person having a catheter, that they receive regular District Nurse intervention and that staff must change the catheter bag. No specific care plan is in place and information within the other plans does not include what infection control measures should be used. The health records for this person detail four urinary tract infections (UTI) from 14/10/08 to 19/01/09. We spoke to three members of staff regarding this resident and their needs regarding catheter care. Two explained that the catheter site must be cleaned regularly and one did not. Two confirmed that the resident was at increased risk of UTI and that fluids should be encouraged to reduce the risk of infection. Both confirmed that fluid charts are not maintained. The third persons care planning documentation that we looked included a West Sussex County Council care plan that states they are at high risk of developing pressure areas due to frailty and reduced mobility, that continence Stanbridge House DS0000014744.V373423.R01.S.doc Version 5.2 Page 13 management is needed to reduce the risk of sores and infection and to maintain skin integrity. No care plans or risk assessments were in place detailing the actions needed by staff to support the resident in these areas. The same residents file included a weight chart that details from 14/08/08 to 01/12/08 the have lost 1st 2lb. Their health records state that on 17/11/08 the GP instructed that their weight should be monitored. We could find no evidence of this occurring. Records also detail eight falls from 05/09/08 to 15/01/09. A falls risk assessment is in place for this person. It has not been reviewed as and when a fall has occurred. Care plans were not in place for other identified needs for this person such as type 2 diabetes, deafness and impaired memory. While we were talking to this resident we observed them ask a member of staff for a drink, stating that they were “very thirsty”. This was brought to them immediately. The member of staff explained to us that the resident does not like to come out of their room and most of their meals are brought to them. The resident informed us, “its alright here, I do get lonely, sometimes I don’t see anyone”. The member of staff confirmed that fluid charts are not completed for this person. A care plan or risk assessment have not been completed that ensure the resident is not a risk from isolation. At our previous inspection it was noted that staff were recording residents personal information in a diary that could compromise residents rights to confidentiality. At this inspection the assistant manager informed us she has now introduced individual observation sheets that are maintained in each residents folder. She explained that night staff are still using the diary but this new system is going to be introduced for all staff. At our last key inspection four Requirements were made that related to medication. A pharmacy inspection was undertaken 22/10/08 where evidence of continued non-compliance was found. As a result a Statutory Requirement Notice (SRN) was issued. A second pharmacist inspection was carried out on 30/12/08 where it was found that the notice had been met. Our findings regarding this matter have been communicated to the registered provider separately. Whilst the requirements of the statutory notice are essentially met the home must continue to ensure written polices and procedures are reflective of the practice needed in the service and that care plans also have details of how to give any ‘as required medication’ including simple analgesics such as Paracetamol. Staff were observed speaking and assisting residents with dignity and respect. It had been seen on care plans that the preferred choice of name had been recorded and staff were heard to speak to individuals by the name they Stanbridge House DS0000014744.V373423.R01.S.doc Version 5.2 Page 14 wished. When examining the personal care records of residents we noted that all residents’ bowel movements are recorded. We discussed this practice with the assistant manager explaining that unless there is an identified need this practice should cease as it could be viewed as a possible intrusion on residents’ rights to privacy and dignity. The assistant manager agreed to review this practice. Nine residents surveys were completed and returned to us prior to our inspection. Three state they ‘always’ four they ‘usually’ and one they ‘sometimes’ receive the care and support they need. Eight state they ‘always’ receive medical support needed and one did not comment. Stanbridge House DS0000014744.V373423.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to participate in activities appropriate to their age and cultural beliefs. Dietary needs are well catered for with a balance and varied selection of food available that meet residents needs and choices. EVIDENCE: The home has several areas where residents can choose to sit, both inside and out. Some residents choose to stay in their rooms to watch television. There is a pubic phone in the hallway. As at the previous inspection we were able to see from information on the notice board, the homes diary, surveys and speaking with residents when we visited that there are activities available. These include scrabble afternoons; nail painting, bingo, quizzes and outings into the local community. The assistant manager informed us that the home has made enquiries at a local hospital with regard to devising an exercise programme. We discussed the use Stanbridge House DS0000014744.V373423.R01.S.doc Version 5.2 Page 16 of securing the services of qualified people who will visit the home to offer this service. The assistant manager said that she would look into this. Nine residents surveys were completed and returned to us prior to our inspection. All state there are ‘always’ activities arranged by the home that they can participate in. An additional comment was recorded ‘they take us on good outings once a fortnight and to see kin’s folk when desperately ill’. The assistant manager informed us that the home has a trolley that staff take around the home so that those people who have not gone out for whatever reason can purchase items such as cards, toiletries and sweets. The home operates an open visiting policy that supports residents to maintain family contact. People living at the home are encouraged to exercise control over their lives and it is their choice to participate in social activities if they wish. One resident informed us, “the hairdresser visits and I have my nails done, try to keep myself nice. We have bingo, play card games, go on outings, I suggested peas pudding and faggots and they did it, we all loved it. The menus and records of food provided indicated that the food is nutritious and there is a wide range of meals provided with a selection of choices every day. In addition special diets and individual preferences and needs are catered for e.g. soft and pureed meals and diabetics. Of the nine residents surveys returned to us three state they ‘usually’ one they ‘always’ and one they ‘sometimes’ like the meals at the home. An additional comment was recorded ‘always offered alternatives, special dishes cooked sometimes to tempt when lacking appetite’. Stanbridge House DS0000014744.V373423.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have access to a complaints procedure that supports them to raise concerns. Safeguarding procedures are in place, which offer protection to residents. EVIDENCE: The homes complaints policy informs people that verbal and written complaints will be investigated and that if people are unhappy with the outcome the complaint will be forwarded to West Sussex Forum who will investigate separately. The assistant manager informed us no complaints have been received at the home since our last inspection. She also informed us that monthly residents meetings take place where residents are asked if they have any issues or concerns they would like to raise. There is also a suggestions box in the hallway of the home. Nine residents surveys were completed and returned to us prior to our inspection. All state they know how to make a complaint. Stanbridge House DS0000014744.V373423.R01.S.doc Version 5.2 Page 18 The home uses West Sussex safeguarding adult policy, a copy of which was seen on display in the office. Stanbridge House DS0000014744.V373423.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have a pleasant, clean and homely environment to live in. EVIDENCE: We looked around some of the home and we were able to see communal areas such as the dining room, lounge, bedrooms and bathrooms. The garden is accessible to people who use wheelchairs. Residents are encouraged to furnish their rooms with personal belongings such as furniture and pictures, to make it feel like home. The home was seen to be very clean throughout, with no malodour. When we walked about the home we saw that rooms are centrally heated, all radiators and pipe work are covered. Windows are fitted with restrictors where Stanbridge House DS0000014744.V373423.R01.S.doc Version 5.2 Page 20 necessary and emergency lighting is provided throughout the home. Since our last inspection a bedroom has been redecorated and carpeted and the hallway is in the process of being repainted. The assistant manager confirmed that domestic staff are employed to maintain the cleanliness and hygiene within the home. A gardener and handyperson are also employed to maintain the environment. Laundry facilities are sited away from areas where food is prepared and stored. We noted that cloth hand towels are used in the staff toilet. We discussed the possible infection control risks with the assistant manager and the good practice guidance to provide disposable towels. The assistant manager said that she would inform the registered manager of this. Stanbridge House DS0000014744.V373423.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staffing levels meet residents’ needs. Monitoring systems do not ensure sufficient numbers of staff are trained to care for residents. Some recruitment practices continue to place residents at risk. EVIDENCE: The staffing structure at the home consists of: manager, assistant manager, care assistants, kitchen staff, housekeeping gardening /maintenance. The rota indicated that there are three care staff on duty throughout the day. There are three housekeeping staff on duty Monday to Friday and one at the weekend. The cook and kitchen assistant prepare and cook breakfast and lunch and prepare tea, care staff finish off tea. Care staff also carry out the laundry. There are two staff on duty throughout the night. We spoke with three care staff on the day of our inspection. All indicated that they were aware of the needs of residents. However the amount of knowledge they demonstrated varied. When asked if they had read the care plans for residents one of the members of staff said that they had not. Stanbridge House DS0000014744.V373423.R01.S.doc Version 5.2 Page 22 When examining the staffing rotas we noted that hours that the registered manager works at the home are not included. The assistant manager informed us this information has never been recorded on the rota and was unable to say if this information is recorded elsewhere. There was evidence that staff have received training in mandatory areas such as food hygiene, first aid and manual handling, health and safety and safeguarding adults, in addition to training on communication and dementia. When asked what proportions of staff have received training in these areas, when this took place and how the home ensures suitable numbers of qualified staff are on duty on each shift the assistant manager informed us we would have to look through each persons certificates to obtain this information. She confirmed there is no monitoring system in place. While we went to talk to residents and staff we asked the assistant manager to look for this information. When we returned the assistant manager informed us that by looking through files she had found that staffs moving and handling certificates had expired in 2007. She informed us she had contacted a training organisation and this was going to be provided as soon as possible. We explained that the systems for monitoring staffs training need improving. The assistant manager agreed. Also we asked the assistant manager if a qualified first aider is allocated to each shift. She said that she did not think so for every shift. We asked if a risk assessment has been completed with regard to first aid and the needs of residents. The assistant manager checked the records maintained in the office and confirmed that one is not in place. We directed the assistant manager to the CSCI website where further information regarding this can be found. At our last key inspection of 28th July 2008 a Requirements was made that the recruitment process of staff must ensure that the checks, which include references and POVA FIRST, are in place before employment commences to protect people who use the service. We received an Improvement Plan from the home that informed us a tick sheet has been put into place to monitor all documentation as it arrives. Evidence gained at this inspection finds that the Requirement has not been met in full. This will be addressed separately to this report. The assistant manager informed us that one person has commenced working at the home since our last inspection. We examined the recruitment records for this person. They included both a POVAfirst and enhanced criminal records bureau disclosure, terms and conditions of employment, application form, two references and a certificate for fire safety training. It did not contain evidence of a full employment history, a photograph of the person, verification of qualifications other than fire or evidence of an induction. We also noted that the application form on file consists of one A4 piece of paper that asks for name, address, doctors details, NI number, children, qualifications, present Stanbridge House DS0000014744.V373423.R01.S.doc Version 5.2 Page 23 and previous employer. It does not ask for a full employment history or names and details of referees. Stanbridge House DS0000014744.V373423.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Management of this home is not meeting all the needs of residents safely in terms of recruitment practices, staff training and clear documentation of care needs. Residents’ financial interests are safeguarded. Residents’ health, safety and welfare is not always promoted and protected. EVIDENCE: The registered manager is also the owner of the home. The manager has City & Guilds Advanced Management in Care Award and both the manager and assisstant manager have the Registered Managers Award. As mentioned Stanbridge House DS0000014744.V373423.R01.S.doc Version 5.2 Page 25 earlier in this report the Registered Manager was not present during our inspection and the hours that she spends at the home are not included on the staff rota. The assistant manager did not know if this information is recorded elsewhere in the home. She informed us that the Registered Manager is present at the home at least five days a week, for several hours each day. At our last key inspection a total of eight Requirements were made, four of which related to medication. A pharmacy inspection was undertaken 22/10/08 where evidence of continued non-compliance was found. As a result a Statutory Requirement Notice (SRN) was issued. A second pharmacy inspection was undertaken 30/12/08 to monitor the homes compliance with the SRN. This was found to be complied with. Evidence gained from this inspection finds three of the original Requirements have not been met in full. As a result we issued a Code B notice in line with the Police and Criminal Evidence Act and informed the assistant manager that the commission will consider taking further action. In addition to the unmet Requirements we identified new issues (as described in other sections of this report). We found that the people who use the service and their relatives or representatives and the staff, are able to discuss all aspects of the running of the home generally or on a personal level. This opportunity is offered in resident, relative and staff meetings. At our last key inspection of 28th July 2008 a Requirement was made with regard to residents finances. Evidence gained at this inspection finds this Requirement has been met in full. We sampled the records and monies of three residents, with all balances corresponding with written entries. The assistant manager informed us that since our last inspection a ‘float’ of £50 has been implemented in order to supplement residents whose money runs out before their families can bring more to the home. Records are also maintained of when this is used and when the home is reimbursed. When viewing accident records we saw a record dated 26/03/08 that states the resident sustained a cut under their right eye, bump to centre of head and a skin flap to left arm. Records do not inform if any medical intervention was sought. We asked the assistant manager if the home has a policy regarding head injuries or if this information is included in the accident policy. The assistant manager checked the accident policy and informed us information regarding head injuries is not included. She informed us that staff generally ring the GP for advice. She checked the homes diary with no evidence of this occurring being recorded. The assistant manager agreed that the accidents policy would benefit from being expanded to include the procedures that should be followed for head injuries. Stanbridge House DS0000014744.V373423.R01.S.doc Version 5.2 Page 26 Whilst talking to residents one person informed us, “they was running round the house this morning when you came, moving the door wedges, closing the doors”. We discussed this with the resident, explaining the possible risks by wedging doors and that specific door mechanisms can be fitted that close in the event of a fire that offer protection. The resident asked if they could have one of these. We agreed to pass this information to the assistant manager. We saw that a number of wedges were on the floor by doors around the home. We spoke to the assistant manager about the practice of wedging fire doors and asked if this practice is included in homes fire risk assessment. She checked and said no. We instructed that she must contact the Fire Department to seek advice and implement any given. We also said that she should talk to each resident and find out if they want their bedroom doors open and if so provide safe devise for doing this, she agreed. Fire fighting equipment and emergency lighting is tested every three months by external contractors, who had noted on the last three visits that there were problems with the emergency lights. The assistant manager informed us this has now been rectified. Stanbridge House DS0000014744.V373423.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 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 2 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 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 3 X X 1 Stanbridge House DS0000014744.V373423.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 OP7 Regulation 15 Sch 3 (1)(b) Requirement Residents must have clear individual care plans describing the support that staff give to meet identified needs. Not met. Further action will be taken. Where it has been identified that people who use the service are at risk from falls, a risk assessment must be put in place, which describes how the service will lessen those risks. Not met. Further action will be taken. The registered person must be able to demonstrate through the homes records that residents received where necessary, treatment, advice and other services from any required health care professional. The recruitment process of staff must ensure that all documentation and checks, which include references and POVA FIRST, are in place before employment commences to protect people who use the service. DS0000014744.V373423.R01.S.doc Timescale for action 28/02/09 2. OP8 13 (4) (b)(c) 28/02/09 3. OP8 13(1)(b) 28/02/09 4. OP29 19 and Schedule 2 28/02/09 Stanbridge House Version 5.2 Page 29 5. OP30 18(C) 6. OP38 23(4) 7. OP38 13(4) Not met. Further action will be taken. The Registered person must be 28/02/09 able to demonstrate the needs of residents are being met safely by ensuring that suitably qualified staff are on shift at all times. The registered person must 28/02/09 consult with the Fire Authority regarding the practice of wedging residents’ bedroom doors open. Any advice given must be implemented. The registered person must be 28/02/09 able to demonstrate through risk assessment that qualified first aid staff are on duty at all times as described in the CSCI policy guidance: First Aiders RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Stanbridge House DS0000014744.V373423.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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