Inspection on 10/04/08 for Summerfield

This inspection was carried out on 10th April 2008.

CSCI found this care home to be providing an Adequate 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

Summerfield 08/10/07

Summerfield 24/04/07

Summerfield 27/11/06

Summerfield 12/06/06

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Summerfield 42-43 Wellington Road Dudley West Midlands DY1 1RD Lead Inspector Mrs Jean Edwards Key Unannounced Inspection 07:30 10th April 2008 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 Summerfield DS0000066864.V361655.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. Summerfield DS0000066864.V361655.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Summerfield Address 42-43 Wellington Road Dudley West Midlands DY1 1RD 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) 01384 239331 Merron Care Ltd Mrs Jacqueline Spittle Care Home 38 Category(ies) of Dementia - over 65 years of age (18), Old age, registration, with number not falling within any other category (12), of places Physical disability over 65 years of age (8) Summerfield DS0000066864.V361655.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Manager should source and undertake further training in dementia care. 8th October 2007 Date of last inspection Brief Description of the Service: Summerfield was originally two semi-detached residential properties that have been linked and extended to its present form. The home is registered to provide personal care for up to 38 people with up to 18 places accommodating older people who have dementia, up to 12 places for older people who do not fall within any other category and up to 8 places for people who are over 65 years and have a physical disability. The home comprises of three floors. The basement is used to house the boilers and is also a storage area. The ground floor has a number of bedrooms, two offices, the kitchen, communal areas and hygiene facilities. The first floor accommodates further bedrooms, bathrooms, sluice and toilets. Summerfield Care Home is located near to central Dudley and is situated on a main road, which is also a main bus route. Opposite is the Dudley Leisure Centre, there is a Carvery next door and a number of shops are in the local vicinity, a small car park is available to the front of the home. A statement of purpose and service user guide is available to inform residents of their entitlements. Information regarding fee levels can be obtained from the home. Summerfield DS0000066864.V361655.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. We, the Commission for Social Care Inspection (CSCI), undertook an unannounced key inspection visit. This means the home has not been given prior notice of the inspection visit. Two inspectors spent one weekday at the home from 07:30 to 20:10 hours. All Key National Minimum Standards have been assessed at this visit. The range of inspection methods to obtain evidence and make judgements includes: discussions with the registered proprietors / manager and staff on duty during the visit, discussions with residents, observations of residents without verbal communications and examination of a number of records. We also spoke to relatives, district nurses and other professionals who visited the home. Other information has been gathered before this inspection visit including the home’s Annual Quality Assurance Assessment (AQAA), notification of incidents, accidents and events submitted to the CSCI. The CSCI sent out service user surveys, relatives surveys, health care professional and staff surveys and collated responses have been included throughout this report. There were 24 residents living at Summerfield Care Home. Formal interviews with residents were not always appropriate therefore other methods such as observations of body language, eye contact, gestures, interactions between staff and residents have been used. There was a tour of the premises, including the grounds, communal areas of the home, the bathrooms, toilets, laundry, kitchen areas, and residents’ bedrooms, with their permission, where possible. The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. What the service does well: The home provided comprehensive information for prospective residents and their representatives, assisting people to make decisions, which were right for them. The residents were very complimentary about the care and support they received. There was a wide range of organised and spontaneous activities for residents advertised on the notice board in the reception area. The home has a supply of games, puzzles and quizzes, which were enjoyed by residents. There was an Summerfield DS0000066864.V361655.R01.S.doc Version 5.2 Page 6 activities co-ordinator employed at the home and also people who came to the home to provide crafts, exercises and entertainments. Residents spiritual needs were met with visits from church groups to the home, with services, and arrangements can be made to support any resident who wishes to go to church. The home was clean, comfortable, homely, and maintained to good standards comments from residents and relatives included, The staff were caring, knowledgeable about the residents needs and they were welcoming and friendly. Comments from the relatives included, “staff are friendly, welcoming and helpful.” The management of this home demonstrated a strong commitment to training and developing staff, which means that the residents benefit from their skills and knowledge. The registered manager and deputy manager have put in place quality and monitoring systems, which actively involved residents, relatives and staff across a number of areas of the home, including how care was provided, menus, activities, and the environment. This inspection was conducted with full co-operation of the proprietor / registered manager, deputy manager staff and residents. The atmosphere through out the inspection was relaxed and friendly. We would like to thank staff, and residents for their hospitality during this inspection visit. What has improved since the last inspection? The home is using a quality assurance system, which is based on self assessment measured against the National Minimum Standards and Care Homes Regulations. It is very positive that since the last inspection the home has used questionnaires to seek the views of residents, staff and other people interested in the home. The results have been looked at and though they are positive the registered persons are taking action to make further improvements based on suggestions from the surveys. A number of improvements have been made since the last key inspection visit in October 2007. These included the creation two separate units, Sunflower and Daisy for people with dementia. Part of Daisy unit had been creatively decorated with artwork including trees, sunshine, clouds, birds and flowers to engage residents’ interest. There were also pictures of film icons as memory aids. The programme of redecoration has continued with completion of 8 residents’ bedrooms and rendering and repainting the frontage of the home. A newly decorated hospitality lounge, furnished to a high standard, had also Summerfield DS0000066864.V361655.R01.S.doc Version 5.2 Page 7 been created from underused space. Tea and coffee making facilities were have been provided for families when visiting, or for resident’s reviews and private appointments. We were informed that a family recently found this new facility of value when visiting the home when their relative passed away, allowing them to grieve, as a family, in privacy. Residents, relatives and visiting professionals have commented on the improvements to the cleanliness of the home. Other improvements introduced since the last inspection were: the new patio and walkways and raised beds to the side of the home, funded through a government initiative, distributed by Dudley Social Services Department. The registered manager had also purchased a polythene covered greenhouse to encourage residents with gardening interests. There were improvements to the way residents care is planned to involve them more and to include more detailed information for residents with complex conditions such as diabetes, dementia and behavioural difficulties. Two relatives who were visiting commented; “the home is very good, excellent, staff are very good, food excellent”, “moving into this home saved her, they sorted out her vision and got her glasses sorted out her dentures and improved her diet, she now eats well, want to stress that the improvement in Aunt is spectacular.” Staffing levels have been maintained at levels to meet residents’ care needs and a number of new staff have been recruited, using improved rigorous procedures to safeguard residents. Staff were to be congratulated for the efforts made to communicate and offer assurances to residents. For example staff were seen talking in a reassuring manner and at a level and pace a resident understood, reducing their anxiety. They were also seen making good eye contact by kneeling next to residents who were sitting down and explaining processes before carrying out support tasks such as assistance to sit at the dining table. Staff were also knowledgeable about the particular care needs of each resident. The registered manager had sourced and introduced a considerable amount of staff training with the staff training matrix, which clearly documented staff training. The majority of staff either have or are undertaking the NVQ level 2 care award. Senior staff have the NVQ level 3 or level 4 award and the deputy manager has NVQ levels 2, 3 and 4 in care. What they could do better: Improvements were needed to make the homes system of medication administration as safe as possible. Summerfield DS0000066864.V361655.R01.S.doc Version 5.2 Page 8 The maintenance and refurbishment plan for the environment needed to be continued with speedier action, minimising immediate risks posed by the damaged toilet facilities and sodden bedroom carpet. Planned refurbishment of the kitchen, bathing and toilet facilities must be prioritised to safeguard residents from risk to their health and safety and provide a homely and pleasant environment. Infection control measures must be improved, especially in the laundry and sluice. The Registered Provider or a nominated person must consistently undertake monthly, unannounced quality monitoring visits as to the conduct of the home with reports available to the home and CSCI. This is particularly important for the manager and staff to sustain and build on improvements to meet the national minimum standards and provide good quality outcomes for residents living at the home. A number of improvements were needed to some areas of health and safety, some examples were making sure bedrails were a safe fit for the bed when they need to be used and accurate use of accident records with regular analysis of accident and incident records to highlight trends or risks. These actions will make the home a safer place for residents and staff. 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. The summary of this inspection report can be made available in other formats on request. Summerfield DS0000066864.V361655.R01.S.doc Version 5.2 Page 9 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 Summerfield DS0000066864.V361655.R01.S.doc Version 5.2 Page 10 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): 1,2,3,4 Quality in this outcome area is good. The home has a statement of purpose and service user guide. This has the effect that residents and their advocates generally have good information regarding their rights and entitlements, any agreed restrictions and how care will be provided. The home uses comprehensive assessment tools, which means that residents’ needs are thoroughly assessed to ensure that care needs will be met. The home actively encourages introductory visits and there is evidence to demonstrate that people have been given the opportunity and time to make decisions, which are right for them. Standard 6 is not applicable. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Summerfield DS0000066864.V361655.R01.S.doc Version 5.2 Page 11 During this inspection visit we have looked at a sample of four residents’ case files, spoken to the residents, four relatives, a trainer, district nurse and the staff on duty. We noted that the home had a comprehensive statement of purpose and service user guide, which together with the complaints procedure and recent CSCI inspection Reports, good practice information and information about visiting times and advocacy services located in the reception area. The statement of purpose and service user guide provided good, clear, easy to read, information about the home. Examination of residents case files and discussions with residents and relatives confirmed that they had been given copies of the homes statement of purpose, service user guide and complaints procedure. There was evidence from the CSCI service user and relatives surveys and from a sample of case files that each resident was provided with a contract / statement of terms and conditions, including their individual fees. There were 24 residents accommodated. Discussions with registered manager and deputy manager and assessment of the AQQA information supplied by the home, indicated an awareness that if and when residents deteriorate and they may need care, which the home is not able and not registered to provide, they would be supported to access a more appropriate placement. We looked at the care records of two of the five residents most recently admitted to the home. The files contained information showing that families visited the home prior to agreeing the admission, the registered manager’s pre-admission assessment, together with the letters from registered manager confirming the home could meet the prospective residents’ needs in compliance with regulation 14(1) (d). There were also copies of assessment information from the referral agencies, for example Dudley Social Services SAP10 form. The home’s assessments included information relating to activities, goals, and linked to the care plans. The staff spoken to demonstrated that they were aware of residents’ needs, and there were generally good records of each residents preferences such as rising, retiring, likes and dislikes, which reduced risks posed by reliance on verbal communication between staff. A relative of a resident, who had been admitted seven weeks ago, confirmed that the registered manager encouraged residents and/or their families to visit the home prior to admission. She stated she had visited at least 12 homes with registration to care for people with dementia before making the decision for her mother to be admitted to Summerfield. She stated, “had a feeling it was the right place for my mother as soon as I walked through the door, the Summerfield DS0000066864.V361655.R01.S.doc Version 5.2 Page 12 manager was welcoming and staff knew how to communicate with older people”. Summerfield DS0000066864.V361655.R01.S.doc Version 5.2 Page 13 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): 7,8,9,10 Quality in this outcome area is adequate The care planning, risk assessments and monitoring generally provides staff with the information they need to satisfactorily meet residents needs. There is good multi disciplinary working taking place on a regular basis, which results in the health needs of residents being well met. The home’s arrangements for administration of medication do not entirely safeguard residents health and well being. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The standards relating to Health and Personal Care had previously been judged to be poor and a Random Inspection was undertaken on 13th December 2007 to follow up on warning letter of 11 October 2007. The new registered manager had made strenuous efforts to make sure that improvements were made. The Home’s AQAA submitted on 14 February 2008 states, What we do well: Summerfield DS0000066864.V361655.R01.S.doc Version 5.2 Page 14 “We have individual care plans for all aspects of care including, Health, Hygiene, Mobility, Incontinence, Dementia and Social. When we review we look at all aspects of care and needs. We have a clear audit on Eye, Dental and Chiropody appointments.” We examined a sample of four resident’s case files, including a resident who was recently deceased, to assess the end of life care provided. All residents’ files examined showed that residents have a plan for their care needs, with evidence of the involvement of the person and / or their family where appropriate, in the development and review of the plan, which demonstrated good practice. One person, whose care we have looked at had complex needs, such as visual impairment, vascular dementia and diabetes, and all identified needs were included in the care plan. The plans demonstrated how all needs were being met and provided detailed guidance for staff, for example details of foot, oral care, nutrition, and medication regimes. There was evidence that the manager had implemented short term care plans, provided documented information to demonstrate changing actions to show how short term care needs were met. An example was when a resident had a chest infection and needed more care in bed in her own room, with a course of antibiotics and needed extra fluids. This demonstrated a positive approach to give staff additional guidance and ensure additional care needs are not left unmet. During discussions some residents and relatives have confirmed their involvement in developing the care plan and have told us that they receive feedback on decisions made during reviews. There were a range of risk assessments in place, though one of the tissue viability assessments had not been reviewed following a deterioration of the resident’s condition. It was positive that the assessments indicated what preventative measures were in place; such as pressure relieving mattresses for residents deemed to be at high risk. There were also nutritional scores and falls risk assessments, with documented interventions as needed. There were moving and handling risk assessments in place, which identified the level of assistance required. Examples were one resident required the assistance of one carer whilst walking around the home. Another resident’s moving and handling and personal care records contained the information, “needs assistance of 1 carer with bathing” and “after helping him in he likes to be left alone until he needs to be assisted out of the bath”, which demonstrated acknowledgement of risk, sensitivity and respect for independence and privacy. Two records examined noted that the residents could display aggressive behaviour and though there were detailed written risk assessments and documented strategies to manage incidents, the home did not have forms to Summerfield DS0000066864.V361655.R01.S.doc Version 5.2 Page 15 monitor and evaluate. We have recommended that the manager consider using Antecedent, Behaviour, Consequence (ABC) records to evaluate the effectiveness of strategies and use of PRN medication for residents with challenging or distressed behaviours. We noted the positive action relating to a referral to the GP and community dietician, for investigation, support and advice for a resident with poor appetite and swallowing difficulties. Food choice records at the home were in place to indicate whether this residents food intake was adequate. There was documentary evidence that all residents have appropriate access to dentists, opticians, chiropodists and other community services. We looked in detail at the care provided for a resident who had a pressure sore on the sacral area. The registered manager was aware of the grade of pressure sores and had advised the CSCI as a regulation 37 notification, indicating measures in place to manage the care. There was evidence that district nurses were appropriately involved in caring for the pressure sores and managing diabetes. We spoke to a district nurse who had been involved with the home for a long time. She told us she was involved with a resident who required daily insulin injections. She informed us that staff at the home undertake the BM (blood sugar monitoring) before breakfast. We asked whether staff were trained to undertake this invasive body procedure, she stated that she was not aware of whether the staff have done training to carry out the procedure, she personally had not provided any training. She told us that there was a definite improvement in the home since the new manager arrived. She gave examples of; better environment, staff and residents happier, no noticeable malodour now. She told us that she had observed that residents were treated respectfully and privacy and dignity were preserved. Residents were always taken to their own rooms for dressings and they always looked well presented. She stated that the manager and staff were always welcoming and helpful; they were knowledgeable about residents and information was readily available. We have discussed with the registered manager as to whether the staff who have carried out the BM procedure had received training and whether there was a blood glucose monitoring protocol in place for the staff to follow. The registered manager confirmed that there was no written protocol in place and was unaware of training provided from healthcare professionals. She agreed to contact the relevant nurses to obtain training and work with them to devise and implement an agreed protocol for this invasive body procedure. The staff were recording the BM results in the resident’s daily notes but there were no signatures to show which member of staff had carried out the test. We noted that the personal care log sheets have ticks rather than signatures and strongly recommend that staff sign to indicate personal care delivered. On 13th December 2007 the CSCI Pharmacist Inspector undertook an inspection of the control and management of medication within the service to Summerfield DS0000066864.V361655.R01.S.doc Version 5.2 Page 16 ensure that medicine records were being maintained to a safe and agreed standard. At that random inspection our findings were: The majority of the medicine records seen were well recorded with a signature for administration or a suitable code to explain why medication was not administered. Random medication audits undertaken were accurate, and showed evidence that medication was being handled carefully and safely. The date of opening of medicine containers was recorded. This meant that accurate checks on medication could be made to ensure that medication had been administered to the people living within the service. Systems were in place to ensure that medication storage was secure and people who use the service were protected from harm, however it was disappointing that the treatment room was untidy with a lack of organisation. For example, medication for return to the pharmacy was seen stored randomly in various places around the room, next to the sink, on the work surfaces, on a trolley and in a box. We reassessed the home’s systems for the administration of residents’ medication at this Key Inspection. There were some improvements to the storage in treatment room, which was generally tidy. However when we looked at the medication trolley a number of bottles of liquid medication were sticky with residue and the leakages had also made the shelves in the trolley very sticky. We noted that there were a number of creams, inhalers and containers of tablets stored on the same shelves in the medication trolley, which did not demonstrate good practice. The staff were recording the minimum and maximum daily temperatures for the medication fridge but temperatures have varied between 1C – 10C and there was no evidence of remedial actions recorded to ensure the daily temperatures were maintained between 2C – 8C. We observed that a container of Firdrocortizone 0.1mg tablets were stored in the medication fridge had a label with a residents name and instructions which were virtually indecipherable. The registered manager must obtain a new label or new supply from the dispensing pharmacy as a priority. The staff were also storing opened containers of Xalatan eye drops in the medication fridge. We showed the staff the manufacturers instructions, which directed Xalatan eye drops to be refrigerated until opened, after which to be stored below 25C. This means they need not be stored in the fridge after opening and may cause unnecessary discomfort when for residents if they are too cold when administered. We looked at the home’s controlled drugs register, which was satisfactory. However the controlled drugs cupboard controlled medication for a resident who was deceased in March 2008 and we have advised that arrangements must be made for the pharmacist to collect the medicines, without further delay. Summerfield DS0000066864.V361655.R01.S.doc Version 5.2 Page 17 We have seen that each resident had medication listed on admission and there is evidence that this had been kept up to date with any changes as part of their care plan. The home uses the BOOTS MDS (monitored dosage) medication system and there was a contract in place and regular quarterly audits undertaken by the Pharmacy provider. We were told that all staff who administer medication had received medication training and there was a specimen signature list in place. We looked at the medication records, which were generally satisfactory. We have advised the registered persons of additional improvements to make the medication system as safe as possible. We noted that the staff were not always routinely recording variable dosages of one or two tablets. An example was Zopiclone 3.75mgs (1 or 2 at night) the number of tablets given was not recorded for every night. We raised concerns about the MAR (Medication Administration Record) sheet, which contained an entry for prescribed Allendronic Acid 70mgs weekly with the only instruction “to leave 2 hour gap before the administration of Ad Cal”. We advised the registered persons to contact the dispensing pharmacy to document full instructions for the administration of Allendronic Acid on the MAR sheets and we brought the Patient Information Leaflet to the attention of staff at the home, which contained full instructions for administration. The instructions included: to be taken at least half an hour before first food or drink and the person needs to sit or stand for half an hour following administration. We informed the registered manager we intended to raise our concerns relating to the pharmacy’s dispensing practice to the attention of the CSCI Pharmacist. We advised the registered manager to clarify with the GP the administration of the PRN night dose Promazine for a resident who appears to need it on a regular basis. The MAR sheet indicated administration on 1,2,3,4, and 7 April 2008; it was not given on 5 and 8 April 2008. We also noted that BOOTS MAR sheets had new code N = Not required for PRN medication, which may be applicable for medicines such as pain relief but may cause for antipsychotic to be given PRN. We observed the senior carer during the morning medication round on Daisy Unit, accommodating residents with dementia and whilst the administration was sensitive at a pace to suit the resident and the member of staff waited to see that the medication was taken, the medication trolley was unlocked and unattended. We discussed the high risks with the registered manager and required that the practice be improved as a priority. It is positive that the registered manager has introduced a more robust system for recording information on the MAR sheets. From observations and discussions there was evidence that staff are aware of the need to treat residents with respect and they consider personal dignity Summerfield DS0000066864.V361655.R01.S.doc Version 5.2 Page 18 when delivering personal care. The home arranges for residents to enjoy the privacy of their own rooms any time they wish. The residents say that are happy with the way that the staff deliver their care and show them respect. Comments from the relatives survey include, friendly, welcoming and caring. Staff were observed treating residents with respect. For example staff did not rush residents with dementia when communicating, making efforts to ensure they were not excluded from conversations by ensuring they positioned themselves so eye contact could be made, giving residents time to answer questions and using gestures to help them understand. Residents were seen to be dressed appropriately for the weather and efforts have been made by staff to ensure clothing co-ordinated, again promoting residents dignity. It was noted that none of the female residents had stockings or tights on, wearing socks or having bare legs. We discussed this with the registered manager suggesting that efforts be made to ensure female residents leg wear reflects their preferences and age. The registered manager has taken action to meet the good practice recommendation from the previous Key Inspection; that care plans should contain detail of the last wishes of each residents taking into consideration all aspects including religion for example, if last rites are wanted by persons’ following a Roman Catholic faith. Summerfield DS0000066864.V361655.R01.S.doc Version 5.2 Page 19 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): 12,13,14,15 Quality in this outcome area is good. There are planned and spontaneous activities available on a which give residents opportunities to take advantage of and stimulating activities. Residents cultural and spiritual needs majority of residents are able to maintain good contact with regular basis, develop socially are well met. The family and friends. Dietary needs of residents are well catered for with a balanced and varied selection of food that meets residents tastes and choices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s AQAA dated 14 February 2008 stated: “What we do well: We encourage residents to make choices in their daily lives. We involve families in choices and decisions. We have on staff, an Activities Co Coordinator who is solely responsible in assessing all residents in connection with Leisure & Social preferences and choices. What we could do better: We need to introduce visits and outings to places of interest out in the community.” Comments from the CSCI relatives’ surveys echo that this is something the home could do better. The Home’s AQAA stated: “How we have Summerfield DS0000066864.V361655.R01.S.doc Version 5.2 Page 20 improved in the last 12 months: We have appointed an Activities CoCoordinator. We have created a Sports/Movie/ Reminiscence area. We have created a Social & Leisure Area. We have encouraged interaction by re arranging seating areas in lounges. We have implemented a new 3 week menu to meet the needs of all preferences and dietary requirements. We have become members of NAPA (National Association for Activities for Older People) and Our plans for improvement in the next 12 months: We will strive to continue and improve in this area. We also plan to investigate the options on outings within the community. We have plans to make more use of the Garden. We have plans to build raised beds, install a green house and a sensory garden.” We were able to confirm the accuracy of the information detailed in the AQAA, through observations, examination of records and discussions with residents, relatives, staff and the registered manager. We recommended that the registered manager consider consulting residents about transport options for outings and registering people who express interest on the Ring and Ride service. This would facilitate residents to access local community amenities. The routines of the home were flexible allowing residents to get up and have breakfast at times to suit them. Some residents were up and having toast and cereal when we arrived at 07:30, and breakfast was still being served to late risers mid- morning. As part of the inspection we have talked to people about activities and we have been told that the home has an activities co-ordinator and usually the amount of activities has increased. There were activity plans and activity records on two residents case files but none on the residents’ files most recently admitted to the home. We were told that this was because the activities co-ordinator had been on sick leave for the past three weeks. We noted that there is a supply of large print books games and musical instruments, which the residents enjoyed. There was evidence of entertainers brought into the home, such as singers, with references in notes of residents meetings. Most residents were described on their files as Church of England and one resident is Roman Catholic and we were told that one of the nuns visit regularly to give her Holy Communion. The Registered manager has told us that the minister from the local church on the high Street regularly performs a service at the home, with communion and wine enjoyed by the residents who attend. There was evidence that efforts were made to maintain contacts with residents’ families and friends. We were told that the residents could use the phone in the office to ring or to speak to family without any charge. There were a large number of visitors to the home during the inspection and those we spoke to were very positive about the care, staff and management. We were given the following comments from two relatives who were visiting an aunt; “the home is Summerfield DS0000066864.V361655.R01.S.doc Version 5.2 Page 21 very good, excellent, staff are very good, food excellent.” They told us that their aunt had lived on her own and lived on Complan and cakes for many years, “moving into this home saved her, they sorted out her vision and got her glasses sorted out her dentures and improved her diet, she now eats well. The manager, Jackie is very good, there are always staff about and they are very obliging. Want to stress that the improvement in Aunt is spectacular. The residents are encouraged to eat fruit; staff have taken a fruit platter around the home this morning. The home is always warm and clean.” During the tour of the home we noted that residents were encouraged to have their personal possessions around them, which was very positive. Although the residents’ files sampled contained a list of personal possessions, they did not contain a complete inventory, nor were they signed or witnessed. We recommended that all residents have up-to-date inventories of their personal possessions, which are signed dated and witnessed by staff, the resident and / or their representative. There was a record of the decision whether or not the residents wished to have keys to their bedrooms, however the forms had not been fully completed, the statement Do/Do Not had not been specified. Similarly preferred gender of staff forms on files had been signed but not completed, no gender was specified. Residents were observed in the Daisy lounge in the morning and at lunchtime. Seating arrangements in this lounge have been altered since the last inspection under direction of the manager to offer smaller groupings where residents could participate in a number of activities. Seating has been arranged around the television, in a group in the centre of the room and around a window that looks out onto the main road. Residents were seen sitting in all of these areas, some watching television, others having make up applied by staff and others looking out of the window. It was a positive that staff were seen sitting with residents in all groups. For example a member of staff was seen to sit with the residents by the window discussing the view of the traffic passing by and of flowerbeds across from the road. During the observation we noted that the television and a radio were both on at the same time. As we explained to the manager this could cause confusion for people with dementia as they could watch the programme on television but not hear what was being said. At lunch time staff were seen to offer assistance to residents when needed in a discreet way. For example if assistance was needed to cut up food they did this away from view of other residents. Some residents with dementia were now not able to use cutlery. Staff were aware of these residents and did not take away their independence in this area but allowed them the time to do this themselves, promoting independence. Summerfield DS0000066864.V361655.R01.S.doc Version 5.2 Page 22 A menu was seen displayed in Daisy lounge detailing a choice of meals at breakfast, lunch and dinner. It is recommended that further work be undertaken to provide this information in large print, picture format, as residents with dementia may not be able to read this in its present format. On a positive the cook was seen explaining the choices for lunch and seeking the preference of each resident. As with care staff the cook made efforts to communicate with people with dementia, kneeling by the side of residents who were sitting down in order to maintain contact, talking at a level and pace that encouraged residents to join in the conversation. Summerfield DS0000066864.V361655.R01.S.doc Version 5.2 Page 23 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): 16,18 Quality in this outcome area is good. Complaints are listened to and action is taken to look into them, and there are systems to record investigations and outcomes. Arrangements for protecting residents are generally satisfactory. Policies, procedures, guidance and staff training are being implemented, which safeguard residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s AQAA submitted on 14 February 2008 states, “What we do well: We ensure that all staff, residents, families and visitors are made aware of the procedure to make a complaint. We have different formats of the complaints procedure on display in the reception area. We operate an open door and transparent management style. Our evidence to show that we do it well: Evidence in care plans of receipt of the complaints procedure. All new staff during induction is given a copy of the complaints procedure this is documented in staff files. Evidence of Abuse training attended. How we have improved in the last 12 months: Staff have now received social services training in the protection from abuse. We have obtained different formats of the complaints procedure. The Manager and Deputy have attended a training course through Sandwell Primary Care Trust on Management Responsibility For Vulnerable Adults. Our plans for improvement in the next 12 months: Summerfield DS0000066864.V361655.R01.S.doc Version 5.2 Page 24 To ensure that all new staff are booked on social services abuse training. We plan to have a complaints/ suggestions box in situ in the reception area.” The home’s AQAA indicated that there had been 1 complaint in the past 12 months, which was resolved in 28 days and that there had been two safeguarding of vulnerable adult referrals, which were dealt with and resolved. We examined the home’s complaint log and found that the information recorded in the AQAA was not entirely accurate. There was a record of a complaint dated 15/11/07, which related to staff displaying unprofessional behaviour in the home. There was evidence that the registered manager held a staff meeting on 19/11/07 to discuss the issue and interviewed the staff concerned on the 22/11/07, taking appropriate action. There was also a record of a verbal complaint dated 25/11/07 about the phone not being answered. This raised the issue of staff not having access to the phone and only being able to use the payphone. This has now been resolved and staff now have appropriate access to the home’s telephone. A further anonymous complaint was made to CSCI dated 21 January 2008, containing allegations about the registered manager’s behaviour, which was referred to the registered proprietor to investigate and report findings to the CSCI. The registered proprietor provided a comprehensive written response, including all investigation documentation. There was no evidence to uphold the anonymous complaint and it has been accepted and closed by the CSCI. The registered manager had provided a locked box in the reception area of the home for complaints, compliments and suggestions. There were also quality assurance stakeholder questionnaires, which could be taken and filled out at any time. The registered manager had also provided a comprehensive raft of written information displayed in the reception area of the home, for example In Focus, Real Voices, Real Choices, Equality and diversity in Making Choices; Making Choices and Taking Risks etc. from the CSCI. The registered manager and deputy manager had undertaken training with Clara Learning Ltd supported by Sandwell MBC & NHS PCT and certificates dated December 2007were displayed in the reception area of the home. The staff either had undertaken or were booked on safeguarding training provided by Dudley Social Services at Parkes Hall training centre. The manager had established good links with two of the Local Authority training officers and there was access to good quality training. The home had a copy of the multi-agency procedure ‘Safeguard & Protect’, with guidance for the safeguarding of adults. Discussions with residents, relatives, the district nurse and staff demonstrated that they were aware of how to raise concerns and make complaints and would do so if necessary. Summerfield DS0000066864.V361655.R01.S.doc Version 5.2 Page 25 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): 19,21,24,26 Quality in this outcome area is adequate. The positive changes to the décor and furnishings are continuing. The incremental improvements contribute to creating a more pleasing and pleasant environment for residents to live in. The toilet and bathing facilities do are not entirely safe and clean for residents to use. Some of the kitchen facilities do not promote good infection control. The grounds are now maintained to provide a safe, pleasant and stimulating outdoor environment for residents to enjoy. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We undertook a tour of the premises, talked to staff and residents and examined documentation. In the main we found that improvements were Summerfield DS0000066864.V361655.R01.S.doc Version 5.2 Page 26 continuing to be undertaken at Summerfield Care Home. For example the exterior of the premises had been rendered, raised flower beds built and a new patio area laid so that residents could access the garden safely. A development plan for the home detailed monthly schedules for works to be carried out in order that an ongoing programme for maintenance and improvement could be completed. There were two large communal lounge/dining areas. Both of these have been fitted with flat screen televisions and supplied with new armchairs, offering further comfort to residents. Both lounges areas were bright and comfortable with nice carpets and curtains and a good standard of furnishings. This was confirmed by one resident we spoke to who said, “its very comfortable”. We saw that corridors and landings are in need of redecoration, as paintwork was chipped and has seen better days. There is a mixture of single and double glazed windows around the building. Many of the external wooden frames would benefit from attention as those we saw had flaking paint - not giving an appearance of being ‘ well maintained’. The entrance to the home was bright and clean with an abundance of information on display (many in alternative formats such as easy read and Braille). Since the Registered Manager has been in post she had created two areas that were previously not used to their full potential – one ‘garden area’ other ‘sports room’. The garden area had walls painted to include trees, sun and musical notes. It also had a bench and large table with chairs around. The sports room had a television and lots of posters and photographs displayed of films and stars including Audrey Hepburn, Gone with the Wind and Elvis Presley. Comfy chairs were placed around the television. An activity board gave details of the activity coordinator and informed readers ‘all information available in large print on request’. As these new facilities were in place for the benefit of people with dementia we advised the Registered Manager that large print, easy read information should be put in place as a matter of course to aid communication. A hospitality lounge had also been created. This was newly decorated and furnished to a high standard. Tea and coffee making facilities were also provided. The Registered Manager explained families when visiting, for resident’s reviews and private appointments now used this room. We were informed that a family recently found this new facility of value when visiting the home when their relative passed away, allowing them to grieve in privacy. Summerfield Care Home had a large kitchen. As at the previous inspection it was found to need attention. The kitchen was included in the development plan for the home but was not due to receive attention until 2009. A daily and monthly cleaning schedule was in place but due to further deterioration in the cupboards effective cleaning cannot take place. For example grease was seen to be ingrained in the damaged drawers and cupboard fronts, doors were seen not to close properly and cupboards located directly above the cooker posed a hazard as staff needed to lean across the cooker to reach them. The hand wash sink was ingrained with dirt around the taps and the window frame was Summerfield DS0000066864.V361655.R01.S.doc Version 5.2 Page 27 also seen to be soiled. Individual items of equipment were seen to be in place and of a good condition and records were maintained for hot food, fridge, freezer and food deliveries. A good stock of food items was seen to be in place with the cook confirming no ‘ready meals’ are purchased, with all items made in house. We looked at 6 bedrooms. Whilst bedrooms seen were comfortable, some were in need of redecoration. For instance wallpaper looked past its best. In some there were holes in the walls where pictures had been hung then removed. There were gaps in wallpaper where wall lights have been removed and smaller ones fitted. The redecoration of bedrooms was included in the homes development plan that stated ‘we will continue to decorate bedrooms when they become vacant in order to avoid upheaval to our residents and cause any upset’. The Registered Manager informed us that at the time of inspection 8 rooms have been redecorated. None of the bedrooms viewed have the recommended furnishings as detailed in the National Minimum Standards for Older People however no comments were raised regarding this to us during the visit. On the contrary people spoke positively regarding facilities. For example one person stated, “we are very happy with bedroom and we do not need anything else in it”. The home maintained a record on each residents file regarding the lack of furnishing. We discussed this with the Registered Manager recommending that the format be reviewed to ensure it is clear to everyone what they are entitled to and what they choose not to have provided. This will ensure no one is disadvantaged. In one residents bedroom we saw moving and handling equipment as described as needed in there plan of care. This person also had bed rails and protectors and used a pro-pad mattress. Upon examination we found the gap between the bed rails and mattress to be excessive, posing a risk of injury to the resident. Staff that we spoke to were unsure if a suitably qualified person such as an Occupational Therapist with regard to compatibility has assessed the equipment. We instructed that this must be undertaken, immediately, and that until such time as this has occurred a risk assessment must be completed and action taken to reduce the risk of injury. Another bedroom that we viewed had a very strong malodour when entering. A Kylie sheet and mattress protector was in place on the bed and plastic sheeting had been fitted around the divan base. We suggested that the sheeting around the divan be removed as this could pose an infection control risk. The carpeting around a commode was sodden. We issued an Immediate Requirement during the visit to provide suitable flooring that reduces the risk of infection. We looked at all the toilet and bathing facilities in the home and found all need attention to promote good infection control and to make them more homely. The toilet off Daisy lounge has badly stained walls and the flooring is not sealed around the edges. An area of flooring has been replaced however this has come away from the floor posing a trip hazard to residents (we issued an Immediate Requirement regarding this). The toilet flush system was broken, no nurse call lead was in place and the toilet door did not close fully, having Summerfield DS0000066864.V361655.R01.S.doc Version 5.2 Page 28 the potential to impact on resident’s privacy and dignity. The toilet by room 6 had flooring, which was not sealed and water was seen to be around the toilet, with staff unsure if this was from a leak, tiles were missing from the wall and the extractor fan was not working. Some of the wall tiles in the first floor shower room were loose and areas of the flooring are not sealed. The toilet on the ground floor by sunflower lounge has no lock on the door and the second toilet on the ground floor also has no lock or nurse call lead. The ground floor bathroom has a vanity unity that is chipped and worn, with a handle missing and the door does not close properly. This room also has no nurse call lead; the walls are stained and paint flaking. Although many of these areas are detailed for action in the homes development plan it is recommended that this be reviewed to ensure action is taken in a timely manor, to promote good infection control and to ensure residents facilities are safe and clean. Throughout the home many rooms that resident’s access did not have nurse call leads that could be used if a resident requires assistance. We discussed this with the Registered Manager and advised that an assessment be completed and action taken to provide these in areas of high risk. Improvements to infection control practices have been made. For example liquid soap, disposable paper towels and hand washing signage were seen in all bathrooms and toilet facilities. Since the last inspection the laundry flooring has received attention and a separate hand-washing sink had been installed promoting good infection control. We saw a build up of lint behind the dryers in the laundry and advised this should be removed and included in the maintenance programme due to the risk of fire if not regularly removed. We spoke to different ancillary staff regarding the sanitizing of mop heads and were given different responses to how often this should take place. For example one person stated, “just when mop heads gone replace, bleach about once every 3 days” and another “once a week”. No staff that we spoke to could confirm if they had seen or read the latest guidance regarding infection control measures in care home. We recommended that this be obtained and that all staff read to ensure practices reflect latest guidance. We also advised the Registered Manager to seek advice regarding the sluice room as this also contains a toilet that residents use. Summerfield DS0000066864.V361655.R01.S.doc Version 5.2 Page 29 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 good. The staff morale in this home is good. Staff in the home are trained, skilled and in sufficient numbers to support the people who use the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: From viewing rotas and speaking to staff and management we identified that staffing levels were provided as follows; 5 care staff (including a designated senior) shift from 7.15am to 9.15pm every day and 2 wake night staff from 9.15pm to 7.30am. In addition to this the Registered Manager was on shift supernumerary to care 5 days a week and separate kitchen, laundry and domestic staff work 7 days a week. This was an improvement from the last inspection and met the Requirement made regarding staffing levels. When looking at staff rotas we noticed that one member of staff was recorded as ‘general assistant’. We asked the deputy why this person’s job title was different to other staffs and we were informed this was due to them being under 18 years of age. We explained to the Registered Proprietors and Registered Manager that this person could not be included in the staffing numbers. The Registered Manager informed us that this person did not Summerfield DS0000066864.V361655.R01.S.doc Version 5.2 Page 30 undertake any care duties. We explained that restrictions should also be in place for kitchen and domestic duties to ensure the home complied with The Health & Safety (Young Persons) Regulations. During the inspection we spent time observing residents and staff in order to gain evidence on how the home meets the needs of people with dementia. We did this over a 2-hour period and found only 2 minuites during this time when residents were left unattended. At no time did we witness residents having to wait for assistance, indicating that staffing levels during this time meet the needs of residents. This was positive and the home should be congratulated in this area. As already mentioned we spent 2 hours observing practices in the Daisy Lounge, which was used to provide dementia care. Staff should be congratulated for the efforts made to communicate and offer assurances to residents. For example staff were seen talking in a reassuring manner and at a level and pace a resident understood, reducing their anxiety. They were also seen ensuring they gave eye contact by kneeling next to residents who were sitting down and explaining processes before carrying out support tasks such as assistance to sit at the dining table. Staff were also knowledgeable about the particular care needs of residents. For example explaining to us one resident who prefers to use their fingers when eating and not stopping them doing this as it could take away their independence. No residents were seen to be excluded and efforts were made by staff to communicate with all residents. Currently 9 seniors and care staff have undertaken dementia training of varying degrees. The remaining staff are booked to undertaken this during July and October of this year. In addition to this all staff have received training in challenging behaviour and are awaiting certificates. The Registered Manager should be congratulated for the efforts made to ensure staff are suitably qualified to support people living at the home. The staff team were praised by a professional visiting the home during our visit, who stated, “staff more dedicated, motivated”. There has been a good improvement in the number of staff who now hold a National Vocational Qualification (NVQ) or were in the process of completing this. Of the 14 care staff 12 hold an NVQ level 2 with the remaining enrolled and all seniors hold either a NVQ level 3 or 4. This gave residents assurance that they were being supported by a qualified workforce. The Registered Manager had made very good progress to ensure staff could undertake other courses. This is discussed in the management section of this report. We suggested to the Registered Manager that work should start to be undertaken to access specialist training such as continence management, tissue viability, diabetes and foot care to enhance the skills and knowledge of staff further. We sampled the recruitment records of 5 staff and found all contained the required documentation in order to protect residents (meeting previous Requirements). For example all contained evidence that staff have been issued with codes of conduct, that Criminal Record Bureau checks have been obtained prior to commencing employment along with references and Summerfield DS0000066864.V361655.R01.S.doc Version 5.2 Page 31 completed application forms. We suggested to the Registered Manager that the homes application form be reviewed to instruct applications that a full employment history be recorded and that reference requests include validation of authenticity such as use of company letterheads to offer further safeguards to residents. As at the previous inspection we were pleased to see that there was evidence of induction training on all staff files viewed. Summerfield DS0000066864.V361655.R01.S.doc Version 5.2 Page 32 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): 31,32,33,36 and 38. Quality in this outcome area is adequate. The management and administration of the home is based on openness and respect. A qualified, competent manager is implementing quality assurance systems that will allow the home to measure if it is meeting its aims and objectives. The management of medication, infection control and health and safety does not entirely safeguard residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Summerfield DS0000066864.V361655.R01.S.doc Version 5.2 Page 33 Ms Jacquie Spittle has been in post as manager since June 2007. She gained registered status with CSCI October 2007 demonstrating a good understanding of managing a Care Home. She was clear about the homes’ statement of purpose and what her role and responsibilities as a Registered manager are. She has attained the Registered Managers Award in May 2006, which she completed in approximately 7 months. Evidence was seen that Mrs Spittle has undertaken a range of relevant training, including Assessors Award, Medicine Management, First Aid, Health and Safety, Infection Control, Abuse and Managing Challenging Behaviour, Fire Safety, Care Planning, Supervision and Coping with Bereavement. Throughout the inspection Ms Spittle demonstrated a commitment to making improvements in service provision and evidence cited throughout this report, showing that she had already taken action in many areas. Staff and residents praised the Registered Manager and her approach to running the home. For example one person stated, “I love it here, the managers brilliant, better staff now since the managers been here, one big team”. Improvements to quality monitoring systems have been made. These include the introduction of residents, stakeholder and staff surveys, analysis of findings, the introduction of a development plan and regular audits covering all aspects of service provision. All of these areas allow the manager to monitor and make adjustments so that residents can be confident the home meets their needs. An area of weakness with regard to quality monitoring is the undertaking of visits by the Registered Providers in line with Regulation 26 of the Care Home Regulations 2001. We could find only 3 reports of such visits, two of which gave only very brief information and do not include the views of people. It is strongly recommended that visits take place on a monthly basis and include the views of people to enhance further the monitoring systems implemented by the Registered Manager. Staff that we have spoken to confirmed that they receive supervision and support in order to fulfil their duties. This support is offered through induction, one to one supervisions and staff meetings. It was also pleasing to find that on some occasions residents have been included in staff meetings, with written evidence that they were supported to offer their views in areas such as staffing and the environment. It is recommended that staff sign the records of staff meetings as confirmation they understand any agreed actions. We sampled a selection of maintenance and safety records and in the main found most to be up to date and offer protection to residents. For example a electrical installation certificate was issued 16/12/07, West Midlands Fire Service completed an inspection of the premises 20/03/06 stating ‘every thing satisfactory’, the fire alarm system was serviced 26/09/07 and small electrical items were tested 21/07/07 by an qualified electrician. There was some confusion with regard to whether moving and lifting equipment was being Summerfield DS0000066864.V361655.R01.S.doc Version 5.2 Page 34 serviced every six months as some items had certificates evidencing this but others service sheets but no certificates. We advised the Registered Manager to investigate this to ensure all equipment is being serviced and certified as safe. Of the 22 care and senior staff 7 hold up to date first aid certificates and 14 are booked to undertake this during 2008. 17 staff hold up to date infection control certificates with 5 booked to undertake May and June 2008. Also arrangements have been made for 5 general assistants and 1 cook to undertake this. 14 care and senior staff hold food hygiene and 8 others are booked to undertake by September. Both cooks also hold food hygiene qualifications. 17 care and senior staff hold moving and handling certificates. 9 senior and care assistants hold fire safety (also 1 general assistant and 1 cook). We discussed the lack of fire training with the Registered Manage who produced evidence that all staff are booked to undertake this on 15/04/08. The Registered Manager agreed to forward confirmation of staffs attendance to us. All staff have undertaken health and safety training and are awaiting certificates. During the inspection we observed staff transferring a resident from a lounge chair to wheelchair. A lifting belt was used, staff were heard to explain the process to the resident and the brakes were used on the wheelchair as is recommended. Both staff involved in the manoeuvre were seen to use an under arm lift technique. This is not good practice as it can pose risks to residents who are frail. We discussed this with the Registered Manager who agreed with our recommendation to raise with staff concerned and also to discuss as a good practice matter at the next staff meeting. Generally the management of products in line with the Control of Substances Hazardous to Health is appropriate. Items were seen to be stored in a locked cupboard and the majority of products have both risk assessments and data sheets in place. We did observe 3 items to be secondary dispensed with inappropriate labelling and one product did not have a data sheet or risk assessment that contained sufficient information in order to inform staff in the event of an accident. The Registered Manager agreed to take action in both these areas to reduce the risk to individuals. One area the improvement must be made is the recording and monitoring of accidents and incidents. We found incident records being completed when residents have sustained injuries but no accident forms and accident records being completed when injuries have not been sustained. Written guidance is maintained with accident/incident forms that instructs staff which documents should be completed but this is not being followed correctly by staff. As we explained to the Registered Manager a clear record of accidents and incidents must be maintained in order that effective analysis and actions can take place, reducing risks to residents. Summerfield DS0000066864.V361655.R01.S.doc Version 5.2 Page 35 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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 1 2 X 1 2 2 STAFFING Standard No Score 27 3 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 3 2 2 Summerfield DS0000066864.V361655.R01.S.doc Version 5.2 Page 36 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 OP9 Regulation 13(2) Requirement 1) The registered manager must ensure prescribed Allendronic Acid 70mgs weekly is administered in accordance with special instructions: to be taken at least half an hour before first food or drink and the resident to sit or stand for half an hour following administration, this is to safeguard residents from avoidable side effects 2) To request the dispensing pharmacy include full details of any special instructions on the MAR sheets for prescribed medication such as Allendronic Acid 70mgs 3) The registered manager must rigorously monitor the controlled drugs records and stocks and make arrangements for the liquid Oramorph and Fentanyl Patches prescribed for a resident (deceased), stored in the CD cupboard to be collected by the Pharmacist as a priority. Timescale for action 01/06/08 Summerfield DS0000066864.V361655.R01.S.doc Version 5.2 Page 37 4) To ensure that the medication trolley is not left unlocked or unattended during medication administration rounds, as a priority 5) To clarify with the GP the administration of the PRN night dose Promazine for a resident who appears to need it on a regular basis. 6) To document remedial actions taken to ensure the daily temperatures of the drugs fridge are maintained between 2C – 8C.temperatures 7) The registered manager must obtain a new label or new supply for the Firdrocortizone 0.1mg tablets, stored in the medication fridge, with the indecipherable label from the dispensing pharmacy as a priority 2. OP33 26 The Registered Provider or a nominated person must consistently undertake monthly unannounced quality monitoring visits as to the conduct of the home with reports available to the home and CSCI in compliance with Regulation 26 of the Care Home Regulations 2001 The registered persons must take action to ensure the refurbishment of the kitchen is carried out as a matter of priority. This requirement has been made to provide residents’ with wholesome safely stored and prepared food. 01/05/08 3. OP38 13(4)(c) 01/09/08 Summerfield DS0000066864.V361655.R01.S.doc Version 5.2 Page 38 4. OP38 13(3)(4) (c) 1) The registered persons are 11/04/08 required to replace the floor covering in the affected bedroom with suitable, impermeable, washable covering, which reduces the risks of infection and health and safety hazards, within an identified timescale. 2) As an interim measure the registered persons are required to take action to reduce risks of infection and implement a written risk assessment with control measures within 24 hours to safeguard the resident. The registered persons should also consider appropriate arrangements to protect or replace the bed. The registered persons are required to submit documentary evidence of written risk management strategies in place to safeguard residents from risk of harm to the CSCI Birmingham Office by 0900 hours on Thursday 17 April 2008. 5. OP38 13(4)(c) The registered persons are required to make safe the flooring in the affected WC by 1700 hours on 11 April 2008 to minimise the risk of injury to residents. The registered persons are required to submit documentary evidence of written risk management strategies in place to safeguard residents from risk of harm to the CSCI Birmingham Office by 0900 hours on Thursday 17 April 2008. 11/04/08 Summerfield DS0000066864.V361655.R01.S.doc Version 5.2 Page 39 6. OP38 13(4)(c ) The registered manager must ensure that the risk assessments for bed rails are expanded to incorporate all areas of risk to the resident, including risks of entrapment and incompatibility with the bed and / or mattress 01/05/08 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. Refer to Standard OP8 Good Practice Recommendations We strongly recommend that risk assessments for tissue viability should always be repeated when known deterioration has occurred. Not fully Met at key Inspection 10/04/08 It is recommended that the registered manager consider using Antecedent, Behaviour, Consequence (ABC) records to evaluate the effectiveness of strategies and use of PRN medication for residents with challenging or distressed behaviours. 1) It is strongly recommended that the registered manager undertake agreed action to contact the relevant nurses to obtain training and work with them to devise and implement an agreed protocol for this invasive body procedure. 2) That staff recording the BM results in the resident’s daily notes also record their signatures to show which member of staff has carried out the test. 3) It is strongly recommended that staff sign to indicate personal care delivered on the personal care log sheets, rather than use ticks. 4. OP9 1) That staff record variable dosages, such as 1 or 2 tablets administered on MAR sheets 2) The interior of drugs trolley should be thoroughly Summerfield DS0000066864.V361655.R01.S.doc Version 5.2 Page 40 2. OP8 3. OP8 cleaned and any sticky residue from liquid medicines cleaned immediately after each medication round. 3) Internal and external medicine should be stored separately. 4) That an up to date BNF, no more than 12 months old, be obtained to replace the September 2005 edition 5) That discussion be held with BOOTS Pharmacist regarding MAR sheets now have new code N = Not required for PRN medication, which may be applicable for medicines such as pain relief but not for antipsychotic to be given PRN. 6) That staff are ware that Xalatan eye drops are to be refrigerated until opened, after which the drops are to be stored appropriately below 25C 7) That staff are aware of instructions contained in the Patient Information Leaflet supplied with all prescribed medication 5. 6. OP10 OP11 That efforts be made to ensure female residents leg wear reflects their preferences and age It is recommended that the registered manager consider consulting residents about transport options for outings and registering people who express interest on the Ring and Ride service. This would facilitate residents to access local community amenities. 1) That staff be aware that the television and a radio should not both be on at the same time in the same room this could cause confusion for people with dementia; and that programmes should be as far as possible the residents’ choice and age appropriate. 2) The Registered Manager should ensure that large print, easy read information be put in place as a matter of course to aid communication, especially for people with dementia 8. OP12 That the following records be fully and accurately completed: DS0000066864.V361655.R01.S.doc Version 5.2 Page 41 7. OP12 Summerfield • • Record of the decision whether or not the resident wished to have keys to their bedrooms Record of preferred gender of staff . 9. OP14 It is recommended that all residents have up-to-date inventories of their personal possessions, which are signed dated and witnessed by staff, the resident and / or their representative It is recommended that further work be undertaken to provide this information in large print, picture format, as residents with dementia may not be able to read the menu in its present format. 1) It is strongly recommended that the home’s development plan be reviewed to ensure action is taken in a timely manner, to promote good infection control and to ensure residents facilities are all safe and clean. 2) That a timescale is identified for the planned refurbishment of the exterior and interior of the home, including: • • The external wooden frames with flaking paint and in need of attention Residents bedrooms and corridors identified 10. OP15 11. OP19 12. OP21 That a prioritised timescale is identified for the planned refurbishment of the all the toilet and bathing facilities in the home, which were to need attention to promote good infection control and to make them safer and more homely; and that interim measures are implemented to minimise risks That the Registered Manager undertakes an assessment and takes action to provide nurse call leads, which are accessible in all residents’ bedrooms, and in areas of high risk throughout the home, ensuring that they can be used if a resident requires assistance. It is recommended that the format of bedroom audits be reviewed to ensure it is clear to everyone what they are entitled to and what they choose not to have provided. This will ensure no one is disadvantaged. DS0000066864.V361655.R01.S.doc Version 5.2 Page 42 13. OP22 14. OP24 Summerfield 15. OP26 1) That the build up of lint behind the dryers in the laundry be removed and ensure this is included in the maintenance programme due to the risk of fire if not regularly removed 2) That the home has an up to date copy of the DoH ‘Essential Steps’ Infection Control Guidelines for Care Homes and that all staff have awareness 3) That mop heads are laundered daily at thermal disinfection temperatures 16. OP26 It is strongly recommended that the Registered Manager seek advice from the Black Country Health Protection Unit regarding the sluice room as this also contains a toilet that residents use. 1) That the Registered Persons do not included any young person (under 18 years of age) in the care staffing numbers. 2) That the registered manager undertakes and implements a written risk assessment for any young persons (under 18 years of age) The Health & Safety (Young Persons) Regulations 17. OP27 18. OP29 1) It is strongly recommended that the homes application form be reviewed to instruct applications that a full employment history be recorded 2) That reference requests include validation of authenticity such as use of company letterheads to offer further safeguards to residents. 19. OP30 It is recommended that work should start to be undertaken to access specialist training such as continence management, tissue viability, diabetes and foot care to enhance the skills and knowledge of staff further. That the homes Annual Quality Assurance Assessments (AQAA) submitted to the CSCI should contain accurate, verified information and fuller details of the supporting evidence of what the home does well and the improvements made and to how equality and diversity needs are met DS0000066864.V361655.R01.S.doc Version 5.2 Page 43 20. OP33 Summerfield 21. OP36 It is recommended that staff sign the records of staff meetings as confirmation they understand any agreed actions. We strongly recommend that a competent person should undertake a visual check of bedrails in the home on a daily basis to ensure that they are safe. A record must be made of these checks. Not Met at the Key Inspection 10/04/08 It is strongly recommended that the Registered Manager investigate whether all equipment used for lifting is being serviced and certified as safe every six months in compliance with LOLER Regs with certificates available. It is strongly recommended that the Registered Manager ensures all staff are aware that the under arm lift technique must not be used. This is not good practice as it can pose risks to residents who are frail and can cause injuries to staff and should be raised with staff concerned and discussed as a good practice matter at the next staff meeting. That the practice of secondary dispensing with inappropriate labelling of COSHH products is avoided wherever possible or advice and sufficient information be obtained from the manufacturers, in order to inform staff in safe usage or in the event of an accident. That the Registered Manager ensures staff maintain a clear record of accidents and incidents in order that effective analysis and actions can take place, reducing risks to residents 22. OP38 23. OP38 24. OP38 25. OP38 26. OP38 Summerfield DS0000066864.V361655.R01.S.doc Version 5.2 Page 44 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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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