Inspection on 16/02/06 for The Dell

This inspection was carried out on 16th February 2006.

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

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

Other inspections for this house

The Dell 11/03/09

The Dell 29/09/07

The Dell 17/01/07

The Dell 03/12/05

The Dell 03/02/05

The Dell 28/07/04

The Dell 09/03/04

Similar services:

Claremont House

Chesham House

Oak Ridge

Argyll House

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

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

CARE HOMES FOR OLDER PEOPLE The Dell The Dell Nelson Way Beccles Suffolk NR34 9PH Lead Inspector Mary Jeffries Unannounced Inspection 16th February 2006 13:10 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 The Dell DS0000037196.V283548.R01.S.doc Version 5.1 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. The Dell DS0000037196.V283548.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Dell Address The Dell Nelson Way Beccles Suffolk NR34 9PH 01502 712683 01502 712683 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) Suffolk County Council Mrs June Ann Gill Care Home 38 Category(ies) of Dementia - over 65 years of age (11), Old age, registration, with number not falling within any other category (27) of places The Dell DS0000037196.V283548.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd December 2005 Brief Description of the Service: The Dell is a purpose built home owned and managed by Suffolk County Council. Situated on the outskirts of the market town of Beccles in a residential area with shops and other facilities nearby. The home has access to a tail lift mini bus. The home has a landscaped garden with car parking and an attached day centre, which is run separately but available to residents of the home. The home is set out on two floors and divided in to four houses, Balmoral, Windsor, Homelea and Gloucester house. Each house other than Balmoral, which also has it’s own laundry, has bedroom, sitting and dinning rooms, a kitchen, bathroom and toilet facilities. There is a central main kitchen and laundry servicing the home and day centre. The Dell is registered to provide care to 38 older people, of which the 11 places in Balmoral House are offered to people with a diagnosis of dementia. The Dell DS0000037196.V283548.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place during an afternoon and early evening in February. It took 6 hours. The day team leader facilitated the inspection until the middle of the afternoon, when they went off shift, and another senior took over. The inspector spoke with a number of care staff individually, and with a group of carers, including seniors. The cook also participated in the inspection. Staff were very accommodating and helpful. The inspection focused on 2 units, Homelea and the special needs unit Balmoral. 4 residents who live on Balmoral were tracked. Four Residents were spoken with in some detail. There were seven vacancies at the home on the day of the inspection, including one on the special needs unit. What the service does well: What has improved since the last inspection? What they could do better: The homes medication administration system including checks of the system must be improved. Staffing deployment continues to exert pressures. Service users monthly reviews showed gaps over the last six months, whilst all of those seen had been reviewed within the previous two months, this must be kept up. The Dell DS0000037196.V283548.R01.S.doc Version 5.1 Page 6 The recent training analysis has shown up a significant number of shortfalls in refresher training, and a need to address the percentage of care staff with NVQs. A baffle lock fitted to French doors on the special needs unit must be removed. A number of administrative shortfalls were found, for example, lack of completed service users contracts, an incomplete assessment, staffs ability to access a key policy, or risk assessments for fire doors that were held open. 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 Dell DS0000037196.V283548.R01.S.doc Version 5.1 Page 7 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 The Dell DS0000037196.V283548.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,6 Residents can expect to receive a written statement of Terms and Conditions. EVIDENCE: Standards 1,3,4 and 5, were inspected at the previous inspection and were found to be met. Following the last Inspection the Registered Manager advised that contracts for all Residents were now being signed and put onto files. This was checked on four files; two were complete, one for a resident admitted to the special needs unit in January 2006 was not complete, one for a resident who moved into the home in September 2005 was not complete. The team leader facilitating the inspection confirmed that the home does not provided intermediate care. The Dell DS0000037196.V283548.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 8,9 Residents cannot expect to be fully safeguarded by the home’s administration of medicines. Service users cannot expect their care plans to be reviewed every month. EVIDENCE: Standards 7,10 and 11 were inspected at the previous inspection and were found to be met, however of the four residents who were tracked, one had only been admitted the previous month, there were gaps of up to 4 months in the monthly reviews of two during the previous none months .The other resident who had been admitted in September 2005 did not have a fully completed care plan or evidence of reviews. This file had nothing on communication/fears, nothing under preferred times for personal care, nothing under continence, nothing on leisure preferences. The care plan did note a food dislike, which the resident had told the inspector about, and that it was respected. The Dell DS0000037196.V283548.R01.S.doc Version 5.1 Page 10 The home’s action plan following the last inspection stated that Unit Managers and the Special Needs Unit Team were to identify suitable aids for orientation/communication and Activities programme by the end of January. Staff spoken with said that they were going to put up staff photographs, one commented that they “just had to find two minutes” to do so. They advised that they were also aware that the process has started of taking photographs of different meals, so that these can be used for as menus. Written menus were displayed at the time of the inspection. Meaningful signs had been put onto resident’s doors although two were not distinguished in this way however there was one vacancy. The lunchtime medication round was observed on Homelea unit and Windsor Unit. Medicines were kept in locked cupboards on each unit. The Medical Administration record sheets (MAR) sheets were inspected on Homelea unit. There were 5 days in January/February where signatures were missing for 2 residents, and explanation was given. It was noted that where a medicine was marked for one or two to be given, that the dosage was not always recorded. The senior carer administering the medication advised that all staff who administered medicine received Boots Training. Whilst they were administering the medications, the Medical Administration Records (MAR) sheets and medicines were left on the kitchen work surface. Kitchen staff were in and out of the kitchen/diner, but in one instance the carer administering the medication was out of the area and there was no other staff member present, and these were left unsupervised. The carer giving out the medication touched tablets with their hand during the process. This was pointed out, and the carer responded, “I know, it’s a bad habit of mine, I must try not to do it.” Medicine administration records contained specimen signatures of those who administered them. They also contained a photograph and name of the G.P. of each resident. These were not on the record of one resident who, the Inspector was informed, was a recent admission. They had been admitted two weeks prior to the inspection. The carer explained that they had only just got the batteries required for the camera. A requirement was made at the previous inspection that the home ensure that custody and handling of prescribed creams complies with M.A.R. regulation. This was because the Inspector had found that medicinal ointments were seen to be kept loose in resident’s bedrooms and applied by staff undertaking personal care. MAR records for these items were not recorded and completed by staff trained in the homes medicine policy. The Manager had subsequently advised the CSCI that all prescribed creams were, subsequently kept in a locked cupboard, and the MAR sheet signed by the team leader when cream was administered, and coding at the bottom of the sheet used when cream is not used. Care staff advised that they were not aware of any creams other The Dell DS0000037196.V283548.R01.S.doc Version 5.1 Page 11 than aqueous cream or sudocrem in residents bedrooms, an antiseptic cream was in one residents room, and Canesten cream in another, but these were not prescribed creams. Prescribed creams with active ingredient were stored in locked cupboards on individual units, however, in one of these there were three tubes of a cream for separate residents which had not been dated when opened, but the date on two of them when issued was several months ago. These creams stated that they needed to be kept in a refrigerator. The temperature in the kitchen was 25 degrees Celsius. The Dell DS0000037196.V283548.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,14 Residents can expect to enjoy the quality of their daily lives, and have access to an activities programme that has been developed. EVIDENCE: Standards 13 and 15 were inspected at the previous inspection and were found to be met. A requirement had been made at the last inspection that the Responsible Persons must allow for time during which staff are able to offer activities unhindered by routine practical tasks. Staff spoken with confirmed the written response provided by the Registered Manager, that there is an activities carer is in post who works three days a week, and that care staff on units are allowed to do activities on the days that the activity programme is not running. Household staff also work on units, including a domestic and the kitchen staff. Staff were courteous and polite when approaching residents. A group of residents were spoken with after lunch. Whilst they were speaking, the carer told residents, “ I’m now going to make a cup of tea” keeping them informed about what they were doing and what residents could expect. One of the residents said, “I’ve found it very good, they are all very kind and helpful. Another said, “ I’m happy with what they do for me, I can get myself dressed.” The Dell DS0000037196.V283548.R01.S.doc Version 5.1 Page 13 Later on, on Gloucester Unit, a carer was seen sitting talking with three residents at a table, one of the residents was laughing and giggling and clearly enjoying the chat. A resident on the special needs unit said, “ They have plenty to do but they all have time for you. I wasn’t keen when I came, leaving my home, but they are so kind, and my bed was so comfortable I just opened my heart…. I’m treated like a lady. I haven’t seen anybody who has said they are unhappy, they are all very quiet. The Inspector observed that when any resident was assisted, for example, moved into a wheel chair, all of the other residents focused their attention on this activity. A tea dance at Lowestoft during February was advertised, and a number of residents had put their names down to attend this. Staff advised that a number of outings had been arranged, including a lunch outing for the special needs unit. The programme had been based on information and requests from residents. A team leader said that they thought the home’s strengths were in promoting resident’s dignity, respecting their wishes, providing stimulation and in offering choices. They commented, “ That’s why I like working here.” A resident spoken with said, “ I love it here…………. they are good in the night if you want anything, sometimes I wet the bed, they say “Don’t worry, just ring”, they are all very friendly.” They went on to say, “ you are allowed to have a bath when you like, they ask what time you would like it. I had one this morning.” This resident could not think of anything that needed to improve, and said that “everything is nice.” At the time there was a TV programme on about holiday homes in Spain, the resident said, “ we don’t want a home in Spain, we’ve got one in Beccles.” The Dell DS0000037196.V283548.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Residents cannot expect all staff to have a proper understanding of their vulnerability to abuse. EVIDENCE: Standard 16 was inspected at the previous inspection and found to be met. No complaints have been received by the CSCI since then. The complaints log was requested, and the Inspector was informed we do not have a logbook. One resident’s file contained details of a complaint that they had made. This resident was receiving input from their social worker, having experienced behavioural difficulties at a previous home before moving to the Dell. As stated elsewhere, residents can expect staff to be responsive to them, and it may be that few complaints or concerns are generated, however, without checking all files it was not possible to establish this. Evidence of the Registered Managers attendance at a Protection of Vulnerable Adults (PoVA) course in January 2006 was seen. A carer spoken to advised that they had had some input on PoVA in their NVQ2. Records of 8 night staff were looked at in detail, and it was found that only two had had PoVA training, and that was is 2003. Only one of the night carers was recorded as having an NVQ in care. The Dell DS0000037196.V283548.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20, 25, 26 Residents can expect to live in a good environment that is clean and homely. EVIDENCE: Standards 19,21,22,23,24 were inspected at the previous inspection and were found to be met, however a baffle lock had been fitted to the doors of the French window on the special needs unit. A member of staff confirmed this had been fitted since the unit was registered for special needs residents, as they had problems with the arrangements- which included an alarm, agreed at registration. The small quiet rooms were seen to be free of equipment. The home’s environment was otherwise very good; this standard was inspected at the last inspection. The home was clean and attractive through out, with no unpleasant odours; communal toilets were clean and had liquid soap, paper towels and bins. There were, however, towels in the communal bathroom in the special needs unit. The home’s washing machine was seen to have a sluice cycle, and the laundry was in good order. has its own sluice. Arrangements for collecting The Dell DS0000037196.V283548.R01.S.doc Version 5.1 Page 16 and handling laundry were discussed with the team leader and they were appropriate. The procedures were also discussed with a carer who was fully aware of them. A resident spoken with said that “The laundry is very good, it goes one day and comes back the next or the day after – I haven’t lost anything, but I’ve only been here a short time.” Another resident advised that “if the sheets are wet, the carers put them in a pink plastic bag and take them to the laundry house.” She said that the carers wear gloves to do this. There were notices up in the laundry giving rules for infection control, but the senior on duty was unable to find the home’s policy. Plates of biscuits in the kitchen were covered, as was any food opened in the fridge. There was a cleaning programme and checklist for the kitchen on the wall. The cook advised that all temperatures of food trolleys, fridges and freezers, and meat. Were taken and recorded daily, and this was seen to be the case. The kitchen had a Hazard Analysis of Critical Control Points (HACCP), and the cook confirmed that they were to go to a meeting at the District Council the following week to learn about the new European regulations affecting food delivery. The cook advised that they had had an Environmental Heath visit this year, and for small areas in the kitchen where cleaning had to be improved were identified, including behind the dishwasher, cupboard handles, and the floor in the food storage area. These were checked and found to be clean on the day of the inspection. The Dell DS0000037196.V283548.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Residents can expect to be protected by the home’s recruitment practices. Whilst it has been found, under other standards, that residents can expect to find staff considerate and caring, they cannot expect to them to be trained to the level they should be able to expect. Residents on mainstream units can expect to be left unsupervised at times, and whilst they may be appropriately judged to be safe, they may not feel safe at such times. Care plans and reviews may also not be up to date. EVIDENCE: The home’s frail elderly units had one member of staff, plus availability of a float, routinely between 7 or 8 am and 12 noon, and 5.30 and 8.30. If there is no domestic on duty, the late float commences work at 4.30 pm. When the float is not on duty, the carer on the unit may be called to assist the carer on the other unit on the same floor, which has the same staffing pattern, with care needs if a resident requires two persons. Thus there are times when residents are left alone for short periods. A requirement was made at the December 2005 Inspection, that the home must provide sufficient staff cover across each house that prevents periods of time when residents are left unsupervised. It was also required that the decision relating to staffing ratios The Dell DS0000037196.V283548.R01.S.doc Version 5.1 Page 18 must be progressed through line management arrangements. This second requirement related to an application that the Registered Manager had made for additional 70 float hours per week. These requirements were found not to be met at this inspection, however at that time there were seven resident vacancies in the home, and staff were coping well, although they stated that there were times when it staffing could feel “tight”. Staff advised that the float was usually in at 7am instead of 8 am, and that this had helped. Residents dependency needs were discussed the senior carer. Of the 10 residents accommodated on Balmoral and Windsor non needed two residents for personal care, hoisting or personal care. On Windsor, three residents required two residents for either hoisting or transfer, and on Gloucester 2 residents required two carers for hoisting. There were still periods when residents could be left alone on the mainstream units. The home had responded to this in the action plan, stating, “The staff formula used at the Dell is the same as in all 17 SCC Homes.” …. Also that there are times when residents are unsupervised but deemed safe.” It was noted at the last inspection that members of the management team spoken to, acknowledged the inspectors concern that staffing arrangements could not ensure resident’s safety at all times and placed limitations on opportunities for staff and resident intervention. No additional staffing hours had been achieved by the home. The manager was not available to discuss this further at the time of the inspection. During the evening the Inspector went onto a frail elderly unit, and heard a resident who was in their room calling out, “ Help me, help me.” They were sitting with their pants pulled down, on an ordinary chair. No staff were available on the unit, a carer was found after six or seven minutes, coming onto the unit. They stated that there was “not much they could do” for this resident. The copy of the home’s rota provided confirmed the information given. Two floats had been in duty on the morning of the inspection, one commencing at 7 am, the other at 8am, and one was on duty between 5 and 9 pm. Carers take a half hour break in the morning and also in the afternoon, rather than a lunch hour. The float capacity is typically 12 hours per day, and the 5 carers breaks total 10 hrs during the day. Between 10 pm and 7pm there are two care staff and a team leader on shift across the home. Excluding the daytime leaders, who are not generally on the floor, although they can be called upon, this is equivalent to 763 hours. Following the inspection a calculation was made based on the residential forum staffing guidance tool for care homes with older people. On an average The Dell DS0000037196.V283548.R01.S.doc Version 5.1 Page 19 estimate that the home has 11 residents who are high dependency 7 medium dependency and 20 low dependency, staffing levels were within guidance. There was an entry on one carers supervision notes that stated that one worker had discussed finding it “ very hard going” when there is only one float between 4 units. It continued, “every effort is being made to ensure that is a one off.” Training records were inspected. The training analysis requested at the previous inspection had been completed and the home was in the process of organising Training Certificates on personal files. The analysis was not in a format that was easy to analyse in a limited time; particular attention was therefore given to one group of staff, might staff. Records of 8 night staff were looked at in detail. Only one of the night carers was recorded as having an NVQ in care. The analysis indicated that Manual handling updates were overdue for all of them, two were not recorded as having fire training and none had received an update since January 2004. The Registered Manager subsequently confirmed in writing that all staff have had manual handling training and receive regular refresher training, but that this was recorded elsewhere. They also advised that 4 members of night staff had received fire training in February 2006, and the training is planned for the rest of the night team. This will be checked at the next inspection. A resident commented that they felt very safe in the hands of the carer when they are bathed, but another resident was observed being moved in a wheelchair without the footplates down. The home’s action plan, received following the Inspection in December 2005, stated that all staff on the special needs unit had, by January 2006, completed in house training using the “Coping with Margaret” Training pack, and that some staff were on the waiting list to attend the Social Care Services three day dementia course. A care spoken with advised that they and their colleague were waiting to hear if they were on this course, and that they had undertaken the video training pack. Fourteen staff were listed under 3 day Dementia Training, although the dates were not given so it was not clear who had received this and who was awaiting this training. Documentation was provided following the inspection to show that 60 of carers held NVQ 2 or above. Recruitment procedures were seen to be appropriate on three staff files inspected, all included appropriate Criminal Record Bureau checks, obtained prior to commencement of work. The Dell DS0000037196.V283548.R01.S.doc Version 5.1 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,35,36,37,38 The residents can expect to live in a home which is well managed and which provides for their safety, care and well being. Whilst they can be assured that the ethos and leaderships encourages staff to consider The Dell “ to be their (the residents) home” and “ should be their home from home” they cannot expect that the management approach will always be able to ensure their needs are met. EVIDENCE: The Registered Manager has a management qualification and is undertaking an NVQ4 in care. They had contacted the CSCI prior to the inspection to advise that they had obtained a time extension on this. A group of staff, including team leaders were spoken with. They advised that the home has monthly team leader meetings. A team leader advised that they were getting regular supervision, and that the Registered Manager supervised all of the Team Leaders, and that team leaders supervise carers. They advised The Dell DS0000037196.V283548.R01.S.doc Version 5.1 Page 21 that this occurred every 4/6 weeks and a written record was made. The team leader advised that group meetings were also held on each of the units. Three staff files were inspected. One of these was for a relief member of staff. They had commenced work 8 months prior to the Inspection, but there was no record of any supervision on this file. The home does not keep any petty cash for residents, all monies are banked, and accounts managed by Social Care services where necessary. The home keeps a small amount of petty cash that can be used for small purchases, and the resident’s account is then invoiced on the basis of the receipt. Copies of Social care services accounts were seen on files inspected. The home’s certificate of Registration was displayed and correct. The home’s public liability insurance was displayed and was in date. Residents’ records were appropriately stored, but as noted, reviews were not being held on a monthly basis for all residents, and a care plan was found to be incomplete. Whilst fire doors to individual residents rooms had been fitted to residents’ bedrooms, they had not been fitted to for doors between kitchens and lounge diners on the units. One of these was seen to be wedged open. No risk assessment was available. The registered Manager responded to an immediate requirement left in respect of this stating that risk assessments were in place, however did not comment on the practice of wedging which is not acceptable. Each unit had its own locked cupboard for substances hazardous to health. Fire extinguishers were seen to have been serviced in January 2006. Concerns about training in manual handling and fire safety are listed under standard 30. The Dell DS0000037196.V283548.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 2 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 3 X X X X 3 2 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 X X 3 3 2 2 The Dell DS0000037196.V283548.R01.S.doc Version 5.1 Page 23 YES Are there any outstanding requirements from the last inspection? 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 OP2 Regulation 5 (c) Requirement Contracts must be fully completed and signed by the home. This is a repeat requirement from the previous inspection. Care plans must be completed in a timely way. Care plans must be regularly reviewed. Provide aids to communication in formats appropriate to specialist needs of residents. This is a repeat requirement from the previous inspection. Medicinal creams with active ingredients must be stored and used in accordance with given instructions and, if they are not returned on a monthly basis, dated when opened. Medicines and MARs sheets must not be left unattended. Where a medicine is prescribed for one or two to be given, the dosage must be recorded was not always recorded. Any omissions of signatures to confirm that medication has not been given must be supported DS0000037196.V283548.R01.S.doc Timescale for action 05/04/06 2 3 4 OP7 OP7 OP8 15(1) 15(2) 12 (4) (b) 05/04/06 05/04/06 30/05/06 5 OP9 13(4) 15/02/06 6 7 OP9 OP9 13(4) 13(4) 31/03/06 31/03/06 8 OP9 13(4) 31/03/06 The Dell Version 5.1 Page 24 9 10 11 OP16 OP18 OP19 17(2) 13(6) 13(4) 22(2) by an explanation, and should not occur unless there is an explanation. A record of all complaints must be maintained. All staff should have training in The Protection of Vulnerable Adults. The baffle lock which has been fitted to the doors of the French window on the special needs unit must be removed an alternative arrangements put in place. To avoid unnecessary risk of cross infection, towels must not be kept in communal bathrooms The home’s infection control policy must be available within the home and a copy forwarded to CSCI. Staffing deployment must be reviewed. The decision relating to staffing ratios must be progressed through line management arrangements. This is a repeat requirement. All care staff must receive supervision. Staff must be able to access the home’s policies. Footplates must be used when transporting residents in wheelchairs. Any fire doors not on automatic closure must be risk assessed if they are to be held open, and must not be wedged. The risk assessments must be forwarded to CSCI. 31/03/06 31/08/06 15/04/06 12 13 OP26 OP26 13(3) 13(3) 31/03/06 31/03/06 14 15 OP27OP28 OP31OP32 OP33 18 (1) (a) 10(1) 30/04/06 30/04/06 16 17 18 19 OP36 OP38 OP38 OP38 18(2) 12(1)(a) 13(5) 23(4) 31/03/06 31/03/06 31/03/06 15/02/06 The Dell DS0000037196.V283548.R01.S.doc Version 5.1 Page 25 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 OP9 Good Practice Recommendations All medication records should contain a photograph and name of GP. The Dell DS0000037196.V283548.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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