Inspection on 31/05/07 for The Friendly Inn

This inspection was carried out on 31st May 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Friendly Inn 29/10/09

The Friendly Inn 06/07/09

The Friendly Inn 19/02/09

The Friendly Inn 17/12/08

The Friendly Inn 21/02/08

The Friendly Inn 15/11/06

The Friendly Inn 26/06/06

The Friendly Inn 14/03/06

The Friendly Inn 16/08/05

The Friendly Inn 08/03/05

The Friendly Inn 24/09/04

The Friendly Inn 17/02/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE The Friendly Inn Gloucester Way Chelmsley Wood Birmingham West Midlands B37 5PE Lead Inspector Yvette Delaney Key Unannounced Inspection 25 June 2007 09:30 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 Friendly Inn DS0000004561.V334102.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. The Friendly Inn DS0000004561.V334102.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Friendly Inn Address Gloucester Way Chelmsley Wood Birmingham West Midlands B37 5PE 0121 779 5128 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) TheFriendlyInnCH@aol.com Mr Michael John Goss Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places The Friendly Inn DS0000004561.V334102.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th November 2006 Brief Description of the Service: The Friendly Inn Care Home is a large converted former public house. Extended by the current owner in 2003, the home is registered to accept up to 30 residents in the category of old age requiring personal care. Accommodation is provided over two floors. The home has 30 single bedrooms, of which 29 have en-suite facilities. The Friendly Inn is located in Chelmsley Wood and is readily accessible to amenities such as shops, places of worship and public transport. The home has a number of aids and adaptations to assist any frail residents including, emergency call system, shaft lift, hand and grab rails, a mobile hoist and assisted toilet and bathing facilities. There is an ample well-maintained garden area at the rear of the building. Parking facilities are available at the front of the building and on-road parking is readily available outside of the home. The Acting Manager advised that the weekly fees for living in the home is £344. The Friendly Inn DS0000004561.V334102.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection visit was unannounced and took place on a weekday, Monday 25 June 2007 between the hours of 9.30am and 5.30 pm. The acting manager was present at the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for residents and their views of the service provided. This process considers the care home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. Before the inspection, questionnaires were sent to the home to be given to residents, relatives/visitors and visiting professionals to seek their independent views about the home. There were no questionnaires returned to the Commission, which means comments received are limited to those received from residents and relatives at the inspection visit. Comments received provided views of praise from people about the service they are receiving. Some of the comments are included throughout this report to evidence outcomes for people who use the service. The registered person for the home was also asked to complete and return a pre-inspection questionnaire containing further information about the home as part of the inspection process. This was not received; information gained related to assessing actions taken by the home to meet the care standards were collated at the time of the inspection visit. The inspector had the opportunity to meet a number of the residents by visiting them in their rooms and spending time in communal lounges and dining areas and talked to several of them about their experience of the home. General observations of working practices and staff interaction with the people living at the home were included in the inspection process. Two residents were ‘case tracked’. This involves establishing an individual’s experience of living in the care home by meeting, talking or observing them, discussing their care with staff, looking at their care files, and focusing on outcomes. Records relating to the care of the people using the service, training and health, and safety were examined. Residents were able to make active contributions during the inspection visit and information gained throughout the The Friendly Inn DS0000004561.V334102.R01.S.doc Version 5.2 Page 6 day from conversations and discussions with people who use the service and staff are included in this report. The inspector would like to thank residents and staff for their cooperation and hospitality during the inspection visit. What the service does well: What has improved since the last inspection? A new drug trolley has been obtained to ensure that medications can be stored safely. A system for ongoing supervision of staff has been implemented to ensure that staff are supervised at least six times per year. The adult protection policy for the home has been reviewed to ensure that staff are aware of who concerns related to the suspicion of abuse must be reported to. An induction programme linked to the guidelines of the Skills for Care Council has been introduced. The Acting Manager undertakes the checking of fire alarms and emergency lighting in the home. Fire risk assessments have been reviewed in the home. The Friendly Inn DS0000004561.V334102.R01.S.doc Version 5.2 Page 7 What they could do better: However, this report has rated the service as adequate in six of the seven outcome groups. There remains a lot of work to do to ensure that outstanding requirements are addressed. A significant number of requirements have been outstanding for some time indicates that the owner and manager needs to be proactive if they are to improve the quality of service provision is to improve: ♦ To ensure that people who live in the home receive appropriate care all care plans must be sufficiently detailed and updated to reflect their current care needs. Risk assessments must be carried out paying particular attention to the prevention of falls and the use of bed rails. So that the home can be sure, any action necessary to reduce the risks to residents is taken. Risk assessments must be fully completed and updated. This will ensure that residents are not exposed to risk to their health and wellbeing. To ensure the safety of people who live in the home the number of staff that have attended training related to safe working practices needs to be increased. Medication practices in the home need further improvements to ensure that residents are protected from the risk of harm. Areas for improvement include introducing systems, for the safe receipt of medication into the home. An annual quality audit seeking the views and opinions of residents, their relatives and other stakeholders must be carried out and an internal audit used to address any gaps in service delivery. A copy of the findings should be distributed to stake holders and a copy displayed in the home. Areas related to the risk of cross infection need to improve. One of the areas to be addressed is the kitchen and areas to be addressed include ensuring equipment, used for food preparation is kept clean so the residents are not at risk of cross contamination. ♦ ♦ ♦ ♦ ♦ 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. The Friendly Inn DS0000004561.V334102.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Friendly Inn DS0000004561.V334102.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. Standard 6 does not apply, as the home does not provide intermediate care. Quality in this outcome area is good. People who are considering moving into the care home have information available to them, have their needs assessed and are provided with opportunities to assess the home so they can be sure the home can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A Statement of Purpose and Service User Guide are available to provide people who are considering using the service with information about the home. Both documents contain sufficient up to date information to help make an informed decision as to whether the home can meet their needs. The two residents identified to be followed through the case tracking process were both able to confirm receiving copies of these documents. Residents spoken with said that the information helped them when making decisions about the suitability of the home. The Friendly Inn DS0000004561.V334102.R01.S.doc Version 5.2 Page 10 Contracts of residence were available for residents informing them of the terms and conditions of their stay in the home. Information covered topics such as laundry, bedrooms and furniture and fees. Examination of their files demonstrates that a thorough assessment of their care needs before admission to the home had been carried out with the involvement of the residents. The acting manager for the home had visited the two prospective residents in their home. One of the residents spoken with said: “I used to stay for a couple of weeks and knew I would be ok.” The family member of one of the residents whose care was case tracked had been involved in assessing the home, which included a visit to view the home before making the decision to move in. The relative said that: “(...) the manager visited us at home and we visited the home and liked it.” Examination of the care files for the two residents followed through the case tracking process demonstrates that an assessment of their care needs had taken place. Both residents and their families had been involved in the assessment process and assessments were carried out before they moved into the home. The areas assessed during the pre-admission involved were related to individual health and social care needs. These include medical and health history, mobility, medication and potential areas of risk. The referring management teams who include Social Services and the Primary Care Trust (PCT) also provided assessments of health and personal care needs. This information is important to the home as it helps to ensure that staff produce a comprehensive plan of care to meet the needs of residents to be admitted to the home. The Friendly Inn DS0000004561.V334102.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 Quality in this outcome area is poor. Care plans do not consistently describe what staff have to do to meet the identified and changing needs of people living in the home, which puts them at risk of not having their needs met. Safe medication practices in the home are not consistently maintained to safeguard people living in the home. People living in the home are treated respectfully. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The two residents identified for case tracking were seen, spoken with and the interaction between them and staff were observed. Residents looked well dressed and groomed and looked comfortable with the staff as they helped them with their care needs. Examination of the two files showed that the standard of care plan documentation was not consistent in all files. Written details showed that they did not always contain clear, concise or specific information describing the The Friendly Inn DS0000004561.V334102.R01.S.doc Version 5.2 Page 12 range of personal and health care needs of the residents. For example the assessment of a resident identified that they were at risk of falls, however a care plan to describe the support the resident would need to decrease the risk of falls had not been written. A further example was for a resident who had been prescribed Warfarin (a medicine to prevent blood clots) and therefore requires a specific plan of care. This information had not been crossreferenced into a care plan to ensure that staff are aware of their role in the care of a person taking this medication. Staff spoken with were knowledgeable about these residents but the lack of documented information describing their care needs means that there is a risk of inconsistent care being delivered to people living in the home. Risk assessments were not consistently completed in both files examined. In one of the files, for example the following risk assessments had not been completed falls, moving and handling and mobility. Carrying out risk assessments will ensure residents take managed risks with support as required and protect them from potential harm. Daily statements were not consistently written by care staff to describe the day-to-day wellbeing of resident’s living in the home. The lack of information does not demonstrate that care has been given as planned and does not allow for effective audit of care provided in the care home. It was noted, however that details completed in care files by the acting manager were detailed and meaningful. This issue was discussed with her and it was agreed that these would be good practice examples to use when instructing staff, perhaps through supervision sessions. Making sure that care plans are in place, which reflect the current and changing care needs of people living in the home will support staff in providing appropriate care. Entries in residents’ health records and comments by staff confirmed that people are supported to gain access to relevant health professionals where required, such as the GP, Optician, Dentist and Chiropodist. Conversations were held with the residents in the home they were very receptive and liked to talk about the care they received. Observations made during the visit showed that residents were relaxed in the house and integrated well with staff and other residents. People living in the home were well groomed and dressed. Residents were happy with the care they received and expressed positive comments about the staff: The Friendly Inn DS0000004561.V334102.R01.S.doc Version 5.2 Page 13 “They always ask me if I am alright.” “Staff are always happy and friendly and that makes me happy.” “Staff always answer my questions.” Residents’ personal care needs were met in their own bedroom. Residents felt that care staff showed them respect and helped them to maintain their privacy and dignity when helping them to meet their personal care needs. Care staff were observed speaking to residents politely and in a friendly manner. The pharmacist inspector inspected the home on a separate occasion to the main inspection. Six peoples’ medicine charts were looked at together with supporting care plans for two of the medication charts examined. One member of staff was spoken with during the inspection. The staff have worked hard to improve the medicine management, some good practice was seen, and five requirements from the last inspection have been met. The surplus cabinet for storing medicines and all medicines held in the medication trolley were organised. The senior care assistant spoken had a very good understanding of the clinical conditions and what the medicines they are prescribed are for. This was commended. Written supporting care plans detailed doctors visits and reasons why the medicines were prescribed. The majority of audits undertaken indicated that the medicines are administered as prescribed and records reflected practice. A few discrepancies were found. The home has no quality assurance system to confirm staff competence in the handling of medicines since the manager left her position. The home has installed a system to check the medicines received from the pharmacy into the home, but they do not adequately check the medication with the doctor for new residents increasing the risk of error of administering an incorrect dose or a medicine that is no longer prescribed. Currently only one person checks the medicines received into the home and hand writes the medicine charts if necessary. It would be safer practice and safeguard the well being of residents if two care staff to check medication received into the home. Concern was raised when a dose of Warfarin (a medicine to prevent blood clots) was incorrectly written on the medicine chart. No evidence could be The Friendly Inn DS0000004561.V334102.R01.S.doc Version 5.2 Page 14 found what the correct dose should have been. The senior care immediately checked the dose with the Warfarin clinic and amended the medicine chart. A further error was identified on another medicine chart where staff had not written the correct Warfarin dose. An immediate requirement notice was left in the home to check all the remaining Warfarin doses transcribed from the Warfarin booklets to ensure that all the people who live in the home that have Warfarin prescribed have the correct dose written on the medicine chart for staff to administer. This was to be undertaken within 24 hours. The Commission has received this information. All controlled drugs (CD) currently in the home were correctly recorded in the CD register. However, the register recorded that two other CDs were still in the home, but these had been either returned to the person when they left the home or returned to the pharmacy for destruction. The register did not record this. Residents are encouraged and supported to self-administer their own medicines but inadequate risk assessments examined were not robust enough to ensure that residents are supported to do so safely. Staff usually watched the resident taking their medication to confirm they do so safely. On the day of the main inspection visit 25 June 2007 by the Regulation Inspector the member of care staff carrying out the drug round was observed to leave the medication trolley opened and unattended after dispensing and taking the medication to each resident. This is unsafe practice, which could result in medication being taken from the trolley, used inappropriately and could cause harm. Two care files were examined to gather information on the standard of care provided by care staff to a resident that was dying and a further resident that had died. Residents’ care files lacked information. Care plans had not been updated at that time to reflect the resident’s changing care needs and there were no details to identify that resident’s wishes in the event of their death had been discussed. However, on the day of inspection a resident was transferred to hospital. A conversation with staff demonstrated that they were able to describe the action they took and the reasons why there was a need to transfer the person for medical attention. Documentation of this information into care plans as explained by care staff is important to demonstrate the care provided and the actions taken by staff to ensure residents needs have been met. Detailing care given provides The Friendly Inn DS0000004561.V334102.R01.S.doc Version 5.2 Page 15 information for the manager to monitor the care given and determine whether it was appropriate. The Friendly Inn DS0000004561.V334102.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. Social, and recreational activities are limited and therefore do not meet the needs or expectations of residents. People living in the home are supported to maintain their independence, which enhances their quality of life. Open visiting arrangements encourage regular contact with relatives and friends. Mealtimes are a social occasion but residents do not benefit from a varied, tasty and nutritious choice of food. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents said that activities take place in the home and they have a choice whether they join in. On the day of inspection, a singing musician visited the home and entertained approximately twelve residents sitting in the main lounge on the ground floor of the home. To support meeting the diverse needs of residents’ monthly church services take place and communion is offered to residents if they wish to take part. The residents in the lounge area were sociable and all appeared to get on well with each other. There were no rigid rules in the home and residents were The Friendly Inn DS0000004561.V334102.R01.S.doc Version 5.2 Page 17 free to come and go as they wish. Poor mobility was the main compromise that prevented residents to be more independent. Attempts at writing life histories for individual residents showed a lack of informative information. Developing life histories with residents and their families will give staff an insight into a person’s life to date and should help to meet residents’ diverse needs. For example information gained may be related to, what job the person did, what hobbies or interests they had/have and details about their family life. These details will provide staff with information to ensure that care and activities planned is person centred and will help them to look at the residents as individuals. There was some information related to activities that have taken place in the home. These include, and Easter party, Halloween, singing and gentle exercises. A programme was not available and information written in care plans regarding activities and events residents had taken part in was not consistently maintained. Relatives, friends and other visitors are encouraged to visit throughout the day and maintain contact and involvement in the care of their relative. Visitors were observed to visit the home at the time of inspection. On the day of the inspection, one visitor took their relative out for the day. Residents spoken with said that they were free to come and go from the home as they pleased and often made visits out into the community with their family. Some residents continue to part of family gatherings on special occasions. Residents were observed eating their meal at lunchtime. Observation and discussions with residents showed that except for one resident that they did not enjoy their meal. Complaints expressed by residents were: “No taste.” “Meat was tough.” A cake was served as pudding this looked dry and the residents were not pleased and found the cake difficult to eat. However, lunchtime was observed to be a social occasion with most residents choosing to have their meal in the main dining room on the ground floor of the home. One area of good practice was to see that people living in the home drank their tea from china cups with saucers or mugs. This is positive practice, which The Friendly Inn DS0000004561.V334102.R01.S.doc Version 5.2 Page 18 treats the residents as individuals and does not promote institutionalised care by assuming older people can only manage plastic cups or mugs. The few residents using plastic cups/mugs did so by choice. The Friendly Inn DS0000004561.V334102.R01.S.doc Version 5.2 Page 19 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, 17 and 18 Quality in this outcome area is good. People living in the home can be confident that their concerns will be listened to and acted upon. Staff respond to suspicion or allegations of abuse to make sure people living in the home are protected from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Policies and procedures are in place to support staff in managing any complaints received by the home. Speaking with nine residents and two visiting relatives demonstrates that they are aware of who they should speak to if they have a complaint. “I speak to the staff.” Residents spoken with said that they had no complaints about the home and enjoyed living in the home. There has been one complaint reported to Social Services, which is related to standards of care and support at the time of death. The owners of the home and the Social Services care management team are investigating the complaint, which is in the process of being resolved. The Friendly Inn DS0000004561.V334102.R01.S.doc Version 5.2 Page 20 Staff spoken with were aware of the complaint procedure and were able to comment on the action they would take if they received a complaint. The acting manager, residents and relatives spoken with confirmed that some people living in the home manage their own finances with the support of their family or advocate. A policy and procedure detailing the action to be taken by staff to ensure the protection of vulnerable adults was examined. The procedure for the home has taken into consideration Local Authority procedures. Training records show that some staff have attended training related to the protection of vulnerable adults in the last year. It is important that all staff receive ongoing training in the protection of vulnerable adults to ensure that residents are protected from the risk of potential harm. Discussions with two members of staff demonstrated that they are aware of their role and responsibility in reporting any suspicion of, or actual harm to residents. Discussions with the Acting manager advised that further training sessions for staff have been booked. The Friendly Inn DS0000004561.V334102.R01.S.doc Version 5.2 Page 21 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, 20, 21, 22, 23, 24, 25 and 26 Quality in this outcome area is adequate. The environment is varied throughout the home in relation to safety, comfort and hygiene, which might reduce the experience of quality of life for residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A brief tour of the home showed that the home presents as a homely environment. There were no malodours noted in the home and the home except for the kitchen was fresh and clean. Bedrooms are located on the ground and first floor of the home. Most of the bedrooms have been personalised by residents and relatives with their own possessions. The bedrooms of the residents followed through the case tracking process were observed to be individual, homely and residents looked comfortable. Residents and relatives spoken with felt that the home was clean, well maintained and they were happy with their bedrooms. Residents have access to bathroom, The Friendly Inn DS0000004561.V334102.R01.S.doc Version 5.2 Page 22 separate toilet facilities and varied en suite facilities in twenty-nine of the thirty bedrooms. Comments, received from a resident who had the opportunity to move to a larger bedroom was extremely happy and expressed: “I love it. Further comments expressed by people who use the service include: “I‘ve got most of my things around me.” “Its comfortable.” “I can go to my bedroom whenever I want.” Lounge/dining areas are available on the ground floor of the home. Residents were sitting in the ground floor lounge in suitable chairs that they felt comfortable in. There was a social atmosphere in the lounge. Residents were talking to each other, knew each other by name and were very willing to speak to the inspector. The home provides equipment necessary to assist residents to maintain their mobility and independent access around the home. Grab rails are positioned throughout the home. Zimmer frames, tripod walkers and walking sticks were seen in use and residents moved around the home safely. The laundry in the home is small, and not suitably arranged to ensure cross infection procedures are maintained in the home. The room was not organised and clean. The sluice room opposite the laundry was also dirty. The cleanliness and hygiene standards maintained in the kitchen are not good. Cleaning records, temperature checks of food and fridges and freezers were not fully completed, kitchen surfaces are in a poor state and appliances used looked in need of cleaning. Some of the equipment used for preparing food is in a poor state and does not look suitable to be used. The environmental health inspector also visited the home on the same day of the inspection by the Commission for Social care Inspection. The outcome of the inspection is not fully known but concerns were raised demonstrating that issues had not been addressed from a previous inspection. The above also reflects outstanding issues that have not been addressed following previous visits from the health protection nurse and the Environmental Health department. These include fridge and freezer temperatures not being recorded and poor cleaning schedules in the kitchen. Records to demonstrate that these procedures are routinely carried out were The Friendly Inn DS0000004561.V334102.R01.S.doc Version 5.2 Page 23 not available. Hard soap and a cotton towel are still provided in the staff toilet. These are not good practice measures to ensure the prevention of cross infection. Other areas that still need attention is extractor fans had not been cleaned as requested in the last inspection this was discussed with the manager who explained that the cleaning of extractor fans would be added to the housekeepers cleaning rota. The Friendly Inn DS0000004561.V334102.R01.S.doc Version 5.2 Page 24 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 adequate. There are sufficient numbers of staff on duty most of the time to meet the needs of people living in the home. Staff have attended limited training and mandatory training is not up to date to make sure people are cared for by competent staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: It was evidenced from duty rotas and the numbers of staff on duty at the time of inspection that there were sufficient staff to meet the needs of residents accommodated in the home. The acting manager confirmed that the usual staffing complement for the home is: 8.00am – 3.00pm 3.00pm – 10.00pm 10.00pm –8.00am 1 Senior Carer in charge supported by 4 Care Staff 1 Senior Carer in charge supported by 3 Care Staff 2 care Staff The files for two members of staff were examined and one to one discussions were held with nurses and care staff who were responsive and very receptive. New staff have an induction period and evidence available showed that induction training for new staff is linked to the ‘Skills for Care’ induction programme. The induction pack demonstrates that it is linked to a rolling programme of assessment of care staff towards an NVQ (National Vocational The Friendly Inn DS0000004561.V334102.R01.S.doc Version 5.2 Page 25 Qualification) Level 2. The acting manager advised that more than 50 of care staff are qualified to at least NVQ level 2. There have been no new recruits since the last inspection. The files of two of the most recently employed staff were examined and these show that requirements from the last inspection to obtain Criminal Record Bureau checks for all staff have been followed up. The two staff files examined were therefore seen to be complete. Discussions with the acting manager demonstrates that she has an understanding of the importance of ensuring that robust recruitment procedures are followed at all times. An explanation of the procedures she would follow to recruit staff was offered and include; completion of application forms, obtaining two appropriate references, carrying out PoVA first and Criminal Records Bureau checks. Robust recruitment procedures will support ensuring that residents are protected from the risk of harm. Staff training records show that recent staff training attended include moving and handling and fire training. Training for staff in mandatory training requirements was not current. Areas that need updating include food hygiene and Health and Safety. In discussions with staff, they said that they had attended training on using the hoist as part of the moving and handling training and fire protection training. There was very little evidence that care staff had attended specialised training for example nutrition, dementia care, death and dying, management of falls, diabetes, These topics would all be related to the care of residents currently living in the home. Specialised training undertaken by staff in the past year includes managing challenging behaviour. The absence and lack of attendance at training sessions does not demonstrate that staff have the appropriate skills and up to date knowledge to be able to carry out their role to meet the diverse needs of the people living in the home. The Friendly Inn DS0000004561.V334102.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, and 38 Quality in this outcome area is poor. In the absence of a permanent manager, there are shortfalls in the monitoring of services provided and health and safety management, which does not promote residents’ safety and wellbeing. Residents’ benefit from having their needs met by staff who are supervised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home continues to be managed by the deputy manager who is the acting manager for the home. There has been no progress in recruiting a permanent manager. In discussions with the acting manager, she confirmed that she now felt in a position to take up the manager’s post and with the permission of the registered provider will be applying to the Commission to be the registered manager. The acting manager had a very good knowledge of the residents The Friendly Inn DS0000004561.V334102.R01.S.doc Version 5.2 Page 27 needs and was respected by staff, residents and relatives. The acting manager was positive about the plans and had plans to develop the home and improve services. There are good practices and systems in the home, which need to be continuously managed in order to improve. A suitable manager will support the effective running of the home; ensure management tasks are completed and that ongoing maintenance and monitoring of practices are carried out. Evidence of a formal quality assurance and monitoring process was not available. Measuring the quality of the service provided by the home would provide information to demonstrate whether the home is meeting the needs of the people living in the home. This involves an internal audit against identified standards. Effective quality monitoring would cover all areas of the service for example includes, infection control, training and development of staff, food provision, staffing levels and complaints. The process would show a commitment to involving people using the service, relatives and friends, health care professionals and staff through seeking their views. Monies are held by the home on behalf of a number of residents for safekeeping and are stored safely and securely. The records of residents followed during the case tracking process were examined. Generally, the system is robust and evidence of good practice was seen. Residents’ money is held separately in individual envelopes. Manual records are held of financial transactions. Accounts are audited and reconciliation of all accounts takes place. However, individual receipts are not always held in respect of money spent on behalf of the resident. This was particularly evidenced by the absence of individual receipts detailing the services and the fees following visits to the hairdresser. Individual records detailing financial transactions must be maintained in accordance with the Data Protection Act 1998. Supervision of care staff has commenced and action is being taken to ensure that these are carried out at least six times per year. Staff files showed that the outcomes of supervision sessions are consistently recorded. Topics discussed and action or activity that staff would be undertaking before their next supervision to demonstrate any progress made were identified. Records examined and observations whilst walking around the home show that servicing of fire fighting equipment takes place on a regular basis. Fire safety management includes regular testing of fire alarms, emergency lighting, and gas safety records are up to date up-to-date and in good order. A record is The Friendly Inn DS0000004561.V334102.R01.S.doc Version 5.2 Page 28 maintained in the home of any accident or incident that happens to a resident. Records show details are not consistently maintained to explain what first aid measures or accessing medical aid if necessary appropriately manages the outcome of any accidents to residents. Records also evidence that the home is not ensuring that the Commission is informed of all accidents, incidents or events, which affect the well being of people living in the home. Areas that could compromise the health and safety of residents have been mentioned throughout this report. Examples of these are related to poor medication practices and poor maintenance of care plans. There was no evidence that the registered provider is making unannounced visits to the home to oversee the management/conduct of the home. It is a requirement that these visits take place. The visit involves the responsible individual inspecting the environment, reviewing administration and speaking to residents, relatives and staff. A report is then prepared detailing the outcome of the visit and a copy of the report shared with the Commission. Carrying out these visits would provide information on the quality of service provided by the home to demonstrate good and/or poor experiences for people who use the service. The information obtained will also allow the acting manager and owner to identify areas for improvement, giving the opportunity to take appropriate action to improve the service. The home still had no evidence on site that the portable electrical appliances had been checked or that the water system had been checked for the prevention of Legionella. The registered provider said that these were to be completed in the week of the inspection and that evidence of this would be forwarded to the Commission. The registered provider was told that if confirmation was received before the report was written the outcome would be reflected in the report and could be of benefit to the quality rating for the home. Information to confirm that these checks have been carried out or completed has not been received by the Commission. These requirements have been outstanding from previous inspections. The Friendly Inn DS0000004561.V334102.R01.S.doc Version 5.2 Page 29 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 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 3 3 2 3 3 2 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 2 3 X 2 The Friendly Inn DS0000004561.V334102.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(1) Requirement Timescale for action 31/08/07 2 OP7 15 All persons using the service must have an up to date detailed care plan this will ensure that they receive person centred support which meets their needs. Daily records including those 31/08/07 made by care staff working nights must be: • • • • Sufficiently detailed. Linked to care plans. Demonstrate actions taken by staff to deliver prescribed care. Fully inform staff about changes that have taken place. 3 OP7 15 This action will ensure that staff are provided with up to date and accurate information and allow the home to monitor that residents receive care, which meets their individual needs. Care plans must support any changes made to prescribed medication. This will ensure that people who live in the home receive person centred care. DS0000004561.V334102.R01.S.doc 31/08/07 The Friendly Inn Version 5.2 Page 31 4 OP8 13(4) 5 OP9 13(2) 6 OP9 13(2) 7 OP9 13(2) 8 OP9 13(2) Any identified risk to a persons health and wellbeing must be recorded, assessed, monitored and appropriate care and support provided. The outcome of the risk assessment must be written in to a care plan. This will ensure that all people using the service have their needs met. The home must install a quality assurance system to assess and confirm staff competence in medicine management. This will ensure the safety of people using the service. Systems must be further reviewed to ensure that all new medication is safely received into the home. The systems must include two members of staff receiving and receiving all medication received in the home. This will ensure that people living in the home are not put at risk from harm. A second member of staff must check all directions hand written on the medicine chart. This will ensure the accuracy of the directions recorded on medicine charts and the safety of people living in the home. All Controlled Drug (CD) transactions must be recorded in the CD register and witnessed by a second member of staff. This will ensure that people living in the home are not put at risk from harm. People living in the home who wish to administer their own medicines must be suitably risk assessed as able and all compliance checks documented. This will ensure the safety of the residents from the risk of harm. DS0000004561.V334102.R01.S.doc 19/07/07 26/06/07 26/06/07 26/06/07 29/06/07 9 OP9 13(2) 19/07/07 The Friendly Inn Version 5.2 Page 32 10 OP11 15 People using the service whose health has deteriorated and are dying must have their care plan updated to identify their current care needs and include their wishes for the end stage of their life. This will ensure that they receive person centred support, which meets their needs. 31/08/07 11 OP19 23(5) 12 OP21 OP38 23(2) The registered owner must 31/08/07 forward evidence to the Commission for Social Care Inspection, which demonstrates that requirements made by the Environmental Health and Health and Safety departments have been addressed. This will ensure that people who live in the home are protected from the risk of harm. All extractor fans in the home 31/08/07 must be clean and in working order. This will ensure that the residents are protected from the spread of infections in the home and promote their health and wellbeing. Previous time scale of 31/07/06 not met. The registered owner must forward evidence to the Commission for Social Care Inspection to confirm that procedures have been carried to prevent the risk of Legionella in the home. This will ensure that people who live in the home are protected from the risk of harm. Previous time scale of 30/08/06 and 31/01/07 not met. Effective procedures must be in place to reduce the risk of infection or cross contamination so that residents are not placed DS0000004561.V334102.R01.S.doc 13 OP25 OP38 13(3) 31/08/07 14 OP26 OP38 13(3) 31/08/07 The Friendly Inn Version 5.2 Page 33 at risk. To include: • Making sure that the kitchen and the equipment used for food preparation and storage is clean, suitable to be used and are in good order. Fridge and freezer temperatures must be recorded on a daily basis to ensure they are working efficiently and food is stored and maintained at suitable temperatures. • Outstanding from 17/11/06 • The hard soap and cotton towel used for washing and drying hands by all staff using the staff toilet must be removed. Outstanding from 14/12/06 This will ensure the health and well being of people who live and work in the home and that residents and staff are not placed at risk. All staff must receive training appropriate to the health, personal and safety care needs of the people in their care. For example: • • • • Management of residents who are dying. Dementia care Food hygiene and Health and Safety 15 OP30 18 31/10/07 This will ensure the safety of people who live in the care home, that staff are trained, and competent to meet their care needs. The Friendly Inn DS0000004561.V334102.R01.S.doc Version 5.2 Page 34 16 OP31 8(1)(a) A suitable person must be appointed to manage the care home. This will ensure that people live in a home that is well managed and considers their best interests. Outstanding from 14/01/07 A suitable system for reviewing and improving the quality of care provided must be implemented to demonstrate that the home is being run in the best interests of those living in the home. This will ensure that people who use the service are receiving a quality service, which is continuously reviewed and improved. Previous timescales of 17/02/04, 31/05/06, 01/09/06 and 1/01/07 not met. Receipts must be available to demonstrate the purpose for, which items or services were purchased on behalf of residents living in the home. Where possible residents’ should be encouraged to sign confirming authorisation of any withdrawals and where this is not possible, two signatures secured to confirm the transaction. 31/10/07 17 OP33 24 31/10/07 18 OP35 9(a) 31/08/07 19 OP38 37 This will ensure that people who live in the home are safeguarded and not placed at risk of financial abuse. The Commission must be notified 26/06/07 of all accidents, incidents or events, which affect the well being of the residents accommodated in the home. The Friendly Inn DS0000004561.V334102.R01.S.doc Version 5.2 Page 35 20 OP38 13 The standards of health and safety management within the home must be improved. So that residents can be sure that the home is being managed in their best interests and their health, safety and welfare is given the highest priority. This must include: Evidence must be available to confirm that all portable electrical appliances have been checked for safety. Previous time scale of 31/07/06 not met. 31/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP8 OP12 OP15 Good Practice Recommendations Residents care files should be organised to enable staff to record information in a logical format. This will enable residents care to be monitored and audited easily. The views of people who use the service should be sought when making decisions about activities that take place in the home. This will ensure that their needs are met. Residents’ views need to be taken into consideration when planning meals and other food they will receive while living in the home. This will ensure that suitable, wholesome and nutritious food, which is varied and properly prepared, is offered to people who live in the home and will ensure that their individual nutritional needs are met. Records of the food being served to the residents must be kept in sufficient detail to enable any person inspecting the records to determine whether the diet is satisfactory in relation to nutrition and otherwise and of any special diets being catered for. A programme detailing the routine maintenance and refurbishment of the home should be maintained. This will DS0000004561.V334102.R01.S.doc Version 5.2 Page 36 4 OP15 5 OP19 The Friendly Inn 6 7 OP22 OP26 8 OP33 confirm ongoing repair of the home to safeguard people living in the home. Handrails should be fitted along the corridors to assist residents with mobility difficulties. A washing machine with a sluice cycle should be purchased when the existing washing machine in the home needs to be replaced. This will ensure safe cross infection procedures are maintained. The registered provider must visit the home unannounced at least monthly and prepare a report about the conduct of the care. These reports must be made available for inspection. This will ensure that services provided people who live in the home are continuously reviewed and improved. The Friendly Inn DS0000004561.V334102.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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. Extracts may not be used or reproduced without the express permission of CSCI The Friendly Inn DS0000004561.V334102.R01.S.doc Version 5.2 Page 38 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!