Inspection on 23/02/09 for The Grange

This inspection was carried out on 23rd February 2009.

CSCI found this care home to be providing an Poor service.

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

Other inspections for this house

The Grange 20/07/09

The Grange 29/02/08

The Grange 12/07/07

The Grange 06/12/06

The Grange 30/09/05

The Grange 13/06/05

The Grange 21/10/04

The Grange 19/04/04

The Grange 14/01/04

The Grange 10/11/03

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

CARE HOMES FOR OLDER PEOPLE The Grange The Grange Ratcliffe Highway St Mary Hoo Rochester Kent ME3 8RJ Lead Inspector Sue McGrath Unannounced Inspection 23rd February 2009 09:10 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 DS0000029055.V374222.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. DS0000029055.V374222.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Grange Address The Grange Ratcliffe Highway St Mary Hoo Rochester Kent ME3 8RJ 01634 270674 01634 270674 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) Mr Henry Alfred James Holloway Manager post vacant Care Home 10 Category(ies) of Dementia - over 65 years of age (10) registration, with number of places DS0000029055.V374222.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th February 2008 Brief Description of the Service: The Grange is located in a rural area with few local amenities. To the front of the property there is a circular drive and a paved area, offering ample parking. To the rear there is a large garden mostly laid to lawn, with a raised patio area. The home occupies detached premises with accommodation on two floors. There is a single person lift between the two floors. There are 8 single rooms and 1 double bedroom. 2 of the single rooms and the double room have ensuite facilities. There are call bells in bedrooms, bathrooms and toilets. The staff provide 24-hour cover working a rota, there is one waking night staff on duty at night The current fees for the service at the time of the visit range from £426 - £450 per week. Information on the Home’s services and the CSCI reports for prospective service users will be detailed in the Statement of Purpose and Service User Guide. There is no current e-mail address for the home. DS0000029055.V374222.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection that took place on 23rd February 2009 and was conducted by Sue McGrath, Regulation Inspector for the Commission for Social Care Inspection. The key inspections for care home services are part of the methodology for The Commission for Social Care Inspection, whereby the home provides information through a questionnaire process and further feedback is gained through surveys sent to service users and relatives and information provided from professionals associated with the home, wherever possible. The actual date of the site visit is unannounced. Additional information was also obtained through the Annual Assessment Quality Assurance (AQAA) review, which all services registered with the Commission for Social Care Inspection (CSCI) must now complete on a yearly basis. At the site visit, service users and staff were spoken to, records were viewed and a tour of the environment was undertaken. Judgements have been made based on records viewed, observations and verbal responses given by those people who were spoken with. These judgements have been made using the Key Lines of Regulatory Assessment (KLORA), which are guidelines that enable the CSCI to be able to make an informed decision about outcome areas. Further information can be found on the CSCI website with regards to information on KLORA’s and AQAA’s. The owner has appointed a person to run the home on a day to day basis in the position of manager. They are not registered with the commission, but will be referred to as ‘the manager’ within this report. The inspector wishes to thank the manager and her staff for their assistance and hospitality. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. What the service does well: Staff in the home are caring and dedicated to the welfare of the residents in the home. DS0000029055.V374222.R01.S.doc Version 5.2 Page 6 Residents say they like living in the home and that the food is good quality and that they have a choice of menus. They confirmed they are provided with food in sufficient quantities. Drinks were seen to be freely available. Families are encouraged to maintain contact with their relatives and are made welcomed when they visit. Full assessments are undertaken prior to admission to ensure assessed needs can be met by the home. What has improved since the last inspection? What they could do better: Several areas of concern were raised following this inspection. The home had not met three of the requirements made at the last inspection and the Commission will now follow its enforcement pathways and enforcement action is likely to follow. A further thirteen requirements were made following this inspection and will need to be complied with by the date given. The registered provider appears to no longer be involved in running the home on a day to day basis and has not informed the commission of this. Staff say he rarely visits the home. Although he appointed a manager last August she has yet to register with the commission. The provider did not follow the recruitment procedures of the home and this has the potential to put residents at risk. The commission is concerned the provider thought this was an appropriate way to engage a manager. There are insufficient care staff on duty during the day and at night to meet the assessed needs of the current service users who have Dementia. This has the potential to put residents at risk. There are insufficient dedicated domestic staff employed at the home and therefore care staff have to complete this work as well as their care duties, making staff levels very poor. The provider does not employ a cook and again care staff are expected to cook all meals, again taking them off the floor. The provider must employ sufficient staff at all times in all areas of staffing. DS0000029055.V374222.R01.S.doc Version 5.2 Page 7 Some areas of the home are in need of refurbishment including the kitchen, laundry, toilet and bathroom floors. The kitchen itself need to be refurbished at some time and should be included in the financial planning for the home. Some of the bedroom needs new carpets and one room had a broken call bell. Staff training continues to be a concerns, especially first aid training. No one on the staff group holds an HSE ‘First Aid at Work’ certificate. This has the potential to put residents at risk. 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. DS0000029055.V374222.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 DS0000029055.V374222.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 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who live in the home and their families are provided with out of date information about the home when they need to make an informed choice about moving into the home. People who live in the home benefit from a comprehensive assessment of their needs prior to moving into the home to ensure their assessed needs can be met. EVIDENCE: The statement of purpose and service user guide had not been completed fully from the last inspection and the copy given to the inspector contained several areas of red ink where suggestions for change had been made but not acted DS0000029055.V374222.R01.S.doc Version 5.2 Page 10 upon. It did not reflect the current managerial position so is in need of updating again. It is advised that this document be updated on a yearly basis. The current admission policy is that if the client has a care manager, a care plan would be initially obtained from the relevant social services. The manager would then go out to visit the prospective client and complete the assessment form to ensure that the home could meet the client’s needs. The prospective client would be invited to visit the home for an all day or overnight stay. The manager confirmed that the home would not accept a client unless they were confident that they could meet their needs. This home caters for residents with dementia and some staff had received training in this subject. The latest client to be admitted was previously living in Wales, so this assessment process was not undertaken. However, full information was received from relevant health professionals from the North East Wales NHS Trust and the family. All service residents were provided with a contract/ statement of terms and conditions however some did not to contain the weekly costs. This home does not offer an intermediate care service. DS0000029055.V374222.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): 7-10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who live in the home benefit from having care plans that identify their individual needs but do not always give clear guidance to staff. Health needs are met and the people who live in the home benefit from having full access to all professional health care services as required, however outcomes of visits could be better recorded. People who live in the homes are not fully protected by the homes policies and procedures for dealing with medicines DS0000029055.V374222.R01.S.doc Version 5.2 Page 12 EVIDENCE: Examination of care plans evidenced that work on the care plans that had started at the last inspection but had stopped and gaps were seen in the assessments and reviews. However, since the new manager had arrived in September last year these reviews are now regularly taking place. Some areas of the care plans still need to improve and further risk assessments are required to give a full picture of the capabilities of the residents and how best to manage their care. For residents with dementia who display challenging behaviour, it is expected that behavioural plans are in place and that guidance is given to staff on the best way to manage the challenging behaviours. These behavioural plans were not seen in the current care plans. Health care needs appear well met but again records of outcomes of health care professionals visits could be improved. Any incidents of pressure sores were reported to the district nurses who would give advice, treatment, and provide necessary equipment. Advice was also sought from the district nurses for continence problems. Nutritional assessments were carried out and weights were mainly monitored on a monthly basis. Medication administration was viewed as was the homes medication policy. Concern were raised over the wording of the policy as it was clearly taken from a nursing home and describes how nurses would administer drugs . The policy also detailed how complex dosage calculations should be double checked. This does not happen at this home. The Policy also stated the home had a lockable medication fridge, but staff explained they do not have a fridge and if medication is required to be kept cold, they use the fridge in the kitchen. The home is strongly advised to obtain a dedicated medication fridge. The provider must also ensure the medication policy reflects good practise for residential homes and does not reflect nursing practise. The home also needs a policy for the safe administration of PRN medications. Concern was also raised over the administration of controlled drugs. Several medications did not tally with the number of drugs listed in the controlled drugs book. Later in the inspection care staff complained that the lighting in the lounge area was very poor in the evenings and they had difficulty in reading the drug administration records. They were concerned they may make mistakes. This need to be addressed by the Provider. The provider must ensure the medication is managed in a more robust manner. The manager is strongly advised to complete a regular medication audit to satisfy herself and regulation that medication is being managed safely. On the day of the inspection there were nine residents and two care staff on duty both in the morning and afternoon. DS0000029055.V374222.R01.S.doc Version 5.2 Page 13 Residents in the home were treated with dignity and their right to privacy was respected. Some good examples of interaction was seen between staff and residents. However, it was noted that residents were often left on their own for quite long periods during the day, whilst staff had to clean the home and cook the meals. This is not appropriate for residents with dementia and more supervision and support is required. Bath times are dictated by staffing levels and not the needs of the residents. DS0000029055.V374222.R01.S.doc Version 5.2 Page 14 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home have their social and recreational interest and needs provided for with a range of activities organised. People who live in the home are supported to maintain contact with family and friends, which ensures they continue to receive stimulation and emotional support. People who live in the home receive a balanced diet. EVIDENCE: The home organises a variety of activities for the residents to keep them stimulated and motivated. These activities normally take place in the afternoon and a record is kept of who joins in and who declines. One resident said he got bored during the day and was looking forward to using the garden in the summer. Others residents were non committal about the activities. DS0000029055.V374222.R01.S.doc Version 5.2 Page 15 Most activities were recorded but it was noted that one new client had activities recorded for dates before she had been admitted. This could suggest record are done as a paper exercise and may not reflect what is actually happening in the home. No activities were seen to be taking place on the day of the inspection. A visiting professional holds hour-long exercise and motivation session monthly. Visiting entertainers include Old Time Music Hall shows, and a visiting singer. The staff of the home support residents who wish to follow their religious or cultural beliefs and visiting clergy were arranged as required by individual residents. Services are also held on all of the major Christian feast days for those residents who wish to join in. Residents are encouraged to maintain contact with their families and friends. Residents said, “They make visitors welcome”, Residents had choices in most aspects of their daily lives as far as they are able. However some tasks are dependent on staff rotas, for example times of bathing due to the low number of staff on duty. Staff confirmed that when bathing residents who are double handlers they have to either put some other residents to bed early or to rely on other residents to call for assistance if necessary. The single bathroom is on the upper floor and at the farthest end of the building form the main lounge. With up to ten residents with dementia and only two staff this means that again residents are left unsupervised. Two residents have their own telephone lines; others are contacted via the homes telephone. Each client has a copy of their ‘rights’ pinned up in their room and there is a copy on display in the hallway. None of the bedrooms had television aerials so portable one had to be used and some of the pictures were not clear. Mealtimes were seen to be relaxed and at a comfortable pace. The menus were seen and appeared well balanced with fresh fruit and vegetables mainly used. Care staff have to cook all meals and this takes them away from their care duties. The provider must employ more staff to cook the meals. DS0000029055.V374222.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are protected by a complaints system and residents and relatives feel their views are listened to and acted upon. The home has adult protection policies and procedures to ensure that residents are protected from abuse however poor staff training has the potential to put residents at risk. EVIDENCE: The home had a clear complaints policy, and a copy was on display in the hallway. The AQAA confirmed there had been no complaints recorded since the last inspection. The AQAA confirmed there had been no adult protection alerts on the home since the last inspection. The home has policies on Abuse and Whistle Blowing. Not all staff had received recent training in the Protection of Vulnerable Adults. One staff spoken with displayed a good understanding of Adult Abuse and protection. Another area of concern was the lack of first aid DS0000029055.V374222.R01.S.doc Version 5.2 Page 17 training in the staff group. Training will be further discussed in the staffing section of this report. All current staff, except the manager had an enhanced disclosure undertaken by the Criminal Records Bureau. Poor recruitment practised by the provider has the potential to put residents at risk as has poor lighting in the lounge at evening medication time. DS0000029055.V374222.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home needs to be refurbished for the benefit of the people who live there. The home is not as clean as would be expected and poor practise with regards to infection control has the potential to put people who live in the home at risk. EVIDENCE: Residents stated that the home was comfortable although it is a little ‘shabby and tired’ in places. There was a lift to provide access to the first floor. At the rear of the property there was a patio area and a garden that was mainly laid to lawn. DS0000029055.V374222.R01.S.doc Version 5.2 Page 19 At the start of the inspection it was noted that one of the toilets on the lower floor had faeces smeared on the seat, this was still there at the end of the inspection at approx 5pm. The floor covering in these toilets was lifting and needed replacing. The only bathroom for the residents was on the upper floor and had a broken and loose radiator cover that was a risk to both staff and residents. The bath was chipped where the hoist was rubbing against it and the blind at the window was broken and very dusty. The bathroom was not a welcoming place in which to enjoy a pleasant bath. The floor covering also needed replacing as areas around the toilet pan were missing. These are serious infection control issue and needs to be addressed. The inspector found an armchair that was wet; investigation evidenced that a client had had a recent incontinence problem. This was pointed out to staff, they were advised to remove the cushion and ensure it was laundered appropriately. Later in the day the same cushion was seen back in the same armchair and had merely been turned over exposing the frame of the material chair to the dampness. It did not appear to have been washed and was certainly still wet. This is not only an infection control issue but extremely poor practise. The kitchen was viewed and it was noted that the flooring was puckered and was pulled away from the bases of the floor cabinets and should be replaced. There were chips on the tiles around the sink and this could be an infection control issue. The kitchen generally was looking tired and worn and it is advised that replacing the cabinets and updating the equipment should form part of the financial planning for the coming years. There were first aid boxes in the kitchen and the manager is advised to check the contents as they were not complete. They were also very dusty. The bedrooms were satisfactory but one did not have a working call bell and this needs to be repaired as soon as possible for the safety of the resident. It was also noted that not all radiators had covers fitted. The radiators without cover were very hot to the touch and would be a hazard to any client should they fall against them. There were also exposed water pipes that were very hot. Urgent action needs to be taken to reduce these risks. Room nine needed a new carpet and room 6 had a carpet that was loose and was a trip hazard. Room 5 was without a lampshade at the ceiling rose and several did not have bedside lamps. The manager did say she was aware of some of the issues and would deal with the more minor issues immediately. The lounge was also viewed and some residents said it was comfortable. It was noted that the lighting levels were low and that some of the wall lights were not working. Evidence was seen that several lamps were in place. It was a large room with two ceiling lights. Staff confirmed that in the evening the lighting level was low making it difficult to see to dispense the medication and DS0000029055.V374222.R01.S.doc Version 5.2 Page 20 they had concerns they might make an error. Staff also said it would be very difficult for residents to read in the evenings in the lounge. The provider only employs one care worker for fours hours per week to complete all of the domestic tasks. This amount of time for a home of this size is insufficient. Care staff do not have time to complete this role during their shift. The provider must ensure sufficient domestic staff are employed on a daily basis to ensure the home is clean and fresh. Care staff also have to prepare all of the meals in the home and this is not appropriate for a home of this size. The provider must ensure that appropriate levels of staff are employed as dedicated kitchen staff to prepare the residents meals. It was noted during the inspection that two care staff spent time preparing the meals and then washing up after the meal. During this time there were no staff monitoring the resident’s welfare. This is not acceptable for a home specialising in dementia care. The current staff who prepared the food have only had an awareness training in food hygiene not the Basic Food Hygiene course. DS0000029055.V374222.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is understaffed in all areas and this is putting the people who live in the home at risk. Poor staff training has the potential to put the people who live at the home at risk. Poor practise in staff recruitment has the potential to put the people who live in the home at risk. EVIDENCE: Rotas were viewed and evidenced that only two staff are on duty at all times during the day. At night only one staff is on duty. The manager is employed fro thirty hours per week which can be flexible. The new manager does live in the bungalow in the grounds but is not always there. It is not acceptable to say that she is on call for 24 hours over the seven days. At least two residents are considered as double handlers and some residents care plan confirmed they were likely to wander at night. It is the Providers responsibility to ensure that staff are employed and on shift in sufficient numbers at all times to meet the assessed needs and safety of the residents. DS0000029055.V374222.R01.S.doc Version 5.2 Page 22 At the last inspection the inspector was told that the home was advertising for a cleaner and for an additional night carer. This has clearly not been acted upon and a requirement will now be made. As highlighted earlier in the report domestic staff must also be employed to release carers to fulfil their caring role. At the last inspection a requirement was made regarding mandatory training being completed by all staff. It was evident from the evidence given to the inspector on the day that this has not been achieved. There were gaps in adult protection, moving and handling, fire awareness, health and safety, and first aid. It is expected that at least one person per shift has completed HSE (Health and Safety Executive) recognised ‘First Aid at Work’ course. Currently no-one employed by the home holds this certificate. Seven staff held a one day emergency first aid course but these were completed many years ago, so were now invalid. One member of night staff who works alone did not have any training evidenced in her personal files at all. This has the potential to put residents at risk and urgent action must be taken. The level of the induction training also needs to improve to meet the standard required by regulation. Evidence given at the inspection indicated that five staff have completed NVQ level 2 or above. The information given in the AQAA stated six but this could not be evidenced on the day. CSCI enforcement pathway will now be followed and enforcement procedures will be implemented to protect residents. The new manager was appointed by the provider last August but appropriate recruitment procedures were not followed. There was no personnel file for the manager. There was no evidence of an application form, interview notes or any offer of employment. No evidence could be found that references were asked for, proof of identity or POVA first and a CRB were not obtained. The AQAA stated that all staff employed in the last twelve months had satisfactory pre-employment checks. This was clearly not the case. An immediate requirement was left with the provider to ensure these checks are undertaken. Discussion with the new manager confirmed that she did not have a lockable cabinet in which to store staff files. The provider must provider a lockable cupboard/filing cabinet to ensure staff files are maintained confidentially. Staff were seen to be kind and considerate through out the inspection and clearly they are trying their best to provide a pleasant home in which to live DS0000029055.V374222.R01.S.doc Version 5.2 Page 23 but as evidenced in this report are not supported by the provider and the lack of training. DS0000029055.V374222.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The registered provider is not managing the home in a proper manner and this has the potential to put residents at risk. EVIDENCE: The registered provider has not been in the home on a regular basis since last August due to reasons beyond his control. He has however not informed the Commission of the problems he has encountered. There is an expectation that any provider would inform the Commission of any negative effects this may have on the smooth running of the home. The Provider will be required to detail how he intends to continue to support the home and residents. The new manager has the qualification to be registered as the manager but has not yet applied to the Commission to be registered. She was aware of the DS0000029055.V374222.R01.S.doc Version 5.2 Page 25 problems within the home and was hoping to work with the provider and Commission to make the required improvements. Staff spoken with confirmed that they have not seen the provider recently; some said he had not been at the home for several months. It will be a requirement that the provider registers a manager as soon as possible if he is unable to manage the home himself on a daily basis. The low scoring on the management section is not a reflection on the new managers capabilities but because she is not registered with the commission the provider is deemed as managing the home. The manager stated that the owner has said that he cannot employ more staff as he does not have the financial means to do this. The Commission will require copies of the homes accounts to ensure financial viability of the home. A requirement was made at the last inspection that the provider should put in place additional formal quality assurance strategies to ensure that stakeholders’ views are sought and taken into account and that all aspects of the care of the service users are regularly audited. There was no evidence to confirm that this had been complied with. CSCI enforcement pathway will now be followed and enforcement procedures will be implemented to protect residents. The manager said that staff supervision is now happening on a regular basis but that she does not have anywhere lockable to store the supervision notes. The provider must provide secure storage facilities for this purpose. The manager has started to introduce residents and staff meetings. The home has robust procedures in place for dealing with client’s monies. Receipts were kept and all transactions were documented and double signed. Not all of the home’s policies and procedures had been reviewed during the past year. Several need updating to fully meet with requirements. The health, safety and welfare of staff and residents is compromised by the shortfalls in mandatory training. Health and safety monitoring checklists were in place and being completed regularly. There was a health and safety action plan with planned and completed dates. All staff have received handbooks/questionnaires on Health and Safety. Fire risk assessments were completed in 2007. The certificates for safety compliance viewed were all in date. DS0000029055.V374222.R01.S.doc Version 5.2 Page 26 DS0000029055.V374222.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 2 1 X X 2 2 1 STAFFING Standard No Score 27 1 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 1 X 3 2 2 2 DS0000029055.V374222.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 OP25 Standard Regulation 23(1)(a) (2)(p) Requirement The registered provider must ensure that the lighting is suitable for service users in all parts o t he home which are used by service users. In that lighting in the main lounge meets the recognised standard of lux 150. The registered provider must ensure that all parts of the home are kept clean and reasonably decorated. In that sufficient dedicated staff are employed to maintain the cleanliness of the home The registered provider must ensure that all parts of the home are kept clean and reasonably decorated. In that all toilets are kept clean. The registered provider must ensure that call systems with an accessible alarm facility are provided in every room. In that the call alarm is provided in room 8. DS0000029055.V374222.R01.S.doc Timescale for action 20/04/09 2 OP26 23(2)(d) 20/04/09 3 OP26 23(2)(d) 20/04/09 4 OP22 23(2)(n) 20/04/09 Version 5.2 Page 29 5 OP26 13(3) 6 OP19 23 The registered provider shall ensure that staff follow the guidance from the Health Protection Agency with regards to infection control. The registered person shall ensure that the premises to be used as a care home are of sound construction and kept in a good of repair externally and internally. In that flooring on the kitchen, laundry, bathroom and toilets is replaced. The registered provider must ensure that at all times suitably qualified, competent and experienced staff are working at the home in such numbers as are appropriate for the health and welfare of service users increased assessed needs. In that more staff are employed both during the day and during the night. The registered provider must ensure that at all times suitably qualified, competent and experienced staff are working at the home in such numbers as are appropriate for the health and welfare of service users. In that more dedicated domestic staff are employed at the home. The registered person shall not employ a person at the care home unless all of the requirements regarding the fitness of workers are adhered to. An immediate requirement was made regarding the employment of the manager. The registered person shall provide safe and secure storage DS0000029055.V374222.R01.S.doc 20/04/09 20/04/09 7 OP27 18 20/04/09 8 OP27 18 20/04/09 9 OP29 19 20/04/09 10 OP37 17 20/04/09 Page 30 Version 5.2 11 OP37 17 12 OP31 7 13 OP31 25 14 OP25 13 (4)(a)(c) facilities for personnel files. The registered person shall ensure that all policies and procedures are up to date and relevant. A person shall not carry on a care home unless he is fit to do so. The registered provider must inform the Commission of his plans for the running of the home with regards to his own personal fitness. The registered provider must provide the Commission with copies of the homes accounts to ensure financial viability. The registered person shall ensure that all parts of the home to which service users have access are as far as reasonably practicable free from hazards to their safety. In that all pipe work and radiators are guarded or have guaranteed low temperature surfaces. 20/04/09 20/04/09 20/04/09 20/04/09 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 Refer to Standard OP1 OP27 Good Practice Recommendations It is recommended that the homes statement of purpose is updated on a yearly basis to reflect current conditions in the home. It is recommended that the registered provider re assesses the use of the one night staff who has not received any training and who continues to work on her own. This member of staff should either be offered all mandatory training or not work unsupervised. DS0000029055.V374222.R01.S.doc Version 5.2 Page 31 3 4 5 OP9 OP9 OP19 It is recommended that a lockable medication fridge be purchased. It is recommended the manger completed regular medication audits to ensure medication is managed safely It is recommended that new carpets are purchased for the rooms highlighted in the report as needing them. DS0000029055.V374222.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000029055.V374222.R01.S.doc Version 5.2 Page 33 - 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. 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