Inspection on 20/04/05 for The Hermitage

This inspection was carried out on 20th April 2005.

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

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

Other inspections for this house

The Hermitage 07/01/09

The Hermitage 26/02/08

The Hermitage 24/05/06

The Hermitage 17/10/05

The Hermitage 16/11/04

The Hermitage 01/06/04

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 Hermitage 66 Holly Road Uttoxeter Staffordshire ST14 7DU Lead Inspector Sue Jordan Unannounced 20 April 2005 09.55 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 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 Hermitage E51-E09 S5013 The Hermitage V 200405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Hermitage Address 66 Holly Road Uttoxeter Staffordshire ST14 7DU 01889 562040 01889 565299 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Doctor Charles Bamford Convalescent Home Trust Mrs Dawn Dorothy Thompson Care Home 15 Category(ies) of DE(E) 3 registration, with number OP 15 of places PD(E) 6 The Hermitage E51-E09 S5013 The Hermitage V 200405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16 November 2005 Brief Description of the Service: The Hermitage, a large detached Victorian house has been extended to provide accommodation for 15 older people, Six of whom may be physically disabled and three of whom may have dementia care needs. The home is provided by the trustees of the Charles Bamford Memorial Trust and managed by a Care Manager, Dawn Thompson. The home is situated close to the centre of the market town of Uttoxeter and within easy walking distance of local shops and a public house. A bus route passes the end of the drive. Accommodation is provided in three double and nine single bedrooms, none of which have ensuite facilities. One double and six single bedrooms are situated on the ground floor. Access to the first floor is by staircase that has been fitted with a stair chair lift.Communal facilities consist of a large lounge and a dining room. The large square entrance hall leads into a small rear hall with seating. Externally there are small gardens accessible to service users, a large kitchen garden where the vegetables for the home are grown and a bowling green and outbuildings that are used by a local club. Some service users enjoy watching the matches in the summer months. The grounds are landscaped and well maintained. There are ample car parking facilities at the end of the drive.At the time of this inspection there were thirteen service users resident at The Hermitage. The Hermitage E51-E09 S5013 The Hermitage V 200405 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over six hours with two inspectors to check whether the forty requirements made at the last inspection on 16/11/04 had been addressed. An additional visit was also made to the Home on 31/01/05. The methods used at this inspection were discussions with staff, residents, the administrator and the manager, examination of the care plans, staff files and some Health and Safety records. A tour of the Home was undertaken and lunch was shared with the residents. What the service does well: What has improved since the last inspection? Changes have been made to the daily routines and the opportunity for more frequent baths and breakfast in bed offered. Staff are now taking staggered breaks to ensure constant support for the residents and a ‘No Smoking’ policy has been introduced for the staff working in the Home. The Hermitage E51-E09 S5013 The Hermitage V 200405 Stage 4.doc Version 1.30 Page 6 The Home has produced a maintenance plan for the environment and this was sent to the Commission for Social Care. Many improvements have been made to the environment, including the provision of a sluice, a re-furbished bathroom and hand washing facilities in the laundry and an upstairs toilet. All of these additions will help to improve the infection control procedures in the Home. Some Health and Safety concerns have been addressed, which include a Corgi gas test, regular water temperature testing, the removal of unstable room dividers and the covering of some of the Home’s radiators. Bedroom door locks are being offered to potential residents in the Home’s brochure and the Home has sought the advice of the Fire Officer as to their safety. The recruitment procedures for new staff have been strengthened and appropriate checks are now being made prior to employment and the appropriate records kept on file. What they could do better: More evidence is required that all potential residents are assessed prior to admission to ensure that the Home is able to meet their needs. Following a successful assessment and admission a care plan must be produced, which covers all areas of need and informs staff of the care to be delivered and how this is to be done. This should be reviewed monthly but in between additions to the care plans must be made as the needs of the residents change. The medication procedures in the Home need major improvement. The storage, administration and stock control of medication are all inadequate and a number of requirements have been made. The manager must ensure that the Home’s procedures comply with The British Pharmaceutical Society Guidelines. The Home has a copy of the local Adult Protection Procedures, however there is no evidence that staff have received training in how to follow them. Despite major improvements to the Home’s environment, there is a lack of supporting risk assessments. The manager needs to continue with the improvements in staff recruitment, which includes making sure that all staff have a Criminal Records Bureau disclosure and that the correct records are kept for each staff member. The Hermitage E51-E09 S5013 The Hermitage V 200405 Stage 4.doc Version 1.30 Page 7 At present, no one is exactly sure what training has been received and therefore what training staff may still require. Formal supervision for staff is still required. Because of the large amount of requirements made at the last inspection, (16/11/05), it was agreed that the Home would not accept any new admissions without discussing it first with the Commission for Social Care Inspection, (CSCI). The CSCI did agree that the Home could accept a resident for respite care because she is known to the Home and the staff, however a letter was sent to the Home to confirm that they must not accept permanent referrals without discussion. The CSCI offered the Home the opportunity of additional visits if it was felt that the requirements had been met and was ready to accept new residents. At this inspection, two permanent residents and two respite service users had come into the Home and knowledge of the CSCI letter was denied. The records for these residents were checked and previous concerns regarding the lack of vital information were confirmed. The majority of the out standing requirements would normally be considered the responsibility of a registered manager and the Commission for Social Care Inspection has expressed concerns as to whether The Hermitage’s manager has the skills and knowledge needed to fulfil her role. A meeting has been arranged in May 2005, to discuss the requirements and how the Home proposes to address them. 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 Hermitage E51-E09 S5013 The Hermitage V 200405 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection The Hermitage E51-E09 S5013 The Hermitage V 200405 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 3, 4 The residents’ records do not indicate that an assessment of need is undertaken prior to admission or that the prospective service user and/or their representatives have been involved in care planning. This does not give prospective service users the assurance they need that the Home can meet their needs. EVIDENCE: A copy of the newly amended Statement of Purpose was seen at this inspection. It has been sensibly amended as per the requirements of previous inspections by the Commission for Social Inspection. It is noted that the claims and statements within the brochure are not being upheld, as evidenced throughout this inspection and report, this includes the promise of properly prepared personal plans and risk assessments. Four service users have been admitted to The Hermitage since the last inspection, despite concerns raised by the Commission for Social Care Inspection at previous visits that the Home should not admit further residents. The care records for all four service users were checked at this inspection. The Hermitage E51-E09 S5013 The Hermitage V 200405 Stage 4.doc Version 1.30 Page 10 Two of the service users are to be are permanent long-term residents and two are receiving a respite service. The assessment information is incomplete in all records and in two cases an assessment had not been undertaken at all. Social work or hospital care plans had been received for three, however one was a domiciliary care plan. Very few risk assessments have been completed for the four new admissions and those that have are not dated. Manual handling assessments are either incomplete or not available despite there being identified hazards and/or fear of falling. There is no evidence that the residents or their representatives have been involved in developing the care plans and this was confirmed in discussions with the residents during this visit. The manager reported that one of the new residents had been admitted in an emergency and this was the reason why the appropriate assessments had not been made and records in place. She was reminded that the Home’s Statement of Purpose clearly states that emergency admissions will not be accepted and that this had been a recent decision and amendment. The Hermitage E51-E09 S5013 The Hermitage V 200405 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 Although there have been some slight improvements in care planning, more work is required to demonstrate within the records that all of the residents’ care and health needs are being met. Medication systems must be strengthened to ensure the safety of the residents. EVIDENCE: As has been identified at previous inspections, care planning information is incomplete or unavailable. The manager has made some attempt to put together some information, but all of the care records seen at this inspection were missing vital pieces. Many of the records completed were not dated or signed; therefore it was not possible to evidence regular review. The manager has introduced individual daily record books for the residents and these prove to be informative. However some of the concerns/incidents should have been transferred into the care plans. Health care needs are poorly recorded. In one case, staff recorded their concerns regarding the health of a resident in the daily report book for five days with no evidence that this was acted upon. There is evidence that the The Hermitage E51-E09 S5013 The Hermitage V 200405 Stage 4.doc Version 1.30 Page 12 advice of a district nurse and a paramedic was sought but this was only because they were visiting the Home to attend to other residents. After approximately one week, it was recorded that the manager rang the general practitioner, however there is no written information regarding the outcome of this telephone call. There is no evidence that he attended the resident or what treatment was prescribed. None of this information has been transferred into a health care needs section of the care plan. It was recommended at this inspection that a single sheet be introduced into the care records, in which all medical appointments and/or visits can be documented. There is no written evidence that the residents are being weighed regularly or that they have received the services of opticians, dentists, hearing specialists or other medical professionals. One of the newly admitted residents is an insulin dependent diabetic, which is administered by the district nurse daily. There is no information as to how this condition is to be monitored or managed by the staff in the Home. One of the residents has recently sadly died. A letter was sent to the Home by the family expressing their great satisfaction with The Hermitage, it’s staff and the care delivered. A district nurse was attending the Home during this inspection and she reported that she had no concerns, that the staff are very helpful, sensible and that they carry out instructions. She also said that the staff know their limitations and do not call the district nurses unnecessarily. The district nurse has her own records of treatment given. It was discussed with the manager that any instructions from the district nurse to staff should be recorded in the appropriate health care section of an individual’s care plan. The manager did report that new seated weighing scales have been purchased, but there is no evidence of them having been used. Having undertaken a thorough inspection of the medication systems in the Home, a number of serious deficiencies were identified: • There are two medication storage areas and concerns were raised regarding their security. It is strongly recommended that properly designed medication storage be purchased, which also contains the facility to store controlled drugs. • The second storage area was full of medication, that on closer inspection included medication belonging to residents that had died some time previously, non-prescribed medication for which there is no policy and procedure, out of date medication and medication, which should be treated as controlled. Regular stock control must be undertaken, as the levels of medication stored at this present time are dangerously high. • There is no controlled drugs storage facility and no separate register. • No drugs have been returned to the pharmacist since August 2004 and there is no written record of drugs entering the Home. The Hermitage E51-E09 S5013 The Hermitage V 200405 Stage 4.doc Version 1.30 Page 13 • • • • The manager is dispensing medication out of labelled bottles into a dossett box for one of the residents and was advised that this secondary dispensing must cease immediately. It was noticed that the key to the medication cupboard is not stored securely and that staff administering drugs are placing them into their hands, rather than straight from bottle/nomad pack to the resident or a clean pot. There has not been a pharmacist audit of the medication systems in the Home and the manager was required to request such a visit within fortyeight hours of the inspection. Storage, administration and the receiving and returning of medication must be reviewed to ensure that it satisfies the British Pharmaceutical Guidelines. Although the staff have received training in the Safe Handling of medication, the Home’s procedures do not bear witness to this and it is strongly recommended that refresher training be organised. The Hermitage E51-E09 S5013 The Hermitage V 200405 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 14, 15 Major improvements have been made to provide more choices for the residents and control over their every day issues. This will be further supported by including personal preferences, likes and dislikes in all of the residents’ care records. EVIDENCE: The Home has made attempts to organise ‘in-house’ activities and a notice is pinned on the wall of the dining room. One of the residents said that the activities are poorly attended, but that the staff have tried hard to motivate them. The Home is closely situated to a bowling green and some of the residents like to watch an occasional game. There is generally little evidence from discussions with the residents that they have the opportunity to go out of the Home and enjoy local community facilities. It is recommended that a more structured activities plan be introduced, based on individual residents’ wishes. Daily routines have been altered in the Home since concerns were raised at the last inspection. Staff are now staggering their meal breaks and a no smoking policy has been introduced within the Home, meaning that the residents’ laundry is now ironed in a smoke-free environment. Good interaction was noted between the staff and residents during this inspection. The residents are now being offered more opportunities to have a bath and the option of breakfast in bed. The manager reported that the night staff are no longer The Hermitage E51-E09 S5013 The Hermitage V 200405 Stage 4.doc Version 1.30 Page 15 assisting any residents out of bed early in the morning as a means of supporting the day staff. These are major improvements and will be supported further by the inclusion of the residents’ personal preferences in the care plans. The residents spoke highly of the staff team. A lunch was shared with the residents in the pleasant dining room. The permanent cook has recently left and the residents were disappointed, however the weekend cook has accepted a temporary contract to work fulltime. The residents said that they are offered alternatives every day and a menu is on the dining room wall. A resident with diabetes was given an alternative desert and another had a yoghurt from choice. Breakfast in bed is now being offered. The Hermitage E51-E09 S5013 The Hermitage V 200405 Stage 4.doc Version 1.30 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 18 The Home’s policies and procedures, including recruitment and a lack of Adult Protection training do not adequately demonstrate that residents are fully protected from abuse. EVIDENCE: The complaints procedure is incorporated into the Home’s Statement of Purpose. One of the daily records indicated that the resident had complained about not all staff carrying out a required health care procedure. It was discussed with the manager that this could have been recorded in the complaints book, as evidence that all concerns are taken seriously and appropriate action taken. The residents spoken to during this inspection said that they knew who to complain to. One resident said that she had previously complained about her room and had been offered an alternative when it came available. She also said that she had complained about the temperature in her bedroom and that this had been addressed. There is a copy of the local Adult Protection Procedures in the Home, however there is no evidence that staff have received the necessary training. There are four outstanding CRB disclosures for staff employed in the Home and an immediate requirement was made that applications be completed and sent for all four within five working days of the inspection. Lack of care planning, risk assessments and poor medical procedures do not protect the residents. The Hermitage E51-E09 S5013 The Hermitage V 200405 Stage 4.doc Version 1.30 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 24, 25, 26 Major improvements have been made to the Home’s environment and some serious health and safety concerns addressed, these do however need to be better supported by risk assessment. A maintenance plan has been developed for 2005, which will greatly improve the standard of accommodation and it’s safety for the residents. EVIDENCE: A number of concerns were raised regarding the environment at the last inspection and many of these have been addressed. • An unstable divider screen has been removed in one of the bedrooms and arrangements are being made to replace all screens in the double rooms. • A Corgi gas inspection has taken place and evidence of this sent to the Commission for Social Care Inspection. • Water temperatures are now being taken and the results recorded. • One of the residents who had previously complained that her bedroom was cold during the day, now says that this has been addressed. The Hermitage E51-E09 S5013 The Hermitage V 200405 Stage 4.doc Version 1.30 Page 18 • • • • • The Statement of Purpose offers residents the opportunity to have a lock fitted to their bedroom door and the Home has obtained information from the fire safety department as to the required type of lock. A new sluice and wash hand basin have been obtained and fitted and the laundry room has been decorated, a new washing machine purchased and hand washing facilities fitted. A toilet upstairs, previously without a hand basin now has one fitted. The upstairs bathroom has been completely renovated and redecorated and the assisted bath chair serviced, although the manager reported that none of the present residents use this facility. The downstairs bathroom is rather dark and the shower area still cluttered with equipment making it unusable. The radiators in the Home are gradually being covered. A large central heating pipe situated between the office and the staff room is very hot and an immediate requirement was left to risk assess this and take adequate health and safety measures. The Home provided the Commission for Social Care Inspection with a maintenance plan for 2005. Risk assessments completed for the stair lift and the assisted bath chair have not been dated and there is no risk assessment for a new admission choosing to use bed guards. Most of the previous infection control issues have been addressed; the Home has purchased a laundry trolley for wet washing, there is a notice on the sink in the staff room stating that it is for hand washing only. Hand washing facilities have been provided in the new sluice room, the laundry and in a toilet upstairs. A basket of toiletries is still in the downstairs bathroom and these must be returned to individual rooms, until required. The decoration in one of the bedrooms was accepted by a recent admission, however the family have asked if they can change the carpet. This is due to a slight malodour left by a previous resident. The Home has tried to thoroughly clean the carpet and the odour is less evident, however it is the Home’s responsibility and not the family’s to replace this flooring. One of the residents said that they are still not able to access the garden from the lounge area, therefore this requirement is carried over into this report. The present occupancy level means that all of the residents have the use of a single bedroom. The Hermitage E51-E09 S5013 The Hermitage V 200405 Stage 4.doc Version 1.30 Page 19 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29, 30 The staffing ratios are adequate for the present number of residents and improvements have been made to the recruitment procedures for new staff EVIDENCE: On the morning of this inspection, there were three care staff, one cook, one domestic and the manager. The administrator came on duty mid-morning. There were thirteen residents in the Home. Two care staff cover the afternoon/evening period and two waking night staff support the residents during the night. The manager reported a recent period of instability, in that some staff have left and recruitment is underway. A previous requirement was made regarding the recruitment procedures in the Home. CRB, (Criminal Records Bureau), checks were not being applied for appropriately and vital information was missing from personnel files. The file for a prospective staff member was checked and improvements were noted. The Home is now completing POVA, (Protection of Vulnerable Adults), checks and applying for CRB disclosures prior to employment. All staff have signed a declaration that they have no criminal record and health declarations have been developed and are being signed. It was noted however that four existing staff still require CRB disclosures and an immediate requirement was left that these be applied for within 5 working days of this inspection. The administrator is still compiling the required information to keep in the existing staff files and therefore the previous requirement is carried over into this report. The Hermitage E51-E09 S5013 The Hermitage V 200405 Stage 4.doc Version 1.30 Page 20 The Home has obtained copies of the GSCC, (General Social Care Council), code of conduct and given them out to the staff, who have signed for them on receipt. Manual handling risk assessments have been completed for all staff. Work is still being undertaken to address staff training needs and as yet there is no evidence that all staff are attending mandatory courses and the refreshers at the required frequencies. Fire Safety training was completed in April 2005 and negotiations are being made with a First Aid trainer. Distance learning medication training was completed some time ago, however the problems identified at this visit has prompted a strong recommendation that refresher training be organised for staff. Adult Protection training is also required. The administrator believes that the manual handling training is still up to date, but that food and hygiene training is outstanding. Advice and guidance was given regarding the mandatory training required for staff employed in homes for older people. Seven care staff have NVQ 2 and three also have NVQ 3. The manager and the deputy are undertaking NVQ 4 and the Registered Manager’s Award. The Hermitage E51-E09 S5013 The Hermitage V 200405 Stage 4.doc Version 1.30 Page 21 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 36, 37, 38 Management and administration systems in the Home are poor and do not adequately protect the residents or support the staff. EVIDENCE: This was the third visit by the Commission for Social Care Inspection since November 2004 and it was disappointing to note that the majority of the requirements being carried over are the responsibility of the manager. The Home has a small group of residents and good staffing ratios and yet the manager has been unable to develop adequate pre-admission assessments, care planning, risk assessments or a formal staff supervision programme. Staff training needs are not being monitored and the Home’s medication procedures are very unprofessional. The Home’s NVQ Assessor is hoping to become a Trustee and if successful it is anticipated that she will address the training needs and look at the managerial issues still remaining from the CSCI The Hermitage E51-E09 S5013 The Hermitage V 200405 Stage 4.doc Version 1.30 Page 22 inspections. A proposal to introduce a senior care worker system was also discussed. The managerial role remains the responsibility of the registered manager and when asked she confirmed that she does not know how to do some of the required tasks. A meeting has been arranged in May 2005 between the Commission for Social Care Inspection, the Trustees and the manager in May 2005 to discuss the remaining requirements and the action, which must be now taken. The residents’ views of the Home and the care provided were obtained in July 2004 and the results have been included in the Home’s brochure. This quality assurance system should be expanded to include the views of families, friends and professionals involved in the residents’ lives and the Home. The registered provider is now sending a report of his monthly audit of the Home, although it is noted that they could be more informative. The Trustees and the management must now satisfy the Commission for Social Care Inspection that they are able to meet the remaining requirements. A formal staff supervision system is still to be implemented, as previously required. The Home’s records do not adequately support the residents. The lack of information for staff could potentially result in important care needs and the wishes of the residents being ignored. The Health and Safety procedures in the Home have improved and evidence sent to the CSCI that the immediate requirements made at the last inspection have been met. Risk assessment must be improved and in order to safeguard the residents, staff must complete mandatory training courses. A large central heating pipe situated between the office and the staff room is very hot and an immediate requirement was left to risk assess this and take adequate health and safety measures. The Hermitage E51-E09 S5013 The Hermitage V 200405 Stage 4.doc Version 1.30 Page 23 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 1 1 x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 3 COMPLAINTS AND PROTECTION 3 2 3 2 x 2 3 3 STAFFING Standard No Score 27 3 28 3 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 1 1 1 2 x x 1 1 2 The Hermitage E51-E09 S5013 The Hermitage V 200405 Stage 4.doc Version 1.30 Page 24 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 3 Regulation 14, (1a,b,c,d) 14 (2a,b) Requirement An assessment of need must be carried out on all service users, which contains all of the information listed in NMS 3.3. Based on this information a care plan for daily living containing longer-term outcomes must be developed and open to monthly review. Previous Requirement (01/01/05) Care plans need to be more comprehensive towards specific care needs and specialist intervention required by service user. Previous Requirement 01/01/05 Risk assessment needs to be developed on an individual basis for the service users, both in daily living activities within the home and within the community. Previous Requirement 01/01/05 Care plans must be developed, which clearly advice staff as to how specific care needs are to be met. These should be developed in consultation with the service users and/or their significant others and reviewed monthly. Previous Requirement 01/01/05 More information must be Timescale for action 01/06/05 2. 4 15 Sch 3 1(b) 01/06/05 3. 7 13 (4b,c) 01/06/05 4. 7 15 01/06/05 5. 8 13 (1b), 01/06/05 Page 25 The Hermitage E51-E09 S5013 The Hermitage V 200405 Stage 4.doc Version 1.30 12 (1a, 2, 3) 6. 9 13 (2) 7. 9 13 (1b, 2) 8. 9. 9 9 13 (2) 13 (2) 10. 11. 18 20 13 (6) 13 (4), 23 (2o) 12. 22 13 (4) 13. 22 13 (4) included in the care plans with regard to health and medical needs and interventions, which will allow for methodical monitoring and will provide more evidence that health care needs are identified and professional medical services accessed as necessary. Previous Requirement 01/01/05 The manager must ensure that medication procedures in the home are robust and that all staff follow good practice guidelines. Previous Requirement 01/01/05 A request of the pharmacist to undertake a medication audit of The Hermitage’s medication storage, policies and procedures must be made within 48 hours of this inspection. Secondary dispensing of medication must cease immediately. Appropriate medications must be returned to the pharmacist within 24 hours of this inspection and records made. The staff must be trained in the correct local Adult Protection procedures to follow. Risk assess access to the garden area from the lounge, where the gradient has to be negotiated, as the care home is registered for physically disabled and service users with walking aids and wheelchairs. This area must be made safe to assist service users in safe access to the grounds. Previous Requirement 01/01/05 The manager must undertake individual risk assessments on the use of the stair lift. Previous Requirement immediate Risk assessments must be completed for all residents 01/06/05 Immediate Immediate Immediate 01/07/05 01/06/05 01/06/05 01/06/05 Page 26 The Hermitage E51-E09 S5013 The Hermitage V 200405 Stage 4.doc Version 1.30 14. 15. 24 29 16 (2c) 19 16. 30 18 (1c (i)) 17. 31 9 (1, 2bi), 10 (3) 18. 32 9, 12, 13 19. 33 24 20. 33 43, 44 21. 36 18 (20) choosing to, or being advised to use bed guards. The carpet in room 10 must be replaced by the Home and not the family. Information and documents in respect of staff working in the care home be maintained as specified in Schedule 2 and that all staff should have CRB check prior to the offer of appointment. Previous Requirement 01/01/05 Training needs to be reviewed to ensure that all staff, including the manager, be appropriately equipped to perform their roles and responsibility. Previous Requirement On-going The manager must demonstrate that she has the necessary knowledge and skill to fulfill her role and address the requirements in this report. More evidence is required that the manager is fully aware of her responsibilities within the National Minimum Standards and Health and Safety legislation. Previous Requirement 01/01/05 on-going The manager must regularly seek the views of family, friends and stakeholders on how the home is achieving goals for the service users. Previous Requirement 01/01/05 Action should be progressed within the timescales to implement requirements identified in CSCI inspection reports. Previous Requirement immediate A formal staff supervision programme is implemented on a six times a year basis for each staff member and records of the supervision to be kept. Previous Requirement 01/01/05 01/07/05 01/07/05 01/07/05 & on-going 11/05/05 11/05/05 01/08/05 11/05/05 01/06/05 The Hermitage E51-E09 S5013 The Hermitage V 200405 Stage 4.doc Version 1.30 Page 27 22. 37 17, Schedule 2, 3, 4 23. 38 12, 13, 17, 23 24. 38 13 (4), 12 (2), 23 (2p) Records required by regulation for the protection of service users and for the effective and efficient running of the business are maintained, up to date and accurate. Previous requirement 01/01/05 & on-going The registered manager must ensure so far as is reasonably practicable the health, safety and welfare of service users and staff. Previous requirement Immediate. A risk assessment to be undertaken on the large central heating pipe situated between the office and the staff room within 48 hours of this inspection. This must reflect service user health and safety. 01/06/05 7 on-going Immediate Immediate 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. 4. 5. Refer to Standard 8 12 21 9 9 Good Practice Recommendations It is recommended that the residents are weighed at least monthly and the results recorded. It is recommended that a more structured activities plan be introduced, based on individual residents’ wishes. it is recommended that the residents using the upstairs bathroom be offered the opportunity to use the bathroom on that floor. It is strongly recommended that properly designed medication storage be purchased, which also contains the facility to store controlled drugs. it is strongly recommended that refresher training in medication systems and procedures be organised. The Hermitage E51-E09 S5013 The Hermitage V 200405 Stage 4.doc Version 1.30 Page 28 Commission for Social Care Inspection Stafford - Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Hermitage E51-E09 S5013 The Hermitage V 200405 Stage 4.doc Version 1.30 Page 29 - 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!