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Inspection on 20/02/07 for The Homestead Residential Home

Also see our care home review for The Homestead Residential Home for more information

This inspection was carried out on 20th February 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Information obtained from service users and relatives confirmed that the staff group were nice and approachable. During the process of the inspection staff were observed to interact and communicate with service users in a professional manner.

What has improved since the last inspection?

The extension to the home had now been completed and provided additional bedrooms equipped with en suite. A large television had recently been purchased for one of the lounge areas.

What the care home could do better:

There was no evidence that service users were involved in the development or the subsequent review of their care plan, to ensure that the care provided met their needs appropriately with regards to their care, cultural or religious needs.The home was registered to provide a service for individuals suffering with dementia, there was no evidence of a specific service provided for this specialist area, discussions with staff identified that there was a lack of training in dementia awareness. The homes medication system was not robust with regards to the storage and administration of medicines. Information obtained from both service users and relatives confirmed that there was a lack of social activities and community presence. Albeit the Registered Provider have made efforts to address the hot water system within the home, it was evident that there was an inconsistency in ensuring that distribution temperatures accessible to service users were maintained at 43oC.

CARE HOMES FOR OLDER PEOPLE The Homestead Residential Home Wolverhampton Road Prestwood Near Stourbridge West Midlands DY7 5AN Lead Inspector Dawn Dillion Key Unannounced Inspection 20 February 2007 09:40 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 Homestead Residential Home DS0000042500.V324543.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 Homestead Residential Home DS0000042500.V324543.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Homestead Residential Home Address Wolverhampton Road Prestwood Near Stourbridge West Midlands DY7 5AN 01902 335749 01384 873642 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) Knoll House Nursing Home Limited Joyce Lappage Care Home 37 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (37), of places Physical disability over 65 years of age (10) The Homestead Residential Home DS0000042500.V324543.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Total number of beds for DE (E)/PD (E) is ten at any one time Date of last inspection 9 November 2005 Brief Description of the Service: The Homestead Residential Home is located near Stourbridge. The home provides a service for older people and also has a registration category to provide a service for ten people suffering with dementia and ten who have a physical disability. The large two storey detached property is set within its own grounds, located within a semi rural area. Bedrooms are provided on both the ground and first floor, many of which are equipped with en suite. Bathrooms and toilet areas are situated on both floors and are in close proximity to communal areas. Appropriate aids and adaptations are in place to meet the needs of service users who have a physical disability, having wide corridors and doorframes to accommodate wheelchair users, appropriate lifting aids are also provided. A passenger lift ensures that service users have access to all facilities within the home. The property also consists of a large dining area and three lounges; all areas were equipped with essential furnishings and items to provide comfort. Catering staff are employed within the home to meet the nutritional needs of the service user group. Staffing is provided on a twenty-four hour basis to ensure the supervision and support of service users. Service users have access to relevant healthcare services if and when required. The fees chargeable for the service provided at The Homestead Residential Home is from £325.00p - £450.00p per week. The Homestead Residential Home DS0000042500.V324543.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced Key Inspection of The Homestead Residential Home was conducted in eight hours. The inspection methodologies that were used to establish the quality of care provided and the effectiveness of the management of the home, to promote quality, diversity and best practices entailed the examination of the records, relating to the homes policies, procedures and care practices. During the process of the inspection, four service users were interviewed to establish their experience of living within the home. Interviews were also conducted with four relatives and three staff members. A tour of the premises was also undertaken to ensure that the environment and systems in operation were safe and conducive in meeting the needs of the service user group. Information obtained from four relatives comment cards has also been incorporated within the contents of this report. What the service does well: What has improved since the last inspection? What they could do better: There was no evidence that service users were involved in the development or the subsequent review of their care plan, to ensure that the care provided met their needs appropriately with regards to their care, cultural or religious needs. The Homestead Residential Home DS0000042500.V324543.R01.S.doc Version 5.2 Page 6 The home was registered to provide a service for individuals suffering with dementia, there was no evidence of a specific service provided for this specialist area, discussions with staff identified that there was a lack of training in dementia awareness. The homes medication system was not robust with regards to the storage and administration of medicines. Information obtained from both service users and relatives confirmed that there was a lack of social activities and community presence. Albeit the Registered Provider have made efforts to address the hot water system within the home, it was evident that there was an inconsistency in ensuring that distribution temperatures accessible to service users were maintained at 43oC. 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 Homestead Residential Home DS0000042500.V324543.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Homestead Residential Home DS0000042500.V324543.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The examination of the homes Statement of Purpose, contract of residency and the homes pre admission assessment. The homes admission procedure ensured that prospective service users and their representative were provided with relevant information, to enable them to establish whether the service and facility provided at the home would be suitable to meet their needs. EVIDENCE: The homes Statement of Purpose provided in-depth information relating to the service and provisions provided at the home. The Homestead Residential Home DS0000042500.V324543.R01.S.doc Version 5.2 Page 9 Discussions with both the Registered Manager and a number of service users confirmed that they were not in receipt of a service user guide; this has been identified as a requirement within the contents of this report. Files that were examined and discussions with the Registered Manager, confirmed that the majority of service users had been issued with a contract of residency on admission to the home. Service users files that were examined evidenced, that all prospective service users were subject to a pre admission assessment, prior to admission, to ensure that the home would have the capacity to meet their care and social needs. With reference to the assessment, the service user or their representative were given written confirmation of the homes suitability to meet the individuals assessed needs. The Homestead Residential Home DS0000042500.V324543.R01.S.doc Version 5.2 Page 10 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 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The examinations of care plans, risk assessments and the homes medication system and practices. Service users were provided with a reasonably standard of care, the lack of emphasis focused on service user involvement in the development of their care plan and the homes medication practices compromised the quality of the service delivery. EVIDENCE: As previously identified within the contents of this report, all service users were subject to a pre admission assessment, prior to their admission to the home. Information derived from this assessment, provided the foundation for the development of the care plan and risk assessment. The Homestead Residential Home DS0000042500.V324543.R01.S.doc Version 5.2 Page 11 Five care plans were randomly selected for examination, all of which provided relevant information, relating to the level of support and assistance, the individual required to maintain an independent lifestyle. The care plans incorporated information relating to nutrition, moving and handling, necessary equipment required, weight monitoring and continence management. Care plans were reviewed on a monthly basis to reflect the changing needs of the individual service user. There was no evidence that service users were involved in the development or the subsequent review of their care plan, of which has been identified as a recommendation within the contents of this report. The examination of care plans, discussions with service users and general observations on the day of the inspection, confirmed that they had access to relevant health care services if and when required. However, two relatives raised concerns of the lack of chiropodist intervention. Discussions with the service users and the Registered Manager confirmed that where possible service users were able to maintain their own General Practitioner. The home was registered to provide a service for individuals suffering with dementia, there was no evidence of a specific service provided for this specialist area; three staff members that were interviewed confirmed that they had not received training relating to dementia awareness. There were no service users in residence from the ethnic minority groups and the homes procedures and policies provided very little emphasis on diversity. The Inspector raised concerns that records pertaining to a service user, identified that this individual had had their leg in plaster for more than ten months. The Registered Manager was not able to clarify whether this was due to a medical condition or an oversight for the removal of the plaster. The Inspector had previously raised this concern on 1 February 2007. To ensure the health and welfare of this service user, it has been identified as a requirement within the contents of this report that professional advice should be obtained from the General Practitioner. With reference to the homes medication system and practices, the Nomad Monitored Dosage system was used. Two service users self-administered their own medication; the Registered Manager confirmed that a risk assessment was in place for these individuals. The Homestead Residential Home DS0000042500.V324543.R01.S.doc Version 5.2 Page 12 The medicine trolley was very sticky from residue of medicines; the Registered Manager should ensure that the trolley is maintained to a reasonably hygienic standard. A bottle containing tablets with hand written “Senna” identified on the bottle, no name, dosage or prescribing General Practitioner was identified. The Registered Manager removed the bottle from the drugs trolley during the process of the inspection. During the inspection of the property the Inspector observed Co Codamol 500mg tablets and Solpadol tablets within an unsecured drawer. The Registered Manager informed the Inspector that the night staff did not have access to the medication trolley and that these medicines were used on a PRN basis (when required) during the night. The Inspector also raised concerns that the tablets were not contained within the original boxes and did not identify the service users name or the dosage. Another unsecured cupboard contained multistix for the use of urine testing. Discussions with service users confirmed that all staff members were polite and respected their privacy. Two service users informed the Inspector that their mail was distributed to them unopened. Files pertaining to service users that were examined identified the individual’s preferences of their term of address. The majority of bedrooms doors were not provided with a locking device to promote the privacy of service users. Windows within the some bathrooms and shower areas, albeit obscured glazing, were not provided with privacy screening. A bedroom located opposite the workstation provided no privacy for the individual occupying this bedroom. The Homestead Residential Home DS0000042500.V324543.R01.S.doc Version 5.2 Page 13 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 poor. This judgement has been made using available evidence including a visit to this service. Information obtained during the process of interviews conducted with service users and relatives and general observations during the process of the inspection. The lack of emphasis focused on social activities and community presence, impinged on service users choice and lifestyle. EVIDENCE: A notice board located within the reception area of the home provided information relating to forthcoming social activities, of which consisted of a barn dance and religious activities. Discussions with four relatives identified that there was very little emphasis focused on social activities, one relative informed the Inspector that the main recreational activity was the television of which they expressed was not tuned in properly. The Homestead Residential Home DS0000042500.V324543.R01.S.doc Version 5.2 Page 14 One service user informed the Inspector that she went to the Christmas Pantomime, “ we don’t go out much.” “My church visitor came to see me yesterday.” Another service user informed the Inspector that, “my Vicar comes to see me.” Information contained within the homes Statement of Purpose stated that, “religion – The Homestead regards this as an essential need and to this end, we have endeavoured to provide on-going pastoral care for all requirements currently identified by our service users.” One relative informed the Inspector that the home use to provide art and craft sessions of which the service users enjoyed, some service users enjoyed colouring, she identified that this was not age appropriate but some service users found it relaxing. During the process of the inspection there was no evidence of any social activities or stimulation provided, a collection of reading materials were provided within one of the lounge areas. Relatives that were interviewed expressed the need for more social activities and community presence. Care plans that were examination identified service users religion, and there was evidence of contact with different religious denomination within the home. Service users informed the Inspector that they were able to maintain contact with their family and friends who were able to visit at anytime within reason. Discussions with service users and relatives identified that service users had very little community contact and were reliant on their family and friends to take them out. Service users had access to their personal records; the Inspector raised concerns that records pertaining to service users were stored in an unsecured area and was accessible to unauthorised persons. The examination of the homes menus identified that service users were provided with a choice of meals to reflect their likes and dislikes. One service user informed the Inspector that the food was “good, occasionally there are things I don’t like.” Another service user confirmed “we have had some lovely meals in the last day or two.” The inspection of the kitchen evidenced ample supplies of food provisions in storage, having a variety of fresh fruit and vegetables. Discussions with the Cook confirmed her knowledge, that a number of service users were diabetic, of which was controlled by medication and the need for a controlled diet. It was of concern that the Cook did not incorporate this information within the The Homestead Residential Home DS0000042500.V324543.R01.S.doc Version 5.2 Page 15 menu and that service users were provided with the same meals regardless of the sugar, fat or carbohydrate contents. There was no dietician involvement to provide professional advice or support. There were no specific dietary requirements in relation to cultural or religious needs. It was pleasing to see that a previous requirement relating to the hygiene standard of the kitchen had been addressed within the timescale identified. The Registered Manager should ensure that a cleaning schedule within the kitchen is implemented to ensure that the kitchen hygiene standard is maintained. A stool and a pot were used to keep the oven door closed; this posed a tripping hazard and compromised the quality of the cooking. The Registered Provider confirmed that a new cooker had been ordered. General observations and discussions with the Cook identified that some service users were consuming their breakfast as late as 11.30am, with lunch commencing at 1.00pm and the evening meal at 5.30pm. The Registered Manager confirmed that meals would be saved for service users who did not wish to eat at the identified times. The Homestead Residential Home DS0000042500.V324543.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 poor. This judgement has been made using available evidence including a visit to this service. The examination of the homes complaints procedure and previous sampling of staff files. There was a complaints policy in place. The lack of consistency of the undertaking of a Criminal Record Bureau check during the recruitment process compromised the protection of the service user group. EVIDENCE: The homes complaint policy was located in the main reception area; information contained within the homes Statement of Purpose identified that, “complaints and concerns are always prioritised.” “We welcome all comments and will act immediately once an issue has been brought to our attention.” Four relatives comment cards were received which identified their knowledge of the homes complaints procedure. One relative that was interviewed by the Inspector, expressed concerns of reprisal should concerns be raised with the home. Consideration should be given in reviewing the homes complaints policy to incorporate information, that individuals will not suffer reprisal for lodging a complaint or raising any concerns. The Homestead Residential Home DS0000042500.V324543.R01.S.doc Version 5.2 Page 17 Albeit that the complaint procedure was observed on the notice board within the reception area by the Inspector, two service users and four relatives that were interviewed were not aware of the complaints procedure. It has been identified as a requirement within the contents of this report that all service users should be issued with a copy of the homes complaints procedure. The Commission For Social Care Inspection has received six complaints relating to the service delivery from January 2006 to date. Discussions with the Registered Manager confirmed that there had been no new recruitments to home since the last visit undertaken by the Inspector on 01 February 2007. During that visit ten files pertaining to staff members that had been recruited to the home from 30 August 2006, identified that there was a lack of consistency in ensuring that staff were subject to a Criminal Record Bureau check. All but one member of staff had received a POVA (Protection of Vulnerable Adults) clearance. There was also evidence that one staff member’s Criminal Record Bureau check had been undertaken at their previous place of employment. The Registered Manager informed the Inspector that the necessary actions had been taken to ensure that all staff have the appropriate checks and that they were still awaiting Criminal Record Bureau clearance for the identified staff members. The Homestead Residential Home DS0000042500.V324543.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): 19, 21, 22, 23, 24, 25 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The inspection of the property and discussions with service users, relatives and staff. The layout and the design of the property were conducive in meeting the needs of the service user group. The lack of hot water and poor lighting in some areas of the home compromised the comfort of some service users. EVIDENCE: The Homestead Residential Home is located on the A449, near Stourbridge. The two-storey property is situated within its own grounds. The home offered a range of single and shared occupancy bedrooms, located on both the ground The Homestead Residential Home DS0000042500.V324543.R01.S.doc Version 5.2 Page 19 and first floor, bedrooms were pleasantly decorated and service users were encouraged to personalise their bedrooms. Discussions with a relative raised concerns that due to her mothers mental and physical capacity she was unable to open her bedroom door and that when the door was closed she was isolated. The Registered Manager should ensure that this service users risk assessment is reviewed and that the appropriate measures are taken to resolve this problem. The majority of bedrooms were equipped with en suite. Bathrooms/shower rooms and toilets were located in close proximity to communal areas. An assisted bath was provided on both floors to assist service users with restricted mobility. Appropriate aids and adaptations were in place to meet the needs of service users who have a physical disability, having wide corridors and doorframes to accommodate wheelchair users and a hoist. A passenger lift was also in place, to ensure that service users had access to all facilities within the home. Discussions with the Registered Manager confirmed that not all staff had received up to date training in relation to the use of the hoist. The property also consisted of a large dining area and three lounges; all areas were equipped with essential furnishings and items to provide a pleasant and comfortable area. Lighting within the dining area and some bedrooms were very poor, this was discussed with the Registered Provider who agreed to provide additional lighting within the identified areas. The Commission For Social Care Inspection received information on 28 December 2006, that the water supply within a number of bedrooms was cold. It was pleasing to see that attempts had been made to address this concern. One service user informed the Inspector that it was the first time (20 February 2007) that she had had hot water in her bedroom. The service user confirmed that she was admitted to the home two weeks prior to Christmas 2006. The inspection of a number of bedrooms identified that one bedroom did not have hot water; the handy person remedied this problem immediately. The water in one bedroom was very hot to the touch, of which was also confirmed by the handy person. The hot water temperatures were not consistent and the Inspector raised concerns that there were no thermometers available within the bathrooms to ensure temperatures of 43oC. Relatives that were interviewed also identified concerns that either there was no hot water or that it took a long time to reach a comfortable temperature to wash in. One relative raised concerns about service users having to wash in The Homestead Residential Home DS0000042500.V324543.R01.S.doc Version 5.2 Page 20 cold water. A requirement has been identified within the contents of this report, that regular monitoring of water distribution temperatures accessible to service users should be undertaken, to ensure a consistent temperature of 43oC and where necessary a CORGI registered engineer should be obtained to resolve the problem. A laundry area was provided at the rear of the property, one washing machine was equipped with a sluice programme. In the interest of infection control the Registered Manager should ensure that appropriate PPE (Personal Protective Equipment) is provided in the laundry at all times. The hygiene within the home was good, of which was confirmed by the service users, a mal odour was present within a couple of bedrooms, the Registered Manager should ensure that the cleaning regime within these rooms are reviewed and where necessary a reassessment of continence management. Ample car parking was available at the front of the property, discussions with one relative raised concerns that the gravel on the car park made it difficult for individuals who have limited mobility and that it was difficult to manoeuvre the wheelchair. The Homestead Residential Home DS0000042500.V324543.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): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Discussions with service users, relatives, staff and the Registered Manager. The current staffing levels provided were sufficient to meet the needs of the service user group. EVIDENCE: The home was registered to provide accommodation for thirty-seven service users; on the day of the inspection there were thirty-one service users in residence. Discussions with the Registered Manager and the examination of staff rotas evidenced that five staff were provided for the morning shift, having four staff for the afternoon and three during the night. The Registered Manager informed the Inspector that there were no staff vacancies. Interviews with relatives raised concerns regarding the current staffing levels provided within the home. The Registered Manager was confident that the current staffing levels were sufficient to meet the needs of the current dependency levels of the service user group. It is recommended that the staffing levels should be reviewed when the occupancy within the The Homestead Residential Home DS0000042500.V324543.R01.S.doc Version 5.2 Page 22 home is at full capacity and that closer monitoring of staffing arrangements should be undertaken to ensure that appropriate levels of staffing is provided at peak times of the day. Discussions with the Registered Manager confirmed that out of twenty-four staff, eighteen had obtained the National Vocational Qualification in Direct Care and that two staff members were currently undertaking the training. As previously identified within the contents of this report, the home was registered to provided a service for individuals suffering with dementia, staff that were interviewed confirmed that they had not received training in relation to dementia awareness. The Registered Manager is also required to ensure that all staff who use the hoist are provided with the necessary training for the appropriate use of this equipment. Relatives that were interviewed described the staff as “carers are lovely.” “All staff are good but there are not enough of them.” The Registered Manager was also described as “very nice.” The interview of a new member of staff confirmed that they were provided with a structured induction programme and they were given the relevant support and supervision. The individual also confirmed that they were in receipt of a contract of employment. One staff member informed the Inspector the management support was “good and fair.” The Homestead Residential Home DS0000042500.V324543.R01.S.doc Version 5.2 Page 23 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, 35, 37 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. An inspection of the property, examination of records, general observations and discussions with the Registered Manager. Short fallings within the service had an impact on the quality of the service delivery. EVIDENCE: The Registered Manager had 14 years experience in social care and had obtained the Registered Managers Award, National Vocational Qualification The Homestead Residential Home DS0000042500.V324543.R01.S.doc Version 5.2 Page 24 level 2 and 4 and the Assessors Award D32/33 (A1). The Commission For Social Care Inspection has recently approved registration for the Manager. The Registered Manager was aware of the short fallings of the service and demonstrated a positive commitment in promoting best practice to improve the service delivery. Discussions with the Registered Manager identified a lack of understanding of when incidents and events affecting the service provided to service users, should be reported to the Commission For Social Services in relation to the regulations. Systems that were in operation for the safe keeping of service users finances were examined, records and finances pertaining to three service users were randomly selected for examination of which were satisfactory. To promote best practice, it is recommended that receipts should be maintained for all expenditures. As previously identified within the contents of this report, confidential information pertaining to service users were not securely maintained and were accessible to unauthorised persons. Records and systems that promoted the health, safety and welfare of the service users and staff that were examined identified the following: The passenger lift was serviced 07/07/06. There was a current fire risk assessment in place, it has been identified as a recommendation in this instance, that the risk assessment should be reviewed, to provide more comprehensive information, with reference to the new fire regulations and an evacuation plan. The Registered Manager is respectfully reminded that the fire extinguishers and fire blankets are due for servicing in February 2007. With reference to fire fighting equipment, safety checks were undertaken on a regular basis; it has been identified as a recommendation that records should maintain a clear record of dates when checks have been carried out. There was no evidence of portable appliance testing (PAT). The Registered Manager should ensure that restrictors are provided at the identified bedroom windows located on the first floor. The wall dresser within the lounge/dining area should be secured to the wall to ensure the safety of service users. The Registered Manager should ensure that the bed, mattress and drawers stored within the bathroom on the first floor are removed. The Homestead Residential Home DS0000042500.V324543.R01.S.doc Version 5.2 Page 25 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 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 1 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 1 X 2 2 3 3 1 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X X X 3 X 2 2 The Homestead Residential Home DS0000042500.V324543.R01.S.doc Version 5.2 Page 26 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 2 3 Standard OP1 OP30 OP8 Regulation 5(2) 18(c)(i) 13(b) Requirement The Registered Person should ensure that each service user is issued with a service user guide. Staff should be provided with relevant training in relation to dementia awareness. To ensure the health and welfare of the identified service user, professional advice should be obtained from the respective General Practitioner, for the reasons why this individual’s leg has been in plaster for over 10 months. The storage and administration of medicines should be reviewed to ensure that all medicines are maintained within their original containers, that the service users name, dosage is clearly identified on the container. All medicines should be securely stored. The home should refrain from the communal use of tablets, in this instance Senna tablets. In the interest of hygiene the Registered Person should ensure that the medicines trolley is DS0000042500.V324543.R01.S.doc Timescale for action 05/05/07 01/06/07 23/03/07 4 OP9 13(2) 20/02/07 5 OP9 13(2) 20/02/07 The Homestead Residential Home Version 5.2 Page 27 6 OP10 12(4)(a) 7 OP10 12(4)(a) 8 OP12 16(2)(m)( n) 9 OP14 12(2)(a) 10 OP15 12(1)(a) & 13(1)(b) 23(2)(c) 11 OP15 12 OP16 22(5) 13 OP18 OP29 Schedule 2(7) 13(4)(a)( b) 14 OP19 15 OP21 18(1)(c)(i cleaned. To ensure the total privacy of service users, privacy screening should be provided at the identified windows in the bath/shower rooms. Appropriate measures should be undertaken to ensure the privacy of the service user occupying the bedroom located by the workstation. Service users social interests should be established and the appropriate arrangements put in place to ensure that the individual is able partake. The Registered Person should ensure that confidential information relating to service users is maintained in a secure place. Professional information and support should be obtained from a dietician in respect of an appropriate diet for service users identified with diabetes. The Registered Provider should ensure that the cooker is repaired or replaced to ensure the safety of the staff and to promote the quality of meals provided. The Registered Person should ensure that all service users are in receipt of a copy of the homes complaints procedure. To ensure that all staff working within the home are subject to a Criminal Record Bureau clearance. The risk assessment of the identified service user, who is unable to operate the bedroom door handle, should be reviewed and the appropriate actions taken to ensure that this individual is not isolated. To ensure that staff who use the DS0000042500.V324543.R01.S.doc 30/04/07 30/03/07 01/05/07 23/03/07 01/05/07 01/03/07 03/04/07 01/04/07 23/03/07 12/05/07 Page 28 The Homestead Residential Home Version 5.2 16 17 OP25 23(2)(p) 23(2)(j) OP25 18 OP26 13(3) 19 OP26 16(2)(k) 20 21 OP19 OP38 13(4)(a) 13(4)(a) 22 OP19 13(4)(a) hoist have received appropriate training for the use of the appliance. Additional lighting should be provided within the dining room and the identified bedrooms. To ensure that water distribution temperatures accessible to service users are maintained at 43oC. In the interest of infection control, the Registered Person should ensure that personal protective equipped (PPE) is provided within the laundry. The cleaning regime within the identified bedrooms where a mal odour was present should be reviewed and if necessary the management of incontinence should also be reviewed. A restrictor should be fitted to the identified windows on the first floor. The wall dresser located in the lounge dining area, should be secured to the wall to ensure the safety of the service users. Furnishings stored in the bathroom, located on the first floor should be removed to ensure the safety of individuals accessing this area. 30/03/07 20/03/07 20/03/07 20/03/07 14/03/07 14/03/07 14/03/07 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. Refer to Standard OP7 Good Practice Recommendations To promote best practice, where appropriate service users should be actively involved in the development and review DS0000042500.V324543.R01.S.doc Version 5.2 Page 29 The Homestead Residential Home 2 OP7 3 OP10 4 5 6 OP15 OP16 OP19 7 8 9 10 11 OP27 OP35 OP38 OP38 OP38 of their care plan. To ensure that a diverse and seamless service is provided, more emphasis should be focused on equality and diversity within the homes policies, procedures and practices. To promote the privacy of service users, in this instance it has been identified as a recommendation that locking devices as approved by the Fire Safety Officer should be fitted to all bedroom doors as standard. To ensure that a cleaning schedule is implemented within the kitchen to maintain the hygiene standard. Consideration should be given in reviewing the homes complaints procedure to identify that individuals would not suffer reprisal for raising concerns. With reference to concerns identified by a relative relating to the difficulties some service users experience in mobilising on the gravel in the car park and the difficulties posed for wheelchair users. Consideration should be given in addressing this concern. The arrangement of staff working patterns should be reviewed to ensure appropriate numbers during peak times of the day. To promote best practice receipts should be obtained for any expenditure on behalf of the service users. The fire risk assessment should be reviewed to incorporate the new fire regulations and to have an evacuation plan in place. Records of fire safety checks should clearly identify the date that this has been undertaken. In this instance it has been identified as a recommendation that records relating to portable appliance testing (PAT) should be maintained within the home. The Homestead Residential Home DS0000042500.V324543.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES 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 Homestead Residential Home DS0000042500.V324543.R01.S.doc Version 5.2 Page 31 - 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. 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